On the border between health and disease

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On the border between health and diseaseHealth and disease. Two forms of human existence, two forms of being ...

What is mental health?

What do we know about mental health and pathology

It is usually defined as follows: “The state of balance between a person and the outside world, the adequacy of his reactions to social factors (social environment), as well as to physical, biological and mental influences; correspondence of reactions to the strength and frequency of external stimuli; harmony between a person and others, the consistency of ideas about objective reality in a given person with the ideas of other people; a critical approach to any circumstances of life. "

And here is the definition given by experts from the World Health Organization (WHO): "Mental health is a certain reserve of human strength, thanks to which he can overcome unexpected stresses or difficulties that arise in exceptional circumstances."

So, mental health means a condition in which there are no abnormalities in the neuropsychic sphere. However, it is known that there is nothing in the disease that would not occur normally. Indeed, health and illness cannot be sharply distinguished. There are numerous transitional stages between normal and pathological phenomena. In the field of the psyche, mental life, it is much more difficult to determine the boundary between health and illness than in the sphere of the body. The "intermediate strip" that runs between them at the same time connecting them to each other is wide enough, and the boundaries separating it (one from health, the other from illness) are largely unstable and indefinite.

In this regard, the statement of the famous Russian psychiatrist Yu. V. Kannabikh is interesting: “In addition to the healthy and the mentally ill, there are also people about whom it cannot be said that they are healthy, but it cannot be said that they are sick. We are talking here about mental characteristics mainly from the side of feelings. These people are touchy, you have to weigh every word with them. At home, they quarrel with everyone, they certainly want to command, they themselves do not like to obey and know everyone better than others. At the same time, they do not know how to arrange their lives, they constantly change their profession, move from place to place. They do not know how to take care of themselves or work for the public good. For all that, they cannot be called mentally ill, although when they are very worried, it seems that we are faced with a person who is ready to cross the line that separates health from illness. "

Here is another characteristic (taken from the old manual) of mental disorder, which can be attributed to the group of borderline: “These states are usually called nervousness. "Nervous" people are extremely sensitive, worried about any reason, and as a result, easily get tired. They often have a headache, their heart "stops", their hands and feet get cold. Feeling an increased heartbeat, such a person is frightened, because he does not understand that he has it from excitement - he thinks that it is necessarily from heart disease. Due to constant anxiety, such people begin to sleep poorly, go to doctors, and they are forced to write down everything that worries them on a piece of paper, because they are afraid to miss something important. Life becomes quite painful for them. "

A small excursion into history

By inviting the reader to familiarize himself with extracts from old medical books, we just wanted to show that neurosis is not a feature of our time, a disease of an exclusively modern person. On the contrary, it has been known for a long time.

In an ancient medical treatise dating from about the 3rd century. BC, a painful condition is described, which in many ways resembles the clinic of hysterical neurosis. The history of the origin of the very concept of "hysteria" is curious. Translated from Greek, hystera means "uterus". Doctors and thinkers of that time pictured the uterus as a living organism moving independently inside the body and thereby displacing or compressing other organs, which causes painful changes in the mental sphere. This explains the mechanism of neurotic disorders.On the border between health and disease

One of the founders of clinical medicine, R. Sydenham, noted the most distinctive feature of hysteria - its incredible ability to mimic other diseases. His phrase is widely known: “Hysteria - Proteus, assuming an infinite number of different types; a chameleon constantly changing its color ”.

In 1765, the Russian doctor K. Yagelsky noted that hysteria, it turns out, arises not only in women, that it does not have a cause of "uterine rabies" (as previously thought), but is a manifestation of a certain instability of the nervous system.

Physicians in the XVII-XVIII centuries. paid a great deal of attention in their research to mental disorders, which they called differently: "nervous exhaustion", "neuropathy"," Nervous diathesis ", etc. From the brief characteristics given to the indicated diseases, it is very difficult to establish what exactly was meant by these names.

If you look at the tables of contents of the then treatises on nervous diseases, you will notice one detail on which the authors place special emphasis. Noteworthy is such a strange list: "the extraordinary illness of Madame de Bezons", "the unusual illness of Bishop de Noy", "the amazing illness of the Duke of Peko." This list can be continued, but the same will follow. The heading of each section will contain the words “extraordinary”, “rare”, “amazing”, “unusual”, which rather resemble the contents of not a medical manual, but a catalog of some museum.

For a long time, neuroses were actually "extraordinary" diseases, that is, inexplicable and incomprehensible. This group of diseases, as the French psychiatrist Pierre Janet aptly put it, served as "a convenient box where they threw all the facts for which there was no definite place."

