Where does doctor balu live address. Doctor of Fairy Sciences

Andrey Vladimirovich was born in 1940 in Leningrad. In 1963 he graduated from the Leningrad Pediatric Institute. After residency, he retrained as a psychiatrist. He worked at the Bekhterev Psychoneurological Institute, and from 1973 to 1983 at the Oncological Institute. In 1976 he defended his candidate's dissertation and in 1996 his doctorate. In 1990, he created and headed a hospice in the Primorsky district of Lakhta of St. Petersburg.

Andrey Vladimirovich is a real St. Petersburg Storyteller who has preserved traditions Good Wizards. Andrey Gnezdilov is a devotee and public figure, a tireless researcher and “generator” of new methods in psychotherapy: fairy tale therapy, image therapy, bell ringing therapy.

The psychotherapeutic tale of Andrei Gnezdilov is a gentle touch to the Soul of a person, support for him on the Path, a soft form of communion with spiritual knowledge. The view of the Storyteller is the view of a person who is able to understand and accept the secret aspects of internal processes, support in good and spiritual quests, share pain and give joy.

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Andrey Vladimirovich GNEZDILOV: articles

Andrey Vladimirovich GNEZDILOV (born 1940)- St. Petersburg psychiatrist, Doctor of Medical Sciences, honorary doctor of the University of Essex in England: | | .

SOME TESTIMONY OF A PROFESSOR THAT DEATH IS NOT THE END OF LIFE

“Death is not the end or destruction of our personality. This is just a change in the state of our consciousness after the end of earthly existence. I worked in an oncology clinic for 10 years, and now I have been working in a hospice for over 20 years. Over the years of communicating with seriously ill and dying people, I have had the opportunity many times to be convinced that human consciousness does not disappear after death. That our body is just a shell that the soul leaves at the moment of transition to another world. All this is proven by numerous stories of people who were in a state of such “spiritual” consciousness during clinical death. When people tell me about some of their secret experiences that deeply shook them, the fairly extensive experience of a practicing physician allows me to confidently distinguish hallucinations from real events. Not only I, but also no one else can explain such phenomena from the point of view of science - science by no means covers all knowledge about the world. But there are facts that prove that besides our world there is another world - a world that operates according to laws unknown to us and is beyond the limits of our understanding. In this world, into which we will all end up after our death, time and space have completely different manifestations. I want to tell you a few cases from my practice that can dispel all doubts regarding its existence.”

***
….Once I saw my patient in a dream - as if he came to me after death and first began to thank me for my care and support, and then said: “How strange - this world is as real as my world. I'm not scared. I am surprised. I didn't expect this." Waking up and remembering this unusual dream, I thought: “No, how can this be, we only saw him yesterday - everything was fine with him!” But when I came to work, I was informed that the same patient had died during the night. Nothing foreshadowed his imminent departure, so I didn’t even think about his supposed death, and here’s a dream... There is no doubt - the soul of this man came to say goodbye to me! My feelings after understanding this phenomenon simply cannot be expressed in words...

***
….I’ll give you another impressive case. A priest came to our hospice to give communion to a dying patient. In the same ward there was another patient - who had been in a coma for several days. Having performed the Sacraments of Communion, the priest headed towards the exit, but was suddenly stopped by the pleading look of this man who suddenly woke up from a coma. While the priest was administering communion to the dying man, his roommate suddenly came to his senses and, unable to utter a word, began to look intently and pleadingly at the priest, thus trying to convey his request to him. The priest immediately stopped - his heart responded to this desperate, silent call. He approached the sick man and asked him if he would like to confess and take communion. The patient could only blink his eyes in agreement. The priest again performed the Sacrament of Communion and, when he finished, tears glistened on the cheeks of the dying man. When the priest headed towards the door again and finally turned around to say goodbye…. the patient had already calmly passed into another world.

It is difficult to explain this case as a coincidence - a man in a long coma woke up precisely during the performance of the sacred sacrament. No, this is not a coincidence, I have no doubt that the human soul felt the presence of the priest and the Holy Gifts and reached out to meet them. IN last moments In his life, he managed to join God in order to depart in peace.

***
….There was one woman in our oncology hospital. The prognosis was disappointing - she had no more than a few weeks to live. She had a minor daughter, who, after the death of her mother, had no one to shelter her. The woman was very worried about this, because the girl had to be left completely alone. What awaited her girl - an orphanage, a street? "God! Don’t let me die now, let me raise my daughter!” - the dying woman prayed without ceasing... And, despite the doctor’s predictions, she lived for two more years. Apparently the Lord heard her request and extended her life until the time when her daughter became an adult.

***
Another woman was afraid not to live to see spring, but she so wanted to bask in the gentle sun in those last cold and cloudy days... And the sun looked into her room in those minutes when she was dying...

***
The dying grandmother kept praying to God to live until Easter. She died after the Easter service... Everyone is rewarded according to faith.

***
And this incident happened to my relatives. I'll tell you what happened when my grandmother was dying. They lived then in the south - in the village of Lazorevskaya. Before her death, my grandmother turned to my mother with the following request:

Go get me a priest...
Mother was surprised, because the only church in the village had long been abandoned and closed.
- Where is the priest from? You know, our church has been closed for a long time...
- I'm telling you, go and get the priest.

Where to go, what to do? ... The saddened mother went out into the street in tears and walked towards the station, which was located not far from the house. She approaches the station and suddenly sees a priest standing next to him, who was behind the train that day. She rushes to him and asks him to come to confess and give communion to the dying man. The priest agrees, and everything happens as it should have been. It turns out that in the last hours of her life, my dying grandmother, with God’s help, felt a moment of clairvoyance, which helped her join sacred grace and depart in peace.

***
...I'll tell you another interesting and unusual story which happened to one of my patients. I would like to note that this story made a great impression on academician, head of the Institute of the Human Brain of the Russian Academy of Sciences Natalia Petrovna Bekhtereva when I retold it to her.

Once they asked me to look at a young woman. Let's call her Julia. During a serious oncological operation, Yulia experienced clinical death, and I had to determine whether there were any consequences of this condition, whether her memory, reflexes were normal, whether consciousness had been fully restored, etc. She was lying in the recovery room, and as soon as we started talking to her, she immediately began to apologize:

Sorry that I cause so much trouble to the doctors...
- What kind of trouble?
- Well, those... during the operation... when I was in a state of clinical death.

But you can't know anything about it. When you were in a state of clinical death, you could not see or hear anything. Absolutely no information - neither from the side of life nor from the side of death - could come to you, because your brain was turned off and your heart stopped...

Yes, doctor, that's all true. But what happened to me was so real... and I remember everything.... I would tell you about this if you promise not to send me to a psychiatric hospital.
-You think and speak completely rationally. Please tell us about what you experienced.

And this is what Julia told me then:
At first - after the administration of anesthesia - she did not realize anything, but then she felt some kind of push, and she was suddenly thrown out of the own body some kind of rotational movement. She was surprised to see herself lying on the operating table, saw the surgeons bending over the table, and heard someone shout: “Her heart stopped!” Start it immediately!” And then Julia was terribly scared, because she realized that this was HER body and HER heart! For Yulia, cardiac arrest was tantamount to the fact that she had died, and as soon as she heard these terrible words, she was instantly overcome by anxiety for her loved ones left at home: her mother and little daughter. After all, she didn’t even warn them that she would be operated on! “How is it that I’m going to die now and not even say goodbye to them?!” Her consciousness literally darted to the side own home and suddenly, strangely enough, she instantly found herself in her apartment! She sees her daughter Masha playing with a doll, her grandmother sitting next to her granddaughter and knitting something. There is a knock on the door and neighbor Lidia Stepanovna enters the room and says: “This is for Mashenka. Your Yulenka has always been a role model for your daughter, so I sewed a polka dot dress for the girl so that she would look like her mother.” Masha rejoices, throws the doll and runs to her neighbor, but on the way she accidentally touches the tablecloth: an old cup falls from the table and breaks, a teaspoon lying next to it flies after it and ends up under the tangled carpet. Noise, ringing, turmoil, grandmother, clasping her hands, shouts: “Masha, how awkward you are!” Masha gets upset - she feels sorry for the old and such a beautiful cup, and Lidia Stepanovna hastily consoles them with the words that the dishes are beating for happiness... And then, completely forgetting about what happened earlier, the excited Yulia comes up to her daughter, puts her hand on her head and says: “Masha, this is not the worst grief in the world.” The girl turns around in surprise, but as if not seeing her, she immediately turns back. Yulia doesn’t understand anything: it’s never happened before that her daughter turns away from her when she wants to console her! The daughter was raised without a father and was very attached to her mother - she had never behaved like this before! This behavior of hers upset and puzzled Yulia; in complete confusion she began to think: “What is happening? Why did my daughter turn away from me?

And suddenly she remembered that when she turned to her daughter, she did not hear her own voice! That when she reached out and stroked her daughter, she also did not feel any touch! Her thoughts begin to get confused: “Who am I? Can't they see me? Am I already dead? In confusion, she rushes to the mirror and does not see her reflection in it... This last circumstance completely knocked her down, it seemed to her that she would simply quietly go crazy from all this... But suddenly, amid the chaos of all these thoughts and feelings, she remembers everything that happened to her before: “I had an operation!” She remembers how she saw her body from the side - lying on the operating table - she remembers the terrible words of the anesthesiologist about the stopped heart... These memories frighten Yulia even more, and in her completely confused consciousness it immediately flashes: “I must be in the operating room at all costs now, because if I don’t make it in time, the doctors will consider me dead!” She rushes out of the house, she thinks about what kind of transport she would like to get there as quickly as possible in order to be on time... and at the same moment she finds herself in the operating room again, and the surgeon’s voice reaches her: “The heart is working! We continue the operation, but quickly, so that it doesn’t stop again!” What follows is a lapse of memory, and then she wakes up in the recovery room.

So what is death?

We record the state of death, when the heart stops and the brain stops working, and at the same time, the death of consciousness - in the concept in which we have always imagined it - as such, simply does not exist. The soul is freed from its shell and clearly aware of the entire surrounding reality. There is already a lot of evidence for this, this is confirmed by numerous stories of patients who were in a state of clinical death and experienced a post-mortem experience at these moments. Communication with patients teaches us a lot, and also makes us wonder and think - after all, it is simply impossible to write off such extraordinary events as accidents and coincidences. These events dispel all doubts about the immortality of our souls.

About a Person: Leonid Vinogradov about Andrei Vladimirovich Gnezdilov

Andrey Vladimirovich GNEZDILOV (born 1940)- St. Petersburg psychiatrist, Doctor of Medical Sciences, honorary doctor of the University of Essex in England: | | .

"ANDREY GNEZDILOV: DOCTOR-STORYTELLER"

Is it possible to enjoy life if you face death every day? Many will answer this question in the negative. But our hero has been communicating daily with terminally ill people for more than 30 years. He cannot cure them and only tries to alleviate the suffering and helps prepare for death. At the same time, he doesn’t just love life. At 68 years old, Doctor of Medical Sciences, psychotherapist at the St. Petersburg Hospice, Andrei Vladimirovich GNEZDILOV remains a big child. Fairy tales and dolls occupy a significant place in his psychotherapy.

