erroneous

perception of a real object

affective

Verbal

Pareidolic

More often of exogenous etiology, prognostically favorable

PSYCHOSENSORY WEED DISORDERS

realobjectobject

Metamorphopsia opsia

Disturbances in the perception of the body schema

Testify testify

about the defeat of the parietal parietal

areas (intoxicationintoxication,,

organic diseases

ERRORED PERCEPTION OF A REAL OBJECT

	PHYSIOLOGICAL			PATHOLOGICAL
	associated with the characteristics of the work			misperception
	sense organs and analyzers;			completely overlaps
	misperception			a real object;
	corrected by logic			no criticism

For example, illusions of movement of static objects

AFFECTOGENIC ILLUSIONS

An integral part of bright, polymorphic, dynamic sensory experiences of the metamorphosis taking place in the world (staging, apocalypse)

A.S. Pushkin "Demons"

They are observed in a state of severe emotional stress and in acute psychoses (in the structure

syndrome of acute sensual delirium, syndrome of oneiroid stupefaction)

VERBAL ILLUSIONS

As a rule, they are affective. Occur in the syndrome of acute sensual delirium. Instead of neutral speech or, for example, the sound of wagon wheels, the patient hears abuse addressed to him, accusations, threats.

It is necessary to distinguish from delirium of a relationship, when the patient hears speech correctly, but finds in it

a different meaning, a special subtext (this is an error of judgment, not perception)

PAREIDOLIC ILLUSIONS

variant of affectogenic VISUAL ILLUSIONS ILLUSIONS :: "revival" of static inanimate objects objects

For example, in the interweaving of branches or in the pattern of wallpaper, the patient sees changeable fantastic landscapes, people's faces, unusual animals; portraits on the wall come to life, etc.

Observed in the initial stage of acute exogenous psychoses

with the syndrome of delirious stupefaction

^ 2.1. Psychology of perception and images of representation

Perception is a kind of cognitive activity, the result of which is sensual images of objects that directly affect the senses. Unlike sensation in perception, heterogeneous impressions are integrated into discrete structural units - images of perception; cognitive activity is experienced as a fact of personal activity directed by a specific task, and not as an act of passive registration of impressions.

Perceptual images are made up of external and internal (primarily kinesthetic) sensations. The “contribution” of different types of sensitivity is not the same in this case. Obviously, the images of perception of the blind and the sighted, the deaf and the hearing, the color-blind and the individual with "normal" color sensitivity are different. This relativity does not mean that the outside world is nothing more than a subjective construction. The fact that one does not perceive the melody does not mean that the melody does not exist. As, however, and that, the plausibility of a deception of perception does not prove the reality of the apparent object.

Perception is the process of "creating" an image from "sensory" material. The following phases are distinguished:

Perception - the primary selection of a complex of stimuli from the mass of others, as related to one specific object. In other words, this is the phase of the distinction between figure and ground;

Apperception - comparison of the primary image with a similar or similar one stored in memory. If the primary image is identified as already known, this corresponds to recognition. If the information is new and ambiguous, identification occurs by putting forward and testing hypotheses in search of the most plausible or acceptable one. The object is regarded as previously unfamiliar;

Projection is the addition of the image of the perceived object with the details inherent in the established class, but for various reasons turned out to be “behind the scenes”. The image of perception is thereby "brought" to a certain standard.

The images of perception reflect such qualities of objects for which there are no special receptors: shape, size, rhythm, heaviness, position in space, speed, time. In this sense, the image of perception is, as it were, an over-sensible phenomenon, intermediate between sensory and rational cognition.

In psychological terms, perception is characterized by:

Constancy - the stability of the images of objects in different conditions of perception. For example, the hands are located at different distances from the eyes, but their size seems to be the same;

Wholeness is the unification of different experiences into a cohesive unity. The laws of holistic perception have been studied in Gestalt psychology (“the psychology of images”);

Volume - perception in three dimensions. This is achieved through binocular vision and binauricular hearing. At a distance of more than 15 m, the perception of space is carried out thanks to a linear, aerial perspective, parallax and interposition effects;

Objectification of images of perception is associated with the state of consciousness and search research activity. Early sensory experience is important here.

Perception expresses the activity of consciousness, attention, memory, and other mental structures. This is important to take into account for the analysis and evaluation of perceptual disorders. In the latter, traditionally referred to as sensory disorders, various disorders of all mental functions, as well as the personality as a whole, are found.

By the time of birth, the child has effectively functioning sense organs. By the age of one year, the visual acuity of an infant reaches the level of adults. Best of all, he perceives objects at a distance of 19 cm from his face.

Perhaps because to see the face of the mother during feeding. From the fourth day, the infant shows an innate preference for the perception of the human face. By two months, he recognizes his mother's face, and at four months he distinguishes blue, red, yellow and green colors. The perception of the depth of space is formed by the age of two months. In early infancy, attention is also attracted by moving objects, curvilinearity, and contrasts. From the first hours after birth, children are able to distinguish sounds of different intensities, recognize the mother's voice. They also smell. Taste perceptions develop later. The categorical perception is formed by the end of the first year, and it becomes constant by the age of 12-13.

There is a hypothesis according to which perception develops on the basis of innate "cognitive schemes". The latter allow the child to highlight the most important impressions and structure them in a certain way.

The necessary conditions for the development of perception are:

active movement. Observations have shown that the restriction of free movement disrupts the development of spatial perception;

Feedback. Needed to correct perceptual errors;

Maintaining the optimal amount of incoming sensory information. “Sensory “hunger” prevents the development of perception, and under experimental conditions leads to psychotic disorders;

Structuring of external impressions. The monotony of the latter (deserts, snowy plains, etc.) does not contribute to the formation of perceptual schemes, and in adults it is one of the reasons for the appearance of mirages.

The image of representation is the most complex type of figurative memory (Luriya, 1975). When we say that we have an idea of ​​a tree, a lemon, or a dog, this means that the previous experience of perception and practical activity with these objects has left their traces in us.

The images of representation resemble visual images, differing from the latter in less detail, brightness and clarity, but not only in this. The image of representation reflects the results of the intellectual processing of the impression about the subject, highlights the most significant features in it. So, we are not representing any specific tree, but we are dealing with a generalized image, which can include a visual image of a birch, a pine, and another tree. Blurring and pallor of the image of representation testifies to its generalization, the potential richness of the connections behind it, is a sign that it can be included in any relationship.

The image of a performance is not a mere memory. It is not stored in memory in an unchanged form, but is constantly transformed, the most relevant features are highlighted in it, the most relevant features are emphasized, and individual features are erased. Images of representation are subjective, they are not projected outside. They arise in consciousness indirectly, thereby approaching figurative thinking. Associations of images can go beyond ordinary impressions, thanks to the imagination they become available to creativity.

The following types of pathology of perception and images of representation are observed: violation of the constancy of perception, splitting of perception, illusions, hallucinations, pseudohallucinations, hallucinoids, phenomena of eidetism, violations of sensory synthesis.

^ 2.2. Psychopathology of perception and images of representation

Violation of constancy of perception. Distortions of images of objects depending on changes in the conditions of perception. While walking, the patient sees how the soil “jumps”, “sways”, “rises”, “falls”, trees and houses “stagger”, move with him. When the head is turned, objects “turn”, the body is felt to turn in the opposite direction. The patient feels as if objects are moving away or approaching, rather than he is walking towards or away from them. Distant objects are perceived as small, and near become unexpectedly large and vice versa.

^ Splitting of perception. Loss of the ability to form a holistic image of the object. Correctly perceiving the individual details of an object or its image, the patient cannot link them into a single structure, for example, he sees not a tree, but a trunk and foliage separately. Splitting of perception is described in schizophrenia, some intoxications, in particular, psychedelic substances. Similar (a violation occurs when the secondary parts of the visual cortex are damaged (Brodmann fields 18, 19). Patients, looking at an image (for example, glasses), say this: “... what is it? .. a circle and another circle ... and a crossbar ... probably a bicycle ".

Some patients, looking at the famous Boring drawing (where you can see the profile of a young woman or an old woman), report that they see both images at the same time, which indicates not a split in perception, but possibly simultaneous participation in the perception of the left and right hemispheres.

Sometimes there is a loss of the ability to synthesize sensations of different modalities, for example, visual and auditory. Perceiving a sounding radio receiver, the patient may look for the source of the sound elsewhere. This violation is observed in senile dementia (Snezhnevsky, 1970).

With damage to the parieto-occipital regions of the brain, a slightly different perception disorder occurs - simultaneous agnosia. The patient adequately perceives individual objects, regardless of their size, but at the same time is able to see only one object or its image. If he is shown an image of a circle and a triangle, then after a series of quick exposures he can say: "... because I know that there are two figures here - a triangle and a circle, but I see only one each time."

Illusions. The term is translated by the words "deception, deceptive representation" - a false, with a violation of identification, the perception of objects and phenomena that really exist and are relevant at the moment. For the first time they were singled out as an independent deception of perception and separated from hallucinations by J. Esquirol in 1817.

There are different kinds of illusory perception. With physical illusions, the incorrect perception of an object is due to the physical properties of the environment in which it is located - a spoon in a glass of water at the water-air interface seems to be broken. The appearance of a number of illusions is associated with the psychological characteristics of the process of perception. After a train stops, for example, it continues to appear to be moving for a while. In the well-known Muller-Lyer illusion, the length of individual lines is perceived differently depending on the shape of the figures they are part of. The coloring of the same part of the surface is perceived differently if the color of the figure as a whole is changed. The development of illusions is facilitated by factors that violate the clarity of perception: the color and illumination of objects, features of sound, defects in vision and hearing. The appearance of illusions depends on expectations, affective state, attitude. A timid person, walking along a deserted street at night, may mistake the silhouette of a bush for the figure of a lurking person. With illusions of inattention (Jaspers, 1923), instead of one word, another is heard that is close in sound; an outsider is mistaken for a friend, the wrong word is read in the text, etc. The influence of attitude on perception is demonstrated by the experiments of N. I. Uznadze: out of two balls of the same weight, the larger one seems heavier. A metal ball feels heavier than a plastic ball of the same weight (Deloff test).

The mentioned varieties of illusions are not a sign of a mental disorder. Pathological illusions have a number of important features. This is their psychological incomprehensibility, falling out of the semantic context of the situation. Visual images are completely absorbed, overlapped by imaginary ones, and are subjected to gross distortion. The content of pathological illusions expresses ideas of persecution and other painful experiences. There is no critical assessment of illusory images. Sometimes it is difficult to distinguish between illusions and hallucinatory images, as well as to catch the moment of transition of the first to the second.

There are the following types of pathological illusions: affective, verbal and pareidolic (pareidolia).

^ affective illusions. Associated with fear and anxiety. The patient in the frosty patterns of the window "sees" the face of the robber, in the folds of the blanket - the murderer lurking on the bed, takes the pen for a knife. Instead of the usual noises, knocking, ringing, he hears the clicking of a shutter, guns, shots, the steps and breathing of his pursuers, and death groans.

^ verbal illusions. They contain separate words, phrases that replace the real speech of others. Accusations, threats, abuse, exposures, insults are heard. Verbal illusions that arise against the background of fear or anxiety are considered a verbal version of affective illusions (Snezhnevsky, 1983). Intense, profuse and plot-related verbal illusions are termed "illusory hallucinosis" (Schroder, 1926) .

Verbal illusions must be distinguished from delusional ideas of relationship. With the latter, the patient hears the speech of others correctly, but is convinced that it contains “hints” addressed to him.

Affective and verbal illusions in psychopathological terms are heterogeneous. Some of them are associated with depression (accusations, censure). Others reflect the influence of delusional mood (threats, shooting, unpleasant taste of food). Some of the illusions are consonant with distinct delusional beliefs. Thus, a patient with delusions of jealousy hears the steps of a lover sneaking towards his wife instead of a rustle.

Pareidolia. They are visual illusions with fantastic content. When looking at shapeless spots, ornaments (patterns of tree lines, weaves of roots, the play of chiaroscuro in the leaves of trees, clouds), one sees exotic landscapes, enchanting scenes, mythical heroes and fairy-tale creatures, bizarre plants, people in unusual masks, ancient fortresses, battles, palaces. Portraits come to life. The faces depicted there begin to move, smile, wink, protrude from the frames, make grimaces. Pareidolia occurs spontaneously, attracts the attention of patients, is accompanied by lively emotional reactions.

