Аннотация:
Aim: to create a dynamic model of altered states of consciousness (ASC) caused by psychoactive substances (PS), based on previously obtained data on the psychopathological and pathopsychological structure of states at the peak of intoxication and with an exacerbation of pathological craving (PC) in 647 patients with formed dependence on various substances.
Methods. The main method used was the phenomenological reconstruction of psychopathological symptoms for a qualitative and quantitative evaluation of the structure and dynamics in the state of ASC within the framework of the classical clinical and psychopathological method [28]. The original standardized map of the qualitative and quantitative evaluation of the structure and dynamics of ASC caused by PS [11, 12].
Results. As a result of studying the mental phenomena included in the structure of the ASC, the sequence of their occurrence, interaction and mutual influence of these phenomena on each other in the bodily, affective and ideational spheres is established. The dynamic stereotype of the development of symptoms of ASC is represented by four successive levels of disintegration of the psyche and ends with behavior aimed at the use of PS. At the level I: in the bodily sphere, the process is similar in its development through the stage of "initial disorders of the general feeling" and the stage of "neurological sensations"; in the affective sphere – through the stage of "monoaffect" and the stage of "initial manifestations of mixed affect"; in the ideational sphere – through the stage of "protopathic change of the field of consciousness". At the level II: in the bodily sphere, the process is similar in its development through the "senestopathic" stage; in the affective sphere – through the stage of "pronounced manifestations of mixed affect"; in the ideational sphere – through the stage of "partial disorder of consciousness". At the level III: in the bodily sphere, the symptoms of the previous, "senestopathic stage" are preserved; in the affective sphere, the process goes through the stage of "binary affect; in the ideational sphere-through the stage of "cardinal transformation of consciousness". The culmination of the development of symptoms in the ideational sphere is the moment of individual meaning formation, which in the case of PС coincides with pathological meaning formation in the form of awareness of craving to PS. At the IV level of disintegration, the psychopathological symptoms existing at this moment in the bodily, affective and ideational spheres manifest themselves in a specific behavioral reaction – behavior aimed at the use of PS.
Conclusion. At the level I of disintegration, the activation of symptoms in the bodily sphere serves as the 1st trigger of the entire process of ASC. This trigger directly activates the beginning of the pathological process in the affective sphere and indirectly (through the affective sphere) – in the ideational sphere. The essence of the level II of disintegration is manifested in the transformation of the bodily personality into an affective personality, which coincides with the dynamics of the transformation of the personal configuration in the process of individual meaning formation [23, 24]. At the level III, the 2nd trigger of the process is triggered, which initiates a discrete transition of the accumulated psychopathological disorders into a fundamentally different quality – a cardinal transformation of consciousness associated with meaning formation. The cardinal transformation of consciousness in the final phase of disintegration at the level III is the 3rd trigger of the ASC process. At the level IV of the disintegration of the psyche, the cardinal transformation of consciousness and the emergence of a new individual meaning is reflected in specific changes in behavioral patterns. In the extreme case, this can lead to a change in the current life scenario.
Ключевые слова:
altered states of consciousness, pathokinesis, levels of disintegration of the psyche, cardinal transformation of consciousness, individual meaning formation.