Institutions can be used by their individual members to strengthen mechanisms of defence, especially against early paranoid and depressive anxieties. This is not to imply that institutions become psychotic, but that we would expect to find in them manifestations of unreality, splitting, hostility, suspicion and other forms of maladaptive behaviour which are the equivalent of psychotic symptoms of an individual.

This paper describes some of the attitudes of those who care for psychotic patients in a hospital setting. These attitudes seem to be influenced by basic fears that are provoked by the relationship with the patients and by coming in contact with their needs and disturbance from a position of responsibility. Such fears are accompanied by phantasies and are related to specific defence mechanisms.