Features of social adaptation of a young disabled person. The situation of disabled people in the labor market Features of social adaptation of disabled people with various diseases

Disability in modern society

Disability is specific features of the condition and development of the human body, accompanied by limitation of life activity in various forms.

Note 1

Social adaptation of disabled people is a set of measures that provide for the restoration of lost or previously destroyed relationships and social connections as a result of disability.

As a rule, this socio-demographic group of people has limited educational opportunities, low income, problems in starting a family, and self-realization. Many people have no desire to engage in social life and have lost interest in life. The lack of sufficient practical skills in independent living leads to the fact that they turn out to be more or less a burden for relatives.

Achieving the goal of social adaptation of people with disabilities is based on rooting in the public consciousness the idea of ​​equal opportunities and rights for people with disabilities. There is a need for a transition from segregated types of assistance (in the form of special institutions) to methods that allow people with disabilities to be in the center public life.

A powerful factor in the adaptation process is the relationship between healthy people and people with disabilities. In general, in society there is an unpreparedness of many people for situations in which the capabilities of disabled people are realized on an equal basis with healthy people, for close contact with disabled people.

Relationships between healthy people and people with disabilities should be based on the responsibility of both parties for these relationships. However, many people with disabilities lack the ability to express themselves in the process of communication, have insufficient social skills, and they cannot always correctly assess the nuances of relationships, perceiving the people around them somewhat generally. Relationships are often difficult between disabled people.

Note 2

The main indicator of socio-psychological adaptation of disabled people is their attitude towards their own lives. results sociological research showed that almost half of disabled people rate their quality of life as unsatisfactory.

The process of social adaptation of disabled people is currently difficult because:

• low life satisfaction is observed;
• there is negative dynamics of self-esteem;
• there are significant problems in relationships with others;
• the emotional state is mainly characterized by uncertainty about the future, anxiety, and pessimism.

Types of social adaptation and its diagnosis

Main types of social adaptation of disabled people:

1. Actively positive. Disabled people of this type have high self-esteem, a favorable attitude, energy, optimism, independent judgment, and they independently look for ways out of unfavorable situations.
2. Passive-positive. For disabled people of this type low self-esteem, lack of desire for changes and changes in life, the situation in which he is completely satisfied.
3. Passive-negative. Disabled people are dissatisfied with their situation and have no desire to improve anything. Such people are characterized by a wary attitude towards others, psychological discomfort, low self-esteem, and the expectation of significant catastrophic consequences from minor failures.
4. Active-negative. There is dissatisfaction with one's own life, psychological discomfort, there is a desire to change the situation for the better, but, for a number of objective and subjective reasons, there are no practical results.

IN modern world Methods are widely used to determine the level of socio-psychological adaptation of disabled people. For example, the questionnaire by K. Rogers and R. Diamond diagnoses the characteristics of social adaptation. It includes 101 statements, each expressed in the third person singular to avoid the influence of direct identification.

Sociality is a determining factor in physical development disabled person To perform any social role certain physical qualities are required. The more difficult social activities, the higher the differentiation of the manifestations of physical parameters is needed.

In the modern world, the formation of society involves the education of individuals with high intellectual and physical performance, comprehensively harmoniously developed. For this purpose, methods are being developed and implemented in which the object of research is the levels of social adaptation of individuals.

Problems of social adaptation of disabled people

The problem of social adaptation of disabled people is one of the most important aspects general integration problem.

The essence of the problem of social adaptation of disabled people is determined by economic, legal, industrial, psychological and communicative features of interaction with environment. The most serious aspects of the problem are associated with the emergence of numerous barriers that do not allow people to actively participate in the life of society.

All the needs of disabled people can be conditionally designated as general - characteristic of all citizens and special, consisting in the restoration of impaired abilities, communication, movement, restoration of access to cultural sites, objects of social and domestic and other spheres, the opportunity to study, find a job, have comfortable living conditions, receive socio-psychological adaptation, etc.

Social adaptation of disabled people involves solving the following problems:

• obtaining equal opportunities for disabled people with other members of society;
• protecting the interests and rights of people with disabilities;
• integration into the social environment;
• informing society about the implementation of measures social protection disabled people and their situation;
• formation of positive public opinion.

Social adaptation of disabled children

Due to limitations in adaptive capabilities, disabled children are the most problematic group in terms of social adaptation.

Note 3

The main reasons for the difficult adaptation of children with disabilities include: lack of physical and mental health, unfavorable material and economic situation, limited social experience.

As the number of children with disabilities around the world is steadily increasing, there is a need to effective measures on their adaptation to life in society. The problem of social adaptation of disabled children has social, political, economic, moral and ethical significance. It is necessary to provide children with disabilities with the opportunity to participate in the life of society in accordance with their age.

Social adaptation of disabled children has its own specific characteristics, which must be decided on state level using the latest developments of doctors, teachers and psychologists.

Successful social adaptation allows disabled children to more quickly adapt to a full life, restore their social significance, and increase humane tendencies in society.

Psycho problem social development disability in the family and society remains one of the most difficult problems social psychology. Both the disabled person and his family suffer psychological trauma.

If a child is born with cerebral palsy, there is high risk parental (including maternal) rejection, distance and aggression. The appearance of such a child in the family threatens marital relationships and can negatively affect the psychological state of other children in the family.

Blind babies cannot follow the facial expression of the person caring for them and smile back.

The behavior of deaf children can be mistaken for disobedience.

Children with other serious disabilities are unable to respond to signals from the outside world in the same way that healthy children do.

Obvious deviations in children that are noticeable from the moment of birth, such as Down syndrome and cerebral palsy, create considerable adaptive and psychological difficulties for all family members, especially for young parents. Teaching these parents and other family members patience and communication skills with a sick child facilitates parent-child dialogue, attachment formation, and all subsequent socialization.

The little man was born disabled... Valid- translated from English - “having force.” Disability is “lack of strength,” if translated literally. It sounds like a verdict... However, this verdict cannot be considered final!

During the neonatal period and infancy, a disabled child feels pain and discomfort (inconvenience). The ill health of a child often causes parents to abandon him...

But man is a rational being! Parents are obliged to cope with their feelings about the birth of a “flawed” baby, take control of the situation with their conscience and begin to care for the baby. This is very difficult.

In such a situation, the support of a group of parents raising children with disabilities can significantly help. Valuable advice from parents who find themselves alone with the same grief is very important.

