The inpatient service: therapeutic community versus community therapy

The 'therapeutic community' model of ward organization has many advantages and proved to be helpful to a number of patients, who were able to repattern many of their interpersonal and coping techniques in this milieu. This paper is not intended as an attack on this concept of hospital management but rather is an attempt to point out that it is probably not appropriate in certain situations. The first of these occurs when all patients presented to a hospital ward must be admitted for short-term hospital stabilization and subsequent outpatient and/ or community care. The second situation in which the efficacy of the therapeutic community model may be doubted is where there is a surfeit of staff and facilities.

An alternative form of ward organization based on community psychiatry principles is described and some statistical evidence is presented to support the contention that it is the more appropriate model for these situations.

A case of movement epilepsy with agoraphobia treated successfully by flooding

Seizures induced by movement were first described by Gowers (1901), who considered them a variant of epilepsy. Several reports have appeared since then of attacks of choreo-athetoid movements precipitated by sudden movement (Lishman et al., 1962; Whitty et al., 1964; Stevens, 1966; Kertesz, 1967). The case described here is one of Lishman's et al's original group (Case No. 5); along with the movement-induced seizures he had developed over the years an increasing agoraphobia which had grossly restricted his activities. This paper reports on the successful treatment of this agoraphobia by ‘flooding’ and the associated amelioration of his movement-induced seizures.