Franz Alexander: psychosomatic medicine, method description, results. Free download Franz Alexander, Mogilevsky S

Sometimes it happens that an attempt to cope with a particular disease only with the help of traditional medicine ends in failure. Often this disrupts the already unstable emotional state of a sick person, leading to despair and depression. Naturally, this state of affairs cannot be ignored. It has long been known that many diseases are well cured in a complex manner. It is recognized in medicine, for example, that the early stages of hypertension are miraculously cured by meditation. The only problem is that we are not accustomed to treating health as a resource whose reserves are depleted. Due to the inattentive attitude to one's well-being, the lack of appropriate diagnostics, these early stages remain practically unnoticed by us.

Psychotherapy often comes to the aid of medicine, and specifically psychotherapeutic work with psychosomatic processes.

Franz Alexander - psychosomatics was an area of his scientific interest, he was absolutely sure of the connection between the psychological state of a person and his health.

Working with psychosomatics in therapy is not an easy process. Most of the mechanisms described below are not realized by clients at all. And this is the main difficulty in the psychotherapeutic approach of working with the disease. The task of the therapist is to first discover and then help convey to the client's consciousness precisely his unique way of coping with personal psychological conflicts with the help of a particular disease. The task, I must say, is not an easy one, so few specialists really work with the body. It takes time, trust in the therapist, a high degree of maturity of the client's personality. A very successful option, when choosing a specialist, is when a therapist dealing with psychosomatic problems is also a doctor by education. Psychotherapy often comes from medicine. The condition is not mandatory, but desirable. After all, your health and longevity are at stake.

Psychosomatics of diseases: table of Alexander F.

1. Skin diseases (neurodermatitis, eczema, urticaria, itching)	The mechanism of occurrence of skin diseases is as follows: on the one hand, the use of one's body as a weapon in competition with others in order to attract attention and gain recognition. On the other hand, the feeling of guilt that arises as a result of this demonstration. Thus, the skin, which is the main tool for such a display of the body, becomes the place of punishment for the guilt felt by the person. In these diseases, combing is of great importance. When combing aggressive impulses that are intended for the environment, a person, due to a sense of guilt, directs himself. Urticaria is directly related to unshed tears, often, as soon as the patient ceases to restrain crying, the rash disappears. The cause of itching of the genitals, anus is restrained sexual arousal. In these cases, combing the anus and genitals, the individual gives himself unconscious sexual pleasure.	The feeling of guilt makes a person direct aggressive impulses towards himself, which were originally intended for the environment.
2. Thyrotoxicosis (Graves' disease)	The struggle with anxiety encourages a person to "knock out a wedge with a wedge" - to perform actions that are very frightening. A person demonstrates to others maturity, self-sufficiency, self-confidence, while feeling - fear, anxiety, uncertainty.	The desire to take responsibility and be useful, despite self-doubt and dependence. Pseudo maturity, excessive efforts to assume a maternal role through excessive concern for others, often younger siblings.
3. Cardiac disorders (tachycardia and arrhythmia)	There is a close relationship between anxiety, fear and human heart activity. However, it is not entirely clear why in some cases the body reacts with tachycardia, and in others with arrhythmia. Probably, individual organic factors are involved in this complex process.	In fearful, enslaved, insecure people, hostility breeds anxiety, which in turn increases hostility. It's a kind of neurotic vicious circle.
4. Hypertonic disease	Experiencing hostility in a given situation, modern man has learned to restrain it. This is due to the fact that in our society it is unacceptable to freely express aggression. From early childhood, we are faced with the requirement to control aggressive impulses. Hypertension is the result of this control. The inability to defuse their aggression forces hypertensive patients to live in a state of constantly restrained anger.	Hypertension is a state of chronic tension arising from the inability of the individual to express his aggressive feelings adequately to the current situation.
5. Vago-vasal syncope	There are two ways the body reacts to danger: attack the feared object or run away from it. In order for an individual to flee, the body prepares physiologically - by dilating blood vessels in the muscles. If a person restrains himself and the escape cannot take place, internal bleeding occurs in the muscular system, the pressure drops to a critical level - the person faints. Interestingly, the above reaction occurs only in a standing position. Lying in a faint it is impossible to fall.	Experiencing intense fear and an acute desire to run away, a person restrains himself and remains motionless. The physiological response is triggered and interrupted by the desire to be socially approved.
6. Migraine	It is believed that the cause of migraine is vasodilatation.	Impulses of anger and envy towards more successful people are turned on themselves through the mechanism of guilt. The attack provokes repressed anger. As soon as you manage to recognize your feeling and find how to implement anger adequately to the situation, the attack passes in a couple of minutes.
7. Bronchial asthma	The immediate cause of an asthmatic attack is the constriction of the bronchioles. This local spasm can be caused by both a specific allergen and psychological reasons.	An attack is provoked by aggressive impulses that arise towards the object of love and a subconscious ban on this aggression. Also, any action that reinforces the independence of a person revives the internal conflict between the desire to be independent, independent and the desire for dependent, insecure behavior.
8. Rheumatoid arthritis	Intense muscular reaction to emotional experience. The desire to patronize and take care of loved ones consists of two contradictory tendencies: to dominate, to rule and serve, to please, to satisfy other people's needs. A way to subjugate loved ones, taking care of them and sacrificing yourself.	Attempt to control aggressive impulses through muscular activity: physical labor, sports, housework. Service to others as a way to relieve remorse due to aggressive impulses felt towards loved ones. Chronically restrained anger in this way leads to increased muscle tone and arthritis.
9. Injury prone individual	Such a person is impulsive and incapable of a pause between momentary desire and action. The internal conflict unfolds around the repressed aggression directed against the power structures, people in power and remorse for this protest. The injury, as it were, expiates the guilt for this protest.	Such a person is a rebel, he protests against any authority. Even the power of his own mind, self-control, discipline falls under his protest. Sometimes the psychological cause of the injury is the desire to avoid responsibility, the need for care, perhaps in monetary compensation.
10. Diabetes	People with diabetes experience great difficulty in changing their infantile, irresponsible behavior to more mature and independent behavior. They tend to regress during this process to childish forms of behavior, their desire for maturity is carried out mainly in words. They are rather passive and dependent than mature and self-sufficient people.	An internal conflict between a child's need to be cared for and a more mature need to take care of and be responsible for other people.
11. Ulcer of the stomach and duodenum	Chronic stimulation of an empty stomach, associated not with food intake, but with repressed desires to be loved, protected, leading to the formation of an ulcer.	The body's response to anxiety and fear, in which the desire to be protected is equated with the desire to be fed. In case of danger, a person prone to peptic ulcer regresses into an infantile state. That is, it turns into a child who turns to his mother for help, since one of the first sufferings of an infant is hunger, satisfied by the mother.
12. Chronic psychogenic constipation	In constipation, excrement is retained as something of great value. Usually, this is due to a few preempted installations. The first is that the surrounding world is hostile to me too, there is nothing to expect from it. I have to hold on to what I have with all my might. The second is an unconscious aggressive attitude towards people, as a reaction to a feeling of rejection.	Pessimistic attitude, distrust of the world and people, feeling that you are rejected and not loved.
13. Anorexia	Unconscious feeling of anger as a result of emotional dissatisfaction.	Lack of love and attention. Refusal to eat is a childish way to make parents pay attention, worry, take care.
14. bulimia	The craving for love and the aggressive desire to devour and possess are the unconscious basis of bulimia. The reason is the same emotional hunger, dissatisfaction.	An attempt to satisfy emotional hunger by eating food.

