Emotional reactions of a person to a painful stimulus. Mechanism of pain sensitivity. Emotional-behavioral aspects of pain perception

The complex activity of the cortical and subcortical parts of the brain ensures the multilevel and multicomponent nature of emotional reactions.

1. Physiological components of emotional response:

vegetative-somatic reactions accompanying emotional states. There are such changes as the expansion of peripheral vessels and the acceleration of the pulse in a state of anger, and vice versa, vasoconstriction, slowing down and weakening of the pulse when experiencing fear. Emotional states are accompanied by changes in the rate and rhythm of breathing, pupil size, blood pressure, secretory and motor dynamics of the gastrointestinal tract, sweating, skin-electrical and electroencephalographic changes. The connection of emotions with somatovegetative reactions was noticed a long time ago and has been widely used since then to diagnose the emotional state of a person. So, for example, the verification of suspects with the help of a polygraph ("lie detector");

biochemical changes. The autonomic nervous system regulates the biochemical dynamics of the body with two largely different but interrelated components - sympathetic and parasympathetic. Sympathetic activity nervous system associated with the release of adrenaline-like substances. The sympathetic nerve causes pupil dilation, increased heart rate, increased blood pressure, inhibition of intestinal activity, increased blood sugar, increased muscle performance, increased metabolism. The parasympathetic effect caused by another substance - acetylcholine, is characterized by constriction of the pupils, vasodilation, slowing of the pulse and increased peristalsis and secretion of the stomach, the release of copious hot sweat, and a weakening of metabolism. Experimental studies show that in a state of fear, the concentration of adrenaline increases with a slight change in norepinephrine, in a state of angry irritation or anxiety, the amount of both adrenaline and noradrenaline sharply increases, asthenic emotions (sadness, melancholy) are accompanied by a distinct decrease in both.

2. Expressive components of emotional response:

expressive movements of the whole body - pantomime. Pantomimic changes in gait, posture, gestures usually occur involuntarily, as external manifestations of the general emotional state of a person. The most important component of pantomime is a gesture - an expressive movement of the hands, which serves as one of the means of clarifying speech communication. Gestures are divided into illustrative, explaining and highlighting any thought, and expressive, revealing the emotional state of a person. Some types of gestures in the process of human socio-historical practice have acquired a certain symbolic meaning. For example, the thumb and forefinger folded into a ring - the gesture "OK" - means "everything is fine"; it is understood and used by representatives of different cultures;

movements of the facial muscles - facial expressions. The face of a person has the greatest ability to express various emotional shades. Even Leonardo da Vinci said that the eyebrows and mouth change differently for different reasons for crying. P. Ekman and K. Izard described mimic signs basic emotions, highlighting three areas of the face: the forehead and eyebrows, the eye area and the lower part of the face. So, for example, in accordance with their description in the facial expressions of fear, the eyebrows are raised and shifted, wrinkles are only in the center of the forehead; the upper eyelids are raised so that the sclera is visible, and the lower ones are raised and tense; mouth open, lips stretched. Mimic manifestations of emotions are a synthesis of involuntary and arbitrary ways of responding, to a large extent, depending on the characteristics of the culture in which a person is brought up;

Vocalization: voice timbre and intonation, sound means of expression. Of the sound means of expression, laughter and crying are the most characteristic. Laughter is an expression of several emotions, in different situations it has ambiguous shades and meaning.

In everyday life, it is precisely thanks to the expressive components of emotional response that we, as a rule, quite accurately perceive and evaluate changes in the emotional state, in the mood of the people around us.

Functions of emotion

The importance of emotions in human life is expressed in their functions. In psychology, it is customary to distinguish a number of functions:

· Reflective-evaluative function. Emotions evaluate the significance of objects and situations for achieving goals and meeting the needs of the subject; are the system of signals through which the subject learns about the significance of ongoing, past and future events.

· incentive function. From the assessment of what is happening follows the impulse to action. According to S.L. Rubinshtein, "emotion in itself contains attraction, desire, aspiration directed towards or away from an object."

· Activating function directly related to motivation. Emotions provide an optimal level of activity of the central nervous system and its individual structures. Emotional states differently influence the dynamics of the course of activity, its pace and rhythm. Emotions of joy, confidence in success give a person additional strength, encourage more intense and strenuous work. D. Hebb experimentally obtained a curve expressing the relationship between the level of emotional arousal of a person and the effectiveness of his activity. From it it is clear that there is a curvilinear relationship between emotional arousal and the effectiveness of human activity. To achieve the highest result of activity, neither too weak nor too strong emotional arousal is desirable. Too weak emotional arousal does not provide proper motivation for activity, and too strong one destroys it, disorganizes and makes it uncontrollable. Each person has his own optimum of emotional excitability, which ensures maximum efficiency in work. It depends on many factors: the characteristics of the activity performed, the conditions in which it takes place, the individuality of the person included in it, and many others.

· Regulating function. Emotions influence the direction and implementation of the activity of the subject. The emergence of one or another emotional attitude to an object, object, phenomenon affects motivation at all stages of the course of activity. Assessing the course and result of activity, emotions give subjective coloring to what is happening around us and in ourselves. This means that different people can emotionally react differently to the same event.

· synthesizing function. Emotions connect, synthesize into a single whole separate events and facts conjugated in time and space. A.R. Luria showed that the totality of images, directly or accidentally connected with the situation that gave rise to a strong emotional experience, forms a strong complex in the mind of the subject. The actualization of one of the elements entails, sometimes against the will of the subject, the reproduction in the mind of its other elements.

· Meaning formation. Emotions serve as a signal of the meaning-forming power of the motive. So, for example, A.N. Leontiev wrote: “A day filled with many actions that seem to be quite successful, however, can spoil a person’s mood, leave him with some unpleasant emotional aftertaste. Against the backdrop of the worries of the day, this sediment is barely noticeable, but then the moment comes when a person, as if he looks back and mentally goes over the day he lived, at that very moment, when a certain event pops up in his memory, his mood acquires an objective relation, an affective signal arises, indicating that it was this event that left him an emotional sediment. that this is his negative reaction to someone else's success in achieving a common goal, the only one for which, as he thought, he acted, and now it turns out that this is not entirely true and that almost the main motive for him was to achieve success for himself " .

· Protective function. Such a strong emotional experience as fear warns a person about a real or imaginary danger, thereby contributing to a better thinking of the situation that has arisen, a more thorough determination of the likelihood of success or failure. Thus, fear protects a person from unpleasant consequences, and possibly from death.

· expressive function. Emotions, due to their expressive component, take part in establishing contact with other people in the process of communicating with them and influencing them.

No. 4. Types of emotions: affects, specific emotions, moods, passions, stresses and feelings.

Classification of emotional phenomena (Rada Mikhailovna Granovskaya):

1) Affect- the most powerful emotional reaction. Distinctive features of affect: situational, generalized, high intensity, short duration.

2) Actually emotions- longer states. They can be a reaction not only to past events, but also to probable or remembered ones.

3) Feelings – even more stable mental states that have a clearly expressed objective character. In Soviet psychology, the assertion is widespread that feelings reflect the social nature of a person and take shape as significant relationships to the world around.

4) Mood- the longest emotional state that colors all human behavior.

5) Stress- an emotional state caused by an unexpected and tense situation. According to G. Selye, "stress is an integral part of human life, it cannot be avoided. For each person there is an optimal level of stress at which the greatest efficiency of activity is achieved."

The most significant emotions include the following emotional manifestations: affect, passion, mood.

Affect - the most powerful type of emotional reaction. Affects are called intense, violently flowing and short-term emotional outbursts. Examples of affect are strong anger, rage, horror, stormy joy, deep grief, despair. This emotional reaction completely captures the human psyche, connecting the main influencing stimulus with adjacent ones, forming a single affective complex that predetermines the reaction to the situation as a whole.

One of the main features of affect is that this emotional reaction irresistibly imposes on a person the need to perform some action. At the same time, a person loses a sense of reality, he ceases to control himself and may not even be aware of what he is doing. This is explained by the fact that in a state of passion there is an extremely strong emotional excitation, which, affecting the motor centers of the cerebral cortex, turns into motor excitation. Under the influence of this excitation, a person performs many erratic movements and actions. It also happens that in a state of passion a person becomes numb, his actions completely stop, he seems to lose the power of speech. Similar phenomena can be observed in natural disasters and technological disasters. For example, one of the victims of the earthquake in Armenia described this event as follows: “I have never felt so helpless in my life. People were petrified and did not move... Then people ran without a goal. Those in the park ran in the direction of the buildings, although this was absolutely inappropriate. They ran for their lives and screamed like crazy. Those who were in the houses fled to the parks. Everyone was in a panic."

№5. Anxiety and its impact on the performance of athletes.

Anxiety affects the success of athletes. It has been established that anxiety promotes activity in fairly simple situations for an individual and hinders in complex ones, while the initial level of a person's anxiety is essential.

Studies have shown that in sports activities, the experience of anxiety has its own characteristics. Sustained personal anxiety occurs in athletes with such traits as vulnerability, increased susceptibility, suspiciousness. This type of anxiety acts as a reaction to the threat of something non-existent, which has neither a name nor a clear image, but threatens a person with the loss of himself, the loss of his "I". Such anxiety in an athlete is due to an internal conflict between two conflicting aspirations, when something important for him simultaneously repels and attracts. The athlete becomes socially maladapted and therefore he goes into his inner world. He becomes a chameleon according to the principle: "I (like the inner world) like everyone else." He can also become aggressive, because aggressiveness relieves anxiety. In behavior, this is manifested by increased rudeness, ruffiness, etc. With increased anxiety, the athlete has a feeling of the inevitability of an impending catastrophe, the impossibility of avoiding danger. The highest level of anxiety is anxiety-fearful excitement, which is expressed in the need for motor discharge, panic search for a way out and expectation of help. If the athlete does not receive this assistance, then the disorganization of behavior and activity reaches its maximum. Such anxiety can be generated either by the real trouble of the athlete in the most significant competitions. Or exist, as it were, contrary to an objectively prosperous situation, being the result of certain personal conflicts, inadequate development of self-esteem, etc. Athletes who often compete in competitions, responsibly treat training, social life, and sports discipline often experience such anxiety. However, this apparent well-being comes to them at an unreasonably high price and is fraught with disruptions, especially with a sharp complication of activity. Such athletes have pronounced vegetative reactions, neurosis-like and mental disorders. Anxiety in these cases is often generated by the conflict of self-esteem, the presence in it of a contradiction between high claims and a fairly strong self-doubt. With such a conflict, athletes are forced to strive to achieve success in all areas, but it does not prevent them from correctly assessing success, giving rise to a feeling of constant dissatisfaction, instability, and tension. This leads to hypertrophy of the need for achievement. There is an overload and overstrain, expressed in impaired attention, decreased performance, as well as increased fatigue. Anxious athletes are not a completely prosperous contingent: their sports results can be extremely low, they may develop neurosis. An excessively high level, as well as an excessively low one, is a maladaptive reaction that manifests itself in a general disorganization of behavior and activity and requires various methods of correction.

Attention should also be paid to athletes who are characterized, relatively speaking, by “excessive calmness”. Such insensitivity to trouble is, as a rule, compensatory, protective in nature and prevents the full formation of personality. The athlete, as it were, does not allow an unpleasant experience into consciousness. Emotional distress in this case persists due to an inadequate attitude to reality, negatively affecting the productivity of activity.

Psychodiagnostic studies of athletes have shown that increased anxiety causes overwork, i.e., a temporary decrease in performance under the influence of prolonged exposure to stress. Energy is spent not on sports activities, but on the suppression of anxiety, as a result of which the internal resources of the individual are depleted, and if the problem is not solved, this can lead to the development of a neurotic state.

Also, in 20% of athletes, high anxiety leads to isolation, i.e. neurotic loss of a sense of reality, loss of one's individuality, as well as aggressive behavior aimed at causing physical or psychological harm and accompanied by emotional states of anger, hostility and hatred.

Thus, of course, the existence of distinct differences in the content, nature of the experience of anxiety and stress and the impact of anxiety on the results of activity.

You can also select a number of alarm functions.

Firstly, the presence of “peaks” of anxiety indicates the significance of its experience for satisfying the leading needs that characterize athletes of a certain age and gender. This confirms the idea of ​​its signaling and mobilizing functions, and also testifies in favor of ideas about the relationship of anxiety (both as a state and as a property) with the dissatisfaction of significant needs.

Secondly, speaking about the function of anxiety in sports activities, it should be emphasized that up to the older adolescence, it mainly has a negative impact, especially in training conditions. In preschool and throughout school age, the influence of anxiety on sports activity is mediated by the peculiarities of Turner's behavior and the atmosphere he creates in the team. It is the latter, significantly increasing the affective saturation of the situation, that negatively affects the effectiveness of the athletes.

Thirdly, the interaction in the “anxiety as a state-property” system increases with the age of the athletes, although it is also largely influenced by the position and behavior of the coach.

However, from consideration of the results of studies and observations of the activities of athletes, it follows that:

Along with actual alarm states, there are also simulated ones;

Those athletes whose condition is defined as unpleasant, uncomfortable, i.e. state of anxiety;

The level of mental tension in individual athletes is not a constant value, it is influenced by the situation;

Athletes with different levels of anxiety can perform optimally;

Research findings are often conflicting;

More in-depth reflections lead to the assumption of a rather strong relationship between a person's emotionality and the effectiveness of his activity;

The state of anxiety in sports can also be a subjectively desirable state, and this, in our opinion, is one of the most interesting points.

A well-trained athlete is in a state of "before an explosion of energy" before completing a task. It is said that an anxious athlete "burns out before the start of the fight." The start is expected with impatience, and most athletes subjectively desire this state, but only the inexperienced and with a weak nervous system “burn out” in the pre-start fever. From the point of view of the pre-start experiences of athletes with a strong nervous system, it can be argued with a large approximation that tension and stress for them are associated with a feeling of “comfort of psychological functioning”. The conditions of this "comfort" create a mechanism for conscious control of one's anxiety. In sports activities, external influences and management are exceptionally strong. The "harsh climate" of sport requires the pressure of strong signals rather than "free climate, independence, benevolence." Such a climate, according to L. I. Bozhovich, favors the creativity of people with strong-willed character traits.

External regulation concerns several areas of management, from simple training to complex individual decisions. Functioning in sports is interpreted not only as a personal activity of an athlete, but also as a group, team, social activity. The motivation to achieve success in sports is focused on the public recognition of the personality of the athlete and the personality of his coach.

The problem of conscious localization of anxiety control in athletes is just beginning to be developed in sports psychology. It is possible to identify several interesting facts. The readiness to succumb to manipulation and this expectation by athletes on the part of rivals constitute a certain phenomenon in sports in connection with the basic features of sports - the freedom and independence of a competing personality. The subordination of an athlete to external guidance, for example, a coach in a team, creates only the appearance of “comfort of psychological functioning”, which should also reduce the power of the influence of situations that cause tension and anxiety, i.e. serve as a neutralization in the perception of threat and are the factors through which we will try to determine the state of stress.

In sports activities, two "worlds" coexist:

Realistic world: situation, task, coded program of actions, adequate to the behavior of athletes;

Unrealistic world: "a world of subjectively created anxiety." An athlete builds a threat situation with his mind and thinking, which depends on the peculiarities of his perception of real situations - one sees a threat in it, the other does not. In connection with the thesis about “building a threat situation”, hypotheses may appear regarding the “layers of experience”, because a “subjectively built threat” can have a different duration and significance for an athlete. Omitting here a lot of statements about stress in sports and its impact on performance, let's think about the essence of stress using an unconventional approach.

