Vasily Glebovich Kaleda to get an appointment. Psychiatrist Vasily Kaleda: It is important to understand that depression can be treated
One of the consequences of the fall of man is his sickness (passionateness), his vulnerability to countless physical dangers and ailments; vulnerability not only of the body, but also of the psyche. Mental illness is the hardest cross! But a mentally ill person is dear to our Creator and Father no less, and perhaps, due to suffering, even more than any of us. We talk about these people, about their opportunities in the Church, about mental and spiritual health with Vasily Glebovich Kaleda, a psychiatrist, doctor of medical sciences, professor at the Department of Practical Theology at the Orthodox St. Tikhon Humanitarian University.
You grew up in a deeply believing Orthodox family, your grandfather was glorified in the host of holy martyrs and confessors of Russia, your father and brothers are priests, your sister is an abbess, and your mother also took tonsure in her old age. Why did you choose medicine and then psychiatry? What determined your choice?
Indeed, I grew up in a family with deep Orthodox, church traditions. By the way, my grandfather, Hieromartyr Vladimir Ambartsumov, who was shot at the Butovo firing range, was born in Saratov; Our family has a special spiritual connection with your city, and I am pleased to answer questions from the journal of the Saratov Metropolis.
However, before becoming a priest, my father devoted many years to geology; mother dreamed of becoming a doctor, but became a biologist; two of my priest brothers are geologists by first education, and the sisters have a medical education. Doctors were in the family before. Perhaps there is some connection with the name: four Basils were in the Caled family, and all four were doctors. It can be said that by choosing medicine, I continued the family tradition.
And the choice of psychiatry is the influence of the personality of the father. The pope had great respect for medicine and singled out psychiatry among all medical disciplines. He believed that the competence of a psychiatrist somewhere bordered on the competence of a priest. And he told me how important it is that there are believers among psychiatrists, so that a person, if he or his neighbor needs the help of a psychiatrist, has the opportunity to turn to Orthodox doctor.
A friend of my grandfather, Hieromartyr Vladimir Ambartsumov, was Dmitry Evgenyevich Melekhov, one of the patriarchs of Russian psychiatry. Shortly after his death (he died in 1979), his work “Psychiatry and Problems of Spiritual Life” was published in samizdat, my father wrote the preface to this publication. Later, this book was published quite legally. Dmitry Evgenievich visited our house, and each of his visits became an event for me - then a teenager. While studying at the medical institute, I finally realized that psychiatry is my calling. And in the future, he never regretted his choice.
What is mental health? Is it possible to say with certainty: this person, even with some problems, is still mentally healthy, but this one is sick?
The problem of the norm in psychiatry is very important and not at all simple. On the one hand, each person is individual, unique and inimitable. Everyone is entitled to their own worldview. We are so different. But, on the other hand, we are all very similar. Life puts before all of us the same, in fact, problems. Mental health is a set of attitudes and qualities, functional abilities that allow an individual to adapt to the environment. This is the ability of a person to cope with the circumstances of his life, while maintaining the optimal emotional background and the adequacy of behavior. A mentally healthy person can and should cope with all the difficulties that exist in his life. Of course, the difficulties are very different. There are some that a person can not seem to withstand. But let's remember our New Martyrs and Confessors, who went through everything: the then methods of investigation, prisons, starvation camps - and remained mentally healthy people, mentally healthy. Let us also remember the greatest psychiatrist and psychotherapist of the 20th century, Viktor Frankl, the founder of logotherapy, that is, the direction of psychotherapy, which is based on the search for the meaning of life. Frankl founded this direction while in Nazi concentration camps. Such is the ability healthy person cope with all the trials, in other words, the temptations that God sends him.
From your answer it follows, in fact, that faith is either the most important condition, or, let's say, an inexhaustible source of mental health. Any of us, believers, thank God, people, are convinced of this from personal experience. We would perceive our difficulties, sorrows, troubles, losses in a completely different way if we were not believers. Faith gained raises our ability to overcome suffering to a completely different level, impossible for an unbeliever.
One cannot but agree with this! A person's ability to overcome difficulties depends on his worldview and worldview. Let's go back to Viktor Frankl: he said that faith has the most powerful protective ability, and no other worldview can be compared with it in this sense. A person who believes is an order of magnitude more stable than a person who does not have faith. Precisely because he perceives these difficulties as sent down by the Savior. In any of his misfortunes, he seeks and finds a meaning. In Russia, it has long been customary to speak of trouble: "The Lord has visited." Because trouble makes a person think about his spiritual life.
If we still talk not about the norm, but about the disease, then it is important to understand: a severe, genetically determined mental illness can develop in any person - regardless of his worldview. Another thing is borderline mental disorders that occur in people with certain character traits and, again, with a certain worldview. In these cases, the worldview of the patient is of great importance. If he was brought up in a religious environment, if he absorbed with his mother’s milk the conviction that life has a higher meaning and suffering also has meaning, this is the cross that the Savior sends to a person, then he perceives everything that happens to him from this particular point of view . If a person does not have such an outlook on life, he perceives every test, every difficulty as a collapse in life. And here I can confidently say: borderline disorders, neurotic diseases in people leading a full-fledged spiritual life are much less common than in non-believers.
You teach pastoral psychiatry. What is the essence of this subject? Why is it necessary in the training of future shepherds?
Pastoral psychiatry is a branch of pastoral theology associated with the peculiarities of the counseling of persons suffering from mental disorders. This requires coordination of efforts, cooperation between the pastor and the psychiatrist. In this case, the priest is required to understand the boundaries of mental health, which we just talked about, the ability to see psychopathology in time and make an adequate decision. Mental disorders, both severe and borderline, are common: according to medical statistics, 15% of the population suffer from one or another disease of this kind, the only question is the degree of severity. And people suffering from mental illness tend to turn to the Church, to the priests. That is why there are relatively more people with these problems in the church, parish environment than the average for the population. This is fine! This just goes to show that the Church is a medical clinic, both mental and spiritual. Any priest has to communicate with people who have certain disorders - I repeat, the degree of severity can be different. It often happens that it is the priest, and not the doctor, who becomes the first person to whom a person turns with a problem of a psychiatric nature. The shepherd must be able to behave with these people, help them and, most importantly, clearly see those cases when a person needs to be sent to a psychiatrist. Somehow I caught the eye of American statistics: 40% of people who turn to psychiatrists do so on the advice of clergymen of various denominations.
It should be added that Archimandrite Cyprian (Kern), professor of pastoral theology at the St. Sergius Institute in Paris, stood at the origins of the course on pastoral psychiatry, which is now taught in many theological educational institutions: in his book on pastoral theology, he devoted a separate chapter to this very subject. He wrote about those human problems which cannot be described by the criteria of moral theology, which have nothing to do with the concept of sin. These problems are manifestations of psychopathology. But the author of the first special manual on pastoral psychiatry was just the professor of psychiatry Dmitry Evgenievich Melekhov, whom we spoke about, the son of a repressed priest. Today it is already quite clear that the standard (if we are not afraid of this word) of pastoral education should also include a course in psychiatry.
Of course, this question is more theological than medical, but still - in your opinion: is there a connection between mental illness and sin? Why are the main types of delusions like grimaces of the main sinful passions? Delusions of grandeur, for example, and, as it were, its shadow, the wrong side - delusions of persecution - what is this, if not a grimace of pride? And depression - isn't it a grimace of despondency? Why is that?
The delusion of grandeur, like any other delusion, has only a remote relation to the sin of pride. Delirium is a manifestation of severe mental illness. The connection with sin is no longer traced here. But in other cases, one can trace the connection between sin and the occurrence of a mental disorder - a disorder, I emphasize, and not an endogenous, genetically determined disease. For example, the sin of sadness, the sin of despondency. A person indulges in sorrow, having suffered damage, having suffered some kind of loss, falls into despondency from his difficulties. Psychologically, this is quite understandable. But here the worldview of this person and his hierarchy of values are especially important. A believing person, having the highest values in life, will try to correctly put everything in its place and gradually overcome his difficulties, but a non-believer person is more likely to experience a state of despair, a complete loss of the meaning of life. The condition will already meet the criteria for depression - the person will need a psychiatrist. The spiritual state, thus, was reflected in the mental state. Such a patient of a psychiatrist has something to turn to and a priest too, there is something to say in confession. And he must receive help - from both sides, both from the pastor and from the doctor. At the same time, it is very important that love lives in the priest, that he is merciful to this person and is able to really support him. It should be noted that, according to WHO, by 2020 depression will be the second most common cause of illness worldwide; and WHO experts see the main reasons for this precisely in the loss of traditional family and religious values.
And how possible is spiritual, church life for people suffering from severe mental illness, for example, various forms of schizophrenia?
There is no fault of a person that he came into this world with a serious, genetically determined disease. And if we are truly believing Christians, we cannot allow the thought that these people are limited in their spiritual life, that the Kingdom of God is closed to them. The cross of mental illness is a very heavy, perhaps the most difficult cross, but a believer, carrying this cross, can save for himself a full-fledged spiritual life. He is not limited in anything, this position is fundamental - in nothing, including the possibility of achieving holiness.
It should be added: schizophrenia - after all, it happens very differently, and a patient with schizophrenia can be in various states. He may have an acute psychotic episode with delusions and hallucinations, but then in some cases a very high quality remission occurs. The person is adequate, works successfully, can hold a responsible position, safely arrange his family life. And his spiritual life is not in the least hampered or distorted by illness: it corresponds to his personal spiritual experience.
It happens that a patient in a state of psychosis experiences a certain special spiritual state, a feeling of special closeness to God. Then this feeling in all its depth is lost - if only because it is difficult to lead an ordinary life with it - but the person remembers it and after the attack comes to faith. And in the future he lives a completely normal (which is important), full-fledged church life. God brings us to Himself in different ways, and someone, paradoxically, like this - through mental illness.
But there are, of course, other cases - when psychosis has a religious coloring, but all these quasi-religious experiences are only a product of the disease. Such a patient perceives spiritual concepts distortedly. In such cases, we speak of a "toxic" faith. The trouble is that these patients are often very active. They preach their completely distorted ideas about God, about spiritual life, about the Church and the sacraments, they try to pass on their false experience to other people. This must be kept in mind.
Mental illness is often remembered in connection with demonic possession (or whatever it is called). The spectacle of the so-called reprimands suggests that simply sick people are gathered in the temple. What would you say about this? How to distinguish mental illness from obsession? Who needs to be treated with drugs, and who needs spiritual help?
First of all, I would like to recall that the ever-remembered His Holiness Patriarch Alexy II was a resolute opponent of the widespread and uncontrolled practice of “reprimanding” that spread just in those years. He said that the rite of exorcism of evil spirits should be performed only in extremely rare, exceptional cases. Personally, I have never been present at mass reprimands, but my colleagues - people, mind you, believers - have watched it. And they said with confidence that the majority of the “reported” are, as they say, our contingent: suffering from mental disorders. A mental illness of one type or another has a certain structure, is characterized by many parameters, and a professional doctor always sees that a person is ill, and sees what he is ill with. As for the state of demon possession, spiritual damage - it manifests itself primarily in the reaction to the shrine. This is checked by the “blind method”, as doctors say: a person does not know that he has now been brought to a reliquary or to a bowl of holy water. If he still reacts, then it makes sense to talk about demon possession. And about the help of a priest, of course - not just anyone, but one who has the blessing of a bishop for reading certain prayers over those tormented by unclean spirits. Otherwise, it is a purely psychiatric problem that has nothing to do with the spiritual state. This is a common case, we have many patients who have some kind of religious theme in the structure of their delusions, including and this one: "I have a demon in me." Many of these patients are believers, Orthodox people. If there is a church at the clinic where they are located, they attend services, go to confession, take communion, and in fact they have no demonic possession.
You have already said here that a patient whose delirium has a religious connotation can be very active. But there are people who believe him! Does it happen that an ordinary sick person is mistaken for a saint?
Of course it happens. In the same way, it happens that a person talks about his demonic possession or about some extraordinary visions, about his special closeness to God and special gifts - and all this is really just a disease. That is why we, psychiatrists who teach pastoral psychiatry, say to future priests: there is reason to be wary if your parishioner assures you that he has already reached some high spiritual states, that he is visited by the Mother of God, saints, etc. spiritual path long, complex, thorny, and only a few endure it and become great ascetics who are visited by angels, saints and the Mother of God Herself. Instant ups do not happen here, and if a person is sure that this is exactly what happened to him, in the vast majority of cases this is a manifestation of pathology. And this once again shows us the importance of cooperation between a psychiatrist and a pastor, with a clear delineation of their areas of competence.
Drawings of patients in a psychiatric hospital
Journal "Orthodoxy and Modernity" No. 26 (42)
Caleda
Vasily Glebovich
YOUTHFUL
ENDOGENOUS PARTSIC
PSYCHOSIS
(psychopathological, pathogenetic and prognostic
Aspects of the first attack)
14.01.06 - Psychiatry
A b u r e f e r a t
Dissertations for a degree
Doctors of Medical Sciences
Moscow - 2010
Work is done
in the institution Russian Academy medical sciences
Scientific Center for Mental Health of the Russian Academy of Medical Sciences
^ Official Opponents
Corresponding Member of the Russian Academy of Medical Sciences,
Doctor of Medical Sciences,
Professor Zharikov Nikolai Mikhailovich
Doctor of Medical Sciences,
Professor Kurashov Andrey Sergeevich
Doctor of Medical Sciences Simashkova Natalia Valentinovna
^ Lead organization
FGU "Moscow Research Institute of Psychiatry of Roszdrav"
The defense will take place on __ ______________ 2010 at 12 noon
At a meeting of the Dissertation Council D 001.028.01
In the Institution of the Russian Academy of Medical Sciences
Scientific Center for Mental Health of the Russian Academy of Medical Sciences
Address: 115522, Moscow, Kashirskoe highway, 34
The dissertation can be found in the library
Scientific Center for Mental Health of the Russian Academy of Medical Sciences
Scientific Secretary
dissertation council,
Candidate of Medical Sciences Nikiforova Irina Yurievna
^ GENERAL DESCRIPTION OF WORK
The relevance of research The relevance of the study of endogenous paroxysmal psychoses, which occupy one of the central places in clinical psychiatry, is determined by their social significance and high prevalence. The main direction of the current stage of development of medical science is the study of the etiopathogenetic foundations of diseases with the involvement of the latest paraclinical methods. This approach is most promising in psychiatry as well. As pointed out by many leading researchers at different stages of psychiatric science [Snezhnevsky A.V., 1972; Vartanyan M.E., 1999; Tiganov A.S., 2002], the establishment of clinical and pathogenetic correlations is possible only if there are reliable clinical, psychopathological and clinical and dynamic data on the patterns of manifestation and course of endogenous psychoses, starting from the early stages of the disease. Of particular interest in this regard is the targeted study of the first psychotic seizures, which at the present stage of development of psychiatry has increasingly attracted the attention of many researchers [Gurovich I.Ya, et al., 2003; Movina L.G., 2005; Bessonova A.A., 2008; Shmukler A.B., 2009; Malla A. Payne J., 2005; Freedman R. et al., 2005; Addington J., Addingtona D., 2008; Pantelisa C. et al., 2009]. On the one hand, this direction is based on the possibility of clinical and biological study of patients at the early stages of the disease, and on the other hand, the concept of the determining role of an adequate diagnostic assessment and, accordingly, the choice of therapy and methods of its implementation at the stage of the first manifestation of the disease for its further course and outcome [Smulevich A.B., 2005; Zaitseva Yu.S., 2007; Wyatt R. et al., 1997; Jeppesen P. et al., 2008; Mihalopoulos C. et al., 2009].