Do not forget that both medical treatment and work with the causes of psychosomatics are important: a table of diseases will help you understand the causes.

The father of psychosomatics, Franz Gabriel Alexander, in his book Psychosomatic Medicine, tells in detail and in detail that the disease occurs at the junction of three spheres - psychological, physiological and social.

Psychosomatics: How it works

In his opinion, the GENERAL SCHEME looks like this. There are two factors. physiological(an organ weakened by genetics or developmental conditions) and psychological(personality traits, internal conflicts and a familiar set of emotions). And then the factor comes to them social(adverse situation), and triggers the reaction. You could say the stars aligned.

The most curious thing here is that the psychological factor - the type of initial psycho-emotional conflict - can stand far in time from the disease itself.

That is, “in the beginning there was a word,” and a person did not even know about it until a certain shock happened.

It turns out, in a sense, that inside each of us there is a kind of time bomb in the form of two factors - a weakened organ and a “nuclear conflict” (from the word “core, center”).

Nuclear conflict occurs, as a rule, in childhood, as a result of the confrontation between the desires and feelings of the child and the requirements of the family. . In general, the strongest intrapersonal conflicts develop into conditions of dependence necessary for survival, which is the place to be in childhood.

The child receives from the parents a certain attitude, which calmly dozes off in the unconscious.. After a while, prolonged stress is superimposed on the previously received installation, from which real feelings are suppressed, and illness appears.

Let's now "tell fortunes according to Alexander" and try to figure out what kind of "nuclear conflict" is behind this or that disease. I will try to be as brief as possible, because the description and study of each group of diseases in itself is an endless ocean. We will assume that I will show you a "map of the planet" from a satellite.

SKIN DISEASES

The skin is both the boundary of the body and the sense organ. She is both what protects us and what we come into contact with. Through touch we can convey love and tenderness. They can also be a source of pain. The skin turns red with shame, turns pale and sweats with fear, betraying us as bad partisans.

Skin diseases are always problems with contact and boundaries..

It is always a conflicting message "Touch me - don't touch me".

Somewhere in the depths may lie suppressed and self-directed anger towards those closest to you. Those who, showing love, violated the boundaries too much, or vice versa, were cruelly rejected if they wanted to get closer.

As an example, we can cite an overprotective mother, who constantly not only stroked and caressed the baby, but also unceremoniously disposed of his things and personal space at an older age.

But, since the woman was always affectionate and vulnerable, it was absolutely impossible to be angry with her, because "she is a mother, and she does everything only for him." At the moments of the next violation of the boundaries, the teenager felt anger and guilt for this anger at the same time. It was not possible to recognize and express these feelings. But at such moments of life, neurodermatitis was especially strong.

Another, polar option is a very busy mother. She always left early, and came when the child was already asleep. But, if the baby was covered with spots and sores, she stayed at home and smeared him with ointment, gently touching with warm hands ...

