In a complex human mental sphere thought, imagination, and recollection often become a triggering factor, “stressor of stressors” activating the mechanism of stressogenesis, eliciting the entire range of the vegetosomatic effect inherent to the phases of GAS. As a result mental adaptation becomes more complex, expanded, evolved, reflecting the evolution of the world of man and the evolution of man himself, his knowledge, values, wishes and purpose of life. In the course of evolution there comes about the “central regulating organ”, commonly called “the inner psychic world” that is located between the receptors and the effectors. This inner world (psychic) is built up gradually, by virtue of the so-called existing “stimulus barrier” that enables to perceive and to forward “only a fragment of the initial (stimulus)” reality of the world of man (Freud, 1920).
But man is an amazing creature! He is not content with a life-long adaptation to the actually changing environment, the changing human environment and to his own self. With the development of consciousness an individual, and only he, as shown by many studies, while living his own life, is also permanently forming his own “subjective reality”, his own idea of the world of things, of other people and of his own status. Meanwhile, the latter category is associated with self-rating, varying from an overestimation of oneself, one’s capacities and capabilities, to their underestimation. The result is that the individual adapts not so much to the objective reality but to the so-called “psychic reality” built by himself as an integrative “product”, as a fundamental integrative formation of the perceived outside world, colored by personal experiences and personal estimates. As a result, a “semantic reality” is created, enriched and framed by thoughts, feelings, fantasies, anxieties and suspicions. In forming this reality a sizeable role belongs to the past events, imagination and perspectives, to say nothing of the unconscious predictions forming the guidelines.
The emerging mental reality is not the reality that is mostly identified with the outside world and regarded as “objective reality”. The mental reality, at close scrutiny, is a colored palette of diverse interpretations of the outside world by different people, for each of them “his own reality is the most objective”, the one he is being adapted to. The mental reality is constructed through personal experience enabling perception of current life. E.g., a person gone through a traumatic situation, retains this experience, often perceives this world acting in it at present and in the future in the light of a traumatic reality of the past. It is this person who crosses the threshold of the doctor’s office, having his own idea of the disease, the formulated internal picture of the disease. The mental reality can be regarded as synonymous to the inner and subjective reality. All three terms – mental, inner, and subjective realities are designed to limit the subjective experience of an individual from the world of physical objects. Some theorists attempt to introduce certain corrections to delimit the mental and the inner reality.
They correlate the mental reality with the inner sources of subjective experience that is with unconscious fantasies and images, for which the perceptions incoming from the outside world are an outside source of subjective experience. With regard to the term “inner reality”, they understand it as a most general phenomenon reflecting a total subjective experience based upon integrative images of the perceived outside world.
Similar to the inner reality, which is not a “pure” product of imagination, the outside reality has its complex structure. The outside reality is reducible to two basic manifestations: “the actual” – objectively verifiable and confirmed by the scientific cognition of the world, and “the artificial” – the intersubjectively generally accepted “conventional” consisting of the world of words, myths, traditions, interpersonal and collective forms of behavior. The abovementioned shows the variety of factors and situations that can cause a state of deadaptation, anxiety, stress in modern man, and as a consequence, the improvement and complication of the adaptation system itself.
In the outside world structure the major portion falls on the world of people, so that task number one in human everyday life becomes man’s ability to adapt to another person, to other people who are carriers of individual psychosocial “Egos” that are present from the very beginning of life and to the last breath. “Man is a tangle of interrelationships” is an ancient philosophical aphorism. And this kind of adaptation is a super task and super goal for any person. K. Cherry (1972) believes that every act of communication between people, each new perception of another person adds something to the experience and improves the adaptability. Communication with people of one’s own kind is already a subsystem of social contacts, leading to an expansion of mental adaptation which in fact becomes psychosocial adaptation. L. Feuerbach (1955) noted that the individual “as something isolated” could not comprise the human essence in himself “either as a moral being, or as a thinking entity”; the human essence is “evident only in communication, in the unity of man with man…”. Thus, a crucial adaptation to be performed by man is adaptation to the social structure and his participation in building it up (Bernfeld, 1931). This type can be attributed to the fourth form of adaptation. The SPA is characterized by the multidimensional self-organizing subsystems, which provide greater freedom and variability in the choice of adaptation.
