Blasphemous thoughts. Obsessive Ideas What is an obsessive thought called?

We have all experienced waves of sudden fear or anxiety: “Did I turn off the iron? Did I lock the door? Sometimes, in public place Having to take hold of a handle or handrail, you try to wash and clean your hands as quickly as possible, not forgetting for a minute that they are “dirty.” Or, struck by someone’s sudden death from illness, you listen for a while to your own condition. This is normal, and such thoughts do not become constant and interfere with life. In case

when the opposite happens, and almost every day you return to the same topic that frightens you, moreover, you come up with a “ritual” that should help relieve the tension from the fears that haunt you, we're talking about already about a mental disorder called obsessive-compulsive neurosis.

How to tell if you have a mental disorder

Obsessions (obsessions) and resulting actions (compulsions) are not in themselves a clear sign of illness. They periodically appear in healthy people.

Obsessive ideas are classified as painful manifestations if they arise involuntarily, are persistently repeated and cause suffering and anxiety. The patient, as a rule, realizes the absurdity of the idea that has overwhelmed him, trying to get rid of it. But all his efforts are useless, and the idea comes back again and again. To reduce the likelihood that he is so worried, the patient comes up with protective actions, repeating them with pedantic precision, and as a result receives temporary relief.

For example, a person is afraid of contracting an infection and therefore after each exit from
At home, he washes his hands for a long time, soaping them ten times. He definitely counts this, and if he makes a mistake, he starts washing all over again. Or, fearing that the door is not closed properly, he pulls the handle twelve times. But, having gone far, he again worries about whether it is closed.

Who is susceptible to obsessive ideation syndrome?

Obsessive ideas are constantly recurring states, accompanied by a feeling of fear, with short-term satisfaction after performing a “ritual” (often of an absurd nature). In addition, they are accompanied by fatigue, difficulty concentrating, irritability and mood swings.

TO this species both adults and children are equally predisposed to neurosis, regardless of gender, social status and nationality. They can lead to it long-term stress, overwork, But sometimes the syndrome occurs as a consequence of brain injury or organic damage. Childhood mental trauma, cruelty from parents, connivance, and overprotection - all this can lead to neurosis

How to treat neurosis

The main thing is that both the patients themselves and their loved ones should not be deluded by the idea that this disorder can be overcome by giving the order not to worry. In addition, the more actively you try to control this process, the deeper it will take root. Obsessive ideas are treated only by specialists!

For children and adults, this is a rather difficult process. Everything needs to be taken into account individual characteristics sick person, selecting both psychotherapeutic and drug treatment. Only after understanding what caused it of this disease, how exactly it manifests itself, and having understood the character traits this person, you can choose safe and effective methods help.

Vasily Kaleda

Pastoral psychiatry: distinguishing between spiritual and mental disorders

The relationship between spiritual ailments and mental illness is one of the problems that both the clergy and lay members of the clergy constantly have to face in church life. But more often than not, it is the priest who is the first person to whom a person with mental disorders turns for help.

Three lives

At the beginning of the year, there was a wave of publications in the media about a series of suicides among teenagers. Around the same time, a priest approached me with a request to advise his spiritual daughter, a teenage girl, who had repeatedly mentioned suicide in conversations with her confessor. Masha (name changed) came to the appointment with her mother, who arrived at a loss as to why the priest referred her daughter to a psychiatrist. Family members did not notice any changes in the daughter’s condition. Masha successfully graduated from school and was preparing to enter university. During our conversation, she not only confirmed the presence of suicidal thoughts, but also said that she opened the window several times to throw herself out of it. Masha skillfully hid her condition from her family and friends and only spoke to her spiritual father about her personal experiences. The father made a lot of efforts to persuade the girl to go to a psychiatrist. Masha had severe depression that required hospitalization. If not for the efforts of the priest, she would probably have joined the list of teenagers who committed suicide and left their family and friends in confusion and despair.

Around the same time, the ambulance received a call from a Moscow church. The priest called an ambulance to the young man. For the purpose of “spiritual improvement,” the young man completely gave up food and drank only water. In a state of extreme exhaustion, he was taken to the hospital, where he was in intensive care for ten days. It is noteworthy that his parents saw his condition, but did not take any measures. In both cases, the girl and the boy survived only because the priests recognized they had a mental disorder.

The third, tragic incident also happened in Moscow. The priest, out of incompetence, forbade the young man who turned to him for help to take medication, although he had suffered a schizophrenic attack several years ago. Two weeks later the patient committed suicide.

The prevalence of mental illnesses and disorders in our society is quite high. Thus, about 15.5% of the population suffers from mental disorders, while about 7.5% need psychiatric care. To a large extent, these statistics are influenced by alcoholism and drug addiction. Our country ranks second in the world in terms of suicides (23.5 cases per 100,000 population). According to official data, from 1980 to 2010, about a million people committed suicide. Russian citizens, which indicates a deep spiritual crisis in our society.

It is not surprising that people suffering from mental disorders turn to the Church for help more often than anywhere else. On the one hand, most of them find spiritual support, meaning and purpose in life only in the temple. On the other hand, which is no less important, many mental disorders during an exacerbation have a religious overtones. In addition, as noted by Doctor of Medical Sciences, Prof. Sergius Filimonov, “today people come to the Church not out of the free will of knowing God, but mainly to solve the issue of getting out of crisis situations in life, including those related to development mental illness yourself or close relatives.”

A new subject in the training of clergy

Today, many dioceses have gained serious experience in cooperation between psychiatrists and priests, which began in the early 90s. Then, with the blessing of the confessor of the Trinity-Sergius Lavra, Archimandrite Kirill (Pavlov), classes in pastoral psychiatry began at the Moscow Theological Seminary under the leadership of the vicar of the Lavra, Archimandrite Theognost (now Archbishop of Sergiev Posad). Father Theognost teaches pastoral theology, the structure of which included a cycle on pastoral psychiatry. Subsequently, the course “Pastoral Psychiatry” at the Department of Pastoral Theology (since 2010 - the Department of Practical Theology) appeared at PSTGU on the initiative of Archpriest Vladimir Vorobyov and at Sretensky Theological Seminary on the initiative of Archimandrite Tikhon (Shevkunov).

