Vegetative-vascular ... depression? My chest felt cold, my breath was short, I had a feeling that the air was not getting into my lungs. I had to try to breathe deeper and more often, and I felt dizzy that I might fall and even die. and everyone will decide that I’m just drunk. Real horror and panic set in. I wanted to scream, call for help, the understanding came that this was the end. And with a piercing note, an animal fear that the children would be orphans.” Man, 35 years old: “Suddenly. It became very hot, hot waves spread throughout the body, it seemed that the heart stopped, the legs became weak, the blood rushed to the face. An unaccountable panic came. A clear thought came: here it is, death.” Emergency doctors often hear such complaints. help who arrived to the call and found alarmed relatives and a person rushing about in fear. I, a psychiatrist-psychotherapist with 30 years of experience, hear similar complaints and descriptions of the onset of the disease every day. As if in reality, I go through with the patient, in the course of his story, all the circles of hell, in the form of numerous, cumbersome, complex diagnostic examinations. These include trips to different cities and regions for examinations in specialized centers, consultations with professors of scientific medical departments, and collection of many complex biochemical tests. All this, and even more, will have to go through the vast majority of people who have experienced a vegetative crisis (vegetative-vascular paroxysm, panic attack). The outpatient records of such patients resemble one of the volumes of "War and Peace", with many different, often mutually exclusive diagnoses, or diagnoses which, if desired, can be given to almost any person who does not have such complaints. “There are no absolutely healthy people. There are simply unexamined ones.” For a person who has survived such an attack, the instinct of self-preservation tells him that behind his condition there may be a life-threatening disease, that it is time to stop taking his health lightly, but to get examined, identify the cause of the disease and recover. The doctor’s self-preservation instinct, in turn, requires him to find any justification that could fit the alarming symptoms into the framework of an understandable, specific, generally accepted diagnosis. It often happens that doctors do not know how, do not want or do not have the opportunity, due to their workload, talk to the patient. They leave his questions unanswered, remain thoughtfully silent, or in conversation use complex medical terms that are incomprehensible to a person and therefore even more frightening. Then they prescribe complex examinations (MRI, ultrasound scan) to “exclude a rare disease.” This is where what happens is called “iatrogeny” (iatro - doctor, genius - generated) - a disease caused by a careless statement or non-statement, incorrect behavior of the medical staff. As a result, the person becomes even more frightened: he begins to fixate on any manifestations of the body’s activity, constantly monitor his pulse rate, and measure his blood pressure. Thus, a situation is created that promotes the development of chronic stress. It is necessary to know that the emergence of vegetative pathology is facilitated by: situations in which a person’s desires do not coincide with his capabilities. difficulties in adapting to changed living conditions: change of place of residence, change/loss of job, infidelity, divorce; memory of the subconscious about difficult events suffered: an accident, robbery, violence, illness or loss of a loved one. In any case, a vegetative crisis manifests itself through a neurotic symptom: (palpitations, increased blood pressure, shortness of breath, dry mouth, dizziness, difficulty swallowing, diarrhea). A symptom is a compromise between the conscious and subconscious. In the process of irreconcilable disputes "and I wantand he injects himself, and his mother doesn’t tell him to,” the symptom seems to “appease” both sides of the conflict: the subconscious, which “wants” and the consciousness, which “does not tell.” Remove the symptom, and the conflict will manifest itself with renewed vigor: “Break up with your unloved husband , but what about the children?” Agree that it is better to solve the problem, and not suffer from neurosis or be frozen with fear during a crisis. And for this you need to contact a psychologist or psychotherapist. Psychotherapy is an independent medical specialty, the psychotherapist has a higher medical education and solid training in therapy (internal diseases). Psychotherapy has its own scientifically based methods of diagnosis and treatment. You should abandon false modesty when contacting a psychiatrist-psychotherapist or psychologist-psychotherapist. “Psycho” is a SOUL, that is, a psychotherapist is a healer of the soul. , according to other sources, a healer with SOUL. According to statistics, from 30 to 50% of all visits to therapists (cardiologists, gastroenterologists, neurologists) are explained by psychosomatic disorders. In modern medicine, this phenomenon is called “somatoform disorder.” Complaints in this disease concern those organs and systems that are under the influence of the autonomic nervous system: cardiovascular (cardiac neurosis), gastrointestinal (nervous diarrhea) and respiratory (feeling of lack of air, shortness of breath, hiccups). In one of its manifestations, somatoform disorder is characterized by signs of autonomic arousal, such as heartbeat, sweating, trembling, pallor or redness of the skin. In the second case, complaints are extremely subjective. The patient reports "a feeling of heaviness, tension, fleeting pain, bloating, stretching, burning." The vast majority of people suffering from somatoform disorder may not come to the attention of a psychotherapist for many years, or rather, by the time they contact him, they have already gone through a long and difficult path, many examinations, and often they have even undergone meaningless operations. Somatoform disorder the disorder is closely related to depressive disorders, since with them, it is often not the clearly conscious depressed mood that comes to the fore, but somatic (bodily) complaints. According to the World Health Organization, from 60 to 80% of people suffering from depression seek help from doctors in clinics, and due to the failure of these doctors to identify a depressive state, they do not receive adequate treatment. In the case of a clearly recognized depressed mood, anhedonia (decreased ability to experience pleasure ), insomnia (usually early awakening), suicidal thoughts, everything is more or less clear, and the patient is referred to a specialist: psychiatrist, psychotherapist, psychologist. However, in recent decades, depressed mood is disguised as somatic (bodily) and autonomic disorders. Somatized, masked depression occurs in more than 30% of outpatient patients. These are “complex”, “incomprehensible” patients, with unknown somatic diagnoses, and vice versa, patients with a huge outpatient card, swollen with many diagnoses. At the bodily level, depression is usually characterized by symptoms such as palpitations, constipation, fluctuations in blood pressure pressure, with a tendency to increase, deterioration of digestion, loss of body weight. A change in the appearance of patients is often observed: the skin becomes dry, pale, hair loss and brittle nails often increase, and wrinkles deepen. Patients look much older than their years, which, both for the patient himself and for the people around him, causes the feeling that he has a somatic (physical) illness and the need for examination by a therapist. One of the most common “masks” of depression in general medical practice is persistent pain that can be localized in almost any part of the body: in the muscles, in the back, in the heart area, as well as headaches. I would like to pay special attention to the feeling of migrating pain in)