Milyutina E.V. Ph.D. Polevskoy, Russia Integrative model of spiritual crisis Abstract. This article is devoted to considering the issue of identity of personality structures and science (psychology and medicine). The individual’s desire for integrity and self-realization, through the actualization of the spiritual self, is reflected in the proposed biopsycho-socio-spiritual model and vice versa. The main emphasis of the article: mental disorder is not always a disease, but even in the case of illness, it is the appeal to the spiritual self that can become a powerful resource and direct the vector of personality development in a positive direction. The article describes some examples of overcoming the crisis, ways of non-directive interaction with the patient. Key words. Biopsycho-socio-spiritual model, personality, patient, spiritual self, development vector, integrity of mental reality.Abstract. This article is devoted to consideration of a question of identity of structures of the personality and science (psychology and medicine). Aspiration of the personality to integrity and self-realization, through updating of spiritual – I, find reflection in the offered biopsikhosotsiodukhovny model and vice versa. Main accent of the article: the mental disorder – not always an illness, but even in a case, the address to I - spiritually can become a powerful resource and send a vector of development of the personality to the positive course Article describes some examples of recovery from the crisis, ways of not directive interaction with the patient. Keywords: Biopsikhosotsiodukhovny model, the personality, the patient, I - spiritual, a development vector, integrity of mental reality. In the development of modern medical psychology, quite a lot has already been said about the significance and effectiveness of the bio-psycho-social approach in the general structure of psychiatric care, which corresponded to the idea of ​​complex intervention, since it affected the main aspects of the life of patients and their immediate environment: allowing the use of intact aspects of the patient’s personality; create on this basis a sufficiently high level of motivation for positive changes; to form a conscious attitude towards treatment and responsibility for one’s behavior. At the end of the 20th century, the biopsychosocial model was proposed as a new medical paradigm. The founder of the bio-psycho-social approach, George Engel, believed that the clinician must take into account the biological, psychological and social aspects of the disease - only then will he be able to correctly understand the cause of the patient’s suffering, offer adequate treatment and win the patient’s trust. Engel offered an alternative to the then existing biomedical approach, where analytical, reductionist and specialized methods did not consider the patient as more than an object, while the patient's subjective experiences could also become the subject of scientific research and significantly expand the possibilities of therapy. According to Angel, “biochemical deviations from the normal state of the body are not a disease. Disease is the result of the interaction of various factors, including at the molecular, individual and social levels. But psychological changes under certain circumstances can manifest themselves in the form of somatic diseases, or suffering and experiences that pose a threat to health, which can also be accompanied by corresponding biochemical changes.”[3] The humanity of a specialist, attention not only to symptoms, but to the patient’s personality, interaction and support are one of the most important postulates of the humanization of medicine (according to Angel), which largely determines the outcome of treatment. Many social and mental phenomena are fundamentally physical in nature, but should not beexplained only by the latter. Different levels of the biopsychosocial hierarchy can interact, but their patterns cannot be derived directly from the principles inherent in the upper or lower levels of the biopsychosocial model. The result will most likely depend on the individual characteristics of the person, on the initially stated symptoms, which in itself is unpredictable. Angel believed that clinical reality is always much more complex and diverse and it is impossible and at least primitive to explain it with a linear model of cause and effect relationships. For example, we know that in the case of schizophrenia, the hereditary component plays a role, but social and psychological factors can both provoke a relapse and give rise to the disease, and can also become a restraining and compensating factor in the manifestation of the disease. In clinical reality, as in personal reality, we are faced with many interacting factors and causes. Angel's ideas were revealed, developed in detail and supplemented in psychology. The versatility and multifactorial nature of personal reality, in its scale and unpredictability, has a certain integrity and structure. Many directions and schools are studying this topic; they are quite original and have different names: Gestalt in Gestalt therapy; complex in psychoanalysis; engrams (or engrams) in R. Hubbard's dianetics; cluster in the cluster theory of integration by M. Shcherbakov; systems of condensed experience (CEX) in holotropic breathing by S. Grof; integrity of mental reality - CPR V.V. Kozlov [15], but at the same time they