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In the 1960s, psychiatry was entering a new phase of its development. However, many people were uncomfortable with these changes and fought against what they saw as apostasy, dangerous, and unprofessional decisions by the bureaucracy. The role of Nurses before 1960 was task-oriented, to control behaviour, give somatic treatments when ordered, and provide the daily personal needs of their patients, a custodial model. Since 1960, the nursing profession, ancillary staff and Doctors have been forced to reassess their traditional involvement and develop new skills. All previous somatic treatments were abandoned or rarely used in mainstream psychiatry. The only tools left for nurses were consciously using self in a therapeutic relationship, communicating, sharing, developing empathy and compassion, and helping the patient gain insight, self-awareness and problem-solving skills. No longer were the staff seen as the 'boss', demanding obedience. Nurses had to learn how to work in alternative environments, halfway houses, day clinics, community clinics, night hospitals, acute units, work with mixed sexes, and learn new skills through family therapy, TA, cognitive behaviour modification, encounter groups, gestalt therapy, reality therapy and a therapeutic community and adapt to different age and cultural groups. Management of wards and staff presented a challenge to administrators. In-patients attained much more freedom and self-government with these developments. The hierarchy was flatter, industrial democracy was expected, and workers had to cope with changing organisational structures. Government decision-making was a constant source of conflict. A new approach to management emerged, trust replaced control, and self-government replaced regimentation. Where were all these developments leading? What of the future? Volume Two explores the sequel and exposes the intrigues, promises, hypocrisy, lies, neglect, social engineering, and the fate of long-term residents and people with acute psychiatric episodes.
