PERSUASIVE STATES (synonym obsessions) — thoughts, memoirs, doubts, fears, inclinations, the actions, the movements arising independently and contrary to desire of the patient it is besides insuperable, and differing in constancy. Patients treat them critically, understand their painful character and senselessness, but cannot be exempted from them.
A clinical picture
Persuasive fears, or phobias, meet especially often and besides in the most various forkhma. Sometimes they become so strong that the critical attitude towards them for a short time is completely lost from the patient. The quantity of various phobias is so high that it is impossible to give their full list. The following belongs to the most widespread.
An agoraphobia — fear of open space. The patient has sensation of fear before big spaces, e.g. the areas, streets, it is necessary to pass-rye to it. Such patient leaves the house only accompanied by other person.
Aykhmofobiya, pl oksifobpya — fear of sharp objects. It seems to the patient that it can wound them to itself(himself) or people around.
An arophobia, or a gipsofobiya — the fear of height experienced by the patient who is at height, napr on a balcony or a ladder of the high building on the brink of break. It is pursued by a thought of a possibility of falling from height; at the same time there is also dizziness.
Anthropophobia, or gomilofo-Biya — fear of crowd. The patient is afraid that he will faint in crowd and will be crushed by it.
Dysmorphophobia — fear of ugliness. The patient is tormented by a thought of the wrong, ugly development of his body, noticeable for people around.
Claustrophobia — fear of the closed, enclosed space. The patient is afraid to feel suddenly badly, to faint somewhere — in audience, at a meeting, in theater. The klit-rofobiya, or fear of closeness, stuffy rooms is close to this fear.
A mysophobia — fear of pollution. It seems to the patient that it can be soiled, especially at hiting at to something.
Mifofobiya — fear to tell a lie in this connection the patient avoids communication with people.
Monophobia — the fear of loneliness connected with idea of helplessness of the lonely person.
A nosophobia — fear to ache with some serious illness. Acarophobia (fear of itch), a bacteriophobia, a helminthophobia, a cancerophobia, lisophobias (fear to ache with rage), a syphilophobia belong to this fear.
A siderodromophobia — fear of the increasing speed during the driving by the railroads when the thought of a possibility of the crash seizes the patient.
Thanatophobia — fear of death; that-fefobiya is fear to be alive buried.
Fobofobiya — fear of possibility of obsessional neurosis of fear. Fobofobiya is usually observed in the presence at the patient of various persuasive fears.
A pantophobia — the general fear, as if the highest degree of fear. The patient is afraid of everything surrounding.
V. M. Bekhterev, and also Pitr and Regis (J. A. Pitres, E. Regis) shshsat an erythrophobia, or an ereyto-phobia, i.e. fear of reddening in society. The fear of others look, and also a pet-tofobiya — fear of stay in society in connection with fear is close to this fear that it will not be possible to hold intestinal gases and it will be noticed by all.
Also other, less widespread persuasive fears are described: a ballistofobiya — fear of firearms; a brontophobia — fear of a thunder-storm; a vertigophobia — fear of dizziness; a vomitophobia — fear of vomiting; a hematophobia — fear of a type of blood; gerontophobia — fear of a meeting with old men; zoophobia — fear of animals (the person is afraid of a meeting with animals); a kayrofobiya — fear of any certain situation; a kenophobia — fear of empty rooms; a cynophobia — fear of dogs (the person is afraid of a meeting with dogs); kleptofobiya — fear of assignment of others things; a lalofobiya — fear of the speech at stutterers; necrophobia — fear of dead persons; neophobia — fear of novelty, any changes in usual, current situation; a nyctophobia — fear of night darkness; a pyrophobia — fear of fire; a stazobazofobiya — fear of standing, walking; a sudorofobiya — fear to sweat in society and in this regard to undergo sneers; a tocophobia — fear of childbirth; a topofobiya — fear of certain places; an urophobia — fear of a desire on an urination in an improper situation, napr, in society, at a lecture, in a system.
