 Keywords: psychiatry, a psychosomatic medicine, borderline cases, psychosomatic diseases, psychosomatic frustration, occurrence, the mechanism, formation, vegetative nervous system, a stress, a pathology, illness, a reflex, psychiatry, psychosomatic disease, pathologythere Are no any only mental and only somatic illnesses, THE HISTORY OF THE PSYCHOSOMATIC MEDICINE. THE GENERAL QUESTIONSThe term "psychosomatic medicine" has suggested in 1818 J. Heinroth which explained many somatic illnesses as psychogenic, first of all in ethical aspect. So, it surveyed the reasons of a tuberculosis, an epilepsy and a cancer as result of experience of feeling of rage and shame, and is especial - sex sufferings. In 10 years M.Jakobi has entered concept "somatopsychic" as opposite and at the same time supplementing in relation to "psychosomatic". The term "psychosomatic medicine" has been entered into a medical lexicon only a century after (F. Deutsch, 1922). Originally the concept "psychosomatic" united diseases in which development the essential role is played with adverse psychogenic influences (an ichemic illness of heart, an arterial hypertension, a peptic ulcer of a stomach and a duodenal intestine, a bronchial asthma). Now the term has 2 values: one is connected to his application to area of the medicine, the second - to illnesses in which the important role is played with psychological factors. The frustration categorized to psychosomatic, include not only psychosomatic diseases in traditional, narrow comprehension of this term, but is significant more the broad audience of infringements: somatized frustration, pathological psychogenic reactions to a somatopathy. The alienations concern to these series, frequently complicated a somatic pathology (a nervous anorexia, a bulimia, an alcoholism, etc.) also, The infringements complicating some methods of treatment, for example, of depression and a dysmnesia, developing after operation of a coronary shunting, affective alarming and asthenic conditions at the patients receiving a haemodialysis. Within the framework of psychosomatic frustration the conditions connected to a generative cycle of women (a set of symptoms of " a premenstrual strain " è " premenstrual dysphoric frustration " are surveyed; depressions pregnant and the postnatal depressions including a set of symptoms " long parturient women "; an involutional hysteria, etc.). As psychosomatic frustration rank also somatogenic (symptomatic) psychosises - a delirium, an amentia, a hallucinosis, etc. It is considered to be, that psychosomatic medicine - "coeval" of the current blepharon. However speech thus goes not about occurrence of the new concept in medicine, and about revival of principles of medicine of the antiquity approaching to disease as to specifically individual phenomenon, as to illness of the concrete person, illness douches and bodies. The psychosomatic medicine is old, as doctoring. The history of modern psychosomatic medicine begins with Z.Freud psychoanalytical concept which together with Breuer has proved, that " the suppressed affect ", " a mental trauma " by "conversion" can be shown by a somatic sign. Freud specified, that " somatic readiness " - the physical factor which matters for " a choice of body " and which can be imagined during his occurrence is necessary. U.Kennon has shown, that the organism answers extreme situations the certain adaptable changes in the general physiological frame. T.Uexkull has described " illnesses of readiness " at which there is a transition of emotions in corporal reaction, and readiness can hronifitsirovatsja and result in increase of activation organnyh functions. Disease develops when the sanction of a condition of readiness is impossible. Sifneos has entered concept "alexitimia" - disability of the person to an emotional resonance. Creatively developing Z.Freud, F.Alexander's idea has offered the theory of the emotional conflicts essentially influencing internal bodies, binding specificity of psychosomatic disease with type of the emotional conflict which conducts to that the actions directed on the external conflict are not carried out. The emotional strain cannot be suppressed, as vegetative changes accompanying it are kept. Further there can come changes of tissues and irreversible organic disease. For example, the deep pavor is found out in patients with a thyrotoxicosis before mors. Very much frequently at such patients at early age the psychological trauma, for example, loss of the favourite person on which they depend took place. Therefore after they tried to compensate a pulse of dependence attempts of early achievement of a maturity, for example, attempts to sponsor somebody instead of to remain in a state of dependence. Therefore at the patient who aspires to the prompt achievement of a maturity, the body allocating a secret, an accelerating metabolism falls ill. Hypertensive patients chronically ready to struggle have a dysfunction of the device of a circulation. They suppress free expression of hostility in relation to other people because of desire to be loved. Their hostile emotions rage, but have no output. In a youth they can be squabblers, but with the years notice, that push away from itself people the vindictiveness and as consequence of it, the unfriendly emotions