Dr. Baloo's Alien Pain

Imagine: an introverted, shy boy for whom his own fantasies replace communication with his peers. Everyone around is sounding the alarm: the child lives in virtual reality and is not ready for life. They are trying to fit it into their scheme. This is exactly what Andrei Vladimirovich was like in childhood. Andryusha wrote down his fantasies - this is how the first fairy tales appeared. And for more than 30 years he has been treating the emotional trauma of his patients with fairy tales. Patients at the children's hospital where he worked after college nicknamed him Dr. Baloo, after the bear from Mowgli. The nickname he received from his children became his literary pseudonym.

Since 1973 he has been working with cancer patients. His first patient was a woman whom he, at that time a doctor at the Bekhterev Psychoneurological Institute, prepared for oncological surgery. She knew that she needed an operation, but could not bring herself to go to the hospital - she felt sick at the thought of staying there. Friends advised her to see a psychotherapist, and only after conversations with Dr. Gnezdilov was the woman able to overcome her fear. Visiting her in the hospital, Andrei Vladimirovich saw dozens of the same suffering people and realized that most cancer patients need psychotherapeutic help.

Soon, a psychoneurologist station was opened specifically for Gnezdilov at the Oncological Institute. He worked there for ten years. And in 1990, the first hospice in Russia opened in St. Petersburg, in the Primorsky district of Lakhta, and Dr. Gnezdilov headed the medical service there. The first employees of the hospice were volunteers from the “Mercy” society, created in the 1980s by the writer Daniil Granin. Andrei Vladimirovich and his colleagues went to England to gain experience, then the British came to Lakhta. Today there are more than a hundred hospices in Russia, and many of their organizers came to St. Petersburg to get acquainted with Gnezdilov’s experience, including his art therapeutic techniques.

Psychotherapeutic fairy tales are based on stories that patients tell about themselves, and the doctor turns them into a fairy tale. The plot in a fairy tale develops differently than in real life. It is impossible to guess that this is a “corrected” biography. Everything in them is like in real fairy tales: ancient times, fictional countries, mysterious names, wizards, miracles.

They differ from ordinary fairy tales in that the “hint and lesson for good fellows” is understandable only to the patient to whom a particular fairy tale is dedicated. Only he and the author know what life tragedy hidden behind these fantasies. Thus, in the fairy tale “The Dream,” the romantic girl Talya loses her legs. Forever bedridden, in a dream she meets a handsome prince on a fairytale horse. One day in a dream, Talya finds out that in reality the prince is her companion in misfortune, the boy Ton with sore legs. This fairy tale was written for a girl who died in a hospice at the age of 18. She told her young man, also dying here, and they became close friends.

“Such a fairy tale helps a person to comprehend and accept the situation in which he finds himself. For many patients, a fairy tale that rethinks their lives helped them come to terms with and endure their suffering,” explains Gnezdilov.

In his life, however, it turned out differently - it was not a fairy tale that was realized, but a poem that amazed him in childhood. When Andryusha could not sleep, his mother sat at the piano and sang ballads. The impressionable boy was especially struck by the poem by A. N. Tolstoy:

The princess is afraid of the ringing of the tower,
The gray bell ringer will come for her,
And again it’s quiet on the ancient tower,
Death sneaks, covering the lantern.

“I immediately remembered him,” the doctor recalls, “and decided that I needed a princess. The princess is sick. My profession has become a confrontation with death. I created a castle at home.”

A storyteller by nature, he collected old things (bells, armor, helmet) and stored them in a turret in his old St. Petersburg apartment. This turret, indeed, today resembles a castle. When he was given a Bluebeard doll, he named the turret Bluebeard's Castle.

There, Gnezdilov engages in image therapy with the relatives of his patients and the hospice medical staff. People change clothes, go to the mirror, see themselves in a new image.

But how can changing clothes help a relative of a seriously ill person? Isn't this a hoax? Probably, many have encountered the fact that if you carry unexpressed difficult feelings within yourself for a long time, and then express them in a conversation with an understanding person, it becomes easier. It’s the same here: the difficult experiences and fears that are told in a conversation, drawn in a drawing, expressed in the creation of a new costume, which secretly torment a person from within, become obvious, which means that they can begin to be overcome.

Sometimes, offering new image, the doctor helps a person see that not everything in him dies. He seems to be saying: you are more than your illness and your suffering body. For many, especially non-believers, this is a real discovery that brings hope.

Dolls look like people

In the home collection of Andrei Vladimirovich Gnezdilov there are about two hundred designer dolls. And in his home collection there are about two hundred designer dolls. Some were purchased, but most were donated by craftsmen and even made especially for Gnezdilov. From time to time, one or several dolls move to a hospice at once, because these are not toys. Personalized doll therapy is another of his proprietary techniques. “For a patient, a doll is news from childhood. There is an inner child in every person, and with childish spontaneity he transfers the image of a doctor to the doll,” says the doctor. As always, he cites an example from his own practice to support his words. A 23-year-old girl learned from an oncologist that she was doomed. Returning home, she went to bed and began to wait for death: she did not eat, did not drink, did not talk to anyone. The parents were in despair and called Andrei Vladimirovich to their daughter. He remembered that he had a prince doll in his briefcase, took it out and handed it to the dying woman. "What is this?" - the girl was surprised. “I am Prince Nutcracker, I learned about your misfortune and came to serve you,” he answered. “And you won’t leave me?” “No, I will always be with you,” the doctor answered, left the doll and left. The girl soon died, but with the doll in her hands. “I realized that I had to stay with her and help her endure her suffering, but I could not do this myself,” recalls Dr. Gnezdilov. A doctor cannot be at the patient’s bedside around the clock, and it is important for a person in suffering to have at least a symbol of someone nearby who will not leave under any circumstances.

Old people often seem not to notice that a doll was put in their bed, but when after some time Gnezdilov tries to take it away, they do not give it back.

Moreover, not only people who are far from faith play with dolls, but also those who know well that God is always there. There is a mystery in this. Psychologists say that for a patient, a doll often symbolizes the need for someone with whom everything can be shared - both joy and pain, from whom nothing needs to be hidden (after all, it is difficult even for the closest relatives to say everything, you are often afraid to upset them, you are afraid complain). And a sick person very often looks like a child. And he simply may not have enough mental and spiritual strength to pray.
To everyone who comes to his home for a consultation, Andrei Vladimirovich first of all offers to choose a doll themselves. The doll always turns out to be somewhat similar to the one who chooses it. There are kings, queens, princes and princesses in the collection of the St. Petersburg doctor-storyteller different eras. They are preferred by young hospice patients, since, despite their illness, they continue to identify themselves with youth and beauty.

It’s rare, but it happens that people come to the hospice with their dolls. One old woman brought a purple bear cub with her and played with it. “This teddy bear did not cause laughter - they say, the old lady was playing with dolls. He connected her with the past, she did not feel lonely,” the doctor recalls.

Love leads to faith

Andrei Vladimirovich is convinced that without faith he would not have survived such a job. He repeatedly emphasizes what a huge influence his mother had on him - famous sculptor Nina Slobodinskaya. She was a deeply religious person and even Soviet time, when it could only bring trouble, she sculpted religious sculptures.

Dr. Gnezdilov believes that these are my mother’s best works: the Savior Not Made by Hands (plaster bas-relief “Head of Christ” - one copy was taken to the Feodorovsky Sovereign Cathedral in Tsarskoye Selo), Mother of God“Tenderness”, Mother of God “Defender of Leningrad” - in the semicircular gate, the Mother of God obscures the entrance to the city with her hands (there is no such image in the iconography, the sculpture was made in memory of the blockade that mother survived together with little Andryusha), Crucifixion.

When Dr. Gnezdilov began working with cancer patients, he was not yet a church member, but he believed in God. “I have always considered atheism to be a superstition. What, the world was created on its own?” And in the atheistic 1970s, as a psychotherapist, he could afford to talk to patients about God. Even then, many understood that to overcome the fear of death, faith is the best psychotherapy: “If a dying person thinks that he will disappear after death, his prospect for the future space also disappears. If you tell him about the Kingdom of Heaven, and he believes that what lies ahead of him is not disappearance, but a transition to another life, the space expands.”

From his experience of communicating with dying people, Dr. Gnezdilov knows that believers leave life calmer, in greater harmony with the world and themselves. He considers the presence of relatives at the time of the patient’s death very important. Death, in his opinion, is similar to birth, and just as in infancy it is important to feel the warmth of loving hands, so it is easier to leave life in loving hands.

“It is important for everyone to come into contact with death in one way or another, to see what it is. If a person dies not in confusion state of mind, but with a deep understanding of the meaning of death, then we, just by being nearby, can feel that death is not horror, but a mystery.” Andrei Vladimirovich recalls how one day the father of the family was dying, his wife and children were sitting next to him, and they were all suffering. Doctors and nurses did not know how to support them. One of the staff gave me a Bible. They began to read in low voices. A few hours later they tiptoed out of the room and said in a whisper: “Gone.” There was no despair on their faces - death appeared to them as a mystery. But they may have opened the Bible then for the first time.

One painter once told Dr. Gnezdilov: “It doesn’t matter where I die, it’s important that I die with prayer.” Not all sick people are physically able to pray; it is important to have someone nearby to read the prayer. “A sounding prayer is a switched-on light that illuminates a person and helps him in the most Hard time, at the moment of transition." Therefore, a tradition has developed in the hospice: when someone dies, sisters of mercy sit next to him and pray (if he is not opposed to God and the Church, then out loud). The sisterhood in the name of the Venerable Martyr Elisaveta Feodorovna was created in 1994 thanks to the efforts of priest Artemy Temirov, the current head physician of the hospital of Blessed Xenia of St. Petersburg.

It is known that some doctors, nurses, and volunteers, in a neophyte frenzy, are eager to convert all patients. When working with the dying, the temptation is even greater - how can one not lead a person to salvation? But you can become an eleventh-hour worker only of your own free will. The very example of sisters with crosses on their headscarves, who care for the sick without disgust, helps many patients accept their situation. Andrei Vladimirovich tells how carefully one must lead a patient to faith: “The first reaction of most people who learn about their illness is shock. At this moment, under no circumstances should you convince the person of anything. He needs our empathy, sharing his grief, despair or fear. After the shock stage, fear is repressed and hope appears. At this stage, many try to turn to God, but more often with the desire to “buy” healing. Then aggression and protest appear: why am I being punished like this? And this aggression spills out not only on those around him, supposedly to blame for his illness, but also on himself. This is a very dangerous stage - if medical and psychotherapeutic assistance is not provided in time, thoughts of suicide are possible. Aggression is followed by depression - a person despairs, says goodbye to everyone. But, oddly enough, it is after depression that consent and acceptance of one’s fate can come. (This stage itself does not come; the help of an experienced doctor or sensitive nurses is needed here.) And then the person begins to look for the meaning of the misfortune that has befallen him and of life in general.

