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Part 1 back.gif (2549 bytes) TO CONFERENCE

1. Survey of the psycho-social work with street children
Agapishvili, Nana; Javakhishvili, Helen; Javakhishvili, Darejan; Jorbenadze, Revaz;
Kapanadze, Ketevan;Sarjveladze, Natalie; Sadzaglishvili, Shorena,Tbilisi, Georgia

2. Objective self-awareness and lowering of depression level
Baliashvili, Marina, Ph.D.
D. Uznadze Institute of Psychology, Tbilisi, Georgia

3. Traumatic Stress - Identity Crisis
Beberashvili, Zurab
Foundation for the Development of Human Resources, Tbilisi, Georgia

4. Kosovo Crisis: Some Psychological Factors
Buachidze-Gabashvili, Manana, Ph.D
Foundation for Development of Human Resources, Uznadze Institute of Psychology, Tbilisi, Georgia

5. Children with Learning Disabilities - Final Judgement or Hope for the Future
Gagoshidze, Tamar
Psychometric and Consultation Association, Tbilisi, Georgia

6. Georgian Disabled Women’s International Association
Galuashvili, Manana
Georgian Disabled Women’s International Association, Tbilisi, Georgia

7. Peculiarities of psycho-social rehabilitation of pre-school children
Gvelesiani, Tea
Foundation for the Development of Human Resources, Tbilisi, Georgia

8. The role of public relations in psycho social rehabilitation of Internally Displaced Person
Amiran Dolidze
Foundation for the Development of Human Resources. Tbilisi, Georgia

9. The Concept of "Deposited Image" and Transgenerational Transmission
Volkan, Vamik D., M.D.
Center for the Study of Mind and Human Interaction, University of Virginia, USA

10. Mourning and Refugees
Volkan, Vamik D., M.D.
Center for the Study of Mind and Human Interaction, University of Virginia, USA

11. The Clinico-Psychological Predictors of Post Schizophrenia Depression (PSD)
Zavradashvili, Nana
Tbilisi State Medical Academy, Tbilisi, Georgia

 

Survey of the psycho-social work with street children

Agapishvili, Nana; Javakhishvili, Helen; Javakhishvili, Darejan; Jorbenadze, Revaz; Kapanadze, Ketevan; Sarjveladze, Natalie; Sadzaglishvili, Shorena,Tbilisi, Georgia

The aim of the work conducted by a teem of psychologists was to study street children's two groops (10 school-age child per groop) for purpose of making constructive changes of their attitudes and identifaing the ways of future psycho – social help. The research work was supported by RSS.

To conduct research following psychodiagnostic methods were used: specially elaborated structural interview; Lusher’s Test, Hand Test; Dembo-Rubinsteins modified Scale, Gotshalk-Glazer's Content Analyses. Observation and behavioral experiments were one of the important instruments in the process of investigation.

Psycho-social rehabilitation and bringing up work was based on the principles of humanistic psychology: non-directivness, non-conditional positive attention, parity.

In group activities for the psycho-social rehabilitation we have used role playing, communicative games, psycho-drama and methods of art therapy.

Psycho diagnostic research and observation was conducted to make a psychological portrait of the street children. Portrait of the street children is based on three parameters: the main forms of behavior, motivation and style of communication. Such indicators have decisive meaning to solve street children’s problems effectively.

Our beneficiary's leading form of behavior, according our observation, is a consumption (besides of playing and entertainment), which they call “work”. Consumption behavior unites: self-care, looking after and serving somebody. In our case, particularly - begging, washing cars-to get money and to appease hunger. When the need is satisfied, the aim is achieved, everything looses their meaning for the subject. There is no orientation on the future. The cognitive and social interests, the studying behavior are repressed.

The leading needs of street children are physiological (eating, drinking) and security. All their activities are directed toward satisfying this needs. So, they are chiefly led by deficitar motivation and not by so called meta motivation (which is oriented on personal growth).