The first hospital church at psychiatric clinic consecrated October 30, 1992 His Holiness Patriarch Alexy II of Moscow and All Rus' in honor of the icon of the Mother of God the Healer at the Scientific Center mental health RAMS. Then, speaking to psychiatrists, His Holiness the Patriarch said: “Psychiatrists and scientists are entrusted with the difficult and responsible mission of serving the cause spiritual health human souls entrusted to their care. The service of a psychiatrist is in the true sense an art and feat in the image of the service of Christ the Savior Himself, Who came into the world of existence poisoned by human sin in order to help those who need help, support and consolation.”

For the first time, a special manual for priests on psychiatry based on the concept of holistic Christian understanding human personality was developed by one of the recognized authorities of Russian psychiatry, the son of a priest of the Ryazan province, Professor Dmitry Evgenievich Melekhov (1899-1979). He wrote his concept of the course “Pastoral Psychiatry” for students of theological academies and seminaries in Soviet times. And although he was unable to complete the book “Psychiatry and Issues of Spiritual Life,” Melekhov formulated the basic principles of collaboration between a psychiatrist and a priest in the treatment and care of those suffering mental illnesses. This work was published in a typewritten edition shortly after the author's death. Later it was included in the Clergyman's Handbook, and later in numerous collections.

One of the central problems of this book is the problem of the relationship between the physical, mental and spiritual in a person and, accordingly, the relationship between mental and spiritual illnesses. The priestly confessor Georgy (Lavrov), well known in Melekhov’s youth, who labored in the Danilovsky Monastery, clearly distinguished between two groups of these diseases. He said to some: “You, baby, go to the doctor,” and to others: “You have nothing to do with doctors.” There were cases when an elder, helping a person adjust his spiritual life, recommended that he go to a psychiatrist. Or, on the contrary, he took people from a psychiatrist to himself for spiritual treatment.

In the book “Psychiatry and Issues of Spiritual Life,” Melekhov proceeded from the patristic trichotomous understanding of the human personality, dividing it into three spheres: bodily, mental and spiritual. In accordance with this, illness in the spiritual sphere is treated by a priest, mental illness by a psychiatrist, and physical illness by a somatologist (therapist, neurologist, etc.). At the same time, as Metropolitan Anthony (Blum) noted, “one cannot say that the spiritual ends somewhere and the spiritual begins: there is some area where mutual penetration takes place in the most normal way.”

All three spheres of human personality are closely interconnected with each other. Physical illness often affects mental and spiritual life. Saint John Chrysostom wrote about this back in the 4th century: “And God created the body in accordance with the nobility of the soul and capable of fulfilling its commands; created not just any, but the way he needed to be to serve the rational soul, so that if it were not like that, the actions of the soul would encounter strong obstacles. This is evident during illnesses: when the state of the body deviates even a little from its proper structure, for example, if the brain becomes hotter or colder, then many of the mental actions stop.”

This raises some fundamental questions: can a person suffering from severe physical illness, to be mentally and spiritually healthy? The answer here is clear. We know such examples not only from the lives of saints and from the exploits of the new martyrs, but also among our contemporaries. The second question: can a spiritually ill person be formally mentally and physically healthy? Yes maybe.

The third question is whether a person suffering from a serious mental illness, including severe forms depression and schizophrenia, have a normal spiritual life and achieve holiness? Yes maybe. Rector of PSTGU Rev. Vladimir Vorobyov writes that “a priest must explain to a person that mental illness is not a shame, it is not at all some kind of condition that has been erased from life. This is a cross. Neither the Kingdom of God nor the life of grace is closed to him.” St. Ignatius (Brianchaninov) brought specific examples, "St. Niphon Bishop suffered from insanity for four years, St. Isaac and Nikita suffered from mental damage for a long time. Some St. The desert dweller, noticing the pride that had arisen in himself, prayed to God to allow him to suffer mental damage and obvious demonic possession, which the Lord allowed to His humble servant.”

The attitude of the Church to the problem of the relationship between spiritual and mental illnesses is clearly formulated in the Fundamentals of the Social Concept (XI.5.): “Highlighting the spiritual, mental and physical levels of its organization in the personal structure, the holy fathers distinguished between diseases that developed “from nature” and ailments that caused by demonic influence or resulting from passions that have enslaved a person. In accordance with this distinction, it seems equally unjustified to reduce all mental illnesses to manifestations of possession, which entails the unjustified execution of the rite of expelling evil spirits, and to attempt to treat any spiritual disorders exclusively clinical methods. In the field of psychotherapy, the most fruitful combination of pastoral and medical care mentally ill, with proper delimitation of the spheres of competence of the doctor and the priest.”

On the relationship between spiritual and mental states

Unfortunately, the high prevalence of performing the rite of “exorcism of evil spirits” in modern church practice is noteworthy. Some priests, without differentiating between spiritual illnesses and mental illnesses, send patients with severe genetically determined mental illnesses to perform “disciplines.” Back in 1997, Patriarch Alexy II at a diocesan meeting of the Moscow clergy condemned the practice of “reprimands.”

There are a number of states that outwardly have similar manifestations, but relate to spiritual or mental life and, accordingly, have a fundamentally different nature. Let us dwell on the relationships of some of them: sadness, despondency and depression; obsession and delirium of “non-obsession”; “charm”, manic and depressive-delusional states.

Among spiritual states, sadness and despondency are distinguished. With sadness, loss of spirit, powerlessness, mental heaviness and pain, exhaustion, grief, constraint, and despair are noted. As its main cause, the holy fathers note deprivation of what is desired (in the broad sense of the word), as well as anger and the influence of demons. It should be noted that St. John Cassian the Roman, along with this, especially emphasizes “causeless sadness” - “unreasonable sorrow of the heart.”

Depression (from the Latin depressio - suppression, oppression) is no longer a spiritual, but a mental disorder. In accordance with modern classifications it is a condition, the main manifestations of which are a persistent (at least two weeks) sad, sad, depressed mood. With melancholy, despondency, loss of interests, decreased performance, increased fatigue, decreased self-esteem, pessimistic perception of the future. And also with the loss of the need for communication and sleep disturbances, loss of appetite up to its complete absence, difficulties concentrating and comprehending. In addition, depression often causes unreasonable self-judgment or excessive feelings of guilt, and repeated thoughts of death.

