Cortico-visceral relationship (from lat. cortex - bark and viscera - insides)
natural functional interaction between the cerebral cortex (See Cerebral cortex)
(KBP) and internal organs (IO), reproducible under experimental conditions. Using the method of electrical stimulation of CBP, their effect on VO was established at the end of the 19th century. (V. Ya. Danilevsky, N. A. Mislavsky, V. M. Bekhterev). In this way, it was possible to show that exposure to certain areas of the cortex causes changes in breathing, heart activity, intestinal and bladder motility. The use of the method of conditioned reflexes proposed by I. P. Pavlov (See Conditioned reflexes) to study the central regulation of the activity of the VO allowed his students (K. M .
Bykov and his collaborators) to prove that the KBP can influence the operation of all VO or their systems (circulation, respiration, etc.), just as the activity of the VO can change the functions of the KBP. Thus, when water is repeatedly introduced into the dog’s rectum, the amount of urine excreted by the kidneys increases. This effect can be caused by the very setting of the experiment: placing the dog in the room where the research was carried out, introducing and immediately removing water from the rectum, the presence of experimenters, etc. (K. M. Bykov et al., 1926). Thus, the experimental environment becomes a conditioned stimulus (CS) for the animal. By creating such conditioned reflexes (which are no different from the classical ones discovered by I.P. Pavlov), it is possible to change the activity of any VO. CBP is an indispensable participant in the formation of conditioned reflexes; Thus, the possibility of influence of the PSC on the operation of VOs and their systems has been proven. Subsequently, it was shown that by influencing any VO, it is possible to change the conditioned reflex activity of the CBP. If such an effect on the VO is preceded several times by some indifferent stimulus, then it, applied in isolation, can cause a change in conditioned reflex activity, i.e., become UR. Thus, it was found that the CBP can influence the activity of the VO, and signals from the VO, reaching the CBP under certain conditions, are capable of changing the activity of the higher part of the central nervous system. K. M. Bykov believed that CBP can either change the current activity of the VO (corrective influences), or stimulate an organ that is in a state of physiological rest to activity (trigger influences). The idea of K.-v. O. made it possible to explain from a strictly scientific point of view many facts long known to physiologists and doctors that had not been explained; it made it possible to understand the significance of mental influences on the course of a number of diseases and stimulated research by neuromorphologists who discovered and described sensitive nerve endings in the VO - Interoreceptors -
the initial link in the implementation of influences from the VO on the activities of the KBP. Based on the idea of K.-v. O. the doctrine of interoreception (See Interoreception) and sensitivity of the VO was developed. An important stage in the development of the theory of Q.-v. O. there was evidence of the representation of VO in the KBP (projection zones of VO in the KBP). All this served as the basis for the idea of the corticovisceral nature of some diseases, confirmed by a number of clinical studies (corticovisceral pathology). The idea of K.-v. O. was a further development of the teachings of I. P. Pavlov about higher nervous activity (See Higher nervous activity) .
However, in the light of recent research, the idea of K.-v. O. needs significant additions. Previously, it was believed that the KBP regulates the activities of VOs at all levels of their organization. Modern ideas based on the theory of regulation allow us to doubt that all processes in the body are directly regulated by PBP. Violations of normal K.-v. O. Many diseases (especially those of an infectious nature) cannot be satisfactorily explained. In addition, in modern ideas about K.-v. O. a more important place must be given to the endocrine system - a powerful factor in the regulation of the physiological systems of the human and animal body. The role of different parts of the central nervous system (in particular, the Hypothalamus a) also requires deeper study. ,
being an intermediate link between KBP and VO. Lit.: Bykov K.M., Cerebral cortex and internal organs, 2nd ed., M.-L., 1947; Bykov K. M. and Kurtsin I. T., Corticovisceral pathology, L., 1960; Chernigovsky V.N., Neurophysiological analysis of the corticovisceral reflex arc, L., 1967; him, To characterize the current stage in the development of the concept of cortico-visceral relationships, “Physiological Journal of the USSR”, 1969, v. 55, no. 8. V. N. Chernigovsky.
Great Soviet Encyclopedia. - M.: Soviet Encyclopedia. 1969-1978 .
See what “Cortico-visceral relations” are in other dictionaries:
Interoception (from the Latin interior internal and receptio acceptance, reception), the occurrence, conduction and perception by the central nervous system of impulses appearing as a result of the excitation of sensory endings scattered in the internal... ...
The main part of the nervous system of animals and humans, consisting of a collection of nerve cells (neurons) and their processes; is represented in invertebrates by a system of closely interconnected nerve nodes (ganglia), in vertebrates and... ... Great Soviet Encyclopedia
A set of physiological processes associated with the activity of individual subcortical structures of the brain (See Subcortical structures of the brain) or with their system. From an anatomical point of view, all ganglion formations are classified as subcortical... ... Great Soviet Encyclopedia
Functions (from the Latin functio ≈ execution, accomplishment) are physiological, the implementation by humans, animals and plant organisms of various functions that ensure their vital activity and adaptation to environmental conditions, physiology ... Great Soviet Encyclopedia
I Functions in mathematics, see Function. II Functions (from the Latin functio execution, accomplishment) physiological, the implementation by humans, animals and plant organisms of various functions that ensure their vital functions and... ... Great Soviet Encyclopedia
Basic principles of corticovisceral pathology. The cortico-visceral theory of disease pathogenesis was developed by Soviet researchers (K. M. Bykov, I. T. Kurtsin, etc.) and is based on the reflex theory of I. M. Sechenov, I. P. Pavlov and N. E. Vvedensky.
The basic principles of corticovisceral pathology (K. M. Bykov and I. T. Kurtsin, 1960) are as follows.
- The possibility of reproducing some pathological reactions through the mechanism of a conditioned reflex, which shows the undoubted participation of the cerebral cortex in their pathogenesis. Indeed, after repeated injections of bulbokapkin into animals in a certain experimental setting, A. O. Dolin observed, under the influence only of the experimental setting, the emergence of a cataleptic state characteristic of the action of this poison. In the laboratory of A.D. Speransky, the possibility of conditioned reflex reproduction of anaphylactic shock was proven. There are many facts in the literature indicating the possibility of conditioned reflex reproduction of relapses of other pathological processes.
- A major role in the pathogenesis of corticovisceral diseases belongs to the neurotic state.
