8. Emotional disorders (apathy, euphoria, dysphoria, weakness, inadequacy of emotions, ambivalence, pathological effect).
Emotions- sensual coloring of all mental acts, people’s experience of their relationship to the environment and themselves.
1. Euphoria– elevated mood with endless self-satisfaction, serenity, slowing down of thinking. Ecstasy- an experience of delight and unusual happiness.
2. Dysphoria- sad-angry mood with increased sensitivity to external stimuli, with bitterness, explosiveness, and a tendency to violence.
3. Incontinence of emotions (weakness)- decreased ability to correct external manifestations of emotions (patients are touched, cry, even if it is unpleasant for them, characteristic of cerebral atherosclerosis)
4. Apathy (emotional dullness)– complete indifference to everything, nothing arouses interest or emotional response (with dementia, schizophrenia).
5. Inadequacy of emotions- inadequate affect, paradoxical emotions; the emotional reaction does not correspond to the occasion that caused it (the patient laughs when talking about the death of a relative)
6. Emotional ambivalence- duality, dissociation of emotions (in schizophrenia)
7. Pathological affect- occurs in connection with mental trauma; accompanied by twilight stupefaction, delusional, hallucinatory disorders, inappropriate behavior appear, and serious offenses are possible; lasts minutes, ends with sleep, complete prostration, expressed by vegetation; the period of impaired consciousness is amnesic.
9. Depressive and manic syndromes. Somatic symptoms of affective disorders.
Manic syndrome - characterized by a triad of symptoms: 1) sharply elevated mood with increased positive emotions, 2) increased motor activity, 3) accelerated thinking. Patients are animated, carefree, laugh, sing, dance, are full of bright hopes, overestimate their abilities, dress pretentiously, and make jokes. It is observed during the manic phase of manic-depressive psychosis.
The main diagnostic symptoms for a manic state:
A) elevated (expansive) mood: a state of high spirits, often contagious, and an exaggerated sense of physical and emotional well-being, disproportionate to the circumstances of the individual's life
b) increased physical activity: manifests itself in restlessness, moving around, aimless movements, inability to sit or stand still.
V) increased talkativeness The patient speaks too much, quickly, often in a loud voice, and there are unnecessary words in his speech.
G) distractibility: Trivial events and stimuli that do not normally attract attention capture the individual's attention and render him/her unable to sustain attention on anything.
d) decreased need for sleep: Some patients go to bed in the early hours of midnight, wake up early, feeling rested after a short sleep, and are eager to start the next active day.
e) sexual incontinence: behavior in which an individual makes sexual overtures or acts outside the bounds of social restrictions or consideration of prevailing social conventions.
and) reckless, reckless or irresponsible behavior: behavior in which an individual engages in extravagant or impractical ventures, spends money recklessly, or undertakes questionable ventures without realizing their riskiness.
h) increased sociability and familiarity: loss of a sense of distance and loss of normal social restrictions, expressed in increased sociability and extreme familiarity.
And) leap of ideas: a disordered form of thinking, subjectively manifested as a “pressure of thoughts.” Speech is fast, without pauses, loses its purpose and wanders far from the original topic. Often uses rhymes and puns.
To) hypertrophied self-esteem: exaggerated ideas of one's own capabilities, possessions, greatness, superiority, or self-worth.
Depressive syndrome - a pronounced decrease in mood with increased negative emotions, slowness of motor activity and slower thinking. The patient's health is poor, he is overcome by sadness, sadness, and melancholy. The patient lies or sits in one position all day long, does not spontaneously engage in conversation, associations are slow, answers are monosyllabic, and are often given very late. The thoughts are gloomy, heavy, there is no hope for the future. Melancholy is experienced as an extremely painful, physical sensation in the heart area. Facial expressions are mournful, inhibited. Thoughts about worthlessness and inferiority are typical; overvalued ideas of self-blame or delusions of guilt and sinfulness may arise with the appearance of suicidal thoughts and tendencies. It may be accompanied by the phenomenon of painful mental anesthesia - painful insensibility, internal devastation, disappearance of the emotional response to the environment. For depressive syndrome characterized by pronounced somatovegetative disorders in the form of sleep disturbances, appetite, constipation, tachycardia, mydriasis; patients lose weight, endocrine functions are upset. Depression in adults can also be observed as part of reactive psychoses and neuroses, with some infectious and vascular psychoses.
Main diagnostic symptoms of depression:
1) depressed mood: low mood, expressed by sadness, suffering, discouragement, inability to enjoy anything, gloominess, depression, a feeling of despondency, etc.
2) loss of interests: Decreased or lost interests or feelings of pleasure in normally enjoyable activities.
3) loss of energy: feeling tired, weak or exhausted; a feeling of loss of ability to get up and walk or loss of energy. Starting a business, physical or intellectual, seems especially difficult or even impossible.
4) loss of self-confidence and self-esteem: loss of faith in one's own abilities and qualifications, a feeling of embarrassment and failure in matters that depend on self-confidence, especially in social relationships, a feeling of inferiority in relation to others and even of little value.
5) unreasonable self-reproach or guilt: excessive preoccupation with some action in the past that causes a painful feeling, inadequate and uncontrollable. An individual may curse himself for some minor failure or mistake that most people would not take seriously. He realizes that the guilt is exaggerated or that this feeling lasts too long, but he cannot do anything about it.
6) suicidal thoughts or behavior: Persistent thoughts of harming oneself, with persistent thinking or planning of ways to do so.
7) difficulty thinking or concentrating: inability to think clearly. The patient is worried and complains that his/her brain is less efficient than normal. He/she is unable to make easy decisions even on simple issues, being unable to simultaneously hold the necessary pieces of information in his/her mind. Difficulty concentrating is the inability to focus thoughts or pay attention to those objects that require it.
8) sleep disorders:sleep disturbances that may manifest as:
periods of awakening between the initial and final periods of sleep,
waking up early after a period night sleep, i.e. the individual does not fall asleep again after this,
disturbance of the sleep-wake cycle - the individual stays awake almost all night and sleeps during the day,
Hypersomnia is a condition in which the duration of sleep is at least two hours longer than usual, representing a certain change in the usual sleep pattern.
9) changes in appetite and weight: decreased or increased appetite leading to loss or gain of 5% or more of normal body weight.
10) loss of the ability to experience pleasure (anhedonia): Loss of the ability to derive pleasure from previously enjoyable activities. Often the individual is not capable of anticipating pleasure.
11) worsening depression in the morning: Low or depressed mood that is more pronounced earlier in the day. As the day progresses, depression decreases.
12) frequent crying: Frequent periods of sobbing for no apparent reason.
13) pessimism about the future: a bleak view of the future regardless of actual circumstances.
Triad of depression: decreased mood, intelligence, motor skills.
Cognitive triad of depression: 1) destructive assessment of one’s own personality 2) negative assessment of the outside world 3) negative assessment of the future.
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In many cases, the causes of emotional disorders are various organic and mental diseases, which will be discussed below. However, these reasons are individual in nature. There are, however, reasons that concern entire sections of society and even the nation. Such reasons, as noted by A. B. Kholmogorova and N. G. Garanyan (1999), are specific psychological factors (Table 17.1) and, in particular, special values and attitudes encouraged in society and cultivated in many families. Becoming the property of individual consciousness, they create a psychological predisposition to emotional disorders, including the experience of negative emotions and depressive and anxious states.
Kholmogorova and Garanyan provide numerous facts in their article confirming this. Cross-cultural studies of depression have shown that the incidence of depressive disorders is higher in those cultures where individual achievement and success and compliance with the highest standards and models are especially important (Eaton and Weil, 1955a, b; Parker, 1962; Kim, 1997). This is especially true in the United States, where depression has become the scourge of American society, which promotes the cult of success and prosperity. It is not for nothing that the slogan of the American family is “Be on par with the Joneses.”
According to the US Mental Health Committee, one in ten people in this country suffers or has suffered from an anxiety disorder in the form of generalized anxiety disorder, agoraphobia, panic attacks or social phobia. At least 30 % people seeking help from therapists, cardiologists, neurologists and other specialists, suffer from somatomorphic disorders, i.e. mental disorders, disguised somatic complaints that do not have a sufficient physical basis. These patients, as a rule, have significantly elevated scores on depression and anxiety scales, but they are not aware of them.
