Critique and Humanism journal | 53 | 2/ 2020 | Mental Health and Social Inequality

issue editor: Veronika Dimitrova, Maria Martinova, Simeon Kyurkchiev, vol. 53, 2/2020, p. 274, ISSN:0861-1718

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Contents

 

* The issue is only available in Bulgarian.

EDITORIAL

 

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Author: Veronika Dimitrova, Maria Martinova, Simeon Kyurkchiev

Psychiatric Expertise and Criminal Stigma

The article represents sociological analytics of the fundamental relation “truth-knowledge” underlying the exercises of the contemporary penal power over “offenders of the law”; it demonstrates in what manner, through the medium of the legal-psychiatric expertise, a criminal stigma on definite individuals is constituted and stabilized into the frameworks of institutional organization of the judicial system; how, by means of incorporation, integration and domination of the medical knowledge on the legal rationality a normative space is generated, which, through permanently produced criminals forms of subjectivity, systematically and irreversibitically is completed with pathological recidivists. Within this boundary powerful order, inside this juridical-medical cognitive sphere, an indiscernible homogeneity between the crime (target of intervention of the penal power) and illness (target of intervention of the medical power) is interweaved. The topic of this sociological research is the social functions of the psychiatric expertise into the criminal law as political technology for constructing and consolidating of a hybrid totality of correlative interconnections between “criminal behaviour” and “pathological existence”.

 

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Author: Evgeni Latinov

Evgeni Latinov is Associate Professor at the Department “Logic, Ethics and Aesthetics” of Sofia University “St. Kliment Ohridski” since 2002. He completed his undergraduate studies and his Ph. D. at Sofia University “St. Kliment Ohridski”. In 2014 he has been conferred the academic degree Dr. habil. of philosophy. His research interests lie in the area of logic.

Paul Grice and the Communication Mechanism

In this paper we present Paul Grice’s most influential insights on language. According to him, the analysis of linguistic meaning should be based on the speaker’s intention to produce an effect in their audience. And the process of understanding is analyzed by Grice as consisting (generally) of the following components: i) X intends to produce an effect in Y by having Y recognize this intention; ii) Y recognizes the intention of X and thus the intended effect is produced. These intentions lie at the core of all types of meaning distinguished by Grice: from the timeless meaning of an expression in a language to the specific utterer’s meaning on a given occasion. Since the conventional meaning of a sentence can differ from the utterer’s meaning on a given occasion, the notion of implicature is introduced as a way of explaining the connection between the two. The specific utterer’s meaning on a given occasion is, for Grice, the most fundamental form of meaning, having a logical priority over the timeless meaning. From this point of view, pragmatics is the framework in which natural language semantics should be examined in order to be better understood.

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Author: Martin Kanoushev

Martin Kanoushev is professor of sociology at the Department “Philosophy and Sociology”, New Bulgarian University, Sofia. He teaches sociology of power, knowledge, subject, law and medicine; author of the fundamental three-volume research The Historical Sociology of the Punitive Politics in Bulgaria and of numerous articles. Managing editor of Critique and Humanism journal, and member of the Editorial board of Sociological problems journal.

Representations of Mental Health Disorders and Persons with Mental Illness in the Popular Media and on the Internet

This article is about the coverage of topics related to mental illness in publications from news media and other sources found by searching the Internet and one of the most popular media portals related to the daily newspaper 24 hours. Automated and semi-automated word processing methods were used to analyze the content of the texts. Logical and network models are considered, offering possible explanations for the ways the mentally ill and mental illnesses are presented in the media and for the influence representations exercise on the audience. Some persistent patterns leading to stigmatization and avoidance of the mentally ill are deeply ingrained, interconnected, and more difficult to break than one can assume if one simply takes them to be superficial. They have their own deep narrative logic and probably this is the reason why they are not significantly influenced by rational and expert argumentation challenging them.

 

 

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Author: Boyan Zahariev

Boyan Zahariev is a program director at the Open Society Institute – Sofia. Boyan leads research and policy analyses in the field of education, poverty and social inclusion. He has worked in Bulgaria, the Russian Federation and other countries as an expert for various NGOs and consulting companies from Denmark, France and the United Kingdom. He holds a master’s degree in economics and a PhD in sociology from Sofia University.