As is known, the occurrence of a neurotic state is associated with overstrain of the excitatory or inhibitory processes of the cerebral cortex, as well as their mobility. Overstrain of the irritative process occurs in animals under the influence of agents of great strength or when using conditioned stimuli that are too complex for the animal’s nervous system. Overstrain of the inhibitory process occurs when the period of action of negative conditioned stimuli is prolonged. Finally, impaired mobility is observed with a continuous change from an inhibitory state to an irritable one or, conversely, with a change in the dynamic stereotype.
Some foreign critics of I.P. Pavlov, questioning his research, pointed out that the animals in the pen were to a certain extent fixed. Therefore, in their opinion, the data obtained cannot be transferred to normal conditions. However, back in 1924 in the laboratory of I. II. Pavlov, dogs that were outside the experimental setting developed a neurotic state as a result of flooding. Later, the students of I. P. Pavlov (P. S. Kupalov and others) proved the possibility of studying higher nervous activity and thereby obtaining neuroses in conditions of free behavior of animals.
"Guide to Pathological Physiology",
I.R.Petrov, A.M.Chernukh
In the complex hierarchy of a vertically organized regulatory system, each “floor” has an important place. However, it was the central nervous system that subordinated other links, heading the entire regulatory apparatus. Its effect on internal organs, including the heart and blood vessels, is mediated in two ways (Fig. 1).
Functional visceral pathology (etiopathogenetic formation).
The first path is transpituitary, first through the releasing (realizing) factors of the hypothalamus, then the tropic hormones of the pituitary gland and, finally, the corresponding hormones of the peripheral endocrine glands. The second path is parapituitary: through the channels of neuro-vegetative connections between the center and the periphery.
If the mechanisms of humoral hormonal regulation, in the words of A.F. Samoilov (1960), act in accordance with the slogan “everyone - everyone - everyone!”, then the influence of the autonomic nervous system is carried out according to the principle of “a letter with an address”, i.e. more substantively, and therefore clearly.
G. Bergman (1936), the most prominent representative of the functional trend in medicine of the 30s, wrote about this: “... a functional disorder covers the humoral and neural together,” but “the neural is clinically more visible.”
The formation of visceral functional disorders is mostly caused by a defect in the neurovegetative regulatory pathway and is topographically associated with dysfunction of suprasegmental (subcortical-cortical) autonomic formations.
As emphasized by A.M.Vein et al. (1981), “a feature of the modern stage is the approach to vegetative-visceral disorders as psycho-vegetative ones. We are talking about a combination of emotional and vegetative disorders that arise either simultaneously or in a certain sequence” (our discharge - A.M.).
Accordingly, the formation of functional visceral pathology can be expressed by the following structure: psychogenic (emotional) disorders - "autonomic dysfunction -> somatic disorders. Thus, functional diseases of internal organs in general and the heart in particular are a consequence and an integral part of neurosis, i.e. represent his “somatic response”.
According to the ideas of I.P. Pavlov, neurosis or a breakdown of higher nervous activity develops as a result of a collision (“mistake”) and overstrain of the cortical processes of excitation and inhibition. This interpretation of neurosis has become textbook, although, as I.P. Pavlov himself admitted, it had a significant gap. If all the paths of the process of excitation as one of the “fighting” parties were accurately traced, it remained unclear how it arises and what constitutes inhibition.
On this occasion, I.P. Pavlov wrote: “No matter how significant our experimental material is, it is clearly insufficient to form a general definite idea of inhibition and its relationship to irritation.” At the end of 1934, i.e. shortly before his death, at one of his famous clinical meetings, he spoke even more categorically: “... it is significant that at present we do not know at all what internal inhibition is.”
And he continued: “This is a damned question - the relationship between excitation and inhibition... there is no solution to it.” A quarter of a century later, P.K. Anokhin tried to answer it. In 1958, his monograph “Internal inhibition as a problem of physiology” was published, which contained a number of provisions significantly different from the generally accepted ones.
Some orthodox physiologists perceived them almost as an encroachment on the teachings of I.P. Pavlov. The author himself did not think so, believing that he was following the behest of his teacher, who more than once called for a “decisive attack” on the “damned question” mentioned above.
According to P.K. Anokhin, internal inhibition never acts as an independent nervous process, but arises only as a result of a collision of two systems of excitations and is a means by which a stronger (dominant) excitation suppresses a weaker one, thereby eliminating “ activities that are unnecessary or harmful at the moment.”
Thus, he contrasted the classical formula of “the struggle of excitation and inhibition” as the main cortical processes, “having their own individuality and, to some extent, independence of course,” with another - “the struggle of two excitation systems” with the help of “a universal weapon - inhibition.”
“Excitement,” writes P.K. Anokhin, “can never fight inhibition, because the latter is the result of excitation and immediately disappears as soon as the excitation that gave rise to it has disappeared.”
P.K. Anokhin’s concept captivates with its “tangibility,” vitality, and closeness to clinical reality. It moves the question of internal inhibition from a theoretical one, relating only to physiological laboratories, to a practical one.
In fact, if you think about it, the collision of multidirectional excitations (impulses) and the conflict-free suppression of one of them by another, stronger system of motivations is a universal pattern of our everyday life. Only thanks to this, orderly human behavior and purposeful actions that meet the “relevance of the moment” become possible.
How can one disagree with A.A. Ukhtomsky, who argued that “it is generally difficult to imagine a non-dominant state of the central nervous system, since at each specific moment the body performs some kind of activity.” Overstrain of higher nervous activity, as P.K. Anokhin believes, occurs when competing excitations, for some reason, cannot inhibit each other and, alternately gaining “victories,” are mutually potentiated and stabilized at a new, higher energy level of excitability . A conflict situation arises that persists for a long time - a state of “explosiveness” or readiness for an emotional breakdown.
Although I.P. Pavlov never considered the genesis of inhibition, like neurosis, from the standpoint of the “struggle” of two excitations, he was close to this when he said: “I am interested in a strong irritable process, and circumstances urgently require me to slow it down. Then it becomes difficult for me...”
Personal conflicts leading to neurosis most often develop precisely according to this type: in one or another life collision, some human impulse comes into conflict with another system of excitations, i.e. with the very “circumstances” that for some reason do not allow its implementation.
This leads to a practical conclusion: if in a specific case of neurosis it is possible to hide the content of conflicting excitations, then by strengthening one and weakening the other, one can reduce nervous tension - the other side of the conflict. As a matter of fact, this is the essence and ultimate goal of psychotherapy or, in the words of P.K. Anokhin, “education of inhibition.”
