Professional Documents
Culture Documents
Mental Health Concepts and Techniques For The Occupational Therapy Assistant 5Th Edition PDF Full Chapter PDF
Mental Health Concepts and Techniques For The Occupational Therapy Assistant 5Th Edition PDF Full Chapter PDF
Mental Health Concepts and Techniques For The Occupational Therapy Assistant 5Th Edition PDF Full Chapter PDF
https://ebookmass.com/product/conditions-in-occupational-therapy-
effect-on-occupational-performance-5th-edition-ebook-pdf/
https://ebookmass.com/product/earlys-physical-dysfunction-
practice-skills-for-the-occupational-therapy-assistant-4th-
edition-mary-elizabeth-patnaude/
https://ebookmass.com/product/introduction-to-occupational-
therapy-e-book-5th-edition-ebook-pdf/
https://ebookmass.com/product/grief-counseling-and-grief-therapy-
fifth-edition-a-handbook-for-the-mental-health-practitioner-
ebook-pdf/
Neeb’s Mental Health Nursing 5th Edition, (Ebook PDF)
https://ebookmass.com/product/neebs-mental-health-nursing-5th-
edition-ebook-pdf/
https://ebookmass.com/product/the-intentional-relationship-
occupational-therapy-and-use-of-self-occupational-therapy-and-
the-use-of-self-1st-edition-ebook-pdf/
https://ebookmass.com/product/frames-of-reference-for-pediatric-
occupational-therapy-4th-edition-ebook-pdf/
https://ebookmass.com/product/occupational-and-environmental-
health-7th-edition-ebook-pdf/
https://ebookmass.com/product/occupational-therapy-evaluation-
for-children-a-pocket-guide-2nd-edition-ebook-pdf/
manufacturer’s package insert) accompanying each drug to verify, among other things,
conditions of use, warnings and side effects and identify any changes in dosage schedule or
contradictions, particularly if the medication to be administered is new, infrequently used
or has a narrow therapeutic range. To the maximum extent permitted under applicable law,
no responsibility is assumed by the publisher for any injury and/or damage to persons or
property, as a matter of products liability, negligence law or otherwise, or from any
reference to or use by any person of this work.
LWW.com
8
Reviewers
9
Nancy Dooley, OTR/L, MA, PhD
Program Director
Occupational Therapy and Occupational Therapy Assistant Programs
New England Institute of Technology in Warwick
East Greenwich, Rhode Island
10
Maureen Matthews, BS, OTR/L
Occupational Therapist III
Behavioral Health
Good Samaritan Hospital
San Jose, California
11
Preface
The fifth edition of Mental Health Concepts and Techniques aims to provide the
occupational therapy assistant (OTA) student with a comprehensive and contemporary
foundation for the practice of occupational therapy for persons with mental health
problems. The book may also be useful to experienced occupational therapy assistants
entering or reentering mental health practice. Occupational therapists with supervisory and
administrative roles with an interest in exploring the delineation and relationships between
the professional and technical levels of responsibility may use the book as a resource. It is
assumed that readers of this text have a background in human growth and development,
general psychology, group process, and activities used in occupational therapy.
Much has changed in mental health care since the first edition. New medications may
better target specific disorders, making improved functioning possible and reducing adverse
effects. Many people with mental disorders have become more assertive about their rights,
alert and proactive as consumers of services. Recovery is the dominant paradigm in
interventions for persons with mental disorders, and the text reflects this. The terms used to
refer to “recipients of services” in the fifth edition correspond to current usage. Box 7-1
identifies some of the names given to the recipient of occupational therapy services in a
range of settings: patient, client, consumer, member, inmate, resident, service user,
survivor, and so on. The student and reader are encouraged to appreciate the ambiguity and
subtle distinctions of these terms, and to be alert to new ones. It is important to develop a
sense for which is the best term for a specific situation, and to cultivate an empathic feel for
the stigma that attaches to labels of any kind.
The text has been updated to reflect the Occupational Therapy Practice Framework, 3rd
edition (OTPF-3E), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5).
12
Overall Changes in the Text
Some chapters from the previous edition have been deleted, on the recommendation of
reviewers of the proposal for this new edition. Their argument was that information from
those chapters (the OTPF-3E, the OT process, documentation, supervision, and personal
organization) is accessible in textbook and online resources that have been developed for
occupational therapy assistants over the past 15 years. This was not the case when the first
three editions of the book published.
The sequence of the remaining chapters has been revised (consumers placed before
contexts, and the activity analysis chapter moved earlier in the book). It is the individual
instructor’s prerogative to determine the optimal sequence for assigning the chapters,
depending on the desired content of a course of study.
Evidence-based practice (EBP) content has been enhanced. Boxes within chapters, and
a new Appendix C, invite the curiosity of the reader. It is assumed that the student will
encounter a thorough exposition of EBP elsewhere in the curriculum. In this text the
purpose is to pose questions that suggest a need for thoughtful answers. The answers may
be multiple, argumentative, and sometimes contradictory. In many cases, no one answer is
correct (to the exclusion of others). Our profession is developing its body of evidence
despite some challenges, explained further in Appendix C.