In group of persuasive fears especially persuasive fears of impossibility of commission of any usual vital or professional act can be allocated. The experienced teacher who is well owning material suddenly begins to be afraid to forget the content of a lecture, the singer is afraid that she will not sing a well-known melody in this connection refuses public statements. The patient feels fear to urinate in the public bathroom in the presence of strangers. The sitophobia — fear of meal, fear of food also concerns to this group of fears. The phagophobia — fear of a proglatyvaniye of food because of fear to choke is close to a sitophobia. Persuasive fear to be insolvent in commission of sexual intercourse, fear of impotence also belongs to the same group. Similar persuasive fears form the main a wedge, a picture of neurosis of the expectation allocated by nek-ry researchers in an independent disease.
At persuasive memoirs in consciousness of the patient painfully again Pi arises figurative reminiscence of any unpleasant, discrediting it event again.
Contrast representations and hulny thoughts according to the contents are opposite to outlook of the patient, his ethical installations. In consciousness of the patient against his desire there are thoughts of harming the closest people, religious people have thoughts of cynical contents concerning religious representations.
The persuasive doubts described by Zh. Falre and Legrand du Saulle are close to persuasive fears. The patient constantly has doubts in correctness and completeness of the acts. Leaving the house, he doubts whether he locked a door, whether switched off heating devices. Having sent the letter, doubts correctness of the address written to them. Persuasive doubts involve need of repeated check by patients of the actions.
Persuasive inclinations represent the strong aspirations arising in consciousness of the patient to make any senseless, dangerous, obscene act. Here the hydromania (an inclination to plunge into the water), a gomitsidomaniye (an inclination to murder), aspiration to cry out the swear, obscene word in society, to bare generative organs belong, e.g. Unlike violent and impulsive acts persuasive inclinations are never carried out.
Persuasive actions are usually connected with persuasive doubts and fears. The patient suffering from fear of pollution uncountable number of times washes hands, and suffering fear to catch a disease several times in day sprays the clothes disinfecting solution.
Nek-ry researchers refer also originally conscious movements to persuasive actions, to-rye further at their frequent repetition become usual and to a certain extent insuperable, napr, the persuasive aspiration to gnaw nails (onychophagy).
The notions of compulsion are shown first of all in sterile or painful sophistication that was for the first time described by W. Griesinger. For this N.'s designation by the village use also the term «sincere, or intellectual, chewing gum» offered by Legrand du Soll and P. Jean. Sterile sophistication is shown in persuasive aspiration again and again to resolve unnecessary and even senseless questions, napr why the sun shines why the table costs on four legs why white chalk why the right hand is called right, and left — left.
The persuasive account (aritmomaniye) is expressed in the persuasive aspiration to precisely consider and keep in memory quantity of the passable steps, houses or columns on streets, the met passersby, the passing cars etc. Nek-ry patients display on syllables of the word and the whole phrases, and are at loss for words in these phrases so that they contained even or, on the contrary, odd quantity of syllables.
Persuasive reproductions, or the rememberings (onomatomania) described. Sharko and V. Manyak, are expressed in the persuasive aspiration to remember, e.g., absolutely unnecessary terms, names of heroes in works of art.
As a special form of protective actions against persuasive fears there are persuasive rituals, to-rye, as well as any other N. of page, are characterized by a sign of insuperability. So, the patient with fear of death during the walking attacked only uneven places of the sidewalk or a pavement, and having got once could not go on the flat, just asphalted site of the sidewalk further; other patient bypassed around all columns, to-rye occurred to it in the path. Sometimes patients resort to protective verbal formulas. In some cases persuasive rituals, especially at a neurosis-like form of schizophrenia, are very difficult and then they can be considered as some kind of persuasive ceremonies.
N.'s current of page is characterized by fluctuations from almost total disappearance before considerable strengthening. The disappeared N. of page can arise through long time terms again. N.'s transition by the village is in some cases noted in nonsense (see) and in mental automatism (see. Kandinsky — Klerambo a syndrome ).
K. Jaspers offered N.'s division by the village on abstract, indifferent according to the contents, and on figurative, with affective, usually burdensome contents. Sterile sophistication, the persuasive account, persuasive memoirs, decomposition of words on syllables belong to the first. It carried the others to group of figurative persistence.