When writing this chapter, the following sources were used: Handbook of Psychology and Psychiatry of Childhood and Adolescence / Ed. S. Yu. Tsirkina. - St. Petersburg: Peter, 2000; Boyko V.V. The energy of emotions in communication: a look at yourself and others. - M., 1996; Khamskaya E. D., Batova N. Ya. Brain and emotion: A neuropsychological study. - M., 1998.
Table 17.1 Multivariate model of emotional disorders
Even K. Horney (1993), having created a sociocultural theory of neuroses, drew attention to the social soil that contributes to the growth of anxiety disorders. This is a global contradiction between Christian values, preaching love and equal partnerships, and the really existing fierce competition and cult of power. The result of a value conflict is the displacement of one’s own aggressiveness and its transference to other people (it is not me who is hostile and aggressive, but those who surround me). Suppressing one’s own hostility leads, according to Horney, to a sharp increase in anxiety due to the perception of the world around us as dangerous and oneself as unable to withstand this danger due to society’s ban on aggression, i.e., on actively counteracting danger. This is also facilitated by the cult of strength and rationalism, leading to a ban on the experience and expression of negative emotions. As a result, they constantly accumulate and the psyche works on the principle of a “steam boiler without a valve.”
And B. Kholmogorova and N. G. Garanyan, using a questionnaire they developed, found out the presence of attitudes to prohibit four basic emotions in healthy and sick men and women. The obtained data are presented in table. 17.2.
The data presented in the table indicate that patients differ in the level of prohibition on various emotions. In the former, the ban on negative emotions is more pronounced. At the same time, cultural differences are visible when comparing data from men and women. Men have a higher ban on fear (the image of a courageous person), and women have a higher ban on anger (the image of a soft woman).
As Kholmogorova and Garanyan note, “the cult of a rational attitude towards life, a negative attitude towards emotions as a phenomenon inner life human beings are expressed in the modern standard of Superman - an impenetrable and seemingly devoid of emotions person. At best, emotions are dumped like in a garbage pit at punk rock concerts and discos. The ban on emotions leads to their displacement from consciousness, and the price for this is the impossibility of their psychological processing and the growth of a physiological component in the form of pain and discomfort different localization" (1999, p. 64).
Table 17.2 Attitudes to prohibit emotions in normal and pathological conditions, %
17.2. Pathological changes in the emotional properties of the individual
Affective excitability. This is a tendency to excessively easily cause violent emotional outbursts that are inadequate to the cause that caused them. It manifests itself in attacks of anger, rage, passion, which are accompanied by motor excitement, thoughtless, sometimes dangerous actions. Children and adolescents with affective excitability are capricious, touchy, conflict-ridden, often overly mobile, and prone to unbridled pranks. They shout a lot and get angry easily; any prohibitions cause violent protest reactions in them with viciousness and aggression. Affective excitability is characteristic of emerging psychopathy, neuroses, pathologically occurring pubertal crisis, psychopathic variant of psychoorganic syndrome, epilepsy and asthenia. In the emerging psychopathy of the excitable type and in epilepsy, affective excitability appears in combination with a prevailing gloomy mood, cruelty, rancor, and vindictiveness.
Irritability is one of the forms of manifestation of affective excitability. This is a tendency to easily experience excessive negative emotional reactions, the severity of which does not correspond to the strength of the stimulus. Irritability can be a property of a pathological personality (for example, in psychopathy of the excitable, asthenic, mosaic type) or, in combination with other symptoms, is a sign of asthenia of various origins (early residual organic cerebral insufficiency, traumatic brain injury, severe somatic diseases). Irritability can also be a feature of dysthymia.
Affective weakness characterized by excessive emotional sensitivity (hyperesthesia) to all external stimuli. Even small changes in the situation or an unexpected word cause irresistible and uncorrectable violent emotional reactions in the patient: crying, sobbing, anger, etc. Affective weakness is most typical for severe forms of organic cerebral pathology of atherosclerotic and infectious origin. In childhood, it occurs mainly in severe asthenic conditions after severe infectious diseases.
The extreme degree of affective weakness is affective incontinence. It indicates severe organic cerebral pathology (early strokes, severe traumatic brain injuries, infectious diseases of the brain). It is rare in childhood.
A type of affective weakness is anger, i.e., a tendency to the rapid emergence of an affect of anger, accompanied by speech motor agitation and destructive aggressive behavior. It manifests itself in patients with asthenic and cerebrasthenic disorders associated with somatic diseases and residual organic lesions of the central nervous system. In epilepsy and post-traumatic encephalopathy, anger lasts longer and is accompanied by brutal behavior.
Affective viscosity. In some pathologies (epilepsy, encephalitis), affective viscosity (inertia, rigidity) may be observed in combination with a tendency to get stuck primarily on unpleasant experiences. In epilepsy, affective viscosity is combined with affective excitability and a tendency to violent, inappropriate emotional reactions. In childhood, affective viscosity manifests itself in excessive touchiness, fixation on troubles, resentment, and vindictiveness.
Pathological rancor - associated with mental disorders (for example, epilepsy), an inappropriately prolonged experience by the subject of a traumatic situation with ideas about inflicting revenge on its source. However, unlike vindictiveness, such an experience is not necessarily realized in action, but can persist for many years, sometimes throughout life, sometimes turning into an overvalued or obsessive goal.
Affective exhaustion characterized by the short duration of vivid emotional manifestations (anger, anger, grief, joy, etc.), after which weakness and indifference set in. It is typical for people with a pronounced form of asthenic conditions.
Sadism - a pathological emotional property of a person, expressed in the experience of pleasure from cruelty towards other people. The range of sadistic acts is very wide: from reproaches and verbal abuse to severe beatings causing severe bodily harm. It is even possible to kill for voluptuous reasons.
Masochism - a tendency to obtain sexual satisfaction only through humiliation and physical suffering (beatings, bites, etc.) inflicted by a sexual partner.
Sadomasochism - a combination of sadism and masochism.
17.3. Perversion of emotional reactions
As V.V. Boyko notes, various pathologies lead to many types of distortion of emotional reactions (Fig. 17.1).
Emotional inadequacy. In a number of pathologies (schizophrenia, pathologically occurring pubertal crisis, epilepsy, some psychopathy), emotional reactions become inadequate to the situation in which a person finds himself. In these cases, autism, emotional paradox, parathymia, paramimia, emotional duality (ambivalence), emotional automatisms and echomimia may be observed.
Autism - this is an escape from reality with a fixation on one’s inner world, on affective experiences. As a psychopathological phenomenon, this is a painful version of introversion. It manifests itself in emotional and behavioral isolation from reality, curtailment or complete cessation of communication, “immersion in oneself.”
Cases characterizing emotional paradox, described and discussed at the beginning of the 20th century. A.F. Lazursky, like other scientists of that time, associated them with the predominance of contrast associations characteristic of the mentally ill. This is the desire to harm or cause trouble to those beings whom a person especially loves, and precisely at the moment when they are most dear. This is the appearance in a sincerely religious person during a service of an irresistible desire to utter a blasphemous curse or to disrupt the solemn ceremony with some wild trick. Lazursky also includes here the peculiar pleasure from severe toothache or from the consciousness of extreme shame and humiliation, which F. M. Dostoevsky describes in “Notes from the Underground.”
All manifestations of emotional paradox can be classified into two groups. In one case, this is the emergence of experiences in the patient that are not adequate to the situation. This disorder is called parathymia. For example, an unpleasant event is reported with a smile, and a joyful event is reported with tears. Such a change in acquired expressive actions is observed with organic damage to the cerebral cortex. In another case, emotional paradox is characterized by a weakening of adequate emotional responses to important events while simultaneously strengthening the reaction to minor accompanying events. This inadequacy is associated with psychesthetic proportion. This is “getting stuck on little things” or “making a molehill out of a molehill.” The patient's emotional reactions are difficult to predict. For example, a child may remain indifferent to the death of a loved one and weep bitterly over a broken tree.
There are also cases when a person loses the ability to adequately assess the appropriateness and correctness of expressing emotions in a particular case. For example, a mother demonstrates emotional paradox when she forgives a child’s serious offense, but cannot calm down after a minor violation of discipline. Emotional paradox is also a perversion of expressive actions, when expression does not correspond to the meaning of what is happening. Thus, with atrophic diseases of the brain, patients lose the idea of why this or that action is needed and use it inappropriately. So, a patient, turning to a doctor with a request, salutes him, leaving the conversation, curtsies, expressing gratitude - crosses herself, etc.
