Psychohygiene and psychoprophylaxis in the system of clinical psychology. V.A

Today, when the level of stress in the world is off the charts, mental hygiene and psychoprophylaxis have become popular among advanced people.

Prevention of stress, depression and neuroses is the best mental hygiene, along with ordinary physical hygiene of the body.

Today, on the website, you will learn what mental hygiene and psychoprophylaxis are, what needs to be done and what methods there are to prevent stress, depression, neuroses and various personality disorders.

Psychohygiene - hygiene of the soul

Everyone probably still knows what personal hygiene is. kindergarten. Hygiene (from Greek - “healthy”) is sanitary norms and rules, developed measures aimed at preventing somatic (physical) diseases, ensuring normal living conditions, promoting health and increasing human life expectancy.

Almost all civilized people learn personal hygiene from early childhood. Everyone washes their face, brushes their teeth, bathes, and takes care of their body (especially women), using various hygiene products.

Psychohygiene is aimed at preventing mental disorders and strengthening a person’s emotional and psychological health.

In the modern pace of life, with many stressful situations in everyday life, in the family, at school, at work, on the street, practically no one is immune from neurotic, stress, depressive, panic disorders, the development of VSD and various psychosomatics.
Only daily mental hygiene - hygiene of the soul, along with body hygiene, will protect a person from mental illness.

Three levels of mental hygiene:

1. Preventive mental hygiene is aimed at preventing emotional-psychological, personality, neurotic and psychotic disorders and preserving the psychosomatic health of the individual and society as a whole.

   Also, preventive psychological hygiene helps prevent the development of both intrapersonal and interpersonal conflicts - preventing the development of personal, family, everyday and social conflicts and their consequences.

2. Restorative (corrective) mental hygiene aimed at psychocorrectional assistance in crisis situations life situations and to prevent the development of serious conflicts in their inception phase.
3. Therapeutic psychohygiene- this is psychological and psychotherapeutic assistance for reversible personality disorders, the development of neuroses and borderline disorders, and the prevention of psychopathological (psychotic) diseases.

The purpose of mental hygiene— satisfaction of basic needs of the individual:
1) Love, 2) Security, 3) Recognition, Approval, Feeling of success, 4) Personal space for free creativity, 5) Positive memories, 6) Self-esteem

And once every six months/year it is not bad to visit a psychoanalyst for psychohygienic conversations, just as normal people who take care of their oral hygiene visit a dentist once every six months.

Second and third level- this is already a visit to a professional psychologist, psychotherapist or psychoanalyst.

But in order not to bring yourself to this point, you should take care of your mental health by maintaining daily hygiene of soul and body.

Psychoprophylaxis

Psychoprophylaxis is almost identical in essence to psychohygiene, but the prevention of various psychological problems is carried out by medical (clinical) psychologists and practical psychologists, and not by each individual individual.

In medical psychology, psychoprophylaxis is a variety of activities that study the mental effects on a person, his psyche itself, and methods for preventing psychogenic and psychosomatic disorders.

In medicine, there are three types of psychoprophylaxis:

1. Primary is protecting the health of the future generation, studying and forecasting possible genetic and hereditary diseases, healthy marital relationships and conception, protecting pregnant women from negative effects on the development of the fetus, preserving it, early detection of anomalies, assistance during childbirth and psychocorrection in the early stages of child development ;
2. Secondary is preventive measures to provide psychological or psychiatric assistance to a person who has the beginnings of the development of psychological, emotional, psychosomatic and mental (psychotic) disorders.
3. Tertiary psychoprophylaxis is psychotherapeutic medical measures, often using pharmacology, aimed at people with existing psychological disorders, psychopathologies, in order to prevent disability and early mortality.

In practical psychology, psychological prevention is similar to primary psychological prevention in clinical psychology.

It is also aimed at protecting the mental health of future generations, but in this context, a practical psychologist works in the preschool and school education and child development, and is officially called an educational psychologist.

The psychoprophylactic work of a teacher-psychologist consists of:

• development, testing and implementation of developmental programs for children of different ages, taking into account the tasks of each age stage;
• control over compliance with psychohygienic conditions for the education and development of children in educational institutions and families, ensuring harmonious, mental development and formation of the personality of children at every stage of their development; eliminating unfavorable psychological factors in the educational environment and family;
• ensuring conditions for the optimal transition of children to the next age level, prevention possible complications in the mental development and personality formation of children and adolescents in the process of continuous socialization;
• preparing children and adolescents to become aware of those areas of life in which they would like to realize their abilities and knowledge;
• timely warning possible violations psychosomatic and mental health of children.

Psychoprophylaxis of stress, depression, neuroses, phobias and psychoses

In practical psychology, psychological therapy and psychoanalysis, as well as in medical and educational psychology, psychological prevention is used.

As a rule, this is individual, couple or group psychoprevention of stress, depression, neuroses, phobic and psychotic disorders and conflicts.

In the process of individual psychological consultations, conducting psychotherapeutic groups and psychoanalysis of interpersonal and family relationships, people are taught both psychohygiene and psychoprevention of the occurrence of psychological problems.

Modern practical psychologists, non-medical psychotherapists and psychoanalysts use various trainings, educational programs, seminars and webinars, literature, audio and video training to prevent stress, depression, neuroses, personality disorders, conflict-traumatic situations.

Almost any adult, boy, girl or older teenager, can learn how to prevent stress, neurosis, depression, anxiety disorders and phobias on your own or with a practical psychologist (psychotherapist, psychoanalyst) and use it daily (not from time to time - large and small stresses every day, and they tend to accumulate in both the psyche and body)

Parents trained in psychohygiene and psychoprevention of stress, depression, anxiety and neuroses can easily teach their children. Without psychodidactics and educational programs - using your own example.

• Psychological morning exercises (and evening release of the psyche from stress and negativity accumulated during the day)

5.2. Definition of the concepts of “psychohygiene” and “psychoprophylaxis”

Psychohygiene – a branch of medical knowledge that studies factors and environmental conditions that influence mental development and mental state of a person and develops recommendations for maintaining and strengthening mental health.

Psychohygiene as a scientific branch of hygiene studies the state of the neuropsychic health of the population, its dynamics in connection with the influence of various environmental factors (natural, industrial, social) on the human body and develops, based on these studies, scientifically based measures of active influence on the environment and functions of the human body in order to create the most favorable conditions to preserve and strengthen people's health.

If until recently the responsibility of hygiene as a science was mainly to study the impact of external conditions on human somatic health, now the subject of its main concerns is the analysis of the influence of the environment on the neuropsychic status of the population and, first of all, the younger generation.

The most substantiated and advanced are the principles of psychohygiene, the starting position of which is based on the ideas that the world is material in nature, that matter is in constant motion, that mental processes are a product of higher nervous activity and are carried out according to the same laws of nature.

Psychohygiene includes the following sections:

age-related mental hygiene;

household psychohygiene;

psychohygiene of family life;

mental hygiene labor activity and training.

Age-related mental hygiene.

This section includes psychohygienic studies and recommendations related primarily to childhood and old age, since the differences in the psyche of a child, teenager, adult and elderly person are significant.

Psychohygiene of childhood should be based on the characteristics of the child’s psyche and ensure the harmony of its formation. It is necessary to take into account that the developing nervous system of a child reacts sensitively to the slightest physical and mental influences, therefore the importance of correct and sensitive upbringing of a child is great. The main conditions of education are:

development and training of inhibition processes;

education of emotions;

learning to overcome difficulties.

Psychohygienic problems have their own specificity in old and senile age, when, against the background of a drop in metabolic rate, overall performance, memory and attention functions decrease, and personality traits become sharper. The psyche of an elderly person becomes more vulnerable to mental trauma, and breaking a stereotype is especially painful.

Maintaining mental health in old age is facilitated by adherence to general hygiene rules - daily routine, rest and sleep, walks in the fresh air, and tireless work.

Psychohygiene of everyday life.

A person spends most of his time communicating with other people. A kind word, friendly support and participation contribute to cheerfulness and good mood. And, conversely, rudeness, a harsh or dismissive tone can become psychological trauma, especially for suspicious, sensitive people. A friendly and cohesive team can create a favorable psychological climate. People who “take everything too personally” give undeserved attention to little things and do not know how to inhibit negative emotions. They should cultivate the correct attitude towards the inevitable difficulties in everyday life. To do this, you need to learn correctly, evaluate what is happening, manage your emotions, and when necessary, suppress them.

Psychohygiene of family life.

The family is a social group in which the foundations of personality are laid and its initial development occurs. The nature of the relationship between family members significantly influences a person’s fate and therefore has enormous vital significance for each individual and for society as a whole.

A favorable atmosphere in the family is created by the presence of mutual respect, love, friendship, and commonality of views. Emotional communication, mutual understanding, and compliance have a great influence on the formation of relationships in the family. Such an environment contributes to the creation of a happy family - an indispensable condition for the proper upbringing of children.

Psychohygiene of work and training.

A person devotes a significant part of his time to work, so the emotional attitude towards work is important. Choosing a profession is a crucial step in the life of every person, therefore it is necessary that the chosen profession matches the interests, abilities and preparedness of the individual. Only then can work bring positive emotions: joy, moral satisfaction, and, ultimately, mental health.

Industrial aesthetics plays an important role in occupational psychohygiene: modern forms of machines, a comfortable workplace, a well-designed room. It is advisable to equip the production of rest rooms and psychological relief rooms that reduce fatigue and improve the emotional state of workers.

Psychohygiene of mental work is important. Mental work is associated with a high consumption of nervous energy. In the process, attention, memory, thinking, and creative imagination are mobilized. People of school and college age are closely connected with learning. Improper organization of classes can cause overwork and even a nervous breakdown, which especially often occurs during exam periods.

Due to your professional orientation, we will dwell on this issue in more detail.

Psychohygiene of educational activities at school.

This issue plays a leading role in protecting the health of the younger generation, since almost all children study for 10 years, and learning constitutes the main content of their lives. During these years there are 2 dangerous crises (7-8 years and puberty - 13-15 years), when the growing organism is especially reactive and most susceptible to neurotic influences.

The tasks of psychohygiene of educational classes are as follows:

1\ promote the timely and harmonious mental development of children;

2\ strive to ensure that learning brings children joy and proceeds against a background of positive emotions, which in turn will be the key to mental health;

3\ avoid excessive mental stress, leading to significant fatigue in children;

4\ prevent traumatic situations at school.

In the problem of preserving the mental health of children, the initial period of education is very often essential. When entering school, a child is bombarded with a lot of new impressions and demands:

strict adherence to rules of conduct;

staying in a relatively motionless position for a long time;

intense mental activity;

inclusion in a diverse group of peers;

One way or another, the process of adaptation to new conditions of social existence for many children is painful, and it is accompanied by a period of inadequate reactions. Such children are often distracted in class, engage in extraneous activities, violate norms of behavior during breaks, scream, run around, or, conversely, are withdrawn and passive. When contacting the teacher, they become embarrassed and cry at the slightest remark. Some children show signs of neurosis: they lose their appetite, sleep poorly, and are capricious. For most children, complete adaptation to school occurs only by the middle of the first year of schooling. For some, it is significantly delayed. The role of the school is great here. The correct behavior of the teacher, his patience and kindness, the gradual inclusion of children in the educational load in compliance with hygienic standards facilitates the adaptation period.

