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بوابة علاج الأمراض النفسية

 

بالرغم من التقدم الكبير الذى شهدته صناعة العقاقير والأدوية النفسية فى السنوات الأخيرة.. وانتاج جيل جديد من مضادات الاكتئاب والفصام وغيرها.. فان معدلات الشفاء والتحسن لم ترتفع بالدرجة المتوقعة.. ولم يواكب تحسن الاعراض الجسمانية والتغيرات البيولوجية تحسن مماثل فى الاعراض النفسية أو فى أفكار المريض وسلوكه.. أيضا لم يتحسن أداء المريض الوظيفى والاجتماعى. كما لم تنخفض نسبة الانتكاس والمشكلات اليومية عند التفاعل مع المجتمع.

ويرجع هذا إلى اعتماد بعض الأطباء النفسيين على العلاج بالعقاقير والادوية فقط واهمال العلاج النفسى.. نظراً لأنشغالهم بالاعداد المتزايدة من المرضى.. أو لان العلاج النفسى يحتاج الكثير من الوقت والجهد.. أولأنهم لم يتدربوا عليه ولم يدرسوه الدراسة الكافية حيث لاينال الاهتمام الكافى اثناء الدراسات العليا فى أغلب كليات الطب.

ولقد أكدت عشرات من الدراسات ان نتائج العلاج بالادوية فقط أقل كثيراً من استخدام الدواء والعلاج النفسى معاً، حتى أصبح من المعتاد القول بان الدواء يحقق 50% من الشفاء وان العلاج النفسى يحقق الـ 50% الأخرى .. ولكن رغم ذلك فان الدمج بينهما وتقديم علاج متكامل بكفاءة ودراية مازال بعيد المنال.

إن الدواء قد ينجح فى تحسين الاعراض الجسمانية الناتجة عن اضطرابات بيولوجية مثل التوتر والرجفة والأرق وبعض اعراض الاكتئاب والفصام وخلافه.. ولكنه لايستطيع ان يساعد المريض على تعديل افكاره الخاطئة غير المنطقية.. وأستنتاجاته المتحيزة وتفسيراته المشوهه.. والدواء أيضا لن يجعل المريض اكثر قدرة على فهم صراعاته وأسباب مرضه.. ولن يعلمه ان يتقبل ذاته والآخرين.. وان يضع لحياته أهدافاً واقعية.

انها مسئولية الطبيب النفسى بعد ان يكتب العلاج المناسب ان يضع برنامجا لجلسات العلاج النفسى.. وان يختار الاساليب المناسبة منه .. وأن يستعين فى تنفيذ البرنامج بالأخصائى النفسى والاجتماعى وباقى أفراد فريق العمل.

ان المريض لايحتاج إلى التهدئة وتخفيض حدة المرض فقط وانما يحتاج إلى تعديل أفكاره الانهزامية المشوهة وسلوكه المضطرب وانفعالاته المتأججه.. وهو يحتاج أيضا إلى معلومات كافية عن مرضه وأسباب ذلك المرض وعن الدواء الذى سوف يتناوله.. فوائده واعرضه الجانبية.

وفى بعض الامراض المزمنة مثل الفصام يحتاج المريض تدريبات على زيادة التركيز والتذكر خاصة اذا كان طالباً فى مراحل الدراسة المختلفة.. كما يحتاج أيضا إلى تنمية مهاراته الاجتماعية ليخرج من عزلته التى يفرضها عليه مرضه.. والى التأهيل الذى يمده من خلال العلاج بالعمل بهوايات ويدربه على اعمال ومهن بسيطة يمكن أن يمارسها بعد تحسن فترة الاعراض الحادة.

اذن فالاعتماد على العلاج الدوائى فقط يترك المريض فى كثير من الاحيان شبه عاجز.. كسول منسحب .. فاقد للمهارات والقدرات الاجتماعية.. لا يستطيع حل مشكلة أو إنجاز مهمة.. وقد يظل لفترات طويلة وهو تحت العلاج الدوائى أسير افكاره الخاطئة وتصوراته ومفاهيمه المشوهة وصريع أوهامه ومبالغاته.

وعندما نتحدث عن العلاج النفسى عامة فإننا لانقصد أسلوباً بعينه.. لاننا يمكن ان نجمع بين اكثر من اسلوب لتعديل اكثر من جانب من التفكير أو الانفعال أو السلوك.. فهناك العديد من الانواع مثل العلاج الجمعى والفردى. والعلاج المعرفى والسلوكى.. والتبصيرى والتدعيمى .. والعلاج بالعمل أو بالدين أو بالفن أو بالرياضة.. الخ.

