Читать книгу Male’s Health in the Objective of Stressology – Beyond the Usual - Армен Мурадян - Страница 6

In medicine it is accepted to speak about individual approach to a patient but behind this concept there is no content that a beginner doctor could learn. Individual has evolved from specimen (biological being) to individual and then to the upper stage of evolution – personality. Carl Rogers was the first who disclosed the difference between the concepts “personality” and “person” – individual. The concept “individual” refers to a carrier of physiological peculiarities of Homo sapiens as a rational being endowed with consciousness and will in whom psychic and biological constitute a single unit and individual actualization – for myself – prevails. For the purposes of medicine, we shall accept the following definition of “personality”: personality is a human who climbed the top step of evolution and has become a social person. His actualization already lies mainly in the sphere of society, in his relationships with other people at all levels of his activity. As the core of the personality appear relations between people in any social medium, for the benefit of which he consciously positively thinks and acts. Individual as an object of doctor’s professional activity is the product of several complex variables, each being complex by itself. These variables are:

• biological component – the body;

• mental component – human psyche;

• social component – the environment.

Each component changes depending on the temporal factor and external effects retaining at that its specific features, its basic function, its mechanisms for realization of existing capabilities and its range of improvement and development.

Example: consider the human organism, his body. It has relatively rigid boundaries and limits of variation. But if we recall bodybuilding, abilities developed by the person practicing yoga, it becomes clear that it is within a person’s power to change also his body despite its biological boundaries. Each variable has a tendency to change and to develop as it is built in the informational combination of bio-psycho-social reflection of the reality.

Human has acquired a huge resource of variability and evolution at the expense of consciousness and will. To date there is no uniform concept of human. We will adhere to a concept that treats human as a developing conscious volitional trinity in both phylo-and ontogenesis. Actualization as a psychological phenomenon manifests itself in realization of possibilities and capabilities ensuring personal growth, self-perfection and self-respect that comprise the main purpose of life for a male. Actualization in contrast to the tendency towards equilibrium (homeostasis) is often due not to a decrease but to an increase in strain. Being optimally actualized, such a person lives a full and bright life every new moment of it. He personally chooses his way of life, as a source of information uses his perceptions, feelings and thoughts rather than other people’s advice. Having made his choice, he is responsible for the consequences of the choice and never blames others but himself. Such people make up the fully functioning human formation that “adjusts life of humanity on the earth”. It is mainly male formation at the age of 35–60.

Today we can speak of a new trend in health care, the trend of studying the role of psyche and brain in human health and illness.

In regulations, programs, and in general it has become popular to talk not only about the bodily but also about the mental health. Behind the facade of popular terms, there is no common understanding of “what the mental health is”. Often, the activity of reforms is reduced to the replacement of just a name, for example, “Center for Mental Health” instead of “Psychiatric Hospital”. As a result the accumulated problems of mental health are not solved, but on the contrary become veiled and deeper, not removing stigma, not improving the state of patients with mental problems, moreover not improving their health. The problem of health and illness, norm and pathology is complicated; their boundaries are relative and depend on many factors and reasons. This is the consequence of the complexity of the very object of study – psyche, its characteristics and properties, criteria to be guided to determine “mental health”.

Study of the population of practically healthy people showed that about 50 % of adults had one or more symptoms of mental register manifested in the form of anxiety, irritability, constant strain, alarm, chronic fatigue, asthenia, insomnia, bad mood. The majority of these people did not apply to a specialist: 71 % – did not undertake whatsoever, 1 % – shared their fears with friends or relatives and only 17 % applied to a doctor. Early symptoms are not well pronounced because more frequently they are connected with deadaptation, functional by their nature and do not much worry a person, his environment and doctors. This is the first level of change in mental health, which should be the object of great attention of primary care doctors. Being in the very focus of attention, these states when timely diagnosed and correctly handled, are reversible.

The following characteristics are distinguished in mental health:

• the field of mental health;

• boundaries of mental health;

• quality of human life.

The field of mental health implies the sphere and range of person’s activity in which individual is adapted. It is enlarged or narrowed depending on the society’s requirements, in other words, the field of mental health due to the specificity of psyche and its laws does not have unique determination. Therefore it is important to specify the concept “Mental health” and define its levels. The boundaries of mental health are the “limits” of acceptable behavior in the society. The boundaries of mental health were historically correlated with the ruling basic vision of religion, philosophy, politics. Today the term “Quality of life” is widely used. It is characterized by valuation standards adopted by the person for himself. Each person has his own life model that meets his and accepted by the society standards. One is quite satisfied with his domestic needs, interests – to be pleased with life or to consider that he lives full-value life. For the other one it is important to have everything that symbolizes prosperity accepted in the given society. The other seeks to know the world and himself; somebody else lives in the world of illusions. Therefore, the life quality has flexible standards for different people, different societies, different ages and generations. Based on the standards of living before and after illness, personal field of mental health is outlined. Mental health and its disorders can be presented by several levels, definition of which is based on the priority and degree of involvement of brain matter, psyche or personality in the process.

