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September 1965

Problems in Treating the Lower-Class Psychotic

Author Affiliations

From the Yale University School of Medicine. Assistant Professor of Psychiatry, Assistant Medical Director of Yale Psychiatric Institute (Dr. Carlson); Clinical Professor of Public Health and Psychiatry, Director of Cooperative Care Project (Dr. Coleman); Assistant Professor of Psychiatry, Chief, Psychiatric Clinic (Dr. Errera); and Coordinator, Cooperative Care Project, Community Council of Greater New Haven (Mr. Harrison).

Arch Gen Psychiatry. 1965;13(3):269-274. doi:10.1001/archpsyc.1965.01730030075010

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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