The lesson is recognized as the main form of the educational process. The degree of fatigue caused depends on the tediousness of the lesson. Difficulty and tediousness cannot be equated, although they are closely related. Difficulty is an objective property of a lesson, while tediousness is its “physiological cost”, a kind of reflection of the impact of the lesson on the student’s body.

The duration and difficulty of the lesson are objective values ​​that do not depend on the students. They affect everyone, but do not cause the same amount of fatigue, and not everyone experiences the same fatigue. This happens because the tiring effect of the lesson is layered with many subjective factors: the type of higher nervous activity of the student; the degree of fatigue with which he began educational activities; mental state from previous circumstances (whether the child slept or not, whether he was full or hungry, what kind of contact he had with parents and peers), etc.

Reducing the tediousness of a lesson primarily depends on its duration and the difficulty of the material being studied. Thus, a 45-minute lesson duration for 1st grade students is unbearable. Therefore, a “stepwise” increase in the teaching load by gradually lengthening lessons is highly desirable: from 30 minutes in September-December to 35 minutes in January-May. At the end of the week (Friday and Saturday), fatigue affects the entire school week, so it is advisable in all classes, without exception, to shorten the duration of the last lessons. Experience shows that in the last 10 minutes the attention and performance of students drop, and that this period of classes is ineffective. Using the freed up minutes for rest increases the productivity of the lesson, and at the same time reduces the fatigue of students at the end of the school day.

The duration of individual training operations is subject to psychohygienic regulation. It has been established that the duration of continuous reading in elementary grades should not exceed 15 minutes, and in 1st grade - 10 minutes. The screening of films and television programs should not last more than 15-20 minutes in junior grades and 25-30 minutes in senior grades. Exceeding this time leads to student fatigue. Switching attention after this to other types of activity gives a good psychohygienic effect.

There are other ways to prevent unnecessary fatigue. It has been experimentally established that the ability to assimilate and process new information and knowledge is less in the second half of the day, and students’ performance at the end of the lesson is less than at the beginning. Consequently, this must be taken into account when constructing each lesson and the last minutes of the lesson should be devoted not to explaining new material, but to repeating it and consolidating it. If this does not happen, then the students “correct” the teacher’s mistake in their own way: they stop listening and do other things. However, only younger schoolchildren resort to this method of “self-defense”. The older ones already know how to overcome the onset of fatigue and continue to work, which leads to more significant fatigue.

One of the indirect but extremely effective means of protecting against the tediousness of a lesson is its attractiveness to students. She plays a leading role in maintaining positive motivation and a favorable emotional climate in the classroom - an extremely important element of mental hygiene. The positive emotional state of students is important in two aspects:

it activates the higher parts of the brain, promotes their high excitability, improves memory and thereby increases performance;

promotes mental health.

Training should take place against the backdrop of a good mood among students and give a feeling of joy. The educational activity of children itself can be a source of positive emotions, when the solution of a difficult task, the joy of overcoming obstacles, shows the student his capabilities and abilities.

The main generator of students' positive emotions is interest in the lesson. Which means he needs to be awakened somehow. In the formation of fatigue, interest acts directly opposite to difficulty. Lack of interest, or simply put, boredom, is a powerful factor in tediousness even when the true elements of difficulty are absent.

However, this should not be overestimated. Interest may sometimes not destroy fatigue, but only mask it. Some teachers believe that emotions can delay and mask the most severe and debilitating fatigue, which will manifest itself sharply in subsequent lessons.

Negative emotions, in contrast to positive ones, reduce the level of functioning of nervous structures and mental activity. From this point of view, school grades appear in a somewhat unusual light. Students, after receiving negative grades, perform other tasks of the same type worse, and their performance decreases. Therefore, teachers need to be very careful in assessing work, not to abuse it and give bad grades only in cases where the student really deserves them, and at the same time be extremely objective. A bad score hurts much more if the child deep down believes that he was awarded unfairly.

To create a favorable emotional climate great importance have a word of encouragement spoken by the teacher, deserved praise, and unnecessary reproaches, especially undeserved ones, lead to a depressed state of children. Teachers themselves note that the student, when interacting with whom the teacher most often becomes irritated and dissatisfied, experiences a certain discomfort, depression and lack of self-confidence. As a result, the student responds worse during the survey, which causes even greater dissatisfaction with the teacher. A vicious circle is created, which often results in the child becoming neurotic.

Even a special diagnosis has been proposed to designate neuroses caused by improper behavior of a teacher - didactogeny. Therefore, the teacher’s relationship with the student should be built on three pillars: fairness, benevolence and respect. The student's respect for the teacher is taken for granted, but the teacher's respect for the student has to be reminded.

You should be especially careful with teenagers. They are characterized by a need for self-affirmation, for recognition of their rights and capabilities by adults. Well-developed physically, almost adults in appearance, teenagers tend to overestimate their social development and are sensitive to its underestimation. This is the source of frequent conflicts with elders, in particular with teachers. A schoolchild, even the youngest, is already a person and has the right to expect respect for himself. This will not reduce the teacher’s authority or destroy the necessary distance. It is necessary to learn to combine demandingness towards children with love and respect for them.

Psychoprophylaxis - a branch of medicine that deals with the development of measures to prevent the occurrence of mental illnesses or their transition to chronic course.

Using psychohygiene data, psychoprophylaxis develops a system of measures leading to a reduction in neuropsychic morbidity and facilitating their implementation in life and healthcare practice.

Methods of psychoprophylaxis include studying the dynamics of a person’s neuropsychic state during work, as well as in everyday life.

Psychoprophylaxis is usually divided into individual and social, in addition, on primary, secondary and tertiary.

Primary Prevention includes the sum of measures aimed at preventing the very fact of the occurrence of a disease. This includes a broad system of legislative measures to protect public health.

Secondary Prevention is the maximum identification of the initial manifestations of mental illness and their active treatment, i.e. this type of prevention that contributes to a more favorable course of the disease and leads to a faster recovery.

Tertiary prevention consists in preventing relapses, achieved by carrying out measures aimed at eliminating factors that impede the patient’s work activity.

The efforts of doctors and teachers are united in order to carry out appropriate psychohygienic and psychoprophylactic work in relation to the education of the younger generation.

A wide network of forest schools, sanatoriums, pioneer camps, and playgrounds successfully serves the cause of mental hygiene and psychoprophylaxis.

Program provisions

Psychohygiene, subject, theoretical foundations, sections, main directions. Hygienic education. Psychoprophylaxis, definition, content, sections. Primary prevention as a system of nationwide measures to improve public health. Secondary prevention - work with high-risk groups for morbidity, diagnosis, correction therapy. Tertiary prevention is assistance to people who have been ill in order to prevent relapses of the disease, decompensation and disability. Tasks of clinical psychology at all three stages of prevention. Advisory, restorative and corrective forms of preventive activities of psychologists. Interrelations and distinctions between the branches of “Psychohygiene” and “Psychoprophylaxis”.

Lecture notes

Psychohygiene - the science of ensuring, preserving and maintaining human mental health. It is an integral part of the more general medical science of human health - hygiene. Studies measures and means of forming, maintaining and strengthening people's mental health and preventing mental illness.

A specific feature of mental hygiene is its close connection with clinical (medical) psychology, which V.N. Myasishchev is considered as the scientific basis of mental hygiene. In the system of psychological sciences proposed by the famous domestic psychologist K.K. Platonov (1972), mental hygiene is included in medical psychology.

Theoretical basis of mental hygiene - social and general psychology, psychotherapy, social psychiatry and physiology of higher nervous activity.

Elements of mental hygiene appeared in human life long before the systematic development of the principles of mental hygiene took place. Even ancient thinkers thought about the need to maintain one’s own mental health and balance in interaction with the outside world. Democritus emphasized the importance of a “good, balanced life” for the human psyche, and Epicurus called it “ataraxia,” the calmness of a wise person. The first special work, “Hygiene of the Passions, or Moral Hygiene,” belongs to Galen.

The very concept of “mental hygiene” arose in the 19th century, when the American K. Beers, being a long-term patient of a clinic for the mentally ill, wrote the book “The Soul That Was Found Again” in 1908. In it, he examined shortcomings in behavior and positions medical workers in relation to patients, and subsequently all his activities were aimed at improving the living conditions of mentally ill people not only in the clinic, but outside the walls of the hospital.

Historically, the emergence of mental hygiene is associated with the first congress of psychiatrists in Russia (1887), at which prominent domestic psychiatrists (S. S. Korsakov, I. P. Merzheevsky, I. A. Sikorsky, etc.) turned to the public with the idea of ​​​​developing a program and creating systems for preventing nervous and mental diseases. The founder of mental hygiene in Russia. I.P. Merzheevsky saw the most important means of preserving mental health and increasing productivity in the high aspirations and interests of the individual.

Psychohygiene deals with the study of the influence of the external environment on human mental health, identifies harmful factors in nature and society, determines and organizes ways and means of overcoming adverse effects on the mental sphere.

Important issues and areas of research are:

human ecology - the study of factors and environmental conditions affecting the mental development and mental state of a person,

caring for the strengthening of somatic health, the harmonious all-round development of the individual,

caring for the proper upbringing of children and adolescents,

rationalization of the learning process at school in order to prevent neuropsychic overload;

psychological climate in large and small social groups;

development of methods for increasing the mental resilience of workers whose professional duties require significant emotional stress;

the system of relationships of a sick person to himself, his illness, medical staff, etc.

epidemiological transcultural studies of morbidity, microsociological,

The main goal of mental hygiene is to maintain mental health and peace of mind. It is designed to help people -

avoid adverse effects that are dangerous to his mental health,

teach him to cope with those difficulties that could not be avoided, using natural resources or changing his attitude towards them.

In practice, achievements of mental hygiene can be realized by:

creation of scientifically based standards and recommendations for state and public institutions that regulate the conditions of various types of human social functioning;

transfer of psychohygienic knowledge and training in psychohygienic skills to medical workers, teachers, parents and other groups of the population that can significantly influence the psychohygienic situation as a whole;

sanitary and educational psycho-hygienic work among the general population, involving various public organizations in the promotion of psycho-hygienic knowledge.

There is a varied taxonomy of sections of mental hygiene. Psychohygiene usually includes:

personal (individual) and

public (social) mental hygiene.

Sections of mental hygiene :

occupational psychohygiene, or industrial psychohygiene, which studies the influence of types and working conditions on mental health,

mental hygiene of children and adolescents

school mental hygiene, the subject of which is the influence of educational conditions on the mental health of school-age children.

mental hygiene of the elderly,

mental hygiene of mental work,

family psychohygiene,

mental hygiene, etc.

Hygiene education

This is a comprehensive educational and educational activity aimed at developing conscious and responsible human behavior in order to develop, maintain and restore health and ability to work. It forms a person’s knowledge, views, beliefs, motives and behavior in relation to health and illness, and is an integral part of both general education and upbringing and the health care system.