The lower fundamental level – the level of psycho-physiology is determined by peculiarities of the internal cerebral neurophysiological organization of psychic activity. The necessary condition for healthy psyche is safety of the brain as the organ, normal functioning of all blocks (human perception of senses, thinking, memory, emotions, mentality). This level is found in any organic brain diseases (tumors, stroke, atherosclerosis, trauma).

The second level of mental health disorders is the adaptation level. Disorders of this level are the largest and diverse group and make the layer that is to be regarded as true disorders of mental health. Disorders of this level are described as borderline states, anxiety disorders, post-stress disorders, psychosomatic, neurotic. They reflect temporary reduction of human ability to self-actualize, adapt, decrease stress resistance, social competence, purposeful activity. Human character traits are inevitably sharpened and manifested in the activity. The whole “psychic discomfort” is accompanied with somatic troubles (dynamic arterial hypertension, pain syndromes – more often in back, headaches, insomnia, itch, lack of air, vegetovascular dystonia, enteric manifestations, etc.).

The third, highest level is the level of personal mental health, which is determined by the quality of human semantic relations, hierarchy of his sense orientations to the world, himself and his place in it. Personally mentally healthy person is the one who is able to accept the reality as it is (illness, loss); able to overcome traumas of the past, and remembering them able to search for his new true place in the life and in the world. The one, who is able to reassess values, be aware of their unique vital meaning, to overcome himself and external obstacles while realizing new meanings and values.

Personal health is a result of sometimes painful search for new himself. History knows many names of famous persons who had this or that mental illness that did not prevent them to adapt socially, realize their purposes and live full, rich life. Remember Caesar’s, Napoleon’s, Dostoevsky’s epilepsy; Darwin’s psychasthenia; Freud’s and Zoschenko’s depressions. People having certain mental disorders, and even diseases, not to mention bodily problems, somatic diseases, can be personality healthy. Often there are people with certain health problems but in the personality aspect, they prove to be healthier than any other one who, according to WHO definition, has “Absolute health”. The human in his body image is one with spiritual and mental “I”. Therefore violation in any sphere necessarily entails violations in others that are frequently of compensatory or protective nature, e.g. rise of temperature due to infection. In medicine clarification of the primary and secondary role of the factor in cause-and-effect relations is the basis for the adequate therapeutic approach and favorable outcome, hence is the presence of the etiopathogenetic and symptomatic treatment. Often it is difficult to determine the precise feature based on which it is possible to talk about mental illness. So any doctor must have at least minimum knowledge in the field of psychology, its laws, their standard functioning; know regularities of transition states manifested by deadaptation situations, mechanisms of psychological protection. All these issues are successfully solved by a new direction in medicine – stressology. “Mental health” should be understood as the state of person able to correctly (adequately) reflect the outside world, set a goal, plan and fulfill adopted decisions, enjoy lively and adequate emotions, able to overcome conflicts, tension and preserve a certain degree of stress resistance. Mentally healthy person has enough secure instinct of self-preservation of bodily, mental and social “I”.

There are three types of social impacts affecting the state of health.

The first type is historical influence that affects the whole generation. Thus, men whose early childhood fell on the years of the “Great Depression” in the United States throughout their lives showed the difficulties of social adaptation. The whole generation of the former USSR who experienced the “37^th year” revealed difficulties of adaptation; the males of Armenia whose childhood and youth concurred with crisis years of the end of XX – beginning of XXI century are still experiencing adaptation difficulties.

The second type – is the so-called “standard events” – life stresses occurring within the regular life flow: entering higher educational institution, moving, marriage, birth of children, retirement. Such factors can go unnoticed, but can become pathogenic, stressful.

The third type is “non-standard events” – disease, psychic trauma, criminal prosecution, participation in combat operations. All these factors as a rule injure a person and can result in one of the versions of post-stress disorders.

The afore-mentioned factors that affect mental health are objective. But mental health of modern males is affected by much more subjective factors, such as “self-concept” and “self-control” or the ability to govern himself. People do not often ask themselves who they really are. Each considers his personal definition so natural that he cannot imagine to what extent everything he does (consciously and sometimes unconsciously) or how he percepts himself is conditioned by the conception that he created about himself.

On the example of some literary heroes, it is easier to understand what is being discussed. The Chekhov’s story “The Death of a Clerk” is about a poor clerk who accidentally sneezed in the theater on the bald head of the General sitting in front. Having apologized, he could not help thinking about that “shameful” fact and his whole life turned into sheer misery, which led him to death. Among the novels of Cervantes there is a story about the man who was sure that was made of glass. When somebody approached him he began to scream and pleaded to keep away so that not to break him by chance. He walked along the very middle of the street with fear looking at the roofs scared if a tile would suddenly tear off and fall on him. Once when a wasp sat on his neck, he did not dare either to hit or shake it off out of fear that he would break himself. He refused to have anything tough like meat or fish and going to bed wrapped in straw.