Nevertheless, already in those years, scientists managed to notice the most important feature of neuroses - the absence of anatomical changes on the part of any organs and systems. The conclusion was made: neuroses are a temporary, transient, reversible state. This position is fully confirmed by the data of modern clinical medicine.

In 1776, the Scottish physician V. Cullen introduced the concept “neurosis", Having designated by this term" nervous disorders not accompanied by an increase in body temperature and not associated with local damage to one of the organs, but caused by general suffering, on which movements and thought specifically depend. " V. Cullen described in detail the clinical picture and course of neuroses, in many respects corresponding to the current ideas. However, it was necessary to find the means necessary for the treatment of neurotic conditions. This required clarifying the mechanisms of their development. As a result of the research conducted, the main difference between neuroses and other diseases was revealed - their psychogenic nature, that is, the development of painful disorders occurs in these cases in response to the influence of various psycho-traumatic factors.

The middle of the 19th century was at times the heyday of capitalism in Western Europe and America. The exploitation of workers is increasing, and working conditions are becoming extremely unbearable. Doctors discover that it is workers who often experience similar painful conditions - increased fatigue, weakness, irritability, noise intolerance, and sleep disturbances. American physician G. Beard in 1869published an article analyzing this disease, which he called "American neurosis." It soon became clear that not only American workers, but also their European colleagues, were susceptible to the same disease. So to the group of neuroses was added "Byrd's neurasthenia" - a disease manifested by irritable weakness of the nervous system and having a specific cause - prolonged neuropsychic overstrain caused by environmental factors.

For many years, science did not have precise methods for studying the disorders of higher nervous activity that underlie neurosis. But in 1935, IP Pavlov, in experiments on animals, drew attention to some regularities. In the first series of experiments, I.P. Pavlov and his co-workers found that the natural protective reflex in response to stimulation by the current is inhibited and a food reflex is developed instead. A gradual increase in the current strength leads to a breakdown of the developed conditioned reflex - for a long time, dogs develop a "painfully agitated state" that has never been observed in them before.

In the second series of experiments, the dog had to distinguish a circle from an ellipse. With the right decision, the animal received food. Further, the experiment became more complicated: the dog was shown an ellipse, the shape of which was more and more approaching a circle, which made it extremely difficult to solve the problem. When the ratio of the diameters of the circle and the ellipse became minimal (9: 8), a breakdown occurred - all the conditioned reflexes previously developed in the dog disappeared, the animal became agitated and aggressive.

Having become interested in this kind of pathological condition, having studied the causes and mechanisms of its development, I.P. Pavlov came to the conclusion that in dogs there is nothing more than an experimental neurosis, which is expressed in the breakdown of higher nervous activity due to its overstrain. At the same time, he found that neurotic disorders appeared during overstrain either of the excitation process (as was noted under the action of a strong current), or inhibition (as it was when too complex and subtle differentiation became unbearable for the animal).

It was also found that experimental neuroses can arise not only suddenly, following an incentive, but also gradually, with chronic traumatization during the experience. In addition, much depends on the animal's organism. All other things being equal, neuroses, as it turned out, developed purely individually and proceeded in different ways in different animals. Why is this happening?

Trying to answer this question, I.P. Pavlov drew attention to the peculiarities of nervous activity in each case. In accordance with this, the following main types of the nervous system were identified:

1) the type is strong, balanced and mobile;

2) the type is strong, balanced, but inert;

3) the type is strong, unbalanced (the irritable process prevails over the inhibitory process);

4) weak type (both processes are reduced).

All that has been said applies not only to animals, but also to humans. It is these 4 varieties that determine the temperament options described by Hippocrates.

People with a strong type of nervous system are highly efficient. They are proactive, persistent, always act purposefully, and in difficult situations they show restraint and firmness. Nervous breakdowns are extremely rare.

People with a weak type of nervous system, on the contrary, are characterized by low efficiency. They tend to avoid all kinds of difficult situations. They are timid, shy, indecisive, do not know how to defend their beliefs and easily fall under the influence of others, unable to find a way out of any difficult situation, for the most part they seek help from others. They have frequent nervous breakdowns.

The ratio of nervous processes can vary widely.A person with a strong "brake" is in perfect control of himself, is extremely organized, with a weakened one - unbalanced, haste, excessively mobile, talkative, prone to emotional outbursts. Due to the inertia of nervous processes, people experience difficulties when switching from one type of activity to another, it is difficult for them to adapt to a new environment, to change the established life stereotype.