Transfer of medical and hygienic information provided through various methods, forms and means.

Informational - receptive the method is based on the presentation of ready-made information and ensures the assimilation of knowledge at the level of perception and memorization;

reproductive method - explanation of the conclusions of medical science, coverage of options for solving the problem;

problem method - discussion of various options for solving the problem, which is aimed at a creative approach to implementing the norms and rules of a healthy lifestyle.

Each of the methods can be implemented using certain forms and means. Distinguish individual, group and mass forms of hygienic education .

Forms of individual influence make it possible to take into account the characteristics of the recipient as much as possible. They are used, for example, in the process of communication between a psychologist and a patient (conversation, instruction, consultation - face-to-face or by telephone, personal correspondence).

Forms of group influence are used for differentiated hygienic education of various age, gender and professional groups of the population, as well as for practical training. Radio and television broadcasts, publications in the press are used to form public opinion and a responsible attitude towards health and health-improving activities, and widely inform the public about the health status of the people and their individual groups.

Psychoprophylaxis

Psychoprophylaxis - chapter general prevention, which includes a set of measures to ensure mental health and prevent the occurrence and spread of mental illnesses.

To carry out these activities, psychoprophylaxis uses a number of methods:

medical examination of the mental state of various population groups - students, military personnel, etc.;

analysis of data from statistical studies of the incidence of mental illness and the conditions for their occurrence;

early diagnosis of mental illness;

sanitary educational work:

organization of special types of medical care - primarily psychoneurological dispensaries, day and night hospitals, sanatoriums.

The objectives of psychoprophylaxis are :

preventing the action of a pathogenic cause on the body and personality;

preventing the development of the disease through its early diagnosis and treatment;

preventive treatment and measures to prevent relapses of the disease and their transition to chronic forms.

Our country has adopted an international classification of the stages of psychoprophylaxis. According to the terminology of the World Health Organization, prevention is divided into -

primary

secondary and

tertiary

Table 1 presents a comparison of the content put into the concept of “psychoprophylaxis” by different authors.

Performing psycho preventive measures requires special knowledge in the field of clinical (medical) psychology, psychiatry and psychotherapy. This is especially important given the close relationship between a person’s physical and mental health. Mental health affects a person's physical health, and physical problems can cause serious emotional distress.

Primary psychoprophylaxis is a set of measures aimed at preventing harmful effects on human psyche and prevention of mental illness in mentally healthy populations.

At this level, the system of psychoprophylaxis consists of studying the mental endurance to the effects of harmful environmental agents and possible ways increasing this endurance, as well as preventing psychogenic diseases.

Primary psychoprophylaxis is closely related with general prevention and provides for the comprehensive participation in it of a large circle of specialists: sociologists, psychologists, physiologists, hygienists, doctors.

In essence, this is a medical examination of a healthy population with the implementation of a wide range of psychohygienic measures, since the following can contribute to the occurrence of neuropsychic disorders:

unfavorable socio-psychological conditions of human existence (information overload, mental trauma and microsocial conflicts, improper upbringing in childhood, etc.),

factors of a biological nature (somatic diseases, brain injuries, intoxication, exposure to harmful substances during the period of intrauterine brain development, unfavorable heredity, etc.).

A special role in the implementation of primary psychoprophylaxis is given to psychiatrists, psychotherapists and clinical (medical) psychologists, which are intended to carry out not only early detection neuropsychiatric diseases, but also to ensure the development and implementation of special psychoprophylactic and psychotherapeutic measures in various spheres of human activity.

Secondary psychoprophylaxis - this is the earliest identification initial phases of neuropsychiatric diseases and their timely (early) active treatment .

It consists of monitoring the severity or preventing the negative consequences of an already ongoing mental illness or psychological crisis.

According to the recommendation of the World Health Organization, under secondaryprevention means treatment . Poor quality, untimely treatment for neuropsychiatric diseases contributes to their protracted, chronic course.

The successes of active treatment methods, especially the achievements of psychopharmacology, have had a noticeable impact on the outcomes of mental illnesses: the number of cases of practical recovery has increased, and the discharge of patients from psychiatric hospitals has increased. However, it should be remembered that secondary prevention is aimed not only at the biological basis of the disease, it requires the use of psychotherapy and sociotherapy in the broad sense of these concepts.

Tertiary psychoprophylaxis - this is the prevention of relapses of neuropsychiatric diseases and the restoration of the working capacity of a person who has suffered from the disease.

Tertiary psychoprophylaxis is aimed at preventing disability if a person has a neuropsychiatric disease .

For example, for various affective disorders such as manic-depressive psychosis, lithium salts are successfully used for preventive purposes. For neuroses, the main place in supportive therapy belongs to psychotherapy, etc.

To prevent loss of performance due to neuropsychiatric diseases or professional and personal crises, it is usually

about professional rehabilitation (search for new resources in professional activities, opportunities for professional growth or, in some cases, a possible change of profession);

about social adaptation (creating the most favorable conditions for a sick person when he returns to his usual environment),

about finding ways for self-actualization of the individual (the individual’s awareness of his own capabilities to replenish the resources of growth and development).

Rehabilitation (Latin rehabilitatio - restoration of rights) - a system of medical, psychological and social measures that prevent further development of the disease, loss of performance and aimed at the earliest and most effective return of sick and disabled people to socially useful work and active social life.

Treatment of the disease can be carried out without special rehabilitation means, but rehabilitation also includes therapeutic means to achieve its goals.

The most important tasks of rehabilitation are the restoration of the personal (in one’s own eyes) and social (in the eyes of others) status of the patient - family, work, social.

MM. Kabanov (1978) identified the principles and stages of rehabilitation for neuropsychiatric disorders.

Basic principles of rehabilitation :

partnership - constant appeal to the patient’s personality, coordinated efforts of the doctor and the patient in setting tasks and choosing ways to solve them;

versatility of influences - indicates the need to use different measures of influence, from biological treatment to different types of psychotherapy and sociotherapy, involving the family and immediate environment in the recovery of the patient;

unity of psychosocial and biological methods of influence - emphasizes the unity of treatment of the disease, impact on the body and personality of the patient;

gradation of influences - includes a step-by-step transition from one rehabilitation measures to others (for example, in the initial stages of the disease, biological methods of treating the disease may prevail, and in the stages of recovery - psycho- and sociotherapeutic methods).

Main stages of rehabilitation :

restorative therapy - treatment in a hospital, active biological therapy with the inclusion of psychotherapy and sociotherapy, a gradual transition from a gentle regime to an activating one;

readaptation - begins in a hospital and continues in out-of-hospital conditions, adaptation to the family, along with supportive therapy, labor treatment is used, and, if necessary, training in a new profession;

rehabilitation in proper meaning words - rational employment, normalization of living conditions, active social life.

Table 2 below presents the content of the concept of primary, secondary and tertiary psychoprophylaxis in medical psychology (Chuprov L.F., 2003).

Participation of clinical psychologists in psychoprophylaxis and rehabilitation of patients and in the restoration of impaired higher mental functions.

Clinical psychology is involved in solving applied problems related to the prevention and occurrence of diseases, diagnosis of diseases and pathological conditions, psycho-corrective forms of influence, in the social and labor rehabilitation of sick people.

Representatives of a variety of professions take part in psychoprophylactic activities - doctors, psychologists, teachers, sociologists, lawyers.

The task of psychologists primary psychoprophylaxis, - to form an idea of ​​a healthy lifestyle, the value of health, a sense of the need for health in all people.

IN within the framework of secondary psychoprophylaxis Clinical psychologists carry out diagnostic, correctional and psychotherapeutic work. The role of psychologists involves advisory and restorative forms of preventive activity. This also includes psychological work with risk groups, correction of risk factors and lifestyle.

Tertiary prevention- work with people who have recovered from the disease, aimed at preventing disability or recurrence of the disease. Clinical psychologists are involved in the decision psychological tasks rehabilitation of patients of various profiles - mental, neurological, somatic, etc. There are three types of tasks:

correction of the risk of suicide or disability, recurrence of the disease;

correction of anxiety, level of aspirations, motivation, post-morbid syndromes;

restoration of impaired HMF;

restoration and normalization of relations in the environment.

Let's consider the question the relationship between two sectors: mental hygiene and psychoprophylaxis, a number of authors put a sign of identity between these two concepts, and they have reasons for this.

The German researcher K. Hecht (1979), in his book, giving an extensive historical review, substantiating the science of mental hygiene, gives the following definition of this science:

“By mental hygiene we mean the preventive protection of a person’s mental health

by creating optimal conditions for the functioning of the brain and the full development of the mental properties of the individual,

by improving working and living conditions, establishing multilateral interpersonal relationships,

and also by increasing the resistance of the human psyche to harmful environmental influences."

According to psychologist K.K. Platonov, “Psychohygiene is a science that lies at the intersection of medical psychology and the medical science of hygiene and, as the latter, is aimed at improving the environment and human living conditions.”

L.L. Rokhlin (1983) distinguishes between these concepts. Noting that “Psychoprophylaxis is closely related to mental hygiene. These concepts can be distinguished only conditionally, since maintaining and strengthening mental health is impossible without preventing mental illnesses.”

He draws this line as follows:

"Psychohygiene, in contrast to psychoprophylaxis, has the main goal of preserving, strengthening and improving health through the organization of an appropriate natural and social environment, an appropriate regime and lifestyle. Psychoprophylaxis is an activity aimed at preventing mental disorders.".

Thus,

Psychohygiene - the science of preserving, strengthening and improving health by organizing an appropriate natural and social environment, an appropriate regime and way of life,

and psychoprophylaxis - activities aimed at preventing mental disorders.

Appendix 2.

Psychiatry: A Guide for Doctors and Students. - ML.: State Medical Publishing House, 1931. - Ch. 5.- pp. 188–203.

