The fantasy residue: an antitherapeutic force on the psychiatric inpatient service.

This paper will attempt a model of organizational behavior to the study of the origin, perpetuation, and rectification of certain antitherapeutic forces (Sacks and Carpenter 1974) on inpatient services, which I shall call the ward's "fantasy residue." The fantasy residue consists of the enduring antitherapeutic patterns of dealing with patients that have become normative for a given ward and evolve from irrational staff responses to a variety of stresses in the absence of appropriate corrective administrative actions. Because they originate in irrational responses to complicated situations of patient management or staff relations, these forces can be called "fantastical." Because they tend to flourish and remain active long after the specific conditions which gave rise to them changed or cease to exist, they are "residual." Hence, the name "fantasy residue." Once established, the fantasy residue can persist either as unacknowledged maladaptive responses in the ward's milieu or as openly espoused, presumedly valid "methods of treatment." In either case, the ward staff an its leaders lose sight of both the irrational base and antitherapeutic consequences of these attitudes and actions. In this sense, a ward's fantasy residue is analogous to a person's ego syntonic character resistances and correction requires a process of confrontation, recognition, and facilitation of objective self-scrutiny among staff and patients.