Buch lesen: «Male’s Health in the Objective of Stressology – Beyond the Usual»
The Law of Gravity is revealed among people as an attraction of a Man towards a Woman. The attraction often arises suddenly, instantaneously and stays forever, creating a whole new world by combining “mismatches” similar to the puzzles of gravity. Once gravity disappears, the attraction remains in the Universe.
Armen Muradyan, Ada Tadevosyan, 2018
Man is a leader (the Universe), a woman is a follower (Galathea). Man teaches, takes action and creates the order on the earth, It is him who is only responsible for both Good and Evil. However, the Woman is the one who is responsible of what type of a man he will become, a Teacher or a Creator or a Destroyer. They are looking for each other, sometimes their whole life, and when they meet, then the Love, the only passion that does not recognize either past or future, becomes their supreme power.
Armen Muradyan, Ada Tadevosyan, 2018
Arshil Gorki. “Mysterious struggle”, 1937
ABOUT THE AUTHORS
Ada (Adel) Tadevosyan was born in Tbilisi, in the family of a serviceman. After graduation from the Yerevan State Medical Institute in 1961, she began her professional career as a psychiatrist in the psychiatric hospital of Ijevan (Armenia). Since 1963 for 30 years she taught at the Department of Psychiatry of the Yerevan State Medical Institute (now M. Heratsi Medical University). In 1969 she successfully defended her PhD thesis, subsequently received the Diploma of Associate Professor.
A. Tadevosyan is the direct organizer and participant of the work on rendering help to victims of the 1988 Spitak earthquake in Armenia. Since 1989 for many years she was the organizer and Head of the “Stress” Center. The term “Stressology” belongs to her. A Tadevosyan in the most difficult conditions that prevailed at that time in Armenia, created a new service, thereby ensuring the development of stressology in Armenia and determining the priority of this direction not only in the extreme crisis situation. The most important aspect of A. Tadevosyan’s activity was the aspect of developing and introducing a new field of medicine – stressology to students, clinical residents and doctors. For these purposes she wrote a monograph (as the first text-book) “STRESSOLOGY – as a field of medicine on the problem of mental trauma and post-traumatic health disorders”. In 1996 in St. Petersburg A. Tadevosyan was awarded the M. V. Lomonosov Gold Medal for her contribution to education and solving problems on human security and life. As a participant of the National Program for the Development of Psychosocial Aspect “Disaster Management” of the United Nations in Armenia, in 1998 A. Tadevosyan conducted training cycles with rescuers and was awarded a commemorative medal from Hungarian Ministry of Civil Protection. A Tadevosyan is a participant of the Geneva Initiative on Reforms in Psychiatry in 1991–1992 and attendee of many World Congresses.
A. Tadevosyan is the author of more than 100 printed works and several monographs on the problems of mentally traumatized. She proposed a stress-phase-oriented model (SPHOM) of health disorders.
For contribution to the scientific and practical medicine was awarded the Gold Medal of Mkhitar Heratsi YSMU, 2017.
A. Tadevosyan – ScD in Medicine, Associate Professor, full member of the International Academy of Ecology and Life Safety (MANEB), Academician of the RA Academy of Law, member of the Association of Psychiatrists of Armenia, World Association of Psychiatrists, International Association of Traumatic Stress, World Association of Biological Psychiatry, International Association “Stress and Behavior”, licensed psychiatrist, psychotherapist, organizer of public health.
Armen Muradyan is Rector of the Yerevan State Medical University named after M. Heratsi (YSMU), Head of the Department of Urology and Andrology, ScD in Medicine, Professor, whose works are devoted to oncourology, andrology, reconstructive and non-invasive surgery. He was born in the family of a doctor and musician. Out of two possible professions, by the call of the heart, he chose medicine, which became a native element for him. His professional career began as a medical attendant, having passed all the stages of becoming primarily practicing urologist.