What problems does a family with a disabled child face?

It is important to consider several aspects of the problem:

1. Firstly, this is the mother-sick child relationship;
2. Secondly, mother - sick child - father;
3. Thirdly, a sick child means healthy children;
4. Fourthly, mother - healthy children;
5. Fifthly, a family with a disabled child and other relatives;
6. Sixth, the family with a disabled child and society;
7. Seventh, a constructive decision to create an association of families with disabled children.

Life, of course, poses many other questions to these families, but let’s consider the problem specifically in socio-psychological aspect.

The family was faced with a fact: there was a disabled or seriously ill person in the family.

Relatives are oppressed by feelings of fear, guilt, and depression; disappointment, as well as rage caused by the intractability of the disease problem itself. These family reactions are not aberrations, but normal human reactions to a situation that is extremely complex, frustrating, incomprehensible, and clearly beyond their control.

The family in this case faces objective and subjective difficulties.

1) Objective: high cost of medicines and treatment, i.e. increased family expenses, disruption of the rhythm and order of family life, additional stress on healthy family members.

2) Subjective: various experiences in connection with the illness of a family member (grief, guilt, despair, fear), i.e. emotional reactions(stress).

The load between members of a family that includes a seriously ill or disabled person is distributed like a “layer cake.”

First, inner, layer- this is usually one person (mother, grandmother, etc.) - the family member who takes on the role of the main “guardian” and who bears the brunt of everyday care, maintenance, and upbringing. The life of this family member is entirely focused on the patient: day and night he thinks about the needs and wants of the patient, takes care of their satisfaction, and the comfort of the patient.

This family member is reading medical articles, visits the doctor, communicates with similar families to learn something useful for his patient. More than other family members, this pecun suffers from all fluctuations and changes in the disease, from any deterioration. It is he who “bores” the attending physician and social workers - he goes into the details of treatment, into little things, and accuses others of inaction.

His life is a continuous stream of affairs and thoughts related to the patient. And the worse things go for the patient, the more activity is required from the caregiver. There are frequent cases when the mother of a disabled child is so “busy” with his care that it becomes a threat to the existence of the family as a whole. The husband and other (healthy) children feel an acute lack of attention, participation, and sometimes even obvious aggression on the part of the mother: the woman accuses her family of not paying enough attention to the patient, and there is a constantly painful atmosphere in the house. There is a rift between the primary caregiver and other family members. There is no cohesion - the family collapses.

The deterioration of the patient's health worsens the situation in the family. Here it is very important for the rest of the family to understand that for the mother this sick child is of paramount importance, it “dominates” in her brain as the most important thing.

The rest of the family members "second layer of layer cake", they manage to “deviate” from the painful home atmosphere at work, study, communicating with friends, etc. They seem to create a “protective barrier” from this traumatic situation, they run away from this painful atmosphere. In such families, the joy of life often disappears, and grief takes over.

How can we positively resolve this situation?

Let us give an example from the practice of one of the Centers for Social Adaptation of Disabled People.

A young woman, mother of two children: one girl is 7 years old, the other girl is 1 year old. The youngest suffers from cerebral palsy. Until then, friendly loving friend friend, the family has been in a state of hopeless grief since the birth of their youngest girl. The mother devotes herself entirely to her sick child, the eldest first-grader girl and the father of the family experience the mother’s alienation and aggression. The father tries to be at home less often and as little as possible; under any pretext he tries to get away from the traumatic situation. He lacks care and " home warmth" In addition, a colleague who “sympathizes” with his grief appears on the “horizon” and is not averse to “caressing and pitying” the father of the family. The situation, frankly speaking, is critical... Fortunately, the young mother found the strength in herself and came for a consultation with a psychologist. As a counselee, she needed to talk out her troubles, she needed an analysis of the situation and specific advice that could save the family. It is not easy to convince an adult, offended and tired person - the mother of a sick child.

Analysis of the situation as if “from the outside,” supported by figurative examples from the Holy Scriptures, allowed the woman to understand her family differently and to assess reality more positively. After all, in this family the atmosphere of joy of life has disappeared, and the sin of despondency has settled.

After several conversations, the mother of the sick child said with gratitude:

“As soon as my worldview changed, the attitude of the rest of the family members towards me also changed: my daughter and husband. I chose the course of treating others kindly. The main thing now is the life of those living next to you. Only through their good will you receive your happiness. Stay close to your family, they will help you in difficult times. And together we are strong! There is no need to be afraid to seek help from specialists in such difficult life situations.”

How do healthy children feel in a family with a disabled child?

Healthy children are characterized by manifestations of anxiety. Their emotional connection with the patient and his problems is not as strong as that of the main “caregiver”. Healthy children continue to study, and when they leave home, go about their professional or educational activities, everything associated with illness becomes psychologically distant from them. But they are afraid that the degree of ill health of the patient will force them to interrupt their numerous professional, educational, personal and other activities. Fear of this can develop into fear of the primary caregiver. There is a desire to “leave, hide in desert island”, i.e. alienation as a result. Here the role of the main guardian in a positive solution to the problem is great.

The following example is from the practice of the Adaptation Center.

The youngest child in this family suffered from a severe oncological blood disease, his life was calculated in months. The mother and father of this child, having learned about the diagnosis from oncologists and after consulting with a psychologist, decided to create an atmosphere of joy for the patient and other children in the family. They glued Christmas tree decorations together, went on short trips with the whole family, and showed a puppet theater at home. Everywhere we tried to be together, to saturate the children’s lives with little joys. Psychologically, it was most difficult for the parents, as they realized the inevitability of the outcome. They found the strength to last day maintain a feeling of mutual care and kindness, without betraying your grief in any way. And this requires great courage and willpower. The unity of the family allowed them to more easily endure the bitterness of loss, and the sick baby to live a short but happy life.

We must not forget that small, even healthy children may develop a complex of lack of attention, a kind of jealousy in relation to the attention paid to a sick child.

Due to the individual characteristics of a particular healthy child, his illnesses are possible, caused by stress, the desire for attention from other family members: frequent colds, weakened immunity, lung and kidney diseases.

Third layer (subgroup), which concentrates around the patient - these are close and distant relatives. Their gossip often boils down to the fact that the cause of the illness was the wrong actions of the main caregiver and other family members. As a result, their opinions and actions complicate the situation of the primary caregiver and other family members, increasing their feelings of guilt and helplessness.

Dissatisfaction among family members with family life is growing, and alienation in the family is growing.

