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In this study of two identical open wards, the author found that in ward 1's highly structured meetings a higher proportion of patients participated, and they distributed their participation in more direct proportion to the relative numbers of each present than in the open meetings on ward 2, where patients directed their participation disproportionately to staff. Staff on both wards disproportionately directed their participation to patients, but less so in the structured meetings. The implications of these observations are discussed in terms of the executive ego deficits of the patients involved and their need for structure in the external milieu in order to compensate for these deficits.