The study of mental disorder, in particular the causes and conditions of its development, is aimed at developing the most rational measures to combat neuropsychic morbidity, which, in ideal plans for a better future, should be subject to complete destruction. The broad scope of psychiatry, the complexity and difficulty of psychiatric problems, the lack of development of many basic issues clinical psychiatry, are the reason for a certain hypertrophy of attention to that part of it that deals with theoretical study, and obscure the actual therapeutic and preventive aspects of it. This state of affairs is explained, on the one hand, by skepticism inherited from the past and not yet overcome in relation to what psychiatry can do in terms of treatment, on the other hand, by its great disunity, which can be discussed even now, with general medicine . A special discipline must be created - mental hygiene, which must engage in the development and systematization of correct information about the most rational conditions for the activity of the nervous system, ensuring the possible long-term preservation of its healthy structure and performance, and about all the harm that threatens it. At the same time, studying should not be an end in itself, but only a starting point for an active struggle for healthy nervous system, in other words, mental hygiene should not only go hand in hand with psychoprophylaxis, but also to merge with it. This work should, to a certain extent, be a synthesis of the activities of a psychoneurologist in the proper sense and a hygienist, sufficiently armed with all the knowledge necessary to ensure that the requirements set by psychiatrists are coordinated with general medicine and hygiene and can provide one integral system of psychosanitary measures. It is necessary to change the current state of affairs, when psychiatrists in most cases are mainly clinicians in their activities, and hygienists do not have sufficient psychiatric information. It should be said, however, that psychiatry, represented by its most prominent representatives, has long been revealing a fairly broad horizon and a clear understanding of the tasks of psychoprophylaxis. For example, in the manual on psychiatry of the late S.S. Korsakov, written 25 years ago, is given so full program preventive measures, that the implementation of much of what was outlined in it began only from the time of the October Revolution, and it has not been fully implemented, despite the correctness of the principles underlying it, even now. Example S.S. Korsakova is far from the only one; psychiatrists who do not limit the scope of their activities to psychiatric hospitals and who display a fairly deep understanding of the state of affairs have always been public figures. They understood that any successful fight against neuropsychic morbidity was unthinkable without changing the very conditions of life and work, and social relations in general. Therefore, it is clear that the implementation of a system of measures, even if absolutely necessary and clear in their essence from a psychiatric point of view, presupposes, however, a change in all public relations, is possible only if such measures are consistent with the progressive course of social development. The psychiatrist must make every effort to disseminate psychohygienic information as widely as possible and especially strive to ensure that it is also taken into account by those on whom changes in lifestyle depend. Great social reformers were at the same time great psychologists, who often intuitively understood the springs that move people, and were able to take into account the psychology of the masses. Not only the neuropsychological improvement of the population, but also the harmonious development of society as a whole, requires, when carrying out social reforms, knowledge of the psychology of both individuals and entire groups, and taking into account the peculiarities of the structure and functioning of the nervous system.

The nervous system and, in particular, the brain, which is the carrier of neuropsychic activity, is a complex in its structure and at the same time very sensitive and easily vulnerable organ, the normal functioning of which requires certain conditions. It is usually not clearly recognized that the brain, like the body as a whole, is a complex and fragile apparatus, a kind of machine that requires very careful care and unusually careful treatment. Meanwhile, it is rare for a person to treat any machine or tool as carelessly and frivolously as he treats his body and health.

Determining the most favorable conditions for the activity of the nervous system, issues of its nutrition, work and rest, fatigue, and the peculiarities of its reaction to changes in external conditions is what neuropsychic hygiene should deal with. Professional work, its conditions, certain dependencies and connections with the team, all these circumstances are essential for a person - a social being and a member of the team.

In view of this, occupational hygiene should occupy a prominent place in hygiene, and as for relationships with the team, the first place should be to clarify the optimal conditions in social relations. Neuropsychic hygiene, which ideally sets itself the task of developing such living and working conditions that would exclude any thought about any pathology, of course, goes beyond the scope of psychiatric work itself. A psychiatrist is obliged to develop psychohygienic problems if he does not want to remain a pure clinician, and must work in these areas hand in hand with a public figure, with a neurologist, internist and hygienist in general. If we have in mind the idea of ​​a psychiatrist in the ordinary sense, then he must, to a certain extent, cease to be himself; This seems like a paradox, but such an expansion of the tasks of psychiatry is logically inevitable.

Of great importance is the question of protecting the brain from any adverse physical influences, questions nutrition him and in particular blood circulation. Although the skull is a relatively serious barrier to any adverse effects, this barrier often turns out to be insufficient. Not to mention gross mechanical damage that violates the integrity of the skull and the very substance of the brain, which are actually related to pathology and give immediate results in the form of changes in neuropsychic activity or some consequences (symptoms of dementia, phenomena of local irritation, convulsive seizures) that affect later more or less significant time, we can talk about minor but long-term trauma, the effect of which may not be felt immediately. This applies mainly to manual workers who must carry significant weights on their heads, or in general to workers who otherwise injure their heads. The latter should also be free from such influences as the pressure of heavy headgear that is not quite suitable in size (firefighter helmets) or any special equipment (for example, employees at telephone exchanges).

Various mechanical moments can more or less significantly disrupt blood circulation, the correctness of which is very important. For the proper functioning of the nervous system, the issue of sufficient blood supply is of enormous importance. If you need to count general rule that each functioning organ needs a greater influx of nutritional material, then in particular these phenomena of functional hyperemia occur in relation to the brain, where we can talk not only about hyperemia of the entire organ, but even of individual parts that are currently functioning. Due to the fact that there is not so much blood in the body that all organs are simultaneously supplied with it sufficiently for intensive functioning, it is of great importance for normal mental activity that the correct blood supply to the brain is not disturbed in any way and that there are no reasons causing increased blood flow to some other organs. This gives rise to the well-known requirement for a more or less long rest after eating, which must be done before continuing work, especially mental work. Work only goes well and gives satisfaction when it takes place in the best conditions, and these, first of all, include a sufficient blood supply. The latter should not be disturbed by any mental moments, worries or distractions to the side. Optimal blood circulation conditions are achieved when attention is completely absorbed in the work being done and is not distracted by anything. Therefore, while working, a person should not only not be tired or excited, but should not be disturbed by anything, for example, the presence of a large number of other people, noise and screams in neighboring rooms.

Blood supply is important because the blood flow brings nutrients and oxygen necessary for tissues. In addition to the quantitative side, namely sufficient blood flow, its composition is important, which largely depends on the composition of the food. The latter is often taken into account mainly in terms of caloric content, which varies depending on the greater or lesser richness of the food in proteins, fats and carbohydrates. If we take into account only the number of calories consumed by workers in various professions, it turns out that in a long row, at one end of which there is a person doing nothing, consuming relatively few calories, and at the other - a mower in the midst of his intense work; A person engaged in mental work, in terms of the number of calories expended, is almost no different from someone doing nothing. From this it would be wrong to conclude that for the success of neuropsychic work, neither the amount of food nor its nature matters. There are certain groups of nutrients that have a particularly beneficial effect on neuropsychic activity. These include substances plant origin, fruits and vegetables, especially tomatoes, spinach, as well as fish, caviar, eggs and dairy products. Vitamin richness matters. If we keep in mind that with all vitamin deficiencies, for example, with rickets, scurf, beriberi, nervous activity is more or less sharply upset, then it is clear that the stimulating effect of vitamins also affects the activity of the nervous system. For the same reason, it should be considered very suitable for nourishing the nervous system. fish fat; It, having a high calorie content, contains a large amount of vitamins and especially the antirachitic vitamin (vitasterol D). For the same reason, caviar can be especially recommended. It, just like eggs, namely the yolk, deserves attention for its richness in phosphorus. The latter is considered a remedy that strengthens and tones the nervous system. The expression “ohne Phosphor keine Gedanken,” which dates back to the times of Buchner and Moleschott, schematically indicates the role that phosphorus plays in the physicochemical processes occurring in the nervous system. Its increased excretion in the urine is a phenomenon that has been precisely proven both in relation to pathological cases, with more or less significant destruction of the nervous elements, and to states of intense intellectual work. The question of the meaning of a meat diet is not entirely clear. The experience of the East, namely the Chinese and Japanese, shows that very productive mental work is possible exclusively with a plant diet, namely rice. The European diet includes meat as something obligatory and sometimes very large quantities; to a certain extent, it is considered advisable that sometimes meat is consumed undercooked, almost raw, if we keep in mind that heating to high temperature kills vitamins. It is known that in the North the best remedy Scurvy is treated with fresh blood from freshly killed animals. But one must think that the diet of a modern cultured person suffers from a more or less significant excess of meat. The abundance of extractive substances cannot be considered useful, especially if we mean game, not always fresh or smoked meat, corned beef, sausages and canned meat. It cannot be denied that known extractive substances taken in limited quantities can tone and stimulate the nervous system, but large amounts of them are in any case harmful. The question of the most suitable substances for nourishing the nervous system and, in particular, the most appropriate diet for people involved in scientific work, was the subject of special research, and the general conclusion is precisely that here, in particular, attention should be paid not to the quantitative, but to the qualitative side, the richness of phosphorus, vitamins, as well as to the taste side and the very form of cooking. In addition to small amounts of meat, preferably white, fish, especially recommended: caviar, fresh vegetables, fruits, grapes, and chocolate.

Nutrition that is sufficient in quantity and quite suitable in quality is one of the most essential conditions for good functioning in general and in particular labor productivity and the associated good health. This applies, of course, to the entire body, but especially to the nervous system, which is a very sensitive reagent. In this case, one very important circumstance should be noted that specifically characterizes the nervous system: reduced nutrition does not immediately weaken intellectual performance, but may cause a temporary state of some increase in productivity. This rise cannot continue for a long time, and after it, if appropriate measures are not taken in time, a decline that is difficult to restore occurs as a result of nervous exhaustion.

In order for the nutrition of the nervous system, as well as the entire body, to be at its best, careful attention to somatic health and in particular to the state of the gastrointestinal tract is necessary. First of all, good condition of the oral cavity and especially teeth is of great importance. With good reason, reorganization, i.e. bringing them all into complete order, which is supported by long-term observation, is considered one of the necessary links in the chain of preventive measures that are included in the activities of children's preventive outpatient clinics. This sanitation is of course just as important for an adult. The same should be said regarding the stomach and intestinal regulation. In the clinic we constantly have to observe the adverse effects of constipation in the sense of worsening mood, frequent intestinal disorders in melancholic patients, cases of agitation in paralytics, which is sometimes relieved by a laxative or an enema. If we recall the facts and considerations given by I.I. Mechnikov in his “Studies of Optimism”, it is clear that the issue of regulating the intestines, in particular preventing fermentation processes in it, is not such an insignificant phenomenon that it can be neglected. Of course, such regulation can be most easily and expediently achieved with an appropriate, predominantly plant-based diet rich in fruits and vegetables. Another aspect that is usually overlooked is the environment and conditions in which food is consumed. It is extremely important that this is not done hastily, that the food is chewed properly, that the person is not particularly tired, agitated, or distracted by anything. We must not forget that taste also matters. appearance, serving and the entire environment in which food takes place. Russian people are very guilty in this regard. He usually tries as quickly as possible, often on the go, taking a break from work for a minute, to fill his stomach with anything and get back to work. The thought of taking care of his nutrition - tastier and better food, eating more calmly - is completely unusual for him.

It is necessary in every possible way to spread the conviction that a well-prepared dinner eaten in a calm atmosphere is not a luxury, not a bourgeois prejudice, but one of the essential requirements of neuropsychic hygiene. Here again, referring to clinic data is useful. Experience shows that it is often possible to quickly calm an excited patient by feeding him. If in the hours before lunch and dinner in psychiatric hospitals usually arousal increases sharply, this is only an exaggerated expression of normal relationships: good and regular nutrition is a necessary condition for good health, productivity of mental and all other work, and long-term preservation of neuropsychic health.

Nutrition also includes the question of sufficient oxygen supply to the brain, which is related to the question of staying in the fresh air. This side is also very often ignored. Physical education, which involves the use of light, sun, and air for various types of exercises, has only recently begun to receive attention. Due to the relatively harsh climate, Russian people must spend a lot of time indoors. Meanwhile, living conditions in terms of cubic capacity and especially lighting and ventilation leave much to be desired, whether we are talking about the rural or urban population.