The street children are objects of manipulation by the police, parents and street criminal elements.They are involved in the net of manipulative interactions, which couses their forming as manipulators. The capacity of manipulating by someone is considered by them as achievement. The typical behavioral stereotype of them could be described in the terms of Erik Bern's well known triangle: persecutor – persecuted – rescuer. So, it could be two possible ways of vicious development: identification with aggressor and criminal activity or identification with the victim and socially passive life-style. The both are destructive for the whole society.

Children were enthusiastically involved in the psycho – social rehabilitation sessions, which held for each group twice per week in the specially organized children's club. During the working year we provided the secure psychological atmosphere and offered the alternative style of relationships (parity, trust, non-evaluation), which was the new personal experience for them, and allow to be open, authentic and creative. Our relationships were interesting and important for them and for us as well. Our experience shows, that such form of the rehabilitation work with the street children is effective and necessary.

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Objective self-awareness and lowering of depression level

Baliashvili, Marina, Ph.D.
D. Uznadze Institute of Psychology, Tbilisi, Georgia

Relation between one’s own sense of self and mental health is very complicated and versatile. Depression is one of the most frequent mental disturbances which entails self. In recent years social psychologists utilize researches about self to help people cope with this disseminated problem.

When individual’s existence in the universe, fate of one’s self becomes questionable, it can be considered as an extreme condition of objective self-awareness. Doubting one’s own abilities, life perspectives and other similar thoughts and feelings that prevail in symptoms of depression indicate on objective self-awareness. By reconstructing imaginations about one’s self individual tries to free from problems of self, restore mental balance and continue to live. Pretty often professional assistance is necessary for resolution of these problems.

Apart from stating the fact that excessive and long term focus on self is one of the leading features of clinical and sub-clinical forms of depression, professionals try to determine the role of focusing on self in development and manifestation of depression . Clarification of this problem is very important for selection of treatment methods. If excessive focus on self summons or intensifies depression, then psychotherapeutic work should be oriented on lowering the extent of this focus. Work directed on insight - clarification of one’s own feelings - isn’t merely less effective, but may be harmful in comparison with behaviorist therapy, which in it’s turn, turns individuals attention to behavior and helps break through the vicious circle of depression.

Our objective is to obtain experimental data about relation of objective self-awareness and depression, to clear out whether objective self-awareness has an impact on the level of depression. Due to the fact that practically healthy people are more or less characterized by depression, we considered it possible to invite healthy people of 20-35 years as subjects.

Subjects were given depression questionnaires elaborated by Beck (BDI). 59 subjects were participating in the experiment. The experiment had two stages. On the second stage, after a two week interval, subjects filled the same questionnaires in front of a mirror - in a situation of objective self awareness.

As a result it appeared that by the degree of depression distribution of subjects was unequal - two categories were marked out: those with low and high depression indictors (25 and 34 individuals). The impact of mirror on the alteration of depression indicators is shown in the table below.

Average group data of subjects with different levels of depression with and without mirror

 

depression level

low

high

without mirror

11,3

22,7

with mirror

10,3

18,6

                                                                            P > 0.05                                                 P < 0.05

Depression indicators lowered in both, “low” and “high” depression groups, but lowering is statistically reliable in the group with high depression indicators. BDI is not a clinical scale and is utilized to determine individual’s depressive predisposition, thus low indicators on this scale suggest non-existence of this predisposition. As a result of objective self-awareness depression indicators are lowered even in subjects with predisposition to depression.

Objective self-awareness lowers depression indicators of individuals with depressive predisposition. As it appeared mirror doesn’t have the function of “critical eye”, on the contrary, it brings in a positive emotional supply.

References:
1. Duval Sh.and Wicklund R.A., Theory of Objective Self-Awareness. New York, AP. 1972.
2. Ingram R.E., Self-focused attention and clinical disorders: Review and conceptual model. Psychological Bulletin, 1990 vol 107, N2, pp. 156-176.
3. Lippa R.A., Introduction to Social Psychology. Belmont, California, 1990.