It is no coincidence that definitions of neurosis acquired etiopathogenetic and clinical overtones. Let us present one of them (V.A. Raisky, 1982) in a slightly edited form. Neurosis is a psychogenic (usually conflict-related) functional neuropsychic disorder that occurs under the influence of traumatic stimuli and manifests itself as pathology in the sphere of emotions in the absence of psychotic disorders, i.e. a critical attitude towards the disease is maintained and the ability to manage one’s behavior is not lost.
There are three clinical forms of neuroses: neurasthenia, hysteria and obsessive-compulsive neurosis. 90% of all cases of neuroses occur due to neurasthenia (Votchal B.E., 1965; Svyadoshch A.M., 1982), which precisely serves as the pathogenetic basis of NCA. Neurasthenia was identified as an independent nosological unit by W. Beard in 1880.
Its main distinguishing feature is considered to be “irritable weakness” - easy excitability and rapid exhaustion of patients. V.N. Myasishchev Reveals the essence of the disease as follows: “With neurasthenia, the source of the disease is that the person is unable to cope with the task facing him, even with the most active desire to resolve it.
The contradiction lies in the relative discrepancy between the capabilities or means of the individual and the requirements of reality. Unable to find the right solution with maximum effort, a person stops coping with work and develops a painful condition.”
It is impossible not to notice that in this definition the same “struggle” of two systems of excitations is clearly visible: “an active desire to solve a problem”, on the one hand, and “requirements of reality”, on the other. A. Păunescu-Podeanu, deviating from dry formulations, calls neurasthenia “a disease of an exhausted, exhausted brain”, qualifies it as “a neurosis of tense people, overwhelmed with worries and anxiety, lashed by lack of time”, i.e. "time squeeze neurosis"
In this he sees its fundamental difference from hysteria - “the neurosis of prosperous people who can waste time and are not involved in the struggle with life,” i.e. “neurosis of free, empty time”2. The cause of neurasthenia in general and NCA in particular are psycho-emotional stimuli (psychogenies) that cause negative emotions.
Emotions are mental processes, the content of which is a person’s attitude to the world around him, his own health, behavior and occupation.
They are characterized by such polar states as pleasure or disgust, fear or peace, anger or joy, excitement or release, acceptance or rejection of the situation as a whole. Consequently, the emotional stimulus with its edge is directed towards consciousness. It requires comprehension and an adequate response, and therefore “emotion is an integral part of understanding.”
The phrase of J. Hassett contains a lot of meaning: “Emotions add flavor to life and serve as the source of all life’s dramas.” The scale of psychogenies leading to neurosis is extensive and unequal in value terms: from overstrain due to persistent intellectual activity, prompted by lofty thoughts, to the so-called primitive emotions.
These include everyday, family and other troubles, love troubles, various kinds of frustrations (dissatisfaction), for example sexual ones. Of great importance are the “silent conflicts” smoldering in the depths of consciousness, caused by the clash between needs and possibilities, desire and decency, motives and rules of society, etc., in a word, everything that I.P. Pavlov aptly called “the deceptions of life” .
Particularly pathogenic are situations that are characterized by relative intractability, putting a person before the need to make an alternative decision: “either-or.” From the standpoint of physiology, we are talking about the “mistake” of two highly competitive excitations, when the strengthening of one (inhibitory excitation) induces the other (inhibited excitation) - a struggle of arguments and counterarguments.
Trying unsuccessfully to slow each other down, they stabilize, maintaining a high degree of psycho-emotional tension. One cannot but agree with R. Dubos that “the need to make a choice is perhaps the most characteristic feature of conscious human life. This is its greatest advantage, but also its greatest burden.”
The source of psychogenesis can be not only external (exteroceptive), but also internal (interoceptive) stimuli. We are talking about secondary psycho-emotional disorders associated with the peculiarities of perception, experience and self-esteem of organic pathology, i.e. about the so-called somatogenic neurosis.
It is clear that a person cannot help but be depressed by the deterioration in the quality of life caused by any disease, be it a previous myocardial infarction, repeated bronchospasm attacks, skin diseases, problems with the gastrointestinal tract, etc.
Someone’s expression that “the rectum determines a person’s state of mind” is by no means a caricature. Even the outstanding French thinker Francois Voltaire (1694-1778) did not ignore this. With his characteristic brilliance, he wrote: “How blessed by nature are those people who empty their bowels every day with the same ease as they cough up phlegm in the morning.
“No” in their mouth sounds much more kind and helpful than “yes” in the mouth of a person suffering from constipation.” It is appropriate to recall the “hemorrhoidal character” described by Hippocrates and the common literary type of the “bilious man.” It is no coincidence that the term “hypochondria,” which refers to a painful fixation on one’s health, comes from the Latin word “hypochondricus” - hypochondrium.
As B.E. Votchal wrote, every person who constantly suffers from his illness “involuntarily acquires neurotic traits.” In turn, somatogenically caused psycho-emotional disorders boomerang on visceral symptoms, exacerbating old ones or giving rise to new ones.
A “vicious circle” or the well-known image of a “snake biting its own tail” is created. The formation of emotions is associated with the activity of the limbic system of the brain (limbic-reticular complex), which includes a large group of subcortical formations concentrated around the brain stem (Vein A.M. et al., 1981; Magun G., 1960; Lindsley D., 1960; Cellhorn E., 1961).
On the one hand, the limbic system has neuronal connections with the “new” cortex, in particular the “orbital cortex,” and takes an active part in organizing behavioral and other conscious acts. This is well illustrated by the words of I.P. Pavlov: “The main impulse for the activity of the cortex comes from the subcortex. If these emotions are excluded, the cortex is deprived of its main source of strength.”
I.P. Pavlov’s idea of the “bright spot of consciousness” is also associated with the function of the limbic system. Explaining this, P.V. Simonov writes: “The bright spot of consciousness,” like a spotlight, “highlights” exactly those phenomena in the surrounding world that are currently of greatest importance to the organism.” On the other hand, the higher autonomic centers are concentrated in the limbic system, mainly in the hypothalamus.
Consequently, it is closely connected with internal organs and is endowed with the functions of regulation and control over their activities. Thus, if we use the terminology of A. Clod (1960), the limbic system is a “somato-psychic crossroads”.
Its functional originality is emphasized by other names: “emotional brain (Konorsky M., 1954), “neurovegetative brain” (Fulton 1943), “visceral brain” (McLean, 1949). The formation of emotiogenic (psychogenic) visceral disorders is shown schematically in Fig. 2. In any emotional reaction, two parallel effects can be distinguished.
Functional visceral pathology (etiopathogenetic formation).
