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The threat of a chemical war has profound impacts on all layers of society. Hospitalized mental patients, as we have observed them, react in more extreme ways than staff members. They may react overanxiously, totally apathetically, or in context-related flights to partial sanity. Denial and projection were heavily used defense mechanisms together with a tendency of the more acute patients to plunge into their bizarre idiosyncratic world, lending strange meanings to what was happening in the world. Many patients were found to have strong narcissistic traits and to invest most of their libidinal energies in their private world. In times of stress this results in even greater social isolation. Different types of patients in different phases of their illness react differently to such overpowering stress, and the way they react illustrates their cognitive, behavioral, and social deficiencies. WWII literature on the reactions of mentally ill patients to "fly-bombing" seem not to take into consideration the different possible reactions of patients. This may be due to a change in emphasis in the care of mentally disturbed individuals in the last two decades. We propose to use even such an extremely stressful situation as a challenge to the mental health profession to further the well-being of their patients.
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Twenty long-term psychiatric patients with criminal charges against them were transferred from the Iowa Security Medical Facility to open hospitals and aftercare settings between 1969 and 1971. Staff prepared the patients for transfer and persuaded authorities to permit the placements. Follow-up shows 19 have adapted to the new settings. The authors speculate that age is a factor in predicting aftercare adjustment; 18 of the 19 patients were at least 44 years old. The authors also feel that clinical staff must take the initiative to reduce the needless confinement of such patients.
In 1974, acting on precedents set in other cases, a federal district court in Ohio ordered the re-evaluation of all patients committed to Lima State Hospital to determine the need for their continuing to be held in a maximum-security facility. The court set a 12 week period for the review of more than 600 patients by three-member teams consisting of a psychiatrist, a psychologist, and a social worker. The author, a psychoanalyst, was one of approximately 30 professionals who volunteered to participate in the project, which was completed three weeks ahead of schedule. He describes the review process and his personal reactions and observations as a participant.
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