Khandourina G.

SOCIAL APPROACHES TO TREATMENT AND

PREVENTION OF SOMATOFORM DISORDERS

(Co-operative aspects). FECOOPA. Khabarovsk. 2000, 3 p.

The growth of depressive disorders has been noticed all over the world. Some authors suppose it to be one disease - depression getting the form of evident melancholic affect. Depressive, anxiety and somatoform disorders can be examined together as they are exactly the disturbances that reflect epidemiological tendencies of psychic disturbances at present. According to the World Health Organization statistics over the last 10 years, spreading of depressive disorders exceeded 4,1%, and anxiety ones - 6,8% of the population. Spreading of somatoform disorders is within 20 - 25%.In the USA 10% of patients of this group are being examined in general hospitals. In Russia 60 - 80% of similar patients attend general hospitals. In half of cases physical complaints predominate.

    Somatoform disorders are characterized by long-term duration, considerable activity in seeking medical aid, intensive usage of health services` resources. Such patients are notable for low capacity for work, they are main clients of alternative medicine.

    Probably the growth of depressive, anxiety and somatoform disorders is a consequence of ethic illness, typical of modern society. "Morals of profit" overwhelming the world destroy traditional schemes which people used to correlate their ethic estimations with. Modern society in which having emotional disturbances is of no prestige may provoke transformation of depressive and anxiety disorders into somatoform ones. It’s obvious that there are specific psychological factors in modern culture which promote the growth of total number of negative emotions suffered such as despair, fear, agression, with their psychological processing being hampered.

    So, while forbidding separate emotions modern culture paradoxically gives birth to the emotions it intends to suppress. Overestimation of success and wealth excludes sorrow, despair and life displeasure but gives birth to depression. The worship of strength and competition are incompatible with the feeling of fear but they are exactly the factors that give rise to disturbance. The worship of ratio and veto on feelings lead to physiologic disorders being correlate of emotions.

    Living standard in civilized countries changes towards intensification. It’s favored by the development of means of communication, mass media and transport. It supposes the growth of load on the adaptation mechanism of human organism and personality. At the same time, deep mechanisms of man’s functioning, his need of safety, love, development are still rather conservative. They are conditioned by human biology. Eternal are such factors as family and social problems, egoism, envy, ambition. Such situation remains a dangerous basis for the development of pathological states of health.

    Hence the clinical neurology and its relative disciplines deal with psychogenic diseases ( vegetative, insomnia’s, motor) to an even greater degree.

    We have examined 270 patients with somatoform disorders in the neurological department. They are mostly young people ( the average age is 35,5 years).77% of them are women.70% of them have middle or low social status. In half of the cases the patients had previous pathology in the form of craniocerebral traumata, perinatal encephalopathy and pathological climacterium.

    Psychotraumatizing factors like conflicts of personal, family or professional character have been revealed in most cases. Such frustrations provoking somatoform disorders could last for some months up to a year or even more than 3 years.

Frequency of psychogenic factors :

-family problems -51%

-personal problems -26%

-professional problems -23%

    It’s obvious that family problems are most significant in the development of somatoform disorders. Family and personal factors cause such disorders more often than professional ones. It’s not surprising bearing in mind the fact that most patients are women.

    In the neurological department biological therapy aimed at recovery of the patients strength , and psychotherapy have been performed. Psychotherapy includes narcopsychotherapy. It’s performed over a patient in the state of trance making him realize his own resources, comprehend the symbolic sense of the symptom "the vital scenario", activize his intuition and fantasy. Transferring patient’s problems from somatic level to the other, mental one, makes it possible to solve these problems in socio-cultural sphere. This is the essence of psychotherapeutic treatment.

    But keeping the same psychotraumatizing, usual disharmonious interrelations, impossibility to realize "the principle of justice" makes further supporting therapy necessary. The way to solve such situations in social sphere is still unclear. It may be working out an adequate individual strategy of self-realization and self-consolidation in the surrounding world. It must be adequate to a man’s capacities and possibilities.

    The government is unable to provide the activity of psychotherapeutic service properly, while private practitioners are not interested in it. As a social factor is prevailing in the pathogenesis of somatoform disorders. it’s therapy should also be sociogenic.

    Correction of social factors can be realized under the following

circumstances :

a) the atmosphere of tough competition existing in the society should be replaced by an atmosphere of mutual aid and co-operation

b) the aim to achieve the top level of living standard and private success should be changed into point of outer criteria correspondence to individual criteria

c) it’s necessary to create favourable conditions for maximum revealing person’s abilities.

    To my mind, realization of standards based on simple and natural principles of justice, co-operation, violence suppression, and promoting group surviving, is possible when wide developing co-operative forms of public life organization.

    There were a lot of co-operative organizations in the Far-Eastern Republic which existed on our territory till the mid 1920s.To our regret, there are no co-operative societies in the Russian Far East nowadays. The main reason is complete absence of information about such organizations, esp. medical co-operatives. We have no information about both those ones having worked here before the USSR establishment and modern co-ops acting as members of the International Co-operative Alliance (ICA).

    In this connection, the only possibility of solving this problem may be to ask the ICA and its institutions specializing in the field of public health for such information.