Media Image of People with Mental Disorders

The article presents the results of a study of media images of people with mental disorders in Bulgaria. Quantitative content analysis of 592 publications in tree media websites – “24 chasa”, “Dnes” and “Dnevnik”, for four-month period (September – December 2019), was conducted. The dominant approach to thematic presentation is through an individual framework; people with mental disorders are presented as aggressive and dangerous. Mental illness is used to signify the severe acts of violence described in the publications. Health information articles are poorly represented in the sample. Here, the representation of institutions does not support future reform, and the health-related information is incomplete and often misleading. One of the contributions of the study is the analysis of sporadic references; there are two types of sporadic uses – metaphorical and literal. In the metaphors, there is a distinction between the world of „madness” and that of the „normal man,” and this is precisely the technique for alienating difference. „Madness” is understood as irrationality and in this sense is associated with both negative and positive meanings. At the same time, articles with sporadic references that use the word with the root „psych-” build mental health as the norm, and hence focus on various micro-deviations (at risk of potentially pathologizing micro-differences in behavior and perceptions).

 

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Authors: Maria Martinova, Veronika Dimitrova

Maria Martinova is PHD in Sociology. Her research interest are in the fields of sociology of medicine and childhood and parenthood studies.

Veronika Dimitrova is Assistant Professor at the Department of Sociology, Sofia University “St. Kliment Ohridski”. She is co-autor of the book Portraits of disappearing Sofia (2012), autor of Governmentality of poverty. Hygiene and medicine in interwar years (2018) and coordinator of the research team of the project Mental health and social inequalities. Fields of interest: sociology of medicine, history of medicine and

Mental Health Aspects of the Covid-19 Epidemic in Bulgaria

This article aims to examine the impact of the epidemic on the mental health of the citizens of Bulgaria in terms of communicational aspects in crisis management, crisis response and the possible long-term psychological consequences. The authors formulate three hypotheses, namely whether the epidemic has increased the levels of anxiety amongst the population, whether there are increased levels of aggression and self- aggression and how the informational environment has affected these processes. Several prerequisites explaining the reaction that the pandemic caused are outlined. An attempt has been made to measure elevated levels of general anxiety, which includes both normal psychological reactions to troubling events and pathological, currently hidden forms of anxiety. In the created proxy model, the increased general anxiety was compared with an analysis of the informational and media environment covering the topic of COVID-19. Correlations were sought in order to interpret the collected data on the subject.

 

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Authors: Hristo Hinkov, Zahari Zarkov, Vladimir Nakov, Rumyana Dinolova, Michail Okoliyski, Stefani Nikolova, Maya Liutskanova, Alexander Kiossev

Hristo Hinkov is MD, PhD, asoc. Prof., is a psychiatrist, Director of the National Center for Public Health and Analysis since Dec. 2014. He graduated in medicine in 1980, and gained a master’s degree in Health management in 2002. He has specialized in psychiatry and Health management in Japan, USA, the Netherlands, Belgium. He was a Deputy Director of the National Health Insurance Fund during the period 1997-2001. Since 2006 he is a Principal Investigator for Bulgaria in the WHO World Mental Health Survey. He is a member of the Bulgarian Psychiatric Association and the Bulgarian Union of Private Psychiatrists for more than 20 years. He has over 35 years in overall postgraduate professional experience in general medicine, psychiatry, health care, organization and financing, training and research

Zahari Zarkov, MD, PhD is Director of the Mental Health and Addiction Prevention Directorate at the National Center for Public Health and Analysis. He graduated in medicine in 1997 at the Medical University of Pleven. In 2005 gained a specialty in Psychiatry. In 2015 he defended his doctorate in psychiatric epidemiology. He works as a psychiatrist at Multiprofile Hospital for Active Treatment-Montana and at the University Clinic of University Multiprofile Hospital for Active Treatment „Alexandrovska”. He has interests and experience in the treatment of affective and anxiety disorders, crisis management, prevention of depression and schizophrenia. He has published articles and reports on Bulgarian and international professional papers.

Vladimir Nakov, MD, PhD, Assistant Professor, is head of department Mental Health in the National Center of Public Health and Analyses. He graduated in medicine in 1997. He has specialized psychiatry and public health in USA, UK, Netherlands, Belgium. He works as a psychiatrist in various psychiatric services in Bulgaria. He has numerous publications in the field of social psychiatry, suicidology, health reform and mental health policy related with de-institutionalization and financial sustainability of the psychiatry services. His main interests are in the field of suicidology and history of psychiatry

Rumyana Dinolova, MD, PhD is a psychiatrist, chief assistant in the Mental Health Department of the National Center for Public Health and Analysis. She graduated in medicine in 1995 at the Medical University of Pleven. In 2004 she acquired specialty in Psychiatry at the Medical University of Sofia. She specialized in Kinki University, Japan; Trimbos Institute, The Netherlands; King`s College, London. She works as a part-time lecturer at Sofia University „St. Kliment Ohridski” and at the South-West University „Neofit Rilski”. She is a coordinator for Bulgaria of the World Health Organization on the problems of violence against children.

