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EN
Problems of reactive mental disorders and of the simulation of mental disorders have lately been very poorly represented in both psychiatrist and criminological literature. The present contribution discusses the sources of a considerable number of difficulties which emerge in practice when discussing the question of “Reactive disorder or malingering?”, as well as the errors of diagnosis in diagnosing malingering. The contribution is based on a analysis of material which comprizes three hundred and fifty cases of reactive mental disorders, and ninety-nine cases of malingering (simulation), with the accused; such material has been obtained from the Department of Forensic Psychiatry of the Psychoneurological Institute and from fifteen mental hospitals in Poland, to which prisoners were sent for observation. When making use of the term of “ malingering” , the contents of that notion ought to be narrowed down so as to comprize behaviour of such kind, which consists in an individual who is not mentally ill consciously producing definite psychopathological symptoms. We could not possibly consider to be malingering in the true sense of the word the producing by a mental patient (e.g. one suffering from schizophrenia) of symptoms which are not characteristic of the disorder in question. What is described by the term of sursimulation, even though it contains elements of malingering, essentially differs from true malingering. On the other hand, the view is not correct which reads that we may only then speak of malingering, when the simulating of symptoms of mental disorders makes its appearance with persons who do not exhibit any abnormal traits. Malingering most frequently makes its appearance with prisoners who exhibit symptoms of psychopathy, encephalopathy, mental deficiency, etc. The problem of metasimulation deserves special attention. The fact that at a given moment we have to do with a behaviour which indicates malingering is not by itself evidence that previously, during the period immediately preceding such malingering, reactive disorders did not appear with same prisoner. The symptoms of reactive disorders during the period which preceded the sending of the prisoner to a mental hospital may have become almost entirely extinguished, while their place was taken by an attitude of malingering, greatly reminiscent of the recent symptoms of reactive mental disorders. Besides, in cases of that kind there also arises, as a rule, the question of whether, side by side with elements of malingering, there do not appear feebly marked symptoms of reactive mental disorders, as remnants of the reactive disorders from which the patient had previously been suffering. Neither should another difficulty, which jurisdiction finds in its path, be forgotten. When having to do with an attitude of obvious malingering, one ought to take into consideration the possibility of malingering being gradually transformed into reactive disorders. The mechanism of malingering becomes fixed in the prisoner’s mind, it undergoes automation, and sets into motion a hysterical mechanism, which, in its turn, acts independently, in the way proper to it, owing to which psychogenic disturbances arise. Such a state as that cannot be described as malingering, in spite of the fact that it was simulation that not only constituted the starting-point of the disorders arisen, but had actually provoked, and to some extent moulded, them. An individual in that state no longer exercises any control over the symptoms of reactive disorders which have appeared, he ceases to exercise any mastery over them; the former malingering mechanism has been driven out of his consciousness and has become transformed into a new, and considerably more complicated hysterical mechanism. The cases discussed above may still run a course complicated in another way, namely after the transformation of malingering into reactive disorders certain symptoms of the latter in their turn are subject to undergo, even after the extinction of the disorders, a conscious consolidation through the new manifestation of the malingering mechanism. Therefore in such cases malingering may be observed, not only at the beginning, but also after the recession of the state of reactive disorders, in the form of metasimulation. The mechanism of the arising of reactive disorders is analogous to that of the arising of malingering; at the basis of both the above mechanisms there lie certain common fundamental tendencies. In all probability malingering runs along the very same tracks as hysterical reaction, and mobilizes, through the intermediary of autosuggestion, analogous mechanisms, causing, as it were, the automation of certain attitudes. Malingering individuals, even though at first they control that mechanism and consciously steer it, may lose their control over it. This leads to the cases of a transformation of malingering into reactive mental disorders, discussed above. The knowledge of making use of a mechanism approximating a hysterical one, of producing and fixing certain symptoms which would constitute a good imitation of disorders, is - as is well known - a most difficult thing. This is why long-lasting and consistently carried out malingering is an extremely rare phenomenon. An individual who simulates in such a way must be equipped with peculiar features, in order to be equal to tasks of that kind. Hence the well-know saying that “ one can simulate well only that which is close to the simulating persons’s individuality” (Lassegue), and that “ a good malingerer must be born such” (Braun). Among psychiatrists there prevails, generally speaking, an agreement as to the view that long-lasting and consistent malingering happens, as a rule, only with persons whose personality exhibits clearly pathological features. The data obtained from sixteen mental hospitals for the period of 1953 - 1960 bear witness to the fact that, out of 5,967 male prisoners sent there for psychiatric examination, mental reactive disorders have been found to exist with 711 cases (11.9 per cent.), and malingering of mental disorders in a mere 99 cases (1.6 per cent.). In the case of the 793 women, sent from prisons to mental hospitals for psychiatric examination, reactive disorders were found to exist in 73 cases (9.2 per cent.), and malingering in a mere 7 cases (0.9 per cent). When we analyse the 99 forensic-psychiatric reports which diagnosed malingering, it appears that we may distinguish two different groups of cases among them. The first of them comprizes 70 prisoners,, with whom the diagnosis of mere malingering does not arouse any essentia] diagnostical reservations. On the other hand, in the second group, which comprizes 29 cases, we have to do with 19 cases of undoubted metasimulation, as well as with 19 cases