Zdravlje
PSIHOSOMATSKE BOLESTI – I
Nijedna bolest tela nije odvojena od duše Sokrat (www.so-vil.co.rs)
Piše: dr sc. med. Dragana Daruši, neurolog Sudski veštak iz oblasti neurologije i psihologije kriminala
OLQLþND SUDNVD MH GRND]DOD GD MH YHOLND ]DEOXGD SRWFHQMLYDWL SVLKRVRPDWVNH SRUHPHüDMH VPDWUDMXüL LK LPDJLQDUQLP SR SULQFLSX ÄVYH MH WR VDPR SURGXNW QHþLMHJ XPD³ )L]LþNL VLPSWRPL NRMH RVRED WUSL L]D]YDQL SVLKRVRPDWVNLP VWDQMHP VX VWYDUQL SRUHPHüDML WUHED LK EU]R OHþLWL L SULVWXSLWL QMLPD R]ELOMQR NDR L X VYDNRM GUXJRM EROHVWL L VLWXDFLML 3VLKRVRPDWVND EROHVW MH WHOHVQD EROHVW L]D]YDQD SVLKLþNLP X]URFLPD þLML VLPSWRPL XWLþX QD IXQNFLMH PQRJLK RUJDQD PHQMDMXüL MH X SRþHWNX UHYHU]LELOQR D ]DWLP VWYDUDMXüL LUHYHU]LELOQH SURPHQH .DGD VX HQGRNULQL L QHUYQL VLVWHP VXYLãH GXJR SRG GHMVWYRP VWUHVRUD L]ORåHQL KLSHUIXQNFLML SULURGQR MH RþHNLYDWL GD üH VH VWYRULWL XVORYL ]D QDVWDQDN SRUHPHüDMD QD SRMHGLQLP VLVWHPLPD RUJDQD âWD MH ]DSUDYR SUHYLãH GXJR L VXYLãH RGUHÿHQR MH LQGLYLGXDOQRP XURÿHQRP SULURGRP RUJDQL]PD NDR VWDQMD X NRPH JD MH VWUHV NDR SVLKLþNL X]URN ]DWHNDR ,VWUDåLYDQMD VX GRND]DOD GD NUDWNRWUDMQL VWUHV QH L]D]LYD SVLKRVRPDWVNL SRUHPHüDM GRN MH GXJRWUDMDQ LQWHQ]LYDQ UHNXUHQWQL VWUHV RGJRYRUDQ ]D QDVWDQDN SVLKRVRPDWVNH EROHVWL 3RVPDWUDQR NUR] SUL]PX YUHPHQD NRMH MH L]D QDV MRã X GRED +LSRNUDWD 6RNUDWD L GUXJLK DQWLþNLK OHNDUD L YHOLNLK PLVOLODFD ± VQDåQH HPRFLMH NDR ãWR VX EHV VWUDK åDORVW L VO PRJX L]D]YDWL WHOHVQD REROMHQMD
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Bolest ± interakcija uma i tela
3UYD UD]PLãOMDQMD R QDVWDQNX EROHVWL NDR SRVOHGLFL LQWHUDNFLMH XPD L WHOD SR]QDWD VX LVWRULML PHGLFLQH MRã X VUHGQMRYHNRYQRP LVODPX X GHOLPD SHUVLMVNLK SVLKRORJD ± OHNDUD $KPHGD ,EQ 6DKO DO %DONLMD (Ahmed ibn Sahl al-Balkhi) i +DOL $EDVD 2ED RYD OHNDUD VX ]DSD]LOD LQWHUDNFLMX XWLFDMD ¿]LRORãNH L SVLKRORã®
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NH IXQNFLMH X WHOX SDFLMHQWD 2YD VD]QDQMD VX XWYUÿLYDOL X SRVPDWUDQLP UD]OLNDPD RQLK SDFLMHQDWD NRML VX ¿]LþNL L PHQWDOQR ]GUDYH RVREH X RGQRVX QD RQH NRML VX ¿]LþNL L PHQWDOQR REROHOL -HGDQ RG SUYLK NRML MH MRã JRGLQH XSRWUHELR WHUPLQ SVLKRVRPDWVNL SRUHPHüDM ELR MH QHPDþNL OHNDU +DMQURW - (Heinroth) 1MHJRYR REMDãQMHQMH ED]LUDQR MH QD WXPDþHQMX VRPDWVNR SVLKLþNLK SRUHPHüDMD NRML SUHPD QMHPX SUHGVWDYOMDMX SVLKLþNH