Other changes include the following:
13
Organization of Content
The content is arranged into five sections. Section I (Chapters 1 to 4) establishes a
framework, discussing the historical origins of psychiatric occupational therapy and the past
and current theoretical foundations on which mental health practice is based. Case
examples are included to illustrate how each theory can be applied.
Section II (Chapters 5 to 8) addresses the context of the occupational therapy
intervention process and includes chapters on psychiatric diagnosis (DSM-5), settings,
medications, and consumers. Content on practice with children, adolescents, families,
veterans, victims of trauma, and other groups has been increased. The purpose of gathering
chapters on such disparate topics under the heading “context” is to suggest the effects of
these factors on the occupational therapy process.
Section III (Chapters 9 to 12) focuses on relationships with patients/clients/consumers.
The therapeutic relationship with the mental health worker is a primary force in motivating
recovery, restoring the patient’s sense of direction, and supporting ability to function.
Logically this material should precede any discipline-specific content. In addition, past
students have expressed a desire to know what to do with the clients whom they meet on
level I fieldwork, which may run concurrently with the mental health coursework in some
curricula. A chapter on safety is included in this section, as is the chapter on groups.
Section IV (Chapters 13 and 14) describes the evaluation, planning, and intervention,
stages of the occupational therapy process. Some information on clinical reasoning (from
the deleted OT process chapter) has been integrated with the evaluation and intervention
chapters. Evaluation instruments cited have been updated to reflect current practice,
consistent with reasonable expectations of service competency for the OTA. The chapters
in this section correspond to the terminology and concepts of the OTPF-3E and official
documents of the American Occupational Therapy Association, at the time of this writing.
Occupational therapy methods and activities are the focus of Section V (Chapters 15 to
20). At the suggestion of reviewers, the chapter on activity analysis has been relocated and
appears as the first in this section. The other five chapters detail specific activities and
methods in the areas of daily living skills, education and work, leisure and social
participation, emotional regulation and management of emotional needs, and cognitive and
sensory and motor factors and skills.
Appendix A contains case examples, some of which are referred to in the text.
Additional case examples appear within the chapters. Appendix B gives sample group
protocols to supplement Chapter 12. Appendix C provides a brief introduction to
evidence-based practice (EBP) in mental health occupational therapy, and EBP boxes can
be found in many chapters. The end papers list abbreviations that students and
practitioners may encounter in mental health settings and medical records.
Popular text features are retained. Chapter objectives direct readers to the learning goals
14
for the chapter, and chapter review questions test the readers’ comprehension. Point-of-
view boxes in selected chapters provide perspectives of consumers and other stakeholders.
Additional retained features include concepts summary and vocabulary review (found
throughout selected chapters in Section I) that reinforce important concepts and provide
definitions for key terms.
With each edition, we (author and publisher) try to move more perfectly toward
gender-neutral language. However, the third person plural is not always appropriate and in
such cases masculine or feminine names or pronouns have been employed.
15
Acknowledgments
No project of this size is ever the work of one person. Many people have helped in direct
and indirect ways throughout the five editions. I remain deeply grateful to Professor JoAnn
Romeo Anderson, Dean Irwin Feifer, and former Dean of Faculty Martin Moed for their
encouragement and mentorship during the T.A.R. project at LaGuardia Community
College in 1980 and 1981; participation in that project enabled me to develop the course
manual from which the first edition evolved. I am grateful to my colleagues and students at
LaGuardia Community College for their companionship and inspiration.
I am most appreciative of the careful suggestions and collegial encouragement of past
and present reviewers. Those for previous editions included Claudia Allen, Linda Barnes,
Alfred Blake, Jody Bortone, Terry Brittell, Anne Brown, Leita Chalfin, Phyllis Clements,
Carol Endebrock-Lee, Edith Fenton, Gloria Graham, Yvette Hachtel, Florence Hannes,
Diane Harlowe, Noel Hepler, Carlotta Kip, Lorna Jean King, Tom Lawton, Siri Marken,
Maureen Matthews, Ann Neville-Jan, Elizabeth Nyberg, Gertrude Pinto, Hermine D.
Plotnick, Margaret D. Rerek, Anne Hiller Scott, Esther Simon, Scott Trudeau, Susan
Voorhies, and Marla Wonser.
I am greatly indebted to the reviewers of the present edition. Their commitment to the
project and their willingness to share their expertise were invaluable. The present text is
very much a collaboration with them. I thank especially the following three individuals who
gave many hours of thoughtful reading and commentary: Myrl Manley, MD; Lynnette
Dagrosa, MA OTR/L; and Maureen Matthews, OTR/L. All the reviewers of the present
edition are listed on page v.