Believers in a state of depression will experience a feeling of abandonment by God, loss of faith, the appearance of “petrified insensibility”, “coldness in the heart”, talk about their exceptional sinfulness, spiritual death, complain that they cannot pray, read spiritual literature. In severe depression, suicidal thoughts are often observed. Believers usually say that they cannot commit suicide, because hell awaits them for this. But, as practice shows - and you need to pay attention to this - they also commit suicide, although a little less often, since mental suffering is the most severe and not everyone is able to endure it.

Depressions include reactive ones, which occur after traumatic situations (for example, after the death of a loved one), and endogenous ones (“unreasonable sadness”), which are genetically determined. Depression is especially common in older people, among whom they occur in more than half of the cases. Depression often takes on a protracted and chronic course (more than two years). According to WHO, by 2020 depression will take first place in the morbidity structure and will affect 60% of the population, and mortality from severe depression, often leading to suicide, will take second place among other reasons. The reason for this is the loss of traditional religious and family values.

Among spiritual states, demonic possession stands out. Here are two examples illustrating this condition. The first of them is associated with Bishop Stefan (Nikitin; †1963), who, even before his ordination to the priesthood in the camp, as a doctor, bore the Holy Gifts. One day, as a doctor, he was asked to consult the daughter of the camp director. When he came to her, she suddenly began rushing around the room and screaming for the shrine to be removed, and the doctor was asked to leave. Another example from the life of Archbishop Meliton (Soloviev; †1986). It dates back to the late 1920s. One day, late in the evening, almost at night, he was moving a portrait of St. from one apartment to another. John of Kronstadt. A man was walking towards him, who suddenly began to shout and call the name of John of Kronstadt. That is, the leading criterion for determining demon possession, as many pastors note, is a reaction to a sacred thing.

At the same time, mental illnesses include schizophrenic psychoses, when often, along with various delusional themes, the patient considers himself the ruler of the world or the Universe, a messiah called to save Russia or all of humanity from world evil, economic crisis, etc. There are also delusional disorders when the patient is convinced that he has been possessed by demons or shaitans (depending on what culture he belongs to). In these cases, the ideas of demonic possession, as well as the ideas of messianic content, are only the theme of the delusional experiences of a patient with severe mental illness.

For example, one of the patients in the first psychotic attack considered himself Cheburashka and heard the voice of the crocodile Gena in his head ( auditory hallucinations), and in the next attack he said that he was possessed by dark forces (delirium of demonic possession) and that the voices belonged to them. That is, in one case the theme of delusional experiences was associated with a children's cartoon, in the other it had religious overtones. Both attacks were treated equally successfully with antipsychotic drugs.

We have encountered situations where priests qualified auditory hallucinations as the influence of demonic forces and did not recommend that patients see doctors. Although these patients regularly received communion, no changes occurred in their mental status, which should have been noted in case of demon possession.

Spiritual states also include the state of “prelest,” the most important manifestation of which is a person’s overestimation of his personality and an intensive search for various “spiritual gifts.” However, this symptom, along with the patient’s feeling of a surge of strength, energy, and a special spiritual state, psychomotor agitation, a disorder of desires, a reduction in the duration of night sleep, is one of the manifestations manic states. There are other states when a person begins to be very actively “engaged in his spiritual growth” and stops listening to his confessors.

Some time ago, the parents of a girl approached me, who had come to faith about a year earlier, but in the last two months her spiritual life had become very intense. She lost so much weight that there was a real threat to her life due to dystrophy internal organs. She prayed for about two hours in the morning, about three in the evening, and in the afternoon for about two hours she read kathismas and certain passages from the Gospel and the Epistle of the Apostles. She received communion every Sunday, and before that, every Saturday she stood in a long line for confession in one of the monasteries. She came to confession with numerous sheets of paper. In the temple she repeatedly became ill and had to call an ambulance. She did not hear the words of her confessor that she was not a schema nun, that she was not supposed to follow such prayer rules. She also did not hear the requests of her elderly parents. They asked to at least sometimes go to a temple near their house, since spending the whole weekend with her in the monastery was physically difficult for them, and they could not let her go alone. She stopped coping with work and communicating with her colleagues. She did not consider herself sick, but she spoke negatively about the priests who tried to limit her prayerful “exploits.” Under pressure from her parents, she passively agreed to take medications, which gradually restored her appetite and ability to work. Prayer Rule(which the confessor insisted on) was reduced to reading the morning and evening prayers and one chapter from the Gospel.

It is clear that in none of the monasteries would any abbess or elder bless a young novice for such “feats.” No one has canceled the old monastic rule: when you see a brother rising sharply, pull him down. When a person perceives himself as a “great specialist” in spiritual life and does not hear his confessor, it is customary to speak of a state of delusion. But in this case it was not delusion, but a mental illness that acquired a religious overtones.

Obsessive states and their forms

When discussing the topic of the relationship between spiritual and mental illnesses, it is necessary to dwell on the problem of obsessive states (obsessions). They are characterized by the emergence in the patient’s mind of involuntary, usually unpleasant and painful thoughts, ideas, memories, fears, and inclinations, towards which a critical attitude and the desire to resist them remain. There are motor obsessions, when a person repeats certain movements. For example, he returns to a locked door several times and checks whether it is locked or not. With mental illness, it happens that the patient bows and hits his forehead on the floor (this happened with both Orthodox Christians and Muslims). In addition, there are so-called contrasting obsessions, when a person has an inevitable desire to throw someone under a train in the subway, a woman has a desire to stab her child.

Such a thought is completely alien to the patient, he understands perfectly well that this cannot be done, but this thought persistently exists. Also included in contrasting obsessions are the so-called blasphemous thoughts, when a person seems to have blasphemy against the Holy Spirit, the Mother of God, and saints. One of my patients had a similar condition at the stage of depression after a schizophrenic attack. For him, an Orthodox man, blasphemous thoughts were especially painful. He went to the priest for confession, but he refused to confess him, saying that everything would be forgiven to a person except blasphemy against the Holy Spirit (cf. Matt. 12:31). What could he do? He attempted suicide. After psychopharmacotherapy, these psychopathological disorders were stopped and did not recur in the future.

conclusions

Noted above depressive states, states with delusions of obsession, with obsessions, with manic and depressive-delusional states generally respond successfully to psychopharmacotherapy, which indicates the biological basis of these states. This was also noted by Metropolitan Anthony (Sourozhsky), who wrote that “ mental states depend largely on what is happening physiologically in terms of physics, chemistry in our brain and in our nervous system. Therefore, every time a person becomes mentally ill, it cannot be attributed to evil, sin or a demon. Very often this is caused more by some kind of damage to the nervous system than by demonic obsession or the result of a sin that has torn a person away from any connection with God. And here medicine comes into its own and can do a lot.”

