Chapter 1.Orientaion on Conceptual Framework

1.1 Concept of Fieldwork

1.2 Objectives/Goals of Fieldwork

1.3 Historical Background of Fieldwork

1.4 Importance of Fieldwork

1.5 Inter-relationship between Social Work Education and Field Work

1.6 Concept of Clinical Social Work

1.7 Scope of Clinical Social Work

1.8 Standards for Clinical Social Work in Social Work Practice

1

Introduction

Social work is a helping profession which fundamental aim is to

help the individuals, groups and community to cope with their

problems through enabling them so that they can solve their

problems. The students of Social Work discipline have to acquire

theoretical knowledge and apply this knowledge in practical

field. Field work gives the opportunities

to the students of Social Work to apply the acquired knowledge in

practical field. In any professional training in Social Work it

is essential to study society and the individual. The department

of Social Welfare is providing the necessary knowledge through

the basic studies courses. Knowledge along is not enough. Social

workers need to have skill to apply this knowledge effectively in

life situation for achievement social improvement. Class room

discussion, plans and theories can not solve the problem. The

social welfare department recognized this and considered

practical work with individual groups and communities.

Concept of Fieldwork

In arena of social work education the term 'fieldwork' is often

used interchangeably with such terms as practicum, field

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instruction, field education, field practicum and internship

(Horejsi and Garthwait 2002:1). Whatever the term is fieldwork

denotes the practical aspect, one of the two facets, of social

work education. Simply fieldwork is a way of getting social work

students used to with the diverse fields of social work

intervention.

Fieldwork is portrayed in several other ways. In 1952 Council on

Social Work Education observed fieldwork as a method of

instruction in a setting where all the ingredients of the social

work curriculum converge and through their fusion provide an

opportunity of integrating the knowledge, skills, and attitudes

contained in the several content areas of the curriculum

(Boehm,1952:27)

In International Encyclopedia of Social Science vol.5 (1968:418)

has defined- "Field work is the study of people and of their

culture in their nature habitat. Field work came to mean learning

as for as possible way to speak, see and act as a member of its

culture and the same time, as a trained social scientist from a

different culture".

R.R. Sing(19S5:54)in "Field Work in Social Work Education" has defined, "Field

work is an educationally sponsored attachment of social work

students to an institution , agency or a section of community, in

which they are helped to extend their knowledge and understanding

and experience the impact of human need."

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In Field Work Manual, M, A Momen (1970:1) has said. Field Work

Programme in Social Work education is to provide the student with

actual experience in applying in Social work method and enables

him/her to become familiar with real social work practice .That

is to relate academic theory to create relating as found in the

agency setting.

Field Work provides the students opportunity to realize how

social problems are influencing the individuals, group, family,

organization, and community. Moreover Field Work enables a

student to understand the roles and functions of social policy,

law, and social service related organization, network and

community resources. In total, practical training gives a chance

to a student to observe the role of a social worker in total

problem solving process.

Figure: Process of Social Work practice 4

(Allen Pincus and Anne Minaham, 1973 p- 86)

About this statement it is said that, the objective of the

fieldwork programme in social work education is to provide the

student with actual experience in applying social work methods

and enable him or her to become familiar with real work of

practice. That is to relate academic theory to concrete reality

as found in the agency setting. It also aims to allow the student

to test himself/herself to develop sense of professional

discipline to gain self-confidence and to feel him or herself a

social worker with beginning competence.

From the above discussion Certain Numbers of characteristics of

Field work can be mentioned below.

1. Field work is an educationally sponsored attachment of

social work. Student to an institution, agency or a section

of community

2. Field work helps the students to extend their knowledge and

understanding and experience the Impact as human need.

3. Field work helps the student to realize the theory, methods

and principle of social work in practice.

4. Field work helps the students to became familiar with real

social work practice.

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5. Field work enable students to apply and integrate previous

learning and current learning.

In the perspective of above discussion, we can say that Field

work is the science of practice in where students can relate

academic theory with social work practice and they can solve

the problems of silent through the application of social work

methods.

Objectives/Goals of Fieldwork:

The fieldwork instruction and classroom teaching are identical

where both are emphasizing "knowledge', 'being' and 'doing'

aspects. Fieldwork helps the students to apply the theory and

principles of social work in actual practice. Students confronted

with real life situations are likely to become more aware of

their own feelings and of his 'professional self or Rifat Rashid

mentioned in his book (1960:70)- "Learn to use himself

creatively, learn to use a body of knowledge and principles

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creatively through the medium of supervision in a social agency

within a professional pattern",

M.A Momen said in fieldwork Manual (1970:2):

1) The student should learn to apply social work methods in the

solution of given individual group or community problems.

They should be exposed to agency practice in which there is

a planned, a systematic, objective approach to problem

solving. The student should learn to start with a factual

material as the basis for professional intervention and

through appropriate study and diagnosis to move forward

step by step to the implementation of a plan of action.

2) The student should develop facility in the use of

organizational structure particularly the committee. He/she

should learn the technology of the committee process

(professional staffing functions) as well as an

understanding of the human dynamic of task oriented groups

(group development, interaction roles, motivations of

individuals, reference group behavior etc.) within a

structure and gain insight regarding his/her special place

in the network of relationships.

3) The student should achieve self-awareness and disciplined

use of self as a helper and an agent of change in a variety

of individual and group situations. He/she should come to

identify with the profession of social work and its values

and ethics.

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4) The student needs to learn the organizational framework of

service. He/she must understand agency structure arid

policy and how to facilitate such policy through his/her

practice. He/she should become familiar with the differing

institutional styles tempos of agencies associated with

various field of practice.

5) The student should become familiar with administrative

procedures and processes. He/she should learn how an office

is run, what kind of routines need to be established, how

to facilitate administrative arrangements relevant to the

discharge of the responsibilities of his/her own

assignment. He/she should be aware of how administrative

decisions are made, conveyed and implemented.

6) The student should acquire knowledge regarding community

structure and process. He/she should know the kinds of

formal and informal groups, voluntary and governmental

agencies individuals, institutions and forces that

constitute a community. He/she should be able to analyze

the interplay of forces which bear on a given social

problem. He/she should have the ability to utilize

community resources in support of social welfare goals.

7) The student should acquire significant substantive knowledge

in the specific field of practice characterized by the

agency in which he/she is placed. This means he/she should

be conversant with one or a cluster of social problems

associated with his/her agency or assignment. He/she should

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become acquainted with the causes of the problem and with

social welfare programmes, agencies, structures, laws and

policies related to its solution.

8) The student should acquire competence in recording and

reporting (process-records, minutes, monthly reports,

administrative correspondence etc.). He/she should know

what to record and how to record. He/she should be

acquainted with the employment of records for the purposes

of planning, evaluating and supervising.

9) The students should acquire and be given an opportunity to

try out a variety of social work methods, skills and

techniques.

Some specific objectives of Field Work Education:

To create a opportunity for the social work student to

justify his acquired knowledge with the field

To help the social work student adjusting with different

work settings

To learn office management, office systems, behavior with

the staffs, dealing with the clients of different agencies

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To understand the gap between theoretical knowledge and

practical situation

To cope with different working situation in different

agencies

To acquire practical experiences, knowledge, and

understanding the principles, programs, procedures, and

activities of different agencies.

To help students learn how to think critically, analytically

and evaluative, all of which are basic to the teaching of

the problem-solving process.

To help students develop fellings and attitudes appropriate

to the helping process.

To help students develop fellings the and capacity to

establish and maintain professional relationships.

The development of skill in helping, involving the

disciplined use of knowledge in thinking about, analyzing

and understanding professional problems and in the helping

process.

Development of the student’s capacity of cooperative

relationships with his fellow workers and with other

agencies in the community

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Historical Background of Fieldwork:

The social work activities started as religious practice. In the

feelings of religion people provided protection for the helpless,

windows, orphans and the sick. On the march of time this social

work becomes organized institutionalized and professional. In the

perspective of professionalism, it is needed education, knowledge

and skill for proper practice in social welfare, working field.

For developing knowledge and skill, fieldwork has begun. So, it

is said that the history of fieldwork is related with history of

evolution of social work activities. The history of fieldwork is

discussed below:

In the history of fieldwork practice, at first he who is

mentioriable is Edward Oenison. In 1867 as a volunteer of the

society for the Relief of Distress in London, he became convince

that the mere distribution of alms was futile. He abandoned his

comfortable life and moved to Stepney, a poor quarter in Hast

London to live with the poor in this slum district. There Denison

taught Bible classes, history and economics. The inhabitants of

Stepney found his reluctant to give them the customary meat and

coal tickets unless he was certain they were in dire need. But he

was generous with his time in listening to their problems and

offered his counsel when he felt they were oppressed.The idea of

living among the people who needed help was most effectively

demonstrated by Samuel Augustus Barnett, born in Bristol in 1844.

Barnett had studied theology at Oxford and in 1873 accepted the

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post of Vicar of St. Judo's Church in white chapel in East

London, one of the poorest parishes in the diocese. Barnett was

encouraged by his fiancee, Henrietta Rowland, who had worked

under Octavia hill. After their marriage Henrietta became her

husband's co-worker. In white chapel, the Barnetts found a great

proportion of the 8,000 parishioner's unemployed or sick, living

in filthy, overcrowded tenements. The Barnetts went to Oxford and

Cambridge and discussed with university students the conditions

they had encountered in St. Jude's. They invited the students to

come to live with them in white chapel to study the life of the

underprivileged, to help in their education and to render

personal aid. Among those who accepted Vicar Barnett's invitation

was Arnold Toynbee, an enthusiastic and gifted young Oxford

graduate.

He was outstanding among his colleagues because of his devotion

and the warm, personal contact he established with the families

of the parish. Unfortunately he was of poor health, contracted

tuberculosis, and died in 1883. In his memory, a number of his

friends built, in 1884, a university settlement in the white

chapel district and called it "Toynbee Hall", the first

settlement house in the world.Toynbee Hall had three main

objectives: education and cultural development of the poor;

information for the students and other residents of the

settlement regarding the condition of the poor and the urgent

need for social reforms; and a general awakening of popular

interest in social and health problems and in social legislation.

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The basic purpose of the settlement was to bring educated men and

women into contact with the poor for their mutual benefit, so

that by common work and studies they could exercise a cultural

influence beyond the teaching of special subjects. The attitude

of a superior "Lady Bountiful" which still prevailed in charity

societies, was replaced by co-operation and learning on the part

of both instructors and workers at Toynbee Hall.

Later then in 1893, Ann L. Bowes presented a proposal to

international congress of charities conference and philanthropy

in USA for arranging a training education program for social

workers. In 1887, Mary Elen Richmond planed to establish a

training school for applied philanthropy for the purpose of

fieldwork training in social work education. In 1898, a training

course is made run for six weeks. The name of this course was

summer training course.In the early of twenty centuries, the

different courses on social work education and fieldwork training

are established in various universities and colleges in

USA.Social work practice in institutional settings developed

primarily in the Massachusetts General Hospital in 1905. Under

(he guidance of Richard C. Cabot, physician to outpatients Ida

Claim on established the first medical social work department in

a hospital in the United States. Once again there was a precedent

for this service in London. However, social workers in the United

States refused to identify with nursing, because of nurses'

subordinate status, and attempted to develop a professional

identity based on the model of the physician: Medical social

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workers became interested in professional education as a means of

moving beyond the "warm-heart" position into an understanding of

the psychic or social conditions at the base of patient distress.