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Traumatic Stress - Identity Crisis

Beberashvili, Zurab
Foundation for the Development of Human Resources, Tbilisi, Georgia

A human being needs psycho-social identity as an anchor for existence “here and now”. If it is temporary, this doesn’t mean that it can be denied... On such claims as, in order to obtain identity one must “loose” it, one must “leave”, I would answer: In order to loose, one must find one’s self at first and in order to leave one must be a member of a union of people at first.
                                                                                                                                              Erick Erickson

These words of Erick Erickson - a famous identity researcher - perfectly reflect the essence of the problem we want to discuss in this article. A sense of one’s identity is probably one of the most important and all encompassing phenomena. It determines persons imaginations about one’s self and gives one a sense of belonging to a certain union of people, forms one’s “self” and model of the universe.

Trauma puts a human being in front of severe and inexorable reality, destroys one’s imaginations about one’s self and the surrounding world. As it appeared universe is an uncontrollable, incomprehensible, unfair, hostile and full of danger, that can cause a lot of pain and suffering. - I am helpless in front of it. Trauma urges a person to perceive one’s self in new unexpected and unknown qualities. “It seems as if someone had changed me, I am different... I became impulsive and anxious, everyone respected me, now I am useless... Even my family doesn’t respect me any more, but this is not surprising, I couldn’t provide their security”. These words reflect very well identity crisis - sense of self identity and realization of one’s social role is lost.

But human being does not want to accept this new reality. One can not bring into internal and external reality traumatic feelings. Traumatized ego wants to escape images of helplessness, weakness, humiliation, embarrassment, guilt, everything that enhances the feeling of one’s inferiority. Human being can not find a place, becomes alienated from the world and looses it. It seems that the world denies one, one is lost for the world. This is the stage in human being’s life, when one must say good bye to old identity in order to obtain a new one. But in order to attain this, one must accept reality no matter how dreadful it might be. A human being in front of this dilemma often is clinging to the “saving circle”, is trying to choose the easier way out. One confronts the world and perceives one’s self as a victim of circumstances. One looks for culprits of one’s misfortunes and creates an “enemy image”. At this time, not only those people are perceived as enemies who caused pain and suffering, but new “alien” social and physical environment as well. Gradually a human being assimilates the new social role of a victim and benefits from it. But in this case victimization is not only a symbol of new identity, it is also a symbol of opposition directed against alien values, culture and social norms. A sense of victimization reveals negative qualities - dependency, irresponsibility, aggression, non-tolerance, passive life position.

The so called “illusory world” supports enhancing of traumatized person’s negative identity - a human being perceives one’s self as special, because he/she had to go through something that could happen only to his/her “counterparts”, while others “don’t understand anything about life”. Sense of belonging to people of the same fate is strengthened at the expense of confrontation with others. This, on it’s part enhances a sense of “clanism” and contains the danger of formation of traumatized population.

Proceeding from the foregoing, the basic objective of psycho-social rehabilitation is to support a traumatized person in accepting new reality towards the world and self image. This is the first step on the complicated path of coping with trauma and obtaining positive identity.

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Kosovo Crisis: Some Psychological Factors

Buachidze-Gabashvili, Manana, Ph.D
Foundation for Development of Human Resources, Uznadze Institute of Psychology, Tbilisi, Georgia

Attitudes towards the Kosovo crisis are discussed. The semantics of a word "territory" and its connotation for various languages are considered. The painful reaction to "distorted territorial body" of Serbia is emphasised. The "ethnic cleansing" and its perception from the viewpoint of traumatised experience are also mentioned.

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Children with Learning Disabilities - Final Judgement or Hope for the Future?