Professional medical growth covers the period from 1998 to 2006. After graduating from the Medical Institute, having received a narrow specialty of urologist, he began to work as urologist-consultant in Uronephrological Clinic. In 2001–2002 worked as an on-call doctor in the Urological Department of the Republican Medical Center “Armenia”; 2002–2003 – Assistant of Surgery Department No.2, YSMU; 2003–2011 – founder and Head of the Department of Urology at the YSMU; Head of the Urological Clinic of the Republican Medical Center “Armenia”; Chief Urologist of the RA Ministry of Health; 2009 – elected President of the Armenian Urological Association. Since 2004, without leaving his main practical work as an urologist, combined it with work in the Ministry of Health, first as an adviser to the Minister of Health, then in 2014–2016 became Minister of Health of the Republic of Armenia. As Minister of Public Health he repeatedly confirmed his devotion to the “White Doctor’s Robe” by his attitude to patients, people who found themselves in difficult situation (war in Karabakh, man-made and technical disasters), disabled people. Throughout all these years he was engaged in scientific activity; in 2005 defended his doctoral dissertation on the theme “Clinical and biological bases of complex treatment of advanced prostate cancer”; Head of 3 candidate and 2 doctoral dissertations, has more than 50 scientific publications, several monographs. Awards: “Gold Medal” of YSMI, Letter of Thanks from RA Prime-Minister, “National Trust” Prize”, “Medal after N. Lopatkin” from the President of the Urological Association, Medal for “Services to the Fatherland” of the 2nd degree from President of RA Serzh Sargsyan.
ABOUT THE PUBLICATION
Rector of the East European Institute of Psychoanalysis, Honored Worker of Science of the Russian Federation, Doctor of Psychology and Candidate of Medical Sciences, Honorary Professor at the Vienna University named after Sigmund Freud
Mikhail Reshetnikov
Life expectance of the male population, although traditionally lagging behind the female population for 4–6 years, is steadily increasing in all developed countries, reaching in some cases, as in Japan, 85 years. Therefore, the problem of male general, mental and sexual longevity acquires special significance, which has been repeatedly emphasized in international forums held under the aegis of WHO. Due to this, the monograph prepared by A. Tadevosyan and A. Muradyan is, undoubtedly, an actual and timely study and generalization of the authors’ many years of scientific and therapeutic activity. Especially I would like to note the interdisciplinary approach, originally laid in the basis of this publication, as one of the authors is a recognized specialist in psychiatry, and the second – in urology, sexopathology and normal sexology.
Unlike the generally accepted approaches that primarily appeal to the biological patterns of the functioning of the organism and the individual, the main accent of the presentation is deliberately shifted by the authors to the sphere of psychosocial problems of health and longevity. For a long time, medicine and psychology were strongly drawn towards describing some kind of average and even asexual personality. At the beginning of the 20th century, this tradition was violated by psychoanalysts Helen Deutsch and Karen Horney, who first prepared works devoted to the specifics of female psychology. On the Soviet space this topic was highlighted in the monograph of Abram Svyadoshch “Women’s Sexual Pathology”, which became a medical bestseller and survived several reprints. However, so far there are not so many systematic works in which an attempt is made to penetrate deeply into the inner mental world of men. It is this penetration that characterizes the peer-reviewed monograph analyzing the links between the neurophysiological and psychosocial mechanisms of male sexual activity, both in norm and in pathology.
I am pleased to note that, unlike most authors who traditionally (mainly because of their ignorance) do not appeal to the brilliant discoveries of Sigmund Freud, the authors actively use the psychoanalytic concept, while not only referring to the works of this outstanding scientist, but also actively disputing with him. On the whole, the book is distinguished by the substantiation and novelty of the view on a number of key problems of psychic and somatic pathology, imbued with the spirit of scientific optimism and humanism. It will undoubtedly be positively welcomed by both the scientific and the general public.