have the main features of integrity and the intention to structure the complexity and integrity of the clinical, mental, social and spiritual reality of a person. The main goal of these studies is the formation of an adequate system of assistance to a person - a client or patient, and the development of a harmonious individual and society. At the moment, in our opinion, the most comprehensive and structured understanding is described by V.V. Kozlov in the model of the integrity of mental reality (CPR). Let's consider some of the principles of the CPR model: 1. The principle of integrity implies an understanding of the individual as an extremely complex, open, multi-level, self-organizing system with the ability to maintain itself in a state of dynamic equilibrium and produce new structures and new forms of organization. Considering the disease as a person’s ability to self-organize and maintain a certain balance for the individual, a specialist can direct the focus of attention to the “ability” and to the search for alternative options for maintaining integrity, and not to the completeness of the symptom. For example, one of the reasons for the occurrence and development of a panic attack is the so-called diathesis of the nervous system, in other words, vulnerability or super sensitivity (extra sensory, from the Latin extra - “over”, “outside”; sensus - “feeling”), the ability to be receptive and sensitive. The phenomenon of hypersensitivity was first described by American psychotherapist Elaine Aron. When a patient, exhausted by attacks, learns that the possible cause of his misfortunes is the ability to superfeel, he begins to assess the situation differently (the principle of positivity), and the ability to self-organize and support oneself is updated, acquiring a vitally significant focus. At the level of action, all the patient needs is to learn to manage his ability for good. For example, a 23-year-old patient has been experiencing a panic attack for two years (unmotivated fear, tachycardia, esophageal spasms, dizziness, etc.), which does not give him the opportunity to get a job after graduating from university. As a result of therapy, the patient (among other things) discovers that he is indeed very sensitive and has good intuition, but is afraid to trust his abilities. As an experiment, a mechanism was proposed for checking one’s feelings and finding confirmation or refutation in external factors. Within 2 months, as a result of the experiment, there wereData have been obtained that in 80% of cases his assumptions and feelings are justified; moreover, the patient has learned to regulate the ability to “turn off” and “turn on” if necessary. 2. The genetic principle or the principle of development explains that the human psyche and personality have many potential vectors of development. These vectors manifest themselves at a critical point in a person’s life, a point of crisis, where the personality “determines” the direction of its further development.[14] Conventionally, the directions can be divided into three paths: 1. the path of positive integration; 2. negative disintegration; 3. refusal of the need to choose. Help plays a huge role in what path a person chooses when at a critical point, and not only in understanding possible ways of developing the situation, but also in empathy, communication, and simply support. For example, a patient (19 years old), registered with the psychiatric service since the age of 16 with manic-depressive syndrome, was asked questions about his “abnormality” in connection with his interest in bisexuality for three weeks with periodic psychological meetings. fetishism (sniffing women's underwear), transvestism, etc. The patient was pretty scared and agitated. When, as a result of communication, it was revealed that in different cultures these manifestations are not considered “abnormal” and are even legalized, everyone has the right to be “Other,” the patient saw in his search a desire for self-expression. Soon he entered the theater institute and successfully graduated. 3. The principle of positivity in its implementation can be expressed in two positions of a specialist in relation to the person in need: a). Finding and building on positive patient experiences. Being in a difficult life situation or a crisis, a person regards this experience as a problem, painting this period of life as a “dark streak,” which emotionally further intensifies an already difficult situation. The opportunity to see a positive meaning or at least elements gives a new vision, support and in itself has a strong transformative potential for a person; b). Reliance on facts and reality, worldly wisdom and understanding that suffering is not necessary, but that it is possible to develop the ability to create and change your life in accordance with your inner needs. Example: a 55-year-old woman, a patient in a crisis department, who lost her 30-year-old son (suicide), was in a state of depression. The treatment did not bring the desired result. The patient repeated that she had not only lost her son, but had also ceased to be a mother. Talking about her son, the woman said that he was very independent and responsible, she always trusted the decisions he made. Based on this fact, the specialist clarified that the son also made this choice himself, apparently for him it was the only solution available at that moment. The mother agreed