SUDWHüH PDQLIHVWDFLMH WHOHVQLK REROMHQMD WH MH SUHSR]QDWOMLY SR REMDãQMHQMX SVLKRJHQRJ GHOD X QDVWDQNX LQVRPQLMH 2G RYRJD GRED GR QHNRJ QDUHGQRJ WXPDþHQMD SURãOR MH YLãH RG VWR JRGLQD GD EL VH X PHGLFLQL SRNUHQXOD LVWUDåLYDQMD YH]DQD ]D SVLKRVRPDWVND REROMHQMD 8 RYRP SHULRGX R QMLPD VX ELOD SULVXWQD MHGLQR WXPDþHQMD X QHNLP RG WUDGLFLRQDOQLK PHGLFLQVNLK VLVWHPD NDR ãWR MH QSU DMXUYHGVND PHGLFLQD 3RþHWNRP YHND )UDQF $OHNVDQGHU MH ]DSRþHR LVWUDåLYDQMH GLQDPLþNH SRYH]DQRVWL WHOD L XPD 8 RYRP SHULRGX MH WDNRÿH UDGLR L 6XJPXQG )URMG QDNRQ SUHSLVNH VD *HRUJRP *UXGHNRP (Georg Groddeck) NRML MH X WR YUHPH LVWUDåLYDR PRJXüQRVW OHþHQMD ¿]LþNLK SRUHPHüDMD SULPHQRP SVLKRORãNLK SURFHGXUD 7DNDY SULVWXS SRGUD]XPHYDR MH UD]PLãOMDQMH R EROHVWL NDR R NRQWLQXLUDQRM LQWHUDNFLML SVLKLþNLK L VRPDWVNLK IDNWRUD âH]GHVHWLK JRGLQD SURãORJD YHND %DOLQWRYH JUXSH Misheale Balint VX XND]DOH GD MH QHRSKRGQR GD OHNDU WRNRP WUHWPDQD SULVWXSD FHORM OLþQRVWL SDFLMHQWD MHU VX VPDWUDOL GD YLãH RG RGVWR NRQVXOWXMH OHNDUD ]ERJ VLPSWRPDWRORJLMH NRMD X RVQRYL LPD HPRFLRQDOQX GLVIXQNFLMX 8 SRPHQXWRP SHULRGX SUYH SRORYLQH YHND UD]YLMDMXüL NRQFHSW SRVWRMDQMD XONXVQH NRURQDUQH LOL WUXPDWR¿OQH OLþQRVWL )ODQGULMD 'DQEDU SRNXãDOD MH GD
(RSQ@ĝHU@MI@ OQNSDJKHG FNCHM@ ONJ@YTIT C@ ID OQDJN NCRSN ONRDS@ KDJ@QT ONRKDCHB@ YCQ@URSUDMHG SDFNA@ M@ JNID ID A@QDL CDKHLHęMN TSHB@N RSQDR 2SNF@ ORHGNRNL@SRJD ANKDRSH HL@IT LMNFN UH½D Y@IDCMHęJNF R@ MIHL MDFN ½SN RD TNO½SD N SNLD H Q@YLH½KI@ SRMHGLQH EROHVWL GRYHGH X YH]X VD SVLKLþNLP RVRELQDPD OLþQRVWL 2VLP NRQFHSWD NRURQDUQH OLþQRVWL RGQRVQR W]Y $ WLSD OLþQRVWL QMHQR XþHQMH MH NDR KLSRWH]D GDQDV XJODYQRP RSRYUJQXWR 7]Y NRURQDUQD OLþQRVW MH RNDUDNWHULVDQD SUHWHUDQRP VNORQRãüX ND WDNPLþDUVNRP GXKX DPELFLR]QRãüX D YLÿHQD MH X QMHQLP QHUHãHQLP SUREOHPLPD SUHPD DXWRULWHWX ãWR VH REMDãQMDYD DPELYDOHQWQLP RGQRVRP SUHPD URGLWHOMLPD X GHWLQMVWYX 2G LK X 1HPDþNRM L GUXJLP ]HPOMDPD VYH VH YLãH VSURYRGH LVWUDåLYDQMD D ELRVHPLRWLþND WHRULMD VH VYH YLãH SRNXãDYD SULPHQMLYDWL NDR WHRULMVND RVQRYD X SVLKRVRPDWVNRM PHGLFLQL =QDþDMDQ GRSULQRV SURXþDYDQMX SVLKRVRPDWLNH GDOD MH SVLKRDQDOLWLþNL RULMHQWLVDQD PDÿDUVND SVLKRVRPDWVND ãNROD NRMX MH SUHGYRGLR 6DQGRU )HUHQ]L. 2Q MH UD]YLR NRQFHSW ELRORãNLK RVQRYD SVLKRDQDOL]H NRQFHSW ELRDQDOL]H 3RVHEQR
