Neuropsychiatric disorders, their treatment and prevention. Mental illnesses - causes, diagnosis and treatment. Hoarding or excessive generosity

Shekhar Saxena1, Eva Jané-Llopis2, Clemens Hosman3
1Shekhar Saxena, Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; 2Eva Jané-Llopis, Mental Health Programme, Regional Office for Europe, World Health Organization, Copenhagen, Denmark; 3Clemens Hosman, Department of Clinical Psychology, Radboud University Nijmegen, Department of Health Education and Health Promotion, University of Maastricht, The Netherlands
Prevention of mental and behavioral disorders: implications for policy and practice
© World Psychiatric Association 2006. Printed by permission

There is sufficient evidence indicating the effectiveness of interventions in reducing risk factors, enhancing protective factors, and preventing psychopathological symptoms and new cases of mental disorders. Macropolicy interventions aimed at improving nutrition, housing and education, or reducing economic instability have been shown to reduce the incidence of mental disorders. In addition, specific interventions aimed at increasing the resilience of children and adolescents through parenting, early interventions and programs for children at risk of developing mental disorders, such as those with a mentally ill parent, the loss of a parent or family disruption, have been shown to improve outcomes. mental health, weaken depressive symptoms and reduce the incidence of depressive disorders. Interventions for adults - from macro-policy policies, such as taxation of alcohol industry products or legislation on workplace, to individual support for individuals with signs of mental disorder - can reduce psychiatric morbidity and the associated social and economic burden. It has also been shown that exercise, social support and participation in public life improve the mental health of older people. Public mental health systems will benefit from the continued development of evidence by combining different assessment methods in low-, middle- and high-income countries. Translating the findings into policy and practice requires efforts at the international, national and local levels, including the development of concepts of legal capacity, protection, channeling mental health into the health system, as well as other policies, safe infrastructure and stability. Mental health professionals have an important role to play in improving the quality of evidence on the prevention of mental disorders, promoting mental health in communities, engaging stakeholders in program development, and (as health care professionals) in their practice.

IN last years Opportunities for the prevention of mental and behavioral disorders have emerged and significantly expanded. This article provides a brief overview of the evidence for the place of prevention of mental and behavioral disorders within overall health policy, briefly describes current evidence on typical preventive interventions, and makes suggestions for how they can become part of policy and practice. Readers wishing to obtain further information may refer to two publications published by the World Health Organization.

Universal, selective and specific preventive interventions belong to primary prevention. Universal preventive measures are aimed at the entire population that does not belong to a high-risk group, selective - at individuals or subgroups of the population in which the risk of developing mental disorders is significantly higher than average and is confirmed by biological, psychological or social risk factors. Specific preventive interventions are used for high-risk individuals who exhibit minimal but detectable signs or symptoms that predict the development of a mental disorder, or biological markers that indicate susceptibility to a mental disorder but do not meet the criteria for the disorder at that time.

Secondary prevention involves reducing the frequency of well-known cases of a disorder or disease in a population (prevalence) by early detection and treatment of diagnosable diseases. Tertiary prevention involves interventions aimed at reducing the severity of disability, improving the quality of rehabilitation and preventing relapses and exacerbations of the disease. This article is about primary prevention of mental disorders.

The difference between promoting mental health and preventing the development of a mental disorder lies in their target outcomes. Mental health promotion aims to positively stimulate it by improving psychological state, increasing competence and resilience, and by creating supportive living conditions and environments. Prevention of mental disorders is aimed at eliminating symptoms and, of course, mental disorders. Strategies that promote mental health are used as one means of achieving these goals. Mental health support, which includes measures to strengthen it in the population, may also have the additional effect of reducing the incidence of mental disorders. Good mental health is a powerful protective factor against the development of mental illness. However, mental disorders and good mental health cannot be described as conditions located at opposite ends of a linear scale, but rather as two overlapping and interrelated components of one separate concept of “mental health”. Prevention of mental disorders and promotion of mental health often occur within the same programs and strategies, involving much the same types of activities and producing different but complementary results.

Formation of a database for the prevention of mental and behavioral disorders

The need for evidence-based prevention of mental disorders has stimulated debate among researchers, practitioners, health promotion advocates and policymakers internationally. To paraphrase Sackett et al.'s definition of evidence-based medicine, evidence-based prevention and health promotion is defined as “the conscientious, accurate, and rational use of the best current evidence in selecting interventions for individuals, communities, and populations to minimize morbidity and create opportunities for people to gain greater control over and improve their health.” Evidence from systematic research will help avoid decision uncertainty due to lack of information or decisions based on biased assumptions, which would lead to unnecessary waste of time and resources or the funding of interventions with poor outcomes.

When making a positive decision, the use of scientific data becomes especially important if the consequences of the decision are large (for example, the choice of a new prevention program for implementation on a national scale). Given the high costs and lack of accountability in spending public money, it is imperative that such a decision be based on strong evidence showing that the program is effective and can pay for itself. Therefore, the use of evidence on the cost-effectiveness of these interventions is also important.

When assessing the value of scientific evidence, various factors must be taken into account. First, to avoid biased observations and unfounded conclusions, it is necessary to evaluate evidence in terms of its quality, determined by the adequacy of the research methods used. Evidence from several meta-analyses suggests that effect sizes are larger in studies that use established, high-quality methods. Second, the significance of the results themselves, including the strength and type of effects, should also be assessed. Third, the value of scientific evidence must be assessed in terms of its actual use and impact on decision making. Finally, data values ​​should be combined with other indicators that are also important when discussing the spread or selection of prevention programs, such as the transferability of programs to other situations or cultures, their adaptability and feasibility.

When assessing the quality of scientific evidence, perhaps one of the hottest debates is whether randomized controlled trials should be considered to best ensure the internal validity of results from complex interventions. Although the power of such trials is widely recognized and used in research into the effectiveness of preventive interventions, many scientists in the field have seriously objected to considering them as one single gold standard. Randomized controlled trials are designed to study causal factors at the individual level using single-component interventions under strictly controlled conditions, and are therefore suitable primarily for evaluating clinical or preventive interventions at the individual or family level. Many prevention interventions are targeted at schools, companies, communities or the population at large. These trials examine multicomponent programs in a dynamic community setting where many contextual factors are unlikely to be controlled. A rigorous randomized controlled trial design is not entirely suitable in this context, so to maintain its benefits in a community intervention setting, randomization should be carried out at the level of larger components such as classrooms, schools or community populations. However, the feasibility of such community-based randomized trials is limited for practical, political, financial or ethical reasons. When the use of randomization is opposed on ethical grounds, quasi-experimental studies, which use matching techniques to achieve comparability between treatment and control groups, and time series studies are valuable alternatives.

Building a database requires a step-by-step and sequential approach using different methods depending on the information required for a given decision. Sharing information internationally through common databases is essential to building a strong evidence base as well as a deep understanding of cultural factors.

Study of risk and protective factors

Risk factors are associated with an increased likelihood of developing more pronounced degree severity or with a longer course of severe health disorders. Protective factors are conditions that increase people's resilience to risk factors and disorders: they are defined as factors that modify, improve, or change a person's response to certain environmental risk factors that predispose them to impaired adaptive capacity.

There is compelling evidence of risk and protective factors and their association with the development of mental disorders. By their nature, both factors can be individual, family, social, economic or environmental. The presence of multiple risk factors, the absence of protective factors and the interaction of dangerous and protective situations generally give a cumulative effect, which predisposes individuals to mental disorders, then to increased vulnerability, then a mental disorder and finally a full-blown clinical picture of severe mental illness.

The main socioeconomic and environmental determinants of mental health are related to macro-issues such as poverty, war and inequality. For example, poor people often live without basic political agency, choice, and the right to security, which do not require proof. They often lack adequate food, shelter, education and health opportunities; different types of deprivation prevent them from leading a lifestyle that everyone values. Population groups living in poor socioeconomic conditions are at increased risk of poor mental health, depression and lower levels of subjective well-being. Other macro factors, such as urbanization, war and displacement, racial discrimination, and economic instability, are associated with increased symptom frequency and high incidence of mental disorders.

Individual and familial risk and protective factors may be biological, emotional, cognitive, behavioral, interpersonal, or related to the family context. They can have the greatest impact on mental health during particularly sensitive periods of life, and their influence can be passed on from one generation to the next. In table Table 1 lists the main factors that have been found to correlate with the development of mental disorders.

Preventive interventions should target modifiable determinants, including disease-specific determinants, as well as more typical risk and protective factors common to several mental health and mental disorders. Interventions that effectively target such typical factors can produce a wide range of preventive effects. There is also a relationship between mental and physical health: e.g. cardiovascular disease can cause depression and vice versa. Mental and physical health may also be linked by common risk factors, for example poor housing can worsen both mental and physical health.

A thorough understanding of the links between different mental disorders and between mental and physical health, as well as the pathways through which common and disease-specific risk factors contribute to mental health conditions, is required. However, sufficient evidence has been generated to justify the investment of government and non-governmental organizations in the development, dissemination and implementation of evidence-based programs and policies. For policymakers and other stakeholders, the most cost-effective and attractive investments are those that address risk factors and protective factors that have a large impact on or are common to a range of related issues, including social and economic ones.

Evidence for macro strategies that reduce the risk of developing mental disorders

Changes in policy, legislation and the deployment of resources can significantly improve the mental health of populations in different countries and regions. It has been proven that such changes, in addition to reducing the risk of developing mental disorders and improving mental health, have a positive impact on overall health, social and economic development of society.

Table 1. Mental health and mental disorders: risk and protective factors

There is strong evidence that improving the nutrition and development of children living in socioeconomically disadvantaged environments promotes normal cognitive development, improves educational achievement and reduces the risk of poor mental health outcomes, especially for children at risk or living in impoverished areas. The most effective intervention models are those that include supplementary nutrition and monitoring and promotion of development. These models combine nutritional support (eg, nutritional supplements) with psychological counseling and psychosocial support (eg, compassion, listening). It is believed that the cost of maintaining developmental charts (in which a child's body weight is plotted against expected weight) is also effective. In addition, iodine plays an important role in preventing mental and physical development delays and learning disabilities. Programs that supplement foods with iodine, along with iodized salt or water, ensure that children receive an adequate dose of iodine. Global programs, such as those supported by the United Nations Children's Fund (UNICEF), have brought the use of iodized salt to 70% of households worldwide. This protects 91 million newborns from iodine deficiency and indirectly prevents the development of related mental and physical disorders. physical health.

Poor housing is considered an indicator of poverty and a target for improving public health and reducing health inequalities. Evidence from a recent systematic review of studies examining the health effects of housing improvements suggests favorable mental and physical health outcomes. These include improved mental and physical health and less self-reported mental stress, as well as wider positive social impact on factors such as perceptions of safety, involvement in crime, social and community activities.

Low levels of literacy and education are major social problems in many countries, especially in South Asia and sub-Saharan Africa, and are more prevalent among the female population. Lack of education sharply limits individuals' ability to access economic benefits. Most countries have made impressive strides in improving literacy rates through better education programs for children, but much less effort has been directed at the current illiteracy among adults. It is expected that programs aimed at eradicating illiteracy, especially among adults, can provide tangible benefits by relieving psychological stress and promoting mental health. For example, ethnographic studies in India have shown that literacy programs have been highly successful in addition to skills acquisition. By bringing women together in a new social format that allowed them to receive information and gain new ideas, the classes served as a catalyst for social change. By participating in teacher volunteer campaigns, impoverished literate women and girls gained a sense of pride, self-worth, and purpose in life. Positive effects on mental health were mediated in a variety of ways, including increased quantitative reasoning skills that reduced the risk of being a victim of fraud, greater confidence in claiming rights, and overcoming barriers to opportunity. All of these gains are associated with preventing deterioration in mental health and reducing the risk of developing mental disorders.

In many developing countries, economic insecurity is a persistent source of stress and anxiety, which can contribute to symptoms of depression, mental illness and suicide. Non-governmental organizations, such as the Bangladesh Rural Development Committee, have developed poverty reduction programs targeting credit sources, gender equality, basic health care, education and human rights. Lending from such sources may reduce the risk of developing mental illness by eliminating a major cause of stress—the threat of informal borrowing. An evaluation of the Bangladesh Rural Development Committee's poverty alleviation programs targeting millions of the poorest people in Bangladesh finds that the psychological well-being of women members of the Committee is better than that of non-members.

Many community-based interventions focus on developing processes of empowerment and building a sense of belonging and social responsibility among community members. An example is the Communities Supporting Program initiative, which has been successful in several hundred communities in the United States and is currently being adopted and replicated in the Netherlands, England, Scotland, Wales and Australia. This initiative encourages communities to implement a violence and aggression prevention system by using local data to identify risk factors and develop appropriate interventions. This involves interventions at multiple levels simultaneously: at the community level (mass media, policy changes), at the school level (changes in management or teaching methods), at the family level (parenting classes) and at the individual level (e.g. improving social competence ).

Regarding addictive substances, effective regulatory measures are taken at the international, national, regional and local levels: levying a tax, limiting the availability of these substances and a complete ban on direct and indirect advertising.