I am grateful to the staff at Wolters Kluwer Health, Lippincott Williams & Wilkins,
and their predecessor, Raven Press, for editorial and other support over the years. Vickie
Thaw was especially encouraging in her stewardship of the project during the development
of the second edition. For the third edition, Margaret Biblis, Linda Napora, Amy Amico,
Lisa Franko, and Mario Fernandez created wonderful text features and a beautiful design,
which live on in altered form in the current edition. For the fourth edition, Elizabeth
Connolly provided careful and thoughtful guidance as managing editor. I am also indebted
to Kim Battista (artist) and Jennifer Clements (art director) for enhancing the look of the
book and the images within it.
The development of the current edition was managed with great patience and care by
Amy Millholen. Her receptivity, flexibility, creativity, and concern were immensely helpful.
Mike Nobel met with me and discussed the project via phone and e-mail for what seemed
like several years, and encouraged me in countless ways. This project would not have
happened without his and Amy’s support. Others in the publication process who
contributed their labors to this edition included Shauna Kelley, Marketing Manager; David
16
Saltzberg, Production Product Manager; and Stephen Druding, Design Coordinator.
My husband, Bob, always assured me that I would manage to complete this edition just
as I have completed others. To that end, he did not let me waste away but frequently
offered treats and nurturance of all kinds, insisted that I go for a walk when I was tired, and
distracted me appropriately (and sometimes inappropriately but hilariously) when I needed
a break. He read passages for clarity and for student readability, a job for which he is well
suited given his decades of teaching high school English. Most of all, he was there for me
when I needed him. What more can one ask? Thank you, Bob.
17
Contents
Reviewers
Preface
Acknowledgments
18
4 Human Occupation and Mental Health Throughout the
Life Span
Motivation Toward Occupation
Changes in Occupation over the Life Span
Mental Health Factors Throughout the Life Span
19
8 Psychotropic Medications and Other Biological Treatments
Psychotropic Medications
Consumer Concerns Related to Medications
Other Biological Treatments
Herbal and Alternative Therapies
Concerns Related to the Internet
11 Safety Techniques
Universal Precautions
Controlling the Clinic Environment
Medical Emergencies and First Aid
Psychiatric Emergencies
Addressing Safety in the Community
20
Starting a New Group
Adaptations of Groups for Low-Functioning Individuals
Other Models for Groups
Program Evaluation
22
Appendix B: Sample Group Protocols
Index
23
List of Figures
1.1 Timeline.
3.1 Some people find social behavior very hard to understand.
3.2 Task checklist.
3.3 Allen’s level 3.
3.4 The process of occupational adaptation.
3.5 Person–Environment–Occupation Model.
4.1 The balance and interrelationship of work and play during the life span.
6.1 Marine Gunnery Sgt. Aaron Tam (Ret.), holding the mask he made to illustrate his
feelings about his traumatic brain injury.
6.2 Homeless persons may establish encampments under highway overpasses.
6.3 Visual analog scale.
7.1 OT client drawing reflecting on obstacles to changing behavior.
7.2 Townhouses such as these in Brooklyn, NY, may contain supported apartments.
7.3 A drawing by a child showing how different body parts feel when she is angry.
7.4 Three levels of environment.
8.1 Aging individuals and those with arthritis or diminished sensation will have difficulty
opening medication containers.
8.2 Storing several medications in the same container makes it difficult to remember the
name, purpose, dosage, and schedule for each one.
9.1 Eye contact, leaning forward, and facial expression convey empathy, sensitivity,
respect, and warmth.
10.1 Postural habits associated with depression (left) and anxiety (right).
10.2 A. Cluttered environment. B. Clarified environment.
11.1 Always use a stairway to evacuate during a fire or smoke condition.
11.2 Hunting is a valued occupation for many individuals and families across the United
States.
12.1 Interaction patterns in groups showing leader and members.
12.2 Group interaction skills survey.
12.3 Typical elements of a group protocol.
12.4 Sample group protocol: self-care group.
12.5 Sample group protocol: caregiver education and support group.
12.6 Sample group protocol: therapeutic activities (acute care unit).
13.1 Empathy and pacing help the client trust the therapy practitioner.
24
13.2 Occupational Performance History Interview version-II.
13.3 Comprehensive Occupational Therapy Evaluation scale.
13.4 Definitions for the Comprehensive Occupational Therapy Evaluation scale.
13.5 The Allen Cognitive Level screening test.
14.1 Reasoning with the model of human occupation.
14.2 Working with plants requires basic task skills and provides a link with nature, a sense
of responsibility, and hope.
14.3 Assembling a wood project provides feedback about the effectiveness of actions and the
sequence of steps, and is adaptable to many goals.
14.4 A guided discussion after a group activity helps the members process what has
occurred.
14.5 Examples of questionnaire statements related to patients’ satisfaction with the delivery
of occupational therapy care.
