أيها الشاكي وما بك داء

أيها الشاكي وما بك داء

الإثنين 20-06-2016

 

بقلم ريم ضيف

“أيها الشاكي وما بك داء … كن جميلاً تر الوجود جميلاً” .. كم أثلجت كلمات إيليا أبو ماضي من صدور، ولكن هل تفيد نصيحته في عالم يكون فيه المرض ابتلاء يخافه البعض ووهم يسعى إليه آخرون؟ وهل يكون شاكي المرض دائماً “شاكياً”؟ ليس بالضرورة، حيث يُعرف الدليل التشخيصي والإحصائي للاضطرابات النفسية اضطراب التصنع ويقسمه إلى نوعين:

1- اضطراب التصنع الواقع على الذات : وفيه يلجأ المريض إلى تزييف أعراض مرضية أو إحداثها بطريقة خداعية ويظهر حينها في صورة المريض. الجدير بالذكر أن ذلك يحدث مع عدم وجود أي مجزيات عائدة على تصرفه أو دوافع واضحة. وعادةً ما تكون الأعراض الخاصة بالشكوى عضوية أكثر منها نفسية. وتُعرف الصورة الأشد والطويلة المدى من هذا الاضطراب في السياق التاريخي بمتلازمة مونخهاوزن، نسبة إلى البارون مونخهاوزن الذي عُرف بخياله الواسع ومبالغاته خلال فترة الحرب.

2- اضطراب التصنع الواقع على الآخر : وفيه يلجأ المريض إلى اختلاق أو إحداث أعراض مرضية في شخص آخر ويقوم في هذه الحالة بدور القائم بالرعاية وليس دور الضحية.

ومع تطور التكنولوجيا ظهرت صورة حديثة من هذا الاضطراب درسها بولمان وتايلور (2012) في شكل التصنع على الإنترنت حيث يقوم زائري مواقع التواصل الاجتماعي والمنتديات بادعاء المرض والشكوى. وهنا قد يظن البعض أن مرضى اضطراب التصنع يختلقون المرض أو يحدثوه بغرض لفت الانتباه أو لوجود عائد مادي أو معنوي. ولكن الحقيقة هي عكس ذلك. فعلى عكس حالات التمارض والتي يكون فيها التمارض عمدي ولغرض محدد كالحصول على أجازة مرضية أو الإعفاء من واجب معين، يكون التصنع مجهول الدافع وبلا مبرر واضح مما يثير الغموض حول مسببات هذا الاضطراب. وفي حين أنه لا يوجد حتى الآن دليل واضح على دور العوامل النفسية والبيئية والبيولوجية على ظهور هذا الاضطراب بصورته المحيرة، يشير بعض الباحثين إلى احتمالية ارتباطه باضطرابات الشخصية أو سمات شخصية معينة، كالاعتمداية أو الاحتياج إلى منقذ على سبيل المثال. كما يكون لمرضى هذا الاضطراب في بعض الأحيان خلفية طبية تمكنهم من اصطناع أو إحداث المرض بشكل إكلنيكي صحيح. وهنا تكمن الصعوبة الأولى في مواجهة اضطراب التصنع ألا وهي التأكد من صحة الأعراض من عدمها في مرحلة التشخيص، والتمييز بين اضطرابات الشخصية والاضطرابات النفسجسدية على ناحية واضطراب الاصطناع على الناحية الأخرى، وخصوصاً في حالات الأعراض النفسية والتي قد يصعب التيقن منها.

تعتمد مضاعفات هذا الاضطراب بصورة أساسية على مدى إحداث المريض للمرض أو لجوءه إلى تدخلات طبية قد يكون لها آثار جانية. هذا بجانب سرعة ودقة تشخيصه كاضطراب نفسي في المقام الأول ولذلك يكون الخيار الأساسي هو اللجوء لتدخل علاجي سريع. وعلى ذلك يتم تحويل المريض كمريض، وليس مدع أو ممثل، إلى طبيب نفسي لمعالجة الجوانب النفسية وتعديل السلوك. في بداية العلاج النفسي يتم إبلاغ وتوعية المريض بحقيقة مرضه دون لومه أو عقابه. ففي هذه الحالات، وعلى عكس حالات التمارض العمدي، لا يجوز إبداء نصيحة على سياق مقولة “لا تمارضوا فتمرضوا”. وأياً كان الأسلوب العلاجي المتبع، تكون الأولوية دائماً هي الحفاظ على سلامة المريض طوال عملية العلاج بحيث لا يدخل في مزيد من متاهات العلاج والمرض. ففي زمان غير زمان أبو ماضي، اصطناع المرض هو مرض وادعاء الداء هو داء يستحق العلاج كي يستطيع الشاكي أن يصبح “جميلا” ويرى “الوجود جميلاً”.

 

 

 

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