loss syndrome. The psychology of death. Medical ethics in relation to the dying. Psychology of grief and loss Psychology of "loss" of the soul
Psychological features patients with incurable diseases.
The psychology of loss and death. Grief reaction.
Loneliness (sensory and social deprivation).
Dying and death (stages of the patient's reaction: denial, anger, deal, depression, acceptance).
Rules of conduct with a dying patient.
.
Organization of hospice work.
Psychology of suicidal behavior. Stages of suicidal behavior.
1. Psychological characteristics of patients with incurable diseases. In the study of incurable diseases, great importance given to the psychological characteristics of patients with these diseases. As such diseases today are primarily cancer, AIDS, oncohematology, which are perceived by many people as processes that inevitably lead through withering and pain to death. The emotional burden experienced by dying patients is determined primarily by their personal characteristics, as well as thoughts of pain and possible slow and painful death. In the first place is the patient's fear of the rapid and inevitable end of life. Particularly pronounced fear may be due to the inevitability of risky surgical intervention.
The reactions of the individual to the disease at this stage can be different: the patient commits impulsive acts that are harmful to his own health, an anxious and suspicious attitude to what happened, throwing the patient from one doctor to another, then despair, then hope. And the overall success of treatment depends on how the patient treats his disease.
Among the mental manifestations, the leading ones are disorders classified as adaptive (psychogenic): depressive and mixed (anxious-depressive) reactions, behavioral disorders. However, in the diagnostic period, psychogenic reactions rarely reach the psychotic level. From this time on, the struggle of the individual with the impending formidable danger begins, and all forces are mobilized for the struggle - instinct, the affective sphere, restructuring intellectual activity, a changing attitude to the external and internal world.
The extended (stationary) period is characterized, in addition to psychogenic disorders, by the appearance of somatogenic changes in the psyche, with astheno-depressive manifestations in the first place. The active forces of the personality are used for a true or symbolic exit from the disease. Difficulties of a psychological order can be overcome thanks to the knowledge of the characteristics of the psychology of patients, which is based on faith in a successful outcome of the disease. And it must be supported by demonstrating examples of positive treatment results with complete recovery or long-term remission.
The mental state of the patient depends on the stage of the disease, the severity of intoxication and the tolerance of treatment methods. In some patients, there is an asthenic-dreary background of experiences, some lethargy is observed. Such patients are unable to endure even mild pain. Speech, appearance, posture, facial expressions become monotonous and monotonous. Despite some external detachment, these patients need a sympathetic attitude, because they are afraid to be alone with their gloomy thoughts. In patients with cancer intoxication against the background of cachexia, oneiroid states are possible: patients, lying in bed with their eyes closed, see moving images and scenes in front of them. The orientation is preserved. Some patients may develop anxiety and suspicion: they are treated incorrectly, drugs are confused, they are given harmful substances, experiments are carried out with them, neighbors say something unfriendly, hint at them, show them with a look. These disorders can be regarded as delusional ideas of persecution and attitude, which can be identified by careful questioning of patients and which can be partially corrected.
Psychoses in oncological patients are observed infrequently, manifested in the form of oneiric delirium, depression, paranoid outbreaks. The influence of the phenomenon of cancer intoxication on the mental state of patients can manifest itself in the form of specific cancer depressions. Inner world patients becomes faded, the perception of time changes (it goes faster). The personality of the patient in the terminal stage remains intact, but intellectual intensity and purposefulness are falling. Speech changes due to exhaustion. The effects subside. The content of the mental world is reduced, criticism weakens, internal isolation grows, which resembles the state of patients with apathetic disorders. In a number of patients, the pre-mortem period is devoid of the experience of fear of death. The idea of death in them is subjected to the so-called repression, “one’s own disease is alienated”, i.e. there is dissomatonosognosia, which is manifested by capriciousness, exactingness towards others, as well as quarrelsomeness, conflict.
2. Psychology of loss and death. Grief reaction. Grief is a specific syndrome with psychological and somatic symptoms. This syndrome may occur immediately after a crisis, it may be delayed, it may not manifest itself clearly, or, conversely, it may manifest itself in an overly emphasized form. Instead of a typical syndrome, distorted pictures may be observed, each of which represents some particular aspect of the grief syndrome.
Reactions of grief, grief and loss can cause the following reasons: 1) the loss of a loved one; 2) the loss of an object or position that had emotional significance, such as the loss of valuable property, deprivation of work, position in society; 3) loss associated with illness.
There are five pathognomic features for grief - physical suffering, preoccupation with the image of the deceased, guilt, hostile reactions and loss of behavior patterns.
The main thing in assessing a person’s condition is not so much the cause of the grief reaction, but the degree of significance of a particular loss for a given subject (for one, the death of a dog is a tragedy that can even cause a suicide attempt, and for another, grief, but fixable: “you can start another"). With a grief reaction, it is possible to form behavior that poses a threat to health and life, for example, alcohol abuse.
The duration of the grief reaction is obviously determined by how successfully the individual performs the work of grief, namely, he emerges from states of extreme dependence on the deceased, re-adapts to the environment in which the lost face is no longer there, and forms new relationships.
Stages of grief:
1. Numbness or protest. Characterized by severe malaise, fear and anger. Psychological shock can last for moments, days and months.
2. Longing and desire to return the lost person. The world appears empty and without meaning, but self-esteem does not suffer. The patient is preoccupied with thoughts of the lost person; periodically there is physical restlessness, crying and anger. This state lasts for several months or even years.
3. Disorganization and despair. Restlessness and performance of aimless actions. Increased anxiety, withdrawal, introversion and annoyance. Permanent memories of a departed person.
4. Rearrangement. The emergence of new experiences, objects and goals. Grief weakens and is replaced by memories dear to the heart.
Tactics of behavior with patients in a state of grief:
1. The patient should be encouraged to discuss his experiences, to allow him to simply talk about the lost object, to recall positive emotional episodes and past events.
2. Do not stop the patient when he starts to cry.
3. In the event that the patient has lost someone close, one should try to ensure the presence of a small group of people who knew the deceased (s), and ask them to talk about him (her) in the presence of the patient.
