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April 1970

The Therapeutic Milieu as an Open System

Author Affiliations

From the Michael Reese Service, Illinois State Psychiatric Institute, Chicago.

Arch Gen Psychiatry. 1970;22(4):360-364. doi:10.1001/archpsyc.1970.01740280072013

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,

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