Notes on a Contextual Approach to Medical Ward Consultation: The Importance of Social System Mythology

Abstract

The psychiatric consultant requires a broad understanding of the context of consultation to supplement his knowledge of psychodynamics. The authors propose viewing the medical ward in the model of a “quasi-open community,” in which a culture is transmitted from one generation of personnel to the next through a ward mythology-which embodies ideals, for example, for the roles of Nurse and Doctor. Requests for psychiatric consultation often result from the partial breakdown in this mythology; the consultant's immediate task is to reconstruct group ideals and facilitate community re-unification in order to promote the recovery of patients. Later on, when the staff has had a chance to distance itself from the threat to its solidarity, the consultant can help the ward community understand both the adaptive and non-adaptive aspects of its own mythology. Case examples illustrate how respecting the quasi-open character of the medical ward and giving credence to its mythology can promote the reconstitution of ward communities in disarray and aid individual patients as well.