While living conditions have changed for the better in many respects since the revolution, in many cases, especially for peasants, they remain extremely difficult. A small, poorly lit village hut or a room in a crowded apartment in the city cannot guarantee sufficient use of fresh air. This is also facilitated by the fact that food is usually prepared here and clothes are washed: in the village, a calf or piglets are often found here. In addition, lighting - a smoking kerosene lamp - is not uncommon now, as is a smoking hut. Sometimes some kind of handicraft production is carried out in the same premises. Under such conditions, poisoning of the nervous system, as well as the entire body, is inevitable with various toxic products formed as a result of the decomposition of organic substances, fumes, secretions of the human body, and food debris. The adverse effect of such conditions on the nervous system is beyond doubt. In addition to the great danger of developing various types of infections, you need to keep in mind more or less severe consequences for general condition. They, of course, especially affect the developing organism, which is why children often develop scrofula, tuberculosis, and rickets.

The reaction from the nervous system, which is constant in these cases, is well known. In addition to frequent headaches, dizziness, nausea, irritation from the respiratory system, it can be expressed in the most various symptoms. For example, according to new works, the irritating effect of decaying particles of the epidermis of human skin may be the allergic moment that gives bronchial asthma. The bad influence of stale air suggests that a long stay in the fresh air, together with an increase in the cubic capacity of the room and better ventilation, should act extremely beneficial in all respects. Here, the influence of air as such and the ozone contained in it is joined by the action of sunlight, the significance of which has not yet been fully appreciated. If the climate and, above all, the more or less bright sun explain the difference in the character and temperament of cheerful, expansive southerners and gloomy, serious northerners, if more and more evidence is presented that the biological processes occurring in the body depend on cosmic influences and, above all, on those , which come from the sun, then the huge role of sun rays for the life of the nervous system is clear. As you should think, ultraviolet rays especially play a role here. Therefore, even staying in a large, well-ventilated, often sunny, but glassed room cannot replace being in the sun, because... glass blocks a significant amount of rays of this kind. In America, houses are now being built with windows made of glass prepared in such a way that as much ultraviolet rays as possible are transmitted. Not to mention the high cost of such glasses, they still cannot replace the direct action of sunlight. Our country, for most of its extent, is rather sparingly illuminated by the sun, but it is all the more necessary to make fullest possible use of the beneficial effect that is associated with its rays. The Germans have a special concept of Sonnennaturen - sunny natures. These are mental individuals with a bright, elevated mood, with great resistance to adverse influences, always remaining clear and calm, with great activity and performance. It is assumed that these individuals received the basic properties of their nature from the sun, and this is not without reason. It is therefore necessary to fight in every possible way not only for large, bright, well-ventilated premises for the broad masses of the population, but also to promote the need for as much exposure to the sun as possible, not only for walking, but always and wherever possible. Working outdoors in the sun is always more productive than working indoors. From here - useful action children's and other playgrounds, outdoor schools. Not to mention the beneficial effect of being in the sun in terms of lifting your mood and increasing overall productivity, it can be argued that one hour of mental work after a long walk will give more than poring over a book for several hours in a cramped, stuffy room. Taking care of physical health in general is one of the essential aspects of neuropsychic hygiene. To the long-known mens Sana in corpore sano, pathology could add a lot of facts that represent, so to speak, a repetition in a negative form of the same situation. Not only is a fully expressed mental disorder a general disease in which both the central nervous system and the entire body suffer, but also the most initial, just outlined disorders are closely related to somatics. One can even say that it is precisely these mildly expressed phenomena, which include most of what is defined by doctors as general nervousness, that usually represent only the reaction of the neuropsychic sphere to certain disorders in bodily health. Pulmonary tuberculosis is almost always accompanied by changes in well-being, instability and increased excitability, and this applies not only to fully developed forms, but even to hidden ones. One can definitely talk about a special form of nervousness caused by tuberculosis intoxication. In many cases, in connection with developing tuberculosis, we have to observe more significant changes in character, sometimes with the appearance of isolation, distrust, and a kind of schizoidization of the personality. The same applies to other infections - both chronic and acute. The general weakening of the body, no matter what it is caused by, makes it more vulnerable, less stable in the fight against various harms and, as it were, creates the conditions of physical readiness for the development of neurotic reactions.

From what has been said, it is clear how important the demands now put forward and put into practice are. physical education. Naturally, care in this regard should be taken as early as possible, namely from childhood, because The foundations of health in general and neuropsychic health in particular are laid very early. A hardening system is useful, which should take into account not only an increase in resistance to various physical agents, for example, cooling, infections, but also to mental factors. Various cases From pathology, especially in childhood, they clearly show that, completely artificially, thanks to the wrong approach of others, a special nervous sensitivity can be developed, due to which a child can easily become a toy of various unfavorable external moments. Caring, but not having sufficient experience, the mother often shows too warm sympathy for small troubles in the child’s life, cries over him when he hurts himself, laments pitifully over him and unnecessarily fixes the child’s attention on unpleasant experiences, develops tearfulness in him and increases general sensitivity . And on the other hand, it is natural that a system of ignoring pain, whether it be purely physical pain, or mental experiences caused by some life complications, can significantly reduce the traumatic significance of such moments and make a person stronger and more resilient in the fight against life’s adversities .

Correct resolution of issues plays a huge role in neuropsychic hygiene. sex life. It is here that even seemingly minor deviations lead to severe nervous disorders, and here, in particular, hygiene should begin from childhood. The main guiding points must be considered that sexual desires are revealed much earlier than the maturation of the sexual apparatus in its full form, and that long before the appearance of fully formed sexual desires, vague desires and feelings that are closely related to them are discovered, in which there is nothing directly sexual. Thanks to Freud, we are familiar with the phenomena of infantile sexuality, elements of which can be seen in the child’s feeling of love for his father or mother, in admiring his body, in interest in the structure of the genital organs, in everything that is known as manifestations of sexual curiosity. Frequent cases of masturbation, possible in very young children, should be interpreted in the sense of the manifestation of early, although not formalized, sexuality. Early awakening of sexual desires in a period when their adequate satisfaction is impossible is a frequent source of various nervous phenomena. Therefore, one should strive by all means to ensure that, while counteracting the development of sensitivity in general, one should avoid everything that can awaken even unformed sexuality in a child. In this regard, it is dangerous to treat a child with too much tenderness, to hug him warmly, as mothers often do, to kiss him passionately; Kissing on the lips should generally be avoided; You should also not tickle children, which is often done for your own amusement or out of a desire to entertain the child. Equally important is the requirement that the child have his own bed and not sleep in the same bed with his mother or with his brothers and sisters. Particular care must be taken to protect the child from exposure to the sexual functions of adults. He must grow and develop among interests appropriate to his age, and in an environment accessible to his understanding. Everything incomprehensible frightens and worries him, and this especially applies to sexual acts. Even if we assume that the role of sexual trauma in relation to childhood and exaggerated by Freud's supporters, yet their significance is enormous. Psychoanalysis proves how a child's imagination is affected when he finds himself an unwitting spectator love relationship between adults, and what role these experiences play in the genesis of neurotic states developing on this basis. There is even more danger when the child himself becomes the object of some kind of sexual manipulation of him by adults or older children and adolescents.

From the point of view of neuropsychic hygiene, the correct resolution of issues of sexual education is of great importance. The previous system, when gender relations, conditions of conception and birth were shrouded in mystery not only for adolescents, but even for young people, especially girls, was condemned and gave way to principles sex education. At an age when such questions naturally arise about where children come from, it is useful to provide information about reproduction in plants and animals, the most general data about the corresponding processes taking place in humans. This, firstly, removes the aura of something mysterious and therefore tempting from the area of ​​sexual relations, and on the other hand, it prevents undesirable consequences when the teenager himself seeks answers to his questions from more experienced comrades or from reading random books. In these cases, it is more than likely that he will receive one-sided and completely incorrect information. It is necessary to fight in every possible way against the harmful influence of inappropriate literature, which, by providing incorrect coverage of various issues related to sexual life, often gives rise to misunderstandings and sometimes directly traumatizes. This primarily applies to the so-called. popular literature concerning masturbation (“Onanism and its consequences”, “Sins of Youth”, etc.). It usually, out of a laudable intention, warns against masturbation and force those who have already become acquainted with it to abandon it, its harm, consequences for memory are described in too vivid colors, its role in the origin of nervousness, etc. is strongly emphasized. It cannot be denied that prolonged and persistent practice of masturbation is a phenomenon that is not indifferent to the nervous system, but its harm is excessively exaggerated. Its main danger is that satisfying a need that has become a habit, depending only on the masturbator and not requiring the assistance of others, can be very frequent and lead to purely physical exhaustion. Also not indifferent are the efforts of imagination that the masturbant makes on himself, performing his act and imagining some other situation. Most cases of masturbation, which can be observed in almost half of all children and adolescents, are random and quickly passing phenomena that do not leave behind any consequences. Cases of serious and even mental disorders, which one reads and hears about as phenomena caused by masturbation, refer to subjects in whom these disorders developed on another basis, and masturbation itself is not the cause, but the consequence of them. A teenager who learns from some popular book that he is a masturbator and that masturbation leads to serious consequences, even mental illness, will undoubtedly, first of all, be traumatized by the information he has received and, not being able to more or less immediately lag behind his habits, will torment himself with remorse, will find in himself a weakening of the will and other phenomena that he has read about, and little by little a situation may be created that is very conducive to the recording of painful phenomena. Sanitary education, the importance of which has been placed especially high recently, has a lot of work to do. There is no denying the value of the various popular books and pamphlets that are published last years in large numbers, but very many of them do not provide a completely appropriate coverage of the issues raised, not to mention the fact that they lack proper unity. Sexual education is therefore of great importance, but it must be approached with great caution. The same can be said to a certain extent regarding some scientific monographs, even those written by prominent scientists, for example, about the book of Forel “The Sexual Question”, Krafft-Ebing R. “Sexual Perversions”, etc. The presentation of the subject in them, of course, is strictly scientific, but it is designed for people who have received special education. Thanks to this, certain passages can be misunderstood by an unprepared reader with the same effect as reading inappropriate literature. Moreover, in the interests of protecting neuropsychic health, attention should be paid to the publication of books in which the presentation would not only be scientific, but also, with proper coverage of the subject, sufficiently understandable not only for doctors and, in general, persons who have received a special education.

