Abstract correcting edit summary
The term hysteria original comments as "too sick mind", also known as hysteria, is a more common neuropathy, more common in rural communities. Now that the hysteria over a vulnerability in patients with suggestive, hi exaggeration, such as emotional and highly self-centered character, often because of mental factors in causing disease or adverse implied. Can present a variety of clinical symptoms, such as sensory and motor function disorder, visceral organs and autonomic nervous system dysfunction, and psychosis. Such symptoms without organic damage to the foundation, it can arise by implication, can change or disappear due to imply.
Hysteria - Basic Overview
Hysteria is more common in the clinical subjects of a neural disorder, but the incidence declined in recent years. Psychological consultation in general hospital outpatient, the disease is also rare, accounting for only 0.3% of all consultation cases.
Patients of this disease have been feeling sick before the regular rich and full of fantasy, imitate, vulnerable to suggest that such self-centered personality. Such people often a social factor in some mental stimulation or implied, the sudden appearance of temporary mental disorder or motor, sensory, autonomic, visceral aspects of disorder. These symptoms may suggest the production, also by implication away, and. Most age of onset of the disease in 16 to 30 years old, female is far more common in men.
Hysteria for a variety of performance, there is the motor, sensory and other nervous system disorders like symptoms, but also a variety of visceral disease symptoms similar subjects, but also short-term episodes of psychiatric symptoms (abnormal psychology symptoms). Hysteria can be said that the performance of the clinical subjects can imitate the performance of any disease, so easily misdiagnosed. There are many initial diagnosis is hysteria, and in fact is physical disease, and thus delay treatment of the lesson. Therefore, the clinical hysteria to make the right judgments, the difficulty is greater, particularly those speaking for the lack of clinical experience, Do not, under the diagnosis of hysteria.
However, the first attack of hysteria, the vast majority of a certain incidence of mental stimulation, and later met a similar stimulus, or the patient recall the case of this kind of stimulation can also promote hysteria recurrence. In addition, the hysteria arising from a variety of performance, whether sensory dysfunction, movement disorders, visceral lesions, etc. The clinical symptoms are often varied and easy to change the disease by suggesting the performance, extent, and these lesions often do not meet performance human anatomy and physiology or disease on the inherent characteristics of the law, which for the right to judge hysteria is helpful. Mental symptoms of hysteria can be varied, but the symptoms presented and the performance characteristics of vent, makes a deep impression, and some can also be naive of the emergence of many movements, behavior, or running away from home, wandering around, etc..
Hysteria - etiology
Mental factors and the implied effect is the main reason the disease hysteria. However, when people are mental factors and the implied role of the future, why some people stay healthy, some people are suffering from hysteria? This difference related to their personality. Hysteria in patients with premorbid personality, emotions are strong, the lack of strong intellect, will, unstable, fantasy and more belligerent, vanity, emotional instability, impulsiveness.
Such a person who has the following characteristics:
(1) emotion instead of reason: a person who hysteria are highly emotional, strong and stable emotional reactions, easy to shift from one emotion to another emotion, usually doing things they were emotional, the mental activities are vulnerable to emotional the effects of extreme trends. If someone has a good impression, I felt he was perfect, the world's few good guys, but when we had some minor issues when people immediately think that nothing is the biggest villain. This is the hysteria of those "emotional logic." Completely from the time of its Judgement, the emotion, feelings have changed, also changed its Judgement.
(2) implies strong: their emotions and behavior are vulnerable to other people's words and acts imply that impact, especially when he was a good impression on someone, then that person's views would not blindly accept the increase of down. Their self-talk is also very strong that the body does not make sense of all kinds can be used as the basis for self implies.
(3) self-centered and a good fantasy: that they may boast of themselves, show themselves willing to become a center of attention, like the praise by others. They are rich and vivid imagination, especially when a strong emotional response, the imagination and reality often confused with, so sometimes they are not sure in the end is the imagination or the truth, resulting in the impression he was lying.
Hysteria frequently-occurring disease in 16 to 30 years old, women outnumber men. Mental factors and the implied role in the pathogenesis of hysteria. Fear, humiliation, grievances, unsatisfactory, and their loved ones away from the more intense the trauma, is often the first incidence of hysteria in the incentive. As for the disease, may not have very strong spiritual element. May also be associated with trauma cases, or in connection with the first onset of scenarios similar to creating an association of a sudden onset. Some patients may be due to physical factors, such as pain, fever, malaise, fatigue, etc., causing fear or mental stress and unhappiness and disease.