Price is one of the most significant determinants of alcohol and tobacco use. An increase in tax that increases the price of tobacco by 10% reduces consumption tobacco products by about 5% in high-income countries and by 8% in low- and middle-income countries. The same pattern applies to alcohol: a 10% increase in price can reduce long-term alcohol consumption by almost 7% in high-income countries and, although data are very limited, by almost 10% in low-income countries. In addition, increasing alcohol taxes reduces the incidence and prevalence of alcohol-related liver disease, traffic accidents, and other intentional and unintentional injuries, such as domestic violence and the negative effects of alcohol-related mental illness.

Laws increasing the minimum legal drinking age are helping to reduce sales and problems among young drinkers. Reductions in hours and days of sale and fewer stores specializing in the sale of alcoholic beverages, as well as restrictions on access to alcohol, have been accompanied by a reduction in both alcohol use and alcohol-related disorders.

Evidence that interventions remove stressors and enhance resilience

Working with vulnerable populations to mitigate stressors and increase resilience helps effectively prevent the development of mental and behavioral disorders and promotes mental health. The following subsections provide some data relevant to different periods of life.

Infancy, childhood and adolescence

Data from home visits to pregnant women and young children, including maternal smoking, poor social support, poor parenting skills and early parent-child interactions, show that the health, social and economic consequences are of great public health importance . These included improvements in mental health for both mothers and newborns, reductions in health service utilization, and long-term reductions in behavioral problems after 15 years. When long-term outcomes are considered, these interventions may also be cost-effective.

Home visiting program for women during pregnancy and early infancy, a two-year home visiting program nurse poverty-stricken first-time pregnant teens is a prime example of a program with favorable outcomes for both mothers and newborns. Randomized controlled trials showed an increase in birth weight of almost 400 g, a 75% reduction in the number of preterm births, a more than half reduction in the number of emergency visits, and a significantly lower incidence of child abuse by teenage mothers . Employment among mothers increased by 82%, and the birth of a second child was delayed by more than 12 months. When children reached the age of 15, they were 56% less likely to have problems with alcohol and other psychoactive substances, the number of arrests decreased by the same amount, the number of convictions decreased by 81%, and the number of sexual partners decreased by 63%. The families were financially well off, and the government's spending on such families more than offset the cost of the program. However, it has been found that not all nursing and social worker programs are effective, and therefore there is a need to identify factors that predict the effectiveness of interventions.

Interventions for children from poor families aimed at improving cognitive functioning and language skills have contributed to better development cognitive functions, higher school performance and less severe behavior problems. For example, Project Perry, which spanned participants from preschool through adulthood, demonstrated favorable outcomes before ages 19 and 27 in lifetime arrest rates (40% reduction) and a sevenfold return on the government's economic investment in the program.

Parent coping training programs have also demonstrated significant preventative effects, such as the Incredible Years program, which provides behavioral interventions that enhance positive child-parent interactions, improve problem solving and social functioning, and reduce disruptive behavior at home and at school. . The program uses video-based modeling techniques that include modules for parents, school teachers and children.

Only two types of proactive strategies have been shown to be effective in preventing or mitigating child maltreatment: home visiting programs for high-risk mothers and self-defense programs for school-age children to prevent sexual abuse. Home visiting programs (such as the Pregnancy and Infant Home Visiting Program mentioned above) have shown that the number of verified cases of child abuse or neglect decreased by 80% within the first two years. Self-defense programs enable children to acquire the knowledge and skills needed to prevent their own victimization. These school-based programs are widely implemented in the United States in elementary schools. Well-controlled trials have shown that children feel better about their knowledge and skills. However, there is no evidence yet that these programs reduce the incidence of child maltreatment.

Children who have a parent with a mental illness, such as depression, have a 50% increased risk of developing a depressive disorder before age 20. The findings indicate that the intergenerational transmission of mental disorders is the result of an interaction of genetic, biological, psychological and social factors operating both during pregnancy and infancy. Interventions to prevent the intergenerational transmission of mental disorders target risk and protective factors, such as increasing family knowledge of the disorder, increasing psychosocial resilience in children, improving parent-child and family interactions, stigma, and the social network support. There are still very few controlled studies examining the effects of such programs, although they are promising, such as a randomized controlled trial of the effectiveness of a program targeting the cognitive functioning of group participants. This trial showed a reduction in new cases of depressive disorder and relapse from 25% in the control group to 8% in the intervention group during the first year after the intervention and from 31 to 21%, respectively, during the second year of follow-up.

School-based programs improve mental health through environmental interventions and teaching appropriate social-emotional behavior. Some interventions in a comprehensive approach are carried out across the whole school over a number of years, while others target only one part of the school (for example, children in one class) or a specific group of students at identified risk. The results were improved school performance, increased problem-solving skills and social competence, and decreased internalizing and externalizing problems such as depressive symptoms, anxiety, bullying, substance use, aggressive and delinquent behavior.

Ecologically focused interventions target contextual variables in the child's home and school. Programs that restructure the school environment (e.g., the School Transition Project) have been shown to influence the psychological climate of the classroom (e.g., the Good Behavior Game) or the entire school (e.g., the Norwegian Bullying Prevention Program*) improve emotional reactions and behavior and prevent or mitigate symptoms and associated negative outcomes.

Adolescents whose parents are divorced are more likely to drop out of school, have higher rates of pregnancy, internalizing and externalizing disorders, and are at higher risk of divorce and premature death. Effective school programs for children of divorced parents (e.g., child support group, intervention program for children of divorced parents), providing coping skills training using CBT techniques and social support, reduces stigma and reduces depressive symptoms and conduct problems, which was noted during one-year follow-up study. Programs aimed at improving parenting skills and coping with divorce-related emotional reactions in parents improve the quality of the mother-child relationship and mitigate internalizing and externalizing disorders in children. One six-year randomized follow-up study found a difference in the prevalence of mental disorders: in the experimental group, the one-year prevalence of diagnosed mental disorders among adolescents was 11% compared with 23.5% in the control group.

The death of a parent is associated with greater rates of anxiety and depressive symptoms, including clinical depression, behavioral problems, and lower academic performance. Although many interventions are available for bereaved children, few have been evaluated in controlled trials. A case in point is an intervention that simultaneously targeted children, adolescents, and surviving caregivers that promoted positive parent–child relationships, effective coping, good mental health among caregivers, improved discipline, and facilitated sharing of feelings and experiences. The effects were more pronounced in children who were at higher risk, meaning those who were already symptomatic at the start of the program.

Period of adulthood

Work stress and unemployment can worsen mental health and increase the incidence of depression, anxiety, burnout, alcohol use disorders, cardiovascular disease and suicidal behavior.

To reduce work stress, interventions should be aimed at either increasing workers' ability to cope with stressors or eliminating them in the work environment. Three types of strategies can be used to organize work environments: business and technical interventions (eg, increasing job variety, improving work processes and working conditions, reducing noise, reducing workload), clearly defining job responsibilities, and improving social relationships (eg, communication , conflict resolution), as well as interventions aimed at multiple changes aimed at both work and employees. Although there is national and international legislation regarding the psychosocial work environment that emphasizes risk assessment and risk management, most programs focus on reducing the cognitive appraisal of stressors and their subsequent effects, rather than reducing or eliminating the stressors themselves.

The most widely known universal interventions in response to job loss and unemployment include regulations governing job loss insurance and unemployment benefits, or regulations aimed at improving job security. Their availability varies widely in different parts of the world. A number of job regulations are aimed at reducing the risk of job loss and unemployment, including split pay, provisions guaranteeing employment with a given employer, reduced pay and reduced working hours. There is no empirical evidence of their potential to protect workers' mental health, although it is clear that they may reduce unemployment-related stress.

A number of programs support the unemployed by helping them return to paid work, such as the Workers' Club and the Jobs Scheme. These simple, low-cost programs combine basic job search skills with increased motivation, social support, and coping skills. In the United States and Finland, the workplace program was tested and replicated in large randomized trials. They demonstrated increased rates of reemployment, better quality and higher pay for jobs obtained, increased self-efficacy in job search and skill, and reduced symptoms of depression and distress.

Caregivers of the chronically ill and older adults are at increased risk of experiencing excessive stress and an increased incidence of new cases of depression. Many controlled studies examining the effectiveness of psychoeducational programs for family caregivers of older relatives indicate a reduction in burden, depressive symptoms, subjective well-being, and perceived caregiver satisfaction. Psychoeducational programs provide information about the person's illness and available resources and services, as well as training in how to effectively respond to problems that arise with the relative's specific illness. Such programs provide holding lectures, group activities and the use of printed materials.

Groups of elderly people

Mental health of older people with to varying degrees Various types of interventions improve effectiveness, including exercise, improving social support through companionship, and education for older people with chronic illness and their caregivers.
their people, early screening, treatment by primary care providers, and programs that use techniques to discuss life events. Prevention of traumatic brain injury, normalization of high systolic blood pressure and high serum cholesterol also appear to be effective in reducing the risk of dementia.

For example, exercise such as aerobics and tai chi provide both physical and psychological benefits to older adults, including greater life satisfaction, good mood and mental well-being, reduced psychological distress and symptoms of depression, lower blood pressure, and lower incidence of depression. falls. Other programs, although showing promising effects, require repeated studies, such as studies of the effectiveness of early mass screening of older people and case management, including different types of care. social assistance as a means of reducing depression and increasing life satisfaction.

Although depression is quite common among older people, there have been few controlled studies of the effectiveness of prevention. the specified disease and suicide in this population. There is some evidence of improved social relationships and decreased depressive symptoms among participants in a peer support program involving widows. Preliminary evidence also suggests that life-debriefing sessions and reminiscence therapy may reduce the risk of depression in older adults, particularly nursing home residents, although the beneficial effects appear to fade over time, suggesting need for ongoing support.

Depression is often observed in people with chronic or stressful somatic diseases. However, there are very few examples of effective programs in this area. Patient education techniques aimed at teaching prognosis and coping skills for chronic conditions have produced short-term beneficial effects, such as reducing symptoms of depression. Providing hearing aids to older adults with hearing loss may also promote better social, emotional, and cognitive functioning and reduce symptoms of depression.

From research evidence to strategy and practice

Evidence collected over the past few decades and summarized above clearly demonstrates that it is possible to reduce the risk of poor mental health and prevent the development of mental disorders. Next, an important task is to facilitate the use of the obtained data for strategy development and for practical work. This section summarizes some of the steps and factors that can facilitate international, national, and local efforts to prevent mental and behavioral disorders.

International level

A global advocacy campaign is needed to raise awareness of and confidence in mental health care about prevention work. The findings need to be widely disseminated among policymakers and the general population. Modern knowledge and resources to prevent mental disorders and promote mental health are unevenly distributed around the world. International programs are needed to support countries that do not yet have the capabilities and experience in this area. International curricula, especially in middle- and low-income countries, should be developed in collaboration with international organizations that already have the capacity and expertise to do so.

To strengthen the knowledge base, research evaluating the effectiveness of prevention should be expanded, especially through international collaboration. To achieve this, a network of collaborating research centers should be formed that respond to the needs of low-, middle- and high-income countries. Researchers should pay particular attention to multisite and replication studies examining the ability of program and policy designers to respond responsively to the cultural background of subjects. In addition, longitudinal studies should be conducted to examine the long-term effects of preventive interventions; research into the relationship between mental, physical and social health disorders; cost-effectiveness studies to identify the most effective strategies and determine the value of prevention beyond its mental health benefits; research to identify predictors of effects to improve cost-effectiveness.

State level

Government services should develop national and regional strategies for the prevention of mental disorders and the promotion of mental health as part of a public health strategy and in accordance with the principles of treatment and rehabilitation. Public policy should include action horizontally across different government sectors, such as security agencies environment, housing, social security, labor and employment, education, criminal justice and human rights. National governments and health insurers should allocate appropriate resources to implement evidence-based activities, including supporting the development of capabilities across multiple sectors with established responsibilities; funding training, education, implementation and evaluation research; promoting coordination between different sectors that are related to mental health.

Government services must develop national and local infrastructure to prevent mental disorders and promote mental health, and work in collaboration with other public health and public policy agencies. Government agencies and health insurance companies should allocate appropriate resources to implement evidence-based activities, including supporting the development of human resources across multiple sectors with established functional responsibilities; funding internships, education, program implementation, and evaluation research; promoting coordination between different sectors that are relevant to mental health.

Given the high comorbidity rates of mental disorders and poor physical health, comprehensive prevention strategies in primary care and skilled nursing are essential. Supportive prevention methods are needed along with increased resources and training for primary care and skilled nursing professionals.

To sustain beneficial public health outcomes over time, it is critical to build community accountability to support strategies to maintain stability within health authorities. Government authorities and implementers must choose programs and strategies that make use of existing infrastructures and resources. Mental health promotion and prevention components must be structurally integrated with existing effective health promotion programs and social policies in schools, workplaces and communities.

Local level

Preventive strategies should be based on systematic assessments of the needs of the public mental health system. To extend the impact of preventive interventions to the mental health of all populations, programs should be developed that are widely accessible to these groups. Program designers and implementers should consider evidence-based principles and conditions that can improve effectiveness and cost-effectiveness while improving mental and physical health, as well as social and economic benefits.

