What exactly are murder tendencies

Rehistorization as the destruction of action technology27 “Every person with a mental handicap is a human being enjoying the right to respect for his human dignity. All mentally handicapped persons have the same fundamental, civil and political rights as other human beings. "(Inclusion International: Fundamental Principles of Inclusion, Principle 1; Lachwitz 1998, 9)" Whatever decision we make will be unfair as long as how we do not take full account of the victim's view and do not give his voice full weight. Doing less is not only unfair, it is politically dangerous. «(Judith Shklar 1992, 203) 1. Mental disorders in mentally handicapped people From the 1960s onwards, the image of mental handicaps changed dramatically. In the context of new theoretical and practical approaches (Lurija's neuropsychological theory of intellectual disability, learning theory and behavioral therapy models, normalization), the classic image of almost uncontrollable intelligence deficits coupled with specific forms of "moral idiocy" dissolved into a more development-related perspective. Inhelder's (1968) application of Piaget's constructivist intelligence theory to the field of intellectual disability played an important role in this. Numerous empirical research has shown that mentally handicapped people go through the Piagetian levels in the same order, but at a slower rate. This view was increasingly differentiated through the detection of domain-specific differences between different subgroups of intellectual 181 27 Co-author: Nicole Mertens. Disability and in relation to the development of non-mentally disabled people. In Williams syndrome there are clear limitations of spatial analysis and synthesis, in Down syndrome slowness and impaired grammar acquisition form core areas of area-specific impairment, in autism it is the limited ability to develop a "theory of mind", i. H. the ability to empathize with other people. In the context of such research and a social practice aimed at integration, the previously static and defect-related image of intellectual disability has increasingly changed. This also relates to the area of ​​social competence, which has always been considered from the outset at the same time as the intellectual disability. Correspondingly, today's diagnostic “disease judgments” (e.g. according to DSM III R, 1989 and IV, 1994) contain statements about intellectual deficits as well as simultaneous deficits or impairments of social competence. If both are restricted before the age of 18, intellectual disability must be diagnosed. The limitations in the area of ​​social competence were also increasingly understood as the result of development (cf. Holtz 1994). It was more difficult, and it is still evident to this day, to have psychopathological limitations such as B. to include aggressive and autoaggressive, depressive and hyperactive, compulsive and psychotic states in a developmental perspective. After all, it was these who, in addition to the image of backwardness, had produced the image of moral idiocy and psychopathic inferiority, and thus a perspective of intellectual disability that was always present behind the cloak of intellectual limitation (cf. Jantzen 1980). Moral nonsense, later translated into "psychiatric disorders" or psychological abnormalities, was regarded as the direct expression of a hard and hardly influenceable core of those natural processes that led to idiocy, imbecility and debility. It was only when problematic behavior could be changed through behavioral therapy that the hard core of natural deviance began to be called into question, which, like intellectual limitation, fatefully goes hand in hand with brain damage. Nevertheless, it would be a long time before constructivist views began to influence the development process of behavioral disorders and psychological disorders, and where they did so, until today they were by no means always at the level of the theoretical discussion that can be found outside the field of "intellectual disability" is. After all, from the mid-1980s onwards there is talk of a necessary dual diagnosis. This means making a psychiatric diagnosis in addition to the previous double diagnosis of intellectual deficit and social competence. In doing so, it should not be overlooked that the outsourcing of this diagnosis on the medical side should also take into account the differential use of psychotropic drugs, i.e. it was more an extension of the medical model to the area of ​​behavioral disorders in mental disabilities than a psychodynamic theory to orientate mental disorders 28. A turning point was the conference on "Mental Retardation and Mental Health" held in 1985 with the support of the Presidental Committee on Mental Retardation and published in 1988 (Stark et al. 1988). In its context and stimulated by it, it is not only the simultaneous diagnosis of psychological abnormalities and intellectual disabilities that receives significant impulses. The conflict between behavioral and more psychodynamic views that can be read there also breaks the previous dominance of behavioral strategies. Nevertheless, the naturalization of mental disorders in the sense of the immediate consequences of a defect is far from over. Obviously, it is difficult (1) to recognize that everything that was previously thought of as the consequences of an organic brain defect is a psychological construction in a changed relationship to people and the world. Because like blindness or deafness, a specific defect of the CNS also radically changes the relationship to humans and the world. And (2) it is evidently even more difficult to recognize that this other world for mentally handicapped people under the conditions of their greater vulnerability would already be a world full of violence, if not hospitalization, submission to medical, therapeutic and educational programs, accommodation in special facilities , Withdrawal of caregivers, etc. would be added in a serious way. If one begins to understand intellectual disability in this context as a relationship to the world that arises under conditions of greater vulnerability on the one hand and greater violent impact on the other, then the view changes radically (cf. e.g. Jantzen 1999b). This double problem is also evident in the debate about mental disorders in mentally handicapped people and their therapy. Christian 183 28 We do not