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This book describes various types of psychiatric hospital programs, listed according to duration of treatment and primary treatment modality, and the various therapeutic procedures the programs use. Its purpose is to show how these procedures may be made to reinforce each other to form a unified treatment program in which every action taken by every member of the treating staff is directed to the same clearly understood goal—creating a “reactive environment.”
The authors define a reactive environment as one in which “the unit's overall structure maximally utilizes and coordinates the entire staff's efforts towards the rehabilitation of the patient's particular behavior problems so that ultimately he becomes a longstanding and productive member of society.” They contrast this type of unit to the one run on the traditional psychotherapy model, where staff see themselves as having only supportive or recreational functions while the patient awaits the all-important few hours a week with his “doctor.” The authors do not attempt to explain why the latter type of unit is conceptually inferior, but they imply that it is responsible for the undesirable conditions found in mental hospitals—conditions which consumers of hospital care have complained about in recent years. Among these conditions are the total control exerted over patients' lives by the hospital, for which they do not apologize at all, but rather see as having therapeutic potential, as well as the staff demoralization and patient apathy and regression, which they feel the reactive environment would prevent.
A feeling of optimism about treatment in general, and about the contribution of the mental hospital ward, in particular, permeates the book. To achieve this feeling, the authors are willing to forgo certain arguments about theory in favor of arguments based on pragmatic observation and on history. For example, rather than extoll the merits of behaviorism relative to a psychodynamic model on the basis of greater