Letters to the Editor
Re: Diogenes Syndrome in a Pair of Siblings
Dear Editor: We refer to the interesting letter from Dr Esposito and colleagues in France, describing 2 siblings who lived in severe domestic squalor (1). One was an unmarried woman, aged 61 years; the other was her brother, aged 58 years and suffering from a physical handicap. The authors state that Diogenes syndrome is rare in a pair of siblings and that the few reported cases of a pair living together all concerned married couples. We agree that the frequency of cases of severe domestic squalor encountered by health workers in the community is not reflected in a comparable number of reports in the medical literature. However, we are also aware of various reports that refer to cases wherein 2 or more persons were found to be living together in squalor.
We have identified at least 70 reported cases of 2 or more people mentioned or described as living together in a state of severe domestic squalor (references available on request). In research undertaken by one of us, 15 of 81 people living in squalid conditions shared their accommodation with other people (2). Among them were 5 couples and a family of 3, all of whom were included in the sample. Another of the 15 subjects was a mother whose son sometimes lived with her but was thought not to be responsible for much, if any, of the squalor. The 15th was a female homeowner who lived in severe squalor but whose boarder lived in a separate, and much cleaner, part of the house. With specific reference to siblings living together, we found 4 case reports in addition to 5 pairs of siblings mentioned in a series of cases of Diogenes Syndrome or severe domestic squalor. One case report is that of a man, aged 73 years, who was bedridden with severe arthritis and lived with his sister, aged 77 years (3,4). Another report concerned a single woman, aged 50 years, who suffered from mild developmental disability and lived in squalor in the downstairs rooms of a house she shared with her sister, who occupied the upstairs and thus (it is implied) mostly escaped the squalor (5). The case of 2 sisters who lived in a rural area in uninhabitable conditions and who resisted services or assistance has been described in Spanish (6). Perhaps most striking of all is the case of the “hermits of Harlem.” Granick and Zeman referrred to these individuals in their research on 105 newspaper reports (published from 1942 to 1959) of aged recluses living in New York (7), and they were also referred to in lay accounts of the “strange and unusual” (8). The hermits were siblings living in a state of severe self-neglect. One was described as the brightest in his university class, and the other aspired to be a concert pianist and played at Carnegie Hall. The brothers became increasingly reclusive after the death of their mother. They stopped all utilities and refused to open mail or answer the door. After an attempted robbery of their house in 1938, they never left the house together again and lived in almost total isolation until 1947, when they were found dead. After their deaths, the house was found to be filthy and severely cluttered with boxes stacked from floor to ceiling. Almost 50 tons of debris were removed from it.
The question of how and why individuals come to live in a state of severe domestic squalor and social isolation is often puzzling. How and why 2 people can come to live in such conditions is doubly intriguing. The problem may not, however, be as uncommon as first appears.
References
1. Esposito D, Rouillon F, Limosin Fl. Diogenes syndrome in a pair of siblings. Can J Psychiatry 2003;48:571–2.
2. Halliday G, Banerjee S, Philpot M, MacDonald A. Community study of people who live in squalor. Lancet 2000;355:882–6.
3. Allen V. Care study: William and Louisa (Part 1). Nursing Times Community Outlook 1983; April 13:105–8.
4. Allen V. Care study: William and Louisa (Part 2). Nursing Times Community Outlook 1983; May 11:139–42.
5. Williams H, Clarke R, Fashola Y, Holt G. Diogenes Syndrome in patients with intellectual disability: a rose by any other name? J Intellect Disabil Res 1998;42:316–20.
6. Geijo Uribe MS, Sanchez Losada M, Esteban IF. Un caso de Sindrome de Diogenes compartido en una pareja de hermanas. Psiquis 2000;21:59–62.
7. Granick R, Zeman FD. The aged recluse—an exploratory study with particular reference to community responsibility. J Chronic Dis 1960;12:639–53.
8. Reader’s Digest. Facts and fallacies: stories of the strange and unusual. Singapore: Reader’s Digest (Australia) Pty Ltd; 1989.
Graeme Halliday, BMed, FRANZCP, MD;
John Snowdon, FRACP, MPhil, FRCPsych, FRANZCP, MD;
Brett Simpson, MBBS, FRANZCP
Rozelle, Australia
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