) are diseases in which symptoms of various bodily diseases caused by psychological causes and mechanisms are revealed.
Psychosomatic symptoms can accompany many psychological problems and illnesses, for example, weakness in depression, or rapid heartbeat in anxiety. But there are also disorders that manifest themselves predominantly as bodily symptoms, in which mental problems, mental experiences and conflicts are veiledly expressed.
Main psychosomatic disorders by organ system:
The cardiovascular system: coronary artery disease (CAD), hypertension, vasomotor (vasodepressive) syncope, cardiac arrhythmias, psychogenic cardiac complaints in persons not suffering from heart disease.
Respiratory system: psychogenic cough and shortness of breath, bronchial asthma, hay fever, hyperventilation syndrome, neurotic respiratory syndrome (Da Costa Syndrome).
Digestive system: functional disorders (appetite disorders, psychogenic nausea and vomiting, functional constipation and diarrhea, abdominal pain, functional disorders of intestinal tone and motility, cancerophobia), peptic ulcer, ulcerative colitis.
Diseases of the musculoskeletal tract: musculoskeletal pain, low back pain, rheumatoid arthritis, fibromyalgia.
Pseudoneurological disorders: mental hyperesthesia and headache, thymopathic dizziness, psychogenic neuralgia, restless legs syndrome, tic, insomnia of inorganic nature.
Skin diseases: itching, redness, burns, sweating, urticaria, alopecia, psoriasis, eczema, neurodermatitis, acne.
In addition, psychosomatic disorders may include many immune diseases, as well as other symptoms.
Mechanisms of occurrence
Psychosomatic diseases according to the mechanisms of their occurrence can be classified into three groups:
- Symptoms (such as headache or arm muscle paralysis) that are a reflection of psychological conflict(for example, between a desire and a prohibition on its satisfaction), when psychological tension is displaced into the body. This includes many hysterical symptoms.
- Symptoms that occur in order to divert a person's attention from difficult feelings and conflicts relationship related. A person switches attention to the body, and thus can evoke sympathy from others and often satisfy his needs. This includes hypochondria (preoccupation with or presence of a non-existent disease or, conversely, a healthy lifestyle due to fear of getting sick). This may include various pains, which are a displacement of hatred that arises in interpersonal relationships onto the body.
- Symptoms that reflect deficits in psychological forms of expressing needs. Needs are expressed, like a baby's, through the body, and emotions are also expressed through bodily pains and symptoms. This includes classic psychosomatosis (for example, the so-called Chicago seven diseases: bronchial asthma, ulcerative colitis, essential hypertension, neurodermatitis, rheumatoid arthritis, duodenal ulcer, thyrotoxicosis).
Features of mental activity
Psychosomatic clients are characterized by specific features of mental activity. Psychotherapeutic treatment should be aimed at correcting these patterns of thinking, emotional response and behavior in the client in order to reduce or eliminate psychosomatic symptoms.
- The thinking of a psychosomatic client is not connected with feelings, consists of cliches, learned instructions, is not free, and has little connection with fantasy. P. Marty called this thinking operator-like, like that of a computer or a robot. In psychotherapy, operator thinking gradually goes away, a person accepts more of his individuality and more mental freedom appears.
- The emotions of a psychosomatic client, as a rule, are not realized by him, there are no words for them, a person cannot say anything about them. Sifneos called this phenomenon alexithymia (no words for feelings). If something happens in a psychosomatic client’s life that would usually cause sadness or depression, then he does not feel it, but rather complains about a drop in vitality, energy, loss of pleasure from life, etc. In psychotherapy, a person develops the ability to understand his feelings and emotions, which brings greater richness and inclusion to life.
- The behavior of a psychosomatic client is characterized by acting out, a person will do a lot, act and thereby relieve his stress - this is his only way to cope with the excitement brought by life, a way that can protect him from illness. In psychotherapy, a person develops the ability not only to act, but also to think and feel, which makes him mentally richer and relieves his body of stress and symptoms.
Psychotherapy helps a person understand the reasons that led to the disease, as well as resolve those conflicts that support the disease and develop mental functions (thinking, understanding emotions) that relieve the body of tension.
Treatment of psychosomatic diseases
Some psychosomatic symptoms, for example, hysterical ones, need to be treated only by a psychotherapist. People often turn to general practitioners, surgeons, and neurologists for help, but in the case of the psychosomatic nature of the symptom, treatment does not help, and the disease takes a protracted course. Also, self-medication or treatment from psychics is not effective.
Psychosomatosis, that is, more severe diseases (for example, bronchial asthma, ulcers, etc.) must be treated with a combination of standard medical treatment and psychotherapy. A person’s diseased organ (stomach, lungs, heart, etc.) is treated by a general practitioner, and the psyche, which affects the course of the disease, is treated by a psychotherapist specially trained for such treatment.
Psychotherapy helps to get rid of operator thinking, develop an understanding of one’s feelings and emotions that are hidden behind psychosomatic symptoms, develop the ability to think and feel, and then act, which generally improves the quality of life and reduces the severity of symptoms.
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Psychosomatics(from the Greek psyche - soul and soma - body) - a section of medical psychology that studies mental factors in the development of functional and organic somatic disorders.
Psychosomatic medicine gained rapid spread and development at the beginning of the 20th century. At this time, millions of cases were recorded of so-called “functional” patients, “difficult patients”, whose somatic complaints were not confirmed by objective research, and whose treatment with orthodox medications was ineffective. First of all, it was necessary to correct affective states that affected the interpersonal relationships of patients, that is, psychotherapy, psychological counseling.
Among changes in somatic well-being due to emotional influence, one should distinguish between non-pathological psychosomatic reactions, psychosomatic diseases, the influence of the emotional state on the occurrence and course of somatic diseases, and somatoform mental disorders.
In the International Classification of Diseases, 10th edition, the term “psychosomatic” is not used in relation to any diseases, so as not to create the impression that psychosomatic relationships may not be significant in other disorders.
The psychosomatic approach as a principle of therapeutic activity presupposes a holistic perception of the sick person, with all his personal characteristics, cultural norms and values, biological hereditary and constitutional characteristics, environmental influences and interpersonal relationships. At the end of the 20th – beginning of the 21st centuries, the biopsychosocial concept of disease, which is based on the principles of multifactoriality in understanding the causes of the onset and course of the disease, is becoming increasingly recognized in medicine. Thus, the psychosomatic approach is practically generally acceptable today.
