Abstract
In this paper an attempt is made to examine, by a brief review of literature and of diagrams of actual psychiatric wards, some present thinking about the nature of a treatment environment.
Three “dimensions” are abstracted from published material, two of them American and one English in origin. These are: 1. The idea that a “therapeutic” milieu can be distinguished from an “institutional” one, by its emphasis on making of the staff and patients real people (a personalistic dimension) 2. The idea that the hospital is a society or community, with staff and patients playing integrated parts (an organismic dimension) 3. The idea that traditional staff and patient roles are not helpful in psychiatric treatment, and that more active sharing of responsibility, and more active communication and interaction, between staff and patients, will more effectively combat the regression of psychiatric illness (a communal dimension).
Three examples of wards are given: 1. A large chronic ward, where anti-therapeutic size and tradition pose serious obstacles to community 2. A small day hospital, where a degree of community has been achieved 3. A high turnover admitting ward where experiments are needed to draw the group together.
It would seem that the crucial element in any ward milieu is a good staff, plus an adequate recognition of the humanity of staff. An attempt is made to assess the relative importance of various staff echelons in the daily living of the ward, nurses evidently having the greatest influence and doctors probably very little, at least directly.
Attention is drawn briefly to a probable heightening of conflict regarding change in staff and patient roles, as psychiatry moves more and more into the general hospital, where traditional ideas about staff and patients are clearly established.