IF YOU SACRIFICE YOURSELF. Client story with permission. Client. Woman of status. 56 years old. Owner and director of the company. Divorced for 15 years. Adult son. No grandchildren. Query: Chronic cystitis, acute stage. Urinary incontinence (occasionally). Work on psychosomatics (referred by a doctor) Health problems. Hypertension. Arrhythmias. Chronic hemorrhoids. Endometriosis. Night sweats. Noise in ears. Migraine-type headaches. Biliary dyskinesia. And all this is chronic and has long been habitual. But cystitis and incontinence are a big problem. The woman assured that she had never had and does not have mental problems. And she still has that “Nordic/persistent” character. She does not cry and does not give up. Orthodox, moderately churched (attends services, prays, fasts, tries to keep the commandments.) Without VP. She has not been noticed in “defamatory connections.” She is working with a psychologist for the first time. Before applying, she studied materials on “psychosomatics of cystitis.” She did not find anything similar and is inclined to continue to think that there is a physiological reason for her problem. However, she will be interested in working with a psychosomatologist. PROGRESS OF THERAPY Necessary theory. In order not to overload the article with excess volume, I present to your attention my material on the psychosomatics of cystitis at this link (here on the website): Interstitial cystitis, OAB, cystalgia or? Client stories with permission and hoping that you have read it and are ready to follow. I will continue with the course of my thoughts. The special role of the psyche in the implementation of the function of urination has never been disputed by anyone. However, in practice, the possibility of dysfunction of urination of a psychogenic nature is not always taken into account. Many patients with this disorder have indications of the presence of a psychological one. stress. Often, involuntary leakage of urine is caused predominantly or even purely psychogenic reasons. The whole variety of psychogenic mental disorders is divided into two large groups - reactive psychoses and neuroses. I will skip psychoses. This is not our case. But let’s look at neuroses. Based on the set of health problems the client has and their character, it is similar to vegetoneurosis. Usually, with it, doctors diagnose VDS (vegetative-vascular dystonia) without explanation - such a convenient and incomprehensible disease for all occasions. A few words about the functioning of the nervous system, especially its central part - the brain. Performs three functions: - responsible for the study and analysis reality, that is, for thinking; - regulates motor function; - allows you to feel, experience emotions and associate them with the functioning of internal organs, endocrine glands and metabolism. The part of the nervous system responsible for the third function is called autonomic. Its work does not depend on conscious, volitional impulses. The body reacts to various emotions by increasing or slowing down the heartbeat, breathing rate, stomach, intestines, bladder. It happens that the signals entering the brain are very strong or last too long and a person does not have the opportunity to relieve mental stress and relax, autonomic system cannot return to a state of balance and begins to spin out of control of the brain. As a result, neurosis appears. Autonomic neurosis is a collective term for physical ailments that arise as a result of psychological problems. This disease has many faces. It can manifest itself in a wide variety of symptoms that resemble diseases of the heart, stomach, intestines and other organs. VN is not life-threatening, but if it is not treated for a long time, functional disorders of internal organs gradually become organic. In recent years, mild antidepressants of a new generation are increasingly recommended to relieve neurotic symptoms. But the drugs do not eliminate the cause of the disease. Therefore, the main method that makes it possible to cure autonomic neurosis is psychotherapy. It helps to detect andremove the root of the problem. However, in about half of the cases, psychotherapy has to be combined with pharmacotherapy. And in our case, I started counseling, but referred the client to a vegetarian/neurologist for a consultation. Vegetologist is a doctor who treats autonomic disorders that accompany other diseases or are independent dysfunction of the autonomic nervous system (ANS). By the way, I applied myself after COVID. SYSTEM PSYCHOANALYSIS OF A CLIENT CASE. Consultation 1. I’ll immediately try to explain why I am inclined to believe that the cause of the problem for which the woman came to me (cystitis, urinary incontinence) is systemic in nature and incontinence is only one of the symptoms of a systemic disorder (SID). Because: 1. Health problems. Hypertension. Arrhythmias. Chronic hemorrhoids. Endometriosis. Night sweats. Noise in ears. Migraine-type headaches. Biliary dyskinesia, cystitis, is a characteristic bouquet. If we add to it urinary incontinence that worsens from time to time and has no physiological explanation (as it turned out later, in certain periods after stressful situations), then it’s even closer. Let’s add an understanding of the expected level of stress in single woman during menopause, head of an enterprise))! We will return to this point in more detail later. We add “Nordic character” = frustration of true healthy needs. We add parental stories - dad is an alcoholic, mom is hysterical. These observations are enough. But this is just the first glance. Further more. Consultation 2. At the second consultation, we were able to establish contact that allowed greater frankness than dry answers to the questions posed. And what emerged was a surprise to me, one might say. Obsessive-compulsive neurosis is a mental disorder based on obsessive compulsions. thoughts, ideas and actions that arise beyond the mind and will of a person. Obsessive thoughts often have a content that is alien to the patient, however, despite all efforts, he cannot get rid of them on his own. Yes, for a month now, the woman, along with involuntary urination, has been haunted by a “horrible thought” in relation to her son. She