ويمكن ان يقوم بالعلاج النفسى الأخصائى النفسى اذ تعذر قيام الطبيب النفسى بذلك لأى سبب من الاسباب التى ذكرناها .. الا أنه يتعين ان توضع خطة العلاج النفسى بالاتفاق بين الأثنين .. حيث ان الطبيب يرى الكثير من جوانب المشكلة اثناء مرحلة الفحص والتشخيص. وبالتالى يكون اختياره لأسلوب العلاج النفسى المناسب على أساس الاحتياجات الفعلية للمريض ومدى ملاءمة اسلوب معين لشخصية المريض وقدراته.. وكثيراً ما يتم تعديل نوع العلاج الدوائى والجرعات اثناء مراحل العلاج النفسى المختلفة.

لقد أتضح - بما لايدع مجالاً للشك - ان الفصل بين العلاج الدوائى والعلاج النفسى هو امتداد لفصل الحضارة الغربية بين المادة والروح .. وبين الجسد والنفس

ولقد ادرك علماء الغرب خطأ هذا الفصل المصطنع خاصة عندما أكدت معامل علماء النفس الفسيولوجى والسلوكى.. ان أفكار واعتقادات الانسان يصاحبها تغيرات مباشرة فى النشاط البيولوجى للجسم.. فالتجارب أثبتت أن الانسان عندما يتخيل أو يفكر فى شىء مؤلم أو كريه أو مخيف تزداد نبضات وضربات قلبه ويشعر بشىء من الإختناق والعرق وسخونة الجسم وجفاف الحلق واضطراب معدته وجهازه الهضمى. وصعوبة التركيز وتوتر عضلاته وارتجافها.. إلخ .. ورغم ان هذه التغيرات قد تكون بسيطة أو غير ملحوظة إلا ان استمرار التفكير والانشغال الذهنى بأمور مؤلمة أو مخيفة يؤدى بالتالى إلى طول فترة التغيرات البيولوجية والجسمانية المصاحبة لها.. والذى ينتهى غالبا بأحد أمراض القلب أو الشرايين أو قرحة المعدة أو أحد أمراض الجلد والحساسية - إلى آخر هذه القائمة الطويلة مما يسمى بالامراض النفسجسمانية (النفسية الجسمية).

ولقد دفعت نتائج هذه الملاحظات التجريبية التى سجلت بأجهزة دقيقة الكثير من علماء النفس والعلاج النفسى إلى ابتكار اساليب تساعد مرضاهم على ضبط التفكير والتخيل والتحكيم فى النشاط الذهنى لضبط وظائف الجسم العضوية.

ولقد ازداد فى الآونة الأخيرة الاهتمام بدور العوامل الفكرية والذهنية التى تشمل التفكير والتوقع والتخيل والتصور ودورها فى التسبب فى الأمراض النفسية المختلفة.. وأصبح ينظر إلى الانفعال على أنه تفكير يحمل فى طياته حكماً عقلانياً تجاه موضوع أو موقف ما بأنه جيد أو سىء .. سار أم مخيف مزعج

ويقوم الفرد طوال الوقت بالتركيز على الافكار والتصورات التى قد تحقق له الاستقرار والسعادة أو الخوف والتوتر والشقاء وذلك من خلال الحوار الداخلى والجمل والمعانى والمفاهيم الذى يقولها الفرد لنفسه طوال الوقت.. أى أن الأنسان يختار الصحة النفسية والسعادة أو المرض والتوتر والشقاء من خلال أفكاره وتوقعاته.. هل هى متفاءلة منطقية أم متشاءمة سوداوية.

ان اكتشاف اخطاء التفكير والتوقع لايحدث إلا من خلال جلسات العلاج النفسى كما ذكرنا .

علينا ان نوفر كافة الوسائل للتدريب على العلاج النفسى والاهتمام به حتى نقدم للمريض علاجاً متكاملاً يحميه من الاعاقة والعجز. وان استخدامه بمفرده بدون عقاقير وأدوية مناسبة لايفى بالغرض فى اغلب الأحوال ولايحقق الشفاء والتحسن المتكامل فى كافة جوانب الشخصية.

ان قضية العلاج المتكامل مسئولية يجب مناقشتها بصراحة ووضوح حتى لو أدت إلى الصراع وعدم قبول أو استحسان البعض.. فمصلحة المريض يجب ان تعلو فوق جميع الاعتبارات.

ان الطب النفسى كعلم حديث خاصة فى الدول النامية.. مازال يواجه العديد من الصعوبات تحول بينه وبين ممارسة دوره الهام فى حياة ابناء تلك البلاد التى يتعرض ابنائها إلى متغيرات وتناقضات وأيضا تطورات سريعة .. وأنفتاح على ثقافات وعادات وسلوكيات تختلف عما لدينا من قيم ومفاهيم وعادات أختلافاً كبيراً

 

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