fail to recognize the need to resort to medication under certain circumstances. The current practice, however, is still extremely crude and undifferentiated, if one compares this with the state of the differentiated scientific discussion (cf. e.g. Ratey 1991). Gaedt, a major protagonist of the debate about dual diagnosis in German-speaking countries, marks the point where the recognition of the changed world construction is advanced, but not the recognition of the specific and particular transactional relationships of open and structural violence, which from our point of view is the basis of the social construction are of intellectual disability. For Gaedt, it is the essence of mental handicap »that the mentally handicapped cannot deal competently with the given social environment. He does not have the ability in these complex structures to independently design his living space according to his needs, to organize his environment that is important for him, that is, that he understands ”(1987, 139). The decisive question of the way in which the capabilities of this world are restricted in relation to people who differ from their constructed normality is not asked. There is talk of a lack of integration ability, but not of social exclusion. The position of the English psychoanalyst Valerie Sinason, who sees mental disorders in the case of intellectual disabilities as the result of living in a world that sees mentally disabled people from a racist perspective not only as a tribe of poorer means, but also as a tribe, is quite different here Extermination is on the agenda (Sinason 1992). Insofar as this disposition, habitualized and institutionalized in the people of our society, as we would call it Bourdieu's sociology, is not reflexively broken, the desire for annihilation, wishing away, wanting to make invisible is constantly and everywhere in the social world mentally handicapped people present to them. And all too often this happens in the cloak of well-meaning care, one should add (Jantzen 2001d) In depth, Dietmut Niedecken, also standing in psychoanalytic traditions, states that intellectual disability is not an individual characteristic but as a social institution that only becomes apparent through specific processes of damage to » certain forms of interaction «becomes a subjective construction in social intercourse. Certain forms of interaction29 are products of action that arise in the interpersonal exchange between the child and the primary caregiver and ensure the possibility of safe interaction in the future. »Successful interaction products are characterized by the fact that they are consciously available at all times as symbolic, from the subject in his confrontation with the world 184 29 This term comes from Alfred Lorenzer's psychoanalytic and materialistic theory of socialization; see Lorenzer 1973. can be used playfully and reflectively, while damaged forms of interaction prevail behind the subject's back and often against his conscious intention with an apparent inevitability «(Niedecken 1998 a, 28). This takes place on the basis of the subjective socialization of the caregivers and the wider social environment in the »institution of intellectual disability«. This institution is brought about by three organizers: 1. The diagnosis, which acts as a "concrete in concrete" perception of self and others in the early mother-child relationship and at the same time guarantees relief from guilt and transforms social murderous tendencies (wishing away, etc.) into the unconscious (op ., 29). 2. Social phantasms that determine the child's development in the mother's imagination, e.g. B. the effect of the phantasm »mongoloid child«, which as a »monster« determines the perception that one's own child is (not) so »mongoloid«, and thus superimposes all actions as a dimension of wish and fear (op. Cit., 30 ; see also Niedecken 1998b, 25). And 3. "Finally, treatment technologies serve to set up the reality of the person being treated even more perfectly, as diagnosis and phantasms allow us to perceive" (1998 a. 30). From Niedecken's point of view, mental handicap is a social institution that leads to pathological changes in the exchange between child and world, as a result of which intellectual backwardness, social limitations and psychological disorders result. This does not mean that biology does not play a role, but rather that it is just as constitutively part of this process as the social conditions that are ever at work due to the changed relationship to humans and the world that it causes. Niedecken's consideration of an institution of »intellectual disability«, which prevents it from adequately meeting the dialogical, social and learning needs of the child and which at the same time makes this process invisible, not only marks the starting point for appropriate psychodynamic action and understanding . With the identification of the institution of intellectual disability, the social place becomes visible, the radical negation of which defines rehistoric diagnostics. 185 2. Some remarks on the problem of rehistoric treatment Rehistoric diagnosis is a method that was developed by us in the traditions of Alexander Lurija (cf. Jantzen 1994b, 1998b, 1999a, c; Jantzen and Lanwer-Koppelin 1996, Jantzen and Schnittka 2001) . The main question is not about the defect, but about the role of the defect in personality development. Correspondingly, the reified defect diagnosis is liquefied into a syndrome approach, as is very nicely expressed in the neurological stories by Oliver Sacks (1987, 1995b): What are the specifics of the changed human-world relationship, or expressed in Vygotsky, what is it other social development situation resulting from the impact of the defect? The application of this syndrome approach to life history does two things: it decodes the defect diagnosis as a reifying disease judgment, construction of a medical body detached from the historical existence of the disabled person, and thus clears the way for the dialectical decoding of the life process. For this purpose, solid theory is required, whereby we use a theoretical set of instruments which, although in many points reaches views comparable to psychoanalysis, differs significantly in other respects (cf. Jantzen 1987a, 1990). However, following Basaglia (1973), this ideological and dialectical decoding of the psychopathological history of the other is only one side