Can’t sleep? Cause may be depression

You spend about a third of your entire life asleep. Most often we sleep about eight hours a day, although there are those among us who need four hours to get enough sleep. Sleep is important for the proper functioning of many body functions, including mental ones. There are several possible reasons for its violation. Depression is one of them.

Lack of sleep makes depression worse and vice versa

The relationship between depression and poor sleep can be two-way. Sleep disturbance is one of the possible manifestations of already developed depression; on the other hand, prolonged lack of sleep can aggravate depression as such or even contribute to its development. For some people, mood drops and other depressive symptoms appear long before sleep problems, while for others, insomnia is the onset of mental problems.

Sleep long and get up early

According to experts, people with insomnia are ten times more likely to develop depression than those with good sleep. For people with depression, sleep problems are very common, with four out of five patients. However, they can take many forms. Depression can lead to:

  • Difficulty falling asleep (it may take a person several hours to fall asleep)
  • violation of the so-called general picture of sleep (sleep of a shallower and lower quality);
  • sleep disturbance (repeated awakenings occur during the night);
  • Premature waking in the morning and inability to fall asleep again (usually waking up at about four in the morning);
  • increased need for sleep.

Sleep hygiene rules

Sleep disorders associated with depression require treatment. It is true that the earlier you go to bed, the better for your overall mental health. Sleep can be positively affected in several ways, and you can also use a combination of different methods. First of all, you must follow the rules of the so-called sleep hygiene:

• If you need naps, limit it to a maximum of half an hour.

• Avoid stimulants like nicotine or caffeine before bed.

• Do not use alcohol to induce sleep, as it degrades sleep quality in the second half of the night and exacerbates anxiety and depression.

• Spend at least 10 minutes a day doing aerobic exercise (such as brisk walking or cycling).

• Do not eat before bed.

• Encourage healthy alternation of the sleep-wake cycle by exposing yourself to adequate daytime sunlight and reducing the amount of light during the night.

• Count on regular sleep patterns (go to bed around the same time, take a relaxing bath, and do other calming treatments).

• Try to avoid activities that may unnecessarily activate you before bed (working on the computer, watching an exciting movie, annoying conversation, etc.).

• Provide a pleasant environment in the bedroom suitable for sleeping (the room should be quiet, dark and ventilated, the temperature is fairly cool, the mattress is of sufficient quality).

Psychotherapy and antidepressants

If a depressive disorder is causing your sleep disorder, treatment is appropriate. The standard treatment is a visit to a psychotherapist or the use of so-called psychotropic drugs. When it comes to antidepressants, it is best to consult your doctor in more detail. His choice is determined by the specific manifestations of depression in you. In the case of insomnia, antidepressants can be successfully used, which have a positive effect on both well-being and sleep. In some cases, you can try a variety of soothing teas or natural products to complement your treatment. However, it is important to discuss their suitability and safety with your doctor or pharmacist beforehand.

Depression? overweight? blame the lack of light!

Posted on August 29, 2020  in Uncategorized

Bad mood and excess weight from lack of light?

Many people notice that working capacity decreases in the autumn-winter period, they want to eat more and lie under the covers. Scientists say that all this is from a lack of light.

The psyche of people is very dependent on lighting. Scientists’ research shows that we are light-loving creatures. Let’s talk about how a short daylight affects us.

Dependence on light

Daylight has an impact on more than just our performance and mood. Our health depends on daylight. With a sufficient amount of light, the body’s immunity increases, it is easier for it to resist viruses and bacteria.

Our weight also depends on this factor. The fact is that through daylight the body receives a certain amount of energy. When this source of energy disappears, the body tries to make up for the lack of energy through food. We become hungry more. And, unfortunately, we want just fatty and sweet food, that is, the one from which we recover.

The production of certain hormones in the body is also dependent on light. This means that the lack of this factor can greatly affect our mood. This is especially true for women, because they are more hormone dependent.

How can one be saved?

How to behave in the autumn-winter period in order to avoid such influence of the lack of daylight:

  • In winter, there is still sun. On sunny days, be sure to go outside, “consume” the sun while you can.
  • Saving energy is great, but it can be harmful to your health. Sometimes, to cheer yourself up, you just need to turn on a bright electric light. It is not difficult to allow yourself this, especially when you consider that your good mood and slim figure depend on it. Even a professional psychologist will advise you . 
  • Add vibrant colors to clothes. Wear bright clothes at home, it also cheers up.
  • Use intense floral scents that will remind you of summer. It can also be citrus aromas.
  • Go in for sports. Physical education activates the hormonal system, helps restore metabolism, increases the production of happiness hormones. Start practicing even through “I don’t want” you will see, at the end of the workout your mood will improve. 
  • Support your body with artificial vitamins and a variety of foods. Natural antidepressants from food are: spinach, garlic.

How does Facebook cause depression?

Posted on August 25, 2020  in Uncategorized

Facebook leads to depression if viewing friends’ pages makes you envy. Social media is a great way to keep in touch with your friends and family. But they also let you learn about other people’s successes – exciting vacations, great relationships, career achievements, etc. Sometimes such messages, instead of joy, cause envy and disappointing comparison with your life. In this case, the development of depressive symptoms is possible.

Viewing the Facebook feed has become a daily ritual for hundreds of millions of people. Researchers from the University of Missouri are interested in how this habit affects the emotional state. They monitored young Facebook users and found that people who track the progress of their acquaintances were more likely to have symptoms of depression. Facebook has no negative impact on people who use it simply to keep in touch with friends. Facebook gives you the opportunity to observe the lives of others and compare it with your achievements. The news of buying an apartment, getting married, or getting a promotion at work can make some people feel jealous, and as a result, depressed and anxious. Researchers advise to be aware of this risk and not use Facebook as a “ruler” to measure your own and others’ success. You need to understand that most people perceive social networks as a way of self-presentation, therefore they write only about their achievements, hiding failures. Remember this the next time you experience an unpleasant feeling of envy.

The main foods that cause depression are named

Posted on August 21, 2020  in Uncategorized

Recently, scientists have found a direct relationship between depression, impaired central nervous system activity and specific foods that negatively affect the functioning of the brain.

What kind of food should be avoided in order not to fall into a state of depression? We will tell you more in this article!

From fatty and fried to fish

Doctors believe that it is absolutely impossible to take vitamin supplements Omega3 and Omega6 in the wrong ratio. This is bad for memory functions. Therefore, Omega3 and Omega6 supplements are best taken in a 1: 4 ratio. 

If you drink alcohol on a regular basis, your productivity level also decreases. Experts believe that this is due to the fact that the human brain is under increased stress. A periodically drinking person gets tired faster, and his central nervous system is greatly overstrained.

To avoid provoking depression, eat as little fatty meats as possible. The fact is that it contains a lot of cholesterol, which causes the appearance of atherosclerotic plaques and causes blockage of blood vessels. Also, lovers of fatty meat have problems with contextual and spatial memory, and Alzheimer’s disease develops.

Fried foods, such as the beloved French fries, can cause tangible harm to the body. Excessive use leads to blockage of blood vessels and increases the risk of dementia. Do not get carried away with fish, because some species of fish accumulate pollutants in themselves. So tuna accumulates mercury, a toxic substance that causes irreparable harm to the central nervous system and the brain.

High glycemic index foods

Scientific studies show that women who consume high glycemic index foods are more prone to depression. This is due to the fact that such foods cause a sharp rise in blood sugar levels and increase insulin production.

Therefore, we advise you to eat a balanced diet, eat healthy foods, regularly consume food antidepressants that improve your mental well-being and produce serotonin. A little dark chocolate or a handful of nuts are guaranteed to keep your mood from getting worse! 

How depression affects the human body

Posted on August 17, 2020  in Uncategorized

Danish scientists carried out a global study, in the process of which they found out that people who underwent inpatient treatment in medical institutions had a higher risk of developing suicidal tendencies. The highest rate, close to 50% above the norm, was in those patients who had HIV infectious hepatitis.

The causal relationship of such a parallel is rather blurred, but researchers argue that this is not only due to the violation of a psychological state due to a serious illness. There is speculation that infections have a direct relationship with suicidal moods and can provoke inflammation in areas of the brain that cause depression . This information was confirmed earlier when studying the effect of a number of substances on the human body and the presence of side effects.      

The new study involved 7 million volunteers, taking over 30 years in total to confirm the link between the number of hospital visits as a patient due to infection and death due to suicide. The only exceptions are infections that occur during pregnancy.  

This information will form the basis for the subsequent study of infectious mechanisms. Researchers are hoping for a new leap forward in the treatment of complex depressive conditions. At the moment, about 10% of the suicides occurring can be called “infectious”.      

Research by scientists has once again confirmed that depression is not only a mental disorder, but actively affects physical health. Earlier, other studies have confirmed its links to diseases such as migraines, arthritis, and the effect of depression in pregnant women on brain development in babies.  

How stress affects the gut microflora

Posted on August 13, 2020  in Uncategorized

Scientists from McMaster University (Canada) have found that intestinal microflora affects anxiety and depression. They first investigated the role of microflora in behavioral change after suffering stress at an early age.

Scientists have conducted experiments on laboratory mice. They stress the young by taking them away from their mother for several hours. After that, the mice showed signs of anxiety and depression, and their levels of the stress hormone corticosterone increased. In addition, their intestines were disrupted. When the experiment was conducted on mice with sterile intestines (no bacteria), they also increased their stress hormone levels, but their behavior did not change. If the intestines of such animals were inoculated with microorganisms from anxious mice, then they also fell into depression. This indicates complex mechanisms of interaction between the intestinal microflora and the brain.  

