IN CONSIDERING possible reasons for the chronicity of patients with schizophrenic reactions or other forms of serious mental illnesses, and with particular attention to the difficulties in their being discharged from treatment settings and being maintained in the community, many authors have considered such factors as metabolic dysfunctions, intrapsychic and interpersonal deficits, and/or adverse influences of the patient's milieu, whether it be familial, cultural, vocational, or others. We propose that particular transactions between patients and various elements of their total milieu may contribute to the problem of the intermittent1 or chronic patient, and that these transactions may be relevant regardless of, and along with, other etiologic considerations. Our intent is to describe several group, intergroup, and system phenomena which may contribute to the understanding of the patient's lack of movement and inability to respond to treatment.
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von Mering O, Schiff SB. The Intermittent PatientHis Reference Groups and Intergroup Tensions. Arch Gen Psychiatry. 1968;18(4):400-404. doi:10.1001/archpsyc.1968.01740040016003