Summary A study is reported of a group of patients with respiratory paralysis resulting from poliomyelitis and necessitating care in a special Respirator Unit. Although the nature of the illness, the consequent handicaps, and the special form of treatment appear to exercise a definite influence on the adjustment of the individual patient, the personality structure prior to the illness seems to be the most important single determinant in this regard. Other variables, such as the age level or level of psychosexual development at the time of onset of illness, immediately antecedent experiences, the meaning of the illness in terms of punishment or castration as well as possible secondary gain, the attitudes of parents or relatives, and cultural factors such as the stigma of dependency and socioeconomic pressures appeared as well to play significant roles. In spite of individual variations, a consistent pattern of reaction to the illness exists, varying in degree but little in nature. Regression, a common phenomenon in any illness, is marked and is fostered by the almost absolute physical dependence of the patients. Infantile mechanisms of adaptation such as denial, projection, and the use of primitive fantasy are used to cope with anxiety. With normal sexual outlets abolished, pregenital forms of gratification assume prominence. In accepting reality, patients go through one or several periods of depression of varying intensity, often followed by irritable and demanding behavior. Attitudes of family, and of staff as family surrogates, are especially important at this time, as patients tend to interpret illness as punishment for primitive instinctual impulses. Tolerance to and mechanisms of handling of dependence vary widely in different patients, with greater conflicts apparent in those who had experienced difficulties in adaptation prior to illness. The ease of weaning a patient from the tank respirator or from any other form of respiratory aid appears to be intimately connected with his current emotional state, his personality structure, and with the attitudes of the ward personnel. Intercurrent happenings on the ward tend to assume the proportion of "crises," and often seem to produce relapses, both physical and emotional in nature. Preliminary studies have shown significant interrelationships between respiratory function and emotional state. More detailed studies in this area are being organized on a multidisciplinary basis. Material is discussed regarding the attainment of optimal attitudes and techniques of management by ward personnel. Preliminary conclusions in relation to the type of psychiatric techniques most appropriate for such patients are summarized. Psychotherapeutic procedures seem to be of value in: Handling anxiety, furthering acceptance of disability by patients, and promoting healthy striving towards independence within the limits imposed by the disease; Fostering more constructive attitudes toward patients by families through discussion of feelings, particularly guilt and resentment; Helping ward personnel to operate more effectively through understanding the patients' needs and their own reactions to the patients. Observations on group behavior and patient-staff relationships are reported. The need for further investigation is stressed, with particular regard to the acute phases of illness and the adjustment of patients following discharge.