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Transnistrian State University named after. T.G. Shevchenko
Faculty of Medicine
Abstract on the discipline history of medicine
on the topic: “History of the development of psychiatry”
Completed by: student gr.301/1
Tkachenko A.I.
Scientific adviser:
Assoc. Krachun G.P.
Tiraspol 2014
History of the development of psychiatry
In psychiatry throughout its development, three approaches to solving treatment problems can be distinguished: mental illness:
1. Magical approach - based on the fact that the treatment of diseases is possible by attracting supernatural forces. It is characteristic of the early, ancient period of the development of psychiatry. It is also characteristic of the Middle Ages, when persecutions of witches were carried out. The essence of this approach is that the influence on a person occurred through suggestion. In this aspect it has much in common with the psychological.
2. Organic approach - assumes the idea that everything is normal and pathological processes The human psyche can be explained by the laws of the material world, i.e. within the framework of natural science. - chemistry and physics. This approach is characteristic of later studies, starting with the Renaissance.
3. The psychological approach assumes that the cause of violations mental activity lies in the field psychological processes and therefore their treatment is possible using psychological methods.
Currently, the treatment of the mentally ill consists of a combination of the last two methods. The first approach is unscientific.
The contribution of the ancients.
The history of psychology began with one person trying to alleviate the suffering of another by influencing him. In those days when mental and physical illnesses were not differentiated, the role of a psychiatrist could be taken on by anyone who sought to alleviate the pain of another. Therefore, the history of psychiatry goes back to the first professional healers.
Babylonian priests and doctors treated internal illnesses, especially with mental manifestations, which were attributed to demonic origin, resorting to magical-religious views. Medicines were used, but more effective treatment associated with belief in a spell. The spell was quite a powerful psychological weapon. The peoples of Mesopotamia discovered some medical methods and began to study the patient’s life history. They also achieved great success in the development of hyena, social. medicine, honey ethics.
The Egyptians achieved quite great success. They treated people with artificial sleep as a form of psychotherapy. Long before the Greeks, they learned to create in temples where the sick were treated an atmosphere that was beneficial to human health: participation in an excursion along the Nile, in a concert; dancing and drawing classes. The Egyptians also identified a type of emotional disorder later called "hysteria." The symptoms of this disease were associated with abnormal position of the uterus. The treatment was fumigation of the vagina. The method was very common outside Egypt.
The medicine of the Israeli people was formed under the influence of the development of medicine among the Babylonians and Egyptians. In contrast, the Jews had such systematic medical texts. The Talmud describes stories that prove the presence of psychological knowledge. The psychological mechanism of judging others for one's own sins or sinful thoughts, now called projection or “scapegoating”, was described; a psychological observation is also described that states that the righteous also have sinful dreams, which means the recognition that dreams serve to express those desires that in reality are consciously suppressed by our moral principles. Distraction was recommended as psychotherapy, and the patient was encouraged to speak freely about his problems. At the same time, demons were considered the cause of madness, asthma and other incomprehensible conditions. Thanks to the Talmud, Jewish medicine was less magical than the medicine of Babylon and Egypt. It is worth saying that the concern of the Jews for the sick had a significant influence on the formation of the humanitarian aspects of medicine and psychiatry. So, back in 490 BC. A special hospital for the mentally ill was built in Jerusalem.
The first significant period of Persian medicine began in the middle of the 1st millennium BC. Venidad contained several chapters devoted to medicine. Venidad reports 99,999 diseases affecting the human race that are caused by demonic forces. In Venidad, 3 types of doctors are mentioned, one of whom was probably a psychiatrist (equivalent to our time). Magicians or spiritual doctors enjoyed the greatest trust.
Buddhism, which was widespread in the Eastern world, including India, emphasized the process of self-knowledge, which was a central factor that had an invaluable influence on the development of psychiatry. Buddhist meditation has a special psychotherapeutic value: in fact, it can support a person psychotherapeutically not only with mental disorders, but also with difficulties Everyday life. Focus on oneself is the main characteristic of a person. Through self-knowledge, a person establishes a connection with the outside world, of which he is a part. This connection does not contradict, but complements the understanding of the physical world.
Classical era
The cult of Asclepius dominated Greek medicine for centuries. Hundreds of temples were built, which were located in picturesque places. Perhaps the suffering patient found inspiration and hope. Although not everyone who wanted to went to the temple. The most significant event was a therapeutic stay in the temple or incubation - sleep. Apparently, while sleeping in the temple, the patient was exposed to certain influences. Through dreams, the patient was given information about what to do in order to recover. There is a possibility that the priests of these temple hospitals were charlatans who gave patients opium or its derivatives, after which they were indoctrinated with certain prescriptions. They used hypnosis as a healing factor.
Medical thought developed within the framework of Ancient Greece. Hippocrates was an outstanding physician and psychiatrist. He was the first to consistently try to explain diseases on the basis of natural causes. Hippocrates and his students established that the cause of epilepsy is a disease of the brain. All of Hippocrates' ideas were based on the idea of homeostasis, i.e. constancy internal environment body, the ratio of which determined the proper functioning of the body. In treatment, he used bloodletting and laxatives, and prescribed medications: hellebore, emetics and laxatives. In case of mental disorders, he warned about the need correct dosage and monitoring the patient's response. Hippocrates made a great contribution to the development of clinical medicine. He was the first to express the idea that the brain is the most important human organ. Physicians of the Hippocratic circle were the first to describe organic toxic delirium, a symptom of depression, which they called melancholia, characteristic features childbirth insanity, phobia, the term “hysteria” was introduced. They proposed the first classification of mental illnesses, including epilepsy, mania, melancholia and paranoia. They also characterized personality traits in terms of their humoral theory.
The Greek experience was further developed in Rome. One of the outstanding scientists of this period is Asclepiades. He used the following methods to treat mental illness: bright, well-ventilated rooms, music, baths, massage. Asclepiades noted the importance of differentiating acute and chronic diseases and the need to distinguish between delusions and hallucinations. He sympathized with the mentally ill and viewed mental illness as a result of emotional overload. Asclepiades and those who followed him used the reverse treatment method, i.e. To get rid of the disease, it must be influenced by the opposite factor.
Arytaeus was another representative of the Roman scientific and medical direction. He observed mentally ill patients and studied them closely. As a result, he found that manic and depressive states invariably repeat, and between manic and depressive periods there are light intervals. He, considering mental illnesses from the point of view of the way out of them, attaches special importance to the course and prognosis of the disease. Arytheus was the first to describe in detail a person who had suffered mental breakdown, and he also realized that not all mentally ill people suffer from a decrease in intelligence as a result of the disease - a fact that was not recognized by scientists until the 20th century.
The Roman clinician Claudius Galen made a great contribution to the development of the anatomy and physiology of the central nervous system. He drew attention to the fact that brain damage entails dysfunction on the opposite side of the body. He traced the location of the seven cranial nerves and distinguished between sensory and motor nerves. He noted that complete rupture of the spinal cord leads to loss of motor function throughout the entire area of the body below the injury and proposed a theory about the role of nerves in transmitting impulses from the brain and spinal cord. He believed that sudden emotional disruptions could indicate brain damage, however, he persistently looked for connecting threads between mental disorders and physical injuries. As a result, he recognized the active organizing principle behind spiritual force.
The psychological ideas that prevailed in Rome and Greece were too abstract to be useful to the individual. They were virtually divorced from understanding simple human aspirations, fantasies, emotions and motivations. These lofty abstractions could not be suitable for creating the basis for studies of individual individuals, leaving aside the problem of the behavior of mentally ill persons. Cicero put forward the idea that physical health may be influenced by emotional manifestations. He can rightfully be called the first psychosomatologist. He identified two main parameters necessary to identify the similarities and differences between physical and mental illnesses.
Soranus was the most enlightened physician of his time in approaches to understanding mental illness. He refused to treat the mentally ill with harsh methods. Harsh methods were used only in extreme cases when patients became very dangerous. Soran sought to reduce the discomfort of the mentally ill by talking to them. He was against the reverse treatment method.
In general, Ancient Greece and Rome were noted for their humane approaches to treating mentally ill people. Physicians mainly relied on materialistic and empirical approaches, and the psychological method was used very hesitantly. But there were also doctors (such as Celsus) who believed that only rough measures and intimidation could force a patient to give up illness. Celsus tied up the sick, starved them, placed them in an isolated room, prescribed laxatives, trying to bring them to health through fear.
The Middle Ages brought new approaches to understanding and treating mental illness. Imbued with creationism, science tried to explain all phenomena by divine origin. Medieval psychiatry was hardly different from pre-scientific demonology, and psychiatric treatment was practically no different from exorcism. Although Christian scholastics and Arab doctors made a significant contribution to the development of humanitarian psychiatric care. In the late Middle Ages, Christian ideas began to become obsolete, depending on the authorities. At the same time, supernatural explanations for illness appeared, and the treatment of mental illness became much worse. At the beginning of the Middle Ages, treatment methods were chosen depending on the views of the community to which the sick person belonged, but from the 14th century, the mentally ill began to be considered sorcerers and witches who were persecuted.
Treatment of patients at the beginning of the Middle Ages was more professional and scientific than in the period from 12 to 13 centuries. One of the earliest asylums for the mentally ill, Bethlenham Hospital in London, was originally quite different from the snake pit that later became known as Bedlam. In those early days the sick were treated with great care. In the 13th century, an institution was founded in Geel (Belgium) to help developmentally delayed and mentally ill children.
Byzantine doctors and psychologists made significant contributions to the development of psychiatric thought in the Middle Ages. Aethius described three types of "phrenia" brain diseases involving the anterior, middle and posterior lobes of the brain associated with memory, reason and imagination. Alexander from Tral described mania and melancholy, drawing attention to the fact that these conditions can be observed in the same patient. He recommended baths, wine, and sedatives for mental disorders.