Illusions are characteristic of states of shallow stupefaction of consciousness (the second stage of delirium, according to S. Libermeister), occur in acute symptomatic psychoses. They are also observed in delusional and affective psychoses of a different etiology. Episodic and unstable illusions occur in neurosis, neurosis-like states. In the pathogenesis of illusions, the role of hypnoid states of cortical analyzers is assumed.

hallucinations(“delusions”, “visions”). Imaginary perceptions, false images that arise spontaneously, without sensory stimulation. M. G. Yaroshevsky (1976, p. 23) mentions Bhatt, an ancient philosopher of the Mimams school, who expressed consonant modern guesses about the deceptions of perception. The reality or illusory nature of the image, Bhatta argued, is determined by the nature of the relationship between the organ and the external object. The perversion of these relationships leads to illusory perception. The causes of the latter can be peripheral (a defect in the sense organs), as well as central (manas), when images of memory are projected into the external world and become hallucinations. In the same way, according to Bhatt, dreams arise. Until now, the definition of hallucinations by V. Kh. Kandinsky has not lost its significance: “By the name of hallucinations, I mean the excitation of the central sensory areas that does not depend directly on external impressions, and the result of such excitation is a sensual image that appears in the perceiving consciousness with the same character of objectivity and reality, which under ordinary conditions belongs only to sensory images obtained by direct perception of real impressions. A hallucination is an image of a representation identified by the patient with a visual image. The definitions of hallucinations usually indicate the following signs.

The appearance of hallucinations is not directly related to the perception of real and available objects (the exception is functional and reflex hallucinations). This is where hallucinations differ from illusions. A hallucinating patient, along with false images, can adequately perceive reality. At the same time, his attention is distributed unevenly, often shifting towards deceptions of perception. Sometimes it is so absorbed in the latter that reality is almost or not noticed at all. In such cases, one speaks of detachment or hallucinatory congestion.

Hallucinations are characterized by sensual liveliness, projection into the real world (rarely they are devoid of a certain projection: “Voices from nowhere ... The hand reaches out from nowhere ...”), spontaneous appearance and alienation to the content of consciousness They are characterized, in addition, by the feeling of their own intellectual activity - the patient " himself" with interest or fear "listens", "looks", "peers". An integral expression of these qualities of perceptual deceptions is the experience of the corporality of imaginary images, their identification with images of real objects. Understanding the pain of hallucinations is largely lacking. Impressed by them, the patient behaves in exactly the same way as if what seems to him were actually happening. Often hallucinations, no matter how irrational their content, are more relevant to the patient than reality. He finds himself in great difficulty if imaginary and real images enter into relations of antagonism and have an equal power of influence on behavior. With such a "split" personality, the patient seems to exist in two "dimensions" at once, in a situation of conflict between the conscious and the unconscious.

There are the following types of hallucinations: visual, auditory, olfactory, gustatory, tactile and general sense hallucinations (enteroceptive, visceral, endosomatic). Close to the latter are vestibular and motor hallucinations.

^ visual hallucinations. Elementary and complex optical illusions are observed.

Elementary hallucinations - photopsies, phosphrenes - are simple optical illusions that do not add up to an objective image: flashes of light, sparkles, fog, smoke, spots, stripes, dots.

Complex visual hallucinations are characterized by subject content. Taking into account the latter, some special types of them are distinguished.

Zoological hallucinations - zoopsia - visions of animals, insects, snakes known from past experience.

Demonomanic hallucinations - visions of devils, mermaids, angels, gods, houris, and other characters from the field of mysticism and mythology. Fairy-tale creatures and monsters, "aliens", and other fantastic images can be perceived.

Anthropomorphic hallucinations are visions of images of close acquaintances and strangers, both living and dead. In recent decades, some authors have noted a decrease in demonomaniac and an increase in anthropomorphic perceptual deceptions. Sometimes, in imaginary images of relatives, according to patients, strangers, unfamiliar, hostile people can “disguise themselves” and vice versa. There are hallucinatory visions of fragments of the human body: eyes, head, limbs, pupils, internal organs - fragmentary hallucinations. Autoscopic hallucinations are visions of oneself. The phenomenon of geatoscopy is described: an imaginary perception of one's body, projected inside one's own body.

Polyopic hallucinations - multiple images of imaginary objects: glasses, bottles, devils, coffins, mice. False images can be located on a line that goes into the distance, and gradually decrease in size. Diplopic hallucinations - visions of double imaginary images: "People split in two - the same one is seen on the right and on the left."

Panoramic hallucinations - static visions of colorful landscapes, landscapes, space scenes, pictures of the consequences of atomic explosions, earthquakes, etc.

Scene-like hallucinations - visions of hallucinatory scenes, plot-related and sequentially arising from one another. Funerals, demonstrations, trials, executions, battles, afterlife scenes, adventures, adventurous and detective events are perceived. A variant of the stage-like hallucinations are pantophobic hallucinations of Levi-Valensi - frightening stage visions for patients.

Segla's visual verbal hallucinations are visions of letters, words, texts. The content of such symbolic hallucinations may be other sound systems: numbers, mathematical formulas, symbols of chemical elements, musical notes, heraldic signs.

Endoscopic (visceroscopic) hallucinations - visions of objects inside your body: "I see that my head is filled with large white worms"). Autovisceroscopic hallucinations - visions of one's own internal organs, sometimes affected by an imaginary disease: "I see my shrunken lungs." There are hallucinatory visions of one's organs, the images of which are taken out into the outside world, sometimes projected onto some surface, for example, onto a wall.

Negative visual hallucinations - a short-term blockade of the ability to see separate real objects.

Visual hallucinations also differ in color, size, clarity of contours and details of imaginary images, the degree of similarity with real objects, mobility, localization in space. Imaginary images can be black and white, painted indefinitely or predominantly in one color. For example, in epilepsy, they are intensely red or blue.

The color scheme of false images can reflect the peculiarities of color perception inherent in the individual. For colorblind people, for example, it lacks red. Normoptic hallucinations - the sizes of imaginary images are adequate to the size of the corresponding real objects; macrooptical, gulliver hallucinations - visions of enormous dimensions; microoptical, midget hallucinations - extremely small. For example, “I see bodies on the wall, as if under a microscope.” There are hallucinations with an ugly distorted form of imaginary images, elongated in one direction, remote, approaching, skewed - metamorphoptic hallucinations. Reduced and seemingly distant hallucinatory images are a phenomenon known as Van Bogart microtelopsia. Relief hallucinations - the contours and details of false images are perceived very clearly, voluminously. Adelomorphic hallucinations - visions are foggy, blurry, "ghostly", "airy" ("ghosts, ghosts", as defined by patients). Cinematic hallucinations - imaginary images are devoid of depth, volume, sometimes projected onto the surface of walls, ceilings and are replaced "as on a screen." Patients at the same time believe that they are "showing a movie." Cinema, as noted by E. Breuler (1920), existed for patients long before its discovery.

Hallucinatory images are mobile, sometimes changing kaleidoscopically quickly or chaotically. They can be perceived as moving from left to right and back, moving in a vertical direction. Sometimes they are motionless like statues - stable hallucinations. The localization of optical illusions in space is different. For the most part, they are projected into the real environment, perceived along with the surrounding objects or obscure the latter. With extracampal hallucinations, optical illusions are localized outside the field of vision - from the side, from above, more often "behind the back". Hemianoptic hallucinations - perceptual delusions are localized in one of the halves of the visual field. Visions can occur in one eye - monocular hallucinations.

Visual (and auditory) hallucinations should be distinguished from the phenomenon of personified awareness (or extraneous presence), which is an imaginary experience of the presence of another, often hostile person. This is also a false sensation of someone else's gaze ("someone is looking out the window", "watching"). Descriptions of patients are so detailed that these experiences can be mistaken for hallucinations. So, the patient reports: “I feel a man standing behind me, a man, tall, all in black, he extended his hand to me and wants to say something ... I don’t see him, but I clearly feel that he is.” In another observation, the patient "felt" the deaf-mute father standing on the side and talking with gestures, so that she could understand what he was "talking about". Imaginary speech can be perceived in the same direct way: the patient “clearly hears” how neighbors scold her, give offensive nicknames. Upon detailed questioning, he clarifies: “I don’t hear, but the feeling is that they are scolding. I listen - no one is talking, but still I continue to feel how they scold me.

Sometimes the structure of visions is schematic, contour, very general, so that it rather resembles a model, a prototype of an object. It is known that the development of perception is built on the basis of "cognitive schemes", which can be likened to a geometric pattern. It seems that the "maturation" of the hallucinatory image may repeat the early stages of perceptual formation.

The clinical features of visual hallucinations are of known diagnostic value, indicating the nature of the disease or the localization of the lesion. Thus, extracampal hallucinations are usually observed in schizophrenia (Bleyler, 1920). Cinematic hallucinations are more common with intoxication, in particular, alcoholic psychoses. Intoxication psychoses are more common demonomaniac, zoological and polyopic hallucinations. The presence of abundant visual illusions of perception with disorientation in the location, environment and time indicates a delirious clouding of consciousness. Hemianopsic hallucinations are observed in organic diseases of the brain (Banshchikov, Korolenko et al., 1971). These authors observed autoscopic hallucinations during cerebral hypoxia and expressed the opinion that such optical illusions indicate severe brain pathology. Multiple visual hallucinations are found in the structure of the epileptic aura - Jackson's visual hallucinations (1876). Pantophobic hallucinations and hallucinations of fantastic content are found in oneiroid stupefaction. Micro-, macrooptical hallucinations, as well as ugly distorted visions moving in a certain direction, bear the imprint of a local, organic brain lesion. The clinical significance of many details of visual deceptions is far from fully disclosed. Perhaps their most common feature is the symbolic content, which is not directly translated into the language of verbal-logical formulas. Thus, the patient's thirst is manifested by visions of a river, a stream, a fountain, a waterfall; pains form images of a biting dog, a biting snake, etc. An analogy with dreams seems appropriate, the hidden meaning of which cannot always be precisely established. In dreams, as well as in visual deceptions, the regression of thinking to the figurative level of its organization is reflected, while verbal hallucinations indicate at least a partial preservation of the mature structures of logical thinking. This may also mean that visual deceptions occur with a deeper lesion of mental activity than verbal hallucinations.

^ auditory hallucinations. Like visual ones, they are the most frequent and varied in content. There are acoasms, phonemes and verbal hallucinations, as well as hallucinations of musical content.

Acoasma - elementary non-speech hallucinations. Separate sounds such as noise, hiss, rumble, creak, buzz are heard. Often there are more specific, subject-related, though also nonverbal auditory deceptions: footsteps, breathing, stomping, knocking, phone calls, kissing, car horns, sirens, creaking floorboards, clinking dishes, grinding teeth, and more.

Phonemes, elementary speech deceptions - shouts, cries, groans, crying, sobs, laughter, sighs, coughs, exclamations, individual syllables, fragments of words are heard.

With hallucinations of musical content, the playing of musical instruments, singing, and choirs are heard. Well-known melodies, their fragments sound, sometimes unfamiliar music is perceived. Musical hallucinations are often observed in alcoholic psychoses. Usually these are vulgar ditties, obscene songs, songs of drunken companies. Musical deceptions of perception may occur in epileptic psychoses. Here they look different - this is the sound of the organ, sacred music, the ringing of church bells, the sounds of magical, "heavenly" music. Hallucinations of musical content are also observed in schizophrenia. So, the patient constantly hears songs in the retro style - "melodies of the 30s." "Concerts" have not been interrupted for more than six months. One hears songs and orchestral works that she remembers, as well as those long forgotten by her. Melodies arise and change on their own or begin to sound as soon as she thinks about them - "concert by request." Sometimes the same melody is compulsively repeated many times in a row.

Verbal (verbal) hallucinations are much more common. Separate words, phrases, conversations are perceived. The content of hallucinatory statements may be absurd, devoid of any meaning, but for the most part they express various ideas that are far from always indifferent to patients. S. S. Korsakov (1913) considered a hallucination as a thought dressed in a bright sensual shell. V. A. Gilyarovsky (1954) points out that hallucinatory disorders are not something divorced from the patient's inner world. They express various disorders of mental activity, personal qualities, the dynamics of the disease as a whole. According to V. Milev (1979), hallucinations reveal echolalia, perseverations, broken thinking, inadequacy or paralogy. All this makes clinical analysis of the content of hallucinations in general and verbal hallucinations in particular useful.

At the beginning of a mental disorder, verbal hallucinations are in the form of calls by name, surname, usually single and rarely repeated. Calls are heard in reality, when falling asleep, waking up, in silence or noisy environments, alone and surrounded by people, in situations where patients expect to be called. It is not always possible to determine whether it was a hallucination, a call was actually made, or an illusory perception took place. When repeating hails, patients often identify hearing deceptions themselves. At the same time, it is often indicated that the “calls” are repeated in the same voice. There are "silent" hails. Sometimes patients refer calls to another person: "They call, but not me."

Commentary or evaluative hallucinations reflect the opinion of "voices" about the patient's behavior - benevolent, caustic, ironic, condemning, accusing. "Voices" can talk about current and past actions, as well as evaluate what he intends to do in the future.

In a state of fear, hallucinations acquire a threatening character, consonant with the delusional ideas of persecution. Imaginary threats of murder, reprisals, revenge, brutal torture, rape, and discredit are perceived. Sometimes the "voices" have a distinctly sadistic connotation.

Dangerous for others and the patients themselves, a variety of auditory deceptions are imperative hallucinations containing orders to do something or prohibitions on actions. Patients more often attribute the orders of the votes to their own account. They are less often considered to be related to others. So, the voice orders others to kill the patient. Voices may demand actions that are directly contrary to conscious intentions - to hit someone, insult, commit theft, attempt suicide or self-harm, refuse to eat, medicine or talk with a doctor, turn away from the interlocutor, close your eyes, clench your teeth, stand still , walking without any purpose, rearranging objects, moving from one place to another.