Furthermore, with professional education it would be possible to

move into a colleague relationship with the physician. By 1912, a

one-year course in medical social work was established in the

Boston School of Social work. (Morales, shefor, 1986:46-47)

In Pakistan Period

The first short term in service social work training course held

in 1952 at Karachi jointly sponsored by the government of

Pakistan and The United Nations Technical Assistants

Administration, was under the direction and supervision of United

Nations consultants an their Pakistani colleagues. Three days

were given to classroom work and two days to supervised field

demonstration. The curriculum of this course was divided into

three major phases:

o Orientation

o Social work technique

o Fieldwork

Fieldwork consisted of supervised observation and practical work

in seven fields:

Labor welfare

Medical social work

Youth work

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Rural welfare

Delinquency

Industrial management

Child and family welfare

The next course was held in Dhaka in September, 1953. The

duration of the course was three months. The curriculum of this

course was divided into four major phases:

Orientation course

Techniques course

Fieldwork

Review and examination

Fieldwork as a learning process, involving two days of a Five day

week, was planned to provide observation and practical

demonstration in the field of community organization, rural

welfare, child and family welfare and medical welfare. Fieldwork

was taken as an integral part of the curriculum where

opportunities were provided to lest class room knowledge in

practical situation (Rashid 1960:28-29).The Dhaka training

program was evaluated by the international team. They were

convinced that the field work in particular demonstrated that

modern social work techniques could be applied effectively in

encouraging self help in individuals and in groups. [Ibid, P.

p:28-29] .

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On the basis of three month training courses conducted in Dhaka

from September 1953, the recommendations of the international

team, Dhaka College and Research Centre was introduced in Dhaka

in 1958. Later on, it is named as Institute of Social Welfare and

Research in 1973. College of social work was established in

Kajshahi in 1964, This college included as a department at Arts

Faculty in Rajshahi University in 1964. Now different

universities and Colleges are teaching professional social work

course under the department of social work in Bangladesh. The

curriculum of these departments has developed including fieldwork

program.

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Importance of Fieldwork:

Field work has immense importance to the students of social work.

Social work is primarily the professional activity of helping

individuals, groups and communities enhance or restore 'their

capacity for social functioning and creating societal conditions

favorable to that goal (NASW, 1995), and it is fieldwork chat,

for the first time, provides an opportunity for students to

interact professionally with individuals, groups and

organizations (Nelson, 1993). It is believed that in professional

social work education, knowledge alone is not enough and the

development of skills in practice is necessary. On the other

hand, classroom instruction, group discussion, and reading alone

cannot produce professional skills because 'to know' does not

result automatically in the ability 'to do' (Rashid, 1960:3).

"Fieldwork component of the social work curriculum then provides

a structured learning environment to the students for the

development of professional social work skills.

Fieldwork provides students with genuine experience in applying

social work methods and enables them to become familiar with the

real world of practice, i.e. to relate academic theory to

concrete reality as found in the agency setting. It allows the

students to test himself/herself and helps to develop a sense of

professional-self among them. Fieldwork also generates

professional discipline and self-confidence among students and

17

helps them to feel himself/herself a social worker with beginning

competence (ISWR, 1996:1). Moreover, it helps them to identify,

clarify and assess their own needs as social work students as

well as the needs of different types of persons coming to the

agencies as clients. In addition, students become able to

understand the organizational and community context of social

work practice through fieldwork (Corliss and Corliss, 1998:54).

In "Field Work Manual', M.A. Momen (1970:12) has mentioned the following

importance of field work practices:

Students should learn to apply social work methods in the

solution of given individual ground or community problems.

The student should develop facility in the use of

organizational structure; particularly the committee. He/

she should come to know how to foster and use relationships

within structure and gain insight regarding his/ her special

place in the net-work of relationship,

The student should achieve self-awareness and disciplined

use of self as a helper and group situations.

The students need to learn the organizational framework of

services. He/ she must understand agency structure and

18

policy and how to facilitate such policy through his/ he

practice.

The student should become familiar with administrative

procedures and processes,

The student should acquire knowledge regarding community

structure and procures,

The student should acquire significant substantive knowledge

in the specific field of practice characterized by the

agency in which he/ she in placed.

The student should acquire competence in recording and

reporting (process records minutes, monthly reports,

administrative correspondence, etc.).

The student should acquire and be given an opportunity to

try out a variety of social work methods, skills and

techniques,

Field work helps the students to realize the theory, methods

and principles of social work in practice which facilitates

them to develop professional self.

The students acquire and are given an opportunity to try out

a variety of social work methods, skill and techniques. This

may include among others preparing news release public

speaking, arranging and conducting conference, engaging fact

finding and statistical work on specific problem, conducting

finding, personal interviews, preparing budget work schedule

etc.

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Some other importance of fieldwork

Developing social work skill with emphasis on

individualizing the problem-solving process.

Developing understanding of board policy issues and the

legislative process and administrative process.

To give opportunity for students to learn to work with other

professional and voluntary workers.

To help the student to develop a deeper awareness of himself

and his part in the problem-solving process.

The students learn how to apply social work knowledge and

methods in the solution of given individual, group or

community problems. The students come to know how to

accomplish study, diagnosis and treatment process of

client's problems.

The students can understand how to work under an

administrative and organizational structure and they can

learn how an office is governed and what kinds of routine

needs to be established,

The fieldwork practices in social work education should enable

students, using acquired knowledge of social work methods,

concepts and principles, to work with individuals, groups and

communities, and should further encourage developmental teaching,

leading student from their present status to the desired outcome.

Inter-relationship between Social Work Education and Field Work

20

Mutual relationship between social work education and practice:

Modern social work education has two dimensions: theoretical and

practical. A social worker gains knowledge about society, social

problems, property, social structure, social values, human

behavior, social work process when practical training enable them

to use this knowledge acquired knowledge in this field for real

life purposes. Thus practical training is required for social

worker to solve social problems of human beings/society for

modern social work. Taking notice of this requirement higher

education has been provided with practical training course in its

syllabus about social work, through which students can apply

theoretical knowledge for solution of problems. Social and

Economic Council of United Nations has recognized social work as

a profession in 1951 and formulated the following decisions.

Social Work is a profession based on trained male and female and

who are obtained theoretical and practical knowledge in social

work degree from established and recognized educational

institutions is mandatory to fulfill by them.

Social Work is a practical education, which is learned through

theoretical study of society and social work. This is because

‘public good’ can be affected only by applying theoretical

knowledge in real life in a scientific way. And practical

training helps apprentices to be full-hedged social workers by

making arrangements of applying theoretical knowledge in

practical life. And these together make social work education and

practical training inter-dependent upon each other. Therefore we

21

may say social work education and field work are interrelated

concept just like two branches of a tree.

Figure: Interrelationship between social

work & Field work

From the above discussion, we can say that field work is a

process by which students gather practical experience from the

related field. In social work subject, field work very much

important because of its professional attitude. We know every

profession is composed with academic learning as well as

practical experience.

Clinical social work is a healthcare profession based on theoriesand methods of prevention and treatment in providing mental-health/healthcare services, with special focus on behavioral andbio-psychosocial problems and disorders. Clinical social work’sunique attributes include use of the person-in-environment

22

Social WorkTheoretical PerspectivePractice Perspective

perspective, respect for the primacy of client rights, and strongtherapeutic alliance between client and practitioner. With200,000 practitioners serving millions of client consumers,clinical social workers constitute the largest group of mental-health/healthcare providers in the nation.

Clinical Social Work

Clinical social work is the professional application of social worktheory and methods to the diagnosis, treatment, and prevention ofpsychosocial dysfunction, disability, or impairment, includingemotional, mental, and behavioral disorders (Barker,2003).Clinical social work is broadly based and addresses theneeds of individuals, families, couples, and groups affected bylife changes and challenges, including mental disorders and otherbehavioral disturbances. Clinical social workers seek to provideessential services in the environments, communities, and socialsystems that affect the lives of the people they serve.

Clinical social work has a primary focus on the mental,emotional, and behavioral well-being of individuals, couples,families, and groups. It centers on a holistic approach topsychotherapy and the client’s relationship to his or herenvironment. Clinical social work views the client’s relationshipwith his or her environment as essential to treatment planning.Clinical social work practice also focuses on collaborativeproblem solving, helping clients increase connections with othersand their environment and advocating for the social environmentto be more responsive to the client’s need. Clinicalpractitioners are trained to do this work through use of aprofessional relationship, purposeful conversation, plannedactivity, and resource mobilization. Guiding principles ofclinical practice include worth and dignity of all people, use ofa strengths perspective, confidentiality, and client self-determination in decision making.

The knowledge base of clinical social work includes theories ofbiological, psychological, and social development; diversity andcultural competency; interpersonal relationships; family and

23

group dynamics; mental disorders; addictions; impacts of illness,trauma, or injury; and the effects of the physical, social, andcultural environment. This knowledge is inculcated in social workgraduate school and is fused with direct-practice skills that aredeveloped by the practitioner during a period of at least twoyears of post-graduate experience under clinical supervision.This period should suffice to prepare the clinical social workerfor autonomous practice and state-licensure as a clinical socialwork professional. In the years that follow, clinical socialworkers may pursue an advanced-generalist practice or may decideto specialize in one or more areas. Clinical social workers areoften the first to diagnose and treat people with mentaldisorders and various emotional and behavioral disturbances.Clinical social workers are essential to a variety of client-centered settings, including community mental health centers,hospitals, substance use treatment and recovery programs,schools, primary health care centers, child welfare agencies,aging services, employee assistance programs, and privatepractice settings.

Scope of Clinical Social Work

Clinical social work students are trained to practice within acontext of social policy and macro systems and to consider howthese policies and systems impact clients and worker practices.Clinical social workers are employed in a variety of settingsincluding early childhood intervention programs, hospitals,community health settings, schools, housing developments, nursinghomes, mental health clinics, and child welfare.

Clinical social work is notable for the versatility of itspractitioners and the variety of their roles, including that ofteam member and team leader in a multi-disciplinary setting.Client consumers—individuals, couples, families, and groups—benefit from a variety of direct services, including assessment,diagnosis, treatment planning, intervention/treatment, evaluationof outcomes, and case management. Clinical social work settings

24

and services include, but are not limited to, the following (inalphabetical order):

•child & family services • private practice offices• clinics • public & private schools

• court & forensic venues • public sector health/mentalhealth

• elder care facilities • rehabilitation facilities

• home health care • religious/spiritualorganizations

• hospice • residential treatment• hospitals • rural healthcare• not-for-profit agenciesand   organizations agencies

• social services

• palliative andrehabilitative care

• uniformed services andVeterans Affairs

The scope of clinical social work extends across many practicesettings and populations. It is anticipated that these standardswill reinforce and support current clinical practice in allsettings, while affirming the value of clinical social workservices as a discrete practice area.

