Élni jó pozitív pszichológia, csíkszentmihályi mihály
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Csíkszentmihályi MihályIsabella Selega CsikszentmihalyiSZERKESZTETTE
az elme kerekei
mm
Élni jó!TANULMÁNYOK˙A POZITÍV PSZICHOLÓGIÁRÓL
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AKADÉMIAI KIADÓ
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Harmadik rész: ÉLETHOSSZIG TARTó POZITíV FEJLőDéS A SZUBJEKTíV éLMéNYEK HATáSA AZ éLETMINőSéGRE
alapvetően pozitív oldalról, a működés szempontjából közelítsük meg.Az1CF azt próbálja kideríteni, hogy az emberek ténylegesen mire képesek hétköznapi tevékenységeik során adott társas környezetükben. A be¬tegségek következményeiről (egészségkárosodás, mozgáskorlátozottság)azegészséges állapot egyéb tényezőire, mint példáula fizikaierőforrások,a mindennapi tevékenységek vagya társas feladatvállalás, helyezi a hang¬súlyt. Fontosnak tartja kideríteni azt is, hogy az egyén milyen módonáll aktív kapcsolatban környezetével. Nyilvánvaló, hogy két, ugyanolyanegészségi állapotnak örvendő ember más-más szinten tartja környezeté¬vel a kapcsolatot. Az egészségi állapotot jelző változók - miközben
feosan összefüggenek az egészséggel - nem feltétlenül csak a testi-fizikaigyapotot tükrözik. Az egyéni pszichológiai jellemzők, a családi és a szo¬ciális támogatás, az anyagi és a gazdasági erőforrások, az iskolázottság,fevábbá az adott kultúra és a társadalom elvei is befolyásolják az egész¬égi állapotot (Ingstad, 1999; Simeonsson, Lollar, Hollowell és AdEjO;Ostün és munkatársai, 2001).
A legtöbb kutató egyetért abban, hogy az egészség egy olyan multi-
dimenzionális konstruktum, mely a fizikai, szociális és pszichés dimen¬
ziókat egyaránt magában foglalja. A fenti gondolatot először az Embe¬
ri Jogok Nyilatkozatában fogalmazták meg (1948), és az Egészségügyi
Világszervezet (WHO) Alma-Atában tartott ülésén (1986) hívták fel rá
újfent a figyelmet. Kihangsúlyozták, hogy az egészség nem egyenlő a
rendellenességek hiányával, hanem egyfajta fizikai és pszichés jóllétet is
feltételez. Ezzel párhuzamosan a betegségek diagnosztizálásában és ke¬
zelésében is újszemlélet kezdett formálódni, az úgynevezett biopszicho-
szociális modell (Engel, 1977, 1982), mely rámutatott a nyugati orvoslás
biomedikális, a tünetekre és a rendellenes szervi működésre koncentráló
szemléletének korlátáira. Olyan, átfogóbb érvényű megközelítést képvi¬
selt, mely a beteget olyan embernek, egyénnek, egy adott kulturális közeg
termékének tekinti, akinek az egészségről-betegségről egyéni, szubjektív
szo-
elképzelései vannak.A biomedikálisés a szociális modell integrálására tett első kísérletnek
az International Classification of Impairments, Disabilities and Handi¬
caps,az ICIDH (Funkcióképesség, fogyatékosságés egészség nemzetközi
osztályozása, FNO; World Health Organization, 1980/1993) tekinthető,
mely elismerte a betegségek és a tartós egészségromlás kialakulásában
iális tényezők szerepét (Thuriaux, 1989). Sajnos ezen a sommás
megállapításon kívülaz ICIDH a továbbiakban nem foglalkozott a társas
világ azon elemeivel, melyek az emberi teljesítmény és a képességek napi
szintű működését befolyásolják (Chapireau és Colvez, 1998), mint ahogy
a pszichés tényezőket is teljes mértékben figyelmen kívül hagyta. Egy át¬
ütő erejű reformmozgalomnak köszönhetően (Thuriaux, 1995) született
meg a nemzetközi osztályozás olyan új változata (ICIDH-2), amely már
maradéktalanul képviselni tudta a biopszichoszociális modell szempont¬
jait, vagyis a betegségek és fogyatékosságok egyes dimenzióita személyi¬
ségvonások és a társas-fizikai környezet közötti dinamikus kölcsönhatáseredményeiként jelenítette meg.
Az újváltozat végleges formájábanaz ICF(InternationalClassificationof Functioning-A működés nemzetközi osztályozása;World Health Or¬
ganization,2001) elnevezést kapta. A terminológiai módosítás nem egy-
szerű nyelvészeti koncepcióváltást, hanem valódi szemléletátalakulástgészség aktuális állapotát konstruktív.
ii ,
Kultúra és egészség
E˙kultúrközi (Dasen, Berry és Sartorius, 1988) és a természeti népekreirányuló kutatások (Kim és Berry, 1993) azt bizonyítják, hogy az em¬beri test és megbetegedései társadalmi reprezentációja az adott kultúranormái és hiedelmei szerint alakul. Az egészség társadalmi reprezentá¬ciója és viselkedéses modelljei betegségről betegségre, kultúráról kultú¬rára változnak. Wallander, Varai, Babani, Banis és Wilcox (1988) többolyan intraperszonális, interperszonális és környezeti tényezőt azonosí¬tott, melyek még a krónikus betegségek következményeit is befolyásol¬ják. Egy, az indiai gyerekek egészségi állapotára irányuló kutatásábanSaraswathi (1992) kimutatta, hogy egy gyermek testi és lelki növekedé¬st jelentősen befolyásolja mind a (természeti és kulturális) környezet, a
'ttaládszerkczet (összjövedelem, családtagokszáma és kora), mind pedig82 anya helyzete (kora, foglalkozása, iskolázottsága, családban betöltöttszerepe). Tripathi és Agarwal (2000) a krónikus betegségben szenvedőindiai gyermek életminőségét vizsgálva megállapította, hogy fizikai ésPszichés fejlődésük alakulása elsősorban édesanyjuk attitűdjétől, hie-
a szoc
jelez. Fontosnak tartja, hogy az e
216 217
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