The purpose of the study was to develop a grounded theory about individuals' perception of the situation of being a psychiatric patient. Thirty-five inpatients (19 males, 16 females), ages 18 to 68, in two psychiatric units of an urban, public facility were interviewed on a biweekly basis from admission to discharge. Data were analyzed using the constant comparative method, and the data indicated that participants used the basic social process of managing self-worth to deal with the stigmatizing social predicament of being a mental patient. Events occurring before admission that shaped their responses were substance abuse, medication noncompliance, and the lack of social capital, which led to norm violations and subsequent hospitalization. Six attribution categories emerged: problem, disease, crisis, punishment, ordination, and violation. Findings support the need for professionals to improve their practice by acknowledging the effects of patients' subjective assessments on their response to hospitalization and by placing more emphasis on assisting patients to deal with the stigmatizing effects of a psychiatric diagnosis.

The purpose of this study was to develop a grounded theory about the joking behaviors of psychiatric unit staff. Fifty nine staff members (Male D 23, Female D 36), ages 28 -62, who worked in an urban, public facility were observed in unit meetings over a two year period. Data were analyzed using the constant comparative method. Participants used aberrant humor to deal with the basic social process of facing a series of ultimately unresolvable problems. The factors involved included the organizational context of the working environment, contact with a stigmatized patient group, and stressful staff-patient interactions which led to the erosion of a sense of professional competence and the resulting demoralization, resentment, and vengeful counteraction. Two major categories of joking emerged: whimsical and sarcastic humor. Six subcategories of humor also emerged: incongruous, bravado, self-mocking, discounting, malicious and gallows humor. Staff engaged in more sarcastic than whimsical humor. Findings support the need for professionals to recognize the potentially detrimental effects of joking behaviors on their treatment effectiveness.Setting: Morning staff conference on a psychiatric unit First psychiatrist: This new admission is manic-depressive; he tried to kill himself by breaking a thermometer and swallowing the mercury.

The purpose of this study was to develop a grounded theory about the joking behaviors of psychiatric unit staff. Fifty nine staff members (Male = 23, Female = 36), ages 28-62, who worked in an urban, public facility were observed in unit meetings over a two year period. Data were analyzed using the constant comparative method. Participants used aberrant humor to deal with the basic social process of facing a series of ultimately unresolvable problems. The factors involved included the organizational context of the working environment, contact with a stigmatized patient group, and stressful staff-patient interactions which led to the erosion of a sense of professional competence and the resulting demoralization, resentment, and vengeful counteraction. Two major categories of joking emerged: whimsical and sarcastic humor. Six subcategories of humor also emerged: incongruous, bravado, self-mocking, discounting, malicious and gallows humor. Staff engaged in more sarcastic than whimsical humor. Findings support the need for professionals to recognize the potentially detrimental effects of joking behaviors on their treatment effectiveness.