GASTROINTESTINAL AND NUTRITIONAL DISORDERS

Remember the phrase "not sparing your belly"? The words "belly" and "life" go hand in hand. During feeding, the child receives not only mother's milk, but also warmth, attention, care, affection, pleasure and comfort.

If the mother feeds on time, the child feels loved, protected, and he likes life. A prolonged feeling of hunger makes you angry, and then greedily absorb more than you need. Stale, untimely, unloved food or too much of it makes you feel disgusted, nauseous.

Just think how many feelings are associated with food! The spectrum of psychosomatic diseases is also huge.

BULIMIA- insatiability, greed for food, as a metaphor the greatest lack of love and security. “Eat now, as much as you like, otherwise you may not have it later” - as a metaphor for longing for love and attention, rare and insufficient spiritual contact with parents.

ANOREXIA- refusal to eat rebellion as an extreme way to draw attention to yourself. Hunger strike as an expression of anger and resentment. “Maybe at least this way you will pay attention to me, hear, notice me. It was me, and not your expectations and deeds!

GASTRIC ULCER and duodenal ulcer- a disease of "people of Western civilization, living with aspirations and ambitions", businessmen and hyper-responsible hard workers.

“I am stubborn and independent enough that I will cut off the branch on which I sit to prove that I can cope with all the difficulties on my own. I will even feed myself. Himself."

On the surface - ambition, activity, independence, and in the depths - a repressed desire for love and great resentment. This symptom says the following: “Once upon a time I really wanted your love and care, but you rejected me in my weakness and noticed only when I was independent. I will never be weak again. I can do everything myself.”

RESPIRATORY DISORDERS

Do I need to say something about the importance of breathing? Smooth and deep, it is associated with freedom, lightness and contentment. Heavy - with a load of experiences, prohibitions, fear. Stopped - with anger and indignation. Inhalation is filling. Exhalation - devastation, relaxation. Speech is a natural extension of breathing.

Premember the phrase "stepped on the throat of your own song"? People who deprive themselves of the "right to vote" often have colds with various complications.

BUT At the heart of bronchial asthma lies the conflict between the need for love and the fear of rejection.“Don’t come so close to me, you won’t let me breathe. But don’t go far, I won’t be able to live without you, ”says the child to an overly anxious, protective and demanding mother, who does not allow the child to express herself naturally, cry where it hurts or hurts (“Why are you crying, calm down now!”) , show interest where something new appears.

The need for love and support is strong, but suppressed because it threatens to "suffocate", anger is also impossible, as it threatens to reject. So the asthmatic remains somewhere in the middle, between inhalation and exhalation, due to increased demands and expectations, not being able to relax, experiencing asthma attacks.

CARDIOVASCULAR DISEASES

“Heart, you don’t want peace…” we sing when we fall in love. “Heart person” - we are talking about kind and sweet people. We like them, these sincere, always smiling people. We also say “eyes are bloodshot with rage” and avoid those who show their displeasure and openly express anger.

In our world, being a "darling" is much more profitable than openly expressing your intentions, desires for power and control. "Girls don't get angry", "Boys should be able to control themselves." And they grow up and learn to look decent in the eyes of others, to be sweet and restrained.

What about anger and resentment? If a child has not been taught to express them in a constructive, civilized way to defend their boundaries and respect their values, then he will learn to suppress anger in order to be a good, decent person. And the stronger the pressure of the medium, the higher the pressure column will rise.

“I want to be in charge here, to control everything and put you in your place. I'm very, very angry, but it's so indecent. I have to keep a good face. Therefore, I will smile at you now, ”the hypertensive patient will tell you. Not with words. Tonometer.

METABOLIC AND ENDOCRINE DISORDERS

Have you ever noticed your own development at the moment of development itself? Do you have an experience of how satiety occurs, or do you face its result in the form of satiety?

Metabolic processes inside the body occur quietly and imperceptibly, showing us only the result: changes in mood and condition, drowsiness or alertness, activity or lethargy.

Detecting the pathology of metabolic processes is one of the most difficult tasks, because the “metabolic process” itself does not hurt. Sometimes a person does not hurt at all, and only indirect signs can determine that something went wrong. The most common diseases of this spectrum are diabetes mellitus, hypo- and hyperfunction of the thyroid gland. The psychological factors that cause their occurrence are very different from each other.

HYPOTERIOSIS

I can't help but quote “The thyroid hormone plays an important role in the growth process. Phylogenetically, it first appears in amphibians, in which it performs the function of stimulating metamorphosis.

The artificial introduction of thyroxine accelerates the salamander's transition from aquatic to terrestrial existence, from gill breathing to lung breathing. The evolutionary transition from aquatic existence to earthly existence is due to the development of the thyroid gland. (F. Alexander, "Psychosomatic Medicine")

So, the thyroid gland is an organ directly related to development. Hypothyroidism manifests itself outwardly as fatigue, lethargy, impaired attention and memory. Simply put, a person suddenly stops being active. He literally has his hands down. The reason for this may be a banal disappointment, the rejection of your dreams. “Why strain and invest your vitality if your desires are placed on the altar of other people's requirements, norms and rules? I'm going on a sit-in."