N of page meet at the most various diseases. So, at neurosis of persuasive states are possible different persistence along with the frustration inherent to neurosises in general — irritability, hypersensitivity, frustration of a dream, vegetative frustration. Very often N. are observed by page at psychasthenias (see), they are frequent at neurosis-like option of slow schizophrenia (see), are possible in a depressive phase maniac-depressive psychosis (see), at involutional melancholy (see. Depressive syndromes ), psychoses at idiopathic hypertensia (see), somatopsychoses (see. Symptomatic psychoses ), epilepsies (see), organic diseases of a brain, hysteria (see).
Fact of common knowledge of emergence separate, besides extremely unstable N. of page at mentally healthy people; any melody or the poem can arise in consciousness, especially at exhaustion, after the postponed infections, also at heavy experiences again and again.
Pages, typical for N.'s schizophrenia, are connected with features of schizophrenic process and are procedural symptoms, to-rye can be carried to phenomena of partial depersonalization. Pages of neurotic character poorly expressed affective coloring and a component of fight are characteristic of them bystry accession of persuasive rituals, and also unlike N. The critical relation of patients with schizophrenia to N. of page in the period of an aggravation sharply decreases in this connection villages begin to remind N. nonsense and mental avtomatizm. They differ in big firmness and inflexibility in relation to psychotherapeutic influence. Often their contents is extremely ridiculous. At the progreduated course of schizophrenic process N.'s transition by the village to the sketchy crazy ideas, and also to stereotypies is possible.
N of page at epilepsy (most often it is gomitsidny persuasive inclinations) differ in the simplicity and usually proceed paroksizmalno within not roughly broken consciousness. The persuasive inclinations observed at hron, a current epid, encephalitis and also at other organic diseases of a brain (posttraumatic diseases, tumors of a brain) having similar with epid, encephalitis localization morfol, changes, not can be carried to the real N. by page Due to the sign of violent insuperability which is brightly presented to them they shall be considered in special group of violent states. Unlike the real persuasive inclinations violent inclinations after short and unsuccessful fight against them from patients are implemented in the corresponding actions (see. Impulsive inclinations ).
The N of page arising in a depressive phase of maniac-depressive psychosis develop on the basis of the mixed state with a component of alarm and in the absence of braking (see. Maniac-depressive psychosis ). Persuasive doubts are especially characteristic of maniac-depressive psychosis.
In an initial stage of the idiopathic hypertensia proceeding with psychological disturbances single persuasive fears can develop. Usually it is fear of death and fear of open space. The same fears enter a wedge, a picture of psychological disturbances at cardiogenic psychoses.
Very seldom found N. usually are shown by page at presenile melancholy in the form of persuasive memoirs of extremely heavy contents. Also persuasive inclinations, e.g. aspiration to kill any of close people are observed.
The etiology and a pathogeny
From the very beginning of development of the doctrine about N. of page were outlined in views of foreign researchers disagreements on what disturbances are the cornerstone of N. of page — intellectual or emotional. The leading role of intellectual disturbances was especially upheld it. psychiatrists, in particular To. Vestfal, the first’ pointed to it in 1877. The French researchers stood on the point of view of Ekhmotsionalny conditionality of persuasive states. B. Mo-rel (1866) carried N. of page to special «emotional nonsense». Further the German researchers continued to study N. of page preferential in purely psychological plan, in a separation from that clinical soil, on a cut they developed. Followers of psychoanalysis considered N. of page in the light of Freud's theory. The idea of the sexual maintenance of nek-ry N. of page was introduced in 1892 by R. Krafft-Ebing. In addition to the assumption that N.'s development by page is the cornerstone psikhol factors, in foreign literature there is also other point of view. So, epidemic of encephalitis after World War I gave an impetus to formulation of the question about integrally cerebral conditionality of N. of page.
Domestic researchers studied N. of page by their clinical, and afterwards patofiziol, the analysis. S. S. Korsakov, pointing out complexity of structure of N. of page, objected those researchers, to-rye conducted a sterile dispute about intellectual or, on the contrary, emotional conditionality of persuasive states. V. P. Serbsky noted in 1890 need of allocation from the IT group. page of all patol, the phenomena having with them only purely external similarity, napr, stereotypic movements at a catatonia. In 1902
S. A. Sukhanov and P. B. Gannushkin in a joint research put forward the provision on need of the differentiated N.'s studying by the village for direct dependence on that a wedge, bases, on a cut they arise.
