ABSTRACT
In this chapter, the author describes general policies for instituting psychiatric treatment services. The newest team member was a young, psychotherapeutically oriented psychiatrist, too inexperienced in state-hospital psychiatry to have a developed operational philosophy for such a setting. The chapter describes the dominant treatment ideology, organization of treatment, and division of labor in each ward. It depicts the thinking and processes that characterize each service—as if consensus on all salient social structures and functions had been achieved and stabilized. The author finds patients ordering passes and discharges and even prescribing medications, beside organizing and directing most facets of their own ward life. The principal mechanism for organizing and executing these tasks was a patient-government system, which allowed patients to vote on most matters related to their own management and treatment. The representative system grew out of recognized needs for managing large numbers of patients and for having each patient "covered" or "understood" by someone.