Sometimes the orders of "voices" are "reasonable". Under the influence of hallucinations, some patients turn to psychiatrists for help, without being aware of the fact of a mental disorder. Some patients point to a clear intellectual superiority of the "voices" over them.

The content of imperative deceptions and the degree of their influence on behavior are different, so the clinical significance of this type of deception may be different. So, "orders" of a destructive, absurd, negativistic nature indicate a level of personality disorganization close to catatonic. Such orders, like catatonic impulses, are realized automatically, unconsciously. Commands with a sense of compulsion are also carried out, but the patient tries to resist or at least realizes their unnaturalness. The content of such orders is no longer always destructive or absurd. Orders of persecutory content are observed. Contradictory, ambiguous orders of voices are encountered, when, along with absurd ones, quite reasonable orders are also heard. Sometimes orders are heard that are consonant with the patient's conscious attitudes.

There are imperative hallucinations of magical content. Thus, the “voices” force the patient to stretch ropes, threads in the apartment, put things in the indicated places, and not touch some objects. "Voices" claim that there is a mysterious connection between the mentioned actions and the well-being of loved ones. In response to the refusal to obey the orders of the "voices" predict inevitable death. In another observation, the "voices" demanded that they wash their hands for a strictly defined number of times - seven or twelve. The patient believed that in the number "seven", there is a hint of her family - "seven is a family." Washing hands seven times means saving the family from misfortune. The number "twelve" contained an allusion to the twelve apostles. If she washed her hands the indicated number of times, then she was “cleansed” by this from all sins. The “voices” told a patient with alcoholic psychosis: “Listen, we are sawing a log. As soon as we cut it, you will die.” Or a voice orders: “Take a mirror and destroy the witch, - she moved into the mirror. It happens that the voices belong to "witches", "demons", "devils". From the above examples it is clear that in verbal hallucinations the regression of thinking to the archaic (magical) level of its organization is expressed.

Hallucinatory orders, as mentioned, are not always implemented. Sometimes patients do not attach importance to them, or consider them ridiculous, meaningless. Others find the strength to hold themselves back or “in spite of the voices” to do the opposite. More often than not, imperative hallucinations have an irresistible influence. Patients do not even try to oppose them by following the wildest orders. According to patients, at this time they feel "paralysis" of their will, act like "machine guns, zombies, puppets." The irresistible imperativeness of hallucinations testifies to their proximity to catatonia and phenomena of psychic automatism. According to V. Milev (1979), imperative orders can be classified as schizophrenic symptoms of the first rank.

Hallucinations, containing not orders, but persuasions, exhortations, false information, which acquire great persuasive power for patients, show some similarity with imperative hallucinations. So, the “voice” persuades the patient to commit suicide: “Jump from the bridge. Don't be afraid, it's not scary. Why live, understand, life has ended for you a long time ago. There are hallucinations with the character of suggestion. The schizophrenic patient did not hesitate to believe that he had committed the murder when the "voices" told him about it. He clearly "remembered" the details of the "crime" and declared himself to the police. “Voices” can further assure the existence of witchcraft, the afterlife, predict the future, and report absurd and fantastic information. Hallucinatory fictions do not leave patients indifferent, their truth may seem obvious to them. “Voices” can not only “suggest” what should be done, but also the very way to perform this or that act. So, the “voice of the father” pushes the patient to commit suicide, calls to her at the cemetery. He says that you need to poison yourself with vinegar essence, indicates where to get it. The patient, indeed, finds the essence in this place, although earlier she seemed to be unable to find it anywhere.

There are auditory hallucinations with the nature of ascertaining - an accurate recording of what the patients themselves perceive or do: “This is the station ... The policeman is coming ... This is the wrong bus ... He got up ... He goes ... He puts on shoes ... He hid under the bed ... He took the ax ... ". Sometimes voices name objects not seen by the patient. So, he wants to and cannot determine the name of the street he is walking on, and the “more observant” voice correctly tells him this. Statements concern not only external impressions and actions, but also motives, intentions: “I am duplicated, repeated. I'll just think of doing something, and the voice will say it. I want to leave the house and immediately I hear people talking about it…”. Patients believe that they are "recorded, listened to, photographed, videotaped." Sometimes the "voices" require patients to say out loud or mentally the names of perceived objects, to repeat what has been said many times. And, on the contrary, the same word, phrase, uttered by the patient or someone from those around him, can be repeated in voices like an “echo”, sometimes 2-3 times or more. Such auditory delusions can be referred to as echolalic or iterative hallucinations.

Hallucinations can "duplicate" not only the statements of others or the patients themselves. Own thoughts begin to "sound" - the "voice" immediately "repeats" what the patient thought about. When reading, the content of what is read is copied - a symptom of echo-reading. The voice "reads" what the patient has written - "echo letters". The repetition of thoughts can be repeated. According to the patient, before going to bed, he “inspires” himself: “I calmed down, relaxed, I want to sleep, I fall asleep.” Following this, he hears a "voice" that says this phrase five times - "now I do without sleeping pills, my voice is lulled." The tempo of repetition can be slowed down, accelerated or changes, speeding up towards the end of pronunciation. Sometimes repetition concerns individual words, the end of a phrase. So, the voice "inside" every second repeats the threat: "I'll plant" and says this for days. As you speak, the volume of the sound gradually fades, the timbre of the voice changes. Repetitions are not always identical; variations in shades of sound and meaning are possible. One of the patients reported repeating phrases 6 times, but each time in a different voice and some change in content.

There are stereotypical hallucinations - the same thing is constantly heard. A patient with Huntington's chorea for a number of years had a hallucination in the form of the phrase repeated from time to time: "Vitya, cuckoo!". At first I thought that they were “playing hide-and-seek” with him, looking for the hiding person, but then I was convinced of the deception of hearing and stopped paying attention to him. In a repeated attack of illness, sometimes the same voices “return” and say the same thing as before. There are "double voices" - one of them a little later exactly copies what was said first.

Verbal hallucinations can be in the form of a monologue - the "voice" is an endless story about something, not allowing either to interrupt himself or change the subject. For example, the “voice” recalls and tells in detail the biography of the patient, giving such details that he “has long forgotten”. Hallucinations can be multiple (polyvocal). Several voices simultaneously talk about different things, talk to each other. With hallucinations in the form of a dialogue, two “voices” “argue” with each other about the patient, and one of them praises, approves, emphasizes his merits and virtues, the other, on the contrary, accuses, condemns, demands punishment, physical destruction. Contrasting hallucinations - one of the "voices" says or orders to do one thing, and the other at the same time - just the opposite. There are scene-like auditory hallucinations - many "voices" create a visible impression of a complex situation that is developing dynamically. There are hallucinations of poetic content - "voices" compose poems, epigrams, puns.

Verbal hallucinations can maintain complete autonomy from patients, not to enter into "contacts" with them, or even "think" that they do not hear them. Sometimes they speak instead of the patient. Thus, a “voice” answers the doctor’s questions, while the patient “does not think” at this time, she only “repeats” his answers. Voices can also address the patients directly, ask, ask to repeat something, talk with them. So, the “voice” comes to the patient every morning, wakes up, greets, and says goodbye in the evening. Sometimes he notifies that he will leave him for a while, returning by the appointed time. Answers the patient's questions, gives advice, asks in detail about his life, as if collecting an anamnesis. Before disappearing, he announces that he "leaves forever, dies." Or the voice tells about the patient and specifies the year and place of her birth, the details of school, life, family, is interested in work, children. Through the mediation of patients, it is possible to "talk to the voices." When answering questions, “voices” can refuse, fall silent, get lost, and laugh mockingly. Some of them report different information about themselves. So, in response to a questioning “voice”, the patient says: “Does he (that is, the doctor) really understand that I am a disease. I have nothing to say about myself. I will disappear as soon as the illness passes. At the same time, the patient herself believed that the “voices” were a messenger of “another, invisible world.” Or “voices” speak, give their names, age, describe their appearance, claim that they hold high important positions, that they intend to commit suicide or that they “hear voices themselves”, that they suffer from seizures, express a desire to be treated, etc.

Voices often express judgments, evaluations independent of the patient, show interest in external events, express their own desires, talk about their origins, make plans for the future. They can also say what coincides with the patient's opinion, express his views and expectations. With "smart" voices, patients "advise". So, the patient consults with the “voice” whether she will go to the hospital in the future. To which he cautiously replies, “Most likely, yes.” Sometimes it is possible to test the mental capabilities of voices. They perform arithmetic operations, interpret proverbs and sayings in their own way. The level of their "thinking" for the most part is lower than that of patients. The emotional context of the utterances of voices - and this can be seen from the tone, speech forms, content of what was said - is more often unfriendly, aggressive, cynical, rude. All this shows that "voices" are the expression of a complex pathological structure that integrates various psychological functions into a holistic formation at a different, usually reduced level. They represent a kind of personality neoplasm, often opposed to the personality of the patient.

There are hallucinations with the character of anticipation. "Voices" seem to be ahead of events and predict that the patient will soon feel, think about or find out. They notify that he will have a headache, there will be an “urge” to urinate, defecate, vomit, or he will soon “want” to eat, sleep, say something. And, indeed, these predictions often come true. The patient has not yet had time to realize what happened, and the "voice" informs about what actually happened. It also happens that when reading, the “voice” runs ahead and “reads” what is written at the bottom of the page, while the patient looks only at the top lines. It turns out that voices perceive subthreshold signals that do not reach the level of consciousness.

"Voices" can speak slowly, in a singsong voice, in a patter. So, voices that are normal in tempo, with an exacerbation of the condition, begin to say “very quickly”. Their previously connected speech becomes broken, reminiscent of a set of separate words. Sometimes the voices come in swells, sometimes they are interrupted by sudden pauses. Meanwhile, in hallucinations, there are practically no such phenomena as stuttering, paraphasia, aphasia, dysarthria and other neurological pathology, even if it is in the speech of patients.

There are verbal hallucinations in the form of neologisms, as well as verbigeration - a stringing of words that are incomprehensible to either the patient or others. Sometimes patients claim that they hear voices in "foreign languages" and at the same time perfectly understand what was said, although they themselves do not speak any languages ​​​​- cryptolalic hallucinations. For polyglots, "voices" can sound in foreign languages, including those that are forgotten - xenolal hallucinations.

Auditory hallucinations can be different in volume, distinctness, naturalness. Most often they sound the same as the conversation of the surrounding people. Sometimes subtle, indistinct, “rustling” sounds are heard, or they sound deafeningly loud. There are "premonitions" of voices - "they are not there, but I feel that they are about to appear." There is a fear of voices that "should" appear. Hallucinations are usually perceived as living, natural speech, but they can be heard as "on the radio", from a tape recorder, sound like in a "stone bag". Sometimes they seem "unreal". Quite often they are individualized, the persons known to patients are recognized in them. Sometimes the patient's own voice is heard. Recognition of the voice of this or that person, apparently, is a fact of delusional interpretation. The same voice may belong to different persons. There are “fake”, “similar to familiar” voices, which, according to the patients, belong to unknown persons, and, on the contrary, the voices of loved ones, “on purpose” distorted beyond recognition. For example, voices "imitate" the speech and thoughts of real people. The patient even "sees" at the same time "images" of people whose voices she hears.

The source of hallucinations is localized by patients, as a rule, in a real environment. Voices are perceived as sounding somewhere nearby, even the direction from which they come is indicated. Sometimes they sound "around", and patients cannot determine from which side they hear them. Sometimes the voices are localized at a great distance, far beyond real audibility. They can also be perceived near or on the surface of the body, near the ears ("whisper in the ear"), in the ear canals. But even in such cases, the voices are perceived as coming from the outside towards the sick. The opposite happens less often: the voices “fly off”, go from the patients in the outward direction. The patient reports that the voice sometimes "flies" out of her head, she even sees a receding gleam. At this time, he thinks that the voice becomes audible to others. For the most part, voices are picked up by both ears, but can be perceived with one ear - one-sided hallucinations. There are hearing deceptions that occur simultaneously with a variety of synesthetic sensations.

Auditory hallucinations are observed mostly with formally unchanged consciousness in the clinical picture of various diseases. Some features of auditory hallucinations may be of diagnostic value. Threatening hallucinations, for example, indicate a paranoid mood swing, accusatory or inciting suicide, indicate depression, benevolent, approving, laudatory - an elevated mood. The symptom of sounding thoughts, the symptom of echo-reading, duplicate hallucinations, hallucinations with the nature of iterations (multiple repetition), contrasting hallucinations are more common in schizophrenia. The alcohol theme of the content of hearing deceptions is revealed in alcoholic psychoses.

^ Olfactory hallucinations. Imaginary perceptions of various smells. These can be familiar, pleasant, disgusting, vague or unfamiliar smells that you have not encountered before. The projection of olfactory hallucinations is different. Patients may believe that odors come from surrounding objects or claim that they smell from themselves, from the legs, genitals, from the mouth, etc. Sometimes they say that the source of “the smell is the internal organs.