Studies have shown that the link between gut function on the one hand and emotional and cognitive processes on the other is mediated through bi-directional neuroendocrine regulation, immune activation and gut-to-brain signaling, and tryptophan metabolism. An increase in the synthesis of tryptophan, a precursor of the hormone “happiness” serotonin, leads to improved mood, decreased pain, and improved sleep.

How to resist the spring depression

Posted on August 9, 2020  in Uncategorized

Spring depression is a fairly common case. The prolonged absence of the sun causes a deficiency of vitamin D in us, the reserves of other nutrients accumulated in the summer are also exhausted during the autumn-winter period.

All this, combined with prolonged stressful situations and suppression of one’s own emotions, is highly likely to provoke depression. Let ‘s figure it out: how to maximally protect your body from a state of depression and apathy, and meet the spring with a smile?         

Respect your body

Do not neglect the prescribed sleep rate, cleanse your diet of heavy foods and cultivate a love for regular physical activity. Develop a regime that is right for you and then you will be able to recover your strength to the fullest.        

Hobby

Having an activity that brings peace of mind and good spirits at the same time is very important for maintaining the balance of a person’s psychological health. In his absence, do not be afraid to expand horizons and experiment in search of yourself and your outlet.      

Protect yourself

In all spheres of your life, define clear boundaries of what is permissible, which will allow you to protect you from negative emotions. Learn to say no, and not inconvenience yourself. DO NOT END! Relieve discomfort and define your territory.       

Accept yourself

Being aware of all your advantages and disadvantages is an important aspect of peace of mind. Don’t torment yourself by being afraid to ask for help or reveal your feelings and feelings to someone . Only after receiving a response can you set up a relationship and get rid of contrived problems.       

Surround yourself with a pleasant atmosphere, make yourself some gift, for example, finally buy that expensive blouse that you really like, or arrange a day at the spa or an evening of your favorite comedy films, lying on the couch with popcorn. 

Principles of psychodynamics

Posted on August 5, 2020  in Uncategorized

Conflict concept

In psychodynamics, the central idea is the conflict caused by the rejection of certain aspects of one’s own personality. The very expression “dynamics” was borrowed by Freud from the physics of the 19th century to convey the idea of ​​a conflict between two forces, the result of which is a third force directed in the other direction.
Since medical students study only anatomy and physiology (or their separate parts – histology and biochemistry), it is no wonder that the doctor tries to understand the patient’s complaints as symptoms of anatomical or physiological disorders and, accordingly, find a drug treatment path. It is generally accepted that about a third of patients suffer primarily from emotional problems that cannot be cured in this way. This is precisely the reason for the despair that both doctors and patients come to from fruitless attempts at such treatment. Too romantic can be called the idea that it was our time that gave rise to new phenomena in this area: in 1723 the London physician Cheyne wrote that about a third of his patients did not suffer from organic diseases.
If we take into account that (as in the case of Mrs. A.) the patient’s complaints may not be symptoms of a specific disease caused by external causes, but indicate an internal conflict, then it will be possible to fully understand the strange complaints of some patients. The discovery of microorganisms in the last century made it possible to make significant progress in understanding the nature of diseases, but at the same time led to a focus on external causes. This fully meets the need of a person to find guilty outsiders (in a way, an updated theory about devilish intrigues as the cause of disease).
The importance of internal conflict in human misery is important not only for psychiatry, but for all medicine. If a child complains of abdominal pain, this means either some real illness, for example, appendicitis, or unwillingness for some reason to go to school, which is not named because of the fear of causing a negative reaction in adults. A woman complaining about the pain of intimacy, suffers from some somatic disorders (for example, from erosion of the cervix) or simply does not want this intimacy, but for some reason does not consider it possible to say it directly. The problem may not be hidden in the state of the organism, but in the relationship. The level at which the conflict arises may be relatively conscious or deeply unconscious.
A young lonely woman complained to her family doctor about the acute disgust she got from her own nose. The doctor took all this at face value and sent the patient to the surgeon for plastic surgery. The surgeon, not seeing any special deviations in the shape of the nose, advised the woman to first consult with a psychiatrist. However, she insisted on her own: she just did not like the nose (the underlying conflict was deeply unconscious). Gradually, the woman began to realize that it was not her nose that caused her disgust, but herself (the conflict reached consciousness) and especially her homosexual feelings. You can go further and add that her disgust is caused by dissatisfaction with her own sex and, accordingly, the genitals given out by nature. But such dissatisfaction in a substituted form was expressed in claims to the nose.
The concept of conflict is not something made up by people. Ethologists recognize the usefulness of these concepts in explaining animal behavior. A bird, guarding the borders of its possessions, can very aggressively fly into another, being on the very edge of its territory, but then get scared, retreat, again depict an attack, which will be a vivid example of internal conflict. Another form of the bird’s reaction is to fly off a certain distance and begin to furiously hammer the ground with its beak, giving vent to its rage. This behavior, called redirection by ethologists, is termed bias by psychoanalysts.
What aspects of your own personality cause conflicts? We’ll explore this in more detail later when we talk about motivation. The most common distortion of Freud’s views reduces conflicts to the sphere of sex, from which it is readily concluded that psychoanalysis is not universal in nature, it only reflects the specifics of the bourgeois Vienna of the 1880s. Freud did find that the real cause of hysteria in many patients lies in sexual conflict. It is instructive to quote his true words on this matter (1894: 52): “In all the cases I have analyzed, the suppressed conflict was caused by problems of sexual relations … Theoretically, it cannot be considered impossible to manifest itself in any other area. I can only state that I have not yet met any cases caused by other problems. ” Since then, the great importance of conflicts arising “in other areas” has become clear, for example, aggressive feelings can be directed against oneself (states of depression and attempts to commit suicide) or be replaced by psychosomatic symptoms (such as migraines or hypertension).
Depression, bereavement grief, and other losses essential to a person’s self-esteem may not be recognized by the person and find a way out in physical symptoms. This often manifests itself in the aggravation of complaints precisely on the anniversary of the loss suffered (and such a connection may not be realized by the patient himself).
It should not be thought that all forms of mental illness can be explained as a result of internal conflict. There is a genetic predisposition to functional psychosis such as schizophrenia or manic-depressive psychosis. There are also quite rare forms of organic psychoses caused by brain dysfunction, such as brain tumors or vitamin deficiencies. In the context of manifestation of borderline psychoses and deep personality disorders, we are talking about the “harm caused to the personality by the surrounding external conditions and deep-rooted whims and whims, ie. about that which is beyond the control of the person himself ”(Anna Freud, 1976). All this undermines the strength of the individual and its ability to contain and control primitive reactions and impulses. Today, many types of trauma are known, including early weaning, loss (Bowlby, 1973, 1980), and child abuse (Bentovim et al., 1988). Injuries sustained at an early age influence, as has been shown in the study of miraculously surviving victims of the Holocaust and similar disasters, all further development and the emergence of new injuries later (Pines, 1986; Kestenberg and Brenner, 1986; Menzies Lyth 1989; Garland 1991 ).
The concept of conflict is even more important in the description of neurotic disorders, when it comes to the internal self-destruction of the personality through suppression and other forms of defense. Neurotic conflicts mainly arise in the field of personal relationships during the period of personality formation, when the conflict is driven inside, and later it determines the nature of relations with others. However, the outcome of the conflict here strongly depends on what is currently happening in the sphere of relations with the immediate environment, as will be shown in detail in the chapters on family therapy and therapy for married couples.

Unconscious processes

Those aspects of our “I” that contradict our conscious values ​​can be denied, suppressed, alienated – forced out into the unconscious. It is preferable to talk about different levels of awareness and use the term “unconscious” as an adjective rather than as a noun. Then it becomes possible not to imply the existence of the mysterious realm of the “Unconscious”, isolated from the rest of the brain.
Something may be unconscious simply because we have no idea about it at a certain moment (for example, the color of the front door at the time of reading these lines) or because it is easier to live by suppressing unpleasant sensations and painful memories, although we can easily recall them … Freud called these levels preconscious. On the other hand, some ideas may be unconscious, because they are actively suppressed, since thinking about them is intolerable. These are memories, fantasies, thoughts and feelings that contradict our ideas about ourselves and about what is acceptable. Thoughts that can cause too much anxiety, guilt and pain, if you are aware of them. Freud called this level the dynamic unconscious. Suppression can sometimes weaken, as a result of which the unconscious comes out, although, as a rule, in an altered form thanks to protective mechanisms. For example, in a dream in the form of a dream, during stress in the form of symptoms, or under the influence of drugs or alcohol in the form of a manifestation of seemingly alien impulses.
The concept of various psychic levels is created in parallel with the neurological levels, when higher-level centers control more primitive centers that manifest themselves in conditions of weakening of control. Freud, being a neuropathologist by training, was always influenced by the statement of the neuropathologist Hughlings Jackson (1835-1911): “Learn all about dreams – and you will learn all about madness.” In sleep and in a state of madness, the deepest layers of the psyche are most directly revealed. The winged expression “I never dreamed of this” implies several semantic layers: firstly, there is something about which you see dreams, but you will not do it in reality, and secondly (on a deeper level), there is something that we will not allow ourselves see even in a dream.
Some philosophers dispute Freud’s ideas about the unconscious on the grounds that only conscious phenomena can be considered as events of mental life. However, the concept of the unconscious was increasingly discussed throughout the 19th century. Psychologists such as Herbart (1776-1841) emphasized the conflict between the conscious and the unconscious, and the philosopher Schopenhauer (1788-1860), anticipating Freud, wrote: “Resistance of the will to penetrate into the consciousness of what is unacceptable for a person is the place through which the spirit can be struck with madness ”(Ellenberger, 1970: 209).
As the authority of the idea of ​​God declined in medieval Europe, there was a corresponding increase in the desire of people for self-knowledge, which became especially intense at the turn of the 17th century. The word “conscious” appeared in European languages ​​in the 17th century. The dualism of Descartes (1596-1650), separating mind from body and thought from feeling, testified to the close connection of this movement with the following statement: mental processes are limited to the sphere of the conscious. The emphasis on rational thinking was one of the forces that led to the Enlightenment in the 18th century and to many advances in education and political freedom. But this power devalued imagination and emotional life, a natural protest against this was the Romantic movement that began in the early 19th century, typified by such poets as Wordsworth, Keats and Shelley. The idea of ​​“unconscious” mental processes, “hidden at the turn of the 18th century, became essential at the turn of the 19th century and became effective at the turn of the 20th century” (Whyte, 1962: 63). By 1870, “Europe was ready to abandon the Cartesian view of reason as awareness” (ibid: 165). Freud’s doctrine of the unconscious only temporarily lost popularity due to the fact that it was initially focused only on sexuality.
Perhaps this idea has taken root in our thinking so much that there is no room for argument. Evidence for the truth of the concept of unconscious mental activity can be gleaned from the following sources.

