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12. The typological development of Post Traumatic Stress Disorders in evolutionary - age direction
Zurabashvili, David, M.D.
M. Asatiani Research Institute of Psychiatry, Tbilisi, Georgia

13. Individual Traumas and Adaptations
Thomson, J. Anderson, M.D.
Center for the Study of Mind and Human Interaction, University of Virginia, USA

14. Rehabilitation Sunday School – the Model of the of Psychosocial Rehabilitation of Children
Vazha Kvernadze
Centre for Social and Psychological Aid “Ndoba”, Tbilisi, Georgia

15. Organizing and conducting pre-medical and self-help trainings of IDP population
in Tbilisi and nearby territories

Kiladze, Nino; Ckhaidze, Iuza; Gigauri, David
Foundation for the Development of Human Resources, Tbilisi, Georgia

16. The I-Ching or Book of Changes as a projective and prognostic method
Korinteli, Revaz, M.D.
Republican Psychotherapeutic center, M.Asatiani Research Institute of Psychiatry, Tbilisi,Georgia

17. Psychological Support to Inmates
Kurdgelashvili, Lela; Jibuti, Maya

18. Peculiarities of group crisis intervention
Lazarashvili, Veta; Rogovskaia, Manana; Jibgashvili, Nana; Gegelashvili, Marina; Agapishvili, Nana
Centre for Social-Psycological Aid “Ndoba”, Tbilisi, Georgia

19. Planing of life span in students (Sketch of empiric research)
Lodia,Theona
Tbilisi State University, Tbilisi, Georgia

20. Professional burn-out and ways of prevention
Makhashvili, Nino
Foundation for the Development of Human Resources, Tbilisi, Georgia

21. Rorschach's Test – Research Method of Mental Development from the Position of
General Psychological Theory of Set

Ketevan Makashvili
D. Uznadze Institute of Psychology, Tbilisi, Georgia

22. The Working Principles of Mentally Disceased “Club House”
Merkviladze,Ia
Foundation for Rehabilitation of Mentally Diseased, Tbilisi, Georgia

 

The typological development of Post Traumatic Stress Disorders in evolutionary - age direction

Zurabashvili, David, M.D.
M. Asatiani Research Institute of Psychiatry, Tbilisi, Georgia

The author clinically studied 343 patients from 7-15 years with Post Traumatic Stress disorders.

He marks the psychopathological differences in the groups of patients and suggests some measures of a correction of the initial symptoms.

The clinical picture is characterised by a pathology of behaviour, affective disorders and disturbances in the sphere of drives. It is shown, that the psychopathological syndromes in children's and adolescents can be seen in a continuous form of stress disorders.

The diagnostic criteria for Post Traumatic Stress disorders in children's and adolescents include the following adults: avoidance of stimuli which can be connected to the psychological trauma, reliving of the traumatic event in various ways, intensity levels which are necessary for the stresses to elicit PTSD, and person variables or individual characteristics that may contribute to either resilience or vulnerability to PTSD.

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Individual Traumas and Adaptations

Thomson, J. Anderson, M.D.
Center for the Study of Mind and Human Interaction, University of Virginia, USA

Post-traumatic stress occurs when the individual is placed in a situation where action is to no avail, where neither successful resistance nor escape is possible. Components of normal human responses to danger persist in altered and exaggerated form after the fact. A combination of hyper-arousal states, memories of the trauma, withdrawal, and disconnection is predictable. In their extreme forms, they lead to disability of the individual and are readily identifiable as psychiatric illness. The manifestations of post-traumatic stress disorder, which constitute serious and lasting changes in arousal, thinking, emotion, and memory, can be summarized and illustrated as follows:

Hyper-Arousal: Hyper-arousal states are characterized by unabated physiological arousal. It is as if the central nervous system has been reconditioned and there is no longer a baseline state of calm or comfort. The individual may startle easily and describe himself as constantly vigilant. Often the sufferer is irritable and easily erupts into explosive anger. Chronic anxiety, psychosomatic disorders, and altered pain perception frequently occur. Sleep disturbances, including difficulty falling asleep, being easily awakened, and enduring, repetitive nightmares are common.

Nearly all the individuals we interviewed reported not feeling safe. Many were chronically anxious and said that they were easily startled. Most expressed constant concern about and fear of another invasion. Often, we heard "others" described as having low frustration tolerance, irritability and explosive bouts of anger. An official of the judicial system told us that people could no longer control their angry impulses; an educator expressed concern that students were easily frustrated, irritable and more prone to arguing.

Traumatic Memories: Trauma-inducing experiences, such as being taken hostage, tortured, and terrorized, resist encapsulation in the normal memory. The memory of such trauma often lacks a clear verbal narrative. Images are vivid, frozen and seemingly indelible and can be fragmented_overpowering emotion without image or image without emotion. Since they lack the coherent form and clear context of a narrative, there may sometimes be doubt about their reality.

The traumatic memories are dreaded and the suffering individual tries to suppress them. They are, however, intense and frequently relived involuntarily in thoughts, daydreams and nightmares. They may also be relived in actions without the individual being aware of the true source and motivation of his or her behavior. Following liberation, for example, one man accepted a job as a security guard at the building in which he had been imprisoned and tortured.

It is believed that traumatic memories differ from usual memories because the normal linguistic encoding of memories is deactivated. The central nervous system reverts to primarily sensory and imagery forms of storage. In this form, they can persist unchanged indefinitely. They are not integrated into the individual's normal narrative sense of identity and personal history. They break through in flashbacks and nightmares and may easily be triggered. One respondent reported that the theme music from CNN evoked such painful memories that he was no longer able to watch it.

Distortions of time were common in the accounts we heard from survivors. Many described the period of the occupation as a "dream" or a "nightmare." In fact, some heard the news of the invasion in the early hours of the morning and reported attempting to go back to sleep. Recalling the seven months of occupation, one male remembered: "There was no need for time. I didn't even wear a watch in that period. There was nothing to do."

For survivors of Iraqi torture, the time distortions were even more pronounced. One described the Iraqi techniques and duplicity:

... After they would stop questioning me, they would take me back to the holding cell, and tell me they would come back the next day. But sometimes, they would wait three, maybe four, days. I could not tell.

Even after detainees were assured by the International Red Cross that they would be released, the torture of time continued:

... The Iraqi officer would smile and say, "You will go home, but we do not know when. You might go home in a day, or a week, or a month, or a year, or in ten years. Rest assured that you will go home one day. Aren't you happy to know this?" In a way, this was the most difficult time, with false promises and continued hunger. The place was rife with rumors, and they continued to play games with our minds. We would be taken out and counted, and forced to stand in lines by the buses. Then, night would fall, and we would know that we would be prisoners for another night.