What is driving this global family dissatisfaction? Firstly, a feeling of guilt for the illness: a family experiences an illness especially hard if its members blame themselves or the patient for what happened. Kenneth Terkelsen in 1987 described the two most common family views on the causes of illness:

a) Biological: families that consciously or unconsciously adhere to this theory see the causes of the disease in some mutations-changes in the body independent of the patient’s will. In this case, the family overestimates the possibility drug treatment, one is often tormented by fear for genetic heredity, or fear that, contrary to all the doctor’s assurances, the disease is contagious.

b) Psychological: its supporters blame themselves, all family members or the disabled person for everything. There is hidden aggression of all family members towards each other.

It is important to understand all this and try to relieve irritation and aggression in the family. The accumulation of knowledge and experience leads to the fact that the family can gradually free itself and cease to be emotionally dependent on temporary fluctuations in the course of the disease.

Particular attention should be paid to families in which one of the members has a severe neuropsychic disorder. Let's consider the dynamics of such a family. Significant internal and external pressure on this family, a state of neuropsychic tension, anxiety, unhealthy feelings of guilt - all this leads to the fact that the structure of such a family is unstable.

This situation is perceived as difficult to bear, and family members are intensely looking for a way out of it.

The family in this case can either fall apart or mobilize in the face of misfortune, such as the mental illness of one of its members.

What problems does such a family face? Firstly, understanding the patient and establishing the level of requirements for him.

To keep the patient from inappropriate behavior, the family is looking for ways to influence him.

Example. Patient N. - in March 1999. Refusal of food for 3 days, difficulty in swallowing, depressed state, combined with the need to “run wherever one looks”, asthenia. History: asthenic-neurotic syndrome. Drug therapy prescribed by the doctor (atarax, Coaxil, Relanium) did not give any effect. Periodic monthly breakdowns in premenstrual phase. Family members' reaction: The family mobilized to solve this problem. Massage, magnetic therapy for 20 days, conversations with the patient, forcing one to take one’s mind off the fear of an “attack of illness.” Every year a family with modest income goes to the sea as “savages”, as this gives remission for about 4 months.

This constructive solution to the problem, although it did not bring complete recovery, did allow the family to relieve tension and unite.

A destructive version of such a case is the collapse of L.’s family, where the mother of three children developed a mental illness after suffering stress.

The emotional climate in the family is very important. Conducted in last years Studies of families where there is a patient with schizophrenia have shown that the presence or absence of a relapse of the disease largely depends on how much the family is able to understand and take into account the increased sensitivity of the patient. This was first discussed in studies by the Medical Research Council's Social Psychiatry Unitin London (1962), and the phenomenon was given the name EE-expressiveness of emotions. It was proven that in “emotionally agitated” families, there were more frequent relapses of the disease, and the calmer the climate in the family, the less frequent were the exacerbations of the disease. It is very important for families to master emotionally gentle statements.

Examples of emotional statements...

sparing:

• Maybe you can do it differently
• Sorry, I didn't quite understand you
• It's hard for me to concentrate
• This should have been done a little differently

hard:

• You did everything wrong
• What are you saying?
• Stop making noise and disturbing me
• You ruined everything again

When a family decides to use gentle language, it helps avoid negative emotions based on bitterness, resentment, and resentment.

Dominant negative emotions can develop into behavioral antipathy towards the patient and the desire to “get rid of” him. The concentration of the family’s attention on the positive, preserved aspects of the personality of an individual with a severe neuropsychic disorder gives rise to a motive of care, the “Exupery Motive” (“We are responsible for those we have tamed”).

Werner1989 proved that in prosperous families children with serious postpartum complications showed a slight lag behind healthy children, while in a dysfunctional family the child remains “Wild”.

Since the 70s of the 20th century, programs for comprehensive assistance to disabled children and members of their families have been tested in the United States (Broussard 1989, Sasserath 1983). These programs allowed parents of disabled children to develop effective ways managing their attention, increasing their ability to learn the most necessary skills, and identifying even small changes for the better in their developmentally delayed child.

Unfortunately, in small regional towns of Russia and rural settlements, work with disabled children and their families is of a purely formal “entertainment” nature (excursions to nature, to the theater), there are few training programs, there are no psychosocial rehabilitation instructors for working with disabled children and their families. Most often, the chairman of the society for the disabled only manages to deal with the organizational aspects of events for these children. When should we care about their physical development?

By the time healthy children begin to go to kindergarten, school, and communicate with each other, disabled children remain unsociable. Why? It's just very difficult for them to find friends. Such a child is clearly different from the rest: less dexterous, less mobile and less strong. It is the latter aspect that greatly influences the attitude of his peers towards him. After all, a “children’s” society is akin to a primitive one: the law of “who is better,” the law of the leader, operates here. When communicating with healthy peers, a disabled child may experience anxiety and fear, excessive stress, and a feeling of inferiority. Little children are very cruel people. Many have not yet learned to have compassion for their neighbors. Therefore, a sick child often turns into an outcast among healthy peers.

In these conditions, it is important for parents, educators, and teachers to achieve the following goals:

1. Creating a friendly atmosphere in communication between healthy and sick children.
2. Learn to recognize and relieve stress reactions in children. Restore the child's self-confidence through warmth and affection, encourage the child to be frank.
3. Don’t stop, but try to understand why the child sucks his finger, bites his nail, or hides his head under the blanket. Affection, care, a kind word coming from the heart will calm and encourage the baby.

Among disabled children there are also children who are unable to learn due to the specific nature of their illness. These are children with dyslexia who have difficulty writing. Children with hyperactivity are those who cannot for a long time sit quietly. With each failure, such children believe less and less in their ability to learn something. Some become withdrawn, others become cheeky and aggressive. However, it should be noted that Thomas Edison, Nelson Rockefeller, and Hans Christian Andersen suffered from dyslexia in childhood. They managed to overcome themselves. Currently, numerous correction training programs are being developed, based on the need to create a sense of self-confidence in the child.

In their youth, older children begin to understand that there are Various types the human body and its various ideals. They develop a fairly clear idea of ​​their body type, its proportions and dexterity. Teenagers pay much more attention to their bodies. During this period, young people acutely feel the need for the attention of the opposite sex. Here a disabled teenager faces bitter disappointment. A wheelchair, crutches or a hockey stick attracts the attention of healthy teenagers only as an object of curiosity.

