features of an internal picture of illness at children with an emiction pathology.

At the present stage of development the person is the individual of a society, therefore from first days of a life of the child its corporal functions start to get socially comprehensible form. In development of the child all natural processes of departure of physical and physiological requirements get
Fixed in society at the given historical stage the form, i.e.

ritualizirujutsja. In the cultural-historical concept of h.p. Vygotsky the teoretiko-methodological basis of understanding of the psychosomatic party of life is defined. Each level of development of the person is interfaced to the activity which is a leading and defining basic vector of development. High-grade mental and psychosocial development inseparably linked with a harmonious combination of psychophysical and psychosomatic development, and also to timely and correct formation of socially comprehensible forms of departure of physiological functions of an organism [35, 36, 61, 62, 195].

At the modern person its corporal development inseparably linked with mental development. The factor of a growing of the child and its socialisation the formed interrelation of physiological and mental functions of an organism is important, thus leading value get a sociality, oposredovannost, possibility of any control. Development by the child of the znakovo-symbolical form of regulation is the important element of its psychosomatic development. As a result physiological requirements and corporal functions are gradually transformed to psychosomatic phenomena: an image of a body, concept of a pain, an internal picture of illness (VKB). Thus, various disorders of somatic and psychosomatic functions are a consequence of disturbance of socialisation of corporal phenomena [66, 143, 153, 155].

Key role in development of a corporal phenomenon in the child plays its mutual relations with mother. According to level of the development, formation and social adaptation mother designates, fills with sense physiological requirements and corporal actions of the child. It is especially important, that, defining the form of departure of physiological requirements, mother strongly fixes them in system of value and senses of the child, causes formation at it the psychological formation called an image of the world. The semantic designation of each corporal phenomenon is carried out through emotional reaction of mother and the child. Thus, interaction of mother and the child (emotional, physical, social) makes predominating impact on formation of the socialised forms of the somatic phenomena, their completeness and probability of occurrence of their pathologies [154, 155, 292].

One of the first as having znakovo-symbolical sense through a psychoanalysis prism Z.Freud and its followers began to estimate psychosomatic conditions. To the basic mechanism of formation of symptoms of psychosomatic conditions researchers had been carried so-called disputed sense [198, 199]. Authors of the theory of objective relations (M.Klein, D. To V.Vinnikott, M.Balint) in formation of psychosomatic conditions attach special significance to interpersonal contacts of the child to adults, character and intensity of their emotional mutual relations. In the works devoted to a psychoanalysis (Z.Freud, A.Adler, To. G.Jung, K.Horni, N.I.goat, etc.) Disturbances MI, as a whole, and an urine incontience, in particular, carry to ways of attraction by the child of parent attention, to kinds to sweep and the protest.

Finally, disorders MI, including an urine incontience, start to carry out functions of interpersonal dialogue, to carry nonverbal dialogical sense [184, 199, 208]. Thus, vectors
Mental and psychosomatic development of the person make the most powerful impact against each other, and disturbances in one of them will inevitably entail changes in other [45, 86, 88, 188, 282].

One of key concepts modern psychology and the medicine, reflecting influence of a chronic somatopathy on development of the child and the teenager, is the internal picture of illness (VKB). The problem of personal experiences and sufferings of the person during illness has not lost the urgency in spite of the fact that it and is comprehensively described for a long time. At a dawn of development of medicine Gippokrat, and then and great domestic clinicians (M.J.Mudrov, G.A.Zaharin, S.P.Botkin, N.F.Filatov, V.M.Bekhterev), urged doctors to treat the person (patient), instead of symptoms and syndromes of its illness, understanding under it set of its personal and physiological features. As a result of medicine development, and also perfection of methods of diagnostics and treatment of diseases there was a necessity of understanding the doctor of the person of the patient and the account of its features. In the XX-th century middle-extremity in connection with prevalence in foreign and, the main thing, in domestic medicine paternalisticheskih and materialistic approaches in treatment of diseases, on illness in a practical link of public health services the attention almost was not given to features of personal reaction of the patient. Nevertheless, on a psychological condition of the patient many researchers were engaged in studying of influence of disease. At each of them own representation about mechanisms of occurrence and development of reaction of the person on pathological process in an organism [46, 183, 146, 147] was generated.