Dreaming

Freud always considered dreams to be “the main road to the unconscious.” Of his greatest work, The Interpretation of Dreams (1900), Freud wrote: “This kind of deep insight falls to the lot of a person only once in a lifetime” (Freud, 1900: xxxii). He drew a distinction between the often seemingly absurd external content of the dream and the latent content hidden under the outer shell by censorship, but this censorship can be circumvented by the use of free association. Dreams are “disguised forms of the realization of repressed desires.” This function of fulfilling desires in a dream is a banal evidence. Children dream of holidays, adults dream of forbidden pleasures or those people and places with which attracted memories are associated, to which they would like to return again. Dreams can be an attempt to cope with unpleasant situations or solve problems. Rycroft (1979) emphasized the creative and imaginative aspect of dreams, contrasting them with simple reflections of conflicts and neurotic reactions, and viewing dreams as a non-destructive form of communication in the non-dominant hemisphere of the brain.

Artistic and scientific creativity

Many writers, artists and composers, describing the process of creativity, say that they are seized by some kind of inner force that is not completely subject to conscious control. Often the creative process takes place in a dream. Kekule, investigating the problem of the structure of benzene, saw in a dream a snake devouring its tail, which immediately prompted him to think about the ring structure of the benzene molecule (Findley, 1948). Coleridge is said to have composed the Kubla Khan poem while under the influence of opium (Koester, 1964). Playwright Eugene O’Neill claimed that in his dream he dreamed of several completed scenes and even two whole plays. When he went to bed, he tuned himself in, repeating: “My little subconscious, bring me a tidbit” (Hamilton, 1976). In a letter, Mozart described a living manifestation of his creative genius, when ideas rush upon him: “I do not know when and how they come, and I can’t cause them to appear … In my imagination I hear parts that do not follow one after another, but all all at once … All this invention, creation takes place in a pleasant living dream ”(Vernon, 1970: 55).
Unlike the flashes of inspiration that enlightened Mozart, Bertrand Russell felt a slow process of “subconscious bearing” before the final insight came:
“It turned out that after the appearance of the preliminary design of a book on some issue and a serious preparatory stage, I needed a period of unconscious bearing, which cannot be accelerated and which proceeds as if something interferes with intentional reflections … Having endured the problem at the unconscious level through intense concentration, I expect it to mature in depth and unexpectedly appear in the form of a dazzlingly clear solution, so that all that remains is to write down what has appeared at the moment of insight ”(Storr, 1976: 65).
In addition to describing the creative process taking place in a dream, many playwrights and writers reported that their characters live their own lives as if in reality. Pirandello showed this process in the play Six Characters in Search of an Author. In his diary, he wrote: “Someone lives my life. And I do not know anything about him ”(preface to Pirandello, 1954).

Hysterical symptoms

We have already seen how, after a trip to Paris, Freud developed the theory according to which hysterical states – paralysis, anesthesia, ataxia – can be caused by a patient’s perception of which he is not aware. A similar state can occur as a result of external influence (hypnosis) or from within (self-hypnosis). These hysterical symptoms, according to Freud’s assumption, are constructed, like dreams, in the form of a compromise between the demands of repressed impulses and the resistance to censorship by one’s own self (Freud, 1925: 45).
One young woman went to the hospital with complaints of her left arm. It turned out that she had just received a course of psychotherapy in a group where she was very annoyed by the male psychotherapist sitting to her left, but she did not dare to say this directly. The complaints about her arm arose as a compromise between the desire to hit him and the fear that kept him from doing this, although she found the courage to tell the doctor about everything. In order to fully understand what happened to the patient, it is necessary to know her history. The woman became angry with the therapist for his intention to leave the group. As a child, she herself was abandoned, and she was taken up by elderly spouses who did not allow “bad behavior” and threatened to abandon the girl if she did not behave well.
Post-hypnotic phenomena

A person can be hypnotized and given the instruction to completely forget what the hypnotist will suggest to him, but after a certain time interval at the snap of the fingers, which the hypnotist will produce, the person will cross the room and open the window. A person brought out of hypnosis opens a window on a signal. If you ask him why he did it, he will be slightly embarrassed and answer that the room is too hot.
This example shows how an unconscious idea (suggested under hypnosis) generates a complex sequence of actions and, moreover, rational explanations for these actions in response to a question about the reasons.

Erroneous actions

If we make a slip of the tongue or forget about something, it can be viewed as a slight malfunction of the brain, but more often than not (and this was the first to suggest Freud in Psychopathology of Everyday Life (1901)), there is an emotional motivation for what happened. For example, we forget about the appointment or the name of the one who causes our irritation, but this happens unintentionally, apart from our consciousness.
A certain young woman didn’t show up for the meeting. Later, she met the chairman and began to apologize to him: “Dr. H. made me surrender, or rather, give time to another occupation.” Was it just a slip of the tongue, or an expression of a hidden desire, or (most likely) an expression of internal protest against the fact that she was forcibly forced to do something?
Behind the “psychopathology of everyday life” one can often see the simultaneous coexistence of many levels of consciousness. Drivers often catch themselves thinking “far, far”, but at the same time continue to adequately react to the traffic situation. Often people notice that a popular melody has become attached to them, as it were, for no reason, although through associations one can always find a connection with some flashing mood, word or semi-conscious idea.

Subthreshold Perception, Selective Attention, and Perceptual Defense

Sound and light stimuli that arise below a certain threshold cause psychophysiological reactions that are not noticed by consciousness. About 30 years ago, there was a huge buzz in the United States about the use of subthreshold advertising: the message “Eat cornflakes” flashed on the movie screen for a split second, such exposure was not enough for viewers to consciously perceive the message, but enough for a sharp increase in sales of cornflakes. A host of experimental results (Dixon, 1971) indicate that the threshold of perception depends on motivation (for example, we see what we want to see, but are blind to what we do not want). It seems that there is some kind of filtering mechanism functioning at a subthreshold, unconscious level, which is very similar to Freud’s assumptions about the mechanism of sleep censorship.
Sometimes beginners who begin to assimilate the image of psychodynamic thinking wonder how these distant events remain unconscious and stay dormant for a long time until (for good or for evil) they cause some reactions, like underground currents that suddenly burst to the surface. This seems more natural to writers. Thomas Hardy wrote: “I can bury a feeling in my heart and thoughts and after 40 years exhume it, and it does not lose its freshness and sharpness in the least” (Gittings, 1975: 5).

