The power relations were totally different

Insight came most often to practitioners who began their careers working in the old-line custodial institutions and who later moved into community mental health positions or into non-nursing roles with community agencies. Some recalled that it was only once both they and their former patients were established in the community that they was able to discern the fictions that masked involuntary confinement or to revision former patients as people. Others commented that working in the community gave them the opportunity to re-evaluate their implication role in prior regimes of paternalism and authoritarian control.

While some clients fought to remain in the hospital and continued to regard it as a refuge, most everybody wanted to get out and stay out. We used to joke and brag that the bars were there to keep the discharged patients from climbing back in the windows, but even those who struggled and had tough times seldom wanted to come back. In the end I took this as a sign that whatever kind of community we provided, for most it was never really home to them. We were fooling ourselves, I guess, but you had to believe you were doing the right thing.

You’re quite blinded when you only work with in patients. You only see a patient. Only when I became a CPN (Community Psychiatric Nurse) did I see a person.

Out in the community, the power relations were totally different. OK, they weren’t really reversed, because you still had the power, but when you went to see them, it was like you were a guest in their home. And that made a big difference.