All we have experienced a sudden fear or alarm: "Did I turn off the iron? Do I locate the door? " Sometimes, in a public place forced to take the handle or handrail, you try to wash as quickly as possible, clean your hands, not for a minute, not forgetting that they are "dirty". Or, amazing someone's sudden death from illness, listen for some time to your own state. This is normal, moreover, such thoughts do not become permanent and interfering to live. In the case of
when the opposite happens, and you are almost every day to return to the same frightening topic, moreover, invent the "ritual", which should help relieve the tension from the harassment of you, we are already talking about mental disorder that is called obsessive-compulsive name neurosis.
How to understand that you have a mental disorder
The obsessive ideas (obsessions) and forced as a result of this action (compulsion) themselves are not an obvious sign of the disease. They periodically appear in healthy people.
Painful manifestations of obsessive ideas are attributed in the case of involuntary occurrence, steadily recurring and causing suffering and anxiety. The patient, as a rule, is aware of the absurdity of his idea, trying to get rid of her. But all his efforts are useless, and the idea returns again and again. To reduce the likelihood that it is so worried, the patient comes up with protective actions, repeating them with pedantic accuracy, and results in temporary relief.
For example, a person is afraid to infect infection and therefore after each exit from
houses for a long time my hands washed, laundering them ten times. This he necessarily believes, and if he does, begins washing at first. Or, afraid that the door is closed badly, twelve twigs a handle. But, moving nearby, again worries about whether she is closed.
Who is subject to obsessive ideas syndrome
Obsessive ideas are constantly repeating, accompanied by a sense of fear, states with short-term satisfaction after the implementation of the "ritual" (often has absurd character). In addition, they are accompanied by fatigue, complexity in the concentration of attention, irritability and mood differences.
To this type of neurosis is equally predisposed and adults, and children, regardless of gender, social status and national affiliation. Long stresses, overwork, but sometimes syndrome occurs, and as a result of the injuries of the brain or its organic lesion. Children's mental injuries, cruelty from parents, and connivance, and hyperemp - all this can lead to neurosis
How to treat neurosis
The main thing, and the patients themselves, and their loved ones can not be dedicated to the idea that this disorder can be defeated by giving the order not to worry. In addition, the more active you try to control this process, the deeper it is rooted. The obsessive ideas are treated only by specialists!
Children and adults are a rather difficult process. It is necessary to take into account all the individual features of the disease, selecting and psychotherapeutic, and drug treatment. Only realizing that it was the cause of this disease, as it is manifested, and deraiding in the peculiarities of the nature of this person, you can choose safe and effective methods of help.
Obsessive disorders, first of all, obsessive fear, were described by other antiquity doctors. Hippocrates (V c. BC) led clinical illustrations of such manifestations.
Doctors and philosophers of antiquity attributed fear (phobos) to the four main "passions", from which diseases occur. Zeno Chinese (336-264 years BC) in his book "On Passions" defined fear as an expectation of evil. For fear, he also ranked horror, timidity, shame, shock, fright, torment. Horror, according to Zeno, there is fear that is a downstream. Shame - fear of dishonor. Movidity - Fear to make an action. Showing - Fear from unusual presentation. Scare - Fear from which the language is taken away. The torment is the fear of unclear. The main types were clinically described much later.
In the 1930s of the XVIII century, F. Lepe (F. Leuret) described the fear of space. In 1783, Moritz (Moritz) published observations of obsessive fear to get an apoplexy. In more detail, some types of obsessive disorders are given by F. Pinel in one of the sections of its classification called "Mania without Breda" (1818). B. Morel, considering these disorders with emotional pathological phenomena, indicated them the term "emotional nonsense" (1866).
R. Kraft-Egging in 1867 introduced the term "obsessive representations" (Zwangsvorstellungen) into circulation; In Russia, I. M. Balinsky proposed the concept of "obsessive states" (1858), which quickly entered the lexicon of domestic psychiatry. M. Faole-Son (1866) and Legrant Du Solly (1875) allocated painful states in the form of obsessive doubts with the fear of touching various subjects. Subsequently, descriptions of various obsessive disorders began to appear, for the designation of which various terms were introduced: IDEES Fixes (fixed, adopted ideas), obsessions (siege, obsession), Impulsions Conscientes (Conscious Increases) and others. French psychiatrists more often used the term "obsessions", the terms "Greenankasm", "Annincasts" were established in Germany (from Greek. Ananke - Goddess Rock, fate). Kurt Schneider believed that the anankascular psychopaths more often show the tendency to identify intrusion (1923).
The first scientific definition of the obsessions was given by Karl Westfal: "... under the name of obsessive, it should be implied by such ideas that appear in the content of the consciousness of the person against them against and contrary to his desire, with an independent intelligence in other ways and not being due to a special emotional or affective state; They cannot be eliminated, they impede the normal flow of ideas and violate it; Patient with constancy recognizes them for unhealthy, alien thoughts and resists them in their healthy consciousness; The content of these representations can be very complex, often, even mostly, it is meaningless, not in any obvious relationship with the previous state of consciousness, but even the sick itself it seems incomprehensible, as if coming to him from the air "(1877).
The essence of this definition, exhaustive, but quite cumbersome, was subsequently not subjected to fundamental treatment, although the discussion was considered the question of the absence of any significant role of affects and emotions in the occurrence of obsessive disorders. V. P. Osipov Just this thesis K. Westfal was not quite accurate, but still noted that the opinion of V. Grizinger and other competent scientists coincided with the opinion of K. Westfal. D. S. Ozerkivsky (1950), who studied this problem quite thoroughly, determined obsessive states as pathological thoughts, memories, doubts, fears, desires, actions that arise independently and desire for patients, and with a large constancy. Subsequently, A. B. Snezhnevsky (1983) gave a clearer designation of obsessions, or obsessive disorders.
The essence of the obsessions is a forced, violent, indispensable occurrence in sick thoughts, ideas, memories, doubts, aspirations, actions, actions, movements in the awareness of their pain, the presence of a critical attitude towards them and combat them.
In clinical practice, they are divided into those that are not related to affective experiences ("abstract", "distracted", "indifferent") and on affective, sensual painted (A. B. Snezhnevsky, 1983). In the first group of "neutral" with respect to the affect of obsessive disorders, often described frequently found phenomena of "obsessive wise". The author of their discharge is V. Grizinger (1845), which gave a special designation to such a phenomenon - Grubelsucht. The term "obsessive wiseness" (or "fruitlessness") V. Grizinger suggested one of his patients who constantly thought about various subjects who had no importance and believed that he was developing "the wise of a completely empty character." P. Jean (1903) called this disorder "mental chewing", and L. Du Solly - "Mental Zvumka" (1875).