Suggesting a pathogenic role. Talk of special significance, expression and legends, as well as see other patients may become a cause of disease, or through their own experience and Lenovo, have misgivings about the disease and the disease they will believe it is the role of self-implied. Patients vulnerable to suggest, is the hysteria caused by personality.
Hysteria - clinical symptoms
Hysteria is extremely complex and diverse clinical manifestations, the symptoms can be similar to many diseases, account for almost all branches of medical clinical symptoms of the disease. Some people say "the symptoms of hysteria, including the medical content." France Shack said the patient as a "great imitator" and also called the patient is "bad actors, the various roles can play," "naughty children, mischief," and so on, which shows that hysteria performance of strange, full of wonders which a doctor can not completely describe all the symptoms of hysteria.
Classification of mental disorders in China's revised second edition will be the clinical manifestations hysteria is divided into two types: ① separation symptoms: the main manifestations of psychiatric symptoms; ② conversion symptoms: mainly for the physical dysfunction. In the same patients are often only 12 kinds of symptoms, and symptoms of each attack and more for the same duplication. Hysteria is a clear mental factors, such as life events, inner conflict or emotional, implied or implied by self-induced mental disorders. Most of onset was 35 years ago, abrupt onset, mainly based on non-organic sensory or motor deficits, or altered consciousness. Specific performance of the following:
(1) hysteria disorder, also known as type separation barrier.
① emotional outbreak: patients affected by mental stimulation in order to vent after the sudden appearance of clinical symptoms characterized. Wailing cries, noises and, to a grossly exaggerated gestures to tell people suffered grievances and unhappiness, and even lamented kicking foot to head against a wall, or rolling on the ground, but no significant disturbance of consciousness. Attack duration and the surrounding environment. The outbreak of hysteria in patients with affective is the most common mental disorders.
② consciousness: the performance of the consciousness dim state, or sleeping, the patient suddenly collapsed, calling for should not, push the fixed; hysterical twilight state of excitement, emotion, or have hallucinations, illusions; hysterical fugue disorder, patients exhibited from family leave, wander; Hysterical Dream-line disease, sleeping in the bed, open the door to go out or make some moves later recovery sleep; hysterical pseudo-dementia, expression childish, irrelevant answers, or similar but not the right answer.
③ Hysterical psychosis: patients with emotional expression, speech messy, short-lived hallucinations, delusions, blind run or assault and breaking things, generally last for 3 to 5, Ji Yu.
④ Hysterical ghost possessed: common in rural women, attack the narrow sense, to dead relatives or neighbors for many years the tone of speech, or claimed to be the embodiment of certain gods, or into the netherworld, said some "hell" things, and superstition, the religious or cultural backwardness.
(2) Hysterical physical barriers, also known as transformational hysteria.
① sensory disability: sensory loss, patients can only be a slight feeling of strong stimulation or no perception, characterized not by anatomical distribution, which can not be explained by the knowledge of neuropathology: hypersensitivity, the patient's touch particularly sensitive to the local , very slight touch or feel pain disorders; feeling abnormal, the patient felt a foreign body or obstruction of the throat, as if spherical objects moved up and down, but check Quewu abnormalities found in the throat; visual impairment, blindness common are sudden, there are amblyopia, centripetal vision narrowed, but fundus examination was normal, Double Vision light reflex well, patients can not see anything, but avoid obstacles when walking; hearing impairment, mental factors in the strong, the sudden loss of hearing both ears, but the voice from the back reaction can be caused by blinking, sleeping in can be a wake-up, objective examination Wu positive discovery; psychogenic pain, in the spirit stimulated by the emergence of severe headache, back pain or pain in other parts of the body, but the objective Check the appropriate organic disease was not found.