Despair takes hold of young people with disabilities. In this situation, trusting relationships with loved ones are important.

In this situation, a reasonable solution is possible. Important with early childhood develop the talents of a disabled child. At a young age, this will be very useful, it will give you a sense of self-esteem, a sense of worth, as an individual, as a person. It is important that disabled children make friends with each other.

The development and upbringing of a disabled child is undoubtedly a complex process that requires a lot of effort from parents and educators. However, it is very important to instill in a person the confidence that disabled people are people called upon by life to be tested, and not outcasts from society.

conclusions

Experience shows that the use of psychological rules allows a family with a disabled person to survive. In addition, the mindset for success significantly facilitates the social adaptation of the disabled themselves and their family members. These are the rules.

1. Don't lose hope and believe in victory over difficulties. Rejoice in every small victory over the disease.
2. Try to understand the patient better than he understands himself.
3. Allies in your fight against the disease are the trust and frankness of the patient. Try to win them over.
4. Look for approaches to the patient, analyze failures and mistakes when communicating with a sick family member.
5. Look for allies - organize your social “habitat” (clubs for the disabled, sports sections for the disabled, classes in clubs, etc.). Develop the talents of a disabled child.
6. “Fight and search, find and not give up” - this is the motto of those who have followed this path.

Disability- This specific feature development and state of the individual, often accompanied by limitations in life activity in a wide variety of areas. But nowadays, disability is no longer a problem of a certain circle of supposedly “inferior people” - it is a problem of the entire society as a whole. And this problem is determined at the level of legal, economic, production, communication and psychological characteristics interaction of disabled people with the surrounding reality.

There are about 16 million disabled people in Russia, i.e. more than 10 percent of the country's residents. Disability, alas, is not a problem of one person, but a problem of the entire society as a whole.

Unfortunately, in Russia, people around them most often treat people with disabilities from a purely medical point of view, from the position of the “medical model”, and for them a disabled person is considered to be a person who is limited to one degree or another in the ability to move, hear, speak , see, write. A certain paradoxical and absurd, and very offensive for disabled people, situation is created in which this person is perceived as a constantly sick person, as not meeting a certain standard, which does not allow him to work, study, or lead a normal “healthy” lifestyle. And, in fact, in our society the opinion is cultivated and formed that a disabled person is a burden to society, its dependent. This “smacks”, to put it mildly, of “preventive genetics”

Let us remember that from the point of view of “preventive eugenics”, after the Nazis came to power in Germany in 1933, the “T-4 Euthanasia Program” began to be implemented, which, among other things, provided for the destruction of disabled people and those sick for more than 5 years, as incapacitated.

Problems of disabled people in Russia

Problems for disabled people in Russia, and even in the West, are associated primarily with the emergence of numerous social barriers that do not allow disabled people to actively participate in the life of society. Alas, this situation is only a consequence of incorrect social policy, focused only on the “healthy” population and, in most cases, expressing the interests of this particular category of society. The very structure of production, life, culture and leisure, as well as social services often not adapted to the needs of people with disabilities.

Let us remember the scandals with airlines, and not only in Russia, but also in the West, which refused to allow disabled people with disabilities on flights. wheelchairs! And in Russia, both public transport and the entrances of houses are not yet fully equipped with special lifts and other means... Or rather, they are almost not equipped at all... In Moscow this still occurs, and even then these lifts are locked with a certain key, as in metro. And in small towns? What about buildings without an elevator? A disabled person who cannot move independently is limited in movement - often cannot leave the apartment at all!

It turns out that disabled people are becoming a special socio-demographic group with less mobility (which, by the way, is contrary to the Constitution!), a lower level of income, less opportunity for education and especially adaptation in production activities, and only a small number of disabled people have the opportunity to work fully and receive wages adequate for their work.

Social and labor adaptation of disabled people

The most important condition for social and especially labor adaptation is the introduction into public consciousness of the idea of ​​equal rights and opportunities for people with disabilities. It is the normal relationship between disabled people and healthy people that is the most powerful factor in the adaptation process.

As foreign and domestic experience, often disabled people, even having certain potential opportunities to actively participate in the life of society and especially to work, cannot realize them.

The reason is that some (and often most of) of our society does not want to communicate with them, and entrepreneurs are afraid to hire a disabled person due to established negative stereotypes. And, in this case, even measures for the social adaptation of a disabled person will not help until psychological stereotypes are broken both on the part of the “healthy” and, importantly, employers.

Let us note that the very idea of ​​social adaptation of disabled people is “verbally” supported by the majority, there are a lot of laws, but there is still complexity and ambiguity in the attitude of “healthy” people towards disabled people, especially towards disabled people with obvious “disabled characteristics” - those who are unable to move independently ( so-called “wheelchair users”), blind and visually impaired, deaf and hard of hearing, patients with cerebral palsy, patients with HIV. In Russia, people with disabilities are perceived by society as supposedly different for the worse, as deprived of many opportunities, which generates, on the one hand, their rejection as full members of society, and on the other, sympathy towards them.

And, importantly, there is an “unpreparedness” of many healthy people for close contact with disabled people in the workplace, as well as the development of situations where a disabled person cannot and does not have the opportunity to realize himself on an equal basis with everyone else.

Unfortunately, one of the main indicators of the socio-psychological adaptation of disabled people is their attitude towards their own lives - almost half of them rate the quality of their life as unsatisfactory. Moreover, the very concept of satisfaction or dissatisfaction with life most often comes down to the poor or unstable financial situation of a disabled person, and the lower the income of a disabled person, the more pessimistic his views on his existence and the lower his self-esteem.

But it has been noted that working disabled people have much higher self-esteem and “outlook on life” than the unemployed. On the one hand, this is due to the better financial situation of working disabled people, their greater social and industrial adaptation, and greater opportunities for communication.

But, like all of us, people with disabilities experience fear of the future, anxiety and uncertainty about the future, a feeling of tension and discomfort, and for them the loss of a job is a stronger stress factor than for healthy person. The slightest changes in material disadvantage and the slightest difficulties at work lead to panic and severe stress.

Labor legislation for disabled people in Russia and in the world

In Russia, there is a practice of employing people with disabilities or, as they say, “people with limited physical capabilities” in both specialized (for example, for the blind and visually impaired) and non-specialized enterprises. There is also legislation obliging large organizations to employ disabled people in accordance with a certain quota.

