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New York state psychiatric hospital Pilgrim
Science begins with a General recognition of the existence of a problem or field of study. In the next phase we will concentrate on what, in fact, need to learn to solve. Where to start? You need to watch, what facts we need to identify what data to collect? We never tire of repeating that one of the greatest misconceptions about science is that the facts already given, clearly defined, well-defined and necessary, and that they begin with a scientific study. Actually it is not so.
when Faced with any problem, we understand that a number of facts that can be considered is enormous, and we must begin by determining what facts should be considered significant and which are not. And if we say that the bias can mislead, we can only reply that we have to take that risk. The most useless advice you can get, starting to solve the problem is to let go of all pre-installed. We should get rid only of the attitudes, but how to identify them?
the Awareness of psychiatrists that mental health clinic — the only certain example of how social environment affects the mentally ill and his behavior, has led to the development of more General concepts than the hospital neurosis; this concept is called "syndrome of social disorder". (Syndrome is a medical term that refers to a group of symptoms, usually manifested together, regardless of whether they are symptoms of the particular disease. This syndrome is in accordance with the definition of E. M. grünberg consists of many symptoms was believed to be specific to psychosis, such as schizophrenia or depression: a "Syndrome of social disorder can manifest in a wide range of styles is clearly abnormal behavior. Detachment, untidy, aggressive behavior, screaming, self-harm, inability to work and inability to enjoy the rest — here are the main symptoms... the Disease is sometimes sneaks up on you, goes unnoticed and ends with the desire for plant life, as described in textbooks. More often the disease begins with the outbreak of violent behavior or a sudden cessation of all normal social functions, often accompanied by clouded and troubled state".
This behavior leads to the placement of the patient in hospital, often against his will. Is this behavior inherent to this disorder, or it is the result of the interaction of persons in a mentally abnormal state, and its social environment? Grünberg inclined to the second opinion. He believes that such conduct is occurring "as a result of a cycle of interactions of the patient with his social environment".
According to him, it appears, when a person begins to feel the discrepancy between what he believes, he is able to do and what, in his opinion, expected of him. However, the perception of such a discrepancy by itself is not a symptom of mental disorder — rather it is a situation in which most of us live. We strive to resolve it one way or another without disruption: we are starting to work harder or, conversely, stop working, leave school, change occupations or find other friends. The man, who is the failure, may not have sufficient flexibility and inner strength to find a constructive way to overcome a mismatch. It seems that he is trapped, with which he cannot cope with and cannot escape from it. He desperately tries to find new forms of behaviour to cope with their difficulties — the distancing, the anger, fantasies— but they do not always work. People close to him can be scared and upset by his behavior. First, they can attempt to cope with the situation, but ultimately they have to seek help and advice.
Often the consequence of this is advice for friends and family of the patient asking him to be hospitalized due to "mental disease." By the time they begin to treat him differently than before as a result of worries and anxiety, stimulated by his own behavior, and in response to public opinion about his mental abnormality. After a hospital stay, people often believe that loved ones have betrayed him, finds himself in a situation where he is told that he is ill, requires care and more responsible for their own behavior.
the Patient now finds himself in an atmosphere different from that in which he suffered a breakdown. It can depending on where he is, method of treatment and degree of seriousness of disorders to recover and to be discharged, or he may remain for a longer period, exposed to additional risk of developing "hospital neurosis". And hospital neurosis and syndrome of social disorders can be treated as results of interaction with the patient's social environment. These environments, however, are quite different, and these two States are not identical, although over time one and the same person can suffer from this and from that.
How to get rid of the influence of social connections and really study the schizophrenia or depression? This question may not be a satisfactory answer. There are people who think that there is no such disease as "schizophrenia in itself" or "depression itself" that this disorder "interpersonal relationships", and they can't be defined outside of the situation of social relationships. Thus, a more fruitful may be considered part of sociology, not psychology of personality. Some adherents of this view schizophrenia went so far as to say there is no such disease as schizophrenia that it's just a label hung on us certain types of behavior, is extremely deviant from the norm, and thus we ourselves create a problem. This idea will be discussed below in this Chapter.