For a normal state of both physical and nervous health, it is necessary that all the body's needs find natural satisfaction. How is that general rule also applies to sexual life. But, keeping in mind that sexual desire usually manifests itself before the full maturity of the corresponding apparatus is achieved, one should be warned against starting sexual activity too early. It cannot be considered normal when teenagers 16, 15, even 14 years old and earlier are practically familiar with sexual intercourse. Of course, more or less complete physiological maturity occurs individually, but we can still consider that sexual activity before 17–18 years of age is an undesirable phenomenon from the point of view of neuropsychic hygiene. The same applies to various excesses, which are a very common phenomenon. Sexual intercourse can be considered a normal phenomenon when it follows a naturally occurring attraction and is not caused by any artificial stimulants, such as wine, reading literature that is too light in content, or appropriate conversations. You should remember the rule given by prof. V.F. Snegirev: if coitus it is performed without any coercion before going to bed, after a day of work, it is completely normal; coitus after sleep and in the morning - always an excess. From the point of view of neuropsychic hygiene, one should consider this form of sexual intimacy when nothing is done to prevent its natural goal - conception - to be considered completely normal. All contraceptives cannot be considered indifferent, even mechanical or chemical. In particular, one should be warned against such deviations from normal sexual intercourse when, in order to avoid conception, it is interrupted ahead of time. Pathology indicates that such coitus interruptus can lead to various neurotic disorders, in particular to states of obsessive fear. It is very important that sexual intercourse gives complete mental and physical satisfaction. Its absence on one side or the other can lead to various nervous phenomena. This should be especially borne in mind when sexual intercourse only excites, but does not satisfy. The latter often occurs in a woman when her partner suffers from weak potency or, which happens especially often, ejaculatio praecox. On the other hand, continued coitus, so-called coitus prolongatus, produced so that the other party (usually a woman) receives satisfaction is also dangerous in the same respect. Ideal conditions for neuropsychic health should be considered when both parties are equally and simultaneously satisfied. In this case, one must keep in mind not only purely physiological satisfaction, but also mental satisfaction, achieved when both partners in love are not only physically and physiologically suitable for each other (Sympatie d'epiderme of the French), but when they are attracted to each other in other ways. relationship, or at least they are not disgusted with each other.

There is no doubt that the most normal relationships are those in which a person’s life flows most fully, when all aspects of it are developed more or less harmoniously and when all natural instincts, of which sexual is one of the strongest, find appropriate satisfaction. For the affirmation of one’s personality, for a more complete expression of the consciousness of one’s “I,” it is also important that sexual life allows a person to feel like a source of other lives closely connected with him. But it would be too hasty to conclude that sexual abstinence is always harmful under all conditions. Here, of course, a lot has to be taken into account, including individual differences. There are frequent cases of complete sexual abstinence throughout life without observing any changes in neuropsychic health that could be associated with this moment. The intensity of sexual desire varies greatly, and there are cases when quite strong people do not have intercourse for long periods and do not feel any worse for it. But with intense sexual desire, lack of satisfaction can be accompanied by an unpleasant feeling, and can sometimes be the cause of increased nervousness, bad sleep, etc. This can be especially observed during the period of greatest sexual activity. Complete abstinence in such cases is also dangerous because it can cause masturbation. It is definitely harmful if sexual arousal, strongly caused by some special circumstances, does not find appropriate satisfaction. There is no reason to think that sexual abstinence can be a cause of more severe disorders or even psychosis in itself. There are many misunderstandings and misconceptions on this issue in society and even in medical circles. It is a very common belief that the cause of mental disorder is sexual dissatisfaction. Often, caring relatives even marry young people who begin to show signs of a nervous disorder. Such therapeutic marriages are especially often arranged in villages. And here, as in many other cases, we have to take into account the fact that the effect is taken for the cause. As can be considered precisely clarified, the hormonality of the gonads in dementia praecox is usually very low, which is the reason for weakly expressed sexual desire, which is why such patients usually have no sex life. When assessing the importance of sexual abstinence for neuropsychic health, one must also take into account the issue of sublimation, i.e. the transition of lower levels of energy to higher ones, in this case the switching of sexual energy to increased activity in other directions. These pathologies teach that a sexual feeling that has not found satisfaction can be overcome by being directed in another direction, it can be expressed, for example, in a particularly loving performance of the duties of a nurse in caring for the sick, or in increased mental or artistic creativity. It is impossible to imagine the matter in such a simplified form that there is an inversely proportional relationship between sexual life and mental creativity: the more one is, the less the other, and vice versa. The period of greatest sexual activity usually coincides with the most vigorous and productive activity in all directions. One might think that gonadal hormones increase overall activity, either by themselves or by stimulating other hormones.

An example of mild forms of manic-depressive psychosis shows that along with increased sexual excitability comes increased performance and desire for activity. This applies especially to cases of cyclothymia. One can point to Goethe, whose life passed through periods of rise and decline, typical of cyclothymia. At the same time, his periods of most productive creativity coincided with an increase in sexuality, with a tendency to fall in love with all the passion characteristic only of youth, and his last such period was at the age of 70. The activating effect of sexual hormones on performance can be judged by the example of castrati. Although their mental abilities, as such, do not suffer any significantly, they still lack the desire for activity, energy, and courage. Moebius definitely says that castrati have no artistic talents.

All of the above makes it especially necessary in the interests of neuropsychic health to observe the rules of sexual hygiene. Sexual energy is so valuable that it cannot be wasted indiscriminately. The nervous system should be protected in every possible way from the too early awakening of sexual desires and from early sexual activity. Sexual life is especially harmful when the sexual apparatus is not fully formed and the body is not yet fully developed. It is during adolescence that one must strive to ensure that there is no unnecessary waste of nervous energy and that all of it goes not to the side, but to a more complete and harmonious formation of the body. Without reservation, sexual activity may be permitted when it can lead to completely normal childbearing, which usually can only occur after 18–19 years of age. There should be no excesses after. There should be no artificial stimulation for sexuality. Sex life should not be an end in itself and serve only as a means of pleasure. It should be only one of the elements of a complete, harmoniously developed and active life and should naturally lead to childbearing. Moderation in sexual relations should be the slogan of neuropsychic hygiene.

Extremely significant from the point of view of neuropsychic hygiene is the question of the general structure of an individual’s life and the related question of labor . Since the latter is the fundamental thing that gives a person the right both to exist and to a certain expression in the world around him, he is the center around which a person’s entire life with his interests, concerns, hopes and fears fits. Depending on its nature and conditions, it can be the reason that the whole life will be an unbroken chain of unbearable suffering, at best full of boredom and disgust, or work can be a source of joy with which the whole existence will be permeated. Work should essentially be pleasant and joyful. Under normal conditions, a person cannot help but strive to ensure that his energy is directed toward something, so that his muscles or brain are not inactive. The ancient Greeks looked at the situation correctly when, in works glorifying their heroes, they said “that they satiate their hands with labor,” believing that labor is the same need for the hands as food is a need for the stomach. Work is what strengthens the body, stimulates it to increased activity, tones the nervous system, idleness is what relaxes the muscles, leads to general obesity, relaxation, lethargy and boredom. But for work to be just that, certain conditions are needed. First of all, it must be not only involuntary, but also freely chosen and corresponding to the characteristics of the psycho-physical makeup of an individual person. The work of the Chinese coolie and, in general, slaves of all colors and of all times cannot be joyful and leading to health, just as the work of our peasants during serfdom could not be strengthening and health-improving. The hopeless melancholy that is so often heard in Russian folk songs is undoubtedly inspired not only by the boundless expanse of fields and the monotony of Russian nature, but also by the difficult living and working conditions in which workers and peasants were placed throughout their past history until recently. What matters here is not so much the exorbitant burden of labor associated with severe physical exhaustion, but rather the fact that it is forced, and its fruits go least of all to those who work. The concept of hard labor, which is the personification of something especially unbearable, includes not only the idea of ​​its severity, but also the consciousness that it is unnecessary and meaningless from the point of view of the interests of the worker. The emancipation of the peasants as such had a certain significance, but essentially it changed the situation little, because the almost landless peasant remained in the same dependence on the landowner. The transfer of all land, as well as factories and factories to all workers, represents a radical reform, posing the problem of labor in a completely new way. Labor ceases to be hard labor and forced labor and acquires in the eyes of the working people a completely new meaning and significance that they understand. If you pay attention to the fact that it is also decreasing in quantitative terms, then we must admit that a lot has been done to ensure that work is the way it should be, easy and joyful. If, in order to generally improve the economic life of the country, the unemployed disappear, the situation will come even closer to what should be considered desirable from the point of view of neuropsychic hygiene.

In order for working conditions to be completely ideal, an accurate dosage is needed to match the worker’s strengths; it is also necessary that the work be pleasant to him and correspond to his abilities and interests. One of common reasons nervousness - that a person is not doing his job, doing work that does not satisfy him by its nature, precisely because it is not the one that could be most suitable for him due to the characteristics of his psycho-physical organization. Often this happens because a person has not yet had time to sufficiently recognize himself and determine the type of activity for which he was born. This is all the more likely to be the case since some abilities are not immediately revealed. In contrast, for example, to early-detected musical abilities, mathematical talent and an inclination toward scientific creativity are revealed much later, sometimes after puberty. Much more often we have to take into account the fact that a person has to do this or that work out of necessity, and not because he feels a special attraction to it. Previously, this usually took place because the fate of the future employee was controlled by the elders, who determined the life path of the child or teenager and least of all took into account his own needs and inclinations. If in this regard the situation has now radically changed for the better, then difficulties in finding work, forcing one to take on the first job that comes along, represent an abnormal phenomenon that, from the point of view of neuropsychic hygiene, should be eliminated. A significant step forward is the replacement of previous exams as tests of knowledge itself - with tests that set as their goal examinations of a psychotechnical nature, identifying the strengths and weaknesses in the characteristics and talents of an individual. Such examinations are extremely desirable for admission to universities, especially those with a special purpose; they are carried out upon admission to factory teachers and various special schools. Under ideal conditions, the entry of each employee into one or another type of work should be preceded by psychotechnical examination aimed at career guidance- an indication for the employee of the profession most suitable for him according to his abilities. This is partly done, but from a slightly different angle, namely, not by determining the character and talent of a person with an indication of the most suitable types of activity for him, but by selecting the most suitable workers for a certain profession and removing all unsuitable ones. Research carried out in various psychotechnical laboratories, which first appeared in the West, grew out of practical needs to select the most suitable workers for certain professions and were more interested in increasing labor productivity. But because they help ensure that each person finds his or her place in a job that requires as little stress as possible, they are also important from a mental health perspective. Methods for definitions of persons, most suitable for the work of drivers, carriage drivers, pilots, etc. Methods for determining the characteristics of intellectual talent of prof. A.P. Nechaeva and prof. G.I. Rossolimo in the modification that makes it possible to simultaneously study a group of several dozen subjects is especially important because may, in the sense of obtaining reference points for indicating the most suitable type of activity, be suitable on a mass scale. Of course, the existing methods are not yet accurate enough to give completely undoubted conclusions, but the approximate value behind them cannot be denied. In any case, it is necessary to strive to ensure that a person’s life and the axis of his existence - work - more or less accurately correspond to his strengths and characteristics. The research that should precede such an indication of the life path should also take into account the characteristics of physical health. Everyone, even a generally healthy person, may have weaknesses along with strengths; Some organs may be less strong from birth and, under intense stress, may be more likely than others to become insufficient. On the other hand, the far advanced study of occupational pathology, the study of the hazards inherent in each individual profession, has revealed a lot of interesting data. The Institute of Occupational Diseases named after Obukh in Moscow, the Institute of Occupational Medicine in Kharkov and other institutions have established many features related to the profession of teachers, doctors and medical personnel, telegraph operators and telephone operators, various groups of skilled workers; Many occupational hazards have been identified that lead to diseases of specific organ systems. Therefore, when orienting in some cases to a certain profession, it is necessary to take into account not only a person’s abilities, but also his strengths, bearing in mind the harm that threatens him. This especially applies to work that requires a lot of mental effort. Intellectual work is not, of course, the lot of a select few and is more or less accessible to everyone, but great caution is required if we are talking about the fact that throughout a person’s life the basis of his existence will be intense mental work. In this regard, the facts of pathology can teach a lot . It is known that many psychoses, in particular dementia praecox, develop especially often in students of the senior groups of the second stage or in the first years of university. This is partly explained adolescence students, during which a person turns out to be especially vulnerable in all respects, but that’s not all. main reason that during this period the student is required to exert especially great stress, which only those who are sufficiently strong, both physically and nervously, can withstand. In relation to many cases of this group, it can definitely be said that if these young men and women had been given a different attitude without an unbearable intellectual load, they might not have gotten sick at all. The supporting points that made one think in these cases about the need for mainly physical labor and, if intellectual, then not so intense, could be indications of great physical weakness, signs of nervous diseases in the past, perhaps, the accumulation of severe mental illnesses in close relatives. Less severe, but more frequent and therefore, perhaps, especially conclusive are cases when intense intellectual work associated with the implementation of the curriculum turns out to be unbearable, not because we were talking about the possibility of severe psychosis, but due to relative intellectual insufficiency. Bleuler established the concept of relative dementia for those cases of psychopathic characters when increased demands and thirst for various kinds of quests put a person in a position that he is not able to fully cope with due to the conditions of his talent. Without any relation to psychopathy, young people may find themselves in this situation, not suffering from dementia itself, but with limited abilities that prevent them from keeping up with others who are quite gifted. Not wanting to lag behind others, they stretch with all their might, strain their health, fall behind in their achievements, notice this and give various neurotic reactions. In such cases, a change in working conditions and a simpler attitude, with goals that are quite achievable for a given student, can quickly eliminate neurotic disorders, and a more thoughtful attitude to issues of neuro-mental health and a more careful choice of profession, with an accurate consideration of available forces, could help them and prevent. A phenomenon of the same order - an increase in school years previously rare attacks of epilepsy, or even their first appearance in this period. It also points to the need to accurately take into account all the features of a given psychophysical organization when resolving issues related to the choice of profession, preparation for it, the nature and extent of the implementation of the curriculum.

