There can be little doubt that ward-based operant programmes have achieved considerable success in relieving the handicaps of many chronic schizophrenic patients (Atthowe and Krasner, 1965; Ayllon and Azrin, 1968; Kazdin, 1977). In addition, there are now several comparative studies of the token economy (T.E.) and the more traditional therapeutic approaches. Osborne and Adams (1970), found improvements in certain target areas when a reinforcement programme was compared with the traditional form of institutional control in a school for the deaf. Further evidence for the superiority of operant methods over social therapy techniques is provided by Stoffelmayr, Faulkner and Mitchell (1973). The T.E. programme which they implemented, differed from the two social therapy regimes with which it was compared, primarily in that the programmes were devised, specifying the behaviours which were to be encouraged and in that these behaviours when they occurred, were systematically reinforced. The results showed that when the two forms of treatment were compared using direct observation and rating scale techniques, the T.E. regime was superior to social therapy in promoting the following changes: an increase in social interaction, a decrease in apathy (operationally defined), and an increase in self help skills.

Following the setting-up of the token economy programme (T.E.P.) in St. Brendan's Hospital, Dublin in 1968 (Fingleton and Mccutchan, 1969) and completion of the first series of studies (Fernandez, 1972, a) this author was awarded a Travelling Fellowship by the World Health Organization, Geneva; which enabled him to visit a number of T.E. Programmes in the United States. Following the above visit, a Final Report was submitted to the funding agency (Fernandez, 1972, c). This paper will concern itself with a summary of all observations made in the above Report, and where relevant, these observations have been up-dated in the light of recent research developments and with other informal observations not mentioned in the Final Report.

The recognition that psychological theories, and methods of behaviour change derived from them, are value laden seems to be relatively recent. Vine (1977) has commented on the fact that ethical questions receive the least attention of any topic area in psychology examination questions. He believes that psychologists “are evidently impervious to all those many critics of psychology who object to our irresponsible methodologies, to our philosophical ignorance in recognising that data are theory-laden, and to our frequent and unrecognised prostitution of our discipline” (Vine, 1977, p.377). In view of attempts at restriction of behaviour modification practice already made in the United States and in Britain, it becomes a professional necessity, not a mere armchair luxury, to assess the ethical status of behaviour modification procedures.

We have been engaged in running token economies at St. Crispin Hospital for four years; the initial impetus coming from a Research Grant from Oxford Regional Health Authority at the instigation of the Principal Psychologist here. The patient group we have concentrated on, is the severely chronic long stay male, averaging 25 to 30 years in the institution. In consequence, the goals of such schemes have so far been towards rehabilitation within the institution, by increasing the level of activities of chronically withdrawn patients and by restoring some of the most personal responsibilities for themselves, through the use of structured activities.