Psychosomatic diseases arise as a result of stress caused by long-term and insurmountable psychotraumas, internal conflict between the individual’s motives of equal intensity, but differently directed. It is assumed that some types of motivational conflicts are specific to certain forms of psychosomatic diseases. Thus, hypertension is associated with the presence of a conflict between high social control of behavior and the individual’s unfulfilled need for power. An unfulfilled need causes aggressiveness, which a person cannot demonstrate through social attitudes. Moreover, unlike neuroses, which are also based on intrapsychic conflict, with psychosomatic diseases there is a double repression - not only of a motive unacceptable to consciousness, but also of neurotic anxiety and all neurotic behavior.
There is a close system of somatopsychic and psychosomatic relationships that must be recognized and taken into account in the treatment of the patient. When considering the relationship between somatic and mental states, it is advisable to distinguish the following types:
1. Psychological factors as the cause of somatic illness (actually psychosomatic illnesses).
2. Mental disorders manifested by somatic symptoms (somatoform disorders).
3 Mental consequences of somatic illness (including psychological reaction to the fact of somatic illness).
4 Mental disorder and physical illness, coincidentally coincidental in time.
5. Somatic complications of mental disorders.
Psychological factors play a role in the formation of various diseases, such as migraines, endocrine disorders, malignant neoplasms, etc. Among them, real psychosomatosis should be distinguished, the occurrence of which is determined by mental factors and the prevention of which should be aimed primarily at eliminating and correcting emotional overstrain (psychotherapy and psychopharmacology ), and other diseases on the dynamics of which mental and behavioral factors have an important influence, changing the nonspecific resistance of the body, but are not the root cause of their occurrence. For example, it is known that the influence of psycho-emotional stress can reduce immune reactivity, which will increase the likelihood of diseases, including infectious ones.
Representatives of psychoanalysis approach the explanation of psychosomatic pathology, focusing on the predominance in patients with psychosomatic symptoms of repression of emotional experiences (a protective psychological mechanism that manifests itself in the subconscious exclusion of unacceptable thoughts or emotions from consciousness), which then manifest themselves as somatic symptoms. However, this ignores organic pathology, and in practice one cannot neglect the fact that patients develop organic lesions over time, and after the onset of the disease, psychotherapy alone is not enough, but appropriate treatment using modern pharmacological agents, and sometimes surgical assistance, is necessary.
A scientific explanation of psychosomatic relationships is possible on the basis of the conditioned reflex theory of I.P. Pavlova. Russian neurophysiologist P.K. Anokhin developed the biological theory of functional systems - the concept of organizing processes in an entire organism that interacts with the environment. The theory is based on the idea of function as the organism achieving an adaptive result in interactions with the environment. In the light of this theory, any emotional reaction is considered as an integral functional system that unites the cerebral cortex, subcortical formations and corresponding somatic links.
From the standpoint of neurophysiology, emotional processes involve both central (thalamus, limbic system, activation and reward structures) and peripheral structures (catecholamines, adrenal hormones, autonomic nervous system). Stimuli of excessive strength and duration alter the functional state of the central nervous system and peripheral nervous system. This can result in functional impairments and so-called “places of least resistance” (locus minoris resistentiae). There is a system of constant feedback that determines the possibility of therapeutic, healing effects of the emotional factor.
An unresolved conflict of motives (as well as unresolved stress) ultimately gives rise to a reaction of capitulation, a refusal to search, which creates the most common precondition for the development of psychosomatic diseases in the form of masked depression. The defeat of certain organs and systems is caused by genetic factors or features of ontogenetic development.
The importance of the doctor’s understanding of the essence of protective psychological mechanisms requires a brief description of them in this section. Defense mechanisms are divided into primitive, or immature (splitting, projection, idealization, identification), and more mature (sublimation, rationalization, etc.). However, neither the number of protection options (several dozen of them are described), nor their classification, nor their names are generally accepted.
One group combines defense options that reduce the level of anxiety, but do not change the nature of the impulses. These include: suppression or repression from awareness of unacceptable motives or feelings, negation the source or feeling of anxiety itself; projection or transference of one's desires or feelings onto others; identification- imitation of another person with attribution of his qualities to oneself; inhibition- blocking in behavior and consciousness all manifestations associated with anxiety.
Another group includes forms of defense in which mechanisms are triggered that reduce the severity of anxiety and at the same time change the direction of impulses: self-aggression- turning hostility towards oneself; reversion- polar reversal, or a change in motives and feelings to the opposite; regression- reduction, or return to early, childhood forms of response; sublimation- transformation of unacceptable ways of satisfying needs into other forms - for example, in the form of creativity in art or science.
Let's consider 9 main forms of psychological defense, regardless of their classification.
1. crowding out. Repression means suppression or exclusion from consciousness of unpleasant or unacceptable events and phenomena, i.e., removal from consciousness of those moments and information that cause anxiety. With neuroses, for example, the main event that caused it is often repressed. Such psychological experiments are interesting in this regard. The subjects were given photographs that depicted specific conflict situations that were close to their experiences. It was expected that the subjects would tell their contents, but they seemed to “forget” these photographs and put them aside. When the corresponding photographs were reproduced in a situation of hypnosis, the protection was removed and the photographs produced an effect adequate to their content. A similar defense mechanism underlies the widespread phenomenon when other people's shortcomings in behavior are noticed, and their own are repressed. In other experiments, subjects were offered tests to achieve a certain success in performing a particular task; they remembered only those tasks that they completed well, and “forgot”, i.e., crowded out uncompleted tasks.
2. Substitution- reorientation from one object (topic) causing anxiety and unpleasant experiences to another. This version of psychological defense can be represented by the following simple examples. After a conflict with a boss at work or a quarrel with a loved one, an individual unleashes anger on family members (this often involves rationalization, which will be discussed below). A man crumples a piece of paper during an exciting conversation. A girl, when her friend says “your boyfriend always lets you down,” throws away the cat sitting on her lap.
3. Rationalization. In this case, we are talking about an attempt to rationally justify desires and actions caused by such a reason, the recognition of which would threaten the loss of self-esteem. There can be many examples here. If a stingy person is asked for a loan, he will always justify why he cannot lend (for educational reasons, etc.); if a person is unpleasant, then it is always easy to find a lot of shortcomings in him, although hostility may not be associated with them at all; The patient may explain his interest in medical literature by the need to broaden his horizons.