which are doubtful. Doubts arise in connection with the possibility of the co-existence of reactive disorders with simulation (5 cases), as well as with the presence of reactive disorders during the period immediately preceding malingering (3 cases), or finally, because of data which speak in favour rather of reactive disorders than of malingering (11 cases). Thus it is only in seventy cases that the diagnosis of malingering does not arouse any serious doubts; neither should it be forgotten that, at the same time (i.e. during the same seven-and-a-half-year period) as many as 711 cases of reactive mental disorders were observed with prisoners in sixteen mental hospitals. Thus cases of malingering of long duration are an extremely rare phenomenon in forensic psychiatrist practice. For the purpose of establishing how do the data look which concern long-term malingering of mental disorders in prisons, data concerning the number of cases of malingering within the period of one year have been obtained from the psychiatrists employed in two large Warsaw prisons, which are, in principle, destined only for prisoners under investigation. It was found that the number of malingering prisoners amounted, in one prison to nine, and in the other to five. Taking into consideration the number of all the prisoners detained in those prisons in the course of twelve months, the “ co-efficient of malingering” , calculated as per one thousand prisoners, amounts to 1.86 and 0.96 respectively. After a correction has been introduced, because of the possibility of certain prisoners failing to report for examination, that co-efficient should not exceed 2 pro mille.[1] Among the 350 cases of reactive disorders, selected by lot out of the total number of reports with a diagnosis of “ reactive disorder” for the purpose of obtaining a representative sample, metasimulation during the period of clinical observation has been stated to take place in as many as 24.8 per cent, of the cases.  When examining the two groups of cases: those of “ pure” malingering and those of metasimulation, we can establish the essential differences which exist between them. Those prisoners with whom no reactive disorders have been found to exist during observation, simulate other symptoms of psychotic disorders than those prisoners, with whom malingering has made its appearance only after the extinction of reactive disorders in hospital.   In the group of the seventy “ pure” cases of malingering the most numerously represented is the simulation of memory defects and of mental deficiency, or else of dementia; apart from the above, prisoners also simulate symptoms of conversion hysteria, of hallucination or delusion, as well as, exceptionally, symptoms of stupor.  On the other hand, in the group of fifty cases of metasimulation, more than one-half of the total number consisted of prisoners who simulated symptoms of pseudodementia along with elements of puerilism (which were altogether absent from the group of “ pure” simulation). Of cases of con- fabulation with symptoms of pseudodelusions there were eight, while there were none of them in the “ pure simulation” group. Of individuals who simulated memory disorders there were three times less.  Deserving of particular attention are the twenty-six cases of “ pure” malingering, in which the whole manner of simulating, the contents of the pseudo-symptoms produced, and the prisoner’s entire behaviour are of such a kind, that it seems improbable that the simulating individual could suppose that he would succeed in deluding his environment. The attitude of such prisoners is one of playful contradiction, usually coupled with irony and mockery with regard to the medical personnel; their behaviour is characterized by elements of acting and indeed of clowning; the absurdity of their utterances is glaring. Periodically, however, states of a certain inhibition make their appearance, and from time to time sudden changes of mood are visible, considerable tension, violent attempts at aggressive behaviour, and tendencies to self-mutilation.  It was Mönkenmöller who, once upon a time, drew attention to that peculiar form of malingering, in which it is impossible to detect any intelligible purpose. In such cases malingering assumes the character of acting which gives the malingerer some satisfaction (“spielerische Simulation' 4, as Utitz called it); The picture of malingering gives one to think by its specific features, and is distinguished, from the other types of malingering, by its altogether exceptional primitivism and inconsistency. 92 per cent, of the prisoners who simulated in that way were recidivists with a considerable number of previous convictions to their names. In the anamnesis of nearly one-half of them alcoholism and brain trauma, as well as other chronical brain diseases, made their appearance. More than one-half of their total number have performed self-mutilation in prison. In the cases of “pure”, true malingering there appear, in the hospital material investigated, numerous prisoners with symptoms of encephalopathy (37.1 per cent.) and psychopaths (about 40 per cent.), as a rule described as impulsive, irritable, aggressive. Not a single malingering prisoner has been qualified as an individual with a normal personality. The prisoners who simulated mental disorders are recruited - 81 per cent, of them - from among recidivists, as a rule from among juvenile or young offenders: sixty-six per cent, of the investigated were under twenty-five years of age. They belonged to the category of offenders who commit common offences, mostly offences against property, with thefts predominating. Among the reactive mental disorders to be met with in forensic psychiatrist practice and in the prisons, two kinds of disorders may be distinguished. First of all, the group of disorders of the type of hysterical disorders, the majority of which has a more primitive character; they are: pseudodementia, Ganser’s syndrom, puerilism, states of incomplete stupor and of stupor, fancies with contents similar to those of delusions, and symptoms of conversion hysteria. It is precisely that category of disorders that oftentimes causes particular difficulties in practice, when it is a matter of distinguishing them from malingering. The second group of reactive disorders, with more psychotic symptoms, comprizes: reactive depressions, stupor, and syndroms with delusions and hallucinations and paranoid states. In this category of disorders disturbances of consciousness are much more clearly discernible than they are in the first. Bunyeyev, however, correctly emphasizes the fact that clinical experience points to the fact that in the several syndroms distinguished above there are frequently contained elements, of other reactive syndroms, and, moreover, in a considerable number of cases it can be observed, how, in the course of the disorders, one set of syndroms gives way to other symptom syndroms. Consequently, the clinical picture is usually considerably more complicated than would result from a description that would only take into consideration the most fundamental elements. Among the three hundred and fifty cases of reactive disorders with prisoners under investigation the several syndroms make their appearance In the following dimensions:   Pseudodementia                                                 90 cases    25.7 per cent. Puerilism                                                              16     “          4.6 per cent.  