In the twenties the XX-th centuries the concept about autoplasticheskoj to an illness picture (A has been generated. Goldscheider, arising at the patient against sensations and experiences from somatic defect available for it. In 1940th years concept VKB (R.A.Lurija), as an integrated image of the disease formed at the patient, which in comparison with a number of similar terms of medical psychology (illness experience, consciousness of illness, the relation to illness, etc.) has been entered Is integrativnym and most the general. Among the factors influencing formation VKB, personal features of patients, their private world, the relation to illness, the medical personnel and treatment have been considered and comprehensively studied. The obtained data have allowed to generate integrated concept VKB, the knowledge of which key aspects helps the doctor with a correct estimation of disease, diagnostics, selection of therapy and the forecast of disease taking into account personal features of the patient [147]. In VKB allocate external and internal components. To the first, and objective symptoms of disease have been carried to the second - subjective complaints of the patient, its representation about the illness. Initially in structure VKB there were sensitive and intellectual levels. Sensitive level included the subjective sensations caused by disease or change of the general condition of the patient, and intellectual - psychological reactions to illness, reflexions concerning the disease, modelling by the patient of a current of the disease. Further VKB it has been differentiated by allocation of four levels (V.V. Nikolaeva): sensual (represents a complex of painful sensations of the patient), intellectual (includes subjective knowledge and representations of the person of the illness and its objective estimation), emotional (emotions and experiences concerning illness and its outcomes) and motivational (here on the bases of the received experience taking into account outlook
The person there is a change of the relation to disease, formation of the new way of life promoting recover) [46, 183, 130, 151].

Thus, illness represents not only unpleasant sensations and their experience, but also their motivational processing. As the motivation level is interconnected with the relation of the patient to the illness and possibility of entering of corrective amendments in its behaviour and a way of life, necessary for recover here gets special value activity of the doctor and the clinical psychologist on conservation and health homing, and also aftertreatment of the patient [153, 155].

At carrying out of psychological diagnostics and working out psihokrrektirujushchih actions for children with disorders MI, it is necessary to consider, that formation of reaction to illness has age features. So, owing to physiological features of nervous system, children do not part for a long time corporal and mental. Disturbance of work of organs and systems, a painful syndrome, various dysfunctions do not influence on kognitivnye abilities and a condition "I", however VKB the child is thus deformed [99, 147, 153, 192].

Considering a key role of age aspect in formation VKB at children, it is necessary to underline, that the the child is more younger, the more appreciably it VKB differs from that at adults. VKB, closely being intertwined in personal features of the child as it is positive, and progress negatively influences implications and a current of disease, the relation between members of a family and contemporaries, at school, conducts to development of experiences with formation of neurotic disorders [151, 153].

At children allocate components VKB similar to those at adults which include: objective implications of illness, feature of emotional reaction, the mental abilities, the saved up customary experience and experience of the transferred diseases, sexual features, the information received about a state of health, disease, its reasons, treatment and the forecast and other. During too time powerful value in formation VKB of the child influence of the doctor, average and younger medical staff on the sick child concern parents and other persons from an environment of the child its pathology, and also.

It is necessary for doctor to consider, that the child with pathology MI regularly stays in a special, deficiental social situation of development. Its degree of expression depends on character of a current of a pathology (whether it is hidden from strangers, for example, at an uracrasia or occurs in socially unacceptable situation - a day stressful incontience of urine), relations surrounding (relatives, contemporaries, the medical personnel etc.) To illness of the child, features of microsociety (frequent change of a habitual situation at hospitalisation, long stay in a hospital) and a therapy kind. It is interesting, that at children the deficiental social situation of development, causes activation of their own informative activity, including to available disease which is referred on overcoming by its all accessible ways more often. It has been established, that the special social situation of development promotes occurrence in the sick child of new properties of the person. Thus the somatopathy gets properties of the crisis period of development of the child causing change or transformation of the developed social situation [62, 65, 121, 147, 151].

Taking into consideration high compensatory possibilities of a children's organism for overcoming of somatic and-or psychological disturbances, at children with disorders MI in education process should be necessarily included various techniques of the aftertreatment, allowing to level this or that defect. Thus for working out and drawing up of programs of aftertreatment the special accent should be made on studying of level of uneasiness, level of a self-rating and level of claims of the patient and its environment, as one of the important factors in formation VKB, relations of the patient and its relatives to treatment [16, 61, 121, 147].

It is necessary to notice, that reaction of the person to illness, being integrativnoj the structure including affective, kognitivnye, behavioural and physiological components, it is shown not only on conscious, but also at unconscious level.