4. Frequent and short visits with the patient are preferable to long and infrequent visits.
5. Consideration should be given to the possibility that the patient may have a delayed grief reaction that manifests itself some time after the death of a loved one and is characterized by behavioral changes, anxiety, mood lability and substance abuse. These reactions may appear on the anniversary of death (called the anniversary reaction).
6. The reaction to expected grief occurs before the loss occurs and can reduce the intensity of the experience.
7. A patient whose close relative has committed suicide may refuse to talk about his feelings, fearing that this fact will somehow compromise him.
3. Loneliness (sensory and social deprivation). The state of loneliness is caused by a lack of external stimulation of a physical and social nature.
Based on the psychoanalytic concept, S.G. Korchagin (2001) identifies several types of the state of loneliness.
Self alienating loneliness. If the processes of identification with other people predominate in the mental life of a person, then there is an alienation of a person from himself, a loss of connection with himself, a loss of his own self, the impossibility of personal isolation, an almost complete loss of the ability of a person to reflect.
alienating loneliness. The consequence of the suppression of identification processes by processes of isolation is the alienation of the individual from other people, the norms and values accepted in society, the loss of like-minded people, the loss of spiritually significant connections and contacts, the impossibility of truly close, spiritual communication, unity with another person. Such loneliness is often accompanied by agonizing enduring feelings of resentment, guilt, and shame. At the same time, the processes of reflection are activated, but often come down to self-accusation.
Loneliness can be absolute or relative(fighter pilots, astronauts, drivers of vehicles).
Signs of loneliness.
sensory deprivation - (from Latin sensus - feeling, sensation and deprivation - deprivation) - a prolonged, more or less complete deprivation of a person of visual, auditory, tactile or other sensations, mobility, communication, emotional experiences.
In another way, the term "deprivation" means the loss of something due to insufficient satisfaction of any important need, blocking the satisfaction of basic (vital) needs to the extent necessary and for a sufficiently long time. In the case when it comes to insufficient satisfaction of basic psychological needs, it is used as equivalent concepts of "mental deprivation", "mental starvation", "mental insufficiency", defining a state that is the basis or internal mental condition specific behavior (deprivation consequences).
Deprivation situation It is the inability to satisfy important psychological needs. Deprivation experience suggests that the individual has previously been subjected to a deprivation situation and that, as a result, he will enter into each new similar situation with a slightly modified, more sensitive or, on the contrary, more “hardened” mental structure.
has a negative impact on personality development. emotional deprivation. The socio-psychological consequences of deprivation include fear of people, which is replaced by numerous unstable relationships, in which an insatiable need for attention and love is manifested. Manifestations of feelings are characterized by poverty and often a clear tendency to acute affects and low resistance to stress.
It has been proven that with a deficit of sensory information of any order, a person actualizes the need for sensations and strong feelings, develops, in fact, sensory and / or emotional hunger. This leads to the activation of the processes of imagination, which in a certain way affect the figurative memory. Under these conditions, a person's ability to preserve and reproduce very vivid and detailed images of previously perceived objects or sensations begins to be realized as a protective (compensatory) mechanism. As the time spent in conditions of sensory deprivation increases, lethargy, depression, apathy begin to develop, which for a short time are replaced by euphoria, irritability. There are also memory disturbances, the rhythm of sleep and wakefulness, hypnotic and trance states, hallucinations of various forms develop. The more severe the conditions of sensory deprivation, the faster the thinking processes are disrupted, which manifests itself in the inability to focus on anything, to think about problems consistently.
Experimental evidence has also shown that sensory deprivation can induce a temporary psychosis in a person or cause temporary mental disturbances. With prolonged sensory deprivation, organic changes or the appearance of conditions for their occurrence are possible. Insufficient brain stimulation can lead, even indirectly, to degenerative changes in nerve cells.
It has been shown that under conditions of deprivation, disinhibition of the cortex will occur, which can usually appear in the form of hallucinations (not corresponding to reality, but perceived by consciousness), and in any form: tactile sensations (crawling, warm streams, etc.), visual ( light flashes, faces, people, etc.), sound (noises, music, voices), etc. However, the "contemplation" of a certain image, provided by the corresponding dominants in the cerebral cortex, can cause lateral inhibition of the cortex. Thus, there are two oppositely directed tendencies - to disinhibition of the cortex and to inhibition.
social deprivation. This phenomenon is due to the lack of the ability to communicate with other people or the ability to communicate only with a strictly limited contingent. In this case, a person cannot receive the usual socially significant information and realize sensory-emotional contacts with others. A person isolated from society can structure time in two ways: with the help of activity or fantasy. Communication with oneself, both as a specific mechanism for real control of one's own personality, and as a fantasy (communication "in memory" or "dreams on a given topic") is a way of filling time with activity. Different ways of filling time are play activities, and especially creativity.
In modern domestic psychology, loneliness refers to one of the types of "difficult" states. At the same time, there is also a subjectively positive type of the state of loneliness - solitude, which is a variant of the normal experience of loneliness, which is personally conditioned by the optimal ratio of the results of the processes of identification and isolation. This dynamic balance can be considered as one of the manifestations of the psychological resistance of the individual to the influences of society. Solitude contributes to the growth of self-awareness, activates the processes of reflection and self-knowledge, is one of the ways of self-actualization and self-determination of a person in the world. As a peculiar form of "social hunger", by analogy with dosed physiological starvation, loneliness can be useful and even necessary for a person as a means of psychological restoration of his "self" and self-improvement.
4. Dying and death (stages of the patient's reaction: denial, anger, deal, depression, acceptance). Thanatology is a branch medical science dealing with the whole range of problems associated with death.
In the past, a person from childhood faced the death of relatives and loved ones, but now this is happening less and less. With more frequent deaths in hospitals, death is institutionalized. Until the age of six, a child has an idea of the reversibility of death. A full understanding of its inevitability comes in the puberty period. Religious ideas about afterlife are now extremely rare. The cult of suffering, expressed in rituals and prayers (“Remember death!”), Turned thoughts about death, illness and suffering into an integral part of a person’s mental equipment. Religious institutions could provide people with psychological relief by forming in them certain "psychic antibodies" against the fear of illness and death. Therefore, a religious person more often (but not always) dies calmly, easily.