Ganser’s syndrom                                              17     “          4.9 per cent. Depressions                                                         79      “        22.6 per cent. Syndrom of stupor (41)                                      59      “          and states of incomplete stupor (18)              47       “       16.9 per cent. Syndroms with hallucinations and delusions                      13.4 per cent. Paranoid states                                                    12       “        3.4 per cent. Conversion hysteria                                             20      “         5.7 per cent. Fancies with contents similar to delusions     10       “         2,8 per cent. Pseudodementia, Ganser’s syndrom and puerilism between them account for 35.2 per cent, of the material investigated. Pseudodementia and puerilism frequently constitute the source of serious difficulties when it is a matter of distinguishing them from malingering, if hospital observation is of too short duration. Seventy per cent, of the above cases spent over three months on observation in hospitals, including nearly twenty per cent, who spent more than six months there.  After a syndrom of pseudodementia, it may be sometimes observed the malingering of the extinct symptoms of that syndrom (metasimulation). Among the cases of metasimulation in the material under investigation in fifty-five per cent, malingering was precisely connected with pseudodementia. Reactive depressions are the second set, as far as numbers are concerned, in the material under investigation (22.64 per cent.). Reactive depressions are of various character. The obvious colouring of the majority of such states with hysterical traits frequently lends a peculiar stamp to the clinical picture, and may incorrectly suscitate a suspicion of malingering.  Mental disorders with a stupor syndrom, as is well known, rarely arise as isolated type of reaction. Considerably more frequently stupor takes place after pseudodementia, Ganser’s syndrom and puerilism, not infrequently after a period of a seeming withdrawal of all reactive symptoms. What is more, after stupor there frequently appear once more symptoms of other reactive disorders, first and foremost those of pseudodementia (Bunyeyev, Pastushenko). In cases of incompletely developed stupor there frequently appear suspicions of malingering, even though such casses ought to be numbered undoubted mental disorders.  When discussing cases with a hallucination and delusion syndrome one ought to remember that even in such cases the suspicion of malingering occasionally makes its appearance. This is influenced by the fact that the contents of the hallucination are closely connected with the prisonner’s own situation, that his behaviour is characterized by lively emotional reactions, and that he not infrequently manifests interest in his further lot, his family, etc. In fact the suspicion of malingering as a rule proves to be unfounded. Morever, it should not be forgotten that, in cases with a hallucination and delusion syndrome there not infrequently emerge serious diagnostic difficulties in connection with the posibility of the existence of schizophrenia.  Among the reactive disorders observed with prisoners in the hospitals there were twelve cases of acute paranoid state. In this, relatively very infrequent, syndrom, which develops against a background of intensified fear and anxiety, and rapidly disappears under conditions of hospitalization, the existence of hallucinations, mainly visual ones, has also been found.  The symptoms which approach delusions include the so-called confabulation, with contents resembling those of delusions (“wahnhafte Einbildungen” ), which had been described by Birnbaum more than fifty years ago. The inventing of occasionally the most improbable and queerest facts takes place against a background of usually glaringly expressed hysterical traits; occasionally elements of pseudodementia and puerilism become visible. All this together may suscitate serious suspicions of malingering; prolonged observation, however, makes it posible to find the existence of clearly reactive disorders. Of such cases there were ten in the material under investigation. Predominant among them were cases of persecutory pseudodelusions (eight cases), with the most absurd and fantastical subject-matter. In the remaining two cases it was grotesque grandiose pseudodelusions that made their appearance. Both the attitudes and the behaviour of all such individuals were, as a rule, in complete contradiction with the contents of their utterances. Those prisoners who exhibited symptoms of reactive mental disorders differ in an essential way from those prisoners who simulate pathological symptoms. First of all, there are considerably less recidivists among them: the percentage of the latter did not exceed 33 per cent, while with the simulators it reached 81 per cent. Among the prisoners with reactive disorders there are less individuals who would exhibit organic changes of the brain (23 per cent., as compared with 37,1 per cent, with the malingerers), while, on the other hand, the percentage of persons of the schizoid type is considerably larger (36 per cent., as against about 10 per cent, with the malingerers), as well as that of psychopaths with obvious hysterical traits (31.4 per cent., as against about 20 per cent, with the malingerers).  