of the perception of the reality of the mentally ill or handicapped person. The second aspect, that he is an excluded, an outlaw, is indispensable. Or let's say in terms of Bourdieu's sociology that he is so close to the pole of powerlessness in the respective "field of power" that he is part of a total institution within which his human and civil rights are no longer or only extremely limited Can be asserted. Niedecken's analysis of the institution of “intellectual disability” clearly shows that such a relationship in the “field of power” is constitutive for intellectual disability and by no means only occurs in large institutions (cf. also Jantzen 1997a, 2000b, 2001d). From this point of view, mental disorders would arise precisely where social disputes freeze in a "field of power" and, with the simultaneous breakdown of the dialogue, require mental solutions that restabilize the subject in situations of destabilization. In this regard, psychopathological constructions are constructions that take account of a changed social development situation through the maintenance of the self. In this respect, they are systematic and meaningful. At the same time, however, according to René Spitz (1992) in his psychological field theory of ego formation, they lead to luxuriant, i.e. H. I-kernels that are not involved in social dialogues and that are resorted to in times of need30, e.g. B. in the sense of autoaggression or aggression. The more this recourse becomes the only alternative through shifts in the "field of power", the more it occurs and is socially strengthened, as Goffman (1972) has worked out in the corresponding "looping" processes in total institutions. So when we speak of exclusion and ostracism, the mechanisms of overt and structural violence have to be taken into account, as well as those dimensions of violence that survive in the constructions of the self in the psyche and body of the subject. Rehistorizing diagnostics would fail to meet its concern if it did not fundamentally refuse treatment technologies, as these continually import violence into the social relationship of intellectual disability by creating the object character of the other. Rehistorization is always the unity of the negation of violence through recognition and dialogue and a thought movement which liquefies the reality of the mentally ill and handicapped person as an expression of a peculiar psychopathological history under the conditions of violence, and thus enables understanding. However, we do not go into the process of understanding, which has been presented in detail elsewhere (cf. in particular Jantzen 1999c). Rather, we are interested in the unity of diagnostics and dialogical action. As a report by Dagmar Meyer on the problem of "dissociation and intellectual disability" has just appeared from my work context (Meyer 2000), the story of a rehistoricization under conditions of aggressiveness, destruction, autoaggressiveness and "autism" will appear in the near future (Jantzen and Schnittka 2001 ), we have decided here to present a rehistorization in the context of severe depression. This is also of particular interest, as depressive state images form an essential part of the mentally handicapped people 187 30 Spitz (1972) speaks of the regression to fixation points that exist where the breakdown of perception, thinking and affect and at the same time broken dialogical Situation has already been dealt with once on an individual basis at a corresponding organizational level. diagnosed disorders. In a regional investigation in the Braunschweig-Helmstedt-Wolfenbüttel area of ​​1619 mentally handicapped people, 50 percent found clear psychological abnormalities.In the case of multiple answers, for the most part, it is a good half (26 percent) of all mentally conspicuous, mentally handicapped people whose behavior is classified as "depressive behavior, passivity, withdrawal"; (Gaedt et al. 1993, 152). In addition, Gaedt's conception of the psychiatric and psychotherapeutic approach to "depressive stagings", combined with a theory and practice of "structural care" and the "places-to-live concept", provides a theoretical and practical view that is alternative to our approach, we clearly differ from their ontological basic assumption (see above) (cf. also Jantzen 1999d). However, we will not go into this conception in the following (cf. the detailed critical discussion by Cheong 1999), but merely present our own approach. 3. Syndrome analysis of depression Recent studies on the neuropsychology of depression suggest that the old separation of reactive or neurotic and endogenous depression is no longer justified. (Aldenhoff 1997). The core problem with depression seems to lie in fundamental changes in the stress coping mechanism, for which the hypothalamus, pituitary, and adrenal cortex axes play the main role. With depression, but also with post-traumatic psychosyndrome, there are specific changes in the stress management mechanisms of this axis (cf. also Graham et al. 1999, Post et al. 1998). The state of great depression is characterized by an overactive corticotropin (ACTH) releasing hormone CRH (CRH overdrive). This corresponds to an overactive phase 1 of stress management according to Selye's model, the activation phase. At the same time, there is a pathological change in phase 2, the adaptive stress reaction, due to the reduced ability to adaptively adapt to stress conditions. The transition to this phase takes place through the formation of cortisol. It is required for the formation of corticosteroids, which lead to the breakdown of CRH overproduction. In depression, corticosteroids are not released because there is a reduction in specific receptors, the glucocorticoid receptors in the hippocampus. This area is of great importance for the perception of one's own situation in the world and thus for the development of biographical memory (cf. Squire and Kandel 1999). As a result of the changes in phase 1, weak stressors act as strong stressors in depression, which increases fear. At the same time, changes in the glucocorticoid receptors lead to significant cognitive deficits. Accordingly, one's own situation is presumably perceived as helpless, which in turn increases the stress level. This is a dead end from which one cannot escape by one's own means. 