A modern healthy or temporarily ill person overcomes thoughts of death thanks to the mechanisms of psychological protection of the individual, which exist in the form of suppression and repression. With the problem of dying and death, a medical worker can meet in contact with very seriously and long-term suffering patients. At the same time, medical personnel are obliged to ensure the patient's right to a dignified death.
Elisabeth Kübler Ross, a pediatric psychiatrist in the Department of Psychopathology at the University of Chicago, studied the problem of death and dying in today's unbelieving person. She created her own scientific school and, together with her students, studied this problem. Elisabeth Kubler Ross stated that the mental state of a person with a fatal illness is unstable and goes through five stages, which can be observed in a different sequence (E. Kubler-Ross, 1969).
The first stage - denial stage and rejection tragic fact. It is expressed by disbelief in a real danger, the conviction that a mistake has occurred, the search for evidence that there is a way out of an unbearable situation, manifested by confusion, stupor, a feeling of explosion, deafness (“Not me”, “It can’t be”, “This is not cancer” ).
Second stage - protest stage. When the first shock passes, repeated studies confirm the presence of a fatal disease, a feeling of protest and indignation arises. “Why me?”, “Why others will live, but I have to die?” etc. As a rule, this stage is inevitable, it is very difficult for the patient and his relatives. During this period, the patient often turns to the doctor with a question about the time that he has left to live. As a rule, this stage is inevitable, it is very difficult for the patient and his relatives. During this period, the patient often turns to the doctor with a question about the time that he has left to live. As a rule, symptoms of reactive depression progress, and suicidal thoughts and actions are possible. At this stage, the patient needs the help of a qualified psychologist who knows logotherapy, the help of family members is very important. The resulting anger is determined by the recognition of danger and the search for the guilty, moaning, irritation, the desire to punish everyone around. One of the manifestations of this phase in AIDS patients are attempts to infect someone else.
Third stage - request for a delay (deal). During this period, there is an acceptance of the truth and what is happening, but "not now, just a little more." Many, even previously non-believing patients, turn their thoughts and requests to God. The beginnings of faith are coming. An attempt to negotiate with death is expressed in the search for ways to delay the end, active treatment. Patients may try to negotiate with doctors, friends, or God, and in exchange for recovery promise to do something, for example, give alms, go to church regularly.
The first three stages constitute the period of crisis.
Fourth stage - reactive depression, which, as a rule, is combined with feelings of guilt and resentment, pity and grief. The patient understands that he is dying. During this period, he mourns for his bad deeds, for the grief and evil caused to others. But he is already ready to accept death, he is calm, he has done away with earthly worries and has gone deep into himself.
Fifth stage - acceptance of one's own death (reconciliation). The person finds peace and tranquility. With the acceptance of the thought of imminent death, the patient loses interest in the environment, he is internally focused and absorbed in his thoughts, preparing for the inevitable. This stage indicates a restructuring in consciousness, a reassessment of physical and material truths for the sake of spiritual needs. The realization that death is inevitable and unavoidable for all. The methods of psychocorrection depend on the phase of experiences and the characteristics of the patient's personality, but all of them are aimed at a faster and painless achievement of the stage of reconciliation.
5. Rules of conduct with a dying patient . In a special approach that requires a doctor, a psychologist to solve very difficult psychological tasks needed by patients with incurable diseases.
1. The doctor, knowing that the patient's prospects are very sad, should inspire him with hope for recovery, or at least for a partial improvement in his condition. You should not take a rigid position, for example: "in such cases, I always inform the patient." Let the characteristics of the patient's personality determine your behavior in this situation. Determine what the patient already knows about the prognosis of his disease. Do not deprive the patient of hope and do not convince him if denial is his main defense mechanism, as long as he can receive and accept the necessary help. If the patient refuses to accept it as a result of denial of his illness, gently and gradually let him know that help is needed and will be provided to him. Reassure the patient that he will be taken care of regardless of his behavior.
2. You should spend some time with the patient after giving him information about the condition or diagnosis, after which he may experience a strong psychological shock. Encourage him to ask questions and give truthful answers.
3. It is advisable, if possible, to return to the patient a few hours after receiving information about his illness, in order to check his condition. If the patient has severe anxiety, then he should receive adequate psychological and psychopharmacological support, specialist advice. In the future, communication with a dying patient, practically devoid of meaning from a professional point of view, should not be interrupted, performing the function of psychological support for the patient. Sometimes medical workers, knowing that the patient is doomed, begin to avoid him, stop asking about his condition, make sure that he takes medication, and perform hygiene procedures. The dying person is alone. Communicating with a dying patient, it is important, without violating the usual ritual, to continue fulfilling the appointments, asking the patient about how he feels, noting every, even the most insignificant, signs of improvement in his condition, listening to the patient’s complaints, trying to facilitate his “care”, not leaving him alone with death . The fear of loneliness should be prevented and suppressed: the patient should not be left alone for a long time, carefully fulfill even the smallest of his requests, show sympathy and convince him that there is nothing to be ashamed of his fears; “Drive them inside” is useless, it’s better to speak out in front of someone.
4. It is necessary to give advice to the patient's family members regarding his illness. Encourage them to communicate with the patient more often and allow him to talk about his fears and worries. Family members will not only have to cope with the loss of a loved one, but also face the realization of the thought of their own death, which can cause anxiety. Also, relatives and other relatives of the patient should be persuaded to leave the feeling of guilt (if it is inadequate), let the patient feel his value to family and friends, empathize with him, accept his forgiveness, ensure the fulfillment of last desires, accept the “last forgiveness”.
5. The pain and suffering of the patient should be relieved. Psychotherapeutic assurances about the need for patience must have limits, and the fear that the patient may become a drug addict is cruel and pointless.
6. When a patient dies, it is necessary to create conditions that take into account the interests of the surrounding patients, who are very sensitive to manifestations of professional deformation on the part of the staff. For example, at the time of the death of a neighbor in the ward, patients asked the nurse to somehow alleviate the suffering of a dying woman who had near-death dyspnea, to which she replied: “There is no need for this, she will die anyway.”
