What is psychiatry and who is a psychiatrist?

What is this

Looking at the definition of psychiatry , which implies the presence of a soul that cannot be accurately measured, it becomes clear why it can baffle any nonsense and bring millions of hatred to various followers of religions, sects and public organizations that have their own views on working with the soul. Meanwhile, representatives of official science are worried about a small problem: diagnoses in psychiatry are made almost exclusively clinically, i.e. Based only on the clinical picture, and not laboratory, this fact implies the subjectivity of the psychiatrist’s observations, which is generally fundamentally incompatible with science and gives wide scope for quackery and commerce. Just like in psychology.

And friends of psychiatrists from related specialties are furious about the fact that they have to objectively prove the presence of a disease in a patient using X-rays and tomographs, while psychiatrists make a diagnosis based only on the words and actions of psychos. However, this greatly complicates the development of psychiatry, which moves forward only by rewriting and combining old terms, even taking into account the sluggish progress of medicine in general.

Progress in psychiatry itself looks like this: once every ten years, bearded psychiatrists gather and revise their section of the classification of diseases, and in a considerable proportion of cases only because many short diagnoses turn into insults, going into the mainstream and descending to the everyday level of language . In the latest ICD-10 classification, neurotics disappeared and were replaced with PTSD. Now hysterics will be proudly called carriers of dissociative-conversion disorders. The same thing happened to other convenient forms of addressing the suffering - idiots, morons and imbeciles. But there is also DSM, which is a little clearer there.

Depressive disorder.

Similar tendencies towards self-blame, self-deprecation, and often self-destructive behavior also prevail in another type of mental depression - recurrent (i.e., recurring) depressive disorder. This disease is also called unipolar depression, since it (unlike manic-depressive psychosis) does not cause manic episodes. It is most often observed between the ages of 25 and 45, although it can occur in adolescence. Women get sick twice as often as men. The advanced stage of depression is accompanied by painful and gloomy feelings. Family, friends, social activity, professional activities, hobbies, books, theater, company - all these diverse interests lose their attractiveness for the patient. He is overwhelmed by one feeling: “No one needs me, no one loves me.” Under the influence of this feeling, all ideas about life change. The present seems gloomy, the future devoid of hope. Life itself is perceived as a joyless burden. Everyday problems, once unnoticed or easily solved, grow to insurmountable proportions. Exhortations to “get rid of the bad mood” or “pull yourself together” are usually useless. The danger of suicide, as with manic-depressive psychosis, remains as long as the depressive state lasts. The old saying that people who threaten to commit suicide never do so does not apply in this case. No other disease has such a high percentage of patients attempting suicide.

How it works

It depends on which side you take - you can be either a psychiatrist or his patient.

How to become a psychiatrist

No more difficult than any other doctor: six years of hellish medical university, then N years in residency, plus a little (5-10 years) practice in a clinic and voila! After this, you can consider yourself a real psychiatrist who sees right through people’s souls, lol.

In the real world, everything is a little worse, because the Soviet domestic psychiatrist, in addition to the entertaining work of healing lost souls, will have to treat pneumonia, diarrhea, angina pectoris, and in addition all concomitant neurological diseases - yes, mental illness does not relieve one from the obligation to suffer from other diseases. And a psychiatrist will have to treat all this due to the fact that a significant proportion of patients are useless, asocial and stigmatized people who, before entering the hospital, did not wash and did not eat anything except vodka.

Therefore, remember, a patient, a psychiatrist is still a doctor! And do not confuse him with a psychologist, who is sometimes also almost a doctor (clinical psychologist), but more often just an illiterate humanist from some pedagogical university. The value of a truly cool psychiatrist tends to infinity, since he will be able to treat the same as a regular therapist, and he will also recognize schizophrenia in a timely manner, reducing the likelihood of new disabled people.

