First impression: I liked the format of this poem - free verse, yet structured into stanzas of four lines each; the form itself reflects the content.
Suggestions: I don't really have any; the poem features concrete imagery, with a few abstractions that fit within such as "obscure unease." But these serve to highlight the imagery, not replace it.
Overall: Having looked at the contest this was written for, I can see where this comes from. But I'm not sure that's necessary; the poem stands on its own. Relating the structure of the asylum to its former residents is an apt metaphor. Good one - keep it up!
Exercise your writes! C'=='==============>' the pun is mightier than the sword
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