Arab psychiatric thought also developed in parallel with Western medicine. Arab doctors made major contributions to the understanding of mental illness and their treatment. They proceeded mainly from the experimental method, and did not pay attention to speculative guesses.
The most famous among Arab doctors was Razi. He headed the Baghdad Hospital (one of the world's first hospitals for the mentally ill). In the field of psychiatry, Razi was a supporter of the followers of Hippocrates. He described all diseases in detail. He combined psychological methods and psychological analysis. He was against giving a demonological explanation for the disease.
Avicenna drew attention to the dependence of the physiological reaction on emotional state. He described psychotic delusions and their treatment. Avenzor condemned the method of cauterization, which was widely used by the Arabs in relation to mentally ill patients. The organic approach has revived interest in pathology nervous system and especially the brain in the study of mental illness. For example, abscesses of the cerebral ventricles were considered a cause of psychosis and were treated with diet, bloodletting, and medications.
Although in the Middle Ages there were people who preached rational approaches and methods to understanding mental disorders, the overall picture remained sad. The etymology of mental disorders was considered in terms of divine origin or as a consequence of the influence of external forces. The situation of the sick in the late Middle Ages worsened significantly; the sick began to be treated like animals. In addition, during this period the church began mass persecution of witches and sorcerers. The mentally ill began to be considered slaves of Satan and, therefore, appropriate measures were applied to them - mainly the torture of the Inquisition. At that time, the treatment of soul and body was carried out using equivalent methods.
The Renaissance to some extent changed the worldview of doctors and ordinary people. Gradually, the ideas of humanism began to penetrate into scientific circles, in particular psychiatry. Man has become open to study as a specific individual. Now not only the soul, but also the body was fully studied. Psychiatry is becoming a more objective science, free from medieval prejudices.
Leonardo da Vinci dissected the brain and carefully sketched all the grooves and cavities of this organ, making a great contribution to the development of human anatomy. Felix Plater made the first attempt to define clinical criteria for mental illness; he tried to classify all illnesses, including mental illnesses. To this end, he studied the psychological deviations of prisoners. Plater concluded that most mental illnesses depend on certain types of brain damage. His " Practical medicine"contains a large number of clinical observations.
Gerolamo Cardano realized that in order for patient treatment to be successful, the patient must, first of all, believe in the doctor. Confidence in the correctness of one’s method, which consists in the idea of necessity close connection the very process of treatment with the patient’s desire to be cured, made it possible for Cardano to use suggestive therapy (suggestion therapy) as one of the components of his general therapeutic effects.
Philip Paracelsus believed that mental illnesses arise from internal disorders and cannot be the result of external influences. He believed that illnesses, both mental and physical, could be cured medical supplies, while he prescribed simple medicines in certain dosages.
Johan Weyer argued that witches were just mentally ill people and should be treated rather than interrogated and executed. He noticed that the witches showed symptoms that are characteristic of mentally ill people. This led him to believe that these women were actually suffering from mental illness.
The further development of psychiatry dates back to the 17th century, when the first steps towards a realistic understanding of this science were taken during the Renaissance. Attitudes towards mental illness began to free themselves from prejudices and misconceptions of authorities. XVII century was destined to lay the foundation for the modern world.
Thomas Sydenham described the clinical manifestations of hysteria, a disease widespread and therefore of particular importance to practitioners. Sydenham's achievements are the result of his precise clinical observations. In his opinion, men also suffer from hysteria; he called this form hypochondria. Sydenham discovered that hysterical symptoms could simulate almost all forms of organic disease.
William Harvey described the effect of emotional stress on cardiac activity. When affected, the body experiences changes, while blood pressure changes, when angry, the eyes turn red and the eyes narrow, when there is tightness, the cheeks become covered with red spots, etc. Any mental affects of various contents can be accompanied by exhaustion and health disorders or be associated with a violation of chemical processes and their insufficiency, with an exacerbation of all manifestations of the disease and exhaustion of the human body.
Georg Stahl believed that some mental disorders, as well as physical ones, can occur from purely psychological causes, and they can be distinguished from such mental states that are based on organic damage, such as toxic delirium.
Robert Barton recognized the most important components of melancholia and described some of the essential principles of psychoanalysis. He pinpointed that the emotional core of depression is unrelenting hostility. He also reproduced its self-destructive component and correctly described the characteristic internal conflicts that arise against the background of the individual’s constant confrontation with the hostility overwhelming him. He showed how they manifest themselves in jealousy, rivalry and ambivalence. These therapeutic recommendations comprised a fairly large set of remedies - sports, chess, baths, bibliotherapy, music therapy, laxatives, moderation in sexual life.
Many scientists characterize the 18th century as the Age of Enlightenment. Faith in reason has taken hold of all strata of society. The objective point of view had exorcised the demons of human illness, and psychiatry was close to finding its way into medicine through organic channels. In the first decade of the century, doctors looked to damaged matter in the brain as an explanation for mental illness, and concepts such as the "seat of the soul" or the "animal spirit" gradually faded away. The wealth of medical and scientific information was so great that the material required comprehension and systematization. Psychiatrists who tried to classify the symptoms of the mentally ill in the 18th century found themselves in a difficult situation because... had too few direct observations of patients. However, the symptoms of mental illness have been described and classified. Methods of psychiatric treatment were practically not affected by the classifiers.
Herman Boerhaave. Basically a reactionist. For him, psychiatry consisted of the following methods - shock bloodletting, cleansing enemas, immersing the patient in a bath of ice water. He also introduced the first shock instrument into psychiatry - a rotating chair in which the patient lost consciousness. Despite his conservative views, he had many admirers among scientists. In general, scientists of the 18th century were attracted to unusual, strange, out-of-the-ordinary features of mental disorders. This century is also characterized by a deep study of human anatomy, incl. anatomy of the brain and nervous system. Some zones of localization of mental functions have been identified.
Benjamin Rush was a staunch advocate of the swivel chair. He was the founder of American psychiatry and proceeded from the fact that mental illness causes congestion of blood in the brain and that this condition can be relieved by rotation. Rush also suggested that mental illness could be caused by somatic reasons, for example, dropsy, gout, pregnancy or tuberculosis, excessive sexual activity. He suggested that some mental states, such as fear, anger, loss of freedom can cause pathology of cerebral vessels.
Boerhaave's students became interested in the symptoms of neurotic disorders, and each of them proposed their own system of classification of mental illnesses based on physiology. Witt divided neuroses into hysteria, hypochondria and nervous exhaustion. The system proposed by Witt is not very different from the modern clinical descriptive classification. He was also the first to describe the pupillary reflex and study shock as a consequence of spinal injury.
The most complete classification was William Cullen's classification of diseases. Using diagnostic and treatment methods, he classified almost all diseases known at that time according to their symptoms. He was also the first to use the term "nervous" to refer to diseases not accompanied by fever or localized pathology. He believed that neurosis is caused by a disorder of either the intellect, or the voluntary and involuntary nervous system. All neurotic illnesses must be based on some physiological malfunction. Cullen's treatments were based on diet, physical therapy, exercise, cleansing, forehead burning, cold baths, bloodletting and emetics, which were common methods used to combat physical illness. Disorders. Cullen treated severely mentally ill patients using strict isolation, threats and straitjackets
Giovanni Morgagna was a pathologist whose main interest was brain pathology. He revealed that the symptoms that appear during an impact are not the result of a disease of the brain itself, but only the result of rupture of blood vessels that have a secondary effect on the brain. Neurologists, neuroanatomists, and therapists were influenced by Blink’s concept that illness can be localized and began to deeply and thoroughly examine the brain when studying the causes of mental illness.0
Philippe Pinel created a new, simple classification of mental illnesses. He divided all disorders into melancholia, mania without delirium, mania with delirium, dementia (mental retardation and idiocy), and he described hallucinations. His description of symptoms is presented in a system; he distinguished between disorders of memory, attention, and judgment abilities, and recognized the significance of affects. He believed that the basis of the disorders was damage to the central nervous system. His descriptions of illnesses are simple and accurate. Pinel believed that traditional methods treatments are not suitable. He followed the psychological method - you have to live among the insane. Not only heredity, but also improper upbringing can lead to mental disorders. Pinel's main merit is that he changed society's attitude towards the insane. He said that it is impossible to determine what is the cause of disorders - internal causes or the result of disorders. But the conditions of detention for the mentally ill were monstrous. It should be noted here that in Spain, and then in other countries, under the influence of the views of Pinel and other psychiatrists, a humane approach to the maintenance and treatment of the insane is gradually beginning to be introduced. It should be noted that in Russia humane methods were mainly used.
Despite the promotion of scientific ideas by scientists such as Rush, Pinel, etc., charlatans also appeared who put forward anti-scientific ideas. For example, Franz Meismer - the idea of animal magnetism; John Brown, who gave his patients drugs that reversed their symptoms; Franz Gall, who believed that by feeling the bumps and depressions on the head one can determine a person’s character.
Johann Reil - the first systematic treatise on psychiatry, an adherent of the psychotherapeutic approach, believed that diseases should be treated with psychological methods, but at the same time the specialist must have extensive training, believed that somatic diseases can be cured by the same method. Pushed for the importance of psychiatry. He spoke in defense of the insane, describing the horror of keeping them in hospitals and society’s attitude towards them.
Moreau de Tours, a leading psychiatrist, considered introspection to be the main method; he himself tried hashish to feel the patient’s condition. Moreau was the first to point out that dreams contain the key to understanding mental disorders. Dreams are of the same nature as hallucinations, being a borderline link. He said that a mad person dreams in reality. In this way he anticipated the idea of the unconscious. Genius and madness are close concepts.