suppress. Suffering an arthritis - the one who is always ready to attack, but suppresses in itself(himself) this aspiration. There is an appreciable emotional influence on muscular expression of feelings which thus is extremely strongly monitored. The patient with a neurodermite have the expressed aspiration to the physical contact, suppressed by restraint of parents, therefore it has infringements in bodies of contact. At an asthma the most specific psychological conflict concentrates around of dialogue with key figures of life. For example, initial communication mother - the child is broken. This infringement at the small child is observed in suppression of a pulse of crying. Later the child cannot come into confidential verbal contact to mother. Therefore the asthmatic has difficulties in verbal dialogue as the body necessary for the given function, is unhealthy. Suffering a ulcer "dreams" to have a meal well, and there is a damage to a tissue of the top department of a gastrointestinal path. Gastric functions are upset at people which bashfully react to the desire to receive the help or display of love on the part of other person, desire to lean against somebody. In other cases the conflict is expressed in feeling of fault because of desire to select by force something at another. The reason explaining why gastric functions are so vulnerable for the similar conflict, has been found in widely known fact, that the meal represents the first obvious satisfaction of retseptivno-collective desire. In ideas of the child desire to be by loved and desire to be fed are connected very deeply. When at more mature age the desire to receive the help from another causes shame or shyness that the desire it is frequent in a society which main value considers independence, finds regressive satisfaction in the raised bent for to absorption of nutrition. This draft stimulates a secretion of a stomach, and chronic rising of a secretion at the predisposed individual can result in a ulceration. At a ulcerative colitis it is not found while direct psychophysiological correlations, but suppression of destructive pulses and infringement or the loss of key mutual relations accompanied with feeling of hopelessness and despair is supposed, that, can be causal factors of illness also. These patients also show subconscious tendencies to dependence, they also try to compensate their desire to give something in exchange for desire to receive. However they do not have not enough confidence for realization of these ambitions. When they lose hope for achievement of to what there is an infringement of intestinal activity. The formulations given by F.Alexander, to specific psychological conflicts, have caused many objections because of which his other statements have been forgotten. Actually his perception of these illnesses had 3 aspects:
Besides there are direct differences in independent reactions of individuals to various forms of loads. Specific features of intensity and displays of independent reactions can explain various displays of psychosomatic diseases. F.Danbar has put forward the concept of dependence of a psychosomatic pathology from those or other structures of the person. K.Jaspers accented attention to roles of infringements of social dialogue in a genesis of a psychosomatic pathology. A.Micherlih who has opened first-ever psychosomatic clinic, believed, that at chronic psychosomatic development there is all over again a struggle against a neurotic complex by his replacement, and then - shift in dynamics of somatic protective processes. After T.Ikskjulem's second world war " the biopsychosocial model " has been stated and theoretically proved original wraparound. The biopsychosocial approach initially surveys the person in his natural biological development with reference to health and illnesses in his environment which it not only perceives, it and as far as possible frames itself. T.Uexkull has frameed the concept of an external world and an organism as " dynamically developing the whole ". Viner who has tried to describe " an organism in health and in illness " at all levels and steps of the organization and development as the integrated regulation system adhered to similar views also. Z.Bjutler carried to psychosomatic diseases of frustration at which provoking event in human life in the beginning starts the general nonspecific reaction of acclimatization on G.Selje, and then causes to some extent a reversible damage of the most vulnerable tissue, body or system. COMPLEXES OF THE THIN AND THICK INTESTINEV.Garbuzovym is developed the concept of 2 fundamental complexes of an organism: a thin and thick intestine. In its basis east theories of health and illness lay. Healers of the Ancient East attached great importance to a self-regulation of an organism, both in health, and in illness and understood illness, as interaction of the pathogenic factor and protective mechanisms in view of their force, features, an estimation of the general condition of an organism and individuality of the patient. Their comprehension of a pathology in an organism was expressed, for example, that after long treatment uncured same illness and already other. Healers of Ancient China believed, that energy in an organism flows on the certain channel is similar to water in canals and