Everyone with whom we spoke expressed vivid memories of the moment they learned of the invasion. Between that fixed moment and the liberation of the country there was often a temporal gap of painful images and emotions. Many productive, working people described persistent, intrusive thoughts and memories that disturbed, but did not disable, their daily lives. Some spoke of avoiding any reading material or television programming about the occupation out of fear of the distressing feelings they triggered.

Dissociation: In extremely traumatic situations an individual's active self-defense system will shut down. There can be a temporary, but drastic, modification of character or sense of personal identity to avoid or minimize emotional or physical distress. This phenomenon is known as dissociation. The individual will restrict his life to recreate some sensation of safety. Capacities for anticipation, initiative and planning are often curtailed. As described above, survivors begin to live in an "endless present" as a way of protecting themselves from painful disappointment, which would create an even greater sense of desperation.

This dissociative defense can then persist after the trauma has ended. Individuals will narrow and deplete their quality of life. They deprive themselves of new opportunities for coping that might mitigate the effects of the trauma. Living in an "endless present" persists so long after the precipitating event that the reaction is not readily recognized as linked to the trauma.

Numerous interviewees told us about how the occupation had changed people's personalities. Living for today and not thinking about the future was the way many perceived others around them. Several educators talked about students not working as hard as they did before the invasion, exhibiting less capability to plan and work for the future. Some saw men as slower to make a commitment to marriage. We heard, on the one hand, that people were afraid to leave the country, even for a vacation, while others were apprehensive about returning on a permanent basis. Wariness in establishing relationships of all kinds was perceived in a large percentage of interviews.

Disconnection: Disconnection, or loss of the ideal self, is another manifestation of post-traumatic states. There is disconnection within the individual and disconnection from others. For the individual, one is disconnected from the developmental stage that he or she had attained prior to the trauma. Old conflicts, previously-completed developmental stages, and psychological developmental tasks which have been mastered may all be reopened.

If autonomy has been mastered, then this may be undone and the individual will begin to experience shame and uncertainty. Whereas the individual may have developed initiative, he now feels doubt. Whereas the person may have reached a level of feeling competent, he now feels inferior. Having been held against one's will, a positive identity may now feel contaminated. One student who felt capable and successful before the invasion was tormented by persistent questions about his personal courage. A young woman in her thirties who appeared content and at ease with herself revealed a painful, ongoing internal struggle about her identity and her faith as a consequence of the Iraqi occupation.

Disconnection from others and from society was even more pronounced in our sample. We were told repeatedly how individuals felt they had lost the capacity to trust others. A few interviewees revealed that they no longer had confidence in their capacity to determine what is good and what is bad. The assumptions of their value system seemed to have been severely shaken by the occupation and the strong sense of betrayal associated with it.

Coercive Control: The above disturbances in comfort level, memory, and a secure sense of self and connection with others can be explained as a consequence of the brutality inflicted by the Iraqi army. The occupation is a classic example of traumatic captivity in which the population was subjected to coercive control.

The profile of a practitioner of coercive control is ofen the same whether he is a political tyrant operating on a massive scale rather than a common criminal kidnapping or violating a limited number of victims, or a cult leader controlling a small following. He may appear outwardly normal, but he is innately authoritarian, secretive, grandiose, and paranoid. Individuals of this type seek situations where they can impose their tyranny and have it tolerated, condoned and even admired. The objective is complete control of the victim. Ultimately, they want the victim's affirmation and "gratitude." Their ideal is the creation of a willing victim. These individuals attempt the systematic, repetitive infliction of emotional trauma so as to disempower the victim and disconnect them internally and from others. To achieve this result, they seek to instill isolation, terror and helplessness. They destroy the victim's autonomy and sense of self, especially in relation to others. Not only do they try to inculcate the fear of death by arbitrary murder, they also desire to make the survivor feel gratitude for being allowed to live. The perpetrator wishes to convince those under coercive control that their tormentor is all-powerful, that resistance is futile and dangerous and that survival depends on winning his indulgence through absolute compliance.

Techniques of coercive control are universal. Either by design or serendipitously, whenever ruthless human beings attempt to terrorize and dehumanize their fellow man, they fall back on similar methods. The perpetrators seek to dominate the body and bodily functions of the victim. They exhibit inconsistent and unpredictable outbursts of violence, capriciously enforcing petty rules or temporarily granting small favors.

Attempts are made to isolate victims of coercive control from reliable information, material aid and emotional support from family, friends and society. The perpetrator tries to convince the victims that their closest allies have forgotten or betrayed them. He tries to deprive the victims of any objects of symbolic importance, including identity. The name of a country may be literally wiped off the map.

If possible, the practitioner of coercive control tries to force victims to violate their basic moral principles and to betray fundamental human attachments. Classic examples of this technique are observed in the compelling of people to stand by while others, particularly loved ones, are tortured or murdered, or posing the moral dilemma of betraying a friend to save a loved one. We were told numerous stories of how families were brought outside their homes and made to witness the torment and murder of a loved one. The natural human effect of such experience is to create intense shame, defeatism and impotent rage in the surviving witnesses. They feel, and this is the intention of the perpetrator, that they have failed to meet responsibilities and loyalties. They may feel as if their tormentor has completely usurped even their inner life and the core of their identity, which can seem contaminated. According to one account:

... The Iraqis left him in the front yard, but forbid anyone to touch him, saying, "If you try to touch him, we will kill him." There he lay, in great pain, unable to move. It was obvious he had been tortured severely. After six hours, the Iraqi officer called all of this man's family and friends out of their houses, including me. In front of us, the officer shot my friend in the head, and we all watched him bleed to death in front of us. The Iraqi officer left with his men, but only drove around the block before returning. He sarcastically asked us, "What happened to this man? Who shot him?" We were all silent, since the family had teen-age daughters, and we knew they were in danger. The officer sarcastically said, "You better go to the police station and report this suspicious death! We must bring the offender to justice!" The soldiers all laughed and then drove away.

Survivors of such brutality and coercion naturally begin to feel helpless and to mask their inability to preserve their autonomy and attachments. Such coping mechanisms certainly apply to those who were in the country during the occupation; we found, however, that those trapped outside the country tended to experience analogous reactions. In some cases, individuals in these circumstances may shut down their feelings, thoughts, initiative and judgment as a way of minimizing their pain.

