ABSTRACT
This chapter explores different ways of thinking about the impact of the institutional setting on mental healthcare. It begins with a nurse called Claire, who sees herself torn between an imaginary job that matches her clinical intuitions, the more data-recording based job she is expected to do, and the job she actually does, which is a compromise between the first two. She stresses that these tensions impacts care quality. Next we turn to some extended ethnography in which neither knowledge nor power play out in Foucauldian ways. A patient is described by members of her care team as not mentally ill, but possibly vulnerable to iatrogenic harm. They say she is better off not being treated for depression. However, the patient is able to secure antidepressants. The change of mind reflects the priority of institutional needs (to maintain good relations with the patient) over clinical needs (to offer effective treatment).
