• A review of the literature on the psychosocial problems attending hemodialysis provides no coherent theory or approach to explain the high incidence of psychiatric morbidity in this medical population. The literature is characterized in the main by the assumption that the problems lie either in the patients or in the stresses consequent to the treatment. Little recognition is given the fact that hemodialysis patients, unlike patients in other medical categories, are involved in intense, ongoing, and in many cases permanent, interpersonal relationships with medical professionals.

Instead of looking at the personalities, predispositions, or capacities of patients, or how these responded to handicap and stress, the focus here is on the structure or pattern of the staffpatient relationships in this context.