HYPERTERIOSIS

The thyroid gland looks like a shield. That's why it's called that.

The desire to be protected appears in a situation of threat. When a person is scared, his heart beats faster, his palms sweat, motor excitement appears and metabolism accelerates. Exactly the same effect on the body has the release of thyroid-stimulating hormone, which produces the "thyroid gland". According to the psychodynamic approach, hyperthyroidism can be triggered by a lack of security, a sense of security in childhood, and mental trauma.

DIABETES

Literally translated as "sugar flow". Joy and pleasure leave the body without being retained in it. Yes, and from the outside to get them in the form of sweets is not possible. What can lead to such a sad picture? Sadness can. And also chronic stress and conflicts, being in constant tension and experiencing self-doubt, that you can be loved and needed.

Hunger, fear and feelings of emotional abandonment. These are the feelings that are always present in the background in the life of a diabetic. It's not a sweet life at all.

DISEASES OF THE musculoskeletal system

Movement is life. Run, jump, push forward, learn, move and act. This is how energy and strength manifest in a person. We like active adults. But kids are annoying. “Yes, sit down already, don’t run, don’t turn around, calm down. Become comfortable and obedient. Get in control."

Tell me, how would you feel if you were put in a "straitjacket"? Resentment, anger, anger at those who dared to deprive you of your freedom.

What if these outrageous people are your loving mom and dad? How to be then?

Where to put your destructive impulses?

That's right, in physical activity and constant monitoring. Patience and humility on the outside, no matter what happens, and suppressed anger on the inside are what can become the internal basis for the occurrence of rheumatoid arthritis.

AUTOIMMUNE DISEASES

Immunity is designed to protect the body, destroying harmful micro-objects that get inside. How does it happen that one's own organs begin to be perceived as something threatening, requiring suppression, destruction? Everything is simple. You are probably familiar with the erroneous division of emotions into negative and positive. Joy, pleasure, tenderness - leave. We get rid of anger, disgust, envy. But, my friends, this is not the case.

The emotional background, as well as the hormonal one, is one in a person. You can't "remove" one without changing the other. If there is a Person, then there is also a Shadow. Diseases of this spectrum occur when one of the own parts of the personality has been severely sentenced to destroy.

I want to warn you against the instant desire to blame your parents for all your troubles. Believe me, they raised you based on the resources they had. And if they knew how to raise you better, they certainly would have done it. But everything turned out the way it happened.published

©Natalia Emshanova

Psychosomatics- direction of psychology, exploring the relationship between mental experiences and bodily reactions of the body. The disease carries us this or that symbolic message - we just need to learn to understand the language in which it speaks to us through its symptoms.

Psychosomatic diseases are diseases, the causes of which are to a greater extent the mental processes of the patient than directly any physiological causes. If the medical examination cannot detect a physical or organic cause of the illness, the illness is classified as psychosomatic.

Psychosomatic approach begins when the patient ceases to be only a carrier of a diseased organ and is considered holistically. Then the psychosomatic direction can be considered as an opportunity for "healing". The main goal is to find links in time between the onset of somatic manifestations and authentic life situations.

All ways and methods of work are aimed at unfolding the energy, sensations and experiences that are blocked in the symptom. i.e. directly in the body of the client. On the study of ways of interacting with the outside world through the disease. Search and formation of new, healthy manifestations through awareness, sensation, feelings, search for an object and action.

Psychosomatics helps:

find the root of the problem of psychosomatic disorder;
hear and understand the signals of your own body;
learn to express repressed emotions and feelings;
speak openly about your needs;
build relationships with others in a healthy way, without using symptoms.
understand the causes of diseases of your loved ones;
to realize how the disease is beneficial for you;
learn to cope with the symptoms of the disease on their own;
resolve unsolvable life situations without getting sick.
learn to speak and hear people close to you;
help your children build healthy relationships, and be healthy;
live a more fulfilling and creative life.

From the history of psychosomatics:

Psychosomatics - "Psychosomatic" in Greek means "psycho" - the soul and "soma, somatos" - the body. The close relationship between the mental and the somatic has been noticed and studied for several centuries, since the time of Hippocrates and Aristotle. This term was introduced into medicine in 1818 by the German psychiatrist Johann Heinroth, who was the first to say that a negative emotion left in the memory or regularly repeated in a person’s life poisons his soul and undermines physical health. From the works of Z. Freud in the late 19th and early 20th centuries, a systematic study of the mutual influence of the psyche and body in the picture of the disease began. As is known, he argued that memories suppressed as a result of psychic trauma and the psychic energy associated with them can manifest themselves in somatic symptoms through conversion. Freud also pointed out that "somatic readiness" is an important influence, a physical factor that matters for "organ selection"

The term "psychosomatic" finally took root in medicine thanks to the Viennese psychoanalysts (Deutsch 1953), and since that time psychosomatic medicine has been designated as "applied psychoanalysis in medicine". A huge contribution to the study and development of psychosomatics was made by Deutsch, Flanders Dunbar, Franz Alexander, Adler, Szondi ...