How to get into trouble

Usually people tend to believe that they are not at all in danger of ending up in a mental hospital, because there are notorious psychos there. Alas, everyone has a chance, there is a whole sea of ​​ways and reasons:

• Life became boring, and you tried your luck at suicide, but failed;
• They called psychiatrists for you when you started catching squirrels after another drinking session;
• Your head received a good right hook, there was a concussion and you were found to have something “sharp”, something “transient” (passing, yeah);
• You often invoked the muse through substances and experienced personality changes;
• You have a brain disease (from infection and encephalopathy to brain cancer);
• People around you considered you a danger to them or to yourself;
• Are you a little shy or an overly hot-tempered conscript;
• A loved one died and you couldn’t cope with it;
• There was an earthquake, a fire, a war, where you lost everything, and you can’t come to terms with it;
• you need to remove the article to get a job.

Schizophrenia

(from the Greek schizein - splitting and phren - mind) - one of the “big” mental disorders. It is usually a chronic and gradually developing disease that often begins in adolescence or young adulthood. It has a wide variety of symptoms that gradually progress, increasingly limiting the patient’s capabilities until they finally affect his entire personality, affecting behavior, emotional reactions, thinking and life. See also SCHIZOPHRENIA.

Doctor, what will happen to me?

Fortunately, almost all psychiatric diseases can be, if not treated, then at least reliably stopped.

But in our country you are constantly faced with densely ignorant skepticism: “Why are they needed?!”, “A waste of money and time!”, “How can they help?!”, “How can they know my life?!”, “ They will teach more, I have more experience!”, “I’m strong!”, “What, am I crazy?!”, which incredibly interferes with the quality work of the psychiatric service. This gives rise to minor social problems such as a huge number of suicides, widespread alcoholism, etc.

Mutilation methods

• Electric shock, called electroconvulsive therapy, is still used to treat severe depression and catatonia, but the method has now become less punitive due to the use of anesthetics and muscle relaxants. In the decaying West, the method is used even for PMS and postpartum depression; in this country, due to some historical features of psychiatry, it is used less often.
• Advanced treatment methods of the past were distinguished by amazing humaneness, for example, wet wrapping: the patient was under cold water, then packed in a wet sheet and tied to the bed at night, not forgetting to add cold water and not allowing the subject to fall asleep. After several days of repeating the procedure, a persistent tranquilizing effect is obtained.
• An excellent remedy for transforming a sick person into a harmless tame vegetable deserves a separate article - Haloperidol.

Psychosurgery

In 1848, by chance, the prerequisite for a new method was born, from which many brains were damaged: during an accident at the factory, a steel pin flew into the head of a worker. Hard worker Phineas Gage survived, but those around him noted a strong change in his character. 70 years later, this served as an idea for a new torture of the “doctor” from Portugal Egas Moniz, who, without wasting time, drilled into the skulls of patients and poured copious amounts of alcohol into them.

The lobotomy was modified with an awl file by Dr. Walter Freeman, who hammered it (without anesthesia) directly above the eye, slightly lifting the eyelid and moving it in different directions. The success was so obvious that the good doctor traveled all over America, performing more than 3,500 such operations, but one day his hand misfired and the patient died in his arms, for which the aesculapian was deprived of his license. More than a million lobotomies were performed between 1940 and 1960.

Now, due to some undesirable effects, this crowning achievement of psychiatric thought had to be abandoned. But they are still picking the brain a little, now simply cauterizing some of its areas.

Paranoia

Paranoia (delusional disorder) - This condition was previously defined as a syndrome associated with schizophrenia, but paranoia is now considered as an independent type of mental disorder, which is characterized by a tendency to blame people and attribute malice to them. In many cases, unfounded suspicion, mistrust, jealousy and envy, suspiciousness, fear of persecution and ideas of grandeur prevail. These symptoms are often combined into a kind of delusional system. See also PARANOIA.

