P. Kovalevsky on Russian national education. The creative path and scientific heritage of professor P.I. Kovalevsky: a short essay Kovalevsky pavel ivanovich

Pavel Ivanovich Kovalevsky (1850-1931) - famous psychiatrist, publicist and public figure. Rector of Warsaw University (1894-1897). He graduated from a theological school, and then from the Yekaterinoslav Seminary. Nevertheless, he made a professional choice in favor of natural science. In 1869 P.I.Kovalevsky entered the medical faculty of Kharkov University. Already there, he chose the problem of mental illness as his specialization. After graduating from the university in 1874, he was left at the faculty to prepare a doctoral dissertation in psychiatry, which he defended in 1877 on the topic: "On the change in skin sensitivity in melancholic patients." The scientist combined scientific research with the practical work of a supernumerary resident of the department of the mentally ill at the Kharkov Zemstvo Hospital (the so-called "Saburova Dacha"). After defending his doctoral dissertation, Pavel Ivanovich was appointed Associate Professor, and then, in 1884, Professor of the Department of Psychiatry at Kharkov University.

In 1889, P.I.Kovalevsky became dean of the medical faculty of Kharkov University, and then rector of Warsaw University (1895-1897). Subsequently, from 1903 to 1906, he headed the Department of Psychiatry at Kazan University, then taught a course in forensic psychopathology on faculty of Law Petersburg University and worked as a senior physician of the psychiatric department of the Nikolaev military hospital in Petersburg - the most advanced medical institution of that time. At the same time, Pavel Ivanovich translated the works of foreign psychiatrists: Philip Pinel, Theodor Meinert, Karl Wernicke and others.
PI Kovalevsky wrote over 300 books, brochures, journal articles on various issues of psychiatry and neuropathology. Among them are the books "Guide to the correct care of the mentally ill", "Forensic psychiatry", "Forensic psychiatric analyzes" (3 editions), "Mental illness for doctors and lawyers", "Psychology of gender", "Hygiene and treatment of mental and nervous diseases ”,“ Fundamentals of the mechanism of mental activity ”,“ Textbook of psychiatry for students ”(4 editions),“ Brain syphilis and its treatment ”,“ Puerperal psychoses ”,“ Migraine and its treatment ”. PI Kovalevsky published the first Russian manual on psychiatry written by him.

In wide circles of the Russian intelligentsia, PI Kovalevsky's authority as a historian was rather high. His works such as "Peoples of the Caucasus", "The Conquest of the Caucasus by Russia", "History of Little Russia", "History of Russia from a National Point of View" enjoyed great interest, withstood several editions in pre-revolutionary Russia (in Soviet times they were recognized as reactionary and were not published ).

PI Kovalevsky was one of the first to use historical analysis to draw up a psychological portrait of prominent personalities. Deserved fame was brought to him by "Psychiatric Sketches from History" (sometimes this book is published under the title "Psychiatric Sketches from History"). In Soviet times, this book was also not published, since it contradicted the Marxist position on the role of the individual in history and the concept of socio-economic determinism.

PI Kovalevsky was the foreman of the Russian National Club, a member of the Council of the All-Russian National Union and a member of the Russian Assembly.

Petryuk P.T., Petryuk A.P., Ivanichuk O.P. (Kharkov, Ukraine)

	Candidate medical sciences, associate professor, psychiatrist, researcher of the history of psychiatry; Kharkiv City Charitable Foundation for Psychosocial Rehabilitation of Persons with Mental Problems, st. Academician Pavlova, 46, Kharkov, 61068, Ukraine. Tel .: +380 57 396 0458. E-mail: [email protected]
	Psychiatrist, freelance research fellow, researcher of the history of psychiatry; Kharkiv Regional Clinical Psychiatric Hospital No. 3 (Saburova Dacha), Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine, st. Academician Pavlova, 46, Kharkov, 61068, Ukraine. Tel .: +380 57 738 3387. E-mail: [email protected]
	Neurologist, clinical intern of the Department of Neuropathology and Neurosurgery, researcher of the history of neurology and psychiatry; Kharkiv Medical Academy of Postgraduate Education, st. Korchagintsev, 58, Kharkov, 61176, Ukraine. Tel .: +380 57 711 8025. E-mail: [email protected]

Fate rarely hinders the wise.
Epicurus

Professor P.I. Kovalevsky

Professor Pavel Ivanovich Kovalevsky (1849-1931) - a well-known Russian scientist, psychiatrist, psychologist, publicist, ideologist of Russian nationalism, public figure, editor and publisher of medical periodicals, translator of works of famous foreign psychiatrists, who at one time worked at the Saburova dacha, - a former Saburyan, who belonged to a galaxy of doctors-intellectuals that formed in the last third of the 19th century and did a lot for the formation of national psychiatry, including for the Kharkov psychiatric school.

P.I. Kovalevsky - Doctor of Medicine, professor, founder of the first psychiatric journal in Russian "Archive of Psychiatry, Neurology and Forensic Psychopathology", editor of the Russian Medical Bulletin, "Bulletin of Idiocy and Epilepsy", "Bulletin of Mental Diseases", co-editor of the Strasbourg journal "Archiv für Psychiatrie und Nervenheilkunde ", the author of the original concept on the role of blood circulation and metabolism in the central nervous system (CNS), the first national manual on psychiatry, organizer of the first independent department of psychiatry in Ukraine and one of the first experimental psychological laboratories at Kiev University, rector of Warsaw University , a member of the Russian Assembly (RS), the All-Russian National Club (VNK) and the All-Russian National Union (VNS). Delegate to the Russian Foreign Congress held in Paris in 1926, from the Russian emigration in Belgium.

Among the many merits of Pavel Ivanovich - the creation in 1882 of a separate classification of mental diseases based on metabolic disorders in the brain and the central nervous system, as well as the convocation in 1887 of the First Congress of Russian Psychiatrists, which was the final stage in the design of domestic psychiatric science. It should also be emphasized that the authors of the well-known work "History of Psychoanalysis in Ukraine" (1996) rightly name the name of the psychiatrist P.I. Kovalevsky is the third after the names of the outstanding Ukrainian educator-humanist, philosopher, poet and teacher G.S. Skovoroda and the German philosopher, the first professor of philosophy at Kharkiv University I.B. Shada, noting that it was from them that the tradition of psychoanalysis originated in the east of Ukraine - in Kharkov.

It is interesting to note that in 1951 in Paris, a detailed pedigree of the Kovalevsky family was published, spanning three centuries. Although the brochure was published without a signature, it was written in the preface that its author was “a prominent figure in the Russian emigration in Paris, P.Ye. Kovalevsky is a historian, bibliographer, organizer of church life. In the genealogical tree, the author attributed Osip Mikhailovich Kovalevsky - professor of the Mongolian language, rector of Kazan University (seventh generation) and Nikolai Osipovich Kovalevsky, dean of the medical faculty and rector of Kazan University (ninth generation) to the Kazan branch. Among the representatives of the Kharkov line was named Pavel Ivanovich Kovalevsky - professor of psychiatry, rector of Warsaw University.

Concerning the origin of P.I. Kovalevsky, the authors of the textbook "History of World and Ukrainian Culture" (2000) note that "the Kovalevsky family, descendants of the Slobodsko-Ukrainian foreman of the Kharkov regiment, generally turned out to be rich in scientists." According to their testimonies, the Minister of Education Evgraf Kovalevsky (1790-1867) came from this family; geologist Igor Kovalevsky (1811-1868); one of the founders of evolutionary embryology and physiology, professor at several European universities Alexander Kovalevsky (1840-1901); an outstanding paleontologist with a worldwide reputation, husband of Sofia Kovalevskaya - Vladimir Kovalevsky (1843-1883), one of the first sociologists, author of works on jurisprudence and history of the state system Maxim Kovalevsky (1851-1916), professor of psychiatry Pavel Kovalevsky (1849-1931).

Pavel Ivanovich was one of the leading Russian psychiatrists of the early twentieth century, his they were rightfully called the best metropolitan psychiatrist and even the “father of Russian psychiatry”. He was one of the first to compose psychological portraits of great personalities: the Prophet Muhammad, Jeanne D'Arc, Ivan the Terrible, A.V. Suvorov and many others.

The result of large-scale scientific and practical activities carried out by P.I. Kovalevsky, he began to develop the most important scientific theories, such as the materialistic idea of \u200b\u200bthe essence of mental phenomena in health and disease, the theory of psychosis, the position on the role of blood circulation in the central nervous system, and others. For his services in the development of medical science, P.I. At the end of the 19th century, Kovalevsky received a number of government awards, including the Order of St. Vladimir, a gold snuffbox named after Emperor Alexander III, and the rank of actual state councilor.

The name of Pavel Ivanovich is still relatively little known today. As a rule, only historians of medicine know about it, because P.I. Kovalevsky was, as we have already noted, one of the leading Russian psychiatrists of the early twentieth century, and a few experts in the ideology of Russian nationalism, since P.I. Kovalevsky was rightfully considered the ideologist of this direction of Russian thought, who actively participated in the activities of such organizations as the VNK and VNS ... Before the revolution, in right-wing circles, his name was no less famous than the recently returned name of the prominent nationalist publicist M.O. Menshikov.

However, in the next 70 years of Soviet power, these names were deliberately consigned to oblivion. Little by little, the works of patriotic thinkers begin to be reprinted, and special studies are devoted to their authors. But unlike M.O. Menshikov, about whom a whole monograph has already been written, Pavel Ivanovich was less fortunate: the political biography of this prominent ideologue of Russian national thought, superficially reflected in several small articles devoted to him, essentially remains unknown.

P.I. Kovalevsky was born in 1849 (according to other sources - in 1850) in the town of Petropavlovka of the Pavlograd district of the Yekaterinoslav province (now an urban-type settlement of the Dnepropetrovsk region of Ukraine) in the family of a priest. In the sixth week of his life, Pavel lost his father and grew up with his brother, two sisters and a widowed mother in extremely constrained material conditions: the main source of subsistence for the Kovalevsky family was a ten-ruble annual pension. At the age of nine, following the family tradition, the boy was sent to a religious school as a half-board student, in the senior classes of which, through tutoring, "not only earned money for himself, but also gave some of it for household use."

Having successfully completed his studies at the school, P.I. Kovalevsky entered the Yekaterinoslav Theological Seminary, from which he graduated as his first student in 1869. However, being ardently passionate about natural science, the young man did not follow the spiritual path, but decided to continue his education at the medical faculty of Kharkov University.

In 1869 P.I. Kovalevsky entered the medical faculty of Kharkov University. Already from the second year, he has been engaged in scientific research in the laboratory of the Department of General Pathology, headed by I.N. Obolensky. The future doctor pays most attention to nervous and mental illnesses. After graduating with honors from the university in 1874 and receiving the degree of a doctor and the title of a district doctor, Pavel Ivanovich, in view of his demonstrated abilities, was left at the faculty to prepare a doctoral dissertation in psychiatry on the topic "On the change in skin sensitivity in melancholic patients", which soon, in 1877 , successfully defended.