6. Ethical issues of euthanasia.Euthanasia – it is the deprivation of life of a patient at his will, it concerns terminally ill people and implies that the deprivation of life of such patients occurs with the help of medical workers.
Distinguish between passive and active euthanasia. Passive euthanasia (also called “delayed syringe method”) is the termination of “life-prolonging medical care”, which hastens the onset of death. This method is practiced in almost all countries, including Russia. Active euthanasia (“filled syringe”) is the administration of any drugs or other drugs to a dying person, or other actions that entail a quick death. Active euthanasia has three forms: 1) "mercy killing" (the doctor injects the patient with an overdose of pain medication); 2) "suicide assisted by a doctor" (a doctor helps a sick person to commit suicide); 3) actually active euthanasia (the patient himself, without the help of a doctor, turns on a special device that leads to a painless death).
Active euthanasia is punishable by law in most countries. In Russia, euthanasia is strictly prohibited and its accomplishment is a criminal offense. This should be known and remembered by everyone starting medical activities.
Euthanasia is opposed by representatives of almost all religious denominations.
Particularly debatable is the issue of refusing intensive care measures (droppers, dialyzers, mechanical ventilation), when there is absolutely no possibility of improving the patient's quality of life and suffering or "vegetative existence" is replaced by care and attention. Official documents providing for such events exist in the West. This testament living will- will to live) and DNR tactics (do not rehabilitate!). The issue is decided by a commission consisting of lawyers, doctors, priests, and members of the public.
Opponents of euthanasia, which include many specialists, primarily doctors, believe that modern civilization goes the way of justifying suicide. They insist on a position that says that more important than an individual's right to an easy death is his right to a decent, quality life in conditions of illness. One of the ways to ensure a decent life for the hopelessly ill is to create shelters, or hospices, where specialists work to alleviate the suffering of patients without killing them. Along with medical methods (reliable pain relief, symptomatic and restorative drugs), psychological and psychotherapeutic assistance to patients is widely used. The patient's appeal to the doctor with a request to speed up the end of life should be considered as a hidden call for salvation: after all, if a person really decided to die, he will not warn anyone about this and place this exorbitant responsibility on another. This behavior most likely indicates the presence of depression. It should be remembered that depressed patients tend to end their lives even when there is no real danger to their existence. Timely treatment of depression shows that, upon leaving the state of depression, patients express gratitude to the doctors who did not allow them to realize their desire for suicide. Often, pain and somatic symptoms contribute to the onset of depression, which must be fully overcome by doctors. It has been shown that the cessation of depression also contributes to an increase defensive forces organism and correlates with longer life expectancy in terminally ill patients.
7. Organization of work of hospices. HOSPICE is a medical and social institution for the provision of palliative care. Palliative care is the provision of medical, social, psychological, legal and spiritual support to terminally ill people and their loved ones. HOSPICE gives people the opportunity and hope to live without pain, fear and loneliness, to fully use the remaining time of life.
According to WHO, about 56 million people die in the world every year. Every week, 1,000,000 people die in the world, about one in 10 people die from cancer. More than 40 million people are infected with HIV/AIDS, and a growing number of people are living with other chronic fatal diseases and conditions. 90% of patients with advanced cancer and 70% of AIDS patients suffer from pain.
In Russia, more than 300,000 patients die of cancer a year, one patient dies every two minutes. More than 80% of them need palliative care. More than 200,000 patients suffer from chronic pain syndrome.
Care for incurable cancer patients and their families in HOSPICE creates a sense of security in this group of “outcasts”. The rights of a dying person, thanks to HOSPICE, are protected: the right to freedom to live without pain, without discomfort, respect for the individual; guarantee of fulfillment of the last will; support for hope even when the goal is comfort rather than cure, respect for dignity, privacy and spiritual hope; open and sensitive communication; attention to the quality of life; attention and care for those who are left behind.
HOSPICE patients are people of any age (from children to the elderly), different social status. Patients in HOSPICE are observed from several hours to several years.
The main principle of HOSPICE is free, affordable help for everyone!
Structurally, HOSPICE consists of a mobile service and a hospital. The basis of the work of HOSPICE is an outreach service, the activity of which is based on the principle of providing the maximum possible assistance directly at home: adequate, maximally complete pain relief, relief of painful symptoms, various manipulations and procedures (bandaging, pleural punctures, laparocentesis, epicystostomy, catheterization, etc.). ), training in the rules of caring for sick relatives and many others. In the same service, socio-psychological work is carried out by a psychologist and social workers who serve mainly lonely and “abandoned” patients.
In the HOSPICE hospital, complex therapy is carried out, the effect of which is aimed at alleviating all the painful symptoms that cause suffering to the patient. About half of the patients are hospitalized for medical and social reasons (there is no one to take care of them at home, they do not admit cancer patients to boarding schools).
There are many polemical observations about the specifics of working with the dying, about the qualities that hospice doctors should have. However, some of the most important principles are:
1. Death cannot be paid.
2. Death is a natural process that should neither be rushed nor slowed down.
3. Work with the dying should be individual, without ready-made recipes tested on the “majority”.
4. The time of the dying is special, and one approaching the bed of death should never be in a hurry.
5. Service, not submission, is at the heart of working with the dying.
8. Psychology of suicidal behavior. Stages of suicidal behavior. Suicide is a purely human act. The term "suicide" was first used in written sources, according to the Oxford Dictionary, in 1651 and is of Latin origin. Suicide is defined as intentional self-harm. Suicidal behavior is a person's auto-aggressive actions, consciously and deliberately aimed at depriving himself of life due to a collision with unbearable life circumstances, for psychopathological and psychological reasons.
Depending on the presence of a fatal outcome, a completed suicide is distinguished, which ended fatally, and an incomplete, or parasuicide, which in turn is subdivided, depending on the motivation, into a true and demonstratively blackmailing suicide attempt.
A suicide attempt without a fatal outcome often does not aim to end life, but symbolizes a “cry for help”, serves as a communicative act, is an appeal to others. Parasuicide is 10 times more common than completed suicide.
According to the form of committing, there are two types of suicide:
active - direct active auto-aggression;
hidden - passive, causing harm to the subject indirectly.