More

• Aminazine
• Antidepressants
• Thanks to numerous stories from patients about the mental hospital, the word “Kashchenko” became Kashchenka
  - a common noun meaning a madhouse, or in everyday life - a mental hospital. In all likelihood, it was in “Kashchenka”, which was well known among the Moscow man in the street, that the events described in M. A. Bulgakov’s novel “The Master and Margarita” took place, as the clinic of Professor Stravinsky, where the Master and Ivan Bezdomny were assigned for treatment [2 ].
• clinical psychiatry;
• Vladimir Vysotsky was able to evaluate (and repeatedly) advanced Soviet psychiatry as an alcoholic, writing a review in the form of “Song about a Madhouse”:

Organic psychoses

– deep mental disorders caused by one or another damage to brain tissue. Both rapidly developing acute and quite severe mental disorders and chronic protracted disorders are possible. The differences between acute and chronic organic psychoses concern not only the nature, but also the prognosis, as well as treatment.

The causes of organic psychoses can be infectious diseases, poisoning, hallucinogenic states (alcoholism or drug addiction), metabolic disorders, neurosyphilis, tumors and other brain diseases, and hormonal pathologies. These organic causes cause pronounced changes in the structure and function of brain tissue. Such changes, accompanied by damage to the blood vessels of the brain, can lead to mental disorders, which often resemble mental illnesses caused by psychological factors. Meanwhile, these two types of psychoses differ both in their origin and in the clinical picture of disease progression.

Notes

1. What Gilyarovsky himself didn’t like: “the anachronism “psychiatry” presupposes the existence of the soul or psyche as something independent of the body, something that can get sick and that can be treated on its own.” — Gilyarovsky V. A. Psychiatry. Guide for doctors and students. - M.: MEDGIZ, 1954. P. 9.
2. It is also “Kanatchikova Dacha”, in 1994 it again became named after N. A. Alekseev.

Affective insanity

– a serious mental illness that mainly affects the mood of patients. It is also called bipolar affective disorder. The disease is characterized by repeated attacks of manic agitation followed by periods of depression. Between these attacks, patients may return to normal. During the manic phase, the mood is so elevated that anxiety, insomnia, racing thoughts, increased aggressiveness and irritability occur. During the depressive phase, which can last for weeks and months, there is mental retardation, expressed in slower physical and intellectual activity, general fatigue, apathy, feelings of failure, hopelessness, personal sinfulness, as well as hypochondriacal ideas and ideas that life is leaving the body , health is forever lost, death is approaching. Depression is usually accompanied by a significant decrease in self-esteem. This is often noticeable in a person’s appearance and behavior. In severe depression, there is a constant risk of suicide as self-destructive tendencies spiral out of control.

Causes of mental illness.

Although the essence of “major” mental disorders still remains unclear, the causes of some mental illnesses have already been established, and specialists diagnose and clinically study them. First of all, this applies to mental disorders associated with organic diseases (such as traumatic brain injuries, infections or other brain disorders arising from concussions, syphilis, tumors, cerebral atherosclerosis), poisoning with toxic substances (alcohol, drugs, lead , mercury, etc.), deficiency of certain nutrients and vitamins (for example, with pellagra), endocrine and metabolic disorders, mental retardation, aging. This group also includes epidemic viral encephalitis, postencephalitic parkinsonism (shaking paralysis), as well as delirium (stupefaction with hallucinations, delirium and motor agitation) associated with alcoholism, acute infectious hepatitis, trichinosis, typhus and other diseases accompanied by high fever . Structural damage to the brain can cause epileptic seizures. In general, any damage to brain tissue can cause disruption of its functions, manifested by more or less pronounced disorders of thinking, emotions or behavior.

