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Problems in Treating the Lower-Class Psychotic

Arch Gen Psychiatry. 1965;13(3):269-274. doi:10.1001/archpsyc.1965.01730030075010.
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THIS PAPER discusses some of the problems encountered in outpatient work with severely disturbed patients of the lowest socioeconomic level. It examines how patients discharged from a state hospital interacted with the staff of a university-community psychiatric clinic in an attempt to understand the apparent reluctance of patients and psychiatrists to work together.

The psychiatric clinic of the Grace-New Haven Community Hospital is staffed by faculty and residents of Yale's Department of Psychiatry and provides a variety of diagnostic, consultative, and treatment services. Residents' case loads are carefully limited, and most patients are seen weekly for an hour's interview. A few patients are seen more often and a number less frequently, usually for much shorter appointments in contacts that center around drug management. A major emphasis of the teaching program and of the residents' work is on interviewing and therapy skills. Because


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