Michail Okoliyski, Assoc. Prof., graduated in Social Therapy with a profile in Sexology in 1995 at Humboldt University in Berlin. In 1998 gained a doctorate in sexology from the same university. Since 2014 he has been an expert at the World Health Organization. Since 1998 he has been working as an expert in the Mental Health Department at the National Center for Public Health and Analysis. He is author of many reports and has participated in seminars in Europe, Asia and the United States. He has publications in Bulgarian and international scientific papers and in the International Encyclopedia of Sexology. He works as a part-time lecturer at the South-West University „Neofit Rilski” in Blagoevgrad.

Stefani Nikolova is a psychologist, expert in the Mental Health Department at the National Center for Public Health and Analysis. In 2018 she gained a bachelor’s degree in Psychology at „St. Cyril and St. Methodius“ University of Veliko Turnovo. At the moment, she studies Clinical Psychology at Sofia University „St. Kliment Ohridski“. She has undergone trainings in the field of psychodiagnostics. She has specialized as a psychologist at the State Psychiatric Hospital – Tserova Koriya and social rehabilitation and integration centers for children and youth with disabilities.

Maya Liutskanova works in Public Relations at the National Center for Public Health and Analysis. She graduated in Slavic Philology at Sofia University „St. Kliment Ohridski”. She has worked as a journalist and editor in national daily newspapers, periodicals and publishing houses. She has specialized in healthcare PR in the USA, and has been involved in institutional, corporate, and political PR.

Alexander Kiossev is professor in History of Modern Culture and Director of Cultural Center of the University of Sofia. His research interests are in the spheres of reading research, visual culture, cultural history of totalitarianism and the transition period. He published four books in Bulgarian language and was editor of collective volumes in Bulgarian, English and German; many of his essays are translated in English, German, French, Dutch, Ukrainian, Czech, Polish, Romanian, Serbian and Macedonian languages.

 

The Perception of Mental Disorder and Its Link to Biography

The article presents an analysis of interviews with people with mental disorders that were conducted under the project „Mental Health and Social Inequalities”. The main approach biographical, looking for significant differences in the time of onset of the mental disorder in the life of the individual (age, marital status, etc.) and the perception of the diagnosis. We interpret the overall acceptance of the diagnosis as a dominant characteristic of identity as an imposition of a stigma on oneself. Respondents who have schizophrenia and early onset, but also those who have several people in the family with similar diagnoses, suffer the most from this self-stigmatizing perspective. In people with the so-called common mental disorders, another model is observed: a search for a diagnosis and its successful formulation lead to a feeling of complete identification with it. Acceptance, however, has another function here – embracing therapeutic optimism. The disorder is not seen as a stigma in this case, but as one of many personality traits.

 

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Author: Veronika Dimitrova, Maria Martinova

Life with Elderly People with Dementia: Social, Phenomenological and Phsychoanalytical Reconstructions

The analysis unfolds two main aspects. On the one hand, it is assumed that dementia is not only a medical problem but also (in specific aspects) a social problem – in terms of social conditions and environment, biographic situations that influence its development. To illustrate this thesis six cases of living with dementia are shortly described and by “case” here is meant not only the person with dementia but also his/hers social environment/situation in which he/she is living. Interviewing a significant other is the main key to this situation. On the other hand, the article shows how phenomenological and psychoanalytical approaches in interpretation/reconstruction and validation methods are practically helping the person who is taking care in a direct way and the one with dementia indirectly. The transformation of the caregiver in a phenomenologist and a psychoanalyst gives him/her the opportunity to understand him/herself and the one he/she cares for in a new way.

 

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Author: Boryana Bundzhulova

Boryana Bundzhulova, PhD, is an assistant professor at the department of Sociology at the Sofia University “St. Kliment Ohridski”. Her research interests are in the field of phenomenology, existentialism, psychoanalysis, in the world of people with disabilities and more concrete – blind people and elderly people with dementia. Her main texts by now are the monograph Body and everyday world: cases of total blindness and the articles “Blindness and “normality” – Rumi’s case” and “The Other as a different and strange body: reconsideration of the notion “disability””.