A holistic description of stress in sports can be given through:

Description of the phenomenon based on the chosen general theory;

Description of the process of the behavior of athletes on the basis of the essential elements contained in the chosen concept of stress.

Taking the second of these ways, consider:

Normal behavior and genesis of disorders;

The occurrence and place of the threat in the situation;

The problem of coping with stress and the "psychological cost" of violations.

Under natural conditions, the athlete is included in the system of interactions that prepare him for the task. At the same time, the task-oriented action dominates. This is the elimination of interference, the resumption of attempts. This is also an increase in the intensity of the reaction, an improvement in orientation processes.

Along with the behavior specific to a sport action, states and reactions arise that are not directly related to the implementation of the task or the goal of the competition. These are, first of all, enhanced processes of anticipation, attributing a threatening influence to various situations that create anxiety and emotional tension Khanin Yu.L. . Behavior similar to defensive reactions is also manifested, which worsens the athlete's well-being.

The activation of defense mechanisms by the type of repression or suppression of anxiety is characterized by two different "regulatory planes", or "levels of regulation". One of them makes it difficult to complete the task, the other makes it easier to endure the situation, helps to take action, despite the difficulties.

In general, it can be argued that defensive reactions (to a certain extent of their intensity) act only as “accompanying phenomena”. They "only accompany" until a state of "real threat" arises in the field of activity.

It is allowed that the threshold of perceptual stability means the proportion between the saturation of the image of the situation:

Factors relating to achieving a valid task (well chosen).

Factors relating to other states and objects (various types of assessments, foreseeing consequences, attributing characteristics to rivals, etc.). The predominance of “outside the task” elements in the task image or the lack of task elements creates a situation of lack of concentration on the task or its minimum size.

The threat is described as a loss of security, some deformation, i.e. as circumstances that portend undesirable effects or deprivation of something. In other words, the concept of threat is a signal of possible trouble. For sports, such situations are very typical.

Without describing in detail the athlete's preparation for the start, which, in connection with the indicated categories of actions and signs of the situation in the successive stages of preparation for the start, forms a picture of the future task and its general situation. The picture evolves or shrinks as information and expectations become available. The actualization of this picture is associated with motor activity. This abbreviated thought image signals that there may be an "undulating sense of threat." More precisely, regardless of the athlete, there is an "undulating sense of threat" .

It is noted that in all types of sports competitions that differ in the structure of motor actions (the evaluation criterion is the maximization of the athlete's effort in the process of implementing the entire program of actions), the common moment is the "suspension" of the perception of the threat or its "wear and tear" under the condition of automation of activity. If under these conditions an automatically performed action is violated by consciousness, there is reason to look for the causes of this violation in the athlete's psyche.

The characteristics of activity in many sports perfectly support the state of threat, which attracts people to these sports who crave these acute threatening experiences - for example, skydiving, freestyle, auto racing, etc. Thus, it is unlikely that some of the defensive reactions can be eliminated in them feeling threatened.

No. 7. Aggression and aggressiveness of athletes.

Aggression is behavior in which the goal is to cause other people physical and moral harm or to limit their desires. From this point of view, sport is already competitive in its essence, as athletes in competition seek to infringe on the desire of others to win. According to a number of scientists, competition is aggressive behavior regulated by the rules, it is aggressiveness expressed in a socially harmless form. Often the concept of "aggressiveness" is replaced by the concept of "sports anger".

Distinguish aggression hostile and constructive. Constructive aggression is prohibitions aimed at solving pedagogical problems. Aggression can be direct physical (fight), direct verbal (quarrel), indirect physical (direction of physical aggression to objects, for example, the goalkeeper, who guessed the direction of the blow when breaking a penalty kick, kicks the goal post out of annoyance) and indirect verbal (negative statements of the athlete on about the coach behind him). Due to the manifestation of aggression, aggression can be deliberate (for example, the defender deliberately hits the attacker on the legs in order to interrupt the attack or disable him) and provoked (the attacker's response to the defender).

No. 8. Stages and features of a sports career.

Research carried out over the past decade has provided insight into what a sports career is and how sports careers differ from other careers. The beginning of career research was laid by B. G. Ananiev. He believed that any career consists of four stages: preparation, start, climax and finish.

· "training" includes the choice of profession and basic vocational training - adolescence and early adulthood;

· "start" - the beginning of the actual labor activity and adaptation to the profession from 23 to 30 years;

· "climax" - the stage of the highest achievements in the profession, reflected in the social status of the individual - from 30 to 45-50 years;

· "Finish" is associated with preparation for retirement and retirement adaptation - from 50 to 60-65 years.

In our opinion, such a division of a career into stages is universal and suitable for any professional career. However, in the case of a sports career, there are specifics. A sports career begins very early, even in preschool childhood, and ends also early by the standards of professions that are not related to sports.

Our Belarusian colleagues E.A. Lupekina, O.N. Melnikov identified the following features of a sports career:

An earlier start of the “preparation” phase. Usually this is preschool or primary school age, but it happens earlier, especially in sports families;

relatively early start of a sports career and the choice of a specific sport;

Relatively early culmination of a sports career;

· gender differences in terms of climax and finish of a sports career;

· a greater shift towards birth than a professional career;

· spasmodic nature of development is expressed in a sports career;

Since sport is one of the most energy-intensive activities, therefore it is associated with the use of human reserves;

sports are characterized by tougher conditions of competition than in most other areas of activity;

· a sports career is not always professional in the sense of constant earnings, but always in the sense of a professional attitude to business;

· a sports career is characterized by relative uncertainty of the moment of retirement - its dependence not so much on age, but on the dynamics of sports results and many other reasons - as opposed to the retirement typical for most professions;

The athlete has the opportunity to extend his SC by changing his sports role or sport. In many professions, similar opportunities are very limited;

“Sport is a concise model of life”. In it, due to the extreme conditions, you can find all the richness of the manifestations of human nature. It more versatile forms the adaptive capabilities of a person in the broadest sense than most other professions. For example, athletes adapt more easily in business, as the competitive situation stimulates them. Thus, a sports career lays the real prerequisites for a transition to another professional career, which is important, since it usually ends in a period very far from retirement age.

Thus, a sports career (SC) is a long-term activity of an athlete, which involves the achievement of high results, in accordance with the goals and objectives of a particular stage of a long-term professionalization of an athlete.

2. Periodization of sports career

A professional career, during which the formation of a professional takes place, is the main problem of labor psychology. That is why we consider it possible to turn to the research of this scientific discipline. Foreign and domestic researchers have repeatedly addressed the problem of the professional development of a person. The authors of the most famous concepts of the professional development of a personality are: S. Buhler, E. Gintsberg, A. A. Derkach, V. G. Zazykin, E. F. Zeer, T. V. Kudryavtsev, E. A. Klimov, K. M. Levitan, B. Livehud, A. K. Markova, L. M. Mitina, Yu. P. Povarenkov, N. I. Povyakel, A. T. Rostunov, E. Rowe, D. Super, A. R. Fonarev, R. Heyvighurst, D. Holland, E. Spranger, V. D. Shadrikov and others. Despite significant differences, common to all theories is that professionalization is a process that involves the passage of an individual through a number of stages of professional development. The analysis of the concepts of the above-mentioned authors, as well as their generalization, made it possible to present the following stages of the professional development of the individual.

Option stage. The stage of determining the sphere of interests and abilities of the individual, as well as the choice of professional activity, which can last from birth to graduation.

· The stage of vocational training, which involves the acquisition of professional knowledge, skills and abilities within the walls of a vocational educational institution (4-5 years).

Stage of professional adaptation. It is the stage where the subject of activity enters the profession, masters the basics of professional skills (2 - Years).

The stage of becoming a professional. It involves the formation of professionally important qualities and self-realization of the individual in professional activities.

· Stage of professional mastery. Here the subject of labor, having mastered professional activity, actively and creatively self-realizes.

It should be noted that the determination of the time parameters for the formation of a professional is not possible, since their passage is subjective and is determined by the specific social conditions for the implementation of professional activity, the individual meaning of its implementation, etc.

Sport is a unique model, where, as mentioned earlier, the achievement of professional excellence occurs in a shorter time, and a professional career ends very early - at 25 - 30 years. The time frame for active professionalization of the subject in sports is determined by the specifics of the sport, those physical and mental resources that are necessary for the effective self-realization of the individual in sports activities.

No. 9. Crisis of a sports career.

A career in modern sports begins very early (at 4-5 years old), and ends just as early (at 25-30 years old), that is, the beginning of a sports career falls on that period of an individual's life, which is the most sensitive in terms of the development of his physical and mental properties, qualities and abilities. In addition, this is the period when an individual, in the course of mastering and professional self-realization in sports activities, faces a complex of crisis contradictions and problems that determine the course of his sports career.

The problem of sports career crises has not yet become the subject of a wide study of sports specialists. In the domestic psychology of sports, a number of works by N. B. Stambulova, I. B. Ivanov, O. Yu. Senatorova and S. N. Shikhverdiev. Most of the works mentioned above are devoted to the problems of choosing methods psychological help athletes, organizing psychological counseling, creating psychological and pedagogical conditions for the social adaptation of athletes who are at the stage of completing their sports career. That is, these works represent only the stage of completion of a sports career. Therefore, it cannot be argued that this problem has been studied sufficiently.

The most complete crises of a sports career are presented in the work of N. B. Stambulova. The imposition of various periodizations of a sports career allowed N. B. Stambulova to identify seven crises-transitions of an elite sports career:

crisis of the beginning of sports specialization;

· the crisis of transition to in-depth training in the chosen sport;

· crisis of transition from mass sports to sports of the highest achievements;

· Crisis of transition from youth sports to adult sports;

· crisis of transition from amateur sports of the highest achievements to professional sports;

· crisis of transition from the climax to the finish line of a sports career;

· the crisis of the end of a sports career and the transition to another career.

Each of the presented crises is very symptomatic and is a period of transition from one stage of a sports career to another. The author describes crisis contradictions and problems, the solution of which is necessary at a particular stage of a sports career, as well as the results of passing each of the crises.

Paying tribute to the work done by N. B. Stambulova, however, we note that the crises of a sports career presented by her do not take into account the fact that an athlete, like any person, is faced with crisis phenomena not only in the course of mastering sports activities, but also outside of it on throughout his life. Therefore, for a more complete understanding of the crises of a sports career, in our opinion, it is necessary to consider a generalized typology of crises.

The whole set of crises is usually divided into normative and non-normative. Normative crises are natural, determined by the logic of development itself. These include age crises, crises of mental development, as well as directly crises of professional development. Non-normative crises include neurotic, critical and life crises. Abnormal crises are the result of random, unforeseen events in a person's life.

Rice. Personality crises according to E. F. Zeer

In our opinion, for a more effective understanding of the essence and structure of a sports career, a model for describing crises is needed. This model has been proposed by us. During the development of the model, the results of research by N. B. Stambulova, a list of requirements for the stages of many years of preparation, as well as a typology of development crises were used.

We note that sports activities are so diverse that the creation of a single model for describing the crises of an athlete's professional career is very problematic for quite objective reasons. This is a different beginning and end of a sports career, this is a diverse degree of investment of an athlete in terms of physical and mental costs necessary for successful self-realization in sports activities, etc. Nevertheless, it offers a generalized model for describing the crises of an athlete's sports career, without pretending to be universal.

In the model we propose, the professional development of a personality is represented by the stages of many years of training in sports (vertical). According to the definition of crises, the transition from one stage (stage) to another generates normative developmental crises and non-normative crises (horizontal). In the presentation of this issue, we will restrict ourselves to a description of the preliminary stage of many years of preparation.

The leading factors that determine the specifics of crises of mental development are: the social situation of development, the essence of which is the restructuring of the system of relations with adults and the outside world, a change in the leading activity, as well as the emergence of psychological neoplasms. Naturally, at the stages of mental development, there is a change in the social situation of development, leading activity, and central neoplasms also appear. The essential characteristics of the crisis of mental development vary depending on the stage of many years of preparation. For example, the preliminary stage of the long-term training of a judoist falls on the beginning of adolescence. At this age, the crisis of mental development is characterized by the fact that the social situation of development is defined as the ambivalence of the position of the child between the state of not yet an adult, but no longer a small child. The leading activity here is socially significant activity, which is represented by learning activities communication and socially useful activities. As the main new formations, we will name the emergence of abstract thinking, reassessment of values, gender identification, the emergence of a sense of "adulthood".

In the studies of B.G. Ananiev, heterochrony of development was shown. Transformations of mental abilities are the result of age-related changes. This means that it is legitimate to consider age-related changes in a person, generated by his biological development, as an independent factor that determines age-related crises. Main characteristic adolescence is biological maturation, which is marked by rapid physical development, coinciding with puberty. The restructuring of the body begins with changes in the endocrine system. The activity of the pituitary gland is activated, especially its anterior lobe, hormones that stimulate tissue growth and the functioning of other important endocrine glands (thyroid, genital, adrenal glands). The face of a teenager is changing. The development of muscles in boys occurs according to the male type, and soft tissues in girls - according to the female. The restructuring of the motor apparatus is often accompanied by a loss of harmony in movements, an inability to control one's own body appears (general awkwardness, angularity, an abundance of movements and their insufficient coordination). The growth of various organs and tissues places increased demands on the activity of the heart. It grows faster than blood vessels, which can cause functional disorders in the activity of the cardiovascular system and manifest itself in the form of palpitations, increased blood pressure, headaches, and rapid fatigue.

Thyroid and gonadal hormones are metabolic catalysts. Since the endocrine and nervous systems are functionally interconnected, adolescence characterized, on the one hand, by a rapid rise in energy, and on the other hand, by increased sensitivity to pathogenic influences. Therefore, mental and physical fatigue, prolonged nervous tension, affects, strong negative emotional experiences can be the causes of endocrine disorders and functional disorders of the nervous system. They manifest themselves in increased irritability, weakness of restraining mechanisms, fatigue, absent-mindedness, a drop in productivity at work, and sleep disturbance.

Comparison and evaluation of oneself in terms of standards of femininity and masculinity becomes relevant. Boys and girls begin to engage in various sports. The main attraction of these activities is the possibility of strengthening one's physical strength, acquiring the appearance of a man, and for girls, harmony and flexibility. Thus, physical changes play a large role in the development of adolescent self-awareness.

However, not only the normative crises of the professional development of the personality accompany the career of an athlete. There are so-called non-normative crises. These include neurotic, life and critical crises.

Neurotic crises are caused by intrapersonal changes that provoke an internal conflict and lead to a mismatch of the psychological integrity of the individual. Neurotic crises are widely represented in the works of the Freudians, according to ideas that all our neurotic crises find their origin in childhood. They are determined by the specifics of the relationship of children with adults and with the environment. For example, a neurotic desire for power, formed in early childhood, under the influence of fear, anxiety and feelings of inferiority, causes the neurotic to be always right, control everyone and always do his own thing.

Life crises are caused by important events for a person. For a teenager, this can be a divorce of parents, a change in a sports school or team, a change of residence, etc., that is, these are changes in a person’s individual biography that lead to mental tension, a restructuring of the system of social relations and consciousness.

Another group of non-normative crises is represented by critical, tragic events in the life of an individual. These events can have catastrophic consequences for a young athlete, which lead to a revision of life values, loss of the meaning of life, etc. These crises can be caused by the unexpected loss of loved ones, a series of sports failures, severe injuries, and, as a result, the impossibility of continuing a sports career.

The two groups of crises considered in the life of each person are intertwined, and when they overlap, the course of crises of professional development is very acute, conflicting. In this situation, the question arises of the need to provide psychological assistance to the athlete. We believe that the most effective form of dealing with crises is their prevention, which consists in regular monitoring of mental states.