With a serious illness, moments are almost inevitable when one’s own life seems meaningless, but the mind cannot accept the meaninglessness of the world around us. A world where every speck of dust shows the laws of the universe that people do not create, but only discover. The task of doctors and loved ones is to help a person not reach the point of despair when everything around him seems meaningless. Well, when a person understands that the world has an intelligent beginning, there is only one step left to call this beginning God. If there is God, there is no death, and if there is death, there is no God. And this alternative is an incentive to search for a spiritual door. A real, heartfelt appeal to God occurs at the stage of a person’s discovery of his spiritual beginning. For this stage to occur, great tact is required from others. If a person does not believe and is closed to talking about God, the doctor’s duty is still to help him rely on what was valuable to him throughout his life. For some it is family, children, for others it is their favorite job. Some people value their involvement in life, the change of seasons, and the beauty of nature.”

For many, a fatal illness helps them think about God for the first time, and this always makes Dr. Gnezdilov and his colleagues happy. Most of those who work in hospice eventually become believers.

The Sisters of Charity also work with children whose parents died in a hospice. There are already about thirty such children. Among them there are orphans who live in a special home with the sisterhood, the rest of the children spend their free time there from school. On weekends and holidays, the sisters take children on excursions and pilgrimages.

No burnout

In the West, the optimal period of work in a hospice is four to five years, then professional burnout begins. Theoretically, Gnezdilov agrees with this, but in practice... In Russia, working in a hospice is still not prestigious: there are no permanent sponsors, the salary is small, and there are no further prospects. Therefore, many sisters of mercy have been working here from day one, that is, 18 years. Andrei Vladimirovich himself has been working with cancer patients for more than 30 years and constantly emphasizes that if he holds on (and he believes that he holds on unsteadily), it is only thanks to faith. “We forget that whenever we turn to God, we will definitely receive an answer. I am always consoled and guided by the thought that I need God as much as I need life itself, but I always remember that God needs me too. This is the highest thing you can hope for - to understand that God needs you, and through you He can help people.”

Often people who have succeeded in their profession do not want their children and grandchildren to follow in their footsteps. Doctor Gnezdilov’s daughter has become an art historian, studying sculpture, which her grandmother studied all her life. My grandson is now two years old. When asked whether he would like his grandson to work in a hospice in the future or would never wish him such a heavy cross, the doctor-storyteller replied: “This is a difficult but blessed cross. Our patients teach what no one can teach. Meeting them, experiencing their lives and experiences is invaluable.” It seems that Dr. Gnezdilov is far from professional burnout.

Andrey Vladimirovich GNEZDILOV: interview

Andrey Vladimirovich GNEZDILOV (born 1940)- St. Petersburg psychiatrist, Doctor of Medical Sciences, honorary doctor of the University of Essex in England: | | .

WALK THROUGH Grief

Death loved one always comes suddenly, even if you expect it and prepare for it. Grief is too wide to go around, too high to jump over, and too deep to crawl under; You can only go through grief, says popular wisdom. But how to do that? What do you need to know to deal with it? A psychotherapist at the St. Petersburg hospice, a professor at the Department of Geriatric Psychiatry at the Psychoneurological Institute named after A. V. M. Bekhtereva Andrey Gnezdilov.

Therapy we cry

Andrei Vladimirovich, when a person loses a loved one, he cannot live normally, fully, until he experiences grief. How to survive it? What is included in this experience, what does it mean to experience?
- First of all, you need to know that any stress goes away over time due to a change in the way of life that existed before the death of a loved one. The wound itself heals without asking us. But this requires time and help - because sometimes this process drags on, turns into persistent depression and becomes very painful for a person: until you overcome the state of pain, you cannot control yourself.

For example, the first stage of experience is shock. Remember how Lot’s wife was petrified in shock, turning to the dying city. But any emotion - to be experienced - must be splashed out. Otherwise, it threatens neurosis. It's like in a steam locomotive: if there is nowhere for the steam to escape, it breaks the mechanism. Therefore, at this time you should not hold back your tears - they cleanse the soul of the grief experienced.

In the old days, people had traditions of crying. I once witnessed a mother bringing her dying ten-year-old son to a rural hospital. He accidentally took a sip of vinegar essence. When she realized that he was dead, she screamed and then howled. After a few minutes, the howling turned into crying and lamentations: “My little orphan, my little berry, to whom did you leave me...” This crying organized the space of pain and framed the frantic shock reaction associated with the death of his son. She wailed for an hour, talking about the child’s life and her grief, and then calmed down and fell silent. In the morning we saw a completely adequate woman. Yes, she lost her son. It's a terrible pain, but she was already calm and able to do some things. And it seems to me that the loss of a folk act, such as crying and lamentation, is a very great loss, because it softened the pain itself.

Nature can also alleviate pain. And if a person treats nature as a part of our universe and a part of himself, and sees himself as a part of nature, then he sees eternity in nature, where his loved one goes.

In Russian folklore there are songs of lamentation, when the deceased is identified with nature. And this is a very powerful influx of some special state, understanding, perhaps irrational, of the mystery of death, its acceptance and humility.

The word of God can be of great help. Once, the father of the family died in our hospice. Family members watched the agony and did not know what to do. We invited them to read the Gospel. Three hours later he died. They come out and whisper: “He’s gone.” But in their eyes there was no tragedy and despair, but only the feeling that they were present at the sacrament. Death did not frighten them, but, thanks to the words of the Eternal Book, it was perceived as a transition or birth into another world.

"Don't sleep, stay with me"

Who should I go to with a diagnosis of “grief”? To a therapist, a friend, a priest? Doctors need to be paid, but there may be no money, a friend and a priest may not understand, may not have experience...
- It doesn't matter who you approach. It is important that you immerse yourself in a different space. Each of us has our own personal time and space. For example, children (which is why old people love them so much) live in a different space and time - it moves much more slowly than in an adult. Taking time from a child does not mean robbing him, but means identifying with him, connecting to him. And in this space and time you ease your mental heaviness. The child also involves his imagination in the perception of life - he does not get bored. Give him a toy or tell him a story - he will survive the whole situation and the whole life. He does not dwell on all his sorrows, unlike adults. The child emits an amount of energy that far exceeds his own needs for it. We always think that parents keep their child warm. But more often it happens the other way around - it is the child who warms the parents with his warmth and gives strength for life.

In a situation of grief, it is important that the other person is able to accept you. Acceptance is empathy. It's very difficult. Remember from Tyutchev: “And we are given sympathy, just as we are given grace.”

I was once asked to look at a patient from a cancer hospital who was crying all the time. We talked with him for two hours. I just sat and listened to him. Then his attending physician asked for a long time what kind of psychotherapy I used, because the patient calmed down and became adequate. It turned out that this doctor also listened to these complaints, but at that time he was thinking about some of his own affairs, although he did not take his eyes off him and waited for him to speak out to the end.

When you are listened to and empathized with, this is special listening. Because they take your grief and put it on their back - this psychological backpack. And relief comes.

Remember in the Gospel, when Christ suffered in the Garden of Gethsemane and asked his disciples several times: “Don’t sleep, stay with Me” (and they fell asleep every time)? So these are His words - this key phrase, which gives a solution to what and how to help another.

"Swing of Misery"

- It happens that a person suffers, but at the same time he doesn’t seem to want to be consoled, he rejects consolation, explaining this to himself for various reasons: he doesn’t go to others - “they won’t understand”, he doesn’t go to a therapist - “he takes money”...
It’s as if a person finds himself on a swing: one part of the consciousness pushes away these memories, since they destroy you, and the other attracts, because in your mind suffering keeps you near your loved one. And you are afraid to get off this swing and fall into the abyss. How to learn to suffer correctly?
- It takes time for the “swing” to stop; you can neither speed it up nor slow it down. You just need to trust God and the flow of life. A similar situation exists in palliative medicine - when death is already predictable and you cannot save the patient. Here you can’t speed up his departure and you can’t slow him down.

This also applies to the experience of grief. After all, the most interesting thing is that if you experience grief constructively, suffering with an open soul, - it becomes a rich spiritual experience. Here's an example. One day I saw a patient wince in pain. "Tell me exactly where your pain is concentrated?" - I ask. "Never mind, Doctor." “Well, why, we would give an analgesic.” “Doctor,” she says, “it seems to me that along with the pain, everything bad comes out of me.” Pain and suffering, when a person opens up to suffering for purification, becomes redemption, pain itself is a harbinger of some new, more sublime state. If you could see what absolutely holy and extraordinarily beautiful eyes a woman who has just given birth has, although before that she suffered madly, you would understand me.

On the other hand, the cause of protracted hesitation “on the seesaw of suffering” may also be the desire for self-punishment, an unrepentant feeling of guilt towards the departed. In this case, the help of a psychotherapist may be necessary.

It helps many people in this situation when they write letters to their deceased, sharing their grievances, asking for forgiveness, and so on. One psychotherapist had such a case.

The young man quarreled with his father, who soon died. Living in another city and not having time to make peace with him, the son began to feel guilty that he did not have time to ask his father for forgiveness. He began to unconsciously seek death - drive a car quickly, jump with a parachute... In psychology this is called passive suicide. However, his soul became increasingly heavier. And suddenly he received a letter from his father, which was written before his death, but for some reason was delayed. The father wrote something ordinary, but it was clear that he was not angry with his son. The doctor recommended that the son write a response to his father. He did just that (the letter took several pages) and relieved his lingering stress.

And someone writes books. And as if literary, the departed people are already brought to life in memory. The issue here is constructive and destructive grief. It is destructive when a person brings himself on this “swing” to psychosis and depression. And constructively - when he finds the right use of his grief. Because grief is ambiguous, you are not just sad, you also blame yourself for not paying enough attention to this person, and you feel guilty. At this time you need to find work for your soul. The soul should not ossify in this grief, it should creatively develop further and look for a field of activity, a new sphere of application of its love. This, for example, could be works of mercy, it could be a prayer for another who is as seriously ill as your loved one.

Here's an example. One young man, a leader by character, lived with his mother, also a strong and powerful person. They fought constantly. It seemed that there were no people who no longer understood each other. The son didn’t even get married, reasoning: how can I bring a wife into the house who won’t find common language with Mother. He expected his mother to die, then he would arrange his life. Time passed, she still lived, clinging to life and believing that until her son’s life was settled, she would not leave.

When she died, he felt horror that he had no one closer to his mother. That, despite all the arguments, swearing, rudeness and struggle for leadership, they loved each other very much. This horror plunged him into such despair that he was ready to commit suicide. Then suddenly someone offered him a job in a nursing home. He began to look after old women, old men, trying through them to repay the debt that he considered his duty to his mother. And he came out of his impasse.

How can a person understand that in his experiences he is destructive, that he has approached the point beyond which the disease begins?
- Only psychiatrists can accurately determine this. Typically, the triad of depression is expressed in inhibition of thought, inhibition of feelings (melancholy) and inhibition of the volitional sphere, psychomotor skills - when a person is constrained and anemic. It is a bad sign when depression is accompanied by feelings of personal worthlessness and guilt.
Here you need the advice of a psychiatrist.

Life is a rhythm

Previously, people had a ritual: mourning for a certain period, when people did not appear in public places, in a certain way got dressed. There were certain forms for experiencing grief that were approved by society and within which a person felt protected and oriented. Now everything is blurry, you don’t know how to behave at work: being sad is like violating general atmosphere, don’t be sad - again they may not understand. And people push their feelings away because they don’t know how to express them correctly. How not to depend on the opinions of others? How to be truthful with your feelings?
- It seems to me that if the people around them understood the significance of experiences and depression, they would give those grieving the opportunity to be themselves. After all, we wear some kind of masks all the time and try to live up to them. And what is good for the crowd is bad for the individual. If you want to cry, then cry. Someone told me that he simply could not hold back his tears - his wife was dying, and when colleagues asked, looking at his red eyes, he said: it’s an allergy, don’t pay attention.

