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Mental illness


The concept of psychiatry. The Greek word psychiatry literally means the science of healing, the healing of the soul. Over time, the meaning of this term has expanded and deepened, and now psychiatry is the science of mental illness in the broadest sense of the word, including the causes and mechanisms for the development of mental diseases, a description of their clinical picture, methods of treatment, prevention, the content of the mentally ill. and rehabilitation.
Anatomical and physiological substrate of mental, mental activity is the brain. The causes of violations of the brain are different. These are internal (endogenous) factors caused by hereditary predisposition and impaired biochemical and metabolic processes, or external, associated with the influence of environmental factors directly on the central nervous system (craniocerebral, mental trauma), and on the organism as a whole (infections, intoxication , vascular atherosclerosis, etc.).
The degree of impaired brain activity varies from mild, functional (reversible) disorders to severe organic lesions. Psychopathological manifestations depend on the nature and severity of these disorders. In mild disorders of the brain function, neurotic reactions, neuroses, shallow depressions occur - the so-called borderline conditions in which the well-being and adaptation of patients in society changes, but control over their behavior and critical assessment of the condition remain. In diseases caused by a deeper damage to the brain, psychosis occurs, in which the perception and evaluation of the surrounding, self-impaired, human behavior changes completely, determined by painful attitudes, in other words, the patient's behavior is completely out of control of consciousness, self-control and self-esteem. Accordingly, the measures of influence on the patient, both medical and social, differ significantly with 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 belongs to the XVIII century. Until that time, patients were not treated, but only isolated by various methods from society: during the Middle Ages, they were burned at the stake, kept in prisons chained to walls, walled in monasteries. The first major institution for the mentally ill appeared in Ireland at one of the monasteries in the XV century. In the XVI century, there was already a fairly large shelter, called Bedlam, but the official institution for the mentally ill was only opened in 1751 in London.
The crucial stage in relation to the mentally ill and their content was the reform carried out by the French psychiatrist Pinel in 1792, as a result of which chains were removed from the mentally ill and some treatment methods began to be used (bleeding, violent baths and showers). The release of patients from chains marked the beginning of a new stage in psychiatry — the introduction of a system of non-constraint, or more precisely the non-binding of the mentally ill. 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), so-called "straitjackets" were used (special shirts with very long sleeves tied around the body) and even small chains that chained patients to the bench, beds.
In Russia, a more humane attitude towards the mentally ill was always. From ancient times, the "insane" were considered "poor", "strange", "holy fools", "blessed" and found shelter in monasteries. The first psychiatric hospitals were built by decree of Empress Catherine II in Novgorod (1776), at the Obukhovsky 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-Surgical Academy.
Since then, psychiatric science has undergone very strong changes. Contain mentally ill patients 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 the person was at the reception of a psychiatrist, is sometimes regarded as evidence of his "inferiority".
Despite various negative phenomena, international experience indicates a widespread development of psychiatric care, especially in developed countries. Creating not only purely psychiatric, but also special psychological, psychosomatic and psychotherapeutic services not only helps to get rid of mental diseases, but also helps in the treatment of somatic diseases, in getting rid of "internal complexes", intrapersonal and interpersonal conflicts, in solving many social and familial problems.
In our country, the provision of psychiatric care to the population is carried out by a number of medical institutions. The patient can turn to the neuropsychiatric clinic himself or is sent 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, according to the existing legislation, patients with borderline mental disorders (neurosis, psychopathy and other non-psychotic states) are not registered and do not have any legal and social restrictions.
In cases where the examination and treatment of a patient for one reason or another cannot be carried out on an outpatient basis, he is placed in the hospital only with his consent. Forced hospitalization is used mainly in two cases. 1. When a patient is dangerous to others, he may commit asocial acts and criminal offenses for painful reasons. For example, a patient with a delusion of persecution can kill his “imaginary” pursuer, a patient with imperative hallucinations (“voices”, ordering something to do) can perform any unforeseen action that harms others. 2. When a patient is dangerous for himself, i.e. can commit suicide (suicide). Suicidal thoughts may be due to depression, associated with a delusion of a certain content, imperative hallucinations and so on. Sometimes patients commit the so-called "extended" suicides, i.e. kill their loved ones (wife, husband, child), and then themselves. This behavior is also usually associated with mental disorders (severe depressions, delusional behavior).
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 in its provision", adopted by the Supreme Council of the Russian Federation on 02.07.92.