A study in institutional change: the experience of trauma and the role of rumour in a case of paranoiagenesis 1

The clinical material for this study comes from change that occurred in a major psychiatric teaching hospital in the early 1990s. The process began in a subtle manner. For a long time, the principal clinicians at this hospital were in denial about what was happening. Specifically, they knew that change was occurring, but minimized or even ignored its significance. Once the change had occurred, they reacted in a manner that was uncharacteristic of them. They demonstrated paranoid reactions that were transmitted through rumour.