V. P. Osipov (1923) brought vivid examples of this kind of obsessive disorders in the form of continuously emerging issues: "Why is the Earth turns in a certain direction, and not in the opposite? What would happen if she was driving in the opposite direction? Would people live or differently? Would they be different? What would they look like? Why is this scrap four-storey? If he had three floors, would there be the same people in it, would they belong to the same owner? Would he be the same color? Would he stand on the same street? " S. S. Korsakov (1901) refers to a clinical example, which led the leg du Solly.
"The patient, 24 years old, the famous artist, a musician, intelligent, very punctual, enjoys an excellent reputation. When she is on the street, she is pursued by this kind of thought: "Does anyone fall out of the window to my legs? Will this man or a woman? Does this man do not hurt, will not be killed to death? If he hurts, then hurt your head or legs? Will there be blood on the sidewalk? If he immediately kills to death, how do I find out? Should I call for help, or flee, or read a prayer, what prayer to read? Will you blame me in this misfortune, will my students leave me? Can I prove my innocence? " All these thoughts crowd master her mind and greatly worry her. She feels shifting. She would like someone to calm her encouraging word, but "while no one else suspects what happens to her". "
In some cases, such questions or doubts concern any very insignificant phenomena. So, the French psychiatrist J. Bajerge (1846) tells about one patient.
"He developed the need to ask about various details relating to the beautiful women with whom he met, at least quite by chance.This obsession was always. when the patient saw anywhere there was a beautiful lady, and not to do according to the need he could not; On the other hand, it was connected, understandable, with a lot of difficulties. Gradually, it was so hard that he could not calmly take a few steps on the street. Then he came up with such a way: he began to walk with his eyes closed, he drove him. If the sick will hear the rustling of a female dress, he now asks, is it beautiful to have met or not? Only by having received the answer that the opposite woman of Nekrasiv, the patient could calm down. So it went pretty good, but once at night he was driving along the railway, suddenly he remembered that, being at the station, he did not know whether the special was beautiful that sold tickets. Then he woke his companion, began to ask him, was it good or not? He, barely waking up, could not immediately figure out and said: "I do not remember." This was enough so that the patient was excited so much that it was necessary to send a trustee back to learn what was the appearance of the saleswomen, and the patient calmed down after he was informed that she was ugly. "
The described phenomena, as can be seen from examples, are determined by the appearance in patients, contrary to their desire, endless issues of random origin, these issues have no practical importance, they are often insoluble, follow one after another, there are intrusive, in addition to desire. According to F. Meses (1872), such obsessive questions penetrate the patient's consciousness like screwing the infinite screw.
The obsessive account, or arrhythmia, is an obsessive desire to accurately count and hold the number of past steps, the number of houses encountered on the road, pillars on the street, passers-by men or women, the number of cars, the desire to put their numbers and others. Some patients decompose on syllables Words and whole phrases, choose separate words for them with such a calculation so that it is an even or odd number of syllables.
Obsessive reproductions or remember are denoted by the term onomomatomia. This phenomenon was described by M. Sharko (1887) and V. Manyan (1897). Pathology with such disorders is expressed in an obsessive desire to recall completely unnecessary terms, the names of the heroes in artistic works. In other cases, there are obsessively reproduced and recall various words, definitions, comparisons.
One patient S. S. Korsakov (1901) sometimes among the night was to be looking for in old newspapers the name of the horse, which won the prize once, "so strong he had an obsessive thought associated with the names of names. He understood the absurdity of this, but did not calm down until I found the desired name.
Contrast representations and hard thoughts can also acquire obsessive character. At the same time, in the minds of patients there are ideas that opposite to their worldview, ethical settings. Against the will and desire of patients, they are imposed by thoughts on damage to close people. Persons of religious people arise the thoughts of cynical content, obsessively tied to religious ideas, they are contrary to their moral and religious installations. An example of the "abstract" obsessions of the irreal content can be the following clinical observation of S. I. Constorum (1936) and its co-authors.
"Patient G., 18 years old. The psychos in the family was not noted. The patient himself at the age of 3, having received a long-wing toy, unexpectedly hit her mother on his head. From 8 years - pronounced phobias: the fear of the death of loved ones, fears of certain streets, water, numbers, etc. At school brilliantly engaged in literature, poorly - by other subjects. In the pubertal period began to pursue peculiar thoughts and conditions: began to be afraid of fire (matches, kerosene lamp) from fear of burning, burn eyebrows, eyelashes. If I saw a cursory man on the street, my mood was spoiled for the whole day, I could no longer think about anything, seemed lost all the meaning of life. Recently, the patient's fire bothers less. After graduating from school, I was paining pleurrites, at that time it appeared when reading lying in fear - it seemed that the book was racing eyebrows. It seemed that eyebrows everywhere - on the pillow, in bed. It was very annoyed, spoiled the mood, threw in the heat, and it was impossible to get up. Behind the wall at this time, the kerosene lamp was burning, it seemed to him that he feels like a fever sinks, feels how eyelashes are burned, eyebrows. After discharge, I got an instructor in the magazine, but I was afraid to be in the sun, so as not to burn the eyebrows. The work was to him. It could easily cope with it if they did not interfere with obsessive thoughts on the shower of eyebrows on the book and paper. Gradually appeared other obsessions associated with concerns for their eyebrows. He began to be afraid to sit at the wall, because the eyebrow "can stick". He began to collect eyebrows from the tables, dresses and "waters them to place." Soon I was forced to leave work. Two months rested at home, I did not read, did not write. Kerosynok began to be afraid less. It felt good on vacation, but the thought of shuffling with eyebrows did not leave him. The table is to wash the time once a day to wash off "from the face and hand of eyebrows." Attach the eyebrows so that they do not crumble from drying out. When walking away from the station home 3 km, closing the eyebrow with my hands, so that the Kerosene lamp was not burned down. He himself considered it abnormal, but could not get rid of such fears. Soon again got a job, in the winter wearing a demi-season coat, as it seemed that in winter - eyebrows. Then I began to be afraid to enter the room, it seemed that on the tables - eyebrows, which would fly to him, which would make it. I was afraid to touch your hand to the folder. In the future, there was a fear of getting into the eye glass. Left work, at home basically lies, "fights with thoughts", but can not get rid of them. "
The obsessive doubts described by M. Falre (1866) and Ligrand du Sollem (1875) are close to obsessive fears. It is most often doubtful in the correctness of its actions, the correctness and completion of their actions. Patients doubt whether they locked the doors, whether the lights were put out, whether the windows were closed. Omitting a letter, the patient begins to doubt whether the address has written correctly. In such cases, multiple checks of their actions arise, while various ways are used to reduce the rechecked time.