No. 10. Feeling as a mental process. Properties, types, functions, development of sensations.

mental process - this is the course of a mental phenomenon, caused both by external influences and stimuli coming from the internal environment of the organism. The central place in the human psyche is occupied by cognitive processes: sensation, perception, memory, thinking, attention and imagination.

Feeling- This is the first and simplest form of sensory knowledge. Thanks to sensations, we learn certain aspects or properties of objects and phenomena (color, shape, smell, thirst, heaviness, etc.).

Types of sensations reflect the uniqueness of the stimuli that give rise to them.

Feelings can be classified in different ways. According to the leading modality (qualitative characteristic), there are:

· visual sensations - are caused by exposure to light, i.e. electromagnetic waves that are emitted or reflected by various physical bodies. The receptor is the retina of the eye. Light waves differ in length, amplitude and shape. Length is the number of oscillations of a light wave per second. The larger the number of oscillations, the shorter the wavelength, and, conversely, the smaller the number of oscillations, the longer the wavelength. The wavelength of light determines the color tone. Colors have different psychological meanings. The amplitude of the light wave oscillations determines the brightness of the color. The shape of the light wave, resulting from mixing light waves of different wavelengths together, determines the saturation of the color.

auditory sensations - are caused by sound waves, i.e. rhythmic fluctuations in the air. There is a special physical unit by which the frequency of air oscillations per second is estimated - hertz - numerically equal to one oscillation per second. The higher the frequency of air vibrations, the higher the sound we perceive. On average, a person hears sounds in the frequency range from 16 Hz to 20 kHz. Sound below the human hearing range is called infrasound; from 20 kHz to 1 GHz - by ultrasound, from 1 GHz and above - by hypersound. The loudness of the perceived sound depends on its strength or intensity, i.e. amplitude and frequency of air oscillations.

· olfactory sensations are a reflection of smells. They arise due to the penetration of particles of odorous substances that spread in the air into the upper part of the nasopharynx, where they act on the peripheral endings of the olfactory analyzer, embedded in the nasal mucosa.

· taste sensations play an important role in the process of eating, in distinguishing between different types of food. Taste sensations have four main modalities: sweet, salty, sour and bitter. All other varieties of taste sensations are a diverse combination of the four main ones. The olfactory analyzer plays an important role in the emergence of certain taste sensations.

· tactile sensation or skin sensitivity is the most common type of sensitivity. The familiar feeling that occurs when an object touches the surface of the skin is the result of a complex combination of 4 others: pressure, pain, heat and cold. For each of them there is a specific number of receptors, unevenly located in different parts of the skin surface. The strength and quality of sensations are themselves relative. For example, when the surface of one area of ​​the skin is simultaneously exposed to warm water, its temperature is perceived differently, depending on what kind of water we act on the neighboring area of ​​the skin. If it is cold, then in the first area of ​​the skin there is a feeling of warmth, and if it is hot, then a feeling of cold. Temperature receptors have, as a rule, two threshold values: they respond to high and low impacts, but do not respond to medium ones.

These sensations are called exteroceptive and constitute a single group according to the type of analyzers, the receptors of which are located on the surface of the body or near it. Exteroceptive sensations are divided into contact and distance. Contact sensations are caused by direct contact with the surface of the body (taste, touch), distant sensations are caused by stimuli that act on the sense organs at some distance (vision, hearing). Olfactory sensations occupy an intermediate position between them.

To proprioceptive sensations include a sense of balance, provided by the work of the vestibular apparatus, and a kinesthetic sensation, which carries information about the state of the muscular system. kinesthetic sensations(from the Greek kinesis - “movement”) come from muscles, ligaments and tendons; allow you to perform and coordinate movements. They are formed automatically, enter the brain and regulate movements at a subconscious level.

Signals from internal organs are called visceral sensations and are interoceptive. These include hunger, thirst, nausea, and internal pain.

In addition, a person has several specific types of sensations that carry information about time, acceleration, vibration. Vibrating sensations occupy an intermediate place between tactile and auditory sensitivity.

Feeling properties. Feelings have the following properties.

1. Modality- a qualitative characteristic of sensations is a property that allows you to distinguish one type of sensation from another.

2. Intensity- this is a quantitative characteristic of sensations, which is determined by the strength of the acting stimulus and the functional state of the receptor.

3. Duration is a temporal characteristic of sensations. It is determined by the functional state of the sense organ, the time of exposure to the stimulus and its intensity.

4. Sensitivity is the ability of the nervous system to respond to stimuli. Sensitivity is characterized by two thresholds - lower and upper. The lower threshold is the minimum amount of stimulus that can cause a subtle sensation. The upper one is the maximum value of the stimulus at which pain sensation occurs. High sensitivity corresponds to low thresholds, and vice versa, low sensitivity corresponds to high ones. The threshold for the occurrence of sensation in different people is not the same. The value of the threshold varies with age and depends on the state of health and mental state of the person. Sensitivity can be increased or decreased by pharmacological means. An important role in changing the sensitivity is played by the fitness of the analyzer. For example, musicians develop auditory sensitivity (“musical ear”), tasters develop olfactory and gustatory sensitivity.

5. Adaptation is the adaptation of the sense organ to external conditions. Through adaptation, the receptor gets used to the sensation. For example, when moving from bright light to darkness, we do not see objects at first, but gradually begin to distinguish their outlines (dark adaptation).

6. Synesthesia- this is the appearance under the influence of irritation of a certain analyzer of a sensation characteristic of another analyzer. For example, in some people, the sounds of music can cause a sensation of color (the so-called "color hearing") or a combination of colors gives rise to musical associations.

7. Compensation- this is a property of sensations to have taken away

No. 11. Perception as a mental process, its properties, types, functions.

Perception - this is a mental process that reflects a holistic image of objects and phenomena in the human mind with their direct impact on the senses.

Perception includes sensation and is based on it. But it is not reduced to a simple sum of sensations. It is something whole included and reproduced past experience, and processes of comprehension of what is perceived, and other mental processes. In other words, perception differs from sensation in that it is an active process, as a result of which an image of an object is formed.

Perception is often called human perceptual system.

Types of perception

1. Perception of space can take place at different levels. The spatial properties of an object include: size, shape, position in space. In the perception of three-dimensional space, first of all, the functions of a special vestibular apparatus located in the inner ear, as well as the apparatus of binocular vision, are involved.

2. Perception of time, despite the importance of this problem, much less has been studied than the question of the perception of space. The difficulty of studying this issue lies in the fact that time is not perceived as a phenomenon of the material world. Its course can be judged only by certain signs.

The most elementary forms are the processes of perception, which are based on elementary rhythmic phenomena, known as the "biological clock". In general, there are two main aspects to consider when studying the perception of time: perception of temporal duration and perception of temporal sequence.

Estimation of the duration of a time interval largely depends on what events it was filled with. If there were a lot of events, and they were interesting, then time goes faster. And vice versa, if there were few events or they were not interesting, then time drags on slowly. A time span filled with various events seems to be longer, and vice versa.

Estimation of the length of time also depends on emotional experiences.. If events cause a positive attitude towards oneself, then time seems to go quickly. Conversely, negative experiences lengthen the time period.

In addition to the internal mechanisms of time perception, a person also uses certain time intervals. Such intervals can be a day, a week, a month, a year, a century, etc. The existence of these intervals is possible because a certain change of events alternates in them, for example, sunset and sunrise. So, by the number of sunrises, we can judge how many days, weeks, months, years have passed.

Thus, in the perception of time by a person, it is necessary to distinguish two aspects: subjective and objective-conditional. The subjective aspect is connected with our personal assessment of passing events, which, in turn, depends on the occupancy of a given time period with events, as well as their emotional coloring. The objectively conditional aspect is associated with the objective course of events and a series of conditionally contractual reference points, or time intervals. If the first aspect reflects the inner sense of time, then the second aspect helps a person to navigate in time.

Basic properties of perception

The main properties of perception include the following: objectivity, integrity, structure, constancy, meaningfulness, selectivity.

Objectivity of perception - this is the ability to reflect objects and phenomena of the real world not in the form of a set of sensations that are not related to each other, but in the form of individual objects

Another property of perception is integrity . Unlike sensation, which reflects the individual properties of an object, perception gives a holistic image of the object.

The integrity of perception is also related to its structure (property opposite to integrity) - the ability to distinguish parts in the image of an object or phenomenon, as a result of which it is possible for a person to establish relationships between parts

The next property of perception is constancy . Constancy is the relative constancy of the reflection of certain properties of objects when the physical conditions of their perception change. For example, a truck moving in the distance will be perceived as a large object, although its image on the retina will be much smaller than its image, as if it were nearby.

The next property of perception is its meaningfulness. Perceptual images always have a certain semantic meaning. As mentioned above, human perception is closely related to thinking. The connection between thinking and perception is primarily expressed in the fact that to consciously perceive an object means to mentally name it, that is, to attribute it to a certain group, class, to associate it with a certain word.

Another property of perception is selectivity. It lies in the fact that at any time a person can perceive only one object or a specific group of objects, while the rest of the objects of the real world are the background of perception, that is, they are not reflected in consciousness. For example, a student, listening to a lecture or reading a book, does not pay attention at all to what is happening behind him.

No. 12. Representative system

Each person perceives the world in their own way. Its perception is based on one or another channel of information flow: visual (visual), auditory (auditory), kinesthetic (bodily). In this article, we will look at what representational systems of perception and information processing exist, understand what each of them means, and learn how to determine the types of systems in ourselves and others.

We use our sense organs not only to perceive the external world, but also to represent these experiences to ourselves, i.e. represent. Hence the name representational systems - these are the ways in which we receive and store information in our brain. The visual, auditory, and kinesthetic representational systems are primary to Western culture. We use all of them constantly, although we are not equally aware of them, giving preference to some, and "forgetting" about others.

There are leading systems that we use most often to process information. So, many people think mostly in pictures, as if playing a movie in their head. Others find it difficult and prefer to have an internal dialogue. Still others will prefer to base their actions on internal feelings in relation to the situation that has arisen (“warms the soul” or not, “catches”).

Therefore, different people become more successful in solving certain tasks, depending on what the specifics of this task are. For example, a musician's auditory channel of perception will be clearly more developed, while an athlete needs to develop a kinesthetic channel. The architect, by virtue of his profession, prefers to think in images.

There are very few people who equally own all channels of perception and processing of information and can use them at their own discretion. Although representative systems are not mutually exclusive, basically, a person has one leading channel for perceiving, processing and storing information, the second is auxiliary, and the third is the least developed.

How to determine by a person which way of processing information is “native” for him and which is not. There are a number of indicators that can help us with this: behavior (breathing, speech rate), eye access cues, speech (words and expressions). Let's analyze each of them in order.

No. 13. Psychomotor sphere of athletes and its manifestation in sports activities.

The concept of "psychomotor" was introduced into scientific use by I. M. Sechenov. It emphasizes the dependence of human motor manifestations on mental regulation. So, the implementation of voluntary movements (physical exercises) occurs under the control of consciousness, and the manifestation of motor qualities requires the participation volitional effort. Therefore, the psychomotor sphere of a person is an alloy of psychological and physiological mechanisms for controlling movements, motor actions, reflected in the manifestation of various psychomotor (motor) qualities.

6.1. Qualities that characterize speed

Performance indicators are divided into four groups:

1) the time of contraction and relaxation of muscles;

2) the time of a single movement;

3) response time to the signal;

4) frequency of movements.

There is some connection between these high-speed manifestations, in particular, due to their common high-speed typological complex of properties of the nervous system, which includes a weak nervous system, mobility of nervous processes, and high lability. However, there is also specificity in their manifestation. Therefore, you can quickly contract the muscle, but relax it more slowly. It is possible to have a high frequency of movements and a relatively poor response time to the signal. This makes it necessary to approach the assessment of the speed capabilities of an athlete in a differentiated way. In addition, it is necessary to keep in mind the specificity of the manifestation of performance indicators in laboratory conditions in comparison with the change in the speed of movement of an athlete in real conditions. As a rule, in the first case, such tests are offered that exclude the influence of anthropometric characteristics of a person on the measured indicators. In the second case, anthropometric features play a big role. Speed ​​indicators in natural conditions of sports activity depend on the developed acceleration, and it is determined by the strength of the muscles and through it - by the mass of the body or its links, the length of the lever (limb), the total length of the body, etc.

In addition, many sports activities require the manifestation of all forms of speed (for example, sprinters), so the sports result depends on each of them. Although in a number of sports only one of the speed manifestations is predominantly expressed (for example, in skeet shooting - the reaction time to a moving object).

Signal response time (reaction time). Reaction time is measured by the interval between the appearance of a signal and the start of a response (as, for example, in runners, skaters taking a start). This time is determined by:

1) the speed of excitation of the receptor and the sensory center (depends on the sensitivity of one or another analyzer - visual, auditory, tactile);

2) the speed of signal processing in the central nervous system (recoding, recognition);

3) the speed of the athlete's decision to respond to the signal;

4) the speed of sending a signal to the beginning of action along the motor nerves;

5) the speed of development of excitation in the executive organ (muscle) and overcoming the rest inertia of the corresponding link of the body.

When measuring the reaction time in laboratory conditions (on a reflexometer), the time taken to overcome the resistance of the device button, which stops the stopwatch started by the experimenter at the moment the signal is given, is added to this. In real conditions of sports activity (taking a start), there is preliminary period reactions to the starting signal associated with his expectation (from the command "Attention!" to the command "March!" or the starter's shot).

Based on this, the reaction time includes sensory and motor components. The first is called the latent period of the sensorimotor reaction. Its duration depends on the modality of the signal (sound, visual, etc.), since the sensitivity of different analyzers is not the same: the latent period for sound signals is somewhat shorter than for visual ones; among the latter, the latency period for red is shorter than for green and blue.

Allocate also voltage latent time and muscle relaxation, determined by an electromyogram (recordings on the device of the electrical activity of the muscle, that is, biocurrents).

In many cases, the athlete is required not to simply respond to a single signal, but to assess the situation, the significance of this or that stimulus, especially if there are many of them and they appear simultaneously. Then the question arises before the athlete: which of them to respond, in what way? In this regard, allocate simple sensorimotor reactions(reaction to a single signal) and complex, which are divided into differentiation(when you need to respond to one signal, but not to another) and to choice reactions(when you need to respond to each signal, but in different ways). In complex reactions, the latent period increases due to the time spent on distinguishing and recognizing the stimulus (that is, assigning it to a certain group, which is important for unraveling the opponent’s intentions), and choosing the most appropriate response in a given situation. As a result of this "central delay", the time of a complex reaction can exceed the time of a simple reaction (120–140 ms) by almost two times. True, for experienced athletes (for example, boxers) it can approach the time of a simple reaction if they react to well-known actions of the opponent.

There is no correspondence between the simple reaction time and the "central delay" time. For example, with the development of a state of monotony, the time of a simple reaction is shortened, and the time of "prices

Pain sensitivity occurs when the integrity of tissues is violated, the action of damaging factors on them and is often one of the painful symptoms of the disease. According to the definition of P. A. Anokhin, “pain is a kind of mental state of a person, determined by the totality of physiological processes in the central nervous system, brought to life by some overpowered or destructive irritation."

The process of pain sensation consists of 3 parts: D) receptor systems; 2) sensitive pathways; 3) cortical centers that form the feeling of pain (the term "receptor" was introduced by Sherrington, 1906). Pain is formed as a response of the body to destructive stimuli. It arose in the process of evolution as an adaptive property aimed at improving survival in the external environment.

