Unconventional treatment of treatment-resistant hospitalized patients

Summary

Experiences with unconventional modes of dealing with treatment-resistant hospitalized patients are described. Such patients could be practically defined as those individuals who were not able to adapt to open units or to the community despite intense use of such traditional maneuvers as manipulating medications, vocational rehabilitation, etc. Such patients commonly manifested unstable behavior rather than “chronic schizophrenia” or “brain damage.” When a variety of unconventional treatment techniques were instituted —token economy, selective use of restraints and seclusion, paradoxical de-emphasis of improvement—return of stable behavior appeared to be inversely related to the total months of prior inpatient experience. Improvement was not related to degree of unstable behavior, age, or diagnosis. This finding, hardly unique, is discussed. It is postulated that both the processes of reinforcement and extinction operate to produce treatment-resistance. Finally, the efficacy of the token economy in modifying acting-out behavior of both staff and patients is reviewed, as well as its tendency to redefine roles in the direction of a teacher-pupil interaction.