At the same time, often when we grieve, we forget that life is a rhythm. Like inhalation and exhalation, ebb and flow. And it’s wrong if we think: “How can I go to nature or visit when a loved one dies?!” There is a time to care for a dying person, there is a time to take a break from this care, and in the way that person likes.

In terms of how to behave to others, I think that simply friendly silence, sympathy, co-experience, and understanding of what is happening to this person are valuable.

Loyalty to the past or abandonment of life?

There is an expression - you can’t live in the past, you have to live on. This confuses some people; they believe that getting married is a betrayal of the past. And even when they create new families, they often compare the new spouse with the old one, and families fall apart. What does it mean to live on?
- One man’s wife died, and he was left with a five-year-old child. When after a while the child asked: “Where is my mother?” - the father replied: “She died.” The child thought for a moment, and then said: “Then we need a new mother.” Cruel? But life cannot stand still. The father dies - the child chooses an uncle or friend. When a mother dies, she chooses an aunt and finds her mother’s traits among those around her.

There is devotion to memory when we remain faithful to the person who has passed away. But not everyone can do this. A new meeting is often inevitable. It also happens differently that a person who remains faithful to his deceased spouse was quite lonely during his lifetime. It’s just that his need for people is small, and loyalty has nothing to do with it. And when such a person loses his spouse, he embellishes him in every possible way in his fantasies. But this is more fantasy than reality.

According to statistics, the greatest fear that people experience today is the fear of losing loved ones. How to prepare for natural death close?
- First, create spiritual relationships. It’s one thing when relationships with loved ones manifest themselves in the form of feelings, and another thing is when the state of mutual understanding and love gives that feeling of eternity, a moment of the present past and future. You enter a state of love where only the present exists. The past no longer exists, the future has not yet arrived. The only general recipe is turning to God. If you trust your loved one to God, then you pray with him, pray for him as for yourself, and then this fear goes away. Remember the case when the Monk Seraphim of Sarov invited his spiritual daughter Elena to ask the Lord for death and die in place of her brother, Motovilov. And so it happened.

When losing a loved one, many people engage in rituals, constantly going to the cemetery to be “closer” to the deceased. Isn't this kind of obsession dangerous?
- I was told that one woman goes to the cemetery to visit her husband every Saturday. She says that he knows everything that is happening on earth, and she seems to receive his advice. On other days she was completely adequate. This has been going on for five years now. She explains that it’s good for her and she doesn’t want anything else. Friends could not convince her.

There is such a concept - the charm of grief. When you enter the ritual, you feel sorry for yourself, you feel sorry for the whole world, you feel sorry for the departed person to whom you remain faithful, etc. At the same time, you seem to be offended by the world, by fate, and in fact you are simply leaving, giving up on life.

In my youth, I believed that if you love, then you need to remain faithful to your spouse until your death. But then I realized that this was wrong. The point here is not even to necessarily look for a replacement in the form new lover. It is important that your personality, your life develop. After all, life is creativity.

Love manifests itself in different ways. The main thing is to find it for her creative expression. This can also manifest itself in grave care. Even when they feed crumbs to the pigeons at the grave, they perform some kind of mercy for these little ones. Or when they plant flowers, they decorate that piece of earth that is connected with the space of a loved one. Decorating the space of a loved one - wasn’t that the purpose of life when we lived with him?

Gnezdilov Andrey Vladimirovich,Saint Petersburg

Psychiatrist, Doctor of Medical Sciences, Honorary Doctor of the University of Essex (UK).

Professor of the North-Western State Medical University named after. I.I. Mechnikova, expert in assessing existential and terminal factors of illness at the Clinic of Community Psychotherapy and Rehabilitation of the National Medical Research Center for Psychiatry and Neurology named after. V.M. Bekhterev. Consultant at Hospice No. 1 “Lakhta” (St. Petersburg).

Chairman of the Association of Oncopsychologists of Russia.

In 1963 he graduated from the Leningrad Pediatric Institute. In 1976 he defended his candidate's dissertation and in 1996 his doctorate.

After residency, he retrained as a psychiatrist and worked at the St. Petersburg Research Institute named after V.M. Bekhterev (now - National Medical Research Center for Psychiatry and Neurology named after V.M. Bekhterev) chief researcher. From 1973 to 1983 he worked at the Oncological Institute. In 1990, he created and headed the first hospice in Russia for cancer patients in Lakhta (St. Petersburg).

From 2000 to 2005, he headed the department of geriatric psychiatry (psychiatry of the elderly) of the St. Petersburg Research Institute named after. V.M. Bekhterev. Under his leadership, the department worked on the topic of the quality of life of mental patients of late age, developed a comprehensive system of medical, social and psychotherapeutic correction aimed at stabilizing the condition of geriatric psychiatric patients after discharge from the clinic and adapting to social reality.

Main scientific and practical interests: psychosomatic disorders, mental disorders of dying patients, psychiatric care in hospice settings, creativity.

A.V. Gnezdilov is the creator of new methods in psychotherapy: supportive, palliative and terminal psychotherapy, fairytale therapy, image therapy, bell ringing therapy.

Existential interview

1. Based on your experience, how would you define the mission of psychology in the modern world?

Psychology is a science that people need. Even in ancient times, healers tried to give recommendations based on the characteristics of the characters of the people who turned to them. Modern psychology permeates everything: not only people who have problems in personal relationships turn to psychologists, but also businessmen are now actively using psychology, realizing that without it they are like blind puppies. Existential psychology helps a person realize the meaning of his life. Having realized why you live, you will be able to face not only the difficulties of life, but even death without much horror. From my experience working in hospice, I see that people who have time to think about life and death can make sense of death, make peace and find their place alongside those who have passed on.

At the hospice we care for people's psychological, social and spiritual needs. Some people want to share spirituality and psychological science without acknowledging that they are related. Departure from the canons of faith, from the culture in which people grew up for centuries, only brings harm to science. Our country is going through various crises during which spirituality lights the way and helps people live. In the books of the great Russian writers Tolstoy, Dostoevsky, Kuprin, Chekhov, the Russian spiritual principle is clearly expressed, at the same time, they are permeated with psychology. Psychology and spirituality cannot be separated.

2. What advice could you give to a young psychologist?

I am not a theorist, but a practitioner. It seems to me that a novice psychologist should ask himself about death and see a dying person at least several times.

When I was working as a doctor on duty during my studies, I came to the ward in which a six-year-old boy was lying dying. His parents were in another city, he lay alone - the other children were moved away so as not to traumatize them by their presence at his death. I asked him what I could do for him. He immediately opened up, reached out to me and said: “Uncle, tell me a story.” I took the child in my arms, began to tell him and felt that he was leaving for another world. I wanted to call nurse, knowing that this would not help, but he came to his senses and really asked to tell the story further. And I talked about the golden carriage, the pages, the King and Queen, who would meet him in the magic castle. The child died in my arms, and I was afraid to interrupt the story, because I was not sure that he could no longer hear me...

Contact with death in reality is a very important experience. Yes, we all know that someday we will die and we will no longer be here, but it is one thing to know intellectually, but to gain the experience of contact is completely different. Awareness of mortality encourages us to realize ourselves in this world, to understand the world. People call it different words, but the meaning is the same.

If we talk about the work of a psychologist in a hospice, I am close to the idea of ​​a wounded healer who, thanks to his pain, becomes sensitive to the needs of others. We fight diseases so desperately, but if we understand the meaning of these diseases, it opens up for us new world. I have many illnesses, I put up with them, realizing that if I were deprived of this suffering, which I often have to experience, I would be a more limited, less sensitive person. Suffering helps me understand others and appreciate the beauty of the world around me. Therefore, not only a psychologist in a hospice, but any psychologist, any doctor must be sensitive. As Paracelsus said, “The time will come when every doctor must become a medicine for the sick.” Can you imagine how high the bar is! You can come to a person without having a medicine to relieve his pain, but if, when you leave, you take a piece of his pain with you, then you are a doctor. This is the high meaning of the work of people who heal bodies and souls.

3. What is love for you? in a broad sense this word?

For me, love is, first of all, a mystery. The sages spoke of love as the highest feeling and that the Universe was created by love. It is very strange to connect physical and chemical phenomena with moral laws, but the source of life is in love. When we begin to think that not only do we, people, need God, but also that God needs us - this cannot be expressed in words... My childhood was covered in the poems of Rabindranath Tagore, thanks to them I began to realize that God is it is, first of all, love. When you realize that in the entire world around you there is a mind that puts into action the most complex laws of the universe, you remain silent and kneel. We can accept this world as a gift that the loving heart of God brings us.

4. How do you feel about death?

In the hospice, I often come into contact with the death of others, I know something about it, but if we talk about myself, I am afraid of death. This is an area of ​​the unknown and it scares me.

I remember a dying woman I once spoke to in a hospice. She really surprised me by the fact that she was not at all afraid of death. She said: “I lived a happy life - I married for love, gave birth to my beloved daughter, and nursed my granddaughter. I've learned everything I need to know about life, and now I want to know something more about death." Death is so tragic because we lose this world, our loved ones, but if a person believes that death is like a mask that he takes off, and under it there is another life, he acquires a new attitude towards both life and death.

I talked with Natalya Petrovna Bekhtereva. We have discussed more than once about whether the experience of another life in those people who have emerged from a state of clinical death is a hallucination or an experience that we cannot yet explain. She believed that these were only hallucinations, but when Natalya Petrovna had trouble - her husband and stepson died, she shared with me that when she was in despair, another world opened up to her. She saw, felt, heard him, but said that she could not convey these sensations to others: “In order for them to understand me, they must also experience this state.”

5. Please formulate the main thing that you have understood in this life.

Honestly, it's scary to ask yourself this question. My life has always been permeated with imagination - I searched for beauty that would answer the call of my heart. Therefore, it is both easy and difficult for me to live.

It’s easy to live - because I always knew how to dream, I didn’t need to appropriate someone else’s things for myself: in fantasy I could get anything I wanted. I love reading fairy tales and I think that people use their imagination too little, which hides enormous wealth. After all, childhood is the best period of a person’s life, because he fantasizes and creates worlds. God's greatest gift to man is that each of us is in our own world. The Inner Child continues to live in every grown person, and it is he who helps people get through all the trials that they encounter in life.

It’s hard to live - because after a while, I look back and wonder if I did everything to realize what I would like, I wish to correct mistakes... I ask myself if I used the time of my life correctly, not Has my love for fairy-tale reality obscured for me some other reality of this world that I have not yet had time to know?

Participation in the “Golden Psyche” competition

• “Procedural fairytale therapy in the Castle of Doctor Balu”, master class (in the nomination “Master Class of the Year for Psychologists”, 2018), participant
• “Creating and ensuring the operation of a service to provide comprehensive palliative care to incurable patients and their loved ones in a hospice setting”, (in the nomination “Contribution to the development of a unified professional psychological community in Russia”, 2009), nominee

You may not go to a resort or on an excursion, or go to college or work. But we will not pass by the ending of our own lives. And past what will happen next, too.