Anxiety and mental distress

Some traits of our own personality or some facts from our experiences are unacceptable for our consciousness because they cause anxiety and mental suffering. The concept of mental suffering may seem strange at first glance to those who are used to considering suffering as physical. They believe that pain can be real (physical) or imaginary (psychological). However, all pain and suffering are phenomena highly related to psychic experience, be it somatic or psychological pain. Moreover, physical pain depends on the mood and state of the moment – in the heat of battle, severe wounds can go unnoticed. The old English expression “sore” unites the two kingdoms – psyche and soma, as we say “feeling sore” in both senses. We say that trauma is inflicted both bodily and mental. No wonder they say “headache” about a tormenting problem, “bald head eaten” – about a person. All of these expressions highlight how physical pain reflects the relationship between mental and physical pain.
For a short time, the person is able to endure significant anxiety, for example, in extreme circumstances, or significant mental distress and depression (after suffering bereavement). But this emotional discomfort can be combated through a number of defense mechanisms. If the stress is too strong, the defense mechanism may not be able to cope with it. Then the state of decompensation sets in and mental or somatic illness begins.
The state of anxiety, of course, is far from always unnatural for a person. Anxiety is associated with arousal, which is a normal response to a threatening situation, and prepares a person for a fight or flight. In ancient times, this feeling had an initial value in terms of survival. And now we experience anxiety in situations of competition and competition, which helps to raise the creative forces of the individual and inspire him for optimal activities. If anxiety is excessive or disproportionate, it can be considered maladaptive and unnatural. The anxiety that comes with having to speak in public can be annoying because you can’t defuse that anxiety.
The problem of anxiety and its overcoming is central to most descriptions of the nature of neuroses. Freud formulated the nature of anxiety differently in his early and later works. Initially, he believed that anxiety is generated by defense mechanisms, later he argued that defense mechanisms are excited as a result of anxiety.
In an early model (1894), there was a more physiological approach: it was assumed that anxiety is an expression of undischarged sexual energy, or libido. The classic example of such a statement is interruption of intercourse, which generates symptoms of anxiety due to failure to achieve discharge. Although this model has now been largely abandoned, there are situations in which it is applicable. For example, in a dangerous situation, a person does not feel anxiety as long as he is completely absorbed in salvation from impending danger. The feeling of anxiety arises when everything is over. Freud (1926) revised his ideas about anxiety as an uncharged libido and began to interpret it as a response of the individual to the threat of internal sexual or aggressive urges. Nevertheless, although the early model of anxiety in relation to sexual urges has largely been abandoned, the idea of ​​”actual neuroses” as the result of undischarged aggressive urges remains useful in explaining psychosomatic disorders (McDougall, 1974).
Bowlby made some interesting comments on the relationship between worry, discouragement, and protection. A small child attached to his mother, when separated from her, expresses his despair in three distinct phases: protest, despair and rejection. Bowlby (1973: 27) writes: “The phase of protest reflects the problem of separation anxiety, the phase of despair reflects grief and discouragement, and the phase of rejection reflects defense.” The essence of the remark is that the three types of reactions are phases of one process, and only by considering them in this way, one can understand their true meaning. Freud viewed these three stages of the separation response in reverse order. First of all, he realized the importance of protection (Freud, 1894); somewhat later – despondency (Freud, 1917) and, finally, he approached the revision of his ideas about the meaning of anxiety (Freud, 1926).
Initially, Freud dealt with the problem of anxiety and defense mechanisms against it, observing neurotic states: hysteria, obsessive states and phobias. Only later did he turn his attention to depression, the clinic of which seems to be a much larger problem: in psychiatry, more than half of patients suffer from depression. The simplest way to determine the link between anxiety and depression is to say that, as much as anxiety is a response to the threat of loss, depression is a consequence of actual loss.
Freud in his work “Sadness and Melancholy” (1917) sees a similarity between loss and depression in the manifestations of sadness, despair, loss of interest in the outside world, inhibition of activity.
“Sadness is usually a reaction to the loss of a loved one or to some abstract loss that is significant for a person: the loss of homeland, freedom, ideals, etc.…. In melancholy, the painful condition is caused in most cases by situations not associated with death, and extends to feelings of disrespect, neglect and disappointment, which include the opposite feelings of love and hate.
In other words, in melancholy or depression, the loss is not necessarily external, but rather internal in nature, associated with a person’s self-esteem. Depression, for example, can result from a failed attempt to achieve some desired goal that is vital to self-esteem (Pedder, 1982).
Otherwise, this thought can be expressed as follows: painful contradictions arise between the subjective ideal representation of myself (I am what I would like to be) and the real “I” (I am what I really am). These contradictions can cause physical distress (Joffe and Sandler, 1965), resulting in the following reactions. The normal reaction is protest, when a fight is preferred to flight, directing their aggression against the source of pain. A person may try to cope with pain through adaptation, and a mature strong personality can endure pain and overcome the frustration and damage done to self-esteem. There are several other (though less healthy) ways of responding to unbearable mental suffering. Failure to recover the desired state often results in a state of helplessness, which, according to Ioffe and Sandler (1965: 395), “is a fundamental psychobiological response, referring to the most basic responses, such as anxiety. Its roots are in the primary psychophysiological state, which manifests itself in helplessness in the face of any physical and mental suffering. “
One of the reactions to the state of helplessness is complete surrender and transition to physical illness, described by Engel (1967) as a “defeat complex”, often preceding physical illness. Another response is the transformation of mental pain into psychogenic bodily suffering (Merskey and Spear, 1967). The third is falling into depression.
On the other hand, a defense mechanism such as loss denial may be sufficient to cope with pain, at least temporarily. Let’s give an example.
The middle-aged woman had severe depression. She knew that her father died when she was only ten years old. The girl was told that he was missing, most likely died during the war. But the hope of her father’s return did not leave her all these 30 years, forcing her to shudder in anticipation at any knock on the door. During psychotherapeutic treatment, the woman recalled with horror the episode when her brother, a ten-year-old girl, who entered the room, told her about a man in the garage, covered in blood. At that moment, she instantly realized that her father had committed suicide, but immediately rejected this guess from herself. Only through the painful process of recognizing the fact of her father’s death and the terrible circumstances of his death, she was able to begin the struggle to overcome her despondency and depression.
The following sections will take a closer look at protection mechanisms.

Defense mechanisms

The inclusion of various defense mechanisms is one of the ways to approach those aspects of oneself that, if conscious, can cause intolerable anxiety and mental suffering.
Each of us applies protection in certain situations. The question is to what extent and when. Sometimes overly carried away psychiatrists speak out in the sense that no protection should ever be used, denouncing it as a kind of modern form of sin. The opposite of this point of view is an unprovoked attack on someone’s defense, which is just as unjustified as any form of aggression. Another parallel with religion is the belief in the neurotic’s ideas that sinning in thoughts is just as bad as in deed, so there is no choice: either completely suppress sexual urges and the urge to kill, or obey them and act in accordance with these urges. … The peculiarity of a mature personality lies in the ability to recognize and tolerate such inclinations, preventing them from manifesting outside acceptable situations.
Freud (1894) was the first to use the term “defense” when studying the behavior of patients with hysteria. Later, he called this form of defense repression and described some other forms. In 1936, his daughter Anna listed nine forms of defense mechanisms (regression, repression, reactive formation, alienation, inaction, projection, introjection, turning against oneself, turning into the opposite). She also added the tenth normal mechanism – sublimation, as well as two additional ones (idealization and identification with the aggressor). Melanie Klein emphasized that protection, which takes place in the form of splitting and projective identification (Segal, 1964), occurs in both normal and painful development. Below is given and considered a list of mechanisms, although not exhaustive all possible, but includes the most common forms.

crowding out

As it was shown at the beginning of the previous section, we all at certain moments suppress our unpleasant or uncomfortable inner urges, or even completely supplant something that is not acceptable to our consciousness. This is completely natural, unless it is taken to extremes. Before the advent of effective anesthesia, a surgeon with a sensitive soul had to suppress his reaction to the patient’s screams in order to provide him with the necessary help. In extreme cases, when, for example, people claim that they do not have anger or sexual arousal, they simply supplant these feelings in themselves in the most merciless way.

Negation

We may deny or cast out unpleasant events in our outer life, such as a bad deal or failure on an exam. There is evidence that up to 40% of widowed people retain the illusion of the presence of a deceased spouse and 14% actually believe they see and hear the deceased (Parkes, 1972). This is a form of denial of painful loss, quite normal in exceptional circumstances. Feelings of phantom pain in amputated limbs can also be understood as some form of loss denial. Interestingly, phantom pain occurs more often with unexpected amputations (for example, as a result of an accident) than with amputations that were preceded by a long illness, i.e. appropriate mental preparation. A sharper form of denial is hysterical flight or amnesia. During the war, the soldiers resorted in a hysterical state from the front line, where, in front of them, a shell covered all their comrades, and were forced to somehow reject this intolerable memory from themselves. In peacetime, patients sometimes appear who do not remember their name, the place where they live, and who have forgotten any details of their past life. As a rule, such phenomena are a consequence of committing some absolutely unbearable actions for consciousness (for example, the accidental murder of his wife during a violent quarrel).

Projection

We often alienate unacceptable feelings from ourselves and even attribute them to others. “The pot calls the kettle smoked.” Jesus Christ spoke about this: “Why do you notice a speck in your neighbor’s eye, but you don’t see a beam in your own?” The accusation of one’s own shortcomings on neighbors, neighbors, residents of another area, foreigners, foreigners is as old as the world. This is a natural, albeit tragic, dangerous human trait. In extreme manifestations, it reaches paranoia, when its own hostile and sexual manifestations are declared alien and even directed against the individual himself.
Sometimes people behave in such a way as if not only their feelings, but also important aspects of their personality are transferred to others (for example, a mother, unconsciously transferring feelings of her own deprivation in childhood to her child, spoils him and interferes with his independent development, but this behavior helps the mother to cope with the pain of the desire for intimacy and dependence, which she did not realize in childhood. The child’s needs are not taken into account, the mother sees in him a part of her “I”, forcing him to play this imposed role). In the professional language of the Klein psychoanalysts, such a phenomenon is called projective identification (Segal, 1964; Ogden, 1982).
In the same aspect, one can also consider the splitting, consisting in the complete separation of good and bad in oneself and in others, which is reflected in the constant interest of children in heroes and villains, good fairies and evil witches (Bettelheim, 1975). Clinically, the phenomenon of splitting can be observed in the separation of good and bad feelings, idealization and contempt both in relation to oneself and in relation to others.

Reactive education

When hiding unacceptable feelings, you can go to the opposite extreme. For example, such is the excessive stiffness observed when trying to hide the temptation to behave at ease. Excessive cleanliness can be helpful. But it can take unhealthy forms with neuroses, when many hours of ablution ritual is observed daily. The psychodynamic explanation for such neurotic states is an attempt to hide hostile feelings. A person who carefully checks three or seven times (magic numbers!), Whether he turned off the gas, might be horrified, realizing that he is suppressing his unconscious desire to harm others. Instead, he explains his behavior by the fact that he seeks to save gas – an example of the rational justification of unconscious processes.

