Abstract
A difficult patient arouses staff feelings to the point where a hospital therapeutic community ceases to function and the patient is forced to leave. The events reveal that there are social forces operative in the community at all times that may become disruptive. They lie in the ambiguities between egalitarian and authoritarian organization of the ward, and role conceptions of attendants, doctors and nurses. Such disruptions may recur more often as conflict over role and status becomes widespread. To manage these forces requires a sensitivity to the dynamics of the community, and a readiness on the part of the members to express their own needs and respond to the needs of others.
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