The flexible and skillful application of knowledge, theories, andmethods in a bio-psychosocial approach is a hallmark of clinicalsocial work. Interventions—the direct person-to-person(s) process—are conducted with people of all ages and range in nature frompreventive, crisis, and psycho-educational services tocollaborative client advocacy and brief and long-term counselingor psychotherapy. Typically, clinical social workers superviseand consult with professional colleagues and may engage inindirect practice (e.g. administration, research, teaching, andwriting). It is a standard of practice for clinical socialworkers to engage in career-long continuing clinical educationand to adhere to a professional code of ethics.

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Standards for Clinical Social Work in Social WorkPractice

The NASW Board of Directors (2005) adopted following standards

Standard 1. Ethics and Values

Clinical social workers shall adhere to the values and ethics of the social work profession, utilizing the NASW Codes of Ethics as a guide to ethical decision making.

Standard 2. Specialized Practice Skills and Intervention

Clinical social workers shall demonstrate specialized knowledge and skills for effective clinical intervention with individuals, families, and groups.

Standard 3. Referrals

Clinical social workers shall be knowledgeable about community services and make appropriate referrals, as needed.

Standard 4. Accessibility to Clients

Clinical social workers shall be accessible to clients during nonemergency and emergency situations.

Standard 5. Privacy and Confidentiality

Clinical social workers shall maintain adequate safeguards for the private nature of the treatment relationship.

Standard 6. Supervision and Consultation

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Clinical social workers shall maintain access to professional supervision and/or consultation.

Standard 7. Professional Environment and Procedures

Clinical social workers shall maintain professional offices and procedures.

Standard 8. DocumentationDocumentation of services provided to or on behalf of the client shall be recorded in the client’s file or record of services.

Standard 9. Independent Practice

Clinical social workers shall have the right to establish an independent practice.

Standard 10. Cultural Competence

Clinical social workers shall demonstrate culturally competentservice delivery in accordance with the NASW Standards for CulturalCompetence in Social Work Practice.

Standard 11. Professional Development

Clinical social workers shall assume personal responsibility fortheir continued professional development in accordance with theNASW Standards for Continuing Professional Education and state requirements.

Standard 12. Technology

Clinical social workers shall have access to computer technologyand the Internet, as the need to communicate via e-mail and toseek information on the Web for purposes of education,networking, and resources is essential for efficient andproductive clinical practice.

27

Chapter 2.Concise Delineation on DMC

2.1 History of DMC

2.2 Entrance Examination

2.3 Principals

2.4 Role in National History

2.5 Facilities and Achievements

28

2.6 Clubs and Association

2.7 Alumni Trust

Dhaka Medical College Hospital (DMC)

29

Dhaka Medical College and Hospital (DMCH) is a medical college located in Dhaka, Bangladesh. It is situated inthe Bakshibazar area of Dhaka, the capital city of Bangladesh. The college is close to the University of Dhaka and the Bangladesh University of Engineering and Technology.

History

At the beginning, the college did not have a building of its own.The present building was there before the Partition of Bengal of 1905. The building was first used, in 1904, as the secretariat (headquarters) of the newly formed provinces of East Bengal and Assam. During this period bureaucrats, not doctors, used to roam its busy corridors.In 1921, when the University of Dhaka began its journey, the building was handed over to the University administration. At that time a part of this huge building was used as the University's Medical Center, another part as the students' dormitory and the rest as the administrative wing of the Arts faculty.In 1939, the Dhaka University Council requested that the British Government establishes a medical college in Dhaka. The proposal was postponed due to the Second World War,During World War II it became an American Armed Forces hospital. The Americans left at the end of the war, but the hospital remained.Dhaka Medical College was established in 1946 and the college began admitting students. Academic class started on July 10 whichis celebrated as "DMC DAY". The 1st year was named K-5, 2nd year K-4, 3rd year K-3, 4th year K-2, and 5th year K-1. All the students except K-5 had transferred from the Calcutta Medical College. The main reason behind this was the partition of 1947.

30

At first there were no female students but now about half of the students are females.Over time, the original 100 bed hospital has grown to become Bangladesh's largest hospital. After adding 500 beds on October 3, 2013, DMCH is now a 2300 bed hospital. The new beds were addedin a new building known as DMCH-2. The Medinine (Medical Center) is gradually being shifted to the new building, DMCH-2, which will open with a bone marrow transplantation facility very soon.Major W J Virgin, the head of the committee formed to establish the Dhaka Medical College, was the first principal. At the beginning there were only four departments – Medical,Surgery, Gynecology and Otolaryngology (ENT). Since thecollege did not have'at first, a Anatomy nor a Physiology department the students attended those classes at Mitford Medical School(now the Sir Salimullah Medical College). After a month, Professor of Anatomy Pashupati Basuand and Professor of Physiology Hiralal Saha joined the staff and the classes began in ward number 22 of the hospital.There was no lecture hall or dissection gallery at this time. These needs were met after the foundation of the college buildingin 1955. The institute did not have any student housing. Male students were allowed to reside in the Dhaka University's studenthalls, but girls had to live at home. The college and hospital premises were expanded with temporary sheds, some of which were built for outdoor services of the hospital and some for student housing. New buildings for housing, college and hospital were constructed in phases: a dormitory for girls in 1952, a dormitoryfor male students in 1954–55, a new complex of academic buildingsin 1955, and a dormitory for internee doctors in 1974–75. A new academic and hospital building, Dhaka Medical College Hospital-2 (DMCH-2), was inaugurated by Prime Minister Shiekh Hasina on October 3, 2013.

Entrance examination

Every year, after passing the Higher School Certificate, nearly 65,000 (sixty five thousand) applicants from all over the country

31

sit for the medical college entrance examination. The top 200 students get the opportunity to study at the Dhaka Medical College. Each class of the Dhaka Medical College are named with the prefix K and a number, such as class K-71 (the latest class at the Dhaka Medical College.)

Principals

Serial Name Period

1. Dr. Major W JVirjin

01.07.46 –14.08.47

2. Dr. Colonel E GMontgomery

15.08.47 –19.07.48

3. Professor T Ahmed 19.07.48 –01.01.52

4. Dr. Colonel A KAfridi

01.01.50 –20.03.53

5. Professor NowabAli

21.03.53 –10.04.54

6. Professor A K M AWahed

11.04.54 –20.01.55

7. Professor Nowab 21.01.55 –

32

Serial Name Period

Ali 01.02.57

38. Professor QuaziDeen Mohammad 27.01.08 –

Role in national historyThe Dhaka Medical College has been involved in all the national movements of Bangladesh. Dhaka Medical College dormitory (known as Barrack) was at the heart of thelanguage movement from 1948 to1952. Barrack was formerly situated at Central Shaheed Minar current location.There were about 20 tin shed barracks where the medical students resided. Being close to the Parliament of East Pakistan (presently Jagannath Hall of Dhaka University). For strategic reasons the medical dormitory was chosen as the center of the student movement.In the early hours of February 21, 1952, all the students of Dhaka Medical College gathered in front of the medical college dormitory. In the afternoon the group headed for the parliament which was in session. No procession was allowed due to Section 144. The students decided to break Section 144 at 4:00 PM at the historical "Aam-tola" (which was situated beside the present day Emergency gate).The police fired at the procession, resulting in the deaths of Salam, Barkat, Rafique, Jabbar and Shafiur.After sundown on February 21st, at the site of the deaths, the students of Dhaka Medical College decided to build a monument. They worked continuously on the 22nd and 23rd of February and

33

finished the construction, using bricks, gravel and cement reserved for the hospital.The students of DMC played a vital role in the student and mainstream politics of the 60's as well. When the military government of Ayub Khan started torturing opposing political leaders, the central student leaders took refuge in the Bakshibazar student dormitory. Most of the meetings deciding the upcoming line of action were held on the college campus. During the movement protesting the martial law and the Hamidur Rahman Education Commission, DMC and its dormitories were the only safe refuge for the student leaders. Many students of this institutionactively participated.On January 20, 1969, police charged and fired into a procession of students near the present emergency gate. Student leader Asaduzzaman was severely injured. He was admitted to the hospitalbut died in ward number 8 before any treatment was possible. The students of the medical college led a procession with the blood stained shirt of Shaheed Asad. Shortly after the students of Dhaka University raised the flag of independent Bangladesh in the"Bot tala" of DU. On March 2, 1971, the doctors of DMCH raised itat the peak of present Doctors' Cafeteria. Dhaka Medical College had also made its mark in the mass uprising of the 90's. The doctors actively participated in the movement protesting the anti-health policy of the government of that time under the banner of BMA.[1]

Liberation War, 1971Students, nurse, staff and doctors who had passed from DMC playeda major role in the war of independence. Many of them were engaged in the battlefield, while others risked their lives to treat the injured freedom fighters in the hospital. Almost all the doctors working at DMCH helped the injured freedom fighters by admitting them under false names. Dr. Fazle Rabbi. Moazzem Hossain, Selim ahmed, Ali Hafiz Selim, Abu Yusuf Mia, Iqbal Ahmedfaruq, Muzibul Haque, Mostafa Jalal Mahiuddin, Mozaffar, amzad Hossain, Wali, Osman, Golam Kabir, Zillur Rahim, Dalu,

34

Nurujjuman, Shahadat and many more students took part in the war as liberation fighters. Many of them fought in the Dhaka city.

Facilities and achievmentsIn order for students to post graduate, they must undergo intensive preparation. If desired, one can justify themselves online. To justify your post graduation admission preparation Click here. Sample questions and model tests are provided, which can aid in this process.Dhaka Medical College has two museums. The National Forensic DNA Profiling laboratory is first of its kind in Bangladesh. The laboratory assists in investigations concerning murder, rape, paternity, maternity, immigration, distribution of wealth among successors, deformed dead bodies and other cases needing identification.Shahjahan Hafiz, a student in the fifties was a leading Rabindra song artist in the East Pakistan Radio. The notable alumni of DMCincludes current Foreign Minister Dr Dipu Moni, current Health Minister Professor Dr Ruhul Huq, Health Advisor to the Prime Minister Dr. Syed Modasser Ali, former President of Bangladesh Dr. A.Q.M. Badruddoza and many other distinguished personalities.DMC became champions and runners up in the Debate Competition organised by Bangladesh television more than once and came in third at 'Gyan Jiggasa' (a national general knowledge competitionof Bangladesh Television) in 1985 and Champions in 1987. Dr. Rifat Haider of Batch K59 became champion in 2008 at the Bangladesh chapter of World Quizzing Championship and Dr. Ahmad Fayezi Tamal of Batch K64 became champion four times (2009,2011,2012,2013) in the same competition. Sheikh Mahmood Hasan of Batch K64 and Rajat Das Gupta of Batch K66 became runnerup in that competition in 2010 and 2011 respectively. Dhaka Medical College quiz team became champion in IFIC Bank DQS-SSMC Carnival Captive 2013 competing among 68 teams in 2013. Dhaka Medical College has many voluntary organizations such as the Computer Club of Dhaka Medical College, Debating Club of DMC, Rotaract Club, Medicine Club and so on.