Distinguished GDOU Chair Professor of Neuroscience and Pharmacology of the St. Petersburg State University, Professor of Neuroscience of the Institute of Translational Biomedicine of SPSU (Russia), Professor of Southwestern University (China), President of the International Stress and Behavior Society (ISBS)
Allan V. Kalueff
The very title of the book “Male’s Health in the Objective of Stressology – beyond the usual” did not raise any doubts and promised to be an interesting reading. Indeed, modern biology long ago came to understanding that the body of a man and the body of a woman are completely different in both physiology and neurobiology. This book thoroughly analyzes the male body also from the point of view of psychology and psychiatry.
The main attention in the publication is devoted to stress and how stress is combined with biological factors of the male body, creating a fine line between the pathology and the limits of the norm. The authors organically combine biology and psychology in their analyses and observations.
The theme of human sexuality touched by the authors is also important. Undoubtedly, human sexuality is an interesting topic in itself since it includes a whole range of preferences and complex forms of behavior, especially in men. For example, the authors try to give a rather objective biological picture of homosexuality and include it into socio-cultural frameworks and norms. Perhaps we can say that the authors are a bit conservative-traditional in their conclusions and that it is important for the society (and even necessary) to inculcate even greater tolerance. However, the reader will have to charge for himself how often the norms themselves changed in the history of mankind.
This also applies to other forms of behavior – aggression, paternity, suicidal behavior. The book gives a deep analysis of both psychoanalytical theories and modern psychiatric diagnostics in these behavioral domains.
Finally, a special, informal language of the material presentation is also of interest: on the one hand, it is clear that the book is written by experts with knowledge of the subject-matter, and on the other hand – it is read easily and comprehensible to any reader. On the whole, the authors’ book is not authoritarian conclusions of two well-known medical scientists, but rather, a thoughtful and considerate invitation to the reader to think about a complex system called the male body. The book turned out deep, philosophical and wise.
Head of the Department of Medical Psychology of YSMU, PhD in Psychology им. Гераци, к.п.н.
Khachatur Gasparyan
The monograph “Male’s Health in the Objective of Stressology – beyond the usual” is devoted to the study of male health from the point of view of medicine, psychology and psychiatry. A detailed and in-depth analysis of all those stressogenic impacts, factors and peculiarities of male socialization that affect health and longevity of male life has been done. Male’s health is seen as the result of the effect of multi-aspect factors including somatic problems, stressful life situations and psychological traumas. The authors demonstrate system and interdisciplinary approach to the problem of male health in which the entire structure of the personality and not just of a man as a carrier of a particular disease, is considered which corresponds to the modern approaches in medicine and medical psychology.
For a long time female gender role and the limitations associated with it have been in the focus of researchers’ attention. However, it should be noted that the traditional male role also has a number of stereotypes and limitations that overlap their carriers and men also suffer from gender prejudices and stereotypes. In this regard, the authors consider the historical development of concepts about male sexuality, male gender role and those difficulties that affect the psychological and physical health of men.
The authors pay great attention to phylogenetic and ontogenetic development of the concept of male sexuality. The phenomenon of body, phallic symbolism and phenomenon of libido energy are analyzed at different stages of the historical development of mankind, as well as within the life cycle of each male. The authors analyze the views of different scientists on the problems of consciousness, spirituality, relationship of ideal and material principles and conduct deep psychological and culturological analyses of the development of male identity. As part of the analysis of life stages of the development of libido energy and sublimation of this energy, the psychological aspects of erectile dysfunction along with the enormous influence that the psychological reasons have on the development of this problem are considered. The system approach to this problem of male health opens new opportunities for doctors, psychologists and patients since only with an interdisciplinary approach and taking into account the whole range of psychosomatic relationships it is possible to effectively treat not only the symptoms but also the disease itself.
Considering the above, it should be noted that this monograph is undoubtedly a valuable contribution to the scientific literature in the fields of psychology, medicine and stressology.
INTRODUCTION
The wisdom of my grandfathers
stuck in my head:
we were born to enjoy work, fight, love,
we were born for this and for nothing else.