Pain is divided into 2 main types: 1) acute epicritic pain, which is quickly recognized, easily localized, adaptation quickly develops to it and lasts as long as the stimulus acts; 2) protopathic pain, rough, which is realized slowly, poorly localized and determined, persists for a longer time and there is no adaptation to it. In addition, there are somatic, neuralgic (localized) and vegetative (diffuse) leucorrhoea. Special types of pain are causalgia and phantom pain. Causalgia is considered as the result of prolonged irritation at the site of damage to the nerve or spinal nerve root and the formed dominant focus in the cerebral cortex, which attracts any irritation to itself. Such patients experience excruciating burning pain from the slightest irritation. Phantom pains occur in the stump after amputation of a limb. Patients have a false idea of ​​the presence of an amputated limb. The cause of the pain is improper wound treatment, foreign body, scars, neuroma. Often, repeated operations are necessary to remove the focus of irritation in the stump.

The sensation of pain is associated with a change in certain vital body constants. In acute epicritic pain, the integrity of the protective integumentary membranes is violated, due to which the constancy of the internal environment of the body is maintained. The sensation of pain signals even a slight destruction of the protective shell and thus prevents its further destruction. Acute epicritical pain occurs under the action of destructive stimuli on the protective membranes of the body, it differentiates the place of the violation, which enables the body to take appropriate measures.

The formation of rough, poorly differentiated protopathic pain is associated with a change in the level of oxygen respiration of tissues. The introduction of any substances that disrupt the oxidative processes in the tissues leads to pain. The causes of pain can be different: inflammation, metabolic disorders, tissue rupture or blockage of blood vessels, but the pain appears when it is the oxidative tissue processes that support their normal vital activity.

pain receptors. There are two theories explaining the perception of pain: 1) pain is the result of excitation of special pain receptors, has its own specific ways of conducting excitation and specific nerve centers. These are non-encapsulated, free nerve endings; in the dental pulp, for example, there are a lot of them; 2) excessive irritation of any somatic receptors (tactile, thermal, cold) causes pain, that is, there is a non-specific mechanism of pain excitation.

It is known that all somatic receptors according to the threshold of sensitivity are divided into low- and high threshold. Low-threshold ones are excited by non-damaging stimuli (pressure, touch). High-threshold receptors are excited when exposed to strong, damaging stimuli (pricks, incisions, strong temperature effects, etc.). But they can also react to non-damaging factors. These high-threshold receptors are called pain receptors, or nociceptors. Noci-

21centors are free nerve endings of unmyelinated fibers.

If we consider nociceptors according to the mechanism of their excitation, then we can distinguish two types: 1) mechano- and 2) chemo-monociceptors. To mechanociceptor include receptors of the skin, epidermis, muscles, joints and thermal nociceptors of the skin that respond to mechanical irritation and heating above 36-43 ° C and do not respond to cooling. Excitation is carried out along A l fibers.

Chemonocyceptors are localized both on the integumentary membranes of the body, and in deep tissues, visceral organs, especially a lot of them in the membranes of blood vessels. They transmit impulses mainly through afferent C-fibers.

Sensitive pathways. Pain impulses traveling along the AD and C-fibers enter the spinal cord through the posterior roots and form two bundles. The classical three-neural specific spinothalamic pathway has been most fully studied. The pain receptors of this pathway can be viewed as a collection of non-encapsulated nerve endings of the axon of the spinal ganglion. Pain is perceived and transformed by the neurons of the spinal ganglion, that is, the 1st neuron is located in the spinal ganglion. In the posterior horns of the spinal cord lies the 2nd neuron, the fibers of which go to the opposite side of the spinal cord and, as part of the lateral spinothalamic pathway through the medial loop, reach the thalamus opticus, where the 3rd neuron is located. Its fibers are diffusely sent to the region of the posterior central gyrus of the parietal lobe of the cerebral cortex, where pain is formed. Strictly localized pain with a certain projection on the surface of the body is perceived and transformed along this path. It is also called somatic pain. It is transmitted along A^ fibers.

There is also a non-specific reticulocortical pathway that forms non-localized diffuse pain (stomach pain, body pain, etc.). This path is subdivided into spinoreticular, spinothectal and spinobulbothalamic. The reticular formation plays the role of a kind of battery in the central nervous system. The participation of the reticular formation in the formation of diffuse pain is evidenced not only by numerous experimental data, but also by its anatomical connections throughout the trunk of the mo:ma with a specific three-neuron pathway. In the formation of non-localized pain, the frontal lobes of the brain and the gelatinous substance of Roland, located in the posterior horns of the spinal cord, take part.

Using electrophysiological research methods, it was shown that all levels of the central nervous system (cortex, thalamic and limbic systems, nuclei of the posterior hypothalamus, elements of the dorsal parts of the spinal cord) are involved in the formation of pain. The pain reaction is the response of the entire CNS. An important link in the CNS in response to a painful stimulus is the entry of nociceptive impulses into the structures of the hypothalamus, since the hypothalamus is both an emotional and a vegetative center. Excitation of the hypothalamus is accompanied by a state of negative emotion, activation of the ANS occurs, and hormonal reactions of the body change through the connections of the hypothalamus with the pituitary gland. The function of the adrenal glands is activated, the release of adrenaline and corticosteroids increases. Removal of the adrenal glands leads to the death of animals with severe pain irritation. The release of releasing factors (or liberins) by the hypothalamus regulates the release of pituitary hormones: ACTH, thyroid-stimulating, ADH (anuria in case of painful excitation).

Neurochemical processes of pain excitation. The main chemicals that cause the activation of chemociceptors are mediators: acetylcholine, norepinephrine and serotonin. In addition, in case of tissue damage (trauma, inflammation), the formation of potassium chloride, histamine, serotonin, prostaglandins, kinins, substance P, somatostatin increases, which increase the excitation of both mechano and chemociceptors. Of the kinins, bradykinin is the most studied, the amount of which increases with pain irritation in the perfusate of the skin and tooth pulp. The introduction of bradykinin is used to prove the participation of certain nerve units in pain stimulation. Fibers containing bradykinins are found in the hypothalamus and cerebral cortex. In the mechanisms of pain excitation, substance or substance P is of great importance. It has been established that during antidromic stimulation of the fibers of the pulp of the tooth, substance P is released, which is currently considered a mediator of nociceptive impulses at the level of neurons of the posterior horns of the spinal cord, and not at the level of peripheral receptors. However, substance P differs from classical mediators in a number of ways, so substance P is more of a modulator rather than a mediator of nociceptive impulses,

In the body, in addition to the nociceptive system, there is an endogenous antinociceptive system that controls and regulates pain sensitivity. Since ancient times, the analgesic properties of opium preparations have been known. The introduction of morphine causes a decrease in pain in humans and an increase in the threshold of nociceptive reactions in animals. The existence of opiate receptors in the body has led to the assumption that they bind morphine-like substances, not only exogenous, but also endogenous - ligaids related to this type of receptor.

In 1975, such endogenous morphine-like substances were isolated for the first time from the brain, as well as from the pituitary gland of pigeons and other animals in the form of oligopeptides. In 1976, oligopeptides were found in human cerebrospinal fluid and blood. Various types of these oligopeptides are called endorphins (END) and enkephalins (ENK). Some properties of ENCs are characteristic of mediators. Currently, it is believed that END are produced mainly in the hypothalamus and pituitary gland, ENK - in the hypothalamus. ENKs have a wider localization in the CNS. The largest amount of ENC in humans was found in the globus pallidus, 2 times less in the substantia nigra, 3 times less in the caudate nucleus, hypothalamus, etc. The precursor of END is lipotropin, which is produced in the hypothalamus. Activation of the endorphin mechanisms of the hypothalamus leads to an increase in the release of hormones and END from the pituitary gland, while the content of END in plasma and cerebrospinal fluid increases. This allows it to contact various opiate receptors.

In contrast to END, ENC-containing cells and fibers are localized in almost all switching stations of pain impulses: neurons of the dorsal horn of the spinal cord, giant cell nucleus, reticular formation, nuclei of the hypothalamus, thalamus, and even the frontal cortex. This leads to the assumption that the mechanisms of ENC action on the nociceptive system are associated with their direct and local influence on opiate receptors and are carried out depending on the level of their localization. The opioid system can have 2 mechanisms of action on opiate receptors: 1) through the activation of the hypothalamic END with subsequent activation of the pituitary END and their influence through the blood and cerebrospinal fluid. This is the epdorphin mechanism; 2) through the activation of terminals containing ENC and END.

As a result of research, it was found that morphine and morphine-like substances inhibit the conduction of pain impulses, starting from peripheral nociceptors. It has been shown that morphine reduces the content of bradycypium in the perfusate of the skin, as well as in the dental pulp when they are painfully irritated, and blocks the release of prostaglandins.

Injecting morphine directly into a person's spinal cord produces more pain relief than intravenous injection. One of the main mechanisms for the transmission of pain impulses at the level of neurons in the posterior horn of the spinal cord is the release of substance P, a modulator that enhances the excitation of pain interneurons. Morphine in doses that cause analgesia in cats, led to the disappearance of the effect of increasing the amount of substance P during electrical stimulation of the sciatic nerve. There is an opinion about it. that morphine and opioid peptides act presynaptically on the release of substance P from the primary terminals and thereby inhibit the conduction of pain impulses.

It is assumed that the opioid system is the controller of the intensity of nociceptive excitation. People with a high content of opioids in the cerebrospinal fluid respond to an increasing stimulus with a decrease in sensitivity to it, and people with a lower content of opioids, on the contrary, respond with an increase in sensitivity. The restrictive function of the endogenous opioid system also plays a certain role in the genesis of some body reactions that occur to superstrong stimuli, leading to a state of shock. With all types of shock, there is a decrease in general and pain sensitivity, a lack of response to electrical stimulation, which indicates a blockade of the conduction of pain impulses. This can be done through the mechanism of the endogenous opioid system.

A decrease in pain sensitivity is caused by neurotensin (its analgesic effect is 100-1000 times greater than that of morphine), serotonin. There is an independent mechanism for the regulation of pain sensitivity - serotonergic, different from the opioid mechanism. The cerebral cortex regulates pain sensitivity. If a person is warned about pain, then he feels it less. The emotional regulation of pain sensitivity is well known. Stressful situations reduce the feeling of pain. Emotional states such as fear sharply increase the reaction to pain, lower the threshold of pain sensitivity, and states such as aggression, on the contrary, reduce pain sensitivity. It is not yet known through which mechanism the action of emotional arousal is realized: opioid or serotonergic.

An independent adrenergic mechanism of anti-tinocyception associated with the activation of negative emotional areas of the brain was found. This mechanism has an adaptive value, as it allows the body in stressful situations to neglect pain effects and thereby give all its strength to the struggle to save life: for example, with emotions of fear - to flee, with emotions of anger - aggression.

25 Thus, there is a constant interaction of nociceptive and antinociceptive mechanisms of the organism. This forms the threshold of pain sensitivity and its functional fluctuations.

Introduction

Chapter 1 Theoretical and clinical aspects of pain

1.1 Features of pain sensitivity

1.2 Factors that determine the perception of pain

Chapter 2 Influence of psychosocial factors on the course of the disease

2.1 Mental factors in chronic and acute pain

2.2 The effect of gender differences on the perception of pain

Chapter 3 The influence of the disease on the psyche and behavior of the individual

3.1 Emotional-behavioral aspects of pain perception

3.2 Influence of socio-constitutional factors

on the concept of disease

Conclusion

List of sources used

Introduction

The doctrine of pain is one of the central problems of biology, medicine and psychology. Pain - one of the most common sensations - is characterized by a variety of its manifestations. Many people know that the nature, severity, duration, localization and other features of pain can be very different. Pain is always unpleasant, and a person seeks to get rid of this sensation. At the same time, it turns out that pain is useful, as it signals about the problems that have arisen in the body. The ancient Greeks said that pain is "...it is the watchdog of health."

The feeling of pain warns the body about the harmful effects of mechanical, chemical, electrical and other factors. Pain not only notifies a person of trouble, but also forces the body to take a number of measures to eliminate the causes of pain. This happens in a reflex way. It is known that a reflex is a response of the body to the action of various stimuli. Indeed, as soon as a person touches something hot or very cold, sharp, etc., he immediately instinctively moves away from the action of a harmful factor.

In the process of evolution of the organic world, pain has turned into a signal of danger, has become an important biological factor that ensures the preservation of the life of an individual, and hence the species. The occurrence of pain mobilizes the body's defenses to eliminate painful irritations and restore the normal functioning of organs and physiological systems.

Of all types of sensitivity, pain occupies a special place. While other types of sensitivity have a certain physical factor as an adequate stimulus (thermal, tactile, electrical, etc.), pain signals such organ conditions that require special complex adaptive reactions. There is no single universal stimulus for pain. As a general expression in the human mind, pain is caused by a variety of factors in various organs.

Anokhin defined pain as a kind of mental state of a person, due to the totality of the physiological processes of the central nervous system, brought to life by some super-strong or destructive irritation. In the works of domestic scientists Astvatsaturov and Orbeli, ideas about the general biological significance of pain are especially clearly formulated.

By its nature, pain is a subjective sensation, depending not only on the magnitude of the stimulus that causes it, but also on the mental, emotional reaction of the individual to pain.

The object of the study are people experiencing pain.

The subject of the study is changes in the emotional and personal characteristics of an individual with various manifestations of pain.

The purpose of the study is to consider the impact of pain on the psyche and behavior of the individual.

Consider theoretical and clinical aspects of pain;

Determine the influence of psychosocial factors on the course of the disease;

Analyze the impact of the disease on the psyche and behavior of the individual.

Chapter 1 Theoretical and clinical aspects of pain

1.1 Features of pain sensitivity

The multifactorial nature of pain processes prevents researchers from even reaching a single definition. "Pain should be considered as an integrative function of the body, which includes such components as consciousness, sensations, emotions, memory, motivations and behavioral responses." Pain is an unpleasant sensation or suffering caused by irritation of specific nerve endings in damaged or already damaged tissues of the body. It seems that the biological significance of pain is that it serves as a warning signal and causes a decrease in physical activity during an injury or during an illness, which facilitates the recovery process.

Pain is not only a signal, but also a protective device. People who do not have a sense of pain, which in rare cases can be a birth defect or a consequence of a disease of the nervous system, are not able to avoid the impact of a damaging factor in time and may become a victim of an accident, despite the fact that they constantly resort to precautionary measures, trying to save themselves from burns, injuries, exposure to radiant energy, etc. These people are easy to recognize upon examination: they usually have numerous scars on their skin from burns, injuries, etc.

However, no matter how difficult it is for a person deprived of the feeling of pain, it is even more difficult for someone whose pain continues for a long time. Having performed its protective function at first, pain becomes the worst enemy of the body. It depletes strength, depresses the psyche, disrupts the functions of various body systems. The motor activity of a person decreases, sleep, appetite, etc. are disturbed.

As you know, the feeling of pain in the human body is formed by the nervous system. The main parts of the nervous system are the brain, spinal cord, nerve trunks and their terminal devices (receptors), which convert the energy of external stimulation into nerve impulses.

The brain and spinal cord make up the central nervous system, and all other divisions of the nervous system make up the peripheral. The brain is divided into hemispheres and the brain stem. The hemispheres are represented by white matter - nerve conductors and gray matter - nerve cells. The gray matter is located mainly on the surface of the hemispheres, forming the cerebral cortex. In the form of separate accumulations of cell groups, it is also located in the depths of the hemispheres. These are the so-called subcortical nodes. Among the latter, visual tubercles (left and right) are of great importance in the formation of pain sensations. Cells of all kinds of body sensitivity are concentrated in them. In the brainstem, accumulations of gray matter cells form the nuclei of the cranial nerves, from which various nerves originate, providing sensory and motor innervation to the head, face, oral cavity, pharynx, and larynx.