Totally repressive organization
a Decisive step in the opening of the hospital of neurosis was the recognition that apathetic state for a long time subjected to the hospitalization of the mentally ill resembles the condition for a long time in prison — "prison psychosis". Barton, in his book, he drew Parallels and comparisons between these patients and contained in prisons, concentration camps, sanatoria, etc. the Sociologist Ervin Goffman conducted a detailed and in-depth analysis of such Parallels in the article "About the features of totalitarian organizations", reprinted in his book "Psychiatric hospital". Hoffman follows describes a totalitarian organization:
"the Basis of social order in modern society is that people are mostly sleeping, resting and working in different places, make friends with different people with different authority and does so without any rational plan suitable for all occasions. The main feature of totalitarian organizations can be described as the disruption of the barriers usually separating these three spheres of life. First, all aspects of life concentrated in one place and under one leadership. Secondly, each phase of daily human activities in an organization is passing in the immediate neighborhood with a large group of other people, to all of which the ratio of the same, and they all want to do the same things. Third, all phases of daily activities are strictly regulated, one action in the pre-stipulated time is replaced by another, and the whole sequence of actions imposed on top of the system is clearly formulated formal institutions and staff of the organization. Finally, various prescribed actions consolidated into a single rational plan designed to fulfill the official objectives of the organization".
the Book of Hoffmann is a study of important features common to all such organizations that form the members of those organizations in the sample, considered desirable for a given organization or society. He does not claim that everything is totally organized institutions are identical in all he quite understands that they differ in many ways. Hoffman schematically subdivides the total institutions into five different types: "first, there are organizations to care for people who are considered to be something inferior— house for the blind, the elderly, orphans and the poor. Secondly, there are places established to care for people considered unable to look after themselves and pose a threat to society, albeit unintentional: TB sanatorium, mental hospital and a leper colony.
the Third type of total organizations created to protect companies from what is considered a deliberate threat to him, and the benefit of prisoners is not its immediate goal: prisons, penitentiaries, pow camps and concentration camps.
Fourthly, there are organizations designed to best perform labor tasks, which only the existence of this useful function and to justify, barracks, ships, boarding schools, work camps, colonial manors and large mansions from the point of view of those living in them servants. Finally, there are organizations designed to remove from the world, although they often also serve the purposes of religious education: examples are abbeys, monasteries for men and women and other religious organizations".
of Course, in some of these cases, membership in the organization voluntarily, but not others; some have a certain period of stay, and in the other it is not limited. Such factors must be present for their inhabitants a significant difference.
What is common in monasteries and concentration camps?
However, there are certain common features in these various organizations, as a monastery and a concentration camp that focuses Hoffman. He is interested in the way these organizations form the identity: the transition from a state characterized by freedom of choice, self-esteem and personal life, in a new state with the impersonal patterns of behavior that serve the purposes of the organization. Not outlining the entire book of Hoffmann, will try to pass it on to the creature using only some quotes describing what can be called "initiation" rookie:
"Recruit enters the organization with a specific view of himself made possible by certain stable social structures of his home environment. After joining the organization, he immediately loses the support of these structures. On the exact language of one of the oldest organizations of our total it goes through a series of humiliations, insults and defilements. His "I" systematically, though often unintentionally, be humbled... many total organizations the right to have visitors or to leave the organization at first entirely prohibited, which provides deep initial break with previous social roles and a sense of loss of their role. An illustration of this is the description of the life of cadets in the military Academy...
After that, a member of the organization finds that it is lost for certain roles because of the barrier that separates it from the outside world. Membership in the organization is usually associated with other losses, and humility. It is widely used special admission procedures, such as the presentation of his autobiography, photographing, weighing, fingerprinting, assigning numbers, searching, compiling a list of personal belongings for storage, undressing, washing, disinfection, hair cut, the results adopted in the organization of clothing, instructions and room assignments".
it is Necessary at the outset to set recruits on cooperation. The staff of the organization often finds that the willingness of the recruit to the expression of piety in personal contacts is a sign that he takes the role of the person obeying the established routine. The situation in which the staff for the first time tells the recruit about his duties, may be intended to create a situation of challenge — balked whether a rookie or prefer not to look for trouble. Thus, these first moments can contain a "test of obedience" and even fight to break the will: showed disobedience immediately gets the punishment, which increases until he openly "request for mercy" and will not accept.