4. Projection. Defense in the form of projection is the unconscious transference of one’s own unacceptable feelings and drives to another person, attributing one’s socially unapproved impulses, desires, motives, actions and qualities to others. A striking example of this is the behavior of a wealthy young man who places his mother in a nursing home and is indignant that the staff treats her indifferently or poorly.
Projection to a certain extent simplifies behavior, eliminating the need in everyday life to evaluate one’s actions every time. We often transfer our behavior onto other people, projecting our emotions onto them. If a person is calm, self-confident, and friendly, then in his eyes those around him share his goodwill, and vice versa - a tense, frustrated person, dissatisfied in his desires, is hostile and attributes and projects this hostility to others.
5. Somatization. This form of protection is expressed in getting out of a difficult situation by fixating on the state of one’s health (schoolchildren “get sick” before tests - the simplest example). In these cases, the main importance is the benefit from the disease - increased attention and reduced demands from loved ones. In more severe cases, this form of protection takes on a chronic nature, and, as a rule, there is an exaggerated attention to one’s health, an exaggeration of the severity of the disease, even to the point of creating one’s own concepts of the disease, and a hypochondriacal syndrome can form.
6. Reactive education. In this case, we are talking about replacing unacceptable trends with the exact opposite. Thus, rejected love is often expressed in hatred of the former object of love, boys try to offend the girls they like, secret envious people often quite sincerely consider themselves among the devoted admirers of the one they envy.
7. Sublimation. With this form of psychological defense, unacceptable impulses are transformed into socially acceptable forms of instinctive needs that cannot be realized in an acceptable way out and way of expression (for example, childless people have animals). In this regard, a hobby is of interest, which for some is a way of realizing the most incredible motives and drives. Selfish and even “forbidden” goals can be sublimated by active activity in art, literature, religion, and science.
Aggressive impulses, for example, can be sublimated into sports or political activity. But we are talking about psychological defense itself when the individual does not realize that his activity is determined by hidden impulses, which sometimes have a biological and egoistic basis.
8. Regression. In this case, we are talking about a return to primitive forms of response and behavior. This form of psychological defense manifests itself especially often in children. For example, when deprived of parents, children often exhibit behavior consistent with developmental delay: a child who began to walk suddenly stops walking, or the child resumes enuresis that occurred in infancy. We can also mention the habit of thumb sucking in difficult situations (this feature sometimes manifests itself not only in children, but also in adults). Elements of psychological defense in the form of regression can also be observed in some mental illnesses.
9. Negation. This form of defense is a defense mechanism by which impossible desires, motives and intentions, as well as facts and actions are not recognized, rejected by unconsciously denying their existence, i.e., in denial, the real phenomenon is considered non-existent. It should be emphasized, however, that denial does not involve a conscious attempt to renounce or retreat, as in pretense, simulation, or lying.
In everyday life, most real situations often involve the use of several forms of psychological defense simultaneously. This must be taken into account when a doctor works with both healthy and sick people.
The mechanisms of psychological defense outlined above are part of psychological adaptation processes. Adaptation is a property of any living self-regulating system, which determines its resistance to environmental changes. Highlight physiological, psychological, social adaptation of the individual. Violation of adaptation to environmental conditions is called maladjustment . Adverse external influences (stress) that exceed adaptation capabilities are called distress.
In response to psycho-emotional stimuli, various non-pathological psychosomatic reactions arise (visceral, sensory, etc.). Psychosomatic reactions can occur not only in response to mental, emotionally significant influences, but also to the direct effects of stimuli (for example, the sight of a lemon). Ideas can also influence a person’s somatic state. Psycho-emotional factors can cause the following physiological disorders in various organs and systems of the body:
a) in the cardiovascular system - increased heart rate, changes in blood pressure, vascular spasm;
b) in the respiratory system - its delay, slowdown or acceleration;
c) in the digestive tract - vomiting, diarrhea, constipation, increased salivation, dry mouth;
d) in the sexual sphere - increased erection, weakness of erection, swelling of the clitoris and lubrication (secretion of the genital organs), anorgasmia;
e) in the muscles – involuntary reactions: muscle tension, trembling;
f) in the autonomic system - sweating, hyperemia, etc.
Psychosomatic diseases - these are somatic diseases, in the occurrence and course of which psychological factors play a decisive role. The cause of psychosomatosis is affective (emotional) stress (conflicts, dissatisfaction, anger, fear, anxiety, etc.) subject to the presence of certain personal characteristics. These diseases are often called “major” psychosomatic diseases, emphasizing the severity of the disease and the leading role of the psychogenic factor in their occurrence.
Actually psychosomatic diseases are characterized by the following features:
Mental stress is decisive in provoking;
After manifestation, the disease takes a chronic or recurrent course;
First appearance at any age (but more often in late adolescence).
Historically, the classic pictures of seven diseases are classified as psychosomatic, namely: essential hypertension; peptic ulcer; bronchial asthma; neurodermatitis; thyrotoxicosis; ulcerative colitis; rheumatoid arthritis.
Characteristics of psychosomatic disorders.
The search for psychological characteristics responsible for the occurrence of psychosomatic diseases has today led to the description of characterological traits that are found in different combinations in patients with different diseases. These are traits such as isolation, restraint, anxiety, sensitivity, etc. Below are some features of patients with certain psychosomatic disorders.
Hypertension (essential arterial hypertension). The main properties of a personality prone to the formation of essential hypertension are considered to be intrapersonal conflict, interpersonal tension between aggressive impulses, on the one hand, and a feeling of dependence, on the other. The appearance of hypertension is due to the desire to openly express hostility with a simultaneous need for passive and adaptive behavior. This conflict can be characterized as a conflict between such contradictory personal aspirations as a simultaneous focus on directness, honesty and frankness in communication and politeness, courtesy and avoidance of conflicts. Under stress, such a person tends to restrain his own irritability and suppress the desire to respond to the offender. Suppressing negative emotions in a person during a period of stress, accompanied by a natural increase in blood pressure, can worsen a person’s general condition and even contribute to the development of a stroke.