Providers have a responsibility to ensure that programs are culturally appropriate and appropriate, especially when they are evidence-based from other countries or cultures, or when they are used in communities and target populations that differ from those for whom they were originally developed. and tested. Adaptation of programs, even taking into account the cultural characteristics of its participants, must be subject to the principles of effective intervention and successful implementation. There is a need for greater understanding of the transferability of evidence-based programs and strategies, and the potential for adaptation and adaptation across different countries and cultures.

Practitioners and program implementers must ensure high quality implementation and the use of tools that improve quality and ensure accurate implementation of programs, such as software manuals, guidelines for effective implementation, training and expert advice.

Roles and responsibilities of mental health professionals

Mental health professionals, including psychiatrists, psychologists, psychiatric nurses, social workers, and other professionals trained in mental health, can and should play several roles to make the prevention of mental and behavioral disorders a reality. We will briefly describe them below.

As prevention advocates

Mental health professionals are committed to raising awareness and communication about prevention among policymakers, other professionals, and the general public, creating an environment conducive to prevention efforts. Currently, it is generally believed that mental disorders arise from an unknown cause and are almost impossible to prevent. To address these myths, correct information about the identified causes and possible methods to reduce the incidence and improve the course of mental disorders must be widely available.

As technical consultants for the development of prevention programs

With their knowledge base in place, mental health professionals should advise public health planners and program developers on opportunities to initiate preventative interventions or integrate mental health interventions with existing programs. The opportunity to fulfill this role is enormous, as most countries and communities have public health and social programs that can serve to prevent mental disorders. Even if no changes are required, the perception that the program is helping to prevent the development of mental disorders helps reinforce the need for continuation or expansion of the program.

As leaders or as working collaboratively with other professionals in prevention programs

In many cases, mental health professionals must play an active role in initiating prevention programs. This may be a leadership or active collaborator role, especially in an interdepartmental program. Some of the most effective prevention programs have been initiated by mental health professionals working closely with other professionals.

As scientific researchers

Mental health professionals should begin further research to evaluate the effectiveness of preventing mental disorders. It is known that there is far less research on mental health as part of all health research than the proportional burden of mental disorders, and even less research in low- and middle-income countries. Even among the available mental health studies, the effectiveness preventive measures has not been studied enough. Mental health professionals and researchers must correct this imbalance and build a better evidence base, especially in low- and middle-income countries. The evidence base for real-life implementation of prevention programs is particularly compromised: this gap is being addressed by systematic evaluation within existing prevention programs. Innovative proposals, especially those that are interdepartmental in nature and target multiple outcomes, are likely to help overcome funding gaps, increasing interest from potential funding agencies.

As medical specialists

Mental health professionals come into close contact with people with mental disorders and their families. The opportunity for primary prevention in these settings is enormous. People with one or more mental disorders (active or in remission) are more likely to develop another mental disorder. Preventative interventions among these people, even if they are in contact with mental health professionals, are ignored. An example would be preventing depression in people with a substance use disorder, or emotional disorders in a child with a specific developmental disorder.

Another way that mental health professionals can promote prevention efforts is by initiating preventive interventions with family members of individuals receiving mental health care. Preventive methods for children whose parents suffer from a mental disorder, who are at particular risk, can be highly effective, but, unfortunately, are rarely used. Mental health professionals must combine the provision of adequate medical helping patients receiving treatment, preventing the need for medical care among their family members in the future.

CONCLUSIONS

Preventing mental disorders is a public health priority. Given the gradually increasing burden of mental and behavioral disorders and the known limitations in their treatment, the only feasible method of reducing this burden is prevention. Sociologists and biologists have brought significant clarity to the role of risk and protective factors in shaping the development of mental disorders and poor mental health. Many of these factors are amenable to intervention and are potential targets for preventive and other appropriate measures. A wide range of evidence-based principles and strategies (in addition to those specific to specific mental disorders) are available for implementation to help prevent the development of mental and behavioral disorders. It has been established that preventive strategies mitigate risk factors, enhance protective factors, reduce psychopathological symptoms and more often prevent the development of certain mental disorders; they also improve mental and physical health and generate social and economic benefits.

Although sufficient evidence supports implementation of programs, additional efforts are needed to further expand the range of effective preventive interventions, improve their effectiveness and cost-effectiveness in changing environments, and enrich the evidence base. This requires regular evaluation of the effectiveness of programs and policies and their implementation, and a sufficient number of controlled scientific studies.

Mental health professionals must serve several important roles in the field of prevention, namely: prevention advocates, technical consultants, program managers, researchers, and prevention implementers. These roles are challenging but appear to be very rewarding responsibilities. However, the results of population-level prevention programs can only be expected after investing sufficient human and financial resources. Financial support should be directed toward the implementation of evidence-based prevention programs and strategies and the development of necessary infrastructure. In addition, investment in capacity building at the country level should be promoted through internships and an informed workforce. Much of the investment should come from the government, as it is ultimately responsible for the health of the population. Current resources for preventing mental disorders and promoting mental health are unevenly distributed around the world. International programs should aim to reduce this gap and support low-income countries to develop knowledge and experience in prevention, as well as strategies and interventions that take into account needs, cultures, contexts and opportunities.

Prevention of mental disorders and promotion of mental health should be an integral part of public health and related policies at local and national levels. Interventions to prevent mental disorders and promote mental health should be integrated into public policies that include different activities across different government sectors, such as the environment, housing, social welfare, labor and employment, education, criminal justice and defense human rights. This will create win-win situations across sectors, including a wide range of health, social and economic benefits.

LITERATURE

1. Hosman C, Jané-Llopis E, Saxena S (eds). Prevention of mental disorders: effective interventions and policy options. Oxford: Oxford University Press (in press).

2. World Health Organization. Summary report: Prevention of mental disorders - effective interventions and policy options. Geneva: World Health Organization, 2004.

3. Detels R, McEwan J, Beaglehole (eds). Oxford textbook of public health, 4th ed. Oxford: Oxford University Press, 2002.

4. Boddy D (ed). The evidence of health promotion effectiveness: shaping public health in a new Europe. A report for the European Commission. Brussels-Luxembourg: ECSC-EC-EAAEC, 1999.

5. Brown CH, Berndt D, Brinales JM et al. Evaluating the evidence of effectiveness for preventive interventions: using a registry system to influence policy through science. Addict Behav 2000; 25:955–64.

6. MacDonald G. A new approach for evaluating the effectiveness in health promotion interventions. In: Norheim L, Waller M (eds). Best practices: papers on quality and effectiveness in health promotion. Helsinki/Tallinn: Finnish Center for Health Promotion/Estonian Center for Health Promotion and Education, 2000: 155–62.

7. McQueen DV. Strengthening the evidence base for health promotion. Health Promot Int 2001; 16: 261–8.

8. McQueen DV. The evidence debate. J Epidemiol Community Health 2002; 56:83–4.

9. Rada J, Ratima M, Howden-Chapman P. Evidence-based purchasing of health promotion: methodology of reviewing evidence. Health Promot Int 1999;14:177–87.

10. Raphael D. The question of evidence in health promotion. Health Promot Int 2000; 15: 355–66.

11. Tones K. Beyond the randomized controlled trial: a case for judicial review. Health Educ Res 1997; 12:1–2.

12. Tones K. Evaluating health promotion: beyond the RCT. In: Norheim L, Waller M (eds). Best practices: papers on quality and effectiveness in health promotion. Helsinki/Tallinn: Finnish Center for Health Promotion/Estonian Center for Health Promotion and Education, 2000: 86–101.

13. Sackett DL, Rosenberg WM, Gray JA et al. Evidence based medicine: what it is and what it isn’t. Br Med J 1996; 312:71–2.

14. Jané-Llopis E, Hosman C, Jenkins R et al. Predictors of efficacy in depression prevention. Meta-analysis. Br J Psychiatry 2003; 183:384–97.

15. Tobler NS, Stratton HH. Effectiveness of school-based drug prevention programs: a meta-analysis of the research. J Prime Prev 1997; 18: 71–128.

16. Hosman CMH, Engels C. The value of model programs in mental health promotion and mental disorder prevention. Int J Ment Health Promot 1999; 1:1–14.

17. Schinke S, Brounstein P, Gardner S. Science-based programs and principles. Rockville: SAMHSA, Center for Substance Abuse Prevention, 2003.

18. McQueen DV, Anderson LM. What counts as evidence: issues and debates. In: Rootman I, Goodstadt M, Hyndman B et al (eds). Evaluation in health promotion: principles and perspectives. Copenhagen: World Health Organization, 2001: 63–82.

19. Nutbeam D. Achieving best practice in health promotion: improving the fit between research and practice. Health Educ Res 1996; 11: 317–25.

20. Nutbeam D. Measuring effectiveness of health promotion. In: Boddy D (ed). The evidence of health promotion effectiveness: shaping public health in a new Europe. A report for the European Commission. Brussels-Luxemburg: ECSC-EC-EAAEC, 1999: 1–11.

21. Nutbeam D. The challenge to provide ‘evidence’ in health pro-motion. Health Promot Int 1999; 14:99–101.

22. Speller V, Learnmouth A, Harrison D. The search for evidence of effective health promotion. Br Med J 1997; 315:361–3.

23. Jané-Llopis E, Katschnig H, McDaid D et al. Evidence base of interventions for mental health promotion and mental disorder prevention. A report of the EC Mental Health Working Party, Task-force on Evidence. Luxembourg: European Communities, 2006.

24. Rutter M. Resilience in the face of adversity. Br J Psychiatry 1985; 147:598–61.

25. Coie JD, Watt NF, West SG et al. The science of prevention: a conceptual framework and some directions for a national research program. Am Psychol 1993; 48: 1013–22.

26. Ingram RE, Price JM (eds). Handbook of vulnerability to psychopathology: risk across the lifespan. New York: Guilford, 2000.

27. World Bank. World development report: attacking poverty. Oxford: Oxford University Press, 2000.

28. Patel V, Jané-Llopis E. Poverty, social exclusion and disadvantaged groups. In: Hosman C, Jané-Llopis E, Saxena S (eds). Prevention of mental disorders: effective interventions and policy options. Oxford: Oxford University Press (in press).

29. World Health Organization. A critical link: interventions for physical growth and child development. Geneva: World Health Organization, 1999.

30. World Health Organization. The world health report 2002: reducing risks, promoting healthy life style. Geneva: World Health Organization, 2002.

31. United Nations Children's Fund. UNICEF annual report 2002. New York: United Nations Children’s Fund, 2002.

32. Thomson H, Petticrew M, Morrison D. Housing interventions and health - a systematic review. Br Med J 2001; 323:187–90.

33. Cohen A. Our lives were covered in darkness. The work of the National Literary Mission in Northern India. In: Cohen A, Kleinman A, Saraceno B (eds). World mental health casebook: social and mental health programs in low-income countries. London: Kluwer/Plenum, 2002: 153–190.

34. Chowdhury A, Bhuiya A. Do poverty alleviation programs reduce inequities in health? The Bangladesh experience. In: Leon D, Walt G (eds). Poverty, inequality and health. Oxford: Oxford University Press, 2001: 312–22.

35. Hawkins JD, Catalano RF, Arthur MW. Promoting science-based prevention in communities. Addict Behav 2002; 27: 951–76.

36. Anderson P, Biglan A, Holder H. Substance use disorders. In: Hosman C, Jané-Llopis E, Saxena S (eds). Prevention of mental disorders: effective interventions and policy options. Oxford: Oxford University Press (in press).

37. Brown H, Sturgeon S. Healthy start of life and reducing early risks. In: Hosman C, Jané-Llopis E, Saxena S (eds). Prevention of mental disorders: effective interventions and policy options. Oxford: Oxford University Press (in press).

38. Olds D. The Prenatal/Early Infancy Project: fifteen years later. In: Albee GW, Gulotta TP (eds). Primary prevention works. Thousand Oaks: Sage, 1997: 41–67.

39. Olds DL. Prenatal and infant home visiting by nurses: from randomized trials to community replication. Prev Sci 2002; 3: 1153–72.

40. Olds DL, Eckenrode J, Henderson CR et al. Long-term effects of home visitation on maternal life course and child abuse and neglect: fifteen-year follow-up of a randomized trial. JAMA 1997; 278:637–43.

41. Olds DL, Henderson CR Jr, Cole R et al. Long-term effects of nurse home visitation on children’s criminal and antisocial behavior: a 15-year follow-up of a randomized trial. JAMA 1998; 280:1238–44.

42. Villar J, Farnot U, Barros F et al. A randomized trial of psychosocial support during high-risk pregnancies. The Latin American Network for Prenatal and Reproductive Research. N Engl J Med 1992; 327:1266–71.

43. Schweinhart LJ, Barnes HV, Weikart DP. Significant benefits: the High/Scope Perry preschool study through age 27. Monographs of the High/Scope Educational Research Foundation, 10. Ypsi-lanti: High/Scope Press, 1993.

44. Schweinhart LJ, Weikart DP. The High/Scope preschool curriculum comparison study through age 23. Early Child Res Q 1997; 12: 117–43.

45. Webster-Stratton C, Reid MJ. The Incredible Years parents, teachers and children training series: a multifaceted treatment approach for young children with conduct problems. In: Kazdin AE (ed). Evidence-based psychotherapies for children and adolescents. New York: Guilford, 2003: 224–40.