Of particular relevance is the study of endogenous diseases, taking into account the age factor. Among the so-called crisis stages, which largely determine the specific psychopathological and dynamic features of endogenous psychoses, adolescence occupies a special place. During this period, there is a whole complex of rapidly flowing psychobiological processes, the formation of cognitive functions, the formation of personality, the choice of a future profession, and a change in the stereotype of life. At the same time, in adolescence, due to the incompleteness of biological and psychological maturation, the brain retains relatively high plasticity, which increases its susceptibility to external influences and in particular to adequate therapy.
According to epidemiological data, the peak of manifestation of endogenous psychoses falls on adolescence [Shmaonova LM, Liberman Yu.I., 1979; Davidson M. et al., 2005; Lauronen E., 2007]. Moreover, in this age period, the frequency of manifestations of psychosis is especially high in men, who also have a worse outcome for the course of schizophrenic spectrum diseases.
Described by a number of researchers [Tsutsulkovskaya M.Ya., 1967; Kurashov A.S., 1973; Geller B. et al., 1995; McClellan J., Wery J., 2000] clinical isomorphism characteristic of endogenous psychoses of adolescence, as well as noted at the present stage [Dvirsky A.E., 2002, 2004; Vilyanov V.B., Tsygankov B.D., 2005; Tiganov A.S., 2009] general and therapeutic pathomorphosis mental illness with a significant modification of their clinical picture and patterns of flow significantly complicate their differential diagnostic and prognostic assessment.
The problem of paroxysmal forms of endogenous psychoses, manifesting in adolescence, was reflected in a number of studies on both the clinic of schizophrenia and schizoaffective psychosis, [Kurashov AS, 1973; Mikhailova V.A., 1978; Gutin V.N., 1994; Barkhatova A.N., 2005; Kuzyakova A.A., 2007; Omelchenko M.A., 2009; Cohen D. et al., 1999; Jarbin H. et al., 2003]. However, the psychopathological features of the first seizures, due to the pathogenetic and pathoplastic influence of adolescence, remain insufficiently studied, criteria for the early diagnosis and prognosis of youthful endogenous paroxysmal psychoses have not been developed, taking into account not only clinical and psychopathological, but also clinical and pathogenetic parameters. . The conducted studies did not reflect the study in the structure of the first attack of cognitive disorders, which at present, along with positive and negative disorders, have come to be considered as one of the main manifestations of diseases of the schizophrenic process [Magomedova M.V., 2003; Sidorova M.A., Korsakova N.K., 2004; Fitzgerald D. et al., 2004; Milev P. et al., 2005; Keefe R., 2008]. Also, the issues of the pathogenetic participation of a number of biological factors in the formation of the picture of the first attack remain unexplored. So, according to a number of researchers, based on the concept of the functional unity of the nervous and immune systems [Akmaev I.G., 1998; Zozulya A.A., 2005; Hosoi T. et al., 2002; Zhang X. et al., 2005], of particular relevance is the analysis of innate and acquired immunity at the first manifestation of the disease, as well as the study of the effect immune factors on the effectiveness of antipsychotic therapy [Abrosimova Yu.S. 2009; Maes M. et al. 2002; Drzyzga L. et al., 2006].
The study of adolescent patients with the first attack of endogenous psychoses is the most optimal model for studying the fundamental pathogenetic foundations of endogenous diseases, as it allows to determine the features of the functioning of various brain structures at the time of the manifestation of the disease, even beyond the influence of antipsychotic therapy on them.
Thus, all of the above determined the relevance of a special multidisciplinary approach to the study of the first attacks of juvenile endogenous psychoses.
Purpose and main objectives of the study The purpose of this work is to substantiate the defining influence of the age factor on the clinical and psychopathological parameters of the first seizures juvenile endogenous paroxysmal psychosis (SEPP), with the establishment of their characteristic clinical and pathogenetic patterns, differential diagnostic and prognostic evaluation criteria.
Permission was granted following tasks:
The study of the features of clinical and psychopathological manifestations of the first attacks of JEPP with the identification of their main typological varieties and the determination of the role of the age factor in the formation of their clinical picture.
The study of cognitive disorders that occur in patients in the structure of the first attack, both at the stage of its manifestation, and at the stage of the formation of the first remission, taking into account the differences in its psychopathological patterns.
Determination of a number of indicators of innate and acquired immunity during the manifestation of the first attack and at the stage of remission, as well as the study of their influence on the effectiveness of antipsychotic therapy.
Analyzing the conditions for the formation of pictures of the first attack and determining the main patterns of the subsequent course and outcome of JEPP.
Identification of clinical-psychopathological and clinical-pathogenetic parameters of the first attack, significant for assessing the prognosis of juvenile endogenous psychoses in general.
Carrying out a comparative clinical and nosological analysis of UEPP with the selection of criteria for their nosological differentiation.
The study of the pathomorphosis of the course and outcome of juvenile endogenous paroxysmal psychosis in modern conditions.
The studied sample consisted of 575 male patients hospitalized with the first attack of juvenile endogenous paroxysmal psychosis(SUEPP) to the Clinic of the NTsPZ RAMS (VNTSPZ AMS of the USSR). Of these, the clinical group consisted of 297 patients who were first admitted and examined from 1996 to 2005, the follow-up group - 278 patients who were first hospitalized in the period from 1984 to 1995. with the first attack, the clinical features of which were assessed retrospectively based on the study of case histories. Patients of this group were subsequently examined by the clinical follow-up method.
The sample of patients for the study was formed in accordance with the following inclusion criteria: the onset of the disease within adolescence; manifestation of endogenous psychosis (schizophrenia or schizoaffective psychosis) in adolescence (16-25 years); the presence in the first attack of psychotic disorders incongruent to affect; the duration of observation of patients (for the follow-up group) is at least 10 years. The exclusion criteria were: the presence of signs of a continuous course of the disease; the presence of concomitant mental pathology (mental and behavioral disorders due to the use of psychoactive substances, alcoholism, mental retardation), as well as somatic or neurological pathology(chr. somatic diseases, epilepsy, severe traumatic brain injury, etc.), complicating the study.
To solve the tasks set in the study, clinical-psychopathological, clinical-catamnestic, psychometric methods, as well as in cooperation with the relevant departments and laboratories of the NTsPZ RAMS - neuropsychological, experimental psychological, neurophysiological, clinical and immunological. Statistical processing and counting were carried out using the Statistica 6.0 software package.
Scientific novelty of the research Developed and substantiated new scientific direction in a clinical and psychopathological study of juvenile endogenous paroxysmal psychoses, in which the decisive importance is given to the pathogenetic and pathoplastic influence of the youthful age-related psychobiological stage of development and the clinical, psychopathological and prognostic significance of the characteristics of the first attack for the dynamics of the disease as a whole. For the first time, the problem of the influence of the age factor on the formation of clinical and psychopathological manifestations, dynamics, and also the prognosis of the first attacks of endogenous paroxysmal psychoses was solved. The relationship and specificity of biological markers of the clinical and psychopathological state of patients with the first manifestation of endogenous psychosis in adolescence, which in turn can be considered as age-specific parameters of pathogenesis that determine the prognosis and individual sensitivity of the drug response to therapy, have been established. The specificity of cognitive disorders in patients with the first attack in adolescence was revealed, reflecting its effect on the characteristics of their cognitive activity and personal characteristics. For the first time, a relationship has been established between differences in the topography of structural and functional anomalies of the brain, which cause differences in the configuration of cognitive impairment, with the clinical and psychopathological features of the first seizures. On the basis of a comparison of the data of clinical-psychopathological and clinical-catamnestic studies of patients and taking into account clinical and pathogenetic parameters, nosological heterogeneity of juvenile endogenous psychoses was established.
The practical significance of the work The data obtained in the course of the study provide a solution to the problems associated with timely diagnosis and determination of an individual prognosis for juvenile endogenous paroxysmal psychoses, which is especially important in this age period: at this stage, significant psychological and physiological, as well as social changes occur in the life of an individual. Regularities established during the research clinical manifestations and the course of endogenous psychoses manifesting in adolescence, the features of cognitive disorders and immunological parameters in patients with a first attack will contribute to the optimal solution of issues related to the diagnosis and prognosis of the disease, as well as the choice of adequate therapeutic tactics for managing these patients and substantiating indications for preventive drug therapy, including its duration, and ways to optimize social rehabilitation measures. The data obtained in the study of the patterns of the course and outcome of JEPP have been used in practical work Psychoneurological dispensaries of Moscow No. 10 and No. 18, Moscow City Medical Center for Youth, Medical and Pedagogical rehabilitation center at PB No. 15, as well as the seminar “Modern aspects of clinical, expert and social problems adolescent and youth psychiatry. The results of the study can be used in the lecture process and teaching activities of the departments of psychiatry medical universities and systems of postgraduate education.
Basic provisions for defense
The first attacks of endogenous paroxysmal psychoses manifesting in adolescence are characterized by distinct psychopathological and psychobiological features due to the pathoplastic and pathogenetic influence of the pubertal stage of maturation, which must be taken into account when solving both differential diagnostic and prognostic, as well as therapeutic and social rehabilitation tasks.
The manifestation of endogenous psychoses in adolescence is accompanied by severe cognitive impairments that have different configurations and dynamics depending on the psychopathological picture of the first attack, which indicates that these patients have differences in the topography of their structural and functional brain disorders.
The manifestation of endogenous paroxysmal psychosis in adolescence is accompanied by changes in the parameters of innate and acquired immunity, which correlate with the effectiveness of antipsychotic therapy, but do not have significant differences depending on the psychopathological structure of the attack.
The course of juvenile endogenous paroxysmal psychoses is characterized by a pronounced tendency to the development of repeated attacks while maintaining the psychopathological features of the first attack in their syndromic structure, while the period of the most intense attack formation occurs here in the first ten years of catamnesis.
The prognosis of the further course and outcome of juvenile endogenous paroxysmal psychosis in patients with the first attack should be based on the totality of the clinical, psychopathological and clinical pathogenetic parameters that characterize them.
According to the nosological affiliation, juvenile endogenous paroxysmal psychosis seems to be the most adequate to assess within the framework of schizophrenia, and less often - within the framework of schizoaffective psychosis.
At the present stage, in comparison with previous time periods, juvenile endogenous paroxysmal psychoses have a more favorable course.
Scope and structure of work The thesis is presented on 347 pages of typewritten text, consists of an introduction, 8 chapters, a conclusion, conclusions, a bibliographic index containing 458 titles (207 works by domestic and 251 foreign authors), and an appendix. The introduction justifies the relevance of the study, formulates its goals and objectives, presents the scientific novelty and practical significance of the work. The first chapter presents data from domestic and foreign literature, highlighting the development and current state of the problem of a comprehensive, multidisciplinary study of the first attack of JEP, as well as the characteristics of the course and outcome of the disease. The second chapter describes the characteristics of the clinical material and research methods. The third chapter presents the features of clinical and psychopathological manifestations of the first seizures and their typological varieties. The fourth chapter presents data on the features of the structure and dynamics of anomalies of cognitive processes in patients with the first attack and their relationship with the psychopathological type of attack. The fifth chapter presents the characteristics of a number of indicators of innate and acquired immunity during the manifestation of the first attack, and also shows the significance of these immunological factors for predicting the effectiveness of antipsychotic therapy. The sixth chapter reflects the main patterns of the course and outcome of JEPD, obtained on the basis of a clinical follow-up study. The seventh chapter presents some clinical and pathogenetic correlations and prognostic criteria. The eighth chapter highlights the issues of nosological differentiation of JEPP. In conclusion, the results of the study are summarized and 7 conclusions are presented. Thesis is illustrated clinical histories diseases, 34 tables and 12 figures.
^ RESULTS OF THE STUDY
In the course of the clinical and psychopathological study of patients with the first psychotic attacks of juvenile endogenous paroxysmal psychosis (JEPP), the determining role of the age factor in the formation of their clinical and psychopathological features was established. These include: polymorphism of the clinical picture with incompleteness, fragmentation and variability of psychopathological symptoms; high representation of varying degrees of severity of affective disorders, which are characterized by a distinct age-related atypicality of manifestations; the frequency of catatonic disorders, which have a wide range of manifestations from generalized forms to symptoms of "minor catatonia", accompanied, as a rule, by severe somatovegetative disorders; the predominance of sensual delirium with a rare occurrence of seizures with systematized interpretive delirium; the presence of "pubertal features" in the picture of productive symptoms, which are manifested both in the subject of delusional and hallucinatory disorders, and in the frequency of delusional fantasies and hallucinations of the imagination; the predominance of ideational automatisms in the structure of the Kandinsky-Clerambault syndrome in comparison with sensory and kinesthetic ones; dominance of autochthonous mechanisms of occurrence of an attack over psychogenic and somatogenic ones; the protracted nature of the entire attack, as well as the stage of formation ("ripening") of remissions; significant representation in their picture of cognitive disorders.
Based on the clinical and psychopathological study of the pictures of the first seizures in the studied patients of the clinical group, three types of them were distinguished, differing in their syndromic characteristics: with the dominance of catatonic symptoms without symptoms of clouding of consciousness and distinct affective disorders (23.9% of cases), with the dominance of hallucinatory-delusional ( 34.7%) or affective-delusional (41.4%) symptoms. More in progress detailed analysis the structure of these states, it was found that in addition to their differentiation depending on the clinical characteristics of the leading syndrome, their division according to the mechanism of delusional formation is justified (Fig. 1).
Rice. one. Typology of the first attacks of juvenile endogenous
paroxysmal psychoses
At the first attacks with dominance of catatonic symptoms (type I) two subtypes have been identified: lucid-catatonic (9.7%), in which there was a predominance throughout the attack of catatonic symptoms, represented by both its hypokinetic and hyperkinetic variants, in the presence of fragmentary and rudimentary unsystematized crazy ideas, and catatonic-hallucinatory-delusional (14.2%), characterized by a combination throughout the attack of severe catatonic disorders, represented in most cases by substuporous symptoms, interrupted by impulsive outbursts of excitement, with delusional disorders (represented mainly by delusions of perception) and massive, often verbal, pseudohallucinations.
At the first attacks With dominance of hallucinatory delusional disorders(II type) three subtypes have been identified. Seizures were the least common (5.7%) with acute systematized interpretive delirium, where the interpretative nature of delusional formation was represented by the delusions of other people's parents, relationships, hypochondriacal, dysmorphophobic content, less often - reformism, invention or love content. At the same time, the picture of interpretive delirium was supplemented by vaguely expressed phenomena of mental automatism, delusional ideas of influence in the presence of the relationship of all these disorders on the basis of a single delusional plot. For subtype with acute unsystematic interpretive delusions and verbal hallucinosis (11.4%) was characterized by the almost simultaneous appearance of unsystematized interpretive delusional ideas and verbal hallucinations, followed by the addition of manifestations of the Kandinsky-Clerambault syndrome (primarily ideational automatisms in the form of a symptom of openness of thoughts). With subtype with a mixed (sensual and interpretive) nature of delusion formation (17.6%,) there was a simultaneous coexistence of both delusional perception and delusional unsystematized interpretive ideas. Crystallization of delirium occurred according to the type of insight, in most patients the psychopathological picture of the attack was determined by the varying degree of representation of the manifestations of the Kandinsky-Clerambault syndrome. With this type of syndromes, in all its subtypes, the psychopathological picture in a number of observations was supplemented by affective disorders, which, however, did not have a decisive role in the formation of the attack structure.
First attacks with dominance of affective-delusional disorders (type III) were characterized by a double - affective and perceptual-delusional mechanism of delusion formation . Three subtypes have also been identified here. At the first - with the dominance of intellectual delirium of the imagination(9.8%) - in the psychopathological picture of the attack, delusional ideas of fantastic content came to the fore, formed according to the mechanism of delusion of imagination, often in combination with manifestations of acute delusion of perception. With a subtype with dominance of visual-figurative delusions of imagination (14.8%) the sharpness, polymorphism and variability of the psychopathological picture were most pronounced. There was a combination of acute figurative delirium, characterized by the appearance of "antagonistic" delirium of a megalomanic nature, the phenomena of the Kandinsky-Clerambault syndrome and catatonic-oneiric symptoms. In the cases studied, the pole of affect could often change during an attack, and therefore it was sometimes difficult to determine the dominant mood background. With a subtype with dominance of delusions of perception (16.8%) characteristic was the appearance of these delusional disorders of the type of acute paranoid against the background of a pronounced depressive or manic affect.