Many in Kuwait fought valiantly against the Iraqi occupation; we heard many cases of resistance, both physical and mental, and of those martyred in the effort. The present state of our scientific knowledge does not allow us to measure the degree to which such resistance to coercive control may mitigate the psychological effects of the perpetrator's campaign for total dominance of body and mind. Finding means of resisting the onslaught, however, could theoretically enable one to carve out small areas of autonomy and to feel better about him- or herself

Systemic Analysis

A more systematic way of looking at post-traumatic stress in individuals, as well as society, is to organize the effects into six areas (Herman, 1992):

These alterations can occur in any individual who has been subjected to totalitarian control. Victims of torture, hostages, prisoners of war, political prisoners, terrorized civilian populations, survivors of sexual assault, or anyone subjected to a form of coercive control, experience them in direct proportion to the degree of trauma endured.

The changes in the regulation of emotion include persistent sadness and protracted depression. There may be chronic suicidal feelings and self injury, sometimes manifested, for example, in automobile "accidents." The individual may alternate between episodes of explosive anger and periods of extremely inhibited anger. There may be, alternately, compulsive or extremely inhibited sexuality. A student interviewee hinted at his depression when he remarked, "I don't know what I'll do in five years. Maybe I will be dead by that time." Another young man added, "This occupation has made us all older and weary. We are young and should be planning our lives and planning to marry. Instead, we wait and worry."

The changes in consciousness include amnesia or hyper-amnesia (vivid memory) of traumatic events. The individual may experience transient dissociative episodes, temporary, but drastic, modifications of character or sense of personal identity to avoid distress as discussed earlier. The most dramatic examples among those interviewed occurred to persons who were held prisoner and tortured during the occupation. Some of them experienced episodes of rank dissociation and psychosis that were evident to their fellow prisoners.

The victim may experience de-realization, a subjective sense that one's familiar surroundings are strange or unreal or they may report a feeling of change in reality. Distortions of space were evident from the first surreal moments of the invasion. Suddenly, there were alien tanks in the streets and corpses in quiet residential neighborhoods. One resident recalled:

It was like being in a play, not real, you know? ... I saw abandoned cars in the middle of the street, with their doors open. It was like we had just suffered a chemical attack. I heard artillery fire all around me.

Depersonalization_a subjective sense of being unreal, strange or unfamiliar to one's self_may persist long after the events. The victim may relive the trauma even in the form of intrusive symptoms or unusual preoccupation. A middle-aged professional man, who was "safe" in Europe throughout the occupation, reported to us the persistent, intrusive daytime image of Iraqi soldiers chasing him as he fled with his infant daughter in his arms. Three years after liberation, he continued to experience this image daily with all the accompanying feelings of vulnerability and terror.

Changes in self-perception include a sense of helplessness or paralysis of initiative. The individual may continue to experience shame, guilt and self-blame. A young man painfully acknowledged, "When I think about the bodies that were dropped in front of us, I feel like crying. Sometimes I am brought back to that time."

There is frequently an internal sense of defilement or stigma. A student who was caught outside the country and remained abroad for the duration of the occupation admitted that he was preoccupied with the belief that he was a coward. He was tormented by a question he could never answer_what he would have done if he had been at home at the time of the invasion and by fears that the answer would shame him.

Victims may experience a sense of complete differentiation from others that can be manifested in a feeling of specialness, utter loneliness or the belief that no one else can understand or empathize with what they went through. Often, there is a contaminated identity with an internalized image of an "enslaved self." A student described to us his feeling of altered personality: "I used to live my life one way, then suddenly it is completely different. I feel that I am still alone."

There are also changes in the perception of the perpetrator. Victims are frequently overly preoccupied with their relationship to the author of their trauma, including an obsession with revenge. Often the perpetrator is accorded unrealistic attributes of the total power he wished to project. There may even be idealization of or paradoxical gratitude toward the criminal. A sense of special or supernatural bond between aggressor and victim is possible. Sometimes, the victim may accept the belief system or rationalizations of the perpetrator_a traumatic bonding.

One of the most striking aspects of our interviews was the common fixation, in one form or another, with Saddam Hussein. None of those with whom we talked could comfortably incorporate him into their thinking. Many recalled their admiration for him before his attack and believed his reassurances until the last moment. His acts of treachery were universally incomprehensible: "How do I feel?" responded one male interviewee, "Stabbed in the back!"

For some Kuwaitis searching for a role model before 1990, Saddam served as an idealized vessel. He was an Arab, "a Muslim brother, one of us," who appeared to be strong and to combine aspects of modern secularism with an Arab mantle. A number of our respondents confessed, regretfully in retrospect, that they chose to overlook or deny the brutal manner with which he treated his internal enemies. They were then all the more horrified and ashamed when he unleashed his brutality on them. A teenage boy remembered the time when Saddam gave His Highness the Amir a red ribbon and reinterpreted the gesture: "That symbolizes something, I think; a foretelling that Saddam would surround us with blood and destruction".

The betrayal by Saddam Hussein was so unanticipated, so sudden and complete, and so disorienting that it still could not be fully digested and integrated into the "history" of many Kuwaitis. To accept what he did was to call into question all the assumptions about the environment in which Kuwaitis placed their trust prior to the Iraqi invasion. Some sought to bridge the chasm with conspiracy theories that attempted to absolve Saddam of sole and ultimate responsibility for his actions. If they were not completely wrong in their trust in Saddam Hussein, they may not be totally wrong in the other convictions which they held. Other Kuwaitis, various Arab governments and the United States were occasionally drawn into these theories in partial exculpation of Iraq's treachery. It was less important whether these explanations could bear critical scrutiny than that some Kuwaiti victims were prepared to embrace them in an effort to re-establish some continuity in their view of their world.

Many with whom we talked explained the invasion and occupation as punishment from God for straying from their faith and they sought to rectify their perceived failings by a stricter interpretation of and adherence to that faith. By believing the invasion was in part a result of their own failings, they restored some sense of control over their fate at the hands of the Iraqis. Although this necessitated accepting much of the blame themselves, it also allowed them to avoid feeling utterly helpless over the human and other losses associated with the trauma.

We are proud of this invasion experience ... This experience is from my God. You see, I am still loving Him. This is what He wants. This experience shows who is a true Muslim_you know if the person is still loving God after this experience. I think this experience has brought people closer to God. It has increased our attachment to Islam ... The one thing we missed was safety, our security. But God helped us to have what we needed. Nobody died from hunger during the occupation, even though we couldn't use our cars to get food, we had everything. So, we really did not have any losses from this.