A mere 4.5 per cent, of the total number of prisoners with reactive mental disorders under investigation were found to be persons whose premorbid personality did not suggest any suspicions concerning pathology; all the remaining ones figure, in the diagnoses, either as psychopaths, or else as persons with symptoms of encephalopathy. In spite of the lack of any exhaustive anamneses in a great many cases it was found possible to state that at least 17 per cent, of the prisoners sent to mental hospitals because of reactive mental disorders had already previously suffered from such disorders. The cases of reactive states of a protracted character, numerous in the material under investigation (32 per cent, among the cases dealt with in the Institute of Psychoneurology) make one realize the importance of a proper conception of the problem of reactive mental disorders with prisoners. In those cases states which could at first produce an impression of simulation were relatively numerously represented. Mistrust in such cases might well be increased by the fact that nearly one-half of them consisted of prisoners accused of the perpetration of homicide. A hospital observation which went on for many months on end, not only did confirm the diagnosis of a reactive mental disorder, but has also, over and above that, demonstrated that those mental disorders had, in a considerable number of cases, become so deep, that a large number of the patients had to be assigned for release from prison. Merely about 22 per cent, of the total of those suffering from protracted disorders recovered their health and could, later on, be prosecuted before a law-court.  A working hypothesis in both prisons and forensic-psychiatric practice should therefore be the premisse that a pure malingering of mental disorders going on for a longer period of time is an altogether exceptional phenomenon, and that, as a rule, we have to do, in such cases, with reactive disorders. A different approach not only does run counter to the present-day state of psychiatrist knowledge, but is also highly harmful for both forensic and prison practice, as well as being inhumanitarian.   [1] In order to avoid any misunderstandings it ought to be emphasized that we are here referring to cases of long duration, of a malingering of mental disorders going on for at least several weeks on end. Clumsy attempts at simulating pathological symptoms for a period of a few days, naturally, altogether elude a psychiatrist who is not permanently employed in the prison in question, and, in all probability happen much more frequently
PL
Środowiskowe domy samopomocy to ośrodki wsparcia dziennego dla osób z zaburzeniami psychicznymi. Świadczą one różnorodne usługi na rzecz osób z chorobami psychicznymi oraz z niepełnosprawnością intelektualną. Celem artykułu jest ukazanie roli i zakresu działania tego typu placówek w tworzeniu sieci wsparcia społecznego dla osób z zaburzeniami psychicznymi, na przykładzie Środowiskowego Domu Samopomocy nr 2 w Stalowej Woli. Analiza przeprowadzona na podstawie dokumentacji wewnętrznej placówki wykazała, że ośrodek zapewnia swoim podopiecznym różnorodne formy wsparcia i aktywizacji, w tym zajęcia praktyczne obejmujące: treningi funkcjonowania w życiu codziennym (np. trening higieny osobistej, trening porządkowy, kulinarny, gospodarowania środkami finansowymi), treningi umiejętności interpersonalnych i rozwiązywania problemów, treningi umiejętności spędzania czasu wolnego, a także różne formy terapii (np. terapia zajęciowa, arteterapia) oraz treningi relaksacyjne (np. zajęcia w ogrodzie). Ośrodek realizuje też działania mające na celu przygotowanie podopiecznych do udziału w innych programach wsparcia środowiskowego, w tym także do aktywności zawodowej. Celem tego rodzaju działań jest kształtowanie i wzmacnianie umiejętności życiowych i społecznych osób z zaburzeniami psychicznymi, wspieranie ich zaradności i samodzielności, a także przełamywanie barier izolacji oraz tworzenie warunków integracji społecznej osób niepełnosprawnych w ich środowisku lokalnym.
Ius Matrimoniale
|
2004
|
vol. 15
|
issue 9
87-114
EN
El can. 1095 del Código actual contempla las enfermedades mentales y los trastor nos psiquicos, regula los casos en los que esos supuestos de hecho, tan variados, constituyen una incapacidad para expresar el consentimiento valido, que es la causa, en el Derecho actual, de la nulidad del matrimonio. E nel Código anterior, sin embargo, no habia ninguna regulación, consagrada directam ente y ùnicam ente a los casos de incapacidad “psiquica”,  provocada por enferm edades y trastornos mentales. Habian, es verdad, canones, que tocaban el tema de la capacidad mental de expresar el consentimiento. Sin embargo, el can. 1095 es novedoso en su modo de tratar el tema, es decir de intentar de abarcar en el texto de un solo canon toda la variedad de casos de incapacidad de contraer el matrimonio provocada, entre otras, por enferm edades о trastornos m entales; el canon que contem platres tipos juridicos a través de los cuales esa incapacidad se manifiesta en form as especificas о causas de nulidad autônomas; el canon, que ubica todas las cuestiones relacionadas con el tema en el Capitulo IV titulado ’’Del consentimiento matrimonial”.En los tiempos del Código de 1917 los canonistas intentaban resolver las causas de incapacidad de contraer el matrimonio provocada por enferm edades mentales sin poder acudir a este tipo de regulación juridica. En esta época, precisamente en los ańos cincuenta y sesenta, apareciô sin embargo un factor nuevo, que provocô un crecimiento del interés por las enferm edades y trastornos mencionados. El factor fue un desarrollo râpido de psicologia y psiquiatria.En consecuencia, el conocimiento mejor de los trastornos mencionados permitiô ver desde otra perspectiva los problem as provocados por estos trastornos, entre otros los problem as de la vida matrimonial. Con el paso del tiempo los tribunales eclesiâsticos empezaron a alegar los nuevos logros de sicologia y psiquiatria como también utilizar mâs frecuentemente los términos provenientes de estas ramas de la medicina moderna.En nuestro estudio vamos a detenernos en una etapa concreta de la historia de la reflexion juridica sobre la capacidad humana de contraer el vinculo matrimonial valido, en el caso de trastorno metal ocurrido. Al concretizar todavia mâs, vamos a estudiar los textos de John R. Keating, un autor de lengua inglesa, quien fue uno de los primeros, en ocuparse del tema de la influenda de dichos trastornos en la validez dei matrimonio. El autor, prâcticamente desconocido fuera de la cultura de habla inglesa, en su tiempo fue uno de los precursores mâs destacados del tema mencionado, preguntando y poniendo de relieve unas ideas nuevas en cuanto a la influencia de los trastor nos mentales en la validez dei matrimonio. Creemos, que por este articulo vamos a despertar de nuevo el interés por la cuestiôn resuelta por ahora por medio de las nuevas regulaciones del Código de 1983.
PL
Praca jest jedną z podstawowych form działalności ludzkiej. Niestety, aż 95% pracodawców nie widzi możliwości zatrudnienia osób chorych psychicznie. Szczególnie dotyczy to osób chorych na schizofrenię, którym ciężko znaleźć pracę na jakimkolwiek stanowisku. Wynikać to może ze stygmatyzacji osób chorych psychicznie lub z wewnętrznych przyczyn tkwiących w danej osobie. Zatrudnienie pracownika z chorobą psychiczną niesie ze sobą nie tylko zagrożenia, ale także korzyści dla pracodawcy. Dla osób z chorobą psychiczną praca jest natomiast źródłem leków, ale także radości. Ma ona istotne znaczenie dla stabilizacji zdrowia psychicznego.