Franz Alexander (January 22, 1891 - March 8, 1964) was a Hungarian-American psychoanalyst. One of the founders of psychosomatic medicine, founder and leader of the "Chicago School" of psychoanalysis. Professor of Clinical Psychiatry, University of Southern California (1957). Laureate of the 3igmund Freud Prize (1921) of the International Psychoanalytic Association and other scientific awards and distinctions. President of the American Psychological Association (1938). Editor-in-Chief of the Journal of Psychosomatic Medicine (1939). President of the American Society for Research in Psychosomatic Problems (1947). Author of more than 120 articles. "Psychoanalysis of the Whole Personality", 1927; "Psychoanalytic Therapy", 1946, et al. with T. French; "Fundamentals of Psychoanalysis", 1948; “Psychosomatic medicine. Its principles and application”, 1950; "Dynamic Psychiatry", 1952, et al. with G. Ross; History of Psychiatry, 1966, et al. with Sh. Selesnik. In the Russian translation "Man and his soul: knowledge and healing from antiquity to the present day", 1995, etc.

Franz Alexander graduated from the Medical Faculty of the University of Budapest (1913). He explored a wide range of diverse psychological problems, including the negative consequences of raising children in exorbitant severity or pampering. Studied and typified emotional conflicts. During the First World War, Alexander was a military doctor (1914 - 1918). After the war, he took up psychotherapy and psychoanalysis, worked as an assistant at the Neuropsychiatric Clinic of the University of Budapest (1919-1920). Alexander worked and taught at the Berlin Psychoanalytic Institute (1924-1925), where he practiced short courses of psychoanalytic therapy along with the standard ones.

Alexander formulated the principle and created the model of "corrective emotional experience", according to which the psychoanalyst can consciously and actively regulate his own emotional reactions and direct his influence on the patient in order to resist his unproductive attitudes.

Franz Alexander interpreted obsessive-compulsive disorder, conversion hysteria, and manic-depressive psychosis as different forms of disruption in the interaction between repressive ego functions and repressed drives.

Alexander differentiated the concepts of "guilt" and "feeling of shame" according to their emotional content and functional results. In 1930 he was invited to lecture at the University of Chicago, where he became the first professor of psychoanalysis. Soon he moved to the USA and in 1932 organized and headed the Chicago Institute of Psychoanalysis, which he led until 1956.

Franz Alexander founded the first psychosomatically oriented psychoanalytic laboratory, where, together with colleagues, he researched and described conflict models of diseases that manifest themselves in different personality types, studied social disorganization and a number of criminological problems. In the late 40s - early 50s. Alexander developed and systematized the ideas of psychosomatics. He became one of the founders of psychosomatic medicine. He developed a functional theory of personality, within the boundaries of which he established four main functions of personality:

perception of subjective needs (internal perception);
perception of information from the surrounding world (external perception or “sense of reality”);
integration of external and internal perceptions (involving the planning of actions to meet subjective needs);
control of voluntary motor behavior (executive function "I").

Alexander completed a series of works on the emotional causes of hypertension and stomach ulcers, which are considered classics of psychosomatics and psychosomatic medicine. From 1956, for a number of years, he was director of the Psychiatric and Psychosomatic Research Institute in Los Angeles. He was considered the leading psychoanalyst in the United States.

The term "psychosomatics" should only be used to illustrate the methodological approach in research and therapy, which means the simultaneous and coordinated use of somatic - that is, physiological, anatomical, pharmacological, surgical and dietary - methods and concepts, on the one hand, and psychological methods and concepts on the other. The emphasis here is on the expression "consistent use", showing that two methods are applied in the conceptual framework of causal sequences. Alexander Psychosomatic medicine.

Therapists about psychosomatics:

As a former healthcare professional, I want to help clients stay out of the hospital. Learn to listen to the signals of your body and not postpone your symptoms for later.

Personally, for me, understanding bodily reactions helps to stop the development of symptoms.

There are good results in working with panic attacks, with migraines, with pain of various localization, with gynecological problems.

For me, psychosomatics is the possibility of meeting with the inner world of a person, with his hidden resources, with his ways of interaction, with his secret desires to be seen, heard, recognized. Meeting with his impossibility, with his desire to change his life and his world, to become healthier!

Name: Psychosomatic medicine. Principles and practical application.
Franz Alexander, Mogilevsky S.
The year of publishing: 2002
The size: 1.29 MB
Format: doc
Language: Russian

The presented book by Franz Alexander in the translation "Psychosomatic Medicine. Principles and Practical Application" consists of two basic parts, the first of which discusses the general principles of the issue covered, presents the development and principles of various areas of psychiatric science at the present stage, the second part characterizes emotional factors in various somatic diseases.

Name: Disorders of the psychosomatic spectrum. Pathogenesis, diagnosis, treatment
Storozhakov G.I., Shamrey V.K.
The year of publishing: 2014
The size: 1.38 MB
Format: pdf
Language: Russian
Description: In the practical guide "Disorders of the psychosomatic spectrum. Pathogenesis, diagnosis, treatment", edited by Storozhakov G.I., et al., the issues of the anatomical and physiological foundations of psycho...