Many classics of psychiatry and modern researchers noted that the Christian perception of life makes a person resistant to various stressful situations. This idea was formulated very clearly by Viktor Frankl, the founder of the theory of logotherapy and existential analysis: “Religion gives a person a spiritual anchor of salvation with a sense of confidence that he cannot find anywhere else.”

The difficulty of distinguishing between mental and spiritual illnesses acutely raises the question of the need for mandatory inclusion in training programs for future priests in all higher education institutions. educational institutions Russian Orthodox Church course in pastoral psychiatry, as well as special courses in psychiatry in preparation social workers. Professor Archimandrite Cyprian (Kern) wrote about the need for this knowledge for every pastor in his manual “Orthodox Pastoral Ministry”, devoting a special chapter to the issues of pastoral psychiatry. He strongly recommended that every priest read one or two books on psychopathology, “so as not to indiscriminately condemn as a sin in a person that which in itself is only a tragic distortion of mental life, a mystery, and not a sin, a mysterious depth of the soul, and not moral depravity.” .

The task of a priest, when identifying signs of mental illness in a person, is to help him think critically about the condition, encourage him to see a doctor, and, if necessary, to receive systematic treatment. drug therapy. There are already many cases when patients, only thanks to the authority of the priest, with his blessing, take supportive therapy and long time are in a stable condition. As practice shows, further improvement of psychiatric care is possible only with close cooperation between psychiatrists and priests and with a clear delineation of areas of competence.

Notes:

Data from the Scientific Center for Mental Health of the Russian Academy of Medical Sciences.

Filimonov S., prot., Vaganov A.A. 0 counseling for mentally ill people in the parish // Church and medicine. 2009. No. 3. P. 47-51.

Melekhov D.E. Psychiatry and problems of spiritual life // Psychiatry and actual problems spiritual life. M., 1997. P. 8-61.

Anthony (Blum), Metropolitan. Body and matter in spiritual life / Trans. from English from the ed.: Body and matter in spiritual life. Sacrament and image: Essays in the Christian understanding of man. Ed. A.M. Allchin. London: Fellowship of S.Alban and S.Sergius, 1967. http://www.practica.ru/Ma/16.htm.

Cyprian (Kern), archimandrite. Orthodox pastoral ministry. Paris, 1957. P.255

Blasphemous thoughts

A type of contrasting obsessive states; their content is indecently cynical and inappropriate to the situation.

. V. M. Bleikher, I. V. Kruk. 1995 .

See what “blasphemous thoughts” are in other dictionaries:

Blasphemous thoughts- – contrasting obsessive ideas. See Obsessions...

Thoughts that contradict the moral and ethical properties of the individual, the patient’s ideas about ideals, worldview, attitude towards loved ones, etc. Because of this, they experience extreme distress and depress the patient... Dictionary psychiatric terms

blasphemous thoughts- obsessive thoughts, which in their content represent an outrage against the patient’s ideals (his worldview, attitude towards loved ones, religious ideas, etc.) and are painfully experienced by him... Large medical dictionary

Contrasting thoughts- the phenomenon of obsessive thinking in the form of the appearance of blasphemous, offensive or obscene thoughts when perceiving or remembering objects that are of special personal value to the individual. Synonym: Blasphemous thoughts... encyclopedic Dictionary in psychology and pedagogy

Obsessive states- (synonym: obsessions, anankasms, obsession) the involuntary occurrence of irresistible thoughts (usually unpleasant), alien to the patient, ideas, memories, doubts, fears, aspirations, drives, actions while maintaining a critical attitude towards them... ... Medical encyclopedia

Obsession- Felix Plater, scientist who first described obsessions... Wikipedia

Sin- This term has other meanings, see Sin (meanings) ... Wikipedia

Obsessive ideas- – irresistibly arising thoughts and figurative, most often visual representations of inadequate, “crazy”, often contrasting, contrary to reality and common sense content. For example, the patient vividly and in horrifying detail... ... Encyclopedic Dictionary of Psychology and Pedagogy

SECOND COMING- [Greek παρουσία arrival, arrival, advent, presence], the return of Jesus Christ to earth at the end of time, when the world in its present state will cease to exist. In the New Testament texts it is called “appearance” or “coming”... ... Orthodox Encyclopedia

Gennady Gonzov- (Gonozov) saint, archbishop of Novgorod and Pskov. Almost no news has survived about his life before 1472; apparently he came from a boyar family (the Degree Book calls him “high-ranking”) and owned estates (by... ... Large biographical encyclopedia

Obsessive ideas are ideas and thoughts that involuntarily invade the consciousness of the patient, who perfectly understands all their absurdity and at the same time cannot fight them.

Obsessive ideas constitute the essence of a symptom complex called the syndrome obsessive states (psychasthenic symptom complex). This syndrome, along with obsessive thoughts included obsessive fears(phobias) and obsessive urges to act. Usually these painful phenomena do not occur separately, but are closely related to each other, together making up an obsessive state.

D.S. Ozeretskovsky believes that in general concept obsessive states should show a sign of their dominance in consciousness in the presence of a generally critical attitude towards them on the part of the patient; As a rule, the patient’s personality struggles with them, and this struggle sometimes takes on an extremely painful character for the patient.

Intrusive thoughts sometimes they can appear sporadically in mentally healthy people. They are often associated with overwork, sometimes occurring after a sleepless night, and are usually of the nature intrusive memories(a melody, a line from a poem, a number, a name, a visual image, etc.). Often, an obsessive memory in its content refers to some difficult experience of a frightening nature. The main property of intrusive memories is that, despite the reluctance to think about them, these thoughts obsessively pop up in the mind.

In a patient, obsessive thoughts can fill the entire content of thinking and disrupt its normal flow.

Obsessive thoughts are very different from crazy ideas the fact that, firstly, the patient is critical of obsessive thoughts, understanding all their painfulness and absurdity, and, secondly, the fact that obsessive thoughts are usually fickle in nature, often occurring episodically, as if in attacks.

Characteristic of obsessive thinking are doubts and uncertainty, accompanied by a tense feeling of anxiety. This is an affective state anxious tension, anxious uncertainty - suspiciousness is a specific background of obsessive states.