Title pages of a number of works by Pavel Ivanovich Kovalevsky

At the same time, the theoretical work of P.I. Kovalevsky was closely intertwined with the practical. The young scientist combined his scientific research with the work of a supernumerary resident of the department of the mentally ill of the Kharkov provincial zemstvo hospital (Saburova dacha). It is appropriate to note here that before the intervention of Pavel Ivanovich, who was shaken to the depths of his soul by what he saw in the insane asylum, the situation of the mentally ill was very painful. Here is how a contemporary describes him: “A guard, armed with a whip, was placed over the unfortunate. With any disobedience, the one who deserved received a reminder of the observance of decency by a full blow of the whip. If the lash did not exert the proper effect, the madman was chained, and if this did not calm the brawler, he was simply shackled! " ...

P.I. Kovalevsky boldly spoke out in defense of the mentally ill, proposing a number of measures to reorganize the institution, incl. he soon embodied an innovative idea - the creation of workshops for the mentally ill and their introduction to physical labor. Thanks to his labors and the labors of his students, the plight of the patients of the institution came to an end - the chains and shackles disappeared, and the insane were entitled to be considered sick. After defending his doctoral dissertation, Pavel Ivanovich consecutively consisted of a privat-docent (1877), an associate professor (1878), an extraordinary (1884) and an ordinary (1888) professor of the Department of Psychiatry at Kharkov University, was, as noted above, the initiator of the First Congress of Psychiatrists and Neuropathologists of Russia (1887).

In 1877, the first independent department of psychiatry and neurology in Ukraine was organized at Kharkov University, headed by privat-docent P.I. Kovalevsky, student of A.U. Frese, who began his scientific career at the Saburova dacha. Clinical demonstrations were carried out first in the Kharkov provincial zemstvo hospital (Saburova dacha), and later in the private hospital of I.Ya. Platonov, where the laboratory was organized and, within the limits of possible, everything necessary for the most successful teaching was created due to the fact that Saburova's dacha was located outside the city of Kharkov and there was no paved road there.

In 1889, Pavel Ivanovich was appointed dean of the medical faculty of Kharkov University, and then rector of Warsaw University (1892-1897). Unfortunately, a serious illness suffered in the summer of 1896 forced him to leave the university. From 1903 to 1906, Kovalevsky was the head of the department of psychiatry at Kazan University, after which he taught a course in forensic psychopathology at the law faculty of St. Petersburg University and worked as a senior physician at the psychiatric department of the Nikolaev military hospital in St. Petersburg, an advanced medical institution of that time. At this time, Pavel Ivanovich continued to publish magazines, was engaged in the translation of works of foreign psychiatrists F. Pinel, T. Meinert, K. Wernicke and many others, taking an active part in the work of a number of public organizations: he collaborated at the Institute of Mercy of the Red Cross, was a member of the board of his Petersburg committee, was in the parental circle and in the charity society for cripples and idiots. In addition, since the beginning of the 20th century, P.I. Kovalevsky was a consultant to the Holy Trinity Hospital and was engaged in medical practice.

The implementation of innovations that have matured in psychiatry and the attraction of wide public attention to them gave rise to the need to create a special printed organ in Russia. In 1893 P.I. Kovalevsky became the founder and editor of the first psychiatric journal in Russian, called the Archives of Psychiatry, Neurology and Forensic Psychopathology (the journal ceased to exist in 1896). The editor promptly announced that the journal "will pursue the study of abnormalities in human nervous life, diseases, crimes, the conditions for their development and the means to eradicate them." He has published a number of foreign monographs and guidelines on the most important issues of neuropsychiatry. Domestic psychiatrists owe him an acquaintance with the clinical lectures of T. Meinert, whose ideas were especially close to P.I. Kovalevsky; lectures by J.M. Charcot, books by W.R. Gowers, O.L. Bienswanger, Ch. Richet and others. In addition, he published the Journal of Medicine and Hygiene, Russian Medical Herald, Herald of Idiocy and Epilepsy, Herald of Mental Diseases, and for 15 years was a co-editor of the European psychiatric journal published in Strasbourg (Germany). Pavel Ivanovich they were rightfully called the best metropolitan psychiatrist and even the "father of Russian psychiatry" - he is the author of a large number of scientific works on various issues of psychiatry, including forensic psychiatry, psychology, neurology, and a large number of translations of the works of foreign psychiatrists.

In his scientific research P.I. Kovalevsky, relying on the anatomical and physiological knowledge of that time, in particular on the reflex theory of I.M. Sechenov, developed materialistic ideas about the essence of mental phenomena in health and disease. He created an original concept about the role of blood circulation and metabolism in the central nervous system, believing that the basis of any mental illness is a malnutrition of the nerve elements and that the degree of their anatomical destruction depends on the duration of this disorder. In the etiology of psychoses, Pavel Ivanovich attached great importance to the combination of hereditary factors with external agents causing the disease, both somatogenic and psychogenic. A number of his works are devoted to the study of syphilitic lesions of the nervous system, issues of forensic psychiatry, neuropathology of childhood and other issues. P.I. Kovalevsky created a classification of mental illnesses, where he took the predominance of disorders in one or another area of \u200b\u200bmental activity as the basis for the division.

It should be emphasized that the founder of the Kharkov school of psychiatrists, the founder of one of the first journals in Russian devoted to the problems of psychiatry - "Archive of Psychiatry, Neurology and Forensic Psychopathology" - P.I. Kovalevsky, despite the conservatism of his political convictions, was an outstanding psychiatrist of his time, a spontaneous materialist who held consistently physiological positions. “The central nervous system,” wrote Pavel Ivanovich, “is an organ of mental activity ... The cerebral cortex serves as the center of conscious mental life. All information about the external world is brought here, and from here all information about the relation of our organism to the external world is carried. Therefore, it is the center of interaction between the external world to us and ours to the world. "

The continuity of his understanding of the psyche as human interaction with the world and the teachings of A.U. Frese is beyond doubt. The activity of nerve cells - the physiological processes occurring in them - is, according to P.I. Kovalevsky, the material basis of the psyche. Referring to such physiologists as V.Ya. Danilevsky, N.Z. Umikov, O. Langendorf, he notes the role of alkaline reactions in the brain, the dependence of excitability, mental activity on phosphorus-containing neuroglobulin and neurostromin in the gray medulla and on the quantitative ratio of these proteins. The active state of nerve cells is always associated either with the formation of a new one, or with the reproduction of an already former sensation in the same tracks. Pavel Ivanovich notes that irritation that has not turned into sensation leaves cells in an inert state, and molecular and chemical changes that make up the mechanism of sensation are associated with the expansion of the walls of cell vessels and, accordingly, with the influx of nutrient material. He believes that the following conditions are necessary for the formation of impressions: 1) the effect of the stimulus must be within the limits of a certain physiological tension; 2) the receiving organ must be ready for perception; 3) at least a minimum time of exposure to the stimulus is required. The primary "unit of mental activity" P.I. Kovalevsky calls performance as the final act of a reflex that does not end with movement. The organs of sensation, according to Pavel Ivanovich, are, first of all, the subcortical centers, and the distinctness of sensations is the greater, the more often they are repeated, the less abstraction in the perception of a given sense organ (vision, hearing, etc.), the more this sensation is coupled with the sensations of other organs feelings about the same subject. “The whole essence of mental life,” he writes, “will be in the cerebral hemispheres; here is the center of ideas, here is the source of mental activity. " He subscribes to the opinion of T. Ribot, who proposed to distinguish between static memory, inherent in each nervous element, and dynamic, inherent in whole "groupings of nerve elements" and serving as "memory of concepts."

Following V.M. Sechenov and T.G. Meinert P.I. Kovalevsky considers reflexes to be the basis of all mental acts, noting the uniqueness of psychophysical reflexes, the need for thinking to “delay” purely motor reactions, a complex combination of the activity of cortical and subcortical centers, etc. He considers mental processes as an interaction (often acutely conflictual) of mind and emotions, associated with will, without which these processes cannot end. “Will is not an independent ability, but rather a result of the above-mentioned struggle between thinking and well-being. Will is a diagonal between these two mental forces: thinking and feeling or passion ... in some cases it approaches towards one, in others towards the other, depending on the intensity of this or that figure, ”P.I. Kovalevsky [Ibid]. He defines mental illness as a disorder of thinking and well-being, diseases of the central nervous system, primarily of the forebrain, which in one way or another affect the entire psyche of the patient.

Of the "quantitative" sensitivity disorders, P.I. Kovalevsky dwells on anesthesia and hyperesthesia, noting the typicality of the former for passive melancholic people, and the latter for active melancholic and maniacs. Illusions and hallucinations are referred to as "qualitative" sensitivity disorders. "Any illusion," writes Pavel Ivanovich, "is a perversion of really existing irritations of the external world, and in this sense it can be understood as a qualitative change in nervous excitability, since this time it brings to our consciousness information about the qualities of the object in a modified form." [Ibid]. Paying attention to the presence of certain deviations of "sensitivity" in some healthy people, P.I. Kovalevsky sees their difference from the mentally ill in that the latter are affected by the controlling thought centers, and their attitude to the world is pathologically changed.

Referring to the research of V.F. Chizha and others, Pavel Ivanovich associates quantitative disturbances of ideas with a weakening of the activity of active apperception, and (with the exception of the initial stage of progressive paralysis) psychophysical reactions in all mentally ill patients tend to slow down. He associates qualitative disorders in the field of representations primarily with memory pathology. He notes that with amnesia, it is not so much memorization that is disturbed as reproduction, and the "long-standing assets" of memory are the most stable. “With a gradually increasing loss of memory, - states P.I. Kovalevsky, - first, the memory of the recent is disturbed, then the ability to localize in time is lost, then the memory of feelings, which is very stable; finally, the memory of habits; when this kind of memory also ceases, then it is no longer possible to distinguish any signs of personality ”[Ibid.]. Allowing the presence of violent ideas in some otherwise healthy people, Pavel Ivanovich expresses the opinion that these ideas develop or may develop into a disease and, therefore, are, if not diagnostic, then, in any case, an alarming sign. Such ideas differ from delusional ideas in that, for all the inability to get rid of them, a person still retains a critical attitude towards them, while there is no criticism in relation to delusional ideas.

The pathologizing, triggering mechanism of psychosis, the role of violent representations is, according to P.I. Kovalevsky, primarily in their ability to become the "central core" of delirium. About the mechanisms of delusional formation, he wrote the following: “Ridiculous ideas can manifest themselves in different ways: they can be completely lonely, they can form a certain delusional nucleus, without affecting the rest of the mental life, as, for example, with partial primary insanity, they can, forming a certain nucleus, lead it in combination with other ideas and influence them, as in melancholy - finally, these absurd ideas can fill a person's whole life, producing complete confusion in his mental activity.<…> In the consciousness of this or that person, this or that absurd and meaningless idea appears and is firmly held in it. This will be the main core, this will be the main fixed point. But the difference in this case from the violent idea is that the sick admit that the crazy idea is quite reasonable and natural. Moreover, they are not burdened by her presence. They combine the rest of their thoughts with her. It will be the center from which painful radii go to all other ideas, unite them and make up something whole, a consonant. A distinctive feature of a fixed thought is that, once it has appeared, it remains motionless, expressed very sharply, and in most cases serves as a focus for all the rest of the delirium. Very often these fixed ideas are supported by hallucinations of the sense organs, especially auditory hallucinations ”[Ibid].