MH ELR SRVYHüHQ UD]PDWUDQMX GD OL SVLKRVRPDWVND EROHVW LPD VLPEROLþNR ]QDþHQMH 2YDM LVWUDåLYDþ MH JRYRUHüL R IHQRPHQX KLVWHULþQH PDWHULMDOL]DFLMH SRNXãDR GD UD]JUDQLþL KLVWHULþQX QHXUR]X RG SVLKRVRPDWVNRJ SRUHPHüDMD
Bolest prepoznata u svim oblastima medicine
3VLKRVRPDWVND EROHVW MH GDQDV SUHSR]QDWD X VYLP REODVWLPD PHGLFLQH 1D SRMHGLQLP SVLKLMDWULMVNLP L PQRJR þHãüH L QD LQWHUQLVWLþNLP NOLQLNDPD X VYHWX SRVWRMH L SRVHEQD RGHOMHQMD ]D OHþHQMH SVLKRVRPDWVNLK EROHVWL =ERJ VYH YHüHJ EURMD REROHOLK X PHGLFLQL VH SURWHNOLK JRGLQD UD]YLMD L SRVHEQD REODVW ± SVLKRVRPDWVND PHGLFLQD 2QD LPD ]D FLOM GD QDV RVORERGL Kartezijanska podela þRYHND QD dušu i telo i oslobodi nas GXDOLWHWD WYUGQMH GD MH XYHN UHþ R VLPXOWDQRM UHDNFLML QD L]YHVQH VSROMDãQMH LOL XQXWUDãQMH QDGUDåDMH NRMD VH RGYLMD NDNR X SVLKLþNRM WDNR L X VRPDWVNRM oblasti 8 RYRP &LUFXOXV YLWLRVXV X X NRMHP MH EROHVQLN ]DUREOMHQ GYD RWNULüD VX X PHGLFLQL ELOMD RG YHOLNRJ ]QDþDMD 3UYL MH SRWHNDR L] REODVWL NRMD WUHWLUD OMXGVNX SVLKX SVLKRDQDOLWLþNR GRN MH GUXJR SRWHNOR L] REODVWL ¿]LRORJLMH DXWRQRPQRJ QHUYQRJ VLVWHPD 2WNULüH SVLKRDQDOL]H GD RãWHüHQMH QDãLK IXQNFLMD SRWLþH RG QHVYHVQLK NRQÀLNDWD onih NRMH MH QDãH VYHVQR -D RGEDFLOR L SRWLVQXOR X QHVYHVQR NRML VX QDELMHQL ÄHQHUJLMRP³ L NRML SUHGVWDYOMDMX L]UD] QDãLK RVQRYQLK QDJRQVNLK WHåQML GDOR MH RGOXþXMXüL GRSULQRV X UD]YRMX SVLKRVRPDWVNH PHGLFLQH 8 SRþHWNX VYRJ LVWUDåLYDQMD )URMG VH QLMH SULPDUQR EDYLR SVLKRVRPDWVNLP EROHVWLPD LSDN VH RJUDQLþLR QD LVSLWLYDQMH X]URND SURPHQD W]Y ³YLãLK´ IXQNFLMD PLãOMHQMD JRYRUD PRWRUQH L VHNVXDOQH IXQNFLMH ...ubrzo mu je postalo MDVQR GD RYH SURPHQH PRJX QDVWDWL NDR SRVOHGLFH QHUHãHQLK D SRWLVQXWLK XQXWUDãQMLK NRQÀLNDWD L GD ]DGLUX PQRJR GXEOMH X WHOR VYH GR YHJHWDWLYQRJ i endokrinog sistema L GD VX YHJHWDWLYQH IXQNFLMH QDMEOLåH QHVYHVQRP GHOX OLþQRVWL NRMX MH )URMG QD]YDR Ä2QR³ 3D NDR ãWR DQLPDOQH LOL YROMQH PRWRUQH IXQNFLMH QHPDMX QLNDNDY XWLFDM QD YHJHWDWLYQH NRMH VH RGYLMDMX EH] XþHãüD VYHVWL WDNR QL QDãH VYHVQR Ä-D³ QHPD GLUHNWQX NRQWUROX QDG QHVYHVQLP Ä2QR³ 'DNOH NDR ãWR VPR UDQLMH QDJODVLOL SVLKRVRPDWVNL NRQFHSW XND]XMH QD RGDYQR SR]QDWR PLãOMHQMH YHRPD ]QDþDMQH L þYUVWH YH]H L]PHÿX WHOHVQLK L SVLKLþNLK þLQLODFD 'DQDV VH RYLP SRMPRP åHOL QDJODVLWL GD VH UDGL R EROHVWL
X þLMRM SDWRJHQH]L OHåL HPRFLRQDOQL SRUHPHüDM NDR RVQRYQL SRYRG L X]URN UD]EROMHYDQMX
Vremenski i sekvencijalni J?L?A BME?â?H?
