4. Simulations, dissimulations and aggravation of diseases and their prevention types and causes, recognition.

The concept of simulation and aggravation. Simulations and aggravations of diseases relate to widespread types of deviant behavior among minors in places of social isolation, in boarding schools, as well as among young people when drafted into the army. Due to the needs of medical practice and the activities of medical examinations (labor, military, judicial, etc.), the medical side of simulation and aggravation is well known and covered in many textbooks and manuals. However, the psychological and educational-preventive aspects of this problem in relation to the behavior of persons held in closed educational and correctional institutions have not been studied, and there is not enough literature on this issue1.
When resorting to simulation and aggravation, the minors consider that each disease has objective manifestations (temperature, pulse rate, blood pressure, reddening of the skin, etc.) and subjective indicators (patient complaints). To mislead the doctor, simulators use both of these indicators in combination. Simulation - from lat. simulatio -
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1 See: our work: Psychological foundations of the re-education of students of special vocational schools. M .: 1988, Ch. XIII, 2; Psychology simulator // Bulletin All-Union Scientific Research Institute of the Ministry of Internal Affairs of the USSR, "Correctional labor institutions." M .: 1981. vol. 14. p. 23-26.
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pretending, creating a false notion about something with a view, for example, to show a non-existent disease. To do this, they resort to aggravation (from the Latin. Aggravare - to do it harder, to exaggerate): raising the temperature by artificial means; increased heart rate by taking certain substances, causing boils by injecting various irritants under the skin. In order to create the appearance of compliance of subjective indicators with the overall picture of the disease, the simulators set forth their “complaints” about diseases, the objectivity of which is difficult to verify. At the same time, they take into account that sometimes in the medical departments of places of social isolation there are no reliable methods of biochemical and instrumental examinations of patients.
Most often, diseases that require emergency medical care are simulated and aggravated and which the lower-level physician will not treat, but will refer the patient to the hospital (to the city or regional hospital), which the offenders are counting on. Mainly simulated and aggravated: a) acute surgical pathology; b) acute therapeutic pathology. Most often, minors resort to the simulation of an "acute abdomen" with suspected appendicitis, requiring urgent surgical intervention; renal colic, the identification of which requires special methods; catarrhal diseases with a high fever; various infections, etc.
There are simulations and aggravations of diseases: without self-harm (without self-harm), through self-harm and combined, which in turn can be: a) simple, carried out by the most accessible means and justified by appropriate subjective data and b) sophisticated (qualified), based on knowledge of physiology human, the action of pharmacological agents and the use of tools (syringes, probes, clips, etc.).
In practice, the combined methods prevail, when the simulation is combined with aggravation and when the simulator balances on the verge of self-harm or resorts to it. In this case, a large proportion is occupied by qualified methods associated with the use of information from medicine, as well as pharmacological tools, knowledge of anatomy and physiology, with the use of a psychological factor.
In order to constantly receive benefits and "sickness" benefits, offenders seek to diversify the methods of simulating and aggravating diseases. Up to 50% of cases of simulation and aggravation of diseases they commit during the adaptation period of being in places of social isolation, which makes it difficult to identify these types of deviant behavior, since the personality of the newcomer has not yet been sufficiently studied. During the main period of being in places of social isolation, more favorable conditions are created for identifying aggravants and simulators, since the doctor and other employees have the opportunity to observe the behavior of the minor for a long time, to study the personality not only from the side of the illness, but also its everyday behavior in everyday life. , in the classroom, in a group and in a small group, compare the frequency of treatment of a minor and his friends with complaints to the doctor.
At the same time, such a sign of identifying simulators and aggravants, such as the frequency of visiting a doctor of minors who are on friendly terms, "affected" by the illness of members of a friendly group ("family", "hut") to which a teenager belongs, especially a criminal one, is quite informative. . Thus, members of criminal groups go to the doctor 3-4 times more often than members of positive-minded groups.
When diagnosing simulation and aggravation of diseases, it is necessary to pay attention to persons who regularly read the Health magazine, medical literature, which detail the symptoms of various diseases, as well as the action of pharmacological agents and drugs.
The methods of simulation and aggravation of minors are kept secret and inform each other under a big secret, often for a fee. The transmitters of this experience are those who have been treated in hospitals and have communicated there with adult simulators and aggravants, as well as those who have served their sentences in corrective labor colonies, from whom they “learned the lessons of the black craft” 1. A favorite activity of some categories of minors is "mow under the psyche."