Isaak Babel
The Armenian painter Aram Vramshapu Vanetsian in early 1939 began writing I. Babel’s portrait which turned out to be the last lifetime portrait of the writer (repressed and shot at the age of 46, January 1940).
Isaak Babel
A serious scientific question can be put to Babel’s words. If he is right, then the male mortality at a relatively young age is the result of the biological characteristics of the male body and its functioning.
Further presentation of the material is a search for the answer.
We searched for the answer proceeding from the following provisions:
1. “Human evolution is an important part of the universal evolution as an open nonlinear system, and the most complex one” (V. E. Klochko, 2017).
2. “A person is such a level of system research, when the not very favorite word “system” can be quite adequately replaced by the more euphonic concept of “integrity” (I. Prigogine, 1986).
3. “A person is an integrative entity” possessing the brain and higher nervous activity (HNA) owing to which an internal notional subjective world is formed, including:
Conscious triunity (biological/psychic/social);
“appropriate” part of information from outside, from the collective unconscious;
the soul of a particular person (“affective/emotional clot”);
will and faith.
4. The psychology of the development of culture and religion led us to the need not to ignore the stages of development of the studied paradigms both in phylo- and ontogenesis.
5. The analytical interdisciplinary system adaptive approach was used.
Analyzing the phenomenon under study or the psychic paradigm, metaphors were often used. “In the era of changing paradigms and great breaks, the science starts to use the language of metaphors. To denote new phenomena, established concepts are insufficient” (T. Kuhn, 1975).
6. Research material:
rich clinical experience of working as urologist/sexopathologist;
rich clinical experience of working as psychiatrist/stressologist;
achievements of science in the field of studied paradigms
A. Muradyan, A. Tadevosyan, 2017
Patient’s drawing1
Where there is the tree of knowledge,
there is always Paradise
Nietzsche
And you will know the truth,
And the truth will make you free
(The Gospel of John, 8:32)
Part One
MAN IN THE SCIENTIFIC PICTURE OF THE WORLD
The “father” of humanistic psychology Abraham Maslow was engaged not so much in sick people and causes of diseases, as in study of healthy people (who have “realized themselves”), trying to understand where human health comes from. His long-lasting observations resulted in a conclusion that the source of health lies in the person himself. A person is healthy if he uses all his abilities, strengths, and talents (self-actualization). He reveals his feelings to the fullest, outward-oriented on the perception of the surrounding world and inward-directing experiences of external impressions. No human emotions are alien to such a person; he is open to all forms of their expression. These people, according to John Powell, see the beauty of the world, hear its music and poetry, perceive a unique flavor of each day; they know the admiration of any moment of existence. Practically healthy people will not live mindlessly in a strange world. They are well aware of the wise saying of Socrates: “It is not worth living without thinking” and we will add “and acting”. They are able to correctly question the life and flexible enough to let it raise questions and tasks before them. To live life to the full means to have developed imagination and sense of humor, retain spontaneity and liveliness of emotions and sensitively listen to the voice of nature, which in its constant development subjects human to it too. Care and love – this is the main content of the relationship of these people to everything and everyone. And when they encounter the shady side of the life they understand its objectivity and try to perceive its reason; and to perceive means to forgive. Forgiveness for them is restoration of internal harmony which is actually the basement the health rests on. Healthy people truly love and truly respect themselves and respecting themselves they respect others. Every tomorrow – is a new opportunity, which is eagerly awaited. Life and death find meaning for them. And when the hour of death, their hearts are full of gratitude for what has been, for “The Way They Were,” for the whole life experience.
MAN IN MEDICINE
MENTAL HEALTH
In medicine it is accepted to speak about individual approach to a patient but behind this concept there is no content that a beginner doctor could learn. Individual has evolved from specimen (biological being) to individual and then to the upper stage of evolution – personality. Carl Rogers was the first who disclosed the difference between the concepts “personality” and “person” – individual. The concept “individual” refers to a carrier of physiological peculiarities of Homo sapiens as a rational being endowed with consciousness and will in whom psychic and biological constitute a single unit and individual actualization – for myself – prevails. For the purposes of medicine, we shall accept the following definition of “personality”: personality is a human who climbed the top step of evolution and has become a social person. His actualization already lies mainly in the sphere of society, in his relationships with other people at all levels of his activity. As the core of the personality appear relations between people in any social medium, for the benefit of which he consciously positively thinks and acts. Individual as an object of doctor’s professional activity is the product of several complex variables, each being complex by itself. These variables are:
• biological component – the body;
• mental component – human psyche;
• social component – the environment.
