This article deals with 'fake roles' of patient, physician and nurse. These fake roles originated over the years in mental as well as general hospitals. We call them fake roles because dysfunctional aspects of theirs with respect to therapeutic objectives have grown in the meantime into nearly unacceptable  dimensions. Which are the forces in the background of this situation and which forces are maintaining it? Of the most important forces we mention here the Jack of relational among physicians and nurses, and the present nature of organizational structure in hospitals. In the general hospitals fake roles can be summarized as follows: The doctor pretends to be the coordinator, but does not really play that part. The nurse pretends to be powerless, hides herself behind the doctor and is at the same time the one who really makes decisions with respect to the patient. The patient pretends to be inferior and dependent, but actually he is the one who commissions all therapeutic activities in a hospital. Also in psychiatric hospitals we find similar roles. The task for psychiatric hospitals in the near future is to create a social climate in which:

• social and emotional needs of patients can be met, and
• patients can work on their problems which are occupying them at a given moment.

For such a purpose the broadening of knowledge and increasing of skills are a necessary but insufficient condition. Attuning hospital organization to the therapeutic goals is not less urgent.