ABSTRACT
This chapter presents case studies of institutional crisis, with accompanying commentary. It provides an example of the kind of severe institutional test posed by an unanticipated influx of a relatively new kind of patient to the hospital. The chapter illustrates what can happen when an immensely difficult patient passes through the hospital. A patient like Barry adds a special dimension to professional relationships. The resident pointed out that precedent existed for appointing such special administrators to manage difficult patients. Recent increases in admissions of such patients reflected a metropolitan trend toward treating adolescents, a trend encouraged by medical insurance. The chapter summarizes Barry's impact upon the hospital structure. It describes that the passage of troublesome patients through psychiatric hospitals was compared to a fast motorboat, which stirs the waters without leaving permanent traces. The chapter describes that ordinary organizational procedures prove inadequate for series of troublesome events that build up perilously over many weeks.
