Ward 3A revisited

In 1973, I wrote in Psychiatry about an ideological clash on a psychiatric ward involving paraprofessionals. The article pointed out that there is a growing trend of therapeutic sophistication among the more educated technicians and aides working in mental hospitals today. At the particular unit studied, Ward 3A, the paraprofessional clash involved a fraction supporting milieu therapy versus another advocating a more aggressive confrontation therapy, which they themselves called "harassment therapy." I wished to demonstrate the power of the modern paraprofessional in psychiatry, and to show some of the organizational dynamics behind the growth in power and sophistication. This is a follow-up to the original study, based on an additional three and a half years of work on the ward; it reports on the eventual organizational response to the paraprofessionals' power, and includes a broader and deeper analysis of the phenomenon of harassment therapy.