,VWUDåLYDQMD QRYLMHJ GDWXPD VX GRND]DOD GD MH SVLKRVRPDWVNL SURFHV YUHPHQVNL L VHNYHQFLMDOQL ODQDF GRJDÿDMD NRML VH MDYOMDMX QDMþHãüH SRMHGLQDþQR LQGLYLGXDOQR D NUDMQML UH]XOWDW WRJ SURFHVD PRåH ELWL NOLQLþNL SUHSR]QDW NDR y SUROD]QL IXQNFLRQDOQL ¿]LRORãNL L HPRFLRQDOQL RGJRYRU SVLKRVRPDWVNRJ SRUHPHüDMD NRML QH GRYRGL GR SURPHQH RVQRYQLK RUJDQVNLK VWUXNWXUD organa date osobe;
y psihosomatski sindrom koji SRND]XMH SULYUHPHQH LOL WUDMQH organske promene (psihosomatske bolesti ili organske bolesti) .DGD JRYRULPR R SVLKRVRPDWVNRP SRUHPHüDMX RQ NDR SRMDP SRMHGLQDþQRJ X]URND ]D VYDNL SRUHPHüDM YLãH QLMH RGUåLY 1DLPH NRG VYDNRJ SDFLMHQWD ]QDþDMQX XORJX LPD VDGHMVWYR PQRJREURMQLK IDNWRUD PXOWLIDNWRULMDOQRVW ELOR GD RQL GHOXMX VDPRVWDOQR LOL NRPELQRYDQR =DWR SVLKRVRPDWVNL NRQFHSW LPD ]D FLOM GD LGHQWL¿NXMH REMDVQL L UD]XPH SRPHQXWH SURPHQH QMLKRYH PHÿXVREQH YH]H L QMLKRY VSHFL¿þQL XWLFDM X SRUHPHüDMX KRPHRVWD]H VWDQMD UDYQRWHåH RUJDQL]PD QDVWDYDN X VOHGHüHP EURMX ®
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Zdravlje
14*)040."54,& #0-&45* **
Nijedna bolest RCJ? LGHC MBTMHCL? MB BSqC '' (Sokrat)
(www.so-vil.co.rs)
.GqC BP QA "P?E?L? "?PSqG LCSPMJME Sudski veĹĄtak iz oblasti neurologije i psihologije kriminala
5ZROCI PRENADRAÄœENOSTI POJEDINIH ELEMENATA AUTONOMNOG NERVNOG SISTEMA MOGU DATIRATI JO½ IZ RANOG DETINJSTVA A MOGU SE AKTIVIRATI POD ODREÄ–ENIM USLOVIMA U BILO KOM PERIODU U ÄœIVOTU A POSEBNO SU PREPOZNATLJIVE NAKON STRESNIH situacija
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DR ãWR VPR X UDQLMHP WHNVWX SLVDOL SVLKLþND ]ELYDQMD L SVLKRJHQL IDNWRUL XPQRJRPH XWLþX QD WHOHVQH UHDNFLMH L LJUDMX YDåQX XORJX X QDVWDQNX PQRJLK EROHVWL 3R]QDWR MH GD WHOHVQL VLPSWRPL NDR L SVLKRVRPDWVND REROMHQMD PRJX ELWL GLUHNWQD UHDNFLMD QD HPRFLMH 9HRPD QDJODãHQH UHDNFLMH LPDMX VWUDK NRML VH þHVWR PDQLIHVWXMH GUKWDQMHP ]DWLP VWLG NRML MH SUHSR]QDWOMLY SR FUYHQLOX NRåH OLFD L VO 1DVXSURW RYRPH X SVLKRVRPDWVNLP EROHVWLPD WHOHVQL VLPSWRPL PRJX ELWL L LQGLUHNWQD UHDNFLMD QD HPRFLMH X NRMRM RQH WUDåH L]OD] L QD NRPSOLNRYDQLML QDþLQ GROD]H GR RUJDQD L RãWHüXMX LK 6YH QDYHGHQR GRYRGL GR SUHQDGUDåHQRVWL