15.1 Gradation of decision-making.
15.2 Dynamic performance analysis decision tree.
15.3 Making a simple sandwich is a task-specific activity.
16.1 Proposed sequential adherence process.
16.2 Using an umbrella and wearing a well-fitting coat suitable for rain creates a positive
impression.
16.3 Preparing a grocery list and using it help save time and money.
16.4 The immense size, bright lights, and visual stimulation of a large store may be
overwhelming to someone with sensory issues or a cognitive disability.
17.1 Stocking shelves in a supermarket or health aids store requires skills that are within the
range of high school students and persons with mental disabilities who are
beginning to explore the world of work.
17.2 Working alone and at night or other time when few workers are present may be an
effective accommodation from someone with social anxiety or high distractibility.
18.1 Here, a woman instructs her granddaughter in knitting, a leisure activity that she
enjoys, and a social participation experience for both of them.
18.2 Many people enjoy spending their leisure time experiencing nature directly.
18.3 A. Solitary computer gaming activity may interfere with social participation and with
success in school. B. Enjoying an Internet activity with others is different from
doing it alone. In this case, each person has the social proximity of friends.
18.4 Social participation may include pets and other animals.
19.1 The modal model of emotion.
19.2 The process model of emotion regulation.
19.3 Maslow’s hierarchy of needs.
20.1 Postures associated with chronic schizophrenia.
25
20.2 Volleyball elicits spinal extension and open postures.
20.3 Multisensory room.
26
List of Tables
27
17.3 Examples of Accommodations that Have Been Considered Reasonable
19.1 Emotion Regulation Processes and Foundation Skills
19.2 Stress Management Techniques
20.1 Examples of Cognitive Impairments
20.2 Sensory Room Equipment Considerations
28
List of Boxes
2.1 Six Dimensions of Rehabilitation Readiness
2.2 Three Examples of Cultural Syndromes
3.1 Mode 4.2: Engaging Abilities and Following Safety Precautions When the Person
Can Differentiate the Parts of the Activity
4.1 Sample Statements of Persons Anticipating Retirement
5.1 ICD-9 and ICD-10 Codes for Schizophrenia
5.2 DSM-5 Diagnosis, “Ozone Layer”
5.3 Brief Occupational Therapy Interventions Related to Substance Use (For the OTA)
6.1 Children with Psychosocial Problems: Focus of Intervention
6.2 Adolescents with Psychosocial Problems: Focus of Intervention
6.3 Elders with Psychosocial Problems: Focus of Intervention
6.4 Veterans with Psychosocial Problems: Focus of Intervention
6.5 Questions for Effective Liaisons with Caregivers
6.6 Four Types of Interactions with Caregivers
6.7 Examples of Cultural Norms for Behavior in the United States
6.8 Behaviors That May Indicate Low Levels of Literacy or Health Literacy
6.9 Homeless Persons: Goals and Areas of Intervention
7.1 The Recipient of Mental Health Services: What’s in a Name?
7.2 Ten Guiding Principles of Recovery
7.3 Guidelines and Strategies for Supporting Recovery
7.4 Short-Term Inpatient Programs: Focus of Intervention
7.5 Longer-Term Inpatient Programs: Focus of Intervention
7.6 Community Programs: Focus of Intervention
7.7 Psychosocial Clubhouse: Focus of Services
7.8 The Nuclear Task Approach to Crisis Intervention
7.9 Psychiatric Home Care: Focus of Intervention
8.1 Recommended Internet Sources for Drug Information
9.1 A 21st-Century Definition of Therapeutic Relationship
9.2 Improving Understanding of Self and Others Through ALOR
9.3 Communication Techniques
9.4 The Six Guiding Principles of the Occupational Therapy Code of Ethics
10.1 Anxiety: Examples of Appropriate Activities
10.2 Depression: Examples of Appropriate Activities
29
10.3 Mania: Examples of Appropriate Activities
10.4 Hallucinations: Examples of Appropriate Activities
10.5 Delusions: Examples of Appropriate Activities
10.6 Paranoia: Examples of Appropriate Activities
10.7 Anger, Hostility, and Aggression: Examples of Appropriate Activities
10.8 Seductive Behavior and Sexual Acting Out: Examples of Appropriate Activities
10.9 Cognitive Deficits: Examples of Appropriate Activities
10.10 Attention Deficits and Disorganization: Examples of Appropriate Activities
11.1 Hand Washing: The First Defense Against Infection
11.2 Some Risk Factors for Suicide
11.3 Signs of Suicidal Intent
11.4 Recommended Home Modifications for Consumer Safety
11.5 NAMI’s Position on Violence, Mental Illness, and Gun Reporting Laws
12.1 Techniques to Promote Interaction in a Group
12.2 Sample Group Session Plan: Grocery Shopping
12.3A Sample Notes from a Project-Level Group
12.3B Sample Notes from a Project-Level Group, Reflecting on Goals of Individuals
13.1 Guide to Observing and Describing Behavior
14.1 The Focus of Clinical Inquiry
14.2 Steps in Planning Intervention
14.3 Making Goals Measurable and Time Limited
15.1 Activity Analysis Following the Model of Human Occupation
16.1 Activities of Daily Living
16.2 Instrumental Activities of Daily Living
16.3 Focus: Relapse Prevention
17.1 Education
17.2 Structures for Homework Success
17.3 Work
30
SECTION One
31
History and Basic Concepts 1
Occupational therapy has a great deal to learn from its history. The profession was founded on
the visionary idea that human beings need, and are nurtured by, their activity as by food and
drink and that every human being possesses potential that can be achieved through engagement
in occupation.