In the process of long-term adaptation of living beings to environmental conditions, special sensitive nerve endings have formed in the body, converting various types of energy that come from external and internal stimuli into nerve impulses. They are called receptors. Receptors are different in their structure and function. They are present in almost all tissues and organs. Some of them perceive tactile stimuli (feeling of touch, pressure, weight, etc.), others - thermal (sensation of heat, cold, their combination), others - chemical (action of various chemicals), etc. The simplest device have pain receptors. Pain sensations are perceived by the free endings of sensitive nerve fibers. Pain receptors in the head do not differ in structure from pain receptors located in other areas of the body.

Pain receptors are located unevenly in various tissues and organs. Most of them are in the fingertips, face, mucous membranes. Vessel walls, tendons, meninges, periosteum (surface shell of the bone) are significantly supplied with pain receptors.

Everyone knows how painful blows are felt in the area of ​​the periosteum, especially in those areas where it is not covered by soft tissues, for example, on the front surface of the lower leg. At the same time, operations on the bone itself are painless, since the bone does not contain pain receptors. Few pain receptors in the subcutaneous fat. The substance of the brain has no pain receptors, and neurosurgeons know that the brain can be cut without resorting to painkillers. Due to the fact that the membranes of the brain are supplied with pain receptors to a sufficient extent, squeezing or stretching the membranes causes pain of considerable strength.

The activity of the cerebral cortex largely depends on a special formation of the nervous system, called the reticular formation of the brain stem, which can both activate and inhibit the activity of the cerebral cortex.

Pain sensitivity to superstrong and destructive stimuli is associated with the occurrence of pain sensations that have a sharply negative emotional coloring, and vegetative reactions (accelerated breathing, dilated pupils, constriction of peripheral vessels, etc.). Pain sensations of a different nature can be caused by any damaging stimuli (temperature, mechanical, chemical, radiant energy, electric current).

Pain is a stimulus for various defensive reactions, the main purpose of which is the elimination of external or internal agents that caused pain. Pain sensitivity is therefore of great biological importance.

Some believe that any super-strong irritation or destruction of any receptor in the body can lead to pain. On the skin surface, the total number of pain points corresponding to the location of pain sensitivity receptors in the skin is 900,000-1,000,000 (up to 100-200 per 1 cm³).

Pain is easily evoked by a conditioned reflex. So, if you combine a bell with painful skin irritation, then after several combinations, the isolated effect of the bell begins to cause pain and characteristic vegetative reactions. Pain sensitivity is the most primitive, undifferentiated form of sensitivity. Pain is very difficult to localize. Their localization becomes possible due to the accompanying tactile and other sensations.

Sensitivity to pain depends not only on the number of pain receptors, but also on age and gender. There is a dependence on the state of the psyche.

Anything that diverts attention from painful irritation reduces the sensation of pain. This explains the weakening or cessation of pain during the period of affects, during anger, fear. A person who is passionate about something does not feel pain. For example, in the heat of battle, he may not notice the wound. And, conversely, in states of depression, physical fatigue, nervous exhaustion, the sensation of pain increases.

Expectation and fear increase pain; the same happens in the absence of distractions. This can also explain the increase in all types of pain at night.

Pain impulses, being received by receptors, then cope in a complex way through special sensitive fibers to various parts of the brain and ultimately reach the cells of the cerebral cortex.

The centers of pain sensitivity of the head are located in various parts of the central nervous system. The activity of the cerebral cortex largely depends on a special formation of the nervous system - the reticular formation of the brain stem, which can both activate and inhibit the activity of the cerebral cortex.

1.2 Factors that determine the perception of pain

Pain is a psychophysiological reaction of the body that occurs with strong irritation of sensitive nerve endings embedded in organs and tissues. This is the oldest evolutionary protective reaction of the organism. It signals trouble and causes the body's response, aimed at eliminating the cause of pain. Pain is one of the earliest symptoms of some diseases.

There are a huge number of factors that determine the perception of pain by a person or animal. Among them are racial, and gender, and age characteristics, and the state of the autonomic nervous system, and fatigue, and experimental conditions, and the research environment, and the order of irritations, and many other physiological, biochemical, psychological and other reasons that affect the thresholds of pain. . Soviet pharmacologist A.K. Sangailo argues that social conditions largely determine the perception of pain. According to him, adolescents are more tolerant of pain and adapt to it more easily than adults. Persons of young age react sharply to painful stimuli, but easily adapt to them. The elderly are somewhat less sensitive to pain.

Beecher counted 27 factors that determine pain sensation, but there are probably many more. That is why, when studying pain in an experiment, it is necessary to carefully observe the homogeneity, uniformity of the conditions in which the study takes place.

Of great importance for the perception of pain is the mental state of the subject. Expectations and fears increase the pain sensation; fatigue to insomnia increase a person's sensitivity to pain. However, everyone knows from personal experience that with deep fatigue, the pain is dulled. Cold intensifies, heat relieves pain.

T. Schatz speaks about the strategic importance of pain both for the person reporting it and for the relatives, friends and acquaintances around him. Therefore, when assessing pain, one should take into account the social situation, the subjective characteristics of the suffering person, the reaction of people close to him.

It must be assumed that the perception and overcoming of pain to a large extent depends on the type of higher nervous activity. When Leriche says: “We are unequal in the face of pain,” this, translated into the language of physiology, means that different people react differently to the same painful stimulus. The strength of irritation and its threshold may be the same, but the external manifestations, the visible reaction, are purely individual.

The type of higher nervous activity largely determines a person's behavior in response to pain stimulation. In people of a weak type, whom I.P. Pavlov referred to as melancholic, a general exhaustion of the nervous system quickly sets in, and sometimes, if protective inhibition does not occur in time, a complete violation of the higher parts of the nervous system.

In excitable, unrestrained people, the external reaction to pain can take on an extremely violent, affective character. The weakness of the inhibitory process leads to the fact that the limit of the efficiency of the cells of the cerebral hemispheres is crossed and an extremely painful narcotic or psychopathic state develops.

At the same time, people of a strong, balanced type, apparently, suppress reactions more easily and are able to emerge victorious in the fight against the most severe pain stimuli.

In some people in the normal state, in others - with various diseases, there is an increased sensitivity to pain, the so-called hyperalgesia. In order to cause pain in them, it is enough to apply a weaker irritation than in people with normal pain sensitivity. These people have a lower pain threshold and respond to irritation and skin damage that is completely invisible to most people.

There are people in whom far from strong pain irritation causes excruciating pain that does not fade for a long time. Sometimes hypersensitivity is limited to certain areas of the body surface, sometimes it captures the entire skin and visible mucous membranes.

People who suffer from hypersensitivity begin to complain of soreness with every touch. It is difficult for them to wear clothes, they cause pain. It is enough to lightly stroke the skin to cause a burning sensation in them, which sometimes lasts quite a long time.

There are, though not very often, people who react poorly to pain. In many diseases of the nerve trunks, brain and spinal cord, sensitivity to pain decreases. Sometimes on the surface of the body you can find areas, irritation or damage to which does not cause pain.

Reduced pain sensitivity (hypoalgesia) is also observed in some nervous and mental diseases, such as hysteria.

Such data allow a new approach to resolving some of the controversial aspects of the problem of pain. The absence of pain sensitivity, says Melzak, is perhaps the most convincing evidence of the positive value of pain in human life.

Chapter 2 Influence of psychosocial factors on the course of the disease

2.1 Mental factors in chronic and acute pain

Pain tolerance is individual. It depends on how much attention is paid to pain, on the characteristics of the patient's personality, and can vary greatly with mental illness.

Pain is usually divided into acute and chronic. It is necessary to determine what is considered acute pain and what is chronic. Acute pain is always a symptom of some organic suffering. On the contrary, chronic pain, as a rule, is not a symptom, but a disease in itself, in which not morphological tissue damage is of decisive importance, but defective perception and other dysfunction of mental processes. Chronic pain is usually defined as pain that lasts 6 months or more.

One of the main difficulties in chronic pain is that in addition to the pain itself (even if it is the only complaint), it is necessary to evaluate many other factors that affect the patient's condition. Mental factors affect pain of any origin. The football player, having been injured during the game, soon returns to the field; the same trauma in everyday life can put him to bed for several days. The dependence of pain on the psychological state is well known to those who were in the war.

The following factors contribute to increased pain:

Depression. Since the affective component is more pronounced in chronic pain than in acute pain, it can be assumed that the intensity of chronic pain depends on the influences of the limbic system. With major depression and associated despondency, dysphoria, or irritability, pain sensations intensify. In chronic pain, the first thing to look for is depression; some even believe that almost all chronic pain is due to severe depression.

Anxiety. Many patients with chronic pain are in a state of anxiety or even fear, which increases the severity of pain.

Psychogenic pain. If it is not possible to identify the physical causes of pain, but its connection with psychological factors is found, we can talk about psychogenic pain. In this case, there must be a temporal relationship between the occurrence of pain and the subconscious benefit that the patient receives from his condition. So, an unsuccessfully landing pilot may feel an excruciating headache during the briefing before the next scheduled flight. Another psychological factor often identified in psychogenic pain is the need for sympathy, which the person cannot obtain in any other way.

In pain and depression, there are common formation mechanisms associated with angioedema - the inability to experience pleasure. Therefore, depression is one of the forms of mental disorders closely associated with the occurrence of psychogenic pain. These disorders can occur simultaneously or one ahead of the manifestations of the other. In patients with clinically significant depression, the pain threshold decreases, and pain is considered a common complaint in patients with primary depression. Patients with pain associated with a chronic somatic disease also often develop depression. From a psychodynamic position, chronic pain is seen as an external protective manifestation of depression, which alleviates mental impulses (feelings of guilt, shame, mental suffering, unrealized aggressive tendencies, etc.) and protects the patient from more severe mental anguish or suicide. Pain is often the result of a defense mechanism, repression, typical of hysterical conversion. In many cases, the combination of pain symptoms and depression is considered as a masked depression, where the pain syndrome or somatoform pain disorder comes to the fore.

Psychopathies may play a major role in chronic pain; this is especially true of antisocial, dependent and borderline psychopathy. The doctor almost always focuses on the pain itself and its treatment, losing sight of possible pathological personality traits.

Currently, chronic pain is considered as an independent disease, which is based on a pathological process in the somatic sphere and primary or secondary dysfunction of the peripheral and central nervous systems. An integral feature of chronic pain is the formation of emotional and personality disorders; it can only be caused by dysfunction in the mental sphere, i.e. refer to idiopathic or psychogenic pain.

The close relationship between chronic pain and depression is clear. Statistical data on the presence of mental disorders of a depressive nature in half of patients suffering from chronic pain; according to S.N. Mosolov, chronic pain syndromes are found in 60% of patients with depression. Some authors are even more specific, believing that depression occurs in all cases of chronic pain syndrome, based on the fact that pain is always accompanied by negative emotional experiences and blocks a person's ability to receive joy and satisfaction. It is not the coexistence of chronic pain and depression that causes the greatest controversy, but the causal relationship between them.

On the one hand, long-term pain limits a person's professional and personal capabilities, makes him abandon his usual life stereotypes, violates his life plans, and so on. A decrease in the quality of life can give rise to secondary depression. On the other hand, depression may be the root cause of pain or the main mechanism of chronic pain syndrome. So, atypical depressions can appear under various masks, including under the mask of chronic pain.

It is obvious that a chronic disease can affect the psyche, upsets the target settings of the individual, changes his character, emotional response to stimuli, creating an imbalance between the processes of excitation and inhibition.

2.2 The effect of gender differences on the perception of pain

Differences between men and women in response to pain have been confirmed by many epidemiological and experimental data. In most cases, it is found that women and girls report pain to a greater extent than men and boys. The same differences, but to a lesser extent, were noted in clinical studies.

To explain these differences, in most cases, the biological characteristics of men and women are involved. Recently, studies have appeared showing the important contribution of psychological and social factors to differences in pain response in men and women. At the same time, much more attention is paid to the influence of affective factors on the sensation of pain.

There are still very few studies devoted to the study of the role of social factors, although the problem (“the influence of social factors”) seems to be very relevant. In recent years, the issue of gender socialization has been a hot topic of discussion.

To date, only a few studies have been carried out that directly studied the role of gender differences in pain syndromes. Available data show that the role of psychological and social factors in the context of gender differences is sometimes decisive for the assessment of pain.

Social-cognitive learning theory and cognitive development theory suggest that young boys and girls identify as male or female during learning. By observing other people and whether their actions are punished or rewarded, they learn different types of behavior. The theory of gender by S. Bem integrates elements of both theories to explain the reasons why men and women choose masculine or feminine types of behavior in accordance with existing cultural stereotypes. Several studies have shown that the consequences of breaking gender norms differ for boys and girls (men and women). Parents, especially fathers, tend to reward boys more for conforming to gender stereotypes and punish boys more severely if they break gender norms. If boys who act “unmanly” are ridiculed by their peers, scolded by their parents, girls can more often get away with deviation from their gender role. This leads to the fact that boys are more determined to match their gender role, including pain tolerance, than girls.

Since the male gender role suggests a high tolerance for pain, gender theory suggests that men who choose the male stereotype of behavior will be motivated to endure pain so as not to appear "unmanly".

Psychosocial theories of pain behavior focus on the contingency effect on the emergency and on the persistence of pain behavior, and on the important role of learning in observing pain behavior and considering the consequences (reward or punishment) of pain behavior in others.

Several researchers have shown a correlation between the number of people with pain behavior in the family and the frequency of presentation of pain by young people from these families. It was shown that this dependence was more pronounced in females. Women also show greater alertness to pain and a greater willingness to report pain (complain about pain), while men do so reluctantly and with embarrassment.

Ample evidence suggests that men and women, on average (generally), differ in their pain reports in most cases with different characteristics of the pain stimulus and different methodological approaches to the study.

Also, according to epidemiological studies, it is clear that women complain more about pain and more often go to medical institutions for pain. However, until recently, all work on the study of sexual dimorphism was reduced mainly to the identification of physiological/anatomical causes (determinants) of detected sex differences. The role of biological features on the manifestations of sexual dimorphism has been sufficiently covered, but there are practically no studies where an attempt would be made to assess the specific weight and role of psychosocial factors on the manifestations of sexual dimorphism in pain syndromes. Numerous features of the behavior of men and women, including the manner of communication, manner of dressing, professional and non-professional interests, can be explained to a greater extent by differences in social learning, gender stereotypes of behavior than by biological features.

Various data (laboratory, clinical, epidemiological) indicate that, on average, men and women assess clinical symptoms differently, the severity (severity) and significance of symptoms for health, differ in their attitude to their health and the system (various types) of medical care , and differently see how a man and a woman should respond to pain. Men and women also differ in how they express their negative emotions, which is an essential part of any pain syndrome.

It can be argued that men and women differ greatly in regards to pain expectation. These expectations are gender-specific, that is, in accordance with gender stereotypes (norms), both men and women believe that men are less sensitive to pain, better tolerate pain, and less willing to report pain. However, the degree of these differences varies greatly depending on the type of study (experimental or clinical), cultural factors (ethnic norms, etc.).

Chapter 3 The influence of the disease on the psyche and behavior of the individual

3.1 Emotional-behavioral aspects of pain perception

The perception of pain is associated with a person's early childhood experience. Depending on this experience, the individual develops attitudes that determine the attitude towards pain. Pain and suffering are perceived as the opposite of joy and pleasure.