A manifestation of inappropriate expression of emotions is grimacing. It is understood as exaggerated, exaggerated, rapidly changing facial movements. In terms of their expressiveness or emotional content, the grimaces do not correspond to the situation, as a result of which the patient’s facial expressions acquire a “strange” coloring. Mild variants of grimacing are a manifestation of hysteroform syndrome. Its rougher manifestations with caricature and caricature and at the same time with their emotional emasculation are observed in the structure of catatonic and hebephrenic syndromes, as well as with organic damage to the central nervous system.
Paramimia - This is a discrepancy between facial expressions and the content of the patient’s emotional state. Manifests itself as pathological motor excitation in facial muscles Oh. At the same time, some arbitrariness of facial expressions, their mutuality, and one-pointedness in the external expression of a certain emotion may remain. Another manifestation of paramimicry is dissonant facial expression, when individual groups of facial muscles are involved in the process of excitation with different intensities, and at the same time their coordination and synergism are lost. As a result, a combination of different, often contradictory, facial movements is observed. For example, joyful, laughing eyes can be combined with a tightly compressed “evil” mouth, or, conversely, a frightened, questioning look with a laughing mouth. Paramimia is characteristic of deficiency states in endogenous psychoses and organic diseases of the brain; it enters into a catatonic syndrome with lesions of the subcortical nuclei.
Emotional duality (ambivalence) manifests itself in the fact that a person experiences different emotions in relation to the same object: “I’m mortally tired of work, I should leave, but without it it will be boring.” Ambivalence is typical of a neurotic personality. In its extreme expression, emotional duality indicates a deep degree of personality splitting.
"Uncontrollable Emotions" observed in patients suffering progressive paralysis or senile dementia, who think only about what corresponds to their emotions and desires. Affects flare up, but quickly disappear. A trifle can make such patients happy or drive them to despair. This is due to the weakening of the inhibitory influence of the cortex on the subcortical centers of emotions.
Emotional automatisms manifested in the patient in the feeling that own feelings and the moods do not belong to him, but are caused from outside.
Echomimia characterized by automatic reproduction of the partner’s expressive means. Facial expressions, intonation, and gestures are unconsciously copied. Echomimia is caused by a lack of mental energy necessary to inhibit the automaticity of responses. An example of this is a scream in response to a scream, laughter in response to laughter, anger in response to anger. If both partners are prone to echomimia, then their emotions swing like a pendulum, increasingly increasing their strength.
This phenomenon is observed in both healthy and sick people.
Ideosyncrasy. For some people, a pronounced sensual (emotional) tone takes on the character ideosyncrasies, that is, a painful aversion to certain stimuli that are indifferent or even pleasant to other people. Such people cannot stand touching soft, fluffy things, velvet, the smell of fish, grinding sounds, etc.
Emotional lability characterized by instability of the emotional background, its dependence on external circumstances, frequent changes in mood due to a slight change in the situation. The most typical changes in mood are from elated-sentimental to depressed-tearful, or from elevated with a tinge of complacency, euphoria to dysphoric with dissatisfaction, grumpiness, anger, aggression. Emotional lability is included in asthenic, cerebrasthenic, encephalopathic syndromes in connection with severe somatic diseases, including infectious, intoxicating, traumatic brain injuries, and organic diseases of the brain. In children, emotional lability is most often found in states of decompensation with residual organic cerebral insufficiency, as well as in subdepressive states of various origins.
At emotional monotony emotional reactions lack flexibility and natural dependence on external and internal influences. Emotions are monotonous, speech is dry, devoid of melody, imagery, the tone of the voice is muffled. Facial expressions are poor, gestures are scanty, and of the same type.
Emotional callousness- this is the loss of subtle emotional differentiations, i.e. the ability to determine the appropriateness of certain emotionally charged reactions and dose them. A person loses his previously inherent delicacy, tact, and restraint, and becomes intrusive and boastful. He loses his attachment to loved ones and loses interest in his surroundings. Emotional hardening is observed in organic disorders that reduce intelligence (alcoholism, drug addiction, pathological manifestations of aging).
Emotional dullness, coldness (sometimes referred to as “moral idiocy”, olothymia) characterized by spiritual coldness, heartlessness, spiritual emptiness. The emotional repertoire of the individual is sharply limited; there are no reactions in it that include moral or aesthetic feelings. May be combined with a negative attitude towards others. At the same time, the child is not happy when the mother takes him in her arms and caresses him, but, on the contrary, pushes her away. Emotional coldness is common in schizophrenia and some forms of personality disorder. Sometimes observed in encephalitis lethargica.
At superficiality of emotional experiences The patient’s experiences are shallow, do not correspond to the reason that caused them, and are easily switched. The superficiality of experiences can be combined with the immaturity of certain aspects of the psyche and mental infantilism.
Hypomimia- this is a motor depression that develops in the facial muscles. It manifests itself in a slower pace, a decrease in the intensity and variety of voluntary and involuntary expressive facial movements. Reducing only the variety of facial movements is called impoverishment of facial expressions. Hypomimia as a temporary phenomenon is observed in depressive, catatonic and other syndromes, and as a progressive phenomenon - in cases of damage to the subcortical centers of the brain (Parkinson's disease, some forms of dementia). It is observed in schizophrenia, toxic and other brain lesions, and some psychopathy.
Amimiya- this is the highest degree of hypomimia, characterized by immobility of the facial muscles, “freezing” of a certain facial expression (“mask-like face”), which persists when the situation in which the patient is located changes.
Amymia is characteristic of those born blind due to the impossibility of children imitating the facial expressions of adults. V. Preyer (Preyer, 1884) described their facial expressions as follows: “Their facial expression changes very little, their physiognomy seems motionless and impassive, like a marble statue, their facial muscles hardly move, except when they eat or They say; their laughter or smile seems forced; since the eyes are not involved; some of them even forget how to wrinkle their foreheads” (quoted in Lazursky, 1995, p. 159).
Hypermia. In pathological cases, hypermia is not caused by the experience of emotions. Expression is, as it were, mechanically imposed, caused by disturbances in psychophysiological regulation. For example, in a state of catatonic excitement, patients laugh loudly, sob, scream, moan, dance, bow, march, and take majestic poses. Similar behavior is observed when alcoholics become intoxicated.
“Pseudo-affective reactions” are known with imitation of the external expression of affects, which are believed to arise as a result of disinhibition unconditioned reflex. Patients grimace, gesticulate intensely, and curse cynically. Cerebral sclerosis is characterized by “violent laughter and crying.” Patients say that they are forced to laugh, cry, pretend to be happy, or angry.
Involuntary crying and laughter are observed during hysteria - “I’m sobbing and can’t stop.” The patient may cry bitterly in the morning, after which he feels relief. Laughter and a smile also arise involuntarily.
Revitalization of expression is also observed in a manic state.
Alexithymia(literally: “without words for feelings”) is a reduced ability or difficulty in verbalizing emotional states. Everyone knows how difficult it can be to express your experiences in words. The words chosen seem to be insufficiently vivid and incorrectly express various emotional states and especially their shades. The term “alexithymia” appeared in the scientific literature in 1968, although the phenomenon itself was known to doctors before. Alexithymia manifests itself:
1) in the difficulty of identifying and describing one’s own experiences;
2) the difficulty of distinguishing between emotions and bodily sensations;
3) in a decrease in the ability to symbolize, as evidenced by poverty of imagination and fantasy;
4) focusing more on external events than on internal experiences.
As V.V. Boyko notes, the cause of alexithymia remains unclear: either the person’s emotional impressions are dulled and therefore difficult to express in words, or the experiences are quite vivid, but the impoverished intellect cannot convey them in verbal form. Boyko believes that both occur.
Manifestations of alexithymia have been noted in patients with depressive symptoms (Dracheva, 2001).
17.4. Pathological emotional states
Pathological affects and delusions. Affective states are characterized by a strong persistence of ideas that arise in a person. With pathological affects, this manifests itself in the occurrence crazy ideas. Delusional ideas are associated, as a rule, with the most intimate aspects of the patient’s personality, and therefore evoke in him a lively emotional attitude towards them. Delusions of grandeur in progressive paralytics and delusions of self-blame in melancholics owe their origin to the peculiarities of their emotional sphere. It is this connection with emotions that explains the persistence of delusional ideas and their resistance to all logical arguments. G. Gefding (1904) believes that since the reason for this is the conditioning of the idea by emotion, only another emotion, and not experience and reason, can resolve or refute this idea. The patient begins to realize the absurdity of his delusions only during the period of recovery, when the emotion caused by the painful state of the brain has already disappeared and delusional ideas are only memories, devoid of experiences, a sensory tone (Kraepelin, 1899)
Mental traumatic conditions. According to the initial ideas of Z. Freud (1894), which corresponded to his psychoanalytic theory, an external event causes an affective reaction in a person, which for one reason or another, for example for moral reasons, cannot be expressed. A person tries to suppress or forget his affect, but when he succeeds, he does not “discharge” the excitement associated with the affect. The stronger the suppression, the more intense the affect that provokes the emergence of a mental traumatic state. Therapy based on this theory aims to bring an event or associated repressed idea back into consciousness, along with the accompanying feeling. This return leads to a release of feeling (catharsis) and the disappearance of symptoms of the traumatic state.