Gagoshidze, Tamar
Psychometric and Consultation Association, Tbilisi, Georgia

The attention is attracted to the category of children who face difficulties in acquisition of writing, reading and accounting at school. Until a child starts attending classes his/her parents, most frequently, do not notice any disturbance in child's development, neurological assessment does not reveal any symptoms as well, neither does psychological testing show mental retardation, the situation becomes undetermined, the child finds himself/herself in very unfavourable conditions. Both parents and teachers suspect that the child is not sedulous enough or has attention deficit. They consider that the child is lazy and lacks interest, or, even, is mentally retarded. It is difficult for them to imagine how hard are the child's efforts and how strong is his/her willingness not to cause frustration to the people he/she loves. The child is trying hard but he/she is not able to cope with the problem himself/herself. The tragedy of children with learning disabilities is that there is a big gap between their development potential and learning achievements. Consequently, they need special learning environment and special individual programme on the basis of which they will more easily acquire academic skills. Very frequently, parents walk in our Association with a frightened child whose attitude towards learning is negative, who has a low self-esteem, who is depressed because of constant notices and humiliation. When such a child is offered to do something, even to play, his first reaction is "I am not able to do it. I do not know". Parents, teachers and even children themselves, have made a final judgement: "disabled".

The experience of our Association shows that adequate assessment of child's strong and weak points and development of psychological-correction programme on its basis improve significally the child's senso-motor integration rate, his/her self-esteem and acquisition of learning skills. At the same time, our experience shows that it is impossible to cope with the problem without active support from the child's micro and macro-social environment. Psychological assistance is less effective unless the education system is oriented on such children as well and unless the rate of consciousness towards the problem increases in the family. The children are actually out of the context: their participation in a learning process is formal, and the family's attitude towards learning problems is often inadequate. Hence, implementation of individual psycho-correction programme is not consistent with requirements and conditions of children's social environment. Such a dissonance lowers the efficacy of psychological assistance.

Stemming from the above described situation, we believe that co-operation of psychologists with education system and families is necessary. It is necessary to change structure of special education and methodology of teaching in accordance with child's individual requirements in order to involve the children with learning disabilities in learning process, school life and, consequently, society. At the same time, the multi-disciplinary counselling of families (psychological, legal, pedagogic, medical etc.) is also necessary. If the society is not able to acknowledge the problems of children with learning disabilities and if families and schools do not invest active efforts to manage these problems, such children will end as invalids or criminals. In both cases, they will be isolated from the society.

But the joint efforts of psychologists, families and schools can succeed in changing of this judgement.

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Georgian Disabled Women’s International Association

Galuashvili, Manana
Georgian Disabled Women’s International Association, Tbilisi, Georgia

The Georgian Disabled Women’s International Association, incorporated on July 3, 1998, represents a volunteer civic public union that unites women with active life position and conducts its activity under the Constitution of Georgia, Georgian Civic Law, current legislature and rules of the Regulations (the Initiative Group had been functioning since 1996).

Objectives

  1. Raising life quality and degree of independent living of disabled women
  2. Monitoring of disabled women condition at the national level
  3. Protecting disabled women’s rights
  4. Integrating disabled women’s into the mainstream society and tackling issues of their employment
  5. Highlighting challenges disabled women have to deal with through Mass Media
  6. Searching for ways of solving those problems that disabled women have to face up to

At present the following sections function at the Association:

  1. Monitoring Section
  2. Rights Protection Section
  3. Training Section
  4. Public Relations Section
  5. Projects Elaboration Section
  6. Psychological Support Section
  7. Employment Section
  8. Disability Arts Section
  9. International Relations Section

Intervention strategy

  1. Public awareness: highlighting challenges disabled women have to deal with through governmental and independent media, TV and Radio channels; issuing a newsletter on disability issue;
  2. Networking: gaining direct links with manifold organizations, both governmental and non-governmental, at national, regional and international levels through obtaining and giving information through Internet, exchange visits, workshops, participation in joint activities, etc.
  3. Elaborating and implementing long-term and short-term projects/ programs;
  4. Bringing out the spectrum of problems disabled women have to face up to and their systematization; setting up a permanently renewed database on disabled women’s condition at the national level;
  5. Lobbing at the national, regional and international levels;

Fulfilled activity

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Peculiarities of psycho-social rehabilitation of pre-school children

Gvelesiani, Tea
Foundation for the Development of Human Resources, Tbilisi, Georgia

Traumatization of pre-school aged children is not conditioned by direct witnessing or immediate participation in the past, traumatizing incident. Their traumatization is determined by the fact that they are growing up in a peculiar environment where the risk of indirect traumatization is very high.

