How does the setting in chapter 23 affect the tone of suspense in One Flew Over the Cuckoo's Nest??

The setting is the ward but the atmosphere is much different. Nurse Ratched has reasserted her control over the institution in Chapter Twenty-Three, again a mother or a warden who dominates the men. She speaks to them in utterly condescending terms, even referring to them as “boys” and treating them as children who cannot accept any sense of responsibility.

“Boys, I've given a great deal of thought to what I am about to say. I've talked it over with the doctor and with the rest of the staff, and, as much as we regretted it, we all came to the same conclusion—that there should be some manner of punishment meted out for the unspeakable behavior concerning the house duties three weeks ago.” She raised her hand and looked around. “We waited this long to say anything, hoping that you men would take it upon yourselves to apologize for the rebellious way you acted. But not a one of you has shown the slightest sign of remorse.”

“Please understand: We do not impose certain rules and restrictions on you without a great deal of thought about their therapeutic value.