You may not go to a resort or on an excursion, or go to college or work. But we will not pass by the ending of our own lives. And past what will happen later, too.

Psychiatrist Andrei Vladimirovich Gnezdilov works with the most severe cancer patients. A quarter of a century ago, he founded the country's first hospice - a hospital that alleviates the lives and suffering of people whose hope is microscopically small or non-existent. Today it is called the First Hospice, in Lakhta near St. Petersburg. From there the Russian hospice movement began.

We talk with Andrei Vladimirovich, who is also called Doctor Baloo, in his apartment full of mysterious things, dolls and fairy tale characters. Doctor Gnezdilov writes works on psychotherapy, and Doctor Balu writes fairy tales that also help patients.

The main conclusion from our conversation is that life, not death, triumphs, and we move up it, along it. ringing strings to end up high. And to whom it is given - very highly.

Often patients, returning from the hospital or institute, burn their old wardrobe,” says Dr. Gnezdilov. - Imagine: separating from the disease, changing the stereotype. And I took advantage of this moment, I have a whole theatrical wardrobe that we use for a person to transform himself.

Do sick people come to your home?

Yes, sure! Many people hold on because they start living again, for the sake of interests in some other area or to overcome the situations that drove them into illness. Often a disease, and especially an oncological one, is, I would say, metaphysical.

Testament of Paracelsus

We hear a scream - we rush to help. Patients do not always want this help. I walk through the hospice, I see patients who are huddled, a grimace of suffering on their faces. I say: “What’s wrong with you? Are you hurt? - “Don’t pay attention, doctor.” - “How can you not pay attention? We started a whole movement and opened a hospice so that you don’t experience pain.” - “Doctor, you know, it seems to me that along with the pain, everything bad comes out of me.”

Bang Bang! The moral principle appears. When we get sick, we think: we sinned somewhere, did something wrong. But here it turns out that illness and pain act not as punishment, but as atonement.

And then Dostoevsky comes to mind, Tolstoy and our entire galaxy famous writers and teachers of life. Of course, under these conditions the hospice service movement itself takes on an ethical character. After all, you can not only heal, but at least alleviate a person’s suffering with a smile, special treatment. And this also applies to gerontology, helping the elderly. We found so many unironed old people that it was time for us to cry ourselves, because when you touch a person with a gesture or affection, he begins to cry. Why is he crying? But, he says, no one pets me.

The medieval physician Paracelsus said that the time would come when every doctor should become a medicine for the sick. It is impossible to cure, and it is also impossible to turn away. If you can't help, share it with him, because he can't be left alone against the tanks that fate brings with it. The problem is narrowed to the point that palliative medicine should only relieve pain, but the concept of pain itself is quite complex.

Because pain sometimes has the character of a psychosomatic relationship, when a psychological impasse in life turns into a somatic disease, that is, a real one. A real doctor is the one who comes to the patient and, without even writing a line of prescription, but simply talking, calms him down with his appearance.

Even in the old days, it was noted that there are special midwives who take birth well, there are nurses, a whole community of nurses who were placed with the child and the child recovered. These nurses were even tested: they were given pearls and turquoise from the dying, on which they faded, and the stones were again filled with colors and freshness. This is a fact that is widely known.

For God's sake, don't take me for a fan of extrasensory perception - I'm against it, but a fact is a fact.

That is, it is not just the hospice that is important, but first of all the doctor’s personality?

This is the idea with which we entered the hospice movement. This is romance, this is a dream. In order for a doctor to say that he won’t be scared, won’t be in pain, won’t be lonely, he must himself experience a tragedy: either the loss of a loved one or his own illness.

There are some life scenarios that serve as motivation to go to study to become a doctor, to become an assistant to humanity. The myths of Ancient Greece speak of the centaur Chiron, who was on the side of the titans, fought with the gods, then made peace, everything is fine. He was artistic, was fond of music and was such a sensitive man-horse. Heroes came to him and talked about their problems and exploits.

And Hercules also got into the habit. Once he came to tell how he dealt with creepy birds, how he shot them with a bow. The centaur asked to see the bow and began to twirl the arrows: is it really possible to kill birds with this? "Be careful, the arrows are poisonous Lernaean Hydra. If you get scratched, it will be bad,” Hercules warned. He laughed: “Hercules, you forgot that I am immortal, nothing threatens me.”

And suddenly he accidentally scratches his hand, a terrible poison pours into his body and begins to devour him. He seeks salvation from pain in minerals and plants. Some things make it easier, some make his condition worse. He eventually becomes proficient in medicine and trains the god Asclepius. Wounded healer - that's what it's called.

Either the person experienced pain, or in his memory is the pain that his parents experienced, or some kind of pain awaits him ahead, and he anticipates it. This pain is an incentive for self-sacrifice.

Summon Granin

Previously, there were knights, templars, and hospitallers; they established monasteries for pilgrims who went to worship shrines, which, if necessary, protected them and gave them shelter during the journey. That's what they were called - hospices, hospices. Hospitality - hospitality.

But it's all much deeper. The life of any person can be imagined as a pilgrimage. We go, we make a fortune and so on. But this is not the meaning of life. And the meaning of life is the example of the Savior.

If you remember, before going to Calvary, he prayed in the Garden of Gethsemane. And he prayed like this: “Lord, let this cup pass from me.” But before that, he told his disciples: “Stay with me, don’t sleep.” Three times he called to them, and three times they said: “Yes, teacher.” And three times they fell asleep.

In fact, somewhere in the depths of the hospice movement, many - although I don’t know for sure, I speak for myself - perceived it as a call to be with the patient. The greatest psychotherapeutic effect on the patient is not even the medicine, but the psychotherapy of presence. Very often, an adult, having found himself in a situation of illness, returns to the path of his childhood. And, as in childhood, the child runs to his mother: “Mom, I hurt my knee.” She will kiss this place, stroke it - everything goes away, he runs on. From these foundations the hospice movement grew.

How did the hospice movement begin in our country?

We must first of all remember Daniil Granin, who in the 1980s addressed people from a high rostrum and said: “Citizens, comrades, friends, do not hope that the authorities will ever be concerned about your situation. If you want to do something good, hurry to do it now with your own strength.”

And then, I remember, people had a great upsurge. We met, were ready to give an apartment, a house, each blowing his own tune. I was blowing the hospice trumpet without even knowing that hospices existed.

He spent ten years at the Oncological Institute, where he came from the Bekhterev Institute of his own free will, when there were no psychiatrists at all in oncology. I understood that I couldn’t drag all this mass - and there were three hundred patients there. There was also a dose from Babayan, the chief narcologist who reigned at that time: 50 mg of the drug per day and not a drop more, otherwise the patient would become a drug addict. As if it mattered whether a person became a drug addict or not when he died.

Into nothing and nothing

We organized the first hospice in 1990. The English journalist Victor Zorza came, he was actively involved in hospices in England, and when it became possible, he came to us.

We went to England with Victor Zorza and at his expense, where I studied how all this should be arranged. Thanks, I believe, to Granin, a group of not even nurses, but simply people without medical education who came to the hospice, followed me.

Who could they be? Nurses, paramedics - no education required here. Penny salaries. And many retrained to become sisters. But the most interesting thing is that the team was such that I remember every single one of them. Poor conditions, a rural hospital in Lakhta, which was built by Princess Olga. But warm. Something happened there that I have never seen in the world - equality of all medical workers.

In terms of?

When you walk into a regular hospital, who’s in charge? Chief physician. And then the head of medicine. And then the doctors. And then the sisters. And then the nurses. And then the sick. When the patient must come first! And there must be a reference group to which he trusts his health and so on.

There is no offense here that the patient is frank and asks that they send not a doctor to him, but, say, a nurse. Which is simply easier.

I don’t know if you’ve ever been to a hospital where everything immediately comes down to the issue of stool. You are lying in a room, and there are three other people with you. Doesn't matter. You should go big. Right here, lying in bed, wearing all sorts of diapers. But you're embarrassed to fart or something. And suddenly Zinochka, our nurse, who was once Romanov’s thrush, appears. She looked after the cow that gave milk to Grigory Romanov.

First Secretary of the Leningrad Regional Committee of the CPSU?

Well, yes. And here she is - this creature is so, well, a little ridiculous. Big growth, rude. But somehow calm. She comes, the patients are waiting for her when she comes on duty. With her, pooping is not scary and it all happens naturally. And what? Everything is fine. Calm down. They wiped and washed everything. It was very important that patients could choose someone with whom they felt easier. Partnerships.

Was it a religious institution?

Not religious, but spiritual. What is spirit? Everyone understands as they please. But first of all they think that spiritual means religious. Call Father and so on. But this is only part - religious care of the sick. And each according to the confession to which he belongs.

Spirituality is much deeper. This is the introduction into the patient’s consciousness of some ideas about death. Because they ask: what should they expect, what will happen next. And our important task is not to give a recipe for an easy death to the patient, but to make him comprehend it.

Meaningful death is associated with the meaning of life. And dying is much easier when you understand what you are dying for. Or dedicating your death: for example, “let me die, but my children will be healthy.”

But a person dies not as part of an act of self-sacrifice, but from an illness that happened to him involuntarily.

One of my clients underwent surgery and found out that she had rectal cancer. They didn’t touch him, they only took him for a biopsy. And they discharged me, saying that everything was fine. She understood that this was not order, it was just said that way, for the word. She says: “I must live. I have a daughter, my husband is an alcoholic. And I got sick because my husband chased me drunk with an ax and kicked me in the crotch. After a month and a half, my tumor began to grow. I must live."

And she lives. She lives for a year, although she was not given a month. One and a half lives. Finally, things somehow work out: the husband disappeared somewhere, unable to bear the aroma, some relative appeared, the daughter got a job in college. She says: “Now I can die in peace. Everything is built in." And he dies.

They perform an autopsy on her and find no cancer. There is no doubt that it was, she just actually beat cancer. She was so connected with her daughter, and there was such an internal attitude.

So talk about the disease being a self-sacrifice is not empty space arose.

By the way, it is curious that when young doctors come to an oncology clinic or hospice, their first question is: “Are there cases of healing?” There are.

And a wonderful example of this is the story of Seraphim of Sarov. Father Motovilov was very friendly with him and became seriously ill. They started talking about how “you are not ready for death.” “Yes, father, I’m not ready, I don’t know what to do.” - “Okay, let’s pray, think.” He comes the next time and says: “You will live, my spiritual daughter, yours, agreed to die instead of you.” cousin. She is already ready for anything, she will die instead of you.” And indeed, my sister dies, but this one remains.

Now, let’s say, in St. Petersburg, a person with stage 4 cancer can always count on hospice care?

Yes. We always remember Victor Zorza well. He said that it would be better for us not to open a hospice at all than to make it paid. And then this principle of free palliative medicine was adopted from us by dozens of institutions across the country. In general, I won’t even say how difficult it was to rouse and stir up the masses in order to instill in them something new.

Why is Russia such a stumbling block? With us, any undertakings dissolve into nothingness and end in nothing. Perhaps we survive because both bad and good things don’t come out of us, they drown. Therefore, all this had a hard time taking root in Russia.

