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Mental illness


The concept of psychiatry. The Greek word psychiatry literally means the science of treatment, of the healing of the soul. Over time, the meaning of this term has expanded and deepened, and now psychiatry is a science of mental illness in the broad sense of the word, which includes the causes and mechanisms of the development of mental illness, a description of their clinical picture, methods of treatment, prevention, and the maintenance of mentally ill patients and rehabilitation.
The anatomical and physiological substrate of mental, mental activity is the brain. The causes of brain disorders are various. This is either internal (endogenous) factors due to a hereditary predisposition and a violation of biochemical and metabolic processes, or external, associated with the influence of environmental factors both directly on the central nervous system (craniocerebral, mental injuries) and the body as a whole (infections, intoxications , vascular atherosclerosis, etc.).
The degree of disturbance in brain activity varies: from mild, functional (reversible) disorders to severe organic lesions. Psychopathological manifestations depend on the nature and severity of these disorders. With mild disorders of brain function, neurotic reactions, neuroses, and shallow depressions occur - the so-called borderline conditions in which patients feel and adapt in society, but control over their behavior and a critical assessment of the condition remain. In diseases caused by a deeper damage to the activity of the brain, psychoses arise, in which the perception and evaluation of the surrounding self is disturbed, the person’s behavior completely changes, determined by painful attitudes, in other words, the patient’s behavior completely gets out of control of consciousness, self-control and self-esteem. Accordingly, the measures of influence on the patient, both medical and social, differ significantly in case of neurosis and psychosis and are determined by the nature and severity of mental disorders, taking into account the individual characteristics of the person.
Psychiatry is a young science; the beginning of its development dates back to the 18th century. Until that time, patients were not treated, but only by various methods were isolated from society: during the Middle Ages they were burned at the stake, kept in prisons chained to the walls, walled up in the walls of monasteries. The first major institution for the mentally ill appeared in Ireland at one of the monasteries back in the 15th century. In the XVI century there was already a rather large shelter, called Bedlam, but the official institution for the mentally ill was opened only in 1751 in London.
The turning point in relation to the mentally ill and their maintenance was the reform carried out by the French psychiatrist Pinel in 1792, as a result of which the chains were removed from the mentally ill and some treatment methods were used (bloodletting, forced baths and souls). The release of patients from chains laid the foundation for a new stage in psychiatry - the introduction of a system of non-constraint or, more precisely, non-binding of mentally ill patients. However, this does not mean that all patients were immediately released from all measures of restraint. For many years (and in some countries up to now) the so-called "straitjackets" (special shirts with very long sleeves tied around the torso) and even small chains that riveted patients to a bench or bed were used.
In Russia, there was always a more humane attitude to the mentally ill. Since ancient times, "insane" were considered "wretched", "strange", "holy fools", "blessed" and found refuge in monasteries. The first psychiatric hospitals were built by decree of Empress Catherine II in Novgorod (1776), at the Obukhov Hospital in St. Petersburg (1782) and the Transfiguration Hospital in Moscow (1785). The teaching of psychiatry in Russia was officially introduced in 1835 at the Imperial Medical and Surgical Academy.
Since then, psychiatric science has undergone very strong changes. They contain the mentally ill in specially equipped medical institutions, apply all modern methods of diagnosis and treatment. However, in public opinion, many prejudices continue to exist. The news that a person was received by a psychiatrist is sometimes regarded as evidence of his “inferiority”.
Despite various negative phenomena, international experience indicates the widespread development of psychiatric care, especially in developed countries. The creation of not only purely psychiatric, but also special psychological, psychosomatic and psychotherapeutic services not only helps to get rid of mental illness, but also helps in the treatment of somatic diseases, in getting rid of "internal complexes", intrapersonal and interpersonal conflicts, in solving many social and family problems.
In our country, the provision of psychiatric care to the population is carried out by a number of medical institutions. The patient can go to the neuropsychiatric dispensary himself or is referred by doctors of other specialties. Depending on the nature of the disease and its severity, the patient is treated on an outpatient basis, in a day hospital or in a hospital. It should be noted that under existing legislation, patients with borderline mental disorders (neurosis, psychopathy and other non-psychotic conditions) are not put on special records and do not have any legal and social restrictions.
In cases where the examination and treatment of the patient for one reason or another cannot be done on an outpatient basis, he is placed in a hospital only with the consent of him. Forced hospitalization is mainly used in two cases. 1. When the patient is dangerous to others, he can commit asocial acts and criminal offenses for painful reasons. For example, a patient with delusions of persecution can kill his "imaginary" stalker, a patient with imperative hallucinations ("voices" ordering to do something) can commit any unforeseen action that causes harm to others. 2. When the patient is dangerous to himself, i.e. may commit suicide (suicide). Suicidal thoughts can be caused by a depressive state, are associated with delusions of a certain content, peremptory hallucinations, etc. Sometimes patients commit the so-called "extended" suicides, i.e. they kill their loved ones (wife, husband, child), and then themselves. This behavior is also usually associated with mental disorders (severe depression, delusional behavior).
The provision of assistance to the mentally ill, hospitalization, including compulsory, is carried out in accordance with the law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens when it is provided," adopted by the Supreme Council of the Russian Federation on 02.07.92.