The paper presents reflections on the problem of cognition, especially of knowing another person's mental states, in the context of experience of clinical psychiatry. (Eds.)
The author's personal reflections in connection with his 20 years' anniversary of work as a psychiatrist are presented. Some ideas and theories emerging in psychiatry are considered in terms of truth and lie. Such problems are taken under consideration, as e.g. the definition of mental health and mental illness, the phenomenon of delusions, methodology of empirical research in psychiatry, ethical aspects of "deinstitutionalization", accountability of schizophrenic patients.
The author presents hermeneutics as a discipline of knowledge useful in clinical and theoretical reflection on the problems of psychiatry. (eds.)
An overview is presented of theoretical conceptions and research findings concerning the subjective (individual) experience of schizophrenia. Basic sources and approaches making this sort of knowledge available are outlined, and results of relations, observations, reflections and research on this subject are discussed. Moreover, major clinical implications of such knowledge are pointed out.
Paradigm and results of a study on treated patients' subjective response to neuroleptics and on their evaluation of the medication are presented. The significance of this research for short and long-term prediction of treatment outcome, patients' compliance and the planning of appropriate treatment strategies in schizophrenia is discussed. The following categorization is proposed of phenomena connected with experiences of patients treated with neuroleptics: subjective response to a neuroleptic drug, undesirable mental symptoms, subjective interpretation of drug action, attitude towards neuroleptics, and quality of life in the course of treatment with neuroleptics.
Clinical outcome of psychopharmacological treatment depends not only on pharmacological action of the drug, but also on its subjective interpretation by the patient. Due to this interpretation the administered medication is included in the patient's whole familial, personal, and social situation, as well as in his/her relations with the doctor and hospital staff. Atypical responses to medication occurring sometimes are connected with the effect of the drug on the patient's psychological and behavioral defence mechanisms. A clinical case serves as an illustration of an attempt at a joint psychopharmacological and psychodynamic interpretation of an unexpected response to medication.
Delusions are thinking phenomena occurring in various mental disorders. Although for many decades now researchers have been seeking for a key to the mystery of delusions, no holistic explanation has been found so far. Thought content is known to be one of the criteria allowing to judge whether a given thinking process is delusional or not. It is to the content of delusions that this theoretical/empirical paper is devoted. Subjects in the study were 72 patients with paranoid schizophrenia. Their delusions during the schizophrenic episode under study were analyzed. The most frequent were delusions of control, of reference, and persecution, while delusions of thought exposure, of grandeur and depressive delusions were found somewhat less often. Interestingly, in the selected sample of patients with paranoid schizophrenia the latter two types of delusions, usually associated with mood disorders, were relatively frequent. Somatic delusions, as well as fantastic ones and delusions of personal change were only sporadic.
Schizophrenia is one of the few diseases showing similar prevalence rates in various countries. In the study an attempt was made to find out factors that result in territorial differentiation in the hospitalization of patients with schizophrenic psychoses, with an emphasis on the inpatient care accessibility. In the analyses an additive, four-year hospitalization index was used. Its distribution for the 416 territorial units (ZOZ) selected for comparisons ranged from 7.3 to 0.6. While the marginal values of the hospitalization index differed markedly (there were 12 ZOZs with definitely high hospitalization rates and 15 ZOSs representing low hospitalization levels), the distribution as a whole was characterized by small differences. In all the analyses the same tendency was found: the easier accessibility of psychiatric care, the higher the hospitalization index. Urbanization level turned out to be a factor interfering with the shape of the phenomenon. Day hospitals, functioning more often in large cities, do not seem to be an alternative to hospital treatment, but rather its continuation.
The author presents new opinions on the etiopathogenesis, diagnostics and methods of treatment of dystonias. Effectiveness of the hitherto used pharmacological and surgical treatment methods was limited. This group of diseases, so far rather scantily presented in the Polish language literature, requires a modern approach, since a highly effective treatment has been recently developed in the form of locally injected botulinum toxin.
Results of an opinion poll taken from a representative, random sample of adult population of Poland regarding mental illness are reported. In the social stereotype of mental illness pejorative descriptions of the affected persons predominate. Friendliness towards the mentally ill is smaller than that towards people "innocently suffering a misfortune" (such as physical or mental handicap), but more pronounced than that towards patients "guilty of breaking social norms" (e.g. with AIDS, drug addiction, alcoholism). Respondents declare that their own friendliness is greater than that they perceive in others. The degree of objection against fulfilling various social roles by the mentally ill depends on whether the roles in question involve taking up responsibility for other people's fate. There is a considerable permissiveness as regards the use of justified compulsion in the treatment of the mentally ill, and the opening of various psychiatric facilities in the local community.