The question of work, of this or that type of labor that determines the direction of each person’s life, is connected with the question of the social value of this work, and here we naturally enter the field of social relations. In modern reality, work is only to a small extent self-service, aimed only at satisfying personal needs. It leads to the creation of values ​​that are also necessary for others, for the collective to which the worker belongs, and ultimately for the entire state. We have seen how important it is for neuropsychic health that work provides a certain amount of satisfaction. There is no doubt that the most complete satisfaction comes from working in a team and for a team. Labor productivity undoubtedly increases when it is carried out jointly, collectively. This has been established more or less long ago in relation to physical labor. The amount of labor performed by a group of workers cannot be calculated by simple arithmetic addition of what each worker does individually. Suffice it to recall what is reported in one story by M. Gorky about the unloading by an artel of loaders of a barge that has broken through the bottom. The artel, united by the consciousness of its unity, in which each of the workers felt not only had no right to lag behind the others, but considered it obligatory to do as much as possible for the common interests, in a short time completed a huge, seemingly impossible job. What matters here is the consciousness of a community of interests and one common goal, competition with each other. The same applies to intellectual work; This feature has to be taken into account in pedology.

Currently, specialists pay a lot of attention to the dynamics of a children's team precisely because working on it not only in terms of education, but also training, represents great advantages over working with individuals. Experimental studies various kinds have shown that the productivity of an individual’s work increases when it is carried out as part of a team, even in relation to more complex activities - assimilation tasks, various calculations. From the point of view of neuropsychic health, it is extremely important to increase labor productivity simply because it gives great satisfaction; but another circumstance is even more important, namely, that in this case the employee feels like a member of the team, doing something useful for the common interests and, to a certain extent, responsible to it. To obtain complete satisfaction from one’s activities and from one’s entire life, it is of great importance to realize one’s belonging to one or another group or, more precisely, to groups that are connected with each other, and each more general group includes the previous ones as part of approximately in this order: family, loved ones, trade union, class. If it has always been the case that an individual felt weaker, more defenseless and more uncomfortable than organized groups, then in the conditions of the modern structure of social relations this general rule is especially emphasized. The Clinic of Neuropsychiatric Disorders presents extremely many examples confirming this rule. Already in the past, when psychiatry studied a sick person regardless of his environment, it was noticed that various painful disorders were much more often observed in people who for some reason lived alone and were deprived of the support of their loved ones.

The events of war and revolution, with colossal shifts in social relations, provided even more material on this issue and, moreover, such that it applies not to individuals, but to entire groups and classes. These new facts established especially clearly that the neuropsychic morbidity of an individual is closely dependent on the position of the group to which he belongs. The World War 1 provided clear evidence of this. At first, in the Russian armies that successfully attacked on the Austrian front, there were relatively few neurotic patients, and shell shock rarely led to neurotic pictures, which we later had to become familiar with in such abundance. As the situation worsened, their number began to grow rapidly in direct proportion to the defeats and retreats. The number of nervous patients was especially large, in particular the so-called. traumatists in units that were heavily damaged. The October Revolution made profound changes in social relations, awakened class consciousness in various groups of workers, employees and peasants, and at the same time declassed some groups that had lost their importance under the new system. As some special works have shown, for example A.V. Zalkind, the number of nervous patients is especially high among these declassed elements, former military and clergy, former traders, people who lived on unearned income.

An even more striking example of this can be seen in the white emigration. As economic life within the USSR and its international situation, the aspirations of emigrants to return to the past and hopes to again play a more or less significant role are increasingly replaced by despair, the consciousness of their powerlessness and the lack of any ground under their feet in countries where they still remain an alien element, aliens, separating them from the indigenous population known means and increase unemployment. This is also consistent with the frequency of illnesses among emigrants with various nervous disorders, as can be judged from the data reported in the French specialized literature. French psychiatrists describe among them special diseases, the origin of which is attributed mainly to isolation from their country and loss of social contacts - les maladies de depaysement et de perte des contactes sociales.

Both in the army at war and in the peaceful army of work, well-being and the associated neuropsychic health are entirely determined by connections with the team and its position. The labor army retreats and suffers damage, neuropsychic tone decreases and morbidity increases; she moves forward, overcomes obstacles to building a new life, the number of sick and backward people decreases. In terms of general conditions, the situation has changed greatly for the better over the past decade. With further improvement of the situation and strengthening of economic life in the country, with the disappearance of unemployment, with an improvement in the housing and nutrition situation, we must also expect an improvement in the neuropsychic health of the population and a reduction in morbidity. The same appeal to pathology will help to further clarify the situation. In eliminating neurotic disorders, a huge role is played by creating an acceptable and achievable goal in life for the neurotic. It is possible to re-educate him, create a new attitude towards a healthy active life, convince him of the full possibility of achieving the goals planned and important for him, recovery becomes very easy. So it is with neuro-mental health in general. If a person’s life is colored by work that satisfies him and provides him with work, if he is aware of his connection with the team and knows that his own work is necessary for this team and the whole society, it is easier for him to endure various hardships of life and maintain his nervous health. Under such conditions, there will be fewer sick and backward people in the entire collective and in the entire army of labor, and it will be able to move further towards the ultimate goal - the reconstruction of life on new principles. Weak and sick members of the team interfere with the maximum productivity of its work, but their elimination should not be done by mechanically discarding them as unnecessary ballast. For a worker who devotes his energies to the benefit of society, it is extremely important to be convinced that he is provided for in case of old age and illness, that old age with its illnesses and disabilities will be, as was put forward as one of the wishes at the hygiene exhibition in Düsseldorf, not frightening a ghost, but a pleasant “evening of life.” In modern conditions, there is still a lot of hard work left in this regard, and a lot of effort remains to be put in on the way to the ultimate goal - creating optimal working conditions.

1 Meaning First World War- Note. ed.

Source of information: Aleksandrovsky Yu.A. Borderline psychiatry. M.: RLS-2006. — 1280 p.
The directory was published by the RLS ® Group of Companies

Psychoprophylaxis and rehabilitation. They laid the foundations for understanding nervous, that is, psychogenic diseases. Psychological assistance is a type of independent psychological practice that can be addressed to a subject group or organization. Psychological assistance is provided healthy people with a variety of everyday problems, those in critical condition, as well as patients with various mental or somatic diseases having psychological problems, neurotic or psychotic disorders, as well as...

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Lecture No. 6.1.

Topic: Psychohygiene and psychoprophylaxis.

Plan:

Full lecture notes

§ 1. Psychohygiene: concept and sections.

Psychohygiene, being part of general hygiene, at the same time is an independent branch with its own goals, objectives and research methods

Psychohygiene is the science of ensuring and maintaining mental health. The goal of mental hygiene is to develop a system of measures aimed at the formation, maintenance and strengthening of mental health.

Psychohygiene includes the following sections:

1. Age-related mental hygienedevelops a system of age-appropriate activities. Psychohygienic activities in childhood and old age occupy a special place. Education, diet, rest, training, etc.

2. Psychohygiene at homedevelops a system of measures for people with weakened and unstable psyches, measures to prevent domestic drunkenness, alcoholism, and drug addiction.

3. Psychohygiene of work and trainingdevelops a system of measures in the field of labor activity, aimed primarily at observing the principles of professional suitability, carrying out career guidance activities, preventing labor conflicts, states of fatigue and monotony in the labor process. Separately, measures to comply with the principles of mental hygiene in educational activities (mental work) are considered.

4. Family psychohygiene and sex life - a system of activities that contributes to the formation of a favorable atmosphere in the family for spouses and children. One of the main tasks of mental hygiene is to help create a harmonious sex life, because... violations in this area are often the source of many mental injuries and nervous disorders.

5. Psychohygiene of collective liferegulates relationships between people in the family, work environment, school class and other groups, develops measures to take into account the compatibility of communication participants.

Psychohygiene in the provision of medical care.

Psychohygiene in medicine originates in psychiatry. In 1948, the World Mental Health Organization was created, whose main task is to develop the concept of mental health and measures to preserve it. In almost all branches of medicine, the attention paid to the preservation of mental health, the prevention of psychogenic disorders and psychosomatic diseases is clearly insufficient. The same can be said about the mental health of health workers themselves.

Psychohygiene of the patient.Mandatory at all stages of medical care.The atmosphere is honey. institutionsshould be conducive to recovery, staying in it should not resemble imprisonment. Psychohygieneprovider-patient relationship, is subject to the principles of medical deontology. The success of treatment depends on their mutual relationship; the following factors can disrupt this relationship, for example the rigid attitude of the doctor, reluctance to listen to the patient’s complaints, the patient’s attitude towards a specific health worker, medicine in general, etc. Discussion has a significant impact (not always positive) on the patient’s mental statefeatures of the diseaseduring rounds, clinical discussions and consultations. The patient attaches importance to the content of statements and the psychological nuances of the behavior of health workers. An important link in psychohygienic measuresovercoming alienation and mechanical manipulationcarried out for therapeutic and diagnostic purposes. Especially it concerns instrumental methods, evoking a feeling of respect and fear in the patient.