In some cases, doubts arise in the form of obsessive performances in contrast. This is an uncertainty in the correctness of the actions performed with the tendency to act in the opposite direction, implemented on the basis of the internal conflict between equivally, but either unaccounted or incompatible desires, which is accompanied by an inseparable desire to free themselves from the unbearable tension situation. Unlike the obsessions of the re-control, under which the "alarm of the back" prevails, the obsessive doubts about the contrast are formed on the basis of relevant anxiety, they apply to events currently occurring. Doubts of contrasting content are formed as an isolated phenomenon out of connection with any other phobias (B. A. Voluel, 2002).
An example of obsessive doubts about the contrast consider, for example, the insoluability of the situation of the "love triangle", since the residence with the beloved accompany the ideas about the inviolability of a family structure, and, on the contrary, finding a family in a circle is accompanied by tremendous thoughts on the impossibility of parting with the object of affection.
S.A. Sukhanov (1905) gives an example from an obsessive doubt clinic, describing one gymnasium, who, having prepared her lessons for the next day, doubted whether he knew everything well; Then he started checking himself, repeating learned again, making it several times in the evening. Parents began to notice that he until the night was preparing for lessons. If the son was asked, he explained that he had no confidence that everything was done as it should, he all the time doubts himself. This was the cause of appeal to doctors and conducting special treatment.
The bright case of this kind described V. A. Gilyarovsky (1938). One of the patients observed by him, who suffered with obsessive doubts, was treated for three years at the same psychiatrist and at the end of this period, having come to his reception to another expensive, began to doubt whether he did not get to another doctor with the same name and name. To calm yourself, asked the doctor three times in a row to call his surname and confirm three times that he is his patient and what is treated with him.
Especially often in the most diverse form there are obsessive fears in practice, or phobias. If simple phobias, in Gofman (1922), is a purely passive experience of fear, then obsessive phobias are fear or generally negative emotion plus an active attempt to eliminate the latter. Obsessive fears most often have an affective component with elements of sensuality, the imagery of experiences.
Earlier, the other was described the fear of large open spaces, the fear of the square, or the "square" fear, according to E. Cordes (1871). Such patients are afraid to move wide streets, Square (), as they fear that at this moment something fatal, irreparable with them (fall under the car, will be bad, and no one can assist). At the same time, panic can develop, horror, unpleasant sensations in the body - heartbeat, cooling, numbness of the limbs, etc. A similar fear can also be developed when entering closed premises (claustrophobia), and in the thick of the crowd (anthropophobia). P. Jean (1903) proposed the term agoraphobia to designate all phobias of the position (agorable, claustor, anthropo- and transport phobias). All these types of obsessive phobias can lead to the emergence of the so-called, which occur suddenly, are characterized by a vital fear, most often the fear of death (tanatophobia), generalized by the alarm, sharp manifestations of vegetative psychosindrome with heartbeats, impaired heart rate, breathing difficulties (disposte) avoiding behavior.
Obsessive fears can be the most diverse on the fabul, content and manifestation. The varieties of them are so much that it is not possible to list everything. Almost every phenomenon of real life can cause relevant fear in patients. It is enough to say that phobic disorders are changed and "updated" with a change in historical periods, for example, even the phenomenon of modern life, as the overwhelming all countries of the fashion for the purchase of Barbie dolls, gave rise to fear of acquiring such a doll (barbifobia). All the most constant are quite common phobias. So, many people are afraid to be on an exalted place, they develop the fear of height (hypsophobia), others are afraid of loneliness (monophobia) or, on the contrary, finding people, the fear of performances in front of people (sociophobia), many are afraid of injuries, incurable disease, bacteria infection , viruses (nosophobia, carchaticophobia, speedophobia, bacteriophobia, virusophobia), any contamination (misophobia). There may be a fear of sudden death (tanatophobia), the fear of burials alive (tapfefobia), the fear of acute items (oxyphobia), the fear of adopting food (sithophobia), the fear of going crazy (Lispobia), fear of reddening with people (erethobia), described by V. M . Bekhterev (1897) "obsessive smile" (fears that a smile will appear on the face and insecurity). Also, an obsessive disorder, which consists in the fear of someone else's view, many patients suffer from fear not to keep gases in the society of other people (Pettoofobia). Finally, fear may turn out to be total, comprehensive (panfobius) or fear of fear (phobophobia) may develop.
Dysmorphophobia (E. Morselli, 1886) - Fear of bodily change with thoughts about imaginary external deformity. Typical frequent combination of the ideas of physical disadvantage with the ideas of relationships and a decrease in mood. There is a tendency to dissimulation, the desire to "correction" of a non-existent lack (, according to M. V. Korkina, 1969).
Obsessive actions. These disorders are manifested in different ways. In some cases, they are not accompanied by phobias, but sometimes they can develop with fears, then they are called rituals.
Indifferent obsessive actions - movements committed against desires, which cannot be kept in force (A. B. Snezhnevsky, 1983). In contrast to hypercines, which are involuntary, obsessive movements refer to the volitional, but the usual, it is difficult to get rid of them. Some people, for example, are constantly scolding their teeth, others touch their hand to face, the third makes the movement with the language or have a special way to be shrugged, the air exhausively exhale through the nostrils, rushes with fingers, shake up, squinting her eyes; Patients can repeat any word or phrase without need - "understand", "so to speak", etc. This includes some forms of teak. Sometimes patients develop generalized ticks with vocalization (Libil de la Tourette syndrome, 1885). For obsessive actions, many include some types of pathological habitual action (nail biting, pickling in the nose, licking of fingers or sucking them). However, they apply to obsessions only when they are accompanied by the experience of them as alien, painful, harmful. In other cases, these are pathological (bad) habits.