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On the Relation between Anxiety and Neurosis

The article presents a few theses on anxiety, anxiety disorder and neurosis. The main concept that connects the supported positions is that anxiety differs from anxiety disorder. The experience of the anxious person is understood as an openness to a primal horror; hence, the neurotization, the anxiety disorder is an effect of the efforts to gain distance and protect the psyche from this experience (which transforms it into fear and makes it endurable). Thus, the neurotic subject is described as a producer of objects of fear. Regarding the social aspects of suffering of anxiety disorder, the article suggests that the neurotic person has access to no specific language that could effectively convey his/her experience as the vocabulary of anxiety is widely used to describe daily forms of worry and insecurity.

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Author: Simeon Kyurkchiev

Simeon Kyurkchiev, PHD in Sociology. He is Assistant Professor at the Social Sciences Department at the University of Architecture, Civil Engineering and Geodesy. His fields of interest are sociological diagnostics of contemporaneity, particularly the issues of mental health and neuroses, psychological expertise and ontology of the subject. He is author of the book Psychological Expertise and the Care of the Self (2019).

Suicide in the Elderly between Pathology and Autonomy: Local Historical Traces and New Statistical Data

The problem of suicide in non-terminally ill elderly people is extremely complex both morally and as a social policy and legal regulation. In this article we demonstrate how strong currently is the temptation of experts of different types, but most often those coming from the psychiatric field, to accept by default that a state in which a person defines suicide as his/her best interest invariably pertains to the zone of mental illness. However, a resistance, both professional and activist, intensifies. Against the background of this contemporary situation, the history of socialist psychiatry in Bulgaria reveals the curious fact that the ideological contradiction faced by the local experts actually left room for individual autonomy. It is the autonomy of a lonely, abandoned and suffering elderly from late socialism, but still recognized by experts as autonomy and not as illness. Current statistics (2009-2018) suggest that today the contours of the same deeply suffering figure are clearly visible. Unfortunately the expert and public discussion on the ways we die in Bulgaria lies still ahead.

 

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Author: Vladimir Nakov, Ina Dimitorva

Vladimir Nakov – see above.

Ina Dimitrova received her PhD in social and political philosophy from Bulgarian Academy of Sciences, Institute for the Study of Knowledge and Societies, and currently is associate professor at Plovdiv University in social philosophy and bioethics as well as honorary lecturer at Sofia University in the MA programme “Integrative Bioethics”. Her research interests include disability studies, politics of reproduction and population, social studies of science, technology, and medicine. She is author of two books and among her most recent publications are the following: Dimitrova, I. 2020. Impasses of Disability Alliance-Building in Bulgaria: Successful Phantom Activism and Toxic Grassroots Mobilization. In Alliances, Allies, and Disability edited by Allison Carey, Joan M. Ostrove and Tara Fannon. Volume 12 of Research in Social Sciences and Disability. Dimitrova, I. 2020. Offering hope, subverting hope: The hybrid strategy of promoting egg freezing in Bulgaria. In Demographic Change, Women’s Emancipation and Public Policy: Interrogating a Divisive Nexus – Gender and Intersectional Perspectives edited by Heike Kahlert, Wiesbaden: Springer VS; Dimitrova, I. 2019. Disability in the world of work: Images of productivism. Sofia: Collective for Social Interventions/Rosa Luxemburg Stiftung Southeast Europe.

Modernity, Depressive Disorders, and the Forecasts for the Near Future

The high rates of depression and suicide in developed countries are frequently attributed to the rationalization of life which culminated in the Enlightenment and dominates (post-)industrial capitalism. However, the present study suggests that highly influential Enlightenment figures such as Hume, Smith, Samuel Johnson and Kant were actually confronting a pre-existing depressive tendency in Western culture caused by the traumatic beginnings of modernity: the Catholic-Protestant split, the Thirty Years War, the British Civil Wars, the Lisbon Earthquake, etc., which shattered the classical Platonized Christian outlook and led to a more pessimistic view in which humans are animalistic and self-centered. Later socio-economic theory generally followed Adam Smith, who rejected pessimism by combining individualism with the old monotheistic beliefs, having realized that a “fatherless” universe appears full of “endless misery and wretchedness”. Yet today’s individualistic solutions to depression still fail to consider the need for solidarity and common values among modern “fatherless” individuals.