There is an unusual projection of deceptions of smell - smells are perceived, for example, inside the head. Imaginary smells are often associated with crazy ideas. So, unpleasant odors emanating from the body are combined with the phenomena of dysmorphomania (delusions of physical deficiency), odors with an external projection - with the delusions of poisoning; smells coming from within - with nihilistic and hypochondriacal delusions. The appearance of olfactory hallucinations often precedes the development of the delusion itself.

^ Taste hallucinations. False taste sensations that occur out of connection with the intake of food or any substances. Taste hallucinations can also occur while eating - there is an unusual, uncharacteristic daisy food permanent taste (“metallic”, “taste of copper, potassium cyanide, unknown poison”, etc.). Taste delusions are sometimes localized "inside" the body and are explained by patients with "rotting, decomposition" of the internal organs.

^ Hallucinations of the skin sense. Various perceptual delusions associated with various types of skin sensitivity.

Tactile hallucinations - imaginary sensations of touch, touch, crawling, pressure, localized on the surface of the body, inside the skin, under it. Deceptions of perception are subjective in nature. Patients claim that they feel the touch of hands, stroking, feel how they are sprinkled with sand, dust, pricked with a needle, scratched with nails, hugged, bitten, patted, pulled by the hair, they believe that living beings are on the skin or inside it and move. Often, tactile hallucinations are localized in the oral cavity, where the presence of hair, crumbs, wires, and other foreign objects is felt. The imaginary presence of a hair in the oral cavity is considered characteristic of psychoses that occur in connection with tetraethyl lead poisoning. Cocaine psychoses are characterized by imaginary sensations under the skin of small objects, crystals, insects - a symptom of Manyan.

Haptic hallucinations are imaginary sensations of a sharp grasp, blows, shocks, coming, according to patients, from outside.

Erotic (genital) hallucinations are imaginary sensations of obscene manipulations performed by someone from the outside on the genitals.

Stereognostic hallucinations - imaginary sensations of the presence in the hand of an object - a matchbox, a glass, a coin, etc. - Ravkin's symptom.

Thermal (thermal) hallucinations - false sensations of burning, cauterization, cooling of a part of the body surface. Unlike senestopathies, thermal hallucinations are of an objective nature - “apply a red-hot wire, burn it with an iron”, etc.

Hygric hallucinations - a false sensation of the presence on the surface of the body or under the skin of drops of liquid, streams, streaks, blood, etc.

^ Interoceptive (visceral hallucinations, hallucinations of the general feeling). False feeling of the presence inside the body of foreign bodies, living beings: mice, dogs, snakes, worms, feeling of additional internal organs, "sewn-in devices", other objects. They differ from senestopathies in physicality, objectivity. The following observation may serve as an illustration. The patient claims that for many years she has been "tormented by worms." Helminths, which previously filled the abdominal cavity, recently penetrated into the chest and head. He clearly feels how the roundworms move, twist into balls, crawl from place to place, stick to internal organs, touch the heart, squeeze blood vessels, close the lumen of the bronchi, swarm under the skull. The patient insists on an immediate operation, believing that otherwise she is in danger of death. Visceral hallucinations are usually accompanied by delusions of possession. A variety of interoceptive hallucinations are transformation hallucinations, expressed by a feeling of change in specific internal organs: “The lungs fell asleep, the intestines stuck together, the brain melted, the stomach wrinkled, etc.”

^ Motor (kinesthetic) hallucinations. Imaginary sensations of simple movements or complex actions. Patients feel how their fingers are clenched into a fist, their head turns or shakes, their body bends, their hands rise, their tongue sticks out, their face twists. In acute psychotic states, particularly in delirium tremens, they feel as if they are going somewhere, running away, performing professional activities, pouring wine, while actually lying in bed. There are kinesthetic verbal and graphic hallucinations with imaginary sensations of movement of the articulatory apparatus and hands, characteristic of speaking and writing. False sensations of movement can be violent - patients are "forced" to speak, write, move around. Motor deceptions of verbal content mostly belong to pseudo-hallucinations. Sometimes there are automatisms of written speech. According to the elephants of one of the patients, she communicates with God in a very unusual, "amazing" way. Her hand involuntarily writes texts, and the patient herself learns about the content of the latter later, only after reading what was written. She writes, she "without thinking", at this time "there are no thoughts in my head." Something is moving her hand, some extraneous force, she only meekly obeys her.

^ Vestibular hallucinations (hallucinations of the sense of balance). Imaginary sensations of falling, lowering and lifting up, as in an elevator or in an airplane; rotation, tumbling of one's own body. There may be a feeling of movement of surrounding objects, directed in a certain direction or disorderly, chaotic - an optical storm.

The object of hallucinatory perception can be one's own body. With typhus, there is a feeling of doubling the body - a symptom of a double (Gilyarovsky, 1949). In a state of confused consciousness, the patient feels another person lying next to him, exactly the same person as himself. There are hallucinations of reincarnation in animals (zooanthropy): lycanthropy - in a wolf, galeanthropy - a cat, kynthropy - a dog. There may be a sense of transformation into inanimate objects. Thus, the patient has a feeling

It was as if his body had turned into a passenger car with a bucket in front. The patient, as he later said, moved along the carriageway according to all the rules of traffic: “braked”, “honked” at turns, clenched his fists, etc. The normal sensation of the body disappeared for this time. The phenomena of such reincarnation can be considered as a hallucinatory variant of depersonalization. Such phenomena are often characteristic of the state of oneiroid clouding of consciousness.

Depending on the conditions of occurrence, the following types of hallucinations are distinguished.

^ Functional (differentiated) hallucinations. They develop simultaneously with the perception of a real stimulus and within the same modality of sensation. More often these are auditory, less often - visual hallucinations. For example, under the sound of wheels, a repetition of the phrase is simultaneously heard: “Who are you, what are you, who are you, what are you ...”. When the train stops, the hallucination disappears. At the sight of a passerby, the patient notices how someone's head is peeking out from behind him. Unlike illusions and illusory hallucinosis, imaginary images in functional hallucinations coexist with an adequate perception of real objects.

^ Reflex hallucinations. Unlike functional ones, they are an imitation of a real stimulus in a different modality of sensation. The patient reports: “I hear a knock, a cough, a door creak, and at the same time it echoes in my chest - as if they knocked, coughed, turned.” Reflex hallucinations may be delayed. So, the patient saw a broken window, and a little later she felt broken glass in her stomach. In the morning she spilled kerosene, and by lunch she felt as if “all soaked in it”, even heard his smell coming from inside.

^ Hypnagogic hallucinations. Occur in a half-sleep, when falling asleep, with eyes closed, in a state of light drowsiness. Often portend delirious stupefaction. Usually these are visual, auditory, tactile hallucinations. Motor and speech-motor hallucinations may sometimes appear - it seems to patients that they get up, walk, talk, shout, open doors ... Hypnagogic hallucinations are clearly distinguished by patients with dreams. Understanding the pain of perceptual deceptions appears some time after waking up.

^ Hypnopompic hallucinations. Occurs when waking up from sleep. Usually these are visual, less often - auditory deceptions of perception. Hypnagogic and hypnopompic hallucinations are combined with sleep disturbances and can be considered as particular variants of oneiric perceptual deceptions. Hallucinations, as clinical observations show, can be timed not only to the phases of "slow" it. Thus, there are unusually vivid dreams, which later patients refer to as real events. Apparently, hallucinations also occur during REM sleep.

^ Hallucinations Bonnet . First described in a patient suffering from senile cataract. Their appearance is associated with eye pathology - cataracts, retinal detachment, inflammatory processes, operations on the eyeball. These are visual single or multiple, scene-like, in some cases colored and moving visions of people, animals, landscapes. With a low intensity of hallucinations, the critical attitude of patients towards them remains. With the intensification of hallucinations, the understanding of pain disappears, anxiety, fear appear, behavior is disturbed. Damage to the cochlear apparatus, neuritis of the auditory nerve, sulfur plugs can contribute to the development of auditory deceptions. The appearance of Bonnet hallucinations is associated with pathological impulses from receptors, as well as with sensory hypostimulation. Each of the mentioned factors and individually can facilitate the development of hallucinations. Numerous studies show that under conditions of perceptual and sensory deprivation (restriction of the flow of internal and external stimuli), a variety of mental disorders develop - the illusion of turning the body, lowering the threshold of visual sensitivity, hallucinations. A significant phenomenological similarity of the mentioned disorders with the symptoms of schizophrenia is noted. Hyperstimulation may also facilitate the onset of hallucinations and influence their clinical structure. Toothache is sometimes accompanied by auditory hallucinations with a projection into the affected teeth. Auditory hallucinations are more likely to increase in silence and disappear in noisy environments, but it can also happen that noise contributes to their appearance.

^ Peduncular hallucinations of Lhermitte. Occur when the brain stem is damaged in the area of ​​\u200b\u200bthe legs. Against the background of incomplete clarity of consciousness, visual midget visual illusions are observed, usually in the evening hours, before going to bed. Animals, birds are perceived, usually mobile and painted in natural colors. Criticism of hallucinations may persist. As they increase, it disappears, joins, anxiety, fear.

^ Plaut's hallucinations . Described in neurolues. Loud verbal deceptions are characteristic, a delusional interpretation is possible with the loss of a critical attitude towards them, and behavioral disorders.

^ Van Bogart hallucinations. Seen in leukoencephalitis. Multiple color visions of zoological content (animals, fish, birds, butterflies) appear in the intervals between attacks of increased drowsiness and are accompanied by anxiety, an increase in the affective coloring of imaginary images. Subsequently, delirium develops, complex acoustic disorders, amnesia for the period of disturbed consciousness.

^ Berce's hallucinations. Combined opto-kinesthetic perceptual delusions. Patients see luminous telegrams on the walls, written by someone's invisible hand. Occur in alcoholic psychosis. We observed patients with schizophrenia reading short printed, usually stereotyped phrases on the wall that did not have any clear meaning. Phrases appeared spontaneously, but could also occur after the patient's attention could be drawn to this phenomenon.

^ Pick's hallucinations. Visual illusions in the form of people, animals, perceived through the walls of the building. During hallucinatory episodes, nystagmus and diplopia are detected in patients. Described with damage to the brain stem in the region of the fourth ventricle.

^ Hallucinations of Dupre's imagination. Associated with ideas and ideas that are long cherished in the imagination and are consonant with the latter in content. It develops especially easily in children and persons with a painfully heightened imagination. V. A. Gilyarovsky called such hallucinations identical. Close to them are “paranoid reflex hallucinations of the imagination” (Zavilyansky et al., 1989, p. 86) - a vivid visualization of the images of representation with their alienation from the personality and projection outside. Hallucinations are unstable, fragmentary. Their genesis is associated with a heightened morbid imagination.

^ Psychogenic (affectogenic) hallucinations. O reflect the content of emotionally colored experiences in conditions of mental shock. Psychological comprehensibility of the content of hallucinations, closeness to the actual experiences of the patient, emotional richness, projection of imaginary images outward are characteristic. The difference between hallucinations of the imagination and psychogenic hallucinations can be shown in the following examples.

A patient suffering from tuberculosis of the spine experienced hard physical deformity. He was afraid to appear in public, he believed that everyone was paying attention to him, treating him with a feeling of disgust, laughing at him. In society, he felt very constrained and thought only about the impression that he could leave on others about himself. On the street, I constantly heard passers-by talking about him: “Well, freak! What a freak! Hunchback ... Humpbacked Horse ... ". In this case, one should think of hallucinations of the imagination associated with the dominant experiences of physical deformity and the corresponding expectations.

A young woman, after the death of her only child, was in a psychotic state for two weeks. During the day, more often in the evening, at night I saw my daughter, heard her voice, talked to her, caressed her, braided her hair, fed her, collected her for school, met her after returning from lessons. At that time, she did not realize that her daughter was not alive. In the latter case, we are talking about psychogenic hallucinations that characterize reactive psychosis. Psychogenic inclusions often sound in the hallucinations of endogenous patients. So, in the psychosis of a patient who has lost his wife, her voice is heard, and she herself is seen alive, since the patient managed to "revive" her. Hysterical character traits and high suggestibility contribute to the emergence of psychogenic hallucinations.

Psychogenic hallucinations are obviously associated with the activation of psychological defense mechanisms. The content of perceptual delusions often reproduces the desired situation, while at the same time the real, psycho-traumatic situation is ignored, ideas about it are forced out.

^ Segle's associated hallucinations. Develop in the clinical picture of reactive psychoses. The plot of hallucinations reflects the content of traumatic events. Perceptual delusions appear in a logical sequence: the “voice” announces a fact that is immediately seen and felt. Associated hallucinations can also occur in schizophrenia. So, the “voice” says the following: “If you want to see me, go to the toilet. In a dark corner you will see me in the guise of a devil. The patient, indeed, went and saw a devil in the toilet. The next time, the "voice" made me see myself on the TV screen in the form of a man. Sometimes he demanded to "touch" himself, and the patient clearly felt his hair. In another observation, the "voice of the sorceress" spoke to the patient about how she looks. As it was reported, the patient began to see the eyes, head, torso, limbs, then, finally, saw the whole witch.