CHAPTER OBJECTIVES
The popular view is that people with mental health problems have trouble controlling
their feelings, thoughts, and behavior. What is less obvious is that many people with mental
disorders also have trouble doing everyday activities, things the rest of us take for granted.
Occupational therapy practitioners address this part of human life—how people carry out
the tasks that are important to them, how well they do these tasks, and how satisfied they
feel about them. Occupation has been defined as “man’s goal-directed use of time, interest,
energy, and attention” (5). Occupation is activity with a purpose, with a meaning unique to
the person performing it (6). Occupational therapy views engagement in occupation as
essential to both physical and mental health. Occupational therapy practitioners evaluate
occupational functioning; work with consumers and caregivers (patients, clients, families)
to identify goals; and intervene to help troubled individuals, families, and communities
learn new skills, engage in occupation, maintain successful and adaptive habits and
routines, explore their feelings and interests, and control their lives and destinies.
32
Mental Health and Mental Illness
Before we look at how occupational therapy approaches the intervention process for
persons with mental health problems, it is useful to examine what we mean by the terms
mental health and mental illness. The World Health Organization has defined mental
health as “a state of well-being in which every individual realizes his or her own potential,
can cope with the normal stresses of life, can work productively and fruitfully, and is able to
make a contribution to her or his community” (67). The mentally healthy person can
manage daily affairs despite the stresses of the real external world and is able to respond
constructively and creatively to the changing demands and opportunities of real life.
If mental health is relative, defined in relation to changing life conditions, at what
point can we say that someone has mental health problems? Throughout recorded history,
mental illness has been defined and redefined, reflecting increases in knowledge and
understanding and changes in cultural beliefs and values. The American Psychiatric
Association has defined mental disorder as follows:
33
Relation of Occupation to Mental Health
The notion that involvement in occupation can improve mental health is not new; it
appears in records of ancient civilizations from China to Rome. It is such an excellent idea
that it is continually rediscovered and acclaimed. At the 1961 annual conference of the
American Occupational Therapy Association, Mary Reilly expressed it this way: “That
man, through the use of his hands as they are energized by mind and will, can influence the
state of his own health” (54, p. 1).
Every person is born with a drive to act on the environment, to change things, to
produce things, to work, to be engaged with life, and to use hands and mind. The
satisfaction of having an effect and the challenge and pleasure of solving problems give life
meaning and purpose. We know that both the unemployed and those employed in routine
jobs experience stress and may develop mental disorders because they lack the stimulation
of challenging activity. Their drive to act is denied, frustrated, and weakened. We know too
that those diagnosed with mental disorders grieve because they cannot do what they once
did; disease and social stigma have obstructed their capacity to engage in valued
occupations as they would like. Unhappiness and inactivity reinforce each other; those who
fail to act become less able to do so.
Occupational therapy uses occupation to reverse the negative cycle of inactivity and
disease. Occupation requires attention and energy; it has a unique meaning to the person
performing it (33). Activity that engages the entire human being—heart, mind, and body
—is powerful therapy. Not every activity is therapeutic, only those that ignite the person’s
interest and empower the will, that strengthen skills, and improve the ability to act.
Helping the client explore, discover, master, and manage the occupations that give that
individual’s life purpose and direction is the essence of psychiatric occupational therapy.
34
A Few Words About Language
In this chapter, we will use the phrase “persons with mental disorders” to refer to the
patients and consumers we encounter in mental health practice. This “person-first” phrase
limits the stigma associated with having a psychiatric diagnosis. It puts the person first, and
the disorder second. Historically, however, different words were used that would be highly
stigmatizing today:
Moron, imbecile, idiot—these were historical descriptors through the 1970s with
specific meanings for persons who today would be diagnosed with intellectual
disabilities
Mad, lunatic, crazy—now used casually, but once had specific meanings
Of unsound mind, mentally ill—terms that were historically accurate in their eras
This is not an exhaustive list. To avoid confusing the reader and generating more stigma,
we have not used any of these terms in the history that follows.
