Abstract

M.D. and ANTHONYBy LILLI HOFSTATTER, Clinical Assistant Professor University of Missouri SchoolAssistant of MedicineDivision, WashingtonK. ProfessorBUSCH,M.D.St. LouisHospital,University Missouriof MedicineTii AWAKENING OF THE PUBLIC through our mental health programs has led to a readier acceptance of psychiatric help. More and more patients of all ages, psychotic or not, with acting-out, aggressive, manipulating, or self-destructive impulses are being placed in state hospitals by a distressed public. Some of these newly admitted patients join the ranks of the chronic ones who have been populating the back halls for years with their apparently unchangeable behavior patterns. Others, particularly the younger ones, tantalize the hospital by using it as the stage for their unpredictable, antisocial acting-out. The hospital community is faced with the task of maintaining its emotional balance, which these patients seek to undermine. The patients, even though they resist help, must be treated. In frantic self-defense, the chronically understaffed state hospital concentrates the efforts and the time of a disproportionately large number of its medical staff and personnel on this minority of patients. In the face of an anticipated influx of acting-out patients and little prospect of an appreciable increase in personnel, this problem has to be solved with the means