Along with violent representations, the sources of delirium are, according to Pavel Ivanovich, illusions, hallucinations, pseudo-hallucinations, and he associates the occurrence of delusion with changes in the functioning of the cerebral cortex. The loss of criticality in relation to delusional ideas is most characteristic of the latter, as well as the fixation of the "central core" of delusion, its relative stability and constancy. P.I. Kovalevsky especially emphasizes the centripetal nature of this “core”, the activity of the dominant delusional idea, which comes in connection with other ideas and gives all of them, all the thinking and attitude of the patient a pathological character. “Mad ideas, as painful phenomena, as the nucleus of cerebral changes, are of paramount importance in the mental life of the patient. This is the essence and salt of his thinking. All other ideas are subordinate to them and serve as a guide. The patient lives by them. The patient lives for them. "

Pavel Ivanovich attaches great importance to disorientation in time and place, closely associating it with memory disorders. By the influence of the latter, he also explains the disorders of personal identity, when different actions are attributed to two different, simultaneously coexisting "I" or when finally self-alienation from one's own personality occurs. The most profound disorders are caused, according to P.I. Kovalevsky, radical changes in the functioning of the brain are expressed in a sharp decrease in the number of representations and in violations of the formal-logical apparatus of thinking.

P.I. Kovalevsky was in the forefront of Russian psychiatrists who began to investigate the relationship between the conscious and the unconscious, both in norm and in pathology. He wrote: “... the color of the personality, its peculiarity, individuality largely depends on the area and manifestation of our unconscious activity. In pathological cases, violations can occur both in the field of conscious and unconscious activity. " Pavel Ivanovich insisted on the hypothesis of the active participation of the entire sphere of the unconscious in the formation of human individuality, its psychological originality. Following D.Kh. Jackson and others, he suggests that the release of the unconscious from the control of consciousness constitutes the deep soil of mental pathology and that this process leads to further pathologization of the sphere of the unconscious. He singles out as the mildest "quantitative" form of disturbance of consciousness a special type of dizziness, which is characterized by dimming of consciousness from insignificant to short-term, but complete, often with hallucinations. Such "dizziness" are, according to his observations, with mania, progressive paralysis, alcoholism, epilepsy, senile dementia. Then, according to the severity, there are twilight states, when the representations of the space-time order and the consciousness of one's own personality are indistinct. Consciousness darkens even deeper in mori-like states, when confusion of ideas is combined with manic excitement, and often with loss of memory of what was happening. "Confusion" is a special ("sleepy") state characterized by a mixture of present and past circumstances, various places and events, and one's own personality with strangers [Ibid].

The most severe "quantitative" disorders of consciousness PI. Kovalevsky considers pathological deep "hibernation" - stupor and coma, in which it is not possible to cause a reaction even with strong irritation. Supporting the idea of \u200b\u200bD.Kh. Jackson and G. Mercier that coma is an acute dementia, and dementia is a chronic coma, he conjectures that many mental illnesses and pathological conditions are related to "mild" coma and precomatous states.

Highly appreciating the role of well-being in mental life, especially in volitional actions, P.I. Kovalevsky writes: “Our actions and relationships are often based on this phenomenon of the reaction of well-being. It is one of the most important factors of our spiritual life and serves as a determinant in the manifestation of volitional actions, and therefore, constitutes one of the elements of will ”[Ibid.].

He pays great attention to affects, which he considers as "deviation in mental activity, characterized by an instant loss of consciousness and the destruction of free will, with a consistent exhaustion and short-term clouding of the mind, while maintaining often the most complex activity on the part of the motor system" [Ibid.]. Stenic affects are accompanied by excitement of mental and especially muscular activity, asthenic - by a sharp oppression of the latter, up to complete numbness. P.I. Kovalevsky points to a number of conditions that contribute to the emergence of affect: 1) hereditary irritability and excitability; 2) difficult living conditions and circumstances that systematically undermine the balance of the psyche; 3) organic suffering (heart defects, menstrual disorders, etc.); 4) various nervous and mental illnesses (especially hysteria, epilepsy, melancholy and progressive paralysis).

P.I. Kovalevsky distinguishes three stages in the development of affect. The preparatory period is characterized by excessive mental tension, which accumulates and grows for a long time or for a short time (but intensively), providing a ready ground for the "last irritation" that directly causes the affect. The second period - the actual affect, or "insanity" - is determined by the degree of surprise and (or) the strength of the shock that affected the already prepared soil. Typical for him is an instant stop or a sharp slowdown in the course of performances, of which only those associated with the dominant passion are preserved; turning off "criticism" and logical assessment in general; lack of freedom of choice, when every action is a "direct affect of feeling", i.e. “Is a simple reflex, is a machine-like, fatal image” [Ibid.]. At the same time, activity in the field of ideas stops, the course of thinking stops, actions are performed reflexively, freedom of will is completely absent. In the third, post-affect period, the nervous system is exhausted and relaxed, a decline in sensory perception, emotional indifference, fragmentation and incoherence of ideas, both momentary and about events in a state of passion, are observed. The work of consciousness at this stage is characterized by a clear insufficiency of personal attitude and evaluation. Pavel Ivanovich explains all this as a consequence of deep general overwork.

Of the "qualitative" disorders of well-being and emotions, the most interesting observations of P.I. Kovalevsky over pathological melancholy with an active form of melancholy and over such a specific variety of it as “atrial melancholy”. He explains these phenomena by an insufficient supply of oxygen to the brain with the simultaneous "rapidity and intensity of excitations and associative play in the cerebral cortex." Atrial anguish is accompanied by vasomotor convulsions and subsequent respiratory distress. If melancholy in mentally healthy people is caused by a real "external" cause, and the strength and acuteness of affect are directly proportional to the vital significance of this cause, then in mentally ill people this longing has a vital character in tension and severity, is relatively independent of "external" causes and is not in direct correspondence with a real vital meaning for a given patient of those "facts" (and in fact - reasons) to which he refers.

P.I. Kovalevsky puts forward a hypothesis according to which agoraphobia, claustrophobia, misophobia and other phobias are manifestations of one general condition - pathological fear ("pathophobia"). They are caused by similar changes in brain chemistry and functioning. He puts violent drives in close connection with violent ideas and obsessions, although he refrains from recognizing the direct genetic dependence of drives on ideatorial phenomena.

Pavel Ivanovich divides movement disorders of a mental order into hyperkinesis - an increase in movement against the norm (various types of seizures) and akinesis - a pathological weakening of movement (different types, forms and degrees of paralytic disorders). The special diagnostic value of P.I. Kovalevsky imparts speech and writing disorders [Ibid]. As typical pathological signs, he notes dysphrasia, dysphasia and anarthritic disorders (“jumping” speech, ambiguity, indistinctness of articulation). From dysphrasias, he draws attention to the pathological acceleration and deceleration of the tempo of speech, up to fragmentary, incoherent; specific forms of "childish" speech in adults, pathetic-declamatory, mannered, etc .; annoying repetitions of words - verbigeration; “Conventional” and invented words (pathological neologisms), and sometimes “new” language. The signs of writing disorder associated with mental illness and related to the choice of paper, the direction of lines, the hardness and softness of handwriting, the shape of letters, their connection into words, the correctness of the placement of letters, omissions, errors and rearrangements of letters in words and syllables are varied and interesting.

Disorders of facial expressions and body position in melancholy and related conditions appear, according to P.I. Kovalevsky, in depression and muscle relaxation: the head is lowered, the body is tilted forward, the limbs are passively hanging, the face is stiff, the movements are sluggish, the position of the body is almost unchanged. For manic states, tension, energy, convulsions are typical: the body is always in motion, the head is held high, facial expressions are emphatically expressive, the voice is excessively loud. P.I. Kovalevsky notes the stereotyped motility in catatonia and "secondary" psychoses, its "mechanical" nature, as well as the diagnostic role of violent, impulsive, automatic movements, pointing out that all of them are only superficially similar to arbitrary, expedient, but in fact are performed against the will or unconsciously, automatically. Automatisms, according to the observations of Pavel Ivanovich, are most typical for epilepsy, hysteria, severe forms of alcoholism, many traumatic psychoses, etc. He dwells in particular on various forms of mental paralysis caused precisely by mental disorders. He points out, in particular, that with hysteria, violent representations and delirium, such disorders as astasia and abasia are not uncommon (inability to stand upright and a violation of the correct gait while maintaining sensitivity, muscle strength and coordination of all other movements of the lower extremities); actually mental paralysis, when the patient thinks that his legs are paralyzed; functional paralysis due to nervous exhaustion. “A distinctive feature of this functional paralysis,” states P.I. Kovalevsky, - it is that the muscle strength of the healthy side during paralysis is stronger than after recovery from it ”[Ibid].

Have not lost some interest and observations of P.I. Kovalevsky on violations of "secretory" (autonomic) functions in mental illness, if only because these disorders are insignificant, weakly expressed and usually elude the attention of a doctor. This increased sweating with delirium tremens and often with "primary insanity"; weakening it in a number of cases of hysteria and melancholy; acrid, unpleasant smell of sweat in many hysterical, melancholic, epileptics. He notes a decrease in urination in hysteria and melancholy, an increase in progressive paralysis; an increase in the specific gravity of urine in maniacs, its fall in melancholic patients; very light color of urine in melancholic and in hysteria. As a rule, with melancholy, sugar appears in the urine, and with epilepsy, progressive paralysis, delirium tremens, circular psychosis, albuminuria periodically occurs. Abundant salivation is noted in manic patients, with hebephrenia and in "initially obsessed", in many mental illnesses it is insufficient and causes dry mouth. In melancholic, paranoid, and especially in hysteria, appetite often decreases up to a complete refusal to eat, at the same time, the appetite is pathologically increased, often in imbeciles, with epilepsy, and progressive paralysis. P.I. Kovalevsky writes: “Mental illness, as a pathological manifestation of physiological extremes, cannot but respond to the nutrition of the body, as well as to its weight” [Ibid.]. With melancholy and mania, according to his observations, the weight of patients falls as the disease intensifies, but recovers as the disease recovers and, as a rule, rises above normal. Often, body weight drops sharply with epilepsy in anticipation of seizures, etc.