The study of cognitive disorders in the studied patients during the manifestation of the first attack and after the reduction of acute psychotic symptoms at the stage of formation of subsequent remission, carried out using neuropsychological, neurophysiological and experimental psychological methods, established significant differences in their structure and dynamics, correlating with the psychopathological symptoms identified in them. types of seizures, which confirmed the validity of their clinical typology based on the identification of the leading syndromes.
Data obtained from neuropsychological research showed that patients with JEPD already at the initial stage of the first psychotic attack demonstrate distinct violations of the regulatory, neurodynamic and operational components of cognitive processes. At the same time, each type of first seizure corresponds to a special configuration of the neuropsychological symptom complex, which differs not only in the presence or absence of certain disorders, but also in their different hierarchical organization, as well as the severity of these disorders (Fig. 2).
Rice. 2. Neurocognitive profile of patients with different types of first
seizures
Thus, in patients with I (catatonic) type of seizures, the least diffuse picture of cognitive disorders occurred in comparison with patients of the other two types of seizures. The disorder of the dynamic component in the motor, intellectual and mnestic spheres of the psyche came to the fore. In addition to these disorders in these patients, there was a decrease in control over the course of various kinds mental activity, which indicated the insufficiency of the mechanisms of its arbitrary regulation. In addition, there were some limitations in auditory-speech and visual memory.
In patients with II (hallucinatory-delusional) type of seizures, the identified neurocognitive symptoms were of a "generalized" nature, i.e. affected almost all components of cognitive processes and was characterized by a significant degree of severity. The most deficient in the structure of the neuropsychological symptom complex were voluntary regulation of activity and energy supply of mental activity. Disorders of auditory-speech and visual memory, as well as visual-spatial, tactile and acoustic non-verbal gnosis in these patients were more pronounced. There were also violations of the dynamic component in the motor, intellectual and mnestic spheres, however, unlike patients with type I seizures, they did not have the character of a leading syndrome.
In patients with type III (affective-delusional) seizures, the general pattern of neurocognitive disorders (with a lesser degree of their severity) was similar to that described above in patients with type II seizures. This was especially true for violations of voluntary regulation of activity, its neurodynamic parameters and energy supply, as well as auditory-speech memory, acoustic non-verbal gnosis and optical-spatial disorders. At the same time, distinct violations of spatial praxis were observed here.
When assessing the dynamics of established disorders in the cognitive sphere in the studied patients, based on a comparison of the data of their initial and repeated examinations (at the stage of remission), it was found that with different types of first attacks, changes in neurocognitive functioning not only differentially affect different components of this symptom complex, but also are not the same in intensity of their reduction during the attack. During the re-examination of patients with all three types of seizures, an increase in the resources of voluntary regulation of mental activity was noted, which serves as an indication of the actualization of their autoregulatory behavioral strategies during the formation of remission. Positive shifts in the cognitive sphere in patients with type I and II seizures were not statistically significant (p> 0.05), which reflects the lack of determinism of neurocognitive deficit by the severity of clinical symptoms, which is characteristic of patients with schizophrenia according to a number of other researchers. While in patients with III type the first seizures, as shown by the analysis, the severity of neurocognitive anomalies corresponded to the severity of psychopathological disorders, i.e. here, after the reduction of acute psychotic symptoms, there was a clear positive dynamics in the indicators of neurocognitive deficit (p
The study of cognitive functions in patients with the first attack of juvenile endogenous paroxysmal psychosis was also carried out using neurophysiological method
in conditions of selective attention, the so-called. oddball paradigm, or P300, according to which different components of evoked potentials are associated with different stages of auditory information processing. Thus, the analysis of the physical parameters of sounds is associated with the N100 wave, the classification of stimuli with the N200 wave, the assessment of the significance of incoming information, the activation of attention resources - with the P300 wave. It was found that in all the examined patients at the initial stage of the first attack, the early stages of information processing were not so strongly affected, although in all three types of the first attacks, violations of the processes of analyzing the physical parameters of sound were noted. It has been established that at the initial stage of the first attack, patients quite successfully keep the set-task for differentiation proposed by them. At the same time, it turned out that significant pathological changes were recorded in the studied patients when assessing the significance of incoming information, recording it in memory, and choosing a reaction.
Based on the comparison of the data obtained with the psychopathological type of the first attack, it was found that in the studied patients, despite the unidirectional anomalies of the neurophysiological parameters of cognitive functions, there are certain features of the studied characteristics that correlate with the dominance of various psychopathological syndromes in them in the picture of the first attack. Thus, in patients with type I (catatonic) seizures, the slowdown of mental processes turned out to be decisive, which began at the stage of stimulus classification and persisted in the interval associated with the activation of attention resources and preparation for performing an action. At the same time, deviations in the values of the P300 amplitude do not reach the level of significance in the parietal zones here, which allows us to assume a relative structural integrity in this group of patients with P300 generators projecting maximum activity to these departments. In type II (hallucinatory-delusional) seizures, the slowdown in mental processes at the stage of stimulus classification was less pronounced; moreover, when moving to the next stage of information processing, this slowdown persisted only in a few topographic zones. In contrast to the above data, in the III (affective-delusional) type of seizures, there were practically no disturbances in the processes of classifying stimuli. At the same time, with this type of seizures (compared to the two above), there were more distinct deviations for the P300 wave. A likely explanation for this may be that, according to clinical characteristics, patients in this group had severe disorders in affective sphere, which, possibly, led to greater desynchronization of processes at the late cognitive stage, associated, among other things, with the assessment of the significance of stimuli.
During re-examination at the stage of formation of remission in most of the studied patients and, first of all, in types I and II of seizures, “normalization” of the amplitude characteristics of the late cognitive component P300 was noted while maintaining the slowdown of the N200 and P300 components. At the same time, a re-examination of patients with type III seizures revealed the persistence of anomalies in both amplitude and time parameters of P300.
Thus, the neuropsychological and neurophysiological methods used in this study to study cognitive functions in patients with various psychopathological types of the first seizure made it possible to approach the solution of one of the main tasks in the field of biological psychiatry - "identification of brain mechanisms that mediate clinical picture mental illness” [Iznak A.F., 2008; Flor-Henry P., 1983; Andrewsen N., 2000]. The results obtained by us using modern neuropsychological and neurophysiological methods for studying cognitive functions in these patients allowed us to confirm Karl Kleist's hypothesis that the psychopathological picture of an attack is determined by the different topography of structural and functional disorders of the brain (Fig. 3).
Rice. 3.
Typography of structural and functional anomalies of the brain
(according to neuropsychological and neurophysiological
studies) with different types of first seizures
The neuropsychological and neurophysiological data obtained in this study made it possible to establish both signs of damage to the subcortical and limbic structures and the temporal region of the brain that are common for all types of the first attacks of JEPD, as well as their certain differences: in patients with a catatonic type of seizures, predominantly premotor and prefrontal sections of the cortex, with a hallucinatory-delusional type - prefrontal and parietal sections, with an affective-delusional - parieto-occipital. It should be noted that the topography of cognitive impairments established in this work in the studied patients is also confirmed in the works of a number of researchers conducted using the MRI method, especially with regard to hallucinatory-delusional disorders. At the same time, data concerning patients with dominance of catatonic symptoms, as far as is known from the literature, have been established for the first time.
results experimental psychological research patients with the first attack of JEPP , carried out from the position of the pathopsychological syndrome [Kritskaya V.P., Meleshko T.K., Polyakov Yu.F., 1991; Kritskaya V.P., Meleshko T.K., 2003, 2009] at the stage of formation of remission also testified to varying degrees the severity of cognitive deficit depending on the type of first seizures, which corresponds to the data established during neuropsychological and neurophysiological studies. In addition, a high representation in patients with all types of first attacks of schizoid personality traits was established, manifested in their cognitive style and giving a peculiar coloring to their appearance and behavior, which to a certain extent is mediated in them by the influence of the age factor. In general, the majority of the studied patients were characterized by the predominance of inadequate personal self-esteem, the absence of real plans for the future, as well as the field-dependent style of cognitive activity, which, as one might suppose, contributed to the more frequent formation of the first attacks of sensory delirium in their picture, even in the absence of it in its structure. affective disorders. According to the obtained pathopsychological data, the dependence on the perceptual field, characteristic of most of the studied patients, was combined with their “release” from the social context, as evidenced by a decrease in the level of communication, which was more pronounced in patients with I and II (catatonic and hallucinatory-delusional) types of the former. seizures. Other significant pathopsychological differences were noted depending on the psychopathological picture of the attack. So, in terms of parameters characterizing mental activity, motivation and self-regulation of activity, patients with type I and II seizures showed a more pronounced decrease compared to these indicators in patients with type III, where there was a practically intact level of self-regulation and the presence of more than half of the cases high pace of cognitive activity with a high degree of initiative. Another equally important indicator should be considered statistically significant differences between the studied groups of patients in terms of the level of disruption of communication processes and a decrease in emotionality. Thus, in patients with type I and II attacks, the level of communication was sharply reduced, while in patients with type III this occurred only in isolated cases. In addition, proactive communication was practically absent in patients with the first two types of seizures, while it was observed with a significant probability in patients with type III seizures.
Thus, the differences in the pathology of cognitive activity established in the studied patients, correlating with the psychopathological type of the first attack, were additional criteria significant for the prognostic and nosological assessment of their disease at the stage of the first attack of endogenous paroxysmal psychosis manifesting in adolescence.
Taking into account modern data on the involvement of the immune system in pathogenetic processes in schizophrenia [Kolyaskina G.I. et al., 1996; Vetlugina T.P. et al., 1996; Klyushnik T.P., 1997; Shcherbakova I.V., 2006; Abrosimova Yu.S., 2009; Muller N. et al. 2000; Mahendran R., Chan Y., 2004; Drzyzga L. et al., 2006] to elucidate the pathogenetic significance of a number of biological factors in the formation of the picture of the first attack, in the studied patients in the study, a number of indicators of innate and acquired immunity were analyzed during the manifestation of the first attack, as well as at the stage of formation of remission. In addition, the influence of their immune status on the effectiveness of neuroleptic therapy was studied. It was found that in adolescent patients during the first attack, regardless of its psychopathological type, there is an increase in the activity of a number of immunological indicators that reflect the characteristics of the immune response to the first manifestation of endogenous psychosis, as evidenced by a significant (p increase in their activity of leukocyte elastase, α1-proteinase inhibitor, increased production of interleukin-1b and interleukin-10 and the concentration of interleukin-2 in blood serum.At the same time, there were no significant differences in these indicators between groups of patients identified by syndromic types of the first attack.According to the activity of leukocyte elastase and α1-proteinase inhibitor, no there were differences even between manic-delusional and depressive-delusional patients.
On the basis of the data obtained, it was concluded that immunological indicators can simultaneously be considered as the pathogenetic basis for the formation of an individual drug response in patients to the therapy being carried out and thus serve as predictors of its effectiveness. Immunological predictors of the effectiveness of therapy, indicating a high reactivity of the patient's body, include: a high level of production of interleukin-1b and interleukin-10, a low concentration of interleukin-2 in the blood serum, a high activity of leukocyte elastase, and the absence of an increase in the level of antibodies to nerve growth factor during an attack. The high efficiency of ongoing antipsychotic therapy with an increase in the activity of leukocyte elastase, an α1-proteinase inhibitor is explained by their ability to disrupt the protective properties of the blood-brain barrier and, accordingly, increase its permeability to medicines. Thus, the data obtained make it possible to predict the effectiveness of antipsychotic therapy already at the initial stages of its implementation and to guide physicians in the search for options for its optimization.
According to the World Health Organization, by 2020 depression will become the most common disease in the world. Many call it an epidemic of the 21st century, although even Hippocrates described a condition called “melancholia.” What is depression, why does it occur and how to deal with it? Answers these and other questions psychiatrist, MD Vasily Glebovich Kaleda, Deputy Chief Physician of the Mental Health Research Center of the Russian Academy of Medical Sciences, Professor of PSTGU.
Vasily Glebovich, what are the signs of depression and how to recognize it?
Depression (from the Latin deprimo, which means “oppression”, “suppression”) is a painful condition that is characterized by three main features, the so-called depressive triad. Firstly, this is a sad, sad, melancholy mood (the so-called thymic component of depression), secondly, motor, or motor, lethargy, and finally, ideational lethargy, that is, a slowdown in the pace of thinking and speech.
When we talk about depression, the first thing we think of is a bad mood. But this is not enough! The most important sign diseases - a person loses strength. Outwardly, his movements are smooth, slow, inhibited, while mental activity is also disturbed. Patients often complain about the loss of the meaning of life, a feeling of some kind of stupefaction, internal slowdown, it becomes difficult for them to formulate thoughts, there is a feeling that the head is empty at all.
Characterized by a decrease in self-esteem, the emergence of a conviction that a person is a complete loser in life, that no one needs him, is a burden to his loved ones. At the same time, patients have sleep disturbance, difficulty falling asleep, often there are early awakenings or the inability to get up in the morning, reduced appetite, and a weakening of sexual desire.
The clinical manifestations of depression are very diverse, so there are quite a lot of its varieties, which outwardly can be very different from each other. But one of the main characteristics of depression is its severity: it is relatively mild - subdepression, depression of moderate severity and severe depression.
If, with a mild degree of the disease, a person remains able to work and this mood does not greatly affect his daily life and the sphere of communication, then moderate depression already leads to a breakdown and affects the ability to communicate. At severe depression a person practically loses both working capacity and social activity. With this form of depression, a person often has suicidal thoughts - both in a passive form, and in the form of suicidal intentions and even suicidal readiness. Patients suffering from this form of depression often attempt suicide.
According to a WHO study, about 90% of all suicides on the planet are committed by patients with various mental disorders, of which about 60% suffered from depression.
With severe depression, a person suffers unbearable mental suffering; in fact, the soul itself suffers, the perception narrows real world, it is difficult - or even impossible for a person - to communicate with his relatives and friends, in this state he may not hear the words of the priest that are addressed to him, often loses the life values \u200b\u200bthat he had before. They already, as a rule, lose their ability to work, because the suffering is very severe.
If we talk about people of faith, then they make suicidal attempts much less often, because they have a life-affirming worldview, there is a sense of responsibility before God for their lives. But it happens that even believing people are not able to endure this suffering and do something irreparable.
From sadness to depression
How to understand when a person is already depressed, and when “just sad”? Especially when it comes to close people, whose condition is objectively extremely difficult to assess?
Speaking of depression, we mean a specific disease that has a number of formalized criteria, and one of the most important is its duration. We can talk about depression when this condition lasts for at least two weeks.
Each person is characterized by a state of sadness, sadness, despondency - these are normal manifestations of human emotions. If some unpleasant, psycho-traumatic event happens, then an emotional reaction to it normally appears. But if a person has a misfortune, but he is not upset - this is just a pathology.
However, if a person has a reaction to a traumatic event, then normally it should be adequate to the level of the event. Often in our practice we are faced with the fact that a person has a traumatic situation, but his reaction to this situation is inadequate. For example, being fired from a job is unpleasant, but reacting to it with suicide is not normal. In such cases, we are talking about psychogenic-provoked depression, and this condition needs medical, medication and psychotherapeutic support.
In any case, when a person has this long-term condition with a sad, sad, depressed mood, loss of strength, problems in understanding, loss of the meaning of life, lack of prospects in it - these are the symptoms when you need to see a doctor.