Later (1915), Freud associated the emergence of a mental traumatic state with the suppression of the energy of drives, which causes anxiety in the subject; the release of tension causes a variety of, mostly pleasant, emotions.
Fears (phobias). Psychopathic individuals have unreasonable fears that defy any logical arguments and take over the consciousness to such an extent that it makes the life of these people painful. Such fears also occur in those suffering from psychasthenia, fear neurosis and expectation neurosis.
Persons with fear neurosis are divided into “thymics”—those suffering from vague fears—and “phobics”—those suffering from specific fears. There are also various phobias:
Agarophobia - fear of squares;
Aichmophobia - fear of sharp objects;
Social phobia - fear of personal contacts;
Ereytophobia - fear of blushing, etc.
P. Janet notes that psychopaths have a fear of activity and of life.
In childhood (most often preschool), fears can be signs of a pathological personality (autistic, neuropathic, psychasthenic, disharmonious, etc.). In this case, fear arises when the situation changes, the appearance of unfamiliar faces or objects, in the absence of the mother, and manifests itself in an exaggerated form. In other cases, fears may be symptoms of the prodromal period of psychosis or appear throughout this pathological condition.
Undifferentiated (pointless) fear is understood as protopathic fear with the experience of a diffuse, non-specific threat. It is combined with general motor restlessness, somatovegetative symptoms (tachycardia, redness or paleness of the face, sweating, etc.). Unpleasant somatic sensations are possible, close to somatoalgia, senestopathies (feelings of parts of one’s body as foreign, disobedient). Such fear is often accompanied by general wariness, a feeling possible danger from not only strangers, but also from their loved ones. It can occur both in neuroses and non-neurosis-like conditions, as well as in schizophrenia.
Night terror occurs mainly in children of preschool (from five years old) and primary school age. The child begins to be afraid of the dark, afraid to sleep alone, wakes up at night screaming and trembles with fear, then cannot fall asleep for a long time. The occurrence of night fear can be preceded by real experiences during the daytime - fear, traumatic situations when watching horror films. In cases of depression, dreams often contain themes related to death.
Night fear is also present in adults. At night they become more suspicious. For some it appears as fear of insomnia. As L.P. Grimak writes (1991), night fear manifests itself in the form of a kind of waiting neurosis, when a person lies with his eyes closed, with a wary consciousness and “vibrating nerves” due to a peculiar conflict between the constant focus of thought on the desire to fall asleep and latent confidence that you still won’t be able to fall asleep.
In cardiovascular and depressed patients fear of sleep often arises due to the fear of falling asleep “profoundly.” In these cases, patients force themselves not to sleep. A.P. Chekhov, in his story “A Boring Story,” gave a vivid description of the behavior of such patients: “I wake up after midnight and suddenly jump out of bed. For some reason I feel like I'm going to suddenly die. Why does it seem? There is not a single sensation in my body that would indicate an imminent end, but my soul is oppressed by such horror, as if I suddenly saw a huge ominous glow.
I quickly light the fire, drink water straight from the carafe, then rush to open window. The weather outside is magnificent... Silence, not a single leaf moves. It seems to me that everyone is looking at me and listening to me die...
Creepy. I close the window and run to bed. I feel my pulse and, not finding it on my hand, I look for it in my temples, then in my chin and again on my hand, and all this is cold, slimy with sweat. My breathing is becoming faster and faster, my body is trembling, all my insides are in motion, my face and bald head feel as if a cobweb is landing on them... I hide my head under the pillow, close my eyes and wait, wait... My back is cold , she’s definitely being drawn inside, and I have a feeling as if death will certainly approach me from behind, slowly... My God, how scary! I would drink more water, but I’m too scared to open my eyes and I’m afraid to raise my head. My horror is unaccountable, animalistic, and I just can’t understand why I’m afraid: is it because I want to live, or because a new, unexplored pain awaits me?”1
A peculiar fear of sleep is described in the work of A. Matthews (1991): “My parents, not experiencing material need, nevertheless did not allow me to spend an extra cent. They said that I should remember that “one fine morning” we could wake up beggars. And so I sometimes lay in bed at night, afraid to close my eyes, lest I wake up the next morning in poverty, hunger and cold” (quoted in: Fenko, 2000, p. 95).
In toxic and infectious psychoses, night fear contains phenomena of abortive delirium, and in schizophrenia it can be associated with frightening dreams. In patients with epilepsy, night terrors may be associated with dysphoria with a hint of sadness and aggressiveness, and sometimes with twilight disorder consciousness.
A description of night terrors is given in a poem by V. Bryusov:
At night, the terror is unreasonable
In the incomprehensible darkness it will wake you up
At night, the terror is unreasonable
The scorching blood will cool down
At night, the terror is unreasonable
Will force you to look around the corners
At night, the terror is unreasonable
To be motionless will be awarded.
You will say to your heart:
“Enough to fight! Darkness and silence, and no one is there!
Someone's hand will touch in the darkness...
You will say to your heart: “Stop beating!”
Something groans in the silence...
You will say to your heart: “Stop beating!”
Someone will tilt their face to face.
Straining willpower
You will shout: “Nonsense of empty beliefs!”
Neurosis expectations, according to E. Kraepelin (1902), is that persons suffering from it, fearing failure in performing any function, enter a state of such fearful expectation that they experience constant difficulty in performing this function (sexual, urination, etc.) .d.).
U mentally ill an unreasonable fear of persecution arises, they are afraid that they will be killed, strangled, their living space taken away, etc.
Hyperthymia. With hyperthymic psychopathy, pseudopsychopathy, and endogenous diseases, elevated mood may be observed, having various shades (Fig. 17.2).
In combination with motor and speech excitation, acceleration of thinking and associative processes, increased desire for activity, subjective feeling of strength, health, vigor, hyperthymia forms a manic syndrome.
Complacency occurs with oligophrenia and organic lesions of the central nervous system. Patients live in a momentary cloudless present, experiencing a feeling of contentment, with indifference to the external situation, the mood and attitude of others, their condition and their fate, with carelessness, good-naturedness, weak or completely absent reactions to unpleasant events. They are content with idleness, indifferent to comments and reproaches.
Exaltation, i.e., elevated mood with excessive inspiration, overestimation of the properties of one’s personality, appearance, capabilities, is the main disorder in many outpatient manias in adolescents. It is also typical for psychopathic personalities and accentuated personalities of the hyperthymic and hysterical type.
Euphoria - This is an increased carefree and cheerful mood, combined with complacency and contentment in the absence of a desire for activity. Euphoria is characterized by suppression of mental activity with extremely poor speech production. It is often observed in mental retardation and organic diseases of the central nervous system, leading to dementia.
At the core ecstatic affect lies the extraordinary sharpness of the emotions experienced with a tinge of happiness, delight, and admiration. It is usually accompanied by derealization and is characteristic of schizoaffective psychoses, occurring with figurative-sensual delirium and oneiric clouding of consciousness, as well as for some types of emotional auras in epilepsy. It can manifest itself in psychopathic and accentuated personalities.
Moria is a combination of manic excitement, complacent gaiety, carelessness, foolishness with dementia. Manifests itself in organic diseases of the central nervous system.
Hypotymia- this is a decreased mood of various shades (Fig. 17.3). It occurs with dysthymic personal accentuations, psychopathy such as “innate pessimism” (P.B. Ganushkin), post-process pseudopsychopathy, after a suicide attempt, and drug addiction. Hypotymia is the core of the depressive syndrome and manifests itself in combination with slowness of thinking, motor retardation, pessimistic ideas and somatovegetative disorders. There may be exhaustion physical strength, pain, sleep disturbance. The pessimistic attitude towards life increases, self-esteem decreases. Negative experiences worsen - sadness, guilt, anxiety, fears, melancholy. The consequence of deep depression can be diseases of the internal organs, cardiovascular and nervous systems.