The first effect is ascending, or cortical, controlled by consciousness. It determines the sensory coloring of the stimulus and the adequacy of the mental and behavioral reaction to it, including facial expressions, gestures, and words.
It can be suppressed by an effort of will (external calm) and artificially reproduced (acting skill). The second effect is descending, or neurohumoral, escaping cortical control. It has the function of autonomic support of holistic behavior.
On this occasion, P.K. Anokhin wrote: “A person who has subordinated to cortical control all types of external expression of his emotional state, ... with fatal inevitability, “turns pale” and “blushes” due to his visceral organs, and also performs a “facial reaction” due to smooth muscles of their insides"
So, in the clinical understanding, emotion is a psycho-vegetative reaction of the body, where the autonomic nervous system acts as an intermediary between the cerebral cortex and the visceral organs (Topolyansky V.D., Strukovskaya M.V., 1986). In the language of metaphors, which E.K. Krasnushkin, one of the most famous psychiatrists of the past, resorts to, “the autonomic nervous system is the “mouthpiece of emotions,” and the “inner speech” of emotions is a function of the organs.”
This is, in a summary presentation, the physiology of emotions, which, under the circumstances discussed above, develops into their pathology. It manifests itself in the same two directions: ascending (psychoneurosis) and descending (vegetative dystonia). To understand the psychogenesis of neurosis, it is important to keep in mind that the pathogenicity of a psychotraumatic effect is determined not by the “physical strength” of the stimulus, but by its high individual significance, i.e. extreme for a given individual.
Indifferent or insignificant for one, qualitatively the same stimulus is highly relevant for another. Moreover, the main significance is not so much acute severe shocks, which at once age a person for several years, as long-term mental stress, which acquires the features of chronic emotional stress with the formation of a stagnant-dominant focus of excitation, displacing all others - idea fix.
At the same time, “in cases of prolonged and repeated release of emotional excitations onto the vegetative organs, all conditions are created for the emergence of so-called autonomic neuroses,” or otherwise, dysregulatory visceropathies. The role of unreacted emotions is especially important in their development. As P.K. Anokhin emphasized, “when the cortical component of emotion is suppressed, the body’s reaction does not cease to be holistic, but the entire force of central excitations is directed along well-defined centrifugal vegetative pathways” (Fig. 3).
Moreover, “excitements with emphasized intensity rush to the internal organs through the centers of emotional discharge” (our discharge - A.M.). The same meaning is contained in the aphorism of H. Mandsley: “sadness that does not pour out in tears makes other organs cry.”
Functional visceral pathology (etiopathogenetic formation).
Thus, autonomic disorders in neurosis are obligate (Vein A.M. et al., 1981; Svyadoshch A.M., 1982), but the form of their clinical expression is different. In some, they are limited to peripheral (nonspecific) stigmas, in others, certain viscero-organ syndromes are formed, including cardiac syndromes. This is a subject for a separate discussion (see Chapter 5).
Let’s finish with another quote from P. Kanokhin (p. 420): “Which effector path will be prevalent for reaching the periphery of emotional excitement depends on the characteristics of the emotion, the nervous constitution of a given person and the entire history of his life. As a result of these determining factors, we will have in each individual case various kinds of visceral neurotic disorders.
They can affect smooth muscles (pylorospasm, cardiospasm, spastic constipation), have a predominant expression on blood vessels (hypertensive conditions), have access to the heart, etc.” . As clinical practice shows, the heart is the main visceral target of psychoemotional disorders and associated autonomic dystonia.
Introduction
The mechanisms of cortico-visceral disorders that occur during mental trauma, emotional stress, the action of stimuli that are extremely strong or have different biological and social significance are no less complex and multifaceted than the mechanisms that interact with the cerebral cortex with internal organs and visceral-vegetative systems under normal conditions. This is especially true for the central mechanisms associated with the structures of the neocortex, paleocortex and subcortex, which play a major role in the occurrence of psychosomatic diseases that have become widespread throughout the world in recent years.
The cortico-visceral theory was developed in the twentieth century by the school of I.P. Pavlova, namely K.M. Bykov. This is the doctrine of the functional interaction of the cerebral cortex and internal organs. The extension of the concepts of the cortico-visceral theory to the field of pathology has made it possible to understand the role of mental influences in the occurrence and course of certain diseases.
The purpose of this work is to consider the emergence of psychosomatic disorders from the perspective of the cortico-visceral theory. To do this, you must complete the following tasks:
Reveal the general provisions of the cortico-visceral theory;
To determine the influence of cortico-visceral relationships in the occurrence of psychosomatic diseases.
Chapter 1. General provisions of the cortico-visceral theory
1 Historical aspect of the cortico-visceral theory
The Pavlovian school of psychophysiology is one of the most striking and interesting phenomena in Russian science, and the doctrine of conditioned reflexes it develops is often used as the foundation for building natural scientific ideas about man. After the completion of the scientific session of 1950, K.M. became the actual and formal leader of the Pavlovian school. Bykov, who simultaneously led three leading research institutes. Bykov is the author of the cortico-visceral theory. In his opinion, this concept should be considered as an integral part of Pavlovian psychophysiology. The main provisions of Bykov's theory were expressed during Pavlov's lifetime. However, most of the work of this author dates back to the 40-50s, and the theory itself received maximum recognition after the results of research by his students were published in the 60-70s.
The goal of the cortico-visceral theory was to elucidate the mechanisms of influence of the cerebral cortex on the functioning of internal organs. Bykov recognized Pavlov's method of conditioned reflexes as a basic methodological technique that allows one to objectively study intracortical processes. He believed that in order to build a theory of cortico-visceral interactions, it is necessary, firstly, to obtain an accurate criterion for the cortical nature of a particular phenomenon and, secondly, the ability to experimentally influence brain activity. The development of a conditioned reflex leading to changes in the functioning of the organ, Bykov believed, indicates that the regulation of the functioning of this organ is carried out precisely by the cortex, since, in his opinion, all conditioned reflexes in mammals occur with the obligatory participation of the cerebral cortex. At the same time, the method of conditioned reflexes made it possible to make changes in the activity of the cortex during the experiment. Thus, Pavlov's method of conditioned reflexes met both requirements that Bykov considered necessary for the fundamental basis of his theory.
The first fundamental task that Bykov set for himself was to develop and observe conditioned reflexes, during which a change in the physiological activity of as many internal organs as possible occurs.