The mechanisms of the SBA and SPA, which determine the vital activity of a person, are extremely complex structures containing multiple subsystems, interconnected and interdependent. N. P. Bekhtereva regarded the increasing number of flexible links in the control system of mental activity as the main principle of complicating the brain systems. She assumed that the mental activity was supported by the cortical-subcortical structural-functional system with links of varying degrees of rigidity. Human adaptive capabilities have the widest range of flexible links, which when interacting with the environment allow to keep “essential variables” within the physiological boundaries. This is reflected in the”interfunctional” reorganization of the entire structure of mental activity in the process of ontogenesis.
The system adaptive approach enables to present a complete picture of man in his onto- and phylogenetic development; in health and illness; a picture stipulated by psychosomatic interrelations between the component paradigms – the biological and the psychosocial.
A historical development of human consists in the fact that today we have a person as a conscious volitional trinity (biological, social and mental), for whom sense formation (meaning formation) has become a leading need. Sense formation is the main function of the brain distinguishing a person from all living beings, and it is this ability to attach personal significance to environmental signals that makes each person unique and unrepeatable. It is sense formation that underlies many conscious and unconscious psychological defenses that make up the core of the SPA.
Example. They say that “Rafael Santi was driven mad with love towards a model for the image of Psyche. Once he, a dreamy young man was walking in the park thinking about finding a model for his canvas “Cupid and Psyche”. Suddenly he noticed a beautiful girl resting in the shade. Such pure features, such angelic face he had never seen! “Psyche” looked with interest at Rafael blinded by her beauty. She was 17 years old. Her name was Margarita Luti. Rafael immediately invited her to become model for the image of Psyche. Painter offered her a gold ring for ten kisses. Maid graciously agreed. Rafael lost his head with passion. Rafael went mad with beautiful “Fornarina” (translated from Italian means “baker”). Her delicate face with expressive brown eyes, silky skin and lush shoulders forced him to get off the breath. But that was not the Fornarina, whom worshiped Rafael. The young mistress of Raphael, though living with him, twisted love affairs with wealthy Romans right and left, often returning home at dawn. What about Rafael Santi? He did his job – he painted, and his paintings have become part of the golden fund of world art. The beauty with innocent charm, that struck the painter’s heart, became a common courtesan. Rafael went crazy with countless betrayals of Margarita but in work continued to depict the ideal he “was looking for Psyche”. The most famous of his creations became written in the years 1512–1513 “Sistine Madonna.” Flying in the clouds the Virgin with child still touches deeply. The model for the image of Mary became the same Margarita Luti. The artist gave her face an expression that he would like to see and “saw”: a mother’s love, the fear of the loss of a child, tenderness. He loved and painted the one whom he sought, whom he loved and by virtue of whom created his works. He lived in his world woven out of values, desires and symbols. Suffering from reality, he immersed into work and came back to reality again. Rafael suffered unspeakably, like any addict, splashing his hidden feelings on canvas or wet plaster. Perhaps his work would not be so heartfelt, if his life with Fornarina evolved happily.
Patient's drawing.
Is it so or not – we will never know.
We will not make any conclusions with respect to a specific example, because we are deeply convinced that it will be another version and nothing more if follow the basic principle of psychology “That might be so, might be otherwise” of which we wrote at the beginning.
But it seemed to us that the example will help understand all of the above said on the individual, his life, motivation, adaptation, objective and subjective realities, psychological defense and the role of suffering in his deeds.
CORRELATION OF CONCEPTS:
“STRESS”, “EMOTIONAL STRESS”,
“TRAUMATIC STRESS” (APES)
Stress. For the first time the word “stress” emerged in the English language in 1303 when the poet R. Manning wrote: “The Lord had sent manna of heaven for the people in great stress”.