35
Another random document with
no related content on Scribd:
das Essen bereits gewonnenen seelischen Ausgleich erhöht und
jegliche Aufregung verhindert. Man stelle sich jedoch andererseits
einen Geistesarbeiter vor, der nächtelang über kniffligen Problemen
sitzt, und dessen unbedingt zur Arbeit erforderliche Konzentration
durch langsames Ermüden nachläßt. Wenn er dann zu einer milden,
weichen, versöhnlichen Cigarette greifen wollte, so würde gerade
das Gegenteil der beabsichtigten Wirkung eintreten, und die erhoffte
Spannung würde sich ganz auflösen. In solchen Augenblicken
benötigt er eine herbe, kräftig-aromatische Cigarette von
momentaner anregender Wirkung und möglichst kurzer Brenndauer,
da die Muße für einen langen und stillen Genuß des Tabaks nicht
vorhanden ist.
Es gibt Cigaretten, die man eigentlich nur in einem bequemen
Sessel richtig genießen kann, und die an anderer Stelle,
beispielsweise auf der Straße einfach deplaziert wirken. Es gibt
andere Cigaretten, die den hastigen, kurzen Augenblicken einer
Konzert- oder Theaterpause angepaßt sind, wieder andere, die nach
langen Anstrengungen körperlicher Art eine erfrischende, anregende
Wirkung auslösen, usw.
Neben diesen verschiedenen Wirkungsmöglichkeiten, die der
raffinierte Raucher kennt, gibt es natürlich für jeden einzelnen eine
eigentliche Leib- und Magencigarette, die man als die typische
Gewohnheitscigarette bezeichnen kann. Da die Menschen mit ihren
Bedürfnissen außerordentlich verschieden sind, sind natürlich auch
die Cigaretten verschieden, die den jeweiligen individuellen
Bedürfnissen entsprechen sollen. Wat den enen sin Uhl, is den
annern sin Nachtigall. Eine süße Smyrna-Cigarette, die dem einen
den ganzen Tag über ein immerwährendes Vergnügen bereitet,
würde dem andern völlig unerträglich werden können. Natürlich sind
dies Differenzierungen, wie sie nur der sehr verwöhnte Raucher
kennt, aber bei der Beurteilung von Cigaretten ganz allgemein spielt
der ganz persönliche Geschmack eine so große Rolle, daß man
häufig ein sehr schlechtes Urteil über eine Cigarette erleben kann
trotzdem diese eigentlich nur den jeweiligen
Geschmacksforderungen widerspricht, aber im übrigen qualitativ
unantastbar ist. Ein extremes Beispiel ergibt die bereits erwähnte
Cigarette mit sogenanntem schwarzem Tabak, die von manchen
Ausländern als die einzig mögliche Cigarette bezeichnet wird, und
die der größte Teil der deutschen Raucher mit dem besten Willen
nicht verträgt, ohne daß man deshalb sagen dürfte, die Cigarette
wäre an sich schlecht.
Die Schwierigkeit für das Auffinden einer richtigen Leib- und
Magencigarette beruht vor allen Dingen in der Gefahr der
Geschmacksübermüdung. Je wertvoller die Tabake sind, desto
charakteristischer sind sie in ihren Geschmackseigenarten, und es
ist eine sehr schwere Aufgabe des Fabrikanten, die
Geschmackseigenarten derart abzudämpfen, daß eine
Geschmacksübermüdung bis zu einem gewissen Grade
ausgeschaltet bleibt. Ganz und gar wird sich die Gefahr nicht
beseitigen lassen, denn es dürfte wohl überhaupt kein menschliches
Genußmittel geben, das nicht doch hin und wieder eine
Abwechslung erfordert. So haben sich bereits viele Raucher daran
gewöhnt, mit bestimmten gegeneinander abgeglichenen Cigaretten
hin und wieder abzuwechseln, um sich die Lebendigkeit der Wirkung
zu erhalten und eine Übermüdung zu vermeiden. Andererseits kann
man sich allerdings auch an eine bestimmte Cigarette oder einen
bestimmten Cigarettencharakter so gewöhnen, daß man kaum noch
in der Lage ist, anderen Arten Gerechtigkeit widerfahren zu lassen.
Jede wirklich wertvolle und eigenartige Mischung verlangt auch ein
gewisses Einleben, und man kann sich manchmal an eine anfangs
abgelehnte Cigarette durch gewissenhaftes Nachprüfen so
gewöhnen, daß man gegen diese wiederum keine andere
eintauschen möchte. Man kann eben manchmal erst langsam auf
den richtigen Geschmack kommen.
Die einzige Anforderung, die man bei Voraussetzung
unterschiedlichster Arten an eine Cigarette immer stellen muß, ist die
jeweilig ihrer Art entsprechende wirkliche Reinheit und Qualität.
Wenn jemand an den Genuß reiner Orientcigaretten gewöhnt ist,
wird er stets sofort auch den minimalsten Prozentsatz der
Verwendung unedlerer Tabake feststellen können. Außerhalb reiner
Qualitätsfragen ist ein Streit nicht möglich. De gustibus non est
disputandum.
