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The psychopathology of authority and its loss: the effect on a ward of losing a consultant psychiatrist.

A consultant psychiatrist on an in-patient psychiatric unit left temporarily for a four-week visit to Australia. Eight of 11 patients under his care developed disturbed behaviour, although all had been stable for many months before. Of the other 11 patients on the same ward, under the care of another consultant psychiatrist, only one developed similar problems over this time. It has already been well established in previous research that loss events, particularly of attachment figures, contribute to psychopathology. However, what loss events the psychiatric unit itself presents to patients, and furthermore how the loss of perhaps more distant but important figures, like consultants or senior psychiatrists, also affect patients has not been previously explored. The neglected issue of the role of authority in the therapeutic relationship as well as in psychiatric illness is discussed. It is suggested that this has important implications for psychiatric practice.