Psychiatry residents respond with a variety of coping mechanisms to the
lack of traditional structure in a milieu participatory democracy. To
incorporate themselves into the system they must accept such democratic
ideals as equality among staff and patients, group decision making, and
free self-expression and give up some of their traditional ideas about
staff and patient roles, treatment modalities, and the therapeutic
environment. The author was a first-year resident in psychiatry on a
university hospital inpatient therapeutic community; he discusses the
conflicts between residents, who often adopt a "we-they" attitude, and the
permanent staff, whose protectiveness of the ward community reflects their
personal commitment to its ideals.
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