A case-study investigation into gross neglect in older people living contentedly alone with no evidence of mental illness or cognitive impairment

Williams, Rosemary (2004) A case-study investigation into gross neglect in older people living contentedly alone with no evidence of mental illness or cognitive impairment. University of Southampton, Doctoral Thesis.

Record type: Thesis (Doctoral)

Abstract

Diogenes syndrome is thought to be rare by doctors and refers to older reclusive persons who are living in conditions of gross squalor about which they show no shame. Offers of help are refused and hostility and suspiciousness shown. Of the 44 papers located, mostly written by psychiatrists, no psychological studies have been identified. Little attention has been given to normal persons even though these comprise 50% of those affected and little or no distinction has been made between the two groups in the data analysis. This thesis has sought to understand why these individuals prefer to live in gross neglect and hardship.

The syndrome was named after the 4^th century BC philosopher by Clark et al (1975) who concluded that patients bore a resemblance to the first of the Cynics. This finding was rejected by Cybulska and Rucinski (1986) in favour of two fictional charters, Gogol's Plyushkin and Dicken's Miss Havisham. However the eponym Diogenes is still favoured by most authors.

Six new case-studies have been conducted for this enquiry. Data have been collected, organised and analysed in accord with Bromley's injunctions and guidelines. The resultant profiles have been compared and contrasted with those of Diogenes and Plyushkin who themselves were treated as if they were case-study participants and subjected to the same mode of enquiry as were the six, brief case-studies on normal people identified in the clinical literature.

By the end of the thesis it has been possible to identify a set of common psychological attributes and features together with other attributes. Patterns have emerged as further cases were examined allowing a rudimentary typology to be constructed. A tentative theory has also been generated. The work did not proceed in a linear fashion and some insights only occurred after revisiting earlier data. The shortcomings of the clinical literature were also not immediately apparent, as its examination was ongoing throughout. The findings in this enquiry challenge some of the conclusions reached by physicians and underline the need for in-depth case-study research with regard to mentally ill persons.

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