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Acting Out

JOHN M. MACDONALD, FRCP(E)
Arch Gen Psychiatry. 1965;13(5):439-443. doi:10.1001/archpsyc.1965.01730050053009.
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A MAJOR PROBLEM in many psychiatric hospitals is acting out by sociopathic personalities. This acting out often follows a cyclic pattern. Intermittent acting out occurs over several months without significantly disturbing the ward milieu. An increase in frequency or severity of this behavior gradually leads to collective disturbance on the ward. Morale, of both patients and nursing staff, is lowered and this prompts careful retrospective study of events preceding the ward disorganization. Numerous cues are discovered which should have resulted in prompt remedial action. The staff becomes more alert to the problem but a period of relative peace on the ward leads to relaxation of vigilance. The lessons provided by the wisdom of hindsight fade, acting out gradually increases, and the cycle is repeated.

Sociopaths and hysterical personalities tend to act out their unconscious fantasies in their personal relations. This acting out resembles transference

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