EN
The work is one of the basic forms of human activity. Even 95% employers do not see the possibility of employment for people with mental illness. Especially for people with schizophrenia , which is hard to find a job in any position. This may be due to the stigmatization of the mentally ill or internal causes inherent in the person. Employment of an employee with a mental illness carries with is not only threats, but also benefits the employer. For people with mental illness while work is a source of fears, but also joy. It is important to stabilize mental health.
EN
This article deals with problems in functioning of medical support system and social support and integration system addressed to persons with mental disorders in Poland on the example of Greater Poland Voivodeship. This voivodeship is representative as far as the mental health problems’ prevalence and the type of the most common mental disorders diagnosed among people are concerned. The local data reflect very similar tendencies as cross country and international analyses. Moreover, the analysis of the local system of support for people with mental disorders carried out by the authors of this article revealed that the inadequacies of the system reflect the tendencies observed in the cross country Polish scale. In this context, the recommendations formulated by the authors can be applied (with some necessary corrections) in different local environments.
PL
Przedmiotem artykułu jest analiza problemów w funkcjonowaniu systemów wsparcia medycznego i społecznego dla osób z zaburzeniami psychicznymi na przykładzie województwa wielkopolskiego. Dane o zasięgu międzynarodowym, ogólnopolskim i lokalnym wskazują, że województwo wielkopolskie jest reprezentatywne pod względem natężenia oraz typu najczęściej diagnozowanych problemów zdrowia psychicznego ludności. Ponadto analiza systemu wsparcia dla osób doświadczających zaburzeń psychicznych, przeprowadzona przez autorki niniejszego artykułu, wskazuje na reprezentatywność województwa wielkopolskiego w skali kraju pod względem problemów wynikających z niedostatków systemowych rozwiązań mających na celu przeciwdziałanie zaburzeniom psychicznym. Punktem wyjścia w niniejszym opracowaniu jest zarysowanie globalnego kontekstu problematyki zaburzeń psychicznych. Następnie problematyka ta została omówiona w świetle analiz ogólnopolskich i regionalnych. W tym kontekście zostały opisane zagrożenia związane z funkcjonowaniem systemu ochrony zdrowia oraz systemu pomocy i integracji społecznej, a także sformułowano rekomendacje mające na celu przeciwdziałanie barierom rozwoju systemu wsparcia dla osób z zaburzeniami psychicznymi w różnych uwarunkowaniach lokalnych.
PL
Współczesne kierunki badań w obszarze edukacji ukazują potrzebę stworzenia w uczelniach warunków wspierających studentów z zaburzeniami psychicznymi w procesie kształcenia. Budowanie kultury otwartości na problemy psychiczne studentów oraz wypracowanie skutecznych mechanizmów wsparcia zwiększają ich szanse na efektywniejszy udział w społeczności akademickiej. Autorka pracy stawia sobie za cel ukazanie systemowych rozwiązań wspierających studentów z zaburzeniami psychicznymi na Uniwersytecie Jagiellońskim w Krakowie, ze szczególnym uwzględnieniem jednego z programów profilaktycznych w zakresie zdrowia psychicznego pn. „Konstelacja Lwa”. W pracy przedstawione zostaną wybrane rezultaty z realizacji inicjatywy, w tym opinie uczestniczących w nim studentów o adekwatności programu do ich potrzeb uwarunkowanych stanem zdrowia i sytuacją akademicką.
EN
Contemporary research directions in the field of education show the need to create environment at universities that supports students with mental disorders in the educational process. Building a culture of openness to the psychological problems of students and the development of effective support mechanisms increase their chances to participate more effectively in the academic community. The author of the work aims to show system solutions that support students with mental health difficulties at the Jagiellonian University in Krakow, with particular attention to one of the prevention programs in mental health, namely “Leo Constellation”. The work will present selected results from the implementation of the initiative, including the opinions of the participating students about the program’s relevance to their needs due to their state of health and academic situation.
EN
Research results presented in the article focus on the correlation between attitudes towards people with mental disorders and chosen personality traits. Research involved 150 people – employees of social care homes. Job characteristics and the nature of contact with social care homes dwellers constituted the criterion for placing the analysed person into one of the subgroups. Three subgroups of equal size have been recognised: employees at social – therapeutic department(I), medical staff (nurses) (II), economic department employees (III). The following methods have been used: The Scale for Defining Attitudes Towards People with Mental Disorders, Raven’s Progressive Matrices, Study of Values by G. W. Allport, P. E. Vernon, G. Lindzey, Stait-Trait Anxiety Inventory by C. D. Spielberger, J. Strelau, M. Tysarczyk, K. Wrześniewski, The Questionnaire: ”What are you like?” by P. Sears. Within the analyzed group people from subgroup I manifested the most positive attitudes, people from subgroup II were slightly less favourably inclined, and people from subgroup III showed the least positive approach. The application of multiple regression equation showed that among the analysed variables trait anxiety has significant meaning for the type of attitudes both in group I and II. In subgroup III a significant influence on manifested attitudes is exerted by the following variables: economic values, intellectual level, artistic values and trait anxiety.