The views of P.I. Kovalevsky on the causes of mental illness are mostly outdated and represent a combination of subtle observations, interesting analysis and often erroneous, approximate, and sometimes downright reactionary Lombrosian conclusions. Central to his etiological views is the problem of heredity. He attaches great importance to heredity, especially hereditary predisposition, as an etiological factor in mental illness. However, at the same time he goes to the extreme, arguing that "almost all cases of various types of insanity will be hereditary" and that every born is supposedly fatally predetermined to mental health or illness by the very mental organization of his parents or more distant ancestors. He acts as a follower of the erroneous teaching of French and Italian psychiatrists about the inevitable increase in the incidence and severity of the diseases themselves, the degeneration of the descendants of the mentally ill with each new generation. True, he admits that in a number of cases a hereditary predisposition may not turn into a disease without additional harmful external influences, but he declares mental disorders that are independent of any external factors as typical. He considers a predisposition to mental illness a more frequent and important type of heredity than directly inherited psychoses. He sees this "readiness" of the psyche for illnesses not only in its weakening, but also in its "active" susceptibility to mental trauma and other external harm so high that "the slightest bad influence ... causes a painful manifestation in the form of mental suffering, psychosis, or in the form of nervous suffering, neurosis. "

For all the erroneousness of his general theoretical views on heredity, Pavel Ivanovich does not deny the influence of upbringing and the environment on the emergence and manifestation of psychoses. He, "correcting" himself, says that even a bad hereditary predisposition can be neutralized by the healing psychological impact of education and the environment, ie. in fact, puts this last on a par with heredity. Heredity, its emergence, he explains not only biological, but also socio-psychological "moments", interaction with the psychophysiological natural organization of man, highlighting often social factors.

Like most Russian psychiatrists, P.I. Kovalevsky resolutely opposes the opinion that even such prominent scientists as W. Grisinger, G. Maudsley, R. Kraft-Ebing adhered to, that civilization and its development in themselves lead to an increase in the number of mental illnesses. Recognizing that, on the whole, the progress of civilization leads rather to greater mental health of society, P.I. Kovalevsky shows a certain flexibility and even dialecticism and puts forward the thesis according to which the mindset and way of life in the so-called "transitional" epochs can contribute to mental illness. This idea, which deserves careful scientific verification, unfortunately, is associated with his militant defense of religion and attacks against revolutionaries and "liberalism" in the name of "restraint."

In the classification of mental illness P.I. Kovalevsky proceeded from metabolic disorders in the brain and central nervous system. “With this classification,” he wrote (1885), “an attempt can be made to introduce the pathological and physiological subdivision of forms. Nutrition is the basis for the correct administration of each organ and organism. The greater the metabolism of nutrients, the more energetic the release of the nerve element. The basis of any mental illness is, in essence, a malnutrition of the nerve elements, and their anatomical destruction depends on the duration of the malnutrition. Pavel Ivanovich was a supporter of recognizing the independence of various diseases, but remained in practice, in general, within the framework of the syndromological approach. Perhaps the most interesting thing in his classification is the allocation of periodic psychoses into a special group as qualitatively different, in his opinion, from non-periodic ones.

In the diagnosis of diseases P.I. Kovalevsky considered it imperative to proceed both from a thorough collection of anamnesis and from a detailed individualized study of the present state. “There is no part of the organism,” he wrote about the role of a comprehensive study of status praesens, “to which the nerves have no relation, but the totality of the entire nervous organization is entirely part of mental activity. Therefore, in the study of the mentally ill, the most careful study of all parts of his body is required. The study of the mentally ill is the most accurate and detailed study of the body, plus the study of mental activity ”[Ibid].

P.I. Kovalevsky was one of the foremost forensic experts. His "Forensic Psychiatry" (1902) and especially "Forensic Psychiatric Analyzes" (1880-1881) testify to outstanding erudition, still surprise with the subtlety of specific observations, accuracy of psychological characteristics, attention to the dynamics of mental processes, the study of pathological disorders in close connection with intact personality traits, the desire to differentially assess the mental state of the expert both at the time of the offense and during the examination. However, as noted above, the general meaning of his views on the entire range of these issues was reactionary in view of his Lombrosian positions. He argued (1880) that hereditarily weighed down, primarily psychopaths, are potential criminals and, conversely, that "the features of moral insanity and a born criminal are the same." Proclaiming the incorrigibility of criminals-"degenerates" and patients with "moral insanity", Pavel Ivanovich regarded their behavior as deeply pathological and recommended their long, sometimes lifelong isolation in clinics. True, unlike the anthropological school of successive Lombrosians, who believed that actual sanity was inherent in the very physical nature of criminal acts, he defended the principle of the insanity of "inborn" criminals. He also recognized a certain role of negative social factors in the genesis of mental illness and dangerous actions of the mentally ill, arguing that "physical deprivation and moral bullying also had their share in maintaining dullness." P.I. Kovalevsky considered clinical research insufficient for "moral insanity" and declared, almost literally according to C. Lombroso, that "in none of the types of insanity, comparative psychological and anthropological data would not serve to clarify the matter as in moral insanity."

Errors of a general theoretical nature, however, came into conflict with the observation and conscientiousness of the scientist, and when it came to facts, the clinician was the most victorious. So, P.I. Kovalevsky, following I.M. Balinsky pointed out the possibility of dangerous actions of the mentally ill, not only in connection with productive symptoms, but also under the influence of real external traumatic influences. He, long before V.P. Serbsky, drew attention to the dissimulation (even in acute pathological conditions) of their painful experiences, which is characteristic of patients with "primary insanity", which makes them potentially even more dangerous. Of interest are also those proposed by him, close to the ideas of A.U. Frese, the basic principles of diagnostics of simulation, which consists in the discrepancy between the behavior of simulants "regularities of the course of the disease." Pavel Ivanovich initiated the study of specific forensic psychiatric aspects of the behavior of patients with epilepsy, alcoholism and senile dementia. With all the wealth of factual material, all the subtlety and skill of P.I. Kovalevsky's forensic psychiatric works provide yet another sad evidence of the harm that fundamentally erroneous attitudes and methodological errors can bring even to a major scientist.

In private psychiatry, the most significant works of P.I. Kovalevsky on epilepsy and "primary insanity", to which he attributed the predominantly paranoid form of schizophrenia. The primary defeat of mental activity, constituting, according to P.I. Kovalevsky, the essence of the disease, he sees in the formation of a "nuclear" delusional idea, around which the world of delusional ideas is formed, pathologizing all thinking. In his opinion (controversial in its opposition to the views of V.Kh. Kandinsky), illusions, hallucinations and other deceptions of the senses only in rare cases precede the emergence of the "core" of delirium, and appear, as a rule, simultaneously with the formation of the latter or later. Primary insanity, according to Pavel Ivanovich, never develops from a gloomy or cheerful mood: “Primary insanity never serves as the initial state and the final act of melancholic or manic insanity. It is an independent form of the disease, it appears original and primary and consists in the defeat of the mental area. " From an anatomical and physiological point of view, P.I. Kovalevsky considers primary insanity to be a lesion of the cortex of the anterior lobes of the cerebral hemispheres. He does not deny the painful manifestations of health (sadness, melancholy, irritability, anger, rampage) with this disease, but classifies them as concomitant and optional. He attaches great diagnostic value to distraction and weakened attention. He calls the main signs of the disease the loss of critical judgment, the symbolization of impressions from the outside world, the acceptance of the “fantasized” picture of the world as valid, while the formal apparatus of logical thinking is preserved. He draws attention to the family hereditary predisposition to primary insanity and points out as characteristic psychological signs that these are mostly "nervous, irritable, capricious children ... who love solitude, daydreaming and fantasy", extremely susceptible, sensitive.

P.I. Kovalevsky puts forward a hypothesis about the fundamental relationship of acute and chronic primary insanity. In his opinion, hallucinosis is the “core” of the disease in both cases. The development of the disease is characterized by inconsistency, fragmentary delirium, impaired well-being, the emergence and further increase of hallucinations, aimlessness and illogicality of actions, remissions after seizures and repetition of the latter. As the disease progresses, according to Pavel Ivanovich, there is a change and degeneration of the brain centers, and after this delirium increasingly loses its consistency and "consistency". “Weakening of mental activity, - writes P.I. Kovalevsky, - limited only to the area of \u200b\u200bdelusional ideas, - in other respects, their mental activity is completely correct. In this case, in the literal sense of the word, limited partial dementia occurs. In this way, the disease can continue to the end of life, and it does not pass into other forms of insanity, and especially almost never into general dementia ”[Ibid.]. The main reason for the primary insanity of P.I. Kovalevsky considers hereditary predisposition (alcoholism and other vices of parents, nervous irritable weakness, etc.). He attributes primary insanity to hereditary "degenerative" psychoses, stating: "Heredity is a disease of a person's entire life, with the difference that in one period it is expressed more, in another - less" [Ibid].

As a theoretical psychopathologist P.I. Kovalevsky is significantly inferior not only to S.S. Korsakov, but also to other prominent psychiatrists of the period under review. He did not leave a holistic teaching, his views are largely eclectic and outdated. His "physiological" materialism was mechanistic in its foundations. And yet P.I. Kovalevsky the clinician rightfully belongs to the classics of Russian psychiatry. His specific phenomenological observations, especially the subtlest in terms of the richness of shades of definitions of "external" (mimic, kinesthetic, speech, secretory) manifestations of various psychoses, the ratio of "quantitative" and "qualitative" disorders in the dynamics of mental and emotional processes, represent a real treasure for a patient and thoughtful doctor. If Pavel Ivanovich's views on the "macro-problems" of psychiatry are not of vital interest today, then in the "micro-problems" - in everyday clinical and expert practice - his legacy still remains a useful "reference manual" for clinicians.

In addition, that P.I. Kovalevsky, as already emphasized above, was engaged in scientific and teaching activities, he was an active participant in the national-monarchist movement. For some time he was a member of the oldest St. Petersburg elite monarchist organization of the RS, participated in the activities of the Russian Borderland Society, which emerged on the basis of the Meeting, which aimed to study the national borderlands. Russian Empire and the fight against border separatism. After the formation of the VNS in 1908, Pavel Ivanovich became one of its leading ideologists. He also took an active part in the activities of the VNK, a cultural, educational and political organization created to promote the ideas of Russian nationalism. Within the framework of the VNK P.I. Kovalevsky made several reports, was a member of the editorial board of the Izvestia All-Russian National Club, for some time was the chairman of the publishing committee of the VNK.