In the mid-19th century, medicine adopted the principles of physics and chemistry. Psychiatry also tried to join this trend - behavioral disorders due to the destruction of nervous structure and functions - materialistic theories. Biological, medical and anatomical discoveries are taking place.
Neuropsychiatry
Clinical medicine made significant advances in the first half of the 19th century. The syndromes and essence of the diseases were described in detail.
Wilhelm Griesinger. Great contribution to psychiatry, a guide to psychiatry. He paid special attention to the analysis of the connection between physiological and anatomical phenomena. He believed that all mental disorders could be viewed in terms of the correct or incorrect functioning of brain cells. Therapeutic methods did not include crude techniques such as emetics; he used them only in extreme cases. He insisted on equal use of organic and psychological methods. He also determined that the personality problem in mental illness is closely related to the loss of the ability to self-esteem, alienation from oneself, and therefore, in order to understand the disease, the doctor must study the patient’s personality in detail. Griesinger renewed hope that honey. Psychology will certainly become legal medical science that psychiatry can develop hand in hand with other medical disciplines, as absolute equals. psychiatry cullen disease physiology
The development of physiology and psychiatry in Russia was carried out by such scientists as I. Sechenov - the book “Reflexes of the Brain”. He argued that human mental activity depends on external stimuli, therefore, behavior should be studied from the point of view of physiology. I.P. Pavlov followed the ideas of Sechenov, developed the theory of conditional and unconditioned reflexes. Then behaviorists used all this. The most complex mental functions develop from simple conditioned reflexes. Higher processes are inhibited by lower functions of the brain.
Vladimir Bekhterev. Head of the psychophysiological laboratory in Kazan, founder of the Psychoneurological Institute in St. Petersburg. Used Pavlov's theories in his work. He trained in Wundt's laboratory and studied hypnosis with Charcot. After this, he opened his own laboratory, where he studied physiological phenomena associated with hypnosis, and also experimented in psychosurgery.
The second half of the 19th century was marked by a largely organic understanding of mental disorders, but at the same time many mental illnesses were studied, in many cases through discoveries in the field of human anatomy and physiology. A large amount of factual and experimental material was collected. All this required systematization.
Emil Kreppelin. He carried out a systematization of mental disorders, using mainly an organic approach. He differentiated between dementia and manic depression based on prognosis. He concluded that with the first disease, recovery occurs much less frequently than with the second. Kröppelin showed the importance of generalization in psychiatric research, the need for a careful description of medical observations and an accurate presentation of the findings. Without such an approach, psychiatry would never have become a special clinical branch of medicine.
Jean Charcot became interested in the phenomenon of hypnosis. He came to the conclusion that hysterical paralysis is associated with the mental apparatus. Proof of this was his inducing paralysis in hysterical patients using hypnosis. At the same time, he managed to cure the resulting paralysis. Charcot also suspected that the origin hysterical symptoms sexual impulses play a role
Psychoanalysis and psychiatry
Sigmund Freud is rightfully considered the founder of psychoanalysis, who revealed unconscious processes in the human psyche. He was the first to prove that unconscious processes are important in human behavior, and in many cases determine it. Freud's entire activity can be divided into four periods, two of which intersect each other.
1) Contributions to the anatomy of the nervous system and neuroscience
2) Study of hypnotism and hysteria
3) Detection and study of subconscious phenomena and the development of the method of psychoanalysis as a therapeutic factor
5) Systematic study human personality and structures of society.
Soon after working with Breuer, Freud realized that, despite all the usefulness of hypnosis, it still had limitations as a therapeutic method. On the one hand, not every person can be hypnotized. On the other hand, Freud was convinced that therapeutic effect It is often transient: in place of the disappeared symptom, another appears. The reason is that during hypnosis the subject temporarily loses the functions of the self, especially the functions of critical analysis, and completely entrusts himself to the hypnotist. Thus, he can remember traumatic events that his “I” would normally repress from memory; but subconscious memories do not become part of his conscious personality, and upon awakening the subject usually does not remember what happened during hypnosis. Consequently, hypnotic memories do not eliminate the causes of forgetting - the resistance of the conscious personality to unbearable, suppressed thoughts. Hence the outburst of suppressed emotions under hypnosis - denoted by the term “reaction” - which does not lead to a cure, but gives only a temporary effect of relief from accumulated tension.
Freud began experimenting with other psychotherapeutic techniques. Only later did he realize the limitations of hypnosis. The next logical step taken by Freud was to try to overcome, rather than circumvent, by means of hypnosis the threshold of resistance of the conscious personality to repressed material; that is, to try to encourage patients to consciously face the unbearable, to force patients to consciously remember forgotten, painful moments in their lives. Based on Bernheim's theory that suggestion is the essence of hypnosis, Freud first tried to use suggestion by inducing his patients, while fully conscious, to recall traumatic life events associated with the symptoms of their illness. After a short period of unsuccessful experimentation with the use of various techniques in 1895 Freud discovered the method of free association.
Freud's new technique was to ask his patients to give up conscious control over their thoughts and say the first thing that came to mind. Free association promotes the involuntary release of subconscious material that seeks this release, but is suppressed by repressive opposition. When the patient ceases to direct his mental processes, spontaneous associations are guided by repressed material rather than by conscious motivations; the uncontrolled flow of thought thus reveals the interaction of two opposing tendencies - to express or suppress the subconscious. Free association, as Freud found out, after a sufficiently long time led the patient to forgotten events, which he not only remembered, but also lived again emotionally. Emotional response with free association, in essence, similar to the state that the patient experiences during hypnosis, but it is not so sudden and violently expressed; and since the response comes in portions, with full consciousness, the conscious “I” is able to cope with emotions, gradually “cutting a path” through subconscious conflicts. It was this process that Freud called “psychoanalysis,” using the term for the first time in 1896.
Subconscious material does not immediately appear during free association; rather, it directs the flow of thoughts in a certain direction, which is not always realized. Listening to the free flow, Freud learned to read between the lines and gradually understood the meaning of the symbols with which patients expressed deeply hidden things. He called the translation of this language of subconscious processes into the language of everyday life “the art of interpretation.” However, all this was truly realized and understood only after Freud revealed the meaning of dreams.
Freud became interested in dreams after noticing that many of his patients, in the process of free association, suddenly began to talk about their dreams. Then he began to ask questions about what thoughts came to them in connection with this or that element of the dream. And he noticed that often these associations revealed the secret meaning of the dream. He then tried, using the external content of these associations, to reconstruct the secret meaning of the dream - its latent content - and in this way discovered a special language of subconscious mental processes. He published his findings in The Interpretation of Dreams in 1900; this book can rightfully be considered his most significant contribution to science.
The core of Freud's theory of dreams is the idea that dreams are an attempt to relieve emotional tension that interferes with a feeling of complete peace. These tensions accumulate during the day due to unfulfilled aspirations and desires, and the sleeper frees himself from them, drawing in his imagination a picture of the satisfaction of his aspirations. The clearest example of this process can be children's dreams of “wish fulfillment”, where all desires and dreams that were not realized during the day seem to be fulfilled. In adults, the process of satisfying aspirations through dreams is much more complicated. Many adult desires, unlike children’s, are suppressed not so much by external obstacles as by internal conflicts. Quite often these internal conflicts are the result of unfulfilled aspirations adolescence because of the negative attitude of their parents towards them. This is the so-called “alien I” or “It”. In their dreams, adults express the desires of their “alien self” in a distorted form. This is a defense against the internal conflicts that would inevitably arise if the tendencies of the “It” were to manifest themselves openly. Adult dreams are a compromise: they satisfy the desires of the “It” in a veiled, symbolic form, expressed in the infantile language of unconscious processes, in expressions no longer accessible to the adult. In this way, the internal conflict is circumvented, and the dream fulfills its function as a guardian of sleep.
The study of dreams has provided the necessary key to understanding psychopathological phenomena. The technique of free association and interpretation opened a wide path into the subconscious and offered a path to understanding psychopathological phenomena, because these phenomena, like dreams, are a product of the unconscious aspirations of the “superego”. Psychopathological symptoms and dreams are products of primitive thinking - Freud called them "primary processes" - and they are not subject to the usual restrictions imposed by the social environment. The study of dreams revealed to Freud a number of psychological mechanisms. One of them is “condensation,” the reduction of various thoughts that have a certain common denominator into a single symbol. For example, a person may see in a dream a face with the eyebrows of his father, the nose of a teacher, the mouth of a brother, the ears of his wife, and at first glance the face will not resemble any of the people mentioned. If an individual with such a face is killed in a dream, then subconsciously the people who are represented in this face are precisely those against whom the sleeping person has bad feelings.
The next mechanism can be thought of as “displacement.” In a dream, the patient can transfer hatred or love from one person to another, to one for whom he can harbor these feelings without experiencing internal conflict. Freud also discovered several other different characteristics of unconscious processes. These include the use of allegories, symbols, allusions, parts instead of wholes, and “expressing something by its opposite.” “Expression through the opposite” means the denial of what is desired, which for some reason is unacceptable. For example, a person experiencing unconscious enmity towards his brother wants to bypass him, say, in search of a job. But the internal rejection of this hostile desire leads to the fact that in a dream he cedes this job to his brother. The essence of these complex dream mechanisms is to hide, disguise an unacceptable subconscious desire.
Freud paid much attention to demonstrating the "dynamic subconscious" in his various appearances- slips of the tongue, witticisms, forgetting. In his brilliant work “The Psychopathology of Everyday Life,” he showed that seemingly random slips of the tongue, seemingly causeless forgetting of words (or actions, intentions, etc.) - all this is the result of suppressed aspirations.
