HOW TO MAKE YOUR PATIENTS CHRONIC.
HOW TO MAKE YOUR PATIENTS CHRONIC.
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如何让您的患者成为慢性病。
DOI：
10.1176/ps.15.1.37
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发表时间：
1964
期刊：
影响因子：
--
通讯作者：
H. Salzberg
中科院分区：
文献类型：
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作者：
R. Heckel;H. Salzberg
当患者的症状几乎没有或没有改善或停止，并且似乎对住院治疗做出了被动调整时，疾病就变成了慢性疾病。慢性病患者可能会出现妄想和幻觉，但不会达到扰乱医院常规或给工作人员或其他患者造成困难的程度。他对所有环境刺激的敏感性和反应性显着降低。事实上，他似乎能够融入家具和墙壁——可以说，成为“风景的一部分”。这种情况持续至少两年后，他通常会被贴上慢性病的标签。慢性精神疾病的发展有许多公认的原因：终生的边际调整历史；患者无法或不愿意对现有治疗做出反应；延迟寻求治疗，直至疾病导致失去所有环境支持；缺乏足够的治疗设施和医院来治疗处于急性期的疾病；患者脱离现实的程度达到了无法接受所有可用治疗方法的程度。不幸的是，医院治疗的某些方面往往会诱发和强化慢性行为模式。例如，大多数心理治疗师将焦虑及其减轻作为心理治疗过程中的主要动机。病人“受伤”了，为了减轻焦虑，努力改善。电击治疗和镇静药物消除病人的焦虑；因此，他没有动力去解决引起焦虑的问题。个人和团体心理治疗鼓励患者通过表达和情感行为来减少焦虑，重温引起冲突的情况，并解决他们的强烈感受。然而，许多医院甚至不提供轻微的情绪化和表达性行为。相反，当出现这种行为时，患者会被限制或送往上锁的病房。事实上，他们因为表达过多而受到惩罚，一
ILLNESS HAS BECOME CHRONIC when a patient shows little or no improvement or cessation of symptoms and appears to have made a passive adjustment to hospitalization. The chronic patient may suffer from delusions and hallucinations, but not to a degree that upsets the routine of the hospital or causes difficulties with the staff or with other patients. He exhibits markedly decreased sensitivity and reactivity to all environmental stimuli. In fact, he seems to be able to blend into the furniture and the walls-to become, as it were,‘‘part of the landscape.” After a period of at least two years in this condition, he is usually labeled chronic. There are a number of generally accepted rcasons for the development of chronic mental illness: a lifelong history of marginal adjustment; inability or unwillingness of the patient to respond to available treatment; a delay in seeking treatment until the illness has led to a loss of all environmental supports; a lack of adequate treatment facilities and hospitals to treat illness when it is in the acute phase; withdrawal from reality to such a degree that the patient has become inaccessible to all available treatment methods.Unfortunately, certain aspects of hospital treatment tend to induce and reinforce the chronic pattern of behavior. For example, most psychotherapists make use of anxiety and its reduction as the prime motivators in the psychotherapeutic process. The patient“hurts” and, in an effort to reduce his anxiety, works toward improvement. Electroshock treatment and tranquilizing drugs remove the patient’s anxiety; therefore, he is less motivated to come to grips with his anxiety-producing problem. Individual and group psychotherapy encourage patients to reduce their anxiety through cxpressive and emotive behavior, to relive the situations that caused their conflicts, and to work out their intense feelings. However, many hospitals do not provide for even mildly emotive and expressive behavior. Instead, when such behavior appears, patients are restrained or sent to a locked ward. In effect, they are punished for being expressive, one