illness - a pathology of course of energy. Illness of body is an infringement of circulation of vital energy in a nem that results in pathological exaltation - acute rough illness of body - or to a pathological attrition - flaccid chronic illness. Disorganization of circulation of energy in one element results in infringement of its circulation in other elements and in all an organism. The doctrine about two opposite beginnings in an organism, about interaction Yang and In` - one of the central parts of Ancient east medicine. Essence Yang and In` - indissoluble unity of two contrasts: forces and delicacies, activity and rest, " hot and cold ". And one abirritates and stimulates another, providing a regulation and a harmonicity Yang and In` in an organism. There are Yang's bodies - making energy and In' bodies - clearing, concentrating, storing and distributing vital energy, as though accumulators of her. As In' bodies are hierarchically more important for conservation of life and their illness more serious and are dangerous to an organism, Yang's, which illnesses are less dangerous, as a rule, the first take up influence of pathological factors, i.e. cover In' canals from a pathology. In' bodies: mild, a lien, a pancreas, heart, kidneys, a liver. Yang's: a thick and thin intestine, urinary and cholic bubbles. Being aggravated, illness of Yang's body involves In' body conjugate to it in pathological process. All systems of an organism are parted on 2 supersystems: the complex of a thin intestine integrating functions of systems of heart, a liver both a cholic bubble and the complex of a thick intestine integrating functions of systems mild, of a lien, a pancreas, a stomach, kidneys and a bladder. Additional systems of an organism: integuments, a locomotorium, genesial, sense organs, tonsils, a pharynx and an oral cavity, also concerns to a complex of a thick intestine. The most general strategy of treatment depends on what complex from these 2 is struck. A complex of a thin intestine - Yang's, open, sated with energy; it is characterized with hope, struggle, presence of forces, thirst of life. The pathology of system of a thin intestine is generated aggressively - protestnymi by experiences, is mainly functional, with prevalence of sympathetic effects. It protective in relation to a complex of a thick intestine. Persons with congenital dominance of a complex of a thin intestine - choleric or sanguine temperament, the "sinewy - lean" constitution. Their illnesses become aggravated at midday and in first half of night. At this time they require calm, decrease of a pain and in a spasmolysis of vessels. A complex of a thick intestine - In', latent, with deficiency of energy, deep; for him threat of capitulation before the damaging factor, predilection to a somatization of depression is characteristic. A pathology of a complex of a thick intestine mainly organic, with damage of frames, tissues, with prevalence of effects parasimpaticheskoj nervous system. Persons with congenital dominance of a thick intestine - flegmatic temperament, the "muscular - spherical" constitution. Illnesses at them become aggravated in second half of night and in the morning. They require encouragement, strengthening, a soft stimulation, rising of a level of forces. Transition from a pathology of a complex of a thin intestine to a pathology of a complex of a thick intestine - the beginning of capitulation of protective forces of an organism, an attrition of his forces, transition from rather easily curable to hard to cure, from a Yang's pathology to In'. STAGES of PSYCHOSOMATIC ACCLIMATIZATION (on V.Garbuzovu)
To psychosomatic diseases of a complex of a thin intestine concern: a ulcer of a duodenal intestine, enteritises of not infectious nature, illness of a cardio-vascular system, including an ichemic illness of heart, a myocardial infarction and a hypertensive disease, an insult; illnesses of a cholic bubble, including a bile tract disease, illnesses of a liver of not infectious nature, a functional pathology of genesial system and a vegetative dystonia. Colitises of not infectious etiology, a bronchial asthma concern to psychosomatic diseases of a complex of a thick intestine, etc. illness mild not infectious nature, illness of respiratory ways and a nasopharynx, including allergic, illnesses of an oral cavity and a teeth, including a parodontosis; illnesses of tonsils and a thyroid gland, gastritises and a peptic ulcer of a stomach, illnesses of an esophagus; illnesses of a pancreas, including a diabetes. Illnesses of a lien and the kidneys, caused by pathogenic influence on the part of other systems of an organism and premature his withering; illnesses of urinary ways, including urolithic. Illnesses of a locomotorium and a skin, genesial sphere, including gynecologic, prostatites and oncologic. MODERN ASPECTS OF THE PSYCHOSOMATIC MEDICINEIn modern domestic medicine A.B.Smulevicha's position which believes, that psychosomatic frustration - group of the morbid conditions shown by an exacerbation of a somatic pathology, formation of the general, somatic at interaction somatic and mental factors of symptom-complexes - somatized mental infringements, the alienations reflecting reaction to a somatopathy is recognized. In modern medicine section of a psychosomatic