When analyzing the dreams of his patients, Freud discovered that sexual impulses play a very significant role in the occurrence of neuroses. He found out that the content of the “Alien I” (“It”), which is repressed into the subconscious and subsequently manifests itself in dreams and neurotic symptoms, invariably has a sexual connotation. Freud delved extremely deeply and carefully into the essence of the phenomenon, but, once convinced of the results of his observations, he fearlessly and firmly defended them. His own introspection, the interpretation of his own dreams, gave Freud the first hint of the Oedipus complex - the sexual attraction of a child to a parent of the opposite sex and a feeling of rivalry with a parent of the same sex. His conclusions, supported by observations of patients, were published in Three Essays on the Theory of Sexuality (1905). His theoretical conclusions regarding the sexual nature of man became known as the "libido theory", and this theory, together with the discovery of childhood sexuality, was one of the main reasons that Freud was rejected by his fellow professionals and the general public.
The libido theory revised traditional views of the sexual instinct as an instinct for procreation. Freud came to the conclusion that many aspects of a child's behavior, such as thumb sucking or bodily functions, are a source of sensual (sexual) pleasure, having nothing to do with procreation. Thus, this conclusion moved the concept of sexuality beyond the concept of reproduction. Freud's theory of libido replaced the previous narrow definition of sexuality with a comprehensive theory of personality development in which biological (including sexual) and psychological development are closely intertwined. The infant, still completely dependent on the mother for the pleasure it experiences in the mouth, is in the oral phase and in the biological stage characterized by rapid growth. His psychology is dominated by the desire to absorb food. At this stage of development, the infant exhibits receptive dependence: when he is upset, he becomes demanding and aggressive. The oral period is followed by an "anal phase", during which he first begins to control his bodily functions. This phase begins at approximately eighteen months of age. Learning toilet habits prevents the child from receiving the pleasure he experiences from holding or excreting excrement, and his psychology during this period is dominated by aggression, envy, stubbornness, and possessive feelings. He develops defensive reactions against coprophilic tendencies (the desire to touch feces), such as disgust and cleanliness.
These phases and psychosexual development occur unevenly, overlapping each other and mixing. The next phase begins at approximately three years of age. It is characterized by childhood masturbation, sexual curiosity, competitive and ambitious feelings, and most of all the Oedipus complex. These years are referred to as the "phallic phase." Around the age of six, a “latent” period begins when the child’s previous curiosity about sexual manifestations gives way to curiosity about the entire world around him. He goes to school and most of his energy goes into studying.
Around the age of twelve, with the onset of adolescence, when the reproductive system matures, sexual interest reappears. Central psychological characteristics, this turbulent period is characterized by uncertainty and instability, explained by the fact that a fully developed body is controlled by an inexperienced brain. The desire to test oneself and establish oneself is expressed in excessive competition and awkward attempts to show one’s maturity and independence, although these attempts are undermined by internal doubts. During these years, a revival of the Oedipus complex may occur.
Maturity, or the so-called genital phase, is characterized mainly by self-awareness, a sense of self-confidence and the capacity for mature love. This form and manner of behavior is possible only when the concentration on one’s own personality decreases. All pregenital phases are basically centripetal, narcissistic, because the individual is concerned own development, exploring your physical and mental environment. Only after development reaches a certain limit and a person realizes himself as a given, can he turn his love to other objects.
Of Freud's many concepts, it was "consolidation" and "regression" that helped explain the essence of neurotic and psychotic symptoms. Consolidation is an individual's tendency to retain behaviors, feelings, and thoughts that have served him well in the past. Regression is the tendency to return to the most successful skills developed in the past, in cases where a situation arises that requires some other skills, adaptation and training, for which one’s own “I” is not yet ready. Neurotics have a special tendency to regress, and neurotic symptoms are a disguised expression of former habits of the “Id” which are not applicable in the present situation. For example, a child finds out that by shouting he can achieve what he is not allowed to do. Later, when he goes to school, the teacher may forbid him to play with something. And then he “regresses,” trying to get permission by shouting, instead of accepting the teacher’s conditions or getting permission in some other, less aggressive way.
The “I” uses defense mechanisms to prevent the outdated tendencies of the “It” from breaking through to the surface, into consciousness. Among these mechanisms, the most important are “overcompensation”, or “reverse action” (say, when a weak person behaves like a very strong one, sometimes to the point of hooliganism), “rationalization”, “directing the hostile impulses of the “It” against oneself” (in cases self-destructive actions or thoughts) and “projection,” that is, attributing unacceptable intentions to other people. There are other defense mechanisms, such as “sublimation” (directing forbidden impulses into acceptable behavior, say, voyeuristic tendencies turn into photography) and “transferring” hostility or love from an unsuitable object to an acceptable one (transferring love for a mother to love for a girl). All these defense mechanisms serve to avoid conflict between the social essence of the individual and his internal, primitive aspirations. They serve to reduce the anxiety that arises when repressed impulses from the “alien Self” (“It”) threaten to force their way into the sphere of consciousness.
Neurotic symptoms, when viewed in this light, can be defined as unsuccessful attempts at self-medication. They are unsuccessful because the defense itself becomes the source of the disease. For example, a person who is angry with his father is ready to shout at him. This desire contradicts his morality, which rejects the possibility of expressing anger towards his parents. As a result, he loses his voice. Now he cannot work, because work requires conversation. What originally was defense mechanism against the insult of the father (loss of voice), became a disease. Example: The following person feels that he is weak. Nobody loves the weak, so he tries to gain love by trying to act like a strong person. But he may overdo it (overcompensation) and come across as a bully. However, no one likes hooligans either. Thus, a defensive action (strong behavior) itself turns into a disadvantage.
An important point in psychoanalytic treatment is “transference”. It is based on the fact that during treatment the patient not only remembers the events of his past, but, more importantly, transfers to the doctor the feelings that he had for people from his past who meant a lot to him - most often his parents. He behaves with the doctor the same way he behaved with his parents. Experiencing and reproducing initial neurotic reactions gives the patient the opportunity to correct them. By reliving past events, the adult patient has the opportunity to overcome some traumatic events or emotions of childhood: his adult experience helps him resolve those emotional difficulties that turned out to be insurmountable for him in childhood. Freud's main thesis was that in order to heal, it is necessary for there to be recollection of past events and insight into the meaning of these events.
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Clinical(phenomenological, descriptive) direction psychiatry has its origins in ancient times. In particular, descriptions of insanity can be found in Homer’s “Iliad” and “Odyssey”, the epics “Mahabharata”, “Prose Edda” and “Kalevala”. They can also be found in the sacred texts of the Bible, Koran and Talmud. Human metaphysical experience is associated with religious practices, random and directed use psychoactive substances, as well as the experience of loss, sin, pain, dying. Almost 4,000 years ago, it made it possible to establish the boundaries of the soul and body, to determine the degree of finitude of existence and the dynamics of mental states. Theories of the structure of the soul vary among Jewish, Buddhist, Christian, Muslim, and other religious traditions. However, they all emphasize the inseparability of mental phenomena from the surrounding world, and also separate individual and collective spiritual experience.
A detailed description of mental disorders, especially epilepsy and hysteria, belongs to Hippocrates (460-370 BC), who gave some mythological images properties characteristic of mental disorders - for example, he described mania and melancholy. He also identified four main temperaments associated with the predominance of one of the four fluids - blood, phlegm, black or yellow bile. Hippocrates showed the dependence of mental disorders on the ratio of “fluids”; in particular, he associated melancholy with black bile; he also argued that hysteria is associated with wandering of the uterus. This view persisted until the 19th century. He described the typology of epilepsy and proposed dietary treatment for this disease. Plato (427-347 BC) identified two types of madness - one associated with the influence of the gods, the other associated with a violation of the rational soul. In the Platonic and Neoplatonic traditions, a classification of negative and positive human souls was introduced. Aristotle (384-322 BC) described the basic emotions, including fear, anxiety, and identified the concept of super-strong emotion - affect. Galen of Pergamon, who lived during the Roman period, believed that depression was caused by an excess of black bile. St. Augustine (354-430 AD), in his letters from North Africa, first introduced the method of internal psychological observation of experiences (introspection). The description of an experience, according to St. Augustine, allows others to understand it, share it, and empathize.
His descriptions can rightfully be considered the first psychological treatises. Avicenna (980-1037 AD) in the “Canon of Medical Science” describes two causes of mental disorders: stupidity and love. He also described for the first time the state of possession associated with turning a person into animals and birds and imitating their behavior. He also described the special behavior of a doctor when talking with a mentally ill patient.
In medieval Europe, states of possession were described in numerous treatises of the scholastics. The classification of disorders was demonological in nature, depending on the style of behavior of the mentally ill. Nevertheless, the medieval period made it possible to approach the classification of spiritual phenomena. Paracelsus (1493-1547) denied the connection between psychosis and heredity, believing that there was a connection between the mineral, the star, the disease and the character; he proposed the treatment of mental disorders with chemicals. During the Renaissance, descriptions of the typology of emotions in mental disorders appeared, in particular, Leonardo da Vinci and Michelangelo wrote a series of drawings illustrating changes in facial expressions and behavior during mental and physical suffering. Already T. Bright (1551-1615) believed that depression can be caused by psychological factors and suffering is directly related to mental disorders.
The first classification of mental disorders belongs to F. Platter (1536-1614), who described 23 psychoses in 4 classes associated with external and internal causes, in particular imagination and memory, as well as consciousness. He was the first researcher to separate medicine from philosophy and classify it as a natural science. W. Harvey (1578-1637) believed that mental emotional disorders are associated with the work of the heart. This “cardiocentric” theory of emotion has generally remained central to Christian theology as well. P. Zacchia (1584-1659) proposed a classification of mental disorders, including 3 classes, 15 types and 14 varieties of diseases; he is also the founder of forensic psychiatry. V. de Sauvages (1706 - 1767) described all mental disorders, 27 types in total, in 3 sections; he based his classification on a symptomatic principle similar to somatic medicine.
