5. Self-harm (self-harm) and their prevention

The concept of self-harm. Self-harming (self-mutilation) is an act of aggressive behavior aimed at whom one is self-acting (auto-aggression) and dangerous in its consequences; human health. It is used by minors to achieve their goals, both in conjunction with the simulation and aggravation of diseases, as well as independently and is an object for imitation and a way to achieve certain Benefits or evidence of superiority over other individuals to the asocial and criminal community of both adults and minors.
We will show in two examples how to achieve "benefits" and demonstrate superiority over others. Teenager B. learned that he was threatened with an act of pederasty. He pretended to be ill, to hide for a while in the hospital and to avoid reprisals. “The doctor, having discovered the simulation, refused to hospitalize V., as he neither requested. Then V., coming out of the medical unit, saw an ax with which he chopped wood, grabbed it and cut off his finger. He was forced to hospitalize. In the hospital, he told why he took such a step. If the doctor came more closely, the act of self-harm could have been avoided. By self-reproof, by causing damage to his health, a teenager saved his honor and dignity. It can hardly be condemned for this, knowing through what kind of humiliation and harassment pass persons subjected to pederasty in places of social exclusion. The second case was told to me when I visited the Warsaw prison. It consisted in the fact that a novice came to the camera who claimed to be the owner of the camera. He was opposed by a teenager who until now was a leader. A conflict arose between the newcomer and the host, which the camera was watching closely. The newcomer threw off the master's bed from the bed, put his mattress on it, and when the owner tried to resist, the newcomer tore his eyes off, proving his superiority over the old leader in this way.
Malnutrition is widespread in places of social exclusion. We give the most common of their methods in places of social exclusion.


Table 14.8. Prevalence of self-harm (self-harm) in places of social isolation among minors (ranked by the number of detected cases)

The table shows that the most common in places of social isolation are such methods of self-harm as the ingestion of foreign objects that cannot be removed, the call of tumors and abscesses, fracture of the extremities, the stabbing and cutting wounds, provoking infectious diseases, the introduction of various objects into the urethra.
Minors swallow: a) items that are currently in sight (nails, pieces of wire, glass, medical thermometers, chess pieces, tubes of toothpaste, spoon cuttings, plastic wrap; a total of 93 item names are identified (see fig 14.1-14.3); b) objects specially manufactured for this purpose that are not naturally removable and require surgical intervention (“anchors”, “antennas”, etc.); c) strong drugs, poisonous mixtures that can cause stomach burns, which can be given for peptic ulcer.
"Anchors" and "antennas" are pieces of wire, bent in the form of hooks, anchors, which does not allow them to be pulled out after ingestion without resection of the esophagus. All other items are swallowed in such a way that without the intervention of the surgeon they could not be removed and they could not come out naturally. Some individuals have resorted to this kind of self-harm repeatedly. Thus, in the regional hospital of correctional labor institutions (Uglich), convict L. resorted to swallowing non-recoverable objects 13 times, underwent 13 stomach surgeries, just not to be sent to the forest corrective labor institution.
Such persons in criminal jargon are called “sword-swallowers”, “live-necks”. Among them there is a significant proportion of psychopaths with disorders of desire, "organics" with a low development of intelligence.
Tumors and boils are caused by the introduction (under the skin or into some organ) of various substances: morning saliva, plaque from the teeth, real tobacco, which, upon opening and medical diagnosis, do not give the smell that occurs when opening the usual "mastyrok" caused by the introduction under skin soap, kerosene, grease, etc. This makes it difficult to diagnose tumors and boils. So, in Daugavpils special vocational school such self-damages in the form of "mastyrok" were very widespread, until an experienced surgeon from the passenger marine fleet came to work in the medical department of the school. Knowing the custom of adolescents to check for new doctors, he discovered the whole "mastyrka" gathered the whole friendly group and performed an operation in her presence (he opened the "mastyrku" without anesthesia), warning that in the future he would do the same with other members. Several teenagers felt sick at the operation. But such a "shock method" had an effect, the cases of the use of "masyrok" in the school stopped.