31 If one now examines other disorders of the HHN axis, the first thing that is noticeable is posttraumatic psychosyndrome (PTSD). With him we find a distribution of functions that is inverse to that of depression: the CRH system does not show any “overdrive”, but rather a damping of the cortisol system with a simultaneous increase in the glucocorticoid receptors. In stress theory, this means the change from previously strong stressors into weak stressors with a higher level of adaptation. This would correspond to the behavioral trias to be found in PTSD of (1) hyperactivity combined with (2) dissociation, i. H. emotional neutralization of noxious events, as well as (3) the process of intrusion, the unexpected reliving in the form of flashbacks, which can be reactive or autonomous in nature (cf. Herman 1993, Putnam 1997). Post et al. (1998, 830) compare them as emotional attacks with epileptic convulsions of the motor system. They take place on an altered neuroadaptive background of overexcitation on the one hand and depression, confusion and dullness on the other. Such processes also lead to the destruction of cell substance in the hippocampus, a process that can also be observed in early childhood deprivation 32, where the relationships are on the HHN axis 189 31 Both antidepressants and short psychotherapeutic therapies show extremely clear effects, with psychophysiologically verifiable effects in psychotherapies Changes occur. Since at the same time it must be assumed that genetic factors can be predisposing for the development of acquired helplessness, the situation arises that the psychological level acts back on the organic level, just as the organic level can already be genetically predisposing in the sense of greater vulnerability (Aldenhoff op O.). 32 However, there are opportunities for regeneration even in adulthood, as the more recent research literature impressively shows, provided that traumatic situations are dealt with accordingly or stable attachment processes are rebuilt by the environment (Post et al. 1998, 839f.). however similar to depression and not PTSD. This leads to a reduction in CRH receptors with unchanged CRH release, which also leads to the perception of weak stressors as strong stressors. On this basis, "biological scars" arise, which, according to Aldenhoff's depression model, increase the vulnerability to later noxa. This view is largely supported by the empirical literature. Children who are deprived early also show massive attachment problems long later, e.g. Sometimes different at home and in the public education of small children with a corresponding release of cortisol at the same time (Graham et al. 1999, 558). Aldenhoff therefore assumes that early trauma and depression cause biological noxa (increased vulnerability can also be genetic or caused by viral diseases, among other things). This "biological priming" can be reactivated after a latency phase through social events such as deprivation, grief, loss and in the event of a lack of emotional-cognitive processing. After a new, second latency phase, there may be a separation of emotional-vegetative and cognitive parts, thus a psychobiological stressful situation due to the perception of one's own helplessness and finally great depression. Against the background of these considerations, one would expect a relatively high rate of disorders of stress processing in the sense of depression or PTSD, especially in the population of disabled facilities, especially when they take in the corresponding people as small children, due to the massive symptoms of depression and experiences of violence allowed to. On the basis of Niedecken's considerations and the experience with dehospitalization that the downsizing of facilities does not necessarily mean de-institutionalization, corresponding rates can also be expected outside this range. The following story, which comes from the context of advising a large institution, reads like an illustration of the previous one. Both authors were involved in different ways: Wolfgang Jantzen through a corresponding specialist advice in spring 1997, Nicole Mertens as a freelance worker from June 1997 with two three hours a week in the group of Mr. M., who is now being discussed. 190 4. Phantasms and rehistoric diagnoses using the example of Paul M. At the time of the specialist consultation, Mr M. was still one of the "monsters" created by the institution itself. Born in 1961, in the facility from 1965, escalations such as running away, destroying the room furnishings, auto-aggressions occurred again and again from the mid-seventies and increasingly in the eighties, so that in 1994 she was transferred to the closed department of a psychiatry. “He had to be picked up here after three days because he hadn't left any clothing on and had started to seriously injure himself in the calming room by inflicting wounds on himself. Back at the facility, his behavior was immediately reduced to the previously known behavior pattern «, according to a development report from August 1996. The problems escalated again, with the destruction of a listed toilet in the neighborhood undoubtedly the public highpoint33. Reading the files gave the following picture: Paul M. comes from a socially disadvantaged family, later in the files the mother is once said to be "weak-minded". At the age of 1.5, he came to a DRK infant home in Lower Saxony, with signs of righteousness and in a state of undersupply, "an extremely calm and disinterested child." At a little over two years old, he sits free and stands with support. At 2.5 years of age he has hardly changed, lies on the floor for hours and "howls"; When he was three years old, there was a lot of crying again: "He is now lively and mostly happy." Nevertheless, at the same time as the diagnosis of cerebral damage and moderate nonsense, another placement is requested from the insurer. Shortly afterwards, the diagnosis "Debile!", Marked with an exclamation mark in the ongoing file, takes place. After that there are only a few entries about the development. At the age of 3.7 (early 1965) "now runs alone, repeats a few words", in mid-1965 "lies or sits on the floor and wobbles back and forth". In a letter to the cost bearer it was said shortly beforehand: "In interaction with other children he proves to be completely incapable, remains in heavy monotonous movements for half an hour" and shortly before the transfer to the large institution "is now livelier again and plays with the 191 33 Events of this kind