A few glances at psychiatry

This paper discusses the knowledge derived from weekly seminars with hospital psychiatrists, held by the author over a two-year period. Patients were selected by the psychiatrists from their own settings to be presented at the group, and material is presented from various transactions of the psychiatrists with these patients, and with the nursing staff in the hospital, to illustrate the particular constraints inherent in the hospital setting for doctors attempting to work psychotherapeutically. Five clinical examples are given of situations in which doctors had been led, by nursing staff, by the hospital system, or by the patient herself, to treat physical symptoms, or to treat with ECT, or to follow administrative requirements, in order to make the situations more comfortable, or to achieve immediate, though short-term, gratification. In this way the seminar provided a means of learning in the situation where more conventional ‘supervision’ had failed.