Rituals - obsessive movements, actions arising from the presence of phobias, obsessive doubts and having, first of all, the value of protection, a special spell that protects from trouble, danger, all of what patients are afraid of. For example, to prevent misfortune, patients with reading misses the thirteenth page, in order to avoid sudden death avoid black. Some are in the pocket "facing" their subjects. One patient before leaving the house should have clapped his hands three times, it "saved" from a possible misfortune on the street. Rituals are so diverse as various obsessive disorders in general. The fulfillment of an obsessive ritual (and the ritual is nothing more than obsession against obsession) facilitates the state for a while.
Obsessive attachments are characterized by the appearance, contrary to the desire of the patient, the desire to make any meaningless, sometimes even a dangerous action. Often, such disorders manifest themselves in young mothers in a strong desire to cause harm to their baby - to overeat or throw away from the window. In such cases, patients experience extremely strong emotional stress, the "wrestling of motives" brings them to despair. Some are horrified, representing what will happen if they fulfill what they are imposed. Obsessive attractions, in contrast to impulsive, are usually not performed.
So called a variety of thoughts, attractions, fears, doubts, submissions involuntarily invading the patient, who perfectly understands all their absurdness and at the same time can not fight with them. The obsessions as it were imposed by a person, to get rid of them with the effort of will, he cannot.
Obsessive thoughts can appear episodically in mentally healthy. They are often associated with overwork, sometimes arise after sleepless night and usually wear the character of obsessive memories (any melody, lines from poem, number, name, etc.).
The obsessive phenomena are conditionally divided into two groups:
- abstract, or affective-neutral, i.e., flowing without affective reactions of obsession - an obsessive account, fruitlessness, obsessive actions;
- fashionable, or sensual obsessions flowing with a pronounced affect - contrasting performances (consumer thoughts, obsessive feelings of antipathy to close people, obsessive desection), obsessive doubts, obsessive fears (phobias), etc.
Obsessive invoice It is an insurmountable desire to consider counter-colors of a certain color, passersby, glowing windows, own steps, etc.
Obsessive thoughts ( fruitlessness) Forcing a person to constantly think, for example, about what it would be if the land in the form turned out to be a cube, where in this case there would be south or north, or as it would be moved, if he had not two, and four legs .
Obsessive actions Expressed in involuntary, automatic execution of any movements. For example, while reading, a man mechanically screws a strand of hair strand or bites a pencil, or automatically eats one after another candy on the table.
Abstracted obsessions, especially obsessive actions, are often found not only in patients, but also in mentally completely healthy people.
Obsessive memories Manifest themselves in a constant involuntary memory of a unpleasant, compromising fact from the life of the patient. This update is always accompanied by negatively painted emotions.
Contrast obsessions Include, as already mentioned, hard thoughts, a sense of antipathy and obsessive attractions.
Hugging thoughts - These are intrusive, cynical, offensive ideas regarding certain persons, religious and politicians, other people, to which the patient actually belongs to greater respect or even a diet. For example, during the church service, a deeply religious person arises an insurmountable desire to shone insult to God or Angels. Or during the meeting of freshmen with the rector of the institute, one student arises an insurmountable desire to shout that the rector is a fool. This desire was so intense that a student, clinging to his mouth, bullet jumped out of the assembly hall. High thoughts are always accompanied by a pronounced affect, they are extremely painful for patients. It should be emphasized, however, that hard thoughts, like all contrast obsessions, are never implemented.
Obsessive feeling of antipathy It is that the patient besides his desire, there is a painful-irresistible feeling of acute dislike and hatred towards the closest and beloved people, for example, to a mother or their own child. These obsessions occur with a particularly pronounced affect of fear.
Obsessive desection They are expressed in the appearance of an acute desire in a patient, to hit the person respected by him, whipped her eyes to his boss, spit in her face the first oncoming, urinate in sight of everyone.
The patient always understands the absurdity and pain of these fluxes and is always actively struggling with their implementation. These obsessions proceed with severe fear and disturbing fears.
Obsessive doubts - An extremely unpleasant feeling that is experiencing a patient, doubting the completeness of this or that action. So, the doctor who wrote a patient a recipe, for a long time can not get rid of his doubt that he correctly indicated the dose in the recipe, whether this dose of death will not be fatal, etc. People with obsessive doubts, leaving the house, are repeatedly returned to check whether the gas or light is turned off, the crane is well closed in the bathroom, the door is tightly closed, etc. Despite numerous checks, the intensity of doubt is not reduced.
Mastering ideas - This is the adoption of implausible for reality in spite of consciousness. At the height of the development of seductive ideas, the critical attitude towards them and the awareness of their pain disappear, which brings such disorders with supersensual ideas or nonsense.
Obsessive fears (phobias) - The painful and extremely intensive experience of the feeling of fear of certain circumstances or phenomena during critical terms and attempts to deal with this feeling. Fobies are quite a lot. Most often found:
- Agorafobia is an obsessive fear of open spaces (squares, streets).
- Acrophobia (gypsophobia) - obsessive fear of height, depth. Algofobia - obsessive fear of pain.
- Anthropophobia - obsessive fear of contacts with people in general, regardless of gender or age.
- Astrophobia is an obsessive fear of thunder (zipper).
- Vertigophobia - obsessive fear of dizziness.
- Vomitophobia is an obsessive fear of vomiting.
- Heliophobia - obsessive fear of sunlight.
- Hematofobia - obsessive fear of blood.
- Hydrophobia - obsessive fear of water.
- Ginekofobia - obsessive fear of contacts with women.
- Dottofobia is an obsessive fear of dental doctors, dental chairs and tools.
- Zooofobia - obsessive fear of contacts with animals.
- Kaitofobia is obsessive fear of the setting.
- Claustrophobia - obsessive fear of closed spaces, premises (apartment, elevator, etc.).
- Xenososophobia - obsessive fear of someone else's view.
- Mizophobia - obsessive fear of pollution.
- Non-necrofobiya is obsessive fear of dead, corpses.
- NOFUBIA - obsessing the fear of darkness.
- Nosophobia - obsessive fear of getting sidewood (speedophobia - fear of falling AIDS, cardiophobia - fear of any cardiovascular disease, carcurtobia - fear of becoming an oncological disease, syphilophobia - the fear of sifilis sifilis, physiophobia - the fear of sifting the tuberculosis of the lungs, including CHAKHOTKA).
- Oxyfobia - obsessive fear of acute items.