greatly impair the "symbolic capital" of an institution, especially if, as in this case, it is located within a small town. other children «. During the entire period in the nursery, he was clearly underweight. Already here there is an inseparable structure of severe deprivation, withdrawals of depressive mood and a strongly hospitalizing environment, within which Paul produces typical symptoms of the hospitalism syndrome. In the large facility, he finds himself in a particularly favorable situation in his group as “the little one” and is pampered by the staff. A note on the file at the age of 6.5 indicates that stereotypes and autoaggressions as well as earlier rather autistic behaviors have further diminished; this suggests a much deeper disorder than was expressed in the ongoing notes of the children's home. An IQ test at the age of a little over seven years gives a value of 50; a closer look at the problem solutions shows that out of ten problems in age group V, he still solves five correctly. Mainly, he fails in all tasks that are particularly sensitive to cultural deprivation. Incidentally, he never goes to school, but there are a number of internal support measures and, at the age of 30, a two-year adult education measure implemented by the adult education center for facility residents who do not attend school. At the age of nine he tries to get out of the role of the little one in the group. In the meantime, he can close buttons, but cannot yet tie any bows. At the age of ten he begins to speak grammatically correct in the form of multi-word sentences, he is fearful of anything new. At the age of eleven he knows all colors, can find his way around matching games without any errors, knows the numbers from 1 to 5, but without a number concept. In free play he is on a much lower level and "if left to his own devices, drives a car back and forth in a stereotypical manner or touches and fingers a squeaky doll without finding any beginnings in a real role-play game." Due to early childhood deprivation and disturbed attachment, it is less in the area of ​​practical intelligence than in particular in the area of ​​dialogical intelligence34, i. H. in dialogue with oneself as another, clearly impaired. Or let's say it psychoanalytically with Winnicott: The construction of a safe inner space is considerably disturbed with him. A little later, for the first time, it is said again that, as cognitive development progresses, aggressiveness with tendency to occur again and again. 192 34 Cf. on these terms, which Wallon introduced into psychology, Voyat 1984, chap. 12. gene leads to considerable self-harm. Later at the age of 13 and again at the age of 16, he cannot pay attention to the lines when sawing frets in the institution's support or working groups and shows a noticeably strong desire to destroy things, although at the age of eleven he was quite able to walk along lines to cut. More and more problems arise, each of which is closely linked to the change of living group. From 1970, when he was nine years old, he was in a group with rather weaker groups, within which he tried to assume the dominant role. But since the aggressions and autoaggressions increase there and he suffers from it on the one hand, and on the other hand she takes over problems increasingly arise. He tries to dominate the group and is regulated with drastic penalties. His aggression and auto-aggression increase dramatically; the situation becomes untenable. From 1976, now 15 years old, he was moved to a more efficient living group, in which he met some "big ones" from his first group and found himself again in the situation of the "little ones". On the one hand, according to a rehistoric report by the institutional psychologist from 1989, this opens up new possibilities for him, on the other hand, it again restricts his development "towards greater personal autonomy and self-assertion." After another move to another house and partial re-staffing of the living group, the employees hardly noticed an increasingly strong withdrawal from Mr. M. At the turn of the year 1979/80, he is now 18 1/2 years old, »he lies motionless in bed for days and refuses any activity. The suspicion of an incipient depressive stupor is expressed «, says the psychologist. In the other files, there is talk of a catatonic stupor, combined with refusal to eat, which occurs again and again over the years, but which "can be controlled with medication," according to the corresponding medical reports up to 1985. Corresponding to the development model by Aldenhoff (1997 ) However, this means that after the second latency phase, major depressions have repeatedly occurred over the years. In addition to the medical diagnosis of "catatonic stupor with refusal to eat" from 1981, the diagnosis of "generalized tics in the sense of a Gilles de la Tourette syndrome" was added in 1985. Once, in 1983, there was an epileptic seizure that was never repeated. Only the EEG recorded immediately after the attack shows a lesion on the left frontal-precentral and parietal. In terms of location, this corresponds to the change in cortical functions during depressive processes and suggests that this unique event should be understood as the result of severe stress. After moving again in 1982 and 1988, the group is concerned that the 193 depressive stupor could repeat itself. The psychologist writes the rehistoric report already mentioned, which remains largely without consequences. For a few more months she herself works once a week with Mr. M., after which she leaves the facility. The years until another serious crisis, which leads to recourse to psychiatry, are bridged positively by working in the "learning group" in adult education at the adult education center from autumn 1990 to 1992. At the same time, the large facility is increasingly in a serious crisis is reflected at all levels and of course down to the situation of the individual residential groups (cf. Jantzen 1999d). In addition, in the fall of 1993 the group moved again from House B, which Mr. M loved so much (this is also the place where his long-time group leader ended her service at the facility). The group is promised to withdraw later, but this is no longer possible due to renovation work. In the new environment the situation escalates more and more, after the stay in the psychiatry the problems persist. In 1995 and 1996, competent specialist advice was obtained