When examining the mental state of patients with arterial hypertension in combination with daily blood pressure monitoring, it was revealed that at the early stage of arterial hypertension after an increase in blood pressure in patients, there is a decrease in the level of anxiety, which confirms the compensatory role of a rise in blood pressure due to prolonged psycho-emotional stress.
In the initial stage of hypertension, most patients adequately assess their health status and correctly perceive the doctor’s recommendations and prescriptions. Some patients with anxious and suspicious traits perceive an increase in blood pressure as a tragedy, a catastrophe. The mood of such patients is reduced, attention is fixed on sensations, the range of interests is narrowed, limited to the disease.
In another group of patients, the diagnosis of hypertension will not cause any reaction; they ignore the disease and refuse treatment. This attitude towards the disease is observed mainly in people who abuse alcohol.
It should be noted that there is no parallelism between the level of blood pressure (BP) and the likelihood of developing mental disorders. When examining the mental state of patients with arterial hypertension in combination with 24-hour blood pressure monitoring, for the first time, indicators of 24-hour blood pressure monitoring were established that are significant in relation to the prognosis of the development of mental disorders in this disease. These are high variability of blood pressure during the day and disruption of the circadian rhythm of blood pressure fluctuations: increased or absent physiological nighttime decrease in blood pressure levels.
A patient with hypertension should explain the cause of his condition, say that his nervous system disorders are of a functional nature, that they are temporary and with appropriate systematic treatment, the affected function will be restored.
Cardiac ischemia. For many years, emotional stress was thought to predispose to coronary heart disease. The literature describes a “coronal personality.” These types of ideas are difficult to test because only prospective studies can separate the psychological factors that contribute to the development of heart disease from the psychological consequences of the disease itself. Research conducted in the 1980s focused on several groups of possible risk factors, which included chronic emotional disorders, socioeconomic difficulties, overwork or other long-term aggressors, and type A behavior patterns. Most supported There is evidence of a Type A behavior pattern, which is characterized by such basic traits as hostility, excessive desire for competition, ambition, a constant feeling of lack of time and a focus on restrictions and prohibitions. When conducting studies on primary and secondary prevention, the main approach was to eliminate risk factors such as smoking, poor diet, and insufficient physical activity.
Angina pectoris . Angina attacks are often triggered by emotions such as anxiety, anger and agitation. The sensations experienced during an attack are at times extremely terrifying, and often the patient becomes overly cautious over time, despite all the assurances of the doctors and despite their efforts to encourage him to return to his normal active lifestyle. Angina may be accompanied by atypical chest pain and shortness of breath caused by anxiety or hyperventilation. In many cases, there is a discrepancy between the patient's actual exercise capacity, as determined by objective measurements, and their complaints of chest pain and activity limitation.
A good effect in overcoming these problems is usually achieved by conservative treatment in combination with regular physical exercises appropriate to the patient’s condition. Some patients are helped to regain self-confidence by behavioral therapy, carried out according to an individually developed program.
Cardiophobia. One of the psychovegetative syndromes that is often observed in medical practice is cardiophobia. Discomfort and unusual sensations in the left half of the chest, which first arise in a situation that is psychologically traumatic or even in its absence after prolonged asthenia, determine the increasing anxiety and vigilance of patients, fixation on the activity of the heart, which increases confidence in the presence of a serious heart disease and fear of death. At first, vague concern and growing affective tension, anxiety, suspicion, fears, constitutional, as well as acquired personality characteristics become the basis for the development of an acute cardiophobic attack. The unbearable, vital fear that patients feel in connection with cardiovascular disorders cannot be compared with ordinary human sensations and experiences, either in their intensity or in their nature. The feeling of imminent death becomes the only existing reality for the patient. And the obvious fact that dozens of similar heart attacks he had previously suffered did not lead to either a heart attack or heart failure does not matter to him. Since it has long been known that it is scary not to die - it is scary to die, the fate of these patients who “die” repeatedly is truly tragic. Here rational psychotherapy and suggestion are of particular importance. In some cases, even the patient’s life depends on their correct use by doctors.
Dyspnea, which is caused by many respiratory and cardiac disorders, may increase under the influence of psychological factors. In some cases, shortness of breath is purely psychological in origin: a typical example is hyperventilation associated with an anxiety disorder.
Asthma. It has been suggested that asthma is caused by unresolved emotional conflicts associated with subordinate relationships, but there is no satisfactory evidence to support this idea. In bronchial asthma, there are contradictions between the “desire for tenderness” and the “fear of tenderness.” This conflict is described as a “own-give” conflict. People suffering from bronchial asthma often have hysterical or hypochondriacal character traits, but they are not able to “release their anger into the air,” which provokes attacks of suffocation. Also noted is a quality of asthmatics such as hypersensitivity, especially to odors, which is associated with reduced accuracy.
Compelling evidence suggests that emotions such as anger, fear and agitation can trigger and increase individual attacks in patients with asthma. The literature has reported that children who had severe asthma and died from the disease were more likely to have chronic psychological and family problems than other children with severe asthma.
Mental morbidity among children with asthma is not much higher than among the general child population. However, if such children develop psychological problems, then treatment, as a rule, becomes significantly more complicated.
Attempts have been made to treat asthma using psychotherapy and behavioral therapy, but there is no convincing evidence that these methods are more effective than simple advice and support. Individual and family psychotherapy may be beneficial in treating children with asthma where psychological factors are important.
Gastritis. In patients with gastritis and peptic ulcer disease, a unique character is formed in early childhood, leading to the fact that the individual experiences a constant need for protection, support and care in adulthood. At the same time, he is simultaneously instilled with respect for the strength, autonomy and independence that he strives for. As a result, there is a clash of two mutually exclusive needs (care and independence), which leads to an insoluble conflict.
Peptic ulcer . People who get peptic ulcers of the stomach and duodenum have certain characterological characteristics. Among them there are often people with violent emotional reactions, categorical judgments, and straightforwardness in assessing the actions of others. Another category of patients is not prone to external manifestations of emotions. Often there are gloomy, dissatisfied, distrustful people. Some authors associate peptic ulcer disease with an unacceptable need for protection and intercession for self-perception.