Some persons with whom members of the research team spoke expressed the conviction that stricter observance of religious ritual could give them a sense of control over their destiny and protect them from the terrifying prospect of a repetition of the helplessness experienced during the occupation. Although we talked with both women and girls who did not wear traditional clothing and those that did, there was broad agreement that the number of females adopting the veil had increased during and since the Iraqi occupation. The reflections of a well-educated woman regarding the current significance of the veil provided important insights into its function in enhancing the security of the wearer:

There are various reasons why women wear the veil. You should not do it to be recognized by others. Maybe in the University you do not need to wear the veil, but if you go shopping, that is something entirely different. Then, you should wear the veil so you won't be noticed or looked at in bad ways. You see, men watch all the movements a woman makes. If you don't want men to form bad impressions of you, then you should wear the veil. In order to keep negative things from being said about you, you should wear it.

It bothers women to cover up and go out in public, but they must do this to protect themselves in our society. Also, they must do it to protect their reputations and to keep men from watching them. ... There are some women, but I do not think it is many, who cover their face and wear the veil in order to hide their bad deeds. Perhaps they want to hide from others because they have done bad things and acted in wrong ways, like maybe with dating. Maybe they wear the veil so that others cannot recognize them.

In post-traumatic stress states there may be profound changes in relations with others. These are characterized by isolation and withdrawal, and disruption in intimate and non-intimate relationships. Repeatedly, we heard concerns expressed about increased rates of divorce and the breakdown of trust between individuals. The survivor may engage in a repeated search for a rescuer, the active search phase alternating with periods of isolation and withdrawal. Persistent distrust of others is common. A teenage boy summed up the way he saw the changes:

Have we changed since the occupation? Yes, indeed! It is a lot different. Apart from the buildings, streets and facilities, the Kuwaiti human being is different. The Kuwaiti is different in that he mistrusts everybody. He doesn't feel safe in this area_threatened all the time. I feel this way, for example. I don't give promises to anybody. I don't give anybody something for a deposit, because I know that when I come back for it, it will be gone.

Perhaps the most unexpected theme in our interviews concerned disapproval of the outlook and behavior of "others" in the wake of the occupation experience. A substantial majority expressed the perception that others were more focussed on "making money" and fulfilling personal goals today than before the invasion. They perceived a broad decline in social consciousness, cohesion and concern for other Kuwaitis. Given the admirable and cooperative resistance of Kuwaitis to the Iraqi occupation authorities, we had not anticipated that so large a proportion of our sample would cite signs of social fragmentation as a major concern.

Another striking effect of traumatic captivity is a change in systems of meaning. There can be a loss of sustaining faith and a feeling of hopelessness and despair. Some of the phenomena described above, including the perception of others, ambivalence toward the perpetrator, and differential approaches to the place of Islam in personal life, appeared to reflect an absence of consensus in the post-occupation period.

Treatment and Recovery

There are basically three principles in dealing with PTSD in the individual. First, establish security; then, remember and mourn; and, finally, reconnect with ordinary life. The first stage, which many experts in the field regard as an absolute prerequisite for recovery, is to establish safety. Of paramount importance is physical security (safety of the body), the safety of the environment, the restoration of self care, the re-establishment of social networks, and concrete plans for future protection. There must also be a clear acknowledgment of psychological harm.

The second stage of treating an individual is remembrance and mourning. One must mourn all of the losses which occurred during the period of trauma. Ordinarily, there are no customary conventions of bereavement for the kinds of losses sustained during massive trauma. Whatever means one seeks to mourn for loved ones is prevented or disrupted. Even after liberation, losses are so numerous and widespread that a society possesses no conventional rituals for appropriate bereavement.

The objectives of the remembering and mourning phase (Herman, 1992) are:

The final phase of dealing with the traumatized individual is reconnection. This entails reconciliation with one's self and reintegration into a normal life. To achieve reconciliation with one's self, the individual must integrate his past identity with the positive aspects of the traumatic period and accept himself as recovering. The goal is to recreate an ideal sense of self and to recover aspirations, confidence and initiative. Finally, successful reconciliation requires the survivor to embrace the traumatic past in order to escape a continuing possession by it. This necessitates a full disclosure of the traumatic period. After this, it is possible to renew the capacity for tolerance and trust.

Although individuals will naturally question how they were before the aggression, and will search for things that may have made them vulnerable to attack, such self-examination occurs optimally only after there is an unequivocal establishment and acceptance of the perpetrator's sole responsibility for the trauma.

Another important aspect of reconciliation with one's self is an acceptance of the memory of the traumatized self and of the inevitability of incomplete recovery. Stress, anniversaries and other reminders will inevitably reawaken memories of the trauma.

The literature on post-traumatic stress cites several criteria for recovery (see Herman, 1992):

From Individual to Societal Identity

Assessing the signs and symptoms of post-traumatic states in individuals is relatively easy compared with the task of discerning the effects of a massive trauma, such as Iraq's brutal occupation, on an entire society. A review of the literature regarding PTSD confirms that the overwhelming bulk of serious study in the field has concentrated on the individual, with occasional attention to relatively small groups of "survivors" of terrorist incidents or natural disasters. Two of the primary reasons for this bias are evident_the physical difficulty of dealing with large numbers and the lack, historically, of an adequate conceptual framework for ordering and processing the data involved. Even if it were theoretically possible to interview every member of a large group, the conceptual problems would not be solved because society is both more and less than the sum of all individual identities.

The Iraqi occupation was so overwhelming and universal in its impact that the trauma inevitably transformed each citizen's sense of himself or herself as a Kuwaiti wherever they may have been. It also altered the corporate sense of identity of their society. As children, we all develop an idea of who we are by incorporating from the adults in our group shared reservoirs_symbols, assumptions, "history"_that define the common elements of our society or culture and differentiate "our" group from "others." This normally is a natural process whereby adults, secure in their social identity, pass on their values, preferences and prejudices.

The strength and durability of ethnic groups and nations derives from this natural human impulse to belong, to define identity in terms of those who are "like me" and those who are not. The resulting identity is neither inevitable nor accidental. It was the product of both conscious and unconscious decisions, shared dedication and a common history.

When such a process of ethnic or national identity formation is interrupted by massive trauma, however, confidence in these "certainties," in the identity of the group, is shaken and children may find themselves absorbing their corporate identity from adults who are also attempting to come to grips with a new conception of their identity.

Trauma and the Ethnic "Tent"

CSMHI has been a pioneer in the effort to develop theories of the integral link between the individual and his or her larger social order. Its Director, Dr. Vamyk Volkan, has described this complex relationship in the following terms:

Think in terms of learning, from childhood on, to wear two layers of clothing. The first garment, which belongs just to the individual who is wearing it, fits him snugly. The second set of clothes, the ethnic layer, is a loose covering that protects him like a mother or other caregiver. At the same time, because the garment is not form-fitting, it shelters many individuals under it as though it were one big canvas tent, so to speak.

