From the author: A. G. Belyaev, psychiatrist, psychotherapist, NLP coach, highly qualified manager (MBA), director of the consulting company "El - Consul", g . Barnaul. When reprinting, a link to Register here on the website using the link: RECEIVE a gift for registration! Cork over strong iodine! How quickly you faded away! So the soul invisibly burns and eats away the body. V. Khodasevich (1921). The relevance of the question of the presence of unconscious motives that make psychosomatic diseases conditionally pleasant for patients suffering from them leaves no doubt due to the fact that this question remains open for discussion by specialists in various fields and there is no clear answer to it. The purpose of this article is to familiarize readers of this publication with one of the options for a positive answer about the existence of conditioned pleasantness, or as it is also called, “secondary benefit” in patients suffering from psychosomatic diseases. The author of the article examines this problem both through the prism of analyzing her own experience of working with patients who have been diagnosed with this pathology, and by citing data from other specialists confirming the put forward version. After birth, a child, like any living creature, has unconditioned reflexes aimed at its survival. If something or someone appears in the world around the child, he can distinguish whether it is pleasant or not, whether it will bring pain or satisfaction. The child reacts directly and spontaneously to what is happening in the external environment. And a lot depends on what the environment around the child will be like. If the adults who communicate with him support the child’s development in the direction of his natural inclinations, encourage and allow him to rely on his own resources, doing this to a greater extent in a playful way, then, most likely, a free, healthy, independent personality will develop, capable of adaptation. Usually, the child is implanted with an evaluative system of understanding the world. What is “good - bad”, “right - wrong”, “should - don’t”, how you “should - shouldn’t” act, “for - against”, “yes - no”. And quickly or gradually, the child develops conditioned reflexes to live according to these instructions, and even feel this way, often ignoring some personal sensations, feelings, thoughts that still appear. As soon as this happens, the child begins to lose, as he grows up, the immediacy of the bodily, emotional experience of contact with the outside world. Monotony and boredom of life appear. The child is already afraid to rely on direct experiences and feelings. Trying to act in accordance with the rules that authoritative adults put into him. And as he becomes an adult, he is constantly looking for new authorities, new “pointers” that could help him live correctly and well. Yes, of course, life according to instructions, rules, directions allows a person to adapt to a certain social environment. But, finding himself in a new, unfamiliar environment, a person begins to feel lost. To avoid troubles, the number of contacts is reduced, the circle of communication is narrowed. Against the background of such an energetically low external level, the level of emotional internal tension increases. If previous behavioral stereotypes are not suitable in new conditions, then the person comes into conflict with the external environment. The less spontaneity a person has, the more difficult it is for him to adapt to new living conditions, meeting people, etc. As one of the consequences, the occurrence of illness. Although, as usual, the disease is perceived as unambiguously, something very bad, requiring merciless eradication and fight. This only confirms that at this moment we ourselves are captives of habit, and therefore cannot see the other side of the coin. I would like to suggest considering illness (primarily this concerns so-called psychosomatic diseases) as a way to solve many problems using examples from personal practice. For example: Vladimir P. 36 years old. I consulted a psychotherapist withcomplaints: a significant decrease in mood, fatigue, decreased desire to do anything at work, at home. Periodically, pressing pain in the stomach area, which intensified with psycho-emotional stress. Vladimir was admitted by a referral from a therapist to the AKKPB, psychotherapeutic department (hereinafter referred to as PO) for the purpose of consultation and recommendations for treatment. Diagnosed with duodenal ulcer, subremission phase, superficial gastritis. Subdepressive syndrome. It was found out that the disease began about five years ago, after he took up entrepreneurial activity and began to lead a very active and stressful lifestyle. A year ago, I first began to notice that pain in the stomach began to occur not only due to poor nutrition and spontaneous cessation of treatment due to established gastritis, and then peptic ulcer disease. But even with psycho-emotional overstrain, which arose due to the need to contact a large number of people, it often manifested itself in difficult-to-correct outbursts of anger, aggression, and some bitterness towards even strangers. Then, I was depressed for a long time. Complex treatment at the PA was carried out jointly with a gastroenterologist who had been observing this patient for a long time. In addition to pharmacotherapy, acupuncture, and physiotherapy, the treatment included individual psychotherapy and psychocorrection. The patient realized that the appearance of pain and exacerbations of the disease is the most powerful and, unfortunately, the only way to solve many life problems. Because Only when he became seriously ill and suffered from excruciating pain did he allow himself to truly rest, stopped communicating with people who were unpleasant to him, and received a lot of attention and care from his family. Vladimir was asked to look for other ways to receive the benefits that he received through the disease: timely, complete rest from unwanted contacts, a sufficient amount of attention, support, love