Strong prolonged affects, negative emotions, such as constant fear, great grief, severe fright with overstrain and depletion of cortical activity can lead to prolonged spasm of the blood vessels of the stomach wall, with reduced resistance of its mucous membrane to the action of hyperacid gastric juice, leading to the occurrence of ulcers . The further development of peptic ulcer disease depends both on the action of these factors, which does not stop, and on the occurrence of pain impulses from the interoreceptors of the affected organ. Psychotherapy greatly influences the course of the disease and the effectiveness of treatment.
Colitis. In ulcerative colitis, the onset of the disease is observed after experiences of “loss of an object” and “catastrophes of experience.” Patients have low self-esteem, excessive sensitivity to their own failures and a strong desire for dependence and guardianship. Illness is often seen as the equivalent of sadness.
Diabetes . The personality of a patient with diabetes is described as necessarily including a feeling of chronic dissatisfaction. However, it is believed that, unlike representatives of other psychosomatic diseases, there is no specific diabetic personality type.
Neurodermatitis. Neurodermatitis of psychosomatic origin includes eczema and psoriasis. Patients are often characterized by passivity and find it difficult to assert themselves.
Diseases of the musculoskeletal system. For patients with rheumatoid arthritis, the patient’s “frozen and exaggerated position” and demonstration of a high level of self-control are considered specific. There is also a tendency towards self-sacrifice and an exaggerated willingness to help others. At the same time, “aggressive coloring of assistance” is noted.
Principles of prevention of psychosomatic diseases
Therapeutic tactics in the treatment of psychosomatic diseases include the main role of somatologists and appropriate methods of therapy. However, psychotherapy plays an important role in preventing the occurrence of these diseases and at all stages of treatment and rehabilitation. In the prevention of psychosomatic diseases, an important role is played by the timely identification of personal predisposition and the conduct of long-term person-oriented psychotherapy with the help of a psychotherapist. General practitioners and family medicine doctors must master themselves and teach patients the skills of mental self-regulation, autogenic training for the purpose of mobilization or relaxation in stressful situations.
Another approach is applied to the treatment of neurotic and somatoform disorders, when the patient’s somatic complaints are associated with functional somatic disorders, the main cause of which is mental illness. In these cases, treatment is carried out by a psychiatrist using psychotherapy and psychopharmacotherapy.
Definition. Psychosomatics – direction in medicine (at the intersection with psychology), studying the role of mental, primarily personal, factors in the occurrence and course of diseases.
Psychosomatics is a section of clinical psychology. Border science between medicine and psychology.
The psychosomatic approach is an attempt to extend a personal approach to the problem of “disease of the body.”
The psychosomatic concept is based on the idea of "holism"", the integrity of the body and psyche when considering various diseases. As a rule, a two-way, but unified nature of psychosomatic relationships is observed: psychogeny turns into somatogeny and vice versa.
The origin of the psychosomatic discipline is associated with the works Z. Freud, who was the first to describe the occurrence of a physical symptom through the mechanism of hysterical conversion.
This approach arose in the 40s of the XX century. Founder Alexander “The term psychosomatics should be used to illustrate a methodological approach in research and therapy,” which means the simultaneous and coordinated use of somatic (physiological, anatomical, pharmacological, surgical) methods and concepts on the one hand) and psychological ones on the other. Alexander created his theory of psychosomatic medicine - the theory of specific emotional conflict. The main method for diagnosing psychosomatic conditions is therapeutic conversation.
One of the main factors in the occurrence of psychosomatic diseases- the presence of a peculiar soil (constitutional predisposition and changes in the bodily constitution under the influence of certain periodic changes in ontogenesis, diseases, etc.). The role of the personal factor in the occurrence of human diseases was also recognized by supporters of nervism when they talked about the importance of types of higher nervous activity, but they understood this as a general mental characteristic of a person. They did not attach importance to personality, as a special construct of the psyche, the highest level in the mental hierarchy of a person. American psychosomaticians have developed the concept of a personal personality profile of patients predisposed to psychosomatic diseases. Thus, they differed: over-reacting persons predisposed to peptic ulcer disease and ischemic coronary disorders; insufficiently responsive - ulcerative colitis, dermatitis, rheumatoid arthritis; those who react with restraint - hypertension, bronchial asthma, migraines, thyroid disorders. These statements were not always confirmed by practice, and the term personality profile was replaced by the term personality constellation\
Psychosomatic disorders are considered to be disorders of the functions of organs and systems in the origin and course of which the leading role belongs to the influence of psychotraumatic factors (stressful, conflict, crisis conditions). There is no single classification. For practical purposes, a system of correlating psychosomatic disorders with the main organs and systems of the human body is used. These disorders are described within the framework of the cardiovascular, digestive, skin, urogenital, and reproductive systems. Distinguish between psychosomatic reactions and psychosomatic diseases. Psychosomatic reactions are not yet a clearly defined pathology and occur in healthy people as isolated reactions to certain stressful moments (diarrhea in students during exams). Recently, functional and organic psychosomatosis have been distinguished. In the first, there is no organic pathology.
M. Bleuler identified three groups of psychosomatic diseases. 1. Psychosomatoses in the narrow sense of the word - hypertension, peptic ulcer, bronchial asthma, ischemic disease . II. Psychosomatic functional disorders - borderline, functional, neurotic. These include cardiovascular reactions to psychogenia, sweating, stuttering, tics, intestinal disorders, and psychogenic impotence. III. Psychosomatic disorders in the wider , in the indirect sense of the word, for example, a tendency to injury associated with individual personality characteristics.
Psychosomatic disorders (psychosomatosis)– disorders of the functions of bodily organs and systems, in the origin and course of which the leading role belongs to the influence of psychotraumatic factors (stress, conflicts, crisis conditions, etc.) with a certain personal predisposition. Functional psychosomatosis. 1.functional dysphagia 2.psychogenic nausea and vomiting syndrome. 3. Psychogenic gastralgia syndrome. 4. Syndrome
irritable colon.
Psychosomatoses, being essentially psychogenic disorders, constitute, along with neuroses and psychopathy, the largest share among diseases traditionally classified as minor (borderline) psychiatry. Those suffering from psychosomatosis never turn to psychiatrists and are unsuccessfully (sometimes for years) treated by doctors of other specialties, often moving from one doctor to another.