Depression for no reason
It is important to understand that in addition to reactive depression, which occurs as a reaction to some kind of traumatic situation, there are also so-called endogenous depressions, the causes of which are purely biological, associated with certain metabolic disorders. I had to treat people who are no longer there, and who can be called ascetics of the 20th century. And they also had depression!
Some of them had endogenous depressions that arose without any visible, understandable reason. This depression was characterized by some kind of sad, sad, depressed mood, loss of strength. And this condition went very well with drug therapy.
That is, believers are also not immune from depression?
Unfortunately no. They are not immune from both endogenous depression and psychogenic-provoked depression. It must be borne in mind that each person has his own special level of resistance to stress, depending on his character, personality traits and, of course, worldview. One of the greatest psychiatrists of the 20th century, Viktor Frankl, said: “Religion gives a person a spiritual anchor of salvation with a sense of self-confidence that he cannot find anywhere else.”
"Christian" depression
When we talk about people who believe, in addition to the above symptoms associated with mood and lethargy, there is a feeling of God-forsakenness. Such people will say that it is difficult for them to concentrate on prayer, they have lost their sense of grace, they feel on the verge of spiritual death, that they have a cold heart, a petrified insensibility. They can even talk about some special sinfulness and loss of faith. And that feeling of repentance, the degree of their repentance for their sinfulness will not correspond to the real spiritual life, that is, the real misconduct that such people have.
Repentance, the sacraments of Confession and Communion - these are the things that strengthen a person, instill new strength, new hopes. A depressed person comes to a priest, repents of his sins, takes communion, but he does not experience this joy of starting a new life, the joy of meeting the Lord. And for believers, this is one of the main criteria for the presence of a depressive disorder.
They are not lazy
Another important complaint of a person suffering from depression is that he does not want to do anything. This is the so-called apathy, the loss of desire to do something, the loss of the meaning to do something. At the same time, people often complain of a lack of strength, of rapid fatigue - both during physical and mental work. And often people around perceive it as if a person is lazy. They tell him: "Pull yourself together, force yourself to do something."
When such symptoms appear in adolescence, the relatives surrounding them, stern fathers sometimes try to influence them physically and force them to do something, not realizing that the child, the young man, is simply in a painful state.
Here it is worth emphasizing one important point: when we talk about depression, we are talking about the fact that this is a painful condition that arose at a certain moment and caused certain changes in a person’s behavior. We all have personality traits, and they tend to accompany us throughout our lives.
It is clear that with age a person changes, some character traits change. But here is the situation: before, everything was fine with a person, he was cheerful and sociable, was active, studied successfully, and suddenly something happened to him, something happened, and now he looks somehow sad, sad and sad, and there seems to be no reason for sadness - here there is a reason to suspect depression.
Not so long ago, the peak of depression was between 30 and 40 years old, but today depression has dramatically “younger”, and people under 25 often get sick with it.
Among the varieties of depression, the so-called depression with "youthful asthenic failure" is distinguished, when it is the manifestations of the decline of intellectual, mental strength that come to the fore, when a person loses the ability to think.
This is especially noticeable among students, especially when a person successfully studies at an institute, has completed one course, a second, a third, and then there comes a moment when he looks into a book and cannot understand anything. He reads the material, but he cannot master it. He tries to read it again, but again he cannot understand anything. Then, at some stage, he drops all his textbooks and starts walking.
Relatives can't figure out what's going on. They try to influence him in some way, and this condition is painful. At the same time, there are interesting cases, for example, “depression without depression”, when the mood is normal, but at the same time the person is motorally inhibited, he cannot do anything, he has neither physical strength nor the desire to do anything, he has lost where - intellectual ability.
Is fasting depression a reality?
If one of the signs of depression is the loss of the physical ability to work, to think, then how safe is it for mental workers to fast? Can a man, working in a responsible leadership position, feel good eating porridge or carrots? Or, for example, a woman accountant who has just the reporting period during Lent, and no one has canceled household duties? To what extent can such situations cause stress, lead an organism weakened after winter to depression?
First, the time of fasting is not the time of hunger strike. Be that as it may, lean food contains a sufficient amount of substances necessary for the body. One can cite as an example a large number of people who strictly observed the fast and at the same time fulfilled the serious duties assigned to them.
I remember Metropolitan John of Yaroslavl and Rostov (Wendland), who, of course, led an entire diocese, a metropolis, who had a unique dish during Lent - semolina on potato broth. Not everyone who tried this lean food was ready to eat it.
My dad, Father Gleb, always, as far as I remember, strictly fasted, and combined fasting with serious scientific and administrative work, and at one time he had to drive one and a half to two hours one way to his place of work. There was quite a serious physical load, but he coped with it.
It has become much easier to fast now than it was 30 years ago. Now you can go to any supermarket, and there will be a huge selection of dishes marked “Lenten product”. Recently, seafood has appeared that we did not know before, a large number of frozen and fresh vegetables have appeared. Earlier, in childhood, relatively speaking, we knew only sauerkraut, pickles, potatoes during Lent. That is, the current variety of products was not.
I repeat: fasting is not a time of starvation and not a time when a person simply follows a certain diet. If fasting is perceived only as observing a certain diet, then this is not fasting, but just a fasting diet, which, however, can also be quite useful.
Fasting has other purposes - spiritual ones. And probably, here each person, together with his confessor, must determine the measure of fasting that he can really endure. People may be spiritually weak or, for one reason or another, begin to fast very strictly, and by the end of the fast, all their physical and mental strength is already running out, and instead of the joy of Christ's Resurrection, they are tired and irritable. Probably, in such cases it is better to discuss this with the confessor and, perhaps, get a blessing for some weakening of the fast.
If we talk about us, about people who work, then in any case, lean food differs from ordinary food in that it is more “labor-intensive”. In particular, with regard to cooking - it needs to be cooked longer and more in quantity. Not every person at work has a buffet where lean food is offered, or at least close to lean. In this case, a person must somehow understand what fast he can endure and what his personal fast will consist of.
My dad once gave an example - his spiritual daughter came to him (it was the beginning of the nineties or the end of the eighties). She lived with unbelieving parents, and it was very difficult for her to fast at home, causing constant conflicts with her parents, tension in the family situation.
It is clear that because of these conflicts, a person approached the bright holiday of Easter not at all in a festive mood. And dad told her as an obedience to eat absolutely everything that her parents prepare at home. Just can't watch TV. As a result, after Easter, she said that it was the hardest post in her life.
Probably, those people who, due to some circumstances, find it difficult to fully observe the fast in relation to food - and all of us - need to set some individual goals during the fast. Everyone knows their weaknesses and can impose some feasible restrictions on themselves. This will be a real fast, which has primarily spiritual goals, and not just abstaining from food, a diet.
You and I must always remember that Orthodoxy is the joyful fullness of life in Christ. A person by nature consists of three parts: spirit, soul and body, and we must strive to ensure that our life is full and harmonious, but at the same time the spirit must dominate. Only when spiritual life dominates in a person is he truly mentally healthy.
Interviewed by Lika Sideleva (
An online conference with Doctor of Medical Sciences, Professor Vasily Glebovich Kaleda was held on the Orthodoxy and the World portal. We publish the answers of V.G. Kaledas to questions submitted by readers.
Vasily Glebovich Kaleda. Answers to questions from Pravmir readers
Confessor and psychiatrist
Good afternoon! How to avoid dependence on communication with a confessor? In many life situations, you have to ask for advice or help, since there is mail and a telephone for communication. This is good. But sometimes there is no connection, and it can be very difficult to make a decision on your own. Thanks for the replies and your work. Best regards, Natalia
Dear Natalia! In your situation, first of all, you need to talk not about dependence on the spiritual father, but about the features of your character, due to which it is difficult for you to make a decision.
It is very difficult for people with a similar character (anxious and suspicious) to make any decision on their own, both on important issues and on secondary ones. You left the decision of all such issues to the confessor, since you can almost always contact him. Really serious questions that need to be asked the blessing of a confessor do not arise so often. Each person should have his own active moral position in life.
Please tell us how you yourself would determine which issues should be resolved with a priest, and which with an Orthodox psychiatrist or psychologist? Vasily Glebovich, I believe that our priests often do the work of psychiatrists, playing, so to speak, "in a foreign field." What do you think?
A psychiatrist should be consulted in cases where there are signs or suspicion of a mental illness or mental disorder, and, accordingly, the treatment of these conditions is the competence of a psychiatrist. Often it is the priest who is the first to realize that the existing emotional experiences do not fit into the “relative norm” and blesses to turn to a psychiatrist.
There are cases when priests and psychologists, as well as relatives of the patient, not recognizing the morbid nature of the condition, prevent an appeal to a psychiatrist.
It also happens that psychiatrists (with insufficient qualifications) mistake some spiritual experiences for pathology.
For a better understanding by priests of the manifestations of mental illness, a number of educational institutions of the Russian Orthodox Church (PSTGU, Sretensky Theological Seminary, etc.) teach the course "Pastoral Psychiatry".
General issues
Dear Vasily Glebovich!
Please inform the entire audience of this site that there are no separate Orthodox and non-Orthodox psychologists, just as there are no separate, for example, Orthodox and non-Orthodox surgeons, firefighters and policemen.
No, of course, I understand that an Orthodox believing psychologist, other things being equal, will tell the patient about God and advise him to come to the temple, but still he will not take on the functions of a priest. But this does not mean at all that a non-Orthodox psychologist, in principle, is not able to help a churched person in any way. Unfortunately, in the Orthodox environment, the opinion is very widespread that "Orthodox psychologists are not needed."
I do not share the point of view that "Orthodox psychologists do not need." Psychologists face very different tasks - there are psychologists who work in emergency situations, are engaged in the rehabilitation of patients and people with disabilities. handicapped help to solve family problems and specific problems of various age periods, determined by prof. suitability, etc. etc..
Any professional psychologist in working with a person with psychological problems will rely on the resources of his personality. The most important "psychological resource" Orthodox person is his faith, his Orthodox worldview (willingness to rely on the will of God, the priority of spiritual values, the rejection of suicide as an option for solving one's problems, etc.). Therefore, if an Orthodox person has psychological problems, it is better to turn to an Orthodox psychologist (if any), provided that he is highly professional. If not, then you need to contact the psychologist who is available.
Of course, if there is an opportunity to communicate with an experienced confessor who can devote enough time to you, then this is wonderful and most likely will be enough. But in our real life priests are objectively very busy and a psychologist at the parish can help find answers to some questions and help formulate the question to the priest better.
1. What is the nature of the occurrence of mental illness? Can a mentally healthy person suddenly become sick?
2. What is the difference between mentally unbalanced person and the mentally ill? Or is it one and the same?
3. Is it possible to “get infected” while being close by, communicating with a sick person for a long time?
4. How to behave with such people? Is it possible to make contact or is it better to avoid communication?
5. Can such people work? Or they need to be protected in every possible way from work, for example, in the parish.
Thank you!
1. There are several groups of mental illnesses: endogenous (schizophrenia, schizoaffective psychosis, affective psychoses), endogenous organic diseases (epilepsy, mental disorders in atrophic processes of the brain, including Alzheimer's, Pick's, Parkinson's, etc.), exogenous organic diseases (after traumatic brain injury, with brain tumors, with infectious organic diseases), exogenous (alcoholism, drug addiction, substance abuse), psychosomatic disorders, psychogenic diseases, borderline mental disorders (neurotic disorders and personality disorders), as well as pathology of mental development (including mental retardation). The nature of these diseases is different. In endogenous diseases, including schizophrenia, one of the main causes is hereditary predisposition. In some cases, a provoking factor is necessary for its implementation. The underlying concept behind the onset of schizophrenia is the disruption of dopamine production. In addition, some other transmitter systems of the brain are involved in the pathological process. Psychogenic diseases, as the name suggests, occur after traumatic situations. Unfortunately, it often happens that a mental illness manifests itself in an “absolutely mentally healthy person” (for all the conventionality of this term), who does not have a hereditary predisposition.
2. These are different concepts. Each disease has its own clear diagnostic criteria.
3. Mental illnesses are “not contagious”, however, being close to a seriously ill person for a long time, some people may experience psychogenic disorders. I admire the courage with which a number of deeply religious relatives of my patients bear their life's cross.
4. The approach to the mentally ill is strictly individual, but we have no right to turn away from them, they need our help and our support. We must remember the words of St. Ignatius Brianchaninov: “Show respect to the blind, and the leper, and the mentally crippled, and the infant, and the criminal, and the pagan, as the image of God. What do you care about his infirmities and shortcomings? Watch over yourself so that you do not lack love.
5. Many of them can work very successfully, including writing and defending dissertations, and holding very high positions. But the working capacity of some of them is reduced or almost lost. Many of them are left to their own devices, no one takes care of them. To obedience in the parish, if there is an opportunity, they should be attracted, for them it is very important. But at the same time, one must be prepared for the fact that they will not arrive at the appointed time, they will be very late without apparent reason, may suddenly abandon their obediences and go home, and then appear only after a few days.
How true is the statement that Orthodoxy does not accept yoga and considers yoga as a preparation for communion with demons? Is it true that these activities shake the psyche and cripple the soul?
I will answer your questions in part (I answer questions as an Orthodox psychiatrist), and I will express only my personal point of view. It is possible to do physical exercises according to the method of yogis, but at the same time one cannot cross the line when a change in world perception and worldview is required.
I have no scientific evidence that among yoga practitioners, the number of mentally ill is higher, I do not have. Among my patients there are patients who managed to practice yoga.
Spirina Vera
Good day, Vasily Glebovich!
I am a beginner psychologist with little experience. I work at the Center for Additional Education for Children and Youth "Bogolep" at the John the Baptist Monastery in the city of Astrakhan.
Please answer the following questions:
1) Is it planned to create a distance course on Orthodox psychotherapy at PSTGU?
3) How did you overcome or overcome difficulties and failures on your way?
Save you Lord!
Dear Vera, good day!
Psychotherapy is a medical specialty, and the creation of a medical faculty at PSTGU is not yet planned. From modern books, I would like to advise you to read: Melekhov D.E. "Psychiatry and issues of spiritual life" (available on the Internet); Metropolitan Hierofey (Vlachos) "Orthodox Psychotherapy", Holy Trinity Sergius Lavra, 2004, 368 p.; Jean-Claude Larcher "Healing of Mental Illnesses (Experience of the Christian East of the First Centuries)", M., From Sretensky Monastery, 2007, 223 p.
When I had difficulties and failures in my life, I had a firm conviction (my parents instilled it in me) that this is the Will of God, that there is some meaning in this, which will be understood later.
I wish you God's help in your difficult ministry.
Dear Vasily Glebovich! Is it true that with the introduction of the Unified State Examination, the number of mental illnesses among school graduates has sharply increased? Thank you.
I don't have such data. I think that the peak of various reactive states among school graduates has shifted to the Unified State Examination from the experiences associated with entering the institute.
depression
Good afternoon! Lately, I have been experiencing symptoms of irritability, tearfulness, and many others. I turned to a psychotherapist. She diagnosed me with deep depression and prescribed tranquilizers. The effect is good though for a reason high cost I can't take them regularly. In addition, she said that drug treatment only relieves the symptoms, but does not completely cure. As a treatment, she suggested that I be like shallow hypnosis sessions and hinted that my problems may be due to the fact that I do not live a sexual life. I don't know if I can be allowed to interfere with my psyche, no doubt an excellent specialist in his field, but still a person whose recommendations may go against my Christian principles?
I think that the advice given to you by a psychotherapist should be divided into two groups. The first is in relation to drug treatment. Antidepressants need to be taken and in some cases long courses. Depressive states often disappear completely. Indeed, some modern antidepressants are quite expensive, if you are not able to take them, discuss this issue with your doctor, ask him to choose another antidepressant therapy regimen. The second group is psychotherapeutic advice, here you must have your active moral position.