QHUYQRJ VLVWHPD L DNR WD UHDNFLMD GXJR WUDMH PRåH GRYHVWL GR RãWHüHQMD WNLYD L SRMDYH VLPSWRPD EROHVWL 8]URFL SUHQDGUDåHQRVWL SRMHGLQLK HOHPHQDWD DXWRQRPQRJ QHUYQRJ VLVWHPD PRJX GDWLUDWL MRã L] UDQRJ GHWLQMVWYD D PRJX VH DNWLYLUDWL SRG RGUHÿHQLP XVORYLPD X ELOR NRP SHULRGX X åLYRWX D SRVHEQR VX SUHSR]QDWOMLYH QDNRQ VWUHVQLK VLWXDFLMD
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.?RMÃ¥XGMJMEGH? NQGFMQMK?Rskih bolesti
3UHPD NODVLþQRM $OHNVDQGHURYRM VKHPL UH]XOWDW MH UDQH HPRFLRQDOQH WUDXPH X GHWLQMVWYX L UHDNWLYDFLMH WH LVWH WUDXPH X ]UHORP GREX RQGD NDGD åLYRWQH RNROQRVWL SRGVHüDMX QD UDQX HPRFLRQDOQX WUDXPX 3RMDYOMXMH VH KURQLþQD HNVFLWDFLMD MHGQRJ RG GYD GHOD QHXURYHJHWDWLYQRJ QHUYQRJ VLVWHPD L QD ED]L QDVOHGQRJ LOL NRQVWLWXFLRQDOQRJ IDNWRUD REROHYD QHNL RG RUJDQD X WHOX NRML MH QDMRVHWOMLYLML .OLQLFL MH SR]QDWD þLQMHQLFD GD SUHQDGUDåHQRVW VLPSDWLNXVD NRML MH RGJRYRUDQ ]D KLSHUDNWLYQL L ERUEHQL åLYRWQL VWLO XþHVWYXMH X QDVWDQNX PLJUHQH KLSHUWHQ]LMH GLMDEHWHVD KLSHUWLUHR]H UHXPDWVNLK EROHVWL L MRã PQRJLK SDWRORãNLK SRUHPHüDMD ELOR GD VH UDGL R SRMHGLQDþQLP REROMHQMLPD LOL XGUXåHQLP VLPWSRPLPD RGUHÿHQLK NOLQLþNLK SRUHPHüDMD 3RMHGQRVWDYOMHQR PHKDQL]DP QDVWDQND RYRJ SRUHPHüDMD LQLFLUDQ MH SVLKLþ®
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NLP GRåLYOMDMLPD NRML VH IRUPLUDMX X NRUL YHOLNRJ PR]JD L QDGDOMH LPSXOVLPD SUHQRVH X KLSRWDODPXV =DWR X VWUHVQRM VLWXDFLML GROD]L GR DNWLYDFLMH OLPELþNRJ VLVWHPD NRML VD KLSRWDODPXVRP NRQWUROLãH LQWHJULãH L UHJXOLãH HPRFLMH L QDJRQVNL åLYRW ,VWH RYH VWUXNWXUH OLPELþNL VLVWHP L KLSRWDODPXV NDQDOLãX VYRMH XWLFDMH NUR] DXWRQRPQL L HQGRNULQL VLVWHP 6YRMRP HNVSUHVLMRP L HNVFLWDFLMRP VYDND HPRFLMD XWLþH QD PHKDQL]PH HQGRNULQRJ L DXWRQRPQRJ QHUYQRJ VLVWHPD 7RNRP RYRJ SURFHVD X FHQWUDOQRM åOH]GL HQGRNULQRJ VLVWHPD KLSR¿]L SRMDþDYD VH OXþHQMH VHNUHFLMH $&7+ NRML X QL]X ELRKHPLMVNLK SURFHVD L]D]LYD SRYHüDQR OXþHQMH NRUWL]ROD X QDGEXEUHåQRM åOH]GL NRML SRUHG RVWDOLK LPD L OLPIRFLWROL]QR GHMVWYR 2YDNR UHDOL]RYDQ SVLKLþNL RGJRYRU QHJDWLYQR XWLþH QD üHOLMH LPXQVNRJ VLVWHPD L UHPHWL LPXQRORãNL QDG]RU L LPXQRORãNX KRPHRVWD]X WM UDYQRWHåX X RUJDQL]PX $NR ELVPR QDYHGHQH þLQMHQLFH SRMHGQRVWDYLOL LPDOL ELVPR MDVQX VKHPX QL]D PHÿXVREQLK UHDNFLMD NRMH ]DSRþLQMX SVLKLþNLP RGJRYRURP QD VWUHVRU RGQRVQR VWUHVQX VLWXDFLMX ELOR NRJ SRUHNOD ± QDNRQ QHDGHNYDWQRJ SVLKLþNRJ RGJRYRUD VOHGL VODEOMHQMH RGEUDPEHQLK PHKDQL]DPD LPXQRJ VLVWHPD ãWR X]URNXMH SRUHPHüDMH IXQNFLMH SRMHGLQLK RUJDQD L VLVWHPD RUJDQD ãWR ]D UH]XOWDW LPD EROHVW 'R VDGD VX YUãHQD PQRJD LVWUDåLYDQMD NRMD VX GRND]DOD QHSRVUHGQX YH]X L LPXQRPRGXODFLMX WRNRP ]DUDVWDQMD UDQD L GHMVWYR SVLKRVRFLMDOQLK IDNWRUD NDR UHPHWHüLK VWUHVRUD 7DNRÿH MH GRND]DQR GD VH WRNRP VWUHVQLK UHDNFLMD SRMDþDQR OXþH HQGRJHQL RSLMDWL RG NRMLK MH QDM]QDþDMQLML HQGRU¿Q 'XJRWUDMQD XVORYOMHQD ¿]LRORãND VWLPXODFLMD RVOREDÿDQMD HQGRJHQLK RSLMDWD XWLþH QD VODEOMHQMH LPXQRJ VLVWHPD 1DMQRYLMD PHGLFLQVND VD]QDQMD XND]XMX GD LQLFLUDQMH L WRN PQRJLK SRUHPHüDMD RG NDUGLRYDVNXODUQLK EROHVWL GR VODERVWL L IXQNFLRQDOQRJ LVFUSOMLYDQMD RUJDQL]PD PRåH ELWL X]URNRYDQR SURLQÀDPDWRUQLP FLWRNLQLPD 3R]QDWR MH GD MH SURGXNFLMD FLWRNLQD SRG GLUHNWQLP XWLFDMLPD QHJDWLYQLK HPRFLMD L VWUHVQLK LVNXVWDYD 'RND]DQR MH GD VH
DXWRQRPQL QHUYQL VLVWHP ODNR XVORYOMDYD 1D WDM QDþLQ QDVWDMX ORãH UHDNFLMH NRMH VH YUOR EU]R XWHPHOMXMX D VOHGVWYHQR ¿NVLUDMX NDR REUDVFL SRQDãDQMD WH QDVWDMH W]Y ÄOXGLOR RUJDQD³ NDNR MH WR QD]YDR EHþNL SVLKLMDWDU 0HQJ QDNRQ þHJD VOHGL QL] SVLKRVRPDWVNLK SRUHPHüDMD 6DVYLP MH VLJXUQR GD QH UD]YLMD VYDND RVRED VD HPRFLRQDOQLP SRWHãNRüDPD SVLKRVRPDWVNX EROHVW 2QD ]DYLVL L RG QL]D GUXJLK UHDNFLMD L IDNWRUD NDR QD SULPHU QDVOHGQH RVRELQH SRGUãND RNROLQH ]DWLP YUVWD XþHVWDORVW WUDMDQMH L LQWHQ]LWHW VWUHVRJHQRJ IDNWRUD L VWUHVRJHQLK PRPHQDWD X åLYRWX NDR L NXOWXURORãND REHOHåMD PRGHO SRQDãDQMD QDþLQ åLYRWD SUHWKRGQL VWDWXV RUJDQL]PD L SUHWKRGQH EROHVWL .ODVLþQL SVLKRDQDOLWLþDUL VPDWUDMX GD VYDNL REROHOL RUJDQ LPD RGUHÿHQX VLPEROLNX WM GUXJDþLMX SRUXNX $XWRULWHWL X RYRM REODVWL VPDWUDMX GD GXJRWUDMDQ VWUHV PRåH L]D]YDWL VQDåDQ LPXQRORãNL RGJRYRU L SVLKRVRPDWVNX EROHVW GRN NUDWNRWUDMDQ LDNR MH VQDåDQ QH PRUD L]D]YDWL QLNDNYX SVLKRVRPDWVNX EROHVW ,DNR VX VWDUL 5LPOMDQL NRULVWLOL L]UHNX ÄX ]GUDYRP WHOX ]GUDY GXK³ SVLKRVRPDWVNRM