 

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Author: George Gherjikov

George Gherjikov is Assistant Professor at Sofia University’s Faculty of Philosophy. He teaches Social Philosophy and Philosophy of Politics. His main interests include the history of Western culture, contemporary Western philosophy, critical theory in the information age, and the critical study of religion. He is the author of the book Forms. Viewing Contemporary Philosophy through the Broader Cultural Outlooks upon Time (in Bulgarian, Sofia University Press), as well as several articles, including “Transhumanism and the Western Monotheistic Traditions” (Balkan Journal of Philosophy, 12 (1)/2020).

What Does Depression Mean? Development and Construction of the Meaning of Depression and Antidepressants

Modernity imposes a unique way of conceptualizing and treating conditions of despair and hopelessness. Unlike other approaches to depression in history, the modern interpretation is formed by a biological and mechanistic view of the human mind. This scientific paradigm has its strongest progress after the 1950s, developing alongside the field of psychopharmacology. The purpose of this study is to draw attention to how understanding depression is influenced by the ways of thinking about consciousness and the advancement of psychopharmacology. Semiotic methods are employed to interpret the pivotal moments in the transformation of this vision. The study seeks out the conditions that make this thinking possible. In conclusion, the study suggests a semiological link between scientific thought and pharmaceutical development on the one hand, and on the other a link between the diagnosis and representation of depression in popular media.

 

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Author: Martin Tomov

Martin Tomov is a Student in Masters program Integrative Bioethics (Sofia University), Bachelor in Culturology (Sofia University). Scientific internship: Internship Project “Invisible hands” (May-June 2017) Ecological Association ‘Za Zemiyata’ and Documentary Theater Studio ‘Vox Populi’. His interests are in history and philosophy of science, semiotics, ethics studies and social constructivism theory. He has previously done studies on medical ethics in Bulgaria during the 1920s and construction of the medical subject in the same period.

Punitive Care in Correction-Educational Institutions in Bulgaria

The text is an attempt to introduce and substantiate the private sociological concept of punitive care in correction-educational institutions: Labor Educational School and Boarding School for Students Subject to Education through Labour renamed in 1996 Educational Boarding School and Social-Pedagogical Boarding School. Punitive care comprises the entire process of educational impact on minor and juvenile perpetrators of anti-social acts from the moment of committing the misdemeanor to their placement in a correction-educational institution – boarding school. It also includes the entire stay of the inmate in the boarding school. It is characteristic of the punitive care that it is carried out primarily by the public educator before entering the boarding school and by the educators in the correction-educational facility.

The text clarifies the stages of punitive care, its different types depending on the type of correction-educational facility and answers the questions how it develops, transforms and dies out during the various periods of existence of the boarding school in Bulgaria.

 

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Author: Zdravko Angelov

Zdravko Angelov, PhD student in sociology at Sofia University “St. Kliment Ohridski”. Topic of the dissertation paper: “Transformation of the Labour Educational Schools after the collapse of the regime of state socialism in Bulgaria”.

 

The Poor Public Awareness as an Obstacle in Fighting Stigma towards Mental Illness

This article examines the stigma over mental health due to the social and institutional impact on it. There are few systems that seem to have larger influence in Bulgaria- media, political and medical. The lack of information that these institutions seem to present leads to mass confusion and misconception that only increase the stigma and moreover, not contribute to empowering the need for self-care for the potential patients. This paper focuses on the beneficial outcome of the well informed society and the possibility of improving the well-being through social welcoming methods that can only be established by legitimating the existing power through knowledge.

 

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Author: Yana Hristova

Yana Hristova has a Bachelor degree in Sociology, Sofia University St. Kliment Ohridski. After an internship in the field of Urban Sociology, now she works as а Reporting specialist in a company for Market research.

 

The World is Already Here and We Would Better Know It – a review of Ralitsa Kovacheva’s book News of the World. On the Meaning and Value of International Journalism.

 

 

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Author: Maria Neikova

Prof. Maria Neikova is a long-term lecturer at the Faculty of Journalism and Mass Communication at Sofia University “St. Kliment Ohridski”. She is a Doctor of Political Science, a researcher in the field of international journalism and international relations. She is the author of the books Double Challenge, Point of Intersection and Monologue or Dialogue? The Controversial World in the Lens of Global Television.