ABSTRACT
This chapter deals with the interplay of institutional, ideological, and professional forces as they affect the practice of psychiatry in hospitals. The institution is conceived as having outer boundaries and a number of interior regions or subdivisions. The chapter shows that a sociotherapeutic ideology was emphasized at the state hospital, while a psychotherapeutic ideology was more salient at the private hospital. One type of evidence is based upon responses to a lengthy attitude questionnaire in which embodied scales were designed to measure adherence to three posited ideological positions: the somatotherapeutic, psychotherapeutic, and sociotherapeutic positions. The fieldwork data further support inference that ideological conviction is patterned by professional affiliation. The treatment wards of the state hospital brought together four different professions, one "professionalizing" occupation, and one occupation. On the CSH treatment services, ideological differences in ward organization were even more striking. The general picture highlights considerable negotiation of basic ideological and role issues and relatively little negotiation of daily work.