Each component changes depending on the temporal factor and external effects retaining at that its specific features, its basic function, its mechanisms for realization of existing capabilities and its range of improvement and development.
Example: consider the human organism, his body. It has relatively rigid boundaries and limits of variation. But if we recall bodybuilding, abilities developed by the person practicing yoga, it becomes clear that it is within a person’s power to change also his body despite its biological boundaries. Each variable has a tendency to change and to develop as it is built in the informational combination of bio-psycho-social reflection of the reality.
Human has acquired a huge resource of variability and evolution at the expense of consciousness and will. To date there is no uniform concept of human. We will adhere to a concept that treats human as a developing conscious volitional trinity in both phylo-and ontogenesis. Actualization as a psychological phenomenon manifests itself in realization of possibilities and capabilities ensuring personal growth, self-perfection and self-respect that comprise the main purpose of life for a male. Actualization in contrast to the tendency towards equilibrium (homeostasis) is often due not to a decrease but to an increase in strain. Being optimally actualized, such a person lives a full and bright life every new moment of it. He personally chooses his way of life, as a source of information uses his perceptions, feelings and thoughts rather than other people’s advice. Having made his choice, he is responsible for the consequences of the choice and never blames others but himself. Such people make up the fully functioning human formation that “adjusts life of humanity on the earth”. It is mainly male formation at the age of 35–60.
Today we can speak of a new trend in health care, the trend of studying the role of psyche and brain in human health and illness.
In regulations, programs, and in general it has become popular to talk not only about the bodily but also about the mental health. Behind the facade of popular terms, there is no common understanding of “what the mental health is”. Often, the activity of reforms is reduced to the replacement of just a name, for example, “Center for Mental Health” instead of “Psychiatric Hospital”. As a result the accumulated problems of mental health are not solved, but on the contrary become veiled and deeper, not removing stigma, not improving the state of patients with mental problems, moreover not improving their health. The problem of health and illness, norm and pathology is complicated; their boundaries are relative and depend on many factors and reasons. This is the consequence of the complexity of the very object of study – psyche, its characteristics and properties, criteria to be guided to determine “mental health”.
Study of the population of practically healthy people showed that about 50 % of adults had one or more symptoms of mental register manifested in the form of anxiety, irritability, constant strain, alarm, chronic fatigue, asthenia, insomnia, bad mood. The majority of these people did not apply to a specialist: 71 % – did not undertake whatsoever, 1 % – shared their fears with friends or relatives and only 17 % applied to a doctor. Early symptoms are not well pronounced because more frequently they are connected with deadaptation, functional by their nature and do not much worry a person, his environment and doctors. This is the first level of change in mental health, which should be the object of great attention of primary care doctors. Being in the very focus of attention, these states when timely diagnosed and correctly handled, are reversible.
The following characteristics are distinguished in mental health:
• the field of mental health;
• boundaries of mental health;
• quality of human life.
The field of mental health implies the sphere and range of person’s activity in which individual is adapted. It is enlarged or narrowed depending on the society’s requirements, in other words, the field of mental health due to the specificity of psyche and its laws does not have unique determination. Therefore it is important to specify the concept “Mental health” and define its levels. The boundaries of mental health are the “limits” of acceptable behavior in the society. The boundaries of mental health were historically correlated with the ruling basic vision of religion, philosophy, politics. Today the term “Quality of life” is widely used. It is characterized by valuation standards adopted by the person for himself. Each person has his own life model that meets his and accepted by the society standards. One is quite satisfied with his domestic needs, interests – to be pleased with life or to consider that he lives full-value life. For the other one it is important to have everything that symbolizes prosperity accepted in the given society. The other seeks to know the world and himself; somebody else lives in the world of illusions. Therefore, the life quality has flexible standards for different people, different societies, different ages and generations. Based on the standards of living before and after illness, personal field of mental health is outlined. Mental health and its disorders can be presented by several levels, definition of which is based on the priority and degree of involvement of brain matter, psyche or personality in the process.