PHGLFLQL MH EOLåD L]UHND ÄX ]GUDYRP GXKX MH ]GUDYR L WHOR³ 2VREH VD SVLKRVRPDWVNLP EROHVWLPD LPDMX WHãNRüH X L]UDåDYDQMX VYRMLK HPRFLMD SUHSR]QDWOMLYH VX SR WRPH ãWR UHWNR PDãWDMX L LPDMX XRþOMLY SUHSR]QDWOMLY QDþLQ NDNR XVSRVWDYOMDMX RGQRVH VD GUXJLP OMXGLPD NRML MH X VNODGX VD WHãNRüDPD X HPRFLRQDOQRP IXQNFLRQLVDQMX 3R]QDWR MH GD VWUHV VYRMLP GHMVWYRP SUHNR QHXURHQGRNULQRJ L LPXQRJ VLVWHPD PRåH GRYHVWL GR R]ELOMQRJ QDUXãDYDQMD ]GUDYOMD DOL GR GDQDV SRX]GDQL L HJ]DNWQL PHKDQL]PL QDVWDMDQMD SRUHPHüDMD MRã QLVX X SRWSXQRVWL UD]MDãQMHQL ,] WLK UD]ORJD ODNãH MH LGHQWL¿NRYDWL VWUHV NDR DJUDYDFLRQL IDNWRU YHü QDVWDOLK SRUHPHüDMD QHJR VWUHV NDR HWLRORãNL IDNWRU SRUHPHüDMD 7DNRÿH XRþHQR MH GD ¿]LRORãNH UHDNFLMH QD VWUHV ]DYLVH RG YUVWH VWUHVRUD RGQRVQR GD PRJX ELWL YLãH LOL PDQMH VSHFL¿þQH RGQRVQR GD VX ]QDþHQMD NRMH PX X GDWRP WUHQXWNX RVRED SULGDMH SUHSR]QDWOMLYD
SR LQGLYLGXDOQLP UD]OLNDPD PHÿX OMXGLPD 3VLKRORãNL SUR¿O RVREH NRMD LPD SUHGLVSR]LFLMX ]D SVLKRVRPDWVND REROMHQMD NDUDNWHULãH QHGRVWDWDN NRQWDNWD VD VYRMLP RVHüDQMLPD L QHPRJXüQRVW QMLKRYRJ SUHSR]QDYDQMD 7H RVREH VYRMH WHOR GRåLYOMDYDMX NDR GD MH WXÿH L GD IXQNFLRQLãH QH]DYLVQR RG QMLKRYH SVLKH 6NORQH VX GD RVHüDQMD SRWLVNXMX ]DPHQMXMX VWDOQLP DNFLMDPD L GD VYRMH HPRFLMH L GHãDYDQMD
=D QMLK MH NDUDNWHULVWLþQD VSRVREQRVW YHOLNRJ L EU]RJ SULODJRÿDYDQMD NDR L VSRVREQRVW VDYODGDYDQMD VWUHVQLK VLWXDFLMD NRMH X WUHQXFLPD DGDSWDFLRQRJ LVFUSOMLYDQMD L SRSXãWDQMD SVLKRORãNH RGEUDQH LVSROMDYDMX WHOHVQH UHDNFLMH 2YH RVREH VX VNORQH GD ]DQHPDUH VYRM XQXWUDãQML QHPLU OMXWQMX EHV WXJX DJUHVLMX NDR L QHND GUXJD RSWHUHüXMXüD RVHüDQMD 3UHRVHWOMLYH VX L QD ¿]LþNX WUDXPX LOL ERO 7DNRÿH SVLKRVRPDWVNLP
EROHVWL L QMLKRY XEU]DQ WRN MH SURFHV VWDUHQMD 3RVHEQR VX XJURåHQH GHSUHVLYQH RVREH 'HSUHVLMD MH MHGQD RG PQRJREURMQLK SRVOHGLFD VWUHVRJHQLK GRJDÿDMD X åLYRWX D þLMD VH XþHVWDORVW OLQHDUQR SRYHüDYD VD JRGLQDPD VWDUHQMHP 2G SRVHEQRJ ]QDþDMD VX GRJDÿDML X åLYRWX NDR ãWR MH VPUW URGLWHOMD LOL GUXJLK EOLVNLK URÿDND GHFH PXåD LOL åHQH RGOD]DN X SHQ]LMX L PQRJL ]GUDYVWYHQL SUREOHPL NRML QHPLQRYQR SURLVWLþX L] SURFHVD VWDUHQMD
*CáCLHC NQGFMQMK?RQIGF NMPCKCà ?H?