Education is of great importance in overcoming pain. However, the strength of a person is not in an accidental, but in a strong-willed, conscious overcoming of pain, in the ability to overcome pain, to rise above suffering, to achieve victory over a stubborn, persistent feeling of pain.

It has long been known that people who grew up in harsh conditions, accustomed to firm discipline and constant self-control, are better in control of their feelings than the pampered, undisciplined and selfish representatives of the human race. They do not respond to every pain stimulus with a cry, tears, fainting, or an attempt to escape.

This is taught by the experience of our whole life, the experience of health and illness, work and rest, peace and war. Of course, one should not go to extremes here and think that the only way to deal with pain is to suppress painful emotions. On the contrary, pain must be fought, it must be destroyed in all its manifestations. But it must be done courageously. A person must rule over excruciating pain sensations. He must not become their prisoner.

Fear, rage, pain and pangs of hunger, writes the outstanding physiologist W. Cannon, are elementary feelings that are equally characteristic of both humans and animals. They are among the most powerful factors that determine the behavior of living beings. These are subjective states, covering all kinds of feelings and experiences of a person. And their role in human life is extremely important.

Much has been written about the emotional perception of pain. Pain, with rare exceptions, is regarded as a negative emotion. But the elimination of pain, the cessation of excruciating pain is a positive human experience.

Acute flowing pain is usually accompanied by a cry, which is the result of convulsive contraction of the respiratory muscles. The cry arose from the initial sharp movement - exhalation. He became a signal of danger, a call for help, turned partly into an instrument of defense, since he could frighten the attacker.

Some physiologists have tried to explain the cry as self-defense of the organism. They argued, and perhaps not without reason, that the cry - and, moreover, a long one, characteristic of pain - is, among other things, an analgesic. It relieves and soothes pain, partly because it promotes the accumulation of carbon dioxide in the blood.

If the medical examination cannot find a physical or organic cause of the disease, or if the disease being investigated is the result of emotional states such as anger, anxiety, depression, guilt, then it may be classified as psychosomatic.

Psychosomatics (from Gr. psyche - soul, soma - body) - studies the influence of psychological factors on the occurrence and subsequent dynamics of the development of psychosomatic diseases. According to the main postulate of this science, the basis of psychosomatic illness is a reaction to an emotional experience, which is accompanied by functional changes and pathological disorders in the organs.

In modern psychosomatics, there are: predisposition, factors that allow and delay the development of the disease. The impetus for the development of psychosomatic diseases are difficult life situations, including, as a result of complex relationships in the family. In any case, for the diagnosis of both psychosomatic and neurotic diseases, it is necessary to understand the situational nature of its origin.

Often, when a psychosomatic illness occurs, conflict dynamics is defined by the concept of "stress". But this is not just stress, i.e. stress that leads to illness. A person who is in harmonious relations with his environment can endure extreme somatic and mental stress, avoiding illness. However, in life there are also such intra-family problems that cause such painful fixation and mental discord that, in certain situations, lead to negative emotions and self-doubt, and ultimately “turn on” psychosomatic diseases.

Both in functional pains and in pains based on organic changes, personal relationships play an important role (not in the occurrence, but in the degree of pain experience). Pain often reaches its greatest severity in patients with personal disorder, lack of purpose and other unresolved conflicts. Focusing the attention of patients on themselves, pain in such cases is used as a means of getting out of a traumatic situation, helping patients to get away from resolving real life difficulties.

In the course of human development, pain and relief from pain influence the formation of interpersonal relationships and the formulation of the concept of good and evil, reward and punishment, success and failure. As a means of eliminating guilt, pain thus plays an active role in influencing interactions between people.

Psychosocial influences, interacting with factors of hereditary predisposition, personality traits, the type of neuroendocrine reactions to life difficulties, can change the clinical course of some diseases. The action of psychosocial stresses, provoking internal conflicts and causing an adaptive reaction, can manifest itself secretly, under the guise of somatic disorders, the symptoms of which are similar to those of organic diseases. In such cases, emotional disorders are often not only not noticed and even denied by patients, but also not diagnosed by doctors.

3.2 Influence of socio-constitutional factors on the concept of disease

People who have experienced trauma believe that the world is full of dangers, and you need to be on your guard all the time. This belief can have a profound effect on everything that people experience. Core beliefs play a central role and influence the organization of virtually all experience. Some core beliefs place limits on what can be experienced.

It is known that for each age group there is a register of the severity of diseases - a kind of distribution of diseases according to socio-psychological significance and severity.

For children, adolescents and young people, the most difficult psychologically are diseases that change the appearance of a person, making him unattractive. This is due to the system of values, the prioritization of a young person, for whom the highest value is the satisfaction of a fundamental need - "satisfaction with one's own appearance." Thus, the most severe psychological reactions can cause diseases that are not medically life-threatening. These include any disease, negatively, from the point of view of a teenager, changing appearance (skin, allergic), mutilating injuries and operations (burns). At no other age is there such a severe psychological reaction of a person to the appearance of boils, acne, freckles, birthmarks, pallor, etc. on his skin.

Persons of mature age will respond psychologically more difficult to chronic and disabling diseases. This is also connected with the system of values ​​and reflects the aspiration of a person of mature age to satisfy such social needs as the need for well-being, well-being, independence, independence, etc. It is the satisfaction of such needs that can be blocked by the appearance of any chronic or disabling disease.

The second highly significant group of diseases for a mature person are the so-called "shameful" diseases, which usually include venereal and mental diseases. The psychological reaction to them is due to their assessment, not as a threat to health, but is associated with feelings about how the social status and authority of the sick person will change if others become aware of this.

There are groups of the population (primarily people in leadership positions) for some of which heart disease (heart attack) is shameful, which is associated with a limited opportunity for promotion.

For the elderly and the elderly, the most significant is the disease that can lead to death. Heart attack, stroke, malignant tumors are terrible for them not because they can lead to loss of work or performance, but because they are associated with death.

Characterologically conditioned subjective attitude to the disease is formed mainly in the process of family education. Moreover, there are two opposing family traditions of educating a subjective attitude towards diseases - “stoic” and “hypochondriac”.

Within the framework of the first, the child is constantly encouraged for behavior aimed at independently overcoming ailments and poor health. He is praised when, ignoring the existing pain, he continues to do what he was doing before it occurred.

The “hypochondriac” family tradition, which is opposite to it, is aimed at the formation of an overvalued attitude to health. Parents are encouraged to be attentive to the state of their health, thoroughness in assessing painful manifestations, identifying the first signs of the disease in themselves. In the family, the child gets used, at the slightest change in well-being, to pay his own attention and the attention of others (first parents, and then educators, teachers, spouses, etc.) to painful symptoms.

Family traditions determine the peculiar ranking of diseases according to their severity. For example, the most severe ones may not be “objectively” severe, but those from which most often died or were most often ill by family members. As a result, hypertension may be subjectively the most significant disease, rather than cancer or mental illness.

The typology of response to diseases accepted in domestic clinical psychology was created by A. E. Lichko and N. Ya. Ivanov on the basis of an assessment of the influence of three factors:

1) the nature of the somatic disease itself;

2) personality type, in which the most important component

determines the type of character accentuation;

3) attitudes towards this disease in the reference for

Similar response types are grouped into blocks.

The first block includes types of attitude to the disease, in which social adaptation is not significantly disturbed (harmonious, ergopathic and anosognosic types).

Harmonious. A sober assessment of one's condition, without a tendency to exaggerate its severity and without reason to see everything in a gloomy light, but also without underestimating the severity of the disease. The desire to actively contribute to the success of treatment in everything. Unwillingness to burden others with the burdens of self-care. In the case of an unfavorable prognosis in terms of disability - switching interests to those areas of life that will remain available to the patient.

With a harmonious type of mental response, realism in the perception of symptoms and understanding of the objective severity of the disease is important. At the same time, the patient tries to rely in his reactions on the facts known to science (medicine) about the possibility of a cure for a particular disease, the origin of symptoms, etc. And such information can be provided to him.

Ergopathic. "Escape from illness to work." With the objective severity of the disease and suffering, patients try to continue working at all costs. They work hard, with even greater zeal than before the illness, they devote all their time to work, they try to be treated and undergo examinations so that this does not interfere with work.

Therefore, they try not to succumb to the disease, actively overcome themselves, overcome malaise and pain. Their position is that there is no disease that cannot be overcome on one's own. Such patients are often fundamentally opposed to drugs (“I have never taken analgesics in my life,” they proudly say).

Anosognosic. Active rejection of thoughts about the disease, about its possible consequences. Not recognizing oneself as sick. Denial of the obvious in the manifestations of the disease, attributing them to random circumstances or other non-serious diseases. Refusal of examination and treatment. The desire to "get by with your own means."

Anosognosia is quite common. It may reflect an internal rejection of the status of the patient, unwillingness to reckon with the real state of affairs. On the other hand, behind this there may be a person's delusion about the significance of the signs of the disease. Active non-recognition of oneself as sick occurs, for example, in alcoholism, since it contributes to avoidance of treatment.

The second block includes types of responses that lead to mental maladjustment with a predominantly intrapsychic orientation (hypochondriac, anxious and apathetic).

Hypochondriacal. Focusing on subjective painful and other unpleasant sensations. The desire to constantly talk about them to others. Reassessment of real and seeking out non-existent diseases and suffering. Exaggeration of the side effects of drugs. A combination of desire to be treated with disbelief in success. Demands for a thorough examination coupled with a fear of harm and pain from diagnostic procedures.

Anxious. Continuous anxiety and suspiciousness regarding the unfavorable course of the disease, possible complications, inefficiency and even the danger of treatment. Finding new treatments, thirst additional information about the disease, possible complications, methods of therapy, the continuous search for medical "authorities".

Apathetic. Apathy in the true sense is complete indifference to one's fate, to the outcome of the disease, to the results of treatment. Passive obedience to procedures and treatment only with persistent prompting from the outside. Loss of interest in everything that previously worried.

The third block includes types of responses with impaired mental adaptation according to the interpsychic variant, which to the greatest extent depends on the premorbid personality traits of patients (neurasthenic, obsessive-phobic and paranoid).

Neurasthenic. Behavior of the type of "irritable weakness". Outbursts of irritation, especially with pain, with discomfort, with treatment failures, with unfavorable examination data. Irritation often pours out on the first person who comes across, and often ends with repentance and tears. Pain intolerance, impatience, inability to wait for relief. Subsequently - regret about the anxiety and incontinence caused.

Obsessive-phobic. Anxious suspiciousness, which primarily concerns fears that are not real, but unlikely: complications, treatment failures, poor outcomes, as well as possible (but also unfounded) failures in life, work, family situation due to illness. Imaginary fears excite more than real ones.

Paranoid. The belief that illness is the result of something malicious. Extreme suspicion of drugs and procedures. The desire to attribute possible complications treatment or side effects of drugs negligence or malice of doctors and staff. Complaints to all instances, accusations and demands for punishment in connection with this.

Thus, the level of education of a person and the level of his culture, as personality traits, also affect the assessment of the subjective severity of the disease. This is especially true of the level of medical education and culture. Moreover, both extremes turn out to be psychologically negative: both low medical culture and high, which are equally likely to cause psychologically severe reactions. However, their mechanisms will differ. In one case, this will be associated with a lack, in the other - with an excess of information about diseases, their objective severity, course and outcomes.

Pain plays an extremely important role in the psychological life of the individual. In the course of human development, pain and relief from pain influence the formation of interpersonal relationships and the formulation of the concept of good and evil, reward and punishment, success and failure. As a means of eliminating guilt, pain thus plays an active role in influencing interactions between people.

Conclusion

Pain is a complex phenomenon that includes perceptual, emotional, cognitive and behavioral components. Physiological pain plays a protective signal value, warns the body of danger and protects it from possible excessive damage. Such pain is necessary for our normal functioning and security.

Pain sensations are sensations that characterize such influences that can lead to a violation of the integrity of the body, accompanied by negative emotional coloring and vegetative shifts (increased heart rate, dilated pupils). In relation to pain sensitivity, sensory adaptation is practically absent.

The idea of ​​pain as a simple alarm sounding in the brain seems to be true only at first glance. The modern point of view is much more complicated. In understanding the intensity of pain, the emotional aspects of the trauma are immeasurably more important than the degree of physical damage. The holistic perception of pain depends on the emotional state and thought process, coordinated with pain signals coming from the source of damage.

As it turned out, the threshold of pain sensitivity does not have significant age differences, however, laboratory analysis reveals a whole set of small variations in the nature of responses to pain stimuli.

There were also gender differences in pain tolerance. Men, in general, are somewhat better than women in terms of pain tolerance. In general, however, it is difficult to judge, since the external expression of pain is often due to education. In addition, between the elderly and the young, as well as between men and women, there are differences in the expression of reactions to pain, even with similar upbringing.

Pain is a mental state that occurs as a result of super-strong or destructive effects on the body with a threat to its existence or integrity. It is known that the emotional state of a person is the cause of many diseases. Even scientists of antiquity implied the inseparability of the physical and mental.

The noted features of the social situation of development in which a suddenly ill person finds himself can change the whole style of his life: his life attitudes, plans for the future, his life position in relation to various circumstances important to the patient and to himself.

The intensity of pain is almost impossible to measure objectively. As a person thinks, so he hurts. The strength of pain depends not only on the sensitivity of nociceptors, but also on how pain signals are perceived by the brain, on the physiological state, upbringing, education, personality traits, “pain experience”. If a person is depressed, the pain will seem stronger to him. An optimist who has not been used to whining and complaining since childhood will endure it more easily.

It can be argued that pain is the most valuable acquisition of the evolution of the animal world. The clinical significance of pain as a symptom of a violation of the normal course of physiological processes is exceptionally great, since a number of pathological processes in the human body make themselves felt in pain even before the appearance of external symptoms of the disease.

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They are manifested by emotional reactions that are disproportionate in intensity or inadequate in quality in response to changes in situations that are essential for patients.

Emotional explosiveness or explosiveness. It is manifested by an increased readiness for emotional reactions in the form of disorders or disorders close to those in response to various emotional stimuli. From the outside, one may get the impression that violent emotional reactions arise over perfect trifles (a rude word, an ironic remark, etc.). But these are usually such “trifles” that hurt the wounded self-esteem of the individual very much. Reactions of expressed discontent, anger with verbal, and often with physical, prevail. It happens that in such a rush, the victim is seriously injured, sometimes incompatible with life. Sometimes in such patients "free-floating aggressiveness" is detected, so that external aggression can immediately transform into auto-aggression. Such aggressors do not value their own or other people's lives. Most often they are psychopaths. During the reaction, self-control is significantly reduced, patients mostly act impulsively.

Explosiveness is often found in patients with psychopathic disorders of various origins (TBI, schizophrenia, etc.). E. Bleuler notes in "easily excitable psychopaths" and bouts of despair with attempted suicide, as well as "fear or even stuporous states." Recall that here we are not talking about acute reactions to stress or reactions to repeated stress, when the first, as it were, prepared the ground for a reaction to the latter (“mental anaphylaxis”, “mental allergy”). Sometimes hysterical patients can turn themselves on to the point of affect, especially if they have developed such a defensive reaction somewhere in the zone.