medicine the researches shining a role of a stress in a pathogeny of somatopathies, communication of characterologic and behavioural features with sensitivity or fastness to the certain somatopathies, dependence of reaction to illness from type of a personal depot represent, influence of some methods of treatment on a mental condition. Frequency of psychosomatic frustration is high enough and changes in the population from 15 up to 50 %, and in therapeutic practice - from 30 up to 57 %. Within the limits of somatized frustration be relative isolated functional infringements of separate bodies (" functional sets of symptoms " on T.Uexkull) - organnye neurosises are allocated. The set of symptoms of a hyperventilation (a psychogenic short wind), an achalasia (cardiospasm), a set of symptoms of the "angry" stomach ", angry " or the "erethitic" colon, the "angry" bladder and so forth distinguish kardio-and angionevrozy. Psychopathologic displays of such neurosises are settled by a combination of conversion and somatized symptom-complexes to disturbing - phobic frustration and, in particular, with phobias of the hypochiondrial maintenance more often. ÌÊÁ-10 psychosomatic frustration can be classified in the following sections: " Organic, including symptomatic, alienations " (headings F04-F07 corresponding to reactions of exogenous type Ê. Bonhoffer), " Neurotic, connected to a stress and somatoform frustration " (headings F44.4-F44.7 corresponding to psychogenias, and F45 - somatoform frustration), and also " the Behavioural sets of symptoms connected to physiological infringements and physical factors " (heading F50-F53). MECHANISMS OF DEVELOPMENT OF PSYCHOSOMATIC DISEASESIn comprehension of mechanisms of psychosomatic frustration very important are I.P.Pavlova's theory and his pupils (K.M. Bykov). According to the doctrine about conditioned reflexes, psychosomatic processes - the complex, structured reflexes. The big interest is represented also P.K.Anokhin and N.P.Behterevoj's with works on the flexible functional systems of an organism formed at a pathology. Some authors specify, that during vital activity of the person at various levels of system of an integrated regulation pathological processes develop and there are the weakened or pathological parts united under certain conditions in uniform pathological the mechanism of a symptom-complex of disease. By a lot of researches it fixed, that completely various on the character negative emotions (the despair, pavor, alarm, melancholy) are accompanied by rather same visceral shifts. The excitability of sympatic system, and, hence, secretion of catecholamins that causes an acceleration of palpitation and rising the HELL, intensifying of a rush of blood to muscles raises grows. there Is a question: how the mentality and a body are connected? A link between psychological and somatic sphere is the affect expressing, mainly, in the form of melancholy and constant alarm, vegetative both endocrine motor reaction and characteristic sensation of pavor. Complete development of feeling of pavor is prevented by protective physiological measures, but is usual they only reduce, instead of eliminate completely these physiological phenomena. In result the appreciable affect which renders pathogenic action is kept. This process can be surveyed as inhibition that is when psychomotor and verbal expressions of alarm or hostile feelings are blocked in such a manner that the stimulus acting from a central nervous system, are allocated to somatic frames through vegetative nervous system and, thus, result in pathological changes in various systems of bodies. At presence psihichskogo experiences which is not blocked by psychological protection, and amazes somatic system corresponding to it, the functional stage of defeat develops into destructive - morphological changes in somatic system, there is a generalization of psychosomatic disease. Thus, the mental factor acts as damaging. To psychosomatic diseases carry those infringements of health, which etiopathogenesis - a true somatization of experiences, that is a somatization without psychological protection when, protecting mentality, the body is damaged. And hysterical conversion is only somatic demonstration of experience, original "cunning" of a body. In this case there is a neurosis as psychogenic disease, but there is no illness as a destruction of body. There is no generalization of a pathology. Process of formation of psychosomatic frustration. Superactual experience is fixed, forming the adjusting majorant being the functional center of a mental pathological impulsation. The vague feeling of physical discomfort inherent to patient causes realization of morbid sensations and their fixation at the certain influences. The unusual impulsation acting from internal bodies in a central nervous system, strengthens these sensations, that, finally, results in formation of a pathological condition. Negative emotions of a visceral parentage, thus, are as though supported with personal reactions of these patients to this or that sign or a condition of an organism as a whole. Repetition of psychogenic influences "sensitizes" nervous system, the bark becomes sensitive to external influences and interoceptive signals. Therefore occurrence of somatic sensations can be caused not