The content of painful obsessive thoughts can be varied. The most common is the so-called obsessive doubt, which in a mildly expressed form can periodically be observed in healthy people.

In patients, obsessive doubt becomes very painful. The patient is forced to constantly think about, for example, whether he contaminated his hands by touching the door handle, whether he introduced infection into the house, whether he forgot to close the door or turn off the light, whether he hid important papers, whether he wrote or did something correctly. what he needed, etc.

Due to obsessive doubts, the patient is extremely indecisive, for example, he rereads a written letter many times, not being sure that he has not made any mistake in it, checks the address on the envelope many times; if he has to write several letters at the same time, then he doubts whether he has mixed up the envelopes, etc. With all this, the patient is clearly aware of the absurdity of his doubts, and yet he is unable to fight them. However, with all this, patients relatively quickly become “convinced” that their doubts are unfounded.

In some severe cases, intrusive doubts sometimes lead to false memories. So, the patient thinks that he did not pay for what he bought in the store. It seems to him that he has committed some kind of theft. “I can’t tell if I did it or not.” These false memories apparently arise from the obsessional, poor thought but intense activity of fantasy.

Sometimes obsessive thoughts become obsessive or painful philosophizing. During painful philosophizing, a number of the most absurd and in most cases unsolvable questions obsessively arise in the mind, such as, for example, who can make a mistake and what kind? Who was sitting in the car that just passed? What would happen if the patient did not exist? Did he harm anyone in any way? and so on. Some patients experience a kind of obsessive “jump of ideas in the form of questions” (Yarreys).

We have already indicated above that obsessive thoughts are accompanied by a tense feeling of anxiety. This feeling of anxiety can become dominant in obsessive states, acquiring the character obsessive fear.

Obsessive fears(phobias) are a very painful experience, expressed in unmotivated fear with palpitations, trembling, sweating, etc., obsessively arising in connection with some, often the most ordinary life situation. At their core, these are inhibitory states with fear under various circumstances. These include: fear of crossing large squares or wide streets (agoraphobia) - fear of space; fear of closed, cramped spaces (claustrophobia), for example, fear of narrow corridors, this can also include obsessive fear of being among a crowd of people; obsessive fear of sharp objects - knives, forks, pins (aichmophobia), for example, fear of swallowing a nail or needle in food; fear of blushing (ereitophobia), which may be accompanied by redness of the face, but may also be without redness; fear of touch, contamination (mysophobia); fear of death (thanatophobia). Various authors, especially French, have described many other types of phobias, up to obsessive fear of the possibility of the appearance of fear itself (phobophobia).

Obsessive fears sometimes occur in certain professions (professional phobias), for example, among artists, musicians, and speakers, who, in connection with public speaking, may have a fear that they will forget everything and make a mistake. Obsessive fears are often associated with obsessive thoughts, for example, fear of touch may appear due to doubts about the possibility of contracting a disease, such as syphilis, by touching a door handle, etc.

Obsessive urges to do things are also partially associated with obsessive thoughts, and also with fears and can stem directly from both. Obsessive urges to act are expressed in the fact that patients feel an irresistible need to perform one or another action.

After the latter is completed, the patient immediately calms down. If the patient tries to resist this obsessive need, then he experiences a very difficult state of affective tension, from which he can only get rid of by committing an obsessive action. Obsessive actions can be varied in content - they can consist of the following: the desire for hands; obsessive need to count any objects - steps of stairs, windows, people passing by, etc. (arithmomania), reading signs on the street, the desire to utter cynical curses (sometimes in a whisper), especially in inappropriate surroundings. This obsessive action is associated with contrasting ideas (see above) and is called coprolalia. Sometimes there is an obsessive urge to perform some habitual movements - nodding the head, coughing, grimacing. These so-called tics are in many cases closely related to obsessive states and often have a psychogenic origin.

A number of obsessive behaviors may be of the nature of so-called protective actions, performed by patients in order to get rid of the painful affect associated with an obsessive state, the patient, for example, takes a handkerchief to door handles, constantly washes his hands in order to get rid of anxiety; associated with fear of infection; checks whether the door is locked a certain number of times in order not to experience painful doubts. Sometimes patients come up with various complex protective rituals in order to protect yourself from obsessive doubts and fears. For example, one of our patients with obsessive fear death felt calmer, having camphor powder in his pocket at all times in case he was in danger of cardiac arrest, or another patient with obsessive doubts had to read the letter he had written three times in order to guarantee himself against mistakes, etc. .

Obsessive thoughts can be of a neurotic episodic nature (neurotic-obsessive states) or be a more permanent chronic phenomenon in psychasthenia, as one of the forms of psychopathy, corresponding, in the terminology of K. Schneider, to the anancastic form of psychopathy. True, even with psychasthenia, periodic exacerbations of obsessive states are observed, especially under the influence of overwork, exhaustion, febrile illnesses and psychotraumatic moments. The phasicity and periodicity of the course of attacks of obsessive states forced some authors (Heilbronner, Bongeffer) to attribute the syndrome of obsessive states to a cyclothymic constitution, to manic-depressive psychosis. However, this is not quite true. Of course, obsessions can quite often occur when depressive phase manic-depressive psychosis. However, obsessive states can be observed even more often in schizophrenia and especially in initial stages illness, as well as in more late stages with indolent forms of schizophrenia. Sometimes there are difficulties differential diagnosis between obsessive states in schizophrenia and anancastic psychopathy, especially , that some authors describe the anancastic development of a psychopathic nature on the basis of a schizophrenic defect. It should also be noted that schizophrenic stereotypies and automatism in their elements of perseveration have a certain similarity with obsessive manifestations - they, however, should be distinguished from secondary obsessive actions

arising from obsessive thoughts and phobias. Obsessive states in the form of attacks have also been described in epidemic encephalitis. Obsessive states have also been observed in epilepsy and other organic diseases of the brain.

Classifying obsessive states, D.S. Ozeretskovsky (1950) distinguishes: obsessive states as typical for psychasthenia, obsessive states in schizophrenia, which are automatisms associated with experiences of partial depersonalization; obsessive-compulsive disorders can occur with epilepsy and arise within the framework of special conditions characteristic of this disease. Finally, obsessive states in epidemic encephalitis and other organic diseases of the brain D.S. Ozeretskovsky considers a group of special violent states that should be separated from obsessive ones.