Bykov and his colleagues focus their attention on solving the following three questions: on proving the fundamental possibility of the formation of conditioned reflexes of internal organs, or, in other words, on studying the connection of the cerebral cortex with the activity of the kidneys, liver and spleen, as well as elucidating the properties of these conditioned reflexes processes; on the study of signal transmission going from internal organs to the cortex and back, i.e. on the study of internal receptors, pathways and their representation in the cerebral cortex; on deciphering the central mechanisms of conditioned reflex activity of internal organs and cortical influences on the general functions of the body.
The first work in this direction was carried out under the direct supervision of Pavlov and concerned conditioned reflex diuresis (urination). During the study, the fundamental possibility of developing a conditioned reflex was established, the effector organ of which is the kidneys. Subsequently, until the beginning of the 50s, Bykov continued to work with conditioned reflex diuresis. The main goal of the research was to determine whether urinary reflexes obey the same laws as salivary reflexes. It was found that urinary reflexes are not qualitatively different from Pavlovian salivary reflexes, since they are inhibited by the action of extraneous external stimuli and are differentiated from similar stimuli. However, a quantitative difference was observed in the rate of formation and extinction of these two types of conditioned reflexes.
Subsequently, the same methodological technique was used by Bykov and his students to study the functioning of the liver, spleen and gas exchange. When carrying out these works, the task was set to experimentally substantiate one of Pavlov’s main methodological postulates: in the body, processes that differ in appearance obey qualitatively identical laws. The functioning of various organs was described by Bykov and his students as being subject to the same fundamental principle. Different reflexes could differ in their quantitative indicators, but they did not differ from each other qualitatively.
The next problem that proponents of the cortico-visceral theory solved was to clarify the mechanisms of impulse transmission from the cortex to the organs. In the original scheme, Bykov recognized the presence of only one type of signal propagation - an electrical impulse transmitted along nerve fibers and leading to changes in the functioning of organs. However, the scientist subsequently abandoned the idea that such a path is the only one. The work of his students showed that it is possible to preserve the visceral conditioned reflex with the destruction of all the nerves leading to the organ. This phenomenon is explained by the presence of a humoral signal transmission pathway additional to the nervous one. In this case, the brain signal is transmitted from the cortex to the endocrine gland, and only then affects the effector organ with the help of a hormonal intermediary. Thus, within the framework of the cortico-visceral theory, ideas have developed about dual (nervous and humoral) cortical control over the functioning of organs.
In 1950, the laboratory was organized by Kurtsin. The main direction of work in the period from 1950 to 1976. - study of the functional relationships of the cerebral cortex and internal organs. The concept of cortico-visceral pathology was developed, and on its basis theories of the pathogenesis of a number of diseases of internal organs were created. In 1976-1987 The laboratory was headed by Doctor of Medical Sciences. N.N. Bellaire. The mechanisms of participation of limbic system structures in the implementation of cortical influences on the functions of internal organs were studied.
Since 1987, the laboratory has been headed by Professor V.A. Bagaev. The main direction of the laboratory's work is the study of brain structures included in the central autonomic nervous network and the mechanisms of their participation in the processes of regulation of the activity of visceral systems and organs. A study of the structural and functional organization of bulbar “stomach” neurons was carried out. The patterns of formation of patterns of their impulse activity, ensuring the implementation of the vago-vagal motor gastric reflex, have been established. The mechanism of its centrifugal modulation has been identified, based on changes in the efficiency of impulse conduction in the system of “gastric” neurons of the vago-solitary complex. Using immunohistochemical and electrophysiological methods, the mechanisms of modulation of forebrain neural systems by interoceptive impulses and the mechanisms of the therapeutic effect of vagus nerve stimulation are studied. The structural and functional organization of amygdalofugal projections to neurons in brain regions associated with the processes of regulation of visceral functions is studied. One of the mechanisms of possible participation of cerebral cortex neurons in the processes of autonomic regulation is revealed. It has been proven that the intervention of neurons of the “visceral” fields of the infralimbic and insular areas of the cerebral cortex in the activity of internal organs is carried out through the interaction of corticofugal impulses and interoceptive signals within the bulbar autonomic centers. A comprehensive morphophysiological study of the organization of areas of the insular region of the cerebral cortex associated with the processes of regulation of autonomic functions was carried out.
The idea of the “visceral” field of the insular cortex is formulated and a scheme of its organization is proposed. The results obtained are important for developing the theoretical foundations of psychosomatic medicine and understanding the principles of adaptation of visceral systems to changing living conditions. In addition to fundamental problems, the laboratory takes part in the development of applied problems. Among them is a series of studies of the mechanisms of formation of vegetative manifestations of hypokinetic syndrome (together with the Institute of Medical and Biological Problems of the Russian Academy of Sciences), as well as the study of postoperative disorders of the motor function of the stomach, small and large intestine and the physiological substantiation of methods of their treatment (together with the Department of Abdominal Surgery of the Military Medical Academy). A number of new methodological techniques and computer programs have been developed, in particular, software for computer recording of the activity of single neurons and construction of post-stimulus histograms in real time, as well as a software and hardware complex based on a personal computer for long-term multichannel monitoring of motor activity of the gastrointestinal tract.
2 Concept of corticovisceral pathology
visceral psychosomatic neurosis
Bykov constantly combined his scientific activities with medical practice. This was the reason for the scientist’s close interest in the problems of human pathologies. Together with I.T. Kurtsin, he developed a special theory of cortico-visceral pathology, which in the 60s was considered as the theoretical foundation of Soviet medicine.
According to this theory, the emergence and development of a number of diseases of internal organs are associated with a primary disorder of higher nervous activity, which can occur as a result of a violation of extero- and interoreceptive signaling. The basis of this disorder is the functional weakening of cortical cells due to overstrain of the strength and mobility of nervous processes, especially the process of internal inhibition. As a result, a breakdown of the functional relationships between the cerebral cortex and subcortical formations occurs, which involves the entire complex of autonomic and somatic functions in the pathological process.
According to Bykov and Kuritsin, with cortico-visceral pathology, a cyclic process occurs: on the one hand, impulses are sent to the organ from the brain centers, changing its function, trophism, blood supply, and on the other hand, impulses are sent to the brain centers, enhancing their pathological activity. Such a disruption of the body’s functioning can be consolidated and maintained through the mechanisms of a conditioned reflex. Within the framework of the concept of cortico-visceral pathology, disturbances in the functioning of the body are considered to be of a psychotropic nature, i.e., new ideas about visceral pathogenesis are emerging. If previously it was believed that aggressive environmental agents always directly affect an organ and lead to its destruction, now representatives of the Pavlovian school proposed the idea that the pathogenic effect of the environment can be mediated by the cortex, i.e. the direct cause of the disease is impaired brain activity. However, cortical activity itself is traditionally presented as conditioned by the external environment and dependent on the environment in which a person lives.