Rationalization

Another example of the rational foundation of the unconscious is the case of post-hypnotic behavior already described above. The expression “the grapes are green” is an excellent illustration of this phenomenon: the fox, desperate to reach the grapes, consoles herself that the grapes are not yet ripe.

Conversion and psychosomatic reactions

The unacceptable feelings often turn into physical symptoms. Such are, for example, hysterical conversions and psychosomatic disorders. An unreleased rage can, for example, lead to migraines or high blood pressure.
A very experienced and accustomed to restraining herself, the nurse-nurse did not allow herself to show the irritation that boiled in her at the sight of stupid mistakes made by young colleagues, believing that this would harm them. Each time she held back her rage, which that same evening led to violent migraines. After completing a course of psychotherapy, the woman learned to better cope with her irritation and express it in an adequate form. Once, with surprise and joy, she said that she was able to point out the mistake in the correct form and in the evening she really managed to avoid a migraine attack.
In hysterical conditions, the symptoms may have elements of symbolism reflecting the underlying fantasy of the patient, as in the example described earlier with the supposedly poorly functioning hand, which was caused by a defensive reaction to the desire to hit his therapist. Nowadays, psychosomatic disorders are less often interpreted in such a symbolic way, but such situations happen, especially when it comes to people with limited imagination, whose feelings are expressed physically, whose speech is specific and who are not used to talking beyond necessity. The term “alexithymic” is used to describe people who do not express their feelings in words (Nemiah and Sifneos, 1970). This happens in post-traumatic and sexually perverse patients and patients with psychosomatic disorders (Taylor, 1987).

Phobic avoidance

We all, to a greater or lesser extent, try to avoid situations that cause unpleasant sensations – the spectacle of an accident, the need to speak in public, etc. Some phobias – fear of spiders or thunderstorms – often go back to early childhood, easily explained by the traumatic events that once happened to a small child. The so-called “agoraphobia” (fear of open spaces) is also easily explained. It usually arises in adolescence and testifies not so much to a fear of open space as to a fear of collision with people in places overwhelmed with people. This is a social phobia.
A certain young woman, professing the lofty ideals of marital and premarital purity, married a man who had several premarital relationships. A few years later, the husband’s job required him to be absent in the evenings, and the wife had free time to attend evening classes. But she developed agoraphobia to such an extent that the woman was generally unable to go out without being accompanied by her husband. During the psychotherapy sessions, it was possible to reveal that agoraphobia was based on the fear that her suppressed impulses to flirt with men could break through and in this way try to “level the score” with her husband, whose premarital relationship she knew. One day, a woman was treating their married friend to dinner, who, leaving, kissed her in gratitude for the dinner, which was quite acceptable from the point of view of social norms. But, having slapped him in the face, she cursed him as a “dirty beast”, projecting her own unconscious unclean thoughts on him.

Substitution

If we dare not express our feelings directly in front of the one who caused them, then we usually transfer them to someone. A classic feuilleton plot: the boss pours out his anger on the deputy, he – on the next in the hierarchy, and so on to the very bottom, when the messenger kicks the cat in their hearts. A similar phenomenon is observed among animals. This is called a redirect. A common form of substitution is directing unspent anger towards oneself, which leads to self-destructive behavior and even masochism. This is especially noticeable in states of depression and suicidal moods.

Regression

It is absolutely normal and even highly desirable on a day off to drop your usual adult duties and return (regress) to childhood to swim, play, etc. In the face of adversity that we cannot cope with – a serious illness, an accident – we often behave like children, refusing to make independent decisions.
Sleep can turn out to be a normal day-to-day regression where we try to escape the problems we face in reality. For a child who has already learned to ask and does not wet the bed, the appearance of a newborn brother or sister often causes regression, manifested in the fact that the bed will be wet again. In adolescent girls with anorexia nervosa due to a ludicrous diet, the disorder may be a manifestation of regression caused by the horror of repressed adolescent sexuality (Crisp, 1967).

Depersonalization and confusion of consciousness

Both of these terms are well known from the general course of psychiatry. Depersonalization is a state in which the patient considers himself to be some kind of unreal being, separated from his own feelings and from everyone around him like a glass wall. Confusion is a state of disorientation in time and space, usually resulting from somatic brain dysfunction.
However, complaints of confusion are not always organic. Sometimes confusion becomes a protective veil under which a person tries to hide, torn apart by intolerable conflict between irreconcilable contradictions of feelings, for example, love and hate. The same defense mechanism can manifest itself in depersonalization (Lader, 1975).

Sublimation

Anna Freud (1936) defined the state of sublimation as “the substitution of an instinctive goal in accordance with higher social values.” This is the most developed and mature defense mechanism that allows one to partially express unconscious motives in a modified, socially acceptable and even desirable form. For example, murderous lust may find a partial outlet in slaughterhouse work or in violent sports. The impulses break away from their primitive and obvious roots and are redirected in a different direction, manifesting themselves as phenomena of a higher order.

One very intelligent young man of 18, from a family that did not encourage the expression of feelings, grew up very secretive and insecure. He was very insecure, avoided girls, and even at 16, reading about the biological aspects of reproduction shocked him. From early childhood, the young man was fond of playing with tin soldiers and collected a huge collection. This collection gave an outlet in a sublimated form to his need for competition, in the desire to show himself, etc.
In addition to the well-known neurotic manifestations, sublimation contributes to the enrichment of both the individual and society. Freud viewed culture as a sublimation of deeply hidden and dark needs and at the same time the embodiment of the highest impulses. Franz Kafka (1920) expressed something similar in the form of the following aphorism: “All virtues are individual, all vices are social, what passes for social virtues (love, lack of self-interest, justice, self-sacrifice) are just surprisingly weakened social vices.” …
Vital parts of the personality can only be expressed in dreams and fantasies. Culture makes it possible to indirectly express what is simply impossible to express otherwise. One of the prime examples is the carnival. Culture provides an outlet for the life of society at all levels – from primitive instincts to the highest ethical ideals. Unconscious strivings require their expression.

