I recently came across a case that reminded me of working as a consultant in one of the clinics. I remember that I was often called to such conditions when elderly people showed psychosis. The specificity was that, more often after operations with general anesthesia, less often just like that, signs of confused consciousness, double orientation, aggression, and psychomotor disinhibition appeared. It is interesting that these symptoms went away even with almost no treatment or simply with the use of IVs with fairly common medications, such as saline solution and vitamins. I didn’t understand what it was until I was lucky enough to meet an emergency doctor who was called along with me, it just so happened. He said that this is how organics and older people adapt to stress: in a grossly psychotic form. Simply because compensation mechanisms work that way and there is no former flexibility for neurosis and more subtle reactions. Since then, I have thought about the fact that “adaptation disorder,” not in the sense of the description in the ICD, but in such an expanded understanding, can be a spectrum from neurotic, quickly passing reactions to subpsychotic, and maybe completely psychotic states. Now, working as a psychotherapist in PND, I am becoming more and more immersed in this idea. It is not new, but as often happens, in my own experience it sounds different to me. Here is a patient with OCD. (Obsessive-compulsive disorder, maybe a syndrome within the framework of schizophrenia) His task is to jump and kick his legs several times, with all his considerable weight, in different corners of the room. When he hears something falling at his neighbors’ place and feels a “vibration,” it must be extinguished with “his own vibration.” At the same time, when he jumps dozens of times, the furniture in his apartment breaks due to the shaking, the stove and washing machine are damaged, the neighbors come running... But the fight against vibration is paramount. We met and talked, first about vibration and its features, he explained that he understood the destructive nature of his actions, but “it is definitely necessary.” The question “what is needed for” remained open. But gradually, looking further and further into his life, he remembered an episode when, at the age of 6, he lay and slept, trying to fall asleep in a room in a communal apartment. And the parents went to the cinema. And then the neighbor, who was drunk, began to beat something in the kitchen. The patient woke up and began to cry, and even the neighbor’s wife tried to calm him down. But in vain, he continued to cry from fear. To my question, what would an adult like to do now for the boy, he answered, come and “beat” the wall, so that the drunk neighbor would feel what it’s like, and the little boy would see that he is protected. Further conversations led to memories of a father who, when drunk, beat his mother and threatened his youngest patient. And again, when asked what he would like to do, this time the patient answered: “beat dad”... But in reality, all these tendencies were embodied in the “struggle against vibration.” And how to prove this, when the episodes described above were recalled, the patient could “endure more, not hit so hard” (his words). I am amazed by the sophistication and variety of compensation mechanisms. I am pleased with the opportunity to consider any manifestations of mental disorders as an adaptation to the complex world around us within the framework of individual characteristics of the reaction to this world.... I did not touch upon drug treatment. But in the case described above, I work together with a psychiatrist and prescribe pills.