Name: Psychiatry. Scientific and practical reference book
Tiganov A.S.
The year of publishing: 2016
The size: 50.5 MB
Format: pdf
Language: Russian
Description: Reference manual "Psychiatry. Scientific and practical reference book" edited by Tiganov A.S., considers the entire spectrum of psychiatric pathology, which is a practical guide for practitioners ... Download the book for free

Name: Clinical Guide to Mental Disorders. 3rd edition.
Barlow D., Eidemiller E.G.
The year of publishing: 2008
The size: 9.17 MB
Format: pdf
Language: Russian
Description: The book "Clinical Guide to Mental Disorders" as a modern clinical guide to psychiatry examines the practical issues of the discipline, which reflects panic disorder and ... Download the book for free

Name: Handbook of Psychiatry.
Zharikov N.M., Khritinin D.F., Lebedev M.A.
The year of publishing: 2014
The size: 1.06 MB
Format: pdf
Language: Russian
Description: Theoretical and practical issues of psychiatry in the Handbook of Psychiatry give the most complete picture of this section of medical science. The handbook discusses the diagnosis of ra... Download the book for free

Name: Borderline neuropsychiatric disorders in children.
Fesenko Yu.A.
The year of publishing: 2010
The size: 5.88 MB
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Language: Russian
Description: The presented book "Borderline neuropsychiatric disorders in children" deals with a rather urgent problem of child psychiatry - borderline disorders. The publication characterizes diagnostics ... Download the book for free

Name: General psychopathology
Marilov V.V.
The year of publishing: 2002
The size: 4.06 MB
Format: djvu
Language: Russian
Description: The book "General Psychopathology", edited by VV Marilov, considers general issues of studying psychiatric disorders. Pathological states of perception, thought disorders are presented ... Download the book for free

Name: Practical guidance on the application of the ICD-10 in psychiatry and narcology
Churkin A.A., Martyushov A.N.
The year of publishing: 2010
The size: 31.03 MB
Format: pdf
Language: Russian
Description: The book "Practical Guide to the Application of the ICD-10 in Psychiatry and Narcology" edited by Churkina A.A., et al.

Name: Analytical psychopathology. 3rd edition
Tsirkin S.Yu.
The year of publishing: 2012
The size: 2.1 MB
Format: djvu
Language: Russian
Description: The practical guide "Analytical Psychopathology", edited by Tsirkin S.Yu., considers the main psychopathological categories that help to significantly supplement the basic ideas about the psyche ...

Franz Alexander's "Psychosomatic Medicine" bears the imprint of the personality of its author, a professional in both psychoanalysis and medicine. In 1919, having already received a medical education, he became one of the first students of the Berlin Psychoanalytic Institute. His first book, Psychoanalyse der Gesamtpersoenlichkeit (1927), which developed the theory of the Superego, was praised by Freud. In 1932, he helped found the Chicago Psychoanalytic Institute and became its first director. As a charismatic leader, he attracted many European psychoanalysts to Chicago, including Karen Horney, who was promoted to Assistant Director of the Institute. Sharing most of Freud's positions, Alexander, however, was critical of the theory of libido and showed great independence in developing his own concepts, and also supported the unorthodox ideas of other psychoanalysts. In general, his position is characterized as intermediate between orthodox Freudianism and neo-Freudianism. In the history of psychoanalysis, Alexander stands out for his special respect for scientific approach and precise methods, which is why the Chicago Psychoanalytic Institute, which he continued to direct until 1956, was the center of numerous scientific studies on the role of emotional disorders in various diseases. Although the psychosomatic direction began to form in medicine long before Alexander, it was his work that played a decisive role in recognizing emotional stress as a significant factor in the occurrence and development of somatic diseases.

The formation of psychosomatics in the 30s of the twentieth century as an independent scientific discipline was not a simple consequence of the invasion of psychoanalysis into somatic medicine in the process of expanding its sphere of influence, just as it penetrated, for example, into cultural studies. The emergence of psychosomatic medicine was predetermined, firstly, by the growing dissatisfaction with the mechanistic approach, which considers a person as a simple sum of cells and organs, and secondly, by the convergence of two concepts that have existed throughout the history of medicine - holistic and psychogenic. Alexander's book summarized the experience of the rapid development of psychosomatics in the first half of the twentieth century, and the most interesting in it, of course, is a concentrated presentation of the methodology of a new approach to understanding and treating diseases.

The basis of this methodology, which runs throughout the book, is the equal and "coordinated use of somatic, that is, physiological, anatomical, pharmacological, surgical and dietary methods and concepts on the one hand, and psychological methods and concepts on the other", in which Alexander sees the essence of the psychosomatic approach. If now the area of competence of psychosomatic medicine is most often limited to the influence of psychological factors on the occurrence and development of non-mental diseases, that is, the line coming from the psychogenic concept, then Alexander was a supporter of a broader approach coming from the holistic concept. According to this approach, the mental and somatic in a person are inextricably linked with each other, and understanding the causes of diseases is impossible without a joint analysis of these two levels. Although the holistic approach is not currently outright rejected, it often goes out of the sight of both researchers and doctors - probably due to the difficulty of following its methodology, which requires not only a good knowledge of both the psyche and somatics, but also an understanding of them. interconnected functioning. The latter is difficult to formalize, which is necessary in scientific research and in clinical practice, and easily escapes the scope of scientific analysis, especially in the context of continuing differentiation and specialization of the branches of medicine. In this regard, the importance of Alexander's book, in which the holistic psychosomatic methodology is not only formulated and substantiated, but also illustrated by numerous examples of its specific application, has, perhaps, only increased in our days.