- Perophobia - obsessive fear of priests.
- Pettopobia - obsessive fear of society.
- Citophobia (octopobia) - obsessive fear of food intake.
- Siderodromophobia - obsessive fear of driving in the train.
- Tanatophobia - obsessive fear of death.
- Tricyidekfobia - obsessive fear of the number 13.
- Tafefobia - obsessive fear of being buried alive.
- Urofobia is an obsessive fear of an inseparable urination to urination.
- Phobophobia is an obsessive fear of fear in a person who ever experienced an episode of obsessive fear is the fear of repetition of phobia.
- Chromatophobia - obsessive fear of bright colors. There are many other, less well-known phobias (all of their more than 350 species).
Phobias are always accompanied by severe vegetative reactions up to the occurrence of panic states. At the same time, at a height of fear, it may be a critical attitude towards phobias for a while, which complicates the differential diagnosis of intrusiveness from delusional ideas.
Patient I., 34 years old, which suffers from an irritable colon syndrome (psychogenic diarrhea + psychogenic pain in the colon), suspected long time that his problems with the chair were due to colon cancer (carchaticophobia) or syphilitic lesion (syphilophobia), or AIDS (Speedofobia ). Regarding suspects, diseases were repeatedly examined in the relevant medical institutions, despite the negative results of analyzes, did not believe the doctors. He was treated in clairvoyant, signs, who willingly confirmed his suspicions while he was able to pay. Having hit to the sanatorium compartment of the psychiatric hospital, he asked every day that the medicine was gained into a one-time syringe in his presence, as she was panicked to infect AIDS through the syringe.
Rituals - obsessive actions that the patient consciously produces both the necessary protection (a kind of spell) from the dominant obsession. These actions that have the value of the spell are manufactured, despite the critical attitude to the obsessions, in order to protect against one or another impaired misfortune.
For example, with agorophobia, the patient before going out of the house makes some kind of action - in a certain order, it shifts the book on the table or turns around the axis several times, or makes several jumps. When reading, a person regularly misses the tenth page, for this is the age of his child, the passing of the corresponding page "protects" the child from diseases and death.
Rituals can be expressed in the reproduction of patients with loud, whisper or even mentally any melody, a well-known saying or poem, etc. It is characteristic that after the commission of such a mandatory rite (ritual) there comes relative peace of mind, and the patient can overcome the dominant obsession for a while. In other words, a ritual is a secondary obsession, consciously generated by patients as a method of combating the main obsessions. Since rituals are in their content by obsessive action, the patient is usually unable to overcome the need for its commit. Sometimes rituals acquire the character of making (phenomena of mental automatism) or catatonic stereotypes.
The obsessive states cannot be attributed only to the pathology of thinking, since they, especially under the figurative obscenes, are significantly expressed and emotional disorders in the form of fear and disturbing fears. In this regard, we remember that at one time another S.S. Korsakov, and before him Z. Lumeral, argued that with obsessive states suffers from both intellectual and emotional sphere.
The obsessive states differ from the ultra-subject and delusional ideas by the fact that the patient critically refers to their obsessions, regarding them as something alien to his personality. In addition, it is extremely important, he is always trying to fight his obsessions.
Obsessive ideas can sometimes grow into delusional ideas or at least to be the source of the latter (V.P. Osipov). In contrast, non-perisability is usually needed, episodically occur, as if attacks.
The obsessive states are often found in neurosis (especially in neurosis of obsessive states), psychopathy of the braking circle, affective disorders (mainly during depression) and in some psychosis (for example, in neurotic schizophrenia).
A. Durer "Melancholia"
The ratio of spiritual ailments and mental illness is one of the problems that constantly have to face church life as a clergy and worldly representatives of the clearing. But most often it is the priest that turns out to be the first to whom he appeals for the help of a person with mental disorders.
Three Limes.
At the beginning of the year, a wave of publications about the series of suicide among adolescents took place in the media. At about the same time, a priest turned to me with a request to advise his spiritual daughter, a teenage girl, who more than once in conversations with the confessor mentioned suicide. At the reception of Masha (the name changed) came along with mom arriving in bewilderment, why the priest sent her daughter to a psychiatrist. No change in a state of the daughter's family members did not notice. Masha successfully finished school and prepared for admission to the university. During our conversation, she not only confirmed the presence of suicidal thoughts, but also told that he opened the window several times to throw out of it. Masha skillfully hid his condition from relatives and close and only the spiritual father was talking about personal experiences. The father attached a lot of effort to persuade the girl to go to the psychiatrist. Masha had severe depression demanding hospitalization. If it were not for the efforts of the priest, she would surely replenish the list of adolescents who committed with them and left their relatives and closeness in confusion and despair.
At about the same time, the "ambulance" received a challenge from one Moscow temple. "Emergency" to the young man called the priest. A young man with the aim of "spiritual improvement" completely refused meals and drank only water. In a state of extreme exhaustion, he was taken to the hospital, where for ten days was in resuscitation. It is noteworthy that parents saw his condition, but did not take any measures. In both cases, the girl and the young man remained alive only due to the fact that the priests recognized their mental disorder.
The third, tragic, the case was also in Moscow. The priest on incompetence forbade the young man to take medicine to him for help, although he suffered a schizophrenic attack to him several years ago. Two weeks later, the sick committed suicide.
The prevalence of mental diseases and disorders in our society is quite high. Thus, about 15.5% of the population suffers from mental disorders, while about 7.5% need psychiatric care. In a large extent, alcoholism and drug addiction affect this statistics. For suicide, our country ranks second in the world (23.5 cases per 100,000 population). According to official data, from 1980 to 2010, about a million Russian citizens ended up with them, which indicates a deep spiritual crisis of our society 1.
It is not surprising that people suffering from mental disorders appeal for help in church more often than somewhere else. On the one hand, most of them only in the temple acquires spiritual support, meaning and purpose in life. And on the other, which is equally important, many spiritual disorders during the exacerbation period have religious color. Also, as noted by the doctor of medical sciences prot. Sergiy Filimonov, "Today, the church does not come by a goodwill knowledge of God, but mainly to solve the issue of exiting crisis life situations, including those related to the development of mental illness or close relatives" 2.