from his family, loved ones, and friends. In the process of psychotherapy, he found several methods that reduced the level of emotional tension. Could adequately compete with the secondary benefit of the disease. Illness is no longer the only way to satisfy one’s own needs. Moreover, the new methods were more pleasant. Clinically, this was expressed in a reduction in pain and exacerbations of the disease, an increase in self-esteem, and an optimistic outlook on the future. In this case, for Vladimir, one of the reasons for the onset of the disease and contributing to its chronicity was an unconscious internal conflict. Between the desire to satisfy his own needs as he wanted and how “this should be done by a real man,” Vladimir received these “instructions” in early childhood from his father (who, by the way, also suffers from chronic gastritis). Restoring the immediacy of perception of the world around him allowed Vladimir, paying attention to the sensations of his body and emotions, to solve current problems in personally invented ways that allowed him to flexibly adapt to the changed situation. Example No. 2 In a patient who had been overweight for a long time due to overeating, the disease turned out to be a kind of “protector” from vulgar proposals from men. And also as a substitute way of replenishing bodily pleasures (by eating large amounts of tasty food). Example No. 3 A patient consulted about bronchial asthma, atopic form (moderate pollen and food allergies in the phase of subsiding exacerbation). During a psychotherapy session, I suddenly found out for myself that the frequent attacks of choking occur not so much in response to some kind of food, but rather in order to “protect” it from rudeness and negative emotions in the family and at work. Since the attacks of suffocation that began almost immediately stopped the aggression directed at her. Of course, everything is not so simple, and each patient must be approached individually, carefully differentiatingcauses and consequences of diseases. Most of the material presented above requires clinical, statistical confirmation. But the fact that a high level of emotional stress with poorly expressed spontaneity significantly increases the risk of a psychosomatic disorder is explained by the theory of the development of emotional stress by Professor G.I. Kositsky and has already been confirmed by clinical and statistical studies. Emotional stress (hereinafter referred to as E.N.) develops in several stages. In this case, subsequent ones can arise, bypassing the previous ones. When solving non-standard problems, rapidly changing living conditions, circumstances. There is an increase in physical and mental activity, inspiration when solving non-standard, creative problems - stage 1 MA -1 (mobilization, activity). If this activity is not enough, stage 2 of ESR occurs - negative asthenic emotions - maximum mobilization of all the body's resources mentally appears as anger, obsession, rage. If this mobilization is not enough, then stage 3 of ASOE occurs - the asthenic stage of negative emotions. Psychologically it manifests itself as a state of horror, melancholy, “legs give way”, “hands give up”. This stage is of extremely important protective significance. Because if at this moment the goal does not change, the attitude towards it does not change, it is not abandoned, the resource of strength is not replenished. Then the stage of development of the disease inevitably follows: neurosis, neurosis-like state, psychosomatic pathology, exacerbation of any pre-existing chronic diseases that were in remission. Oddly enough, this significantly reduces emotional stress. Somatization of affect is especially characteristic for persons who suffered some kind of harm in childhood, i.e. vulnerability of a particular system or organ. Which had “behavioral risk factors” as personal characteristics: neuroticism, anxiety, aggressiveness. These trends clearly emerged in studies of psychosomatosis of the digestive system. Using clinical and experimental psychological methods, 3 groups of patients located in a single psychosomatic continuum were examined. The chain consists of: functional pathology of the stomach - patients with gastralgia; onset of organic pathology - gastritis; organic pathology - gastric ulcer. Data reflect conditional units 1. Anxiety level: 31.2 28.3 25.6 2. Neuroticism 17.8 15.4 13, 5 3. Anxiety 11.6 9.9 6.2 4. Depression 6.6 6.1 5.4 5. Somatization of anxiety 8.7 8.2 7.5 Data taken from the article by M.V. Korkin, V. V. Marilova “The importance of personal characteristics in the formation of psychosomatic pathology” Moscow 1983. abstracts of reports for the V11 Congress of the Society of Psychologists of the USSR. As one of the most enlightened theologians and scientists of our time, P. Teilhard de Chardin, wrote, “...nowhere are the difficulties that we still face in trying to unite spirit and matter in the same rational perspective more clearly apparent. But nowhere else is the urgent need to build a bridge between the two shores of our existence - the physical and the moral - manifested so palpably, if we want the spiritual and material sides of our activity to revive each other. Successful treatment of psychosomatic diseases is possible only under the conditions of taking into account the different levels - spiritual and elementary organismic - components of human life in their dynamic relationships. When diagnosing, this presupposes the ability to see in the symptoms of a disease not only the expression of an organ or systemic disorder, but also the experience of the developed disease and a personal reaction to it. When determining therapeutic tactics, the doctor needs to find an opportunity to ensure its optimal effectiveness if the degree of participation in the development of the disease is represented not only by specific biological (genetics/constitution), toxic, microbial, atmospheric and other pathogenic factors, but also by the life circumstances of personal characteristics refracted through the lens patient..