Unfortunately, giving a person a guarantee that dying will not be painful, not lonely, not scary is too much responsibility, it is simply a matter of sacrificing oneself.

Inner child

Look, she's not pretty, but she's so cute! I call her Peggy Maggie Molly. In the morning she is Peggy, in the afternoon Maggie, in the evening Molly, she also knows lullabies.

Why dolls?

These are special beings with whom psychotherapy is associated. This is the child's first friend, because he is small, and the doll is even smaller. And on dolls he plays out the relationships that his parents impose on him.

And here a lot of interesting things happen. There was never a time without tears, because meeting with childhood stirs up a lot in patients. This is the reserve we have in life.

After all, how is a child different from an adult? A child has imagination, he can own the world without appropriating it, but freely letting it go. And this possibility of irrational thinking, inherent in a child, consoles an adult. Because the inner child lives in everyone and saves us from the most difficult situations - right up to when we say that cancer is in the last stage, it’s time to die.

The inner child says: “But there is no death. If she threatens me, then she’s gone!” And his thinking is affective, it is saturated with emotions, his faith. She helps him overcome many problems. That's why we practice psychotherapeutic return to childhood.

Surprised medical workers share: our professor is lying in the clinic, which he himself created, turns to the nurse, says: “Could you read to me?” - "Please. What would you like to read? - “Fairy tale.” - “Why a fairy tale?” - “Because there is an element of miracle in a fairy tale.”

People can be divided into:

• those who believe in miracles,
• admitting that our whole world is a miracle,
• on people who don't believe in miracles.

And I began to write fairy tales about our patients. If a fairy tale suddenly begins to sound, it means you have an abyss of time, no less than Scheherazade, and a fairy tale in this sense makes it possible to create, as it were, models of a new life.

Where are these dolls from?

Let's do it. I looked for storytellers, but I couldn’t find them, and it was very sad. And suddenly I came across the puppeteers. And puppeteers, it turns out, are also storytellers, they make fairy tale figurines that replace people. They replace - that is, they know how to build the future.

Build the future?

Yes. Do you know that an action that is lost in some situation is easier to implement in reality? Sometimes a doll becomes a mascot. The most important thing is that the so-called transfer occurs here. A doctor came to the patient and said: “I am the Nutcracker, I have come to serve you.” And he gave me a doll. Due to stubbornness, perseverance, and pride, the patient cannot trust the doctor. But he puts the doll on the sore spot - and he feels better! Here is a doll that has consoled so many sick people!

Death and miracles

In his books, along with detailed description psychotherapeutic methods, as well as conditions experienced by cancer patients, you also talk about unusual phenomena associated with clinical death.

Clinical, not clinical - it is still connected with the same thing.

When does death line up? Heart stops, brain stops, nothing comes in, nothing comes out. But in fact, when a person dies, the heart has stopped, the blood has stopped, the brain does not work, the person experiences what is far away.

A simple peasant woman from the Pskov region suddenly speaks the purest English - personal experience. I was sitting next to her, she was dying, suddenly she came to her senses, smiled and said: “Doctor, do you know what I saw now?” I ask: “What did you see?” “I saw that I was in some strange place. I understand that this is England, and I, in a white bride’s dress, must go down the stairs and go to church to get married. And my name is Annie."

Interestingly, her Russian name sounds exactly like Annie in English. I say: “Do you speak English?” And suddenly she answers me in English, she sounds beautiful English speech. She said something else, her hand fell, her eyes dimmed, and she died.

All sorts of miracles that everyone argues about quietly happen here. The dying patient fell into a coma, and a second patient was placed in his ward. And he, seeing that this one was dying, was afraid for himself and called the priest to confess and receive communion, just in case. They came and received communion. The priest leaves, turns to say goodbye, and suddenly the dying man comes to his senses first and looks with such an expression that it is difficult to make a mistake.

The priest comes up: “Perhaps you, too, would like to take communion?” He doesn’t have a voice, he blinks his eyes: yes. Communion. He began to leave, and again at the threshold he turned to say goodbye: “Goodbye!” - and this one, the first patient, has already died. It’s the last minute, imagine, and receiving communion is something! And feel it, and only a tear in his eyes.

What is important to know when living and remembering death?

I really love Heraclitus. He said: “A man lights a light for himself on the night of death; and he is not dead, having extinguished his eyes, but is alive; but he comes into contact with the dead while asleep, and while awake he comes into contact with the slumbering.”

I don’t want to criticize our Christianity at all, but it seems to me that while we talk so much about sin, we shouldn’t forget about joy. I was brought up on Rabindranath Tagore, where there is such optimism, such light, colors, brightness, love. And for me, God appears not as a judge, but as love. If you maintain love for God, then this already gives you the opportunity to hope for salvation. This is how you can say it.

But here you rely not only on the divine description, here Robert Burns also turns up, the epitaph on the grave:

“Here I rest, Jimmy Hogg.
Perhaps God will forgive me my sins,
What I would do if I were God
And he is the late Jimmy Hogg!

This is a joke, of course, but nevertheless it seems to me that everything is much deeper. And what does it mean: someone will be saved, someone will not be saved? I think that in some deep sense the whole world is striving for unity. It is difficult to believe that God made a mistake in something when creating.

Confessors of Pain

People lose strength, get sick, and decline from quite simple things and stress. Where does the doctor and hospice staff in general get their strength? How do they manage to hold on?

You know, oddly enough, they knock out a wedge with a wedge. And, so to speak, we are induced in our professional burnouts by the sick. On the one hand, they are precisely the factor that burns us out, and on the other hand, it is the sick who become the motivation for support and help.

You understand, we are cooking in the same pot with them. Therefore, do not rush to throw stones at doctors and medical staff: what they have to endure and come to terms with is actually dooming themselves to constant stay in a negative field.

We get used to the sick when we eat a ton of salt with them in pain. And in fact, all the suffering that the patient endures, we also endure on ourselves - in a reduced amount, but more often. But in general this is... What word should I find? Confessors of pain, or something. Yes, maybe.That's who hospice doctors are.

But, of course, we hold on not only to the patients who support us, we also hold on to our loved ones. By the way, you can even check mentally and speculatively who your friend is. Not the one who shares joy and fun with you, but the one whom you would take, dying, to your bed as a mourner.

Is there a hospice community?

It exists, but it... That is, in the West it exists more. We have so many problems all the time that it is difficult to exist. And then everything is based on some kind of competition: whose hospice is better. This is some kind of nonsense. Who will die better, who will die faster? What criteria should you choose? Therefore, it is very difficult here.

But you are talking about a cohort of iron knights. Does this cohort still exist?

It exists in people. Even, perhaps, not in doctors, but in those who are able to understand and feel this problem.

The last lullaby

One simple woman, talking to me, says: “Andrei Vladimirovich, speak to me frankly, I am not afraid of death!” I answer: “Well, what are you talking about, we are all afraid, there is nothing wrong here.” “I have such a case,” she says, “I lived a happy life, although I was not married to a rich man and so on. But I wanted to get married and have a girl - I had a girl, then I wanted a granddaughter - a granddaughter was born. In general, I lived a decent and sufficient life. And having learned everything about her that could be learned in my position, I want more.”

Can you imagine: looking for an explanation of life in death! This is a great thing. This is the beginning of some kind of optimistic philosophy, or something.

While reading your book “The Road to Calvary,” I noticed that a person’s reaction to the news that he has cancer is quite typical and predictable, and his further behavior is also classified. You catch yourself under the impression that we humans are calculated and somewhat mechanical. And the question arises: is there something in a person that is both unpredictable and completely real?

Well, you see, if we generalize everything, we need to remind ourselves of one more factor: every dying person gives himself permission to die. It could be the smile of a loved one... Permission to die from relatives, from a priest... A person gives himself permission to die.

Moreover, death is sometimes viewed as a balloon from which air flows. He falls - and that’s it...

In fact, the last step is very often accompanied by tension. That is, a person must step into the unknown. Allow yourself. He stops struggling and walks. And the current catches him.

In this sense, Sokurov’s statement is interesting. He came to see us there, in Lakhta, and was delighted. He says, “What a wonderful place to die.” Why is it great? “But the bay is nearby. It’s like a platform for planes that take off”...

One woman was dying. Her husband was sitting with her. He held her hand, as if everything was according to the rules. She doesn't die. The sister comes up and says: “You are holding her. She won't die while you're here." - “What should I do?” - “Go for a walk for an hour and come back.” He went for a walk. The sister sat down in his place, took the patient’s hand and began to sing. What do you think she started singing? Lullaby. Suddenly the patient smiled. This death languor subsided from her. She put her hands under her cheeks and took this pose like a child. And she left... She left with a smile, lulled by a lullaby.

Having received a diploma as a general practitioner in 1963, he later became a psychiatrist at the V. M. Bekhterev Psychoneurological Institute, from where he came to the Leningrad Oncology Research Institute. N.N. Petrova, guided by the idea psychological assistance the most severely ill patients. His public lectures facilitated his acquaintance with the English journalist and hospice movement activist Victor Zorza.

With the support of A. Sobchak, in 1990, in the suburb of St. Petersburg (then still Leningrad) Lakhta, they opened the first hospice in our country - a medical institution to provide assistance to incurable patients. published

Interviewed by Mikhail Rogozhnikov

In 1990, in the suburbs of St. Petersburg, in the village of Lakhta, psychiatrist Andrei Gnezdilov created the first hospice in Russia, guided by the principle that if a person cannot be cured, this does not mean that he cannot be helped. Therefore, the hospice motto became the words: “If it is impossible to add days to life, add life to days.”

“We have long wanted to invite Andrei Vladimirovich to Moscow so that he could introduce us to his views on the most important issues of existence: life and death, preparation for death,” Professor Boris Sergeevich Bratus, scientific director of the Faculty of Psychology, began his speech. In the 1990s, amid all this devastation and difficulties, the hospice that Gnezdilov opened was a fundamentally new turn in medicine, a new type of attitude towards people.”

Hospice No. 1 “Lakhta”
Photo: Andrey Petrov/mitropolia.spb.ru

The one who literally “ordained” Gnezdilov into the profession was the Soviet-Polish-English journalist Victor Zorza. He himself played a big role in the development of the hospice movement in the world, although not in the wake of any public interest in this problem, but for personal reasons. His daughter was a cancer patient. She died hard and for a long time, and spent her last days in one of the English hospices. After Jane's death, Zorze wrote a book about her and came to Russia, among other things, to perform last will to my beloved daughter: to open hospices around the world. In Russia, the journalist met Gnezdilov, whom he began to actively help.

Today, the doctor-storyteller, with his therapeutic tales, relieves pain for some and helps others come to terms with the future. “It’s one thing to participate, and another thing to be able to come to a person in his complete helplessness, in his abandonment, loneliness,” Professor Bratus concluded his speech. “This is precisely where Gnezdilov’s main merit lies.”

Death is the biggest mystery

“We begin to understand the world only when we stop defining reality in terms and look at it not from the point of view of stereotypes, but from the position of the heart,” Gnezdilov began his speech. “Only then does it become obvious that death is the biggest mystery that conceals a lot of new things.”