35

Dhaka Medical College Debating Club (DMCDC) is a pioneer in Medical college Debating History. After being established in 2009, DMCDC has hosted two national debate festivals with huge success. Present Debate team of Dhaka Medical College became champion in the TIB-DMCDC National Anti-Corruption Day Debate Competition 2012. They are also runner-up team of SK-F NDFBD DMCDC National Inter-Medical College Debate Competition 2011. TheDebate team also owns the title of runner-up in '1st Bangladesh Television Environmental Debate Competition-2012 ' & the title ofChampion in '2nd Bangladesh Television Environmental Debate Competition'. In Recent Time, Dhaka Medical College Debate Team is the only medical based debate team who reached the final of inter-university debate championship in 2013 JUDS Inter University Debate Championship. By winning 3rd SKF-NDFBD-CMCDC National Inter Medical College Debate Championship In 2014,Dhaka Medical College Debate Team is the present Defending Champion Of Inter Medical College Debate. Present team Consists of team member Ranok Mehedi (K-69),Zahid Hasan (K69),Raisul Arafat (K-71).Dhaka Medical College Football team won Tarubala shield in 1947

which was organised by district sports association. Captain Mirza

Mazharul Islam beat renowned Clubs like Wari on his way to

winning the title. Athletics Secretary of first DMCSU (1949–50)

was Mazharul Islam Damal who expressed his sporting ability by

creating a bang as the opening batsman of Pakistan 'A' cricket

team. Dhaka Medical College Cricket team achieved the pride of

becoming Dhaka division champion in 1962–63 season.

Clubs and associations

36

Medicine Club, DMC Unit Sandhani, DMC branch Computer Club of DMC Ex-Cadets' Association of DMC Debating Club Rotaract club

Alumni trust

Dhaka Medical College Alumni Trust was formed in 1989. Former principal &

professor Wali Ullah was the founder-president.

37

Chapter 3. Introduction to Field Specialization

3.1 Concept of Mental Health

3.2 Concept of Mental Disorder

3.3. Classification and Symptoms of Mental Disorder

38

Concept of Mental Health

Mental health refers to our cognitive, and/or emotional

wellbeing- it is all about how we think, feel and behave. It can

also mean an absence of a mental disorder.

According to WHO ( world Health organization) Mental health

is “a state of well –being in which the individual realizes

his or her own abilities, can cope with the normal stresses

of life can work productively and fruitfully and is able to

make a contribution to his or her community .”

According to the social work Dictionary (1995;231) Mental is

the related state of emotional well –being, freedom from in

capacitating conflicts and the consistent ability to make

and canny out national decisions and cope with environmental

stresses and internal pressure.

At last it can be said that mental health includes a person’s

ability to enjoy life to attain balance between life activities

and efforts to achieve psychological resilience.

The mental health act:

In 1959 mental health act was seen a new era of psychiatric

treatment & care. But less than 10 percent of the psychiatric

39

hospital population is detained, under a section of mental health

act. 1959 Act led to two government publications. The first, a

consultation paper followed in 1978 by a government white paper

entitled review of the mental health act with five main

principles. The Royal assent was given to the Mental Health

(Amendment ) bill in October 1982& the consolidating bill was

passed in the spring of 1983.

Concept of Mental Disorder:

A mental disorder or mental illnesses is a psychological or

behavioral pattern that occurs in an individual and is thought to

cause distress disability.

According to WHO (World Health Organization)

Mental disorders comprise a broad range of problems, with

different symptoms.

However they are generally characterized by some combination of

abnormal thoughts, emotions, behavior and relationship with

others.

According to the Social Work Dictionary

“Mental disorder is impaired psychosocial or cognitive

Functioning due to disturbance in only are or more of the

following process biological, chemical, genetic psychological or

social .

40

Classification & Symptoms of Mental Disorder:

The classification of mental disorders also know as psychiatric

ontology, is a key aspect of psychiatry. Different personalities

and organizations have classified mental disorders in different

ways.

Colemen, divided mental disorders into two general categories in

Abnormal Psychology. These are:

a. Psychotic Disorder.

b. Neurotic Disorders

Psychotic Disorders: Psychotic disorders are divided into two

general categories.

a. Functional psychoses

b. Organic psychoses.

Functional psychoses: Functional psychoses are in turn divided

into four main groups:

I. Schizophrenic disorders (like; Simple reaction, Hebephrenic

reaction, catatonic reaction, paranoid reaction, Childhood

schizophrenia)

II. Paranoid disorders (like; paranoia, Paranoid state).

III. Affective disorders.(Manic- depressive reaction, psychotic

depressive reaction)

IV. Involution Psychotic disorders.

41

Neurotic Disorders: Neurotic Disorders are classified such way

A. Anxiety reaction

B. Aesthetic reaction

C. Hypochondraiacal reaction

D. Conversion reaction.(The most common forms are):

Anesthesia- loss of sensitivity

Hyperesthesia – partial loss of sensations

Paresthesia- exceptional sensations.

E. Dissociative reaction. Such as-

Amnesia,fugue,somnambulism and multiple

personalitly(ideas blocks off)

F . Poblic reaction.(it is a persistent of various fears such

as).

Acrophobia-high places.

Agoraphobia-open places.

Anglophobia-pain.

Astra phobia-storms, thunder and lighting

Clustrophobia- closed places

Hematophobia-blood

Mysophobia- contamination or germs.

Menophobia-being alone.

42

Nyctophobia-. darkness

Ocholophbia - crowds

Pathophobia-diseadse

Pyrophobia-fire.

Syphophobia –syphhilis

Zoophobia-animals or particular animals.

g. Obsessive-compulsive reaction.

h. Neurotic Depressive reaction.

Major Mental Disorders (Psychoses): Major mental disorders are

commonly called psychoses. It is a severe abnormal state of mind

where there is usually disturbance of thinking, felling, mood and

behavior. They are classified into two groups:

a.Organic psychoses

b.Functional psychosis

Organic psychosis: In organic psychoses there are demonstrable

abnormalities in the brain. They may be

1.Acute (Delirium)

2.Chronic(Dementia

)

Delirium: Delirium is the psychoses the commonest organic

disorder seen in the clinical practice. Major symptoms of it-

43

Imparied consciousness

Behavior: Restlessness,

irritability,noisiness,reduced speech.

Motor symptoms: Asterixis, multi-

focal,myoclomous

Thinking: Slow and muddled thinking.

Mood:Anxiety, depression, agitation.

Memory:Disturbance of memory.

Insight:Impaired.

Dementia: Dementia is a chronic organic mental disorder. Major

symptoms of it-

Behavior: Often muddled, distractible,

inappropriate and restless.

Thinking:Thinking slows and becomes impoverished

in content.

Judgment: Judgment is impaired and false idea.

Mood: anxiety, depression and irritability may

be present.

Insight: Insight is lacking into the degree and

nature of the disorders

Functional Psychoses: These are psychoses where there are usually

no demonstrable abnormalities in the brain or in the other

orfgans of the body. Major types of functional psychoses include:

i. Schizophrenia.

44

ii. Mood disorders.

Schizophrenia: Schizophrenia is a major mental disorder. It was

first described by Belgian Psychiatrist Benedict Morel in 1852,

who called it demence precoce. It is a brain disorder and

adversely affect thinking, feeling. Behaviour, social and

occupational functioning. Schizophrenia is grouped into two basic

concepts.

a. Acute Schizophrenia

b. Chronic Schizophrenia

Symptoms of acute schizophrenia:

Lack if insight

Auditory hallucinations

Ideas of reference and suspiciousness.

Flatness of affect and delusional mood.

Thoughts spoken aloud.

Symptoms of acute schizophrenia:

Social withdrawal and slowness.

Lack of drive and initiatives.

Lack of conversation and thought disorders.

Under activity and odd behaviors.

Threats or violence.

45

What Is Schizophrenia?

Schizophrenia is a chronic, severe, and disabling brain disorder

that has affected people throughout history.People with the

disorder may hear voices other people don't hear. They may

believe other people are reading their minds, controlling their

thoughts, or plotting to harm them. This can terrify people with

the illness and make them withdrawn or extremely agitated.People

with schizophrenia may not make sense when they talk. They may

sit for hours without moving or talking. Sometimes people with

schizophrenia seem perfectly fine until they talk about what they

are really thinking. Families and society are affected by

schizophrenia too. Many people with schizophrenia have

What are schizophrenia symptoms and signs?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM),

symptoms of schizophrenia include the following:

Positive, more overtly psychotic symptoms

Beliefs that have no basis in reality (delusions)

Hearing, seeing, feeling, smelling, or tasting things that

have no basis in reality (hallucinations)

Disorganized speech

Disorganized behaviors

Catatonic behaviors

Negative, potentially less overtly psychotic symptoms

46

Inhibition of facial expressions

Lack of speech

Lack of motivation

Signs & Symptoms

The symptoms of schizophrenia fall into three broad categories:

positive symptoms, negative symptoms, and cognitive symptoms.

Positive symptoms

Positive symptoms are psychotic behaviors not seen in healthy

people. People with positive symptoms often "lose touch" with

reality. These symptoms can come and go. Sometimes they are

severe and at other times hardly noticeable, depending on whether

the individual is receiving treatment. They include the

following:

Hallucinations are things a person sees, hears, smells, or feels

that no one else can see, hear, smell, or feel. "Voices" are the

most common type of hallucination in schizophrenia. Many people

with the disorder hear voices. The voices may talk to the person

about his or her behavior, order the person to do things, or warn

the person of danger. Sometimes the voices talk to each other.

People with schizophrenia may hear voices for a long time before

family and friends notice the problem.

Other types of hallucinations include seeing people or objects

that are not there, smelling odors that no one else detects, and

47

feeling things like invisible fingers touching their bodies when

no one is near.

Delusions are false beliefs that are not part of the person's

culture and do not change. The person believes delusions even

after other people prove that the beliefs are not true or

logical. People with schizophrenia can have delusions that seem

bizarre, such as believing that neighbors can control their

behavior with magnetic waves. They may also believe that people

on television are directing special messages to them, or that

radio stations are broadcasting their thoughts aloud to others.

Sometimes they believe they are someone else, such as a famous

historical figure. They may have paranoid delusions and believe

that others are trying to harm them, such as by cheating,

harassing, poisoning, spying on, or plotting against them or the

people they care about. These beliefs are called "delusions of

persecution."

Thought disorders are unusual or dysfunctional ways of thinking.

One form of thought disorder is called "disorganized thinking."

This is when a person has trouble organizing his or her thoughts

or connecting them logically. They may talk in a garbled way that

is hard to understand. Another form is called "thought blocking."

This is when a person stops speaking abruptly in the middle of a

thought. When asked why he or she stopped talking, the person may

say that it felt as if the thought had been taken out of his or

48

her head. Finally, a person with a thought disorder might make up

meaningless words, or "neologisms."

Movement disorders may appear as agitated body movements. A

person with a movement disorder may repeat certain motions over

and over. In the other extreme, a person may become catatonic.

Catatonia is a state in which a person does not move and does not

respond to others. Catatonia is rare today, but it was more

common when treatment for schizophrenia was not available.

Negative symptoms

Negative symptoms are associated with disruptions to normal

emotions and behaviors. These symptoms are harder to recognize as

part of the disorder and can be mistaken for depression or other

conditions. These symptoms include the following:

"Flat affect" (a person's face does not move or he or she

talks in a dull or monotonous voice)

Lack of pleasure in everyday life

Lack of ability to begin and sustain planned activities

Speaking little, even when forced to interact.

People with negative symptoms need help with everyday tasks. They

often neglect basic personal hygiene. This may make them seem

lazy or unwilling to help themselves, but the problems are

symptoms caused by the schizophrenia.

