Factors Underlying the Retention in the Community of Chronic Unhospitalized Schizophrenics

¹ Head of Department of Psychiatry, University of Cape Town
² Research Assistant, Department of Psychiatry, University of Cape Town

The family units of a series of 16 chronic schizophrenics who had never been hospitalized were studied with regard to their attitudes, home circumstances and other characteristics. Non-hospitalization was found to be associated with good domestic organization, residential stability and an almost complete absence of manifest family disorganization and disruptive behaviour. There was an unalterable reluctance on the part of relatives to have the patient admitted to hospital and extraordinary sacrifices were made to keep him at home. They had a very poor understanding of the nature of mental illness and hospitals and tended to deny the psychiatric and medical significance of symptoms—probably because they would not admit the need for other measures. All families had a withdrawn pattern of social and personal relationships both within and without the family, but they tended to be very cohesive internally with much evidence of strong and pervading control. In all cases this was traced to one key figure within the family—the "significant relative" who had an extremely close bond with the patient, who appeared to fill a personal need for the relative. It is suggested that this was the main factor in containing the patient at home. Hospitalization on the other hand was found to be attended by neglected homes, family disorganization and overt disruptive behaviour of its members. There was a marked reluctance to assume responsibility for the patient, amounting in some cases to frank rejection. Many reasons were brought forward by these families to support the need for hospitalization but these had no more validity than for the unhospitalized group where similar adverse home conditions prevailed. The influence of a key relative was very much less in this group of cases.