Recalling his acquaintance with sculptor artists, in whose workshops Gnezdilov visited a lot, he noted one feature: the inseparability of life and death. “No matter how hard artists try to depict death, they inevitably depict it through life. This duality of death is always present and always striking. At the same time, death always and first of all has a negative meaning for us, because it is associated with deprivation and grief of loss. But if you take the Russians folk tales, then you will find that only evil power has immortality in them.

There have been many writers who have tried to describe the state of a person who has achieved immortality. But in this case, a person who constantly lives and does not die, whose life events are repeated, and the freshness of feelings disappears, recognizes his life as cursed. And here the negative of death is more exposed than the positive. A person always sees death not in itself, but through the changes that it brings.” It was this attitude that Gnezdilov and his like-minded people, with whom he created a hospice in the village of Lakhta, wanted to change.

It is significant that on the site chosen for the hospice there once stood a hospital for the poor, built by the Fermor-Steinbrocks, an aristocratic family who migrated from Sweden and served Peter the Great. It was as if the baton of merciful service and help to the needy and hopeless patients was being passed on symbolically.

“The hospice is located on the shores of the Gulf of Finland, which once again helps to understand how important it is for a person to be close to nature. After all, when a person dies in nature, it is as if some kind of harmony occurs, which the ancient Greeks wrote about, the professor continues. “Our first experience was with an old man. He died hard. Next to him were his wife and children. They saw how he suffered, tormented, and suffered with him, unable to alleviate his situation.

We came up with the idea of ​​bringing them the Gospel to read aloud. It soon became clear that the old man had died. The family left him, trying not to make noise. And there was a feeling that they experienced his death not as a loss, but as a sacrament. It was as if they were comforted by the words they read to him, thanks to which they were included in a certain rhythm of the world around them.”

Unmade discoveries

The Greek philosopher Heraclitus compared death with birth and said that when a person dies, he is simultaneously born. “This expression “death-birth” is actually very deep. When we were thinking about how to make the work of the staff in the hospice easier (this work requires special stress and can result in burnout), we decided to send some of the staff to the maternity hospital. And it’s interesting that the feeling of heaviness from the meaninglessness of the suffering of the dying disappeared from our employees when they saw children being born. I myself still remember the faces of women in labor. You see their glowing eyes after giving birth, it’s so beautiful. It can also be noticed when a person leaves, suffering leaves him, but his eyes remain open.

Heraclitus has another expression that I remember: “On the night of death, a man lights a light for himself; and he is not dead, but alive, having closed his eyes; and he comes into contact with the dead - while asleep, while awake - he comes into contact with the slumbering one.” It is impossible to suspect Heraclitus of playing on words. On the contrary, his words provide such support and promise discoveries that have not yet been made.”

Prayer of Jesus Christ in the Garden of Gethsemane

Stay with me

“When Christ was in the Garden of Gethsemane, he asked the disciples to stay with him. They answered him “yes, yes,” but fell asleep again,” Gnezdilov continues. – The words “stay with me” are essentially the basis of the hospice movement. If so Greatest Entity needed the help of ordinary fishermen, then how much does each of us need such help, to sit with him, to make this “transition” easier?

And the transition is often very scary. People are protesting. At this moment, when the most severe struggle occurs, a person feels lonely, sick and rejected. How to withdraw it? How can I help him? This question “what to do?” sounds very clearly in the poems of A.S. Pushkin:

There is ecstasy in battle,
And the dark abyss on the edge,
And in the angry ocean,
Among the menacing waves and stormy darkness,
And in the Arabian hurricane,
And in the breath of the Plague.

Everything, everything that threatens death,
Hides for the mortal heart
Inexplicable pleasures -
Immortality, perhaps, is a guarantee!
And happy is the one who is in the midst of excitement
I could acquire and know them.

These words contain contradiction and truth at the same time. Indeed, we all strive for To the Eternal Beginning, but we cannot feel it. However, this desire leads a person to special condition, special space. Psychologists know that space can be different. And the space of illness is especially painful. Suffering itself causes a person to shift the level of his perception. They say about this state: “the white light has come together like a wedge.”

A person’s personal space always requires special care. Unfortunately, we do not pay any attention to the deep needs of the patient.

But there is one more observation that is relevant to our conversation. Whatever they are medical institutions, even if they are created under the most noble auspices, within them the spirit of purity always coexists with the spirit of loneliness and pain. This is probably why, when we come to the hospital, we rarely feel comfortable here. In the hospital there are no native walls, native people who support, among whom a person would like to die. And even though some people strive for this, I’m sure no one would want to die in a hospice.”

Pain. Punishment or redemption?

One day, Doctor Gnezdilov was walking through the hospice and saw a woman whose face was distorted. She clutched her temples tightly with her hands, clearly suffering from a headache. The doctor asked her what happened and what hurts?

“Don’t pay attention, doctor,” she replied.

- How can it be, I’m here to help you.

“It doesn’t hurt that much, but it seems to me that along with the pain, everything bad comes out of me.”

Pain and illness, according to Gnezdilov, have the same root. This is important to understand when discussing the nature of the disease. The professor is convinced that we often perceive illness as a punishment for sins, for wrong behavior, but at the same time we forget that pain is not only punishing, but redemptive.

“And although this idea is controversial, nevertheless, one must admit that when a patient calls for help, it is not always a sincere desire to fall into the hands of a doctor and be healed. Some people who consciously reject death subconsciously seek it somehow. And often this is the desire to die through suffering, through overcoming some boundaries.”

Andrey Vladimirovich Gnezdilov
Photo: vk.com/club479029

What should you remain silent about?

It is difficult to describe what a person experiences before death. But Gnezdilov is sure that a person always feels its approach. “Depending on people’s beliefs, either angels or white women appear to people,” he says. – And sometimes people have strange requests that would not be taken into account in ordinary medical institutions. For example, put it on the floor or give it a lot of water. But immersing his hands and face in the water, a person suddenly receives great pleasure and consolation. And we understand that connection with the forces of nature helps a person to endure certain difficulties.

At the same time, there are many difficulties. In our time, the possibility of contacts has increased, but all these contacts have become less valuable. You will not always find a person who, for example, will agree to share your sorrows with you. But we are all masters at making predictions, and often the internal picture of the disease that we have is formed through loved ones leaving the doctor’s office with barely hidden tears. Conversations with patients, waiting for a doctor, the glances of relatives - all this can play a tragic role for the patient.”

Gnezdilov remembered shining example from his practice. One cancer patient underwent radical surgery to remove breast cancer. Everything went well and the patient was in no danger of relapse. After the operation, she was taken in for dressing by a young doctor who had a habit of pursing his lips. The woman left his office in tears, convinced that the pursed lips were the doctor’s barely concealed sympathy for her condition. And although those around her consoled the woman, everything was in vain. By the evening of the same day, she had a heart attack, as a result of which she died.

According to Professor Gnezdilov, today this is one of the most pressing problems facing oncologists, psychologists, and hospice staff that require discussion: what and how to tell the patient?

“Hearing the patient, hearing his complaints is very important. Sometimes it is enough to take and hold a person's hand. This is not a simple gesture at all; sometimes it conveys more information than a conversation. Touching your hand helps you feel less lonely. Understand that people cry not because they hurt, but because they are lonely, people don’t approach them, they are disdainful of them.” Sometimes, when the end is inevitable, patients ask to be hugged at the moment of dying. “But even for the sake of this one hug you can live your whole life,” Gnezdilov is sure. “Because the acceptance of one person by another is very expensive.”

Doctor-storyteller Andrei Gnezdilov has been working with seriously ill and dying people for many years. He tells stories at their bedsides. There was a time when his tales were more of an edifying nature. Noticing the features and characteristics of a person, the doctor transferred them into a fairy-tale narrative.

“Now I’m trying to learn more about human life,” explains the professor. – The fact is that many do not find anything worthy of attention in their own lives to even remember about it. And then I ask questions, try to guess their lives, look for whether there was anything wonderful in the patients’ lives.

It's interesting that on different days people evaluate their lives differently. But the craving for beauty, in the end, allows everyone to see heroism when a person meets death. No matter how many of us there are, each of us will have to enter this Gate one by one. And here it is always important that at least something, even a speck of dust from the fairy-tale arsenal, falls on the shoulders of a dying person and illuminates what really makes life beautiful and heroic.

I know that through fairy tales, telling the story of a person, where he was beautiful, or weak like a child and needed help, you can always reveal the present, which justifies both the future and the past.”

Andrey Vladimirovich Gnezdilov​ (Doctor Balu) is a St. Petersburg psychiatrist, Doctor of Medical Sciences, honorary ​Doctor of the University of Essex in England.

Andrey Vladimirovich was born in 1940 in Leningrad.

Andrey Gnezdilov: The day of a person’s death is not accidental, just like his birthday

In 1963 he graduated from the Leningrad Pediatric Institute. After residency, he retrained as a psychiatrist. He worked at the Bekhterev Psychoneurological Institute, and from 1973 to 1983 at the Oncological Institute. In 1976 he defended his candidate's dissertation and in 1996 his doctorate. In 1990, he created and headed a hospice in the Primorsky district of Lakhta of St. Petersburg.

Andrey Vladimirovich is a real St. Petersburg Storyteller who has preserved the traditions of the Good Wizards. Andrey Gnezdilov is a devotee and public figure, a tireless researcher and “generator” of new methods in psychotherapy: fairy tale therapy, image therapy, bell ringing therapy.

The psychotherapeutic tale of Andrei Gnezdilov is a gentle touch to the Soul of a person, support for him on the Path, a soft form of initiation into spiritual knowledge. The view of the Storyteller is the view of a person who is able to understand and accept the secret aspects of internal processes, support in good and spiritual searches, share pain and give joy.

Gnezdilov A.V.. Audio booksGnezdilov A.V. on video

Books (9)

Section: Fairy tale therapy

The book by the famous St. Petersburg doctor and storyteller contains his fairy tales that help people cope with difficult situations for them - family problems, loss of loved ones, discover new strengths in themselves and find inner harmony.

Meetings on the road. Therapeutic tales

Section: Fairy tale therapy

A psychotherapeutic fairy tale is a bridge between realities: social, objective and subtle, mental. Andrei Gnezdilov’s psychotherapeutic tales not only create these bridges, they also nourish our mental world. They form a wiser and more tolerant attitude even towards those things that we cannot change; they allow us to more subtly, spiritually comprehend the meaning of the most difficult life situations.

Labyrinths of the soul. Therapeutic tales

Section: Fairy tale therapy

The book “Labyrinths of the Soul” presents tales of the St. Petersburg psychotherapist, Andrei Vladimirovich Gnezdilov, known to many as Doctor Balu.

Everything described in these stories is reality. But not external, but internal, psychological.

This collection contains many fairy tales that seem to be inspired by the sea. Each breath of the wave brings a new story; they roll over each other, intertwining in a bizarre pattern.

Music of dawn. Therapeutic tales

Section: Fairy tale therapy

The psychotherapeutic tale of Andrei Gnezdilov is a gentle touch to a person’s soul, support on his path, a gentle form of introduction to spiritual knowledge.

The view of a storyteller is the view of a person who is able to understand and accept the secret aspects of internal processes, support in good and spiritual quests, and share pain and joy.