② movement disorders: seizure, often due to psychological factors. Sudden onset often fell to the ground, body stiffness, was opisthotonos, sometimes irregular twitching, shortness of breath, should not be called back, and sometimes pulling hair, torn clothing, face pain. An attack up to tens of minutes or hours, with hints of change around them, attacks a day, many times; paralysis, paralysis or paraplegia with more common, and sometimes quadriplegia, a more acute onset, degree of paralysis can be light Re. Light activity but can weakness, severe cases can not activities. Check does not meet the objective characteristics of nerve damage, limb paralysis usually no muscle atrophy, reflex normal, no pathological reflex. A small number of improper treatment, paralysis time for a visible disuse atrophy; aphonia, the patient does not maintain the language, gestures or Shuxie used to express their views. Objective examination of the brain, lips, tongue, palate or vocal cords no organic damage.
③ somatization disorder: A mainly gastrointestinal symptoms, but also showed symptoms of urinary system or the cardiovascular system. May present with abdominal discomfort, nausea, abdominal distension, anorexia, vomiting and other symptoms can also be manifested as urinary frequency, urgency and other symptoms, or showed tachycardia, shortness of breath and other symptoms. The so-called "possessed by spirits" is a more common form of hysteria attack, occasionally seen in schizophrenia and other mental disorders. This situation more common in good emotional and full of fantasy, or people with superstitions, especially rural women, more common. First, the patients believe in the supernatural existence of ideological basis, there is easy to accept the implied character, in the spirit of strong stimulation, in the case of self-consciousness, through self-suggestion, such as suspicious will be possessed by spirits, or the environment or others words imply, the patient claimed to certain gods, the incarnation of the soul has been dead, then the patient often possessed by persons of these tone, as speech, tone becomes special, speech content and then the inner experience of the patients. And can take minutes or hours, by suggesting treatment, patients can quickly restore its own identity, can be part of the memory after attack after attack.
"Possessed by spirits" itself is merely a symptom of mental illness is a strong emotional response in patients under a morbid experience, to the dead, spirits of the tone of speaking out her thoughts and requirements. Only the patients themselves believe that the existence of ghosts, when they fall ill to appear, "spirits possessed" symptoms. Conversely, people who do not believe in ghosts, no matter how fall ill, it does not appear such symptoms. At present the rural and culturally backward, feudal superstition prevailing circumstances, some patients with diseases that caused hysteria in some of the so-called "possessed by spirits," the phenomenon itself is not terrible, horrible, some witch God take this opportunity to promote Chinese superstition, Kengpian the patient's money, Cui Can the patient's mind and body. Hope that the majority of patients and patient relatives believe in science, not on when those charlatans.
"Old Niu big breath holding" is a form of hysteria, hysteria in rural areas accounted for half of the patients, accounting for hospitalized patients with hysteria 1 / 5. More common in excitable, emotional, opinionated young woman, once against his own wishes, not reach his argument defeat the purpose or to feel wronged and disease. Performance was noted in the location and occasion suddenly fell to the floor, sofa or have to rely on Department to seek sympathy, while the limbs were no laws or tamper with or stiff limbs motionless, his mouth shout, curse, or do odd samples and with deep breath or sigh, breathe. Although the question of did not answer, but unconscious obstacles and respiratory arrest, the patient can hear, see and move around the human response, the attack is also fluctuate. No incontinence episodes and biting tongue, the body very little trauma. Attack at least half an hour or several hours, more during the day, safe and to where the disease is not due to disease and injury or fatal. Normal behavior after the onset of illness, the situation may be completely or piece of memory, after the disease often say: "The mind is clear, that is their own could not help myself."
Hysteria - differential diagnosis
(1) grand mal epilepsy: general non-psychological factors, complete loss of consciousness, incontinence, pathological reflex positive, suggesting that treatment fails, can identify information.
(2) reactive psychosis: a longer course, often a strong history of trauma, symptoms were intermittent, disorderly movements without purpose, suggesting that such treatment can help identify the general invalid.
(1) more common in young women.
(2) acute onset, often a strong emotional experience of suffering mental factors or other incentives.
(3) may have psychotic symptoms, movement disorders, sensory disturbances and autonomic dysfunction and other symptoms much less characteristic signs.
(4) of the patients most affected by psychological factors or implied, or onset of the symptoms disappear.
(5) regular physical examination and laboratory tests found no abnormalities.
(1) remain calm, patient placed in the room so quiet and loud sound isolation.
(2) can be used suggest treatment, or acupuncture people, gu, Tsusanli and springs, etc. The main point, together with the song pool, Sanyang pay, less so with point between the treatment.
(3) psychological treatment to help patients find the causes and impact of disease onset recovery factors.