46. ​​Webster-Stratton C, Reid MJ, Hammond M. Preventing conduct problems, promoting social competence: a parent and teacher training partnership in Head Start. J Clin Child Psychol 2001; 30: 283–302.

47. Hoefnagels C. Preventing child abuse and neglect. In: Hosman C, Jané-Llopis E, Saxena S (eds). Prevention of mental disorders: effective interventions and policy options. Oxford: Oxford University (in press).

48. Rispens J, Aleman A, Goudena PP. Prevention of child sexual abuse victimization: a meta-analysis of school programs. Child Abuse Negl 1997; 21:975–87.

49. Beardslee W, Keller MB, Lavori PW et al. Psychiatric disorder in adolescent offspring of parents with affective disorder in a non-referred sample. J Affect Disord 1988; 15: 313–22.

50. van Doesum K, Hosman C, Riksen-Walraven M. A model based intervention for depressed mothers and their infants. Infant Ment Health J (in press).

51. Clarke GN, Hornbrook M, Lynch F et al. A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Arch Gen Psychiatry 2001; 58:1127–34.

52. Domitrovich C, Weare K, Greenberg M et al. Schools as a context for the prevention of mental health disorders and promotion of mental health. In: Hosman C, Jané-Llopis E, Saxena S (eds). Prevention of mental disorders: effective interventions and policy options. Oxford: Oxford University Press (in press).

53. Felner RD, Brand S, Adan A et al. Restructuring the ecology of the school as an approach to prevention during school transitions: longitudinal follow-up and extensions of the School Transitional Environment Project (STEP). Prev Hum Serv 1993; 10: 103–36.

54. Kellam SG, Rebok GW, Ialongo N et al. The course and malleability of aggressive behavior from early first grade into middle school: results of a developmental epidemiologically-based preventive trial. J Child Psychol Psychiatry 1994; 35: 259–81.

55. Olweus D. Bully/victim problems among schoolchildren: basic facts and effects of a school-based intervention program. In: Rubin K, Heppler D (eds). The development and treatment of childhood aggression. Hillsdale: Erlbaum, 1989: 411–48.

56. Wolchik SA, West SG, Westover S et al. The children of divorce parenting intervention: outcome evaluation of an empirically based program. Am J Community Psychol 1993; 21: 293–31.

57. Wolchik SA, West SG, Sandler IN et al. An experimental evaluation of theory-based mother and mother-child programs for children of divorce. J Consult Clin Psychol 2000; 68:843–56.

58. Sandler I, Ayers T, Dawson-McClure S. Dealing with family disruption: divorce and bereavement. In: Hosman C, Jané-Llopis E, Saxena S (eds). Prevention of mental disorders: effective interventions and policy options. Oxford: Oxford University Press (in press).

59. Wolchik SA, Sandler IN, Millsap RE et al. Six-year follow-up of preventive interventions for children of divorce. A randomized controlled trial. JAMA 2002; 288:1874–81.

60. Sandler IN, Ayers TS, Wolchik SA et al. The family bereavement program: efficacy evaluation of a theory-based prevention program for parentally bereaved children and adolescents. J Consult Clin Psychol 2003; 71:587–600.

61. Price R, Kompier M. Work, stress and unemployment. In: Hosman C, Jané-Llopis E, Saxena S (eds). Prevention of mental disorders: effective interventions and policy options. Oxford: Oxford University Press (in press).

62. Caplan RD, Vinokur AD, Price RH et al. Job seeking, reemployment, and mental health: a randomized field experiment in coping with job loss. J Appl Psychol 1989; 74:759–69.

63. Price RH, van Ryn M, Vinokur AD. Impact of a preventive job search intervention on the likelihood of depression among the unemployed. J Health Soc Behav 1992; 33: 158–67.

64. Vinokur AD, Schul Y, Vuori J et al. Two years after a job loss: long-term impact of the JOBS Program on reemployment and mental health. J Occup Health Psychol 2000; 5:32–47.

65. Vuori J, Silvonen J, Vinokur AD et al. The Työhön job search program in Finland: benefits for the unemployed with risk of depression or discouragement. J Occup Health Psychol 2002; 7:5–19.

66. Sorensen S, Pinquart M, Duberstein P. How effective are interventions with caregivers? An updated meta-analysis. Gerontologist 2002; 42: 356–72.

67. Li F, Duncan TE, Duncan SC. Enhancing the psychological well-being of elderly individuals through Tai Chi exercise: a latent growth curve analysis. Structural Equation Modeling 2001; 8:53–83.

68. Shapiro A, Taylor M. Effects of a community-based early intervention program on the subjective well-being, institutionalization, and mortality of low-income elders. Gerontologist 2002; 42:334–41.

69. Haight BK, Michel Y, Hendrix S. Life review: preventing despair in newly relocated nursing home residents: short-and long-term effects. Int J Aging Hum Develop 1998; 47: 119–42.

70. Riemsma RP, Kirwan JR, Taal E et al. Patient education for adults with rheumatoid arthritis (Cochrane Review). In: The Cochrane Library, Issue 4, 2002.

71. Mulrow CD, Aguilar C, Endicott JE et al. Quality-of-life changes and hearing impairment. A randomized trial. Ann Intern Med 1990; 113:188–94.

72. Rochon PA, Mashari A, Cohen A et al. Relation between randomized controlled trials published in leading general medical journals and the global burden of disease. Can Med Assoc J 2004;170:1673–7.

73. Paraje G, Sadana R, Karam G. Increasing international gaps in health-related publications. Science 2005; 308:959–60.

74, Saxena S, Paraje G, Sharan P et al. The 10/90 divide in mental health research: trends over a ten year period. Br J Psychiatry 2006; 188:81–2.

Mental health is associated with the third purpose of human existence - the need for self-realization as an individual, i.e. it provides that sphere of life that we call social. A person realizes himself in society only if he has a sufficient level of mental energy that determines his performance, and at the same time (residual plasticity, harmony of the psyche, allowing him to adapt to society and be adequate to its requirements.

Stress- a protective-adaptive reaction of the body in response to extremely strong or long-acting stimuli.

Distress- a form of stress, “bad stress”, a negative nonspecific reaction of the body to any adverse external influence, a syndrome that acquires the role of a pathological factor.

Neurotic disorders is a group of psychogenically caused painful conditions, united by three main characteristics:

• all of them belong to functional types of disorders, i.e. they are not accompanied by organic brain damage;
• have a neurotic level of manifestation, i.e. the patient, regardless of the severity of the condition, does not lose contact with reality;
• the disorder has a clear temporal connection with the factor that provokes it.

Prevention of mental stress

Increasing resistance to mental stress. It consists of psychologically preparing a person to face stressful situations, equipping him with the appropriate philosophy, as well as acquiring skills to manage his mental state.

Reacting negative emotions. It can be immediate or in a later simulated situation. Depending on the type of psychosomatic constitution, the forms of response can be different: aggression with motor excitement (more often in choleric people, people with an athletic constitution), verbal excitement with swearing (more often in sanguine people), tears (in people of a melancholic nature).

Psychocorrection. In case of acute short-term stress, they may include: a set of movements for internal utilization of adrenaline); relaxation in all possible ways; self-hypnosis; the use of external relaxing influences (music, smells, natural factors).

Pharmacological correction, which includes the use of drugs or herbs (adaptogens), mainly of a sedative nature.

It is necessary to use methods of relieving stress reactions, such as:

• deep healthy sleep, sufficient in duration;
• increased physical activity as a result of sports training, general cleaning, jogging, hunting (during muscle activity, excess adrenaline, the chemical cause of stress, is burned);
• various types of trainings conducted independently or with the help of specialists - a social worker or psychologist (meditation, autogenic training, group training);
• doing a favorite or monotonous activity (knitting, watching fish, fingering rosaries, playing solitaire, fishing);
• neuro-emotional release through laughter, crying, screaming (there is even a special treatment method - laughter therapy);
• sex, etc.

There are effective interventions to improve mental health

• Early childhood interventions (e.g. home visits for pregnant women, preschool psycho-social interventions, combination of nutritional and psycho-social interventions in disadvantaged populations);
• Child support (e.g. skills programmes, child and youth development programmes);
• Providing socio-economic opportunities for women (eg improved access to education, microcredit schemes);
• Social support for older people's populations (eg befriending initiatives, day centers and community aged care centres);
• Programs targeting vulnerable groups, including minorities, indigenous peoples, migrants and people affected by conflicts and natural disasters (eg post-disaster psycho-social interventions);
• Activities to promote mental health in schools (eg programs supporting green change in schools, child-friendly schools);
• Mental health interventions at work (eg stress prevention programmes);
• Policies to solve housing problems (for example, improving housing conditions);
• Violence prevention programs (e.g. community policing initiatives)
• Community development programs (e.g. Communities that Caring initiatives, integrated rural development)

Effective measures to prevent mental and neurological disorders often fall outside the routine activities of mental health professionals (indeed, they are often not related to health care at all). This is one possible reason why many mental health professionals tend to underestimate the potential for primary disease prevention in their field.

The concept of primary prevention refers to methods aimed at preventing the occurrence of a specific disorder or group of disorders. This definition includes measures applied to a specific disease or group of diseases to stop the effects of their causes before they affect people.

“Primary prevention” should be distinguished not only from treatment and

rehabilitation of patients, but also from propaganda healthy image life.

The latter implies “...procedures used to improve

health, not aimed at any specific disease or

disorder and serve to improve general health and

well-being" and is only one aspect of primary disease prevention.

The distinction between primary, secondary and tertiary prevention is given in Appendix 1.

When discussing primary prevention measures for mental, neurological and psychosocial disorders, a number of factors need to be taken into account:

Features:

Primary prevention measures, especially in sociocultural

context, inevitably affect a number of factors in addition to those they are aimed at; Thus, many conditions that create a predisposition to one disease can also cause other disorders. Before the onset of a particular disease, we cannot determine who exactly will develop it and whether it will manifest itself at all. Therefore, any recommendations for prevention must be made in the context of a broader conceptual model. A remarkable aspect of the prevention of mental, neurological and psychosocial disorders is the fact that relatively simple and inexpensive interventions can produce benefits that far exceed the original goal.

The numerous causes of mental, neurological and psychosocial disorders differ in origin, consequences, mechanisms of action and timing. There are no simple and quick solutions to complex and varied problems in society and health.

Prevention efforts must reflect the understanding that human behavior is the deciding factor. Effective disease prevention requires changes not only in the behavior and attitudes of individuals, but also in social systems.

Methodology

Since it is impossible to discuss methods of primary prevention for all forms of mental, neurological and psychosocial

diseases, it was decided to select a number of them based on the following criteria:

Frequency- morbidity; prevalence of the disease.

Severity- measured by the level of mortality or the degree of dysfunction and disability, the group of disabilities that a given disease causes in a person, or the burden that the family, the public and society as a whole are forced to bear.

Importance- the existence of a certain level of concern expressed by the public or health professionals regarding of this disease regardless of severity.

Possibility of control- is determined by the existence of productive, expedient and, therefore, effective and effective methods disease control (see below for definitions of productivity, efficiency and effectiveness).

Expenses- include expenses for technical devices, equipment, medical supplies and personnel necessary for specific activities.

Based on these criteria, the following disorders have been selected for consideration in this lecture: mental retardation, epilepsy, suicide and burnout among medical and social workers.

Indicator

In the health field, the following indicators are useful when assessing preventive measures:

Effectiveness- the usefulness and practicality of the treatment, regimen, drug, preventive or control activity used or advocated for the patient.

Efficiency- the final results of the activity, its usefulness for the population with from the point of view of the goals set.

Productivity, expediency- the final results achieved, taking into account the efforts expended in terms of financial, material resources and time.

PRINCIPLES OF PRIMARY PREVENTION

MENTAL RETARDATION

is a disorder that affects more than 120 million people worldwide. It manifests itself under a variety of conditions, being a consequence of a wide variety of causes (more than 1000), many of which are completely preventable.

“Mental retardation is understood as a state of delayed or incomplete development of the psyche, which is characterized mainly by a deficiency in the skills that determine the general level of intelligence, that is, cognitive, speech, motor and social abilities, manifested during the period of development. Retardation can be observed in combination with any other mental or somatic disorder or without such a combination. However, people with mental retardation may suffer from a wide range of mental disorders, and the incidence of other mental disorders in this population is three to four times higher than in the general population. In addition, individuals with mental retardation are at higher risk of exploitation and physical/sexual abuse. Their adaptive behavior is always impaired, but in a protected social environment where support is available, this impairment may be completely unnoticeable in persons with mild mental retardation.”

The ICD-10 classification distinguishes four different degrees of mental retardation.

Mild mental retardation – IQ in the range of 50 to 69 points

Moderate - IQ is usually in the range of 35-49.

Severe - IQ usually ranges from 20 to 34 points

Deep – IQ score below 20 points;

FETAL ALCOHOL SYNDROME

This syndrome is characterized by mental retardation, neurodevelopmental abnormalities, growth retardation, craniofacial abnormalities, and congenital heart defects.