Types of psychosomatic disorders:
§ true (“large”) – peptic ulcer of the stomach and duodenum, hypertension, ischemic heart disease, bronchial asthma, thyrotoxicosis, rheumatoid arthritis, neurodermatitis, ulcerative colitis, migraine, etc.;
§ “minor” – neurotic disorders of internal organs (systemic neuroses, or organoneuroses);
§ conversion hysterical disorders;
§ RPS “in a broad sense”, for example, street injuries.
Point of view: all human diseases are psychosomatic (F. Alexander and others).
Basic psychosomatic concepts.
Concept "symbolic language of organs" (S. Ferenczi): somatic illness is the transformation of unrealized sexual energy into dysfunction of the autonomic systems through the mechanism of hysterical conversion in accordance with erotic symbolism. Psychoanalysis is used as a means of understanding illness and a method of treating it.
Concept « specific emotional conflict" (F. Alexander): the main importance is given to psychodynamic conflict; it is believed that any psychosomatic disease arises as a result of chronic or constantly recurring emotional stress. Three factors in the etiology of psychosomatic disorders: systemic failure, psychological patterns of conflict (and defense), current life situations. Principles, which formed the basis of the concept of specificity:
1. Mental factors that cause somatic disorders are of a specific nature and include a certain emotional attitude of the patient towards the environment or his own personality. Correct knowledge of these causal factors can be acquired in the course of psychoanalytic treatment.
2. The patient's conscious psychological processes play a subordinate role in the causes of somatic symptoms so long as such conscious emotions and tendencies can be consciously expressed. Suppression of emotions and needs causes chronic dysfunction of internal organs.
3. The patient's current life situations usually only have an accelerating effect on the disorder. Understanding the causative psychological factors can only be based on knowledge of the patient's personality development, since only this can explain the reaction to an acute traumatic situation.
Concept "personality profile" (Dunbar): emotional reactions are derived from the patient’s personality, which suggests the development of certain somatic diseases depending on the personality profile. She identified coronary, hypertensive, allergic and damage-prone personality types.
Anthropological concept (Weisecker): illness is seen as an existential distress in the internal history of a person's life. The task is to understand the meaning of a painful symptom in connection with the spiritual existence of the patient from the standpoint of analyzing his existence.
Concept alexithymia (Sifneos ) . Alexithymia means: “there are no words to name the feelings.” Observation: People suffering from psychosomatic illnesses exhibit difficulty in verbally expressing emotions. Hypothesis: limited awareness of emotions and cognitive processing of affect leads to a focus on the somatic component of emotional arousal and its intensification, resulting in the development of hypochondriacal and somatic disorders.
Alexithymia is a psychological characteristic determined by the following cognitive-affective characteristics:
1. difficulty in defining (identifying) and describing one’s own feelings;
2. difficulty in distinguishing between feelings and bodily sensations;
3. a decrease in the ability to symbolize, as evidenced by the poverty of fantasy and other manifestations of the imagination;
4. focusing more on external events than on internal experiences
Psic phenomena: Ps-tic reactions – these are short-term incoming states that manifest themselves in stressful life situations (palpitations, loss of appetite). Psychotic disorders :
1. Conversion symptom is a symbolic expression of neurotic conflict. Example: hysterical paralysis, psychogenic blindness or deafness, vomiting, pain. All of them are primary mental phenomena without tissue participation of the body, i.e. there are no pathological disorders in tissues and organ functions.
2. Functional canine syndrome (organ neuroses or autonomic neuroses) is a complex of symptoms that is a nonspecific consequence of the physiological accompaniment of emotions. Most often accompanied by neuroses. There are disturbances in organ functions. Example: migraine, vegetative-vascular dystonia.
3.Organic canine diseases (ps-oses) is the primary bodily reaction to conflict experiences. The disease itself. Functional disorders and tissue pathology. “Chicago Seven”: essential hypertension, gastric ulcer and 12 p.k., bronchial asthma, ulcerative colitis, neurodermatitis, rheumatoid arthritis, hyperthyroid syndrome.
4. Psychotic disorders associated with the characteristics of emotional and personal response and behavior. Tendency to injury and other types of self-destructive behavior: alcoholism, smoking, drug addiction and overeating with obesity, etc.
The term “psychosomatic diseases” is increasingly heard by ordinary people. What is psychosomatics, and most importantly - how and with which specialists to treat it, an Orthodox psychiatrist will tell you Vladimir Konstantinovich Nevyarovich.
What diseases are considered psychosomatic?
Psychosomatic diseases(from ancient Greek ψυχή - soul and σῶμα - body) are diseases, the occurrence of which is closely related to mental and psychological factors. The essence of these fairly common disorders lies, as the name itself suggests, in the close connection and interaction of soul and body. The term itself was proposed in 1818 by the Leipzig professor of psychology and doctor of mental illness (psychiatrist) Johann Christian August Heinroth (1773-1843). Heinroth is also called in dictionaries and reference books: a romantic, a moralist and a mystic. Heinroth believed that the source of many diseases was the pathology of the spirit and the depravity of the soul, on the basis of which he based his methods and models of treatment.
Only a century later, an independent “psychosomatic” direction in medicine was formed, the emergence of which was largely due to the emerging crisis of a purely materialistic view of all diseases in general, which has dominated over the past centuries in the wake of numerous scientific and technical achievements. Many representatives of various schools and directions, both in medicine and in psychology, philosophy, physiology and sociology, took part in the formation of “Psychosomatic Medicine”. Let's point out some of them: the German psychiatrist Karl Wiegand Maximillian Jacobi (1775-1858), who introduced the concept of “somatopsychic” in 1822; Berlin therapist Gustav Bergmann (1878-1955), who developed the doctrine of functional pathology; German philosopher Friedrich Wilhelm Nietzsche (1844-1900); the world famous French psychiatrist Jean Martin Charcot (1825-1893), who studied with the father of psychoanalysis, Sigmund Freud (1856-1939); the founder of the doctrine of neurasthenia (1869), American neuropathologist George Miller Beard (1839-1883); his compatriot the physician Da Costa (1833-1900), after whom the “soldier’s excitable heart” syndrome (1871) is named; American psychoanalyst Franz Gabriel Alexander (1891-1964), who is considered one of the founders of modern psychosomatic medicine; German doctor Alexander Mitscherlich (1908 -1982), who opened a psychosomatic clinic in Heidelburg in 1949; Austrian physician and psychoanalyst, professor of psychosomatic medicine at the University of Washington Felix Deutsch (1884-1964); the founder of the “stress” theory, Canadian pathologist and endocrinologist, Nobel Prize winner Hans Selye (1907-1982) and many, many others. Psychoanalysts, as a rule, see the cause of psychosomatic diseases in the presence of unconscious conflicts in a person, carefully examine mental traumas forgotten by patients, focus on sexual problems, including children’s unconscious relationships with parents, etc. In the development of a psychosomatic illness, psychosomatic reactions, disorders, conditions, and sometimes affects are distinguished.