These risk factors are:

  1. Family factors - Stories told in the families, advises, traditions and norms received in the families, traumatic style of interpersonal relations, all of this is often aggrevated by the factor of incomplete family.
  2. Environment factor - General psychological atmosphere in the community - unmourned trauma, alienation, isolation, hopelessness, idealization of the past and fear of future.
  3. Identification factor - participation in and imitation of adolescents’s traumatic games.

Proceeding from the foregoing psycho-social rehabilitation of pre-school aged children should be conducted similarly to that of traumatized children and factors mentioned above should be taken into account.

Special attention should be drawn to the following:

  1. Working with parents and kindergarten teachers, for preventing traumatization of children;
  2. Family consulting for correcting family members’ interpersonal relations and improving general psychological climate.

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The role of public relations in psycho social rehabilitation of Internally Displaced Persons

Amiran Dolidze
Foundation for the Development of Human Resources. Tbilisi, Georgia

Internally Displaced Persons from Abkhazia and Tskhinvali region are densely populated on whole territory of Georgia.

Degree of IDP’s participation if social life is very poor. IDPs have difficulties in establishing contacts with local population. Harsh social background, social insecurity, create a big risk of mutual confrontation. Percentage of IDP’s employment is very low, they are mostly occupied with trade. Majority of employed people communicate only with each-other. Contacts with local population are random, rare and not intensive, in some cases they are even conflictual.

Confrontation is noticeable even among children. They communicate only in their densely populated areas. Even in schools local and IDP children are studying separately, despite the fact that schools have the best conditions where contacts among children can be established.

Difficulties in establishing contacts with local population, lack of contact with social life, sense of an unnecessary person... these are basic problems of IDP’s that have to be coped.

One of the main directions of psycho-social rehabilitation is establishing contacts between IDP’s - for elaborating solidarity, group responsibility among themselves and towards the local population. This way, despite the difficult conditions they will consider themselves as competent members of society. For these purposes a program for small credits was developed. It is based on the principle of mutual responsibility and self-regulation, so that IDPs will acquire skills for regulating their relations with society.

For coping with these problems several meetings of IDP’s with respected and famous members of society were held and these meetings will continue in the future as well.

With mediation and support of our foundation Tskhum-Abkhazia’s eparchy visited densely populated areas of the Tbilisi Sea - “Turbaza”, “Okros Satsmisi”, “Kartli” - where different religious rituals were held. We also organized the football tournament of children living on the Tbilisi Sea. Local children of that area expressed their wish to participate in the next tournament. A special program is elaborated for involving IDP children in cultural life, for contacting them with the film studio, for organizing joint exhibitions, concerts of local and IDP children, for deepening contacts.

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The Concept of "Deposited Image" and Transgenerational Transmission

Volkan, Vamik D., M.D.
Center for the Study of Mind and Human Interaction, University of Virginia, USA

Consider a person who experiences a traumatic event in which drastic losses occur, and helplessness, shame, and humiliation are felt. Because the individual is traumatized, and the object losses and injury to self-image are too great to accept, the work of mourning does not take place. Furthermore, feelings of helplessness, shame, and humiliation cannot be reversed. According to their individual psychologies and the severity of the trauma, different individuals deal with the effects of a trauma differently. In this presentation, I will focus on those who "envelope" their traumatized self-image, externalize it, and control it "out there". Thus, on the surface they appear to go about their daily lives as if they were not traumatized.

The following is an example: a man's genitals were severely injured during his childhood. He went through painful surgical and medical procedures, but one of his testicles was lost. As an adult, he was preoccupied with symbolically-castrated people. These unfortunate individuals represented his self-image, which was traumatized during his developmental years. As long as he could take care of this displaced self-image in the outside world and "control" other injured individuals, he could function without much anxiety in his daily life. In spite of his intelligence and potential for better employment, he worked as an orderly in an orthopedic hospital looking after "mutilated" patients. In this profession, he responded to his repressed fantasy as though he could repair himself and reverse his feelings of shame over having only one testicle. He was not successful, however, in modifying his traumatized self-image; and was doomed to remain a hospital orderly, until he came to analysis.