^ Combined hallucinations. There are combinations of hallucinations of different sensory modality, united by a common content. One of the options for such a combination is Mayer-Gross's synesthetic hallucinations - patients see moving figures of people and at the same time hear their speech; see flowers and smell them.

^ Induced (suggested) hallucinations. Arise under the influence of external suggestion. They can be collective in nature, facilitated by massive emotional involvement, usually increasing in the crowd and leading to a sharp increase in suggestibility. The existence of such hallucinations has long been known, they are mentioned, in particular, in the Bible. In a crowd stricken with superstitious horror, mystical ecstasy, warlike ardor, especially among easily suggestible persons, various deceptions of perception are rapidly spreading, most often of the same type. Suggested hallucinations are also observed in induced psychoses: perceptual delusions seem to be transmitted from the patient to other members of his family or persons who are in close contact with him. Various hallucinations, including negative ones, can be suggested in a state of deep hypnotic sleep. Upon exiting the latter hallucinations are amnesiac.

There is a special kind of hallucinations that can be induced in patients with the help of special techniques. Lipman's symptom - white-hot visual hallucinations appear at the moment of pressure on the patient's closed eyes. Aschaffenburg's symptom - at the urgent request, the patient hears imaginary speech and talks on the phone (which is disconnected from the network or is faulty). Symptom of Reichardt and Rigert - the patient can be forced to "read" any text on a blank sheet of paper. Purkinje's symptom - pressure on the patient's closed eyes contributes to the appearance of elementary visual hallucinations. Ankylosing spondylitis test - the appearance of visual images suggested with light pressure on the patient's lowered eyelids. Osipov's test - the patient feels an imaginary object in his fist, which the doctor supposedly put in there. The presence of these symptoms indicates an increased readiness for hallucination. Especially often these symptoms are positive in alcoholic psychoses.

Pseudo-hallucinations. For the first time isolated and studied in detail by the Russian psychiatrist V. X. Kandinsky (1890). V. X. Kandinsky considers the following signs to be the most characteristic for pseudohallucinations:

Imaginary images are experienced as being in the represented space, that is, unlike true hallucinations, they are not projected into real space;

Pseudo-hallucinatory images differ from ordinary representational images in that they are involuntary, intrusive, they are also characterized by completeness, completeness of images, their detailing, they are accompanied by a "feeling of torment and melancholy";

Pseudo-hallucinatory images, if there is no stupefaction, do not have the character of objective reality and are not mixed by patients with real objects.

The first feature of pseudohallucinations is clinically manifested as follows. According to the patients, they perceive something not in a real environment, but "inside the head", - "they see with the mind, head, inner eye, mental gaze, brain", "hear with the inner ear, inside the head, hear with the head, mentally". Sometimes pseudohallucinations show a tendency to project beyond the psychic self. Imaginary images in this case are localized "in the eyes", in the immediate vicinity of them, "in the ears, ear canal, at the roots of the hair."

Another sign of pseudo-hallucinations is that, unlike representational images, they arise spontaneously, involuntarily, contrary to the desire and direction of the patients' internal activity, and are steadily retained in their minds. In other words, pseudo-hallucinations are subjectively experienced as “made”, arising under the influence of some external forces. The feeling of one's own activity, which often accompanies the perception of true hallucinations, is absent with pseudohallucinations: the latter "introduce", "invade" the patient's consciousness, are experienced as something alien to his personality. It should be noted that the mention of “tunedness”, “madeness” can accompany various psychopathological phenomena, including true perceptual deceptions. The phenomenon of "made" in pseudohallucinations is a direct, sensual phenomenon, in contrast to the delusions of staging, where what is happening in reality and in the deceptions of perception is regarded in the context of an artificially created situation. The occurrence and content of pseudohallucinations are often completely isolated from what is actually perceived or currently experienced. At the same time, an important feature of pseudohallucinations is that the internal aspects of the “I” are not subjected to such total alienation in them, as is characteristic of hallucinations. As V. M. Banshchikov, Ts. P. Korolenko et al. (1971) point out, true hallucinations are more likely to be addressed to the physical “I”, while pseudo-hallucinations are more characteristic of the focus on the mental “I” of patients. This feature of pseudohallucinations is expressed, in particular, in the fact that pseudohallucinatory characters often identify themselves with the personality of patients. So, the voice that sounds “in the back of the head” says the patient: “I am your brain. Everything you hear from me is true. What I make you do, you will do, because my desires are your desires. This is especially evident when pseudo-hallucinations are accompanied by true perceptual deceptions. At the same time, "external voices" are perceived as "outsiders", and "inner voices" are experienced with a feeling of closeness to the "I", in an intimate connection with the patient's inner world - "my voice, as if my soul is talking to me." The patient simultaneously hears voices "in the soul", "in the head on the right" and outside herself, believing that at times internal conversations "come out." At the same time, she claims that all these voices sound like “her own”. Pseudo-hallucinatory images differ from representational images in sensual brightness, sensitivity, detail, sometimes not inferior in this respect to true hallucinations.

The third feature of pseudohallucinations is that they do not mix with images of perception and representation. Patients talk about "another world", "another dimension", "about special visions and voices" and confidently distinguish them from external objects and memories. At the height of an attack of illness, pseudohallucinations can be identified by patients with reality (Sumbaev, 1958). There is no critical attitude towards pseudo-hallucinations.

It should be noted that the internal projection of perceptual delusions is characteristic not only of pseudohallucinations.

The following observation may serve as an illustration of the foregoing. The patient has been hearing “voices” for a number of years, perceiving them “inside the head”. There are usually several of these "voices" - from seven to twelve, sometimes one or two remain, sometimes there are a lot of them. The patient believes that his own voice sounds, he can "fork" or be divided into many separate voices. All voices, according to the patient, bear his own name. They talk among themselves about him, on other topics, address him directly, he can talk to them. They are perceived distinctly, with a clearly expressed shade of sound, sometimes the “voices” scream loudly. The patient calls them "hallucinations", does not mix with the conversations of others. At the same time, he thinks that “invisible, small people” who are born, live and die live and talk in the head. Deceptions of perception are accompanied by a very painful feeling, a desire to get rid of them, and at the same time there is no consciousness of the disease.

As A. V. Snezhnevsky (1970) emphasizes, the feeling of forcible influence from outside is pathognomonic to pseudohallucinations. Patients report that "voices" do not sound on their own, but they are "made, transmitted, broadcast, evoked, instilled, invested" by means of special equipment, hypnosis. The source of "voices" can be localized by patients at a great distance; "transmissions" are carried out with the help of waves, currents, rays, biofields, which are transformed, "voiced" by the brain or special devices placed in the head. In the same way, patients “make visions, show images, show pictures”, “cause odors”, “irritate the internal organs”, “cauterize the skin”, “make them move”, etc.

Some researchers interpret the violent connotation of experiencing perceptual deceptions differently. V. A. Gilyarovsky (1949) is not inclined to use Kandinsky's pseudo-hallucinations and Bayarger's mental hallucinations, which are alienated from the "I", as synonyms. According to I. S. Sumbaev (1958), it is necessary to distinguish between Kandinsky's pseudohallucinations, which are found in the presence of a single "I" of the patient and mental hallucinations that develop with a disorder of self-consciousness in the form of a doubling of the "I" and are characteristic of the Kandinsky-Clerambault syndrome. The author believes that Bayarger's mental hallucinations arising with the nature of alienation are a special kind of painful ideas (Giro's xenopathic ideas).

^ Objective signs of deceptions of perception and images of representation. In addition to subjective, there are external (objective) signs of perceptual delusions, which are different in hallucinations and pseudo-hallucinations. First of all, these are the behavioral reactions of patients to the fact and content of emerging deceptions.

Patients treat hallucinations in essentially the same way as they treat the corresponding real phenomena. Patients stare at something, turn away, close their eyes, look around, wave away, defend themselves, try to touch or grab something with their hand, listen, plug their ears, sniff, plug their nasal passages, lick their lips, swallow saliva, spit, drop something from the surface of the body. Under the influence of hallucinations, various actions are performed that reflect the content of perceptual deceptions: patients hide, look for something, catch, attack others, try to kill themselves, destroy objects, defend themselves, flee, file complaints with the relevant institutions. With auditory hallucinations, they talk aloud with "voices". As a rule, patients believe that others perceive the same things as they do in hallucinations - they hear the same voices, experience the same visions, smell the same things. Emotional reactions are clearly expressed, the nature of which reflects the content of perceptual deceptions: fear, rage, disgust, enthusiasm. Vegetative reactions are also observed, there are peculiar somatic sensations that accompany hallucinations.

The situation is different with pseudohallucinations. As a rule, there are no signs of external orientation of attention. Patients are absorbed in their experiences, they are diverted to what is happening around with difficulty, without any interest. Pseudo-hallucinations are often accompanied by external inactivity of patients. Behavioral disturbances can nevertheless occur, especially if there are perceptual deceptions of threatening and imperative content. Patients with pseudohallucinations are usually sure that perceptual delusions concern only them and do not extend to others. With verbal pseudo-hallucinations, unlike true ones, patients "communicate" with "voices" mentally, in an outwardly imperceptible way, and not aloud. "Communication" can be involuntary: the patient says that "mentally, involuntarily" she had to answer the questions of "voices".

Hallucinoids. Initial or rudimentary manifestations of visual hallucinations. They are characterized by fragmentation, sensitivity, a tendency to exteroprojection of images with a neutral contemplative and usually critical attitude of patients towards them (Ushakov, 1969). EA Popov indicates that hallucinoids are an intermediate stage in the development or disappearance of true hallucinations (1941).

Eidetism. The ability of some persons to mentally represent and retain for a long time a vivid image of an object or whole pictures after these objects or pictures have been perceived. It is more often expressed in relation to visual, tactile and auditory images. It was first described by V. Urbantschitsch in 1888. In Russian literature, the phenomenon of eidetic images was described by A. R. Luria, who observed a person with a phenomenal visual memory. Eidetic images can remain unchanged for 10 seconds or more. Some eidetics are able to evoke eidetic images long after they were recorded. More often, eidetic abilities are found in childhood and adolescence, then gradually disappear, remaining only in some adults. Some well-known artists possessed such vivid images. In this regard, some researchers consider eidetism as a stage in the age-related development of memory, while others consider it as a more or less permanent constitutional personality trait.

It has been shown that manifestations of eidetism can also be a temporary painful feature of persons suffering from hallucinations (Popov, 1941). The following clinical observation may serve as an illustration. In an acute psychotic state, along with hallucinations, a patient with schizophrenia developed various eidetic images. According to him, he reached the highest degree of yoga - "raja yoga". The patient easily evoked vivid images of people known to him, works of art, illustrations for books, reproduced everyday scenes of the past. He recalled familiar melodies distinctly, with sound. To the accompaniment of music, the products of his imagination were clothed in colorful visible pictures. Images could be unchanged or arbitrarily changed, combined. After leaving the state of acute psychosis, eidetic images disappeared.

Perhaps one should not identify eidetic images with the dynamic and very vivid memories mentioned in the observation just cited. Strictly speaking, an eidetic image is a passive static imprint of what has just been perceived from the real world. The special vividness of memories in mental patients often concerns not only fresh, but also distant impressions. Fantasy images can be just as vivid. The play of the imagination in this case is rather passive in nature and is directed by catatim mechanisms. When intensified, it turns into delusional fantasies, figurative delirium, and with a significant exacerbation of the disease state - into hallucinations.

Eidetism, like hallucinations, can be defined as "perception without an object." Unlike hallucinations, eidetism is the result of the action of previous external stimuli, images appear and disappear arbitrarily, are not identified with reality. The eidetic image differs from the usual way of representation by a high degree of sensitivity and detail.

With mental illness, there may also be a weakening or loss of the ability to imagine and vivid memories. Thus, a depressed patient “lost her idea” of how her husband, children, relatives, acquaintances look like, “forgot” what her apartment is like, she is afraid that she will not be able to recognize her house. She cannot remember the smell of perfume, she does not remember a single melody, she has forgotten how the voices of loved ones sound. Only occasionally and for a short time do stingy and faded images of the past appear in her mind. Before her illness, she said, she always had a good figurative memory. The loss of representational images is a sign of intellectual retardation, characteristic of depressive states.

^ Sensory synthesis disorders. Distorted perception of the size, shape of your body and surrounding objects. The identification of objects, in contrast to the illusion, is not violated.

Metamorphopsia. Violation of the perception of the size and shape of objects and space in general. Objects seem enlarged - macropsia, reduced - micropsia, twisted around the axis, elongated, beveled - dysmegalopsia. Instead of one, several identical objects are seen - polyopia. The distortion of the scheme of perceived objects is usually accompanied by a change in the perception of the structure of space. It shortens, lengthens, objects move away, approach, the street seems to be infinitely long (porropsy), buildings are seen as taller, lower, shorter than they really are.