§ 2. Concept and types psychological assistance.

The origins of psychological assistance to patients in Russia are associated with such names as N.I. Novikov, N.I. Radishchev, A.I. Galich, M.Ya. Mudrov and others. They laid the foundations for understanding “nervous” (that is, psychogenic) diseases. In the 1940-1950s Hypnotherapy is developing in Russia, in 1950-1970. Dynamic psychotherapy develops in the 1980s. explosion in the development of psychotherapy in our country, in 1982, 1992. departments of psychotherapy and medical psychology are created at the Leningrad Institute for Advanced Medical Studies. In 1975, the first order of the USSR Ministry on psychotherapeutic assistance to the population was issued; several hundred psychotherapeutic offices were opened; in 1985, the second order was issued on the inclusion of psychotherapy as an independent branch of medicine in the range of educational specialties. The staff of such offices includes the work of a nurse. In 1995, the Association of Psychotherapists was registered.

Psychological helpthis is a type of independent psychological practice that can be addressed to a subject, group or organization.

Psychological assistance is provided healthy people with a variety of everyday problems that are in critical condition, as well as sick with various mental or somatic diseases, psychological problems, neurotic or psychotic disorders, as well as characterological personality deviations.

Psychological assistance includes:

1. providing a person with information about his mental state, the causes and mechanisms of the appearance of mental, psychological or psychopathological phenomena in him.
2. active, targeted psychological influence on an individual in order to harmonize it mental life, adaptation to the social environment, relief of psychopathological symptoms and personality reconstruction to increase the threshold of frustration tolerance, the formation of stress and neurosis resistance.

There are three maintype of psychological assistance, which differ in purpose and nature of impact. The boundaries between them are very transparent; they can be used together or separately:

1. psychocorrection
2. psychotherapy

1. Psychological counselingdirect work with people, aimed at solving various kinds of psychological problems associated with difficulties in interpersonal relationships, where the main means of influence is a conversation organized in a certain way. The essence of psychological counseling is that a psychologist, using special professional scientific knowledge, creates conditions for another person in which he experiences his new opportunities in solving his psychological problems. Psychological counseling as a type of psychological assistance is addressed mentally normal people to achieve their personal development goals.

2. Psychological correctionthis is the activity of a specialist to correct those characteristics of the client’s personality and mental development that are not optimal for him. The goal is to develop and master the skills of mental activity that is adequate for the individual and effective for preserving health, promoting personal growth and adaptation of a person in society.

3. Psychotherapy this is a system of complex therapeutic verbal and non-verbal influence on emotions, judgments, and self-awareness of a person in various diseases. The main goal is the relief of psychopathological symptoms, thereby achieving internal and external harmonization of the personality.

§ 3. Psychotherapeutic techniques and methods.

The term "psychotherapy" was introduced in 1872 by W. Tuke and began to be widely used from the end XIX century. Psychotherapy has traditionally belonged to medicine and was considered as one of the methods of treatment and prevention of diseases. In 1985 it was separated intoindependent medical specialty.

Methods of psychological influence used in psychotherapy:

• impact
• manipulation
• control
• formation

Psychotherapy this is a psychological impact on the patient, the purpose of which is to treat existing pathopsychic symptoms and syndromes or personality anomalies and deviations, as well as change a person’s thinking, mood and behavior so that he is healthier, more productive and happier. A sick person requires personality reconstruction and, in most cases, against the background of drug treatment.

It is customary to divide psychotherapy into general and private.

Under general psychotherapy understands the whole complex of mental factors affecting a patient of any profile in order to increase his strength in the fight against whiteness.

Private used in the clinicdiseases where mental treatment methods come first, which constitute the main treatment.

Objectives of psychotherapy:

• the health worker helps the patient better understand his problems;
  • eliminates emotional discomfort and tension;
  • encourages free expression of feelings and provides psychological support. First of all, this means listening sympathetically to the patient and giving him advice in a crisis situation;
  • provides the patient with new ideas or information about how to solve problems;
• supports the patient in recognizing and using their strengths and skills;
• helps eliminate maladaptive behavior and form new, adaptive stereotypes;
• promotes awareness (insight) and self-disclosure, as a result of which patients begin to better understand their motives, feelings, conflicts, values;
• helps to mobilize mental and physical regressions of the body to overcome ailments.

Forms of psychotherapy:

1.individual

2.family

3.group

Psychotherapeutic methods and techniques.

1. Cognitive and behavioral methods.

Cognitive methods are based on appealing to the patient’s mind, his logic and personal values: rational therapy.

Behavioral methods of psychotherapy are developed on the basis of behaviorism.

2. Suggestive methodsrepresent various forms of psychological influence on a person using direct or indirect suggestion in order to create a certain state in him or encourage him to take certain actions.

3. Self-hypnosis methodsmeaningful self-influence of a person on the psyche and through it on the entire organism.

4. Psychodynamic methodscreated on the basis of classical psychoanalysis and considers the leading role of intrapersonal conflicts. Aimed at bringing unconscious conflicts and their causes into consciousness.

§ 4. Psychoprophylaxis and rehabilitation.

Other types of psychological assistance aimed at preserving the mental health of the population arepsychoprophylaxis and rehabilitation.

Psychoprophylaxis and psychohygiene are areas of medical psychology, the task of which is to provide specialized assistance to practically healthy people in order to prevent neuropsychic and psychosomatic diseases and alleviate acute psychotraumatic reactions. Methods of mental hygiene and psychoprophylaxis include psychocorrectional work within the framework of advisory centers, “helplines”, other organizations focused on psychological assistance to healthy people, mass examinations to identify risk groups and preventive work with them, informing the population, etc.

Psychoprophylaxisthis is a section of general prevention, within which activities aimed at preventing mental disorders are carried out.

Psychoprophylactic measures are usually divided into 3 stages or 3 levels , depending on whether the person is healthy, suffers from a transient mental disorder or has risk factors for the disease, or whether he has persistent severe mental pathology.

1. Primary psychoprophylaxisthis is a system of measures aimed at preventing the occurrence of mental disorders.
2. Secondary psychoprophylaxisa system of measures aimed at eliminating pronounced risk factors that, under certain conditions, can lead to exacerbation or relapse of the disease, including the occurrence of disorders that are dangerous to the health or life of the patient or others, as well as preventing chronicity of the disease. Most effective method secondary psychoprophylaxis isdispensary observation,including early signs exacerbation of the disease, dynamic observation, targeted treatment, rehabilitation measures.
3. Tertiary psychoprophylaxisa set of measures aimed at preventing the formation of negative mental disorders and disability in chronic mental illnesses. The goal of tertiary psychoprophylaxis is the rehabilitation of patients who have lost the ability to function fully.

Rehabilitation aimed at restoring the patient’s social status resocialization , which involves the possibility of using labor skills, restoring the patient’s social connections and his individual and social value.

Social rehabilitationthis is a method of approaching a sick person, characterized by the principles of appeal to his personality, partnership with a doctor in the implementation of mechanisms aimed at different areas of the patient’s life and at changing his attitude towards himself and his illness.

The essence of rehabilitationis to, through the use of preserved mental abilities and functions, and, if possible, restoration of damaged or lost functions, their training, to adapt the patient to the same or changed working and living conditions.

There are severallevels of rehabilitation:

1. At the core medical rehabilitationrestorative therapy is aimed at recovery or the maximum possible improvement of the condition, preventing the defect and restoring the patient’s ability to work.
2. Under vocational rehabilitationunderstand the use of preserved ability to work to return the patient to his previous or less complex work activity.
3. Under social rehabilitation, or readaptation,imply the creation necessary conditions life and everyday life, restoration of broken contacts with others, which enable the patient to return to society, that is, lead to the restoration of his social position.

Test questions for consolidation:

1. Psychohygiene as part of general hygiene, its sections and tasks.
   1. Psychohygiene of the patient and medical worker.
      1. Psychoprophylaxis as a section of prevention, levels of psychoprophylaxis.
         1. Psychoprophylactic measures and their purpose.
         2. Types of psychological assistance to the population and their specificity.
         3. Psychotherapy as a type of psychological assistance.
         4. Techniques and methods of psychotherapy, their use by average medical professionals. employee.
         5. The connection between psychoprophylaxis and rehabilitation.
         6. Types and levels of patient rehabilitation.

Main sources:

1. Petrova N.N. Psychology for medical specialties: textbook. for students institutions prof. education. 6th edition. / N.N. Petrova. M.: Publishing center "Academy", 2013. -320 p.

Additional sources:

1. Zharova M. N. Moral responsibility in the professional activities of medical workers.//Chief Doctor 2011, No. 1.- URL: http://glavvrach.panor.ru
2. Zharova M. N. Ethics, responsibility and legal norms in the professional activities of medical workers.//RELGA scientific and cultural journal of a wide profile. 2010, No. 7 (205). - URL: http://www.relga.ru/Environ/WebObjects/tgu- www. woa/wa/Main? textid =2621& level 1= main & level 2= articles . Date of access: 05/30/2012.
3. Lavrinenko V.N. Psychology and ethics of business communication. ¶ URL: http://www.syntone.ru/library/books/content/2367.html. Date of access: 02/16/2011.
4. Medical library / Section "Books and manuals" / Guide to autopsychotherapy (history, theory, practice)/ 4.3. Techniques for self-regulation of the emotional sphere: portal. ¶ URL: http://www.medlinks.ru/sections.php?op=viewarticle&artid=2794. Date of access: 02/16/2011
5. Polyantseva O.I. Psychology for secondary medical institutions. Textbook - 6th ed. Series “Secondary professional education" - Rostov n/d: “Phoenix”, 2013. 414 p.
6. Professional problems of a medical worker. URL: http://chereshneva.ucoz.ru/publ/professionalnye_problemy_medicinskogo_rabotnika/1-1-0-3. Date of access: 02/30/2012.
7. Psi factor. Library of practical psychology: portal. ¶ URL: http://psyfactor.org/lybr.htm . Date of access: 02/16/2011
8. Psychology ONLINE. Psychologist's library: portal. URL: http://www.psychological.ru/default.aspx?p=26. Date of access: 02/16/2011
9. Rudenko A.M. Psychology. Series "Higher Education". - Rostov n/a: “Phoenix”, 2012. 560 p.
10. Rudenko A.M., Samygin S.I. Psychology for medical specialties. Series "Medicine". - Rostov n/a: “Phoenix”, 2009. 634 p.
11. Samygin S.I. Social Psychology. Series “Secondary vocational education”. - Rostov n/d: “Phoenix”, 2009. 352 p.
12. Syndrome emotional burnout“in the professional activity of a nurse”: Zdrav.ru - a medical portal for doctors.- URL: http://www. zdrav. ru/library/publications/detail. php? ID =2017. Date of access: 05/30/2012.
13. Elitarium: Distance Education Center: portal. URL: http://www.elitarium.ru.
14. Ethics and deontology of the average medical worker.- URL: http://www.meddr.ru/etika_i_deontologiya_srednego_medicinskogo_r//9000.html. Date of access: 02/16/2011

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