Defensiveness- emotional toughness. It is manifested by persistent fixation of predominantly negative emotional reactions that have arisen in a situation of frustration. Resentment, revenge, aggressive fantasies are typical. The patient, for example, talks about a long-standing conflict with his colleague and at the same time plays with his jaws, clenching his fists as if it were a very recent skirmish. He does not forget to add that if he got this man now, "I would pay him in full." Another patient, 15 years later, severely beat a classmate because he “made fun of me at school in front of everyone.” Such patients get rid of mental trauma for a long time and with difficulty, not being able to switch to something else. They seem to be invariant and strictly adhere to their previous habits and patterns of behavior. Defensiveness can also manifest itself in relation to positive emotions and attachments. Patients say that they are “monogamous” and cannot start a second family if the husband or wife has died, they prefer to live in one place, it is very difficult for them to change their occupation, hobbies, entertainment, they keep old things for a long time, but get used to new ones. quite difficult, they listen to the same music and watch old films they once loved many times, do not include new people in their circle of friends, etc. Emotional viscosity is characteristic of epileptoid psychopaths, epilepsics, individuals with age-related personality changes, described in parkinsonism and postencephalitic mental disorders.

Emotive lability- easy, capricious change of mood under the influence of the most insignificant reasons, sometimes not noticed either by the patient himself, let alone those around him, - tachythymia. The wind rose, the sun went down, it rained, the heel broke, the pen stopped writing, a stain appeared on the blouse - all this can noticeably spoil the mood. But it easily rises if pleasant little things happen right there: the seller didn’t miscalculate, someone said a compliment, smiled, gave way to the bus - and the mood is good again, life makes you happy again, everyone likes you, and rainbow mirages reappear ahead. In some cases, emotive lability reaches the degree of emotional hyperesthesia, when the mood becomes dependent on an infinite number of random details of what is happening.

These are people of the mimosa type, impressionists who cringe at a casual glance, intonation of voice, the smell of sweat, the sight of a withering flower. Such painful fragility makes it difficult to live, maintain equal relations with people, think about something serious, and generally creates a feeling of ephemeral, airy existence, in which everything is so conditional and changeable. Emotive lability is a sign of the corresponding psychopathy, portending the possibility of a more serious affective pathology.

emotional incontinence- inability to control not only their emotions, but also their external manifestations. The disorder is described by E. Bleuler in mental retardation, as well as in the mentally ill. It characterizes a significant decrease in the ability of self-control and dysfunction of higher integrative authorities.

Weakness- compassionate tearfulness, excessive sentimentality, manifested in the perception or memories of touching events. One of the early signs of cerebral atherosclerosis. Weakness is often associated with traumatic events in the past and in such cases is reminiscent of the approaching symptom of "living in the past". Weakness is also found in states of neuropsychic asthenia, when a rational attitude to what is happening is replaced by a fruitless emotional one. Excessive tearfulness is often found with mild hysteria. Sometimes tears characterize impotent anger, self-pity and resentment towards someone, a state of tenderness, a discharge of emotional stress, the ability to share the suffering of someone. There are also tears of joy. The latter things are not actually weak-mindedness.

Weakness should not be confused with violent crying, which, like violent laughter, occurs with pseudobulbar disorders. “Hysterics” with sometimes uncontrollable sobs are due to the fact that patients fall into the appropriate role, in need of consolation, but cannot immediately get out of it on their own. It does not apply to weakness and tearfulness in patients with painful insensitivity: here the tears flow as if by themselves, mechanically, without being accompanied by the experience of the corresponding emotions. There are also "made tears" - someone "forces the patient to cry or he feels that it is not he who is crying, but someone else instead of him." Tears, like laughter, are very meaningful.

Emotional dullness- underdevelopment or loss of higher feelings while maintaining or even reviving simpler emotions. Patients lack such feelings as compassion, tenderness, a sense of justice, remorse, a sense of beauty, a religious feeling, intellectual feelings, etc. Emotionally stupid individuals are callous, cruel, not inclined to repentance, many of them do not even know a sense of shame. They absolutely do not care what feelings they form as parents and educators. Many parents today teach children to be selfish, to love only themselves, not to stand on ceremony with those who are weaker, to refuse help and to learn to say a firm “no” when they ask for something, and if they beat, then lying down. The leitmotif of such teachings is the conviction that “you can’t live good now and you have to win your place under the sun by force.”

Here is an example of the emotional stupidity of a school teacher who was transferred to disability due to illness. The patient is a teacher-mathematician by profession, she taught physics and mathematics in high school. She told me that she had developed a new system of teaching her disciplines and that after six months her class was unrecognizable: the eternal C students began to show miracles in solving problems. That is why - out of envy - she was suspended from lessons. Her method consisted of composing problems of a type that would be of interest to schoolchildren. In a year she came up with four hundred such problems and was extremely proud of it. Here is some of them. “A brick slides across the roof of a five-story building. The length of the sliding path is 5 m. The height of the house is H, the sliding speed is X. An old man is approaching the house at a speed of Y. He is at a distance B from the place where the brick was supposed to fall. The question is: will the brick fall on the head of this bald old man? Or: “The climber fell off a cliff 250 m high. The question is: how long will it take him to reach the gorge and how fast will he break on its bottom?” The saddest thing about this story of emotional stupidity was that all the children liked the tasks, and none of their parents protested.

A slightly lower degree of emotional dullness is referred to as emotional impoverishment or impoverishment. Attachments, altruistic feelings, empathy of such patients are significantly weakened, fragile and quickly dry up. Thus, a 30-year-old patient reports that he is still not married and does not intend to marry, that he has never been fond of anyone before, has never been in love and has not sympathized with anyone.

“Love,” he explains, “is animal magnetism, the relationship of male and female. Why get married - to mate? And then even if you get married, you have to adapt to society, tedious legal procedures will follow. He doesn't even think about becoming a father. “What is it for, what is the point of having children, I don’t like them, and caring for them disgusts me.” Several times I got a job, even for good pay. After 1–2 months, he quit his job, while not formalizing his dismissal, without notifying in advance of his intention. Questions about duties, responsibility, about the fact that he let someone down, left without attention. His motivation for leaving work was as follows: “The work is boring, monotonous, I would like vivid impressions, otherwise everything quickly gets bored.” He does not visit his parents, does not write letters to them. I only had one friend at school. At this time, he is not fond of anything, does not communicate with anyone, practically does not leave the house. Lives on the help of parents. At home he sometimes plays computer games, sometimes watches TV, occasionally reads whatever comes to hand.

“Of course, I should work, but there is nothing that would be to my liking.”

The degree of emotional impoverishment is, of course, different, but usually it concerns the highest feelings: affection, love, friendship, gratitude, cordiality, respect, compassion. Even minor emotional changes play, according to E. Bleuler, "an outstanding role" and "especially because in any disorder, it is affective mechanisms that first of all reveal symptoms."

Emotional Paradox- disproportionate intensity of affective reactions to the objective significance of emerging situations and circumstances. Thus, a 31-year-old patient, a dissector at a children's hospital, is satisfied with his work, it does not depress him, does not darken his mood. He explains: "At the cellular level, the corpse is not visible." A good photographer, especially likes to take pictures of children. He loves nature, serious music, "pop music is disgusting to me." Very vulnerable - "one word is enough to spoil the mood for the whole day." Not married, never had a close relationship: “This is pure physiology; love was invented in order not to feel like cattle.

He endures the atmosphere of the psychiatric ward (located in the general ward) calmly, is not burdened by being here, communicates with patients on an equal footing, goes with them for lunch, to work. The offer to be treated was accepted without resistance. Informed by the doctor that he is ill, and quite seriously. He listened to this calmly, did not ask what he was ill with. He did not ask about what this disease threatens, how it will affect his life. He calmly accepted the offer to apply for disability. For some reason, I remembered that once I spent the night in the morgue for a whole month. "There's one bad thing - it's hot." Another patient reports: “I’m not afraid of fights, the men fight bloody, with knives, and I climb to separate them. Recently, one has broken up seven fights. More than anything, I'm afraid of mysticism and watching thrillers.

Another patient stoically endures the situation of the department, noise, quarrels, fights between patients, he is not traumatized by the fact of the disease (he knows what he is ill with), not too bright prospects for being actually thrown out of life. And yet one day he suddenly became very indignant, shouted, was excited - the reason was that he was moved to another bed in the ward.

Irritability- a tendency to frequent and relatively shallow reactions of discontent on various, usually minor reasons, which often have no direct relationship to the true causes of the disorder. One of the most common causes of irritability is the egocentrism of patients - they are dissatisfied with many things only because "everything is not done the way it should", i.e. "not in my opinion." The egocentric gets annoyed when they don’t listen to him: how can you not listen to me, it’s others who are able to grind nonsense, but not me. It infuriates him when he is interrupted, although he himself does not allow anyone to open his mouth: “he also interrupts, boor, it would be better for him to be silent, listen to what they say smart people". The egocentric constantly reproaches someone, teaches, instructs, gives very impartial assessments, he is generally annoyed by everything that, in his opinion, is unfair, i.e., hurts his exorbitant pride. Tantrums are irritable to scandals: they are offended that they are not appreciated, they do not understand, they do not thank them at every step, they need their path to be strewn with roses of admiration.

Often irritability is a way of defusing accumulated discontent on someone. Resentment and tension splash out on household members, children, animals; gets to the objects. Dishes are shattered, clothes are torn to shreds, pens and pencils are broken. One patient smashed his car with a hammer because it wouldn't start. The transfer of emotions from one object to another is sometimes called the transport of emotions. Patients, irritated, often want at all costs to maintain the illusion of their control over what is happening by demonstrating aggression, the strength of their I. Irritability may be the result of dissatisfaction with themselves: few are able to understand themselves in order to understand what is still wrong with them . The easiest way is to find the culprit in order to divert your attention from yourself with a flash of irritation, as if to displace dissatisfaction with yourself, and at the same time restore self-esteem. Sometimes irritation is a mild form of expressing indignation, that is, dissatisfaction with the merits of the case, which does not offend the dignity of another; such people are often dissatisfied with themselves, or rather, with the fact that they did something wrong, at the wrong time, let someone down and generally did something not worthy of themselves.

Usually they are immediately ready to apologize and rectify the situation as soon as possible. Finally, irritability is a constant companion of asthenia - irritable weakness or "failure of the brakes" - hypersthenia. Such patients are initially indignant, then they think, and then they realize that they “got excited” and were wrong. Emotions are generally difficult to control, but losing control over them is much easier. And when that happens, they always have the first word. If irritability is combined with other manifestations of increased emotional sensitivity, it may be a sign of excessive sensibility of depressed patients. So, irritability can be characteristic of patients with various disorders, some of its main causes, as it seems to us, we have identified.

Emotional coarsening- loss of subtle, differentiated emotional reactions associated with a mild decrease in intelligence with organic brain damage in persons who are premorbidly disharmonious in terms of personality. Due to too simplified, incomplete, fragmentary or one-sided understanding of what is happening, patients become quite inadequate: tactless, naked, familiar, boastful or even dishonest, since deceit and cunning are in the order of things for them. They often change the sense of proportion, delicacy, courtesy, tolerance, in a decent society they resemble an elephant in a china shop. They cannot understand that they are shocking someone with their inappropriate behavior, they can injure someone with an obscene phrase, offend or cause self-loathing. They also love to joke. But their jokes are vulgar, obscene and often repeated to the accompaniment of their own laughter.

Due to importunity, they shamelessly break into someone else's conversation and try to take him away to their side, where they wash the bones for someone. They speak loudly, a lot, as if they are trying to shout someone down. Their phraseology is very far from refinement, the statements are confused, the beginning and end of the latter are rarely on the same line of reasoning. Patients easily cross the boundaries of subordination, interfere with personal relationships with official ones, do not take into account the self-respect and ethical position of the interlocutor. And if the interlocutor is also a subordinate, he falls into the position of a “fool”, which should not be reckoned with at all. Patients are often very cheeky, can be rude and even sneer at people who are addicted to them. They are incapable of dialogue: they interrupt the interlocutor, do not allow him to complete his thought, do not try to understand him, impose their opinion, and then draw dubious conclusions from the conversation, relating not so much to the problem under discussion as to interpersonal relationships.

Subordinates rarely leave the office of such a boss with a light heart, unless they use flattery or something else to appease the "deity". Such a dialogue is a bit like a violation of communication in the form of a double dialogue, described in the families of patients with schizophrenia (J. Batesson, 1956). For example, a son, rejoicing at the visit of his mother, puts his hand on her shoulder. The mother responds with a grimace of disapproval. The patient withdraws his hand, to which his mother reproaches him for not loving her. The patient blushes, but the mother makes a remark to him, they say, you can’t be so embarrassed. In other circumstances, emotionally hardened patients may behave quite differently: they fawn, please, humiliate themselves, agree with everything and eat through the eyes of the boss, trying to talk less so as not to inadvertently anger him. It was rightly said by someone: silence is a shield for a fool, a fool is smart as long as he is silent. The essence of the matter does not change from this change of dishes. Coarseness of emotions and feelings occurs quite often and usually comes to the fore, while intellectual decline remains, as it were, in the shadows, and gross violations are often not detected.

Anniversary reactions- the appearance or intensification of a sense of grief on the date of the tragic event. This happens, for example, on parental day, on days of remembrance of the victims of war or terrorist acts, disasters, etc. For example, participants in battles in hot spots get together from time to time to remember their dead fighting friends. Usually restrained in conversations about mourning events with strangers, here they indulge in detailed reminiscences, reviving the smallest details of what happened in their memory. It does not do without a feast. They drink to remember the dead, to alleviate the severity of the loss and to suppress the guilt of the survivors. In hindsight, it often seems that the misfortune could have been prevented.

parathymia- inversion of emotional reactions, replacement of adequate emotions by directly opposite ones. So, the mother congratulates her daughter on her birthday as follows: “Galina! I don't wish you a happy birthday. I don't wish you happiness. I curse you, the mother's curse is the worst!" The girl was raped in the company, her friends held her legs. In shock, she returned home, did not say anything to her relatives, went to the bathroom, lay down in her clothes in the water and burst out laughing. Another patient remembered that at the age of seven she fell into the water, got frightened, began to drown. She was rescued by a woman passing by. Instead of the joy of salvation and gratitude to the woman, "I scolded the savior in all sorts of ways, told her that she was a fool and ugly."

Idiosyncrasy to emotions- intolerance of various emotions: “I perceive my emotions too sharply. And good ones too. After them, palpitations, discomfort, I feel very bad. I try not to worry or be happy at all. This symptom seems to be the opposite of painful insensibility. In the latter case, patients suffer from the fact that they have ceased to be aware of their emotions. In the second case, on the contrary, the patient is too acutely aware of her emotions and already suffers about this.

Emotional ambivalence- the coexistence of polar feelings in relation to the same object or phenomenon: “I seem to have two I: one loves my mother, the other hates her ... I am attached to my husband, tender with him and at the same time he infuriates me, I am ready to kill him.” The patient wants his wife dead, but when he sees her dead in hallucinations, he despairs. The disorder indicates the splitting of the Self.

Escalation of affectivity- excessive expressiveness (in gestures, facial expressions, postures, voice intonations) in hysterics as a means of suppressing others, self-affirmation and as a mechanism for discharging excessive motivation (to teach a lesson, punish someone, moderate libido, etc.). Patients start small: raise their voice, cry, walk around the room nervously. Then, gradually and as if involuntarily, they inflate themselves to such an extent that they can no longer get out of the role on their own, unless they are saved by a swoon.

Emotional burnout- a symptom complex, including emotional and (or) physical exhaustion, depersonalization and decreased performance (Pelmann, Hartman, 1982). Emotional exhaustion is experienced as inner emptiness, exhaustion of affective resources, emotional overstrain. Interest in work is lost, the patient goes there, as if “to hard labor”, without enthusiasm and enthusiasm, but rather with disgust. Depersonalization is expressed by the feeling of impersonal people, they all seem equally unpleasant.