Interest in classification in psychiatry and medicine paralleled the desire for a descriptive approach to natural history, the pinnacle of which was the classification of Carl Linnaeus. The founder of American psychiatry is W. Rush (1745-1813), one of the authors of the Declaration of Independence, who published the first textbook of psychiatry in 1812. T. Sutton described alcoholic delirium in 1813, and A R. Gooch described postpartum psychoses in 1829. In 1882, A. Beuel identified progressive paralysis, which was the first independent mental illness with a specific etiology and pathogenesis, that is, corresponding to the principle of nosology in medicine. R. Krafft-Ebing (1840-1902) described homosexuality and abnormal sexual behavior. S.S. Korsakov in 1890 identified psychosis in chronic alcoholism, accompanied by polyneuritis with memory disorders.
At the end of the 19th - beginning of the 20th century, E. Kraepelin, in the classification of mental disorders, distinguished oligophrenia, dementia praecox, which in 1911 E. Bleuler called schizophrenia. He also describes manic-depressive psychosis and paraphrenia for the first time. At the beginning of the 20th century, E. Kraepelin became interested in the ethnic shades of psychosis, characteristic of representatives of various nations. Subsequently, his work became a prerequisite for ethnic psychiatry.
In 1893, the first International Statistical Classification of Causes of Death ICD (ICD) 1 was introduced, successively in 1910, 1920, 1929 ICD 2-4 were introduced, in 1938 - ICD 5, in 1948, 1955 - ICD 6-7. By the early 20th century until the 1970s, three main schools of clinical phenomenology could be distinguished, although there were shades of different schools of psychopathology. The German school was characterized by an emphasis on nosological units that included syndromes and symptoms. Russian and then Soviet psychiatrists adhered to the same point of view. The French school relied primarily on the level of symptoms and syndromes. The American school focused on reactions, including adaptation reactions.
In 1952, the original national classification Diagnostic System Manual Mental Disorders (DSM I) was introduced in the USA, which differed from European classifications in that, along with the axis clinical signs the axis of social functioning and stress response was highlighted. DSM II was introduced in 1968, DSM IIIR in 1987, DSM IV in 1993, and DSM IVR in 2000.
In 1965 and 1975, respectively, ICD 8 and 9 were introduced in Europe, and in 1989 - ICD 10, which was introduced into practice by WHO member states in 1994. In Ukraine, the transition to ICD 10 occurred in 1999. However, along with the desire to create common clinical views between Europe and the USA and intentions to combine the ICD and DSM, there are opposing attempts to oppose national schools to a single classification system.
Biological direction psychiatry is based on studies of the connection between physiology and biochemistry of the brain, genetics with basic mental disorders. G. Moreu de Tour in 1845 described an experimental psychosis using hashish. G.T. Fechner in 1860 discovered the relationship between stimulus intensity and sensory response, which formed the basis for the study of perception in health and disease. V. Morel at the end of the 19th century considered the cause of insanity to be hereditary degeneration, which increases from generation to generation from the degree of personality anomaly to psychosis and dementia. Ch. Lombroso at the same time described the connection between genius and insanity, suggesting that these are links in the same chain. Ch. Darwin argued that behavior, particularly the expressions of emotion in the mentally ill and especially the mentally retarded (microcephalic), is one evidence of human origins. Degerotypes of patients were provided to him by H. Maudsley. Neuromorphologist K. Vogt adhered to the same point of view. W.R. White (1870–1937) showed that neurological, psychiatric, and psychoanalytic concepts must be integrated when describing psychosis. E. Kretschmer in 1924, in his work “Body Structure and Character,” establishes a connection between the asthenic constitution and schizophrenia, as well as the picnic constitution and manic-depressive psychosis. In 1917 J.W. Wager-Jauregg received the Nobel Prize for his use of molar therapy for progressive paralysis. This is the first and only award in the history of science received for work in the field of treatment of mental illness. At the beginning of the 20th century I.P. Pavlov, in a series of works on the excursion of physiology into psychiatry, revealed the connection between conditioned reflexes and the formation of pathological thinking. He developed an original psychophysiological classification of personality types and the first physiological theory of psychodynamics. As a result of the development of his ideas, G. W. Watson created the behavioral direction, and later behavioral therapy for mental disorders. F. Kallman (1938) created the first systematic genetic theory of the development of schizophrenia based on a study of the similarity of the disease in twins and close relatives. In 1952, G. Delay and P. Deniker, as a result of the development of the ideas of artificial hibernation, synthesized the first antipsychotic chlorpromazine, which began the psychopharmacological era in psychiatry. In 1981, R. Sperry received Nobel Prize for a series of works of the 60-80s of the XX century, which, among other things, showed the importance of interhemispheric interactions in the development of mental disorders. G. Bowlby (1907-1990) discovers the dependence of mental disorders in children on the factors of separation and deprivation of maternal love. Subsequently, his works formed the basis for the description of the norm and phenomenology of love. E. Kandel in the 80s created a synthetic theory of the connection between psychiatry and neurobiology, studying simple models of the impact of the learning process on changes in neuronal architecture. N. Tinbergen, one of the founders of ethology, in his Nobel speech in 1973, provides the first data on the connection between the biology of behavior (ethology) and the system of dominance and territoriality. He takes childhood autism as one of his models. In 1977 N.Mc. Guire introduces theoretical model ethological psychiatry.
Story psychoanalytic direction associated with the name of S. Freud (1856-1939), who introduced the psychoanalytic method of treating mental disorders, and also substantiated the importance of the structure of consciousness and childhood sexuality for the diagnosis and treatment of neuroses. P. Janet creates the concept of psychasthenia, as well as psychological dissociation, which he used to explain obsessive-compulsive and dissociative disorders. A. Adler (1870-1937) in his theories (“life style”, “inferiority complex” and “male protest”) describes the individual psychological reasons for the development of mental disorders. C. Horney psychoanalytically substantiates the development of neuroses as a result of the social environment. M. Klein and A. Freud in the 30s created a system of psychoanalysis of childhood. E. Erikson describes life cycles as identity crises and introduces them into the practice of psychoanalysis and psychotherapy. N. Sullivan (1892-1949) creates an interpersonal theory, according to which the implementation of unconscious structures arises as a result of interpersonal communication. S.G. Jung (1975-1961) founded the school of depth psychology; when describing psychological types (introvert, extrovert), he interprets personality anomalies and neuroses. He explains psychosis as a result of a violation of individuation and a distortion of awareness of the archetype. J. Lacan (1901-1981) introduces the study of the structure of language and metaphors into psychoanalysis, pointing out that language is a model of consciousness and its distortions can be interpreted by the analytical method.
Social psychiatry describes the systems of society's attitude towards the mentally ill, rehabilitation and epidemiology of mental disorders. Attitudes towards mental disorders depend on the type of culture. In archaic culture, abnormal behavior caused fear, awe, rejection or discrimination. In a number of cultures, persons with abnormal behavior became shamans, and themselves performed ritual effects on other patients. The first social ritual of influencing somatic and mental disorders is the trance-dance of the Kalahari Bushmen, in which the influence on abnormal behavior was carried out by rhythmic singing and dancing. In India and Southeast Asia, as well as in African countries, there has always been a high tolerance for abnormal behavior, while in Europe during the Middle Ages, strict disciplinary measures were taken against the mentally ill. In particular, groups of patients were placed on “ships of fools” that were rafted along the rivers of Europe. Patients were tortured by the Inquisition and burned at the stake, and the first psychiatric clinics resembled prisons, in which patients were kept in shackles. P. Pinel (1745-1826) was the first to point out the need to extend the principles of humanism to the care and treatment of the mentally ill. G. Conolly (1794-1866) introduced the “principle of non-restrain” into psychiatry.
In Nazi Germany, largely influenced by misinterpreted genetic research, the mentally ill were systematically exterminated. And since the middle of the 20th century, psychiatry began to be used in political purposes to control dissent. A reaction to the use of psychiatry as an apparatus of state violence against the individual was the work of N.G. Marcuse and F. Szasz, who created the antipsychiatric direction. Anti-psychiatrists believed that psychiatric diagnosis was a form of discrimination against individual freedom. They called for the doors to open psychiatric hospitals to intensify the revolutionary process. Under the influence of anti-psychiatry, democratic laws on psychiatry were introduced in most countries of the world.
The psychiatric school of the USSR at that time was closest to the German school of psychopathology and was represented by two main groups of researchers: the Moscow group dealt with major psychoses, both endogenous and exogenous. Leningrad school - borderline mental disorders. The founder of the Moscow school can be considered M.O. Gurevich, which also included V.P. Osipov and V.A. Gilyarovsky, and Leningrad - V.M. Bekhterev. As a result of the “Pavlovian Session” of 1952, these schools were destroyed for political reasons due to accusations of “cosmopolitanism.” As a result, the new Moscow school subsequently turned out to be closely connected with political system, and in the future - with discrimination against dissidents.