(4) severe cases, can be taken to the hospital for further treatment.
Hysteria - treatment
Because the disease is under the spiritual factors of acute onset, duration of clinical signs may be different as there are differences. Emotional outbreak of consciousness, convulsive seizure, usually within a short time disappeared, but often had recurrent tendency. Visceral dysfunction and motor, sensory symptoms are lasting longer, and in turn for the better can be re-issued after. Course of disease and is able to return depends on whether the disease correctly. Improper handling or receiving bad implies, in particular medical staff improper language, and often increase the persistence of the disease, Er Shi extension of the course. Thus, prompt treatment, including psychological treatment, suggesting that treatment and drug therapy, appropriate treatment, the symptoms can disappear relatively quickly, but also the effect of the consolidation, to avoid recurrence.
The prognosis is generally good, a small number of patients if the course is very long, or frequently repeated seizures, the treatment is difficult, with the obvious hysteria treatment of personality traits are more difficult, and easy to relapse. Very few showed paralysis or visceral dysfunction in patients with hysteria, if not timely and appropriate treatment, prolonged course, can seriously affect the work and life skills, life can be affected by complications.
The treatment of hysteria is easy also the most difficult, the key is to be enthusiastically medical staff were concerned, to help them find the reasons for the disease, and guide patients to treat the disease properly, confidence in conquering the disease, the disease is cured the joint efforts of doctors and patients results. The treatment of hysteria to psychological treatment, supplemented by drug therapy.
(1) Psychological treatment
① interpretative psychotherapy: let patients and their families know that hysteria is a functional disease is completely curable. Patients and their families to eliminate all doubt, the emotional stability of patients, so patients and their family members have a correct understanding of hysteria, and actively cooperate with medical treatment. Guide patients about the causes and the relationship between the etiology and treatment, patients should be given the opportunity to enjoy catharsis, consolation or encouragement to give appropriate. The patients themselves should also strengthen the self-exercise, a rational attitude all facing, but not emotional, with a pro-active stance to overcome the character deficiencies.
② suggest treatment: the elimination of symptoms of hysteria, particularly hysteria effective way of physical obstacles. Implied in the implementation of the treatment should be aware of the following issues: on the one hand, treatment of the environment to be quiet, to eliminate all adverse environmental impact on patients. All officers are to leave the treatment unrelated to the scene, avoid panic-stricken families or attitude of the people around, or too concerned about the Er Shi symptoms worsened to the treatment difficult. On the other hand, doctors in earnest after detailed history taking, in contact with patients and do a comprehensive inspection process, the attitude should be warm and calm, confident, and should have confidence that a good physician-patient relationship, in which patients trust doctors. Practice shows that the degree of patient trust in the doctors suggest the treatment is often decided the key to success. In the words suggest, it should also take appropriate measures for the symptoms, such as oxygen inhalation, acupuncture, vitamin C given to water for injection or intramuscular injection, intravenous injection of calcium and excitation treatment.
③ Hypnotherapy: Using hypnosis to change when the physiological functions of the brain, through his words, to impose implied, to achieve the purpose of eliminating symptoms of hysteria.
(2) drug treatment
Hysteria attack, if a patient's consciousness disorder deeper, are not easy to suggest treatment, can be combined with chlorpromazine or promethazine hydrochloride in the 25 ~ 50mg, or stability is 10 ~ 20mg, intramuscular injection, in which patients Shen sleep, many patients wake up after symptoms disappeared.
(3) physical therapy
Chinese medicine, acupuncture, or acupuncture, etc. can receive better treatment efficacy in treatment can be verbal, such as implied a better effect. Seizures, twilight state, comatose, stupor state of the patient, can Renzhong, gu, within the relevant acupuncture points are stimulated with a strong power to enhance or stimulate. Of the paralysis, contracture, hiccup, and vomiting, to DC power excited induction therapy or acupuncture treatment. On aphonia, deafness psychosis, but also electrical stimulation therapy electric excitement.
Although the clinical manifestations of hysteria in complex and diverse, but can be summed up in two types of categories: first, separate type, the main manifestations of psychiatric symptoms; Second, conversion type, mainly for the physical dysfunction.