In erster Linie hängt der Charakter einer Cigarette von der Art der
verwendeten Tabake ab. Aber mindestens ebenso wesentlich sind
die Mischungsprobleme. Es ist heute noch wenig bekannt, daß auch
der denkbar edelste Tabak (und zwar je edler, desto weniger) allein
verarbeitet nicht rauchbar ist. Erst durch Mischung verschiedener
Tabake nach bestimmten Gesichtspunkten entsteht das
Tabakmaterial für eine Cigarette. Die Regeln und Rezepte für
Mischungen sind sehr komplizierter und variabler Art, da jeder
Tabak, der verwendet wird, seinen besonderen Eigenarten
entsprechend gemischt werden muß. Es werden immer wieder neue
Variationen erfunden, denen zahllose Experimente vorhergehen. Die
Mischungsgeheimnisse d. h. wertvolle Mischungsrezepte sind ein
sehr wesentliches Besitztum eines Fabrikanten.
Die Begründung der Unrauchbarkeit einzelner Tabaksorten für
sich allein ist darin zu suchen, daß jeder Tabak von Charakter
geschmacklich zu einseitig ist und seinen Charakter übermäßig
aufdringlich zur Geltung bringt. Die Absicht des Mischers ist es nun,
diejenigen Tabake gegeneinander abzuwägen, die sich gegenseitig
ausgleichen und dadurch ihre jeweilige Geschmackseinseitigkeit
verlieren, um dieses oder jenes feine Aroma oder diesen oder jenen
feinen Geschmacksakkord den jeweiligen Anforderungen gemäß
mehr oder weniger unaufdringlich auswirken zu lassen. Die
Mischungsforderung ist ähnlich wie bei weitaus den meisten
Speisen, die für sich genossen schal und leer schmecken würden
und ihren Wert eigentlich erst durch entsprechende Gewürze wie
Salz usw. offenbaren. Die Gewürze selbst wiederum können nicht
allein genossen werden. Erst der fein abgewogene Zusammenklang
und Ausgleich verschiedener Eigenarten ergibt die
Genußmöglichkeit.
Deshalb unterscheidet man genau so wie bei vielen anderen
gastronomischen Materialien Tabake, die als Gewürze verwendet
werden und daher Würztabake genannt werden können, und
Tabake, die eine möglichst ruhige Basis ergeben, und auf denen sich
die Mischungen von Würztabaken frei entwickeln können. Da es sich
bei Tabaken nicht um Nahrungsmittel, sondern Genußmittel handelt,
sind natürlich die Würztabake die wichtigsten und wertvollsten. Die
zur Basis verwendeten Tabake kann man als Fülltabake bezeichnen.
Es sind dies vorzugsweise Tabake sehr ruhiger und unaufdringlicher
Geschmacksarten, die auf Grund der Bezeichnung durchaus nicht
mit Tabaken verwechselt werden dürfen, die man zu Zeiten der
Zwangswirtschaft als Füllsel für Cigarettenhülsen unter teilweiser
Beimischung echter Orienttabake verwendete. Wenn die Fülltabake
auch durch den Wert der edelsten Würztabake übertroffen werden,
so liegt doch gerade in der Auswahl, Verwertung und Dosierung von
Fülltabaken der Kern des ganzen Mischungsproblems. Durch
weitgehende Kenntnis, welche Fülltabake und Fülltabakmischungen
diesen oder jenen Würztabaken oder Würztabakmischungen die
harmonisch ausgleichende Basis geben können, kann ein Fabrikant
allen mit ihm im Wettbewerb stehenden Unternehmungen qualitativ
den Rang ablaufen. Die Geheimnisse der Fülltabake werden als
persönlichste Erfahrungen ängstlich gehütet. Die Schwierigkeiten
der Auswertung bestehen aber gerade darin, daß man jeweils nur
unter den auf dem Markt zur Verfügung stehenden Tabaken die
Auswahl hat und immer wieder neue Rezepte aufstellen muß, da
gleichartig geratene Sorten nur selten wieder aufzutreiben sind. Eine
grundsätzliche Unterscheidung zwischen Würztabaken und
Fülltabaken steht für den Tabakmarkt nicht fest, da in dieser oder
jener Mischung dieser oder jener Fülltabak auch als Würztabak
dienen kann. Weiterhin gibt es auch sehr wertvolle Sorten, die
eigentlich als Würztabake bezeichnet werden können, aber einen
Geschmacksausgleich bereits untereinander finden, ohne daß ein
gegensätzlicher Fülltabak benötigt wird.
Die Bauern der Ursprungsländer des Tabaks sind nicht so
empfindlich gegen starke und sehr herbe Cigaretten wie die
Europäer. Der türkische Bauer kann Mischungen rauchen, die nach
unserem Empfinden sehr einseitig gewürzt sind. Aber trotz der
gewissen Einseitigkeit der Mischungen für die Einwohner der
Tabakländer, die sich aus der bevorzugten oder ausschließlichen
Verwendung der örtlich vorhandenen Tabake ergibt, sind die dort
verwendeten Rauchtabake doch immer wieder Mischungen, in
denen ein Ausgleich wenigstens bis zu einem gewissen Grade
gesucht wird.