For example, in patients with chronic renal failure treated with permanent hemodialysis, one can observe both active (refusal of hemodialysis) and passive (ignoring the necessary medical care, gross violation of compliance, non-compliance water regime leading to the development of complications) a form of suicide.
Also distinguished:
1.presuicide. This stage includes:
passive suicidal thoughts - abstract ideas, fantasies of suicide;
suicidal ideation - contemplating a suicide plan;
suicidal intentions - joining the volitional component, preparing for suicide.
2. Suicidal act.
3.Post-suicidal period. The following types are distinguished:
critical, manipulative, analytical, suicidal-fixed type.
To common features suicidal behavior include:
goals - finding a solution;
tasks - cessation of consciousness;
stimulus - unbearable mental pain;
emotions - helplessness, hopelessness;
attitudes towards suicide - ambivalence;
mental states - narrowing of the cognitive sphere;
communicative action - a message about your intention.
The behavioral expression of suicide is an unexpected, dramatic and inexplicable change in behavior, the so-called "terminal behavior". At the same time, the individual puts his affairs in order, distributes his property, often declares his sadness and despair.
The probability of committing suicide is determined by the ratio of three factors:
1. the intensity of suicidal impulses, for example, associated with the depth of depressive experiences;
2. anti-suicidal barrier - a psychological factor due to individual circumstances, for example, the need to complete a life's work, caring for an animal, having children or close friends;
3. influences that weaken the anti-suicidal barrier, such as loneliness, job loss, iatrogenic influences.
The post-suicidal state includes:
Middle post-suicide - the first week;
Early post-suicide - up to 1 month after a suicide attempt;
Late post-suicide - up to 5 months.
Socio-demographic aspects of suicide. According to researchers, suicide rates vary from country to country. Russia, Hungary, Germany, Austria, Denmark, China and Japan have very high level suicides: annually more than 20 people per 100 thousand of the population; on the other hand, Egypt, Mexico, Greece and Spain have a relatively low rate of less than 5 per 100,000. The United States and Canada occupy a middle position: in both countries this level is 12 people per 100 thousand of the population, in England it is about 9 people per 100 thousand.
Suicide rates for men and women also differ. Women are 3 times more likely than men to attempt suicide, yet the number of deaths in men (19 per 100 thousand) is three times higher than in women (5 per 100 thousand). The difference between these indicators lies in the methods used when committing suicide. In the United States, suicides with firearms account for almost 2/3 of the total number of suicides committed by men, while in women the share of similar suicides is 40%.
Marital status also influences suicidal tendencies. Married people, especially those with children, have the lowest suicide rate, single and widowed people have slightly higher suicide rates, and divorced people have the highest suicide rate.
In considering the relationship between religion and suicide, studies conducted in this direction, suggest that suicide prevention is influenced not so much by formal affiliation to any religious denomination as by individual piety. Very devout people, regardless of their religion, are less likely to commit suicide. It seems that those people who are more reverent about the "miracle" of life are less likely to consider suicide or actually resort to self-destruction.
Concepts of suicide. psychodynamic point of view. Many theorists of the psychodynamic direction believe that suicide occurs due to depression and anger towards others, which a person directs at himself. This theory was first proposed by Wilhelm Stekel at a meeting in Vienna in 1910, when he stated that "he who wants to kill another person, or at least wants the death of another person, kills himself."
Freud and Abraham (1917) suggested that when people experience a real or symbolic loss of a loved one, they unconsciously incorporate that person into their own identity and feel for themselves what they felt for another person. For a short time, negative feelings towards a lost loved one are experienced as self-hatred. Anger towards a loved one can turn into intense anger towards oneself and finally develop into a major depression. Suicide is the ultimate expression of this self-hatred.
Sociological research data are consistent with this explanation of suicide. It has been found that the suicide rate in a nation drops during periods of war, when, one might explain, people are encouraged to direct the energy of self-destruction against the "enemy". Also, in a society with a high homicide rate, the suicide rate is quite low, and vice versa.
However, while hostility is an important part of suicide according to this theory, some researchers find that other emotional states are more common than anger.
Sociocultural point of view. AT late XIX century sociologist Emile Durkheim developed general theory suicidal behavior, according to which the likelihood of suicide is determined by how attached a person is to social groups such as family, religious institutions and society. The stronger the person's ties to these groups, the lower the likelihood of suicide. Durkheim defined several categories of suicide:
selfish suicide suicide, which is committed by people who are not at all or almost controlled by society, people who do not care about social rules or norms. How more number such people living in society, the higher the suicide rate;
altruistic suicide - suicide, which is committed by people who deliberately sacrifice their lives for the public good (soldiers who threw themselves on grenades to save others);
anomie suicide- suicide committed by people whose social environment does not provide them with stability and does not form in them a sense of belonging.
biological point of view. Researchers studying parenting have found higher rates of suicide among parents and close relatives of suicides than in families whose members did not attempt suicide. Based on such data, the researchers suggested that genetic, and therefore biological, factors are at work in these cases.
Assistance to suicides and prevention of suicides. Therapy for people with suicidal tendencies falls into two broad categories: post-suicide therapy and suicide prevention.
The goal of post-suicide therapy is to support people, help them reach a non-suicidal state of consciousness, and show them more effective methods fight stress. In doing so, apply different types therapies, including medication, psychodynamic, cognitive, group and family therapy.
Also, after a suicide attempt, most victims require long-term and serious treatment for associated serious injuries. Psychotherapy and the use of drugs should be started after the correction of physical health. The patient may stay in the hospital for the duration of treatment, or live at home and only come to the hospital for therapy.
In 1955, the first suicide prevention program was launched in Los Angeles in the USA, which found wide support and application in many countries of the world. Currently, these programs offer crisis intervention: they try to help suicidal people assess their situation more objectively, teach them to make smarter decisions, act constructively, and work through their crisis. The centers hosting these programs provide information about their hotlines and always accept those who come without an appointment.