with this statement and decided to accept this choice of her son with trust and respect, while remaining in the position of a loving mother. After a 2-day home leave, the woman returned to the department with a new hairstyle, beautifully dressed and in high spirits. She was soon discharged.4. Multidimensionality of truth. The principle of great respect for the versatility and fragility of human creation. Any explanation and understanding of individual mental reality cannot be complete, which means it cannot be true either, but that is why it has the right to life and truth. A specialist who is able to realize the dynamism of processes, understand and empathize with the patient in his opinion, thoughts, position, allows the patient to structure and broadcast his internal experience, even if we are talking about a delusional idea or significant deviation and disintegration in a person’s attitude and behavior towards any situations. At this moment, there is a transfer and acceptance of trust between those interacting.[6] For example, in order to find trust with a “delusional” patient and begin adequate therapy, it is worth listening to the position and the “delusional” story with great care, clarification and agreementpatient, as an absolutely real reality in which a person currently lives. It is worth recognizing that, unlike psychology in medicine, methods for integrating professional experience and interaction with the patient’s personal mental reality are much less developed than the system for assessing scientific evidence. [20] But , it is also necessary to recognize that for several decades the biopsychosocial approach has inspired researchers seeking to clarify the nature of complex interactions; many integrative options have been formed for a systemic analysis of problems that can support this model: BASIC - ID Lazarus[10] multilevel psycho-social model of affective disorders spectrum, as a means of synthesizing knowledge by Kholmogorova [19], “Flower of Ananyev’s potentials” [1]. Currently, the question of the need to change the medical paradigm is increasingly arising, where the biopsychosocial model no longer satisfies the needs and understanding of the mental reality of the individual and human health, therefore, is not able to operate with categories and create tools for interaction between man and science that meet the demands of the time, in order to preserve the integrity and volumetric process of development of the individual and society. In our opinion, the biopsychosocial model needs to be rethought, accepted and addressed to the spiritual core of a person, his sacred meanings, which is especially important in the context of psychiatric care. The bio-psycho-socio-spiritual model, in our understanding, is more potential and integrative. Despite the fact that the emergence of scientific psychology is associated with the rapid development of the natural sciences, especially physiology and medicine”[5], in this case, it is worth turning to the experience of psychology, where the category of spirit, although it does not find empirical confirmation, has quite naturally and safely entered and revealed the personality structure in its entirety. Being a certain model, the personality in its development, like any other model, structure that responds to the needs of the personality and is related to the structure and manifestation of the latter, strives for self-actualization and completeness (integrity). V.V. Kozlov in the article “Integrative Model of Psychology” identifies seven basic paradigms in understanding the subject of psychology: physiological; psychoanalytic; behavioristic; existential-humanistic; transpersonal; communicative; integrative. V.A. Mazilov in his article “The Ninth Wave of Scientific Psychology” opposes V.V. Kozlov in that this “recount” is quite arbitrary and justifies itself only as an arrangement of milestones, stages on the path to integrative psychology as the ultimate goal. [12] For us, in this case, two points will be important: 1. Inclusion of the category of spirit as an integral structure of personality; 2. observation of the identity of development, the desire for self-actualization and the tendencies of science as a certain organism (or macro model of a person) and personality. That is, in our understanding, science, be it psychology or medicine, can structurally be a macro-model of personality. Any person who has consciousness, as a truly human regulatory mechanism, has a spiritual Self.[5] And, if psychology has been talking about the trinity for quite a long time: body-psyche-spirit or I-material, I-social, I-spiritual, etc., with the help of which it unpacks and creates new, more effective tools for interaction and assistance, then in medicine (especially psychiatry) a similar phenomenon is taking tentative steps. In the existential direction, a person in his integrity is described from three perspectives: he is simultaneously body, psyche and spirit. These three dimensions are in fact inseparable and are in a complex relationship. Each of them has its own contents and driving forces, which may conflict with the aspirations of another dimension. [8] The transpersonal wave is characterized by the identification as a subject of psychology of an area beyond the generally accepted, personal, individual level of experience, in which the sense of self-identity goes beyond the limits of the individual or.