Improvement of the Organization of Medical and Psychological Assistance for Residents of a Large City with Social-Stress-Related Personality Disorders

The dissertation research is devoted to social-stress-related personality disorders among residents of a large city and to the influence of social factors on their development. The study examines autoaggressive tendencies, social maladaptation, dysfunctional families, and family violence as phenomena associated with these disorders, as well as a retrospective characterization of individuals who experienced a threat to their own lives and to their socio-psychological well-being.

The study places particular emphasis on assessing social and personal predictors and on substantiating organizational and methodological principles and forms of medical and psychological assistance. Its practical orientation is associated with differentiated diagnostic and treatment-and-preventive schemes and with such organizational forms as a helpline, a social-psychological assistance office in a dispensary or polyclinic, and a crisis inpatient unit.

Relevance. At present, there is a pressing need to study the influence of social life factors on the formation of the socio-psychological characteristics of individuals from various population categories who have fallen victim to complex and even extreme social situations. First of all, this concerns people who are experiencing difficult mental states in connection with situations of social maladaptation. It should be noted that such difficult mental states are socially determined, but at their core they do not involve any extraordinarily sudden personal shocks. It is precisely this circumstance that distinguishes them from the so-called post-traumatic stress disorders, in which, in most cases, the mechanisms of personal psychological defense do not have time to become activated and, consequently, these people experience acute psychological trauma [1, 2, 3, 9, 18, 31].

In the present study, the subject is the so-called social-stress-related personality disorders. Information about this type of disorder is virtually absent from the literature, and in the few individual publications available, such disorders are most often identified with post-traumatic stress disorders and adaptation disorders. Thus, no information could be found in the accessible foreign literature on social-stress disorders as a group of distinct socio-psychological problems. The literature more often discusses various forms of deviant behavior that are conditioned by factors of social adversity [89, 102, 130].

At the same time, the problem of social-stress-related personality disorders exists. This is evidenced by the works of Russian researchers Yu. A. Aleksandrovskiy (1992), A. G. Ambrumova (1986), Ts. P. Korolenko (1986), M. V. Lyamin (2000), and others. The basis of social-stress-related personality disorders consists of prolonged social situations that deplete the personality's capacity for mental self-regulation in a manner analogous to frustration. In such cases, the personality's psychological defenses do become activated, but their potential is clearly insufficient to prevent personal danger that is slowly and ominously increasing. The issue concerns suicide-risk tendencies, whose psychological essence consists in a global reevaluation of personal values and their inversion; in most cases, these tendencies are accompanied by the devaluation of all a person's social and vital needs. The study of the problem of social-stress-related disorders showed that so-called social predictors of the personality occupy an important place in its structure, that is, the personality's initial readiness for uniform responses to situations of forced endurance and, especially, situations of uncertainty that harbor a hidden threat to the personality's social safety.

The aim of the study is to develop measures for providing medical and psychological assistance to residents of a large city on the basis of studying the influence of social factors on the development of social-stress-related disorders in them.

To achieve this aim, it was considered necessary to solve the following tasks:

1. Determine the structure of social-stress-related personality disorders and identify their characteristic features.

2. Establish the principal predictors of social-stress-related disorders that form a distinctive readiness of the personality for maladaptive and autoaggressive behavior in situations of social tension.

3. Substantiate organizational measures that determine the direction of an optimizing influence on the personality during psycho-correctional procedures.

Hypothesis of the study: social-stress-related personality disorders constitute a group of difficult mental states that develop under the prolonged and intense influence of factors in an unfavorable social environment. At their core, these disorders do not contain stimuli for psychotraumatization; however, their negative influence on human behavior is realized through the prolonged and exhausting effects of an aggressive social environment. This sharply limits the personality's capacity to cope with difficult mental states and gives rise to autoaggressive motivation, which requires appropriate medical and psychological correction.

Provisions Put Forward for Defense:

1. Social-stress-related disorders among the population of a large city should be regarded as a distinct type of maladaptation state that harbors a latent threat to personal safety.

2. The most significant environmental factors underlying the emergence of social-stress-related disorders are social and personal predictors, the experience of a threat to one's own life and of social adversity, personal aggressiveness, and changes in the level of living.

3. At their highest degree of manifestation, social-stress-related disorders give rise to autoaggressive (suicidal) motivation as a regular consequence of the destruction of the system of personal social values. Personal attitudes toward such a concept as the intrinsic value of life serve as a predictor of social-stress-related disorders.

4. Medical and psychological assistance for residents of large cities should be organized comprehensively and in stages. Effective organizational forms for assisting people in a crisis are a helpline, a social-psychological assistance office in a dispensary or polyclinic, and a crisis inpatient unit.

The scientific novelty of the study lies in the fact that, for the first time:

- social-stress-related disorders are examined within the health-care system as an object of scientific research;

- it is demonstrated that these disorders constitute an independent group of difficult mental states that develop in situations of forced endurance and social exhaustion;

- it is established that the psychological potential for coping with such situations is clearly insufficient when the psychological protection of the personality is deficient;

- it is shown that these circumstances regularly lead to the destruction of the system of social and even life values, which requires appropriate medical-organizational and psychotherapeutic measures.

The practical significance of the work lies in the fact that specific differentiated schemes have been proposed for organizing diagnostic and treatment-and-preventive measures for the population under study. Difficult mental states, as predictors of socio-psychological destruction of the personality, also have major practical significance. It is precisely these states that constitute the psychological basis for the personality's acceptance of the possibility of losing its own life values, followed by devaluation of its initial socio-psychological attitudes and aspirations.

Approval of the Work.

The dissertation materials were discussed at:

- the 1st Scientific and Practical Conference of the Moscow State Social University, “A Person in a Difficult Life Situation” (Moscow, 2003);

- the International Congress “Global Social Strategy of Russia” (Moscow, 2003);

- the 4th International Social Congress “Social Processes and Social Relations in Contemporary Russia” (Moscow, 2004);

- the Scientific and Practical Conference “Terrorism as an Economic, Socio-Political Phenomenon and Its Forecasts for Identifying the Financial Flows of International Criminal Structures and Terrorist Organizations” (Balashikha, Moscow Region, 2004).

- the 2nd Scientific and Practical Conference of the Russian State Social University, “A Person in a Difficult Life Situation” (Moscow, 2004).

The work was presented at an interdepartmental meeting of the departments of military-medical examinations and medical-support organization of the Armed Forces of the Russian Federation at the State Institute of Advanced Training of Physicians, Ministry of Health of the Russian Federation (2004).

Practical Implementation and Publications.

The results of the work were implemented at the Psychological Assistance Center at Novosibirsk City Clinical Hospital No. 1 and are being used in the educational process at the Russian State Social University and the Moscow State Open Pedagogical University.

Based on the study, methodological guidelines for providing medical and psychological assistance in crisis situations were published (approved by the Novosibirsk Health Committee on April 28, 2004).

Ten works on the dissertation topic have been published.