According to the World Health Organization (WHO), up to 5% of the world's population suffers from depression. According to American psychologists, among those who have experienced depression, there are twice as many females as males. The reasons for these differences are not clear (Ostrov, Offer, Howard, 1989), but at the same time there is evidence that many girls emerge from adolescence with a damaged self-image, relatively low expectations in life, and much less confidence in themselves and their abilities. than boys. This decrease in self-esteem, noted in a third of girls, is also present in boys, but it is less pronounced. In adolescent boys and young men, depression is often accompanied by breakdowns, and in girls and young women - violations eating behavior(anorexia and bulimia).
Depression can also have a non-pathological origin, for example, when girls are dissatisfied with their body or face. C. Jung noted that sometimes depression takes the form of “empty peace” that precedes creative work. The presence of depression can lead to romantic relationships in adolescence, which is associated with the fact that among girls experiencing depression, the number of pregnancies is three times higher than the average “norm” (Horowitz et al., 1991, cited in Craig, 2000, p. 633).
The likelihood of depression in adolescents increases if the following factors are present:
1) increased ability to critically reflect on the development of one’s personality and one’s future, especially when focusing on possible negative outcomes;
2) problems in the family, economic difficulties and health of parents;
3) low popularity among peers;
4) low school performance.
Moderate and severe forms of depression are quite rare between the ages of 13 and 19, although the incidence increases with age, with peaks at 16 and 19 years. However, its symptoms can be life-threatening (Peterson et al., 1993, cited in Craig, 2000, p. 631).
In autumn or winter, many people experience severe depression, called seasonal depression. affective disorder" With the onset of spring, this depression passes.
One of the manifestations of hypothymia is dysphoria. This pathological affect, characterized by gloominess, gloominess, and irritability of the patient. It manifests itself in dissatisfaction with everything, in hostility, a tendency towards anger and aggression (“pathological malice”, hostility towards the whole world), in rudeness, cynicism. Characteristic of patients with various forms of organic damage to the central nervous system, with depressive states of various etiologies. For patients with epilepsy it is the main background of mood. In children, dysphoria is difficult to distinguish from dysthymia.
Boredom also characterizes hypothymia, since it is poorly differentiated depressive affect. Complaints of boredom, accompanied by tearfulness, are mainly characteristic of children of preschool and primary school age. Boredom is the main symptom of various types of childhood depression, including adynamic, dysphoric, somatized, tearful, Unlust- depression. In some cases, complaints of boredom cover up sadness and anxiety.
Yearning - it's depressing emotional condition, which manifests itself in the experience of deep sadness, hopelessness, and mental pain. In its classic form, melancholy is accompanied by painful physical sensations: a feeling of tightness and heaviness in the chest or pain behind the sternum. In children and adolescents with endogenous depression, complaints of melancholy are extremely rare; most often they define their mood as “sadness”, “depression”, “boredom”, so their melancholy mood can only be judged by indirect signs: presence of complaints of heaviness and pain in the heart, right half of the chest, in the epigastric region; special gestures with hands pressed to the chest; alternating periods of depression with psychomotor agitation; fragmentary statements about the unbearability of mental suffering.
Asthenic condition. Asthenia (from Greek. asthenia - impotence, weakness) occurs when various diseases, as well as with excessive mental and physical stress, prolonged conflicts and negative experiences. It is characterized not only by weakness and increased fatigue, but also by significant changes in the emotional sphere. Emotional instability, frequent mood swings, irritability, and tearfulness appear. A person experiences his own low value, shame, timidity. These experiences can unexpectedly give way to the opposite sthenic experiences.
V.L. Levy and L. Z. Volkov (1970) identified three types of pathological shyness in adolescents.
1. Schizoid-introverted(constitutional). Associated with the isolation of a teenager in a group, his non-conforming behavior, dysmorphophobia, and a reduction in communication with people (“escape from evaluations”). This form, very close to autism, is persistent and the most unfavorable in terms of therapeutic prognosis.
2. Pseudoschizoid. Occurs in a “complex” person due to his existing physical defects, physical or social inferiority (obesity, squint, stuttering, funny name or surname). Appears only with strangers. Trying to overcome shyness, teenagers often show cheekiness.
3. Psychasthenic. Characterized by a reduced level of aspirations in older age, lack of desire for leadership, and conformist behavior. Neglected shyness can take various forms of “escape,” including addiction to alcohol and drugs.
17.6. Emotional sphere in various pathologies
Emotional disorders in children with mental retardation (MDD) and intellectual impairment. In early disorders of a schizophrenic nature, with severe mental underdevelopment, emotional immaturity (underdevelopment). It is characterized by the absence or insufficiency of emotional reactions to the environment. At an early age, the “revitalization complex” (emotional reaction to mother, toys) is weakened or absent; lethargy and drowsiness predominate. IN preschool age there is no or reduced interest in others and in games. At an older age, there is no compassion, empathy, a sense of affection, and emotions and interests are poorly expressed.
According to E.V. Mikhailova (1998), in 7-year-old children with mental retardation, a high level of anxiety occurs in 70% of cases versus 40% in children with normal development. The author attributes this to the fact that the former are not always able to express an adequate emotional reaction to the presented situation. T. B. Pisareva (1998) found that 8-9 year old children with intellectual disabilities are able to identify emotions from facial expressions, but their differentiation accuracy is lower than their peers with normal intelligence. Similar data on children with mental retardation were obtained by D. V. Berezina (2000). They were worse than healthy schoolchildren in recognizing complex emotions from photographs and drawings: surprise, disgust, contempt, as well as a neutral facial expression. When recognizing basic emotions - joy, grief, anger and fear - the results were better than when recognizing complex emotions.
Along with general emotional immaturity in different forms mental development delays and specific emotional disturbances are observed.
At mental infantilism The emotional sphere of children is at an earlier stage of development, corresponding to the mental makeup of a child of an earlier age. Emotions are bright and lively, the motive of obtaining pleasure predominates (Kovalev, 1995; Mamaichuk, 1996).
P ri mental retardation of cerebral-organic origin disturbances appear in the emotional sphere: there is no liveliness and brightness of emotions, there is a tendency towards euphoria, which outwardly creates the impression of their cheerfulness. Attachments and emotional experiences are less deep and differentiated. In children, a negative emotional background predominates; the child is characterized by a tendency toward timidity and fear.
At mental retardation of somatogenic origin There is fearfulness associated with a feeling of inferiority.
With mental retardation of psychogenic origin timidity and shyness are observed when communicating with adults due to psychotraumatic upbringing conditions. Anxiety and low mood are noted (Mamaichuk, 1996).
According to I.P. Buchkina (2001), there is a reciprocity of antipathies between adolescents with mental retardation; These adolescents perceive their peers as less attractive and expect that they themselves will be perceived as less attractive.
Emotional characteristics of children with neurotic manifestations. E. S. Shtepa (2001) notes that these children are characterized by anxiety, tension and emotional instability. Their leading emotional characteristics are resentment, suspicion and guilt.
Emotional disorders with damage to various parts of the brain. As revealed by T. A. Dobrokhotova (1974), with local brain lesions, both permanent emotional disorders (up to “emotional paralysis”) and paroxysmal (temporary) affective disorders are possible, occurring either spontaneously without any external reason, or in response to the real reason, but inadequate to it. The first type of paroxysms is associated with attacks of melancholy, fear, even horror; they are accompanied by visceral-vegetative reactions and hallucinations. This is typical for epilepsy with damage to the structures of the right temporal lobe. The second type of paroxysms is associated with various affects that develop against the background of stable emotional and personal changes in the psyche.
For pituitary-hypothalamic localization of the lesion, according to T. A. Dobrokhotova, is characterized by a gradual impoverishment of emotions, the disappearance of expressive means of expressing them against the background of changes in the psyche as a whole. For temporal lesions characterized by persistent depression and vivid paroxysmal affects against the background of intact personality traits. For defeats frontal regions the brain is characterized by impoverishment of emotions, the presence of “emotional paralysis” or euphoria in combination with gross changes in the patient’s personality. In this case, social emotions suffer first.
A. R. Luria (1969) considered emotional and personal changes (emotional indifference, dullness, euphoria, complacency, etc.) as most important symptoms lesions of the frontal lobes of the brain.
Emotional disorders with damage to the right and left hemispheres of the brain. An attempt to review even the basic research on this issue is completely hopeless; in the 15 years preceding 1980 alone, more than 3,000 papers were published (Bradshaw, 1980). Therefore, I will focus mainly on the works of domestic authors.