As far as ethnicity is concerned, all the individuals under this tent, whether they are men or women, are equal. Whether the individuals are Polish or German, etc., their Polishness is not affected by such factors as social status, or level of wealth. All members of the group share equally in the Polishness of the group. As long as the tent remains stable and strong, the members of the group can go about their lives without paying too much attention to it. If the tent is disturbed or shaken, however, this attracts more notice, and all the individuals under the tent collectively become preoccupied with trying to make the tent strong again. At this point, rituals that maintain a balance between "us" and "them" become more prominent and more observable (Volkan, 1992, p. 8).

Individuals can and do, of course, suffer trauma independent of their society as a consequence of accident, abuse or other loss. When this occurs, the societal tent is not affected; it is not shaken. Although we do not know with any degree of precision what proportion of a particular culture need be affected before the cumulative effect begins to influence societal stability, we do know that a significant group may suffer serious localized trauma, as a result of natural disaster or a terrorist incident for example, without a discernible destabilization of society's norms. Analysis and treatment of the individual or circumscribed group in such circumstances can proceed without reference to larger issues of societal norms and assumptions.

Individual and societal suffering merge when the shock or trauma is massive, overwhelming and universal in the sense that it touches directly every member of the large group. As Volkan has noted elsewhere in the same article:

Under stress, the physical borders that separate neighbors become more psychologized... The individual identity of each member of the group becomes more intertwined with the identity of the group as a whole whenever stressful conditions are present (Volkan, 1992, p. 10).

The individual suffers a two-fold loss, both personally and as a part of the corporate group. His or her individual identity is challenged at the same time that encompassing societal stability is under attack because all fellow members of the group are confronting analogous pain simultaneously.

It is not essential for all members of a society to endure the same intensity of trauma for the experience to become an ingrained aspect of group identity. Individuals who undergo imprisonment, torture, personal humiliation, and the loss of loved ones, close friends and valued symbols are clearly most at risk of incapacitation, although some are able to develop coping mechanisms that allow them to function at some level. Where the traumatic episode is so pervasive and threatening to individual and societal survival, every member of the group shares fully in the intense feeling of loss. Those who may have escaped the more physical brutality of the event nevertheless share the awareness of loss, sense of powerlessness, terror, and general anxiety associated with it. Their private suffering becomes interwoven indelibly with their ethnic or national identity. Personal experience becomes a part of societal "history."

When the individual and group cannot successfully mourn the tragedy that has befallen them, the trauma and feelings surrounding it are passed on to succeeding generations. They remain a dysfunctional part of the corporate identity, shaping attitudes and inspiring actions long after the actual events have faded in the society's memory. To explain this phenomenon, CSMHI has developed the concept of the chosen trauma:

We use the term "chosen trauma" to refer to an event that induces in the members of one group intense feelings of having been humiliated and victimized by members of another group. A group does not, of course, "choose" to be victimized. But it may subsequently draw the mental representation of that trauma into its very identity, assiduously pass the narrative of hurt and shame, and its shared unconscious defenses, from one generation to another. (Volkan and Harris, 1993, p. 16)

The alternative facing the victimized group appears to be a stark one: find culturally appropriate ways to "remember" and mourn its pain and loss, or allow the trauma to play a disproportionate role in reshaping its sense of collective identity in unpredictable and potentially harmful ways.

The understanding and study of these phenomena in victimized groups is still in its early stages. The number of specific cases studied in depth remains small and, of course, is concentrated on instances where the group has not successfully mourned its feelings of victimization. While much more work needs to be done, we have reached a stage that permits us to suggest several possible "outcomes" of that failure. Stated briefly, these patterns seem to fall into at least five categories:

1) Evolution of an "entitlement" ideology: Having failed to come to grips effectively with its trauma and mental defenses, the society may evolve a sense that it has suffered enough and is now entitled to "what others owe us." Some observers have argued that this ideology is a sometime strain in Israel's foreign and domestic policy;

2) Adoption of a "victimization" ideology: The society over time comes to define itself almost solely in terms of the trauma it has suffered. The Armenians may most nearly approach this condition;

3) "Purification" policy: The victimized society, after having freed itself from an oppressor, may harbor too much resentment to adjust to the change in its status. The enemy is viewed as being so contaminated that the group will feel the need to cleanse itself. The Greeks following their War of Independence (1821-1833), the Turks after their War of Independence (1921-22) and, most notably, the Serbs in Bosnia today seem to have followed this route;

4) Policy of "Hopeful Reparation": The society can evolve a policy of seeking to regain its lost sense of wholeness or integrity by focusing on the struggle to recover its physical losses. An emphasis on reparation or restoration of lost territories or other wealth characterize this adaptation, which is recognizable in a variety of irredentist conflicts around the world as, for example, in the Greek objection to the very name of the new Republic of Macedonia in the Balkans;

5) "Fragmentation" Syndrome: Faced with a trauma and mental defense it cannot digest, the society may seek to restore its pre-trauma identity intact. In the process, it freezes the social fragmentation created or exaggerated by the traumatic shock and turns in upon itself. The search for internal scapegoats becomes institutionalized and ambivalent attitudes toward "authority" may feed self-doubt and instability.

It will be evident from the categories and descriptions above that societal maladaptations to trauma do not assume a chronic malignant form overnight. Many of the problems and conflicts apparent today trace their origins to traumas decades or even centuries old.

References:
Gallanter, M. (1989). Cults: Faith, Healing, and Coercion. New York: Oxford University Press.
Herman, J.L. (1992). Trauma and Recovery. New York: Basic Books.
Volkan, V.D. (1992). Ethnonationalistic rituals: an introduction. Mind and Human Interaction 4: 3-19.
Volkan, V.D. and Harris, M. (1993). Shaking the Tent: The Psychodynamics of Ethnic Terrorism. CSMHI Monograph No. 1, University of Virginia

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Rehabilitation Sunday School – the Model of the of Psychosocial Rehabilitation of Children

Vazha Kvernadze
Centre for Social and Psychological Aid “Ndoba”, Tbilisi, Georgia

The Rehabilitation Sunday School is the model Psycho-Social Rehabilitation school for children and teenagers. This model was first practiced in Georgia by the Social-Psychological Aid Centre "NDOBA”.

The project Rehabilitation Sunday School was implemented by the Social-Psychological Aid Centre "NDOBA” and the United Nations Children's Fund (UNICEF) during 1996-1998 in Tbilisi. 200 refugee children from Abkhazia of the age from 6 to 15 were involved in the activities of the school.

The objective of the Sunday School was complex psycho-social rehabilitation of refugee children, which implied (included) the following: correction of personal psychological problems, social readaptation, revealing and development of abilities and interests, familiarization with the universal humanistic principles, paying attention to spiritual (inner) values, increasing level of knowledge.