only psychogenic influence as such, but also any insignificant somatic harmfulness or even by usual work of internal bodies. The generated center of a pathological impulsation acquires humoral communications with those or other systems of an organism. In this process by a key part the long-term memory is, perhaps. Center of emotions, motivations and memories, the lymbic system as is known is. The lymbic system at the same time is one of the maximum vegetative frames. The hypothalamus which is included in her structure, is responsible for a regulation as a vegetative nervous system, and an endocrine link, in a nem there are centers of aggression, alimentary and sexual centers. Thus, the lymbic system is the maximum frame of a central nervous system which basic function is the coordination of emotional reaction and its neurovegetative and neuroendocrinal maintenance. The lymbic system is also center of memory. The long-term memory is always an affect memory. The more brightly an emotion, the probability of activation of a trace of memory further there is more. On expression À. d'Obinie, " at pavor good memory ". The stressful condition tested by the person is fixed in a long-term memory. On the basis of mechanisms of a reverberation of exaltation and long-term postsinapticheskoj potentsiatsii the tested condition of a panic, pavor, horror is kept as " traces of memory " (engrams). Special value for development of psychosomatic frustration receives as a result of a stock of already developed engrams. For example, paroxysms of a tachycardia with sensation of a dyspnea and pavor of mors arise at downstroke of mood or overwork at the patient with a similar episode on a background postnatal endometrita in the past. The original reason of relapse "revival" of a corresponding symptomatology owing to resuscitation of traces becomes frequent only. The the feeling of danger to life and health was more acute, the it is more probability of procreation of the developed clinical picture as depression or its somatic equivalent. The leading part in formation of long-term memory belongs not so much to the valid gravity of the somatic suffering, how many caused by him or casually concurrent sincere experiences. The paramount factor causing primary localization of psychosomatic frustration, becomes the pavor of mors tested even of time in life, tested in connection with any disease. there Is a question: " Than the choice of this or that body is caused? " The centre of gravity of psychosomatic suffering appears always body, the most vulnerable and important for vital activity of an organism in representation of the individual. " The choice of body " testifies practically to a primary orientation of the protective - adaptive mechanisms causing known damaging effect on a measure of increase dezintegratsii in stressful situations. The initiative in a choice of body belongs always to the maximum cerebral communications influencing emotional subcortical devices and programmirujushchim a degree of involving of those or other bodies in a stressful situation. Which effektornyj the way appears more preferably for an output on periphery of emotional exaltation, depends, finally, on features of the given emotion, from features of the nervous constitution of the person and from all history of his life. The center of a mental impulsation is joined to somatic systems of an organism and forms steady functional system, pathological in the basis, but simultaneously and protective as she is a part of mechanisms of a homeostasis within the framework of the existence changed by illness and the adaptation of an organism to influence of the fixed experience. What primary preconditions for occurrence of psychosomatic frustration? THE PSYCHOSOMATIC PERSON AND ITS FEATURESExistence prepsihosomaticheskogo a personal radical - that radical of personal features which result in disease is supposed; it is the center of the psychosomatic impulsation, the fixed psychogenic experience. It is shaped at children's and teenage age, is more often at persons of choleric and flegmatic temperaments. A principal cause of formation of this radical is the infringement of fundamental claims of the person, is especial feelings of the advantage following from the dominating instinct. At defeats of a brain and at presence of psychophysiological defect of display of a radical are aggravated. For all psychosomatic persons the general is to some extent typically: inferiority of mentality, and therefore acuteness of feeling of advantage, egotsentrichnost, narrowing of interests, limitation and distortion of hierarchy of values, the purposes and needs that is shown in an inaaccurance of the claims amounting a vital plan of the individual. Exaggerated courage, isteroidnost, embitternment is characteristic. Statements of patients are frequently banal, they cannot develop the ideas, are not capable to understand indirect sense of statements. The psychosomatic subject is separated from unconscious and closely adhered to world around. Psychosomatic regress is regarded as regress "?" on a primitive protective level with tendencies as a somatization. The psychosomatic frame of the person in the big degree is defined by concept "alexitimia". For patients typically:
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