S. V. Babenkova (1971), T. A. Dobrokhotova and N. N. Bragina (1977) and many others, when observing patients with a tumor in the right hemisphere, confirmed this fact. On the contrary, if the tumor is in the left hemisphere, patients experience depression. The epilepsy clinic in most cases also shows that when the epileptic focus is localized in the right hemisphere, patients experience increased emotionality (Vlasova, 1970; Mnukhin, 1971; Chuprikov, 1970).
True, not all data obtained by researchers corresponds to these ideas. According to T. A. Dobrokhotova (1974), euphoric reactions in case of damage to the right hemisphere and depressive reactions in case of damage to the left hemisphere are observed only when the focus is localized in the posterior parts of the hemispheres. When the frontal lobes are damaged, the sign of emotional disturbances (shift towards euphoric reactions) does not depend on the side of the lesion. When the temporal lobes are damaged, depressive experiences with a tinge of suffering are noted, and when the left lobe is damaged, depressive feelings predominate, and when the right lobe is damaged, melancholy, fear, and horror prevail. These data were partially confirmed in the study of A.P. Chuprikov et al. (1979).
In experiments on patients with recognition of emotions by facial expressions, it was found that with right hemisphere damage, regardless of the sign of the depicted emotion, recognition occurs worse than with left hemisphere damage (Bowers et al., 1985; Tsvetkova et al., 1984).
According to E.D. Khomskaya and N.Ya. Batova (1998), patients with damage to the right hemisphere (especially its frontal lobe) exhibit the most severe emotional disturbances compared to other localizations of the lesion. This is manifested in the maximum number of errors when performing various cognitive operations with emotional stimuli, in the more frequent inability to determine the sign and modality of even pronounced emotions, in poor recognition of emotional standards presented to them for memorization, etc. (Fig. 17.4 and 17.5).
G. Sackeim et al. (Sackeim et al., 1982) analyzed cases of pathological laughter and crying and concluded that the first is associated with right-sided lesions, and the second with left-sided lesions. Surgery to remove the right hemisphere resulted in a persistent euphoric mood.
Patients with vascular lesions of the right hemisphere are less accurate in recognizing facial expressions of negative emotions compared to positive ones, perceive them worse, and portray them worse themselves compared to patients with lesions in the left hemisphere (Borod et al., 1986). Direct memorization and reproduction of an emotionally negative story was more impaired in patients with damage to the right hemisphere (Wechsler, 1973).
According to T. A. Dobrokhotova, when the right hemisphere is damaged, paroxysmal emotional changes more often occur, and when the left hemisphere is damaged, stable emotional disturbances occur.
B. I. Bely (1975, 1987), L. I. Moskovichiute and A. I. Kadin (1975), R. Gardner et al. (1959) note lability of the emotional sphere and inability to control their emotional reactions in right-hemisphere patients.
Emotional disorders in mentally ill patients. S. Vanderberg and M. Mattisson (Vanderberg, Mattisson, 1961) found out how impaired the recognition of emotions by facial expressions is in mentally ill patients. It was found that patients with paranoid schizophrenia give a higher percentage of adequate definitions of emotions than other schizophrenics.
Emotional characteristics of patients with alcoholism. IN The works of psychiatrists note that against the background of alcoholic degradation, characteristic changes occur in the emotional sphere of patients (Korsakov, 1913; Kraepelin, 1912). Emotional experiences become shallow, superficial, and some euphoria appears (Portnov, Pyatnitskaya, 1971; Entin, 1979; Glatt, 1967).
V. F. Matveev with co-authors (19 87) studied changes in basic emotions during alcoholism. For this purpose, the method of self-assessment of emotions by K. Izard (scale of differential emotions) was used. The survey of patients was carried out after relief of withdrawal symptoms, in the post-intoxication period. In patients, compared to healthy individuals, shame, guilt (which is not surprising, given the attitude of others towards them) and joy (which is probably associated with a decrease in self-criticism) were significantly more pronounced. Other emotions (surprise, sadness, anger, disgust, contempt, fear) were also more pronounced in patients, but the differences were not significant.
17.7. Emotionally caused pathological changes in mental and physical health
Emotional experiences can lead to various mental disorders, which in different cultures have their own characteristics and names. A description of these states is given in the book by Ts. P. Korolenko and G. V. Frolova (1979).
In Mexican-American culture these states are "susto" and "billis". Susto state is a consequence of experienced fear, and the source of the latter can be either natural (catastrophe, accident, sudden attack of an animal, etc.) or “supernatural”, mystical - fear of spirits, ghosts, witchcraft. The reason for the occurrence of this state may also be a person’s experience that he could not act “as he should”, that he failed to cope with his social role.
As a result, a person becomes restless, loses his appetite, loses interest in loved ones and in life in general. Physical weakness arises, indifference to his appearance, to the decency and conventions that he has hitherto respected. The person complains of feeling unwell, becomes sad, and withdraws into himself. This is similar to the depression of people from the civilized world.
This condition is especially intense in children, probably due to their greater suggestibility.
Billy's condition It is believed to be caused by the experience of anger, resulting in increased secretion of bile. This condition is more severe than “susto”, as it is also accompanied by indigestion and vomiting.
In the Philippines and various areas of Africa, a condition called "amok". It is similar to the condition of patients with catatonic schizophrenia, but differs from it in the presence of amnesia (patients do not remember anything from the period of illness) and the absence of delusions and hallucinations. In the amok state, patients can cause severe bodily harm to themselves or commit suicide.
It is believed that this condition is a consequence of negative emotions of anger and protest accumulated from long-term suppression, which were hidden under outwardly expressed apathy. An interesting fact is that “amok” developed among American soldiers when they found themselves in the Philippines.
The Eskimos along the Hudson Bay and Lake Ontario coasts develop two other psycho-emotional disorders: whitiko and windigo. "Wichiko" is a supernatural figure believed by the Eskimo tribes, a giant human skeleton made of ice that devours people. Psychosis of the “vgshmko” type begins with the fear of the possibility of being bewitched and turning into a devourer of one’s own children and relatives. From this fear, a person loses sleep, he develops nausea, vomiting, and intestinal disorders. The mood becomes gloomy. Relief comes after traditional shamanic “treatment”.
From sudden fear a condition similar to hysteria can develop - "lata". The person becomes fearful, anxious, and strives for solitude. At first, he begins to repeat his own words and phrases of other people who are most authoritative for him. Subsequently, the patient begins to imitate the gestures and actions of others, even if this is dangerous to his life. In other cases, he reproduces gestures and actions that are the opposite of those observed in others.
Such patients are characterized by anger, cynicism, and obscene language. Most often, this painful mental state is typical for middle-aged and elderly women, but it can also occur in men.
The role of “negative” emotions in the occurrence of various diseases. The negative impact of strong and persistent “negative” emotions on human health is well known. Confucius also argued that being deceived and robbed is much less than continuing to remember this, and the German philosopher W. Humboldt argued that keeping negative ideas in memory is tantamount to slow suicide.
As Academician K. M. Bykov wrote, sadness that does not manifest itself in tears makes other organs cry. In 80% of cases, according to doctors, myocardial infarction occurs either after acute mental trauma or after prolonged mental (emotional) stress.
Strong and prolonged “negative” emotions (including long-held anger) lead to pathological changes in organism: peptic ulcer, biliary dyskinesia, diseases of the excretory systems, hypertension, heart attack, stroke, development of various types of neoplasms. M. Seligman (Seligman, 1974), studying deaths in people under the influence of shamans, found that a person can die from fear as a result of cardiac arrest.
It is generally accepted that holding back anger leads to increased blood pressure and ultimately, if repeated repeatedly, to hypertension. This seemingly axiomatic statement raises doubts among a number of scientists. For example, Harburg, Blakelock, and Roper (1979, as cited in McKay et al., 1997) asked people how they would behave with an angry, tyrannical boss. Some answered that they would try to come to terms with such a situation (anger without release), others answered that they would strongly protest and complain to higher authorities (anger with release), and still others said that they would try to find mutual language with the boss as soon as he cools down (control over the developing situation).
It turned out that the highest arterial pressure was among those who were ready to discharge their anger, and the lowest among those who would negotiate with their superiors. From these data it follows that a person with high blood pressure is more likely to demonstrate aggressive behavior (and this is logical, because both anger and high blood pressure are obviously caused by increased levels of adrenaline in the blood).
