So, picking up from our last post we had left the Cassel Hospital with Tom Main as its insurgent Medical Director trying to flatten the top down Institutional hierarchy, one part of -which entailed in-patients being allowed and even encouraged, to go home at weekends.
This helped to flatten the hierarchy by saying in effect that there were not well/adult staff and sick/childlike patients but much more of a continuum - things were not so artificially made to be black and white.
Remember too, our mantra that symptoms (what you see) are defences and if so, against what are they defending?
At some point after this process, Tom Main left the Cassel Hospital and worked elsewhere only to return some years later perhaps in a slightly different capacity and after some time back, he began to feel that things were 'not quite right', something felt different though he could not quite put his finger on what this was.
Then one day he overheard a Nurse talking with (at?) a patient who was declining the option of having weekend leave: He heard the nurse telling the patient that 'no, you should indeed have to go on weekend-leave adding perhaps that it was good for him/her....part of his treatment.......policy etc etc.
It was at this exchange, that for Tom Main, the penny dropped: This explained & encapsulated what he had felt when he felt that things were not as he had left them. The whole issue of weekend leave was part of a change in attitudes, beliefs and behaviours which had been thought through in all those meetings with nurses over so many months.
This process he theorised, had been worked through in the ego-functioning part of the Service/Team/Institution i.e., the part of the institution which was adult, mature, realistic, in touch with reality and so in touch with both possibilities and also with limitations.
In this state, the institution was not inhibited by primitive defences such as splitting and denial and so was free to make mature, realistic plans including allowing and encouraging in-patients to have a choice over weekend leave.
But what had he just heard? Now, the nurse had re-assumed the role of superior/parent/super-ego and had told the patient that s/he should/must go on leave, with the clear sense that s/he was in charge and the patient should obey!
In other words, things had reverted to how it had been before the changes: That is to say the content had changed - from you cannot have leave to you must have leave - so on the surface still, liberal, progressive etc but underneath, the process had simply re-asserted itself, though now cloaked differently.
Of course, Tom Main was not critical of this nurse, in fact he was very grateful to them for unwittingly providing this insight and again, of course, part of this response was because he knew that the nurse here, was just demonstrating what was happening across and indeed though, the whole Institution.
So, how did Tom Main understood this vignette and what it was saying about this and of course, all other Institutions?
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