Marina A.
Please tell me, with depression without organic disorders, is drinking antidepressants a life sentence? In fact, such a person is likened to a drug addict? Thank you.
In the psychiatric literature, the concept of "lifelong prescription of antidepressants" is absent (in schizophrenia, in some cases, we can talk about almost "lifelong prescription" of antipsychotics).
In some cases, with the so-called prolonged and chronic depressions, it may be recommended to long-term use antidepressants. But antidepressants do not cause the sensations that drugs cause, so this comparison is not correct.
If you follow your logic, then you can compare with drug addicts a large number of patients with serious chronic diseases, for example, a patient with diabetes who injects himself with insulin for life.
Hello, I am 27 years old, I have been depressed for several years. I went to a psychiatrist only this year - I prescribed azafen, I felt better a little and not for long. After Communion it is also easier, but for 1-2 days. Personal life does not add up, at work - no self-realization (although I studied well, I seem to be able to think). I don't have enough strength to think that everything is fine. I know that I need a doctor's help. Advise which psychiatrist to contact. It is important to me that he be Orthodox. Thank you very much.
Contact me via email [email protected]).
Hello! For as long as I can remember, I have been suffering from depression, which, according to the doctor, is an endogenous disease. I began to go to church, I began to feel better, but now all the medicines have ceased to help: from all antidepressants - it makes me sleepy, and from neuroleptics, and from drugs that remove “voices” - tachycardia and weakness. Those. effects are only side effects. There is such a fear that I can’t even go out into the streets, that the Jesus Prayer does not help. Even the doctor doesn't know what to do.
With endogenous depressions, so-called states of resistance sometimes occur, i.e. when there is no response to ongoing drug therapy. However, in recent years, antidepressants with a different mechanism of action have appeared, as well as fundamentally new antipsychotics, which have an officially registered indication for the treatment of prolonged and chronic depression in combination with antidepressant therapy.
I suffer from long depressions, however they sometimes stop. During depression, there is no strength. And most importantly, full confidence in the futility of prayer and any movements, and it is impossible to move, the body and soul strive only for peace. I don't know if a doctor can help in this case.
But the biggest problem is my son. He does not want to do anything, he is 13 years old, and he asks why I gave birth to him. In the diary, two deuces a day, comments due to behavior, due to being late, due to chronically unfulfilled lessons, bad relations with classmates. We perish, our souls perish together. What to do?! (But I am the spiritual daughter of Father Gleb, there is no way for me to justify myself before God!)
I think that your problem should be divided into two problems (although they are interconnected). The first problem is with your health and the second with your son.
With regard to the first, well-chosen antidepressant and supportive therapy allows minimizing the manifestations of depression and more calmly, more rationally treating the problems with the son. In pubertal (adolescent) age, children often have similar problems, which are gradually leveled out in the future.
Hello, Vasily Glebovich!
A year and a half ago, I lost my husband and daughter in a car accident.
For the third month I have been treated by a psychiatrist for depression, a manifestation of which he considers my panic attacks. He believes that a year of mourning is a lot, then pathology. But I don’t believe that longing for loved ones can be drowned out with pills, and I can’t imagine that it can turn into “ bright sadness“.
Nataliya
Dear Natalia! Of course, longing for loved ones cannot be “drowned out with pills”, and a year of “mourning” is not a pathology, the opposite would be pathology.
But now you especially need the support of your loved ones, participation in church sacraments, and …. in drug therapy. Without drug support, it will be even more difficult for you.
Help you Lord.
Vasily Glebovich, good afternoon! Sorry for the long question.
She grew up in a family where there were frequent scandals and very tense relations between her parents. At the institute, I was overworked and fell ill with depression. At the age of 19, I was raped and beaten in a hostel. After that, the depression worsened, sonapax was prescribed, it helped well.
Later she got married, but her relationship with her husband was bad. After 1.5 years, her husband was killed. After that, I began to have strong fears, I could not be alone at home and sleep, I was afraid of evil spirits. She was in a mental health research center, taking neuroleptics and antidepressants. The condition has improved. I started to become churched.
I am now married again and have a child. But the depression seems to have remained, and besides, I can’t get rid of intimate problems. Sometimes obsessive pictures of rape and sometimes the death of her husband pop up. Sometimes there are flashes of fear - in the dark or when alone. I sleep badly, tired, irritable, anxious. I often turn to my confessor, but he cannot help me with all these problems. What to do? I don’t really want to take pills again, it’s scary to go to a sexologist.
Tell me, please, whom to turn to (maybe an Orthodox psychologist?). I would be grateful for any information.
Regards, Anastasia
You write that you do not sleep well, are tired, irritable, anxious, disturbed by intrusive memories - i.e. have symptoms of depression.
I would not rule out the possibility of taking a small course of modern antidepressant therapy. At a minimum, it is necessary to normalize sleep.
There are Orthodox psychologists, contact me by email. mail ( [email protected])
Hello, Vasily Glebovich! After giving birth, I became very nervous, I'm afraid of everything. Almost immediately, tears well up. Please advise if anything can be done about this.
Good afternoon! What you experience is experienced by approximately 15-20% of women in the postpartum period. This condition is temporary and is called postpartum depression. However, so that it does not become protracted, it is necessary to go to an appointment with either a psychotherapist or a psychiatrist.
In these cases, mild antidepressants are prescribed or, if you are breastfeeding, then herbal preparations.
Obsessive Compulsive Disorders
Hello! Tell me, how to deal with obsessive-compulsive disorder (OCD) in the spiritual life? For example, it is very difficult to follow the prayer rules (if I don’t do it by accident, anxiety and palpitations set in). How to deal with suspiciousness and endless repetition of rituals in the ritual side of church life?
On the one hand, you need to ask your confessor to bless you to fulfill the volume of the prayer rule that you can afford. On the other hand, a course of modern antidepressant therapy will allow you to reduce your suspiciousness and anxiety.
I was diagnosed with OCD and prescribed antidepressants, but I think it’s necessary to take pills, especially such ones. Maybe it's better to ask God for healing?
I think the best thing to do is to pray, ask your loved ones to pray for your health and… be sure to take antidepressants.
Neurosis
In the summer there was a situation: I could not fall asleep all night, because suddenly, when I went to bed, an inexplicable horror surged, so that even speech was not complete for a while - I could not pronounce the words of prayer. And then, sometimes to a greater, sometimes to a lesser extent, a specific fear of death persisted.
After that, sometimes in the evenings there was something similar, but in a much milder form. The other day, too, suddenly rolled such a fear. It became better after I read “Let God Arise” and signed himself and the space around with the sign of the cross.
For more than two weeks, heart problems (feel strong heartbeat, heaviness, it is difficult to lie on the left side, sometimes it is difficult to stand). True, thank God, the last days have become better. But on some site they wrote to me that the problems are not with the heart, but it's just a neurosis.
In addition, there is often a state of ... I don’t know what to call it - despondency, depression ... Sometimes even despair - that I am not correcting myself, I am not fighting sin. Probably, this is already a spiritual area, and not a psychic one, but this state is sometimes very depressing ...
I would be very grateful for your attention and help! Save you Christ!
You correctly wrote on some site that it is a neurosis. More precisely - a depressive state with panic attacks.
This condition is temporary, it is successfully treated, contact either a psychotherapist or a psychiatrist. Help you Lord!
Hello! Tell me what the following manifestations of neurosis may be associated with: I am primarily concerned about unusual and inexplicable sensations in the upper chest area - as if it is tightening either the skin or the muscles of the chest, while there is practically unabated pain, pulling, bursting, pressing, as if drilling, and precisely in the chest area. The doctor says that these sensations arise on the basis of nervous exhaustion (I have certain endocrine disorders, which only aggravates the situation).
The doctor (psychiatrist-psychotherapist) treats me mainly with medication, but the drugs help only for a while (sonapax gave a very persistent side effect in the form of pain in the mammary glands, Azafen, if it brought benefits, then only for a short time).
Of course, these are not all the symptoms, but from the bodily manifestations, these are the main “problems” that torment me almost every hour. There is also irritability, fussiness, aggression towards other people and other similar emotional manifestations.
The doctor diagnoses - neurasthenia. Let it be. But to my regret, so far the treatment has not brought persistent positive results(quite the opposite), which certainly brings even more mental anguish and reduces the level of productivity at work (it is very hard to work, although I like my job and really don’t want to lose it).
Once again I will outline my questions: what is the cause of unusual “nerve” pains in the chest area? what can be done to eliminate them?
Thank you for your attention!
It is difficult to answer these questions precisely and unambiguously, there are too many different complaints.
Concerning specific symptom- Unusual pains in the upper part of the chest - their causes can be different: physical sensation anxiety, which is often accompanied by tension in various muscle groups, including the chest; feeling of vital anguish in depression; causeless sensations of mental genesis (the so-called senestopathy).
Azafen and sonapaks do not exhaust all the possible remedies that can help you. Talk to your doctor and discuss the possibility of using more modern drugs.
obsessive states
Hello Vasily Glebovich.
I've been living in hell for 5 years now. obsessive thoughts with terrible scenes of fornication. Fear that children will be raped. It began with the fact that I was sitting at home with small children, there was a slight depression. I watched a terrible program on TV and was very scared for my children. I don’t sleep: from evening to four in the morning, a struggle with thoughts. Fear that I'm a maniac, etc. I am saved by prayer and the temple, but the relief is weak for two days, and then all over again.
Tell me what's wrong with me? I can not do it anymore. If not for faith, I would have committed suicide long ago. What should I do?
Thank you.
Conditions like yours, with a predominance of obsessive ideas, are successfully treated. See a psychiatrist, don't worry.
Hello, Vasily Glebovich!
My brother has suffered from obsessive-compulsive disorder since childhood.
He has a family and a high-paying job, but every day he starts by calling my father and controls him all day out of fear that something will happen to my father. Once he was greatly frightened by my mother, who herself has a number of phobias. In addition, the brother has a psychopathization of character in the form of emotional restraint.
Family happiness is under threat, there are no children yet. He received no treatment.
My father and I are praying for him, asking him to go to church, confess, take communion. I think that the brother avoids going to church because of the large number of superstitions and fears that accompany novice Christians on the path of churching.
On duty, he spends every two weeks of the month in Moscow. Please advise where to start. Is it possible to overcome this kind of disease with the help of the sacraments? Where to find a good priest in Moscow or Novosibirsk?
Help God! Thank you.
You write that at present the brother avoids going to church, which is apparently due to his illness. In any case, he needs to seek help from a psychiatrist or psychotherapist. Clear progress has now been made in the treatment of these conditions.
Since childhood, I have had two phobias: fear of the dark and of heights.
Faith helps with the first. In a difficult moment, I remember the words of the Apostle Paul, “If God is for us, who can be against us?” and the fear goes away.
The second one is more difficult.
As a young child, I had a dream in which I fell from the roof of a tall building, landing on my feet and remaining unharmed. Since then, at a height, I have a wild desire to jump (at the same time, thoughts of suicide do not arise). What can you recommend?
Thank you!
In fact, you are worried about the so-called. contrasting obsessions, i.e. obsessions that are contrary to the desire of a person. At religious people they are often manifested by "blasphemous thoughts", for example, the desire to shout out a cynical phrase in the temple.
As a rule, contrasting obsessions reflect those fears that a person represses and never wants to realize in real life. Perhaps that is why people never implement them. You shouldn't be afraid of them. Cognitive-behavioral therapy can help to cope with them.
Schizophrenia
Hello!
I am a medical student. In the cycle of psychiatry, we were shown many times patients with schizophrenia, whose delusions often had a bright religious coloring in them - for example, the patient himself claims that he is “possessed by demons”, or that he “prays to pagan gods”, they “answer” him, etc.
Treatment - haloperidol, i.e. productive symptoms are removed.
Tell me, are they really “just” mentally ill? Is it possible to distinguish a schizophrenic from a possessed? Is the Kandinsky-Clerambault syndrome just a sign of the paranoid stage of schizophrenia or something else?
Hello dear Katerina Sergeevna!
Congratulations on starting your study of psychiatry! I hope you will agree with me that this is the most interesting and most difficult medical specialty.
The Kandiski-Clerambault syndrome is indeed typical of schizophrenia, for the diagnosis of which it does not matter whose voices the patient hears.
Patients draw the subject of delusional constructions from the reality surrounding them. I had a patient who in one attack heard the "voice of the crocodile Gena", in another - dark forces.
"The syndrome of impossibility" occurs in mental illness (as the subject of a delusional plot), and in special spiritual states.
With endogenous psychoses, which have their own patterns of course, this syndrome is interconnected with other psychopathological disorders.
In spiritual states, this syndrome also has its own characteristics, described in patristic literature and by our contemporaries. At one of the classes in pastoral psychiatry, together with the priests, we analyzed one endogenous patient with this syndrome. Their conclusion is that his statements are a classic manifestation of mental illness (Sch.).
About approaches to differential diagnosis these states, see my lecture "Psychiatry and Spiritual Life" (https://www.site/psixiatriya-i-duxovnaya-zhizn) and the article "The Church and Psychiatry - History and Modernity", Alpha and Omega Magazine, 2008, no. 1 (51), p.218-232 (Bogoslov.ru http://aliom.orthodoxy.ru/arch/051/vgk.htm).
I wish you to join the ranks of Orthodox psychiatrists.
Hello, Vasily Glebovich!
My brother has schizophrenia. The diagnosis was made 15 years ago. I went to the doctor for 5 years, then stopped.
He does not consider himself sick. He takes the medicines that the doctor last prescribed him. He refuses to go to doctors, he also refuses to take other medicines, he does not consider himself sick, he does not work, he does not communicate with people. Recently, obsessions have begun to appear in him, moreover, more and more new ones appear, and the old ones also remain. Turned into a psycho. dispensary, a doctor came, but could not do anything. What can we relatives do in such a situation?
All that relatives can do in this situation is to persuade the patient to come into contact with doctors.
Over the past 5-7 years, many new drugs have appeared that are much better tolerated. Patients are more willing to accept treatment. Judging by your description, the disease is clearly progressing, so act.
Is it possible for a person with a mental illness (schizophrenia) in a state of remission to do mental work (Jesus Prayer) in accordance with patristic instructions?
Yes, it may be available.
However, it must be remembered that "smart doing" must be carried out under strict spiritual guidance. It is the confessor who must bless the reading of the Jesus Prayer in one volume or another, which is determined both by the spiritual maturity of a person and his spiritual state at the moment.
Remissions in schizophrenia are of different quality: in some cases, one can conditionally speak of "recovery", i.e. about the complete absence of any positive and negative symptoms with a high level of social and labor adaptation, in other cases, residual hallucinatory-delusional experiences with disability persist. But even in the latter case, it is possible (moreover, it can be very important) “smart doing”.
Hello, Vasily Glebovich! My name is Alexandra. I was diagnosed with schizophrenia. Thank God I only had one seizure. I read that one of the consequences of this disease is the degradation of the human volitional sphere. I felt it myself. In addition, my mental abilities have declined. How is it possible for an Orthodox believer to fight this phenomenon, and is it even possible? And one more thing: there is a constant fear of relapse, because its probability is high, how to deal with this fear?
Dear Alexandra!
After the first attack, as a rule, there is a rather long (up to 1.5-2 years) stage of remission, during which there is a gradual recovery of the body, including cognitive (i.e., intellectual) functions. So, there is hope that the degradation described by you is a temporary phenomenon. There is a risk of relapse the only way to avoid it - taking preventive therapy.
Hello, Vasily Glebovich. My name is Alexandra.
Let me tell you my medical history.
It all started, in my opinion, from the beginning of my churching. I was quite active in church. Six months later, I began to hear voices. At first it was gentle voices calling me by name and talking to me. Then I began to show signs of charm. I thought it was God talking to me. I had ideas of my own holiness. It also seemed to me that my relatives wanted to kill me. The voices became more and more demanding. At the peak of my illness, I ran barefoot to church, and then the voices ordered me to jump out of the window.