Nevertheless domestic psychiatry has its own original content and history, generally filled with humanistic content. The first manual on psychiatry and the use of the term “psychiatry”, proposed by the German physician Johann Reil (1803), was published in Russia by P.A. Bukhanovsky in 1834. It was called “Mental illnesses, presented in accordance with the principles of the present teaching of psychiatry in general, specific and practical presentation.” Probably it was P.A. Bukhanovsky (1801-1844) was also the founder of the nosological direction. In addition, he was the first in Russia to begin teaching psychiatry at Kharkov University from 1834 to 1844 at the department of surgery and mental illness. Subsequently, manuals on psychiatry in Russia were published by P.P. Malinovsky (1843). Later, in 1867 I.M. Balinsky created a separate department of psychiatry at the Military Medical Academy of St. Petersburg, and in 1887 A.Ya. Kozhevnikov - Psychiatry Clinic at Moscow State University. In 1887 S.S. Korsakov described alcoholic psychosis with polyneuritis (Korsakov psychosis), which became one of the first nosological units in psychiatry. In the 20-30s of the XX century P.B. Gannushkin systematizes the dynamics of psychopathy, and V.M. Bekhterev introduces the concept of psychophysics of mass mental phenomena. He anticipated these data in his dissertation “ Physical factors historical process"(1917) A.L. Chizhevsky when describing mental epidemics over 2000 years. A significant phenomenon was the publication of V.P.’s textbook in 1923. Osipova and neurogenetic research of the 30-40s S.N. Davidenkova. Clinical and analytical studies thinking disorders E.A. Shevalev in the 20-30s were superior to the best examples of world science of that time. Works by L.S. Vygotsky and A.R. Luria, and later V.V. Zeigarnik and E.Yu. Artemyeva allowed her to create an original Russian pathopsychology, which significantly influenced the diagnostic process in psychiatry. During the Second World War, research by M.O. Gurevich and A.S. Shmaryan clarified the connection organic lesions and psychopathological disorders and created a “brain” psychiatry based on functional and organic morphology. In the Korsakov Clinic and the Kazan University Psychiatric Clinic in the late 40s - early 50s, some of the first psychosurgical operations for schizophrenia were carried out, in which A.N. took part. Kornetov. The founders of Russian child psychiatry are considered to be G.E. Sukharev and V.V. Kovalev, sexopathology - A.M. Svyadoshch and G.S. Vasilchenko, and psychotherapy - B.D. Karvasarsky.
Over many years of working in psychiatry, you get used to some particularly stable stereotypes of patient behavior. One of these is the custom, whether we are talking about discharge from a hospital or the end of a course of outpatient treatment, to say goodbye forever. And this behavior is very understandable: who, tell me, wants to return again and again to these walls, always yellow, no matter what their current color? And you, of course, know that
in most cases, a person will come again sooner or later, he’s just so ardently and sincerely convinced that this time was certainly the last or even the only one that it’s a pity to dissuade him.
But in fact, our psychiatric illness is a persistent thing, and once it has clung to it, it is reluctant to let go. If he lets go at all. No, of course, there are one-time episodes - for example, a reaction to some events or circumstances. Neurotic, depressive, even with hallucinations or delusions - there is still a majority of chances for a complete recovery.
Or delirium tremens. It flows brightly and is remembered by everyone around him - and there are not so many repeated cases, apparently, a person gets scared well, tries in the future not to get drunk with little green men, devils, or whatever the heraldic animal of drug addiction specialists brings with him.
Other mental illnesses, for the most part, tend either to occur constantly, or to worsen or decompensate from time to time. Even such a group as neuroses. And it seems that, from the point of view of psychiatry, there is nothing fatal: exacerbations are not of such a formidable nature as in psychosis, and do not lead to madness, and do not make one disabled - unless the patient pays for this disability himself. And certainly no one has died from neurosis yet. But how tired it is to suffer from this very neurosis! Or, as it is now fashionable to put it, the quality of life is noticeably reduced. So a person asks, once again experiencing all the delights of a decompensated neurotic state: doctor, is neurosis really incurable?
Unfortunately, as the same long-term practice shows, and not only mine, yes, it is incurable. And he stubbornly strives to return. Why is that?
The main reason lies in the very essence of neurosis. The fact is that it was once considered a psychogenic disease, that is, one that is caused not by brain damage or a malfunction of other systems, but by psychological reasons. In particular, conflicts that are significant for a particular person and, accordingly, predetermine the development of one or another (but for a specific person - strictly defined) type of neurosis.
For example, neurasthenia was considered to be characterized by a conflict between a completely intact, but tired and exhausted personality, and the external unfavorable circumstances and adversities that befell her, and to such an extent that it is not possible to overcome them; Bolivar cannot withstand two.
For hysterical neurosis, the conflict between the childishly impatient desires of the monstrously egocentric “I” and the impossibility of getting it all right now is considered significant. For hypochondriacal neurosis... well, you remember the quote from “The Formula of Love”: hypochondria is a cruel lust that keeps the spirit in a continuous sad state. By the way, almost to the point: the conflict between secret desires, but condemned by moral norms, and the need to suppress them was considered significant for hypochondria.
Accordingly, it was once believed that it was enough to reduce the severity of neurosis with medications, and then involve psychotherapy in order to reveal the essence of the current conflict and make it irrelevant for the patient - and a cure would occur. Or at least a long remission. Until the next brewing conflict.
Only it turned out that this debriefing was not enough for restitutio ad integrum. And further searches revealed that each type of neurosis has its own special... let's say, genetic firmware. It determines the personality type, character traits, and characteristics of mental and biochemical reactions.
On the one hand, it has become clearer why, say, a neurasthenic has a deeply violet type of conflict that successfully cripples a hypochondriac: he is simply not genetically designed to react sharply to such things. What kind of lust is this - you have to plow, overcome and burden yourself with new problems!
On the other hand, genes are stable things. Find me a psychotherapist who knows how to persuade the genetic program to be ashamed and correct itself - and I will go build him a temple and become an apostle. Well, we don’t yet know how to work with genes - at least, so subtly and with such a predictable result, and without dangerous consequences - to tackle the problem from this side as well. So what to do?
There is, it turns out, one more point that both psychiatrists and their neurotic patients know or guess about, but which somehow always escapes the focus of their attention. And it concerns high spheres, the level of worldview. We are talking about the goals that a person sets for himself. Suddenly?
Meanwhile, if the doctor carefully questions, and the patient remembers it well, it turns out that (if we consider a lot of cases and compile some semblance of statistics) there are moments in life when neurosis is not remembered, even if there were episodes before. And these are precisely the moments when a person had a goal that he wanted to achieve with all his soul. Build a house there, raise a son, plant a tree. Well, or something else fundamental, strategic, from the point of view of your own life. For everyone - their own, but their own, so that there is direct light in the window, so that “I see the goal - I see no obstacles.”
And while there was movement towards this goal - albeit with all the difficulties and hassle - the person did not even remember about neurosis. What kind of neurosis is this? No time, I’m busy making dreams come true!
But when a goal is achieved or lost, and a new one is not set, when there is a lull in plans, then this vacuum begins to be filled with all sorts of ailments and worries. Like a top that lost momentum and staggered. And so, instead of resting on the laurels of what has been achieved or enjoying the pause before the next ascent, a person is forced to waste nerves, time and energy on coping with neurosis.
The conclusion seems to be simple: you need constant movement towards some next goal. But there is, as always, a nuance. Not a single psychotherapist, not a single psychiatrist can take it and say: here’s a new goal for you, dear comrade, move in the indicated direction, you have a smartphone with a navigator, you won’t get lost.
Will not work. Why? It's not enough to suggest. It is necessary for a person to make a decision himself, and not just make it, but with all his soul, including this point in his worldview, as another - his own - directive. But this cannot be done from the outside, which, on the one hand, is for the best, otherwise it would be too easy to control us all, but on the other hand, no one will do this work for a person.
In history psychiatry highlight the following stages in the formation of scientific views and organization of care for the mentally ill.
1. Pre-scientific period, stretching from ancient times to the advent of Hellenic medicine. It is characterized by a primitive theological understanding of the abnormal behavior of patients. There is a complete absence of any medical care for mental illness, however, at this time, although unsystematic, however, extremely important for the future, accumulation of scattered facts and observations takes place, which have received figurative imprinting in mythology and folk poetry.
2. The era of ancient Greco-Roman medicine. Its beginning can be considered to be the 7th or 6th century BC, when for the first time attempts appeared to provide assistance to the mentally ill, whose illness began to be considered as a natural phenomenon requiring the adoption of some natural measures. The first steps have been taken in understanding mental disorders outside of theological trends (Hippocrates’ teaching on the constitution and temperament, the doctrine of hysteria, the mutual influence of soul and body in the development of diseases), and also the beginnings of the organization of assistance are noted mentally ill.
3. Middle Ages (era of the Inquisition) characterized by regression to the level of a pre-scientific worldview. The attitude towards the sick is very contradictory - from the first steps to organize public charity to the extermination of the sick at the stake of the Inquisition.
4. The period spanning the 18th century and the beginning of the 19th century - the period of the formation of psychiatry as a field of medicine, the era of F. Pinel and J. Conolly, who proclaimed the principles of non-violence against the mentally ill. Extensive construction is underway psychiatric hospitals, they carry out research work, on the basis of which the formation of symptomatological psychiatry.
5. The era of nosological psychiatry E. Kraepelin. Creation of a nosological classification of mental disorders. At the same time, psychiatry, due to the enormous increase in so-called nervousness in the general population, is increasingly moving beyond the boundaries of special hospitals and is rapidly approaching everyday life. Study of borderline states – neuroses And psychoneuroses– gives rise to the creation of a new term that will soon receive citizenship rights – "minor psychiatry".
6. Modern stage development of psychiatry– characterized by the expansion of out-of-hospital forms of psychiatric care, the study of social, psychosomatic aspects of mental disorders. The main milestones of this stage are S. Freud’s teaching on the “unconscious”, as well as "psychopharmacological revolution".