At carrying out of treatment and formation of programs of aftertreatment of children with disturbances MI doctors and psychologists should consider insufficient life experience of the child which in overwhelming majority of cases does not allow him to consult with a difficult vital situation that compels it to address for the help to adult relatives. Hence, the the child is more younger, the is more often he will address to relatives in various crisis situations. Thus parents can help with overcoming of the psychological obexes arising against a difficult vital situation, illness of the child, and to aggravate their current. On the one hand, adults can render such influence when obvious changes in the psychosomatic status of the child are ignored by parents and not perceived as disease. So, at an uracrasia, and hyperactivity parents often consider a syndrome of deficiency of attention accompanying it as only individual "feature", instead of the psychological problem bound to disease. Thus to this day for the phenomena of a day and-or day incontience of urine, and also kalomazanie parents offend very many children, humiliate and punish, including with use rukoprikladstva, aggravating available pathological psychological features. On the other hand, the situation when the child has recovered is rather extended, and parents continue to concern it as to the sick person, frequently using developed situation in own mercenary purposes (reception of material grants, social security etc.) [10, 33, 121, 125, 147].

At studying of families and predominating styles of education in them as the factors influencing formation of mental and somatic health of children, psychologists agree in opinion, that disturbances in system of family relations in overwhelming majority of cases provoke occurrence of somatic and psychosomatic diseases at children. Also disturbances of mutual relations in a family can lead to formation patoharakterologicheskih lines of the person. Often in mutual relations between mother and the child the somatic pathology gets special sense (value) that the impact on dynamics of an illness and even its fastness to therapy will make. Today many researchers the sense (value) with which illness is allocated admits, that, becomes up to the end not realised formation and undoubtedly influences mutual relations between mother and the child, and also them with other members of a family and society. Thus disease can favour to dialogue or lead to its absence, and also to become
Possibility to "adhere" the child to themselves (especially at lonely and hysterical women) to maintain with its close symbiotic relations even at teenage and youthful age [97, 142, 156, 207].

It is important to consider, that at often ill children the dual relation to illness in due course is formed. So, on the one hand, the majority of children realise, that disease stirs it is high-grade to develop and harmoniously to be socialised. On the other hand, illness happens "is favourable" to the child as it provides to it constant emotional support from parents in the form of care and attention, at times absolutely excessive. According to researches, only 15-16 % of children are assured, that during illness they will test emotional deprivatsiju and otverzhenie parents, and 84-85 %, on the contrary, that disease will strengthen parent love, attention and care. Considering the above-stated, doctors should not forget about possibility unmotivated (not realised) and motivatsionno supported (more often from financially interested parents) malingerings from children and the teenagers, suffering various psychosomatic diseases, including disturbances MI and SNFTO [16, 40, 105, 121, 150, 173].

Against available disease less favorable psychological situation develops at teenagers, rather than than at children of younger age. So, being ill, the teenager appears in a situation of larger dependence on parents. In modern social formations for teenage age gradual weakening of communication with sponsoring adults (intensifying of independence, responsibility and possibility to make of the decision etc.) is characteristic And illness conducts to appreciable restriction of independence. As a result, pathological attachment to the parents, allocated with protective functions is formed, at the teenager infantilism inappropriate to age accrues. During too time symbiotic links between parents (mother) and the child who prevent to perceive it (it) the teenager as the adult person are strengthened. The close symbiotic communication "parents-teenagers", especially against illness is more longly supported, the it is more difficult to break off it further, and psychotraumas both at parents and at children at attempts of their dissociation arise that is more often. In some cases difficult situations when parents, appealing illness of the teenager and the care shown earlier, start to manipulate it are formed more, patholologically limit its freedom and supervise private life, receiving, thus, "indemnification" for all earlier made for it. Often such situation arises in families with authoritative (selfish) parents and soft, weak-willed, appeasable children (the so-called "gold" child) [14, 43, 121, 156, 220].

Thus, psycho-social development of the child is caused by interaction of its congenital features and conditions of medium. Personal features of children and teenagers with disorders MI are formed of set of these factors for which postpones a print illness that it is necessary to consider by working out of complex programs on diagnostics, treatment and aftertreatment of patients with pathology MI.


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Scientific source MIRONOV ANDREY ANATOLEVICH. the CLINICO-PSYCHOLOGICAL SUBSTANTIATION of APPLICATION of the METHOD of FUNCTIONAL BIOLOGICAL MANAGEMENT At CHILDREN With the EMICTION PATHOLOGY. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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