Key steps in a suicide prevention program:
Establish a positive relationship between the contact person and the consultant;
Understand the nature of this crisis state and then help the person to understand it just as clearly and constructively;
Assess the person's potential for suicide: determine the degree of stress, relevant personality characteristics, how detailed the suicide plan is, the severity of the symptoms, and the caller's coping options;
Assessment and mobilization of the caller's capabilities (his strengths, help from relatives and friends);
Formulation of the plan (development of a joint way out of the crisis, an alternative to the act of suicide).
If callers are already committing suicide during the phone call, the counselor is faced with the task of locating and providing emergency medical assistance.
USED BOOKS:
1. Asmolov A.G., Marilova T.V. The role of changing the social position in the restructuring of the motivational and semantic sphere in cancer patients // Journal of Neurology and Psychiatry. S.S.Korsakov. 1985. No. 12. S. 1846-1851.
2. Zeigarnik B.V., Bratus B.S. Essays on the psychology of abnormal personality development. M.: Publishing House of Moscow. un-ta, 1980. 160s.
3. Kvasenko A.V., Zubarev Yu.G. Psychology of the patient. L .: Medicine, 1980. S. 1 - 180.
4. Clinical psychology/ Ed. M. Perret, W. Baumann. - 2nd ed. - St. Petersburg: Peter, 2003. - 1312 p.
5. Clinical psychology: Textbook / Ed. B.D. Karvasarsky. - St. Petersburg: Peter, 2002. - 960 p.
6. Psychology of health / Ed. G.S. Nikiforova. - St. Petersburg: Peter. 2003. - 607 p.
7. Reikovsky Ya. Experimental psychology of emotions. M.: Progress, 1979. S.ZO 1-352.
8. Hardy I. Doctor, sister, patient. Psychology of work with the patient. / Ed. M.V. Korkina. - Publishing House of the Hungarian Academy of Sciences. Budapest, 1981. - 286 p.
The role of experiences in crisis and extreme situations
The overall goal of the work of experiencing is to increase the meaningfulness of life, “re-creation”, reconstruction by a person of his own image of the world, which allows rethinking a new life situation and ensuring the construction of a new version. life path to ensure the further development of the individual.
Experience is a kind of restorative work that allows you to overcome the inner gap of life, helps to gain the psychological opportunity to live, this is also a “rebirth” (from pain, from insensibility, from a state of hopelessness, meaninglessness, despair). The psychological content of the recovery process and the main task psychological help is the reconstruction of the subjective image of the world of the individual (first of all, re-identification, the creation of a new image of the Self, the acceptance of being and oneself in it).
It should be noted that although the experience can also be realized by external actions (often of a ritual and symbolic nature, for example, rereading the letters of a deceased loved one, erecting a monument on his grave, etc.), the main changes occur primarily in the mind of a person, in his inner space(mourning, revision of life and awareness of the contribution of the deceased to his life, etc.) (N.G. Osukhova, 2005).
Thus, it can be argued that a person resorts to experiencing (experiencing becomes the leading and most productive strategy for a person) in special life situations that are unsolvable by the processes of subject-practical and cognitive activity when transformations in the outside world are impossible, in situations that cannot be overcome and from which a person cannot escape. Mourning is a natural process, and in most cases a person experiences it without professional help. Due to the relative frequency of experiencing the crisis of loss and insufficient knowledge of the stages of its experience by people, it is violations during this crisis that are the most frequent reason for seeking psychological help.
Grief symptom complexes :
Emotional complex - sadness, depression, anger, irritability, anxiety, helplessness, guilt, indifference;
Cognitive complex - deterioration in concentration, intrusive thoughts, disbelief, illusions;
Behavioral complex - sleep disturbances, meaningless behavior, avoidance of things and places associated with loss, fetishism, hyperactivity, withdrawal from social contacts, loss of interests;
Complexes of physical sensations, weight loss or gain, alcoholism as a search for comfort are possible (E.I. Krukovich, 2004).
The normal process of mourning sometimes develops into a chronic crisis called pathological mourning. Grieving becomes pathological when the "work of mourning" is unsuccessful or incomplete. Painful grief reactions are distortions of normal grief. Transforming into normal reactions, they find their resolution.
I will briefly present the manifestations of the dynamics of experiencing loss (grief) in a schematic form (6 stages).
Features of the dynamics of experiences in case of loss (loss)
Loss Crisis Stage 1: Shock - Numbness
Typical manifestations of grief:
Feeling of the unreality of what is happening, mental numbness, insensitivity, stunnedness: "as if it were happening in a movie." The speech is inexpressive, low intonation. Muscle weakness, slow reactions, complete detachment from what is happening. The state of insensibility lasts from a few seconds to several days, on average - nine days
:
"Anesthesia of feelings": the inability to emotionally respond to what happened for a long period of time - more than two weeks from the moment of loss
Loss Crisis Stage 2: Denial
"It's not happening to me", "It can't be!" The person cannot accept what is happening.
Atypical signs of grief (pathological symptoms):
Loss denial lasts more than one to two months from the date of loss
3 Stage of the crisis of loss: Acute experiences
(acute grief phase)
This is the period of greatest suffering, acute mental pain, the most difficult period. Many difficult, sometimes strange and frightening thoughts and feelings. Feelings of emptiness and meaninglessness, despair, a sense of abandonment, anger, guilt, fear and anxiety, helplessness, irritability, a desire to retire. Grief work becomes the leading activity. Creating an image of memory, an image of the past is the main content of the “work of grief.” The main experience is a feeling of guilt. Severe impairment of memory for current events. A person is ready to cry at any moment.
Atypical signs of grief (pathological symptoms):
Prolonged intense experience of grief (several years).
The appearance of psychosomatic diseases, such as ulcerative colitis, rheumatoid arthritis, asthma.
Suicidal intent, suicide planning, suicide talk
Violent hostility directed against specific people, often accompanied by threats.
4 Stage of the crisis of loss: Sadness - depression
Typical manifestations of grief:
Depressed mood, there is an "emotional farewell" to the lost, mourning, mourning.
Deep depression, accompanied by insomnia, feelings of worthlessness, tension, self-flagellation.
5 Stage of loss crisis: Reconciliation
Typical manifestations of grief:
Physiological functions and professional activity are restored. A person gradually comes to terms with the fact of loss, accepts it. The pain becomes more tolerable, the person gradually returns to his former life. Gradually, more and more memories appear, freed from pain, guilt, resentment. A person gets the opportunity to escape from the past and turns to the future - begins to plan his life without loss.