Psychiatric sketches from history.
In 2 volumes (reprinted 1995)

It should be noted that in broad circles of the Russian intelligentsia the authority of Kovalevsky as a historian was rather high. Such his historical and publicistic works as "Peoples of the Caucasus", "Conquest of the Caucasus by Russia. Historical Essays "," History of Little Russia "," History of Russia from a National Point of View "," Russian Nationalism and National Education in Russia "," Foundations of Russian Nationalism "," Jesus of Galilean "," Science, Christ and His Teachings "," John Terrible and his state of mind ”,“ Peter the Great and his genius ”,“ Napoleon I and his genius ”,“ The poor in spirit ”,“ Psychiatric sketches from history (in 2 volumes) ”,“ Psychology of the Russian nation. Education of youth. Alexander III - Tsar-Nationalist "," The Tasks of Russian Nationalism "," The Significance of Nationalism in the Modern Movement of the Balkan Slavs "," The Universe. Natural History Sketch ”, enjoyed great readers' interest and withstood more than one edition in pre-revolutionary Russia. At the same time, Pavel Ivanovich was one of the first to use historical analysis for the development of practical psychiatry. His famous "Psychiatric Sketches from History", combining the rigor and reliability of analysis, ease of style, originality and imagery of presentation, based on specific examples from the life of Ivan the Terrible, Peter III, Mohammed, Jeanne d'Arc, Paul I, Napoleon, Cambyses, Ludwig II Bavarian, Emanuel Swedenborg and others reveal the dynamics of various mental states, show the role of the environment and heredity in the genesis and clinical course of diseases. It should be emphasized that the essays written by P.I. Kovalevsky at the beginning of the 20th century, are still relevant today. Very often, the fate of a people or a state depends on the will and character of the leader of the given people or state.

The students of P.I. Kovalevsky were E.I. Andruzsky, Z.V. Gutnikov, M.N. Popov (professor in Tomsk), N.I. Mukhin (professor in Warsaw, Kharkov), D.B. Frank (professor in Dnepropetrovsk), I. Ya. Platonov, Ya. Ya. Trutovsky, N.V. Krainsky (professor in Warsaw, Belgrade, Kharkov), A.I. Yushchenko (professor in Warsaw, Vinnitsa, Petersburg, Yuriev, Voronezh, Rostov-on-Don, Kharkov, later academician of the Academy of Sciences of the Ukrainian SSR), A.A. Govseev and many others.

Pavel Ivanovich's student professor N.V. Krainsky rightly writes warm words to Pavel Ivanovich in the introduction to his work "Corruption, whoopers and demoniacs": At the same time, I consider it my duty to declare that I, like most of the many students of Pavel Ivanovich who are scattered throughout Russia and employees of Russian psychiatry in university departments, in government and regional hospitals, are deeply convinced that in everything that I can do on the benefit of science and the benefit of the many mentally ill people passing through my hands, I am entirely indebted to those strictly scientific and humane principles that we have always heard from our teacher. With deep respect and gratitude, I recall that strict scientific discipline, which was always the hallmark of Pavel Ivanovich's school, and the unconditional, deprived of any condescension, demand from his students to fulfill his duty, while not allowing any compromises with his convictions and conscience makes it easier for his students the difficult task of struggle in the practical activities and life of Russian psychiatrists.

As a student of Pavel Ivanovich, ten years after he left the position where the best years of his activity passed, where the personality of Pavel Ivanovich developed and formed as an activist and scientist, I had the honor to enter this psychiatric institution as a doctor, and later to hold the position my teacher. Here I could see how colossally fruitful was the work and energy that were invested in the case by Pavel Ivanovich. Despite all sorts of perversions to which everything done by Pavel Ivanovich was subjected, despite the most unprepossessing distortions of his activities by some people, even the ten-year anarchy of Saburova's dacha did not smooth out his ideas and principles (italics by the authors - P.P., A.P., O .AND.)... The same Saburova dacha convinced me that a true assessment of activities sooner or later will not be long in coming, and I publicly affirm that 12 years after Pavel Ivanovich left Saburova's dacha, I heard words of justice and honor addressed to his activities from his personal enemies and foes, and the highest praise is difficult to achieve. I do not grieve that Russian life, society - everything except the impartial field of science - lost Pavel Ivanovich too early as an energetic figure in the struggle of life. This is the common lot of major public figures. Pure science and practical psychiatry, represented by Pavel Ivanovich's numerous students, will show Russian society that its principles and teaching will not be drowned out by the thorns that Russian, especially zemstvo, psychiatric activity is so full of. I think that if you weigh the successes that owes Russian psychiatry P.I. Kovalevsky, who was one of the first to take the chains off the insane in Russia, - from an impossible clinical Saburova dacha, he arranged, although for a time, an exemplary institution, founded the first Russian psychiatric journal, created in a short time a large school of students, and with his brilliant lectures, until recently, attracts all recruits into the ranks of Russian psychiatrists - moreover, he did all this completely alone , without help, rather with hindrances on the part of many, then one will have to admit the position "that there is one soldier in the field."

I am glad that at the present time Pavel Ivanovich, far from the struggle of life, will lead Russian psychiatry for a long time, devoting all his time to pure science and, like an ideal clinician, will complement us with his brilliant compositions what his students used to hear through the medium of a living words in the clinic. If the official Fatherland does not always appreciate its figures at their merits, then it is only necessary to remember whether there can be the highest award for a scientist and clinician when he is no longer in the former toga of the rector and state dignitary, but in the form of a modest private person - he sees every week at his lectures in the ceremonial hall of the university - a large crowd of honest, alien extraneous considerations and, nevertheless, the strictest judges. In this, and not in the toga of a state dignitary, I imagine the highest award and crown that crowned the anniversary of the 25-year scientific activity of my dear teacher. "

During his more than half a century of medical practice, P.I. Kovalevsky wrote over 300 books, brochures, magazine articles on various issues of psychiatry, neurology, psychology, historical analysis and the national question. His numerous works cover all areas of nervous and mental illness - from psychology to anatomical studies and psychographs of famous people. Among them are the most professional and well-known books and scientific works: "On the change in skin sensitivity in melancholic patients" (1877), "Primary insanity: Comp. for physicians and lawyers "(1880)," Guide to the correct care of the mentally ill: Compiled for relatives and others "(1880)," Forensic psychiatric analyzes: Compiled for physicians and lawyers "(1880)," A course in private psychiatry, read in 1881 at Kharkov University "(1881)," Fundamentals of the mechanism of mental activity "(1885)," Psychiatry: A course read in 1885 at Kharkov University "(1885)," Folie du doute "(1886)," General psychopathology "(1886)," The situation of the mentally ill in the Russian Empire: Speech delivered in Moscow at the opening of the 2nd Congress of the Society of Russian Doctors "(1887)," Paramyoclonus multiplex "(1887)," Drunkenness, its causes and treatment "(1888) , "To the doctrine of alcoholism" (1888), "Chorea and choreic madness" (1889), "Treatment of mental and nervous diseases" (1889), "Forensic psychiatric essays" (1889), "Psychiatry. In 2 volumes. T. 1: General psychopathology (1892); Vol. 2: Special Psychiatry: A Course Read in 1890 at Kharkov University (1890), Compendium on Nervous and Mental Diseases (1891), Brain Syphilis and Its Treatment (1891), Epilepsy, Its Treatment and forensic psychiatric value "(1892)," Psychiatric sketches from history. In 2 issues. - Issue. 1: Ludwig II, King of Bavaria; Nebuchadnezzar, king of Babylon; Saul, king of Israel; Cambyses, king of Persia (1892); Issue 2: John the Terrible and his state of mind (1893) "," General progressive paralysis of the mad "(1893)," Puerperal psychoses "(1894)," Nervous diseases of our society "(1894)," Psychology of sex "(1895)," Forensic Psychiatry "(1896)," Forensic General Psychopathology "(1896)," Migraine and Its Treatment "(1898)," Psychology of a Criminal in Russian Literature about Hard Labor "(1900)," Degeneration and Rebirth. The criminal and the fight against crime (Socio-psychological sketches) "(1903)," Mental illness. Psychiatry course for doctors and lawyers. In 2 volumes "(1905)," Retarded children (idiots, retarded and criminal children), their treatment and education "(1906)," Fighting crime through education "(1908)," Mental illness of our society "(1911), "A guide to the care of the mentally ill for sisters of mercy and paramedics" (1915), "Psychology of gender. Sexual impotence and other sexual perversions and their treatment "(1916)," Fundamentals of Human Psychology (with pictures) "(1917).

In 1880, Pavel Ivanovich published the first Russian textbook on psychiatry, which went through four editions "Textbook of Psychiatry for Students" (1885, 1886, 1892).

The historical works of P.I. Kovalevsky: “The conquest of the Caucasus by Russia. Historical sketches "(1911)," History of Russia from a national point of view "(1912)," The meaning of nationalism in the modern movement of the Balkan Slavs "(1912)," Foundations of Russian nationalism "(1912)," History of Little Russia "(1914)," Caucasus. Peoples of the Caucasus "(1914)," Psychology of the Russian Nation "(1915)," Nationalism and National Education in Russia "(1922) and others, which enjoyed great interest, went through several editions in pre-revolutionary Russia (in Soviet times they were recognized as reactionary and were not printed). Pavel Ivanovich was one of the first to use historical analysis to draw up a psychological portrait of prominent personalities. Great fame was brought to him by "Psychiatric Sketches from History" (sometimes this book is published under the title "Psychiatric Sketches from History"). For a long time in the Soviet era, this book was not published, as it contradicted the Marxist position on the role of the individual in history and the concept of socio-economic determinism. This book, combining scientific and popularizing style, reveals the dynamics of various mental phenomena using specific examples from the life of famous historical figures, shows the role of the environment and heredity in the formation of personality.

It should be emphasized that zemstvo medicine played a significant role in the development of medical deontology in our country. From the very beginning of its development, zemstvo psychiatry had a clinical basis and a social orientation. This orientation allows us to say that the emergence of social psychiatry and the rehabilitation of mentally ill people began in our country at the end of the 19th century. At the same time, attention is drawn to the combination of a truly humane attitude to the fate of the patient, constant respect for the dignity of his personality and the desire to use the preserved mental abilities for the highest possible social readaptation. An example is the statements of P.I. Kovalevsky, who is rightfully considered an outstanding physician-humanist. In the repeatedly reprinted Guide to Proper Care of the Mental Ill, he wrote: “Treatment of patients in a hospital should always be humane, gentle, gentle and patient. First of all, you need to gain the confidence of your patients; and they acquire it only by warm sympathy, patience, affectionate treatment, the fulfillment of reasonable desires, a willingness to show good and strict justice in relation to all patients. Lies, deceit and cunning have no place in the treatment of these patients. They are too sensitive even to artificiality and do not really like a person who pretends to be only kind ".

The teachings of Pavel Ivanovich, made by him long before the very concept of "medical deontology" appeared, can serve as excellent illustrations of the proper medical attitude towards patients in psychiatry. In the same Guide, he wrote: "Just as a good surgeon probes a wound only as a last resort, so a good psychiatrist should only touch a patient's mental wound because of research."... P.I. Kovalevsky emphasized that "the main task here is to give this person the means for further existence, to restore his independence, to instill in him the confidence of the society, in whose environment he is a member." The cited "Guide" provides for almost everything that doctors need to do, realizing the care that the patient can more easily and fully return to life outside the hospital: from how to feed and dress him, and to how to simplify the resolution of administrative and legal issues arising after discharge from the hospital, and provide the necessary social and medical assistance to the patient.