In the late eighteenth – early nineteenth centuries Goya, whose art was distinguished by passionate emotional and social orientation, created a series of paintings that he called “Desastress”. The series includes paintings reflecting the human grief and suffering, among them: “Unhappy mother” (Sheet 50 of the famous etchings), “I have seen it” (Sh. 44), “They are a different breed” (Sh. 61), “This is the worst” (Sh. 37).
The concept “stress”, introduced into biology and medicine, is associated with the name of H. Selye and it was used to refer to a non-specific response of the body to any harmful and subsequently a harmless effect too. It is a natural genetically programmed normal and necessary response of the body to provide its survival and development. The essence of Selye’s teaching is his discovery of the three-phase general adaptation syndrome (GAS).
The first phase (stage), called by Selye the “phase of combat alert” includes orientation reflex accompanied with restructuring of the whole body. It is mainly implemented by an automatic neurobiological mechanism, by the action of a sympato-parasympatic nervous system BSA and has a bioelectric character.
The second phase is the stage of resistance (strain); it is also figuratively referred to as the “stage of fight or flight”. If during the first stage the situation is assessed as dangerous, and anxiety as the expectation of an uncertain danger becomes a “concrete fear”, then through the activation of the endocrine glands the second stage of the stress reaction develops and stress hormones enter the bloodstream. Spread by blood to organ/systems, they put the body into the state of readiness either to flight from danger or to fight with it (muscles tense, heartbeat vigorous, pressure jumps, etc.). Self-preservation mode is triggered throughout the body.
The whole complex is a normal, necessary effect of self-preservation instinct and similar for both types of behavior. The choice of behavior depends on the impulsivity and genetic program; but in human more often on the acquired experience of response in the deadaptation situation. It is stipulated by activation of three endocrine axes. The effects are caused only biochemical or neurobiochemical mechanism, which activates the appropriate organ/systems by hormones.
The third phase is the stage of asthenization. H. Selye has shown that stress accompanies any life activity and corresponds, in certain sense, to the life intensity. It increases with nervous tension, bodily injuries, muscular work, infections, in the situations of joy or sorrow, even with recollection of tragic events of the past and leads to the shift of the internal state of balance to deadaptation.
Let us denote the process of deadaptation – adaptation by one term – stressogenesis. A person in the course of the whole life gets “stress” injections and acquires stress-resistance in the form of behavioral patterns of overcoming stressful state, learns to comprehend and act in a constructive direction. If it does not occur, destructive characteristics of stress trigger. Using the expression: “Stress is the aroma and the taste of life” we should not forget that they are also different as the favorite aroma and taste in different people are different. The classical version of GAS, its evolutionary core, has a discrete nature and represents a unity of three phases. In this embodiment, the GAS came into use as “stress” and became the property of biology.
Revealed opportunities of studying and understanding what is happening in a person for a long time made their way to medicine with difficulty because of the lack of the concept “man in medicine”. Throughout the twentieth century medicine developed as an aid and health improvement of the diseased body, therefore it would not be a mistake to call it “body medicine”. Human health and disease were regarded as structural injuries of different organ/ systems under the impact of various external factors. The role of mental component was reduced to zero or completely ignored in both the questions of etiology, etiopathogenesis of diseases and those of dynamics, therapy and forecast. Psychological principles and laws acting in man, psychosocial component of man were disregarded due to total ignorance of medical sciences – psychology and sociology.
This was promoted by principle of parallelism dominating in neuroscience. Psychiatry should have been exclusion but it was also biologized. The desire of psychiatrists to find a biological substrate in the brain as a cause of schizophrenia, manic-depressive psychosis is still alive, despite the generally accepted by WHO definition of health. According to the Constitution of WHO, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This definition provokes lots of questions, reprimands and critics and it needs serious correction and specification. But it will be possible only with appearance of the concept “man in medicine”, when the issues of mental health and social well-being are considered from the viewpoint of a triad concept: “man” as a unity of biological, mental and social.