In 1995, the law “On social protection of disabled people in Russian Federation" In accordance with its 21st article, organizations with more than 100 employees are set a certain quota for hiring disabled people and employers are obliged, firstly, to allocate jobs for the employment of disabled people, and secondly, to create working conditions in accordance with the individual rehabilitation program. The quota is considered fulfilled if disabled people are employed in all allocated jobs in full compliance with labor legislation RF. In this case, the employer’s refusal to hire a disabled person within the established quota entails the imposition of administrative fine on officials in the amount of two thousand to three thousand rubles (Article 5.42 of the Code of Administrative Offenses of the Russian Federation).

Enterprises and employers employing disabled people are required to create special jobs for their employment, i.e. workplaces that require additional measures to organize work, including adaptation of main and auxiliary equipment, technical and organizational equipment, provision of technical devices taking into account the individual capabilities of people with disabilities.

However, most employers do not show enthusiasm when hiring people with disabilities, trying to provide them with the best various reasons, and even if hired, they will try to “get rid” of such an employee as soon as possible. The main thing that stops them is the risk associated with the ability of a person with disabilities to perform the job at the proper level. And accordingly - “won’t I incur losses?”

A question related to risk: “Will a disabled person cope or not with the assigned work or task?” In general, this can be done in relation to any employee, especially since a disabled person is likely to perform his duties more diligently.

Of course, the employer will have additional difficulties and even expenses associated with providing a shortened working day, creating special conditions labor, creation of a workplace adapted for a disabled person, etc. And the very adaptation of a disabled person in work collective more difficult than for a “normal” person, he is either “disgustedly bypassed” or “sorry”, and seeing his efforts at work, it is possible that a person with disabilities can quickly “make enemies”, and people around him will fully created and provoked conflict situations and direct mobbing. But this is already a matter for the administration and team leaders, as well as “full-time” psychotherapists who “wipe their pants and skirts” in many large corporations.

Let us note that in many countries there are laws similar to the law “On social protection of disabled people in the Russian Federation”. For example, in the United States, in accordance with the law, an enterprise that refuses to provide work to a disabled person is subject to a significant fine, and companies that employ disabled people have tax benefits. However, in the United States there is no legislation regarding job quotas for people with disabilities, and each enterprise has the opportunity to determine its own policy in this regard.

The Swedish government encourages employers to pay individual subsidies for each disabled person employed, and German labor exchanges perform professional consulting and intermediary functions in the employment of disabled people.

In Canada, there are many federal, regional and local targeted programs on various aspects of the rehabilitation of people with disabilities and special organizations that provide services for assessing the ability to work, consultation, career guidance, rehabilitation, information, vocational training and employment of people with disabilities.

Let us note that “people with disabilities” in developed countries work not only as seamstresses, librarians, lawyers, etc. You can also find heavy vehicle repairmen who use wheelchairs, which is simply unrealistic for Russia.

Let's consider the issue of a special workplace for disabled people. For example, the National Standard of the Russian Federation GOST R 52874-2007 defines this workplace for the visually impaired (clause 3.3.1):

This is a workplace where additional measures have been taken to organize work, including adaptation of main and auxiliary equipment, technical and organizational equipment, additional equipment and provision of technical means of rehabilitation, taking into account the individual capabilities of people with disabilities.

In addition, the composition of optimal or sufficient technical means and rehabilitation measures to create and maintain a special workplace for people with disabilities in the context of expanding and changing the scope of their work using new technical means of rehabilitation and rehabilitation measures (clause 3.1.2).

Creating a special workplace for disabled people includes selection, acquisition, installation and adaptation necessary equipment(additional devices, equipment and technical means of rehabilitation), as well as carrying out rehabilitation measures to ensure effective employment of disabled people, taking into account their individual capabilities in working conditions that correspond to the individual program for the rehabilitation of a disabled person to work (clause 3.1.3.).

Since the Federal Law “On Social Protection of Disabled Persons in the Russian Federation” dated November 24, 1995 N 181-FZ, provides for “professional rehabilitation of disabled people,” which consists of vocational guidance, vocational education, professional and industrial adaptation and employment, there is also a Code of Practice SP 35-104-2001 - “Buildings and premises with places of work for people with disabilities”, developed by order of the Ministry of Labor and Social Development of the Russian Federation. Buildings and structures must be designed taking into account accessibility for people with disabilities and “low-mobility groups of the population” (SP35-101-2001 “Design of buildings and structures taking into account accessibility for low mobility groups population." General provisions; SP35-102-2001 “Living environment with planning elements, accessible to people with disabilities"; SP35-103-2001 “Public buildings and structures accessible to visitors with limited mobility”).

But what really?

But, despite the laws that are not adopted and social programs rehabilitation, the number of working disabled people in Russia continues to decline and over the past three years has decreased by almost 10%, less than a third of disabled people of working age have a job, although at enterprises in many industries, in various institutions and organizations there are professions and specialties that correspond to the psychophysiological characteristics of disabled people of various categories.

One of the main areas of support for people with disabilities is professional rehabilitation and adaptation in the workplace, which is the most important component of state policy in the field of social protection of people with disabilities and includes the following activities: services and technical means - career guidance (career information; career counseling; vocational selection; vocational selection); psychological support for professional self-determination; training (retraining) and advanced training; assistance in employment (for temporary work, for permanent place work, self-employment or entrepreneurship); quotas and creation of special jobs for the employment of people with disabilities.

Of course, professional rehabilitation of disabled people with their subsequent employment is economically beneficial for the state, since funds invested in the rehabilitation of disabled people will be returned to the state in the form of tax revenues resulting from the employment of disabled people.

But if the access of disabled people to professional activities is limited, the costs of rehabilitation of disabled people will fall on the shoulders of society in an even greater amount.

However, “legislation regarding disabled people” does not take into account one most important fact - the employer still needs not a disabled person, but an employee.” And full-fledged labor rehabilitation and adaptation consists of turning a disabled person into an employee, for which you first need to train and adapt , and only then employ him, and not vice versa! About 60% of disabled people are ready to participate in the labor process after receiving the appropriate specialties and labor adaptation, and, accordingly, receiving a decent wages.

The adaptation of a disabled person in the workplace itself is defined as a logical adaptation to a specific job or workplace performed by him, which allows a qualified person with a disability to perform his duties in his position. That is, adaptation of a disabled person implies finding a way by which it becomes possible to overcome obstacles created by an inaccessible environment; this is overcoming barriers in the workplace, which is achieved through a targeted approach to solving this problem.