It is noteworthy that the organizing committee for the preparation for the celebration of the 200th anniversary of the Kharkiv City Clinical Psychiatric Hospital No. 15 (Saburova Dacha, now the Kharkiv Regional Clinical Psychiatric Hospital No. 3), with the full approval of the scientific and practical psychiatric community of the region, decided to make a bas-relief depicting a portrait of Professor P .AND. Kovalevsky on one of the sides of the commemorative anniversary medal dedicated to the above significant event in the history of Ukrainian medicine, which was done.

Commemorative anniversary medal dedicated to the 200th anniversary of the Kharkiv City Clinical Psychiatric Hospital No. 15 (Saburova Dacha)

On the eve of the revolution P.I. Kovalevsky taught a course in forensic psychology at the Law Faculty of Petrograd University. We do not know how the ideologist of Russian nationalism perceived the February and then the October Revolution. It is only known that after the revolution the elderly professor P.I. Kovalevsky, as a highly qualified physician, was mobilized into the Red Army by the chief physician of a military detachment (already in exile in a private letter to a former party member - Metropolitan Evlogy (Georgievsky) - PI Kovalevsky wrote that the Reds forced him to this cooperation). After the end of the Civil War, until 1924, the scientist worked, as noted above, as a senior doctor of the psychiatric and nervous department of the Nikolaev hospital in Petrograd and even consulted the seriously ill V.I. Lenin, the first to identify his progressive paralysis.

This moment became a turning point in his life. In 1924, Pavel Ivanovich almost died as a result of persecution by the Soviet authorities, but in December 1924, having somehow received permission to travel abroad, P.I. Kovalevsky left the USSR. He spent the rest of his life in the Belgian resort town of Spa, continuing to engage in scientific and journalistic activities. In 1925, the professor wrote to Metropolitan Evlogy with a proposal to read a course in psychology at the St. Sergius Orthodox Theological Institute in Paris, but Pavel Ivanovich, apparently, did not have to return to teaching. The emigrant period of P.I. Kovalevsky is very little known, and this letter allows expanding the knowledge of researchers about the author's stay in Belgium. This outstanding scientist, outstanding psychiatrist, publicist, public figure, convinced Russian nationalist and, without a doubt, a patriot who wished only good for his fatherland and people, died on October 17, 1931 in Liege (Belgium).

Thus, P.I. Kovalevsky made a significant contribution to the development of domestic scientific and practical psychiatry, incl. and Kharkov Psychiatric School, and other disciplines. Undoubtedly, the biography and scientific heritage of Pavel Ivanovich need further careful research, especially the Ukrainian and foreign periods of his life and scientific work.

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Literature

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10. Kovalevsky P.I. Forensic psychiatric analyzes: comp. for physicians and lawyers: in 2 volumes - 2nd ed. - Kharkov: Type. M. Zilberberg, 1881. - T. 1. - 406 p .; T. 2.- 444 p.

11. Kovalevsky P.I. Psychiatry. A course taught in 1885 at Kharkov University. - 2nd ed., Add. and redistribution. - Kharkov: Ed. zhurn. "Archives of Psychiatry, Neurology and Forensic Psychopathology", 1885. - 418 p.

12. Kovalevsky P.I. Psychiatry: in 2 volumes - 4th ed., Add. and redistribution. - Kharkov: Ed. zhurn. "Archive of Psychiatry, Neurology and Forensic Psychopathology", type. M.F. Zilberber, 1890-1892. - T. 1: General psychopathology. - 4th ed., Add. - 1892 .-- 220 p .; T. 2: Special Psychiatry: A course delivered in 1890 at Kharkov University. - 4th ed., Add. and redistribution. - 1890 .-- 432 s.

13. Kovalevsky P.I. Epilepsy, its treatment and forensic psychiatric significance. - 2nd ed., Add. - Kharkov: Ed. zhurn. "Archives of Psychiatry, Neurology and Forensic Psychopathology", 1892. - 239 p.

14. Kovalevsky P.I. Forensic psychiatry. Course taught at the Faculty of Law of the Imperial Warsaw University. - Warsaw: Ed. zhurn. "Archive of Psychiatry, Neurology and Forensic Psychopathology", type. Warsaw educational district, 1896. - 426 p.

15. Kovalevsky P.I. Russian nationalism and the national education of Russia. - SPb .: Type. M. Akinfieva, 1912 .-- 394 p.

16. Krainsky N.V. Corruption, hysteria and demoniacs, as phenomena of Russian folk life. - Novgorod: Gub. type., 1900 .-- 243 p.

17. Kruglyansky V.F. Psychiatry: history, problems, perspectives. - Minsk: Vysh. school, 1979 .-- 208 p.

18. Morozov G.V. Deontology in psychiatry // Deontology in medicine: in 2 volumes - T. 2. Private deontology / Е.М. Vikhlyaeva, V.P. Gamow, S.Z. Gorshkov [and others]; ed. B.V. Petrovsky; Academy of Medical Sciences of the USSR. - M .: Medicine, 1988. - S. 145-162.

19. Petryuk P.T. Pavel Ivanovich Kovalevsky - a famous Russian psychiatrist // History of Saburova's dacha. The successes of psychiatry, neurology, neurosurgery and narcology: a collection of scientific papers of the Ukrainian Research Institute of Clinical and Experimental Neurology and Psychiatry and Kharkov City Clinical Psychiatric Hospital No. 15 (Saburova Dacha) / under total. ed. I.I. Kutko, P.T. Petryuk. - Kharkov: B. and., 1996 .-- T. 3. - S. 57-61.

20. Petryuk P.T. Professor Pavel Ivanovich Kovalevsky - an outstanding Russian scientist, psychiatrist, psychologist, publicist and former Saburyan (to the 160th anniversary of his birth) // Psychne zdorov'ya. - 2009. - No. 3 (24). - S. 77-87.

21. Petryuk P.T., Petryuk A.P. Professor Pavel Ivanovich Kovalevsky: strokes to the portrait and scientific activity of an outstanding Russian scientist, psychiatrist, psychologist and publicist (To the 165th anniversary of his birth) // Psychic health. - 2014. - No. 4 (45). - S. 78-89.

22. Petryuk P.T., Petryuk A.P., Ivanichuk O.P. Professor P. I. Kovalevsky: his "spontaneous" materialism and understanding of mental processes // News of Ukrainian psychiatry. - Kiev-Kharkov, 2015 [Electronic resource]. - URL: http://www.psychiatry.ua/articles/paper444.htm (date of access: 24.06.2016).

23. Letter from P.I. Kovalevsky to Metropolitan Eulogius (Georgievsky) from April 5/19, 1925 - GARF. F. R-5919. Metropolitan Eulogius (Georgievsky) Foundation. Op. 1.D. 66.

24. Platonov K.K. My meetings on the great road of life (Memoirs of an old psychologist) / ed. HELL. Glotochkina, A.L. Zhuravleva, V.A. Ring [and others]. - M .: Publishing house "Institute of Psychology RAS", 2005. - 312 p. (Outstanding scientists of the Institute of Psychology of the Russian Academy of Sciences).

25. Sadivnichy V. Pavlo Kovalevsky - editor of the first medical periodical // Journal. - 2012. - VIP. 11 (36). - S. 114-123.

26. Sozinov A.S., Mendelevich D.M. Professor Pavel Ivanovich Kovalevsky: To the 110th anniversary of teaching at Kazan University // Neurological Bulletin - 2013. - T. XLV, Vol. 2. - S. 85-92.

27. P.B. Stukalov. Pavel Ivanovich Kovalevsky and Mikhail Osipovich Menshikov as ideologists of the All-Russian National Union: author. dis. ... Cand. ist. sciences. - Tamb. state un-t them. G.R. Derzhavin. - Tambov, 2009 .-- 23 p.

28. P.B. Stukalov. Political and legal doctrines in Russia in the second half of the XIX - early XX century: the All-Russian National Union and its ideologists. - Voronezh: FKOU VPO Voronezh Institute of the Federal Penitentiary Service of Russia, 2011 .-- 175 p.

29. Chronology of Saburova's Dacha leadership in domestic psychiatry / P.Т. Petryuk, I.K. Sosin, I.I. Kutko [et al.] // News of Ukrainian psychiatry. - Kiev-Kharkov, 2011 [Electronic resource]. - URL: http://www.psychiatry.ua/articles/
paper367.htm (date of access: 25.02.2016).

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Petryuk P.T., Petryuk A.P., Ivanichuk O.P. The creative path and scientific heritage of Professor P.I. Kovalevsky: a short sketch // Medical psychology in Russia: electron. scientific. zhurn. - 2016. - N 2 (37) [Electronic resource]. - URL: http://mprj.ru (date of access: hh.mm.yyyy).

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P. I. Kovalevsky

Psychiatric sketches from history. Volume 1.

John the Terrible

Part one

Each person represents a certain amount of substance or matter, developing from itself a corresponding number of force. Thus, it will be a unit of matter that generates a known corresponding unit of force. This unit of substance, according to the chemical composition of its individual parts, generates both simple, coarse, physical, and higher, spiritual, in the form of manifestations of thought and feeling. The amount of matter or substance received by each person for his body, and the arrangement of its individual parts are so similar to each other that involuntarily the question of the identity and similarity of people to each other arises. With such an identity of the organization of a person, an identity quantitative and qualitative, thoughts about the identity of the functions of this organization, which means, about the identity of the physical and mental strength of people, are very naturally generated.

However, in reality, it turns out that people differ quite sharply from each other both in the appearance of their organization and in the forms of the spiritual and physical activity of this organization. What is the reason for this difference?

Two figures create a separate person with his features of bodily organization, spiritual appearance and physical activity - heredity and upbringing.

Being born into the world, a small human being is the bearer of the organization of his parents, therefore, this person, both physically and spiritually, must be a repetition of his parents. But there are two parents: father and mother. Children are always like their parents. It's right. But each child is a combination of both father and mother traits. True, in some cases this descendant bears the predominance of the features of the father, and other times - of the mother, nevertheless, we rarely see that the children bore only the appearance and character of the father or the appearance and spiritual organization of the mother. This mixture in the education of the properties of the father and mother in children creates the first principles personal distinctiveness the child - his personal isolation, his individualization. On this hereditary property of children to borrow from their parents the traits inherent in each of them, and to combine them in themselves in a new combination in the form of similarity to their two ancestors, and the ability of the human race to improve and degenerate is based. As a rule, children inherit from their parents those traits that were most severe and most stable in the parents' organism. If the parents in one way or another represented similarities, then these traits in children were combined, intensified and manifested more sharply and more clearly than in each of the parents, with the existence of opposite traits in one respect or another, children, approximately, will inherit the average proportional value of the organization of one or another another feature.

It may happen that parents represent similarities in the features of the organization that contribute to its improvement: a strong body, a great mind, extraordinary energy, etc. The children of these parents are born at a very favorable conditions the existence of their organization, they can also expect to be strong, smart, energetic. In any case, these children have much more data to be such than if there was only one parent with the above properties. Children have different properties if their parents are weak, sickly, apathetic, quarrelsome, etc. Such children are already outlined from birth as a tribute to the propensity to illness and subsequent degeneration.