How do psychosomatic illnesses differ from ordinary illnesses?
Any disease has a connection with the psyche (soul). However, in the development of “psychosomatic diseases”, supporters of this theory see a more pronounced and even decisive importance of the psyche than other reasons. Hence, the treatment of a painful condition consists primarily of treating the mental factor or changing the way one responds to stress.
For example, a person complains of headaches or back pain. But the true cause of suffering in these cases, as it turns out after a comprehensive psychological study, is his personal problems related to work, which are projected onto the body, causing persistent pain that is difficult to relieve with conventional medical means.
The most common psychosomatic diseases include the so-called classic seven(Alexander, 1968):
- essential hypertension,
- bronchial asthma,
- peptic ulcer of the duodenum and stomach,
- nonspecific ulcerative colitis,
- neurodermatitis,
- rheumatoid arthritis;
- hyperthyroid syndrome.
However, supporters of psychosomatic medicine have significantly expanded this list in their assumptions, including coronary heart disease, tuberculosis, stroke, obesity, alcoholism, drug addiction and a number of other diseases. They also identified characteristic personality types: “coronary”, “ulcerative”, “arthritic”. The “Coronal” personality type, for example, is characterized by assertiveness, anxiety, desire for success, and aggressiveness. He is often haunted by a feeling of lack of time. He is prone to suppressing his internal experiences and emotions, which disrupts the physiological processes in the body.
Are psychosomatic diseases defined in the same way by different specialists?
No, there are many different views and discrepancies, both among representatives of the psychosomatic school and on the part of their colleagues who adhere to different concepts on the etiology and pathogenesis of diseases. For example, some psychosomaticians see the cause of bronchial asthma in the patient’s “unwillingness to breathe,” while others associate the pathology of this suffering with excessive assertiveness, which literally takes away the breath, leading to an attack of suffocation; Still others explain the attacks by egocentrism, attracting attention to oneself, and the desire to change the environment.
There are so many discrepancies that it is impossible within the confines of this article to even briefly list the main ones. Thus, psychosomaticians who graduated from doctors of psychoanalytic schools interpret the cause of almost all diseases, first of all, as a consequence of the repression of drives that disrupt the functions of organs; as a replacement of an existing problem with a somatic disorder.
Behavioral or body-oriented psychotherapists offer a different perspective on the problem. The view of diseases in the models of materialistic schools of the Soviet period, based on the physiological teachings of I.P. Pavlov, is completely different.
Which specialists should you contact for the treatment of psychosomatic diseases?
Unlike foreign medicine, where there are official psychosomatic departments, faculties and clinics, in Russia there is no approved status of a psychosomatic doctor, so this problem is most often dealt with by psychiatrists, psychotherapists and partly psychologists. This is the official point of view, theory and practice. But there is also spiritual, spiritual and moral therapy, which has the right to exist and gives remarkable results in the treatment of many diseases (look at this in the series of books by the author of this article: “Therapy of the Soul”, “Healing with Words”, “Vice of the Soul”, “ Treatise on healing in Orthodox explanation", "Miraculous healings").
What role does the type of nervous system of the patient himself play in the formation of the disease?
According to the classical theory of Academician I.P. Pavlov, there are 4 types of nervous system: choleric (strong, uncontrollable), sanguine (strong, agile, balanced), phlegmatic (strong, inert), melancholic (weak, easily exhausted). The types described essentially correspond to temperament.
Persons with a weak type of nervous system are more susceptible to negative influences from the outside. Therefore, under the same circumstances, some people quickly “break down”, are more likely to become exhausted and “burn out” than others. Immune defense also plays a role, its condition, ability to resist and maintain the internal balance (homeostasis) necessary for the body.
How long can treatment last and how effective is it?
It all depends on the nature of the disease, its severity, and timeliness of treatment (an advanced, chronic pathological process is always more difficult to treat). Treatment of some diseases that are based on spiritual (mental) ill health can be very lengthy.
The Holy Fathers mention the so-called “inconvenient” diseases, which have a special sacred meaning. The so-called genetic, hereditary factors cannot be discounted.
In each specific case, the approach to treatment should be purely individual, and, as was taught in Soviet times, personal, clinical and pathogenetic. It must be said that the Russian medical school made a significant contribution precisely to the process of a deep, holistic attitude towards a sick person. Starting with Mudrov M.Ya. (1776 -1831), Zakharyin A.G. (1829 -1898), Botkin S.P. (1832-1889), Pirogov N.I. (1810-1881) - it was the multifactorial one that prevailed, therapy focused on the patient’s personality, the motto of which was: “Treat not the disease, but the person, in the fullness of his personality traits and conditions”
Let me dwell in more detail on some representatives of the Russian school of healing diseases, who could well be included among the outstanding psychosomatists (in the positive sense of the word). Among them is Professor of Therapy and Pathology at Moscow University Matvey Yakovlevich Mudrov, who professed a model of a holistic, multifaceted view of the disease, taking into account mental and spiritual, and not just biological and physiological mechanisms. He wrote, in particular: “Knowing the mutual actions of the soul and body, I consider it my duty to note that there are also spiritual medicines that heal the body. They are drawn from the science of wisdom; often from psychology. With this art you will console the sad, soften the angry, calm the impatient, stop the furious, frighten the daring, make the timid bold, the hidden - frank, the desperate trustworthy. This art imparts to the sick that firmness of spirit that overcomes bodily illnesses, melancholy, and tossing, and which then subjugates the illnesses themselves to the will of the patient. The patient’s admiration, joy and confidence are then more useful than the medicine itself.” Along with medicines, Mudrov prescribed to the sick who and at what time from the heavenly doctors and under what cases they should pray.