Рис. 14.1


Fig. 14.1

Fracture of the extremities is carried out taking into account the data of the anatomy, methods of anesthesia and is issued for an accident, industrial, sports or domestic injury. Most often, the left-handed right-handed and left-handed right-handed are subjected to a fracture if the fracture is made without the help of his comrades. If an outsider participated in this procedure, they usually break their left hand. Depending on the position of the arm, one or two bones break during a fracture. Feet break less often. However, we encountered a case when a minor in the former Alma-Ata special PTU twice broke his leg, presenting a fracture as a domestic trauma (he stumbled as he descended the stairs from the second floor). The real reason was a different one: to avoid persecuting him as a representative of a non-indigenous nationality by an ethnic group of indigenous nationality. The author had to talk with a teenager, who several times broke his arm. To the question: "Is it terrible to break your arm? Do you feel pain while doing this?" - He replied: "Not at all scary. You will only hear the crunch of a broken bone. It is important to pull a hand towel over a wet towel and let it dry so that it pulls together. Then it doesn't hurt at all. To avoid bruises, you can put something soft on or on sweatshirt. An iron bar or brick will be useful for a fracture. Everything is very simple. " When asked whether it is worth harming his health, he replied: “There is no significant harm here, because the internal organs are not affected. I don’t accept“ shaggaglovanie ”when someone would pick my stomach or call boils. Here they are purely mechanical damages. But the benefits are great. For at least two months I don’t work and study, I sit on hospital meals, communicate with cultural and intelligent people (doctors and nurses). Why not live? And time goes faster. "
Sliced ​​and stabbed wounds are applied to the area of ​​the arms, chest, abdomen and less often to the legs. Particularly often found in this group of self-harm is the opening of the veins on the wrist. For this purpose, knives, various sharpening, fragments of bottles, window glass, which is always "at hand", etc. are used. Autopsy of the veins is more common as a reaction to protest the oppression of a minor by the administration or cellmates, members of the criminal community. Minors also love to cut wounds in the abdomen, cutting the skin and the subcutaneous layer (see Fig. 14.6).
Infectious diseases are provoked in various ways. The most common provocation of jaundice (Botkin's disease) is by swallowing bacon, meat, fish, sun-baked (before spoilage) and lowered into the esophagus on a string attached to a tooth. Tuberculosis is triggered by the introduction into the lung of a weak acid from a chemical foam fire extinguisher. To provoke such diseases means to ensure a long hospital stay, enhanced nutrition and freedom from social exclusion. To simulate dysentery, they swallow finely chopped pieces of soap and tear the anus with their nails. In one special school, the majority of adolescents resorted to such self-harm, who were suddenly caught in diarrhea with blood.
Among minors there is another form of self-harm that should be considered about with about-about. This is the introduction of a foreign body into the urethra and the implantation of foreign bodies under the skin of the penis. Balls in the form of beads are smelted from the handles of toothbrushes, which are carefully ground, cut into the skin with pointed objects or special sharpening, put these balls around the circumference of the penis, bandaged, using various kinds of herbs, etc. as antiseptics. The minors are very proud of the implanted balloons, calling them "spurs" in criminal jargon. It is believed that the owner of such "spurs" has the highest sexuality and is able to cause an orgasm in any woman. At the same time, similar methods of self-harm (self-harming the genital organs) are also observed among adult convicts as a kind of mass insanity arising from the looped (tm) convicts on sexual problems. This is evidenced by many former dissidents who have served their sentences in places of detention. Moreover, all this often ends in suppurations, development of phlegmon, fistula formation, which, however, does not stop minors and adults, fueled by various rumors, gossip, unverified information about the traditions of some peoples, implant such "spurs" into the genitals, which is supposedly achieved their particular sexuality.
Recently, in places of social isolation (especially in special PTU and VC), there has been an increase in the share of qualified self-harm that requires a good knowledge of human anatomy and physiology, the use of medical instruments (probes, syringes), for example, to inject solutions into a vein that give a diagnosis close to blood cancer; analgesic methods, knowledge of the actions of pharmacological agents and other substances.