The lower fundamental level – the level of psycho-physiology is determined by peculiarities of the internal cerebral neurophysiological organization of psychic activity. The necessary condition for healthy psyche is safety of the brain as the organ, normal functioning of all blocks (human perception of senses, thinking, memory, emotions, mentality). This level is found in any organic brain diseases (tumors, stroke, atherosclerosis, trauma).
The second level of mental health disorders is the adaptation level. Disorders of this level are the largest and diverse group and make the layer that is to be regarded as true disorders of mental health. Disorders of this level are described as borderline states, anxiety disorders, post-stress disorders, psychosomatic, neurotic. They reflect temporary reduction of human ability to self-actualize, adapt, decrease stress resistance, social competence, purposeful activity. Human character traits are inevitably sharpened and manifested in the activity. The whole “psychic discomfort” is accompanied with somatic troubles (dynamic arterial hypertension, pain syndromes – more often in back, headaches, insomnia, itch, lack of air, vegetovascular dystonia, enteric manifestations, etc.).
The third, highest level is the level of personal mental health, which is determined by the quality of human semantic relations, hierarchy of his sense orientations to the world, himself and his place in it. Personally mentally healthy person is the one who is able to accept the reality as it is (illness, loss); able to overcome traumas of the past, and remembering them able to search for his new true place in the life and in the world. The one, who is able to reassess values, be aware of their unique vital meaning, to overcome himself and external obstacles while realizing new meanings and values.
Personal health is a result of sometimes painful search for new himself. History knows many names of famous persons who had this or that mental illness that did not prevent them to adapt socially, realize their purposes and live full, rich life. Remember Caesar’s, Napoleon’s, Dostoevsky’s epilepsy; Darwin’s psychasthenia; Freud’s and Zoschenko’s depressions. People having certain mental disorders, and even diseases, not to mention bodily problems, somatic diseases, can be personality healthy. Often there are people with certain health problems but in the personality aspect, they prove to be healthier than any other one who, according to WHO definition, has “Absolute health”. The human in his body image is one with spiritual and mental “I”. Therefore violation in any sphere necessarily entails violations in others that are frequently of compensatory or protective nature, e.g. rise of temperature due to infection. In medicine clarification of the primary and secondary role of the factor in cause-and-effect relations is the basis for the adequate therapeutic approach and favorable outcome, hence is the presence of the etiopathogenetic and symptomatic treatment. Often it is difficult to determine the precise feature based on which it is possible to talk about mental illness. So any doctor must have at least minimum knowledge in the field of psychology, its laws, their standard functioning; know regularities of transition states manifested by deadaptation situations, mechanisms of psychological protection. All these issues are successfully solved by a new direction in medicine – stressology. “Mental health” should be understood as the state of person able to correctly (adequately) reflect the outside world, set a goal, plan and fulfill adopted decisions, enjoy lively and adequate emotions, able to overcome conflicts, tension and preserve a certain degree of stress resistance. Mentally healthy person has enough secure instinct of self-preservation of bodily, mental and social “I”.
There are three types of social impacts affecting the state of health.
The first type is historical influence that affects the whole generation. Thus, men whose early childhood fell on the years of the “Great Depression” in the United States throughout their lives showed the difficulties of social adaptation. The whole generation of the former USSR who experienced the “37th year” revealed difficulties of adaptation; the males of Armenia whose childhood and youth concurred with crisis years of the end of XX – beginning of XXI century are still experiencing adaptation difficulties.