At the beginning there is a pre-scientific period, extending from ancient times until the advent of Hellenic medicine. Its characteristic features are the complete absence of any medical care for mental illnesses, which are considered and interpreted in the spirit of a primitive theological worldview. At this time, however, there occurs, although unsystematic, but extremely important for the future, accumulation of disparate facts and observations, which received figurative imprinting in mythology and folk poetry.
The second era embraces ancient Greco-Roman medicine. Its beginning can be considered to be the 7th or 6th century BC, when for the first time there were attempts to provide medical assistance to the mentally ill, whose illness began to be considered as a natural phenomenon requiring the adoption of some natural measures. The dying theological medicine is being replaced first by metaphysical medicine, at the same time, however, a strong scientific-realistic current is breaking through with increasing persistence. This brilliant era, which began in the time of Pericles (5th century BC), lasting about 800 years, ends at the end of the 3rd century of your calendar.
The third period is marked by the regression of human thought to the stage of the pre-scientific worldview in general and the medical one in particular. The Middle Ages are coming with their mysticism and scholasticism. But at the same time, this is an era that is extremely important in the history of psychiatry in one specific respect: the first attempts at public charity for the mentally ill are being made. As we will see later, it is completely wrong to consider this time as exclusively filled with various witch trials and continuous executions of the mentally ill. These phenomena are characteristic not so much of the Middle Ages as of the transition to a new time - the so-called Renaissance.
The fourth period - the 18th century, especially its last decade, represents a decisive step forward: hospitalization of the mentally ill, half of a therapeutic, half of a police nature, is developing everywhere in Europe and America. The consequence of this was, finally, the possibility of at least some organized scientific work over psychopathological material. A huge socio-political shift - the Great French Revolution, fundamental changes in the entire structure of Central Europe and at the same time the progress of a number of sciences, including medical ones, as well as a significant clarification of general philosophical ideology (especially in France) - all this deals a powerful blow remnants of age-old superstitions. And then the mentally ill person stands against the backdrop of new citizenship, presenting a silent demand for medical care and protection of all his interests as a member of society. This period is the era of Pinel in France, which gradually spread to the entire civilized world. Having made a sharp break with the past, the iron chains of which (literally) were broken, this era, however, still fundamentally allowed (in the interests of the patient) physical violence, albeit in the softened form of a straitjacket and a leather belt. At this time, the foundations of truly scientific theoretical psychiatry were laid. The era of Pinel extends to the sixties of the 19th century.
Following it, the era of Conolly comes into its own, named after the doctor who decisively spoke out for the complete abolition of mechanical methods of restraint and himself embodied these principles - as far as the material conditions of his time allowed - in his life and work. The ideas of this English doctor, expressed by him much earlier, took several decades to spread. Having arisen in England during the era of rapid development of industrial capital, they could be embodied on the European continent only when the same socio-economic evolution was finally indicated here. This was expressed, among other things, in the numerical growth and qualitative (material) improvement of psychiatric institutions. Accordingly, the subject material increased every year. Some basic problems of the science of mental illness are posed and partially resolved, numerous classifications of mental disorders are compiled, experimental psychology and neuropathology are developed, and the scientific teaching of psychiatry gradually rises to significant heights. This is the time of the dominance of so-called symptomatological psychiatry, the period of symptom complexes on a psychological basis, with a simultaneous, however, intense search for other criteria for the creation of truly scientific nosological units.
The sixth period, coinciding with the last decade of the 19th century, is characterized by a colossal expansion and improvement of psychiatric care, the organization of colonies, patronages and huge improved hospitals, which see within their walls an increasingly large cadre of psychiatrists and well-trained middle and junior staff. A new era is dawning in the care of the mentally ill: bed rest. And at the same time, there is a gradual and completely natural withering away of one relic of hoary antiquity that was still allowed in Conolly’s era: insulators are being destroyed. Theoretical psychiatry of this period is experiencing a deep and turbulent crisis: symptom complexes are collapsing and their place is being replaced by multifaceted, new, “natural” nosological units, “real diseases”, traced on a huge, clinically and statistically processed material. This is the era of Kraepelin. It is characterized by another essential feature: psychiatry, due to the enormous increase in so-called nervousness in broad sections of the population, is increasingly moving beyond the boundaries of special hospitals and is rapidly approaching everyday life. The study of borderline states - neuroses and psychoneuroses - gives rise to the creation of a new term that soon received citizenship rights - “minor psychiatry”. At the same time, the science of mental illness is becoming increasingly marked by a sociological bias.
Clinical(phenomenological, descriptive) direction psychiatry has its origins in ancient times. In particular, descriptions of insanity can be found in Homer’s “Iliad” and “Odyssey”, the epics “Mahabharata”, “Prose Edda” and “Kalevala”. They can also be found in the sacred texts of the Bible, Koran and Talmud. Human metaphysical experience is associated with religious practices, random and targeted use of psychoactive substances, as well as the experience of loss, sin, pain, and dying. Almost 4,000 years ago, it made it possible to establish the boundaries of the soul and body, to determine the degree of finitude of existence and the dynamics of mental states. Theories of the structure of the soul vary among Jewish, Buddhist, Christian, Muslim, and other religious traditions. However, they all emphasize the inseparability of mental phenomena from the surrounding world, and also separate individual and collective spiritual experience.
A detailed description of mental disorders, especially epilepsy and hysteria, belongs to Hippocrates (460-370 BC), who gave some mythological images properties characteristic of mental disorders - for example, he described mania and melancholy. He also identified four main temperaments associated with the predominance of one of the four fluids - blood, phlegm, black or yellow bile. Hippocrates showed the dependence of mental disorders on the ratio of “fluids”; in particular, he associated melancholy with black bile; he also argued that hysteria is associated with wandering of the uterus. This view persisted until the 19th century. He described the typology of epilepsy and proposed dietary treatment for this disease. Plato (427-347 BC) identified two types of madness - one associated with the influence of the gods, the other associated with a violation of the rational soul. In the Platonic and Neoplatonic traditions, a classification of negative and positive human souls was introduced. Aristotle (384-322 BC) described the basic emotions, including fear, anxiety, and identified the concept of super-strong emotion - affect. Galen of Pergamon, who lived during the Roman period, believed that depression was caused by an excess of black bile. St. Augustine (354-430 AD), in his letters from North Africa, first introduced the method of internal psychological observation of experiences (introspection). The description of an experience, according to St. Augustine, allows others to understand it, share it, and empathize.
His descriptions can rightfully be considered the first psychological treatises. Avicenna (980-1037 AD) in the “Canon of Medical Science” describes two causes of mental disorders: stupidity and love. He also described for the first time the state of possession associated with turning a person into animals and birds and imitating their behavior. He also described the special behavior of a doctor when talking with a mentally ill patient.
In medieval Europe, states of possession were described in numerous treatises of the scholastics. The classification of disorders was demonological in nature, depending on the style of behavior of the mentally ill. Nevertheless, the medieval period made it possible to approach the classification of spiritual phenomena. Paracelsus (1493-1547) denied the connection between psychosis and heredity, believing that there was a connection between the mineral, the star, the disease and the character; he proposed the treatment of mental disorders with chemicals. During the Renaissance, descriptions of the typology of emotions in mental disorders appeared, in particular, Leonardo da Vinci and Michelangelo wrote a series of drawings illustrating changes in facial expressions and behavior during mental and physical suffering. Already T. Bright (1551-1615) believed that depression can be caused by psychological factors and suffering is directly related to mental disorders.
The first classification of mental disorders belongs to F. Platter (1536-1614), who described 23 psychoses in 4 classes associated with external and internal causes, in particular imagination and memory, as well as consciousness. He was the first researcher who separated medicine from philosophy and classified it as natural sciences. W. Harvey (1578-1637) believed that mental emotional disorders are associated with the work of the heart. This “cardiocentric” theory of emotion has generally remained central to Christian theology as well. P. Zacchia (1584-1659) proposed a classification of mental disorders, including 3 classes, 15 types and 14 varieties of diseases; he is also the founder of forensic psychiatry. V. de Sauvages (1706 - 1767) described all mental disorders, 27 types in total, in 3 sections; he based his classification on a symptomatic principle similar to somatic medicine.
Interest in classification in psychiatry and medicine paralleled the desire for a descriptive approach to natural history, the pinnacle of which was the classification of Carl Linnaeus. The founder of American psychiatry is W. Rush (1745-1813), one of the authors of the Declaration of Independence, who published the first textbook of psychiatry in 1812. T. Sutton described alcoholic delirium in 1813, and A R. Gooch described postpartum psychoses in 1829. In 1882, A. Beuel identified progressive paralysis, which was the first independent mental illness with a specific etiology and pathogenesis, that is, corresponding to the principle of nosology in medicine. R. Krafft-Ebing (1840-1902) described homosexuality and abnormal sexual behavior. S.S. Korsakov in 1890 identified psychosis in chronic alcoholism, accompanied by polyneuritis with memory disorders.
At the end of the 19th - beginning of the 20th century, E. Kraepelin, in the classification of mental disorders, distinguished oligophrenia, dementia praecox, which in 1911 E. Bleuler called schizophrenia. He also describes manic-depressive psychosis and paraphrenia for the first time. At the beginning of the 20th century, E. Kraepelin became interested in the ethnic shades of psychosis, characteristic of representatives of various nations. Subsequently, his work became a prerequisite for ethnic psychiatry.
In 1893, the first International Statistical Classification of Causes of Death ICD (ICD) 1 was introduced, successively in 1910, 1920, 1929 ICD 2-4 were introduced, in 1938 - ICD 5, in 1948, 1955 - ICD 6-7. By the early 20th century until the 1970s, three main schools of clinical phenomenology could be distinguished, although there were shades of different schools of psychopathology. The German school was characterized by an emphasis on nosological units that included syndromes and symptoms. Russian and then Soviet psychiatrists adhered to the same point of view. The French school relied primarily on the level of symptoms and syndromes. The American school focused on reactions, including adaptation reactions.