Risk factors. A number of warning signs and warning signs of alcohol abuse have been identified that may be useful in identifying people, including pregnant women, who are at risk of becoming alcohol abusers. The most common risk factors are:

history of addiction to drugs, alcohol or tobacco in family members;

Single-parent family (for example, divorced parents);

Low income and low socio-economic status;

Connecting with peers who are addicted to drugs or alcohol;

Poor working conditions.

Due to genetic characteristics, family history, or long-term behavior patterns, a person with a family history of drug, alcohol, or tobacco addiction is more likely to develop alcohol use problems. For example, children of alcohol-dependent parents are 3 or 4 times more likely to start drinking alcohol than others, even if they were raised separately from alcoholic parents.

Other confirmed factors for its development include:

Negroid race;

Frequent drinking of beer;

Low weight or sudden weight gain in the mother.

In typical cases, pregnant women who abuse alcohol are often older, have given birth multiple times, smoke, and have a high divorce rate.

Health care settings are the primary setting for prevention efforts to address problems associated with alcohol use during pregnancy because, for most women, this is a time in life when contact with health services and personnel increases in intensity and frequency. Identifying medical, including psychiatric, problems that may harm the fetus is a priority for health services responsible for working with pregnant women.

Screening and early detection are particularly effective preventive measures in the fight against conditions such as ASP.

PHENYLKETONURIA

For normal human growth and development, phenylalanine is required, which is contained in any natural protein food. However, if one of the liver enzymes, phenylalanine-4-hydroxylase (PGL), which is responsible for the metabolism of phenylalanine in the body, is deficient, the latter accumulates in the blood and urine. It is believed that it is excess phenylalanine or one of its metabolites that inhibits biochemical processes necessary for normal brain development. There are at least three types of this condition, of which only one (the most common) can be successfully prevented. Many researchers have suggested a relationship between the severity of damage caused by phenylketonuria (PKU) and the level of PGL in the mother's blood. Reduced intelligence should be expected in 95% of untreated or late-diagnosed children with PKU. In addition to mental retardation, common clinical symptoms of PKU include seizures, hyperactivity, and eczema; however, a clinical diagnosis is rarely made before the child reaches six months of age, usually after symptoms appear. obvious signs mental retardation. In many countries, newborn screening allows early diagnosis of PKU, which can help prevent brain damage by prescribing a diet low in phenylalanine. Proper dietary treatment for patients with classic PKU, begun before the child reaches four weeks of age, is highly effective in reducing the severity of mental disorders. Once dietary therapy is started, periodic laboratory testing of blood phenylalanine levels helps ensure that the diet is providing the required low levels. A relatively new problem is that many girls with PKU who were treated early are now reaching childbearing age and are at risk of having children with mental retardation, microcephaly, congenital heart defects and low birth weight.

In this case, diet control during pregnancy is an important preventive measure; Dieting by the mother serves as partial and sometimes complete protection for the fetus, especially if it begins before conception.

All infants under seven days of age, regardless of prematurity, disease, feeding history, or antibiotic treatment, should be screened for PKU.

Effective implementation of a preventive program for maternal PKU is carried out in four stages: 1. Prevention of unplanned pregnancy. 2. Making a decision to have a child. 3. Starting a dietI. 4. Continue following the diet throughout pregnancy.

Actions to prevent mental retardation Raising awareness among the population should be a core part of any preventive program. Up to 15% of cases of mental retardation can be prevented by addressing the causes of diseases that may lead to mental retardation, as in the following examples: Iodine deficiency disorders Iodization of table salt or water supplies. Treatment of people at risk with iodized oil or Lugol's solution. Down syndrome Recommendations for women over 35 years of age to refrain from childbearing. Performing amniocentesis during pregnancy in women over 35 years of age. Fetal alcohol syndrome Using screening tests to identify women at risk. Recommendations for women to abstain from drinking alcohol during pregnancy. Warning women that drinking alcohol close to conception increases the risk to the baby. Phenylketonuria Screen all newborns for the diagnosis of phenylketonuria. Treatment with a special diet low in phenyl alanine. Recommendations for women with phenylketonuria to abstain from childbearing.

EPILEPSY

The condition, characterized by recurrent epileptic seizures, affects approximately 1 in 100 people and poses a significant burden on patients, their families, and the economies of both developed and developing countries. Of the 50 million people worldwide suffering from epilepsy today, at least half receive poor quality treatment or no treatment at all. Moreover, some patients receive medical care only when their seizures cause injury.

Prenatal causes Many people with epilepsy come from families in which some members had uncomplicated epilepsy or epilepsy with symptoms such as mental retardation, developmental abnormalities, or movement disorders

Signs of epilepsy have also been identified in persons with congenital toxoplasmosis. Postmortem autopsies of individuals with epilepsy have revealed a high incidence of abnormalities in the development of the central nervous system, in particular ectopia and abnormal neuronal migration.

SUICIDE

In order for the act of causing one's own death to be reasonably called suicide, it must be deliberately conceived and carried out by the person with full knowledge or expectation of the fatal outcome of his actions. Suicidal acts that do not result in death are called suicide attempts, suicide attempts, parasuicides, or acts of deliberate self-harm. There is a growing tendency among experts in the field of suicidology to expand the concept of suicide, which they propose to replace with the concept suicidal behavior

Risk factors

The presence of mental disorders (including alcohol and drug abuse) is the most significant risk factor for suicide,

Psychiatric diagnoses

Note: * - The number of diagnoses exceeds the number of patients, since some patients received more than one diagnosis.

BURNOUT SYNDROME

Stress may be caused by the following work situation and organizational factors in health services:

Overload with responsibilities or patients served and insufficient structured breaks;

Neglect of client needs while preferentially respecting the administrative, financial and bureaucratic interests of the institution itself;

Inadequate leadership and/or supervision;

Lack of work-specific training and orientation;

Lack of a sense of influence or control over the work situation; lack of social interaction and support between team members;

The predominance of exceptionally difficult clients among supervised patients;

Dedication of most of the time to administrative and “paper” work.

NEUROLOGICAL DISORDERS

These are diseases of the central and peripheral nervous system, in other words, diseases of the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular nodes and muscles. These disorders include epilepsy, Alzheimer's disease and other types of dementia, cerebrovascular disease including stroke, migraine and other types of headaches, multiple sclerosis, Parkinson's disease, neuroinfections, brain tumors, traumatic disorders of the nervous system such as brain injuries, and neurological disorders resulting from malnutrition.

Hundreds of millions of people around the world suffer from neurological disorders. More than six million people die from stroke each year; more than 80% of deaths occur in low- and middle-income countries. More than 50 million people in the world suffer from epilepsy. An estimated 47.5 million people worldwide have dementia, with 7.7 million new cases occurring each year. The leading cause of dementia is Alzheimer's disease, which accounts for 60-70% of dementia cases. The prevalence of migraine in the world exceeds 10%.

The reason for writing this work was a consultation in which an unhappy mother sought my help: her teenage son was facing a serious psychiatric diagnosis, and she wanted to join the fight for her son, but did not know what exactly she could do, and how to do it It turned out she could do quite a lot. Her attitude towards her son, on the one hand, was completely anomalous, on the other hand, this anomaly was easily corrected as soon as I paid attention to it. So I thought that it was necessary to present these simple and clear arguments and it is quite possible that this simple hygiene of mental relationships will save many young men and women from madness, how much benefit humanity has brought from understanding the need to wash your hands before eating.

For those who are interested, the theory of the issue (in brief). The main reason for most mental disorders that first manifest themselves in adolescence lies in the unsatisfactory resolution of the Oedipus complex in boys and the Electra complex in girls. I talk a lot about the Oedipus-Electra complex on the pages of my website; those interested can inquire. The Oedipus-Electra complex is a man’s artificially formed idea of ​​himself and the world, giving him the opportunity to maintain a sense of ownership over death. There are many internal contradictions in this complex, which, if they are fundamentally irreconcilable, drive a person crazy. The main such contradiction is the need to be “married” to the mother (pushing the father away from the mother), to be married to the father (pushing the father away from the mother), and the need to avoid sex with the mother (father). It is unacceptable for a boy to lie with his mother because in this case the mother turns into a woman for him and he, thus, finds himself in the world, both without a mother and without a father, who, at a minimum, will not forgive him for this, and at most, simply , will destroy. It is unacceptable for a girl to lie with her father because in this case her mother becomes her, at a minimum, an irreconcilable competitor, at a maximum she will destroy her physically, in any case she loses her mother. But the girl also loses her father, as he turns into her man. Thus, incest is unacceptable, but it is in the air, since it is presupposed by the logic of the rejection of the father from the mother.

The situation gets worse in adolescence, since it is by that time, for some earlier, for others later, that the brain structures responsible for the instinct to procreate mature. The teenager becomes physically ready for sex, and incest, which was previously objectively impossible, becomes quite possible, which extremely aggravates the problem. Previously, this problem was anticipated by the child, but one could not think about it, since incest was “technically” impossible, but now it has become possible, and accordingly the level of danger has increased incredibly. The crisis of adolescence is caused precisely by the emergence of the “technical” possibility of incest and consists in the teenager’s suppression of this possibility. To suppress the possibility of incest, the teenager takes all the measures he is capable of: first of all, this is, of course, negativism and aggression; there is no more reliable way to avoid sexual relations than conflict. We, in fact, call the measures taken by a teenager a teenage crisis. In this case, we are not interested in the crisis of adolescence itself, but in possible help in overcoming it.

What we can do? We cannot get into the child’s “head”; he does not consider himself sick and does not want to communicate with either a psychotherapist or a psychoanalyst; accordingly, we cannot correct his diagram of the Oedipus-Electra complex from the inside, but it turns out that we can correct it from the outside . Studying the structure of the Oedipus-Electra complex, we discover that an important role in the structure of the complex is occupied by the child’s idea that the parent of the opposite sex himself wants sexual relations with him. The girl is convinced that her father cannot wait until she grows up, the boy, accordingly, is convinced that his mother is ready to claim her sexual rights over him as soon as this becomes possible.

And this idea is much closer to the consciousness of a teenager than one might expect; often it is a completely conscious idea. For example, one of my young patients, who had two trips to a psychiatric hospital and was diagnosed with asthenodepressive syndrome, was completely convinced that his mother was waiting for him to pluck up the courage and finally engage in her sexual satisfaction. He didn’t have enough courage, apparently it was very scary, and he ran away from her to Moscow, where he came to me with a completely upset psyche and crazy plans to put his mother to sleep with ether and satisfy her while she slept. He needed euthanasia to relieve his mother of responsibility for this action. In response to my doubts regarding the consent of the mother herself, he no less reasonably cited facts that can be interpreted as the mother’s sexual interest in him. Only after two years of analysis was he able to tear his libido away from his mother and switch it to another woman; it took him another two years to consolidate this success. I think that if he did not have these facts to interpret, then his psyche would have lived much calmer.

Or another example. At a consultation, a woman in her forties asks for help in sorting out her relationship with her son, which she thinks she is building incorrectly. Along the way, it turns out that the teenage son has become infected with nationalism and has become extremely intolerant not only of strangers, but also of her. Previously kind and sympathetic, he turned into an aggressive person alien to her, in addition, he found himself in prison under investigation, and she was completely confused by all these unexpected changes. In order to understand the details of the conflict, I assumed that there was an aggravation of the sexual component of the Oedipus complex, which is what I spoke about above. Hearing about this possible reason, the woman suddenly burst into tears and said that not long ago, to her utter horror, her son came out of the shower completely naked with an erect penis and asked her to have sex. During the consultation, it turned out that the woman had completely gotten used to the role of a little girl, and she delegated the role of a father, necessary according to the scenario, to her son (she did not have a husband), who, at less than fifteen years old, should be her protection and support. With the educational goal of being closer to her son, she strove to become part of their teenage company and participate on an equal basis with other girls in their midnight get-togethers. In appearance and manner of speaking, she really looked like a little girl. Knowing the peculiarities of the construction of the Oedipus complex and the peculiarities of her relationship to her son, the incestuous proposal made to her does not seem so strange.

What I’m saying for now is that the idea of ​​a lustful mother (father) is much closer to the consciousness of a teenager than one might assume when looking at them from the outside. And this is good, no matter how paradoxical it may sound. This idea turns out to be the only way to correct the Oedipus-Electra complex. A parent, with his competent behavior, can block this idea, and thereby significantly reduce the stress of a problem that is insoluble for his child.

The set of measures that the opposite parent can take to reduce the sexual problems of the Oedipus-Electra complex is determined by the need to block the teenager’s idea of ​​him as striving for sex with him. The measures proposed below are part of the general culture of communication with the child, starting from the moment of his birth.

Absolutely unacceptable:

1. It is absolutely unacceptable to have sex in front of a child of any age. No matter how cramped your living conditions may be, this should under no circumstances be done. Do what you want, get out as you want, but the child should only theoretically know that his parents are having sex.

Watching parents having sex, a child involuntarily associates himself with one of them, forming an incestuous channel for the realization of libido. Moreover, the earlier this observation occurs, the more inadequate these associations may be. So, for example, up to the age of three years, that is, until the age when stable gender-role identifications arise, a son, observing the coitus of his parents, can identify himself with his mother. It is not difficult to guess that from this identification a homosexual channel for the realization of libido will emerge.