Die Mischungsprobleme sind ganz außerordentlich diffizil und
setzen eine Geschmackskritik voraus, die Nichtfachleuten geradezu
märchenhaft erscheinen muß. Es gibt Orientalen, die beim Rauchen
einer Cigarette sofort die zehn oder zwanzig maßgebenden
Würztabake aufzählen, die in einer Mischung enthalten sind.
Infolgedessen werden auch in den europäischen Fabriken von Rang
die Mischungen fast ausschließlich von Orientalen ausgeführt oder
zumindest angeregt. Es ist sehr eigenartig und charakteristisch, daß
solche Mischer immer wieder die Tabaksorten ihrer engeren Heimat
besonders vorziehen und in diesen Sorten allein genügend
Differenzmaterial für Mischungen finden zu können glauben. Im
allgemeinen werden jedoch zu Mischungen für Europäer so ziemlich
alle Gebiete herangezogen, die als Ursprungsländer edler Tabake in
Betracht kommen, um damit Differenzierungen zu schaffen, die den
vielseitigen Anforderungen entsprechen können.
Die Tabake werden in den Ballen, in denen sie aus dem Orient
ankommen, in den Fabrikationsgang gebracht. In der ersten Station
werden die Ballen geöffnet, aufgeteilt, die eng aneinander gepreßten
Blätter werden einzeln auseinander genommen und sortiert. Nach
der Sortierung werden die Blätter (nach ihren Provenienzen
geordnet) in große Holzkisten gefüllt und erwarten in dieser Form
den Mischungsvorgang. Die nächste Station ist der Mischungsplatz,
auf dem aus den Holzkisten in dem angegebenen Verhältnis der
Mischungsrezepte die Tabake der verschiedenen Provenienzen
schichtweise übereinander gelegt werden. Es ist dies ein ziemlich
großer Platz, auf den der Inhalt der Kisten gekippt und von Arbeitern
in gleichmäßigen Lagen auf der ganzen Fläche verteilt wird. Bei
diesem Prozeß wird der Tabak den jeweiligen unterschiedlichen
Anforderungen entsprechend mehr oder weniger angefeuchtet.
Dann wird das Gemisch in große Boxen gebracht, wo es einige Tage
lagert.
Die nächste Station ist die Tabakschneiderei. Das Tabakgemisch
wird großen Schneidemaschinen zugeführt, die die Blätter in feine
Strähnen zerschneiden. Der von den Messern herunterfallende
Tabak wird auf Transportbändern in eine Entstaubungsanlage
gebracht, die als nächste Station die Aufgabe hat, den Tabak von
dem bitteren Tabakstaub gründlich zu reinigen. Aus der
Entstaubungstrommel wird der Tabak wieder in große Holzkisten
gefüllt und neuerlich einem Zwischenlager zugeführt.
Aus diesem Zwischenlager gelangt der Tabak in den
Maschinensaal, in dem er zur Cigarette verarbeitet wird. An Stelle
der früheren Handarbeit ist heute in einem außerordentlich
weitgehenden Maße die weitaus präziser und wesentlich sauberer
arbeitende Maschine getreten. Die fertiggestellten Cigaretten werden
in Schragen gesammelt und dem sogenannten Schragenlager
zugeführt, in dem die Cigaretten wiederum eine Lagerzeit von etwa
drei Tagen durchmachen.
Aus dem Schragenlager kommt die Cigarette in den Packsaal.
Dort wird sie unmittelbar in die für den Verkauf bestimmten
Packungen gebracht. Von hier aus kommen die Cigaretten in ihren
Originalpackungen in ein zweites Zwischenlager, das sogenannte
Unbanderolierten-Lager, aus dem sie den jeweiligen Anforderungen
gemäß zur Anbringung der Banderole abgeholt werden. In der
Banderolierabteilung wird diese Banderole auf maschinellem Wege
um die Originaldosen oder Kartons herumgelegt, und zwar derart,
daß die Dose nun nicht mehr geöffnet werden kann, ohne daß die
Banderole an einer der drei behördlich geforderten Stellen zerrissen
wird. Hinter dem Banderolierten-Lager befindet sich die vorletzte
Station, das sogenannte Fertiglager. Hier erwarten die Cigaretten, in
Halbmille-Pakete geordnet, ihre Expedition. Aus der sich daran
anschließenden Expeditionsabteilung gehen die Cigaretten in die
Welt hinaus.
Wenn man einem Orientalen eine Frage über die Abwertung der
einzelnen Provenienzen vorlegt, so kann man gewiß sein, daß er die
Tabake seiner engeren Heimat als die jeweils besten bezeichnet.