In 1952, the original national classification Diagnostic System Manual Mental Disorders (DSM I) was introduced in the United States, which differed from European classifications in that, along with the axis of clinical signs, the axis of social functioning and reaction to stress was distinguished. DSM II was introduced in 1968, DSM IIIR in 1987, DSM IV in 1993, and DSM IVR in 2000.
In 1965 and 1975, respectively, ICD 8 and 9 were introduced in Europe, and in 1989 - ICD 10, which was introduced into practice by WHO member states in 1994. In Ukraine, the transition to ICD 10 occurred in 1999. However, along with the desire to create common clinical views between Europe and the USA and intentions to combine the ICD and DSM, there are opposing attempts to oppose national schools to a single classification system.
Biological direction psychiatry is based on studies of the connection between physiology and biochemistry of the brain, genetics with major mental disorders. G. Moreu de Tour in 1845 described an experimental psychosis using hashish. G.T. Fechner in 1860 discovered the relationship between stimulus intensity and sensory response, which formed the basis for the study of perception in health and disease. V. Morel at the end of the 19th century considered the cause of insanity to be hereditary degeneration, which increases from generation to generation from the degree of personality anomaly to psychosis and dementia. Ch. Lombroso at the same time described the connection between genius and insanity, suggesting that these are links in the same chain. Ch. Darwin argued that behavior, particularly the expressions of emotion in the mentally ill and especially the mentally retarded (microcephalic), is one evidence of human origins. Degerotypes of patients were provided to him by H. Maudsley. Neuromorphologist K. Vogt adhered to the same point of view. W.R. White (1870–1937) showed that neurological, psychiatric, and psychoanalytic concepts must be integrated when describing psychosis. E. Kretschmer in 1924, in his work “Body Structure and Character,” establishes a connection between the asthenic constitution and schizophrenia, as well as the picnic constitution and manic-depressive psychosis. In 1917 J.W. Wager-Jauregg received the Nobel Prize for his use of molar therapy for progressive paralysis. This is the first and only award in the history of science received for work in the field of treatment of mental illness. At the beginning of the 20th century I.P. Pavlov, in a series of works on an excursion from physiology to psychiatry, revealed the connection between conditioned reflexes and the formation of pathological thinking. He developed an original psychophysiological classification of personality types and the first physiological theory psychodynamics. As a result of the development of his ideas, G. W. Watson created the behavioral direction, and later behavioral therapy for mental disorders. F. Kallman (1938) created the first systematic genetic theory of the development of schizophrenia based on a study of the similarity of the disease in twins and close relatives. In 1952, G. Delay and P. Deniker, as a result of the development of the ideas of artificial hibernation, synthesized the first antipsychotic chlorpromazine, which began the psychopharmacological era in psychiatry. In 1981, R. Sperry received the Nobel Prize for a series of works in the 60-80s of the 20th century, which, among other things, showed the importance of interhemispheric interactions in the development of mental disorders. G. Bowlby (1907-1990) discovers the dependence of mental disorders in children on the factors of separation and deprivation of maternal love. Subsequently, his works formed the basis for the description of the norm and phenomenology of love. E. Kandel in the 80s created a synthetic theory of the connection between psychiatry and neurobiology, studying simple models of the impact of the learning process on changes in neuronal architecture. N. Tinbergen, one of the founders of ethology, in his Nobel speech in 1973, provides the first data on the connection between the biology of behavior (ethology) and the system of dominance and territoriality. He takes childhood autism as one of his models. In 1977 N.Mc. Guire introduces a theoretical model of ethological psychiatry.
Story psychoanalytic direction associated with the name of S. Freud (1856-1939), who introduced the psychoanalytic method of treating mental disorders, and also substantiated the importance of the structure of consciousness and childhood sexuality for the diagnosis and treatment of neuroses. P. Janet creates the concept of psychasthenia, as well as psychological dissociation, which he used to explain obsessive-compulsive and dissociative disorders. A. Adler (1870-1937) in his theories (“life style”, “inferiority complex” and “male protest”) describes the individual psychological reasons for the development of mental disorders. C. Horney psychoanalytically substantiates the development of neuroses as a result of the social environment. M. Klein and A. Freud in the 30s created a system of psychoanalysis of childhood. E. Erikson describes life cycles as crises of identity and introduces them into the practice of psychoanalysis and psychotherapy. N. Sullivan (1892-1949) creates an interpersonal theory, according to which the implementation of unconscious structures arises as a result of interpersonal communication. S.G. Jung (1975-1961) founded the school of depth psychology; when describing psychological types (introvert, extrovert), he interprets personality anomalies and neuroses. He explains psychosis as a result of a violation of individuation and a distortion of awareness of the archetype. J. Lacan (1901-1981) introduces the study of the structure of language and metaphors into psychoanalysis, pointing out that language is a model of consciousness and its distortions can be interpreted by the analytical method.
Social psychiatry describes the systems of society's attitude towards the mentally ill, rehabilitation and epidemiology of mental disorders. Attitudes towards mental disorders depend on the type of culture. In archaic culture, abnormal behavior caused fear, awe, rejection or discrimination. In a number of cultures, persons with abnormal behavior became shamans, and themselves performed ritual effects on other patients. The first social ritual of influencing somatic and mental disorders is the trance-dance of the Kalahari Bushmen, in which the influence on abnormal behavior was carried out by rhythmic singing and dancing. In India and Southeast Asia, as well as in African countries, there has always been a high tolerance for abnormal behavior, while in Europe during the Middle Ages, strict disciplinary measures were taken against the mentally ill. In particular, groups of patients were placed on “ships of fools” that were rafted along the rivers of Europe. Patients were tortured by the Inquisition and burned at the stake, and the first psychiatric clinics resembled prisons, in which patients were kept in shackles. P. Pinel (1745-1826) was the first to point out the need to extend the principles of humanism to the care and treatment of the mentally ill. G. Conolly (1794-1866) introduced the “principle of non-restrain” into psychiatry.
In Nazi Germany, largely influenced by misinterpreted genetic research, the mentally ill were systematically exterminated. And since the mid-20th century, psychiatry began to be used for political purposes to control dissent. A reaction to the use of psychiatry as an apparatus of state violence against the individual was the work of N.G. Marcuse and F. Szasz, who created the antipsychiatric direction. Anti-psychiatrists believed that psychiatric diagnosis was a form of discrimination against individual freedom. They called for the opening of the doors of psychiatric hospitals to intensify the revolutionary process. Under the influence of anti-psychiatry, democratic laws on psychiatry were introduced in most countries of the world.
The psychiatric school of the USSR at that time was closest to the German school of psychopathology and was represented by two main groups of researchers: the Moscow group dealt with major psychoses, both endogenous and exogenous. Leningrad school - borderline mental disorders. The founder of the Moscow school can be considered M.O. Gurevich, which also included V.P. Osipov and V.A. Gilyarovsky, and Leningrad - V.M. Bekhterev. As a result of the “Pavlovian Session” of 1952, these schools were destroyed for political reasons due to accusations of “cosmopolitanism.” As a result, the new Moscow school subsequently turned out to be closely connected with the political system, and subsequently with discrimination against dissidents.
Nevertheless domestic psychiatry has its own original content and history, generally filled with humanistic content. The first manual on psychiatry and the use of the term “psychiatry”, proposed by the German physician Johann Reil (1803), was published in Russia by P.A. Bukhanovsky in 1834. It was called “Mental illnesses, presented in accordance with the principles of the present teaching of psychiatry in general, specific and practical presentation.” Probably it was P.A. Bukhanovsky (1801-1844) was also the founder of the nosological direction. In addition, he was the first in Russia to begin teaching psychiatry at Kharkov University from 1834 to 1844 at the department of surgery and mental illness. Subsequently, manuals on psychiatry in Russia were published by P.P. Malinovsky (1843). Later, in 1867 I.M. Balinsky created a separate department of psychiatry Military Medical Academy St. Petersburg, and in 1887 A.Ya. Kozhevnikov - Psychiatry Clinic at Moscow State University. In 1887 S.S. Korsakov described alcoholic psychosis with polyneuritis (Korsakov psychosis), which became one of the first nosological units in psychiatry. In the 20-30s of the XX century P.B. Gannushkin systematizes the dynamics of psychopathy, and V.M. Bekhterev introduces the concept of psychophysics of mass mental phenomena. These data were anticipated in his dissertation “Physical Factors of the Historical Process” (1917) by A.L. Chizhevsky when describing mental epidemics over 2000 years. A significant phenomenon was the publication of V.P.’s textbook in 1923. Osipova and neurogenetic research of the 30-40s S.N. Davidenkova. Clinical and analytical studies of thought disorders E.A. Shevalev in the 20-30s were superior to the best examples of world science of that time. Works by L.S. Vygotsky and A.R. Luria, and later V.V. Zeigarnik and E.Yu. Artemyeva allowed her to create an original Russian pathopsychology, which significantly influenced the diagnostic process in psychiatry. During the Second World War, research by M.O. Gurevich and A.S. Shmaryan clarified the connection between organic lesions and psychopathological disorders and created a “brain” psychiatry based on functional and organic morphology. In the Korsakov Clinic and the Kazan University Psychiatric Clinic in the late 40s - early 50s, some of the first psychosurgical operations for schizophrenia were carried out, in which A.N. took part. Kornetov. The founders of Russian child psychiatry are considered to be G.E. Sukharev and V.V. Kovalev, sexopathology - A.M. Svyadoshch and G.S. Vasilchenko, and psychotherapy - B.D. Karvasarsky.
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