New subject in the preparation of clergy
Today, in many dioceses, there has been a serious experience of cooperation between psychiatrists and priests, which began in the early 90s. Then, on the blessing of the confessor, the Trinity-Sergiye Lavra Archimandrite Kirill (Pavlova) in the Moscow spiritual seminary began classes on pastoral psychiatry under the guidance of the governor of the Lavra Archimandrite Feoganote (now Archbishop Sergiev-Posadsky). Father Feoganost teaches pastoral theology, the structure of which the cycle on pastoral psychiatry was included. In the future, the course "Pastoral Psychiatry" at the Department of Pastoral Theology (since 2010 - the Department of Practical Theology) appeared in the PSTU at the initiative of the Archpriest Vladimir Vorobyeva and in the Sreten Sector Seminary on the initiative of Archimandrite Tikhon (Shevkunova).
The first hospital church with a psychiatric clinic was consecrated on October 30, 1992 Holy Patriarch of Moscow and All Russia Alexy II in honor of the icon of the Mother of the Healer in the Scientific Center of Mental Health of the RAM. Then, speaking to psychiatrists, His Holiness Patriarch said: "A difficult and responsible mission of ministry is entrusted to psychiatrists and scientists entrusted to their care for human souls. The psychiatrist ministry is in a true sense of art and the feat of the Savior's Savior. Who came to the world of poisoned by the human sin of being in order to help those who need help, support and consolation. "
For the first time, a special leadership for psychiatry priests on the basis of the concept of a holistic Christian understanding of the human personality developed one of the recognized authorities of the national psychiatry, the son of the priest Ryazan province Professor Dmitry Evgenievich Melekhov (1899-1979). His concept of the course "Persian Psychiatry" for students of spiritual academies and seminary, he wrote in Soviet times. And although he failed to complete the book "Psychiatry and spiritual life issues" 3, Melekhov formulated the basic principles of a psychiatrist doctor and a priest in the treatment and cursing suffering from mental illness. This work came out in the typewriting edition shortly after the author's death. In the future, it entered the desktop of the clergy, and later the composition of numerous collections.
One of the central problems of this book is the problem of relations in a person of bodily, mental and spiritual and, accordingly, the ratio of spiritual and spiritual diseases. Known in the years of Melekhov's reaches of Georgy (Lavrov), hung in the Danilovsky Monastery, clearly distinguished two groups of these diseases. One he said: "You, kid, go to the doctor," and others: "Doctors have nothing to do." There were cases when an old man, helping a person to set up his spiritual life, recommended him to go to the psychiatrist. Or, on the contrary, he took people from a psychiatrist to her spiritual treatment.
In the book "Psychiatry and the issues of spiritual life" Melekhov proceeded from the patristic trichotomous understanding of the human person with the division of it into three spheres: bodily, mental and spiritual. In accordance with this, the spiritual sphere disease treats a priest, a mental psychiatrist, a physician, a somatologist (therapist, neurologist, etc.). At the same time, as the Metropolitan of Anthony (Blum) noted, "it is impossible to say that the spiritual soul ends somewhere and the spiritual one begins: there is some kind of area where mutual penetration is performed in the most normal way" 4.
All three spheres of human personality are closely interrelated with each other. A physical disease often affects spiritual and spiritual life. This was still in the IV century, St. John Zlatoust wrote: "And the body of God created according to the nobility of the soul and able to fulfill her velarias; created not just somehow, but what he needed to be a reasonable soul, so if it were There was no such thing, the actions of the soul would meet strong obstacles. It can be seen during diseases: when the state of the body is at least a little controversial from the proper device, for example, if the brain is done hot or colder, then many of the mental actions stop "5.
At the same time, some fundamental questions arise: can a person suffering from a severe physical disease, be mentally and spiritually healthy? The answer here is unequivocal. Such examples we know not only from the lives of saints and from the feats of new martyrs, but also among our contemporaries. The second question is: Can a person spiritually ill be formally mentally and physically healthy? Yes maybe.
The third question: Can a person suffering from a serious mental illness, including severe forms of depression and schizophrenia, have a normal spiritual life and achieve holiness? Yes maybe. Rector of PSTGU prot. Vladimir Vorobiev writes that "the priest must explain to the person that the soul's disease is not a shame, this is not at all a state-crossed state. This is a cross. For him, neither the kingdom of God, nor a graceful life is not closed for him. SVT. Ignatius (Bryanchaninov) brought concrete examples, "St. Nifon Bishop for four years suffered by noise, SVV. Isaac and Nikita for a long time suffered by breathtaking. Some sv. The destroyer who has noticed the pride in himself, praying God, so that there was a breathtaking and explicit restlessness. Which and the Lord of the humility of the servant of his "7.
The ratio of the church to the problem of the ratio of spiritual and mental diseases is clearly formulated in the basics of social concept (XI.5.): "Highlighting spiritual, spiritual and body levels in the personal structure, the holy fathers distinguished diseases developed" from nature ", and ailment, caused by the demonic effects or caused by the consequences of the involvement of human passions. In accordance with this, discrimination seems to be equally unjustified as the formulation of all mental illness towards the manifestations of obsession, which entails the unreasonable commission of the expulsion of evil spirits and an attempt to treat any spiritual disorders exclusively by clinical methods. In The field of psychotherapy turns out to be the most fruitful combination of pastoral and medical assistance to the mentally ill with proper distinction of the competence of the doctor and the priest. "
On the ratio of spiritual and mental states
Unfortunately, attention is drawn to the high prevalence of the commission of "Exile of evil spirits" in modern church practice. Some priests, without conducting differentiation between spiritual ailments and mental illness, send patients with severe genetically determined mental illness to the commission of "follow-up". Back in 1997, the Patriarch of Alexy II at the Diocesan Assembly of the clergy of Moscow condemned the practice of the "countless" practice.
There are a number of states that externally have similar manifestations, but relate to spiritual or mental life and have, respectively, fundamentally different nature. Let us dwell on the ratios of some of them: sadness, despondency and depression; Obsession and nonsense "imagingness"; "Charm", manic and depressive-delusional states.
Among spiritual states, sadness allocate sadness. When sorrowing, the decline of the spirit, impotence, mental severity and pain, exhaustion, sorrow, shy, despair are noted. As its main reason, the holy fathers note deprivation of the desired (in the broad sense of the word), as well as anger, effects of demons 8. It should be noted that Rev. John Cassian Romans, along with this, highlights the "unreasonable sadness" - "unreasonable grief of the heart" 9.