Most prone to the simulation and aggravation of diseases:
a) persons who are not subject to early (parole) release from VC or graduation from special schools and special vocational schools;
b) minors belonging to the criminal "elite" (the leaders of criminogenic groups), usually resorting to qualifications
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1 Medynsky G. Difficult book. Fav. manufacture, M., 1973, vol. 1, p. 215.
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in sophisticated and sophisticated ways and coercing members of their community; c) weak-willed, lowered, oppressed and persecuted by other adolescents, resorting in emergency cases to primitive methods; d) persons with mental illness who resort to simulation and aggravation are unsystematic using primitive methods; e) gamblers who resort to simulation and aggravation in cases of loss and do not have the means to timely repay the debt; e) persons put "on the counter" and not having the ability to pay on it; g) persons who were treated in various hospitals; h) persons who have visited many receivers-distributors, pre-trial detention centers and who have gained experience in simulation and aggravation there; i) persons forced into acts of sexual perversion, etc.
Each minor is guided by his own motives, resorting to the simulation and aggravation of diseases. All the diversity of these motifs can be compared with those situations that provoke simulation and aggravation and can be reduced to typical groups.
Firstly, it is possible to identify the motives of evasion of a minor from the performance of duties prescribed by law: from school, especially in case of academic failure, conflict with teachers and the class team, unwillingness to study; from vocational training due to the reluctance to have the proposed profession, the presence of a negative overall work unit and the desire for parasitic existence, the requirements of "thieves' laws"; from household and other "dirty work", self-service works as degrading a person sticking to the "thieves' laws"; from participation in the work of self-government bodies as “prohibited” by criminal traditions; from ongoing educational work and various cultural events; from punishment by placement in a hospital.
Secondly, the motives of psychological defense stand out: to protect oneself from persecution and oppression of “authorities”, to get rid of persecution from participants of gambling games for loss, from leaders of criminogenic groups who put the defending party on the counter; get rid of the persecution of the "authorities" for the "start-up" (he fell through, did not keep his word); protect yourself from possible acts of sodomy, etc.
Thirdly, the motives for achieving benefits are also important: to go to the hospital and get more nutritious food, talk with female medical staff, meet with relatives or friends, have a rest and just “change the situation”, etc.
Fourthly, let us single out the motives for the prevention of any negative consequences for the evader, if he stays in this institution for a certain time (reduction of status, branding, danger of pederasty, sexual perversion, etc.).
The fifth group consists of motives of imitation of a teenager to members of his community, who managed by simulation and aggravation of diseases to achieve certain advantages in places of social exclusion.
The sixth group consists of motives associated with the fulfillment of the requirements and rules of the criminal subculture, a falsely understood comradely duty, the desire in this way to assert itself in the adolescent and youth environment, to consolidate its position or resolve the situation that has arisen for itself.
From the above it can be seen that the hospital and the medical unit in places of social isolation are the most attractive means for minors to achieve their goals and motives through simulation and aggravation.
Persons who are suspicious, easily susceptible to suggestion who find subjective indicators of a particular disease, as well as people with obsessive thoughts about their non-existent diseases, should be distinguished from simulators and aggravants. They need to be treated carefully, explaining to them the inaccuracy of their subjective sensations, for rude attitude, ridicule can cause a negative reaction to the "callousness of doctors and their heartlessness", which "do not heal, but cripple," which plays into the hands of true simulators institutions.
Prevention and prevention of the simulation and aggravation of diseases. In this work, the organization of collective life, the formation of humanistic interpersonal and intergroup relations in the adolescent and youth environment, the creation of an atmosphere of psychological security of the individual in the team are of particular importance. Much depends on the proper selection of chairmen of councils of self-government bodies, heads of classes, cult-trade and other officials in self-government bodies. If negative positions are placed on these posts, then they, having power, make the weaker and defenseless to do all the "dirty and dirty work" for themselves. Dependent and oppressed minors use simulation and aggravation as a means to go to the doctor’s office, tell them about the situation in the adolescent and youth environment, or make a transfer to another unit. Similar reasons for simulation and aggravation are found where the caregiver is inaccessible to minors (because of his carelessness, employment, obstacles of other teenagers and young men, etc.).