EROHVWLPD VX VNORQH RVREH NRMH WHãNR SULKYDWDMX SURPHQH L SUREOHPH X RGQRVLPD V GUXJLPD QH SRGQRVH NRQÀLNWQH VLWXDFLMH LOL QHPDMX NDSDFLWHW GD LK UD]UHãH NDR L ãWR QLVX VNORQH NUHDWLYQLP L NRPSURPLVQLP UHãHQMLPD ,PDMX L]UDåHQX SRWUHEX ]D UHGRP UDGRP L WDþQRãüX 3UHSR]QDWOMLYH VX SR SUDJPDWLþQRP UHãDYDQMX VRSVWYHQLK L WXÿLK HPRFLRQDOQLK WHãNRüD GRN LVWRYUHPHQR VYRMD QH]DGRYROMVWYD QH L]UDåDYDMX YHü VX QMLKRYD SRQDãDQMD XYHN X GUXãWYHQR GR]YROMHQLP JUDQLFDPD VD YLGOMLYLP VRFLMDOQR SULKYDWOMLYLP QRUPDPD 3VLKRVRPDWVNLP EROHVWLPD VX VNORQH -HGDQ RG QDM]QDþDMQLK SUHGLVSRQLUDRUJDQL]RYDQH L GREUR SULODJRÿHQH RVREH MXüLK IDNWRUD ]D UD]YRM SVLKRVRPDWVNH
RNR VHEH VKYDWDMX NUDMQMH UDFLRQDOQR SUDNWLþQR LVWRYUHPHQR L RWXÿHQR ,GHMD YRGLOMD RYLK RVRED ÄUDGL QHãWR GD QH PLVOLã³ X GDWRP WUHQXWNX PRåH ELWL RG NRULVWL SRQHNDG MH L VSDVRQRVQD DOL VDPR L LVNOMXþLYR SULYUHPHQRJ NDUDNWHUD 6WDOQR XPQRåDYDQMH L XYHüDYDQMH VYRMLK DNWLYQRVWL QLMH GREUR MHU MH WR QDMþHãüH REOLN EHNVWYD RG VXRþDYDQMD VD VRERP L RQLP ãWR QDV ]DLVWD RSWHUHüXMH
1IJMLMQR NQGFMQMK?RQIGK bolestima
/HþHQMH MH YHRPD NRPSOHNVQR L ]DKWHYD WLPVNL UDG 2QR VH VDVWRML X SULPHQL PHGLNDPHQDWD L UD]OLþLWLK SVLKRWHUDSLMVNLK WHKQLND L PHWRGD 3RUHG RVQRYQRJ OHþHQMD SRPRü SVLKLMDWUD RYLP RVREDPD MH GUDJRFHQD 3VLKRORãND SRGUãND L OHþHQMH üH SDFLMHQWX SRPRüL GD SUHYD]LÿH SRVWRMHüX SVLKRORãNX VODERVW L GD SRYHåH SVLKLþNR VWDQMH L WHOHVQH WM RUJDQVNH VPHWQMH LOL EROHVW 1D RYDNDY QDþLQ VH X YHOLNRM PHUL PRåH GRSULQHWL WHOHVQRP L SVLKRORãNRP RSRUDYNX %U]L WHKQLþNL L WHKQRORãNL QDSUHGDN QDXNH UD]YRM VDYUHPHQH GLMDJQRVWLþNH RSUHPH L GLMDJQRVWLþNLK PHWRGD XþLQLOL VX RG OHNDUD SDUFLMDOQRJ SRVPDWUDþD EROHVWL L GRYRGH GR QMHJRYRJ ÄRWXÿHQMD³ LOL RGYDMDQMD RG þRYHND SDFLMHQWD 2YR MH UH]XOWLUDOR PLãOMHQMHP NRMH VH þHVWR þXMH X PHGLFLQVNRM SUDNVL GD ³OHNDUL QH OHþH EROHVQLND YHü EROHVW´ 'D OL MH L NROLNR RYR SRJUHãDQ WHUDSLMVNL SULVWXS SVLKRVRPDWVNRM EROHVWL QDMEROMH SRND]XMX UDGRYL :DOWHU D &DQQRQ-D L +DQVD 6HO\H D NRML VX X SUYRM SRORYLQL YHND LVWUDåLYDOL VWUHVQH UHDNFLMH 2QL VX GRND]DOL GD SUHWHüL þLQLRFL SR RUJDQL]DP SRSXW KODGQRüH SUHNRPHUQH WRSORWH SUHWQMH ND]QRP L MRã PQRJR GUXJLK L]D]LYDMX SDWR¿]LRORãNH UHDNFLMH NRMH VH PDQLIHVWXMX QHXUR HQGRNULQR LPXQRORãNLP SRUHPHüDMLPD NRML PRJX ELWL YHRPD R]ELOMQL GR WH PHUH GD PRJX UH]XOWLUDWL þDN L VPUWQLP LVKRGRP =DWR SVLKRVRPDWLþDUL X WHUDSLML RYLK VWDQMD LQVLVWLUDMX QD KROLVWLþNRP SULVWXSX SDFLMHQWX 6DJOHGDYDQMX þRYHND NDR MHGLQVWYD GXãH L WHOD X] RSWLPDOQX SULPHQX VDYUHPHQH GLMDJQRVWLþNH RSUHPH NRMD WUHED GD SRPRJQH X UD]OLNRYDQMX VRPDWVNRJ RG SVLKLþNRJ SUL þHPX WR VDJOHGDYDQMH QH VPH ELWL X]URN ÄRWXÿHQMH³ LOL RGYDMDQMH WHUDSHXWD RG þRYHND SDFLMHQWD ãWR MH GDQDV QDMYLãH YLGOMLYR L WRNRYLPD HOHNWURQVNLK LQIRUPDFLMD X ]GUDYVWYX 1DVWDYDN X QDUHGQRP EURMX ®
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