from abroad, during which a renewed and clear attempt was made to rehistoricize. Mr. M. »can do a lot and persistently when he knows that he can fall back on someone. However, if no one is available to him, the situation for Paul is decidedly different; because if one also accepts the assumption that Paul has to be assessed as manic-depressive, he can always feel comfortable and secure when other approachable people are available «, according to the protocol of the specialist advice from 1996. And again any suggestion melts away into another Practice in everyday institutional life, although the development report from 1996 claims: "The educational care concept has been changed." A year later, there is little evidence of this in the specialist advice provided by Wolfgang Jantzen, in which Mr. M. now also participates. For the first time it is noted and recorded in the protocol what he himself has to say about all of this: "Paul does not want to move anymore". It is clear that Mr. M. is in no way able to process separation experiences and repeatedly confuses the past and the present. In such situations he reacts with aggression, auto-aggression and the destruction of his room. Noteworthy is the statement made by an employee from the garden group, in which Mr.M.works regularly: "Many promises were made to Paul, but they were not kept" and "One could not think in individual actions that you are doing something well that is not related to the other activities." As a result of the specialist advice, noted that Mr M. needs the opportunity to grieve. This results in a number of instructions and tasks for the employees. They would fizzle out again if the group were not supported to reorganize (cf. also Jantzen 1999b, e). Without massive additional substantive and emotional support, residential groups cannot be expected to operate a different practice. It is completely illusory to expect the introduction of new support concepts through mere specialist advice or by stipulating a reorientation in development reports. Since it was part of Wolfgang Jantzen's arrangements with the management to use graduates of the disability education course at the University of Bremen to support groups on a fee basis in very complicated cases, Nicole Mertens began working in the group in June 1997. Nevertheless, the situation was still problematic for a long time due to tensions between the group and the group management. It was also symptomatic of the situation that the joint discussion of the problems with the home management, which had been promised several times, was not implemented by them. This situation only began to stabilize with a new group management shortly after a last move in October / November 1997. What does rehistorization mean under the real conditions of a large facility, within which every rehistoric diagnosis disappears again and again like water in a dry sponge? It is true that the defect diagnosis was fundamentally questioned in the psychological report from 1989 and again in the specialist consultations in 1995, 1996 and 1997, and we began to work on the phantasms in our own heads. However, these return all too quickly in everyday life. The third and decisive aspect, that rehistoricization basically means opening the "field of power" in favor of the excluded and at the same time creating a situation of mutual dialogical recognition, only comes into play through the radical deconstruction of the third aspect of the "institution of the mentally handicapped" , by destroying treatment technology. 195 5. Rehistorization as the destruction of treatment technology The initial situation The work of Nicole Mertens, which we reproduce in the following on the basis of the detailed work report she has just written, began at a time when Mr. M. was in very bad shape. He destroyed a large number of panes of glass inside and outside the facility, tore power cables from the walls, was highly auto-aggressive and, according to the employees, was massively self-endangered by his actions. According to the employees, the reason for his aggression was seldom apparent. For them, his behavior was mostly expressed without any visible connection. He often left the living group without prior consultation, and tampered with buildings within the facility with various tools that he got on his walks. Paul M. went outside the premises to private houses, often in unlocked garages, and destroyed various things there. In a short period of time he caused so much damage that measures to support him were necessary. A crisis meeting revealed that one of the most important points of the past is his close bond with residential buildings, especially with House B. It became clear that he had already moved within the facility (eleven times up until then, the last and twelfth move was at the end of 1997). and thus was repeatedly separated from buildings, employees and residents without a separation having been prepared and processed accordingly. These breakups can be seen as breakups that have severely traumatized him over the years. Paul M. never got the opportunity to say goodbye and to mourn a move or departure of employees. He did not get to know how to actively understand changes because he was not given the opportunity to do so. His trust in caregivers and the security and reliance on a continuous everyday life has been destroyed again and again over the years. Because of this, Paul M. is difficult to accept rejections from employees without perceiving them as a fundamental devaluation and devaluation of his person and a break in the relationship. In the course of time, due to deep emotional injuries, he has created a world of his own, into which he repeatedly plunges. He isolates himself from the outside world and is difficult to reach. His images, his experiences and his own language exist in his own world. Help from outside is necessary, where he makes his suffering transparent and sends signals, in his desperation, through whatever expression, turns to his personal environment. We would like to describe our understanding of Mr. M.'s traumatization phenomenologically as follows: »The trauma has become deeply buried and has seized our soul and psyche and our body. It has left scars that have not yet healed and can break open again and again. When they break up, the horror comes to light, to the surface, sometimes clear, often covered, distorted, in single shadowy images, torn, the