Sending the patient home

Some patients become grossly disorganized during a hospital stay for medical illness. In the midst of a confusing medical picture, the unpredictable behavior of such patients causes great consternation among the medical or surgical staff. Families also become particularly anxious; their concern about the medical problem shifts to concern about the altered mental state. Physicians and family members frequently agree that such patients should continue their hospital stay past the point where medical attention per se is needed in order to regain control over the disturbed mental functioning. This paper presents an alternative therapeutic approach, suggesting that sending the patient home to a more familiar environment may result in improved psychological functioning. A model for viewing the interaction between 'constancies' in the brain/mind environment (particulary the hospital milieu) is presented. This model takes into account the facts of the internal regulatory mechanisms of the brain, the facts of illness and lack of the more familiar orienting cues in the environment.