Alexander's predecessors and contemporaries described many different kinds of correlations between the emotional sphere and somatic pathology. The most deeply developed in this area was the theory of specific personality types Flanders Dunbar. This researcher showed that the psychological portrait ("personality profile"), for example, patients suffering from coronary heart disease, and patients prone to frequent fractures and other injuries, is fundamentally different. However, as in any other area of scientific knowledge, statistical correlation provides only initial material for studying the mechanisms of a phenomenon. Alexander, who has great respect for Dunbar and often cites her work, draws the reader's attention to the fact that the correlation between character and predisposition to disease does not necessarily reveal the real chain of causal relationships. In particular, between the character and predisposition to a certain disease, there may be an intermediate link - a specific lifestyle that people with a certain character are prone to: so, if for some reason they are inclined to professions with a high level of responsibility, professional stresses can become the direct cause of the disease, rather than the properties themselves. Moreover, psychoanalytic research can reveal the same emotional conflict under the veil of apparently completely different personality types, and it is this conflict, from Alexander's point of view, that will determine the illness to which the individual is most prone: for example, "the characteristic emotional pattern of an asthmatic can be identified in individuals with completely opposite personality types who protect themselves from the fear of separation through various emotional mechanisms. Thus, thanks to the reliance on the psychoanalytic method, Alexander does not stop at a discussion of statistical correlations between external indicators of mental and somatic functioning, which have a very limited value in relation to the main task - treating the patient, and goes much further, trying - although not always successfully - to identify deep mechanisms of pathology.

The theoretical basis of this manual is mainly the theory of psychosomatic specificity, or specific conflicts - Alexander's most famous concept. According to her, the type of somatic disease is determined by the type of unconscious emotional conflict. Alexander proceeds from the fact that "every emotional situation corresponds to a specific syndrome of physical changes, psychosomatic reactions, such as laughter, crying, blushing, changes in heart rate, breathing, etc.", and, moreover, "emotional effects can stimulate or inhibit the work of any organ." Psychoanalytic research reveals in many people unconscious emotional tension that persists for a long time. It can be assumed that in such cases, changes in the functioning of physiological systems will persist for a long time, leading to disruption of their normal functioning and, ultimately, provoking the development of the disease. Moreover, since various physiological changes are observed in different mental states, different pathological processes will be the result of various long-lasting unconscious emotional states: high blood pressure is the result of suppressed anger, dysfunction of the gastrointestinal tract is the result of the frustration of dependent inclinations, etc. In an effort to be an objective researcher, Alexander recognized that the key provisions of his theory require additional verification and justification. Unfortunately, the theory of specific conflicts has not received a clear experimental confirmation, including in numerous studies specially devoted to this, headed by Alexander of the institute. However, it has not been refuted. It continues to be considered one of the leading psychosomatic theories.

A feature of Alexander's approach was the emphasis on unconscious emotional tension, which, from a psychoanalytic point of view, is more pathogenic, since it cannot find a way out in conscious actions. In this, his approach differs from non-psychoanalytic ones, including those prevailing in Soviet medicine, and even prevailing in modern Russian medicine, in which the influence of only conscious mental processes that are accessible to direct observation and description is analyzed. On another plane, the opposite of Alexander's approach is represented by a non-specific concept. According to it, the emergence and development of pathology is caused by prolonged states of stress, however, the specific form of pathological changes does not depend on the type of stress, but on which organs or systems in a given individual are more vulnerable. Criticizing the specific concept, supporters of the non-specific concept emphasize the lack of a complete correlation between the specifics of a psychosomatic illness and the patient's personality. Apparently, there is no antagonism between all these concepts: some cases may correspond more to one of them, others to the other. As noted above, the incomplete correspondence between the disease and the external characteristics of the personality is easily explained if unconscious conflicts are taken into account, as Alexander suggested. However, he by no means made a fetish of psychic influences, recognizing the great role of somatic factors. In particular, he noted that typical emotional constellations characteristic of a certain somatic disease (for example, an ulcer) can also be found in a person who does not develop this disease, from which he concluded that the presence or absence of a disease depends not only on emotional but also from somatic factors not yet sufficiently identified. He turned out to be right - in recent decades, the important role of genetic factors independent of the psyche in determining the individual vulnerability of physiological systems has been convincingly shown.

Most of the space in the book is given to the application of the psychosomatic approach and the theory of specific conflicts to specific diseases. Although Alexander, based on a holistic approach, was against the allocation of a separate group of psychosomatic disorders (both somatic and mental factors can be found in any somatic disease!), The range of diseases he considers almost exactly coincides with what is now customarily attributed to this group. Based on solid clinical material, including his own observations, data obtained by the staff of the Chicago Psychoanalytic Institute, and numerous data from other researchers, he builds a well-thought-out scheme of psychosomatic genesis for each disease. The case histories cited are excellent illustrations of the ways in which the psychoanalytic method can be applied to identify underlying disorders of latent emotional conflicts and treat these conflicts, and ultimately the disease as a whole.