pain, a thought, a face, a feeling, the reliving of the terrible, the need for it no longer having to feel, think and experience, wanting to let it rest, let it be forgotten, repress, extinguish, as it was not, did not happen, and yet, it pushes up, cannot be buried, moves out the deepest depths to light, vent, finally want to be recognized, named and understood, express the pain and let go, finally let go and work on, the horror, the destruction, endless tears and sadness and then [...] become whole , to be healed «(Mertens 1996, 5). Two focal points emerged in the work: On the one hand, this was the visualization and processing of the traumas experienced. We illustrate this using the example of saying goodbye to House B. On the other hand, it was about the everyday situation in the living group and in the facility. Farewell to House B We quote from the work report: »As mentioned above, there is an important relationship between Paul and House B [...] Since this house has been empty since the group moved out in autumn 1993 and is probably about to be demolished, Paul and I went there once or twice a week. We took tools with us and Paul began to actively contribute to the demise of the house. He dismantled sinks, window sills and toilets, unhooked doors, tore out floors, removed nails and hooks, etc. It was and is important to maintain contact with him and, if possible, not to tear it off. During the visits he told bit by bit about his life there, about memories and about employees and residents at the time. Through specific questions on my part, he began to open up more and more and to show his sadness and pain. It was always of central importance to remain in dialogue, not to evade and participate in what was repressed, but to endure and actively support the pain. Since Paul's behavior pattern lies in submerging and retreating, it was important not only to convey understanding and sympathy on the verbal level. I have it from the start, e.g. B. stroked his back, held his hands during auto-aggression, stroked his injuries and offered him my hand as a support, conveyed an intrinsic value about the body. Paul is unable to get physical attention on his own, but has always enjoyed receiving physical attention. If he didn't want to, he made it clear. Paul was always looking forward to the visits to House B. At the beginning, the end of the visit on the respective day was difficult. For the most part, he was so absorbed in his work that I had difficulty getting him to go home. Then a few times he started to become autoaggressive (stamping his foot, screaming, throwing his head back and forth, beating himself). However, he calmed down very quickly after I explained that we only had a certain amount of time available for the visits, which we had to adhere to. I made it clear to him that we could go to house B as long as he wanted. Thus he had the orientation and security of continuity and being personally involved in the activity, in the process. It became clear that he needed more time to get used to the way home. So I started preparing him for it half an hour before the end of the visit, which worked very well. We brought a camera with us and recorded his activities as he wanted to show the other residents his work. He was very proud of this work and repeatedly emphasized that he was helping. The staff told me that he talks a lot about our visits and describes his own actions. After a short time Paul expressed the wish to hold a "funeral party" in house B. I promised him that we would find a way to close House B. The process ended at the end of October. We celebrated the farewell with milk and raisin bread and Paul went into every room and said “Bye” and at the end put a flower he had brought with him into his former room. All in all, from the beginning to the end of October 1997 we were in house B once or twice a week. Paul consciously “said goodbye” for the first time. At times he proudly says that the time in house B is over and that he helped to prepare the demolition of the house. Since that time there have been no more incidents of destruction. «198 Work in everyday life Parallel to the work in house B, the aim was to stabilize Mr. M. emotionally in everyday life, to accompany him and to create an atmosphere in the living group that on Trust, security and acceptance are based. It was and is of central importance to create an understanding of the employees' mental state and behavior. Here, too, we quote the report: “The bond with the living group was very poor at the time I entered. Paul sometimes came to dinner on time, but now and then he didn't come at all or at a later time. He was leaving the group more and more often without prior consultation and had to be looked for in the evenings. Due to the high damage that he caused inside and outside of the premises, he was no longer allowed to go outside unaccompanied. Paul became a professional at escaping. He found ways to leave the group that the staff couldn't always identify. Like a prisoner, he systematically found ways to get out of the house. He removed the window frame with a knife, got the key from employees, tested every window for security and used every moment when the front door was not locked. This time was very bad for him, as he has probably been punished with imprisonment very often in the past and this explains his strong urges to the outside world. During the time he was in the group, various stereotypical behaviors became apparent: Paul very often withdrew to his room and began to rearrange the furnishings over and over again. He changed several times a day, went to the toilet at short intervals, turned on himself, rocked his torso back and forth, stood up while eating and sat down again, etc., moved the chairs back and forth and repeated certain words. Paul kept tearing his clothes and stuffing them in the toilet. He also went to other rooms and took clothes there, and hid or destroyed them. He dismantled the furnishings of his room, the doors and windows. He fought frequently and slipped into his own world. He was staring somewhere and you had the impression that someone was following him. Paul couldn't make eye contact. He expressed his condition in the clearest possible way, e.g. B. in desperation during his auto-aggression screamed “I can't go on”. We deciphered his behavior and his misery bit by bit and tried to get him out of his crisis. Each time I asked