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In recent years there have been many efforts to alter traditionally custodial psychiatric hospitals into more psychotherapeutic rehabilitative organizations. The project herein reported was undertaken to transform a chronic custodial psychiatric ward into one that actively encouraged and supported patient improvement and rehabilitation. As one of several projects initiated to improve patient care in a large state hospital, it was begun shortly after a similar program had been instituted on another ward in the same building. The personnel from both wards met weekly to discuss problems encountered on their respective units, and the over-all approach was evolved in these meetings and personnel conferences on each ward. As is the case in most state hospitals, there were limitations in the number of personnel and amount of money available to carry out the program.This paper is written to describe the evolutionary process on one ward from October, 1956, to October, 1957.

The significance of the adrenal cortex and the thyroid gland in the adaptation of the body to stressful life situations has been a subject of increasing interest in recent years. Evidence for the importance of these functions for vital adaptation has been reviewed previously1 and in more recent publications.2,3 We have reported that hospitalized psychiatric patients had elevated levels of plasma hydrocortisone (17-hydroxycorticosterone; 17-OH) and protein-bound iodine (PBI). The hydrocortisone levels were significantly higher than in controls; the PBI levels were elevated, but not significantly, when compared with those for normal control subjects. When the cases were evaluated from the viewpoint of either the intensity of emotional distress or the extent of personality disintegration, there seemed to be a correspondence between the height of the level of each hormone and the degree of clinical disturbance of the patient. Exceptionally high hormone levels were associated with very intense distress