Metamorphopsia occurs as a result of organic damage to the parietotemporal regions of the brain. Since the perception of spatial relationships is provided by the right (subdominant) hemisphere, it should be expected that metamorphopsias are associated with the topic of the lesion in the right hemisphere. Very often, metamorphopsias are observed in the clinical structure of partial epileptic seizures. Often there are complaints of patients that outwardly resemble metamorphopsia, but in reality due to other reasons. “Everything has somehow moved away, it is perceived as small, as if at a remote distance.” Here there is no actual distortion of the perception of the size and structure of objects, we are talking about the loss of empathy, emotional response, a sense of alienation of the environment.

^ Autometamorphopsia (body schema disorder) . Distortion of the shape or size of your body. With total autometamorphopsia, the body is perceived enlarged - macrosomia, reduced - microsomia. With partial autometamorphopsia, individual parts of the body are perceived as enlarged or reduced. Sometimes the feeling of an increase in one part of the body is perceived simultaneously with the feeling of a decrease in another. The body, any part of it can be perceived as changed only in one dimension - to seem elongated, elongated, shortened. Changes may relate to volume, shape: thickening, weight loss. The head, for example, appears "square". These disorders occur more often with closed eyes, disappear under visual control. They can be constant or episodic, appearing especially often when falling asleep. With pronounced violations, the body is perceived as distorted beyond recognition, in the form of a shapeless mass. So, with her eyes closed, the patient feels her body in the form of a puddle, spreading over the chair, running down to the floor and spreading over its cracks and cracks. With open eyes, the body is perceived normally.

The perception of the position of body parts in space may be disturbed: the head seems to be turned with the back of the head forward, the legs and arms are twisted, the tongue is curled up into a tube. One of the patients felt as if the legs were raised up, clasped the neck and intertwined around it. There is a violation of the perception of the unity of the body, its individual parts are felt in separation from each other. The head is perceived at some distance from the body, the lid of the skull seems to rise and hang in the air, the eyes are out of their sockets and are in front of the face. When walking, it seems as if the lower part of the body is in front, and the upper part is behind, the legs are felt somewhere to the side. The body can be perceived as a mechanical connection of separate parts, "crumbled, glued together."

The phenomena of autometamorphopsia are heterogeneous. Some of them are undoubtedly due to local organic brain damage, in other cases they should be considered in the context of somatopsychic depersonalization. Differential diagnosis is very difficult.

Deceptions of orientation in space can manifest themselves in the form of a syndrome of rotation of the environment. The surroundings seem to be rotated 90 or 180 ° in the horizontal, less often in the vertical plane. There are sleepy, situational and "seizure" variants of the syndrome of rotation of the environment (Korolenok, 1945). In the first case, disorientation occurs in a state of sleepy stupor, usually in the dark with eyes closed. Waking up, the patient for a long time cannot figure out where the door, windows are, in which direction his head, legs. Situational deceptions of orientation occur in the waking state with functioning vision, but only in a special spatial situation - the localization of the main landmark outside the field of vision. The "seizure" variant of the turning syndrome is observed in the waking state, in a normal spatial situation, and is associated, as expected, with transient vegetative-vascular disorders in the systems that provide the perception of space. It can be combined with the phenomena of derealization.

Disorders of perception of time. Violation of the perception of the speed and smoothness of the flow of time, as well as the pace of the flow of real processes. The passage of time can be perceived as accelerated - time passes quickly, imperceptibly, the duration of time intervals seems to have drastically reduced. The patient reports that she does not notice how time passes. It seems to her that it is not even noon, when in fact it is already evening. She lay down for a little rest and did not notice how the day passed. In the morning she wakes up with the feeling that she had just gone to bed, she barely had time to close her eyes, the night flew by in an instant. The flow of time can be perceived as slowing down - “the night seems to never end ...

I wake up with the feeling that it should be morning, I’ll look at the clock, but I slept for only a few minutes ... ”. Sometimes there is a feeling of time stopping: "Time does not pass, it stands still." There may be a feeling of discreteness of time, its discontinuity - only separate moments are fixed in the mind, and the intervals between them do not leave any trace in the memory, the chain of events is interrupted, time suddenly, without sequential development, becomes the past in the form of a jump. “It seems that the morning is immediately followed by the evening, the sun is immediately replaced by the moon, people go to work and immediately come back…”. The distinction between past, present and future may be lost: “The past, present and future are on the same plane, they are nearby, and I can rearrange them like cards from one place to another. I won’t be surprised if I see a knight or a gladiator on the street - for me they are not in the past, but in today. I am talking to you now, and it will remain in me as what is happening now, but for you it will become a thing of the past. The future is also happening now, it is not something that will ever be, but already exists at the moment.” It happens that distant events (are remembered as having just happened, and what happened quite recently refers to the past.

The pace of real processes can also be perceived as accelerated or slowed down. It seems that transport, people move faster than usual, everything is perceived as if it were on an accelerated film - a time-trafter. Sometimes, on the contrary, the movements and speech of others seem to be slowed down, cars drive unusually slowly - zeitlupen.

The perception of oneself can be projected outward. So, an excited patient believes that the people around her are restless and move very quickly; the movements are slowed down not by her, but by those present.

The mechanisms of occurrence of perceptual disturbances are not well understood. There is no single theory explaining the pathogenesis of hallucinations. Historically, the peripheral theory of the origin of hallucinations was the first to develop, according to which they arise in connection with painful irritation of the peripheral part of the corresponding sense organ (eye, ear, skin receptors, etc.). The peripheral theory has now lost its significance. It has been established that hallucinations occur in most cases in the normal state of the sense organs. They can be observed even with the complete destruction of the sense organs or the cutting of the corresponding conductors of sensitivity.

From the standpoint of psychological theory, the occurrence of hallucinations is explained by the intensification of images of representation, confirmation of which was seen in the features of eidetism. The neurological theory associated the appearance of hallucinations with damage to certain cerebral structures, in particular, subcortical formations. S. S. Korsakov (1913) preferred the central theory of excitation of the cortical apparatus with irradiation of this excitation in the direction of the sensory apparatus. O. M. Gurevich (1937) explained the occurrence of hallucinations by a violation of the coordination of lethal and fugal components of perception and their disintegration, which is facilitated by impaired consciousness, autonomic regulation and disorders of proprioceptive sensitivity.

Physiological theories of the occurrence of hallucinations are mainly based on the teachings of IP Pavlov. Hallucinations, according to I. P. Pavlov, are based on the formation of foci of pathological inertia of excitation in various instances of the cerebral cortex, which provide an analysis of the first and second signals of reality. I. P. Pavlov believed that these disorders of higher nervous activity are due to biochemical changes in the brain. EA Popov (1941) emphasizes the role of hypnoid, phase states and, first of all, the paradoxical phase of inhibition in the genesis of hallucinations. Based on pharmacological experiments with the use of caffeine and bromine and the results of studies of sleep mechanisms, he showed that weak stimuli - traces of previously experienced impressions in the presence of a paradoxical phase of inhibition can sharply increase and give rise to images of representations subjectively experienced as images of direct impressions. A. G. Ivanov-Smolensky (1933) explained the exteroprojection of images of true hallucinations by the spread of inert excitation to the cortical projection of visual or auditory accommodation Pseudohallucinations, according to the author, differ from true hallucinations by the locality of the phenomena of pathological inertia of the irritable process, which spreads mainly to the visual or auditory areas.

The similarity of pathological changes in the psyche in conditions of isolation and "sensory hunger" with the psychopathological phenomena observed in various psychoses gave rise to studies in which the role of sensory deprivation in the origin of hallucinations was established. Modern researchers of the electrophysiological nature of sleep associate the mechanism of hallucination with a shortening of the REM sleep phase with a peculiar penetration of the REM phase into wakefulness (Snyder, 1963). Numerous works of recent decades have revealed a connection between the appearance of various mental disorders, including hallucinations, and disturbances in the metabolism of neurotransmitters in the central nervous system. A significant place is given to disorders of dopamine metabolism and increased activity of dopaminergic structures of the brain. The use in the treatment of patients with psychotropic substances that bind to dopamine receptors, for example, haloperidol, in some cases leads to a sharp decrease in the intensity of hallucinations up to their complete cessation.

Since the discovery of endogenous morphine-like peptides - enkephalins and endorphins (Huges et al., 1975; Telemacher, 1975), indications have appeared that some of them carry out mediator functions in specific neuronal systems of the brain. A hypothesis has been put forward about the role of endorphins in the pathogenesis of mental illness (Verebey et a., 1978; Gamaleya, 1979), according to which the latter are associated with a lack of endorphins at receptor sites or with an anomaly of endorphins. Naloxone, an endorphin antagonist, has been shown to reduce auditory hallucinations in patients with schizophrenia.

• ILLUSIONS in Sayings of famous people:
  
• ILLUSIONS in Dictionary One sentence, definitions:
  - the idea that the world is obliged to support the good in us, while for the good one has to suffer, and for free. Alexander …
• ILLUSIONS in Aphorisms and clever thoughts:
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• ILLUSIONS in the Big Encyclopedic Dictionary:
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• ILLUSIONS in the Great Soviet Encyclopedia, TSB:
  (Latin illusio, from illudo - I deceive, mock, play), 1) an inadequate idea of ​​the perceived object, which goes beyond the boundaries of ordinary perception errors. …
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• ILLUSIONS in the Encyclopedic Dictionary:
  (from the Latin illusio - a game of imagination, deceit), a distorted perception of reality, a deception of perception. 1) Illusions as a result of the imperfection of the sense organs are characteristic of ...
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• ILLUSIONS in the Big Russian Encyclopedic Dictionary:
  ILLUSIONS (from Latin illusio - deceit), distorted perception of reality, deception of perception. I. as a consequence of the imperfection of the sense organs; common to all people...
• ILLUSIONS in the Modern Explanatory Dictionary, TSB:
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• SEGLA VISUAL VERBAL HALLUCINATIONS in Medical terms:
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• HALLUCINATIONS VISUAL VERBAL in Medical terms:
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• LANGUAGE OF THE BODY in the Dictionary of Postmodernism:
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• YOU FERREIRA in the Dictionary of Postmodernism:
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• POST ADEQUATION in the Lexicon of non-classics, artistic and aesthetic culture of the XX century, Bychkov:
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• MANIFESTARIAN AESTHETICS in the Lexicon of non-classics, artistic and aesthetic culture of the XX century, Bychkov:
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• CONFUSION in the Explanatory Dictionary of Psychiatric Terms:
  Painful misunderstanding by the patient of the situation and his condition, which seem unusual to him, acquire some incomprehensible meaning, accompanied by anxiety, longing, fear. Characteristic…

Illusion, i.e. erroneous perceptions of real things and phenomena. The obligatory presence of a genuine object, albeit misunderstood, is the main feature of illusions, usually divided into affective, verbal (verbal) and transidolic.

Affective illusions (affect - short-term strong emotional arousal) most often caused by fear and anxious, depressed mood.

The emergence of affective illusions is possible in situations of affect or an emotional state unusual for a person - with strong fear, excessive desire, as a rule, unattainable, intense expectation, depressed and anxious state. Affective illusions arise especially often during periods of painful changes in the emotional state.

It is possible that such a phenomenon may occur in very specific environmental conditions, for example, in low light conditions, at dusk, at night when lightning flashes (at this moment, light illumination is distorted and refracted). A moving curtain can be perceived as a lurking robber, a belt on an armchair - like a snake ready to jump, etc.

Affective illusions also arise in cases where, in addition to affective tension, there is weakness (indistinctness) of an irritable sign (remoteness of an object, quiet rustling sounds, slurred slurred speech) and signs of obvious asthenia. Any perfectly healthy mentally person may experience the phenomenon of affective illusion if he is in an unusual environment for him, an unfamiliar place, in an unusual emotional state (a classic example is a visit to a cemetery at night).

"Materialize" into affective illusions in a healthy person and the constant expectation of something unpleasant for him (for example, if a person is very afraid of dogs, then in an unfamiliar environment with poor lighting, every extraneous movement will seem to him as a dog rushing at him).

The emergence of affective illusions is characteristic of the patient not only in a state of simple depression, but also with obvious tendencies to the depressive phenomenon of delusional formation. A sick person who is in a state of activated depression of a delusional type is constantly in anticipation of punishment, execution, retribution for sins, condemnation of others.

At the same time, in a healthy person, it is necessary to distinguish from affective illusions an erroneous judgment or an incorrect conclusion made under the influence of some physical phenomenon.

So, for example, you can easily mistake a shiny object on the ground for a coin, or a piece of glass brightly lit by the sun for gold, this phenomenon is not considered an illusion, that is, not a deception (false perception) of the sensory definition of something, but an erroneous misinterpreted judgment.

Psychologists and psychiatrists are well aware that the occurrence of individual manifestations of affective illusions (an isolated manifestation) is not at all considered a mental illness or its sign, but most often is evidence of affective tension (arising from overwork, sudden fright, fear).

The main difference between physiological illusions and the pathological manifestation of affective illusions is considered by doctors to be the possibility of correcting the state, as well as the self-critical attitude of the patient to his own state (awareness of the illusory content of what is happening).

Verbal illusions consist in a false perception of the content of the actual conversations of others; it seems to a person that other people's speeches contain hints of some unseemly deeds, bullying, hiding a threat against him.