Main trends of activities of the school:

Forms of the work:

Problems, Revealed after the Diagnostics:

Achieved Results

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Organizing and conducting pre-medical and self-help trainings of IDP population in Tbilisi and nearby territories

Kiladze, Nino; Ckhaidze, Iuza; Gigauri, David
Foundation for the Development of Human Resources, Tbilisi, Georgia

The aim and objective of our activities (medical self-help trainings) was psycho-social rehabilitation of IDPs by helping them acquire new practical skills. The necessity of conducting such trainings was conditioned by circumstances as follow:

1. Hard living conditions of IDPs: bad living environment, material difficulties, increased stressful-neurotic background.

2. Poor outpatient and ambulatory medical service. This is conditioned by excessive amount of IDPs, the fact that they reside in outskirts of the city and lack of sums for medicine and medical researches.

3. Unfortunately IDPs aren’t insured from conflictual situations in future either. In these cases knowledge of the mentioned topics is especially important.

The subject of medical self-help program consists of three basic parts:

1. emergent, pre-medical aid in extreme situations (elements of reanimation, methods of stopping bleeding, help during wounds, electro-trauma, suffocation and other terminal conditions), caring after a patient.

2. Manual therapy in terms of prophylactic and medicinal use.

3. General hygienic and medicinal massage.

Apart from this, medical self-help groups participated in short courses on psychological subjects: psychological self-help, management of conflicts, acquisition of communicational skills, active listening. After passing the full course they received certificates.

Participants of medical self-help trainings were mostly young and middle aged women. Psychological self-help groups consisted of young people of both genders. IDPs’ interest towards this program can be explained by the fact that they considered that trainings had a practical use. For example in cases of necessity these skills gave them an opportunity to save money. Many of them perceived the experience received at the trainings as a source of employment and income, in several cases this actually happened.

Members of Zugdidi’s association of invalid children and women and volunteers from Zugdidi’s NGO “Atinati”, who work with IDPs, successfully participated in similar training-seminars.

The results of the trainings were already clear during the process. Group members utilized their knowledge in everyday life - with family, friends. There were cases of active intervention and help in extreme situations: danger of suffocation and electro-trauma. Some of them managed to find work by utilizing the knowledge received at the seminars (manual therapy). According to our information these processes keep continuing. The knowledge received at trainings was the crucial factor of departure and employment abroad of one of the group members.

But for us the psychological improvements that took place in group members during our work were more important: Establishment and deepening of contacts within the group and among members. Some of them stay in touch with us even now. The level of involvement and personal activeness increased. The result is the small business projects they presented at Tbilisi Sea - projects of pig-breeding and preparation of alcohol. At the end of the program many of them expressed their desire to participate in other trainings. Some of them are planning to participate in conflict management conflicts.

The work was positively assessed by the IDPs’ and group members.

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The I-Ching or Book of Changes as a projective and prognostic method

Korinteli, Revaz, M.D.
Republican Psychotherapeutic center, M.Asatiani Research Institute of Psychiatry, Tbilisi,Georgia

The aim of this research is to study and document the Synchronicity phenomena (C.G.Jung) in medicine - in Psychiatry and psychotherapy in particular; To investigate the projective (Diagnostical) and prospective (Prognostic) ability of the I-Ching.

The projective and prognostic abilities of the J-Ching with different kinds of patient (neurosis, psychoses - in remission, psychosomatic disturbances and pregnant women before the determination of the child's gender) are investigated. 80 tested patients (45 women and 35 men) have been examined aged between 15 to 60. The observed group with regard to nosology has been divided as follows: 1. Neuroses - 45 neurosis patients, including 15 with depressive neurosis, 10 with obsessive-compulsive neurosis, 10 with Anxiety neurosis and 10 with hysterical neurosis 2. Schizophrenia - 10 patients among them 5 - inpatients and 5 outpatients in remission, 3. Manic - depressive psychosis - 6 patients: 2 inpatients, 4 outpatients in remission. 4. Hypertension - 3 patients. 5. Duodenal ulcer - 3 patients. 6. Rheumateud desease - 3 patients. 7. 10 pregnant women before the determination of child's gender. All hexagrams from three perspectives and levels are considered: I. Intrapersonal level. Here we find images of situations representing the primary needs of man, also images that picture the evolution of personality and individual character traits. Depending on the question the author have discerned the following 4 stages with specific definition of a question. I - etiologic stage. At this stage question was directed towards the discovery of a cause of illness and was defined by examinees in the following way: What is the reason of my illness? What is the reason of my being in this condition? II. Hermeneutic-finalistic stage referring to the meaning and aim of the illness. The question was as follows: What is the meaning of my illness? What my unconscious is trying to show and to indicate me through illness? III. Problem-solving stage. At this stage the main question consists of: How to relate to my situation? IV - Prospective stage. On this stage the question has been expressed in the following way what can I expect if I follow and fulfill the advice of I-Ching? What can I expect if I follow my own way. The time in between the stages was from 1 to 2 weeks during which the I-Ching's answers were discussed, deciphered and were connected with the actual life situation of the patients.

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Psychological Support to Inmates

Kurdgelashvili, Lela; Jibuti, Maya

In 1997 we made a psychological evaluation of women-inmates in one of the facilities in Tbilisi. The evaluation was made by MMPI and Luscher Colour Test. The results of this work were reflected in our graduate research paper "Psychological Portrait of Women Inmates". The research has showed that it is necessary to assist psychologically the inmates and this necessity is determine not only and not as much by the inmates interests but by the interests of the whole society. Since then we have been holding psychotherapeutic conversations with the inmates and we have become more convinced that it is necessary to create a special service of psychological assistance for this contingent.

Psychological evaluation of women-inmates showed that the majority of them suffered from:

During psychotherapeutic conversations inmates had an opportunity to express freely their emotions and discharge accumulated emotional energy. Here they talked and had listeners. the listening was emphatic and without any evaluation.

As a result of psychotherapeutic conversations the level of aggressiveness was decreased,, stress-tolerance was increased, the capacity to be flexible in frustrating situations also increased, egocentrism became milder and deeply hidden positive traits began to emerge.

Our experience shows that the psychological rehabilitation of inmates should stars in prisons. This will assist the inmates not only with the actual problems, but with self-growth as well.