The transgenerational transmission of such an image occurs when a traumatized individual "envelopes" his or her traumatized self-image, along with its associated object representations, affects and fantasies, and externalizes it by "depositing" it into the developing self-representation of a child. In this way, the effects of the trauma are then passed on to the next generation. In his or her interactions with the child, the older person, both consciously and unconsciously, attempts to control the "deposited image", since it really belongs to the individual and not the child. He or she then unconsciously, and somewhat consciously, gives messages to the child, making it now the child's task to do the work of mourning pertaining to the losses suffered by the older person, to reverse the unpleasant feelings, and to remove the sense of helplessness. Furthermore, in interacting with the child, the older person overtly and covertly gives approval, or disapproval, of the ego mechanisms the child may utilize to perform his or her assigned task. Under this influence, the child's utilization of certain ego mechanisms, e.g., denial, avoidance, or reversal of affects, may become habituated; and the child may absorb the deposited image, with its associated ego mechanisms, into his personality. This in turn, modifies the identity (the personality organization) of the child. Consequently, the child may also develop symptoms to deal with the deposited image.

If the individual who is the carrier of the deposited image cannot take care of it through the modification of identity or symptoms, the deposited image remains bothersome and influential. When he or she grows up - much like the person in the previous generation (and sometimes with that individual's veiled approval) - he or she may externalize the original enveloped traumatized self-image into the developing self-representation of a third generation, and so on.

As the deposited image is passed from one generation to another, its meaning and influence go through a transformation. This transformation occurs because various unconscious fantasies from individuals in each generation attach to each deposited image. In addition, the ego mechanisms that are used to respond to the conflicts that the deposited image initiates, vary with each individual. Consequently, as the meaning and influence of the original enveloped traumatized self-image change through several generations of transmissions, the individual's internal adaptation to the situation goes through a "change of function," similar to the phenomenon described by Heinz Hartmann in 1939.

When the carrier of the deposited image grows up, he or she usually has a conscious knowledge of the traumatic event that had befallen his or her parents, grandparents, or great-grandparents, simply through hearing family stories. However, what influences him or her on an internal structural level is not the historical truth about the trauma, but rather his or her unconscious obligation to deal with the deposited image.

The study of the transgenerational transmission of trauma as it is carried within the traumatized self-image to successive generations, provides an opportunity to research an important aspect of ethnic or other large group psychology. Interdisciplinary work among psychoanalysts, historians, political scientists, and former diplomats, as carried out by my colleagues and I, focuses on the transgenerational transmission of a trauma caused by a neighboring enemy and shared by thousands or millions of members of the traumatized group. Members of the victimized group, while individually different, possess similar traumatized self-images associated with helplessness, shame, and humiliation pertaining to the traumatic event. The shared trauma is then passed to subsequent generations through the deposited traumatized self-images. This legacy then links the group members of future generations and influences their group identity. I call this shared trauma a "chosen trauma". Since a group does not choose to be victimized, some of my colleagues take exception to my term "chosen trauma". But I hold that the word "chosen" fittingly reflects a large group's unconscious choice of having their group identity defined by the transgenerational transmission of the shared trauma.

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Mourning and Refugees

Volkan, Vamik D., M.D.
Center for the Study of Mind and Human Interaction, University of Virginia, USA

Mourning is a necessary and inevitable human reaction to the loss of loved ones, special places, and other things that we cherish. We can also lose our self-esteem. Often, even the threat of losing the objects that we love, or our self-esteem, can initiate the mourning process.

A typical example of loss, is the loss of a family member through death. When a loved one dies, an adult goes through various phases of mourning which can be divided into two categories: (1) the initial mourning, and (2) the work of mourning.