Hysteria psychiatric symptoms, often after the onset of mental stimulation, showing different levels of consciousness and emotional disorders, patients with strong sense of emotional, exaggerated, affected and vulnerable implied. Dim state of consciousness to more common, limited awareness and emotional experience related content, giving a field show or "vent" impression. Some consciously wronged; some panic apprehension; some emotional eruptions, irritability, or crying laughing, wring hands over to head against a wall, rolling on the ground, dancing, tearing clothing, singing swear so dramatic like chaotic performance; have drowsiness; some hyperventilation; some convulsive seizure; some with vivid facial expressions, exaggerated movements in order to win the attention of bystanders and sympathy, the more crowded places, the more powerful attack. Therefore, the attack should put the patient in a quiet environment, and should minimize the accompanying person, to stabilize the patient's mood, symptoms and signs prompted.
Hysteria has a seizure and overstate the implied features of easy, obvious emotional symptoms with color, and even gives the artificial impression, you can suggest or imply that under the incidence of self can also be improved in the cue. Hysteria as clearly as the onset, the presence of people not to panic, not to blame patients malingering. Correct approach is to calm the tense atmosphere that is not negative nor exaggerated the symptoms, so patients to calm down, so I believe can be improved to a certain stimulus, stimulation or acupuncture in patients randomized to gu, people, relations within and other points, let it calm, ready for relief. For a "big cow suffocating," who, should not cover your mouth and nose, buckling legs, to avoid suffocation. Hysterical excitement or physical impairment, should be timely to find psychiatrists. Some people to avoid unpleasant incidents, or to obtain compensation, or to avoid service, or prisoners, often appear malingering behavior, their performance is sometimes difficult to be differentiated with hysteria. Exaggerated due to hysteria, performing color, often gives people a sense of pretending. However, malingering has a clear purpose, the symptoms will alone, vulnerable, may, when, because people vary, rarely persistent, and often artificial in public.
Collective situations, such as schools, a person suffering from hysteria, the incidence of people around saw, You Yu Li Jie of the disease is not, fear Jinzhangxinli, Huozheshoudao superstitious or unscientific Jie Shi's 影响, more attention to the Jingshenfudan. In this case, because the role of suggestion and autosuggestion, some people have symptoms similar to hysteria attack, some because of mental stress, fatigue, lack of sleep or menstrual period, the more likely to cause seizures. Groups, with the first onset of symptoms of disease are basically the same.
Because hysteria significantly before the onset of mental stimulation, plus the hysteria of the patients before the particular personality characteristics, such as emotional, unstable, easily swayed by emotions, feelings naive, impetuous and headstrong, etc., are highly suggestive, their emotions and behavior easily be someone else's speech, behavior and attitudes influence, therefore, hysteria, if the relatives of the speech, behavior, attitude inappropriate will suggest the formation of new adverse factors, resulting in aggravation of symptoms to treatment difficult. Therefore, the hysteria, the relatives should first calm and avoid undue concern and passion, to avoid panic, to correctly deal with the occurrence of the disease. In order to improve the unhappy mood of patients, relatives of patients can consciously shift attention focus to the things of interest or the patient for the time being to leave the prevailing circumstances.
Psychiatric treatment is a major hysteria and effective treatment, during treatment, the patient's relatives, friends, neighbors and unit leaders can actively cooperate with colleagues, is the key to treatment success. Therefore, the hysteria the patient's relatives should pay attention to listen to a doctor's explanation and persuasion, understanding of the nature and causes disease, that it is a functional disease brain is completely curable. To improve the patient's attitude, reasonable arrangements for the patient's life and work, adjustment of the environment, removal of mental stimulation. Hysteria attack, relatives should not panic or over-concern. In the hysteria of the treatment process, family members should be comprehensive and objective history of the doctor describes. In the implementation of various treatment programs, family therapy should be safely left the scene, to the treatment to create a quiet relaxed environment. Otherwise, the relatives of excessive attention, emotional tension or panic will affect the patient, it may well be a bad hint factors that make symptoms worsened to the treatment difficult. After treatment, some of the symptoms improved, the family should continue to encourage doctors or implied with patients to relieve symptoms better. Relatives should also be properly treated at the same time the spirit of stimulation, to educate patients about the nature and outcome of this disease, relieve the tension of patients to get better effect. At the same time consolidating the treatment of great significance to prevent recurrent attacks.