Thus, heredity determines the future of children, depending on the organization and qualities of their parents. It would be regrettable to look at such a picture of human society if heredity played a sole and exclusive role in its existence. Then, with almost mathematical precision, we would predict that the Ivanovs should die out, and the Petrovs should take the upper hand in society, the Sidorovs oscillate between life and death. In this case, the question should have come up with all its nakedness natural selection, moreover, the parents with all their might would have to take care only of choosing strong and strong husbands for their daughters, and all the weak would have to be doomed to destruction, as in Sparta. This state of affairs is too much like a stable and a stud farm.

Fortunately, in the matter of the physical and spiritual organization of a person, a role is equal to heredity - the second agent is education, rational education in the broadest sense - the nutrition of the body and its education. Education, through exercise, prudent nutrition of the body and the proper environment in the life of a given young organism, can more or less easily paralyze the unfavorable features of the inherited organization of a given person - it, under the opposite conditions, can destroy him.

Thus, heredity and upbringing are very important actors in a person's life, not only in the sense of the formation of his individualization, but also in the sense of his existence in general.

What we said in general about the existence of the human race is quite applicable and in particular to its mental health.

Mental health or ill health of people is conditioned by two main points: heredity and living conditions under which a person grows, develops and improves. It may happen that a person is born from perfectly healthy parents and inherits a strong and powerful nervous system - then there is a lot of evidence that this person, under favorable conditions for growth and development, will come out strong, powerful and healthy. But it can also happen that the parents are sick nervously or mentally, then their children will necessarily inherit from them a nervous system that is not strong, prone to illness and is not able to go, under normal life conditions, to a level with a person who inherited a healthy and powerful nervous system - the organ of mental activity. Thus, if only heredity played a role in the creation of mental health or ill health, then from the first time we would divide the human race into two halves: into healthy and doomed to a disease, into powerful and weak, into fit and useless, on the clean and unclean. But one hereditary transmission of the viability of the nervous system is not decisive for the mental life of people. There is also a second figure who shows a very serious influence in the development of inherited properties and qualities and is no less important than heredity.

Biography

This book, combining scientific and popularizing style, using specific examples from the life of Ivan the Terrible, Peter III, the Prophet Muhamed, Joan of Arc, Paul I, the Persian king Cambyses, Ludwig II of Bavaria, Emanuel Swedenborg and others reveals the dynamics of various mental phenomena, shows the role of the environment and heredity in the formation of personality.

PI Kovalevsky was the foreman of the Russian National Club, a member of the Council of the All-Russian National Union and a member of the Russian Assembly.

Notes

Essays

• The conquest of the Caucasus by Russia. Historical sketches. Saint Petersburg, 1911
• History of Russia from a national point of view. Saint Petersburg, 1912
• Foundations of Russian nationalism. Saint Petersburg, 1912
• History of Little Russia. Saint Petersburg, 1914
• Psychology of the Russian nation. Saint Petersburg, 1915
• Psychiatric sketches from history. In two volumes. M., Terra. 1995. ISBN 5-300-00095-7, 5-300-00094-9

Literature

• Petryuk P.T.Professor Pavel Ivanovich Kovalevsky - an outstanding Russian scientist, psychiatrist, psychologist, publicist and former Saburian (on the occasion of the 160th anniversary of his birth) // Psychic health. - 2009. - No. 3. - S. 77-87.
• Ivanov A. Nationalist professor (to the 75th anniversary of the death of P. I. Kovalevsky).
• Afanasyev N.I. Contemporaries. Album of biographies. - SPb, 1909 .-- T. 1.- S. 133.
• Kotsyubinsky D.A. Russian nationalism at the beginning of the XX century. The birth and death of the ideology of the All-Russian National Union. - M., 2001.
• Savelyev A.N.Nation: the Russian formula of Professor Kovalevsky // Golden Lion. - 2005. - No. 69-70.

Categories:

• Personalities alphabetically
• Scientists alphabetically
• Born in 1850
• Deceased October 17
• Dead in 1931
• Psychiatrists of the Russian Empire
• Members of the All-Russian National Union
• Members of the Russian Assembly
• Russian emigrants of the first wave in Belgium

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See what "Kovalevsky, Pavel Ivanovich" is in other dictionaries:

Psychiatrist. Was born in 1850. He graduated from the course at Kharkov University. Received a doctorate in medicine for a dissertation on altering skin sensitivity in melancholic patients. He was a professor of psychiatry at Kharkov University, then rector ... ... Biographical Dictionary

Professor of Psychiatry; genus. in 1850, he studied at the Yekaterinoslav seminary and at the Kharkov University, where in 1874 he graduated from the course with a doctor's degree. In 1877 he received his doctorate in medicine, having defended a thesis on the change in sensitivity ... ... Big biographical encyclopedia

Kovalevsky Pavel Ivanovich (1849-1923), psychiatrist, professor at Kharkov University (since 1884). Transactions on forensic psychiatry, on the mechanisms of mental activity, etc. The first domestic manual on psychiatry (1880). In 1883 he founded in ... Big Encyclopedic Dictionary

Professor of Psychiatry, b. in 1850, he studied at the Yekaterinoslav seminary and at the Kharkov University, where in 1874 he graduated from the course with a doctor's degree. In 1877 he received his doctorate in medicine, having defended a thesis on the change in sensitivity ... ... Encyclopedic Dictionary of F.A. Brockhaus and I.A. Efron

KOVALEVSKY PAUL - Ivanovich (born in 1850), psychiatrist, graduated from Kharkov University. K. was the first professor of psychiatry at Kharkov University, and then held a department at Warsaw and Kazan universities; subsequently taught a course in forensic psychopathology on ... ... Big medical encyclopedia

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Such are the phenomena in inborn neurasthenics or in people who inherited an unstable nervous system from their sick parents. In addition to the above-mentioned painful phenomena, a lot of others develop in neurasthenics and there is almost not a single painful phenomenon in the nervous system that could not manifest itself in one or another neurasthenic. And this is very natural. Neurasthenia is the instability of the functions of the entire nervous system, with the predominance in one case of some phenomena, and in the other - others; therefore, it is not surprising that neurasthenia is a collection of all morbid phenomena and neuropathology.

It is not necessary, however, to think that every neurotic person embodies all of the above signs; on the contrary, in none of the neurasthenics they are not entirely, but only in parts in various combinations, which is why each case of neurasthenia differs quite sharply, in terms of the combination of painful manifestations, from other similar ones.

Nevertheless, upon careful consideration of all cases of neurasthenia, two groups can be sharply distinguished between them: in one, especially mental instability predominates, and in the second, deviations and painful manifestations in the field of drives, impulses and feelings.

At first glance, neurasthenics of the first group seem to be unusually intelligent and comprehensively educated people. Their mental powers and abilities are extremely brilliant.

They are very sensitive to all things happening around them. Eagerly pounce on everything, quickly assimilate and energetically embody. They show interest in everything, they quickly master everything and express knowledge, experience and competence in everything. Such comprehensiveness and breadth of information involuntarily gives rise to the idea of \u200b\u200bthe singularity and genius of their mental abilities. Their life is unusually active, their mental work is extremely varied and fruitful.

But, strictly examining the mental activity of these persons, we are involuntarily amazed at its extreme superficiality. These people quickly get carried away by other people's messages and plans, assimilate them without any control and criticism, take them for their own inherent in them, at the same moment carry out these plans and leave them at the slightest difficulty. The rapid enthusiasm and fervor in various affairs of such people is accompanied by no less rapid cooling and oblivion of the business they are undertaking. Due to such frivolity, inconstancy, inability to concentrate and settle on one thing, they constantly jump from case to case, from enterprise to enterprise, from subject to subject. They have some kind of need for novelty and some kind of itching for change. They can only exist with such fluttering and gathering not only tops, but even crumbs from these tops. At the same time, the complete incoherence and alienation in enterprises is especially striking. So, they move from the university to the smithy, from the smithy to the production of lace, from the production of lace to the seminary and sermon, from the sermon to the gendarmerie, from the gendarmerie to the production of saltpeter, from the production of saltpeter to travel to Akhaltek, etc. Such versatility, all-embracing, omniscience and the same passion for all these objects clearly betrays the spiritual weakness of a person. It will be in the full sense of the word impotence of the mind, for these people, grabbing at everything, do not complete anything and by their intervention ruin every business and enterprise that has been started. If they could fulfill everything they undertake, then they would be titans of the mind and geniuses of thought. Unfortunately, they quickly get bored of any undertaking, they throw it away with pleasure and attack the new, with great reluctance and hostility looking back at the old.

Of course, this painful condition is expressed the brighter and the wider, the wider and more powerful a person's activity and the more power is in his hands.

To better color this painful picture and to distinguish it from genius, we will cite two fantastic examples from the world of the rulers of nations.

The first inherited a powerful and warlike state. His grandfather and father, in a series of victorious wars, delivered to the state new lands, untold riches, prosperity to the country, submission and fear of neighbors, a powerful and invincible army, brilliant administrators and commanders, great scientists and glorious institutions. At the head of this power, glory and greatness is he, a young, energetic, educated, strong and strong sovereign. With this young power, energy and enviable position of the people under his control, all neighbors have a cautious thought - all this is not enough for him. He wants to try new happiness, new military glory, new lands, new riches ... And he is taken for it. It is taken for this with a brave soul and indomitable energy ... On the way, however, there are obstacles ... These obstacles are presented in the form of advisers, old colleagues of his father and grandfather, people hardened in military struggle and the organization of the state, people covered with civil and military prowess , people revered not only by the citizens of the fatherland and the shadow of their ancestors, but also by the neighboring peoples ... A considerable obstacle.

But what does an obstacle for a person of energy, ardor and tirelessness mean! .. Old advisers are flying into retirement. New people are brought out, pleasing to the sovereign. There is an extraordinary reshuffling of persons, positions, roles and positions. A new course begins. Everywhere the ruler observes disorder, everywhere failure, everywhere disorder. And everywhere the energetic and young ruler strives to be personally and fix everything personally. He composes new laws. He creates a new army structure. He is an archpastor and preacher, as "the voice of God on the waters." He composes operas. He writes ballets. He is remodeling schools. He makes rules for the workers. He changes the upbringing system. He flies around the world with diplomatic negotiations. He suddenly audits parts of the army and institutions. He is so vigilant, versatile and universally busy that he is the rarest guest in his house.

With such a power and all-encompassing mind, tireless energy and personal participation in everything, one can think that it will create a world state, peace and a golden age.

But the overlord does not like to mess around with things that have been started for a long time. He removed the old advisers, but did not replace them with new equals and worthy ones. He shattered the old institutions, but did not create or strengthen the new ones. He undermined the old laws, but did not give new ones. He destroyed confidence in the old system of educating subjects, but did not give a new one. He promised to change the living conditions of the workers, but did not fulfill this, He was great in words, but small in deeds. For he did not have endurance, patience, knowledge, skill, will and understanding.

