A VIEW FROM THE PAST AT THE PHENOMENON OF ALCOHOL DELIRUM (based on the materials of the article by I.D. Ermakov “On delirium tremens”, 1917) Abstract. This work is a theoretical analysis of Ivan Dmitrievich Ermakov’s article “On delirium tremens” of 1917. The features of this article and its theoretical significance are considered, and an attempt is made to establish the prerequisites for its writing. The functions of alcoholization for the population during the war and post-war periods are determined, as well as the significance of delirium delirium in the process of sublimation of unconscious drives and fears. The significance of altered states of consciousness in the works of various writers is given. Alcoholic delirium and the creative process are considered as similar phenomena that perform certain functions for the psyche. At the beginning of the last century, Ivan Dmitrievich Ermakov, an outstanding psychiatrist, psychologist, literary critic and organizer of the Russian Psychoanalytic Society, published an article “On delirium tremens” in the journal Psychoneurological Bulletin. In this article Ermakov I.D. brilliantly describes and analyzes various scientific works devoted to the phenomenon of delirium delirium, illustrates the symptoms with the story of I.S. Turgenev “The Adventures of Second Lieutenant Bubnov” and draws certain scientific conclusions. However, at the end of the article, the scientific style gives way to an artistic one, and the author writes sad lines about the decline in morality of a person who abuses alcohol, about his weak-willedness and passivity. This seemingly insignificant detail is strengthened by the fact that against the background of the scientific works of I.D. Ermakov’s article “On delirium tremens” does not have any logical connections with other works; it is published without specific reasons and has no prerequisites. However, along with this, this article represents a solid scientific work with the author’s obvious knowledge of the issues of alcoholic delirium. [8] What events predetermined the writing of I.D. Ermakov of the scientific work under consideration? We will try to answer this question below. “As a certain form of the disease that develops in connection with alcohol abuse, delirium tremens was identified more than a century ago, since Pearson and Sutton gave it a description in England, and in the 20s In the early years of the 19th century, two Moscow doctors Brühl-Cramer and Salvatori settled on the study of alcoholic diseases.” [4]Ivan Dmitrievich wrote these lines about a hundred years ago. At the beginning of the 20th century, delirium tremens, like today, was far from the most studied phenomenon, because did not contain the valuable experience that is acquired when searching for ways to prevent and treat other mental disorders. Relieving alcoholic delirium for a psychiatrist is only a situational intervention aimed at preventing death. For a psychologist and psychoanalyst, the analysis of delusions and hallucinations reproduced by a patient does not represent therapeutic value, because For them, the problem of alcoholism itself and the mechanisms of its pathogenesis are much more important than the acute psychosis that arises as a consequence. And such views cannot be called incorrect, because Delirium tremens, in reality, is the sad end of long-term alcoholism, which mostly occurs in people diagnosed with chronic alcoholism. Ermakov himself writes: “But if delirium tremens, indicating a special vulnerability of the nervous system, shows us an extreme degree of change in mental activity under the influence of alcohol, then in a moderate drinker, as most researchers agree with this, we observe the same features, but in a weaker state.” degrees. I cannot here touch on the scientifically verified facts that even a small amount of alcohol has a dramatic effect on all higher mental processes - the study of delirium tremens showed only the most dramatic manifestation of that disorder of thinking, attention, memory, deceptions of feelings, self-esteem, etc., which have long been known to everyone involved in or interested in alcoholism.” [4] Because of this, todayEvery day, psychiatrists-narcologists, psychotherapists and psychologists working in the field of alcohol addiction pay attention to the treatment of alcoholism in general, leaving a small gap in their practice for the issue of alcohol psychosis. [3], [7] However, after a hundred years, Ermakov’s reminder of the place of delirium tremens in the history of mankind makes us think about the practical importance of the phenomenon in question. Indeed, if such a phenomenon as delirium delirium exists, it means that it performs some physiological and mental functions. If from the physiological side we at least know the causes and consequences of delirium tremens, then its significance for the human psyche largely remains in the shadows. However, if you try to consider the phenomenon under discussion not through the examples of individual individuals, but through mass phenomena, through culture and art, then perhaps the picture will become clearer. It is possible that alcoholic delirium plays an important role in the development of society. Indeed, qualitative disturbances of perception and consciousness, as a way to take a different look at the reality around us, have been going on in parallel with humanity since the birth of civilization. The mystical nature of such phenomena permeates the work of various