Psychosomatic Medicine 21:131-141 (1959)
© 1959 American Psychosomatic Society

Prestige and Social Interaction on a Metabolic Ward

¹ University of Oklahoma School of Medicine, Department of Medicine, and the Oklahoma Medical Research Foundation, Oklahoma City, Okla.

The events occurring during this study furnish striking evidence of the important effects of prestige and group attitudes upon individual behavior. One patient was able to remain on his diet partly because of the prevailing attitude that to fail in this was a sign of "weakness." A second patient who failed to adhere to the dietary regimen suffered a serious loss of prestige among his fellow patients. A third patient left the hospital before quantitative studies had been started, largely, it was felt, because of her inability to achieve a position of esteem within the patient group.

The dramatic sequence of events involving Mrs. Dietrick and Mrs. Parry drew much of its emotional force from the impact of group attitudes on the individuals involved. Without the background of competition for the place of eminence on the ward, much of what took place would not have. Group opinions affected the dress and manner of Mrs. Dietrick early in the study, influenced participation in ward activities of both women, occasioned requests for special privileges, and probably contributed to the complete withdrawal of Mrs. Dietrick observed at the end of the study.

Another sequence of events of great interest in this regard was that which began with lapses from the strict dietary regimen prescribed for Mr. Potts. Here was a miniature study of delinquency beginning in a group leader. Only one person followed his lead, the man closest to him, who felt somewhat guilty because he had asked to be moved out of the room they had shared. General disapproval of the group and reprimand by the staff ended this deviation from prescribed behavior.

The development of undesirable side effects from placebo administration also seemed to be related to interpersonal relationships on the ward. Although Mr. Potts had received a variety of agents without such effects, he developed feelings of giddiness and malaise while receiving a placebo given to him at a time when he was feeling rejected by a patient to whom he had been very close.

All of these observations indicate the importance of interaction between internal psychologic factors and social forces within the environment in determining behavior and response to treatment. The observations also emphasize the importance of understanding the personality of the patient and the social structure of the therapeutic setting for all those who are concerned with medical care. It is evident that close collaboration between investigators in the social and medical sciences can make a contribution to both fields.