Patients’ Machiavellian orientations were compared to their reputations among the staff as manipulators, helpers, or model patients. For both acute and chronic patients, Machiavellianism was consistently found to relate significantly to the manipulator reputation and not to the other reputations The relationships held for patients diagnosed psychotic as well as nonpsychotic. These findings support the propositions that mental patients attempt to manipulate the staff in their everyday contact with them and that manipulation constitutes one of the major adaptive styles employed by patients The relationships were demonstrated more reliably in group treatment programs than in an individual treatment program Expected differences in the relationships according to birth order were not found Machiavellian social desirability significantly related to the helper and model patient reputations for acute patients, suggesting its potential value as a dispositional variable also.