Depression (from Latin depressio - suppression, oppression) is no longer spiritual, but spiritual disorder. In accordance with modern classifications, it is a state of main manifestations of which is a sustainable (at least two weeks) sad, sad, depressed mood. With longing, despondency, loss of interests, decrease in working capacity, increased fatigue, reduced by self-esteem, pessimistic perception of the future. As well as with the loss of the need for communication and breakdown, a decrease in appetite up to its complete absence, difficulties of concentration and understanding. In addition, when depressed, it is often an unreasonable self-seater or an excessive sense of guilt, repetitive thoughts about death.
People believers in the state of depression will experience a feeling of emptiness, the loss of faith, the appearance of "petitioned inaccuracy", "cold heart", talk about its exceptional sinfulness, spiritual death, complaining that they cannot pray, read spiritual literature. In severe depression, suicidal thoughts are often noted. People believers usually say that they cannot commit suicide, because they are waiting for hell. But, as practice shows - and it is necessary to pay attention to, they also commit suicide, although a little less often, since spiritual suffering are the most severe and not all capable of bringing them out.
Among the depressed, they allocate reactive, arising after psychotrambulating situations (for example, after the death of a loved one), and endogenous ("unfortunate sadness"), which are caused by genetically. Particularly often depressed in people of old age, among which they are celebrated in more than half of the cases. Often, depression acquire a protracted and chronic course (more than two years). According to WHO, by 2020, depression will be released in the first place in the structure of morbidity and will be observed in 60% of the population, and serious depression death rate, often leading to suicides, will be released in second place among other reasons. The reason for this is the loss of traditional religious and family values.
Among spiritual states are emitted demonatherism. Here are two examples illustrating this condition. The first of them is associated with the Bishop Stefan (Nikitin; † 1963), which is still to ordain in the sacred san in the camp, being a doctor, wore the holy gifts. Once he, as a doctor asked to advise the daughter of the head of the camp. When he came to her, she suddenly began to rush around the room and shout to remove the shrine, the doctors were asked to leave. Another example of the life of Archbishop Meliton (Solovyov; † 1986). It refers to the end of the 1920s. One day he is late in the evening, almost at night, endured from one apartment to another portrait of St. John Kronstadt. He was going to meet a man who became unexpectedly shouting and call the name of John Kronstadt. That is, the leading criterion for determining demon-containingness, as many shepherds note, is the reaction to the shrine.
At the same time, soul diseases include schizophrenic psychosis, when often along with a diverse delusional theme of the patient considers itself a lord of the world or the Universe, a Messiah, designed to save Russia or all of humanity from world evil, the economic crisis, etc. There are also delusional disorders when the patient is convinced that demons were settled in him, Shaitans (depending on which culture it belongs to). In these cases, ideas of imperatability, as well as the ideas of messianic content are only the subject of delusional experiences of the patient with severe mental illness.
For example, one of the patients in the first psychotic attack he considered himself a Cheburashka and heard the voice of the crocodile genes (auditory hallucinations) in his head, and in the next attack he said that the dark forces (nonsenselessness) were settled in him and they also belong to them. That is, in one case, the subject of delusional experiences was associated with a children's cartoon, in the other there was a religious subtext. Both attacks were equally successfully treated with antipsychotic drugs.
We had to face situations when priests qualified auditory hallucinations as the impact of demonic forces and were not recommended to treat physicians. Although these patients were regularly communioned, no changes in their mental status occurred, which should have been noted during imperativeness.
The spiritual states include the state of "charms", the most important manifestation of which is the revaluation by the person of his personality and the intensive search for various "spiritual gifts". However, this symptom, along with a sense of patients with tide of strength, energy, a special spiritual state, psychomotor excitation, disorder of impulses, reduce the duration of night sleep, is one of the manifestations of maniacal states. There are other states when a person begins to "engage in its spiritual growth" very actively "and ceases to listen to his ads.
Some time ago, the parents of one girl turned to me, which came to faith for about a year before, but the last two months her spiritual life became very intense. She lost weight so much that there was a real threat to her life in connection with the dystrophy of the internal organs. About two o'clock she was praying in the morning, about three in the evening, in the afternoon about two hours he read the cafes and individual places from the Gospel and the messages of the apostles. She communched every Sunday, and before that, every Saturday defended many hours to confession in one of the monasteries. She came to confession with numerous sheets. In the temple she repeatedly became bad and had to call "ambulance". The words of the confessor that she is not a nun-Schemnica that she is not supposed to fulfill such prayer rules, she did not hear. She also did not hear the requests of their elderly parents. They asked at least sometimes to go to the temple near the house, as they are physically hard with her all weekends in the monastery, and they can not let it go. She stopped cope with work and communicate with his colleagues. She did not consider himself a patient, while negatively responded about the priests who tried to limit her prayer "feats". Under the pressure of the parents, she passively agreed to take medicines, against whom she gradually recovered appetite and ability to work. The prayer rule (what the confessor insisted) decreased to reading the morning and evening prayers and one chapter from the Gospel.
It is clear that neither one of the monasteries no need nor nor the elder would bless a young obedient for similar "feats." No one canceled the old monastic rule: when you see your brother, sharply rising upstairs, drink it down. When a person perceives himself with a "great specialist" in spiritual life and hears his confessor, it is customary to talk about the condition of charms. But in this case it was not charm, but a mental illness, which acquired religious color.
Obsessive states and their forms
When discussing the topic of the ratio of spiritual and mental illness, it is necessary to dwell on the problem of obsessive states (obsessions). They are characterized by the emergence of patient involuntary, usually unpleasant and painful thoughts, ideas, memories, fears, deposits, in relation to which the critical attitude and the desire to resist them. There are motor intrusiveness when a person repeats some movements. For example, it returns several times to the locked door, checks, it is locked or not. In mental illness, it happens that the patient makes bows and knocks his forehead about the floor (it also happened with Orthodox, and with Muslims). In addition, the so-called contrast obsessions are distinguished when a person appears an inevitable desire to reset someone under the train in the subway, a woman has a desire to hit her child with a knife.