Qualified imperators resort to self-harm systematically. So, every third teenager noticed to qualified self-harm, resorted to them more than four times, every second - twice. It should be borne in mind that a complete picture of self-harm is difficult and difficult to obtain, since many qualified self-harm is not recognized by doctors and is diagnosed as a disease or domestic, occupational injury.
In self-harm there is another very important problem - a socio-psychological one, where, due to the action of the mechanisms of mental infection and imitation, some types of self-harm in places of social isolation are characterized as epidemics. First of all, this applies to such types of self-harm as the ingestion of non-removable objects, fractures of the extremities, dissection of the veins, damage to the penis, with which we have met for many years of work on this problem repeatedly. We have already mentioned the epidemic calling boils and tumors in the Daugavpils special technical school. In Kostroma VC, there was a case where in one year juveniles resorted to limb fractures 300 times, in the Dushanbe special technical school there was an epidemic of mass provocation of dysentery, and there is no need to talk about vein dissection - such cases are found in many places of social exclusion.
Although the proportion of persons with mental abnormalities among juveniles admitting self-harm is significant, self-harm is not only the result of neuropsychiatric disorders; it can not always be attributed to random, impulsive manifestations of personality. The study of the motives of self-harm, their comparison with the methods of preparation and implementation show that often adolescents and young men go for it consciously, pursuing clearly programmed goals, prompted by sustainable motives. Risking their health, causing damage to him, they consider this to be a justified more significant goal for them and more significant final results.
Motivators and self-harm motives. A retrospective analysis of situations in which minors resorted to self-harm showed that they resort to this kind of deviant behavior, as well as to aggravation and disease simulation, in situations of pressure, frustration, psychological trauma, and imitation of others. However, they often experience severe mental states. There are also cases of demonstrative self-harm as a protest response to injustice (in its subjective understanding by minors). In this case, the motives and drivers of self-harm in most cases coincide with the motives and drivers of aggravations and simulations of diseases.
The most pronounced motivation for self-harm, associated with the evasion of a minor from the performance of duties prescribed by law. As with the simulation of diseases, this motivation leads to shy away from study, training and production activities, chores and self-service work; from serving a disciplinary action, participation in self-government bodies, duty on the Stump, etc. Here, along with stable motifs, situational, mainly caused by a distressing situation, frustration, imitation of others, are also manifested. The motivation associated with achieving some year is as follows: to go to hospital for treatment in order to receive good care and care, to diversify food, to change the situation, to talk with the medical personnel of the "Viennese sex, to meet in the hospital with relatives, acquaintances in general" necessary people. "
Self-harming is also used in order to protect the honor and dignity of an individual from the encroachments of other persons whom a minor cannot withstand, without the help and protection of his group. However, unlike aggravation and disease simulation, minors resort to self-harm in order to protect their honor and dignity, as a rule, in acute psycho-traumatic (hopeless) situations, when it becomes the only way to avoid major unpleasantness of a person, and when it is impossible to immediately simulate the disease. He broke his hand, cut off a finger, opened a vein and was immediately hospitalized, and achieved a high temperature - there is not enough time to evade trouble.
Self-harming is also used to protect the individual in other situations: from the criminal community's encroachments, in case of violation by the founder of group norms, failure to pay card or other debt, to avoid responsibility for the unfulfilled promise, to defuse the situation of psychological and criminal incompatibility in the department, cell, primary team and etc.
Juveniles often resort to self-harm for personal prophylaxis in order to avoid any more unpleasant consequences. In this case (as compared to aggravation and disease simulation), adolescents act less often, imitating others, because they have to risk their own health. However, this does not mean that with self-harm the mechanism of mental infection and imitation of others does not work. The above cases of “epidemics” of self-harm and mass “frenzy” on this basis speak for themselves.
