This thesis investigates contemporary inpatient psychiatric care. The study aims to describe and analyse how pastoral power – a form of power characteristic of psychiatric care – is exercised in a contemporary neoliberal context that includes hegemonic ideals of individual autonomy. Specifically, it examines how pastoral power is expressed, its consequences for patients and staff in the inpatient psychiatric ward studied, and how it relates to other forms of power exercised within the institution's framework and broader society.

The empirical material for this study comprises observations conducted at a psychiatric ward, as well as interviews with patients and staff, mind maps and questionnaires all related to the same ward. Additional data consists of contextualizing material in the form of laws, governmental reports and more operational texts. The study employs an abductive approach, allowing for analyses that emerged from the interplay between the empirical material and theory. Analytical tools are informed by the theories of power developed by Michel Foucault and Nikolas Rose, along with Erving Goffman’s insights on social interaction and Arlie Hochschild’s theory of emotional labour.

Psychiatry has long grappled with the fundamental issue of balancing patient autonomy against the necessary restrictions that often accompany care. This challenge is especially pronounced in a context where neoliberal ideals of patient self-determination are increasingly emphasised. The thesis underscores the necessity for inpatient psychiatric care to constantly navigate the delicate balance between making patients involved and autonomous while also implementing limitations to promote health. This intricate balance is reflected in the design of the ward’s physical space, the structuring of time, and the dynamics of social relationships, all of which contribute to a complex, ambiguous, and, at times, challenging everyday experience for both patients and staff. The ward is analysed as a ‘temporary total institution’ and a heterotopia, wherein notions of deviation and normality mutually reinforce one another. Consequently, a stay in the ward can elicit feelings of stigmatisation and exclusion for patients while simultaneously fostering a sense of de-stigmatisation and belonging to a supportive context.