The psychiatric ward is a place Jackie constantly finds himself waking up in during the game. This is a place the Darkness sends Jackie whenever he suffers mortal injuries. This is a distraction meant to keep Jackie from going to Hell while it repairs his wounds. It is a part of Jackie's subconscious that serves as a medium between life and death. If he dies here, he goes to Hell.
The manifestations themselves are part of Jackie's subconscious as well. That is why he will see many familiar faces while he roams the halls of the institution. Jenny is there, playing the role as a nurse. This is to make Jackie want to stay there while the Darkness heals him. Even the Darkling makes an appearance as the janitor, and tries to help him escape.
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