They put me in a mental hospital. When I was taken to the hospital, it seemed to me that I was in the Kingdom of God. When I was in intensive care, I saw “angels”, open skies, raved about religious topics. While I was in the hospital, I had a heavy feeling of the close presence of the devil. I was diagnosed with schizophrenia.
My questions are: to what extent can we say that it was a charm, and to what extent it was a disease? After all, if it was an illness, then how to explain the phenomenon of voices, and in general the religious context of my illness, and if it was delusion, then why did I get out of this state exclusively with medical drugs, because I didn’t have any spiritual guidance during the illness and six months after it? It turns out that one of the impetuses for the disease was my churching, can churching be called the cause of the disease?
Dear Alexandra, the condition you endured is described in all textbooks on psychiatry and is called oneiroid. It has a purely painful character and is successfully stopped by neuroleptic therapy. It is very important that the disease, with such hyperacute attacks, is characterized favorable course with minimal severity of so-called negative disorders.
However, it is impossible to relax completely and it is imperative to take preventive treatment. The risk of recurrence is extremely high. Auditory (verbal) hallucinations (more precisely, pseudo-hallucinations) you had, including the so-called imperative (ie commanding) character, which is very dangerous. Thank God, you were detained at the window. In these states, patients, as a rule, consider themselves messiahs, rulers of the world, saviors of mankind, etc. etc. Very often there are various religious themes. Charm, as a spiritual state, it was not.
You write that you were "actively churching" before that. Your churching was unusually fast precisely because you were already at the initial stage of the disease, at which people very often come to church or convert to sects. In such cases, relatives often say that "a person fell ill because of coming to the Church or turning to a sect." Those. everything is completely confused - what is the cause, what is the effect.
But in any case, everything that happens in a person's life happens according to the will of God. I have patients who, after suffering a similar attack, turned to the Church and truly became churched.
A similar state was transferred by Professor Dmitry Evgenievich Melekhov (see about him in my speech on the website) after leaving the state of anesthesia, in connection with complicated operation. He experienced the feeling of a solemn service and assessed it in this way: “from the point of view of the clinical and psychophysical level of understanding, it was a oneiroid state at the exit from a violation of consciousness at the crisis end of a serious state of intoxication. And nothing more. From the point of view of the spiritual level of judgments, this was a truly given great encouragement and consolation, which made it possible for the first time to realize this entire period as a time of “visitation” (Compare Luke 19:44: “You did not know the time of your visitation”).”
Other diseases
Hello Vasily Glebovich! Can you please tell me if there is a cure for autism? And how can a person fight this disease?
Autism means immersion in the world of subjective experiences with a weakening or loss of contact with reality and a corresponding change in emotional contact with people around.
Autism is considered as a manifestation of an endogenous disease, and autistic and autistic-like disorders are distinguished in childhood. These states are very different and, accordingly, the prognosis is also very different. At the same time, in some cases, it is possible to achieve very serious success in the rehabilitation of these patients. The main direction in the management of these patients is education and/or rehabilitation of social skills.
Alcoholism
Please tell me how to help a relative? He is 25 years old, recently began to abuse alcohol, is aggressive, on weekends he strong binges, does not work, blames everyone for his problems, believes that he is the most righteous of all people, that he has no one to communicate with, because everyone is stupid. Sometimes he says that he is a god or a king, and sometimes that he is a nonentity and a failure.
He is not going to be treated, he does not want to go to the temple either. How to talk to him, whether to give him money and food, whether to take him to the doctor forcibly, is it possible that he has a mental illness?
Based on your description, a mental illness is possible, but your relative has no legal basis for involuntary (compulsory) treatment. We need to persuade him to see a specialist.
Of course, it is necessary to feed, given the painful nature of his condition, but it is better to refrain from giving money.
Taking antipsychotics
Dear Vasily Glebovich! The psychiatrist recommended, along with the continuation of treatment with neuroleptics, to cleanse the body of toxins (for example, according to the method of Nadezhda Semenova). There are occult terms in this method, which is alarming. Are there any non-soulful (or at least neutral) methods of cleansing the body? And I would like to know your opinion about their applicability in psychiatry.
In psychiatry, various methods of detoxification are used in the presence of pronounced side effects of neuroleptic therapy. For this purpose, infusion therapy is used (i.e., droppers are placed), therapeutic plasmapheresis is performed, vitamin therapy (multivitamins such as neuromultivit), various antioxidants (drugs such as Mexidol), and drinking plenty of water is recommended.
Dear Vasily Glebovich!
I kindly ask you to help resolve some issues related to the treatment of my adult godson (21 years old) ... He has been under the supervision of psychiatrists for several years, takes various antipsychotics, and several times a year goes to a dispensary to relieve acute conditions, with which he is at home cope hard. And the questions are:
1. To organize a correct spiritual life, an Orthodox Christian needs sobriety, “constant vigilance over himself”, however, some antipsychotics (for example, Copixol / Clopixol) cause and sedation, that is, the suppression of consciousness, albeit partial. What precautions should be taken by the patient and his relatives in this case?
2. Since August of this year, the godson has been taking Clozapine along with strong antibiotics. There is a noticeable improvement in his condition, but at the same time, cases of infectious diseases have become very frequent ... Could this be a consequence of the transition to this drug? How can you fight it?
3. Sometimes, the source of such diseases is not only organic, but also spiritual problems... How can one “get to the bottom” of them? Is it worth it, and if so, how to do it right?
Save me, God! Dimitri
Dear Dimitri! Clopixol is one of the highly effective modern antipsychotics. It has a not very pronounced sedative effect, which in some cases is necessary, in other cases it is considered as a side effect. In such cases, the confessors of the Lavra, Archimandrites Kirill and Naum, gave their blessing to shorten the daily prayer rule.
I don't quite understand why your godson was given additional antibiotics. Clopixol does not cause immune suppression. Your godchild's disease is endogenous, i.e. its occurrence is not connected with his personal spiritual condition. Information necessary for communication with persons with mental disorders can be found on the website of the National Center for Health and Human Development of the Russian Academy of Medical Sciences in the section for non-specialists (http://www.psychiatry.ru)
Personality disorders
Vasily Glebovich, my husband is a former Afghan, and also spent some time in a colony. I would say mentally unhealthy. He periodically has breakdowns into “offended aggressiveness on everyone and everything” (or only on me, when it does). In absentia, 2 psychiatrists said that most likely it was a personality disorder.
He does not want to go to either a psychiatrist or a psychologist. At one time, he agreed to drink magne B6 (advised), but the post office immediately stopped, because. this made him angry (again there was a breakdown and he repeatedly shouted: “then you are sick and you need to be treated in a mental hospital).
Probably the only way to maintain some kind of relationship is to live in his house with a minimum of necessary valuable things (when he breaks down, he either breaks things, or threatens to break, or blackmails with those things without which I cannot go to work, for example) and at the time of breakdowns go to your house ...
I don’t have any questions, I just would like to know what you think about all this, and is there any way to save the family, or there is nothing to save.
The thing is that when he starts another breakdown (even though it has become much less frequent, only once every few months, and he doesn’t seem to break anything anymore, he just resentfully reprimands me how bad I am and can only scatter things and throw something invaluable), I remember those first breakdowns, when he beat, humiliated, broke - and I can’t stand a single minute, I just pray that he would come out somewhere soon and I could close the door. I am immediately pounding, and my body is trembling. He leaves, I close the door, he goes to live in his house and lives there until the end of the breakdown. Then he comes and asks for forgiveness. ... This is usually the picture.
At the moment, everything is finally heading towards a divorce, although I don’t want this, I don’t see any other way out.
The mental disorder described by you at the husband is really similar to disorder of the personality with periodically arising states of a decompensation. You write that "from year to year his breakdowns are getting smaller." You have been living with your husband for several years, all these years you have suffered his breakdowns, and now that they have begun to occur much less frequently ... everything is “going to a divorce”.
The situation remains unclear.
Address to the psychiatrist and ask him to write out drops of neuleptil for your husband. In situations like this, they can be very effective in preventing relapses.
Character and behavior
Hello, Vasily Glebovich!
I am worried about recurrent bouts of anger, irritability-hysteria (?!) in a young man with whom I meet and with whom I currently live together.
During the “attacks”, he starts screaming, waving his arms, tearing off curtains, throwing stools, breaking plates, howling in an inhuman voice. Then given state breaks into uncontrollable crying so that his head begins to shake (perhaps lower jaw, but, in my opinion, the whole head is shaking, as if he were having a chill). Having stopped crying and yelling, he remains angry for a long time, then (usually after sleep) comes to his senses, begins to make amends, to apologize.
When asked why he was angry, he replies, “I don’t know.”
I am especially frightened by the fact that this really happens “out of nowhere”….
Sincerely, Nadia.
Dear Hope!
The condition you describe is correctable. While it is still possible, you should demand in an ultimatum form that your young man would go for a consultation with a psychiatrist (psychotherapist). Naturally, he must go along with you, so you must explain to the doctor what the problem is.
Your support means a lot to him.
Hello! I am 28 years old, I suffer a lot from the fact that I often feel embarrassed and blush, especially in unfamiliar companies. Only when I get used to people do I become more relaxed. It really bothers me at work and in life. I sometimes want to express my opinion, but I know that I will definitely blush. It also frightens those around me, it seems that they didn’t ask anything like that, but already all in “paint”. Sometimes I am offended, right to tears. Can you please tell me how to deal with this?
Fears that are associated with communication are called social phobia. Its treatment is quite real, but it takes time. Ideally, the more and more often you are around people, the more likely it is that this fear will fade away. But, given the fact that it is often painful to start active social communication, doctors usually prescribe at the beginning of treatment drug therapy(tranquilizers, antidepressants). Only a qualified psychiatrist-psychotherapist can choose an adequate treatment regimen.
Hello, dear Vasily Glebovich!
Tell me what's wrong with my husband. He is 29 years old, I am 30. During the day he is at work, advising people. Behaves quite adequately. In the evening he comes home for dinner and leaves.
This is repeated every evening. Arrives late at night or in the morning. He says that in the evenings he is drawn to go somewhere, that he is tired of people, including me, his parents, he wants to be alone. He says he drives alone, sleeps in the car.
We don't have children. We live separately from our parents.
About a year ago, my husband got into a car accident. After 2 months, he changed jobs, left government agencies. Hot-tempered, has recently become suspicious.
Recently, there was an informal relationship with a lady (going to a cafe, he says that things didn’t go any further and that the relationship had ended. Before that, I had a conversation with him. I asked him to be honest with me, end the relationship with the lady. In return, I will stop control of his location, telephone conversations, SMS messages, etc. He agreed.If this is really not a lady, then what is the matter with him?
Save you Lord!
To decide whether it is a mental or psychological problems or a situation of betrayal, this information is not enough. You need (always with your husband) to get an appointment with a family psychologist who can determine further tactics.
Good afternoon! Tell me how to help a child who is very acutely experiencing any, even a minor failure, up to the refusal of any activity at all.
The child is 7 years old, went to school. In situations where things don't work out or don't work out, he shuts down and it's very hard to get him to keep going, or try again, or do something else for the time being. he believes that nothing will work anyway, since it didn’t work out right away. Thank you.
Your child needs your special support. It is necessary to find an occupation for him in which he could achieve some success relatively quickly (for example, modeling, drawing, learning a foreign language from a familiar teacher, etc., etc.).
Hello!
I am a student and in the group I am surrounded by people with whom I have to communicate quite closely, but they are not very pleasant to me, or rather their jokes. They hurt me, but if the guys see my dissatisfaction or resentment, they say that I am offended by trifles, there is no sense of humor, etc., while they perceive such jokes towards themselves both on my part and on the part of each other as inappropriate or manifestations of malice. Alone, you can communicate well with everything, but when I am in a company with these certain people, they seem to pull my strings on purpose, and no matter how I try to control myself, in the end I can no longer manage to pass what was said past my ears and I get a conflict . They rarely act like this with each other because they all have quite explosive personalities, but in our company they think it's the other way around and that I'm the most nervous.
Avoiding contact with them is not the best option, but how to learn this art of self-control ...?
I go to church, take communion several times a year, and pray, but so far my soul is too weak for such attacks.
Thanks in advance!
Dear Nikolay! You have some character traits that make it difficult for you to communicate with classmates. As a rule, these problems with age and with a change in the circle of communication are gradually leveled.
Difficulties in communication, apparently, are also related to the fact that your interests are much deeper and more multifaceted than the interests of your peers. With the problems you describe, if they remain as pronounced, it would make sense to consult a psychologist.
Even with one kind native person(nieces) enmity, hostility and anger arise, how to deal with it? I try to pray for her, but sometimes such hatred flares up in my heart that I have no strength.
You do not write what is the reason for your attitude towards your niece. Maybe the reason is in you, and not in her? And you need to pray for both.
Tell me, please, is it a change of mood, up to a complete loss of critical perception of one’s actions, uncontrollable hysteria, screaming, nervousness, insomnia, a feeling of hatred and a manifestation of verbal aggression towards others, lasting from several hours to 2-3 weeks due to natural regular hormonal fluctuations in female body, as well as for any physical injuries that remind of themselves externally or painful sensations, an abnormal display of mood? Should this be given attention from a medical point of view, or are there improvised ways to deal with such outbursts, if in the normal state the senselessness, causelessness and absurdity of such unrest is obvious?
Thank you. Sincerely, Elizabeth.
Dear Elizabeth!
It is quite obvious that the experiences you describe are painful and need medical correction.
You need to strictly observe the regime of work and rest, provide the body with the necessary nutrients, vitamins and minerals. Some dietary restrictions must be observed. For example, in the second phase of the cycle, it is recommended to limit the intake of coffee, tea, animal fats, milk, salt, spices, chocolate, tea, caffeine, alcohol. Benefits from exercise and sports. General massage has a beneficial effect.
Keep a calendar (chart, diary, or any other form of record keeping) of the symptoms that bother you. The calendar should include the following information: symptoms that bother you, the number (or day of the cycle) of each symptom, the severity of each symptom (for example, on a scale of 1 to 5), observation should be carried out for at least 2-3 months
If lifestyle and nutritional changes have not improved your condition, you should seek medical help. In these cases, antidepressants and anxiolytics are prescribed, as well as homeopathic therapy (including the drug mastodion).
Good afternoon! If a person is emotional, impressionable and takes “to heart”, he worries. How can you deal with such emotionality and impressionability. Is it possible to read moods or something else in addition to prayers and church sacraments? How do you feel about Sytin's moods?
Sytin's moods are not Christian in spirit, they are based on the exaltation of one's "I". Turn to your confessor and ask him to give you advice on “doing smart” (reading the Jesus Prayer). (On the official website of G.N. Sytin it is said that he is four times Doctor of Science (medical, philosophical, pedagogical, psychological).
Vasily Glebovich, is it possible for an adult to get rid of onychophagia on their own, without contacting a psychotherapist? Is there an experience of getting rid of such dependence in Orthodoxy?
The experience of a special "Orthodox" deliverance from onychophagia is not known to me. These conditions are usually successfully treated. Some time ago, a nun approached me with this problem; against the background of small doses of medications, all the symptoms disappeared.
Sexual deviations, sexual relations, marital problems
Tell me, please, is it possible to find an Orthodox sexologist? We have a problem in our family, but the sexologists whom I contacted on the Internet gave answers that are poorly compatible either with our faith or with a specific situation.
In general, it all comes down to the fact that we do not have intimate life, the husband does not want. And I'm tired of reading, incl. in Christian literature about marriage, about how the physical side of marriage is more important for men than for women, and how a woman should give in and accept it ... in our family it is the other way around.
