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The Reciprocal Effect:  How Patient Disturbance Affects and Is Affected by Staff Attitudes

HAROLD A. RASHKIS, M.D., Ph.D.; ANTHONY F. C. WALLACE, Ph.D.
AMA Arch Gen Psychiatry. 1959;1(5):489-498. doi:10.1001/archpsyc.1959.03590050057007.
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Since publication of “The Mental Hospital” by Stanton and Schwartz,1 it has become a matter of wide interest in psychiatry that disagreements among staff members may tend to aggravate the condition of patients, specifically with regard to increasing the degree of overt disturbance. Stanton2 has gone beyond this, recognizing that increased disturbance among patients may be, conversely, upsetting to the staff, tending to produce disagreement among staff members. Typical of this sort of disagreement is the situation in which a hospital patient becomes a serious problem to the nursing staff, who bring pressure on the medical staff to “do something.” There are often differences of opinion as to whether the patient should be treated, for example, permissively or restrictively. Sometimes, when basic philosophies of treatment are challenged, serious rifts develop and become matters of grave administrative concern. This tension in high places is

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