Motivation

Any attempt to understand the origins of both healthy and painful human behavior in all their complexity, sooner or later, will certainly come to the problem of motivation. Playwrights, novelists and poets, exploring the realm of human passions – love and hate, heroism and self-destruction – long before scientific specialists came to a solution to this problem.
Of course, there are several types of innate behavior – from primitive reflexes to complex ones that are highly dependent on learning, for example, the behavior of a mother caring for a child. There are physiological needs for air, food and water, which, when unmet, generate powerful motivations for behavior. But in modern Western society, as a rule, there are no obstacles to meeting these basic needs. Areas that generate conflicts require more attention.
Instincts are defined as “innate, biologically determined impulses to act” (Rycroft, 1972). This term has been used since the 16th century and comes from the Latin designation for impulse. In the 19th century, the concept of instinct received a special coloring in the light of the development of the physical sciences and began to simplify the following idea: the instinctive behavior of animals is just as primitive as the reactive motion of a liquid. Today biologists prefer to talk about innate patterns of possible behavior, recognizing their much greater complexity. Such patterns or “motivational systems” (Rosenblatt and Thickstun, 1977) require a certain external triggering mechanism in order to be activated. However, at times we subjectively feel that our own impulses seem to arise within us against our will. We prefer to use the term “motivational drive” to convey both mental and bodily biological aspects.
It was already mentioned in the introduction that different schools of psychodynamics define motivational drives in different ways and highlight the most important of them in different ways. However, they all emphasize the conflict of motivational urges, with a significant proportion of schools focusing on sexual and aggressive urges. Other important motivations are related to food, attachments, parenting and social behavior. This is best illustrated with a brief historical background.
As has already been shown, Freud, in the early stages of his research, was confronted with strikingly frequent sexual conflicts, especially in hysterical women. Jung (1875-1961), opposing an excessive emphasis on sexuality, coined the term “libido”, by which he understood the existence of broader general vital forces. Adler (1870-1937) attached even greater importance to aggressiveness and the desire for power. Initially, Freud, taking on faith the stories of his patients about sexual abuse that they experienced in childhood by adults, saw the cause of neurotic conflicts in the suppression of these traumatic memories. Later, through introspection, and also feeling that child abuse could not happen as often as his theory suggested, Freud realized that he was wrong. He decided that the stories of his patients were mostly based not on actual facts, but on children’s fantasies about their own desires. He came to the conclusion that very often psychic reality is much more important than physical. Recently, however, there has been renewed talk of recognizing the reality and prevalence of the problem of child sexual abuse (Bentovim et. Al., 1988).
Freud’s discovery of the importance of infantile sexuality is reflected in his book Three Essays on the Theory of Sexuality (1905). Prior to this publication, it was generally accepted that the development of a normal heterosexual orientation was considered to re-emerge during puberty (a myth that illustrates Botticelli’s painting of the birth of Venus rising from the waves as a fully formed woman). Freud noted that this view ignores the phenomena of homosexuality, sexual perversion, child masturbation, and sexual curiosity. He came to consider sexual urges as phenomena that appear from birth and go through various stages as they develop (oral, anal, phallic, etc.), depending on which erogenous zones give pleasure at one stage or another. The most famous is the Oedipus phase (about 3-5 years), named after the hero of the Oedipus myth, who unknowingly killed his father and married his own mother, and then blinded himself (symbolic castration) upon learning of his terrible crime.
In recent years, perhaps under the influence of Adler and the destructiveness of World War I, Freud began to pay more attention to the manifestations of human aggressiveness.
The debate about whether aggressiveness is an innate or acquired property in response to frustration and deprivation is far from over. Both views are valid.
The topic of aggression between representatives of the same biological species was developed by zoologists (Lorenz, 1966). One example of such aggression is the division of territory. Another example is the struggle of males, which helps to select the best individuals for procreation. This phenomenon is especially common among animals leading a herd-nomadic lifestyle (antelopes, bison, etc.), for which the presence of strong males capable of protecting the herd is especially important. In higher primates, aggression is manifested when establishing status in the hierarchy. Social stability is promoted by such a situation in which each member of the group “knows his place”. As for the importance of a strict hierarchy in human society, it is very ambiguous. While undoubtedly a useful phenomenon in an army conducting hostilities, or in an operating team of surgeons, hierarchy can constrain the growth and initiative of an individual where it is not determined by obvious necessity.
The early-stage view of sexuality as a pursuit of pleasure, present from birth, has been very useful in explaining motivation, although some scholars have criticized it for over-focusing on the individual and his satisfaction. Object relations theorists (Fairbairn, 1952; Guntrip, 1961; Winnicott, 1965; Balint, 1968; Greenberg and Mitchell, 1983) have proclaimed the basic human need for the desire to establish relationships (in a broad sense) with other people. In contrast to the theory of seeking satisfaction, for each age, represented by different stages, they believed that different stages at different ages express a different need – different ways of establishing relationships with people (starting with the mother). This method corresponds to different developmental stages of a growing organism and begins with feeding. Instead of an infant seeking satisfaction in an oral impulse, this theory sees an explanation in a couple — mother and child — who find satisfaction in establishing a feeding relationship.
Harlow’s (1958) famous work on baby chimpanzees contains dramatic examples of such object attachments. Taken from their real mothers, little monkeys were attached to dolls and dummies, demonstrating an example of object attachment over hunger (they were fed from bottles – separately).
Bowlby (1969), continuing to develop the problem of weaning from the mother, which he began to investigate back in 1952, came to the conclusion that attachment is an important initial aspiration in humans as well. He argued that “attachment behavior is a form of behavior that is distinct from eating behavior and from sexual behavior, although it is no less significant in human life” (Bowlby, 1975). Attachment behavior peaks between nine months and three years of age. Perhaps the roots of this behavior are related to “adaptation to the environment during evolution” to protect the helpless infant from predators.
However, these biological urges and relationship-building behaviors do not exhaust human activity. Human babies are characterized by curiosity and thirst for knowledge, which Piaget writes about (1953). Should they be viewed simply as a derivative of sexual curiosity, later “sublimated” into the form of scientific and creative research? Or do they represent an independent urge leading to one of human’s most unique creative achievements? Storr (1976) argues that the preservation of children’s ability to play in adults is the basis of human creativity.
Exploratory behavior and attachment behavior are inversely related to each other. The child on the beach, carried away by exploring the surroundings, moves further and further from the mother, and then, frightened, runs back. He returns to her to calm down, gain confidence, how to “recharge the batteries”, and then again embarks on his research.
We need such a base throughout our lives: man is a social animal. About another social animal, the bee, Maeterlinck (1901: 31) wrote: “It is worth isolating it and, no matter how good the food and comfortable environment, it will die in a few days from loneliness. Overcrowding, a common settlement give her an invisible medicine, no less necessary for her than honey. There is no doubt that a person also experiences a natural need to communicate with his own kind, when he can find and realize himself. It remains debatable whether this behavior is a primary social instinct. In more advanced societies, social behavior outgrows biological needs, responding to the satisfaction of psychological needs. Social connections create a structure in which an individual struggles to gain self-worth through relationships with other people. The first social connection is the mother-child structure, then the family, then school, work, sexual partners, a new family and wider social ties. A person’s sense of self and awareness of his own worth depends on the presence and his interaction with other people throughout his life.
The school of American psychologists who made their mark in the 1930s – Fromm, Horney, Sullivan and Erickson – were called neo-Freudians. Representatives of the new school attached particular importance to the interpersonal aspect as opposed to the intrapsychic one. The conflicts and breakdowns seen in these relationships of support and self-determination lead to despair and illness. We are coming to an ever clearer awareness of the need to overcome loneliness and find a replacement for collapsing family and group ties, in other words, to support and correct the need of individuals and communities for cooperation and close ties.
Whatever definition of motivation we have to stop at, the basic concept of psychodynamics remains the conflict of primitive impulses. Freud revised his own theories of instincts several times, but dual conflicting ideas were always present in his writings. At first, he saw a conflict in the contradiction between the instinct of self-preservation and the instinct of procreation, later – between love for oneself (narcissism) and love for others; Finally, Freud poeticly formulated the conflict between the life instinct and the death instinct, echoing with Schiller, who said that until the spirit begins to rule the world, power will be divided between “hunger and love.”
Science and literature continue to understand the complexities of human motivation. Perhaps the current stage of development of knowledge is not yet mature enough for a clearer classification of motivation, in any case, this task lies outside the scope of this book. Psychotherapy is more concerned with impulses, urgent needs, and fantasies that lead to despair and conflict. Behind them are forces that emerge from the depths of the personality and are aptly named by Sandler (1974) “unconscious indisputable needs.” If we fail to get along with such a vital part of our nature, then this leads to obvious mental illness or, at least, to neurotic suffering and inhibitions.

On the issue of adequate therapy for protracted reactive depression

Posted on August 1, 2020  in Uncategorized

Among the psychogenic factors involved in the determination of reactive depressions, the leading role is assigned to bereavement, which damages the sphere of individual personal values. The sudden loss of the object of attachment (“significant other” in the terminology of psychologists) – love drama, tragic death or suicide are considered in the literature as a catastrophic stressful effect. The latter is equated in importance with events of an extreme nature with a universal property – the ability to cause distress1. Only 800,000 people experience marital loss in the modern world every year, and at least a third of them need treatment for an acute psychogenic reaction. At the same time, in half of the patients, after acute affective-shock disorders have passed, clinically outlined reactive depressions are formed, the duration of which exceeds 12 months.
Such protracted depression, denoted in psychologically oriented publications by the concept of “pathological grief reactions” (PRG), not only worsen the quality of life, but increase the suicidal risk, lower the threshold of susceptibility to recurrent affective disorders, contribute to the development of comorbid pathology (anxiety, pathocharacterological disorders, dependence on psychoactive substances).
The data obtained allowed modern researchers to come to the conclusion that protracted psychogenic depressions occurring with the picture of PRG, in contrast to the psychologically deduced phenomenon of “normal work of grief”, cannot be regarded as an “acceptable process” and should be the subject of special attention of clinicians.
However, the psychological clarity of the tragic life situation in the minds of patients (and even, unfortunately, in the judgment of some specialists) often shifts the real idea of ​​a depressive reaction as a mental disorder to its understanding exclusively in the context of a natural, inevitable and irreversible, and thus not in need of treatment for the consequence of the loss suffered.
Meanwhile, in the absence of adequate therapy, psychogenic depression with features of PRH is not only not reduced, but becomes chronic. At the same time, mental trauma becomes a maladaptive “focus” that determines, over a long period of time, violations of behavior, social functioning and the entire life structure of patients. Accordingly, the timeliness of adequate therapeutic measures in such cases is a factor of key importance.
As evidenced by the clinical experience, which is consistent with the literature data, accumulated in the department for the study of borderline mental pathology and psychosomatic disorders of the NCPZ RAMS, in a wide range of therapeutic influences (biological, psychotherapeutic, social rehabilitation) used for protracted psychogenic depressions occurring in the form of PRG , the main component is pharmacotherapy with the predominant use of antidepressants.
This position is based on a revision of the traditional concept of psychotherapy as the only effective method of treating such conditions2. With the accumulation of the results of special comparative studies, which provide statistically reasoned evidence, it became obvious that psychotherapeutic interventions in combination with placebo (i.e., the appropriate monotherapy) can achieve a positive effect in only 29% of patients with PRH [Reynolds Ch.F. et al., 1999]. At the same time, the effectiveness of antidepressant treatment is at least twice as high and can exceed 70%.
The approaches to the choice of therapeutic tactics are carried out in accordance with the concept of psychogenies, consistently developed in a series of works by A.B. Smulevich, devoted to the problem of the contribution of personality disorders to psychogenic response to stress (see, in particular, the publication in the “Journal of Neurology and Psychiatry named after SS Korsakov”, No. 6, 2000, as well as the article in this issue).

