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This article discusses the relation among illness, therapy and the modern urban American family. The analogy of physician, and parents in part is simple and obvious. These are the stronger and more adequate persons on whom the child and the sick person, respectively, are made to rely; they are the ones to whom he must turn to have those of his needs fulfilled which he is incapable of meeting through his own resources. As people shall maintain, these analogies must not be pressed too far. But they do constitute a convenient jumping off place for the analysis. The primary psychodynamically relevant reasons researchers find in the special character of the American urban family, which is extremely vulnerable to certain types of strain. Mechanisms have developed which relieve the family of the additional stresses which would be imposed upon it by making the care of the sick one of its principal functions. At the same time, most cases of illness with psychological components are probably more effectively cared for in the special circumstances of the society by professionalized agencies than they would be in families.

The article discusses common assumptions, dimensions, and problems of Pathway Organizations. Currently all facilities engaged in easing the community restoration of the discharged mental patient are groping, more or less intuitively, toward answers to problems of practice that in some degree affect all of them. While systematic research of the order discussed in the preceding section is necessary for definitive knowledge, it seems possible that by raising and objectively facing these questions in terms of knowledge of everyday practices and policies tentative answers may be found. The editors are aware of the fact that no agency can succeed in its operations without a high level of therapeutic enthusiasm on the part of its staff. Practitioners must believe in what they are doing for their practices to have beneficial effects. But optimism, however necessary to the therapeutic and rehabilitative process, is in itself no guarantee that the goals of the agency are being reached. Obscuring defects and playing up successes in a best-of-all-possible-worlds manner can only serve in the long run to deceive clients, sponsors, public and the agency itself. Honest appraisal of procedures and weighing of shortcomings may not always serve to make the agency a sensational success, but it will insure that its future operations will be based on sounder knowledge and undoubtedly increase the probability of true success.