Excessive optimism and confidence in his approach, it seems, let Alexander down - he often, without sufficient reason, considered the mechanisms of diseases already well understood, in fact, little clarified to date. Because of this, the chapters on specific diseases look, despite the constant reliance on clinical material, somewhat lightweight and lose the theoretical part in persuasiveness. Thus, the connection of psychogenic constipation with anal-sadistic inclinations, although it will not cause doubts among many psychoanalytically oriented specialists, will hardly seem fully proven to the rest. Alexander's well-known hypothesis about the role of repressed anger in the formation of chronically elevated blood pressure is generally very convincing, but even it does not have unambiguous experimental confirmation, and many questions related to it are still not clarified. With other psychosomatic hypotheses, the situation is by no means better: although clinical evidence is periodically reported in favor of one or another of them, it is still too early to draw final conclusions. Finally, the effectiveness of psychoanalytic treatment of psychosomatic disorders seems to have been exaggerated: according to modern experts, many of the psychosomatic patients are simply not able to adequately express their emotions, and therefore classical psychoanalytic techniques often do not improve their condition.

At the same time, one should not lose sight of the fact that these flaws in Alexander's book are the result of the extreme complexity and poor development of the subject. And the understanding of this subject over the past half century, alas, has advanced very little. One of the reasons for this is that most research in the field of psychosomatics unreasonably ignores the methodological principles developed by Alexander. This manifests itself either in focusing only on one side, somatic or mental, or in limiting the analysis to the calculation of correlations of somatic and psychological indicators, on the basis of which only the most superficial conclusions about causal relationships are made. Conducting large-scale "correlation" studies is now a task available to a wide range of specialists: having data from clinical examinations of patients, you just need to supplement them with "psychology" - connect the psychological "profiles" of the personality traced by one of the psychometric tests, and then calculate how they are related to each other. with a friend. There are now a great many psychometric tests, as well as methods of statistical analysis, and both of them are easily implemented in computer programs; as a result, the productivity of the researcher, in comparison with the time of Alexander, increases monstrously. However, if the descriptions of the mechanisms of psychosomatic pathology proposed by Alexander were often too speculative, then correlation studies, picking out only individual strokes in the most complex picture of psychosomatic interactions, often do not clarify anything at all. The result is very little progress in understanding the psychosomatic nature of disease.

It should be noted that Alexander clearly took wishful thinking, believing that the “laboratory era of medicine”, which was characterized by the reduction of the goal of medical research to the identification of “more and more details of basic physiological and pathological processes”, had already ended. On the other hand, his "tendency to squeeze more and more diseases into the etiological scheme of infection, where the connection between pathogenic cause and pathological effect seems relatively simple" does not seem to be weakening at all: more and more new hypotheses that something or other disease - stomach ulcer, cancer, etc. - is caused by some pathogenic microorganism, the scientific and other public meets with genuine interest. One reason for the continued flourishing of the "laboratory approach" is that understanding of human physiology has increased not only quantitatively but also qualitatively over the past half century. The discovery of many details of physiological mechanisms at the cellular and molecular level served as the basis for new advances in pharmacology, and the huge profits of pharmaceutical concerns in turn became a powerful factor supporting physiological research; a vicious circle has developed. This powerful system, spinning on the principle of positive feedback, largely determines the modern face of "laboratory" medicine.

It is curious that the role of physiological mechanisms began to be recognized as leading even in the etiology and pathogenesis of mental illness. This led to a huge progress in the disclosure of the mechanisms of information transmission between brain cells and related successes in the pharmacological correction of mental disorders. The need for a broader, systematic understanding of the disease is not denied, on the contrary, sometimes it is even elevated to a dogma, but the real orientation of research, medical education, and the organization of medicine contributes very little to this. As a result, many researchers and doctors are actually guided by the principle of reductionism - the reduction of phenomena of a higher order to the lower ones. Instead of considering a healthy and sick organism as a psychosomatic unity, in which both cellular mechanisms and interpersonal relationships in which the individual is included are important - an approach justified and developed in detail by Alexander - narrow specialists try to solve all issues without going beyond their favorite physiological level. At the same time, under the banner of the holistic approach, completely amateurish ideas are most often put forward, absurd in theory and ineffective in practice, having nothing in common with the truly scientific approach of the author of this book. Thus, the advent of the psychosomatic era, contrary to Alexander's expectations, is still delayed.

The reader who is not connected with medicine and physiology must be warned that many of the "somatic" details of Alexander's hypothetical mechanisms of pathogenesis are undoubtedly outdated to one degree or another. Even such a seemingly simple phenomenon as ulceration is understood today in a completely different way than in Alexander's time, and instead of one disease, about three dozen types of peptic ulcers are now distinguished, differing in the physiological mechanisms of the onset and development of the pathological process. A lot has become known about the hormonal regulation of physiological processes, about immune processes (which, in particular, play an important role in arthritis), and progress in understanding the mechanisms of heredity is completely colossal - it is worth at least remembering that the carrier of the genetic code was established after the appearance of this books! However, the most valuable in the book are not descriptions of the hypothetical mechanisms of specific diseases, although they also contain many subtle observations and quite indisputable conclusions, but the methodology of penetration into the psychosomatic nature of diseases that opens up behind them.