Despite the presence of appropriate legislation in the Russian Federation, a quota system and rehabilitation infrastructure, the low level of working disabled people suggests that in Russia there are certain factors that interfere with their employment and although there is a policy to encourage the employment of disabled people, nevertheless, psychological, physical and social barriers often prevent its implementation.

Until now in Russia there are many barriers to the employment of people with disabilities: there is no physical access to the workplace and appropriate equipment, people with disabilities are paid the minimum wage without expecting them to work with dignity, which is generally not true, there is practically no accessible transport, and many stereotypes towards disabled people persist among employers. And the disabled themselves, as we noted above, still suffer from low self-esteem, are not ready to enter the labor market on their own, and when they start working, they often fail to cope with the job due to lack of support and even direct mobbing.

In the USA and Great Britain, for example, the main types of labor adaptation are: flexibility of approach to management labor resources, increasing the availability of premises, restructuring responsibilities (including work time), concluding fixed-term contracts with disabled people, as well as purchasing or modifying equipment. Note that in Western European countries about 40 - 45% of disabled people work, and in Russia best case scenario- only 10%, many at home, practically illegally and for extremely low wages...

Although work adaptation may be unique to each individual case, for most Russian disabled people The main need for primary adaptation in the workplace and in the work team is scheduling - for example, flexible hours and regular breaks, as well as, in some cases, reducing the number of certain actions.

But the most serious barrier in Russia to the ability of a disabled person to work is the loss of social benefits (“allowances”) or even the disability pension itself. We note that according to existing legislation, disabled people in Russia have the right to receive free medicines, free travel on public transport and commuter trains, sanatorium and resort treatment, partial payment for housing and communal services, etc. And a disabled person can lose all this by officially getting a job! And often this is the main reason why people refuse to work, especially if work cannot compensate for the loss of a pension and all benefits. In addition, a disabled person who receives a pension supplement has no right to earn extra money anywhere, even temporarily, the “social protection authorities” will immediately remove it, and even fine it! So does it make sense for a disabled person to lose his bonus by tripling his work? Most often not, if the salary is too low and does not compensate, or only slightly compensates for this premium.

For example, a person with a disease of the cardiovascular or endocrine system, who most often becomes disabled, already having enormous experience in scientific or teaching activities, may well perform his usual work, but... “social protection bodies” designed specifically to “protect” the disabled person, however less, on the contrary, they deprive him of the opportunity to work, or even to work part-time or temporarily, for example, under a contract, at the same university, university, research institute or other organization.

Another barrier to the employment adaptation of a disabled person is the physical environment in which people live, which prevents them from going to work; about 30% of people with disabilities indicate the lack of adequate transportation as a serious problem.

There is a concept of “physical environmental barriers”, which include many factors: from inaccessibility of transport to lack of flexible schedule and reduction physical labor at work. It is clear that the need for a flexible schedule is explained by the fact that during the day a disabled person faces many problems outside of work or preparing for it, in particular getting to and from work, and while at work he may be less mobile - even going to the toilet takes a wheelchair user several times longer.

When hiring a person with a disability, employers should assign certain basic activities required in the workplace to perform and use creative assistive technology. For example, disabled people who are unable to move independently are less able to perform work related to computers.

Let’s think about it, but it’s wasteful to entrust a healthy person with a job that a disabled person can do! And disabled people feel their labor isolation as completely unnecessary to society. It is important for them not just to exist receiving a meager pension, but to live and work fully, it is necessary to be in demand by society, to have the opportunity to self-realize!

In developed countries, one dollar invested in solving the problems of people with disabilities brings 35 dollars in profit!

It is not disability itself that is a person’s misfortune, but the trials that he endures due to the fact that the surrounding society limits freedom of choice in employment. Theoretically, a disabled person has all constitutional rights, but in practice, the vast majority of them cannot get an education or get a job, much less a decently paid one.

And most importantly, help society itself adapt and normal operation the disabled person is even more important than for the disabled person himself. A person must see that if something happens to him, he will not be thrown to the sidelines of life, and he must remember that no matter how life turns out (and, alas, it is not predictable), this problem can affect everyone.

Introduction

The relevance of this work is explained by the fact that working with people with disabilities falls into the category the most complex issues in social work. The problem of social adaptation of disabled people - the problem of the adaptation of disabled people to a full life in a society of healthy people has recently acquired particular importance. This is due to the fact that in the new millennium, approaches to people who, by the will of fate, were born or became disabled began to change significantly. The professional field of social work arose in the world about 100 years ago, and in our country - since 1991. Issues of medical, social and labor rehabilitation of people with disabilities cannot be resolved without the participation of social workers and specialists in the field of social work. In the Russian Federation, at least over 8 million people are officially recognized as disabled. In the future, further growth in the number of this category of the population is expected, including in share terms." (18. – P.147).

Despite the growth in the number of disabled people in Russia, there are still negligibly few institutions that work to provide them with social, socio-medical, material, social and other assistance. One of the most important problems for people with disabilities is their lack of inclusion in social production, since only some regions are actively engaged in opening jobs, which negatively affects their financial situation and psychological state. Recently, specialists from various professional fields have been developing technology for social, socio-medical, socio-psychological support for people with disabilities. There is an active discussion of the experience of leading social rehabilitation centers in special journals, at conferences and other scientific and practical forums. However, there is still a need for constant and targeted study of the problems of people with disabilities both in the state and regional level, including university ones. Disabled people in Russia also face problems such as loneliness, since their communication is limited to their parental family or immediate relatives, the inability to continue their education, and more. The state, providing social protection for people with disabilities, is called upon to create for them the necessary conditions for individual development, realization of creative and production capabilities and abilities by taking into account their needs in relevant government programs, providing social assistance in the forms provided for by law in order to eliminate obstacles to the realization by people with disabilities of their rights to health care, labor, education and vocational training, housing and other socio-economic rights. Today, people with disabilities are among the most socially vulnerable categories of the population. The most pressing tasks of social policy in relation to people with disabilities are to provide them with equal opportunities with all other citizens of the Russian Federation in realizing their rights and freedoms, eliminating restrictions in their life activities, creating favorable conditions allowing disabled people to drive full image life, actively participate in the economic, social and political life of society, and fulfill their civic duties.

The object of study of the course work is social work with disabled people. The subject is the problems of social work with disabled people. The purpose of this work: To study the problems of social work with people with disabilities.

