Object Relations in the Psychiatric Hospital1

I have described elsewhere (1964) the seven-year study of a psychiatric ward conducted at Chestnut Lodge. In summary, a total of fifty psychotic female patients, mostly schizophrenic with similar types and degree of illness, were treated and studied in great detail over a seven-year period during which all of them were in individual psycho-analytically oriented psychotherapy and under my administration. The observations on the interactions between all the members of this community (staff, patients and their families) were then analysed retrospectively in order to detect any repetitive patterns with more generalized theoretical implications.

The history of this ward clearly divided itself into three eras, each with its own distinctive philosophy of treatment on the part of the staff, and different prevalent symptoms on the part of the patients:

We found a correlation between a milieu emphasizing limit-setting through the threat of exclusion or abandonment and the preponderance of regressed symptoms during Era I. During Era II, self-destructiveness increased notably in an atmosphere of permissiveness in which the patient had no clear limits set and was threatened with boundarylessness. The emphasis on shifting self-responsibility upon the patients during Era III correlated with an increased amount of acting out such as unauthorized absences as well as more numerous discharges to the community (Woodbury, 1964).

In this paper I intend to examine the pattern of object relations between the psychotic patients, their families, and the staff from the point of view of the Ward Administrator who has decision-making but no individual psychotherapeutic responsibilities on the patients living on his unit. Although this study was done in a Clinic with an experience of more than thirty years in the psycho-analytic treatment of psychotics, similar findings have been obtained in markedly different settings: Saint Elizabeth's Hospital, an eight-thousand-bed Federal Psychiatric Hos