Thus, obsessive-compulsive disorders can occur in various diseases. constant tendency to doubts.

Source of information: Aleksandrovsky Yu.A. Borderline psychiatry. M.: RLS-2006. — 1280 p.
The directory was published by the RLS ® Group of Companies

Those thoughts that periodically “invade consciousness” are called obsessive, or, according to the apt remark of K. Westphal (Westphal K ., 1877): “it’s unclear where they appear, as if they’re flying out of thin air.”

Obsessive thoughts are recognized as one’s own, and their absurd nature is partly understood, i.e. in other words, criticism towards them is preserved, but for some reason, even with a strong desire, one cannot free oneself from such thoughts, “get rid of them.”

A.A. Perelman (1957) in his book “Essays on Thought Disorders” wrote: “A formal analysis of obsessive thoughts (especially obsessive doubts) ... makes it possible to establish that here there is a peculiar violation ... of the flow of thoughts with breakthroughs in their purposefulness. Apart from the will..., with obsessive thinking, a certain thought stagnates in the mind... remains isolated from other thoughts and does not create a subsequent thinking task. Thanks to stagnation... the consciousness of the completion of a thought - its completeness - is not achieved. Therefore, the subject is forced to repeatedly return to the stagnant thought in order to gain confidence in the correct solution of the task assigned to this thought. This creates a mechanism for the obsession of this thought. At the same time and together with the intellectual mechanism of obsession, the subject experiences a severe affective state of helplessness and anxiety associated with uncertainty in completing the obsessive thought and achieving its goal. Thus, the subject is unable to discharge his affective tension"

“An obsessive thought is, as it were, outside the circle of ... experiences, it is, as it were, autonomous, and thereby meaningless” (Kempinski A., 1975).

Some psychiatrists call obsessive thoughts – constantly repeating “persistent” ideas.

It is difficult, almost impossible, not to pay attention to obsessive thoughts, and gradually they begin to subjugate the patient’s time and leave their mark on his behavior.

Sometimes, however, by an effort of will it is possible to suppress an obsessive thought, but at the same time an extremely painful feeling of tension, dissatisfaction, anxiety appears, from which, in the end, a person tries to free himself and get rid of it as soon as possible.

Obsessive thoughts, as a rule, are associated and combined with obsessive phobias, in some cases there is a direct transition of phobias into obsessions.

O. Fenichel (1945), describes possible mechanism such a transition: “First certain situation is avoided, then, in order to ensure this necessary avoidance, attention is constantly strained. Later, this attention becomes obsessive or another “positive” obsessive attitude develops, so incompatible with the initially frightening situation that its avoidance is guaranteed. Touch taboos are replaced by touching rituals, fears of contamination by washing compulsions; social fears - social rituals, fears of falling asleep - preparation for bed, inhibition of walking - mannered walking, animal phobias - compulsions when dealing with animals.”

Somewhat less often, obsessive thoughts are combined with intrusive memories or images; the latter manifest themselves in vivid scenes, often of violent content, for example, a picture of sexual perversion or the commission of actions unacceptable in society.

Obsessions are not always combined with compulsions. Although obsessive ruminations ("pure obsessions", "hidden compulsions", "mental compulsions") are triggered by stimuli almost similar to the triggers of phobias, they appear to be more closely related to depression than anxiety, even in those cases that are accompanied by a tendency to avoidance. At the same time, as noted above, obsessive thoughts are mostly associated with phobias; the latter, with careful analysis, can be identified at least in a weak form in almost all patients with obsessions.

Obsessive thoughts can be observed in the form of simple words, phrases, rhymes. They, just like doubts, also occur in healthy people, but in the latter case disappear if a person becomes convinced of their fallacy or remembers what these thoughts remind of.

Obsessive words pop up in consciousness directly, regardless of the grammatical connection, and usually they cannot be displaced or replaced with other words. Sometimes obsessions manifest themselves in the form of questions (“ morbid passion to questions").

Obsessive words, at their first appearance, may be associated with the logical course of some series of reasoning, but due to a random coincidence in their content with expressed affect, they are recorded in consciousness. Subsequently, they are delayed and already arise out of connection with the primary affect that provoked their appearance.

Contents of obsessive thoughts varied. To some extent, it reflects the time in which a person lives (Salkovskis P., 1985). The content also depends on “... the richness of mental life in general and its individual direction... innate anomalies of character favor the appearance of certain obsessive ideas.” “For example, persistent religious thoughts are found most often in people prone to hypocrisy, obsessive fears about contamination of things or own body- in hysterical patients or hypochondriacs, the same fears about disruption of order, painfully exaggerated worries about everything being in its place - are most characteristic of individuals who, from a young age, amazed with their pedantry and painful, for themselves and others, desire to bring the entire environment in order. On the other hand, it is striking that in numerous cases, among very different individuals, both in terms of social status and degree of education, obsessions turn out to be typically similar and therefore in many ways resemble the primary ideas of delirium...” (Krafft - Ebing R., 1890).

Most often, obsessive thoughts are unpleasant, painful, often striking in their absurdity, strangeness, and can be indecent.

"blasphemous thoughts" appear during prayer or while in church, as if in contrast to the situation in which a believer finds himself. Cynical ideas arise that are blasphemous towards God. “Blasphemous thoughts” are offensive in nature towards those ministers of religious worship, objects or shrines that have special value for the patient, in which he believes and with which he is religiously obsessed. The patient may be constantly disturbed by thoughts that “the devil is pushing him into the dirt,” and during prayer there is a desire to insult God and curse him. Such patients, as a rule, think about fantastic and impracticable religious crimes, but, however, often cannot clearly express their experiences, thoughts, emotions and sensations.

Sexual obsessions usually relate to forbidden or perverted thoughts, images and attractions. Most often they are expressed in fear of having sexual intercourse with children, animals, or being involved in incest or homosexual relations. Typically, patients hide such obsessions and take all measures to exclude any possibility of the realization of thoughts that are dangerous from their point of view. These obsessions can be especially difficult to identify.

One of the options for obsessive thoughts is onomamania- the need to remember names, numbers or other names; in another case, the patient tries to avoid any bad, from his point of view, dangerous word; in the third, words are assigned an incomprehensible, often material meaning. Note that forced repetition of any numbers may have a relatively weak effect on emotional sphere person.