Among the causes of illnesses, he assigned an important place to mental factors: “spiritual disturbances: anger and malice, envy and ambition, luxury or stinginess, jealousy or despair and all sorts of everyday sorrows, which alternately pass through our gloomy life at night,” a person comes to various illnesses and sufferings . Another famous doctor of ours, who treated Emperor Alexander III and Leo Tolstoy, Professor Anton Grigorievich Zakharyin, described “reflected” pain from certain internal organs to the skin, introducing an important milestone in the theory of the relationship between the internal and external in a person. In Soviet times, the famous doctor and psychologist Alexander Luria (1902-1977) wrote: « The brain cries, and the tears go to the heart, liver, stomach..."
What can the patient do? Are there any breathing exercises or physical therapy to cope with psychosomatic diseases?
And breathing exercises (paradoxical according to Strelnikova, or classical, as well as according to the yoga system) plus therapeutic exercise can give a real positive result in complex treatment with an individually selected set of systematic exercises, but they cannot be a panacea in the treatment of diseases, as, indeed, and any other specific type of health procedures (hardening, therapeutic fasting, swimming, massage, autogenic training). Unfortunately, purely materialistically oriented schools do not consider such spiritual factors as sin, conscience, passions - categories that in the system of Orthodox medicine are among the most important, allowing one to study and understand the true spiritual meaning of suffering.
Letter from a reader of the ABC of Health:
I came to the conclusion that my problems with the gallbladder and stomach are pure psychosomatics. It's all about nerves. When you are calm, nothing hurts.
One experienced doctor gave me advice on what to do when you start to get nervous, how to cut off this signal from the stomach.
Exercise against the occurrence of psychosomatic diseases of the stomach and duodenum
Initial position: standing or sitting, arms down.
Simultaneously with a slow inhalation (about 8 seconds), we raise our arms straight up to the sides until they touch. The gaze rises along with the hands and rests on their connection.
Then we hold our breath for 3-4 seconds and, as we exhale, perform a reverse movement of the same duration.
We inhale and exhale in a stream, forming a tube with our lips.
We completely focus solely on breathing and movement.
We repeat three times. After the 2nd time, slight dizziness or drowsiness may occur.
How to relate to the interpretation of psychosomatic diseases given by the authors of esoteric books.
I treat esoteric literature like sweet intoxication. In search of truth, many, especially young people, wander into the fields of occultism and mysticism. Rarely do any of them recover with the help of these teachings, but many are damaged in their minds. In my opinion, some systems based on self-education and strict rules are also unsafe.
There are Orthodox-oriented teachings that have sound foundations with very controversial conclusions and recommendations that claim to be a comprehensive truth. I also remember all sorts of fashionable diets, types of fasting (according to Brag and Shelton). Not so long ago we were keen on healing according to the Seraphim (Chichagov) method as presented by Ksenia Kravchenko, the systems of Boris Vasilyevich Bolotov, Ivan Pavlovich Neumyvakin; It would also not hurt to remember the mass healing sessions of Anatoly Kashpirovsky and Alan Chumak, all kinds of urine therapy, sucking vegetable oil, drinking kombucha, apple cider vinegar, etc. Is it worth repeating that a universal system of healing does not exist in nature, and all esoteric books, from the position of our Russian Orthodox Church, are harmful to the human soul.
Can a properly tuned spiritual life help cope with psychosomatics?
Undoubtedly! The results can exceed all expectations. Sometimes one confessed sin destroys a whole chain of painful conditions.
There is nothing higher and better than the individual conscious path of improvement and education, the pursuit of holiness. As the Athonite elder Porfiry Kavsokalivit emphasizes, diseases, in particular mental ones, are cured, “if a person acquires the correct Orthodox consciousness”, instead of selfish. “When you turn to God, you no longer look for anything, you cease to be an unsatisfied person. On the contrary, you become happy with everything and everyone, you begin to love everyone, you are always happy ... "(Tsvetoslov of the Councils, Holy Mount Athos, 2014, p. 526). The following advice from the elder is also useful: “Try to reject unpleasant memories and fears. Remember the good things that happened in your life. Always look to the future with hope and optimism. Listen to good music... Walk in nature more often, go out of town... in addition to the Divine Liturgy on Sundays, go to evening services and all-night vigils. Pray, turning to Christ with confidence.”(p. 524. Ibid.). Usually illnesses are treated as a great misfortune. But this is not entirely the right position. The Holy Fathers said that illness is a visit from God. And we cannot know for sure whether illness or health is more beneficial for us. Many people have accomplished great deeds and discoveries precisely, and sometimes thanks to illness. And speaking of psychosomatic illness, it is more useful, if possible, to begin treatment with therapy of the soul rather than the body.
From medical practice
One patient suffered from a disease with impaired support and movement functions. She moved independently with the help of a cane. Her husband repeatedly took her to the capital for consultations and treatment with eminent doctors. However, in the process of psychotherapeutic work, the true cause of the disease was revealed, which lay in frequent infidelities on the part of the husband and the woman’s unconscious desire to keep him close to her. After numerous conversations and individual work, the patient gradually got rid of the cane, and her movements were fully restored.
But there were other examples, with a sadder epilogue. Once they brought to me (or rather brought in a wheelchair) a patient who, over the course of several months, had developed an incomprehensible weakness in the lower extremities. Additional research methods did not reveal any pathology, as a result of which he was referred for consultation and treatment to a psychotherapist, who passionately convinced the patient that he was a healthy person, unconsciously simulating due to his reluctance to work. But in a conversation with that young man, it was possible to find out that the disease does not bring any benefit to the patient; on the contrary, it crosses out his much desired plans for the future. After a long conversation, I advised his relatives to show the patient to my friend, an old and very experienced neurosurgeon. A consultation took place, and the neurosurgeon clinically suspected the presence of a tumor in the spine. His diagnosis was soon confirmed by instrumental diagnostic methods. The patient was subsequently operated on in Germany, but, unfortunately, he could no longer walk. A month of sessions with a psychotherapist was irretrievably lost time and did not bring any benefit to the patient.
I would like to wish the readers God's blessing on all good and saving deeds; so that they are not embarrassed by any life circumstances, do not go into illness, but also do not neglect the help of doctors: first Heavenly, and then earthly! To study more the history and culture of our Fatherland, look for ways of holiness and learn to pray; they shunned vices and fought against swearing and sloppiness.
Psychiatrist V.K. Nevyarovich
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