It seems that these facts do not negate the role of constant neuro-emotional stress in the occurrence of hypertension. The authors' mistake in assessing the data obtained is that they are too straightforward in considering the connection between the way of expressing anger (anger) and blood pressure. The data they obtained only indicates a person’s constitutional predisposition to aggressive behavior due to the prevalence of adrenaline over norepinephrine, and elevated blood pressure is only a secondary sign of this prevalence and does not affect the way of expressing anger. But on the other hand, these data cannot be considered as evidence that aggressive behavior is cause high blood pressure.
B.I. Dodonov considers the opinion that “negative” emotions always lead to pathological changes in the body to be greatly exaggerated. He believes that everything depends on the current situation. However, it is not so much the situation that plays a role, but the psychological characteristics of a person, his reaction to certain circumstances. So, among people it did not arise mass psychosis regarding the prediction of the “soothsayers” that the end of the world would come with the advent of the year 2000, however, some neurotic Englishmen after the New Year fell into depression because “they were so afraid, but nothing happened.”
Regarding the influence of “positive” emotions, P. V. Simonov expresses the opinion that they are harmless. “Science does not know mental illnesses, neuroses, hypertension, heart diseases that arise from excess joy,” he writes. “Unique cases of the harmful influence of a joyful shock on an already sick organism cannot serve as a refutation of this pattern” (1970, p. 72).
Pathology of emotions and feelings
Emotional manifestations can also be pathological.
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This is facilitated various reasons. The source of pathological emotions are character traits and the emotional relationships associated with them. For example, shyness as a character trait can significantly influence the occurrence of pathological state of fear and anxiety, in a demanding person, dissatisfaction of desires can cause a reaction anger, and for the undemanding – compliance, submission; at the same time, anger can cause a painful state of overexcitation, and following compliance, a painful reaction of the nervous system can occur.
It should be noted that emotional pathology has important among various mental disorders. Here it is extremely important to note the importance of emotional excitability, for example, a decrease in emotional excitability to the extent that even strong stimuli do not evoke emotions, which is commonly called sensual dullness, the opposite of it increased emotional excitability, when even weak stimuli cause violent emotional reactions, which is characteristic of neurasthenia.
Emotional disorders include mood disorders, such as: depression, dysphoria, euphoria.
Depression– affective state, characterized by a negative emotional background, changes in the motivational sphere, cognitive ideas and general passivity of behavior.
Subjectively, a person in a state of depression experiences difficult, painful emotions and experiences, such as depression, melancholy, and despair. Drives, motives, volitional activity are reduced. Against the background of depression, thoughts of death arise, self-deprecation and suicidal tendencies appear. In addition to a depressed mood, ideational - mental, associative - and motor retardation is characteristic. Depressed patients are inactive. For the most part they sit in a secluded place, with their heads down. Various conversations are painful for them. Self-esteem is reduced. The perception of time has changed, and it flows for a painfully long time.
There are functional states of depression, which are possible in healthy people within the framework of normal mental functioning, and pathological states, which are one of the psychiatric syndromes. A less pronounced condition is usually called subdepression.
Subdepression– a decrease in mood, not reaching the level of depression, is observed in a number of somatic diseases and neuroses.
Dysphoria– low mood with irritability, anger, gloominess, hypersensitivity to the actions of others, with a tendency to outbursts of aggression. Occurs in epilepsy. Dysphoria is most typical in organic diseases of the brain, in some forms of psychopathy - explosive, epileptoid.
Euphoria- an increased joyful, cheerful mood, a state of complacency and carelessness that does not correspond to objective circumstances, in which facial and general motor animation and psychomotor agitation are observed. Everything around you is perceived in bright rainbow colors, all people seem charming and kind. Another symptom is ideational excitation: thoughts flow easily and quickly, one association revives several at once, memory produces rich information, but attention is unstable, extremely distractible, due to which the ability for productive activity is very limited. The third symptom is motor agitation. Patients in constant movement, they undertake everything, but do not bring anything to the end, they interfere with those around them with their services and help.
The instability of emotions manifests itself as emotional lability. Emotional lability characterized by a slight change in mood from somewhat sad to elevated without any significant reason. It is often observed in diseases of the heart and blood vessels of the brain or against the background of asthenia after somatic diseases, etc.
Emotional ambivalence characterized by the simultaneous existence of opposing emotions. In this case, a paradoxical change in mood is observed, for example, misfortune causes a joyful mood, and a joyful event causes sadness. It is observed in neuroses, character accentuations and some somatic diseases.
It is also observed ambivalence of feelings– inconsistency, inconsistency of several simultaneously experienced emotional relationships to a certain object. Ambivalence of feelings in a typical case is due to the fact that individual features of a complex object have different effects on a person’s needs and values, a special case ambivalence of feelings is a contradiction between stable feelings towards an object and situational emotions developing from them.
However, it may be observed inadequacy of emotions, which can sometimes be expressed in schizophrenia, when the emotion does not correspond to the stimulus that caused it.
Apathy– painful indifference to the events of the outside world, one’s own condition; complete loss of interest in any activity, even in one’s appearance. The person becomes sloppy and unkempt. People with apathy treat their family and friends coldly and indifferently. With relatively intact mental activity, they lose the ability to feel.
The formation of a person’s emotions is the most important condition for his development as a person. Only by becoming the subject of stable emotional relationships do ideals, responsibilities, and norms of behavior turn into real motives for activity. The extreme variety of human emotions is explained by the complexity of the relationship between the objects of his needs, the specific conditions of their occurrence and the activities aimed at achieving them.
Pathology of emotions and feelings - concept and types. Classification and features of the category "Pathology of emotions and feelings" 2017, 2018.
Psychiatry. Guide for doctors Boris Dmitrievich Tsygankov
Chapter 14 PATHOLOGY OF EMOTIONS (AFFECTIVENESS)
PATHOLOGY OF EMOTIONS (EFFECTIVENESS)
Under emotion(from lat. emoneo - excite, shock) understand subjective reaction of a person under the influence of various internal and external stimuli. Accompanying almost any manifestation of the body’s vital activity, emotions reflect in the form of direct experiences the significance of various phenomena and situations and serve as one of the main mechanisms of internal regulation. mental activity and behavior aimed at satisfying needs (motivations). Affect also denotes emotional excitement and reflects the emotional state of a person in various conditions and situations, characterizing the characteristics of his experience.
In textbooks on psychiatry, in most cases, we find a fairly clear formulation in the general part: pleasure or displeasure in connection with affects constitutes the concept we are talking about. If we want to differentiate the concepts of “feelings”, “mood”, “emotion”, “affect” so that they become suitable for practical application, then we must first establish that in a mental act only a theoretical, and not an actual division can take place mental qualities in question. E. Bleuler emphasizes that with any, even the simplest light sensation, we distinguish between qualities (color, hue), intensity and saturation. Similarly, we talk about the processes of cognition (intelligence), feeling and will, although we know that there is no such mental process that would not be characterized by all three qualities, even if one of them comes to the fore, then the other. Therefore, when we call a process affective, we know that we are abstracting something, just as we consider color independently of its intensity. We must always be clearly aware that the process that we call affective also has an intellectual and volitional side, which in this case we neglect as an insignificant factor. With the constant strengthening of the intellectual factor and the weakening of the affective factor, a process ultimately arises that we call intellectual. Thus, we cannot divide all mental processes into purely affective and purely volitional, but only into predominantly affective and predominantly volitional, and intermediate processes may occur. A similar analytical approach to the description of psychopathological symptoms and syndromes has now been developed in domestic psychiatry(S. Yu. Tsirkin, 2005).
Like most other psychological terms, the word “feeling” originally meant something sensual. It was equivalent to the modern term "sensation" and still bears the imprint of this origin. A person feels a prick, feels a fly crawling over his face; a person experiences a feeling of cold or a feeling that the ground is shaking under his feet. Thus, E. Bleuler believes, this ambiguous word cannot be suitable for the purposes of psychopathology. Instead, the term “affectivity” is practically accurate, which should serve to express not only affects in the proper sense, but also to designate light feelings of pleasure and displeasure in all kinds of experiences.
In accordance with the predominance of one of these experiences, hypothymia And hyperthymia(from Greek ????? - mood, feeling, desire).
Hypotymia, or depression, characterized by a decrease in general mental tone, loss of a sense of joyful and pleasant perception of the environment, accompanied by the appearance of sadness or sadness. Hypotymia underlies the formation of depressive syndrome.