him what he wanted for the time we had together. We went to the café, to the ›Mausefalle‹ 35, took walks and excursions to Bremen, went to events, went out to eat and visited other groups on the premises. In all the activities, I gave him feedback on his appearance. Encouraged him to put on a clean sweater before we left. Let him know how happy he was when he looked good and his scars on his face had healed. But also told him if, in my opinion, his appearance could look even more appealing without devaluing him personally. At the end of 1997 the group moved one last time and it was time to actively organize this move. Before moving, we went to the new house a few times and looked at everything. On the day of the move, Paul and I went out with the handcart and brought the part of his furniture that he could pack onto the wagon into the new group. This gave him the opportunity to actively experience a move for the first time. In the new group he was allowed to choose the color of his room himself and we drove off and bought furniture for the room, which he chose himself. So far, Paul has had no relationship with property, neither with clothes nor with personal furnishings. In the course of time he repeatedly destroyed his things in crisis situations, but over time he learned to deal with them differently. After a short time in the new home, the group management changed. A positive way of dealing with the residents developed and the group climate improved increasingly. The whole frame of reference stabilized so that Paul also stabilized and was able to find his position in the group. ”So much for the report about the first period of work. How does it look today, two years later? Autoaggressive behavior no longer occurs in everyday life. Very rarely does he stamp his foot when he doesn't get something. However, this situation can be resolved immediately by dealing with him appropriately. Mr. M. has opened up very much to his environment. He shows his joy and keeps eye contact and turns to the staff himself every now and then if he needs help. He is allowed to go outside unaccompanied and mostly adheres to agreements. He can deal with rejections much better. He no longer necessarily relates them to his person and thus no longer experiences them. 200 35 Leisure home and disco for the residents of the facility. inevitably as devaluation and devaluation. Mr M. now pays great attention to his appearance, and his relationship to things that belong to him has changed in a positive way. At Christmas 1999 he called his group home for the first time. If we were to simply breathe a sigh of relief because of this happy outcome, because we had made the correct diagnosis and the wrong one had previously dominated, we would again fall back into a reified relationship between diagnosis, phantasm and treatment method. The "correct diagnosis" would have scared the phantasm away, but the thought that Paul was a "monster" would still be on everyone's mind and would come back as soon as he felt bad again. By then, at the latest, our approach would again be deciphered as not so appropriate. And in this view it would be reduced to a mere method of treatment, a means of warding off our own pain through our failure. But none of this would have anything to do with rehistorization. 6. Rehistorization means the renouncement of transforming people into things Rehistorization takes place within the »institution of intellectual disability«, of which we are part, and within social institutions that deal with social »irrationality «Were created (cf. Basaglia et al. 1980). Its object is not the respective individual at the pole of powerlessness, but the social situation within which this individual is shifted to the pole of powerlessness and reified as an object. In this respect, the core of every rehistoric approach is to keep the "field of power" open and to give the excluded and internees the opportunity to exercise their human and civil rights. This is the reason why rehistoric diagnostics include internees in the dialogue from the outset and make their answers the starting point for one's own thinking. A rehistoric approach means opening up the “field of power” and keeping it open from a “decolonization” perspective (Dörner 1999, 37ff.).Dörner (1998, 519) formulates a kind of “relationship ethical imperative” in this respect: “Act in your area of ​​responsibility in such a way that you can use your always limited resources of passivity, sustainability, substitution, strength, time, manpower, attention and love 201 always start with the weakest, where it is least worthwhile. This is - mind you - a norm that only becomes effective in the knowledge that no one can always fulfill it during his lifetime. ”With reference to Mr M., the work report concludes:“ In everyday dealings with Paul, stable and reliable relationships are essential. It needs a structure and a constancy on all levels. Since he is an introvert, he needs to be approached from outside. It's important to keep in touch with him and realize when he needs support. Crises will reappear at certain points when multiple events come together. The important thing is not to leave him alone, but to get through the crisis together. At this point I would like to emphasize that Paul took a great many steps and his suffering has changed. It is very important to acknowledge this and not to fear that your old behavior will repeat itself when a crisis arises. A trauma does not just go away, even when a lot has changed and one has made progress in its development. When Paul gets the message that he can definitely rely on caregivers who do not isolate him, but who value him, who respect him and accept his behavior, who respect him and who do not care how he is doing, then crises always occur become rarer and shorter. The more self-confidence and self-esteem Paul gains, the less often he will fall back on stereotypes and autoaggressions. "But what can one do about one's own and social phantasms that repeatedly suggest a chronic, untreatable" hard core "? We can only repeat the answer that Antonio Slavich gave in 1983 in Wuppertal at the DGSP conference on the »myth of the hard core«: »I believe that above all one has to have the strength to endure the fear oneself that the persistent Problems of a person who is affected by the therapeutic process can last for a lifetime without being defined as 'chronic' «(Slavich 1983, 36). 202