Unbelieving sexologists are beginning to look for a problem in the fact that we were both virgins before marriage. The husband refuses to seek help. And, of course, they advise me either to come to the reception with him, or, since he does not go, to cheat on him.
I used to look for problems, including in myself. Not because I suffer from a guilt complex, but because I know that everything is more difficult in marriage, and that we cannot but influence each other while living together, in a family. I am sure that somehow it is possible to change the situation for the better, even if I come to the appointment alone, because the changes in me will help my husband too. It is very difficult for me to live the way we live.
You write about some problems in your intimate relationships that reflect the general level of marital relations. I would advise you to address together to the family psychologist. Unfortunately, I don't know an Orthodox sexologist.
I really loved the man. But he deceived me and left me later. I would be glad to forget him on the same day. But it turned out the opposite. The heart does not forget, I think about him all the time, I have already prayed a lot, and the worst thing is that I don’t perceive other suitors. How can I be?
I think it takes time. FROM similar problem many face. You need to switch to something - go on an interesting tourist or pilgrimage trip (now there is a seasonal price reduction), take on some obedience in the parish, start attending fitness, study foreign language etc. etc. Over time, a person will appear to whom you will pay attention.
Hello! Is there such a psychological concept as the fear of marriage and how can we deal with it? The young man is 28 years old, loves his girlfriend, has been dating her for 7 years, does not want to lose her, but is terribly afraid of being a husband, father, and suffers from the fact that he cannot cross the inner barrier. His parents have been married all their lives and he has always had material wealth. He himself does not mind turning to a psychologist for help.
Thanks in advance for your reply!
The fear of marriage has not yet been described. There is gynecophobia (fear of women), erotophobia - fear intimacy etc..
I think that a young person has the so-called anxious and suspicious character traits, due to which it is difficult for him to make one of the most important decisions in life. He really needs to see a psychologist. However, if he has a confessor, it may be enough for him to bless him for this act.
The bifurcation between actions and beliefs - how long can it continue until it saps mental strength? What is fraught with the life of a married person who cannot now participate in all the sacraments of the church, although this is the norm in his family, in the conditions of an office romance of “incomplete intimacy”, but permanent?
You need to gain courage and repent, otherwise, over time, you will have to turn to a psychiatrist.
Hello!
Vasily Glebovich, please tell me, such sexual deviations like homosexuality, lesbianism, etc., are they mental illnesses? Does modern psychiatry recognize these deviations as a disease? If so, what sources can be cited?
Thank you! With great respect, Anatoly. Krasnodar city.
Most psychiatrists consider homosexuality a gross pathology, a disease. A homosexual is an individual with a disorder in emotional sphere incapable of forming normal heterosexual relationships.
In the reference book on psychiatry (M., "Medicine", 1985), homosexuality is described in the section "sexual perversions", which is given the following definition - "the pathological orientation of sexual desire and the distortion of the forms of its implementation."
However, under the influence of threats of physical violence and calls for organizing social unrest, the American Psychiatric Association (APA) in 1973 excluded homosexuality from its Diagnostic and Statistical Manual (DSM), that is, from the list of mental disorders. Later, in 1992, the WHO also removed "homosexuality" from the list of diagnoses.
In the current International Classification of Diseases 10th revision (ICD-10), in section F 66 “Psychological and behavioral disorders associated with sexual development and orientation”, there is a note: sexual orientation itself is not considered as a disorder. "Gender identity disorders" (F 64) include transsexualism, dual role transvestism. Disorders of sexual preference" (F 65) include fetishism, exhibitionism, voyeurism, pedophilia, sadomasochism, etc.
However, not all professionals in the US share the point of view recommended by the APA board. The result of this was the creation in this country of a national association for the study and therapy of homosexuality, abbreviated as NARTH (National Association for Research and Therapy of Homosexuality). This happened back in 1992. This association was founded by Charles Socarides, Benjamin Kaufman and Joseph Nicolosi. C. Socarides became its president, and the psychologist D. Nicolosi, the founder of the Thomas Aquinas Psychological Clinic, became its vice president.
Naturally, most well-known clinical sexologists in Ukraine and Russia also do not consider homosexuality to be the norm. Among them are professors V.V. Krishtal, G.S. Vasilchenko, A.M. Svyadoshch, S.S. Liebig.
Problems in children
Hello! My son is 2.9 years old. I had a severe fright during my pregnancy. Premature birth, but a very long period of exile, although as the doctors say in the "normal range".
The child is vulnerable and sensitive, perhaps due to the fact that she was shaking over him in infancy, because. up to eight months, constant crying because of the stomach, cured only when they turned to a good doctor. Perhaps, according to the temperament, he is prone to tantrums (there is someone). Main problems:
Often incomprehensible tantrums, it is difficult to switch, distract. It's even hard to figure out why. Panic fear of other people, especially acutely responsive to touch when they greet him or want to pick him up. I was afraid to go myself, although I knew how and went already at 1.4, when I “forgot”. I was afraid of the vacuum cleaner. I think that I am to blame for many of his fears, I was afraid that he would be afraid.
2. Jealousy for the younger brother 9 months, mainly for parental attention and for toys. How to melt his heart?
3. Delay speech development(says short words about 40-45, does not add up sentences). We were at the neuropathologist. Treatment prescribed: 1 month. cogitum 1 ampoule per day, glycine - 3 times a day, 1 tablet, Nervochel - 3 times a day, 1 tablet.
We have almost completed the course, there are results, every day at least 1 new word, it has become much calmer, tantrums have been greatly reduced.
But recently, after a massage, they decided to do it to my younger brother too, so that he would develop faster, on the first day he screamed, pulled his arms and legs very much, climbed on me, although the masseuse was well known and he always smiled at her. Then they distracted him, on the second day they distracted him with varying success, but most of the time he screamed. What more benefit or harm from such a massage?
How to respond to prolonged tantrums? How to increase the contact of the baby and reduce aggression towards his brother - can he hit or hug very tightly that the youngest is crying? Whether it is possible to repeat this medical course and through what time? Perhaps we need to undergo some examinations, do we need to contact any doctors? Save you Lord!
In the cases described by you, the massage is cancelled.
When the child is 3 years old, you need to contact a child psychiatrist (up to 3 years, psychiatrists do not look at children).
In connection with the “jealousy” of your son for his younger brother, which happens often, he needs to be given maximum attention from you and from your husband. Sometimes you need to walk with him separately, play separately, make interesting trips separately.
On the American Childhood Stress Scale, the birth of a younger brother is considered moderately stressful. There is a point of view that a child needs to be prepared for the appearance of a brother from the very beginning of pregnancy.
Good afternoon, dear Vasily Glebovich! I have a very attached daughter to me - now she is 4 years old (the only child in the family).
Pregnancy and childbirth were difficult, soon after the birth of the child, a divorce from her husband followed. The child does not go to the garden, the grandmother sits with her. The child is smart, developed - but at the same time emotional, impressionable.
At the age of 3, I had to leave home for the first time for the night - immediately after my departure, she began to cry, scream, complain about her stomach - and so long and hard that my grandmother called an ambulance. Doctors did not find any health problems. Then the child had a fear of going to the toilet for some time. After our joint vacation, everything went away.
A year later, at the age of 4, the child was taken to a developmental circle. From there she returned sad (she said that one of the teachers did not like it). Complaints about her stomach began again, by the night she was already screaming, she could not sleep - they called an ambulance, examined her - everything is in order with her health. After that, for several more days and nights she screamed loudly with complaints about her stomach, then for several more nights she did not sleep due to the fact that she had insomnia, like adults: she woke up at 3 am, could not sleep, cried because this. Then gradually everything came to naught (it lasted about 1.5 weeks in total). The dream resumed.
Doctors say she is in good health. Those. is it psychosomatic? Is it something dangerous? What would you suggest?
Nothing dangerous happens to your child. Similar phenomena in children, in one form or another (for example, frequent urge to urinate), are not uncommon.
However, you must understand that in a few years the child needs to go to school, i. to join a new unfamiliar team, and she needs to be prepared for this. After some time, she must be enrolled either in some sports activities (rhythmic gymnastics), or in some circles, or so that she begins to attend Sunday school. At the same time, the main thing should be the personality of the teacher, and not "sports or other successes." You must be sure that he is attentive and kind to children. If you do not prepare the child for school, she may have serious problems adapting to the new team.
Reader responses
Save you Lord!
https://www.site/psixiatriya-i-duxovnaya-zhizn/
It so happened that I read it at a time when I had a certain temptation, part of which was the weakening of faith. So, after reading the article, faith just dropped to a critical level, it was terrible.
Later, when the temptation was over, I wondered why the article had such an effect on me?
After several days of reflection, I came to the conclusion that the article imperceptibly, implicitly, but “shifted the focus” - from spiritual reasoning to spiritual reasoning, from God to man.
Perhaps here Archimandrite Raphael Karelin has harsh wording http://karelin-r.ru/faq/answer/1000/4289/index.html, but he clearly expressed the essence: “In some critical cases, psychiatrists can help with chemical drugs, which have a sedative effect, but THE MAIN MEANS OF HEALING IS LIFE ACCORDING TO THE GOSPEL AND PRAYER "
It is this basis, hope in God (in my opinion) that is not traced in the article, unfortunately ...
I also decided to express some of my impressions / thoughts:
1. The psychiatrist in the article looks like some kind of independent and self-sufficient figure, the article gives the impression that there is a certain area where the priest (and God) are redundant: there is the “chief” doctor - while God is practically not mentioned anywhere, one gets the feeling that God the doctor is “not needed”, He is somehow “forgotten” - the doctor copes well with the help of his knowledge, medicines, etc. It turns out that the sphere of a psychiatrist (even an Orthodox one) somehow “does not include” God ...
2. Quotes: “The sphere of the human spirit, the disease of the human spirit, is the sphere where the spiritual doctor, the priest, heals. The sphere of the human soul is the sphere in which the psychiatrist heals. “When we talk about mental illness, there are very different conditions here. In one case, priority belongs to a psychiatrist and the patient is not shown communication with a priest, moreover, it can even lead to an aggravation of his condition ... after this acute condition passes, we try, if possible, to invite a priest.” Those. it turns out that for a certain period of time (in this case, an exacerbation of the disease), the patient does not need a priest - only a doctor can help. And the prayers of the priest, of the Church, will they really be “superfluous” in this situation? (not to mention the fact that for an Orthodox person, prayers, hope in God's help should be the main ones). Of course, both medicines and doctors are needed (Trust in God, but don't make a mistake yourself). But the prioritization should not be violated: THE MAIN THING IS PRAYER TO GOD, AND MEDICINES TO HELP. And not vice versa..). And then there is a feeling that the doctor of God is already beginning to replace at some points ...
3. Quote: “In our church environment, the functions of a psychologist, especially a family psychologist, are ideally performed by a priest. And besides him, no one can perform this function better, especially if a person goes to confession and his wife too.” Again, the focus has been shifted: it is not the priest who “performs the functions of a psychologist” (including during confession) – this is the Lord, incl. through the priest saves a person, shows help.
Forgive me for daring to express my thoughts - but I considered it my duty, as a believer, to write all of the above - perhaps you will be interested in such "feedback".
I ask for your prayers!
R.B. Elena
Dear Elena!
I beg your pardon that my article plunged you into a state of despondency. This article is my speech made in the Church of the All-Merciful Savior b. Sorrowing Monastery at a meeting with readers of Pravmir and the editors. Father Alexander Ilyashenko was present at the meeting and we were right next to the altar with him. Apparently in connection with this, in my speech I did not dwell on issues that seemed completely obvious to me in the Orthodox audience. Any work that a Christian begins must be preceded by prayer. When someone gets sick, at the beginning you need to pray to the Physician "of soul and body", and then go to the doctor who was sent by the Lord. It is quite obvious that in an Orthodox environment, if a person ends up in a hospital, everyone tries to pray for him. Recently, in one nunnery (that day, one of the sisters of the monastery was supposed to have an operation) at the liturgy, I heard a prayer for both the sick woman (name) and her surgeon (name), that "The Lord helped him perform surgery."
Now I will try to explain what we (Orthodox psychiatrists) mean when we say that in psychiatric practice “in one case, the priority belongs to the psychiatrist and the patient is not shown communication with the priest, moreover, it can even lead to an aggravation of his condition ... after As soon as this acute condition passes, we try, if possible, to invite a priest.” This position was formulated back in the 19th century by Russian and German psychiatrists. The instructions for employees at the Moscow district hospital for the mentally ill (M., 1907) say that ... "in addition to the immediate duties of church service, the priest conducts a spiritual conversation with the patients of the hospital, on which he will be directed by the medical staff" (i.e. not with all patients of the Orthodox faith).
How can you invite a priest to a patient who is in an acute psychotic state with psychomotor agitation, aggression and declares that he is the Antichrist? Or vice versa, declares that he is Christ? One of my patients (Orthodox), asserted with force that he was both Christ, and Buddha, and the god of the Aztecs. It is clear that these are delusional disorders and, by definition, they are not amenable to persuasion, but only to treatment. The patient must be prepared for the meeting with the priest. Obviously, if the patient has Orthodox relatives, then they will pray for him all this time, this is natural. I recall the words of Archimandrite Tavrion (from the desert, near Riga), who said that if a person close to you cannot take communion at this time, then you yourself should take communion more often. Many doctors (including non-believers) can tell from their practice cases when the course of the disease does not fit into its main canons, and explain this only by someone's prayer.
Now regarding the statement of Archimandrite Raphael Karelin. His position formulated in the website you indicated, in the words of His Holiness Patriarch Alexy II, is not just “a private point of view of one very respected priest”, but is in complete contradiction with the official position of the Russian Orthodox Church on this issue, set out in the "Fundamentals of the Social Concept" and adopted at the Bishops' and Local Councils. Also, Father Raphael has specific statements on pedagogy.
For the treatment of psychosis, neuroleptics are used, in which the sedative effect is not the main one, and some modern antipsychotics(eg Abilify) do not have a sedative effect at all. Their mechanism of action is much more subtle.
For many years Archimandrite Kirill (Pavlov), confessor of the Lavra, sent patients to us at the Center. He referred not only psychotic patients, but also patients of the “borderline” level. When we asked him why he sends patients to psychiatrists, he said that they receive spiritual healing from him, and "pills should also be taken."
If a person refuses medical treatment for any serious illness ( acute infarction myocardium, endogenous psychosis, etc. etc.) and demands a miracle from God - then this is a state of either delusion or insanity. Let us remember what Christ said to the devil, who tempted him and demanded a miracle: "...do not tempt the Lord your God." The power of God is perfected in weakness (see 2 Cor. 12:9), including through doctors and medicines.
No need to tempt the Lord and demand a miracle from Him, but you need to pray and go to the doctor ...
St. Theophan the Recluse wrote: “Is it to be treated? Why not get treated? ... disgust from the doctor and medicines - a reproach to God.
And finally, in relation to my statement that “in our church environment, the functions of a psychologist, especially a family psychologist, are ideally performed by a priest. And besides him, no one can perform this function better, especially if a person goes to confession and his wife too.” It is generally accepted that confession includes the actual sacrament of repentance and counseling. The sacrament of repentance is accepted by the Lord, the priest is only a witness. However, a spiritually experienced priest, based on his own spiritual experience and the experience of the Church, can give instruction, spiritual advice on how to overcome this or that sin or family problem, especially if he knows all family members. And most importantly, he will support everyone with his prayer.
Once again, I apologize to you that my article plunged you into a state of despondency.
I ask for your prayers.
What is modern psychiatry, why those suffering from mental illness are often treated like lepers, and what to do if you yourself or someone close to you get sick - these and other questions of the Pravoslavie.ru portal.Ru" answered the doctor of medical sciences, Professor of PTSGU, Deputy Director of the Scientific Center for Mental Health Vasily Glebovich Kaleda.
