The Therapeutic Milieu as an Open System

SINCE the advent of the "therapeutic community" concept,¹ it has become fashionable to think of previous techniques in hospital psychiatry as less valid therapeutically. Many of today's treatment values are not new or revolutionary,² and excepting the use of phenothiazines, the idea that newer therapeutic community practices are more beneficial has been challenged.³ The contemporary therapeutic milieu mirrors current society, and many of our hospital practices reflect a more egalitarian attitude as contrasted with a medical-hierarchical one. Consequently there is evidence that at times the lines between staff and patient groups are not clear-cut,⁴ and indeed, in many milieu settings, staff problems are discussed openly with patients. I wonder whether or not this is truly a more effective approach or whether or not it is simply an approach that many contemporary mental health workers find more comfortable and more interesting,