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After twenty-five years of experience in clinical administration in a psychiatric hospital, Bullard reports on a research program which investigated the structure of the psychiatric hospital and in particular the relationship between
the hospital personnel and the clinical responses of the patients. Among the various findings, one of the most significant was evidence of much emotional immaturity among aides, nurses, and staff physicians. Part of the difficulty is traceable to the fact that there is a shortage of good personnel for these various positions. Another factor is the difficulty in predicting whether a person will be suitable for a position in a psychiatric hospital. Formal training does not tend to change nursing attitudes to a significant degree. It was necessary to have frequent conferences with physicians and nurses in order to improve the therapeutic results. Much that goes on in a hospital which influences the therapy of the patient occurs outside the field of awareness of the various staff personnel. When the chronic symptoms of a patient do not respond to prolonged therapy, it may well be expressive of some unconscious negative attitude on the part of the hospital staff.