The similarity of the psychology of the lethal, simulator and aggravant. Each minor, before resorting to self-harm, must pass the stages of aggravation and disease simulation. And if the aggravations and simulations did not allow him to achieve the goals set and at the same time a psycho-traumatic situation suddenly arises, requiring urgent measures to get out of it, the minor resorts to self-harm. All this allows us to consider the aggravation and simulation of diseases and self-harm as stages of deepening deviant behavior, having an internal psychological similarity in the action of the motivators and their personal significance, in the identity of the motives of these actions. There is also an external similarity. Qualified simulators, aggravants, and depressants strive to make a good impression on educators and doctors. They are polite, helpful, able to endear themselves, watch their appearance.The exceptions are situational simulators, aggravants and depressants, resorting to these measures in acute life situations, as well as newcomers who have not withstood the oppression during the adaptation period, electing this tool as a means of protest.
There is often competition among simulators, aggravants, and depressors. On this basis, minors, voluntarily, on their own initiative, can expose ways of aggravation, simulation and self-harm, used by members of warring criminal groups, seeking thereby to gain trust in the administration and reduce the number of competitors.
Effective methods of self-harming are transmitted only to trusted, reliable individuals, mostly members of their group ("family"), under a big secret, for a certain fee. Therefore, their direct identification is difficult. Here, as in the identification of simulations and aggravations, it is important to use indirect indicators, paying attention to those who regularly read the medical literature who are interested in the symptoms of diseases and the action of pharmacological agents and drugs; treated in hospitals serving as distributors of these types of deviant behavior, as well as the incidence of diseases of minors belonging to the same friendly group or group.
Хотя статистические показатели самоповреждений, аггравации и симуляций болезней держатся в местах социальной изоляции из года в год примерно на одном уровне, частота их проявлений в конкретном учреждении зависит от общей организации коллективной жизни, типа межличностных и межгрупповых отношений, наличия или отсутствия психологической защиты личности в группе и коллективе, состояния режима, от организации всего воспитательного процесса. Многое здесь определяется составом актива, выборных органов, старост классов, физоргов, культоргов и т.п. Если на этих постах оказывался лица из числа "отрицаловки", то, обладая официальной пастью и опираясь на неофициальных "авторитетов", они начинают притеснять слабых. Последние используют аггравацию, симуляцию и членовредительство как способ психологической 'зашиты. На частоту случаев самоповреждений влияют недостаточно в организации учебно-производственной деятельности (слабый контроль за выработкой и учетом готовой продукции, при-| влечение несовершеннолетних к тяжелым физическим работам), хозяйственных работ; распространенность в учреждении "воровских традиций". В целом значительная часть несовершеннолетних отрицательно относится к случаям самоповреждений и вполне одобряет симуляции и аггравации болезней. Однако встречается открытая и скрытая поддержка и одобрение самоповреждений со стороны определенной части несовершеннолетних, прежде всего когда речь идет об использовании его как средства защиты от притязаний "отрицаловки".
Профилактика самоповреждений. Профилактика самоповреждений в местах социальной изоляции достигает успеха тогда, когда она носит комплексный характер, включая разработку и применение организационных, психологических, педагогических, медицинских, режимно-правовых мер.
Прежде всего воспитатели и другие сотрудники должны знать социальную природу этого вида отклоняющегося поведения, его внутреннюю психологическую структуру, причины и условия, его порождающие, его личностную и групповую ценностную значимость.
Важно исключить из жизни несовершеннолетних ситуации и факторы, провоцирующие их к совершению самоповреждений. Профилактике самоповреждений способствуют: нормализация межличностных и межгрупповых отношений среди несовершеннолетних, создание для каждого подростка и юноши надежной психологической и физической защиты в среде несовершеннолетних: недопущение возникновения и засилья уголовных традиций и "законов" с издевательствами и притеснениями слабых и новичков; четкость и научная обоснованность организации учебно-производительного труда и контроль за выработкой несовершеннолетних; исключение возможности проникновения в "зону&;gt; запрещенных предметов (игл, шприцев, лезвий бритв, зондов и других режущих и колющих инструментов, фармакологических средств, денег и т.п.); недопущение "в зоне" различных азартных игр и появления проигравшихся, проспоривших и т.п.