artists for many hundreds of years. The irresistible attraction of some individuals to a chemical change in consciousness goes against reason and logic, ultimately leading them to irreparable consequences, to a complete separation from reality against the background of the preservation of vital functions. But, despite this, representatives of the modern scientific world often shy away from the possibility of full-fledged research delirium tremens, i.e. from considering the complementarity of physiological (impaired functioning of the brain) and psychological (projection of unconscious images outside) aspects of its occurrence and development. Listing the issues of the pathogenesis of alcoholic delirium, I.D. Ermakov touches on such physiological and social aspects as the amount of alcohol consumed, gender differences, age, heredity, time of year, etc., while referring to many famous authors. Having carried out a detailed theoretical analysis of the scientific research available at that time, he points out the ambiguity of the results obtained and comes to the following conclusion: “As for the purely physical phenomena accompanying delirium tremens, they are not at all characteristic of it, since they also occur during ordinary chronic alcoholism. Such phenomena include gastrointestinal disorders, albuminuria, tremors, sweating, feelings of melancholy, insomnia, fear and even hallucinations. Thus, not in somatic, but mainly, if not exclusively, in mental manifestations we will find characteristic of delirium tremens expression. As Wernicke noted, the cornerstone symptom of delirium tremens is a complete distortion of the external world.” [4] It is interesting that I.D. Ermakov was one of the first to dwell in detail on the very content of delirium tremens and, as one would expect from an erudite literary critic, clearly illustrated the main symptoms of alcoholic delirium using the example of the story by I.S. Turgenev "The Adventures of Second Lieutenant Bubnov." A colorful description of the lieutenant’s visions is followed by medical explanations of the bodily sensations most often encountered with the disease in question: “The stranger, approaching Second Lieutenant Bubnov, said casually and quickly: “I am the devil.” - Having met distrust on the part of the second lieutenant, the devil immediately proves his nature to him - he orders the nettles that have grown along the fences to dance the Cossack, (an illusion due to Bubnov’s own imbalance). The devil drags his legs through his mouth and through the back of his head, throws his own eyes into the air, and in conclusion offers Bubnov his nose as a souvenir, which he hides in the side pocket of his coat (hallucinations of both a visual and tactile nature).” [4]“Looking atBabebibobu, the second lieutenant saw that she was looking at him, narrowing her eyes and smiling, and running her red tongue over her sharp white teeth. “She will eat me!” – the second lieutenant thought in horror. “To your health,” the devil remarked. Any erotic idea, both here and in the previous two cases, causes horror in the lieutenant - which is very typical of the weakening of the sexual ability of an alcoholic, which often leads to delusions of adultery, so often found in chronic alcoholics. In addition, as we see, the devil reads Bubnov’s thoughts, which again happens extremely often among alcoholics, who often complain that all their thoughts are known to others.” [4] Ermakov also cites the significance of altered states of consciousness in the works of such famous writers as Hoffmann and Edgar Allan Poe. Ivan Dmitrievich very clearly draws a parallel between art and alcoholism. It is no secret that the world of creativity and fantasy has a significant number of its representatives who abuse psychoactive substances, in particular alcohol. However, these two writers were not chosen by chance. Their work is united by the reigning atmosphere of fear, horror, despair and hopelessness, which, as Ermakov points out, represents the leading shades of the experiences of a patient with delirium delirium: “A chronic alcoholic plunges into a heavy nightmare, and in this dream, which is called delirium tremens, they awaken and those subconscious fears and horrors that a person experiences when walking the right path to his death act on him.” [4] Indeed, the creative process and alcoholic delirium have a similar effect on a person’s mental state. Both phenomena serve as the realization of the projection of unconscious tendencies to the outside. Thus, the connection between art and alcoholic delirium becomes obvious with only one difference - if creativity is a process of sublimation of unconscious tendencies, accompanied by the control of the Super-ego, then delirium tremens is their direct manifestation. As is known, the human unconscious stores within itself all the drives and impulses that have not passed through censorship or have been repressed by the incorruptible Super-ego. Often these drives are aggressive or sexual in nature, i.e. represent what is most condemned in human society (for example, rape or murder). And if art provides a way out for relieving tension through the symbolization of unconscious drives, then observing alcoholic delirium allows us to see all the patient’s hidden fears and desires with minimal censorship. Perhaps it is for this reason that some peoples welcomed the combination of the images of a warrior and a creator in one person. We should also not forget that the