In order to prevent aggravations and disease simulations, training and production activities should be organized taking into account the latest achievements of science and technology. The process of activity itself is structured so as to encourage minors to be creative. Practice shows that the greatest number of cases of simulation and aggravation is observed when adolescents and young men are involved in routine, heavy unqualified work that does not correspond to the physical capabilities of minors, as well as to monotonous, monotonous work, which causes extreme inhibition in the cerebral cortex. In this case, the simulation and aggravation of diseases by people with mental illness is chosen as a means of protest. An interesting, exciting, creative activity that requires mental and physical abilities of minors, properly stimulated by the achievement of personality-significant and collective (group) perspectives - an important means of preventing simulations and aggravations of diseases.
An effective means of such prevention is also the timely identification and overcoming of "criminal traditions", "thieves' laws" among minors. Along with the above, one of such traditions, especially carefully observed, is the evasion of minors in the period preceding their release (exemption from criminal punishment) from all jobs, the obligation and the right to live, oppressing and robbing others, and above all new ones. Often, by simulating and aggravating diseases, the “old man” emphasizes his adherence to these traditions. In turn, newcomers choose simulation and aggravation of diseases as a way to avoid oppression and extortion from the “old men” during the adaptation period.
The leading role in the fight against the simulation and aggravation of diseases, of course, is played by medical workers. Simulants and aggravants from the first days of their stay in places of social isolation are closely studying the medical staff, especially those who have just entered the workforce. To this end, the “authority” and adolescents regularly visit the medical unit on their behalf and, according to their methodology and a specific plan, identify each of their strengths and weaknesses. Then resort to the simulation and aggravation of diseases with the expectation of a particular physician weakness. Therefore, the study of medical workers I by all employees of the psychology of simulation and aggravation and the development of tactics to combat these phenomena is a necessary condition for success. The effectiveness of such work depends on the close cooperation of health workers with all staff and services of the institution. Constant and prompt exchange of information about the behavior of minors in different life situations will greatly assist here. All cases of exposure of simulators and aggravants should be carefully analyzed and taken into account in further preventive work.
It is especially necessary to carefully control the presence of minors in the emergency room, where they can, using known methods, “raise their temperature”, “raise blood pressure” (rubbing a thermometer, squatting with a leg pulled in the hip area, etc.). Against this trick, re-measuring the temperature in the presence of a doctor or nurse, re-measuring blood pressure helps.
In achieving success in the prevention of simulation and aggravation of diseases, an important role is played by sanitary and educational work among minors, in the course of which physical, economic and moral damage is shown, which is inflicted by simulants of the individual and society. At the same time, it is necessary to seek and use more effective methods of psychological influence addressed to conscience, honor, feeling.
Simulation and aggravation of diseases is a kind of social lie, deception, causing distrust of such people and rejected by society. The public of minors, their self-government bodies should take an active part in the discussion of cases of simulation and aggravation of diseases, it is severely condemn them. Elimination of causes contributing to the simulation and aggravation of diseases, taking preventive measures (dynamic observation of persons prone to such actions, timely warning of their responsibility, immediate resolution of situations provoking such actions) and preventing such cases, identifying and exposing simulants and aggravants, announcing to them public distrust and boycott are necessary conditions for the system of preventing aggravation and simulating diseases as deviant behavior.
Despite all the above, it is unacceptable to everyone who sees a doctor, complains of indisposition, is suspicious, seeing in him a simulator. Indifferent and indifferent attitude of medical staff to sick adolescents is unacceptable, especially since placing a person in conditions of social isolation, causing various negative mental states (stress, frustration, depression, etc.), can provoke an exacerbation of a disease, which a minor previously suffered .

Findings:
1. Simulation and aggravation of diseases is one of the very common types of deviant behavior of minors in conditions of social exclusion. By resorting to the simulation and aggravation of diseases, minors pursue their goals - to obtain certain advantages from this type of behavior.
2. Therefore, the motivation of such behavior is very diverse and is largely determined by the characteristic (psychological, social and moral) personality of the simulator and aggravant, his status in the social environment and authority in the criminal world.It is one thing - the simulation and aggravation of the disease by the leader of a criminogenic group to shirk work and study, a chore, and another thing by an “outsider”, awaiting reprisals against himself, an act of “lowering”, social stigma. In the first case, this is following the "thieves' laws", in the second - a forced act due to carelessness and "deafness" of the staff of the institution.
3. In each institution, a holistic system of prevention of the simulation and aggravation of diseases is needed, including studying the causes and conditions that provoke minors to take such actions, develop measures to eliminate them, suppress cases of simulation and aggravation, expose such persons and take measures to them: psychological, regime , educational, organizational.