Relations with them become purely formal, employees often cause irritation, hostility, discontent and indignation. Conflicts with them are quite likely if colleagues did not realize that they were dealing with a person who was left with mental strength. The decline in efficiency is associated with such reasons as the appearance of a negative assessment of oneself as a professional, self-doubt, feelings of worthlessness, doubts about one's competence, dissatisfaction with oneself, and a decrease in motivation to work.

Emotional burnout occurs in individuals who are in intensive and close communication with clients, patients, pupils, students and colleagues in the provision of professional assistance. It is characteristic of emotional people who do not know how to protect themselves from excessive affective response to production situations. The surgeon should not die with every patient, the psychiatrist should not go crazy with the patient, accepting his grief as his own; teacher - do not worry about the failures of students as if he himself receives ones and deuces. Work should not exceed the optimal level of tension, otherwise it will lead to fatigue and many mistakes in simple situations. The amount of load should be rational and in no case go beyond the scope of mental hygiene. Managers do not know or do not want to know anything, overloading their subordinates; usually, unfortunately, they care more about themselves and their prestige in the eyes of their superiors.

The disorder develops at the age of 30-40 years, more often in women with these professions, as well as scientists and managers. It is sometimes referred to as compassionate fatigue. It is necessary to timely identify patients and provide rehabilitation assistance using and (small doses of antidepressants, nootropics, normalization of sleep, physiotherapy, etc.).

Learned helplessness- a condition caused by "getting into harmful, unpleasant situations", "which can neither be avoided nor prevented" (Seligman). In experiments on animals, the helplessness of the latter becomes such that even the emerging opportunity to get out of the situation is not used. Some authors see this disorder as a factor contributing to the onset or intensification of depression. W. Frankl observed the complete loss of the ability to resist in the Nazi death camps; For some reason, such prisoners were called Muslims, perhaps because they placed their hopes only on the Almighty.

Dyshomophilia- tension, anxiety during homoerotic fantasizing. It is observed in homo-, heterosexuals and even in asexuality. It is recommended not to confuse the disorder with "egodystonic homosexuality".

Emotional Paralysis of Balti(1901), or affective anesthesia. Described as a variant of psychogenic stupor without impaired consciousness with a complete shutdown of emotions without subsequent amnesia. Derealization is also observed, the patient perceives what is happening from a distance, from the outside, as something that seems to him. At the same time, he can move, behave outwardly quite adequately.

Loss of syntonicity It manifests itself in the fact that the patient does not feel the emotional context in someone's conversation with him, and thus cannot discover the meaning of the speech addressed to him. So, the patient perceives the usual sympathetic questions of a doctor about his well-being as an "interrogation", says that "they climb into his soul." When asked to clarify what he means, he declares that they are pestering him, showing inappropriate curiosity. He considers the advice to receive medical treatment as pressure on him, he is indignant that he is “dictated”, “imposed”. He is offended by a joke, believing that he is being “ridiculed”, he regards a benevolent attitude towards himself as an attempt to “manipulate” him, etc. It is more often observed in patients with schizophrenia.

vicarious pleasure- replacement of one's own dissatisfaction with joy or pleasure for other people. The father rejoices, for example, that his son at school gets fives in mathematics, and he himself, no matter how hard he tried, at one time did not know how to do this. A voyeur gets substitutionary pleasure by spying on the intimate relationships of other people.

Phobic reactions- excessive fears of something, observed in timid, fearful natures. It is important that such patients do not know how to assess the true extent of the danger and do not have sufficient personal experience of acting in dangerous situations. They are not able to adequately control their fears. The best form of fear control is the skills to overcome threatening situations. For example, a person sees someone drowning. He runs in fear along the shore and calls for help. Another person silently throws himself into the water and saves the drowning man without fear. Phobic reactions are not obsessive, although the patient fruitlessly struggles with them, is burdened by them, would like to get rid of them, while realizing that they are something not quite normal. In addition, he is also ashamed of fears, he tries not to tell anyone about them. VV Kovalev defines such fears as overvalued, exaggerated.

hypophobia- lack of a sense of fear, leading to an underestimation of the degree of danger or threat of any situations. Described in patients with schizophrenia, in alcoholic intoxication, with neurosis - "sthenic sting of a psychasthenic." There are cases of complete absence of fear - anaphobia. A 30-year-old patient claims that she does not know what fear is at all, she has never experienced it under any circumstances. She says that in her school years she went alone to the cemetery at midnight, even before school she visited the “anatomist”, visited the morgue, even took her friends there out of curiosity. She never had fears in her dreams, no matter what she dreamed. From the very beginning, she watched horror films quite calmly and said: “I don’t understand what people find scary in them.” She jumped from a parachute and “was not at all afraid, even the instructor was surprised,” drowned and “was not at all afraid: I’ll drown like that, so it’s necessary.” “I was not afraid of a psychiatric hospital either, I came myself, what is there to be afraid of.”

Without fear, she walked at night along the unlit streets of the city, where "I know, they killed, robbed, raped." “I’m not brave, no, I just don’t have developed fear. Well, there are people without legs, so I have something similar to this. There is also such a phenomenon as kontphobia - the desire to get into dangerous situations for the sake of sharp impressions, not accompanied by fear.

Satomura Syndrome (1979)- a kind of fear of superiors or another high-ranking person. This is the fear of appearing funny or unpleasant in their eyes. Considered as a neurosis characteristic of the Japanese. Apparently, it is found not only in them.

Humor Disorders- the inability to see something worthy of compassion behind a comical, playful form. First of all, the sense of humor changes when perceiving real life situations humorous plan. At the same time, the sense of humor and in relation to oneself suffers. The perception of humor in the corresponding images (cartoons, etc.) seems to be preserved to a greater extent (Bleicher, Kruk, 1986).

According to our preliminary impressions, the loss of a sense of humor at first manifests itself, apparently, in the fact that when an individual encounters an object of humor, he becomes very cheerful, his mood rises, so that he himself is not averse to amusing someone, and then having a pleasant time. the rest of time. The second, hidden plan of humor is not distinguished at the same time, light sadness and in-depth reflections on human nature, and usually there is no one about oneself. The next stage of the sense of humor deficiency occurs when the individual becomes funny, very funny, when he encounters manifestations of humor. He is sometimes disassembled by Homeric laughter, and he does not think of anything serious.

Starting to laugh, he will do this all evening (for example, at a laughter concert) and at very dubious jokes. It is worth provoking some “decoy duck” to laugh, as amicably, as if on command, the rest of the lovers of humor begin to laugh. A laughing individual resembles a stoned drug addict who finds everything funny that you show him. A. Maslow, meanwhile, noticed that people with a genuine sense of humor usually do not have fun and do not laugh, only a sad smile runs across their face. Such people, according to statistics, are only 1-3 per hundred. The continuing degradation of the sense of humor is expressed in the fact that the individual will laugh with pleasure when someone is laughed at. But he does not accept jokes addressed to him, moreover, he may be offended by this or, worse, angry. Finally, humor dies when it is taken “seriously”, i.e. not taken at all.

The lack of a sense of humor is especially acute in patients with schizophrenia who are educated, intelligent, knowledgeable, but who understand jokes and allegory in general very literally. The best sense of humor - it is well known - is developed among pessimists who see the weaknesses and shortcomings of people better than others and, nevertheless, treat them with particular delicacy and care. However, in depressed patients, a sense of humor, like other high feelings, is blocked, which makes it extremely difficult for them to survive depression - they lose their inner support, which only helps people in misfortune. Patients with epilepsy are deprived of a sense of humor once and for all.

With their rigidity, getting bogged down in trifles, they do not have time to notice how this spark of God sweeps over them - a moment of humor. With alcoholism, the sense of humor degrades to banality, vulgarity, cynicism with an indispensable element of smut - mentions of betrayal, meetings with passionate beauties and something else like that. One would like to call such humor genital. "Black humor" has only one similarity with the original - it is the use of a comic configuration. In the depths of it lies not compassion, not high sadness, but merciless cynicism, ready to strike all the saints and everything that is called the existential, enduring and eternal values ​​​​of human existence.

... chronic or recurrent pain has a multicomponent origin, which is based not only on pathophysiological, but also on closely interacting psychological and social factors.

INTRODUCTION

Any pain has a negative emotional accompaniment, in chronic pain there is always a psychogenic component. Moreover, it has been noticed that the same painful stimuli give rise to sensations that are not the same in nature and severity in different people. Even in the same person, the reaction to a painful stimulus can change over time. It has been shown that the nature of the pain reaction can be influenced by a number of factors, such as individual personality traits, past experience, cultural characteristics, learning ability, and, finally, the circumstances under which the pain effect occurs (Tyrer S.P., 1994).

According to modern concepts, when exposed to a painful stimulus, mechanisms of three levels are activated, and pain has, as it were, three main radicals: physiological (functioning of nociceptive and antinociceptive systems), behavioral (pain posture and facial expressions, special speech and motor activity) and personal (thoughts, feelings , emotions) (Sanders S.H., 1979). In this case, psychological factors play one of the main roles, and the participation and contribution of these factors to pain perception differ significantly when a person experiences acute, short-term pain or a chronic pain condition.

Of particular importance are psychological factors in chronic pain syndromes. Today, the most common point of view is that psychological disorders are primary, that is, they are present initially even before the appearance of algic complaints and, possibly, predispose to their occurrence (Kolosova O.A., 1991; Keefe F. J., 1994). At the same time, long-term pain can aggravate emotional disorders (Sanders S.H., 1979; Wade J.B., 1990). The most frequent companions of chronic pain are depression, anxiety, hypochondriacal and demonstrative manifestations (Lynn R., 1961; Haythornthwaite J. A. et al., 1991). It has been proven that the presence of these disorders increases the likelihood of pain complaints and the transition of episodic pain into a chronic form.

Let us consider in more detail the psychological and social factors that predispose to the development of chronic pain syndrome.

THE ROLE OF FAMILY, CULTURAL AND SOCIAL FACTORS

Family, socio-economic and cultural factors, past life events, as well as personality traits of the patient can predispose to the development of chronic pain syndrome. In particular, a special survey of patients with chronic pain syndromes showed that their closest relatives often suffered from excruciating pain.

In such “pain families”, a specific model of response to pain can form in several generations (Ross D.M., Ross S.A., 1988). It has been shown that in children whose parents often complained of pain, various pain episodes occurred more often than in "non-painful" families (Robinson J.O. et al., 1990). In addition, children tended to adopt the pain behavior of their parents.

It has been proven that in a family where one of the spouses shows excessive care, the likelihood of pain complaints in the second spouse is significantly higher than in ordinary families (Flor H. et al., 1987). The same pattern can be traced in relation to overprotection of children by parents. Past experiences, especially physical or sexual abuse, may also play a role in the subsequent occurrence of pain.

Persons engaged in heavy manual labor are more prone to the development of chronic pain, often exaggerate their pain problems, seeking to get disability or easier work (Waddel G. et al., 1989). It is also shown that the lower the cultural and intellectual level of the patient, the higher the likelihood of developing psychogenic pain syndromes and somatoform disorders. All these facts confirm the important role of family, cultural and social factors in the development of chronic pain syndromes.

THE ROLE OF PERSONALITY

For many years, there has been a discussion in the literature about the role of personality traits of an individual in the development and course of pain syndromes. The personality structure, which is formed from childhood and is determined by genetic and environmental factors, primarily cultural and social, is basically a stable characteristic inherent in each individual and, in general, retains its core after reaching adulthood.

It is the personality traits that determine a person's reaction to pain and his pain behavior, the ability to endure painful stimuli, the range of emotional sensations in response to pain and ways to overcome it. For example, a significant correlation was found between pain tolerance (pain threshold) and personality traits such as intra and extraversion and neuroticism (neuroticism) (Lynn R., Eysenk H.J., 1961; Gould R., 1986).

Extroverts express their emotions more vividly during pain and are able to ignore painful sensory inputs. At the same time, neurotic and introverted (closed) individuals "suffer in silence" and are more sensitive to any pain stimuli.

Similar results were obtained in individuals with low and high hypnotizability. Highly hypnotic individuals coped with pain more easily, finding ways to overcome it much faster than low hypnotizable individuals. In addition, people with an optimistic outlook on life are more pain tolerant than pessimists (Taenzer P. et al., 1986).

One of the largest studies in this area showed that patients with chronic pain syndromes are characterized not only by hypochondriacal, demonstrative and depressive personality traits, but also by dependent, passive-aggressive and masochistic manifestations (Fishbain D.A. et al., 1986). It has been suggested that healthy individuals with these personality traits are more likely to develop chronic pain.

THE ROLE OF EMOTIONAL DISORDERS

chronic pain and anxiety

Individual differences in the response of patients to pain are often associated with the presence of emotional disturbances, of which anxiety is the most common. When studying the relationship between personal anxiety and the degree of pain that occurs in the postoperative period, it turned out that the most pronounced pain after surgery was observed in those patients who had the maximum indicators of personal anxiety in the preoperative period (Taenzer P. et al., 1986). Modeling of acute anxiety is often used by researchers to study its effect on the course of pain syndromes. It is curious that an increase in anxiety does not always entail an increase in pain.

Acute distress, such as fear, can suppress pain to some extent, possibly by stimulating the release of endogenous opioids (Absi M.A., Rokke P.D., 1991). Nevertheless, anticipation anxiety, often modeled experimentally (for example, in the event of a threat of electric shock), causes an objective increase in pain sensitivity, emotional tension, and heart rate.

It is shown that the maximum indicators of pain and anxiety are observed in patients at the end of the waiting period. It is also known that anxious thoughts “around” the pain itself and its focus increase pain perception, while anxiety for any other reason has the opposite, alleviating effect on pain (McCaul K.D., Malott J.M., 1984; Mallow R.M. et al., 1989).

It is well known that the use of psychological relaxation techniques can significantly reduce the intensity of pain in patients with various pain syndromes (Sanders S.H., 1979; Ryabus M.V., 1998). At the same time, high anxiety as a response to acute emotional distress can negate the achieved result and again cause an increase in pain (Mallow R.M. et al., 1989). In addition, the patient's high anxiety negatively affects his choice of pain coping strategies. Cognitive-behavioral techniques are more effective if the patient's level of anxiety can first be reduced (McCracken L.M., Gross R.T., 1993).

chronic pain and depression

Numerous clinical and epidemiological studies have established that there is a close relationship between chronic pain and depression. Data on the prevalence of depression among patients with chronic pain range from 30 to 87%.
Some researchers consider depression to be the leading factor in reducing the ability to work in patients with chronic pain, or the most significant motivation for seeking medical help. Thus, we can talk about a related relationship between pain and depression: pain can be a manifestation (mask) of depression, depression can join pain of organic origin (secondary depression), depression is an independent risk factor for exacerbation and chronicity of pain syndrome.

However, the relationship between depressive disorders and chronic pain does not appear to be unequivocal, and there are various alternative versions of their causal relationship: (1) chronic pain is the cause of depression; (2) depressed patients are more likely to perceive pain; (3) chronic pain and depression are indirectly related to other intermediate factors (disability).

Chronic pain syndrome as a manifestation of depression has the following features: (1) the clinical picture of the pain syndrome does not fit into any somatic or neurological disease, (2) the duration is at least 3-6 months, (3) the nature of the pain is constant, exhausting, dull, monotonous , indistinctly described, (4) senestopathic coloration of pain, (5) localization: wider than initially presented, difficult to localize, (6) pain behavior, (7) pain history, (8) characteristic syndromic environment other signs of depression. Chronic pain is more often observed in the picture of somatized depressions, most often in dysthymia.