Psychiatric wards in Hungary and elsewhere in Europe, even with modern concepts, possess features of totalitarian systems: controlling, maintaining a strong hierarchy in the structure, an authoritarian leadership style, regulated autonomy and reduced to one-way communication. Group therapy aims at free communication, empathic leading, cooperation and functional agreements, reflectivity. In this paper we analyze components of this apparent dichotomy in the context of contemporary psychiatric wards. A theoretical definition is given for the possible degrees of hierarchical rigidity on psychiatric wards based on decision-making procedures, the acquisition and distribution of resources and analysis of boundaries and functional features.
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