Psychopharmacotherapy of prolonged depression with a picture of PRH is carried out taking into account the general principles of treatment of affective disorders: the volume and power of the drug effect are consistent with the severity of the condition. Accordingly, in the treatment of deep depression, the use of a high activity of psychotropic drugs of a wide spectrum is shown, while mild hypothymic disorders require the prescription of drugs with a differentiated effect on psychopathological manifestations (a narrow spectrum of psychotropic activity). However, these provisions are applicable to the conditions under discussion only in part, as evidenced by the already well-known fact that, despite the dominance of hypothetical manifestations in the picture of depressive reactions with features of PRH, the set of drugs used in the treatment, as a rule, is not limited to antidepressants.
The need for complex therapy, as follows from the results of a number of studies, correlates with a special characteristic of psychogenic depression – their clinical manifestations depend on the structure of comorbid relationships of affective disorders with personality disorders. In cases of the formation of protracted depressions with a picture of PRG (this will be shown below), we are talking about a mandatory complicity in the structure and dynamics of the depressive reaction of personality disorders (PD) or even disorders of an endogenous procedural nature3.
The ultimate goal of treatment is the most timely impact not only on the pathologically altered affect, but also on the pathocharacterological manifestations.
Initially, the choice of the psychopharmacotherapy technique depends on the belonging of the clinical manifestations of psychogenia to one of the following levels of personal response to stress, reflecting the stages of the dynamics of the disorder:
1 – the level of “deep personality” with polymorphic undifferentiated affective disorders (acute period);
2 – constitutional characterological / pathocharacterological level with differentiation and modification of affective disorders according to the patterns of post-traumatic comorbidity (subacute period, stabilization period).
For disorders of the first level, as shown in the figure, urgent intensive psychopharmacotherapy is shown, which in severe cases is advisable to be carried out in a hospital setting. Therapeutic tactics are determined by the peculiarities of the clinical picture of affective-shock reactions with abrupt (like rapid hysterical states of raptoid) changes in affect (from confusion, anxiety with a feeling of unacceptability of the catastrophe, despair with demonstration of suicidal intentions to ecstatic “fascination” with visions of a happy past) and dissociative disorders (psychogenically narrowed consciousness, fugiform agitation or stupor, seizures, hallucinations of the imagination).
The primary task of therapy is the timely relief of all components of the syndrome: affective imbalance, signs of hysterically clouded consciousness and psychomotor agitation. This problem is solved using parenteral (intramuscular, intravenous jet or drip) administration of tranquilizers prescribed in high daily doses (30-50 mg of diazepam) from the moment of admission to the hospital. (It should be borne in mind that “classic” affective-shock reactions are not always observed – the state at first may correspond not to an acute reaction to stress, but to an adaptation reaction, i.e., shallow psychogenic depression. This does not exclude the possibility of the formation of prolonged depression with features of the PRG, although there is no need for hospitalization immediately after the loss). It should be noted that stationing not only provides the possibility of intensive medication, but also has a psychotherapeutic meaning. Placing the patient in a hospital setting at least partially shifts attention and alleviates the burden of traumatic memories.
As clinically delineated depression forms, which indicates the possibility of the development of protracted psychogenia with a picture of PRH, antidepressants of the 1st generation in adequate daily doses (250-300 mg of tricyclic antidepressants – TCAs) are added to tranquilizers. The latter, if necessary, are also used parenterally, including intravenous drip. In complex therapy, the antidepressant properties of TCAs can be enhanced by the addition of medium and high (3-6 mg) daily doses of alprazolam (Xanax), a triazolebenzodiazepine derivative, the tricyclic structure of which is not directly related to antidepressants, but radically distinguishes this tranquilizer from other benzodiazepine derivatives. If signs of behavioral toxicity characteristic of benzodiazepines are identified, it is advisable to use non-benzodiazepine tranquilizers (hydroxyzine-atarax – 50-100 mg / day, buspar-buspirone – 20-30 mg / day). Less often (with the predominance of psychogenic deceptions of perception or arousal phenomena), neuroleptics of a wide spectrum of action in low doses are prescribed (aminazine – 100-150 mg / day, haloperidol – 5-10 mg / day, azaleptin-leponex – 50-100 mg / day). Such tactics in a significant part of cases allows achieving a complete reduction of psychogenic disorders.
In the part of cases when the desired therapeutic effect cannot be achieved, i.e. when the transition to the second level of psychogenic response with the formation of subacute affective disorders is registered, the issues of constructing optimal treatment programs acquire special significance.
It should be immediately emphasized that in case of second-level disorders, adequate therapy requires not only the differentiated use of medications, taking into account the spectrum of their psychotropic activity, but also the choice of various methods in which these drugs (antidepressants and drugs of other classes), as well as other biological effects included in very different proportions. The rationale for this strategy is its compliance with clinical reality – the therapy technique is consistent with the nature of comorbid connections between psychopathological formations and PD, which determine the characteristics of the observed manifestations of psychogenia. Differentiation of approaches to the choice of one method or another is carried out on the basis of the typology of protracted psychogenic depression with a picture of the PRG, subdivided, according to A.B. Smulevich (2000), into two options.
The first option is protracted psychogenic depression of the type of characterological dysthymia. As the severity of the condition decreases, clear signs of post-traumatic personality development are revealed. As a result of the interaction of affective disorders with personality patterns by the amalgamation mechanism (literally merger), a gradual transformation of affective disorders into pathocharacterological ones occurs. The persistently lowered mood takes on the character of a gloomy “basic tone” inseparable from the pessimistic outlook of the victim of an unhappy fate. Catatimically charged, mastering representations of the acute period are transformed into persistent overvalued formations with idealization and embellishment of the lifetime virtues of the object of loss and the cultic activity of perpetuating his memory (obsession with grief), less often – with the struggle (up to litigation and even paranoid tendencies) for “just punishment »Perpetrators of misfortune (often imaginary).
Treatment with this variant of comorbid relationships pursues two goals: it is aimed at the fullest possible elimination of depressive symptoms with minimization of the risk of exacerbations in the form of “double depression” and at the same time – at compensation for pathocharacterological manifestations – a decrease in the “emotional charge” of overvalued formations and associated abnormalities. behavior. The amount of drug exposure in this variant of comorbid ratios is rather limited due to the shallow level of affective disorders proper. At the same time, despite the blurring of dysthymic phenomena inseparable from PD, they are distinguished by the pathological resistance inherent in residual states. It is not necessary to expect rapid success from the use of drugs, which would manifest itself as a complete reduction of symptoms; it makes no sense to intensify therapy for this purpose. It should be borne in mind that the regression of psychopathological formations occurs very slowly, and their disappearance is possible after many years. This implies the need for long-term treatment with the prescription of new generation antidepressants (atypical TCAs – selective serotonin reuptake stimulants – SSOZS – tianeptine-coaxil at doses of 25-37.5 mg / day; selective serotonin reuptake inhibitors (SSRIs) bicyclic – citalopram-cypramypram-cypramine -40 mg / day, paroxetine-paxil 20-40 mg / day, sertralin-zoloft 50-100 mg / day; monocyclic SSRIs – fluoxetine-Prozac 20-40 mg / day, fluvoxamine-fevarin 20-40 mg / day; selective serotonin and norepinephrine reuptake inhibitor – SNRIs – milnacipran-ixel 50-100 mg / day, etc.).
An equally important prerequisite for the success of therapy is the use of modern atypical antipsychotics (risperidone-rispolept 2-4 mg / day, olanzapine-zyprexa 5-15 mg / day, flupentixol-fluanksol 1-3 mg / day, sulpiride-eglonil 200-400 mg / days). The preference for such a choice is quite justified, since psychotropic drugs of the latest generations, along with the main effect, have a high safety and tolerability index, are convenient to use, and do not require careful dose titration.
In conditions of the reverse development of hypothymia, a transition to monotherapy with atypical antipsychotics in doses sufficient for the correction of pathocharacterological disorders is shown.
This technique helps to level the signs of exacerbation in the structure of pathologically altered affect (dysphoric outbursts, “anniversary reactions”) and to gradually deactualize litigious and paranoid tendencies.
Of particular importance in conditions of long-term treatment, in which patients often do not see the need, are informational strategies that make it possible to create the necessary and effective medical alliance between the doctor and the patient, to achieve his interested participation in the therapy process, which minimizes violations of the prescribed recommendations. This interaction, according to the concept of completeness of adherence to the treatment regimen (compliance), is greatly facilitated by the expansion of knowledge of medical personnel at all levels, coverage of the current state of the problem. The
second option is protracted PRGs of the type of endogenomorphic depression. Affective disorders interacting with pathocharacterological formations by the integration mechanism (literally unification) reveal features of constitutional reactive lability (“dynamics of susceptibility”). In contrast to the manifestations of characterological dysthymia (option 1), in which each of the components (hypothymia, PD) in the picture of depression loses its independence, with this option their connection is expressed by the generalization of the elements forming the depressive syndrome and the worsening of the clinical picture. Vital disorders (insomnia, anorexia, circadian rhythm) dominate, ideas of self-accusation are strengthened, true suicidal thoughts are formed. This worsening of depression can reach the level of PD-associated quasi-psychosis (signs of dissociative alienation and / or sensitive paranoia and / or basic anxiety with fear of new loss transferred to the substitute).
The clinically substantiated amount of necessary medical care in accordance with the nature and severity of psychopathological manifestations includes active complex effects that reduce the level of generalization of the disorder and thereby – the therapeutic effect.
Treatment begins with the use of newer generation antidepressants; in the absence of an effect, antidepressants of a wide spectrum of action are prescribed with universal psychotropic activity (TCAs – imipramine-melipramine, amitriptyline, clomipramine-anafranil 250-300 mg / day in combination with high-potential tranquilizers of the benzodiazepine series and, less often – traditional neuroleptics / butyrophenerazines – haloperidol 10-20 mg / day, trifluoperazine-stelazine 10-15 mg / day).
When signs of aggravation of the condition or resistance are identified, strategies of intravenous drip of psychotropic drugs are used.
In the absence of a positive response to psychopharmacotherapy, it is advisable to conduct a course of electroconvulsive therapy. The main indication for prescribing ECT is the severity of the affective component of PRH, when the manifestations of hypothymia approach the picture of a severe depressive episode without psychotic symptoms (psychomotor retardation or agitation, consciousness of worthlessness, guilt, high suicidal risk, sleep and appetite disorders) or with psychotic symptoms (delusional ideas of sinfulness, signs of sensitive paranoia). It is clear that intravenous infusions of psychotropic drugs, as well as shock methods, are possible only in a specialized hospital.

1This term (English distress – grief, suffering, severe malaise, exhaustion) denotes stress (“stress stress” in Russian literature), which has a negative, disorganizing effect on the body, activity and behavior; the result of this influence may be psychopathological disorders.

