Psychosomatic Medicine 17:276-290 (1955)
© 1955 American Psychosomatic Society

Irregular Discharge from Tuberculosis Hospitals

A Major Unsolved Problem

¹ Psychosomatic Section of the Medical and Tuberculosis Service, Veterans Administration Hospital, Madison, Wisconsin

The efforts to understand and deal with the problem of the high rate of irregular discharge among tuberculosis patients are presented. This study, undertaken at the V. A. Hospital, Madison, Wisconsin, began with an exploration of the many factors which have been held responsible for irregular discharge. Such single factors as age, race of patient, and distance of hospital from patient's home did not differentiate significantly between patients who received regular discharges and those who left the hospital prematurely. Similarly, extra-hospital situational factors did not provide significant differences between the two groups of patients. Preliminary attempts at distinguishing between the patients on the basis of neuropsychiatric diagnosis also produced negative results.

A further exploration of the problem, however, based on intensive psychiatric interviews and psychological testing resulted in the formulation of a number of fruitful hypotheses concerning the causative factors of irregular discharge. It is proposed that irregular discharge, for the individual patient, centers around the reactivation within the hospital of his earlier developmental patterns of adjustment. The usual course of hospitalization begins with strict bed rest. This places the patient in a dependency state comparable to the one experienced in infancy. In subsequent periods of hospitalization, the patient progresses through stages involving increasing responsibility and independence in relation to the parental figures among the hospital staff. The developmental pattern concludes, after an "adolescent" period, with the resumption of the adult role. The relationship of irregular discharge to the problems of hospital adjustment characteristic of each stage in the developmental process is discussed. The central theme in all of these problems appears to be that hospitalization for tuberculosis requires a marked restructuring of the patient's interpersonal attachments as well as a reorganization of the economy of the patient's personality. Any interference with this reorganization may become manifest in the act of irregular discharge.

Irregular discharge appears to be a function of a complex equation. Some important variables of this equation are described. It is believed that a lessening of the effects of any one of the variables can reduce the incidence of irregular discharge.

Several methods for the early detection of patients who are apt to resort to irregular discharge are discussed. Specific procedures aimed at modifying the factors which make for irregular discharge are described, and suggestions are made for further research in this direction.

Note:
Deceased.