V. Magnan (1874), in his lectures on hereditary deviants, describes a case of onomamania, expressed in the need to utter indecent words of compromising content (coprolalia). Here it is interesting to trace the almost parallel presence in the patient of obsessive thoughts and impulsive drives and, in addition, the transformation of obsessions into delusional ones.

Here is an excerpt from the work of V. Magnan, concerning this patient, whose depressive ideas were partly associated with obsessions and especially the obsessive utterance of certain words and phrases, which were later subjected to delusional processing. “She says, unable to resist, curse words like: “camel”, “cow”, “ass”. These obscenities invade the course of her thoughts and almost immediately escape from her lips - the patient does not have time to stop their utterance. Sometimes they seem to fade away on her lips - she whispers them almost mentally, but feels relieved if she somehow articulates them. It also happens that only one obsession remains - the patient is able to interrupt the speech process by force of will. In such cases, ready to utter the word that is asking from her tongue, she jumps up and says: “I should have said it, but I resisted, I resisted!” Using the example of this patient, we can therefore trace the phases that obsession goes through before becoming impulsive:

1. there is only one mental obsession,
2. there is the beginning of an impulsive act,
3. the word “flew out”, a complete impulsive disorder replaced an obsessive one.

There is another option: the word reaches the lips, but does not go further, and the patient thinks that she said it - she even hears how it echoed in distant places: in the fireplace, on the street. She really thinks she said it because she says, “That’s it.” Obsessions and impulsive acts are accompanied, as is always the case, by somatic reactions. When an obsessional word arises in her mind, she has an unpleasant sensation in her stomach - she says that, without any participation on her part, it rises from her stomach to her lips; As soon as she says it out loud, she immediately feels relieved. Her verbal obsessions are not always so harmless and elementary. Sometimes the patient begins to believe that every word spoken to her can cause harm to others. Then each of them is like a curse that she sends on this or that person. At these moments she calls herself a “despicable creature” who brings misfortune to her relatives and friends...”

The main types of obsessive thoughts can be divided into the following groups:

• fear of committing aggressive actions, fear of infection or contamination;
• causing insults, committing illegal acts, harming oneself or others;
• fear of diseases;
• doubts; blasphemous (“blasphemous”) thoughts;
• sexual phobias.

Painful obsessive doubts of various contents, among the manifestations of obsessive states they occur most often, both in clinical picture neurotic obsessive-compulsive disorder, and, in particular, in the structure of obsessive-compulsive personality disorder.

“The patient doubts everything because, due to disturbances in the course of ideas, he has lost his hidden logical form. Hence the morbid passion for precision, from which he builds a foundation for himself over the shaking soil beneath him. (a painful urge to check all your actions, for example, tirelessly locking doors or checking hidden things)" (Griesinger V., 1881). Due to constant doubts, the patient is extremely indecisive.

In general, weighing, doubts that arise when it is necessary to choose a certain course of action, are often found in healthy person. They are partly justified because they eliminate the possibility of error, but if they take too much time, then, by and large, they are fruitless and only indicate evasion of responsibility for decision. In most cases, successful people and optimists adhere to the principle, which in the words of I. Goethe sounds like this: “What you have done, believe me so insignificant / in front of the abundance of undone deeds.”

It is clear that a pessimist and a person who does not make a decision may end up winning, since he is “not to blame for the failure,” but more often he loses, since he does not make a decision at all, thereby missing a favorable moment for the implementation of his plans. Moreover, decisive actions can create a favorable environment for the implementation of plans, and in the course of taking actions, new and sometimes completely unexpected prospects often open up for a person.

A variant of the desire for completeness or completeness may be the need for an absolute understanding of this or that cognitive material, this or that hypothesis or concept.

Doubts may manifest themselves more pronounced if a person is in an unusual environment: moving to another city, adapting to new conditions, getting a job in a new team, starting an independent life, etc.

One of our patients said that the first manifestations of painful doubts appeared after she moved to Moscow to study at the institute and began to live an independent life separately from her family. As soon as she completed the task, she paid the phone or filled out some important document, she began to have doubts that she had made some serious mistake. To insure against mistakes, she forced herself to re-read everything she wrote before handing it over. But after some time the check stopped working. She began to get stuck more and more on little things, checking the accuracy of written numbers, spelling or stylistic errors. Even after repeated checks, doubts still remained. Sometimes, after sealing the envelope and going to the mailbox, she would open it again to make sure she hadn't made any mistakes. The whole process was repeated again. Of course, her mind told her that this was pointless and that she, in all likelihood, did not make the mistakes that she was so afraid of, however, each check calmed her down temporarily and did not provide a complete guarantee of eliminating mistakes.

With morbid suspiciousness, one is constantly haunted by a painful feeling of doubt about the correctness of the execution and completeness of certain actions.

With obsessive doubts, the patient can “paraphrase” the events of the day, conversations, endlessly making corrections and doubting the correctness of what was said. This may resemble watching a video recording of the same events of the day over and over again for several hours, during which the patient checks whether he acted correctly in a particular case.

Patients can spend several hours a day checking something in their home, in particular, noting whether this or that object is placed correctly (“in its place,” “symmetrically”).

Due to constant doubts about the correctness of the actions performed, even the simplest and most familiar of them can be performed for a long time.

Doubts may be accompanied by a kind of ritual verification of completed actions (turning off the lights, gas, water, closing the door, etc.)

In terms of frequency of occurrence, this variant of rituals, provoked by obsessive doubts, can only be rivaled by the fear of contamination and repeated hand washing.

Obsessive doubts in severe cases can lead to false intrusive memories. “So, the patient thinks that he did not pay for what he bought in the store. It seems to him that he committed some kind of theft and cannot remember whether he committed this act or not. These false memories apparently arise from a poor thought associated with obsession, but intense fantasy activity” (Perelman A.A., 1957).

Obsessive thoughts can be expressed in form fruitless philosophizing, mostly about religious and metaphysical subjects (“obsessive thinking”). Probably, a variant of fruitless philosophizing should be considered intrusive questions, the answers to which, as the patients themselves well understand, do not make sense to them: “What was the name of the mother of the person with whom the meeting took place?”, “How many meters are between the streets and squares?”, “Why does a person need a nose?” etc. In most cases, the questions are of an innocent or metaphysical nature - these people ask themselves questions: how much? When? etc. in relation to everything.