49

Cognitive symptoms

Cognitive symptoms are subtle. Like negative symptoms, cognitive

symptoms may be difficult to recognize as part of the disorder.

Often, they are detected only when other tests are performed.

Cognitive symptoms include the following:

Poor "executive functioning" (the ability to understand

information and use it to make decisions)

Trouble focusing or paying attention

Problems with "working memory" (the ability to use

information immediately after learning it).Cognitive

symptoms often make it hard to lead a normal life and earn a

living. They can cause great emotional distress.

How is schizophrenia diagnosed?

As is true with virtually any mental-health diagnosis, there is

no one test that definitively indicates that someone has

schizophrenia. Therefore, health-care practitioners diagnose this

disorder by gathering comprehensive medical, family, and mental-

health information. Patients tend to benefit when the

professional takes into account their client's entire life and

background. This includes but is not limited to the person's

gender, sexual orientation, cultural, religious and ethnic

background, and socioeconomic status. The symptom sufferer might

50

be asked to fill out a self-test that the professional will

review if the person being evaluated is able to complete it. The

practitioner will also either perform a physical examination or

request that the individual's primary-care doctor perform one.

The medical examination will usually include lab tests to

evaluate the person's general health and to explore whether or

not the individual has a medical condition that might produce

psychological symptoms.

In asking questions about mental-health symptoms, mental-health

professionals are often exploring if the individual suffers from

hallucinations or delusions, depression and/or manic symptoms,

anxiety, substance abuse, as well as some personality disorders

(for example, schizotypal personality disorder) and developmental

disorders (for example, autism spectrum disorders). Since some of

the symptoms of schizophrenia can also occur in other mental

illnesses, the mental-health screening is to determine if the

individual suffers from schizoaffective disorder or other

psychotic disorder, depressive disorder, bipolar disorder,

anxiety disorder, or a substance-abuse or personality disorder.

Any disorder that is associated with bizarre behavior, mood, or

thinking, like borderline personality disorder or another

psychotic disorder, as well as dissociative identity disorder

(DID), also known as multiple personality disorder (MPD) may be

particularly challenging to distinguish from schizophrenia. In

order to assess the person's current emotional state, health-care

providers perform a mental-status examination as well.

51

In addition to providing treatment that is appropriate to the

diagnosis, determining the presence of mental illnesses that may

co-occur (be comorbid) with schizophrenia is important in

improving the life of individuals with schizophrenia. For

example, people with schizophrenia are at increased risk of

having a substance-abuse, depressive, or anxiety disorder and of

committing suicide.

Treatments

Because the causes of schizophrenia are still unknown, treatments

focus on eliminating the symptoms of the disease. Treatments

include antipsychotic medications and various psychosocial

treatments.

Antipsychotic medications

Antipsychotic medications have been available since the mid-

1950's. The older types are called conventional or "typical"

antipsychotics. Some of the more commonly used typical

medications include:

Chlorpromazine (Thorazine)

Haloperidol (Haldol)

Perphenazine (Etrafon, Trilafon)

Fluphenazine (Prolixin).

52

In the 1990's, new antipsychotic medications were developed.

These new medications are called second generation, or "atypical"

antipsychotics.

One of these medications, clozapine (Clozaril) is an effective

medication that treats psychotic symptoms, hallucinations, and

breaks with reality. But clozapine can sometimes cause a serious

problem called agranulocytosis, which is a loss of the white

blood cells that help a person fight infection. People who take

clozapine must get their white blood cell counts checked every

week or two. This problem and the cost of blood tests make

treatment with clozapine difficult for many people. But clozapine

is potentially helpful for people who do not respond to other

antipsychotic medications.

Other atypical antipsychotics were also developed. None cause

agranulocytosis. Examples include:

Risperidone (Risperdal)

Olanzapine (Zyprexa)

Quetiapine (Seroquel)

Ziprasidone (Geodon)

Aripiprazole (Abilify)

Paliperidone (Invega).

Psychosocial treatments

53

Psychosocial treatments can help people with schizophrenia who

are already stabilized on antipsychotic medication. Psychosocial

treatments help these patients deal with the everyday challenges

of the illness, such as difficulty with communication, self-care,

work, and forming and keeping relationships. Learning and using

coping mechanisms to address these problems allow people with

schizophrenia to socialize and attend school and work. Patients

who receive regular psychosocial treatment also are more likely

to keep taking their medication, and they are less likely to have

relapses or be hospitalized. A therapist can help patients better

understand and adjust to living with schizophrenia. The therapist

can provide education about the disorder, common symptoms or

problems patients may experience, and the importance of staying

on medications. For more information on psychosocial treatments,

see the psychotherapies section on the NIMH website.

Illness management skills. People with schizophrenia can take an

active role in managing their own illness. Once patients learn

basic facts about schizophrenia and its treatment, they can make

informed decisions about their care. If they know how to watch

for the early warning signs of relapse and make a plan to

respond, patients can learn to prevent relapses. Patients can

also use coping skills to deal with persistent symptoms.

Integrated treatment for co-occurring substance abuse. Substance

abuse is the most common co-occurring disorder in people with

schizophrenia. But ordinary substance abuse treatment programs

54

usually do not address this population's special needs. When

schizophrenia treatment programs and drug treatment programs are

used together, patients get better results.

Rehabilitation. Rehabilitation emphasizes social and vocational

training to help people with schizophrenia function better in

their communities. Because schizophrenia usually develops in

people during the critical career-forming years of life (ages 18

to 35), and because the disease makes normal thinking and

functioning difficult, most patients do not receive training in

the skills needed for a job.

Rehabilitation programs can include job counseling and training,

money management counseling, help in learning to use public

transportation, and opportunities to practice communication

skills. Rehabilitation programs work well when they include both

job training and specific therapy designed to improve cognitive

or thinking skills. Programs like this help patients hold jobs,

remember important details, and improve their functioning.

Family education. People with schizophrenia are often discharged

from the hospital into the care of their families. So it is

important that family members know as much as possible about the

disease. With the help of a therapist, family members can learn

coping strategies and problem-solving skills. In this way the

family can help make sure their loved one sticks with treatment

and stays on his or her medication. Families should learn where

to find outpatient and family services.55

Cognitive behavioral therapy. Cognitive behavioral therapy (CBT)

is a type of psychotherapy that focuses on thinking and behavior.

CBT helps patients with symptoms that do not go away even when

they take medication. The therapist teaches people with

schizophrenia how to test the reality of their thoughts and

perceptions, how to "not listen" to their voices, and how to

manage their symptoms overall. CBT can help reduce the severity

of symptoms and reduce the risk of relapse.

Self-help groups. Self-help groups for people with schizophrenia

and their families are becoming more common. Professional

therapists usually are not involved, but group members support

and comfort each other. People in self-help groups know that

others are facing the same problems, which can help everyone feel

less isolated. The networking that takes place in self-help

groups can also prompt families to work together to advocate for

research and more hospital and community treatment programs.

Also, groups may be able to draw public attention to the

discrimination many people with mental illnesses face.

Mood disorders: Mood is defined as a pervasive emotional tone

that profoundly influence ones outlook and perception of self,

others and the environment in general. The major classification

of mood disorders is:

a. Major depressive disorders.

56

b.Bipolar mood disorders.

Major depressive disorders: psychological symptoms of these

desease:

Feelings of unhappiness

Reduced energy, concentration and decreased activity

Helplesssness, hopelessness, forgetfulness.

Hallucination and pessimistic thoughts about past,

present and future

Ideas of self harm( suicide attempt)

Delusions of references, guilt.

Biological symptoms are:

Sleep disturbance

Loss of libido, variation of mood

Loss of appetite and weight.

Bipolar mood disorder: Bipolar mood disorders can be devided

into two types

a. Bipolar 1 disorders

b.Bipolar 2 disorder

57

Bipolar 1 disorders: patient who experience both manic episode

and major depressive episode.

Bipolar 2 disorders: patient has had at least one depressive

episode and no manic episode.

The major symptoms of bipolr mood disorders:

Manic phase

Elated mood, flight of ideas over activity,

pressure of speech.

Irritability, sleep disturbance.

Excessive expenditure and energy, increased

libido.

Out burst of anger.

Hallucination with mood.

Minor mental disorders( Neuroses):we can categorize neurotic

in the following groups….

Anxiety disorder:

58

Anxiety Disorder is an umbrella term that covers several

different forms of a type of common psychiatric disorder

characterized by excessive rumination , worrying, uneasiness,

apprehension and fear about future uncertainities either based

on real or imagined events, which may affect both physical and

psychological health. There are numerous psychiatric and medical

syndromes which may mimic the symptoms of an anxiety disorder

such as hyper thyroidism which may be misdiagnosed as generalized

anxiety disorder.

According to DSM IV, “Anxiety disorders are diagnosed when

subjectively experienced feelings of anxiety are clearly

present.”

Anxiety involves a more general or diffuse emotional reaction

beyond simple fear that is out of proportion to treats from the

environment. Anxiety is a neurotic disorder. The emotions present

in anxiety disorders range from simple nervousness to bouts of

terror (Barker 2003)

Classification of Anxiety Disorder:

Anxiety disorder is divided into generalized anxiety disorder,

phobic disorder, and panic disorder, each has its own

characteristics and symptoms and they require different treatment

( Gelder at al. 2005).

There are mostly common 6 types of Anxiety disorder. These are:

1. General Anxiety Disorder (GAD)

59

2. Acute Stress disorder (ASD)

3. Post-traumatic stress disorder (PTSD)

4. Phobic Anxiety disorder

5. Panic Disorder

6. Obsessive Compulsive Disorder (OCD)

Epidemiology:Globally as of 2010 approximately 273 million (4.5%

of the population) had an anxiety disorder. It is more common in

females (5.2%) than males (2.8%) . According to WHO, the number

of mentally ill people in Bangladesh is about 8.4 million ie, 7%

of the population of 120 million. The following Table shows the

estimated population of Bangladesh who suffers from different

types of mental illness

Table estimated population suffering from mental or related

illness

Problem/illnessPopulation (age

group)Percentage

No. of cases

(million)

Major depression General 3 3.6

Anxiety disorder --- 5 6.0

Obsessions --- 0.5 0.6

Schizophrenia/

psychosis--- 1 1.2

60

Learning

disability--- 2.5 3.0

Chronic illness 

(eg, asthma,

diabetes, pain)

--- 10 12.0

Head injury/head

trauma--- .25 0.3

Hypertension/

sleepnessnessAdults 14 8.4

Addictions (inc

smoking)Adults 10 6.0

Dementia (inc

memory impairment)Over 65 years 5 1.2

Source  Powell, G. The future of clinical psychology in

Bangladesh, 1995

Definition of different types of Anxiety Disorder:

1.Generalize Anxiety Disorder:

Generalized anxiety disorder is characterized by chronic feelings

of excessive worry and anxiety without a specific cause that

61

person finds difficulty to control and that lead to significant

distress or impairment in occupational or social functioning.

Individuals with generalized anxiety disorder often feel on edge,

tense, and jittery. Someone with generalized anxiety disorder may

worry about minor things, daily events, or the future.GAD variety

of everyday problems for at least 6 months. When their anxiety

level is mild, they can function socially and hold down a job.