This phenomenon is based on affect and fear, in connection with this, a conversation heard by a sick person is always perceived as a direct accusation against him, insult, abuse, which are most directly related to him. For example, verbal illusions are typical of patients with delusions of persecution, as well as those with mania of jealousy. A patient suffering from alcoholism can eavesdrop on his wife's conversation with a stranger, and, having internal fears of betrayal or punishment, this is what he "hears" in their conversation. But, it should be noted that verbal illusions are manifested not only with the sounds of conversations, but also arise against the background of non-verbal deceptions. Often the patient is confused by the sound of water, thunder, the sound of the surf, and so on. In all these cases, a person is sure that he "hears" something that was not actually said. This interpretation of it is a verbal illusion, which is directly related to the fact that individual sounds that are auditory stimuli are "constructed" by his consciousness into meaningful words, sometimes into a whole speech, which creates a holistic (erroneously recognized) auditory image for a person, while , its content depends entirely on the specific state of the person at that moment. Psychiatrists take it as an axiom that verbal illusions, as a rule, become the basis for the formation of the patient's delusional mood.

In some cases of verbal phenomena, these may be hails that are distinguishable in the real-life noise and sound of voices (it is necessary to distinguish them from hallucinatory hails), and in others, they are directly verbal illusions, which are often very difficult to distinguish from the so-called delusions of the patient's delusions. person.

An interesting example of such a phenomenon is given by the American scientist William James in his book "Psychiatry": "One day, late at night, I was sitting and reading; suddenly a terrible noise was heard from the upper part of the house, it stopped and then, after a minute, the words resumed, I went out into the hall, to listen to the noise, but it did not repeat itself. As soon as I managed to return to my room and sit down at the book, an alarming, loud noise arose again, as if before the start of a storm. It came from everywhere. Extremely alarmed, I again went out into the hall, and again the noise ceased. Returning a second time to my room, I suddenly discovered that the noise was being made by its snoring of a small dog sleeping on the floor. efforts to renew the former illusion".

That is, by his observation, he confirmed that if the consciousness of a healthy person for some reason took for reality that the sound source is located far away, then it seems much louder, but when the real source is established, the illusion goes away.

Pareidolic illusions are usually caused by a decrease in the tone of mental activity, general passivity. For example, when patterns on wallpaper, cracks on walls and ceilings, various chiaroscuro are perceived as bright pictures, fairy-tale heroes, fantastic monsters.

Pareidolic illusion or pareidolia is a type of visual illusion. It consists in the formation of illusory images, the basis of which are the details of a real object. As an example, these are the figures of people and animals in the clouds, the image of a person on the surface of the Moon or Mars, “hidden messages” heard when reversing audio recordings. Some pareidolic illusions arise from the perception of any well-known images. In this case, they can be observed simultaneously in many people. Ink blot. Clouds.

Perception is a holistic reflection of our "I" of an object or phenomenon.

Illusions.

Illusions are called erroneous, altered perception of real-life objects or phenomena, “perversion of perception” (J. Esquirol), “delusion of the imagination” (F. Pinel), “imaginary sensation” (V. P. Serbsky). Illusions can be both mentally ill and completely healthy people.

Descriptions of illusions are given in the "Forest King" by I. Goethe and in "Demons" by A. S. Pushkin. In the first case, instead of a tree, the boy’s painful imagination sees the image of a terrible, bearded forest king, in the second, swirling figures of demons are seen in a blizzard, and their voices are heard in the noise of the wind.

Healthy people may have physical, physiological illusions, as well as illusions of inattention.

physical illusions based on the laws of physics. For example, the perception of the refraction of an object at the border of various transparent media (a spoon in a glass of water seems to be refracted, on this occasion Descartes said: “My eye refracts it, and my mind straightens it”). A similar illusion is a mirage.

Physiological illusions related to the features of the functioning of the analyzers. If a person looks at a moving train for a long time, he gets the feeling that the train is standing still, and he seems to be rushing in the opposite direction. When a rotating swing suddenly stops, the people sitting in it for several seconds retain the feeling of a circular rotation of the surroundings. For the same reason, a small room, covered with light wallpaper, seems larger in volume. Or a fat person dressed in a black dress seems to be more slender than in reality.

Illusions of inattention are noted in those cases when, with excessive interest in the plot of a literary work, a mentally healthy person does not notice obvious grammatical errors and typos in the text.

Illusions associated with the pathology of the mental sphere are usually divided into affective (affectogenic), verbal and pareidolic.

affective illusions arise in a situation of affect or an unusual emotional state (strong fear, excessive desire, intense expectation, etc.), in a situation of insufficient illumination of the surrounding space. For example, a tie hanging on an armchair in the twilight can be perceived as a cobra ready to jump. Affective illusions are sometimes noted in healthy people, because this distorted perception is associated with an unusual emotional state. Almost anyone can experience affective illusions if they visit a cemetery alone at midnight.

A lonely religious patient was afraid to walk past the balcony of her apartment at night, because she constantly saw the “tempter” in the household utensils stored on the balcony.

verbal, or auditory, illusions also appear against the background of some kind of affect and are expressed in an erroneous perception of the meaning of the conversations of people around, when neutral speech is perceived by the patient as a threat to his life, curses, insults, accusations.

Patient N., who suffered from alcoholism, often heard (and saw) against the background of the TV turned on, how he was invited to divide the company “into three” by “hairy people with tails” completely unfamiliar to him, freely passing through the wall of the house.

Paraidolic (circiform) illusions associated with the activity of the imagination when fixing the gaze on objects that have a fuzzy configuration. In this disorder, perception is bizarre-fantastic in nature. For example, in a kaleidoscope of ever-moving clouds, a person can see divine pictures, in the pattern of the wallpaper - millions of small animals, in the patterns of the carpet - his life path. Paraidolic illusions always occur with a reduced tone of consciousness against the background of various intoxications and are an important diagnostic feature. In particular, this variant of illusions may be one of the first symptoms of an incipient delirium tremens.

Sometimes illusions are divided according to the senses: visual, auditory, olfactory, gustatory and tactile. It should be emphasized that the presence of only affective, verbal and paraidolic illusions in an isolated form is not a symptom of a mental illness, but only indicates affective tension or overwork of a person. Only in combination with other disorders of the mental sphere do they become symptoms of certain mental disorders.

hallucinations.

Hallucinations are perceptual disorders when the patient sees, hears and feels something that does not actually exist in this situation. This is the so-called perception without an object. In the figurative expression of Lasegue, illusions are related to hallucinations, as slander is to slander (i.e., slander is always based on a real fact, distorted or distorted, while in slander there is not even a hint of the truth).

Allocate hallucinations by the senses: visual, auditory, olfactory, gustatory, general sense (visceral and muscular).

Hallucinations can be simple or complex. Simple hallucinations are usually localized within one analyzer (for example, only auditory or only olfactory, etc.). Complex (combined, complex) hallucinations are a combination of two or more simple hallucinations.

For example, the patient sees a huge boa constrictor lying on his chest (visual deceptions of perception), which “hisses menacingly” (auditory), feels his cold body and enormous heaviness (tactile hallucinations).

In addition, hallucinations are true, more characteristic of exogenous mental illness, in which the patient sees currently absent pictures or hears non-existent sounds, and false (pseudohallucinations), more often noted in endogenous disorders, in particular schizophrenia. Essentially, pseudohallucinations include not only perceptual disorders, but also the pathology of the associative process, i.e., thinking.

Patient M., a lecturer at one of the Moscow universities, constantly saw in her head two groups of physicists, American and Soviet. These groups stole "atomic secrets" from each other, tested atomic bombs in the patient's head, from which she "rolled her eyes." The patient all the time mentally talked to them in Russian, then in English.

To distinguish between true hallucinations and false ones, which are of great importance for the nosological presumptiveness of the disease, differential diagnostic criteria are distinguished:

1. Criterion of projection. With true hallucinations, there is a projection of the hallucinatory image outside, i.e. the patient hears a voice with his ears, sees with his eyes, smells with his nose, etc.

With pseudohallucinations, the projection of the image inside the body is noted
patient, i.e. he hears the voice not with his ears, but with his head and the voice is located inside the head or another part of the body. In the same way, he sees visual images inside his head, chest, or other part of the body. At the same time, the patient says that there is a small TV set inside the body. Pseudohallucinations are widely represented in fiction as well. So, for example, Prince Hamlet saw the ghost of his father "in the eye of his mind."

2. The criterion of doneness. characteristic of pseudohallucinations.
The patient is sure that the demonstration of pictures in his head, the installation of a TV and a tape recorder in his head that records his secret thoughts, is specially arranged by powerful organizations or individuals. With true hallucinations, there is never a sense of being done, of being attuned.

3. The criterion of objective reality and sensory brightness.
True hallucinations are always closely related to the real environment and are interpreted by patients as existing in reality. The patient sees a small King Kong sitting on a real chair, in a real room, surrounded by real students, commenting on a real television program and drinking
vodka from a real glass. Pseudo-hallucinations are devoid of objective reality and sensual liveliness. So, auditory pseudohallucinations are quiet, indistinct, as if distant. This is not a voice, not a whisper, and not a woman's, and not a man's, and not
childish and not adult. Sometimes patients doubt whether the voice
this or the sound of their own thoughts. Visual pseudo-hallucinations, often bright, never associated with the real environment, more often they are translucent, icon-like, flat and devoid of shape and volume,

4. The criterion of the relevance of behavior. true hallucinations
are always accompanied by actual behavior, because patients
convinced of the reality of hallucinatory images and behave
appropriate to their content. With frightening images, they experience panic fear, with threatening voices coming from a neighboring apartment, they seek help from the police and prepare for defense or hide with friends, and sometimes just
plug their ears. For pseudohallucinations, the relevance of behavior is not typical. Patients with voices of unpleasant content inside the head continue to lie indifferently in bed. It is extremely rare that actions “adequate” to pseudo-hallucinations are possible.
So, for example, a patient who has heard voices for a long time,
emanating from the big toe of the left foot, tried to cut off the latter.

5. The criterion of social confidence. true hallucinations
always accompanied by a sense of social security. So,
a patient experiencing commenting hallucinations of unpleasant content is convinced that all residents of the house hear statements about his behavior. With pseudohallucinations, patients are sure that such phenomena are purely personal in nature and are experienced exclusively by them.

6. The criterion of focus on the mental or physical
"I". True hallucinations are directed to the physical "I" of the patient, while pseudo-hallucinations are always addressed to the mental "I". In other words, in the first case, the body suffers, and in the second, the soul.

7. Criterion depending on the time of day. The intensity of true hallucinations intensifies in the evening and at night.
Such patterns in pseudohallucinations, as a rule, are not observed.

In psychiatric practice, auditory (verbal) hallucinations are most common.

auditory hallucinations can be elementary in the form of noise, individual sounds (acoasma), as well as in the form of words, speeches, conversations (phonemes). In addition, auditory hallucinations are divided into so-called hails(the patient constantly hears being called by name), imperative, commenting, threatening, contrasting (contrasting), motor speech, etc.

imperative (ordering, imperative) verbal hallucinations are expressed in the fact that the patient hears orders, which he almost cannot resist. These hallucinations pose a significant threat to those around them and the patient himself, as they are usually "ordered" to kill, hit, destroy, blow up, throw a child off a balcony, cut off one's leg, etc.

Commenters verbal hallucinations are also very unpleasant for the patient and are expressed in the fact that the voices constantly, as it were, discuss all the actions of the patient, his thoughts and desires. Sometimes they are so painful that the only way to get rid of them the patient finds in suicide.

threatening verbal hallucinations are expressed in the fact that patients constantly hear verbal threats against them: they are going to be hacked to death, quartered, castrated, forced to drink slow-acting poison, etc.

Contrasting (antagonistic) verbal hallucinations are in the nature of a group dialogue - one group of voices angrily condemns the patient, demands sophisticated torture and death, and the other timidly, uncertainly defends him, asks for a respite of execution, assures that the patient will improve, stop drinking, become better, kinder . It is characteristic that the voices do not address the patient directly, but discuss among themselves. Sometimes, however, they give him exactly the opposite orders, for example, to fall asleep and at the same time sing and do dance steps. This variant of auditory perceptual delusions is an imperative variety of antagonistic hallucinations. Contrasting disorders also include clinical cases when a patient hears threatening, hostile voices with one ear, and friendly, approving his actions with the other.

Speech motor Segla's hallucinations are characterized by the patient's confidence that someone is speaking with his speech apparatus, affecting the muscles of the mouth and tongue. Sometimes the speech motor apparatus pronounces voices that are not heard by others. Many researchers attribute Segle's hallucinations to a variety of pseudohallucinatory disorders.

visual hallucinations in terms of their representation in psychopathology, they are second only to auditory ones. They range from elementary (photopsies) in the form of smoke, fog, sparks to panoramic, when the patient sees dynamic battle scenes with many people. Allocate zoopsy, or zoological visual deceptions in the form of various aggressive wild animals attacking the patient (they are more often noted with alcoholic delirium).

Demonomanic hallucinations - the patient sees images of mystical and mythological creatures (devils, angels, mermaids, werewolves, vampires, etc.).