article “On Delirium Tremens” was written in 1917. In Russia, the horrors of the First World War were played out with full force. A war that is recognized as one of the most brutal and bloody wars in human history. Russia suffered defeat after defeat. The officers, recruited mainly from the intelligentsia, were adamant in their patriotism. The top of the bourgeoisie, strengthening its financial position through military supplies, demanded the continuation of the war and supported these demands with loud ideological cries. However, the reality was significantly different from the idea. Russia was in an extremely difficult situation, balancing between the demands of the bourgeoisie and the needs of the masses. In this war, Russia had neither serious military plans nor sufficient food to support the army. By 1917, the masses, consisting mainly of soldiers and peasants, began to experience unrest caused by terrible military and living conditions. The class struggle was growing and the obviousness of the development of the revolution in the near future did not raise any doubt among many. The people longed for an end to hostilities, but the authorities insisted on continuing until victory. [2] If you look at the current situation from the point of view of psychoanalysis, you can see a clear picture of neurosis. Authority that sets rules and regulations plays a roleThe super-ego represses the impulses and desires of the crowd, which can be represented as the id. It is known that the speed and brightness of the manifestation of all mental reactions in a group increases significantly, the critical assessment of what is happening decreases, emotional intensity increases, etc. If we consider the country as a separate individual with a neurotic conflict, then alcohol in such a situation can act as an external defense against the threat of internal unconscious conflicts, opening a pathological path for the release of current drives and impulses. In the war and post-war years, when the fear of death and the fear of punishment for murders are intensified many times over, the release of tension is more necessary than ever, but not every person is capable of constructive sublimation of his repressed experiences. During such a period, many people see relief in alcohol, through the use of which many issues are resolved. With prolonged alcohol abuse and abrupt withdrawal, a projection of all repressed fears and experiences occurs externally through illusions and hallucinations. This is how the voltage output occurs. Perhaps for this reason, images in delirium delirium are often frightening. The German psychoanalyst Ernst Simmel (1948) pointed to the significance of alcoholism in the post-war population's adaptation to the social world: “Addictions offer a magnificent excuse for the post-war Ego, which finds itself involved in a conflict between frustrating realities and impulses - especially aggression - on the part of the Id, the force, controlling the superego, which turned out to be incapable of mediation. In addition, the ego finds a way to deny the painful reality by re-establishing, thanks to artificial pharmacotoxic enthusiasm, the infantile pleasure principle as a liberation from the inhibitions of the superego. [6] Ermakov himself also mentions the importance of alcoholism in the war and post-war period in his 1907 work “Mental Illnesses in the Russo-Japanese War”: “The most prominent role in hereditary data is played by alcoholism, in its various forms, most often very The father drank, and the mother very rarely (according to the patients). <…> Alcoholic psychoses were very common, more often they were delirium tremens, alcoholic degeneration, moral stupidity, several cases of alcoholic paranoia; chronic paranoia, mainly in the form of paranoia inventoria, has given several representatives.” [5] The discrepancy between ideological trends and the real situation of that time may cause the need to defuse unconscious tendencies, and if the people do not have the ability to sublimate tension, the chance of releasing it through art and creativity remains minimal. [8]However, why is the state of delirium tremens the central theme of the article under consideration? Ermakov writes about this: “Therefore, I chose delirium tremens as a paradigm of how alcohol acts on the mental sphere and so that it would become clear to everyone what states it leads to.” [4] Thus, it becomes clear that Ermakov did not write about delirium tremens as a separate phenomenon. The purpose of this article was not limited to determining the mechanisms of the occurrence and development of delirium alcoholism. The beginning of the 20th century was a dying period for the Russian Empire, characterized by a systemic crisis of statehood and chaos in the interaction of society and government. The people existed in fear and confusion, and mass alcoholism was a symptom of a fatal disease that ended with the death of Tsarist Russia and the change from autocracy to dual power. [2] At the beginning of the 21st century, we are witnessing the return of this symptom. Alcoholism, which affects the entire country, of all ages and nationalities, again indicates to us the approach of an unknown disease, the lack of prevention and treatment of which will invariably lead, if not to another death, then to severe disability for the entire country. A lenient attitude towards such a pronounced symptom would be a violation of medical ethics for psychotherapists and professional