understood that this was not her thought. But she couldn’t do anything. She attributed it to “demonic possession,” but everything that was supposed to help from church experience did not help either. The thought was truly frightening: “May you die.” And this is against the backdrop of the fact that the woman and her son have a close relationship. He is the only son and the only truly loved person. The closest and dearest. Moreover, it is also positive from all sides. In addition, this obsession occurs against the background of frequently recurring anxious thoughts and fear that something will happen to his son. It is these thoughts that are accompanied by a panicky state of fear and trigger an exacerbation of urinary pain and incontinence. One can imagine what would happen to a woman in this situation. Here are thoughts of madness, and a huge sense of guilt, and hopelessness and...... And on in fact, it’s about “obsessions,” as another manifestation of neurosis. And this must be treated and not attributed to the properties of one’s personality. Or madness. And this will be treated simultaneously with incontinence. The root of the problems is the same. Obsessions are obsessive thoughts that arise contrary to reason, will, and feelings. These can be ideas, images or impulses that come to a person's mind again and again in a stereotypical form. Often they turn out to be unacceptable for him and contradict his moral and ethical properties. These thoughts are recognized by a person as incorrect and are painfully experienced by him, especially since their very occurrence, due to their incomprehensibility, often gives rise to a feeling of fear in him. Nevertheless, the person considers these thoughts to be his own, even if they are involuntary and disgusting to him. Treatment: It is possible to effectively treat obsessive-compulsive neurosis only by following the principles of an individual and comprehensive approach to therapy. It is advisable to combine medication and psychotherapeutic treatment, social rehabilitation. Consultation 3. We workwith symptoms. Psychological causes of the development of neurosis. Active (beyond one’s strength) mental/mental activity; Prolonged psychological experiences and anxiety; Psychological pressure when it is impossible to solve life’s problems; Long-term loneliness and problems in the personal sphere of life; Traumatic event in life: loss of a loved one, difficult divorce, loss of property, etc. .p.Inflated expectations. In this case, the person cannot achieve the desired goal and experiences a feeling of an impossible plan; Psychological trauma received in childhood. Non-compliance with the work and rest schedule. Everything that I emphasized from the client is off the charts. In addition, taking into account that neurosis is also based on somatic components, vital needs , a sense of self-worth, love, recognition, a sense of security, which were constantly ignored/repressed and not satisfied, then all the prerequisites came together. Why did it happen that such a strong, intelligent, morally strong woman drove herself into neurosis and illness. A banal beginning, - childhood. A child deprived of a sense of love, protection, unconditional recognition, living in constant stress is highly likely to be neurotic. At this session we worked with childhood traumas. But they are so repressed that to get to them is to solve a super problem. In general, a characteristic feature of the client is the use of many psychological defenses, which, alas, are no longer working, but are so necessary for her and have served her in many ways. However, due to the suppression of the emotional/sensual spheres and the body. Everything repressed/suppressed/misunderstood sooner or later returns and wants to be accepted. Let's go in this direction. Suppression: attempts to forget, erase from memory what upset, that is, actually repressing unpleasant memories and experiences in the past; Denial, in which people prefer to believe that everything is fine and everything will always be fine; Projection, which allows you to convince yourself that someone else, not you, is experiencing something bad and unpleasant, and that this person has some negative, negative characteristic; Isolation: isolating emotions from events, numbness; Rationalization and intellectualization: resorting to a rational or intellectual explanation stressful emotional events, as well as one’s feelings; Moralization: an unconscious search for acceptable grounds for some action. For example, a negative event could even be a war, which is perceived as an opportunity to “build character” or an excellent “learning experience.” Any mentally healthy adult has a neurosis of greater or lesser severity. Karen Horney, an outstanding researcher of neuroses, spoke about its multidirectionality, as a result of the formation of psychological defenses that are poorly compatible with each other. But here it looks like this: A woman defended herself from her carnality, vulnerability, weakness, tenderness, desire to be loved. She tried to cover it all with love for God and the observance of righteousness. I overdid it greatly. I didn’t calculate my strength. She didn’t admit to herself that she couldn’t be a saint. She is a laywoman, a living woman. With grievances for betrayal and dislike, for coldness and constant loneliness. Besides God, we also need people. We need human love and warmth. One could say, yes, there is a son. Yes, he is good, loved, but living his own life. He cannot and should not devote himself to his mother. And she misses his love, care, tenderness, and participation. It is from him that she expects all this (although she does not admit it to herself) and does not receive it sufficiently. And you shouldn't receive it. Otherwise, it will destroy her son’s life. She can get all this from herself, from a faithful friend, from her beloved man (and why not? 15 years of loneliness is too much! and she is not yet old). And this must be accepted. Otherwise, the son, overloaded with love, “for whom she lives” becomes in her unconscious a monster who “rejected” her, while taking upon himself to work off all the love and care that the woman has not received, starting with her parents. If you3