2. It is absolutely unacceptable to be naked in front of your child. You should never, ever, under any circumstances, be naked in the presence of a child. We must forget about going to the bathhouse together, not to mention nudist beaches, as monstrous savagery. You must always remember that your child of the opposite sex sees you as a sexual object and this does not at all mean that your child is a pervert - this is a normal situation that all children go through. Unfortunately, many people get stuck in it thanks to their parents.

No joint trips to the pool, fitness club, beach, etc. can force you to share a locker room with your child. If you need to change clothes, there should be only one phrase: “Get out, I need to change clothes.” This one phrase can save your child from going crazy, as it will block his idea of ​​you as a potentially open sexual object.

The savagery in this matter is monstrous. What goes on behind closed apartment doors makes your hair stand on end. Mothers completely blindly walk around the apartment with their breasts bare, “Why, they say, should I be embarrassed, I fed him with this breast.” Under the pretext that “I’m at home, I wear what’s comfortable for me,” fathers consider it almost their prerogative to walk around the apartment in shorts, from which all their belongings stick out. And the fact that the daughter, watching this fashion show, will go crazy from the assumption that her father was showing her his personal belongings, he is in best case scenario not interested.

Under whatever pretext you would like to undress in the presence of your children, this cannot be done. At home, you should wear distinctly asexual home clothes. This emphasis, again, can be the straw that gets your offspring out of the madhouse.

In no case, and under any plausible pretext, do not interfere with the washing process of your offspring, of any gender, after six years. How many of my patients are driven crazy by their mother's desire to rub their back. The phrase “You should wash yourself, you’re already big” will certainly help your child in his terrible struggle with his incestuous fantasies.

There is no need for fathers to break into the bathroom where his four-year-old daughter is washing, and certainly not to take an active part in washing her genitals, let the mother do it; By the way, a son up to six years old should also be washed by his mother, and after five, let him wash himself, he is already big. Only an inexperienced observer might think that a four-year-old girl is an asexual being; if you look more closely, you can find quite a woman, only completely naive.

It is advisable to recall that it is at the age of 4-6 years that the child goes through the genital phase of his mental development, which is such precisely because the genitals are the focus of his close attention. During this period, the child spends a lot of time with his own and other people’s genitals, thinks a lot about their purpose in his life, and often these thoughts lead him to the conclusion about their super value.

Parents should not ignore the complex sexual life of their child and in their attitude towards him it is advisable to use the basic moral rule: “Do not do to others what you do not want them to do to you.” If you don’t want a father or mother to break into your bathroom “for a second,” then you shouldn’t break into your child’s. If you don't want your toilet sitting in the middle of the living room, then you shouldn't sit your child on the potty in front of everyone. Simple tact and respect for the child’s inner experiences will help you make his psyche more stable.

3. It is absolutely unacceptable for a parent, under any pretext, to present himself as a sexual object for his child.

Don't let him peek at you in the bathroom. Even if it is innocent curiosity, it is advisable to go into conflict. The phrase “Stop spying on me - it’s not good, better spy on girls in porn magazines” will be an excellent cure for “Oedipal” problems.

By refusing to be a sexual object for observation, you simultaneously block the entire idea of ​​you as a potential sexual object for everyone else. In addition, and this is also extremely important, by directing the sexuality of your offspring to sexual objects other than you, in this case, to girls from porn magazines, but this is not at all necessary, you are giving other sexual objects the status of permitted by you. This resolution is extremely important for the stabilization of the Oedipus-Electra complex. The fact is that in the structure of the complex there is a fear of sexual betrayal to a parent of the opposite sex. This fear results in the need to be faithful, again in a sexual sense, to your parent. This significantly complicates the child’s internal sexual life, since it blocks all channels for the realization of libido (sexual energy), which the teenager has in abundance, in addition to incestuous.

A child cannot dream about incest, since he is under an internal ban, but he cannot dream about sex with a representative (representative) of the opposite sex, since he tries to remain faithful to his mother (father). And in this case, where the libido goes is completely unclear, all channels are banned, the teenager cannot even engage in autostimulation because it also requires imagining something. As a result, libido floods the consciousness and leads to mental stress. And so, in the child’s mind, a sexual object permitted by you appears, which he can use to organize a legal channel for releasing libido. It will, of course, become much easier for a teenager to live in the world, and, of course, for you too.

N.B. In general, speaking, “incestuous conflict”, let’s call it that, is an extremely useful thing for stabilizing the Oedipus-Electra complex. But, hushing up a conflict, on the contrary, is an extremely harmful thing, since it leaves the teenager space for incestuous fantasies. If it even seems to you that your son or daughter has some kind of sexual goals towards you, it is advisable to have a conflict. A phrase like “You know, dear (dear), you should cover yourself up, or something, I’m your dad, after all, I’m flexing my butt in front of the boy” may offend your daughter, but at the same time it will be much easier for her to survive the influx of her incest fantasies, and ultimately, it will be much easier for her to communicate with you.

There is no need to specially arrange “incestuous” showdowns. There is no need to invite your child to talk about the topic “Maybe you think that I want to have sex with you.” The child will think that you are sacrificing yourself for him, that in fact, deep down, you are not at all against sex with him, but you want to remove the enormous burden of incest from him. Much more valuable is your immediate and, of course, sincere indignation at your offspring, who walks around the house in shorts. Emotion is always more convincing than logic. Your indignation will reach its goal if it is indignation at the behavior of a child of the opposite sex; Indignation at the sexual behavior of a child of the same sex will, at best, not give any result; in the structure of the Oedipus-Electra complex, the same-sex parent is a rival, so your indignation will be perceived as a manifestation of envy of his sexual competitiveness.

There is no need to make your child fall in love with you. Remember, if your child falls in love with you, his sanity is over. For the stable functioning of the child’s psyche, you must be only a parent for him, that is, only his reliable support in all his life's vicissitudes. There is no need to try to become an example of femininity (masculinity) for your child. Remember that your desire to appear before your child as an ideal of femininity (masculinity) is perceived by him as seduction, fills his incestuous fantasies with energy and, ultimately, negatively affects the functioning of his psyche.

There is no need to compete with your son's girlfriend. Only she should he admire, only she should he carry in his arms, give gifts and flowers. All these are elements of sexual action, the threshold of coitus, so your claims to the same attention from your son are absurd. Think ten times before blaming your son for preferring communication with a girl to communicating with you. Your claims on an unconscious level will be perceived by him as a hidden sexual offer, which, of course, will not add joy to his life.

It is not he who should give you flowers, gifts, hugs you and take you to restaurants, it is not with him that you should wander under the moon and admire the stars. If your personal life has not worked out, then it is certainly not your son who should support your feminine reputation. Otherwise, you will be left not only without a man, but also without a son, who, at best, will run away from your sexual proposal to another city, and at worst, will perish in a psychiatric hospital, tormented by the need to satisfy your sexual needs. The same, of course, applies to fathers.

N.B. (For moms) If your son has a girlfriend and has developed a stable sexual relationship with her, consider that he has avoided serious psychiatric troubles. And if you also accept these girls as family, then he will be completely fine. Your approval of your son's sexual choices means to him your renunciation of sexual claims on him, which, of course, will make it much easier for him to fight his own incestuous fantasies and thus be excellent medicine for his psyche.

The problem that drives the young man crazy is the impossibility of tearing his libido away from his mother; the mother and the woman appear to him in one person: in the woman he sees the mother, and in the mother the woman; in the end, he finds himself without both. The goal of psychoanalysis is to separate filial love from libido. When only the sons' love remains with the mother, and the libido receives its own female object, psychoanalysis can be considered complete. So, when the mother meets her son’s girlfriend as her own, thereby approving his sexual choice, then this very sought-after separation of the son’s libido from the image of the mother occurs, the mother herself remains his sons’ love.

If the appearance of your son’s girlfriend causes you to protest, under any intellectual guise, search yourself for a desire to usurp the rights to your child and try to understand the absurdity of this desire. The same goes for fathers: respecting your daughter's sexual choices will only strengthen her psyche..

There is no need to demand from your son that he help you choose clothes, perfume, jewelry, etc. It is not he who should evaluate how beautiful you are and how well this or that dress suits you. This should be done by you yourself or your stylist, or at least your man, but certainly not your child. Ideally, your child should know only one thing about you - “My mother is the best.” Remember, if you ask your son to evaluate how beautiful you are or how well this or that outfit suits you, you are committing a sexual act. By demanding that your son appreciate your feminine beauty, you are demanding that he look at you through the eyes of a man, that is, in essence, to be aroused by you.

N.B. Female beauty is not an aesthetic category, it is a call emanating from a woman to a man “take me, I’m the most beautiful«.

In the structure of the Oedipus-Electra complex, the parent’s call to evaluate his feminine (male) virtues is clearly perceived by the child as a camouflaged sexual offer.

4. It is absolutely unacceptable to treat a child, even jokingly, as a sexual object. How many girls have been driven into neurosis by dad's slapping on their “fat” bottom or close attention to the growth of their secondary sexual characteristics. All the jokes like: “Father, look at how hairy our son’s legs are, he’s growing up like a real man” are bad jokes.

Already from the genital phase of mental development, that is, from the age of 4, or even earlier, children position themselves as a naive sexual object and the main task of parents is to ensure that they do not become such for them.

The sexual behavior of children may only superficially resemble the sexual behavior of adults; in fact, it has nothing to do with it. If the quintessence of adult sexuality is coitus, then the essence of childhood sexuality is self-worth - “look how wonderful I am.” If a six-year-old daughter happily shows her genitals to her dad, it’s not because she wants sex with him, it’s just that she naively considers them an extremely valuable part of her body and brags to her dad about her “priceless diamond.” And if dad is deceived and falls for this “sexual offer”, reacting somehow like: “Oh, how lovely, let me touch it,” then in her Electra complex a powerful objective basis will appear: “dad is delighted with my genitals,” and the girl’s psyche will be at risk. And if the father calmly and seriously grunts: “Daughter, you save this for your husband, you will brag to him, but dad is not interested in all this,” then he, on the contrary, will take away her main trump card from the Electra complex, thereby significantly weakening it. After such an adequate reaction from her father, the girl’s psyche, her idea of ​​the world and herself will also be formed adequately.

Or, another example of the correct reaction to the manifestation of childhood sexuality, one of my patients told me the following story. One Sunday morning, he and his wife were watching TV, unsuspectingly, when suddenly their completely naked six-year-old son appeared in front of the screen. Demonstratively twirling his “farm” with his hands, he began to jump in front of the screen, demanding his parents’ special attention to this action. Unlike the mother, who turned deathly pale and almost fainted, the father managed to compose himself, and quite calmly, which he was especially proud of, with well-chosen indignation, as if he had been rehearsing this phrase for a month, said: “Son, yes If you move away from the screen, don’t interfere with watching. What did the presenter just say, huh?” The mother, having recovered from the first shock and realizing what needed to be done, launched a second wave of indignation at the inability to watch TV in peace. The son became bored, stopped jumping and went to his room to put on his pants, nothing like this has happened since then, and the son calmed down about the pricelessness of his “household.”

To choose the right tone in a relationship with a child’s sexuality, you need to take into account the main rule - “Take your hands off.” The child is defenseless against the sexual aggression of his parents because he is naive and does not understand the symbolic meaning of what is happening, and the parents perceive his lack of understanding as permission and get into his sexuality like a bull in a china shop, and he, poor, stands and smiles.

5. It is absolutely unacceptable for sharing the same bed with a child to be of any sexual nature.

Sharing a bed with a child is a delicate moment. On the one hand, the child needs to be able to fall asleep next to his mother: this “return to the womb” calms him down, relieves all the fears and worries that arise day and night. On the other hand, there is a limit to everything. In this case, this limit is determined by the appearance of a sexual context in the child’s desire to cling to the mother’s (father’s) body.

After six years, it is advisable to gently block the child’s desire to get into bed with his parents with a phrase like “You’re already big, you should sleep alone.” By the age of ten, that is, on the eve of the onset of the teenage crisis, the practice of sharing bed should be reduced to nothing.

It is unacceptable for a mother, after a quarrel with her husband, to go to bed with her son, and she shouldn’t go to her daughter either. The arrival of a mother in her son's bed has a symbolic meaning for the latter and means a demonstration of confirmation of her sexual preference. It is worth recalling here that the Oedipus-Electra complex is based on the child’s confidence in his victory over a same-sex parent in the fight for a parent of the opposite sex, so in this case we are talking specifically about confirming the choice once made by the mother. Having won his mother from his father, the son inevitably falls into the logic of this conquest, and this logic ultimately leads him to the need to fulfill his marital duty. Thus, the arrival of a mother in bed with her son (father with his daughter) once again reminds the latter of his marital duty to her and fills his incestuous fantasies with energy. It is not difficult to guess that ridding the “head” of energetically charged incestuous fantasies requires much greater mental resources from the child, and that in this case a mental breakdown is much more likely. One of my patients was forced to become gay, as I suspect, precisely under the pressure of the “sexual” pressure of his mother, who ran from her husband to his bed until he ran away from her to a rented apartment. For the sake of rigor, it must be said that in this case, in addition to the bed, there was a lot of tenderness, hugs and kisses between mother and son.