"each person has a certain sample itself. The person usually seeks to self-control over the form in which he appears before others. For that we need cosmetics, clothes, cosmetic tools and means of bringing itself in decent condition, as well as some place to store them, in short, a person needs a "unique set" to care for their appearance. He also need experts in beauty care, such as barbers and tailors.
When joining in the totally repressive organization of the person is usually deprived of its normal external appearance, means and possibilities of its maintaining, so it suffers from depersonalization. Clothing, combs, needle and thread, cosmetics, towels, soap, shaving kits and bathing — all of this he can take away or deny to use it, although some of these things can be stored in inaccessible place in order to return at the end. For admission to such organization to the exemption of cosmetic and other means of maintaining the appearance does not allow a person to maintain his image in front of him and other people. His view of himself is under attack from the other side.
the Specified means of expression specific to a civilized society, the movement, posture and position of the humiliated person and tend to avoid them as humiliating. Any rule, command or task that causes a person to resort to this kind of movements or postures, are intended to subdue his personality. In a religiously oppressive organizations such methods of physical humiliation a lot. In psychiatric hospitals, for example, patients can get there all the food with a spoon.
In military prisons from the inhabitants can claim to stand at attention always, when into the room comes the officer. In religious organizations known for such classic penitential actions, like kissing the feet and posture recommended for the sinful monk that he "...fell down silently at the door of the chapel and so face to the ground and let rasprosterlas lying at the feet of everyone leaving the chapel. In some penal institutions we find the humiliation of kneeling at a cross-section whips".
Organization and disease
it is Easy to notice the connection between the General notion of a totally repressive organization of Hoffmann with its inherent mechanisms of adjustment of man and disease of the mentally ill, which Barton described as a "hospital neurosis". Hoffmann introduced as a concept applicable to any types totally repressive organizations, it overlooks the special features that distinguish psychiatric institutions from the rest. Most of the inhabitants of psychiatric clinics is in them due to the disorders of behavior, disorders reactions to stressful situations in everyday life in the wild. This means that their reaction to those features of mental health clinics that integrate it with other similar organizations, is likely to be different in some important respects from the reaction of political prisoners in jail or young people admitted to military Academy.
of Course, such a reaction suggests that schizophrenia actually exists (despite the possibility that the course of development is determined primarily by the social situation in which it occurs). Hoffman is one of those who believes that it is primarily created by our desire to label socially unacceptable behaviors. No doubt, prison psychosis would not exist without prisons. There would be no schizophrenia asylums or without the characteristic of a particular culture type of social reaction to deviant behavior? This is a fundamental issue for our attempts of scientific knowledge of mental disorders, is more important than the question whether the same levels of incidence of various psychoses in the US and UK, but including it.
What do we find?
the reader may be a fair disappointment. He was promised so much from the use of the scientific method in the study of mental disorders, and received so little. We began our presentation with the assertion that the levels of schizophrenia and depressive disorders differ sharply in Britain and the United States, then showed that this difference is a consequence of the difference in the definition of the psychiatrists of these disorders. We found that the symptoms and course of development of schizophrenia, painstakingly studied and klassifitseerimise psychiatrists over the past 50 years, to some extent, determined by the method of treatment of schizophrenics in hospitals, and not specific to this disease.
while Acknowledging the role of social interaction in shaping behavior and symptoms of schizophrenia, we were forced to put such questions: how far does this formation? To what extent is the syndrome called schizophrenia, specific patient and is generated by the social environment? The issues however can be seen as moving forward. We showed that it is possible to develop fairly reliable methods of diagnosis of schizophrenia and depressive disorders.
Different psychiatrists have applied these methods to the same patient, for the most part come to the same conclusions. And using these methods of diagnosis we have shown that the incidence of mental disorders in the UK and the USA actually about the same, and this fact although less impressive than their sharp distinction, yet represents an important and useful step forward.
In addition, the recognition that social environment affects the development of schizophrenia, not only allows us to give a more complete picture of her, but also played an important role in reducing the terrible effects of this disorder. This recognition has put before us an important question: is there a schizophrenia or we invented it?...
the Excerpt from the book "How we learn. The study of the process of scientific knowledge"
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