Autoscopic (deuteroscopic), or double hallucinations - the patient observes one or more doubles that completely copy his behavior and mannerisms. Allocate negative autoscopic hallucinations, when the patient does not see his reflection in the mirror. Autoscopies are described for alcoholism, for organic lesions of the temporal and parietal parts of the brain, for hypoxia after heart surgery, and also against the background of a severe psychotraumatic situation. Autoscopic hallucinations seem to have been experienced by Heine and Goethe.

microscopic (Lilliputian) hallucinations - delusions of perception are reduced in size (many gnomes dressed in extremely bright clothes, like in a puppet theater). These hallucinations are more common in infectious psychosis, alcoholism, and intoxication with chloroform and ether.

Patient M. saw many small, but extremely angry and aggressive rats chasing him throughout the apartment.

macroscopic delusions of perception - giants, giraffe-like animals, huge fantastic birds appear before the patient.

Polyopic hallucinations - many identical hallucinatory images, as if created as a carbon copy, are noted in some forms of alcoholic psychosis, for example, in delirium tremens.

Adelomorphic hallucinations are visual illusions, devoid of clarity of form, volume and brightness of colors, disembodied contours of people flying in a specific enclosed space. Many researchers refer adelomorphic hallucinations to a special form of pseudo-hallucinations; characteristic of the schizophrenic process.

Extracampine hallucinations - the patient sees out of the corner of the eye behind him outside the field of normal vision some phenomena or people. When he turns his head, these visions instantly disappear. Hallucinations occur in schizophrenia.

Hemianopsia hallucinations - loss of one half of the vision, occur with an organic lesion of the central nervous system.

hallucinations like Charles Bonnet - always true deceptions of perception, are noted with the defeat of any analyzer. So, with glaucoma or retinal detachment, a visual version of these hallucinations is noted, with otitis media - auditory.

negative, those. suggested visual hallucinations. A patient in a state of hypnosis is told that after leaving the hypnotic state, for example, he will not see absolutely nothing on a table littered with books and notebooks. Indeed, after leaving hypnosis, a person sees a completely clean and empty table within a few seconds. These hallucinations are usually short-lived. They are not a pathology, but rather indicate the degree of hypnotizability of a person.

In the diagnosis of mental illness, great importance is attached to the subject of visual hallucinations (as well as auditory ones). So, the religious themes of hallucinations are characteristic of epilepsy, the images of dead relatives and loved ones - for reactive states, the vision of alcohol scenes - for delirium tremens.

Olfactory hallucinations represent an imaginary perception of extremely unpleasant, sometimes disgusting smells of a decaying corpse, decay, a burnt human body, excrement, stench, an unusual poison with a suffocating smell. Often, olfactory hallucinations cannot be distinguished from olfactory illusions. Sometimes in the same patient both disorders exist synchronously. Such patients often staunchly refuse to eat.

Olfactory hallucinations can occur in various mental illnesses, but above all they are characteristic of organic brain damage with temporal localization (the so-called uncinate seizures in temporal lobe epilepsy).

Taste hallucinations often combined with olfactory and expressed in the sensation of the presence of rot, "dead meat", pus, feces, etc. in the oral cavity. These disorders occur with equal frequency in both exogenous and endogenous mental illnesses. The combination of olfactory and gustatory hallucinations and illusions, for example, in schizophrenia, indicates the malignancy of the course of the latter and a poor prognosis.

Tactile hallucinations represent a sensation of touching the body of something hot or cold (thermal hallucinations), the appearance of some liquid on the body (hygric), grasping the body from the back (haptic), crawling on the skin of insects and small animals (external zoopathy), the presence of under skin "like insects and small animals" (internal zoopathy).

Some researchers also refer to tactile hallucinations as a symptom of a foreign body in the mouth in the form of threads, hair, thin wire, described in tetraethyl lead delirium. This symptom is essentially a manifestation of the so-called oropharyngeal hallucinations.

Tactile hallucinations are very characteristic of cocaine psychosis, delirious stupefaction of various etiologies, and schizophrenia. With the latter, tactile hallucinations are often localized in the genital area, which is an unfavorable prognostic sign.

Visceral hallucinations expressed in sensation in the body cavities of some small animals or objects (green frogs live in the stomach, they breed tadpoles in the bladder).

functional hallucinations arise against the background of a real stimulus and exist as long as this stimulus acts. For example, against the background of a violin melody, the patient hears both the violin and the "voice" at the same time. As soon as the music stops, the auditory hallucinations also stop. In other words, the patient simultaneously perceives both a real stimulus (a violin) and an imperative voice (which distinguishes functional hallucinations from illusions, since there is no transformation of music into voices). Allocate visual, olfactory-gustatory, verbal, tactile and other variants of functional hallucinations.

close to functional reflex hallucinations , which are expressed in the fact that when exposed to one analyzer, they arise from others, but exist only during stimulation of the first analyzer.

For example, when looking at a certain picture, the patient experiences a touch of something cold and wet on the heels (reflex hygro and thermal hallucinations). But as soon as he takes his eyes off this picture, these sensations instantly disappear.

kinesthetic (psychomotor) hallucinations manifested in the fact that patients have a feeling of movement of some parts of the body against their will, although in fact there are no movements. They occur in schizophrenia as part of the syndrome of mental automatism.

Hypnogogic and hapnopompic hallucinations appear in the patient before falling asleep: against the background of closed eyes, various visions appear, pictures of action with the inclusion of other analyzers (auditory, olfactory, etc.). As soon as the eyes are opened, the visions instantly disappear. The same pictures can appear at the moment of awakening, also against the background of closed eyes. These are the so-called prosonic, or hypnopompic, hallucinations.

Ecstatic hallucinations are noted in a state of ecstasy, differ in brightness, imagery, impact on the emotional sphere of the patient. Often have a religious, mystical content. They can be visual, auditory, complex. They keep for a long time, are noted in epileptic and hysterical psychoses.

Hallucinosis - a psychopathological syndrome, which is characterized by pronounced profuse hallucinations against the background of a clear consciousness. In acute hallucinosis, patients do not have a critical attitude to the disease. In the chronic course of hallucinosis, criticism of hallucinatory experiences may appear. If periods of hallucinosis alternate with light intervals (when hallucinations are completely absent), they speak of mental diplopia.

At alcoholic hallucinosis, there is an abundance of auditory hallucinations, sometimes accompanied by secondary delusional ideas of persecution. It occurs with chronic alcoholism, can manifest itself in acute and chronic form.

Hallucinosis pedicellate occurs with a local lesion of the brain stem in the region of the third ventricle and legs of the brain due to hemorrhage, tumor, as well as in the inflammatory process of these areas. It manifests itself in the form of moving colored, microscopic visual hallucinations, constantly changing shape, size and position in space. They usually appear in the evening and do not cause fear or anxiety in patients. Criticism remains about hallucinations.

Hallucinosis Plauta — a combination of verbal (much less often visual and olfactory) hallucinations with delusions of persecution or influence with unchanged consciousness and partial criticism. This form of hallucinosis has been described in brain syphilis.

Hallucinosis atherosclerotic occurs more often in women. At the same time, hallucinations are isolated at first, as atherosclerosis deepens, there is an increase in characteristic signs: memory loss, intellectual decline, indifference to the environment. The attitude towards hallucinations, which is critical in the early stages of the disease, is lost. The content of hallucinations is often neutral, it concerns simple everyday affairs. With the course of atherosclerosis, hallucinations can take on a fantastic character. It is noted, as the name implies, in cerebral atherosclerosis and in some forms of senile dementia.

Hallucinosis olfactory - an abundance of olfactory, often unpleasant hallucinations. Often combined with the delusions of poisoning, material damage. It is noted in organic cerebral pathology and in psychoses of late age.

Sensory synthesis disorders.

This group includes violations of the perception of one's own body, spatial relations and forms of the surrounding reality. They are very close to illusions, but differ from the latter in the presence of criticism.

The group of sensory synthesis disorders includes depersonalization, derealization, disturbances in the body scheme, a symptom of what has already been seen (experienced) or never seen, etc.

Depersonalization — this is the patient's belief that his physical and mental "I" have somehow changed, but he cannot explain specifically what and how has changed. There are different types of depersonalization.

Somatopsychic depersonalization - the patient claims that his bodily shell, his physical body has changed (some kind of stale skin, muscles have become jelly-like, legs have lost their former energy, etc.). This type of depersonalization is more common in organic lesions of the brain, as well as in some somatic diseases.

autopsychic depersonalization - the patient feels a change in the mental "I": he became callous, indifferent, indifferent or, conversely, hypersensitive, "the soul cries for an insignificant reason." Often he cannot even verbally explain his condition, he simply states that "the soul has become completely different." Autopsychic depersonalization is very characteristic of schizophrenia.

Allopsychic depersonalization is a consequence of autopsychic depersonalization, a change in the attitude towards the surrounding reality of the “already changed soul”. The patient feels like a different person, his attitude to the world has changed, his attitude towards relatives has changed, he has lost a sense of love, compassion, empathy, duty, the ability to participate in previously beloved friends. Very often, allopsychic depersonalization is combined with autopsychic, forming a single symptom complex characteristic of the schizophrenic spectrum of diseases.

A special variant of depersonalization is the so-called weight loss. Patients feel how their body mass is steadily approaching zero, the law of universal gravitation ceases to act on them, as a result of which they can be carried away into space (on the street) or they can soar up to the ceiling (in a building). Understanding by reason the absurdity of such experiences, the sick, nevertheless, "for the peace of mind" constantly carry any burdens with them in their pockets or briefcase, not parting with them even in the toilet.

Derealization - this is a distorted perception of the surrounding world, a feeling of its alienation, unnaturalness, lifelessness, unreality. The environment is seen as drawn, devoid of vital colors, monotonous gray and one-dimensional. The size of objects changes, they become small (micropsia) or huge (macropsia), extremely brightly lit (galeropsia) up to the appearance of a halo around, the surroundings are colored yellow (xanthopsia) or purple-red (erythropsia), the sense of perspective changes (porropsia) , shape and proportions of objects, they seem to be reflected in a glass mirror (metamorphopsia), twisted around its axis (dysmegalopsia), objects double (polyopia), while one object is perceived as many of its photocopies. Sometimes there is a rapid movement of surrounding objects around the patient (optical storm).

Derealization disorders differ from hallucinations in that there is a real object here, and from illusions in that, despite the distortion of shape, color and size, the patient perceives this object as this one, and not any other. Derealization is often combined with depersonalization, forming a single depersonalization-derealization syndrome.

With a certain degree of conventionality, symptoms can be attributed to a special form of derealization-depersonalization. "already seen"deja vu), "already experienced" (deja vecu), "already heard" (deja entendu), "already experienced" (deja eprouve), "never seen" (jamais vu). The symptom of “already seen”, “already experienced” lies in the fact that the patient, who first finds himself in an unfamiliar environment, an unfamiliar city, is absolutely sure that he has already experienced this particular situation in the same place, although he understands with his mind: in fact, he is here for the first time and never seen this before. The symptom of "never seen" is expressed in the fact that in a completely familiar environment, for example, in his apartment, the patient feels that he is here for the first time and has never seen this before.

Symptoms such as "already seen" or "never seen" are short-term, lasting a few seconds and are often found in healthy people due to overwork, lack of sleep, mental strain.

Close to the "never seen" symptom "object rotation" relatively rare. It manifests itself in the fact that a well-known area seems to be turned upside down by 180 degrees or more, while the patient may experience a short-term disorientation in the surrounding reality.

Symptom "disturbances in the sense of time" expressed in the sensation of speeding up or slowing down the passage of time. It is not pure derealization, as it also includes elements of depersonalization.

Derealization disorders, as a rule, are observed with organic brain damage with the localization of the pathological process in the region of the left interparietal sulcus. In short-term variants, they are also observed in healthy people, especially those who have undergone in childhood "minimum brain dysfunction"— minimal brain damage. In some cases, derealization disorders are paroxysmal in nature and indicate an epileptic process of organic genesis. Derealization can also be observed during intoxication with psychotropic drugs and narcotic drugs.

Violation of the body schema (Alice in Wonderland syndrome, autometamorphopsia) is a distorted perception of the size and proportions of your body or its individual parts. The patient feels how his limbs begin to lengthen, his neck grows, his head grows to the size of a room, his torso shortens, then lengthens. Sometimes there is a feeling of pronounced disproportion of body parts. For example, the head is reduced to the size of a small apple, the body reaches 100 m, and the legs extend to the center of the Earth. Feelings of a change in the body scheme can act in isolation or in combination with other psychopathological manifestations, but they are always extremely painful for patients. A characteristic feature of violations of the body scheme is their correction by vision. Looking at his legs, the patient convinces -. and that they are of regular size, not multi-meter; looking at himself in the mirror, he discovers the normal parameters of his Head, although he feels that the head in diameter reaches 10 m. Correction with vision provides a critical attitude of patients to these disorders. However, when visual control ceases, the patient again begins to experience a painful feeling of a change in the parameters of his body.

Violation of the body scheme is often noted in organic pathology of the brain.