PL
Teza. Osoby chorujące psychicznie są grupą szczególnie narażoną na łamanie ich praw oraz stygmatyzację. Badania pokazują, że w naszym społeczeństwie wciąż dominują niechętne postawy wobec osób doświadczających problemów psychicznych, co niesie za sobą wiele negatywnych skutków. Edukacja antydyskryminacyjna może zredukować niechętne postawy społeczne. Omówione koncepcje. Skutkami stygmatyzacji są utrata lub niemożność podjęcia pracy, co w konsekwencji może być przyczyną ubóstwa. Stygmatyzacja jest też przeszkodą w zdrowieniu osób chorujących, może być przyczyną odtrącenia ze strony bliskich, a nawet prowadzić do prób samobójczych. Dzieje się tak mimo prowadzonych działań antydyskryminacyjnych i destygmatyzacyjnych. Wyniki i wnioski. Należy wprowadzić więcej działań antydyskryminacyjnych dotyczących osób chorujących psychicznie skierowanych do uczniów, studentów i całego społeczeństwa. Do tych inicjatyw należy w miarę możliwości angażować osoby doświadczające problemów psychicznych. Oryginalność. Stygmatyzacja osób chorujących jest zjawiskiem powszechnym, jest to też obszar zainteresowania wielu badaczy. Jednak nadal jest zbyt mało analiz, które zajmowałyby się badaniem podejmowanych działań antydyskryminacyjnych oraz opracowywaniem rekomendacji w tym zakresie.
EN
Thesis. People with mental illness are a group particularly vulnerable to violation of their rights and stigmatization. Studies show that our society is still dominated by reluctant attitudes towards people experiencing psychological problems, which has many negative consequences. Anti-discrimination education can reduce reluctant social attitudes. Concept discussed. The effects of stigmatization are the loss or inability to take up a job, which in consequence may lead to poverty. Stigmatization is also an obstacle to the recovery of people who are ill. It may be the cause of rejection from the family, and may even lead to suicide attempts. This is despite anti-discrimination and destigmatization activities. Results and conclusions. More anti-discrimination measures should be introduced for people suffer from mental illness, aimed at pupils, students and society as a whole. These initiatives should involve, where possible, people experiencing mental health problems. Originality. The stigmatization of people suffering from mental illness is a common phenomenon, and it is also an area of interest for many researchers. However, there are still too few analyses which would investigate anti-discrimination activities and develop recommendations in this area being undertaken.
PL
Celem badania było przeprowadzenie ustrukturalizowanych klinicznych wywiadów diagnostycznych (Structured Clinical Interview for DSM-IV-TR, SCID-I) z osobami, które aktualnie nie leczą się psychiatrycznie, i uwzględnienie w ramach tych wywiadów pytań o doświadczenia krzywdzenia w dzieciństwie. Postawiono pytanie o to, czy osoby relacjonujące doświadczenia krzywdzenia w dzieciństwie w porównaniu z osobami bez takich doświadczeń otrzymają częściej diagnozę zaburzenia psychicznego według SCID-I. Zbadano łącznie 98 osób, spośród których 58 relacjonowało doświadczenia krzywdzenia w dzieciństwie. Wykazano istotne statystycznie różnice w zakresie występowania zaburzeń psychicznych – aktualnych i w ciągu życia. W grupie osób relacjonujących krzywdzenie w dzieciństwie 36,2% otrzymało diagnozę bieżącego zaburzenia według SCID-I, natomiast w grupie bez tego typu doświadczeń nie otrzymał jej nikt. Diagnozę w ciągu życia otrzymało 55,2% badanych z grupy osób krzywdzonych w dzieciństwie w porównaniu z 12,5% w grupie osób bez tego typu doświadczeń. Stwierdzono także częstsze relacjonowanie stresu bieżącego i współwystępowanie zaburzeń. Ogólnie przeprowadzone badanie potwierdziło, że osoby relacjonujące doświadczenia krzywdzenia w dzieciństwie w porównaniu z osobami bez takich doświadczeń wykazują więcej objawów psychopatologii i spełniają znacznie częściej kryteria zaburzeń psychicznych z osi I DSM-IV-TR według SCID-I.
EN
The aim of the study was to conduct structured clinical interviews for DSM-IV-TR (SCID-I) in non-clinical sample and to include in these interviews questions about childhood adverse experiences. The main research question was whether participants reporting childhood adverse experiences would be more likely to receive a diagnosis of an Axis I disorder according to SCID-I. A total of 98 participants were examined, of which 58 reported childhood adverse experiences. There were statistically significant differences in the prevalence of current and life-time diagnoses. In the group of participants reporting adverse experiences, 36.2% received a diagnosis of the current disorder, while no one in the group without such experiences. Life-time diagnosis was received by 55.2% participants who reported adverse experiences, compared to 12.5% from the group non-reporting such experiences. Participants reporting adverse experiences reported also more frequent current stress and had a comorbid diagnosis. Overall, the study confirmed that participants reporting childhood adverse experiences as compared to those without such experiences show more symptoms of psychopathology and more often meet the criteria for Axis I DSM-IV-TR disorder according to SCID-I.
