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Harry A. Wilmer, MC
JAMA. 1958;166(12):1445-1453. doi:10.1001/jama.1958.02990120037008.
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A usable and effective way of managing acutely disturbed patients in an admissions ward is described. It consisted in developing a therapeutic community in which it was the role of the patient not to be sick, but to function as near to the norms of society as possible. The control of aggressive behaviour was carried out largely through the patients themselves. During the 10-month period of the experiment, 939 men were admitted for an arbitrary period of 10 days before being transferred to other psychiatric wards. The program included especially a 45-minute discussion period for staff and patients led by a psychiatrist after the morning sick call, six days a week, followed by a staff meeting. There were systematic arrangements for individual conferences of patients with doctors. Seclusion rooms, whose antitherapeutic effects reach out beyond the isolated patient himself to the therapeutic community as a whole, were not used. While the value of this program as a therapeutic procedure was not established under the conditions of the experiment, its value as a type of ward administration was demonstrated. It helped to fill the gap of staff shortages and opened up new possibilities for treatment.


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