6. It is absolutely unacceptable for a parent to fall in love with their child. This is probably the most difficult point to understand. Here it is very easy to hide love under the mask of admiration for the fruits of your labor. They say, look, good people, what kind of guy I raised: he’s handsome and smart, and he’s so handsome that you can’t take your eyes off him, and who will get my treasure? So understand, either the mother is in love with her son, or she admires the fruits of her labor.

Raising a child for yourself, no matter how crazy it may sound, is nevertheless an accepted goal in society. A parent can speak quite openly, without fear of condemnation, in society that he is raising a child, investing his last strength and resources in him for some of his own purposes. Most often, a mother raises her son as a future helper or for his old age, although she hates her daughter-in-law in advance, apparently because she will prevent him from helping her with housework in her old age. Be that as it may, but a teenager, under the yoke of “Oedipal” contradictions, in these delights of the mother (father) imagines a claim to sexual possession, the person always imagines the worst scenario for him.

Here we should emphasize that falling in love with your child, although it is sexual characteristic relationship does not at all involve sex as such, in most cases, at least. The parent, like the child, is afraid of experiencing incestuous arousal and defends against it as best he can. Just like a child, a parent needs this sexual game of falling in love and courtship with his child of the opposite sex, but he, of course, does not need sex itself, in most cases, at least. Why the parent needs this game in this case is not important, most often it is an attempt to prove to others their sexual worth, what is important is that this is a bad game and it must be stopped.

Another thing is that stopping this strange game is not so easy. It is difficult for a parent to give up flirting with his child, because this game keeps his own psyche afloat. The worst situation is for infantile neurotics who so want to be in the image of a child that they become completely indiscriminate in choosing a parent and are ready to delegate parental functions to anyone, even their own children. The infantile mother declares: “And I have him - meaning her fifteen-year-old son - as the owner of the house. He makes all the decisions, I consult with him on everything, and I don’t even buy underwear for myself without his approval.” It’s also not easy for narcissists, they are forced to charm everyone, including their children. But, be that as it may, if there is an internal opportunity to correct your attitude towards your child, it must be adjusted. Otherwise, the child will not be able to block the possibility of incest in the unconscious in ways that are safe for his psyche, and he will have to use dangerous methods, from which his psyche may not be able to withstand it and fall into psychosis.

As a recommendation. The departure of a father from the family often becomes a test that the damaged psyche of a teenager cannot withstand. This is again connected with the Oedipus complex and the need to block the possibility of intercourse with the mother. The leitmotif of the Oedipus complex is “marriage” to the mother; incest is imposed on the child by the logic of this “marriage.” When a mother is married to a father, the son’s “marriage” to her remains underground, and as such burdens the son with the responsibilities of a “husband” to a much lesser extent than when the mother separates from the father and remains entirely in his care. Now, the son must take the place of his mother’s husband, and the mother, of course, wants nothing else, at least that’s what it seems to the teenager. After the father left and the mother remained in the care of her “real husband,” there were no objective barriers to incest at all, the contradiction of the Oedipus complex, which I spoke about above, worsens to the limit, which, in fact, leads to a mental breakdown of the teenager.

The father's departure from the family is often preceded by a long and not at all aesthetic conflict with his wife, in which the son takes a very direct part. Looking at how the son actively participates in the conflict and practically kicks his father out of the apartment with his own hands, one can be deceived and think that he wants to be left alone with his mother. Kicking out his father, the son comes to the defense of his “lady,” but he absolutely does not want to be left alone with his “lady” after the victory. After the father leaves the family, metamorphoses begin to occur with the son, the meaning of which is to create an obstacle to the possibility of incest. Before our eyes, the son turns into a caricature of his father: he becomes irritable, aggressive towards his mother, often leaves home, begins to get drunk and lead a dubious lifestyle, and ultimately ends up in a psychiatric ward.

So, if your son faces the prospect of becoming a winner in a fight with his father, and being left alone with you, make it easier for him to block the possibility of incest. Do what a woman would do if she were left in the space of one apartment, without a husband, alone with a sexually mature man who is stranger to her, with whom she categorically does not want to have any sex. At least, don’t tell your son that he is now left in the house for a man (father, peasant). This phrase, despite its prevalence, is extremely harmful to the psyche of a teenager who remains the only man with his mother.

How not to raise a gay man!

If you ask yourself a similar question, then with a high degree of probability your child will be inclined to have a normal relationship: the parents of a gay man do not bother with such questions.

Parents, of course, are involved in the appearance of mental illness in a child, another thing is that they cannot be blamed for this: a child’s mental problems are a consequence of the mental disorders of his parents, which, in turn, are a consequence of the deviations of their parents... and so on until Adam and Eve, more precisely, before Eve; The devil pulled her to seduce Adam with the crime of God's prohibition; on the other hand, there was nothing to prohibit.

Seriously speaking, it is the mother’s attitude towards the child that determines the appearance of mental pathology in the latter: ideally, such an attitude simply should not exist. The mother’s attitude towards the child is based on the imperative “You must be so and so (my child must be so and so)”: the more conscious, more articulate and persistent the demand is, the more likely the child’s psyche will not withstand such stress.

N.B. Even the mother’s admiring gaze contains an imperative: the admiration “how beautiful you are” latently contains an extension - “you must remain like this (you must admire me).”

The problem is that the mother’s demand distorts, and sometimes simply breaks, the natural formation of the child’s psyche - hence the mental deviations in his development. The demands of the father, in the most psychologically vulnerable period of development (0-6 years), are of little interest to the child; only the possession of the mother gives him the opportunity to live in the maternal, that is, in the positively predictable, world. The father can support the child’s psyche by taking on the maternal function if the mother is too distant from him, but even in this case, possessing the mother remains the supergoal of the child’s activity. Generally speaking, as psychoanalysis shows, the image of the father is a “consumable material” in the child’s psyche in the struggle for possession of the mother.

The requirements of a gay mother for her child are somewhat specific. It is this specificity, apparently, that determines the child’s choice of a homosexual image for self-identification.

To begin with, I’ll tell you how the gay’s mother is not original. The mother of a gay man, first of all, is extremely narcissistic, “pulls” the center towards herself with terrible force, takes away the center from everyone in the family, even from her own child. Let me remind you that for the normal development of a child’s psyche, he must feel in the center, and mom and dad should, at a minimum, not mind. So, in a gay family, everything is the other way around, where the mother occupies the center, and her child must recognize this right for her, realizing that he, in comparison with the mother, is completely insignificant. Here, the mother of a gay man is not unique; many mothers cripple the child’s psyche, tearing out his center; The specificity of a gay man's mother is that she is a sexual center: according to her delusional scenario, all men are in love with her, all men want her, including her own child. It must be said that the gay mother treats her son’s incestuous lust with sympathy and some regret: she understands that her son is a hostage to the situation - he simply cannot help but want her, because she is, indeed, sexually overvalued, all men are doomed to want intimacy with her.

The gay man's mother is convinced of her a priori social exclusivity (chosenness, otherness, otherworldly essence, divinity). Of course, she delegates her exclusivity to her child as an imperative: the future gay man is doomed to be exceptional. According to the unconscious scenario of the gay man, his “divine” mother will abandon him as soon as she discovers that he is an ordinary person. The combination of the experience of inner insignificance and an exalted conviction in one’s a priori social exclusivity is very characteristic. The hysterical conviction of one’s otherness is always based on the experience of one’s own insignificance. In the case of a gay man, this factor is simply more accentuated: homosexuality is, in many ways, an otherness on display. Generally speaking, delegation by a mother to her child of the status of an a priori exclusive social being is quite common: this phenomenon reflects, for example, the concept “noble”.

At some stage, the relationship between a future gay man and his mother is very reminiscent of a sexual one, except that it doesn’t lead to coitus, but everything is in place: hugs, kisses, admiration of her attractiveness, being in bed together. As a rule, it is the future gay man who helps the mother in choosing clothes and underwear: I think that gay fashion designers in their imagination create clothes specifically for their mother. This aspect of the relationship between a gay mother and her son can be called specific: not even in every “noble” family you will find so much tenderness between mother and son.

N.B. On the pages of the site I have mentioned more than once that homosexuality is the ideal solution to the Oedipus complex; it is more relevant in the case when the contradictions of the complex are most clearly expressed. The Oedipus complex is based on the fear of losing his mother; the stronger the fear of loss, the stronger the child’s need to master his mother, the less picky he is in choosing the means to master her: the future gay man is completely indiscriminate in his choice of means, the fear of losing his mother is very pronounced in him. The mother of a future gay man offers her child, at least so it seems to him, a sexual option for mastering her, and he, of course, agrees to it, hence so much “sex” in their relationship. But the child cannot allow incest - coitus leads to the transformation of the mother into a woman, that is, in fact, to the loss of the mother. Homosexuality resolves this paradox: demonstrating his homosexuality, a gay man seems to be saying to his mother: “For me, you are the most desirable woman in the world, I would be glad to have sex with you, but I can’t!” Thus, homosexuality allows a person to control his incestuous relationship with his mother, to keep them from being overthrown into coitus.

Where a gay mother is truly original is in raising her son: the main tenet of her educational process is “A woman chooses her talent with taste!” The mother of a gay man does not want to see in her son a man in the standard sense of the word (a warrior, a breadwinner, a master, an alpha male), such a man for her is a “cattle”; her son must, first of all, be talented. She would be disappointed in her son if he did not in any way declare his chosenness (otherness, divinity). The mother of a gay man is not at all against her son’s homosexuality: she welcomes everything that can in one way or another speak about the “not of this world” essence of her child; homosexuality comes in handy here. It is very likely that by blocking the “man” in her son, the mother of a gay man is blocking her own incestuous fantasies towards him. Speaking about the Oedipus complex, we must not forget that control over the sexual component of the complex is necessary not only for Oedipus, his mother is also interested in controlling her incestuous urges.

The gay father, of course, is not such a terrible character as his son’s imagination portrays him, but he gives a reason for this; his image is easy to demonize. The image of the father is formed by the child with the goal of mastering the mother - this is an axiom, I have spoken about this more than once. In this regard, talking about the gay father as an independent character is not entirely correct. In fact, the gay father does not show any particular aggression towards his son; of course, he is narcissistic, jealous and does not love his son as much as he would like (narcissists generally do not love anyone but themselves), but nothing more. He is a source of fear for a gay man only because of his potential danger; it is difficult to present specific “atrocities” against him. A potential hazard is an imaginary hazard, a regulated hazard; being a figment of the imagination, it becomes an excellent tool for regulating incestuous relationships: as soon as the child is overcome by incestuous arousal (“stands up” on the mother), he immediately begins to fear the father’s reprisal and the arousal disappears.

There is one more nuance that needs to be noted in connection with the theme of “paternal aggression”. Representing the apogee of narcissism, gays are extremely intolerant and arrogant towards the people around them: homosexuality is, in many ways, demonstrative exclusivity, “chosenness” for show. Without even realizing it, a gay man casually distributes the status of “cattle” to everyone around him, and not many who considered this message are able to control their aggression. During psychoanalysis, I always focus on the analysand’s underestimation of his “narcissistic” aggressiveness towards his father. When assessing the degree of aggressiveness and inadequacy of a gay father, one must always take into account that he is in the status of a “cattle” with his son and the latter does not always manage to hide his narcissistic arrogance.

It cannot be said that a gay man is a victim of a crazy mother; he also really likes all these games of being the chosen one and he cultivates them himself. The problem with treating homosexuality is precisely that the patient likes his illness: he doesn’t like dying, but he likes the disease - this often happens. Gays don't like: loneliness and not being needed by anyone, phobias, panic attacks, depression, hostility of the surrounding society; and he really likes chosenness and otherness. Homosexuality, I repeat, is precisely chosenness for show ( open form delirium of being chosen).

The emphasis on the fact that homosexuality is a form of delusion of chosenness is extremely important in the context of the problem under discussion. Everything I talked about in the first part of the work concerns the prevention of the development of homosexual tendencies in a child - the root of all teenage problems schizoid circle is the same.

The question immediately arises: “Is it possible to influence the development of the delusion of chosenness, if that’s what it’s all about?” Of course, I would like to influence, but it seems to me that this is almost hopeless. How can you influence a person’s desire to feel a priori superior to the surrounding “grayness”?! The recipient of your help will look at you knowingly as if you were a redneck, and you yourself will understand that no one needs your help, rather, on the contrary. The problem of correcting the process of forming a person’s idea of ​​his a priori social exclusivity, which certainly includes the idea of ​​the otherness of his sexuality, is the impossibility of becoming gay significant figure, to occupy a significant place in his reference society. This place has already been reliably occupied by his mother, and she has absolutely no intention of giving up either her sexual super-value, or her claims to being chosen, or her persistent desire to see a “genius” in her child. In his mind, a gay man’s mother can only give birth to an a priori exceptional social being, and the gay man is not at all against his “divinity”; everyone who says that this is not so stumbles upon his understanding arrogance.