For a patient, a completely alien is such a thought, he perfectly understands that it is impossible to do this, but this thought is undiscovered. Also, the contrasting obsessions include so-called hardware when a person appears as if Hula on the Holy Spirit, Mother, on the Saints. Such a state was at one of my patients at the depression stage after a schizophrenic attack. For him, an Orthodox person, great thoughts were especially painful. He went to the priest to confession, but he refused to confess, saying that he would say goodbye to a person, except for Hula on the Holy Spirit (Wed: Mf. 12, 31). What could he do? He attempted suicide. After the psychopharmacotherapy, the mentioned psychopathological disorders were stopped and did not repeat in the future.
conclusions
The above-mentioned states, states with non-moderateness, with obsessions, with maniacal and depressive-delusious states, as a whole, react to psychopharmacotherapy, which indicates a biological basis of these states. This also noted Metropolitan Anthony (Surozhsky), which wrote that "mental states largely depend on what is physiologically from the point of view of physics, chemistry in our brain and in our nervous system. Therefore, every time a person is sick of mentally, It is impossible to attribute evil, sin or demon. Very often it is caused by some kind of damage in the nervous system than the infirmity of the demonic or the result of such a sin that a person has touched from any connection with God. And here medicine is in their rights and maybe very Much to make "10.
Many classics of psychiatry and modern researchers noted that the Christian perception of life makes a person sustainable for various stressful situations. Very clear this thought formulated Viktor Frankl, the founder of the theory of logotherapy and existential analysis: "Religion gives a man the spiritual anchor of salvation with such a sense of confidence that he cannot find anywhere else" 11.
The complexity of the distinction of mental and spiritual diseases is acute the question of the need for compulsory inclusion in the training program for future priests in all higher educational institutions of the Russian Orthodox Church of the course of pastoral psychiatry, as well as special courses on psychiatry in the preparation of social workers. The need for this knowledge for each shepherd wrote in his leadership "Orthodox Pastoral Service" still Professor Archimandrite Cyprian (Kern), dedicated to the issues of pastoral psychiatry special chapter. He strongly recommended that every priest read one or two books on psychopathology, "so that the okul is not condemned in a person as a sin that in itself there is only the tragic curvature of mental life, a mystery, not a sin, the mysterious depth of the soul, and not moral spoilness" 12 .
The task of the priest when identifying signs of mental illness, to help him critically comprehend the state, to encourage a doctor, and in cases of need for systematic reception of drug therapy. There are already many cases when patients only thanks to the authority of the priest, according to his blessing, they accept supporting therapy and are in a stable state for a long time. As practice shows, further improvement of psychiatric assistance is possible only with close cooperation of psychiatrists with priests and with a clear distinction of competence.
Notes:
1. Data Scientific Center for Mental Health Ramna.
2. Filimonov S., Prot., Vaganov A.A. 0 There are hearts of mentally ill at the parish // Church and medicine. 2009. No. 3. P. 47-51.
3. Melekhov D.E. Psychiatry and the problems of spiritual life // Psychiatry and actual problems of spiritual life. M., 1997. P. 8-61.
4. Anthony (Blum), Miter. Body and matter in spiritual life / lane. from English By ed.: Body and Matter in Spiritual Life. Sacrament and image: Essays in the Christian Understanding of Man. ED. A.M. Allchin. London: Felship of S.Alban and S.sergius, 1967. http://www.practica.ru/ma/16.htm.
5. John Zlatoust, SVT. Conversations about statues, spoken to the Antioch people. An eleventh conversation // http://www.ccel.org/contrib/en/zlat21/statues11.htm.
6. Vorobyov V., Prot. Repentance, confession, spiritual guide. P. 52.
7. Ignatius (Bryanchaninov), SVT. Selected letters for monastite. Letter No. 168 //
http://azbyka.ru/tserkov/duhovnaya_zhizn/osnovy/lozinskiy_pisma_ignatiya_pisma_ignova_170-all.shtml.
8. Larsch J.-k. Healing of mental illness (the experience of the Christian East of the first centuries).
M.: Publishing House of the Sretensky Monastery, 2007. p.223.
9. John Cassian Roman, PrP. Interviews of Egyptian devotees. 5.11.
10. Anthony Surozhsky, Mitre. Stages. About soul and bodily disease // http://lib.eparhia-saratov.ru/books/01a/antony/steps/9.html.
11. Frank BB Psychotherapy and religion. M.: Progress, 1990. P. 334.
12. Cyprian (Kern), Archim. Orthodox pastoral ministry. Paris, 1957. p.255
Hugging thoughts
A kind of contrasting obsessive states; It is characteristic of the indecent cynical content, the inconsistency of the situation.
. V. M. Blaikher, I. V. Kruk. 1995 .
Watch what is "hard thoughts" in other dictionaries:
Hugging thoughts - - Contrast obsessive views. See obsessive phenomena ...
Thoughts contrary to the moral to the ethical properties of the person, the ideas of the patient about ideals, the worldview, attitude to close, etc. By virtue of this, extremely experienced, deprimate the patient ... Explanatory Dictionary of Psychiatric Terms
thoughts are great - obsessive thoughts representing in their maintenance abuse of the patient's ideals (his worldview, attitude to close, religious ideas, etc.) and painfully experienced them ... Big Medical Dictionary
Thoughts of contrast - The phenomenon of obsessive thinking in the form of the appearance of blasphemous, offensive or obscene thoughts when perceiving or memories of objects representing a special personal value for the individual. Synonym: Higher thoughts ... Encyclopedic Dictionary of Psychology and Pedagogy
Obsessive states - (Synonym: obsessions, pineapple, obsession) involuntary occurrence of insurmountable alien sick thoughts (usually unpleasant), ideas, memories, doubts, fears, aspirations, deposits, actions while preserving critical to them ... ... Medical encyclopedia
Obsession - Felix Planer Scientist, first described obsessions ... Wikipedia
Sin - This term has other meanings, see sin (values) ... Wikipedia
Obsessive ideas - - insurmountable thoughts and figurative, most often visual representations of inadequate, "crazy", often contrasting, contradictory reality and common sense of content. For example, the patient is bright and terrifying details ... ... Encyclopedic Dictionary of Psychology and Pedagogy
SECOND COMING - [Greek. παρουσία arrival, arrival, coming, presence], the return of Jesus Christ to Earth at the end of times when the world in his current state will cease to exist. In the New Testament texts, it is referred to as "phenomenon" or "Coming" ... ... Orthodox encyclopedia
Gennady Gonzov - (Gonozov) Saint, Archbishop Novgorod and Pskovsky. About his life until 1472 was not preserved almost no news; Apparently, he took place from the boyars (the power book calls him "sankovyt") and owned the patrimons (by ... ... Large biographical encyclopedia
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