The B E S T in the treatment and control of chronically…在长期治疗和控制.pdfVIP

THE B. E. S. T. IN THE TREATMENTAND CONTROLOF CHRONICALLY DISTURBED MENTAL PATIENTS--A PRELIMINARY REPORT* BY JAMES A. BRUSSEL, M. D., AND JACOB SCHNEIDER, M. D. To the institution psychiatrist, there is nothing more trying, frustrating and perplexing than the problem of the management of the chronically disturbed patient. T h e situation is a multiple source of disappointments, since it involves more than the isolated question of the patient himself. There are hazards involving other patients; there are dissatisfied relatives who, seeing no im- provement-or perhaps a worsening--in a patients condition, carry unfavorable reports back to the community; there are mat- ters of administration and economy; and considerations of dis- tracted and harassed personnel, constantly menaced by physical harm. The problem of the chronically disturbed patient at Willard (N. Y.) State Hospital reached its zenith on the female continued treatment service which is under the supervision of one of the present authors (J. S.). Here the census of such patients was mounting daily because: (1) None improved sufficiently to warrant even a trial on a quieter ward; and (2) new admissions were con- stantly arriving. It began to appear that major construction might be needed to provide large enough facili~ties for disturbed patients, not to mention increased allotments in employees, drugs, restraint, clothing, bedding, etc. All of the currently-employed methods of controlling disturbed patients had been tried without success, including sedation, individual nursing c