Atypical signs of grief (pathological symptoms):
Overactivity: Abrupt withdrawal into work or other activities. Sudden and radical change in lifestyle.
Change in attitude towards friends and relatives, progressive self-isolation.
6 Bereavement Crisis Stage: Adaptation
Typical manifestations of grief:
Life is getting back on track, sleep, appetite, daily activities are restored. Loss gradually enters into life. A person, remembering the lost, no longer experiences grief, but sadness. There is a realization that there is no need to fill the pain of loss all your life. New meanings appear.
Atypical signs of grief (pathological symptoms):
Persistent lack of initiative or motivation; immobility.
Helping a bereaved person in most cases does not involve professional intervention. It is enough to inform relatives how to behave with him, what mistakes not to make.
Although loss is an integral part of life, bereavement threatens personal boundaries and can shatter illusions of control and security. Therefore, the process of experiencing grief can be transformed into a disease: a person, as it were, “gets stuck” at a certain stage of grief.
Most often, such stops occur at the stage of acute grief. A person, feeling fear of intense experiences that seem uncontrollable and endless to him, does not believe in his ability to overcome them and tries to avoid experiences, thereby disrupting the work of grief, and the crisis deepens.
In order for painful reactions of grief, being distortions of normal grief, to transform into normal reactions and find their resolution, a person needs knowledge about the stages of experiencing grief, about the importance of emotional response, about ways of expressing experiences.
This is where a psychologist can help: to determine where a person has stalled in his experiences, to help find internal resources to cope with grief, to accompany a person in his experiences.
To date, there are no theories of grief (loss, loss) in official psychology that fully and adequately explain how people cope with losses, why they experience grief in different ways, how and after what time they adapt to life without dead people significant to them. ..
Unfortunately (or fortunately), we live in a world where nothing is permanent, everything is temporary, including ourselves. And sooner or later, every person is faced with the death of loved ones: parents, relatives, friends, spouse, sometimes even their own child. For every person, the loss of a loved one is a great grief. Until recently, he was somewhere nearby, saying something, doing something, smiling. And now he's gone. And you have to live with it somehow.
To date, there are no theories of grief (loss, loss) in official psychology that fully and adequately explain how people cope with losses, why they experience grief in different ways, how and after what time they adapt to life without dead people significant to them.
Why in one person the reaction to the death of a loved one can manifest itself as numbness, “petrification”, in another - crying, anxiety, in the third - pathological guilt, and some can endure the blows of fate without experiencing pathological manifestations?
In the classification of grief reactions, different researchers identify from 3 to 12 stages, which a person experiencing loss must consistently go through. The main difficulty of these classifications is that:
they are different;
there are no clear boundaries between the stages;
the state of a person changes, and he can return to a seemingly passed stage;
at different people the severity of symptoms and experiences varies significantly.
In this regard, the concept of J. Vorden has recently become widespread, who proposed a variant of describing the reaction of loss not in stages or phases, but through four tasks that must be completed by the mourner in the normal course of the process.
Let's briefly list them. The first task is the recognition of the fact of loss. The second task is to get over the pain of loss. This means that you need to go through all the complex feelings that accompany the loss. The third task is the organization of the environment where the absence of the deceased is felt. The last, fourth, task is to build a new attitude towards the deceased and continue to live. At each of these stages, there may be deviations. Why precisely these deviations and precisely in this person, Vorden's concept does not reveal.
"All people are different"
The common phrase that all people are different does not explain anything and at the same time explains everything. The system-vector psychology of Yuri Burlan shows exactly which are different. Its provisions not only explain the difference in reactions to the death of a loved one, but also help to survive the pain of loss.
According to system-vector psychology, innate unconscious desires live in each person, given by his species role, which are called one of eight vectors (in a modern person, there are an average of three to five). The reaction to the pain of loss, to the death of a loved one depends on the innate set of vectors, the degree of their development and implementation.
For people with death - a natural continuation of life: "we came from the earth, we will leave for the earth." For them, death is not a tragedy, but a return home. Therefore, they prepare calmly and in advance for leaving for the other world: a place in the cemetery, a coffin, clothes. The main thing is that everything should be like people have. And their feelings about the death of their loved ones are simple and natural: "God gave, God took." This is not to say that they do not experience a sense of loss. Experiencing. But these feelings are not the end of the world, but part of life.
Man with directed to the future. Therefore, experiencing a loss, he can violently express his grief, but all the same, his powerful energy will lead him forward, into new plans, into new projects, into new relationships. These people are brave to the point of selflessness, therefore they are not afraid of their own death and are ready to give their lives for the sake of others.
The specific role of carriers is the extraction and preservation of food reserves. Therefore, no matter how blasphemous it may sound, for them material resources are more valuable than human ones. “Strongly endures the loss of loved ones” - this is how the reaction of a skin person can be characterized.
The most vulnerable of the carriers of the lower vectors can be called representatives. They are concentrated on the past, they attach great importance to the first experience, by their properties they are very attached to their family. When receiving bad news, such a person may even get a heart attack. It is he who often falls into a stupor, a stupor, from which it is difficult to get him out.
Also, it is precisely for the representatives of the anal vector that a pathological feeling of guilt towards the deceased is characteristic, experiencing which, they perceive for themselves any joy as something unacceptable and shameful. For example, a woman a year after the death of her husband does not want to go south on vacation, explaining this by saying that “how can I go, because he is lying there, but am I going to rest?” And the arguments that her husband will not be worse if she rests are not taken into account.
As already mentioned, a modern person is multi-vector, so the properties of the upper vectors (responsible for intelligence) are superimposed on the reaction of the lower vectors.
The olfactory and oral vectors are outside the culture, so their influence on a person's perception of loss cannot be called pathological.
For the representative, the body is only a mortal shell of the eternal soul. A sound engineer feels the finiteness of life better than others. But life as such is not its value. His interest is directed to the root causes, it often seems to him that what he is looking for is hidden just beyond the brink of the material world. In a state of depression, not seeing the meaning of life, he himself thinks about his own death. Therefore, in the experiences of the sound engineer, one can hear not so much regret about leaving, as a philosophical attitude to life and death. If the sound engineer is depressed, it is always a search for one's own meaning in life, although it may look like a reaction to the death of a loved one.