Although the years of highest risk are between childhood and

middle age. Women are more affected than men.

Symptoms of Generalized Anxiety Disorder

Feelings of unreality

Hot and cold flushes   

Nausea

Shortness of breath

Breathing difficulties

Heart palpitations  

Chest pains

Fear of dying, losing control  

Sweating

Tingling sensations

Dizziness

Irritability and agitation

Trembling, weakness

Feelings of choking

Feeling of 'going crazy'

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Difficulties sleeping

2.Acute Stress disorder:

Acute stress disorder is an anxiety disorder which result from a

traumatic experience. Person experienced, witnessed on was

confronted with an event that involve actual treated death or

serious injury self or others. Occurs within minimum 2 days and

maximum 4 weeks after exposure to a traumatic stress.

A person with Acute Stress Disorder may experience difficulty

concentrating, feel detached from their bodies, experience the

world as unreal or dreamlike, or have increasing difficulty

recalling specific details of the traumatic event (dissociative

amnesia).

Symptoms of Acute Stress disorder (ASD):

Derealization

Re-experience ( recurrent image, thought dreams, illusion,

flashback episode)

Avoidance (thought, feeling, conversation, places)

Heighten arousal

Detachment or being in a daze

3.Post Traumatic stress Disorder:

Posttraumatic stress disorder (PTSD) develops after a terrifying

ordeal that involved physical harm or the threat of physical

63

harm.The person who develops PTSD may have been the one who was

harmed,the harm may have happened to aloved one,or the person may

have witnessed a harmful event that happened to loved ones or

strangers. PTSD was first brought to public attention in relation

to war veterans,but it can result from a variety of traumatic

incidents,such as mugging,rape,torture,being kidnapped or held

captive, child abuse,caraccidents,train wrecks,plane

crashes,bombings,or natural disasters such as floods or

earthquakes.

Acute: If duration of symptoms is less than 3 moths

Chronic: If duration of symptoms is more than 3 months

Delayed onset: If onset of symptoms is at least 6 months after

the stressor

Women are more affected than men. Rape and childhood sexual abuse

is the most likely trigger of PTSD.

PTSD affects about 7.7 million American adults,1 but it can occur

at any age,including childhood.7 Women are more likely to develop

PTSD than men,8 and there is some evidence that susceptibility to

the disorder may run in families.9 PTSD is often accompanied by

depression,substance abuse,or one or more of the other anxiety

disorders.

Symptoms of Post Traumatic stress Disorder

Repetitive, distressing thoughts about the event

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Nightmares and flashbacks  

Persistent symptoms of increased anxiety, irritability,

anger, difficulty concentrating

Avoidance or activities or external situation associated

with the trauma

Emotional numbness and detachment

4.Phobic Anxiety disorder:

A persistent, abnormal, and irrational fear of a specific thing.

It is an irrational, intense fear of an object or situation that

poses little or no actual danger. At first glance, a phobia may

seem similar to a normal fear, but it's is the degree to which a

person is affected that determines whether that fear has become a

phobia.

There are three (3) types of Phobia like:

1. Specific / simple phobia: A specific phobia is an intense,

irrational fear of something that actually poses little or

no threat. Some of the more common specific phobias are

heights, escalators, tunnels, highway driving, closed-in

places, water, flying, dogs, spiders and injuries involving

blood. Women are more affected than men.

2. Social phobia: When people become overwhelmingly anxious and

excessively self-conscious in everyday situations that time

is called social phobia. This fear may become so severe that

it interferes with work, school, and other ordinary

65

activities, and can make it hard to make and keep friends.

People with social phobia feel as though all eyes are

focused on them. In extreme cases this intense uneasiness

can progress into a full blown panic attack. In the case of

social phobia that is particularly problematic and in sever

cases can lead to complete social isolation. It is equal

common among men and women.

3. Agoraphobia: The most complex and incapacitating form of

phobic disorder is agoraphobia, which literally means “fear of

the market place (or places of assembly)” and is usually

described as fear of public spaces. Agoraphobia is somewhat

different from the other phobias because it is not so much a fear

of being close to one specific object or situation (animal,

public speaking) as it is of being separated from signals

associated with safety.

Symptoms of Phobic Anxiety disorder:

1. Specific phobia

Is out of proportion to the apparent stimulus

Cannot be explained or reasoned away

Leads to avoidance of the object or situation

2. Social phobia

Symptoms of sympathetic over activity

(tremor,palpitation,sweating)

5.Panic Disorder

66

A panic is a sudden, overwhelming experience of terror or fright

accompanied by a pounding heart, sweatiness, weakness, faintness

and dizziness. It can occur at any time, even during sleep. It

peaks within 10 minutes, but some symptoms may last much longer.

It is common women as men. It often begins in late adolescence or

early childhood. Women are more affected than men. Occurs with

major depression in very high rates.

Three types of panic disorder, these are:

1. Panic disorder with agoraphobia

2. panic disorder without agoraphobia

agoraphobia without history of panic disorder

Symptoms of Panic Disorder

Palpitation, pounding heart or accelerated heart rate

Sweating

Trembling or shaking

Sensation of shortness of breath or smothering

Feeling of choking

Chest pain or discomfort

Nausea or abdominal distress

Feeling dizzy, unsteady, light-headed or faint

Derealization or depersonalization

Fear of losing control or going crazy

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Fear of dying

Paraestheiae (numbness or tingling sensation)

Chills or hot flushes

DSM IV Panic Disorder Criteria

A) Both (1) and (2)

(1) recurrent unexpected Panic Attacks

(2) at least one of the attacks has been followed by 1 month (or

more) of one (or more) of the following:

(a) persistent concern about having

additional attacks

(b) worry about the implications of the

attack or its consequences (e.g., losing control, having a heart

attack, "going crazy")

(c) a significant change in behavior

related to the attacks

B) The Panic Attacks are not due to the direct physiological

effects of a substance (e.g., a drug of abuse, a medication) or a

general medical condition (e.g., hyperthyroidism).

C) The Panic Attacks are not better accounted for by another

mental disorder, such as Social Phobia (e.g., occurring on

exposure to feared social situations), Specific Phobia (e.g., on

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exposure to a specific phobic situation), Obsessive-Compulsive

Disorder (e.g., on exposure to dirt in someone with an obsession

about contamination), Posttraumatic Stress Disorder (e.g., in

response to stimuli associated with a severe stressor), or

Separation Anxiety Disorder (e.g., in response to being away from

home or close relatives).

6.Obsessive Compulsive Disorder (OCD):

It is a type of anxiety disorder primarily characterized by

repetitive obsessions and compulsions (urges to perform specific

acts or ritual).

Obsessions : Persistent thoughts, ideas, impulses or images that

are intrusive and inappropriate and that cause marked anxiety or

distress. Individuals with obsessions usually attempt to ignore

or suppress such thoughts or impulses or to counteract them by

other thoughts or actions (compulsions).

Compulsions : Repetitive behaviours (such as hand washing, ordering

or checking) or mental acts (such as praying, counting or

repeating words) that occur in response to an obsession or in a

ritualistic way.

For example, if the people are obsession with germs or dirt, they

may develop a compulsion to wash their hands over and over again.

Being afraid of social embarrassment may prompt people with OCD

to comb their hair compulsively in front of mirror. Sometimes

69

they get ‘caught’ in the mirror and can’t move away from it.

Performing such rituals is not pleasurable.

Healthy people also have rituals, such as checking to see if the

stove is off several times before leaving the house. The

difference is that people with daily life and they find the

repetition distressing, interferes with daily life and they find

the repetition distressing. Women are more affected than men. One

third of young adults had their first symptoms in childhood.

Symptoms of Obsessive Compulsive Disorder (OCD):

Recurrent and persistent thought, impulse or image

Repetitive behavior (hand washing, ordering, checking) or

mental acts (praying, counting, repeating word silently)

Treatment and Management:

Psychological management:

Different psychological techniques given below:

Psychotherapy:

Cognitive behavioral therapy:

Exposure therapy:

Relaxation:

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Acceptance and Commitment Therapy (ACT)

Dialectical Behavioral Therapy (DBT)

Interpersonal Therapy (IPT)

Eye Movement Desensitization and Reprocessing (EMDR)

Acceptance and commitment therapy

Intolerance of uncertainty therapy

Motivational interviewing

Psycho education

Chapter 4.Dealing with Cases

4.1 Case-1

4.2 Case-2

4.3 Case-3

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Case- 1

Demographic information

Name: Shabnur

Age: 14 years

Sex: Female

Address: Uzirpur Thana, Barisal

72

Siblings: 4

Position: 3rd

Marital status: Married

Occupation: Nill

Religion: Islam

Economic status: Lower class

Source of referral

The patient was referred to the DMC with the help of his familymember.

Chief complain

Raped

Pregnant

Anxiety

Grandiose idea- She feels that she is nothing but a victim.

History of present illness

According to the patients, Her parents were separated when shewas 10 years. Since she lived with aunt’s family. From thebeginning her uncle always disturbed her. When her aunt waspregnant she(aunt) admitted to the hospital. That time uncle took

73

her to a registry office and threatened her to marry him. Aftercompleting marriage, uncle took her to a rent house and they stayhere for 3 months. At a time she felt that she was pregnant. Atthe same time her family searching her every where and finallyfound her. Then they admit her to the hospital and her uncle wasran away.

Family history

Client’s family members are living in village.

Parents: His father is a laborer and mother is a house wife. Therelationship between family members is disappointing.

Siblings: He has two younger brothers. Both of them are students.

Personal history

Mother’s pregnancy and birth: There was no serious illness andbirth was normal and no complication held after birth.

Early development: Her childhood wasn’t normal and there wasseparation or emotional problem during childhood.

Schooling and higher education: She wasn’t a good student fromher childhood. Her education was finished when she read in class3.

Adolescence and adulthood: Her adolescence and childhood wasnormal and no mentionable crisis had been found.

Sexual history: During interview she mentioned above information.

Occupation: Nothing.

Social circumstances: She didn’t found lives in her familyenvironment. Relationship with family members are not well.

74

History of drug abuse: No.

Forensic history: Pregnant.

Diagnosis

Mental Stress

Management

Psychological management

Counseling

Social management

Counsel the family members to be patience on client

Counsel the family members about medication

Inform the family members about client’s situation

Help client for new beginning of life.

Reduce Prejudice

Treatment techniques

Treatment strategy Purpose

Evidence seeking Reduce Prejudice

Providing information Based on clients needs, suchas medication, disease,readmission.

Pros and cones techniques Aggression

Ventilation Emotional release,

75

identifying hidden cause

Relaxation Physical relaxation

Advice and guidance Medication regularly, consultwith doctor

REBT Build-up confidence

Breathing exercise Remove restlessness

Out comes

The client has given 5 sessions

Problems 2nd session 5th session

Aggression Reducing Reduced

Prejudice Present Reduced

Sleep disturbance Removed Removed

Concentrationproblem

Improving Improving

Delusion Present Decreased

Anxiety Present Decreased

Prognosis

Good prognostic criteria

Client is motivated

She removed tabbies from his hand by himself

Bad prognostic criteria

76

Paranoid personality pattern

Depression

Lack of Seriousness

Comments

Client’s situation is improving slowly and gradually. Clientneeds to take medication for regularly for long time and alsoneeds CBT, counseling and follow-up.