I would like our conversation to be useful to those who have the intention to seek help, but for some reason hesitate, or those close to them. We all know that in society there are certain "horror stories" associated with psychiatry - let's try to dispel them, if not, then at least speak them out.
People are sure that psychiatric disorders- this is something extremely rare, and therefore the very fact of the presence of such a disease takes a person out of society. So the first question is, how many people suffer from mental illness?
Mental disorders are quite common. According to available data, about 14% of the population in the Russian Federation suffer from them, while about 5.7% need psychiatric help. Approximately the same figures we will see in the countries of Europe and in the USA. We are talking about the whole spectrum of mental disorders.
First of all, it is necessary to mention depressive conditions that affect about 350 million people worldwide, and about 9 million in Russia. By 2020, according to WHO experts, depression will come out on top in the world in terms of incidence. Almost 40-45% of severe somatic diseases, including cancer, diseases of cardio-vascular system, post-stroke states, accompanied by depression. Approximately 20% of women in the postpartum period, instead of the joy of motherhood, experience a depressive state. It can be immediately mentioned that severe depression in some cases, in the absence of medical care, leads to death. - to suicide.
Due to the increase in life expectancy and the aging of the population in recent decades, the incidence of various types of dementia of late age, including Alzheimer's disease and its associated disorders, has increased.
The problems of autism in childhood have recently acquired particular relevance (the frequency of occurrence is currently 1 case per 88 children). Very often, when a parent begins to notice that their child is significantly different in their development from their peers, they are ready to go with their problem to anyone, but not to psychiatrists.
Unfortunately, the Russian Federation maintains a high specific gravity persons suffering from alcoholism and drug addiction.
Currently, due to the change in the general way of life and the stressfulness of our lives, the number of borderline mental disorders has increased. The prevalence of so-called endogenous mental illness associated primarily with genetic predisposition, and not the influence of external factors, which include bipolar affective disorder, recurrent depressive disorder, as well as schizophrenia spectrum diseases, remains approximately the same - about 2%. Schizophrenia occurs in approximately 1% of the population.
It turns out about every hundredth. And what is the percentage of people among such patients who maintain socialization? Why I ask: in the public mind there is a certain stereotype - a person suffering from such a disease, an outcast, to be crazy is kind of shameful.
- Raising the question of the shame of the disease is completely incorrect. It is unacceptable both from a religious and simply from a human point of view. Any illness is a cross sent to a person - and each of these crosses has its own, quite specific meaning. Let's remember the words of St. Ignatius Brianchaninov that we should respect each person as the image of God, regardless of the position that he occupies and the state in which he is: “And the blind, and the leper, and the mentally impaired, and the infant I will honor both the criminal and the pagan as the image of God. What do you care about their infirmities and shortcomings! Watch over yourself so that you do not lack love. This is the Christian attitude towards a person, no matter what illness he suffers from. Let us also remember the attitude of Christ the Savior towards lepers.
We must honor each person as the image of God.
But, unfortunately, sometimes it happens that our patients are perceived precisely as lepers.
In the psychiatric literature, the problem of destigmatization of the mentally ill is discussed very seriously, that is, changing the attitude of society towards the mentally ill and developing such a system for organizing psychiatric care that would make it accessible to all categories of the population, and the need to contact a psychiatrist would be treated as an appeal for help. to any medical specialist. The diagnosis of "schizophrenia" is not a sentence, this disease has various forms of course and outcomes. Modern drugs can qualitatively change the course and outcome of this disease.
According to epidemiological data, approximately 15-20% of cases of schizophrenia have a single-attack course, when, with adequate treatment, recovery essentially occurs.
We, at the Mental Health Research Center, have many examples when people, having fallen ill at a young age, after 20-25 years have and had a fairly prosperous family and high social status, are married, have children, they have made a successful career, and who - something even in science, having managed to defend dissertations, get academic titles and recognition. There are also those who have done, as they say now, a successful business. But you need to understand that in each case the forecast is individual.
When we talk about schizophrenia and the so-called schizophrenia spectrum diseases, we must remember that patients with this disease need long-term, and in some cases lifelong, medication. Just like type 1 diabetics need to get insulin injections.
Therefore, no independent attempts to cancel therapy are unacceptable, this leads to an exacerbation of the disease and disability of the patient.
Let's talk about how the onset of the disease occurs. A person, and even more so his relatives, may not understand for a long time what is happening to him. How to understand that you can no longer do without a psychiatrist? I was told how a sick sister was brought to the monastery of one of the local Churches. The first thing they did in the monastery was that they allowed her not to take medicine. The patient's condition worsened. Then the mother abbess got her bearings, they began to specially monitor the intake of medicines, but even the clergy do not always understand what a mental disorder is.
The problem of identifying mental illness is very serious and very difficult. The example you gave is very typical - the monastery decided that they could cope with the disease with their love for this sick girl and care for her. Unfortunately, this often happens - people do not understand that "our" diseases have a very serious biological basis with significant genetically determined disorders. Attentive caring care is, of course, very important, but professional help from doctors is still required.
Unfortunately, many do not realize how serious this disease is. One can recall the tragic death in Pskov in 2013 of Father Pavel Adelheim, who was killed by a mentally ill person, who instead of being hospitalized was sent for a conversation with a priest, or the death of three monks in Optina Pustyna in 1993, also at the hands of a mentally ill person.
Patients with endogenous psychosis often express various ideas of implausible or dubious content (for example, about persecution, about a threat to their lives, about their own greatness, about their guilt), they often say that they hear “voices” inside their heads - commenting, ordering, insulting character. Often they freeze in bizarre positions or experience states of psychomotor agitation. Their behavior towards relatives and friends changes, unreasonable hostility or secrecy may appear, fear for their lives with the commission defensive actions in the form of curtaining windows, locking doors, significant statements incomprehensible to others appear, giving mystery and significance to everyday topics. It is not uncommon for patients to refuse food or carefully check the contents of the food. It happens that there are active actions of a litigious nature (for example, statements to the police, letters to various organizations with complaints about neighbors).
You cannot argue with a person who is in such a state, try to prove something to him, ask clarifying questions. This not only does not work, but can also aggravate existing disorders. If he is relatively calm and tuned in to communication and help, you need to listen carefully to him, try to calm him down and advise him to see a doctor. If the condition is accompanied by strong emotions (fear, anger, anxiety, sadness), it is permissible to recognize the reality of their object and try to calm the patient.
- But we are afraid of psychiatrists. They say - "they will slaughter, it will be like a vegetable", and so on.
Unfortunately, in medicine there are no drugs that treat serious diseases and generally have no side effects and cannot be. Hippocrates spoke about this even before our era. Another thing is that when creating modern drugs, the task is to ensure that side effects are minimal and extremely rare. Let's remember cancer patients who lose their hair on the background of appropriate therapy, but they manage to prolong or save their lives. In some connective tissue diseases (for example, systemic lupus erythematosus), hormone therapy is prescribed, against which people develop pathological fullness, but life is saved. In psychiatry, we also encounter serious illnesses when a person hears voices inside his head like a radio, turned on at full power, which insult him, give various orders, including in some cases to jump out of a window or kill someone. A person experiences fear of persecution, exposure, threats to life. What to do in these cases? Watching a person suffer?
At the first stage of treatment, our task is to save a person from these sufferings, and if at this stage a person becomes drowsy and lethargic, there is nothing to worry about. But our drugs act pathogenetically, that is, they affect the very course of the disease, and drowsiness is in many cases their side effect.
Indeed, there are some false fears about psychiatrists, but I must say that this is not only our unique Russian feature, which is connected with something, it happens all over the world. As a result, the problem of "untreated psychosis" arises - patients have been expressing frankly crazy ideas for a long time, but nevertheless neither they go to the doctor, nor their relatives.
This problem is especially pronounced in cases where the subject of delusional disorders has a religious connotation. Such patients in a state of psychosis talk about some kind of mission, that they are messiahs sent by God to save the human race, save Russia, save all of humanity from spiritual death, from an economic crisis. Often they are sure that they must suffer - and, unfortunately, there have been cases when patients with religious messianic delirium committed suicide for delusional reasons, sacrificing themselves for the human race.
Among religious psychoses, there are often states with the dominance of delusions of sinfulness. It is clear that the realization of one's sinfulness for a believer is a stage of spiritual life, when he realizes his unworthiness, sins, seriously thinks about them, confesses, takes communion. But when we talk about the delusions of sinfulness, then a person becomes obsessed with the ideas of his sinfulness, while he loses hope in God's mercy, in the possibility of forgiveness of sins.
A person becomes obsessed with the ideas of his sinfulness, while his hope for God's mercy disappears.
We remember that the most important thing that is required from a person who is trying to live a spiritual life is obedience. A person cannot impose penance on himself, cannot fast without a blessing in some special way. This is a strict rule of spiritual life. In any monastery, no one will allow any young worker or novice, with all his zeal, from the very beginning to fulfill the full monastic rule or the rule of the schemnik. He will be sent to various obediences and the volume of prayer work that is useful to him will be clearly told to him. But when we talk about a patient with delusions of sinfulness, he does not hear anyone. He does not hear his confessor - he believes that the priest does not understand the gravity of his sins, does not understand his condition. When the priest strictly tells him that he does not allow reading ten akathists a day, then such a patient concludes that the confessor is a superficial, shallow person, and goes to the next priest. It is clear that the next priest says the same thing, and so on and so forth. Often this is accompanied by the fact that a person begins to actively fast, Great Lent passes, Easter comes, he does not notice that he can rejoice and break the fast, and continues to fast in the same way.
You need to pay attention to this. This eagerness not according to the mind, without obedience, is an important symptom of a mental disorder. Unfortunately, many cases are known when patients with delusions of sinfulness ended up in intensive care units due to a threat to life due to extreme exhaustion. We at the Mental Health Science Center have seen cases of people with depressive delusions of guilt and sinfulness attempting suicide and killing their loved ones (extended suicide).
Returning to the topic of fear of psychiatry. Of course, we have hospitals - especially in remote provinces - which you really don't want anyone to be in. But on the other hand, life is more expensive - after all, it happens that it is better to send a mentally ill relative to a bad hospital than to lose him altogether?
Problem timely provision medical care - not only psychiatric. This is a public health problem. Unfortunately, we have many examples when a person, having certain symptoms, delays contacting a doctor, and when he finally does, it turns out to be too late. This also applies to oncological diseases that are common today - almost always the patient says that he had certain symptoms a year, one and a half, two years ago, but he did not pay attention to them, dismissed them. We see the same thing in psychiatry.
However, you need to remember and understand: there are conditions that are life-threatening. Vote - hallucinations, as we speak, auditory or verbal - often accompanied by orders. A person hears a voice inside his head that tells him to throw himself out the window - these are specific examples - or to do something to another person.
There are also deep depressions with suicidal thoughts, which are experienced very hard. In this state, a person feels so bad that he does not hear what others are saying to him - he cannot perceive their words due to his illness. He is so hard mentally, psychologically, that he does not see any meaning in this life. It happens that he experiences excruciating anxiety, anxiety, and at this stage nothing can stop him from an antisocial act - neither relatives, nor the understanding that there is a mother who will suffer very much if he fulfills his intention, nor his wife , nor children. And therefore, when a person expresses thoughts of suicide, it is imperative to show him to a doctor. special attention deserves adolescence, when the boundary between when a person expresses thoughts of suicide, and their implementation is very thin. Moreover, severe depression at this age may not appear outwardly: one cannot say that a person is dreary, sad. And yet he can say that life does not make any sense, express the idea that it is better to leave life. Any statements of this kind are the basis for showing a person to a specialist - a psychiatrist or psychotherapist.
Yes, in our society there is a prejudice against psychiatric hospitals. But when it comes to human life, the main thing is to help a person. It is better to put him in a psychiatric hospital than to wear flowers on a famous mound later. But even if there is no threat to life, the sooner we show the patient to a psychiatrist, the sooner he will come out of psychosis. The same applies to the long-term prognosis of the course of the disease: modern studies show that the sooner we begin to provide medical care to the patient, the more favorable it is.
I read in your interview about your dad, Archpriest Gleb Kaleda: “He told me how important it is to have believers among psychiatrists.” And we can read about the same thing in the letters of Father John (Krestyankin), when he blessed the suffering to regularly confess and receive communion and find Orthodox psychiatrist. And why is it so important?
Yes, Father Gleb really said that it is very important that there are believing psychiatrists. Such psychiatrists whom he knew were Professor Dmitry Evgenyevich Melekhov (1899-1979) and Andrei Alexandrovich Sukhovsky (1941-2012), the latter of whom later became a priest. But Father Gleb never said that one should only turn to believing doctors. Therefore, in our family there was such a tradition: when you had to seek medical help, you first had to pray to the Doctor with a capital letter, and then with humility go to the doctor whom the Lord God would send. There are special forms of prayers not only for the sick, but also for doctors, so that the Lord sends them reason and gives them the opportunity to make the right decision. We need to look for good doctors, professional ones, including when it comes to mental illness.
First you need to pray to the Doctor with capital letter, and then with humility go to the doctor whom the Lord God will send
Even more than that, I will say: when a person is in a psychosis, talking with him about some religious aspects is sometimes not entirely indicated, if not contraindicated. In such states, it is simply not possible to talk with him about some high matters. Yes, at a later stage, when a person comes out of such a state, it would be good to have a believing psychiatrist, but, again, I repeat, this requirement is not mandatory. It is important that there is a confessor who supports a person who understands the need for treatment. We have a lot of literate, professional psychiatrists who respect a person's religious beliefs and can provide highly qualified assistance.
And how can one evaluate the state of Russian psychiatry in the context of world psychiatry? Is she good or bad?
At present, the achievements of psychiatry, which are available throughout the world, are publicly available to any doctor in any part of the world. If we talk about psychiatry as a science, then we can say that our domestic psychiatry is at the world level.
The problem we have is in the state of many of our psychiatric hospitals, the lack of certain medicines for patients who are under dispensary observation and should receive them free of charge, and also in the provision of social assistance to such patients. At some stage, some of our patients, unfortunately, are unable to work, both in our country and abroad. These patients need not only medical treatment, but also social assistance, care, rehabilitation from the relevant services. And it is precisely with regard to social services that the situation in our country leaves much to be desired.
I must say that now in our country there has been a certain approach to changing the organization of the psychiatric service. We have an insufficiently developed outpatient department - the so-called neuropsychiatric dispensaries and offices of psychiatrists and psychotherapists, which exist at some hospitals and polyclinics. And now a lot of emphasis will be placed on this link, which, of course, is completely justified.
Vasily Glebovich, I want to ask you one last thing. You teach a course in pastoral psychiatry at PSTGU. What is it and why is it needed?
As we have already said, mental illness is quite common, and the priest in his pastoral work has to meet people who have psychical deviations. There are more such people in the Church than in the average population, and this is understandable: the Church is a medical clinic, and when a person has some kind of misfortune, he comes there and it is there that he finds consolation.
A course in pastoral psychiatry is indispensable. Such a course is currently available not only at PSTGU, but at the Moscow Theological Academy, the Sretensky and Belgorod Theological Seminaries. Metropolitan Anthony (Blum), Professor-Archimandrite Cyprian (Kern) and many other prominent pastors of the Church spoke about the need for this subject in the training programs for pastors.
The goal of this course is for future priests to know the main manifestations of mental illness, to know the pattern of the course, to have an idea of what medicines are prescribed, so as not to follow the lead of their spiritual child and bless him to stop the medicine or reduce the dosage, which, alas, it often happens.
So that the priest knows that, as stated in the Social Concept of the Russian Orthodox Church - and this is an official conciliar document - there is a clear delineation of the scope of his competence and the competence of a psychiatrist. So that he knows the peculiarities of the pastoral counseling of persons suffering from mental illness. And it must be said frankly that maximum success in the management of a mentally ill person can be achieved only in those cases when he is not only observed by a psychiatrist, but is also fed by an experienced confessor.