2In modern balanced strategies with the exclusion of alternative approaches opposing pharmaco and psychotherapy, the latter remains an important part of the treatment process. It is assumed that the community of psychiatrists and psychotherapists provides the possibility of active use of targeted psychotherapeutic influences (rational, cognitive-behavioral, suggestive, family psychotherapy, the tactics of “therapeutic crisis intervention” – an intensive individual psychocorrectional intervention that helps to prevent suicidal intentions). Treatment is differentiated depending on the stage of development of the disorder (see article by A.V. Andryushchenko in this issue). If in the acute period of the psychogenic reaction psychotherapy in the form of adequate support is needed, then in the subsequent treatment techniques include an increasingly subtle study of the traumatic experience aimed at reducing the psychogenic complex, a realistic, distant reassessment by the patient of the loss suffered instead of its pathological denial, building adequate relationships with the environment and modeling of adaptive behavior in general.

3 This aspect of the problem, which requires coverage of the issues of psychogenic provocation of affective diseases (“depressive illness” by modern French authors) and / or “true psychogenies” in schizophrenia, is beyond the scope of this report.

Non-drug treatments for depression

Posted on July 28, 2020  in Uncategorized

Depression is a disease that is quite common in medical practice. It manifests itself primarily in the affective sphere and is accompanied by severe somatic, motivational, autonomic disorders. In the treatment of depression, two directions are developing: pharmacological and non-pharmacological.

The widespread and well-founded pharmacotherapy of depression is still insufficiently effective in 25% of cases due to poor tolerance to drugs and the resistance of the disease itself (S. Dilsaver et al., 1983, S.P. Oskolova, 1985).

In this regard, non-pharmacological methods of treatment, which also have their own pathogenetic rationale, play a significant role.

These include:

– psychotherapy;

– breathing and relaxation training;

– light therapy (phototherapy);

– sleep deprivation (sleep deprivation);

– electroconvulsive therapy.
Psychotherapy

Psychotherapeutic treatments are divided into psychodynamic, non-directive, rational, and interpersonal psychotherapy.

The basic principles of psychodynamic therapy were developed by Bullack. There are ten most important mental manifestations that are subject to research and correction (self-esteem, self-flagellation, anger, disappointment, feelings of loss, narcissism, denial of latent anger, etc.). Classical psychoanalysis is not indicated for severe depression.

Nondirective psychotherapy is based on the concepts of Rogers, Maslow, and Perls. The patient expresses his thoughts and feelings, and the therapist, without imposing his interpretations, helps to understand himself. An important condition for treatment is empathy – the ability of the psychotherapist to put himself in the patient’s place, to look at the world through his eyes. The focus is on the current situation.

Rational psychotherapy is aimed at eliminating irrational ideas expressed by patients with depression. It is more effective in patients with depression compared to the psychodynamic method. There are indications that it is comparable to or even more effective than drug therapy, especially for mild to moderate depression.

Interpersonal psychotherapy was developed by Klerman, Weisman, and others. It improves the social adaptation of patients and interpersonal contacts, reduces the secrecy of patients, makes it possible to express their thoughts and feelings. It has been shown that interpersonal therapy for some manifestations of depression, for example, in relation to social maladjustment, can effectively reduce it, which is comparable to drug therapy.

Thus, it should be noted that psychotherapy is especially effective for mild or minor depression, characterized by decreased mood and some somatic complaints. In general, it should be noted that psychotherapy should be performed by an experienced specialist. However, the treatment of autonomic disorders and sleep disorders is better corrected by combination with drug therapy.
Respiratory relaxation training (DRT)

Depressive disorders are often combined with anxiety, according to A.F. Schatzberg (1995), at 31 – 62%. Therefore, in these cases, it is advisable to use DRT, which combines elements of mental and muscle relaxation with chest excursions in the inhalation – exhalation rhythm. When performing DRT, it is necessary to observe several principles: the gradual inclusion of the diaphragm in breathing, the formation of a certain ratio between the duration of inhalation and exhalation – a ratio of 1: 2. The transition to the abdominal type of breathing causes the Hering-Breuer reflex, which helps to reduce the activity of the reticular formation of the brainstem, reduce mental stress, reduce hyperventilation syndrome and anxiety. Reduced and deeper breathing optimizes the processes of pulmonary ventilation and diffusion, improves microcirculation.
Light therapy (phototherapy)

Among the recently used non-drug treatments for depression and various somatovegetative disorders associated with it, bright white light therapy has begun to be used. Interest in this method has increased in recent decades in connection with the treatment of seasonal affective disorders (W. Rosental, A. Levy; 1982-1984.) , selective hyperphagia of carbohydrates. Body weight increases. Blood levels of melatonin increase in patients with SBP. With an increase in the light phase of the day, the severity of symptoms decreases. In 1980, A. Levy reported on the blockade of melatonin by bright white light. After that, light therapy began to be used in the treatment of various disorders: seasonal and non-seasonal affective disorders, insomnia, etc. Treatment with bright white light is based on its effect through the retina, hypothalamus, b-adrenergic receptors of the pineal gland membrane. Light helps to reduce melatonin, increase serotonin and dopamine. Our experience (Ya.I. Levin, A.R. Artemenko, 1996, A.D.Solovieva, E.Ya. Fishman, 1997) showed that bright white light reduces the level of depression, improves sleep, and vegetative manifestations accompanying depression.

Phototherapy is carried out according to the technique, which consists in the fact that the patient takes light sessions every day (preferably in the morning). The lamp cover is installed at an angle of 45 degrees in relation to a straight line drawn mentally from the center of the eyeball to the horizontal axis of the lamp. The patient is at a distance of 60 cm from the lamp; the session lasts 60 minutes, during the session the patient receives about 3500 – 4000 lux.
Sleep deprivation (sleep deprivation)

In 1966 W. Schulte introduced the treatment of depression by sleep deprivation into psychiatric practice. He showed that deprivation improves the condition of patients with psychogenic and organic depression. Later, other researchers noted its pronounced effect in depressive disorders. It is known that sleep disorders occur in 83 – 99% of patients with depression. Sleep disturbances along with other symptoms are a criterion for diagnosing depression. A study of sleep in patients with depression showed a decrease in its depth and an increase in motor activity during sleep. In the works of A.M. Wayne, R.G. Airapetova, 1983, 1984 it was shown that with various forms of depression, the latent periods of the first, second and third phases of sleep increase, there is a pronounced reduction of the fourth, most profound stage, the phase of slow sleep, a decrease in the latent period of the phase of REM sleep (REM) was revealed, which is associated with the pressure of REM sleep, characteristic for depression. Thus, subjective complaints of patients about sleep disorders are combined with objective changes during the night on the EEG.

Treatment is with total sleep deprivation. Patients do not sleep from the morning of the day preceding the sleepless night until the evening of the next day, i.e. sleep deprivation is 36 – 38 hours. Then there are two restorative nights, during which patients sleep naturally. After which the deprivation is repeated, if the condition improves, then a third sleep deprivation is performed. Sleep deprivation stops if the patient’s condition does not change or worsens after two sessions. When the condition improves, it is recommended to carry out two sleep deprivations per month. Sleep deprivation provides an improvement in mental state in 90% of patients. According to R.G. Ayrapetova (1984), the positive effect of sleep deprivation is especially noted in melancholy depression, where it is not inferior in effectiveness to antidepressants, adynamic depression. It is less effective in asthenic and anxious depression and has not been shown to have a beneficial effect in masked depression. Deprivation actually has a thymoleptic and disinhibitory effect that stimulates activity, while improving mood and physical activity. There is an activation of the REM sleep phase and synchronization in the EEG of wakefulness, which is of a compensatory nature and provides emotional stabilization.

Sleep deprivation therapy is indicated for any depression that is not accompanied by psychomotor agitation. It itself has a positive effect by reducing depression and significantly enhances the effect of antidepressant treatment, which can significantly reduce the dose of pharmacological drugs. The best results, as a rule, can be achieved with combination therapy: sleep deprivation in combination with antidepressants.
Electroconvulsive therapy (ECT)

This type of therapy for depressive disorders was especially widely used in psychiatry in the 30s and 50s, then a period of rejection began. In recent years, there has been renewed interest in this therapy. ECT is used mainly in patients with severe depressive disorders in specialized psychiatric hospitals, as well as in patients with contraindications to pharmacotherapy and in cases where other methods of treatment are ineffective. ECT is the treatment of choice in cases of extraordinary suicide attempts or persistent refusal to eat, where ineffective antidepressant therapy can lead to wasted time. ECT is considered to be the most effective treatment for depressive attacks and is a treatment for depression that prevents manic attacks. Therefore, it is effective in TIR, in which antidepressants increase the frequency of seizure changes, in psychotic depression, in which antidepressants help little or no help.

There are no absolute contraindications to ECT, but a number of factors and the existence of relative contraindications must be taken into account when prescribing. The patient is examined in the same way as during an operation performed under general anesthesia. ECT is considered a minor surgery. For its implementation, special instructions have been developed.

The mechanism of action of ECT has not been definitively established. There is evidence that ECT enhances dopaminergic transmission, affects opiate and peptide receptors. ECT is thought to improve mood and exercise. ECT in comparison with antidepressants faster eliminates vegetative manifestations of depression.

Neurologists, as a rule, deal with depression of mild or moderate severity, which is more often hidden, under the guise of chronic pain syndromes, autonomic disorders, metabolic endocrine disorders, etc. In these cases, psychotherapy, respiratory relaxation and light therapy have been successfully used.