Case- 2

Demographic information

Name: X

Age: 25 years

Sex: Male

Address: Badda, Dhaka

Siblings: 4

Position: 1st

Marital status: Unmarried

Occupation: student-BBA

Religion: Islam

77

Economic status: Middle class

Source of referral

The patient was referred to the DMC with the help of his familymember.

Chief complain

Irrelevant speech, talkativeness

Decreased sleep- sleepless last 10 days

Aggressive behavior

Unwilling to food intake last 4-5 days

Fearfulness

Grandiose idea- he feels that he has some extra capacity fromothers

History of present illness

According to the patients brother he was relatively alright about3 years back. Then he develops irrelevant speech andsleeplessness. He felt hot flash in whole body. He also had theproblem of auditory hallucination .And then he felt frustrationand wanted to take suicide. After that he was admitted in aprivate hospital for 15 days. He was relatively alright for last2 ½ years. Now for last 10 days he develops the previous symptomswith grandiose idea.

Family history 78

Client’s family members are living in village.

Parents: His father is a teacher and mother is a house wife. Therelationship between family members is good.

Siblings: he has two younger brothers. Both of them are students.

There was no history of psychiatric illness in his familymembers.

There was no history of MR in his family members.

There was no history of drug abuse in his family members.

There was no history of Epilepsy in his family members.

Personal history

Mother’s pregnancy and birth: There was no serious illness andbirth was normal and no complication held after birth.

Early development: His childhood was normal and there was noseparation or emotional problem during childhood.

Schooling and higher education: He was an average student formhis childhood. He passed SSC and HSC without any break of study.But he could not continue his study after 6th semester of BBA dueto mental illness.

Adolescence and adulthood: His adolescence and childhood wasnormal and no mentionable crisis had been found.

Sexual history: During interview he mentioned that he has severalextramarital sexual relationships.

Occupation: student, break-up due to psychiatric problem andoccasional involvement in business.

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Social circumstances: He lives in his family environment.Relationship with family members and neighbors are well.

History of drug abuse: He has been taking cigarette from last 5years. He took energy drink, cannabis and alcohols occasionally.

Forensic history: No forensic history was found.

History of past illness

Past medical illness: Nothing contributory

Past psychiatric illness: First time when he was becomeproblematic was in 2010 and he was under medication of apsychiatrist. He also had to admit in private clinic for 15 daysdue to auditory hallucination and illation.

Pre morbid personality

Relationship: Relationship with his own family members is good.But he has some conflict with his maternal uncle and his family.He thought they will kill him. Very much emotional attached withhis paternal aunt.

Leisure activities: He enjoyed spend time with his friends andloves to play cricket.

Prevailing mood: His prevailing mood was inconsistent.

Character: Paranoid personality.

Attitudes and standards: He was not loyal to his cultural normsand religious values but respects those norms.

Mental State Examination {MSE}

Appearance and behavior:

a. General appearance: A young boy wearing pant, T-shirt and ashirt over the T-shirt. His hair was not combed. He waswearing 3 tabbies in his right hand.

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b. Rapport: Eye to eye contact was present, sustained and itwas fixed stare. Rapport was established properly.

c. Posture and movement: Restless d. Social behavior: Proper social behavior was absent.

Affect: Grandiosity

Mood: Emotional liability

Speech

a. Quantity: Increase in rate b. Quality: Volume was normal c. Content: Delusion d. Oddity of speech: Repeat same words and sentence. Thought: Hallucination, he feels that he got some supernaturalpower

a. Stream: Pressure of speech b. Content: Delusion c. Form: flight of idea d. Possession: Thought control

Perception: Auditory hallucination has been found

Cognition

a. Consciousness: Impaired b. Orientation: About time place and person is intact c. Attention: Not fully attentive d. Concentration: Poor concentration e. Memory: Immediate: Impaired – due to medication

Recent: Impaired – due to medication

Remote: Intact

Intelligence: Average

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Abstract thinking: Impaired

Judgment: Impaired

Insight: Lost

Diagnosis

Schizophrenia – According to DSM-IV ant Psychiatrist

Assessment

Clinical interview

Case history

Observation

Assessed problem:

Aggression

Prejudice

Sleep disturbance

Concentration problem

Delusion

Lability

Formulation

Predisposing factors

82

Paranoid personality pattern

Conflict with relatives

Loss of money

Aggressive from childhood

Prejudice

Precipitating factors

Not continue medicine

Conflict with relative

Death of grand mother

Extra marital sexual intercourse

Maintaining factors

Cognitive elements:

Conflict with relatives

Break-up with girlfriend

My girlfriend did black magic on me

My uncle and his family members want to kill me

Affective elements:

Feeling insecure about life

Feeling betrayed by girlfriend

Paranoid personality pattern

83

Management

Pharmacological management

Inj- Halopid

Tab- Cyclid

Tab- V-plen

Tab- Leptic

Tab- Lpoez

Tab- Renidin

Psychological management

Short term goal:

Reduce aggression

Create motivation

Reduce prejudice

Create concentration

Long term goal:

Increase Self-confidence

Make the client stable for long term situation

Social management

Counsel the family members to be patience on client

Counsel the family members about medication

Inform the family members about client’s situation

84

Help client for re admission in BBA

Reduce Prejudice

Treatment techniques

Treatment strategy Purpose

Evidence seeking Reduce Prejudice

Providing information Based on clients needs, suchas medication, disease,readmission.

Pros and cones techniques Aggression

Ventilation Emotional release,identifying hidden cause

Relaxation Physical relaxation

Advice and guidance Medication regularly, consultwith doctor

REBT Build-up confidence

Breathing exercise Remove restlessness

Out comes

The client has given 5 sessions

Problems 2nd session 5th session

Aggression Reducing Reduced

Prejudice Present Reduced

Sleep disturbance Removed Removed

85

Concentrationproblem

Improving Improving

Delusion Present Decreased

Lability Present Decreased

Prognosis

Good prognostic criteria

Client is motivated

He has an educated and understanding family

He removed tabbies from his hand by himself

Bad prognostic criteria

Paranoid personality pattern

Aggression

Comments

Client’s situation is improving slowly and gradually. Clientneeds to take medication for regularly for long time and alsoneeds CBT, counseling and follow-up.

Follow-up

First follow-up after discharge

His condition was improving.

No aggression was seen after discharge {according to his brother}

Restlessness seen in his posture.

86

Readmitted in BBA.

Case No-3

Information of the client:

Name : Labony

Age: 22

Father’s Name: Md. Rejaul Karim

Mother’s Name: Juli

Religion: Muslim

Profession: House wife (before illness)

Sex: Female

Marital Status: Married

Educational Qualification: Illiterate

Present Address: Dhamrai,Savar.

Permanent Address: Dhamrai,Savar.

Information relating to Hospital:

Status of the cabin: Non Paying

Date of Admittance into Hospital: 20-06-14

Date of release: 28-08-14

Date of undertaking case: 08-08-14

Name of Disease:

Duration of Disease: 3 months

87

Family Structure

Sir Name of familymembers

Age EducationalStatus

Occupation Relation

1. Salam 50 Illiterate Driver Husband

2. Md. Rejaul Karim 75 Illiterate Dependent Father

3. Juli 68 Illiterate Housewife Mother

4. Labony 37 Class 3 Housewife Self

5. Akash 03 Illiterate son

12. Mukta 22 Illiterate Housewife Sister-in-law

Source of referral

The client was referred to the Dhaka Medical College Hospital bylocal doctor.

Chief complain

Sleep disturbance

Raped

Anxiety

Not able to cope with her husband

History of Present Illness

According to the patient attendant, she was completely alright 4

months back. Her husband is a CNG driver and she is a housewife.

Some bad boys of local area are disturbing her continuously. Her

husband talked with them but they didn’t stop teasing. One day

88

her husband wasn’t home, when she goes to the outside for

searching him some boys raped her that night. She was found

outside by her husband at next morning. And he discover her as

raped, then he admitted her to the hospital. From then she felt

uncomfortable with her husband.

Rationale of undertaking as case

Being an apprentice psychiatric social worker and as the part of

my academic duty, I decided to take the patient as my case. From

very much professional point of view, I thought I could apply

social work knowledge, skills and values to cure and rehabilitate

Mrs. Labony.

Technique of Data collection:

I collected data through the observation of relevant files,

reports of patient and interview, observation, listening, asking,

and establishing rapport, communication etc basis on the values

and principles of social work profession. The main agents were

Parents, Psycho social worker, doctor (supervisor) & information

desk.

Family history:

Client’s family members are living in village.

There was no history of psychiatric illness in her family.

89

There was no history of MR in her family.

There was no history of drug abuse in her family.

There was no history of Epilepsy in her family.

Personal history

Mother’s pregnancy and birth: During her mother’s pregnancy there was no

serious illness and her birth was normal and no complication held

after birth.

Early development: Her developmental milestones were normal.

According to client’s mother, her childhood was normal and there

was no separation, emotional problem during childhood.

Adolescence and adulthood: Her adolescence was normal and no crisis

has been found.

Sexual history: She was married 4 years back.

Occupation: Housewife

Forensic history: All adult member and she was raped by 3 people.

History of past illness

Past medical illness:

Nothing contributory

Past psychiatric illness:

Nothing contributory

Pre morbid personality

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Relationship: Relationship with her own family and friends was good.

Still her family is trying their level best to give her support.

Leisure activities: She was productive and hard worker. And she had no

intention to waste time in non productive tasks.

Prevailing mood: Her prevailing mood was depressed.

Character: Hard worker and highly ambitious.

Attitudes and standards: Socially accepted and well mannered.

Mental State Examination (MSE)

Speech: Pressure of Speech (Quantity: Too much speech)

Thought: distractibility

Stream: Pressure of speech Content: Obsession Form: Flight of idea Possession: No possession of thought has been found.

Delusion: Grandiose

Insight: Lest

Rapport: Eye to eye contact was not exactly present and notsustained and rapport was not established properly.

Posture and movement: Abnormal

Social behavior: Normal and culturally appropriate social behaviorwas present.

Perception: No hallucination has been found in any modalities.

Cognition:

91

Consciousness: Not intact Orientation: about time, place and person is not intact. Attention: patient is not attentive. Concentration: Slow concentration. Memory:

Immediate: Slow Recent: intact Remote: intact. Intelligence: Average (based on clinical observation) Abstract thinking: Intact. Judgment: out of order. Insight: Least.

Diagnosis

MAJOR DEPRESSIVE DISORDER (M). (According to Psychiatrist).

Management

Pharmacological management

Tab. Olanap

10mg-----------------------

1+0+1

.Tab. Thyrox 50

mg-----------------------3+0+0

.Tab.Pantonix

20mg-----------------------

1+0+1

.Tab. Cyclid 5 mg

-------------------------1+0+1

.Tab.

Epitra(0.5mg)-----------------

-------0+0+1

Psychological management

Short term goal-

92

Increase activity level

Reduce aggressiveness

Reduce depression

Create motivation &aspiration

Long term goal-

Increase self-confidence

Make the client stablefor long term situation

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Social Management

Therapist, psycho-social worker and psychiatrist highlightedfollowing issues as the part of social management:

To inform the family members and peer groups about client’ssituation

To counsel the family members to be patience on client

To inform her husband to take care of her and don’t intendto find her guilt’s.