Within the framework of the concept of cortico-visceral pathology, for the first time in the history of Russian psychophysiology, a kind of “inversion” of the psychophysiological problem is observed. If earlier it was posed as a question about the dependence of consciousness on physiological processes, now it is posed as a question about the dependence of physiological processes on consciousness. This is due to the fact that within the framework of this concept, the mechanisms of occurrence of visceral disorders caused by mental changes are discussed. The works of Bykov and Kurtsin constantly explore the pathogenic effects of neuroses and stress. Therefore, we can talk about the emergence of a special psychosomatic problem, which is the reverse formulation of the psychophysiological problem.
An original opinion regarding the theory of cortico-visceral interaction was expressed by V.N. Chernigovsky. As a student of Bykov, he accepted most of the provisions put forward by his teacher, but suggested revising some of them. According to Chernigovsky, the thesis about the absolute dependence of the work of the visceral organs on the cortex cannot be considered true. He believed that from the possibility of influence of the cortex on the functioning of organs identified by Bykov, it does not follow that such an influence is carried out constantly. From Chernigovsky’s point of view, the influence of the cortex is not absolute, since, firstly, there are intracellular processes in the body that, in principle, are not controlled by the cortex, and secondly, all visceral organs are capable of self-regulation (automation), which ensures the functioning of the organ at constant external load. Thus, the essence of Chernigovsky’s objections was that at rest the visceral organs are not subject to the influences of the cortex, but he recognized the presence of cortical control when the external load changes.
Despite some uniqueness of his position, Chernigovsky is considered one of Bykov’s main followers. The team of scientists led by him has done a great deal of work studying cortical-visceral interaction. Particular attention was paid to the problem of the cortex's perception of impulses coming from internal organs. At the same time, in accordance with the principle of the pyramidal hierarchy of organs, the signal perception system was divided into several links: receptor, afferent pathway, subcortical structures, and cortical analyzer. It is interesting to note that Chernigovsky analyzed the process of afferentation as one-sided, i.e. did not consider the reverse influence of cortical activity on receptors.
In the experimental works of Chernigovsky, the structure and physiological characteristics of the receptors and afferent pathways responsible for the occurrence of visceral reflexes were studied. The main research methodology was the observation of changes in electrical potentials arising in receptors and afferent pathways as a result of exposure to various stimuli. The goal of this work was to establish the relationship between the characteristics of the external stimulus and changes in the activity of the sensitive part of the reflex. Then the physiological mechanisms of reflexes at the level of subcortical structures of the brain were clarified, and much attention was paid to the problem of the interaction of various reflexes. To study the cortical analyzers of visceral reflexes, Chernigovsky used the technique of evoked potentials. The essence of this method is to repeatedly present identical external stimuli to the subject and record electrical responses to them. The responses recorded over multiple presentations are averaged, thereby revealing a stereotypical repeating component of the brain response. It can be noted that this technique is used to study the brain by all psychophysiological schools, both in our country and abroad, however, the goals and objectives that researchers set for themselves may vary significantly. In Chernigovsky's studies, the analysis of evoked potentials was carried out to establish the exact cortical representation of visceral reflexes and to establish the paths of excitation propagation throughout the cortex. These experiments confirmed Bykov's earlier conclusion about the multiple cortical representation of such reflexes, i.e. the principle of duplication of both analyzer and effector structures has been confirmed.
According to Zacharzhevsky, the absolutization of cortical control of visceral functions naturally affected the attitude of the authors of the cortico-visceral concept to the problem of psychosomatic relationships. The genesis of a wide variety of diseases of internal organs and systems began to be directly linked to the primary disruption of the activity of the cerebral cortex. Such an interpretation of the nature of psychosomatic relationships could not but lead to the idea of the actual defenselessness of visceral systems from psychogenic influences. At the same time, many studies have shown that parietal digestion, basal vascular tone and autoregulation of vascular tone, regulation of the pumping function of the heart are not controlled by nervous mechanisms. Their high degree of self-regulation is ensured by intraorgan nervous structures (metasympathetic nervous system).
The founders of the cortico-visceral theory also sought to consider the issue of the specificity of diseases of internal organs, believing that the main thing here is the conditioned interoceptive connection formed with the internal organ as a result of its repeated “traumatization”. Having become an important stage in the formation of the physiological foundations of psychosomatic addictions, the cortico-visceral theory at the same time was not without shortcomings. It did not fully take into account that between the cerebral cortex and the internal organ it regulates there are a number of intermediate links (in particular, the hypothalamic and endocrine), without which the mechanism of psychosomatic disorders cannot be explained. She excluded from her consideration the actual psychological aspect of the study of psychosomatic relationships, the role of personality as the highest form of regulation of human activity in the formation of this pathology, and any attempts to meaningfully understand psychogenic factors in their etiological role in psychosomatic disorders. The requirements to extend the concepts of higher nervous activity to personal functioning, the system of significant relationships of the individual and their violations, naturally, could not be realized either theoretically or methodically.
The cortico-visceral theory in the works of a number of its successors was enriched with new information concerning the concept of the reticular formation as a morphological substrate of powerful influences on the cerebral cortex from its subcortical-stem sections, data from modern neurochemistry and neuroendocrinology, which made it possible to better understand the mechanisms of interaction of disorders of higher nervous activity and vegetative-endocrine-metabolic disorders. Essentially, these studies reflected a broader understanding of corticovisceral pathology with the desire to take into account the entire complex of biological, psychological and social factors in its genesis.
Chapter 2. Causes of ASR within the framework of the cortico-visceral theory
Bykov put forward the following provisions about the mechanism of occurrence and development of corticovisceral diseases. The normal active state of the cerebral cortex, due to negative induction, inhibits the activity of the subcortex. With pathologically weakened or inhibited cortical activity, the activity of subcortical centers increases due to positive induction. Freed from the regulatory influence of the cerebral cortex, this activity acquires a disorderly, chaotic character. In the subcortex, most often in the hypothalamic region, stagnant pathological foci of excitation are formed. Increased excitability of the subcortical centers leads through the neurohumoral route, mainly through the pituitary gland, thyroid gland, adrenal glands and other endocrine glands, to the emergence of pathologically enhanced various vegetative reactions - vascular, motor, secretory - from the internal organs. Violation of the regulatory influence of the cerebral cortex determines that functional changes in the activity of internal organs are long-lasting and persistent. Over time, this causes the development of anatomical changes in organs and tissues. Thus, disorders that are initially purely functional in nature later develop into typical organic diseases.