PL
Łuszczyca jest schorzeniem najczęściej uwarunkowanym genetycznie. Jest chorobą przewlekłą o podłożu wielowymiarowym. Cierpi na nią około 1–3% populacji. U ponad połowy pacjentów rozwijają się stany lękowe i depresyjne. Z powodu łuszczycy 1 na 20 chorych podejmuje próbę samobójczą. Nawrotowy charakter tej choroby jest mocno związany ze stresem psychicznym badanych. Łuszczyca wymaga od pacjentów ciągłego zmagania się z jej nawrotami. Choroba wpływa na poczucie własnej wartości i postrzegania własnego ciała. Chorzy bardzo często rezygnują z aktywności fizycznych (m.in. seksualnej), unikają kontaktów z ludźmi, jak również miejsc publicznych. Stres jest niewątpliwie czynnikiem wyzwalającym bądź nasilającym zmiany chorobowe. Narastające dermatozy w łuszczycy są przyczyną dużych lęków i obaw związanych ze zdrowiem. Bardzo wyraźne i negatywne emocje zostawiają mocny ślad w psychice, skutkuje to skrępowaniem dotyczącym cielesności, a co za tym idzie – obniżeniem samooceny. Zaznaczona jest wyraźnie silna i złożona zależność miedzy stresem a łuszczycą. Choroba, która w widoczny, czasami drastyczny sposób zmienia wygląd skóry, wpływa na jakość życia uwarunkowaną stanem zdrowia. Schorzenie, które zmienia ciało człowieka w sposób zauważalny, wpływa na sposób kształtowania własnej wartości, samooceny, a tym samym przekłada się na jakość życia pacjenta.
EN
Psoriasis is the most often genetically conditioned disease. It is a chronic disease with a multidimensional background. About 1–3% of the population suffers from it. Over half of patients develop anxiety and depression. Due to psoriasis, 1 in 20 patients make a suicide attempt. The recurrent character of this disease is strongly related to the mental stress of the subjects. Psoriasis requires patients to constantly struggle with its relapses. The disease affects self-esteem and the perception of your own body. Patients often give up physical activity (including sexual activity), avoid contact with people, as well as public places. Stress is undoubtedly a factor triggering or intensifying disease changes. Growing dermatoses in psoriasis are the cause of major fears and health concerns. Very clear and negative emotions leave a strong mark in the psyche, which results in embarrassment affecting corporality, and thus a reduction in self-esteem. A strong and complex relationship between stress and psoriasis is clearly marked. Disease, which in the visible sometimes drastic way changes the appearance of the skin affects the quality of life conditioned by the state of health. A condition that changes the human body in a noticeable way affects the way of shaping self-esteem, self-esteem, and thus translates into the quality of life of the patient.
PL
Psychiatryczna terminologia zawiera opisy kilkunastu zaburzeń osobowości. Osobowość psychopatyczną wyróżnia w tym gronie to, że charakteryzujące ją cechy bezpośrednio wiążą się zachowaniami sprzecznymi z przyjętymi przez społeczeństwo normami i zasadami. W ciągu minionego wieku rozumienie osobowości psychopatycznej zmieniało się. Po pierwsze (1) przestawano ją rozumieć wyłącznie jako osobowość przestępczą, a zaczęto ujmować bardziej subtelnie i jako występującą w populacji ogólnej. Po drugie (2) w klasyfkacjach chorób i zaburzeń zastąpiono ją osobowością antyspołeczną lub dyssocjalną. W końcu po trzecie (3), współcześnie osobowość psychopatyczną ujmuje się częściej w kategoriach cechowych i intensywnie bada empirycznie, na przykład jako część tak zwanej Ciemnej Triady osobowości. W artykule przedstawimy zarówno „klasyczne” rozumienie psychopatii, jak i późniejsze, nowsze ujęcia tego rodzaju osobowości, kończąc na prezentacji najnowszej propozycji opublikowanej w alternatywnej sekcji III podręcznika DSM-5 Amerykańskiego Towarzystwa Psychiatrycznego.   Psychiatric terminology contains descriptions of several personality disorders. The psychopathic personality is distinguished in this group by the fact that the characteristics that characterize it are directly related to behaviours that are contrary to the norms and principles adopted by society. Over the past century, understanding of the psychopathic personality has changed. Firstly (1) it was meant to be understood only as a criminal personality, and began to be treated more subtly and as occurring in the general population. Secondly, (2) in the classifcations of diseases and disorders, it was replaced by an antisocial or dissocial personality. Finally, thirdly (3), contemporary psychopathic personality is more often recognized in guild categories and intensively researches empirically, for example as part of the so-called Dark Triad of personality. In the article, we will present both the “classic” understanding of psychopathy, as well as later, newer concepts of this kind of personality, ending with the presentation of the latest proposal published in the alternative section III of the DSM-5 manual of the American Psychiatric Association.
EN
Psychiatric terminology contains descriptions of several personality disorders. The psychopathic personality is distinguished in this group by the fact that the characteristics that characterize it are directly related to behaviours that are contrary to the norms and principles adopted by society. Over the past century, understanding of the psychopathic personality has changed. Firstly (1) it was meant to be understood only as a criminal personality, and began to be treated more subtly and as occurring in the general population. Secondly, (2) in the classifcations of diseases and disorders, it was replaced by an antisocial or dissocial personality. Finally, thirdly (3), contemporary psychopathic personality is more often recognized in guild categories and intensively researches empirically, for example as part of the so-called Dark Triad of personality. In the article, we will present both the “classic” understanding of psychopathy, as well as later, newer concepts of this kind of personality, ending with the presentation of the latest proposal published in the alternative section III of the DSM-5 manual of the American Psychiatric Association.
EN
This article picks certain motifs from Jean-Paul Sartre’s philosophy on the structure of human subjectivity and juxtaposes them with reflections based on phenomenological psychopathology by Thomas Fuchs. The three ‘dimensions’ of human subjectivity, as distinguished by Sartre and Fuchs, are compared: the feeling of self, the feeling of the other and the feeling of time. Consequently, the existential feelings described by Sartre are connected with mental disorders distinguished by Fuchs in an attempt to recognise a place for Sartre’s theory of existentialism in the most recent discussion on phenomenological psychopathology.