The most important mental illnesses include psychoneuroses (such as hysteria or neurasthenia), psychosis, drug addiction and other types of pathological behavior. The significance of these disorders is determined by their extremely high prevalence and profound, often destructive impact on the personality and work ability of patients. Most of these conditions appear to be due to psychological rather than physical reasons. Even diseases such as alcoholism or drug addiction can be considered variants of emotional disorders and treated accordingly. At the same time, ideas have also been put forward about the contribution of biological factors to the development of some severe mental illnesses. Thus, in schizophrenia, disturbances in neurotransmitter processes in the brain have been found; Depression and anxiety may also be associated with similar disorders. In addition, with regard to schizophrenia, a family (genetic) predisposition to the disease has been identified, which, apparently, can be realized under the influence of unfavorable external circumstances. And yet, the origins of mental illness should often be sought in the patient’s early childhood, in the action of deep psychodynamic factors (usually unconscious), which can be identified using various methods of modern psychotherapy. The idea of ​​the existence of unconscious processes in the human psyche can be found already in the works of St. Augustine, St. Thomas Aquinas, Schopenhauer and other thinkers. But only S. Freud was the first to develop in detail the doctrine of unconscious processes, creating a psychodynamic system (psychoanalysis) as a way of understanding mental disorders from the point of view of the patient’s individual experience and his relationships with other people. Many followers of Freud, in particular K. Horney, G. Sullivan, E. Erikson, enriched this understanding.

The systematic study of both pathological and normal behavior initiated by Freud and his students showed that many of the adjustment difficulties, emotional problems, and mental manifestations found in adults are determined by the events and influences of early childhood. A mother's emotional relationship with her child is often the most important factor in determining whether a given person will be mentally healthy or ill. The contact between mother and child in the first years of life determines the atmosphere in which the child grows up and which will affect his future adult life: under the influence of maternal warmth, affection, approval, a feeling of security and inner strength is formed in the growing personality. Conversely, a mother’s refusal of a child, lack of love, and hostility cause feelings of defenselessness, fear, resentment, and emotional lability. These early experiences become deeply ingrained in the personality structure and predispose a person to emotional or mental disorders in adulthood.

Of course, it is necessary to take into account the entire complex of psychological factors operating during the formation of personality: the influence of not only the mother, but also the father, brothers and sisters, other family members, social and economic status, situational conflicts, school, cultural factors, profession, internal and external pressure, i.e. frustrations of various types, originating from all kinds of sources. Thus, each mental disorder is a purely individual problem that can only be understood by revealing its deep dynamic sources. This procedure is difficult, and to find the causes of the disease, one must delve deeply into the life history and personality structure. See also PSYCHOANALYSIS.

Rehabilitation.

In the early days of psychiatry, Freud once remarked: “Work connects man with reality much more effectively than anything else; in the process of work, a reliable connection is established with real life and human society.” Based on this premise and taking into account the importance of rehabilitation of mentally ill people, experts have developed programs that provide for the creation of help services - social (including assistance in choosing a profession) and psychiatric. The activities of these services include vocational training and retraining in hospital workshops, occupational therapy, psychosocial adaptation and counseling, acquisition of new skills or restoration of previously existing ones in a workshop environment where patients feel protected and where there is no competition. Thanks to the work of such services and with the support of such treatment methods as individual and group psychotherapy, as well as appropriate drug therapy, occupational rehabilitation has become possible for many patients, even with severe chronic psychoses. Such measures require a significant investment of effort, time and money, but their results are often encouraging and lasting.

Drug therapy.

The therapeutic capabilities of psychiatrists have expanded significantly with the development of new psychotropic drugs, i.e. chemical compounds acting as “tranquilizers”, “antidepressants”, “psychostimulants”, “mood improvers”, etc. The achievements of the psychopharmacological approach to the treatment of mental illness have been recognized by both doctors and patients. The judicious use of appropriate remedies can eliminate or alleviate many severe mental symptoms: confusion, apathy, chronic fatigue, irritability, agitation, aggressive behavior, depression, fears. Psychotropic drugs are widely used in the treatment of patients with psychoses, neuroses, chronic alcoholism, drug addiction; They are prescribed to adolescents with antisocial behavior, persons suffering from manic agitation or delirium tremens, patients with persecutory delusions or thoughts of murder, mentally retarded children, elderly people with chronic diseases or senile behavioral disorders.