Based on this goal, I set myself the following tasks:

1. Define the concept of disability;

2. Consider types of disabilities;

3. Study the mechanism for implementing state policy regarding people with disabilities;

4. Study the regulatory framework for working with people with disabilities;

5. Outline the basic principles of working with people with disabilities;

6. Consider the features of working with people with disabilities in the social environment;

7. Justify psychological aspect in working with disabled people;

8. Study the main content and types of rehabilitation of disabled people.

Research methods: analysis of literature and documents summarizing the experience of social service centers with people with disabilities. This course work used the works of scientists: E.I. Kholostovoy, M.E. Bochko; P.V. Pavlenok; N.F. Dementieva, B.A. Dolgaev and others.

CHAPTER 1. Social work with disabled people. general provisions

1.1 The concept of disability and its types

The term “disabled person” goes back to the Latin root (volid – “effective, full-fledged, powerful”) and literally translated can mean “unfit”, “inferior”. In Russian usage, starting from the time of Peter I, this name was given to military personnel who, due to illness, injury or injury, were unable to perform military service and who were sent for further service to civilian positions. It is characteristic that in Western Europe this word had the same connotation, that is, it referred primarily to crippled soldiers. From the second half of the nineteenth century. the term also applies to civilians who also became victims of war - the development of weapons and the expansion of the scale of wars increasingly subjected civilians all the dangers of military conflicts. Finally, after the Second World War, in line with the general movement to formulate and protect human rights in general and individual categories population in particular, the concept of “disabled person” is being formed, which refers to all persons with physical, mental or intellectual disabilities.

In accordance with Federal law dated November 24, 1995 N 181-FZ "On the social protection of disabled people in the Russian Federation", a disabled person is a person who has a health impairment with persistent disorder functions of the body, caused by diseases, consequences of injuries or defects, leading to limitation of life activity and necessitating the need for social protection. (8).

Limitation of a person’s life activity is expressed in the complete or partial loss of his ability to carry out self-care, movement, orientation, communication, control over his behavior, as well as engage in labor activity. (17. – P.87).

Today, people with disabilities belong to the most socially vulnerable category of the population. Their income is significantly below average, and their needs for medical and social services much higher. They have less opportunity to receive an education and cannot engage in labor activities. Most of them have no family and do not want to participate in public life. All this suggests that people with disabilities in our society are a discriminated and segregated minority.

All disabled people for various reasons are divided into several groups:

1.2 Mechanism for implementing state policy regarding people with disabilities

Government structures, non-governmental organizations And public associations, private initiatives are designed not only to protect public health and prevent disability, but also to create conditions for the rehabilitation of people with disabilities, their integration and reintegration into society and professional activities.

Targeted federal and regional programs that combine the efforts of various departments have become an effective mechanism for implementing state policy in solving the problems of people with disabilities in the Russian Federation. In 1994, funding began for the program “Development and production of technical means of rehabilitation to provide for people with disabilities.” A federal program “Social support for people with disabilities” has also been created. Within the framework of the Federal Comprehensive Program “Children of Russia”, a program “Disabled Children” is provided.

The implementation of federal programs must create conditions that meet the requirements and norms of a civilized state, under which a disabled person, like any citizen, has the opportunity on equal terms to receive an education, work, provide for themselves financially and have access to all social, industrial and economic infrastructure.

In these conditions, the main task of social work with disabled people is to combine efforts as government agencies, as well as public and private initiatives, self-help groups to most fully meet the needs of this category of the population and self-realization of persons with disabilities.

The main socio-economic and socio-demographic indicators characterizing the position of disabled people in society are: participation in labor and social activities, wages and pensions, level of consumption of durable goods, living conditions, family status, education.

Previously, the main efforts of the state to improve the standard of living of people with disabilities were reduced mainly to providing various kinds material benefits and subsidies for their individual categories. At the same time, there was a fairly developed system of specialized enterprises employing the labor of disabled people, which, however, in a market economy became uncompetitive in comparison with commercial structures. Continuing the social policy towards people with disabilities in the provision of various benefits seems hardly possible in the context of a budget deficit; moreover, it is fraught with a number of negative consequences- opposition between healthy and disabled people (which, in turn, gives rise to a negative attitude towards the latter), as well as various categories of disabled people against each other; reluctance of some people with disabilities to participate in rehabilitation processes due to dependent attitudes and expectations of benefits and subsidies.

Disability is a social insufficiency due to health problems with severe disorders of body functions, leading to limitation of life activities and the need for social protection. The concept of “disability” has social, legal and medical aspects. The establishment of disability is followed by termination of work or change in working conditions and assignment various types state social protection (pension, employment).

Disability is considered one of the most important indicators of social ill-being of the population. It reflects many problems, such as: social maturity, economic viability, moral integrity of society and disruption of relationships between people, persons with limited liability and society. It takes into account the fact that the problems of people with disabilities affect not only their individual interests, but also to a certain extent affect their loved ones, depend on the standard of living of the population and other social factors. From all this we can conclude that their decision lies on a national rather than a narrow departmental level and largely determines the face of the state’s public policy.

Disabled people? these are people with disabilities.

Is the labor market for people with disabilities special socially? demographic segment of the Russian economy, which is subject to its own laws, which must be taken into account in employment policy. Therefore, the country undertakes to promote the unification of citizens with disabilities who lack competitiveness and have difficulty finding work.

The position of disabled people in a group of people is determined by a number of factors such as: objective and subjective, which affect the level of material security, the opportunity to realize oneself in professional field, getting an education, realizing your dream of making a career and satisfying your rights and social guarantees.

Unemployment among persons with disabilities stands out when considering problems of workload in the population due to the particular depth of its negative consequences.

Diseases (injuries) can lead to loss of human health, the consequences of which are significantly - negative consequences in life. They are also violated physiological functions the body, but also the social, including professional, activity of a person decreases. Overcoming the consequences of disability, restoring part of life functions lost in connection with it, as well as socially significant qualities allow a disabled person to become a full-fledged and equal member of society, directly participate in public life, and contributes to his successful rehabilitation and integration into society.

In this process, labor activity plays a major role; it has an positive influence for the life of a disabled person. Employment contributes to the physical, personal and professional restoration of the individual.

The material well-being of a disabled person increases significantly, changes mental condition person, he ceases to feel that no one needs him. Along with him, his prestige in the family, society and state grows. Under the influence of labor, compensation systems develop in the body that help overcome a number of disadvantages caused by disability.