PL
Problemy zdrowotne osób z niepełnosprawnością intelektualną i różnego rodzaju problemami w zakresie zdrowia psychicznego są bardzo złożone, wymagają długiego, skomplikowanego i stale prowadzonego procesu diagnostycznego specjalistów wielu dziedzin. Nadal jednak naukowcy podkreślają brak dostatecznej wiedzy na temat poprawności rozpoznania psychiatrycznego u pacjenta z niepełnosprawnością intelektualną. Decyzje diagnostyczne i lecznicze generują następnie działania terapeutyczne, pielęgnacyjne i opiekuńcze. Zmiana sposobu postrzegania osób z niepełnosprawnością intelektualną wynika jednak z poprawy rozumienia niepełnosprawności jako stanu, w którym mogą wystąpić zaburzenia psychiczne oraz poprawy skuteczności oddziaływań o charakterze kompleksowym w opiece nad pacjentem. Jednym z nich jest poprawa sposobów i skuteczności komunikacji z pacjentem. Rozmowa i wywiad – obok obserwacji, testów, skal i inwentarzy, badania stanu somatycznego – powinny być celem i sposobem przeprowadzenia badania stanu psychicznego. Optymalna komunikacja z pacjentem poprawi skuteczność profesjonalnych interwencji w opiece nad pacjentem z niepełnosprawnością intelektualną 1.
EN
In the process of ageing, elderly people are faced with progressive difficulties in everyday functioning, the problem of deteriorating health, decreasing levels of fitness and satisfaction with their family and social lives. Nevertheless, they can also live through the period of ageing and old age in an active and fully satisfying manner. This process takes place in the life of an elderly person with intellectual disability in a particular way. This group of patients lives through old age despite some limitations in their communicative, cognitive, emotional, social and other capabilities. The care of patients with intellectual disability primarily consists in helping them to understand Pacjent z niepełnosprawnością intelektualną w wieku starszym. Problemy komunikacji the changes occurring in them, satisfying their need of security, as well as supporting them in the process of facing old age and their own mortality
EN
Film is a medium which reaches viewers strongly. Besides its entertainment function, it has influence on shaping attitudes. However, it is a work of art and has its own principles. It is important to maintain moderation in presenting content, so that it is close to reality and does not harm anyone. The paper concentrates on the audio-visual work by James Mangold, Girl, Interrupted. It is known to wide audience, therefore it is worth considering the content which it conveys. The paper presents the results of the author’s analysis based on available literature.
PL
Film jest medium mocno trafiającym do odbiorców. Poza funkcją rozrywkową ma wpływ na kształtowanie postaw. Jest on jednak wytworem artystycznym i rządzi się swoimi prawami. Ważny jest umiar w przedstawianiu pewnych treści, tak by nie odbiegały one od rzeczywistości i nie były krzywdzące dla określonych osób. Artykuł pochyla się nad utworem audiowizualnym w reżyserii Jamesa Mangolda Przerwana lekcja muzyki. Znany jest on szerokiemu gronu widzów, dlatego warto zastanowić się nad przekazywanymi przez niego treściami. Artykuł prezentuje wyniki analizy przeprowadzonej przez autorkę na podstawie dostępnej literatury.
EN
Volunteering is an unpaid activity for the benefit of various groups of people, incl. persons experiencing mental disorders. Motivations for volunteering may differ and involve the desire to gain experience and new knowledge, the need to repay to the community and to help those in need, and also the need to feel accepted or the desire to establish new relationships and verify one’s own aspirations. Some of the reasons for volunteering are related to the willingness to “give”, while others are related to “receiving”. The volunteers working with people with mental disorders are a valuable part of the support system. The volunteers can work in many places and in various ways. Volunteering activities are included both in the law defining the framework of the volunteering as well as in the code of ethics of volunteers, which can be a starting point for designing appropriate volunteering activities. Volunteering plays a significant role in supporting people with mental disorders, volunteering activities complements institutional support, and volunteers themselves can support professionals. In view of the role of volunteering, it is important to continue looking for ways to improve the recruiting, training and management of volunteering, and to support volunteers in their work, to minimize burnout and to reduce frequency of volunteers’ turnover, as well as to maximize the potential of every individual.
PL
Wolontariat jest bezpłatnym i dobrowolnym działaniem na rzecz różnych grup osób m.in. doświadczających zaburzeń psychicznych. Motywacje do działań mogą być różne i wiązać się m.in. z chęcią zdobycia doświadczenia oraz nowej wiedzy, potrzebą odpłacenia się społeczeństwu oraz pomocy potrzebującym, a także potrzebą bycia akceptowanym, chęcią nawiązania nowych relacji oraz zweryfikowania własnych aspiracji. Część motywacji wiąże się z chęcią „dawania”, inne zaś zorientowane są wokół „otrzymywania”. Wolontariusze pracujący z osobami z zaburzeniami psychicznymi są cenną częścią systemu wsparcia, mogą pracować w wielu miejscach oraz w różny sposób. Działania wolontariuszy ujęte są zarówno w ustawie określającej ramy wolontariatu, jak i w kodeksie etycznym wolontariuszy, który może być wyjściem do projektowania odpowiednich działań wolontariackich. Wolontariat odgrywa znaczącą rolę we wspieraniu osób z zaburzeniami psychicznymi, jest uzupełnieniem działań instytucjonalnych, wolontariusz może być wsparciem dla pracujących profesjonalistów. W związku ze znaczeniem wolontariatu ważne jest, aby dalej szukać metod poprawy rekrutowania oraz szkolenia, zarządzania wolontariatem, a także wspierania wolontariuszy w ich pracy, aby minimalizować wypalanie i przeciwdziałać nadmiernej rotacji wolontariuszy, a maksymalizować potencjał tkwiący w każdej osobie.
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