The initial mourning includes responses such as denial, shock, bargaining, pain, and anger, that eventually lead to an emotional acceptance of the fact that the deceased is gone forever. Under normal circumstances, the initial mourning process lasts about three months. Before it is completed, however, the work of mourning begins. The work of mourning involves a slow process of revisiting, reviewing and letting go of the mental image of the deceased person, and generally lasts about a year or so. It is, in a sense, a very slow emotional burial of the lost individual. During this process, the mourner selectively identifies with certain ego functions that had been provided for him or her by the individual who has died, prior to his or her death. This "letting go" of the image of the deceased is not a total process, however, since the mourner continues, through identifications, to keep aspects of the lost individual within him- or herself.

The above describes the "normal" mourning process. Many factors, however, can "infect" and thus complicate this process. At such times, we speak of various types of "complicated mourning". In essence, what the mourner does with the image of the lost object (i.e., the image of a lost love, and so on), determines the outcome of the mourning. As stated above, in "normal" mourning the mourner selectively identifies with certain useful functions of the lost object, while at the same time he or she lets the object "go". The image of the lost object then fades away only to be remembered during certain times, such as on or near the anniversary of the loss. However, if the mourner identifies totally with both the "good" and "bad" functions of the lost object, the mourner does not let the image of the lost object fade away. Consequently, both "good" and "bad" images of the lost object are felt within the mourner, whose internal world turns into a "battle ground" on which the "good" and "bad" images fight. The result is "depression."

There are also those individuals who keep the image of the lost object within themselves, without ever going through a "normal" or "complicated" mourning process. They are "perennial mourners," postponing the work of mourning for years to come. Their lives are dominated with aspects of the process of mourning, without ever completing the process itself. In their postponement of mourning, perennial mourners create "linking objects," which are items that exist in the external world that mentally link the image of the lost person or object with that of the image of the mourner. The mourner then becomes preoccupied with his or her linking object and, by controlling it, he or she controls the perpetuation of the unfinished mourning process.

Refugees who have lost, or have been threatened with the loss of loved persons and things, will inevitably go through a mourning process. It is important to diagnose and evaluate the process by which they mourn, and help them therapeutically to adapt both internally and externally to their losses.

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The Clinico-Psychological Predictors of Post Schizophrenia Depression (PSD)

Zavradashvili, Nana
Tbilisi State Medical Academy, Tbilisi, Georgia

Depression is one of the most prominent features of the psychopathology of schizophrenia and is completely associated with patient's psychological peculiarities, sense of values and socio-cultural values. Thus, postschizophrenia depression deserves a great interest. The latter is very difficult to differentiate, on one hand, from the "negative" schizophrenic symptoms (deficit) and, on the other hand, from the signs, caused by neuroleptics.

Existence of the diverse data about incidence (8-50%) and onset (right after psychosis - up to one year) of PSD indicates the different understanding of the mentioned problem and points out absence of unified terminology on it. At the same time, there is no common opinion among the researchers about etiology of PSD - is it one of the phases of schizophrenia, or can we consider postschizophrenia depression as an independent formation (some authors emphasise the negative influence of neuroleptics).

The role of peculiarities of personality and psychogeny according to the setting up of depression is the question of special interest.

Urgency of PSD determined by the higher risk of suicide among the patients with postschizophrenia depression (mentioned must be accounted during the working and social rehabilitation) and frequent psychotic exacerbation (frequent rehospitalizations). The latter, as is known, is an additional psychological trauma both for patients and for their relatives, and associated with significant extra charges.

Hence, in our opinion, the psychopathological structure of postschizophrenia depression and possible correlation between, on one hand - duration of the diseases, premorbid, peculiarities of personality and psychogeny and on the other hand - structure of depression are the matters of great interest.

For this reason, during the study together with clinical investigations we have been using Beck and Hamilton depression assessment scales, Munich Personology Test (MPT) and Self Assessment Scale for Mental Symptoms - Hopkins Symptoms Chek List (SCL).

The aim of given study is to reveal and investigate the clinico-psychological predictors of Postschizophrenia Depression, that is very important to elaborate the proper tactics of management, which must cover both the pharmacotherapy and the psychotherapy directed to the improvement and strengthening of personal adaptation and maintenance of interpersonal correlation (latter is very important in the prevention of complications of PSD such as suicide and frequent rehospitalizations).

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