The neurosis that has arisen in this or that person has different manifestations. Their nature, as you know, depends on in which direction the overstrained nervous system "breaks down" - the predominance of excitation or inhibition, but in both cases we are talking about a violation of these nervous processes. “By neurosis,” Pavlov emphasized, “we mean a long (lasting weeks, months, and even years) deviation of higher nervous activity from the norm”.

On the functional nature of neuroses

By now, quite clear clinical concepts of neuroses have developed. It has been established that various methods of treating neuroses give a good effect, since the disorders in these diseases are of a purely functional nature. This feature (functionality, reversibility) distinguishes neuroses from organic diseases, in which the impairment of activity is caused by damage (organic change) of the anatomical structure of this organ. For example, pain in the region of the heart or headache may result from insufficient blood supply; however, in one case this is due to the functional narrowing of blood vessels, which occurred due to excitement, anxiety, fear, and in the other - the defeat of their walls by an atherosclerotic process.On the border between health and disease

For clarity, we will give an example. Imagine a hesitantly moving car winding from side to side on the road. In one case, this can be explained by the lack of professional skills of the driver in the absence of any defects in the car itself, in the other - an experienced driver is sitting at the wheel, but there are serious problems in the engine. In the first case, we are dealing with a functional disorder, in the second - with an organic one.

Often, an impressionable person who has heard a story about a serious illness that has arisen in someone, has the idea that he has the same ailment. A complaisant imagination immediately paints vivid pictures, causing a sensation corresponding to one or another painful symptom. Even a special term has taken root in medical institutes - "third-year disease". The fact is that from the third year they begin to study clinical disciplines, and now some students, getting acquainted with the description of various diseases, find signs of a disease that they are currently going through. The reason for this is most often personality traits: increased suspiciousness, anxiety, impressionability, a tendency to pay special attention to one's physical condition.

There are many such cases. And, of course, this kind of phenomenon is seen not only among medical students.

A woman was hit by a motorcyclist while crossing the street in the wrong place. And although there were no organic changes in the brain, she was speechless - she was dumb. The sudden fright caused a sharp overstrain, and then exhaustion in the nerve cells of the brain - a state of “transcendental inhibition” in them, which led to the inability to pronounce words at that moment. Since the attempt to speak failed, she gained confidence in the dumbness that had befallen her, which had already reinforced and fixed the inhibition in the brain - in a special area of ​​the cortex, which “controls” articulatory speech movements.

This is an example of psychogenic functional dumbness, which has nothing in common with an organic disorder caused by damage to the corresponding muscles, nerves and their receptors, nerve cells in the brain, etc.

The chief engineer of a large plant once, when he was excited while checking the work of a very solid commission, developed squeezing pains in the region of the heart. He did not attach much importance to this, but the thought flashed through his head if this was an indicator of a serious illness. Soon the pain stopped and he didn't think about it again. However, a month later, in a similar situation, the previous pain sensations arose again, which then became permanent. And now he was fully convinced of his own diagnosis, formulating it as follows: “Ischemic heart disease. The threat of a heart attack. " After a comprehensive examination, the diagnosis was not confirmed. As soon as the patient found out about this, his pains immediately disappeared and in the future never recurred.

"The main factor causing this kind of" pseudosomatic "disorders, - wrote the Soviet therapist GF Lang, - is mental overstrain of negative emotions."

Irritants that cause the affect of anxiety, fear, fear, can lead to temporary disorders of the function of internal organs: heart activity, renal excretory function, digestion process, manifested by increased acidity of gastric juice, diarrhea (remember the "bear disease" in the same students or schoolchildren before difficult exam).

The starting point for the development of the described disorders may be, in addition, a dysfunction resulting from trauma, infection, intoxication. In the future, despite the fact that the function has recovered, thoughts about the impending need to perform it begin to cause fear and uncertainty. Due to the fear of a possible failure (by the mechanism of self-hypnosis), a disorder or even its complete inhibition, as doctors say, its disautomation, occurs.

The consequence of the impact of purely psychogenic moments is the inability to perform any of the usual, everyday functions (speech, walking, writing, reading, sleeping) arising in some cases. After a speech disorder, which appeared, for example, as a result of an unsuccessful public speech, this person is haunted by a feeling of anxious expectation of failure when it is necessary to speak in front of a large audience and simply in any environment that causes an increased emotional reaction. When you try to say something, fear, confusion appear, the person sweats, he stutters, he cannot utter a word.

The inability to fall asleep, caused by any unpleasant emotions, often leads to a state of anxious expectation that sleep will not occur, and the difficulty in connection with this process of falling asleep.

Tarnavsky Yu.B. - Stalling can be avoided

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