Санитарно-просветительская работа направляется на культивирование здорового образа жизни, на показ физического вреда актов самоповреждений с приведением конкретных примеров из лечебной практики, тяжести последствий этих актов для здоровья человека. Вместе с тем разъясняется, что самоповреждение есть акт вандализма, разновидность нравственной распущенности. Особое внимание обращается на сексуальное просвещение, показ наивности и несостоятельности всех неестественных способов повышения своей сексуальности путем самоповреждений полового члена.
Minors should know and see the economic harm caused to society, the family and themselves by self-harm. This damage includes: the cost of products not released to minors for the period of their stay in the cure and release due to illness, the amount excluded from personal earnings; the cost of missed classes, as well as of each day that a member of the society is detained by the society in the hospital and when he is on the sickness bulletin; the danger of being transformed from a young age as a result of self-harm into a disabled person who is forced to linger on a disability allowance for the rest of his life, etc.
When showing moral and psychological damage to self-harm, it is emphasized that human health is not only personal, but also public, state property. Not caused by public necessity (for example, protection of other citizens, saving public property and goods, etc.) an encroachment on one's health is a profoundly amoral act, and for persons of military age a criminal offense (Article 339 of the Criminal Code of the Russian Federation). The psychological harm of self-harm lies in the fact that other teenagers and young men are starting to take an example from these people, as a result the social and psychological climate is complicated in the institution (“in the zone”), the whole life of the contingent there is disorganized.

Каждый случай самоповреждения подлежит служебному расследованию с целью установления обстоятельств, условий, причин и мотивов его совершения. По их выяснении возбуждаются уголовные дела в отношении организаторов членовредительства, притеснителей. Несовершеннолетние, совершившие акты самоповреждений, становятся на учет, а к лицам, систематически прибегавшим к этому, применяются строгие дисциплинарные меры. К борьбе с членовредительством привлекаются органы самоуправления несовершеннолетних, с этой целью используется общественное мнение, осуждающее акты глумления человека над собой и своим здоровьем. С вынужденными же членовредителями, использовавшими акты самоповреждений в целях защиты своей чести и достоинства, необходимо вести весьма так точную работу, помогая им найти другие средства защиты (объединение позитивно настроенных подростков и юношей, противостоящих "отрицаловке" и т.п.).

Findings:
1. Самоповреждения - наиболее опасное для здоровья человека отклоняющееся поведение, занимающее одно из ведущих мест по своему удельному весу в местах социальной изоляции. По своей психологической природе самоповреждения во многом сходны с симуляцией и аггравацией болезней. Более того, каждый несовершеннолетний, прежде чем прибегнуть к членовредительству, как правило, проходит подготовительную стадию в виде симуляции и аггравации болезни.
2. Наиболее распространенная мотивация членовредительства связана с уклонением несовершеннолетнего от выполнения предписанных законом обязанностей, с достижением каких-то моральных или материальных и психологических выгод путем нанесения ущерба своему здоровью, с защитой своей чести и достоинства, с целями личной профилактики или подражанием другим, с протестом на субъективно понимаемую несправедливость в острой ситуации.
3. Виды самоповреждений весьма разнообразны и касаются нарушения как внешней целостности организма, так и его физиологических функций. При этом многие самоповреждения носят квалифицированный характер и осуществляются со знанием физиологии и анатомии человека.
4. Все это требует разработки целостной системы профилактики, охватывающей все стороны жизни, деятельности, отдыха, быта несовершеннолетних в местах социальной изоляции, исключающей создание ситуаций, провоцирующих несовершеннолетних к членовредительству. Вместе с тем вся профилактическая работа должна дифференцироваться в зависимости от тех мотивов и целей, которыми руководствовался подросток, нанося ущерб своему здоровью.
5. Среди несовершеннолетних широко распространена мода на занятия бодибилдингом, они увлеченно читают книги
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А. Шварценеггера1, стремятся накачать себе мышцы, вести здоровый образ жизни по образцу своего кумира. Это увлечение бодибилдингом необходимо использовать в профилактике членовредительства.