From Custodial to Therapeutic Patient Care in Mental Hospitals Explorations in Social Treatments: By Milton Greenblatt, Richard G. York and Esther Lucile Brown, in collaboration with Robert W. Hyde. (New York: Russell Sage Foundation. Pp. 497. Price $5.00.)

We are witnessing in Britain and in America a dramatic change within the mental hospital. Many features of the behaviour disorders of psychotic patients have been recognized as institutional artefacts and amenable to environmental influence. It has also been acknowledged that the recent trend in the mental hospitals is only a reversal to the doctrines of the psychiatric pioneers of the first half of the nineteenth century. Psycho-analysis has had a large share in initiating this process, mainly by breaking down the barriers which tend to separate the psychotic from the so-called normal population. This book gives an account of the changes in the treatment of patients which have taken place at the Boston Psychopathic Hospital within the last ten years. It also includes reports on allied experiments in two mental hospitals.

The orientation of the authors is chiefly clinical and sociological. Their observations confirm those made by Stanton and Schwartz in the more circumscribed set-up of a psycho-analytically orientated small private hospital. The authors view the mental hospital as a community every part of which has to participate in the therapeutic process of resocialization. This implies the careful study of interpersonal relations and of group processes. The Boston Psychopathic Hospital has established a 'patients' government' into which both the constructive and destructive energies of the patient-members of the community are channelled. The rôle of the nurses in the treatment process is receiving careful attention and the therapeutic potential of the personnel is fully utilized. Psychodrama has been found highly effective in social treatment. The reports from the other two mental hospitals illustrate some of the difficulties which the new approach is bound to encounter in non-teaching hospitals where the spirit of experiment is less alive and where too few doctors have to look after far too many patients. This book deserves to be studied in detail b