Hysteria - psychopathic personality
Hysterical hysteria pathological personality is the emotional and personality of patients show that pathological personality traits become more prominent after the disease:
(1) a high degree of emotion: Emotional bias usually naive, volatile, capricious, irritable, sensitive and suspicious, often because of small things which anger or weeping lock. Excessively strong emotional reactions, easy to shift from one extreme to another extreme, often with exaggerated and dramatic color, Duirenduishi also easily emotional.
(2) highly suggestive: that patients are very easily accepted by people around the words, actions and attitudes impact and generate the appropriate response, said that Lenovo and implied; was itself generated a certain feeling of discomfort and the corresponding association reaction , said autosuggestion. Implied depends on the patient's emotional tendencies, such as something or someone, have an emotional bias, then the vulnerability implied.
(3) a high degree of self-display: a person self-centered tendencies, often too much boasting and displaying themselves like to become a center of attention. After the disease mainly to exaggerated symptoms, pray for compassion.
(4) rich fantasy: fantastic, the content of their vivid imagination, under the influence of the strong emotions easily confused with each other to achieve and fantasy, giving people the impression of lying.
Hysteria - Women Prevention
Hysteria generally occurs in young women, because young women widespread good fantasy, an emotional, will more fragile, suggesting that higher psychological characteristics, if in their growing up, parents too Chong Ni, or other adverse environmental factors effect to the formation of willful, eccentric, or self-display, exhibitionism, to feelings instead of reason to fantasy instead of reality character flaws, then, to ask too much of their lives when we can not do, or major changes in his life (such as bereavement the couple divorced, etc.), or by intimidation, misunderstandings, insults, grievances, etc., will be the psychological ability to collapse, leading to the production hysteria.
As hysteria is a more serious psychological disorders, and the occurrence of symptoms and treatment process, the suggestion and autosuggestion plays an important role in the pathogenesis of certain situations can lead to the collective. Therefore, prevention must be carried out on hysteria. First of all, to the right of patients to treat hysteria, hysteria is not a mental illness neurosis, hysteria is not the nervous system in patients with organic diseases, once the incentive disappears, however, more patients will be Howard. Second, we must pay attention to ease the tension for the patient to create a comfortable, relaxing environment, because the tension is brewing hotbed of hysteria. Third, strengthen the will of the quality of patient training, to cultivate their open mind and pragmatic pragmatism. Fourth, we must seek to eliminate the psychological trauma patients in order to "be made by Miao Dao" means to enlighten and guide the correct treatment of patients with life. Treat their own character flaws. Fifth, the use of suggestion therapy, "fake" magical effect, when the hysteria in patients with sudden loss of function of these symptoms, please have the authority of doctors can prescribe a placebo, but patients can tell the drug to the disease than the cure, in order to achieve and disappearance of the symptoms and reduce the results. Sixth, when the onset of hysteria, the first to control their behavior, to enable patients to calm down and avoid accidents, serious, immediately to the hospital.
Symptoms and signs:
Seizures, tremors, myoclonus, convulsions, paralysis, can not and Buxing can not stand, not words disorders, aphasia, a variety of sensory disturbances and special sensory disorder, autonomic muscle Neng obstacles. Emotional outbreak, hazy state of consciousness, trance, amnesia, child-like dementia.
(1) understand the cause. Patients are under the spirit of the disease factors. Mental factors are causing the patient Qing direct cause of disease onset, hysteria patients have a strong emotional character and emotion variability, emotional, emotional dynamic, lively, shallow, naive; Gaoduo implied; high degree of self Revealed; rich fantasy In the strong influence of emotional reactions, easy to be confused between reality and fantasy.
(2) the use of suggestion therapy. Full of suggestive words and deeds, supplemented by language hints and other therapeutic measures, such as "drugs" injection, acupuncture, acupressure or electrical stimulation, will receive good results.
(3) consultation should help patients understand the disease in the right, to the knowledge of the disease, severity of harm and the social function of patients should be clear, sincere yet gently tell the patient. In this process, the appropriate hint and the guarantee is necessary.
(4) To understand the true "self." Learn to use some sound strategies and methods to deal with all kinds of mental stimulation, learning not to such a childish reaction to cope with the difficulties of the original, learn to mature and creative approach to life difficulties. To help patients have, on people and have a rational understanding of the environment, to become mature and stable personality, can be a rational approach to deal with the difficulties he faces.