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Peculiarities of group crisis intervention

Lazarashvili, Veta; Rogovskaia, Manana; Jibgashvili, Nana; Gegelashvili, Marina; Agapishvili, Nana
Centre for Social-Psycological Aid “Ndoba”, Tbilisi, Georgia

Centre for Social-Psycological Aid “Ndoba” has been functioning from 1990 and is the first structure of social-psycological aid in Georgia, the author of new models of urgent social-psycological aid and psycho-social rehabilitation. During the period of it’s existance centre “Ndoba” has created various services of psycho-social aid.These services are :

Psychological crisis is defined as internal disturbance of emotional balance of person, arising under the threat and provoking social-psychological desadaptation. Intensive negative emotions, feeling of loneliness, vagueness, hopelessness, helplesness, low self-esteem, state of ficsation on travmatizing situation, demobilization and difficulties with future orientation are characteristic features of this state.

Process of crisis intervention (individual and group) consists of several main steps. Crisis intervention brigades of centre “Ndoba” followed these steps during working with IDP's from Gali region. State of crisis is more sharply expressed with these groups of IDP's, and that’s why it’s destructive for them.

The steps of crisis intervention are:

According to our working experience during group crisis intervention with IDP groups revealed some preferences of brigade method in comparision with individual in this concrete situation.

Group crisis intervention:

As a result of group crisis intervention with IDP's from Gali region, we have got:

Via establishing cooperative relationships with crisis brigade and IDP's, decreased psychological distance.

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Planing of life span in students (Sketch of empiric research)

Lodia,Theona
Tbilisi State University, Tbilisi, Georgia

How do students plan their life?
Who can we define problem?

To develop personal resources and to us (spend) them properly (rationally) you have to plan your life effectively, to see your goals clearly, to be aware of your aims and to anticipate the real resources for achieving your determination. Otherwise, persons how are not aware of the meaning their life, they do not have specified goals, their aims are not clarified and resources are not distinguished, may lose their wish to live, can suffer with personal problems and different mood disorders. If we us terminology of famous humanists, these personal conditions are named like this: Frankl defines it as the vacuum of existence, Maslow calls it metapathology.

Yang persons are in search of adequate work, they want to gain success and to achieve self realization. But for a moment think, what are the chances of the person who at first arrives at the job market to find suitable work, where he or she can be successful and self realized person.

As you know, the real situation is very difficult; a lot of yang persons are unemployed, they even are not engage in any proper activities. That is why we are interested:

How person can find his or her way in life?

What does he or she feel about his or her future?

What are the patterns of their general time sensation?

NLP provides us with the very interesting method of finding out time representation. There are many different theories, which presents other points of view about meaning of life, life script and goals of life. Authors like Frankl, Bern, Maslow, Rogers, Murray give us their theoretic concepts and Karl Morris have done very interesting empiric study about choosing life ways in students across different countries.

Purpose of our study
We want to find out:

1. The pacified patterns of planing life span in the yang generation, both in the students and unemployed persons.

We are using different criterions:

  1. Goal specification,
  2. Clearness of aims and resources,
  3. Values included in goals,
  4. Responsibility – relaying on your self to achieve what you want.

2. Time sense differentiation and its relation to personal success.

We are going to use psychological procedure about effective planing of life aims and resources for its fulfillment and the method from NLP, about ways of time representation in person.

Our assumption
In the beginning of our study, we can only discuss general results:

Persons who have work, are successful, have specified aims and resources to obtain them are obvious, they relay on themselves, have personal responsibility, their time sense in well differentiated, they are well organized, are consistent, their orientation in future, present and past is well connected. We can talk more specified about our results after conducting empiric research.

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Professional burn-out and ways of prevention

Makhashvili, Nino
Foundation for the Development of Human Resources, Tbilisi, Georgia

Since 1995 Georgian NGO “Foundation for the Development of Human Resources” is implementing a psycho-social rehabilitation program for Internally Displaced Persons. (With financial support of the Norwegian Refugee Council).

15 professionals were united in FDHR’s working group - psychotherapists, psychologists, doctors, teacher. The rehabilitation process encompassed about 3000 persons. (One time consultation, family consulting, group work with children and adults).

The IDP population is characterized by deep traumatization, victimization, sense of alienation, identification crisis, changing of views about past and future. The professionals involved in psycho-social rehabilitation deal with mourning and despair, fear and uncertainty of IDP’s.

The basic principle of psycho-social rehabilitation is empathy, which implies compassion, understanding of other people’s pain and problems, acceptance, support and consolation. Professionals entering the space of deeply traumatized people with empathy - which requires giving out physical and emotional energy - are in front of the danger of professional burnout. This state affects not only personal level, but has an impact on the quality and effectiveness of professional activities.

Professional burnout is a problematic psychological condition brought about by unrelieved work stress, which requires specific help, but it isn’t a subject of attention. It is expressed in

The risk group of professional burnout are professionals characterized by:

Professional burnout takes place gradually, it is very difficult to diagnose it. During intervention of crisis situation intensification of burnout’s symptoms is especially noticeable.

The “stage model” of professional burnout gives us an opportunity to asses the risk of burnout.

1. “The honeymoon” - is characterized by high professional satisfaction, energy and creativity. The key problem of this stage is which of the coping strategies will activate for coping with working stress.

2. Attempts of retaining balance - when optimism and positivity step aside and give way to working stress. The indicators of this stage are:

3. Chronic symptoms are being added to symptoms of the previous stage

4. Crisis, when symptoms become critical:

5. Occupation with symptoms of burnout on psychological and somatic levels ( motivation, emotions, behavior).

Despite complication of symptoms, activation of effective coping strategies and returning to the first level is possible on all stages. Although it is more advisable to take into account the danger of burnout and prevent it on personal and organizational levels.

By observing FDHR’s group processes and having informal conversations with group members it appeared that group members have sins of professional burnout on psychological and somatic levels. The signs of burnout especially strengthened at the end of the working year, they encompassed: general astenization, intensification of physical and chronic diseases (low resistance towards virus infections, tension, frustration, disagreements and conflictual tendencies among group members, diminishing of motivation and interest, general emotional exhaustion, decreasing of productivity and relatively low quality of implemented work. Some of the non-smokers started smoking. The symptoms were characterized by certain dynamics - if at the end of the first year isolation from group, frustration, conflictual attitudes prevailed, afterwards “deep” expression of burnout became more apparent. Low resistance towards diseases, decreasing of motivation, emotional exhaustion. Generally, it can be said, that symptoms of burnout reached the second stage of the model mentioned above and thanks to methods of prevention were expressed in fragments.

It should be noted, that for optimal functioning of organization certain activities, that are effective means of preventing burnout, were held.

These means comprise:

For avoiding burnout on personal level it is recommended to:

Despite it’s destructive effect it is important to underline the positive side of professional and personal burnout. In particular it can be considered as an impulse for realization significant aspects of professional and personal life and on these basis improving quality of existence.