To counsel the peer groups to behave properly with theclient

To give her chance to realize social context.

Prognosis

Good prognostic criteria:

Her family is highly positive & supportive She has value oriented and acceptance the reality DMC team work professionally and cordially.

Bad prognostic criteria:

Feeling uncomfortable with her husband.

Fear

Comment

Client’s situation is improving slowly and gradually. Clientneeds to take medicine regularly for long time and also needscognitive behavior therapy, family therapy, counseling etc. Aftercure from illness, she needs a sound environment to rehabilitatein the society.

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Chapter 5. Responsibilities and Performance

5.1 Assigned Duties and Responsibilities

5.2 Assigned Task During Fieldwork that I have

Accomplished

5.3 Methods, skills and techniques that I have Applied

5.4 Problems that I Faced During Fieldwork Practice

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Assigned Duties and Responsibilities

I have to bear some assign duties and responsibilities from this

centre as a social worker. This assignment related with this

agency programs and services are following.

Regular attendance in agency during 60 working days.

To be acknowledge with agency employees, nature, objectives

and services

To know an administrative and organizational structure of

the agency.

To practice social work knowledge.

To achieve knowledge about background and evolution of

Agency

To find out the problems/limitation of this centre

Application of social work method in case preparing

Psycho social study, Diagnosis and treatment plan.

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Maintaining register paper for process recording in every

working day

To stay at the agency during the prescribed time

Sitting with Institute supervisor every weekly.

Preparing a field work report on the basis of the work what

I have done during field work and submitting it in the field

time to agency supervisor and institute supervisor.

Assigned Task During Fieldwork that I have Accomplished

After being selected as an apprentice social worker at the agencynamed, Dhaka Medical College Hospital(DMC) some respective taskswere fixed up for me and for my other field mates through awritten work plan by the negotiation of the department supervisorand the agency supervisor. They are as fallows:

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1. Preliminary orientation about the agency

Orientation stage with the agency

Acquaintance with organizational structure

Be familiar with working procedure

Principles of the agency

Objectives of the agency

Introducing with the different welfare projects patronized by theagency

2. I have completed assignments that are bestowed by institutesupervisor.

3. I have studied on different types of diseases through thereading of different kind of books, journals, research papersetc.

4. I have prepared a certain number of cases with the applying ofsocial work method.

5. I attended every sitting class in prescribed time and datewish my Institute supervisor.

6. 1 have tried to diagnosis psycho-social problems of theclients who are taken as long term case study on the behalf ofmine and 1 have followed up and 1 have consulted for removinghis/her psycho-social problem.

7. I have prepared a field practicum paper on selected topics.

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Methods, skills and techniques that I have Applied

During fieldwork I have applied some techniques of case work aswell as social work for collecting data, diagnosis and treatment.

Case study

This is a kind of qualitative analysis. I used this method tocollect in depth data about the clients and to explore theirprevailing situation of their daily life.

Interviewing

Through face-to-face interview, I collected data, facts andinformation concerning their problem for diagnosis and treatment.

Observation

Following this technique, I observed and took notes on theirphysical expression such excitability, cheerfulness, gloomy andfrustration as well as sulky situation through participation.

Listening

To know the problems of the clients deeply, I did let them speakfirst. Then I talked. I followed the technique due to facilitatethe clients to be free in speaking and express their grievancesto me frankly.

Questioning

In order to obtain specifically necessary information and to leadthe clients' conversation from pointless to fruitful channels, Isometimes questioned them.

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Case recording

Through this technique, I recorded the discussions anddeliberations of an interview as meaningful as possible.

Treatment

In treating the clients, I used two methods namely SupportiveTreatment Method and Modifying Treatment Method. I have helpedthem through reassurance, logical discussion and advice, guidanceas well as emotional support.

Acceptance

To work with the clients is very important for me as well as the

clients. I tried to accept the clients assuring them my capacity

so that they could accept me as a social worker.

Rapport building

I was careful to buildup successful rapport with the clients.

Through the effective interaction, body language I tried to make

them understand that I could help them.

Diagnosis

Based on the information I have found through interview, I got a

clear concept about the client’s problem. And it was helpful to

find out the actual problem of the client had. In diagnosis I

have used dynamic and etiological diagnosis techniques.

Psycho-social treatment

100

I have used psycho-social treatment techniques to enable the

clients to cope with their problems. Sometimes I have used own

prudence to solve their problems.

Follow up

After solving the problem I ask cordially in following up the

clients. As a social worker I could not let them to turn into the

previous situation again.

Communication skill

For the effective and sustainable solution of the client’s

problem I have communicated with the clients, doctors, nurse and

to help the clients with financial assistance and medicine etc. I

tried to communicate with the social service officer.

Sympathy and empathy

As my clients were the drug addicted person, I used to show them

my highest sympathy and empathy to them and I tried my best to

make them understand that I also feel their problem as they feel.

Process recording

In my field work practice I have used a quite different and

modern format of process recording provided by my institute

supervisor. I tried to abide by his all of the reactions. Besides

the advocacy methods skill and techniques I have used, other

techniques and methods. When I have done official duties in the

agency prepared research report etc. To prepare the research I

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have used sampling technique and two different questionnaires.

Problems that I Faced During Fieldwork Practice

I have faced manifold problems during my fieldwork at DhakaMedical College Hospital(DMC). They are as follows:

1. Client’s ignorance, superstition, doubtfulness, religiousfanatic etc. are obstacle for build up rapport. On the otherhand, for these reason they express boredom and disagree toprovide real cause about their problems. So it is difficult todiagnosis their problems.

2. There is information gap that are given by clients. So it isdifficult to move forward for solving problems.

3. Poor clients' expectation was to obtain financial assistanceor to get job for their children.

4. But there was no opportunity to fulfill this expectation inDMC. So I could not help them with money and I also could notrehabilitate them by providing job.

5. I have to do case study in office time, so client would havebusy in her family activities. For this reason they could notspend time for providing information.

6. Clients did not know enough about mental illness. So I advisedthem to follow doctor's and therapist consultation and to besincere to their children.

7. It was difficult to find out client's house.

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Chapter 6. Experience Sharing

6.1 My Experience During Field Practice

6.2 Barrier Regarding Field Practice

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My Experiences during Field PracticeThere are many experiences I have faced during my field work

practice. Most of the experiences are related to the development

of my life for becoming a professional social worker. These

experiences are briefly discussed below.

I have gathered practical knowledge with respect to the

diagnosis and psychosocial treatment on different types of

mental illness like MSE, Rapport building, Counseling,

Relaxation etc.

The nature of being disciplined with formal dress was very

crucial for me and be present at the agency at regular time

was very important to develop my professional career.

Rapport building and maintain suitable relation with my

clients are also a positive experiences from my field work

practice.

Dealing with different kinds of problems and person are very

effective experiences during my field work practice.

As a student of social work, observing the client and their

family members through home visit was new experiences for

me.

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I have learnt how to conduct case study and make the report

for case management.

I gathered counseling experience from my field work

practice.

I have learnt the application of case work from social work

perspective.

I tried to apply the principles, skills and techniques of

social work for the development of the psychiatry department

of DMC.

Barriers regarding Field Work PracticeSome barriers I had to face while dealing with the children at

the day care centre that are given following.

1. First few days the agency authority was not cordial and

cooperative enough to work with them effectively; but when

our agency supervisor introduced us with them formally, they

accepted us and helped us to work with them effectively.

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2. The agency has extreme lack of treatment instruments which

is a great hinder for smooth service delivery.

3. I noticed that there exists a massive disparity in supplying

of opportunities between the paying and non-paying patients.

All the patients are staying in the same floor. When they

see that they are deprived in getting food, medicine and

other benefits; they do not want to cooperate in treatment.

4. There is no specific budget for the novice social worker. So

for the lack of finance social worker cannot work with the

patients. They only conduct psycho-social counseling.

5. There is no separate room and library for the novice social

workers.

6. Lack of coordination and cooperation between the hospital

authority and social service department is also mentionable.

7. Lab, pathology and other equipment are not modern.

8. It has no emergency unit and own blood bank.

9. Indoor and outdoor recreational program is very limited.

10. Lack of essential manpower etc.

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Chapter 7. Recommendations and Conclusion

7.1 Recommendations

7.2 Conclusion

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Recommendations

Success depends on proper application of rules and regulations

and other relevant strategies with combination of transparency,

accountability and punctuality. As the social service department

of Dhaka Medical College is now suffering some mighty problems so

some proposal are given to solve this problem and to provide

people friendly service effectively in future to build up a

mostly drug addiction free Bangladesh. Those ares-

The doctors, nurses, & authority of DMC should be more cordialand cooperative

The duration of staying in the hospital for the patients

should be increased.

The institute should take rehabilitation program strongly

The number of the seats should be increased for the patients

To increase the standard of food for the patients of non-

paying ward.

The standard of food of paying ward should also be increased

as they pay a handsome amount of money.

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To manage an interview room and counseling room for the

apprentice social worker.

To increase co-ordination and integration between the

functions of hospital and social service department.

To take some new programs by social service department; such

as- motivation and rewarding, group counseling, family

counseling, medical allowance etc.

Awareness program on drug abusers should also be increased.

To increase to budget of social service department.

Outsourcing and in sourcing attempt should follow to increase

the budget of this department.

To ensure active involvement of the apprentice social worker

with the entire treatment process so that they could

contribute more for the effective treatment patients.

To take some income generating programs for the released

patients so that they could earn some money which will save

them from economic hardship?

The institute should open a separate unit relating tosubstance dependence mental disorder

To increase indoor games and recreational facilities for the

patients under treatment.

Released patients are very much irregular in weekly follow up

though it is an integral part of complete recovery. So the

agency should set up a communication system with the released

patients so that they come to take follow p service.

Group therapy program should be increased to ensure the

attendance of the patients in therapeutic activities. 109

Bureaucratic formalities should also reduce to get quick

treatment and admission.

Apprentice social worker should give full consent to work with

the patients in their ward which is now is strictly

restricted.

The agency should increase its budget for home visit and after

care treatment.

The number of bed, doctors, therapists, social workers ought

to be increased

To conduct some research and investigative works to find out

more effective way for the treatment of the drug abusers.

Free dispensable medicine program should increase.

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ConclusionField work is the application of theoretical knowledge in the

practical field. It helps students to be familiar with different

types of practical experience regarding theoretical aspects. At

the end of the report I can say that field work brings a fruitful

result for the theoretical knowledge of social work. By field

practicum a novice social worker may know how to apply the

academic knowledge in various sectors of society. In our society

are fulfilled by different kind of problematic person who have

absolutely failed to solve their problems. In this point a social

worker can deal with this crisis to solve appropriately by their

achieving practical knowledge which is to gain from field

practicum. The impact of field work plays a vital role in

expanding and enriching the theoretical knowledge to overcome my

assigned duties. It can be said that obviously students may

adjust in any sectors in their future life by overcoming all

obstacles that I realize from my experience in field work. I

should say that in some cases I have achieved success and in some

cases I have failed to achieve it due to my lacking. I apologize

for my unintentional mistake. At last recapitulating above all

performance I warmly wish for prosperous and happy life of the

respondents with whom I worked.

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