Various aspects of promoting the employment of people with disabilities are discussed in documents developed International organization labor (ILO). The issue of social protection of citizens was one of the first to be raised; in 1933, Convention No. 37 “On compulsory insurance on disability of workers of industrial and commercial enterprises, persons of liberal professions, as well as workers working at home and domestic servants", which covers issues of disability prevention within the framework of labor activity. The problems of professional rehabilitation of disabled people are raised in Recommendation No. 168 and Convention No. 159 “On Vocational Rehabilitation and Employment of Disabled Persons,” adopted in 1983. A number of ILO documents disclose aspects of an active employment policy for citizens with disabilities (Recommendation No. 88 “On vocational training of adults, including disabled people” of 1950, and Recommendation No. 99 “On the retraining of disabled people” of 1955).

Market relations are not only positive, but also negative character, this is due to stricter requirements for employees. As a result, the number of citizens falling under the category of non-competitive is constantly increasing. All these processes are especially aggravated during the period of social? economic crises. In this regard, the problem of employment of persons with disabilities takes on new properties. On the one hand, employment issues are extremely important for them, on the other hand? opportunity to fulfill your needs professional activity Not everyone succeeds.

Lesson on Russian market labor for this category of the population remains inappropriate to their probable capabilities, and the workload is quite low. Working disabled people make up less than 10% of the total number. It is especially low among citizens with disability groups 1 and 2. The position of persons with disabilities in the Russian labor market is determined by a number of circumstances.

Firstly, there is an increase in the number of disabled people (approximately 50% of them are of working age), and secondly, the share of registered unemployment among persons with disabilities is increasing on average in our country from 2% to 5%. Disabled people entering the labor market differ in age, gender, education and professional level, health status and life attitudes.

Among the recognized unemployed are persons who have become disabled as a result of various diseases, injuries, those injured at work and during military operations, and those who have been disabled since childhood. Average age unemployed citizens with disabilities 26 ? 45 years. All of them are divided into several groups in different ways. To resolve the issue of employment, the following characteristics are significant:

With a degree of ability to work (persons with disabilities, able-bodied, disabled, temporarily disabled or able to work in limited areas, in benign working conditions)

The nature of the disease (person? mobile, limited mobility, non-mobile).

Depending on membership in a particular group, employment and employment issues for citizens with disabilities are resolved. The relatively low employment status of persons with disabilities is largely explained by the uncertainty of life attitudes and the lack of sought-after professional education and work experience. The situation is aggravated by the fact that it is not profitable for employers to hire disabled people who require specialized jobs and preferential working conditions (reduced working hours, reduced productivity requirements). Despite the laws adopted at the level of the constituent entities of the Federation “On quotas for jobs for disabled people,” entrepreneurs strive to find reasons for refusing employment to a disabled person.

The specific situation of disabled people in the Russian labor market is determined by a number of factors:

Preservation of stereotypes (many employers negatively assess the qualities of disabled people, such as lack of work experience, inability to perform their professional duties efficiently and the inability to build relationships in the work team, instability of behavior, that is, everything that indicates a person’s professional insolvency). The scale and persistence of the influence of stereotypes of this kind leads to discriminatory attitudes towards people with disabilities in the labor market.

The unfounded idea of ​​disabled people about building a personal professional strategy (manifests itself in the definition of a profession and in future employment prospects). Choosing a direction or specialty in which to carry out professional education, is often made disabled based on his physiological capabilities, degree of disability, educational conditions, and accessibility. The main idea of ​​getting an education is “What I can and want, and not where I can find a job in the future.” Teach young disabled people to analyze the real situation on the labor market through the prism of personal capabilities

An area of ​​work that needs to be introduced into the general practice of the employment service as part of the prevention of unemployment of persons with disabilities.

Reduction of jobs at enterprises and specialized organizations aimed at primarily employing people with disabilities. (of particular concern is that a large number of unemployed citizens are graduates of secondary specialized and higher educational institutions). The professions in greatest demand among young disabled people are programmer, economist and accountant, and lawyer. At the same time, among the vacancies offered for citizens with disabilities, mainly low-skilled labor, without taking into account their professional qualities.

The most important condition for social labor adaptation and its features is the introduction into public consciousness of the idea of ​​equal rights and opportunities for people with disabilities. Is it the normal relationship between disabled people and healthy people? the strongest factor in the adaptation process. As foreign and domestic experience shows, people with disabilities, often even having certain potential opportunities to actively participate in the life of society, and especially to work, cannot realize them. The reason is that a part (and often a large part) of our society does not want to communicate with them, and employers do not want to hire a disabled person due to established negative stereotypes. And, even in this case, measures for the social adaptation of a disabled person will not help until psychological stereotypes are broken both on the part of the “healthy” and, importantly, entrepreneurs. The idea of ​​social adaptation of disabled people is “verbally” supported by the majority, there are a lot of laws, but there is still complexity and ambiguity in the attitude of “healthy” people towards disabled people, especially towards disabled people with clearly expressed “disability characteristics”? those who are unable to move independently (i.e., “wheelchair users”), blind and visually impaired, deaf and hard of hearing, patients with cerebral palsy, patients with HIV.

In Russia, people with disabilities are perceived by society as different in a negative way, deprived of many opportunities; on the one hand, they are rejected as full-fledged members of society, and on the other? sympathy towards them. It is also important to note that many healthy people are “unprepared” for close contact with disabled people in the workplace, as well as the development of situations where a disabled person cannot and does not have the opportunity to realize their potential on an equal basis with everyone else. Unfortunately, one of the most important indicators is social? psychological adaptation of disabled people is their attitude towards their own lives? Almost half of them rate their quality of life as unsatisfactory. Moreover, the very concept of satisfaction or dissatisfaction with life most often comes down to the negative or unstable financial situation of a disabled person, and the lower the income of a disabled person, the more pessimistic his views on his existence and the lower his self-esteem. But, working disabled people have much higher self-esteem and “outlook on life” than the unemployed. On the one hand, this is due to the better financial situation of working disabled people, their greater social and industrial adaptation, and greater opportunities for communication. But, like all of us, people with disabilities experience fear of the future, anxiety and uncertainty about the future, a feeling of tension and discomfort, and what does loss of work have to do with them? a stronger stress factor than for a healthy person. The slightest changes in material disadvantage and the slightest difficulties at work lead to panic and severe stress.