References:

  1. Perlman, B. & Hartman, E.A. – Burnout: Summary and Future Research, in: "Human Relations", 35: 283 – 305, /1982/.
  2. Mitchell, S.T. – When disaster Strikes – The Critical Incident Stress Debriefing Process, in: Journal of Emergency Services, Jan, 1983, Baltimore.

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Rorschach's Test – Research Method of Mental Development from the Position of General Psychological Theory of Set

Ketevan Makashvili
D. Uznadze Institute of Psychology, Tbilisi, Georgia

  1. The problems of development psychology are regarded as one of the most remarkable areas of aplying the theory of set (by Uznadze). The concepts of functional tendency and age nvironment were suggested in this connection by the auther of the theory . For experimental study of the concepts,it appeared essential that the classical method of research of set (with its variations) and reality refiexted in these concepts were discrepant. For years the method of fixed set has been considered as the only adequate means within the experiments of psychology of set. Concentration on this method must have been provoked by the reproach towards the concept of set within the Soviet psychology. The reason of the repproach was its subjective nature and impossibility to link consciousness with environment. Not long ago, the prerogative to study the influence of its objective factor on set was removed and the intensive research of the subjective factor (needs) within the social psychology began. Unfortunately, scales measuring valency of set ,by means of which important social-psychological facts of set-nature were obtained,have not appeared to be adequate with problems of psychology of development. At a glance, one might assume that valid method investigating functional tendency should join the behavioristic context of classical method of set with concentration on the subjective factor of set It should be reached by maximum increase of indefinity of objective factor. Rorschach s method of ink stain completely corresponds to the mentioned conditions. Test situation is absolutely allowed. Unlike the ordinary pictures, where perception invariants are coordinated and surplus, in the test material they are mutually esclusive . It displays the selective feature of set .
  2. In the theory of set functional tendency is considered as unity of two circumstances: a) presennce of cultural experience as a possibility within each individual, b)in more or less quantity the mentioned possibiliti es transfer into the urgent set and obtain an ability of surplus actualization by means of age environment and according to its peculiarities.
  3. We think that the first point should be expressed in correspondance with mechanism of set and universal ideal vulues .The latter should be regarded as the main invariants of human experience. Discussed within the contixt of subject-object relation,there is an essential correspondance between the mechanism ofset and the main ideal values: truth – seperation from object, harmony – change according to object, progress – change of object, relgion – self change We also acknoledge that the psychological of the basic determinants of rorschach s test, or formalizationof the plenty variations of data (correspondingly F, FC, FM, and FK,Fc) are in correspondance with subject-object relation of set: contrast, accomodation, assimilation, repudiation.
  4. The above- mentioned correspondence dic tated us the adequacy of usage of Rorschach s test as a method of investigating tendency of functioning. To specify the correctness, the investigation was caried out on the children of different age (5 –16), having normal, atypical biological and social factors (different I.Q.levels, institutional environment). In all, 900 children were investigated. To study the child s intellect together with Rorschach s test we applied Veksler’s test, but in institutions a sociometric method and problem raging were used.

In the received results remarkable was the following: although the growth of main determinat indicators connected with regulation, means the growth of IQ and age level. The connection is not universal. Within the conditions of non-typical (institutional), educational environment, appropriateness takes place only as a tendency, in some cases does not correspond the indicators of IQ and age level. On the contrary, it manifests the reliable connection with different specificity of educational environment. In our opinion, this result is a convincing example to confirm Rorschach’s data of set interpretation. As a result the method will give us a possibility to define variations of scarcity or hyperthropy in ontogenesis and some cases of disogenesis, as well as to create a psychocorrection method based on specific modelling of age environment.

On the other hand, if we plan the experiments applying to Rorschach s test invastigate functional tendency,we can accumulate data and thus, might solve some of particularly those problems which exist within Rorschach’s technique.

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The Working Principles of Mentally Disceased “Club House”

Merkviladze,Ia
Foundation for Rehabilitation of Mentally Diseased, Tbilisi, Georgia

The non-governmental humanitarian organization "Foundation for Rehabilitation of Mentally Diseased" was created in Georgia in October 1998. The organization goal is to set up a club work (unknown in our country) for such vulnerable facet of the community as people with chronically mentally disease. The club’s work is carried out according to the unlimited national, political, religious and social principles. The club services for the mentally diseased are free of charge.

Similar clubs with 50-year experience exist in more than 20 countries throughout the world. There are over 20000 mentally diseased people in Georgia, who need not only qualified medical-psychiatric therapy, but also the psychosocial aid. The "Club House" main objective is to create an equal member of the society from an isolated and socially passive person by means of non-medical treatment. The employed specialists’ qualification and the "Club House" resources will be available for its beneficiaries in and accordance with their interests.

The Main Objectives of "Club House"

  1. Rehabilitating-adapting of the mentally diseased in remission, living in Georgia.
  2. Setting up similar clubs throughout the country (Tbilisi, Kutaisi, Batumi, Gori, Telavi, and so on); establishing and supporting/coordinating their network.
  3. Setting up Volunteers Service aiming at the organized target-groups of the mentally diseased. The would-be volunteers will include people in remission, their relatives, and representatives of various society facets.
  4. Supporting the mentally diseased to take active part in the social life through developing creative skills and self-realization.
  5. Rendering the mentally diseased assistance in providing self-support and managing the “Club House”; supporting the mentally diseased to tackle employment issues.
  6. Training volunteers to work in the similar clubs (seminars, workshops, etc.)

The “Club House” Main Strategy:

  1. Sectional work (sports, art, sections of techniques and nature amateurs, etc.).
  2. Psychological support to individuals and groups.
  3. Psychiatric aid (the psychiatrist’s consultation, available to every club member and his/her family).
  4. Social relief (food and hygienic aid, legal advice, assistance in tackling the employment issue)

The “Club House” Main Directions

  1. Art therapy.
  2. Labor therapy.
  3. Open discussions on various topics.
  4. Sports (special exercises).
  5. Sectional work (hobbies).
  6. Gaining skills in rendering psychological support.

The “Club House” Main Principles:

  1. Membership is voluntary.
  2. The club’s work will be the basis for the non-medical but psychosocial model. The club will not be located within the medical institution with the object of the club’s beneficiaries not having any associations with medical model (“decease”, “medical treatment”, etc.).
  3. The “Club House” activity of the club’s managers and beneficiaries is based on an equal footing.

Expected Outcomes:

  1. Psychosocial rehabilitating-adapting of the mentally diseased and their integrating as equal members of the society into the mainstream life.
  2. Setting up an “outside hospitals” system of support.
  3. Setting up the network of volunteers with the “social worker” status aimed at rendering assistance to the mentally diseased and members of their families.
  4. Raising public awareness in issues regarding the mentally diseased.

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