Such a neurasthenic overlord will not create a state, but destroy it, - not strengthen, but shake it, - not elevate, but belittle, - not order, but stir up.

We will take another ruler, just as broadly active and broad-ranging.

Its area is even larger and more extensive. By inheritance, however, he received disorder and disorder. In all neighboring states there is more improvement, and more education, and more order, and more wealth and more formed armies. In his state there are no advisers, no educated people and scientists, no experienced craftsmen, no factories, no factories, no navy, no trade - nothing that now constitutes civilization and Europeanism. He captured the very throne almost in battle. A young eaglet with his powerful mind sees that his state will be erased and destroyed if he does not establish in it the knowledge and education that has already taken root in its neighbors.

And this powerful young man, with the same tireless energy and restlessness, flies around the world from north to south and from east to west. He personally inspects everything, he personally examines everything, he personally starts and arranges everything. He suits the army, he builds the navy, he makes laws, he arranges the Academy of Sciences, he opens a printing house, he starts factories and plants, he even introduces a new costume for the people, he changes the appearance of people, he makes reforms in the church area, he leads incessant wars, he expands the boundaries of the fatherland, he changes his whole life, he makes a European kingdom out of his Asiatic kingdom and makes him respect and revere himself by the power of his mental power. And this powerful lion did not go on a level with the demands and beliefs of his people, but against them. He did not continue the path of glory and military traditions of his homeland, but he himself created and fulfilled them. He did not have support for his thoughts and plans in the surrounding old and experienced assistants, but personally chose and appointed assistants for himself. He did not write ballets and comedies, but only started theaters. He did not change the school system, but only started schools.

And this sovereign created everything.

What is the difference between the first and the second?

The fact that the first was quickly carried away by all enterprises and just as quickly abandoned them with disgust; and the second, having begun something himself, still brought it to the end with a fatherly love for his creation and brainchild. The first did not have a thought of his own, he seized someone else's, fleetingly assimilated it and just as lightly left; the second had his own thought, thought it over carefully and never left. The first, due to his mental weakness, could not live with all his thoughts at the same time and jumped from thought to thought; the second contained everything in his head, brought everything into connection and order, and gave everything a certain ratio. The first pounced on the appearance of thought, without plunging into its depth, - the second always studied it in essence. The first never knew the matter in its details, - the second always studied the matter to the smallest detail and could always be a teacher in everything personally from beginning to end.

The first was a mental pygmy, a mental neurotic, the second a mental titan, a genius. The first is angry impotence, the second is power and strength ...

In the second group of neurasthenia, mentally people seem to be healthy, but in their character, actions and deeds there is a mass of wrongs, deviations and such manifestations in which the patients themselves repent and society calls them to account. Such people show in some cases an extraordinary irascibility, anger, bloodthirstiness and a tendency to torture, in other cases - a passion for drunkenness, abuse of morphine, opium, etc., in others - a passion for gambling and collecting unnecessary items, and sometimes - the desire bad society, begging, vagrancy, attraction to the same sex, and even sexual attraction to animals. In some cases, such people are attacked by bouts of unreasonable fear and melancholy, while in others, on the contrary, by irrepressible insane fun. Sometimes they are in a state of some kind of longing, excitement and expectation that something is about to happen to them. And they know well that nothing will happen to them, but meanwhile they are expecting it - and something terrible will happen ...

In addition, there may be a lot of other phenomena, so it is hardly possible to list them. The following should be noted about all of these above-mentioned manifestations of the disease: never these phenomena occur together in the same person. It is only from the observation of many neurasthenics that this picture of the disease can be collected and compiled. In reality, neurasthenics develop one or several painful phenomena, which can subsequently be replaced by others.

Having appeared once, this or that symptom remains for a short time, sometimes for several minutes or hours, and then disappears, leaving the person in a healthy state, in order, however, to reappear the next day, or after a while, under unfavorable living conditions.

Thus, in this case, one sees instability of nervous activity, painful manifestations of fear, longing, longing, expectation, drives and passion with full consciousness of their absurdity, morbidity, harm and danger and with a complete inability to resist them.

As neurasthenia, which manifests itself mainly in the field of thought, and neurasthenia of well-being and passions can sometimes combine with each other by their partial manifestations and give a mixed picture of the disease.

The fate of neurasthenia for different cases is not the same: with favorable living conditions and proper treatment, it can pass and disappear without a trace, or temporarily, - in other cases, it can remain for life, giving now more or less long light intervals, - finally, in unfavorable cases it can move forward into the depths of nervous and mental illness. Neurasthenia serves as an excellent soil for the development of diseases of the nervous system, a most successful canvas on which patterns and pictures of all kinds of diseases can be drawn. On the basis of neurasthenia, epilepsy or epilepsy, hysteria, the dance of St. Witt, all kinds of violent attacks of fear and anguish and mental illness.

Of mental illness on this basis, more often than others develops primary insanityor paranoia. In this case, we are most interested in it, and therefore we will try to trace the mechanism of its emergence from neurasthenia and to its full development in the form of persecution delirium.

What is primary insanity or paranoia, we have said in detail about this in another message and now I consider it unnecessary to dwell on this issue.

The ways in which paranoia arises and develops on neurasthenic grounds are very diverse - we will focus on the most frequent of them. Due to nervous irritable weakness and nervous imbalance, under the influence of some unfavorable living conditions, the patient develops increased anxiety, excitement, discontent and an increased expectation that something will happen to him, etc. The patient is looking for the reasons for his anxiety. It seems to him that all the people around him are somehow different from how it was before. Everywhere special attention is noticed to him, special eyeing, special observation. Not one of his steps, not one of his movements, not one of his obstacles do without the fact that those around him would not treat him with particular courtesy. The very thoughts of those around him are, as it were, guessed and foreseen. Such excessive attention from others cannot but lead the patient to reflection ...

In reality, of course, there is nothing of the kind. Everyone treats him today in exactly the same way as yesterday, but the patient has a special increase in the perception of external impressions, which is reflected in the thought of increased attention from others to his personality. Such an erroneous and to some extent even a false sense of observation and the idea of \u200b\u200bobservation on the part of others in relation to the beginning paranoia finds a prototype in the phenomena of everyday life. Yesterday we were in a shabby coat, today in a new one. No one, of course, took notice of this change; but it seems to us that “I” has become, as it were, a different person, and all this change is noticed and everyone responds to it with attention and observation. It also happens when we cut our hair, put on new shoes - when a lady's flower on her hat is moved from left to right, and the bow is three lines higher or lower ... This phenomenon is common and well known to everyone. It is this that can serve as an example and explanation of the painful state that paranoid people express in the form of increased observation of them from others ...

So, they are subject to special attention, special observation from others. Why? What is the reason? There is no answer to these questions yet. But this makes the patients, on their part, pay more attention to everything that happens around them. And so they become extremely suspicious of everything.

Being secretive, withdrawn, concentrated in oneself, paranoids from afar, unnoticed by others, vigilantly observe everything and everyone. And, to their horror, they see that everything around them is being done for a reason. Everything around them is not in the same form as it was before. All this is somehow changed. Everything is not done the way it was before. Of course, it was not the environment that changed in reality, but their ability to perceive, but they attribute the change to the environment and try to find its cause. Suspicion intensifies and fills their entire being. The patient is constantly looking at everything, the patient is always on the alert ...

Such an extraordinary, painful suspicion gives rise to a new state in patients - a tendency to relate everything that happens to oneself. He walks down the street. A passing one spat. This spit is an expression of a desire to offend him. In passing, he hears the words "he is not reliable" ...

I am not reliable ... Why? .. What have I done? .. What is not reliable? ..

And here comes a whole series of agonizing questions: why and how?

The patient is reading a newspaper. They write about the urgent need to eliminate the gophers that are devastating the fields of the Yekaterinoslav province.

Well, yes, gophers ... What does the gophers have to do with it ... Is it "they" who want to harass me?

Any cough, any movement of others, a meeting, etc., are interpreted in the sense of an attitude towards their personality. Such patients, as they say, develop an extraordinary "egocentrism", that is, such a state of mind when it seems to them that their "I" has become the center of the whole world.

But all these are preparatory states. They may or may not be. If they do exist, then in the depths of the patient's soul and for those around them they are decidedly invisible. Only a very experienced eye of a psychiatrist can catch them and, through very careful and distant questions, can partly extract them.

For the sick, these states are extremely painful and painful. They do not give them rest, day or night. They deprive them of sleep. They destroy their peace of mind, breaking relationships with the closest and dearest people: friends, relatives, parents, wife and children ...

Added to this are illusions or erroneous sensations. Patients see suspicion, mockery, contempt, censure on the faces of their loved ones. In their voice, one can hear a shade of discontent, bullying, and so on. In shaking hands, they observe a particular sharpness and the desire to push away. The very air carries in itself something special, suspicious and unpleasant.

All this forces the sick to behave very carefully, to withdraw from sin and to be focused in themselves. Endless insult and resentment is generated in their souls ... Why such persecution? What is the general mockery of him for? Where can he look for help, support, protection and patronage? Everyone is against him. All his enemies. All wish him harm. Everybody wants to put him out. Boundless malice and boundless hatred are generated in these people for all people, especially for people close and formerly dear. Their misfortunes are pleasing to him. Their suffering is a comfort to him. Their torment is a life-giving balm for him. There is no evil that he would not wish for the human race. There is no cruelty to which he would not condemn all people. There is no execution for people that would satisfy him.

For these are his enemies. They all torment him. They all torture him. They all want to bury him. He sees all this. He hears all this. He feels all this. The pursuit delirium is in full swing.

At times, it dies down. Thoughts are generated - is it true? Am I wrong? Am I raising accusations for nothing? And sometimes moments of bewilderment, doubt and remorse can appear ... But, alas, these minutes are short. A wave of anger, hatred for the human race and desire for all earthly evils for it again surges. If such a person could flood the earth with the blood of his enemies, then the highest pleasure for him would be to bathe and bathe endlessly in this blood. This bloodthirstiness, brutality and fanaticism is a logical phenomenon, it is a natural consequence of the suffering and torment that such people experience in their delirium of persecution.

At the same time, in essence, such people can be either evil, heartless and bloodthirsty people, or ordinary mortals who are bloodthirsty with ordinary disgust. In the latter case, bloodthirsty thoughts find resistance to themselves in the general nature of man, alien to cruelty and bloodthirstiness - in the first case, cruel thoughts find support in the cruel nature of a person, and then the crimes of such people are distinguished by extraordinary atrocity and cruelty. But whatever the combination of cruel ideas and aspirations of bloodthirstiness in a paranoid, he will never risk committing these atrocities in vain, for he knows well that a cruel punishment will follow.

Such is the paranoid in his persecution delirium. This is a beast. The beast is merciless. A bloodthirsty beast, ready to tear to pieces the whole world.

But in this person there is also another person, an ordinary person, a healthy person, living an ordinary life and performing ordinary human deeds.