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The hospital treatment of adolescents has become a major focus of concern in the past fifteen years. The admission of younger patients to psychiatric hospitals which began experimentally in the 1950's has now reached major proportions with patients from
twelve to twenty-five years of age comprising fifty to eighty per cent of hospital populations. The increasing displacement of the middle-aged and elderly patients by this young group requires that hospital treatment programs be significantly modified.
Most of these young people suffer from character disorders, borderline states, or schizophrenia, all marked by the presence of severe ego defects and histories of maladjustment antedating the difficulties which lead to hospitalization. As is characteristic of all adolescents, they are struggling with problems of dependence, the need to achieve autonomous control over instinctual pressures, and the crystallization of a meaningful and comfortable identity. Also, like all adolescents, their conflicts and anxieties are expressed in behavior often both self-destructive and socially disturbing.
These and other factors require very special consideration in their treatment. The uncovering psychotherapies are often contraindicated because their weakened egos cannot tolerate the increased instinctual pressure, anxiety, frustration, and threat of regression which are appropriate concomitants of these psychotherapeutic approaches. Treatment must involve the entire milieu, which requires not only understanding of each patient's needs and anxieties but also of the attitudes and reactions of all the personnel with whom the patient comes into contact. Particularly important are concomitant work with parents as well as educational, vocational, and other rehabilitative activities.
Most discussions of treating the hospitalized adolescent have been essentially anecdotal case reports. However, the experiences reported in this book are based upon a variety of systematic observations