1 Gastric ulcer
According to the cortico-visceral theory, peptic ulcer disease is the result of disturbances in the cortico-visceral relationship. Progressive in this theory is the proof of two-way communication between the central nervous system and internal organs, as well as the consideration of peptic ulcer disease from the point of view of a disease of the whole organism, in the development of which a disorder of the nervous system plays a leading role. The disadvantage of the theory is that it does not explain why, when the activity of cortical mechanisms is disrupted, the stomach and duodenum are affected.
Currently, there are sufficient convincing facts showing that one of the main etiological factors in the development of peptic ulcer disease is a violation of nerve trophism. An ulcer arises and develops as a result of a disorder in the biochemical processes that ensure the integrity and stability of living structures. The mucous membrane is most susceptible to dystrophies of neurogenic origin, which is probably explained by the high regenerative ability and anabolic processes in the gastric mucosa. Active protein-synthetic function is easily disrupted and can be an early sign of degenerative processes, aggravated by the aggressive peptic effect of gastric juice.
The works of N. Selye (1953) showed that the mucous membrane of the digestive apparatus is most susceptible to dystrophies of neurogenic origin. As a result of research conducted over many years by employees of the Department of Faculty Therapy of the National Medical University (Kyiv), the neurotrophic theory of peptic ulcer disease was further developed. It has been established that peptic ulcer disease develops against the background of a disorder of the higher hypothalamic centers for the regulation of neurotrophic processes, while the tone of the parasympathetic part of the nervous system increases and the tone of the sympathetic part of the nervous system decreases. As a result, metabolic processes are disrupted, both in the suffering organ and in the liver, protein and amino acid synthesis, electrolyte and vitamin metabolism in the body of patients.
In the mucous membrane of the gastroduodenal zone, energy production and protein synthesis decrease, as can be judged by the increase in the pool of free amino acids in the mucosa, which are not sufficiently included in protein synthesis: catabolic processes intensify, as can be judged by the high activity of lysosomal enzymes, and the activity of major and parietal enzymes increases. cells, microcirculation and the state of local immunity are disrupted. This is associated with neurotrophic disorders, since, as shown by electron microscopy, in the nerve endings of the gastric mucosa the number of cholinergic vesicles, indicating parasympathetic (vagal) activity, increases, and the number of adrenergic granules, indicating sympathetic activity, decreases. Considering the fact that the vagus nerve ensures cell differentiation, and gastrin ensures their proliferation, it becomes clear that increased vagal impulses cause accelerated cell maturation, premature aging and death of young cells, which leads to a decrease in the resistance of the mucous membrane of the stomach and duodenum.
According to modern concepts, trophic processes are regulated by the subcortical vegetative apparatus, which is in close interaction with the cerebral cortex. This makes clear the role of the central nervous system in the development of ulcerative-erosive lesions of the gastroduodenal zone during peptic ulcer disease.
2 The influence of psychogenic stress and hormones on the occurrence of PSD
Already the first use of ACTH and glucocorticoids in clinical practice attracted the attention of doctors to mental and psychosomatic disorders. It turned out that intensive introduction of ACTH, cortisone, hydrocortisone into the body causes delirium, insomnia, euphoria, and depression in a person. During psychogenic stress, excitation that covers the cortical representation of the thyroid gland (the anterior part of the cerebral hemispheres) and the projection zone of the vagus nerves, through a number of subcortical nervous structures (caudate body, thalamus), reaches the anterior and posterior hypothalamus and is directed to the thyroid gland. A morphological study of the thyroid gland of dogs that were in a state of experimental neurosis with increased gas exchange for a long time (from 4 to 8 years) showed that the gland can maintain hormonal activity for several years without pathological changes in its structure. The thyroid gland is connected to the brain centers and feedback, through which they receive feedback about the state of the cells and the rate at which it enters the bloodstream. This is evidenced by: 1) reproduction of pathological disorders of higher nervous activity, vascular tone, gastric secretion and gas exchange typical of psychogenic stress; 2) disorders of cardiovascular and respiratory activity, shifts in metabolic reactions; 3) changes in the bioelectrical activity of the thyroid nerve, hypothalamus and cerebral cortex when the gland receptor is irritated.
At one time, the famous Russian therapist S.P. Botkin said that anger, various kinds of losses, and fear can cause the development, sometimes extremely quickly, within a few hours of the most severe and characteristic symptoms of Graves' disease. Moreover, he argued that the influence of mental factors not only on the course, but also on the development of this form is beyond the slightest doubt. This was associated with a disorder in the activity of the cerebral cortex and subcortical brain centers.
Of particular interest are the observations of N.N. Prosvirina, which she produced on men with functional disorders of the reproductive system. It turned out that this category of patients had a sharp disturbance of higher nervous activity, which she determined by conditioned vascular and respiratory reflexes. An inert pathological focus of excitation in the second signal system (focus on the disease) and significant inhibition of indicative, unconditioned, conditioned first-signal and conditioned second-signal reflexes (from 56 to 78%) were discovered. After completing the appropriate course of treatment, these pathological phenomena disappeared, higher nervous activity was normalized, and sexual function was restored in patients.
visceral theory psychosomatic neurosis
Conclusion
Thus, representatives of the cortico-visceral theory associated the occurrence of psychosomatic disorders with a primary disruption of cortical mechanisms, which, in turn, control the visceral organs. The triggering mechanism for psychosomatic diseases is also factors of the external and internal environment, leading to a conflict situation between excitation and inhibition in the cortex and subcortex.
However, the connection between the form of the disease and the content of the psychological conflict was considered by supporters of the cortico-visceral concept as a random coincidence, since they considered the main cause of the disorder to be the strength of excitation in neural circuits, which is perceived by a person as a strong emotional experience. A somatic disorder can arise only if, at the time of a strong experience, some organ of the body, due to a fatal coincidence, had an unsatisfactory functional state. In other words, the physiological system, weakened at the moment of experience, is involved in the pathological process, regardless of the psychological meaning of the intrapersonal conflict or the problem that caused strong feelings.
Thus, psychosomatic relationships in the neurobiological interpretation are understood either as the influence of emotions accompanying an existing disorder on the dynamics of the pathological process, or as a breakdown of the “weak link” in the morphological structure of the body under the influence of strong affect. The triggering function of emotions in the development of the pathological process is also highlighted.