Further N.'s studying by the village in domestic psychiatry was carried out about a wedge, the points of view.
Lighting of the village by domestic researchers of a problem H. from positions of materialism naturally led to studying them patofiziol, bases. The main patofiziol, mechanisms H. of page were installed by I. P. Pavlov. in 1933 though in 1913 the prominent domestic psychiatrist Mm.Asatiani published a research about a phobia as a conditioned reflex. According to I. P. Pavlov, the page corresponds to N.'s most emergence in a cerebral cortex of the «sick point» isolated functionally, to-ry is characterized by existence in it patholologically of inert, congestive excitement. Such excitement in «sick points» is found in the relation of both motive acts, and the most various representations and feelings. The community patofiziol, N.'s bases of page and the crazy ideas explains a possibility of transition of the first in the second. At the same time patofiziol, N.'s basis of page differs in the smaller force of congestive excitement and respectively smaller force and prevalence of negative induction therefore patol, the center of congestive excitement does not brake other sites of bark in such degree, as at nonsense. This circumstance defines safety at the sick critical relation to N. of the village of Patol. inertness of excitement in «sick points» reports to the formed conditioned reflexes especially big durability, does them irregularly steady. The specified provisions were established by I. P. Pavlov as a result of studying of experimental neurosises.
After M. K receiving. In an experiment on animals of a so-called phobia of depth I. P. Pavlov suggested to explain to Petrova it with operation of the mechanism patol, labilities of braking. M. K. Petrova established that at emergence in an experiment patol, mobility of brake process can rastormazhivatsya the «fears» which are earlier experienced by an animal. These data correspond a wedge, to observations over repeatability at patients at different times of the same phobias. Thus, there are no bases to speak about a uniform patofiziol, origins of N. of page.
Generalizing earlier obtained yielded and results of own researches, A. G. Ivanov-Smolensk (1952, 1974) established that the undoubted role in the mechanism of action of N. of page belongs also to the phenomena of pathological positive or negative induction with a disinhibition of the brake processes developed in ontogenesis. In some cases it is necessary to consider value of phase states. So, the mechanism of an uljtraparadoksalny phase determines by itself emergence of hulny thoughts and contrast inclinations. According to A. G. Ivanov-Smolensk, considerable part H. of page is connected with the second alarm system.
The lull felt by the patient after performance of persuasive ritual actions, apparently, has a talk emergence of the new center of excitement in a motor analyzer with development of negative induction therefore the main center of inert excitement is suppressed. Patofiziol. researches on a problem H. of page are still far before the end.
Treatment it has to be directed to elimination of a basic disease.
See also Neurosises .
Bibliography: Asatiani M. M. Phobia as conditioned reflex, Psychotherapy, No. 4, page 254, 1913; And N of N at sh to and P. B.'s N isukhanovs. A. K to the doctrine about obsessions, Zhurn, a neuropath, and psikhiat., No. 3, page 399, 1902; Ivanov-Smolensk A. G. Sketches of a pathophysiology of higher nervous activity, M., 1952; it e, Sketches of neurodynamic psychiatry, M., 1974, bibliogr.; Lipgart N. N. Persuasive states at neurosises, Kiev, 1978; Ozeretskovsky D. S. Persuasive states, M., 1950, bibliogr.; Pavlov I. P. The last messages on physiology and pathology of higher nervous activity, JI., 1933; Pavlovsk environments, t. 1 — 3, M. — L., 1949; Popov E. A. About some conditions of formation of persuasive states, Owls., psikhonevrol., No. 4, page 133, 1940; Uma-r about in M. B. Nevroz of persuasive states and a psychasthenia, L., 1956, bibliogr.; And 1-s e n Y. Entstehungsbedingungen des pho-bisch-anankastischen Syndroms, Arch. Psychiat. Nervenkr., Bd 213, S. 246, 1970; Janet P. Les obsessions et la psychast-henie, P., 1903; Kraff t-Ebing R., Beitrage zur Erkennung und richtigen fo-rensischen Beurteilung krankhafter Ge-mtitszustande, Erlangen, 1867; Scientific symposium on obsessive compulsive neuroses and phobic disorders, Cambridge, 1977.
D. S. Ozeretskovsky.