It is artistically exaggerated but a vivid example of the role of self-appraisal and “self-concept” in life, person’s behavior and activity. Mentally healthy people as a rule perceive themselves positively. They are able to aware and acknowledge their shortcomings, identify themselves, perceive their individuality. In their minds there is a temporary succession in the form of memories of the past, awareness of the present moment and look to the future. And they are able to overcome even seemingly impossible.

The brightest illustration to our narration about man as a volitional conscious and self-directed person can be the biography of the outstanding Austrian philosopher and psychologist Viktor Frankl. He appeared in a concentration camp almost of his own free will. Frankl, as a successful doctor-psychotherapist, could take an advantage of his American visa. But he remained in the Nazi Austria together with his parents and brother who did not have such a visa. As a result they all ended up in a concentration camp.

The Dachau Concentration Camp.

One day, Frankl completely exhausted walked through the snow, not feeling frozen legs and thought that that was the real end to everything. And then he, barely alive, created a situation in the head that clarified the meaning of all his previous and present sufferings: as if fellow-psychologists entrusted him with the task to conduct participant observation of the psychology of people in the concentration camp! And when this horror is over, he will report on this theme at the World Congress of Psychologists in a black suit and bow tie. And when he imagined this, he had strength to live on against all the odds. He survived and after the concentration camp he lived for more than fifty years, having become a truly world-famous psychologist and philosopher. And his book about the life in a concentration camp was declared by the USA Congress Library one of 10 books that had the greatest impact on Americans.

It is a vivid example of how a person, changing his view on “here and now”, looking at the situation from the other side, mentally constructing a new “psychic reality” is able to survive even in the hell. Perhaps more than once on the pages of this book we will repeat Frankl’s words “If there is something to live for, one can bear any how”. Often it is really impossible to change and leave the psychotraumatic situation, and then the only way is to create a favorable situation in your thoughts; to design a situation in which what is happening would have some meaning, at least the meaning of sacrifice “for someone, for something; to attach meaning to what is happening”.

The second important condition for mental health is the ability to control oneself – self-control. That is to control your thoughts, feelings and actions, not to yield to the power of your drives, desires or emotions, to keep them within the socially acceptable limits, to resist the pressure of others, to be able to establish and maintain relationships with surrounding people, to hold back angers, postpone funs if necessary. A common source of self-control violation is excessive excitement and strain, fatigue. Some people when experiencing violent anger, fright or enthusiasm have spasms, foam on the lips, involuntary urination, sometimes defecation. With the loss of self-control the memory does not fix person’s behavior and state, everything happens at an unconscious level, and therefore, a person does not remember what he did, when was “outraged”. Decline of self-control often occurs in conditions of collective excitation – in the crowd, in a riot, in mass panic. Strong emotional reactions remove self-control and increase person’s suggestibility. In a person who is not able to cope with internal strain, it can erupt like a volcano in the form of aggressive impulsive action. In a crowd people are so absorbed in each other and the object of hate that they lose personal identity and commit acts of unnatural inner “self” that later becomes a source of internal stress.

When determining mental health in each specific case, it is necessary to take into account peculiarities of ethnic culture, existing customs, religious orientation, behavior patterns of the society, age, situation. “You can diagnose a broken leg not knowing the patient’s cultural background, but to call the Indian boy psychopath because he says that has visions in which believes is a great risk. In a peculiar Indian culture the ability to experience visions and hallucinations is considered as a special gift, blessings of spirits and the ability to summon them is deliberately stimulated as something attaching prestige to their owner” (I. Kon).

Ignorance of the language and linguistic characteristics can lead to various incorrect diagnostic conclusions. Thus, after the Spitak earthquake the majority of those who experienced first hours and days in Leninakan were in the state of psychogenic trance, emotional shock. Later telling about themselves, they noted with surprise that had felt nothing. They were looking for an explanation for this in the fact that possibly helicopters scattered some powders so that they should not have gone mad. In the scientific publications of visiting specialists this was regarded as mass psychosis with hallucinations.

In modern person intrapersonal conflicts play a great, if not a leading role: discontent with a wife, work, chosen specialty, place of residence and so on. This discontent often becomes a source of irritation, strain, hot temper, bad mood. Frequently it is a subjective evaluation of reality, personality nature of intrapersonal conflict. In this case there is a great probability of its chronicity resulting in one of versions of deadaptation disorder of mental health. To live in harmony with yourself is the main criterion for providing mental health.

LIVE IN CONSENT WITH YOURSELF IS A STATE, PROVIDING NOT ONLY MENTAL AND PHYSICAL HEALTH, BUT ALSO A FEELING OF FULL VALUE

OF LIFE AND ITS SENSE

Ada Tadevosyan at Noravank, 2015.