So, the very definition of Pavlov’s approach to the problem of psychosomatics indicates that the psyche here means the psychophysiological activity of the higher part of the central nervous system - the cortex. It is believed that all internal organs have their representation in the cerebral cortex.
Bibliography
1. Bykov K.M. Issues of corticovisceral physiology and pathology of neurohumoral regulation: Physiology and pathology of digestion. - M., 1958.
Bykov K.M. Cerebral cortex and internal organs. - M., 1954.
Bykov K.M., Kuritsin I.T. Cortico-visceral pathology. - L., 1960
Karvasarsky B.D. Medical psychology. M., 1992.
Kurtsin I.T. Theoretical foundations of psychosomatic medicine, Publishing house "Science", Leningrad. department, L., - 1973, p. 336.
Prosvirina N.N. Higher nervous activity in men with functional sexual disorders, 1966.
Rikkl A.V. Nervous regulation of the interaction of autonomic functions. - L., 1961.
Savostyanov A.N. Comparative analysis of methodological approaches in various areas of Russian psychophysiology // Philosophy of Science. - 1999. - No. 2 (6). - pp. 74-79
Chernigovsky V.N. To characterize the current stage in the development of the concept of cortico-visceral relationships // Physiol. magazine THE USSR. - 1969. - T. 55, No. 8. - P. 904-911.
Chernigovsky V.N. Neurophysiological analysis of the corticovisceral reflex arc: representation of internal organs in the cerebral cortex. - L., 1967. - P. 5-32.
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CORTIC-VISCERAL PATHOLOGY - a theoretical direction in medicine of the 20th century; postulates the possibility of reproducing pathological visceral reactions by conditioned reflex. Formulation of the concept of K.-v. p. is historically associated with that stage of ideas about the structural and functional organization of conditioned reflexes, when the input and output links of their arc were usually localized within the cerebral cortex. The cortico-visceral theory of pathology developed by K. M. Bykov and other students of I. P. Pavlov, vulgarizing the teachings of the great physiologist, asserted the decisive role of the cerebral cortex in the development of almost all diseases; at the beginning of the 2nd half of the 20th century. this theory, which received support from the party and state. leadership of the country, was declared the banner of the Soviet Union. medicine, both theoretical and clinical, - a comprehensive theory of medicine, a guide to diagnosis (encephalographic study of higher nervous activity in each disease, etc.), treatment (for example, the unrestrained expansion of electrosleep therapy) and prevention (the so-called protective regime in medical institutions, etc.). Like any attempt to universalize particular patterns and create a unified medical system. "system", this concept proved fruitless and was rejected by clinical practice. In modern science, higher nervous activity is considered as a complex multi-level, multi-channel afferent-efferent organization. Conditioned visceral reflexes in their manifestations are much less related to the functions of the cerebral cortex than skeletal-motor ones. Therefore, impulses from internal organs under normal conditions mostly remain outside consciousness. The term "cortico-visceral pathology" has lost its original meaning. It became clear that any form of pathology of internal organs is primarily mediated through the excitation of the corresponding subcortical structures of the brain and, due to the activation of emotional arousals, spreads to the cerebral cortex.
The ideas of I.M. Sechenov about the reflex nature of mental activity, developed in the teachings of I.P. Pavlov on higher nervous activity, and the work of K.M. Bykov and colleagues showed that by conditioned reflex it can not only be caused, but also changed any vegetative function, including the activity of the endocrine glands, the blood system, as well as the permeability of cell membranes, metabolic processes, thermoregulation, etc. This is how the teaching of K.M. arose and was formed. Bykova about the functional relationships between the cerebral cortex and internal organs(cortico-visceral physiology). Subsequently, it was found that with the emergence of a pathological condition of the cerebral cortex, viscero-vegetative disorders develop. In general pathology, a new direction arose - cortico-visceral pathology, which developed the idea of cortico-visceral genesis of a very large group of human diseases that are objects of psychosomatic medicine.
The cortico-visceral theory has made it possible to make significant progress in understanding the etiopathogenesis of not only a large group of functional diseases of internal organs (secretory disorders of the gastrointestinal tract, stomach, liver, intestines, pancreas, endocrine disorders such as diabetes mellitus, thyrotoxicosis, impotence, etc. ), but also diseases with organic manifestations (duodenal ulcer, atherosclerosis, hypertension and hypotension, angina pectoris, bronchial asthma, myocardial infarction).
Together with I.T. Kuritsin, he developed a special theory of cortico-visceral pathology, which in the 60s was considered as the theoretical foundation of Soviet medicine. According to this theory, the emergence and development of a number of diseases of internal organs are associated with a primary disorder of higher nervous activity, which can occur as a result of a violation of extero- and interoreceptive signaling. The basis of this disorder is the functional weakening of cortical cells due to overstrain of the strength and mobility of nervous processes, especially the process of internal inhibition. As a result, a breakdown of the functional relationships between the cerebral cortex and subcortical formations occurs, which involves the entire complex of autonomic and somatic functions in the pathological process.
According to K.M. Bykov and I.T. Kuritsin, with cortico-visceral pathology, a cyclic process occurs: on the one hand, impulses are sent to the organ from the brain centers, changing its function, trophism, blood supply, and on the other hand, impulses are sent to the brain centers, enhancing their pathological activity. Such a disruption of the body’s functioning can be consolidated and maintained through the mechanisms of a conditioned reflex. Within the framework of the concept of cortico-visceral pathology, disturbances in the functioning of the body are considered to be of a psychotropic nature, i.e., new ideas about visceral pathogenesis are emerging. If previously it was believed that aggressive environmental agents always directly affect an organ and lead to its destruction, now representatives of the Pavlovian school proposed the idea that the pathogenic effect of the environment can be mediated by the cortex, i.e. the direct cause of the disease is impaired brain activity. However, cortical activity itself is traditionally presented as conditioned by the external environment and dependent on the environment in which a person lives.
It is especially interesting to note that within the framework of the concept of cortico-visceral pathology, for the first time in the history of Russian psychophysiology, a kind of “inversion” of the psychophysiological problem is observed. If earlier it was posed as a question about the dependence of consciousness on physiological processes, now it is posed as a question about the dependence of physiological processes on consciousness. The fact is that within the framework of this concept, the mechanisms of occurrence of visceral disorders caused by mental changes are discussed. In the works of K.M. Bykov and I.T. Chicken is constantly studying the pathogenic effects of neuroses, stress, etc. Therefore, we can talk about the emergence of a special psychosomatic problem, which is the reverse formulation of a psychophysiological problem.