精神科における新開放病棟の経験

抄録

We will make a report on the outline of the experience that we have been in charge of the open ward in the department of psychiatry for two years, which has been established on the basis of a new idea.
1. Features of This Ward: (1) This ward is situated in the same building that the other various departments. There is no constructional distinction between this ward and the other departments. It possesses the bathrooms and the washingplace in common with the department of orthopedics. (2) The degree of physical and psychological opening in this ward is about the same as others. (3) This is the ward where men and women are hospitalized together. (4) On account of taking in the patients suitable to opening, the rate of schizophrenics is low, and in the most part of the patient, we find those who are not in severe and agitated conditions, and do not give much annoyance to other patients in comparison with the other psychiatric wards. (5) The Patients with the compilcation of other diseases are preferentially hospitalized. We have the close co-operation with other departments, (6) This is the co-operative ward with the National Institute of Mental Health, The psychiatrists, the psychologists and the social workers in this institute take a hand in the treatment of the patient at this ward directly, and exchange the opinions in the close relationship with us. (7) The clinical psychologists take part in the medical treatment actively.
2. The above features have brought forth the all sorts of new problems and experiences which have never been found in the traditional management of psychiatric wards. We have considered about the next two points of them: first, concerning the treatment in the hospital of the mild cases of mental disorder; secondly, about the co-operative system with the psychological staffs of the institute.
(1) The patients with neurosis or early schizophrenia and so on, who have not fall into remarkable personality disorder, express seriously their complicated morbid suffering and their worries about the life to the staffs, and ask for the help of them. At the same time, they are extremely sensitive to the responses of the staffs, On the occasion of the treatment of these patients, the effort to come into contact with them under a delicate sense is required of us, This effort should be accompanied by the respect for the individual patient's inner needs and feelings, and besides the empathic understanding of their internal feeling and viewpoint. There are the patients who show ambivalence, such as dependent feeling and hostility to the staffs, or who feel severely hurted by the staffs' trivial conducts. We have come across the difficult problem how the staffs should deal with their own feeling when they get in touch with these patients, It will also be the subject from now on to treat all of the patients in the ward as a social psychological group, and compatibly to understand deeply each individual. Moreover, we feel that we have to try not to allow the acceptance of a patient to fall into the mere passive indulgence and permitting, and that we have to take a determened attitude toward the ‘freedom and order’ problem which is often difficult to be solved in the open ward, In regard to a clinical psychologist, his concerning has aided the solution of various psychological problems mentioned above, and has contributed to the development and the exchanges of our thought by speaking out and acting on from a standpoint free from the traditions and the customs.
(2) The principal work co-operated with the staffs in the National Institute of Mental Health has been the psychotherapeutic contact with schizophrenic patients. The staffs in this ward have learned the following from the institute; that is to say, the approach based on the patience, the sincerity and the skill toward the patient's inner world which is beyond conjecture leads him to express his unexpectedly complicated and significant internal