N.B. As I have said more than once on the pages of the site, an essentially delusional idea of ​​one’s a priori social exclusivity helps a person manage his mental processes (an expanded version of this thesis can be found in my works “Attributes of Subjectivity” and “Patterns of Formation and Functioning of the “I” human”, they are presented on the website in the section “Phenomenology of subjectivity (new psychoanalytic theory)”). This idea is precisely delusional - it does not correspond to reality: in reality, people do not differ from each other a priori - accordingly, the principle of reality does not allow this idea into consciousness without clear evidence for itself. Homosexual tendencies are just such evidence. They help a person to realize his a priori social exclusivity through criticism of his (!) reality principle. As proof of his a priori social exclusivity, the gay demonstrates to his reality principle his anomalous sexuality; so he says: “What other proof do you need; It is clear that we are special beings with an open receptivity to everything beautiful, refined and status, we are the third gender, our sexuality is as refined as our feelings. It’s difficult for the surrounding cattle to understand why sex with a beautiful young man is more refined than sex with a woman, but this was completely obvious to the ancient Greeks and Romans...”

In order to prevent your son from taking the path of homosexuality, you need to follow all the rules that I talked about in the first part of the work. This is probably the only thing you can do. You are unlikely to be able to influence the very idea of ​​a priori exclusivity, but you are quite capable of giving this idea a viable form.

Bye, end...

Good afternoon I was looking for materials on raising children and came across your text about the prevention of mental disorders. In many ways, it turned out to be unexpected for me - my husband and I simply did not attach importance to some things. But I also had questions. You write a lot about how parents should behave with a child of the opposite sex. Of course this is very important. But I want to ask what mothers of daughters should do. My daughter is five years old, but we are already faced with the problem of gender relations. Now I see that it was present before. But at one and a half, two or three years old everything looked very innocent and funny. We wanted and want our daughter to grow up with a traditional orientation, so we encouraged her interest in boys and men. When she ran up to an attractive man with childish spontaneity and began to roll her eyes and wiggle her butt in front of him, we thought that this was such a natural manifestation of sympathy and childish naivety. We thought that she would outgrow this and learn to show her interest in a more civilized way. And we even praised her for it. But time passes, and the behavior does not change and even becomes more and more intrusive. Besides, she really likes one of our relatives. She literally hangs on him. So his wife already asks with irritation whether she will still be jumping on Uncle B’s lap at the age of fifteen. She also saved up some change and asked the prices of other children’s dads while visiting. I agreed to buy one for “one hundred thousand dollars” and asked my dad to “add it.” Naturally, he refused. She burst into tears and did not want to talk to us. I don’t know if this is a reason to worry about my daughter’s psyche. Or maybe I'm just worried about what others think. And how should a mother behave in such a situation?

From the correspondence:

“She treats her husband quite calmly. As far as I understand, she considers him her property by default. True, she may make faces to spite him when he pulls her back. This usually happens in front of strangers. It might, for example, fall apart and lift up its legs. He tells her “stop it!” and may slap her lightly on the leg. Then she runs back and does the same, but so that she is not immediately caught. Our dad is strict, he can scold you and put you in a corner. It is mainly he who “educates” her, because she listens to his words more. I didn't notice that she was competing with me. But she is clearly in competition with other older women.

She doesn't notice my comments. She either ignores women or considers them rivals. When I found out that my sister would be born soon, I got angry and said “I don’t like the girl,” “the girl is bad.” He often “accidentally” pushes his beloved uncle’s wife when she was smaller – she could have pinched or bitten her.

Sexual behavior does not apply to peers. She also considers them as rivals, and can even beat boys. Don't fight for the sake of fuss, but hit with a stick or a typewriter. Yes, she is beautiful and bright. Thin, tall, she has thick black hair and big black eyes, an expressive face.”

If there are no unconscious distortions in your story, then it should be stated that your daughter has an open Electra complex; accordingly, this is a reason to take care of your daughter’s psyche. I talk a lot about the Oedipus-Electra complex itself on the pages of the site; as for its open version, it should be said that this is a rather rare phenomenon. In any case, the outcome of this variant of the course of the complex, like any other mental disorder, depends on the conditions in which it occurs. In addition to all those rules and restrictions that the process of raising the repressed Oedipus-Electra complex requires, I spoke about them above, raising the open Oedipus-Electra complex will require you to openly correct your daughter’s sexual behavior. You will have to educate your girl’s sexual behavior, which, of course, is not at all easy: adults should deal with their sexuality themselves, but here, the child needs to be educated.

Education of sexual behavior, like any other educational process, presupposes a constructive attitude towards the corrected distortion. Constructive means that you should treat the inappropriate sexual behavior of your daughter as described by you as erroneous, and treat the daughter herself as making a mistake. Accordingly, he treats his daughter inappropriately, as “depraved by nature” or something like that. There’s nothing wrong with her nature, it just seems to her that she will be able to extrapolate her successful experience in winning over her father to someone else’s uncle, a completely common misconception among women. Over time, she will certainly have negative experiences, and if you, parents, maintain a constructive relationship with the girl, you will be able to adjust her “How to be a Princess” scenario and make it more realistic. Judging by your letter, your husband is acting correctly. If he hadn't encouraged her aggressive behavior in relation to her peers, then it would be completely good: the basis of her sexually aggressive behavior is precisely aggression directed at women she associates with her mother, accordingly, it is inappropriate to encourage the girl’s aggressiveness, she is already too aggressive.

The most important thing, but also the most difficult thing, in your situation is for you to get rid of the internal fear of being suspected by others of natural debauchery or natural bitchiness (by “bitch” in this case I understand a woman who openly demonstrates to the women around her that in the fight for any man she likes, she will not stop at any moral, ethical and aesthetic restrictions). If there is such a fear, then your daughter with such demonstrative sexually aggressive behavior will be excellent proof for everyone who suspects that you, in fact, are not at all the angel you want to seem. If such an accusation is unbearable for you, then the fear of it will not allow you to carry out adequate educational work, which I spoke about above. It will be difficult for you to identify yourself with the mother of this little “bitch”; you will begin to involuntarily move away from your child, demonstrating to others that you have nothing to do with it, which will further aggravate the girl’s neurotic situation. If we turn to the neurotic constitution of the “bitch”, we can find that such a woman’s aggressive sexual behavior is due precisely to her protest refusal of her mother, and the transference of the image of her mother to her father, who, according to her unconscious scenario, should be both her mother and father simultaneously. Thus, involuntary distancing from the “vicious” daughter will only exacerbate her original neurotic conflict, which will lead to an increase in her need for a man to replace the lost mother, and her “bitchy” behavior will become completely uncritical.

In your situation, it is wrong to play along with the girl, it is wrong to do what you did when it all looked “naive and funny.” It is correct to take a critical position in relation to what is happening, to demand from the girl a sane answer to the question of what and why she is doing and who needs it. It is advisable to conduct such discussions calmly, ideally, with humor, but also emotional attacks like: “You are acting like an idiot (note, not a “whore” but an “idiot”, that is, stupid). You’re still a child, not a woman, so behave appropriately, when you grow up, then you’ll get your butt in trouble if you don’t wiser up by then” - they’ll also do. Such indignation from the father will be more effective, the indignation of the mother may be perceived by the girl as a manifestation of envy, but the mother’s detachment is even worse, so if the mother intervenes, the father must support and strengthen.

During the educational process, you need to avoid definitions like “whore”, “bitch”, etc., even such a harmless definition as “you are our beauty” is unacceptable in your case. Admiring your girl, and from correspondence I know that you consider her beautiful, you, in fact, see in her a future successful beauty, a socialite all in diamonds and Mercedes, that is, you unconsciously project your own ideal onto her. But none of this will happen, so your enthusiasm is completely misplaced. Early sexuality, no matter how objectively beautiful the girl is, always does not end as desired, so anxiety in your gaze would be more appropriate than delight and tenderness. However, you seem to have enough anxiety.

The educational process should be based on the concept of “stupid” (stupid, inadequate, etc.), in the emotional version: “fool” (idiot, etc.), that is, push on the principle of the girl’s reality, which is nothing more than a natural desire person, and therefore your girl too, to be adequate to your own goals. Only by encouraging the girl’s reality principle to engage in dialogue will you be able to correct her behavior, or rather, she will correct it herself, because she herself wants to be effective more than you do. This, by the way, is the basis of the effect of psychoanalysis. If you operate with such concepts as: “whore”, “bitch”, “bad girl”, etc., then the effect of your upbringing will be exactly the opposite of your expectations. All these definitions do not answer the main question, namely, they do not explain why it is impossible to act this way. What a bitch, what's wrong with that? Why, in fact, is it bad to be a bitch, a whore or a bad girl; unless some asexual women in their society are afraid for their husbands, so let them be afraid, who is to blame for them that they are so-so. This is exactly what those called “bitches” think. This definition elevates them, not degrades them. In addition, modern mass media plays against moral accusations: concepts such as “bitch”, “whore”, “bad girl”, etc. often have a positive content that correlates with the concepts: “successful”, “effective”, etc. (“Good girls will go to heaven, and bad girls will go wherever they want”) Therefore, all your attempts to appeal to moral principles in your daughter will fail. Her reference society will be young “bitches” from TV screens. Having crossed the prohibitions and not caring about all the taboos, they feel great in the kept houses of the “daddy”, proudly looking at the dejectedly weaving “rednecks” from the windows of their expensive cars.

Perhaps your daughter is realizing your own unconscious ideal with her “bitchy” behavior. This can be a major issue in your parenting, children are very sensitive to context. If such a “beautiful” life of “bitches” seems absurd to you and you can correctly formulate your objections, then, in this case, you have the opportunity to re-educate your daughter. If, in the recesses of your soul, you envy those who can cross the line and achieve a sweet life, then I am afraid that the educational process will be under threat.

Psychoprophylaxis is a system of measures, the purpose of which is to study the causes that contribute to the occurrence of mental illnesses and disorders, their timely identification and elimination.

In any field of medicine, be it surgery, therapy, infectious or other diseases, Russian healthcare pays great attention to prevention issues. When addressing issues of preventing various mental disorders and diseases, preventive measures should be promptly introduced into life and healthcare practice.

Methods of psychoprophylaxis include, in particular, the prevention of exacerbations of mental illness. Therefore, it may be necessary to study the dynamics of a person’s neuropsychic state during, as well as in everyday conditions.

Using a number of psychological and physiological methods, scientists study the influence of various occupational hazards in certain branches of labor (intoxication factors, vibration, the significance of overexertion at work, character itself, etc.).

Psychoprophylaxis is a section of general prevention, which includes activities aimed at preventing mental illness.

There is a close connection between the human psyche and his somatic state. The stability of the mental state can influence the somatic state. It is known that with a great emotional upsurge, somatic diseases rarely occur (an example is the war years).

The state of physical health can also influence, lead to or prevent certain disorders.

V.A. Gilyarovsky wrote that the role of nervous uplift in overcoming difficulties for the body and, in particular, harm to the nervous system should be used in planning work of a psychoprophylactic nature.

The objectives of prevention are: 1) preventing the action of a pathogenic cause on the body, 2) preventing the development of the disease through its early diagnosis and treatment, 3) preventive treatment and measures to prevent relapses of the disease and their transition to chronic forms.

In the prevention of mental illnesses, general preventive measures play an important role, such as the elimination of infectious diseases, intoxications and other harmful influences of the external environment.

Mental prevention (primary) is usually understood as a system of measures aimed at studying the mental effects on a person, the properties of his psyche and the possibilities of prevention, etc.

All activities related to mental prevention are aimed at increasing mental endurance to harmful effects. These include: a child, the fight against early infections and psychogenic influences that can cause mental retardation, developmental asynchrony, mental infantilism, which make the human psyche unstable to external influences.

Primary prevention also includes several subsections: provisional prevention, its goal is to protect the health of future generations; genetic prevention- study and prediction of possible hereditary diseases, which is also aimed at improving the health of future generations; embryonic prevention, aimed at improving a woman’s health, hygiene of marriage and conception, protecting the mother from possible harmful effects on the fetus and organizing obstetric care; postnatal prevention, consisting of early detection of developmental defects in newborns, timely application of methods of therapeutic and pedagogical correction at all stages of development.

Secondary prevention. It is understood as a system of measures aimed at preventing a life-threatening or unfavorable course of an already onset mental or other disease. Secondary prevention includes early diagnosis, prognosis and prevention of life-threatening conditions for the patient, early initiation of treatment and the use of adequate correction methods to achieve the most complete remission, long-term maintenance therapy, eliminating the possibility of relapse of the disease.

Tertiary prevention is a system of measures aimed at preventing the occurrence of disability in chronic diseases. The correct use of medications and other drugs, the use of therapeutic and pedagogical correction methods play a big role in this.

All sections of psychoprophylaxis are especially closely related in cases of prevention of mental illnesses, in which we are talking about disorders such as, in the occurrence of which not only psychogenic factors play a role, but also somatic disorders.

As already mentioned, diseases caused by mental trauma are usually called psychogenics. The term “psychogenic diseases” belongs to Sommer and was initially used only for.

V.A. Gilyarovsky used the term “borderline conditions” to designate these conditions, emphasizing that these disorders seem to occupy a borderline position between mental illness and mental health or somatic and mental illnesses.

According to many experts, it is necessary to wage the same intensive fight against neuropsychic disorders and diseases as against infections.

Methods of psychoprophylaxis and mental hygiene include work within the framework of advisory centers, “helplines” and other organizations focused on psychological assistance to healthy people. This may include mass surveys to identify so-called risk groups and preventive work with them, information from the population, etc.