And, finally, people for whom death is the MOST TERRIBLE THING CAN HAPPEN are carriers. They are the ones who experience loss the most. It is they who most often have symptoms of the so-called complicated grief, with which they turn to psychologists and psychotherapists.
Emotional breakdowns, constant mental anguish, sleep and appetite disturbances, helplessness, inability not only to work, but even to think about something else. Often they can feel the symptoms of diseases that the deceased loved one had. Various fears may appear.
"Don't let me die while I'm alive"
For people with a visual vector, life is the highest value. It was they who managed to instill in all mankind the value of life, to introduce cultural restrictions into society. Unlike others, spectators are not able to take life in any form - they cannot even crush a spider. And the death of a loved one brings them back to their root state of fear of death.
Fear of death - "native" fear in the visual vector. In no other vector does this fear manifest itself so clearly and does not cause the most severe deviations, up to panic attacks and psychosomatic illnesses. In order to get rid of the burden of the fear of death, the viewers unconsciously learned (and taught us) to bring their fear outward - to tune in to the experiences of other people, build emotional connections, be afraid not for themselves, but for the other, that is, to sympathize, empathize, LOVE, thereby filling their own naturally huge emotional potential. In this case, there is simply no psychic energy left in them to experience fears.
The meaning of life of a developed visual person is love. A person with a visual vector can build an emotional connection with anyone or anything: with a flower, with a plush hare, with a cat, with a horse. The highest level of emotional connection is with a person. The death of a loved one is a break in an emotional connection, the worst thing that can happen to a viewer. When a significant emotional connection breaks, the viewer falls into fear, his emotions change direction - from others to themselves ...
Subconsciously, it is always a meeting with one's own death. That is why it is most difficult for such a person to cope with the pain of loss. To cope with the fear of one's own death means again to "lose one's temper" and bring one's fear outward through sympathy and empathy for the OTHERS. And then the soul-devastating longing for the deceased loved one can turn into quiet sadness and bright sadness.
At the training "Systemic Vector Psychology" by Yuri Burlan, all fears and problems associated with emotional loss or death are worked out, restoring a person's ability to live and feel joy.
“It was very difficult for me to survive grief - the loss of a loved one. Fear of death, phobias, panic attacks did not let me live. I contacted the experts - to no avail. At the very first lesson at the training on the visual vector, I immediately felt relief and understanding of what was happening to me. Love and gratitude - this is what I felt instead of the horror that was before. The training gave me a new attitude. This is a completely different quality of life, a new quality of relationships, new sensations and feelings - POSITIVE!... "
The “work of grief” is completed when the bereaved are once again able to lead a normal life, have an interest in life and people, learn new roles, create new environments, bond and love. Because life goes on...
Proofreader: Natalia Konovalova
The article was written based on the materials of the training " System-Vector Psychology»Grief reactions.
Stages of grief.
Tactics of medical personnel with patients in a state of grief.
Death and dying.
Stages of approach to death.
Psychological features of incurable patients, changes in the psyche.
Rules of conduct with the dying patient and his relatives.
The themes of death, dying and afterlife are extremely relevant for each of the living. This is true if only because sooner or later all of us will have to leave this world and go beyond the limits of earthly existence.
Elisabeth Kübler-Ross was one of the first to trace the path of the dying from the moment they learned of their near end to the moment they breathed their last.
Approaching death
Life leaves the earthly shell, in which it has been for many years, gradually, in several stages.
I. Social death.
It is characterized by the need of the dying person to isolate himself from society, to withdraw into himself and move further and further away from living people.
II. Psychic death.
Corresponds to the person's awareness of the obvious end.
III. Brain death means the complete cessation of the activity of the brain and its control over various functions of the body.
IV. Physiological death corresponds to the extinction of the last functions of the organism, which ensured the activity of its vital organs.
Death and subsequent cell death do not mean, however, that all processes in the body stop. At the atomic level, they continue their endless dizzying run elementary particles driven by an energy that has existed since the beginning of all time. "Nothing is created anew and nothing disappears forever, everything is only transformed...".
Emotional stages of grief
Often there is an incurable patient in the department. A person who has learned that he is hopelessly ill, that medicine is powerless and he will die, experiences various
psychological reactions, the so-called emotional stages of grief. It is very important to recognize what stage a person is in this moment to provide him with appropriate assistance.
Stage 1 is denial.
Words: "No, not me!" - the most common and normal reaction of a person to the announcement of a fatal diagnosis. For a number of patients, the stage of denial is shock and protective. They have a conflict between the desire to know the truth and avoid anxiety. Depending on how much a person is able to take control of events and how much support others provide him, he overcomes this stage easier or harder.
2nd stage - aggression, anger.
As soon as the patient realizes the reality of what is happening, his denial is replaced by anger. “Why me?” - the patient is irritable, demanding, his anger is often transferred to the family or medical staff.
It is important that the dying person has the opportunity to express his feelings.
3rd stage - bargaining, request for a delay
The patient tries to make a deal with himself or others, enters into negotiations for the extension of his life, promising, for example, to be an obedient patient or an exemplary believer.
These three phases constitute a period of crisis and develop in the order described or with frequent reversals. When the meaning of the disease is fully realized, the stage of depression sets in.
4th stage - depression.
Signs of depression are:
Constantly bad mood;
Loss of interest in the environment;
Feelings of guilt and inadequacy;
Hopelessness and despair;
Suicide attempts or persistent suicidal thoughts.
The patient withdraws into himself and often feels the need to cry at the thought of those whom he is forced to leave. He doesn't ask any more questions.
5th stage - acceptance of death.
The emotional and psychological state of the patient at the stage of acceptance undergoes fundamental changes. Man prepares himself for death and accepts it as a fact. He, as a rule, humbly waits for his end. At this stage, intensive spiritual work takes place: repentance, evaluation of one's life and the measure of good and evil by which one can evaluate one's lived life. The patient begins to experience a state of peace and tranquility.
