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The subtitle of this volume, A Study of Institutional Participation in Psychiatric Illness and Treatment, well indicates its scope. For six years or more Dr. Stanton, a psychoanalytically trained psychiatrist, and Dr. Schwartz, a sociologist, have been collaborating in studies of the interaction of the patient and his institutional environment, and they now present a book which is in many ways a pioneer. Aided by a grant from the National Institute of Mental Health, they have studied intensively the activities of the patients on a ward for fifteen disturbed women in a small private mental hospital. The fact that the hospital employs a staff of one hundred sixty-five (one hundred sixteen of them professional) to care for sixty patients suggests certain economic and other restrictions on the selection of patients; nevertheless some general principles emerge which may be applicable to large institutions such as state hospitals.
The authors' emphasis is on the social environment in a mental hospital. 'It forms', they say, 'the context of which the patient's illness is a part and is also an area of direct access to the psychiatric administrator'. The entire volume is indeed a study of the clinical administrative management of the patient's living 'during the other twenty-three hours', and throughout the book the importance of what goes on among the patients and between the patients and the medical and nursing personnel is emphasized as an important part of the evolution of the patient's disorder. 'The form or configuration of experience is partly determined by many others present, who are themselves arranged according to a pattern of organization, a pattern which is the institution.'
The sections of the book are: Analysis of the Problem; Formal Organization of the Hospital; Ward Organization; Institutional Integration; and Informalities (The Special Case, Hidden Staff Disagreement, Incontinence, Morale and Its Breakdown). There are also eight appendices which deal