The last two decades of American psychiatry have witnessed increasing efforts (recently with vigor) to develop effective treatment programs for people with mental problems. Schizophrenia, as the most costly psychiatric disease, has of course been a particular object of interest. The geographically isolated State Hospital, as custodian for the disturbed, is gradually disappearing from the scene. In its place, day and night systems of care, rapid treatment units within general hospitals, an emphasis on family therapy, etc, are emerging: all are designed to keep the patient as close to his home setting as geographically practical and within it as much as his clinical condition will allow. These changes are motivated by a growing conviction that, if the patient's usual milieu is disrupted as little as possible, his degree of recovery will be enhanced.
At the same time, however, while our efforts have been moving in this direction, our knowledge of