Introduction Discharge against medical advice is a disruptive crisis on a psychiatric ward. The patient, his family, his fellow-patients, and the staff are often disappointed, frustrated, and angry. If the discharge occurs early in the course of hospitalization, the painful sacrifices which have been made to bring about hospitalization seem to have been in vain. If it occurs later, many of the participants feel as if the maximum therapeutic benefits have not been derived. Such crises often result in one or another segment of the staff being blamed for the undesirable outcome. This study was undertaken during the 2-year period between Sept. 1, 1957, and Aug. 31, 1959, when the rate of discharge against medical advice for the psychiatric unit of the University of Chicago Hospitals and Clinics was 11.3% (32 of 283 admissions). We hoped that the information and understanding about the origins and outcome