Intrusive questions occur both in personal and neurotic disorders, especially aggravated in combination with symptoms of depression.

Here, patients strive to get to the root, the essence of things; day after day, in “hopeless monotony,” the same thoughts are repeated, and moreover, in the form of violent questions, without purpose and without practical meaning. Every idea, every process of thought turns into some kind of endless screw for the patient, so that all sentences forcibly take the form of questions, and an endless burden of transcendental tasks falls on the consciousness.

H. Shulle (1880) gives the example of an intelligent patient (with a hereditary predisposition), who had to interrupt his reading at almost every sentence. When he read a description of a beautiful area, he immediately had a question: what is beautiful? How many kinds of beauty are there? Is beauty the same in nature and in art? Does objectively beautiful exist at all or is everything just subjective? Another patient, with a subtle philosophical education, with every impression, immediately became entangled in the metaphysical labyrinth of theoretical questions of knowledge: what is what I see? does it exist? what is existence? what am I? What is creation anyway? where does everything come from?

Sometimes in the endless questions tormenting patients, it is impossible to detect any connecting logical thread; sometimes it can be traced as a desire to discover the source of the problem and take control of it. In general, getting to the core is quite typical for many patients suffering from personality disorders.

Some patients constantly torment themselves with mathematical questions and make complex calculations in their minds.

It is interesting to note that for many people, intrusive questions arise in response to intense emotional experiences.

In some, relatively rare cases, a kind of obsessive “jump of ideas in the form of questions” may occur (Jahreiss W., 1928).

According to the 19th century French psychiatrist Legran de Sole, “obsessive thinking” can later turn into a fear of touching various metals and animals.

Subject religiosity, sounds in another circle of obsessive states. This, in particular, includes the pedantic conscientiousness of some believers who, still doubting the reality of the existence of God, or encountering obsessive seditious thoughts or images, fear punishment from him. These people, in order to get rid of the feeling of anxiety caused by the possibility of such punishment, begin to pray conscientiously, often attend church, trying to carefully follow all religious instructions (Abramowitz J., 2008).

Pedantry can manifest itself in a wide variety of forms. J. Abramowitz et al. (2002) developed a special, fairly reliable scale to assess the severity of pedantry (Penn Inventory of Scrupulosity - PIOS).

One of the types of obsessive ideas, perhaps a variant of morbid philosophizing, is the tendency to constantly obsessively count (“arrhythmomania”).

Here obsessions are combined with a desire to count. In cases of counting errors, severe anxiety arises, so the patient returns to the beginning.

Obsessive counting occurs at appropriate moments in the mood, is accompanied by a feeling of tension, and its end brings a feeling of relief. Counting usually concerns certain specific objects, for example, windows, signs, bus numbers, steps, oncoming people, etc. Often such counting is accompanied by corresponding movements and behavior.

People with mental work and a “mathematical bent” in nature, as well as exhausted and nervous women and patients recovering from serious illnesses are especially prone to obsessive counting.

Obsessive rumination or (“morbid philosophizing” or “mental chewing gum”) manifest themselves in the form of endless internal disputes, fruitless debates in which arguments for and against are given even in relation to everyday simple actions that do not require complex decisions.

Obsessive thoughts can also be expressed in the form of obsessive questions: persistent empty, absurd: “What would happen if a person was born with two heads?”, “Why does a chair have four legs”; insoluble, complex, metaphysical: “Why does the world exist?”, “Is there an afterlife?”; religious nature: “Why is God a man?”, “What is virgin birth? or sexual, etc.

Some questions reflect the patient’s suspiciousness: “Is the door closed?” “Are the lights and gas turned off?” It is interesting to note that in some patients with alcoholism, such obsessive questions are recorded during a hangover.

Sometimes obsessive thinking manifests itself in a tendency to “get to the root of things,” so that the same thoughts are repeated day after day in hopeless monotony and, moreover, in the form of violent questions, without purpose, without practical meaning. At the same time, “every process of thought turns into some kind of endless screw for the patient, so that all proposals forcibly take the form of questions, and an endless burden of transcendental tasks falls on the consciousness” (Schüle G., 1880).

In the literature devoted to “morbid philosophizing,” a case described in the second half of the 19th century is of interest: German doctor Berger, in which the paroxysm of “passion for philosophizing” was accompanied by a pronounced “vasomotor-sensory cycle of seizures” - which began suddenly with “volatile heat”, shortness of breath, twitching of the head and shoulders.

Obsessive contrast states(“contrasting obsessions”) include: obsessive feelings of antipathy, “blasphemous thoughts” and obsessive desires.

They are “contrasting” due to the fact that they are incompatible with the patient’s attitudes and are directly opposite to his views.

At the same time, persistent religious thoughts are most often found in people prone to hypocrisy.

An obsessive feeling of antipathy arises towards those close people who are especially dear or respected by the patient. “In obsessive thoughts of a contrasting type, other sides of the coin of the psyche of a given person appear. They can confirm the concept of K. Jung regarding the shadow (each experience subconsciously has its own shadow with the opposite emotional sign)” (Kempinski A., 1975).

Discussing contrasting obsessions with others, in our opinion, significantly increases the risk of committing them.

Laureate Nobel Prize I.A. Bunin in his story “The Cheerful Yard” brilliantly describes mortal danger talking about this kind of contrasting obsessions. “In childhood and adolescence, Yegor was sometimes lazy, sometimes lively, sometimes funny, sometimes boring... Then he took on a manner of chattering that would make him hang himself. The old man, the stove maker Makar, an angry, serious drunkard, under whom he worked, once heard this nonsense, gave him a cruel slap on the face. But after a while Yegor began to chatter even more boastfully about hanging himself. Not at all believing that he was choking, he one day finally fulfilled his intention: they were working in an empty manor house, and now, left alone in the echoing large hall with the floor and mirrors covered in lime, he looked around thievishly, and in one minute the belt whipped around vent - and, screaming in fear, hanged himself. They took him out of the noose unconscious, brought him to his senses, and twisted his head so hard that he roared and choked like a two-year-old. And since then I forgot to think about the noose for a long time.” However, after the death of his mother, to whom he was outwardly indifferent, cold and disdainful, he still committed suicide: “... began to listen to the approaching noise of a freight train... ... listened calmly. And suddenly he took off, jumped up the slope, throwing his torn sheepskin coat over his head, and threw his shoulder under the bulk of the train.”