Male’s Health in the Objective of Stressology – Beyond the Usual

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 drawing[1 - With a feeling of deep gratitude we remember our patients. Communication and working with each of them enriched our experience. They left a particle of themselves in drawings that we used in this book. Patients’ names are not indicated here because of compliance with medical ethics.]

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 “37

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.

The second type – is the so-called “standard events” – life stresses occurring within the regular life flow: entering higher educational institution, moving, marriage, birth of children, retirement. Such factors can go unnoticed, but can become pathogenic, stressful.