Depressive syndrome in typical cases, it is characterized by a triad of symptoms of inhibition of mental activity: sad, depressed mood, slow thinking and motor retardation. The severity of these structural elements may vary, reflecting wide range depression from mild sadness with a feeling of decreased mental tone and some general discomfort to deep depression with a feeling of melancholy that “tears the heart” and the conviction of the complete meaninglessness and futility of one’s existence. At the same time, everything is perceived in a gloomy light - the present, past and future. Melancholy is perceived by many patients not only as mental pain, but also as a painful physical sensation in the area of the heart, “a stone on the heart,” “precordial melancholy” (vital depression). Some patients in this state also experience other algic sensations, for example, some of them say that it “pains to think.” V. M. Morozov proposed calling such sensations the term “dyssenesthesia,” meaning by this a violation of general sensitivity. Dyssenesthesia in depression is characterized by the fact that expressions relating to mental pain and depression merge with expressions relating to physical pain, which is reflected in the speech of patients (“emptiness in the head”, “longing in the heart”, etc.). The slowing down of the associative process is manifested in the loss of the former, natural and smooth flow of thoughts that was usual for them, of which there are few, they flow slowly, their former liveliness and lightness are no longer present, the acuity of thinking is lost. Thoughts, as a rule, are fixed on unpleasant events: possible illness, one’s own mistakes, mistakes, inability to overcome difficulties, perform the most ordinary, simple actions; patients begin to blame themselves for various incorrect, “bad” actions that, in their opinion, cause harm to others (ideas of self-blame). No real pleasant events can change such a pessimistic mindset. Such patients answer questions in monosyllables, the answers follow after a long silence. Motor retardation manifests itself in slower movements and speech, which becomes quiet, often slurred, and poorly modulated. The facial expressions of the patients are sad, the corners of the mouth are drooping, the patients cannot smile, the expression of grief predominates on the face, and the same posture is maintained for a long time. At the height of the development of depression, complete immobility (depressive stupor) appears. Motor inhibition does not allow many patients, disgusted with life because of their painful state of health, to commit suicide, although they have suicidal thoughts. Subsequently, they talk about how they dreamed that someone would kill them, saving them from “mental torment.”
Manic syndrome (hyperthymia) characterized by the presence of a triad of symptoms indicating the presence of arousal: an elevated, joyful mood, acceleration of the flow of associations and motor agitation, a desire for indomitable activity. As with depression, the severity of individual components of the affective triad varies.
The mood can fluctuate from pleasant pleasure, in which everything around is painted in joyful, sunny colors, to enthusiastic-ecstatic or angry. The acceleration of associations also has a wide range from a pleasant relief with a quick and easy flow of thoughts to a “jump of ideas”, which at the same time lose their goal orientation, reaching a degree of “confusion” (“confused mania”). The motor sphere shows a general tendency towards revitalization of motor skills, which can reach the level of chaotic, incessant excitement. Manic syndrome is characterized by distractibility of attention, which does not allow patients to complete the speech they have begun or the task they have started. In a conversation, this is manifested in the fact that, despite its fast pace, if there is a desire to communicate, there is no productivity, the doctor cannot obtain the information that is necessary for him (for example, find out the sequence of events in the patient’s life preceding hospitalization, etc.) . In a manic state, patients do not make any health complaints, they feel a surge of physical and mental strength, and say that they have a “huge charge of energy.” Women become erotic, claim that everyone is in love with them, men discover naked hypersexuality. Patients are convinced of their extraordinary abilities in a wide variety of areas, which can reach the level of delusions of grandeur. At the same time, a desire for various types of creativity is revealed, patients compose poetry, music, paint landscapes, portraits, assuring everyone of the presence of “extraordinary talents.” They can say that they are “on the threshold of great discoveries”, capable of “turning science around”, creating new laws by which the whole world will live, etc.
Speech agitation is a constant companion of mania; patients speak loudly, incessantly, sometimes, without finishing one phrase, they begin a new topic, interrupt the interlocutor, starting to shout, gesticulate furiously, begin to sing loudly, not realizing that they are behaving inappropriately to the situation, indecently. In many cases, the acceleration of the associative process is revealed when writing; patients do not pay attention to literacy and cleanliness; they can write separate, unrelated words, so that it is impossible to understand the essence of what is written.
A very characteristic appearance of manic patients is that they exhibit excessive agitation: the patients are excessively animated, their face is hyperemic, due to constant speech excitation, saliva accumulates in the corners of the mouth, they laugh loudly, and cannot sit in one place. The appetite is increased, gluttony develops. Depending on the shades of hyperthymia, one can distinguish “cheerful mania”, unproductive mania, angry mania, mania with foolishness, in which the mood is elevated, but there is no lightness, true joy, motor excitement predominates with feigned playfulness, or there is a picture mannerism, a tendency to flat and cynical jokes.
Easy options manic states designated as hypomania, they, like subdepression, are observed with cyclothymia (more detailed description For various types of depression and mania, see the section “Affective endogenous psychoses”).
Moria- a state characterized by a combination of an uplift in mood with some disinhibition, carelessness, while a disinhibition of drives and sometimes a loss of consciousness may be observed. It is most often observed with damage to the frontal lobes of the brain.
Dysphoria- gloomy, gloomy, angry mood with grumpiness, irritability, increased sensitivity to any external irritant, slight onset of brutal bitterness, explosiveness. The condition can be expressed by dull dissatisfaction, pickiness, at times with outbursts of malice and anger, threats, and the ability to launch a sudden attack. One type of dysphoria is moros- a gloomy, grumpy, grumpy mood that occurs immediately after waking up (“gets up on the left foot”).
Euphoria- elevated mood with a feeling of contentment, carelessness, serenity. As noted by A. A. Portnov (2004), citing the observations of I. N. Pyatnitskaya, euphoria during anesthesia is composed of a number of pleasant sensations of both a mental and somatic nature. Moreover, each drug has a special structure of euphoria. For example, when intoxicated with morphine or opium, patients experience a state of somatic pleasure, peace and bliss. Already in the first seconds, the opiate introduced into the body causes a feeling of warmth and pleasant “airy” stroking in the lumbar region and lower abdomen, rising in waves to the chest and neck area. At the same time, the head becomes “light”, the chest bursts with joy, everything inside the patient rejoices, just as everything around him rejoices, which is perceived brightly and clearly, then a state of complacency, languor, lazy peace and contentment sets in, then. which many patients define by the term “nirvana”. Euphoria caused by caffeine, cocaine, and lysergicide is of a different nature. It is combined not so much with pleasant somatic sensations as with intellectual stimulation. Patients feel that their thoughts have become richer, brighter, their knowledge has become clearer and more fruitful; they experience the joy of mental upliftment. Another type of euphoria is observed with alcohol and barbiturate poisoning. Self-satisfaction, bragging, erotic disinhibition, boastful talkativeness - all these are manifestations of an intoxicating or euphoric effect, which patients with alcoholism and drug addiction strive to reproduce. Euphoria is characterized by inactivity, passivity, and no increase in productivity is observed.
Ecstasy- an experience of delight, extraordinary joy, inspiration, happiness, inspiration, admiration, turning into frenzy.
Fear, panic- a state with the presence of internal tension associated with the expectation of something threatening life, health, and well-being. Degrees of expression can be different - from mild anxiety and restlessness with a feeling of tightness in the chest, “fading of the heart” to panic horror with cries for help, running away, throwing. Accompanied by an abundance of vegetative manifestations - dry mouth, body trembling, the appearance of “goosebumps” under the skin, the urge to urinate, defecate, etc.
Emotional lability- sharp fluctuations in mood from its increase to a significant decrease, from sentimentality to tearfulness.
Apathy- complete indifference to what is happening, indifferent attitude towards one’s condition, position, future, absolute thoughtlessness, loss of any emotional response. E. Bleuler (1911) called apathy in schizophrenia “the calm of the grave.”
Emotional dulling affective dullness - weakening, insufficiency or complete loss of affective responsiveness, poverty of emotional manifestations, spiritual coldness, insensitivity, dull indifference. Characteristic of schizophrenia or a special type of psychopathy.
Parathymia(inadequacy of affect) is characterized by the manifestation of affect that is qualitatively inconsistent with the reason that caused it, inadequate to the phenomenon that causes it. Such patients, when reporting a sad event, may laugh inappropriately, joke, show inappropriate merriment for the occasion, and, conversely, fall into sadness and sadness in the presence of information about joyful events. Parathymia, according to E. Bleuler, may be characteristic of autistic thinking as affective thinking that does not obey the laws of strict logic.
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