Petersburg dreams

Section: Miscellaneous

“I don’t know about you, dear reader, but I’ve always been interested in finding out what dreams other people have. But the inquiries were most often in vain. Someone said that they don’t see dreams at all; others admitted that by morning they forget their dreams; those who remembered could rarely convey what they saw in a dream to even the most attentive listener: when retelling the dream, they lost all their charm, turning into dead butterflies with broken wings.

And here are these stories. They are like living butterflies. The wings flutter and shimmer, and the flight path is difficult to predict. These stories do not obey the laws of literature. Whether they are parables, fairy tales or short stories, it is difficult to determine to what genre they can be classified.” Gnezdilov A.V.

Psychology and psychotherapy of losses

Section: Practical psychology

In the book of the famous St. Petersburg psychiatrist, psychotherapist and humanist A.V. Gnezdilov, issues of psychotherapeutic assistance to dying patients are discussed. Based on many years of experience and the results of scientific research, the author analyzes key points palliative medicine: understanding the problems and needs of a terminally ill person; developing the ability to endure inevitable suffering; medical control over the symptoms of a terminal condition, primarily chronic pain syndrome, principles of comprehensive work with loved ones and the family of the dying person; use of various therapeutic methods and techniques. The book also discusses the problem of recruiting personnel to work in hospices and the issue of professional “burnout” of personnel.

Pilgrim's Paths. Therapeutic tales

Section: Fairy tale therapy

The collection “The Pilgrim's Progress” presents more than 20 tales of the famous St. Petersburg psychotherapist and storyteller.

Dr. Baloo's tales are therapeutic tales. They not only transport the reader into the mysterious and mysterious, whimsical and wonderful world fairy tales, but also help people find a way out of current difficult situations, understand themselves and find inner harmony.

The path to Calvary

Section: Basics of psychotherapy

Essays on the work of a psychotherapist in an oncology clinic and hospice.

The book “The Path to Calvary” is a documentary essay on the work of a psychotherapist in an oncology clinic and hospice.

This book fills a serious and socially dangerous gap in the education of doctors. The ascent to the martyr's end of life while dying of cancer is her theme.

The purpose of the book is to teach a doctor to free a person from physical and mental suffering associated with illness, providing the opportunity to perform the last earthly act of the soul, understanding, farewell, forgiveness and reassurance, preserving the work of the mind until the last moments of life.

Old Prince's Chest. Selected Tales

Section: Fairy tale therapy

Everything that is told about in a therapeutic fairy tale is real.

But not in the social, material world, but in the mental world. Our thoughts, feelings, unrealized aspirations, impressions of relationships and travel become heroes. The development of the plot and its twists and turns symbolically convey the dynamics of our experiences. And at the end of the fairy tale, the problem is resolved, answers to difficult questions about oneself and life are found.

This collection includes the best - old and new - fairy tales of the famous St. Petersburg psychotherapist Andrei Vladimirovich Gnezdilov, chosen to become assistants to our thoughts and feelings, desires and possibilities, aspirations and values.

Reader comments

GNEZDILOV Andrey Vladimirovich (born 1940)

GNEZDILOV Alexander Vladimirovich

Doctor of Medical Sciences, Professor

Born on October 8, 1957 in Moscow. Father - Gnezdilov Vladimir Ivanovich (born 1923). Mother - Gnezdilova Galina Petrovna (1930–1988). Wife – Gnezdilova Elena Fedorovna (born 1957). Daughters: Victoria (born 1978), Alexandra (born 1981), Ekaterina (born 1984), Anna (born 1986), Marina (born 1987). Son – Andrey (born 1983). Has ten grandchildren.
In the medical environment, the image of a doctor is often linked to the presence of an academic degree, and official recognition to the title of academician or corresponding member of the Russian Academy of Medical Sciences. This is the established rule. With an academic degree, Alexander Gnezdilov, as they say, cannot be higher. He is a doctor of medical sciences, professor. The attitude of his medical colleagues towards him is clearly respectful, he is recognized as a doctor of the highest rank. The main indicator of class is the crowd of sufferers in the clinic, where he sees dozens of people from all over Russia and neighboring countries from seven in the morning every day. People come to him who have been tormented for years by pain in the spine, joints, musculoskeletal system, headaches... In the treatment of these diseases, Dr. Gnezdilov is a real ace.
Alexander Gnezdilov’s parents had nothing to do with medicine; they worked as engineers in the development of aircraft control systems. Each of the parents has a rather difficult fate. Alexander Vladimirovich’s father, Vladimir Ivanovich Gnezdilov, is a native of the village of Milenino Kursk province. He volunteered for the army in 1941, was surrounded near Moscow, and was wounded near Vyazma.

Due to heart disease he was discharged. Alexander Vladimirovich’s mother, Galina Petrovna, lost her parents very early. During the years of the Leningrad blockade, she was brought up in orphanage. She didn't let her younger brother die. They were taken from besieged Leningrad according to “The Road of Life”, when my mother was 11 years old and my brother was 3 years old. Later, Galina was adopted by her own aunt, who lived in Moscow.
Alexander Vladimirovich’s parents met while studying at the institute, then worked together.

Andrey Gnezdilov: We will not pass by the finale of our own lives

It was a rather late marriage. They were tough people and very demanding. The war and the mother’s childhood during the siege left their mark on the foundations of the family. The family lived in austerity mode. In addition to Sasha, there was a sister eight years younger in the family. Alexander Vladimirovich was born in the famous maternity hospital named after G.L. Grauerman on Arbat, where the best doctors of the country, then the Soviet Union, worked. For the first three years, the family lived in a private house on Mozhaisky Val. There were terrible drafts in the house, the house was being prepared for demolition, and no one was doing any repairs. Got sick little Sasha pneumonia several times, he developed bronchial asthma, which haunted him throughout his childhood. Receiving hormonal intensive therapy, which was fashionable at that time, he was tied to medications. Also in school years he realized that this had to end. I started playing sports intensively. I chose running. When he started running, his face turned blue, he ran for the first 500 meters with signs of suffocation, then it became easier to run, and by the 10th kilometer he returned home, pink and happy. So he fought a serious illness. Until the age of 35, Alexander Vladimirovich ran a marathon distance, jogging up to 10 kilometers daily.
Having suffered a serious illness, in the 8th grade he firmly decided to enter medical school. His technical parents drilled him harshly and demanded that he study well. He had difficulties only with exact disciplines. But by the time he graduated from school, he was well prepared in chemistry and biology - he was interested in these subjects at school. He wrote quite competently, studied physics for several months with a tutor and achieved the amount of knowledge required to enter a university. In 1974, he successfully passed the exams at the 2nd Moscow State Medical Institute named after N.I. Pirogov (MGMI). Starting from the 3rd year, I studied with pleasure and easily, when I left the disciplines that were not in demand in medicine. Specialization began, disciplines such as propaedeutics appeared, which constituted the basis and preceded a more in-depth and detailed study of other disciplines. Since 1977, after nursing practice, Gnezdilov began working as a nurse in the intensive care unit of the Research Institute of Proctology. There he met future wife Elena Fedorovna Gurycheva, who worked as a nurse in the operating room. We became friends and had an early student marriage.
Even then, he decided to become an anesthesiologist-resuscitator, and his work at the Research Institute of Proctology helped him acquire his first practical skills in working with patients, especially the most difficult ones. It was a rather eventful and difficult period in his life. The need to take care of his family forced him to combine work in several places at once. Elena Feodorovna took upon herself all the care of the children. She gave Alexander Vladimirovich the opportunity to develop creatively, do interesting work, and become a unique doctor. While studying at the 2nd Moscow State Medical Institute, he took special interest in his favorite subjects: normal physiology, therapy, pharmacology, neurology, anesthesiology and resuscitation. After graduating from college, he had skills in a number of medical procedures and in intensive care.
In 1980, Gnezdilov was enrolled in a clinical residency in anesthesiology and resuscitation at the All-Union Scientific Center for Surgery (VSC) of the USSR Academy of Medical Sciences (at that time the All-Union Research Institute of Clinical and Experimental Surgery of the USSR Ministry of Health). In 1978, a department of planned microsurgery was organized, a team of young enthusiastic surgeons was organized: researchers, graduate students. Microsurgery work was just beginning there. Gnezdilov’s first teacher was Vsevolod Anatolyevich Svetlov, Candidate of Medical Sciences, senior researcher, who taught him the basics of anesthesiology and resuscitation. Most of During Gnezdilov’s residency, she was given work in the microsurgery department.
It was very interesting, productive work. The first children appeared whose lower limbs were replanted after train injuries, after industrial injuries, frostbite, and burns in adults. Transplantation of flaps, restoration of nerves, blood vessels, muscles, free muscle transplantation with microsurgical techniques, transplantation of organs and tissues - all this was a field of activity in microsurgery. Hours of operations were carried out. The longest operation in which A.V. participated. Gnezdilov, lasted 21 hours. Surgery within 10 hours was the norm. There was a great desire to become a professional anesthesiologist-resuscitator. “In intensive care,” says Alexander Vladimirovich Gnezdilov, “I am a supporter of the fact that any graduate medical university must work in the intensive care unit for some time. This teaches manipulation skills and teaches one not to be afraid of seriously ill patients. You have an approach to them, you are not afraid of difficulties. In a short period of time, you provide the patient with efficient, effective assistance, the results of which you see immediately.”
Since 1982, after completing his residency, Gnezdilov worked as a doctor in the anesthesiology department of the All-Russian Scientific Center for Surgery, mainly in the unit providing anesthesiological care during microsurgical operations. Over seven years of work, Alexander Vladimirovich mastered the entire arsenal of anesthesiological and resuscitation care, except for the anesthesia of patients in cardiac surgery, and primarily the methods of conduction anesthesia, which played a big role in his further work. The work of a resuscitator is lively and interesting, but only until a certain age, according to Gnezdilov. He suddenly became uninteresting and bored. I wanted to treat the patient from scratch, to guide him as an attending physician from the acute period to recovery. Simultaneously with his main work, he became interested in the treatment of acute and chronic pain. However, anesthesiological skills were not enough - pain treatment requires a multidisciplinary approach and knowledge of traumatology: orthopedics, neurology, therapy, radiology. In addition, knowledge of non-traditional methods of treatment was also required: manual therapy, reflexology... By this time, Gnezdilov had independently learned some techniques of manual therapy. His classmate Gennady Ivanovich Demidov, who works as a rehabilitation doctor in Kursk, helped him in this. An amazing, passionate person with a completely out-of-the-box thinking, which, in order to study Chinese medicine in order to read treatises in the original, he independently learned Chinese.
Gnezdilov’s acquaintance and collaboration with Professor V.N. provided enormous assistance and support in mastering unconventional methods of treatment. Tsibulyak. In 1976, Professor V.N. Tsibulak was the first in the country to create a department for the treatment of pain syndromes, where, under his leadership, serious Scientific research, new methods of pain management were developed. Gnezdilov was assigned to work part-time in the physiotherapy department of the pain syndrome therapy department. There were joint meetings with V.N. Tsibulak's work and ideas, interesting publications were published.
In 1988, the first medical cooperatives appeared in the country. I had to earn extra money on weekends, working as a chiropractor. The number of patients per appointment sometimes reached 150 people. It was necessary to provide financially for the family. The Gnezdilov family already had six children growing up.
In 1989, Alexander Gnezdilov defended his PhD thesis on the tactics of infusion therapy during long-term microsurgical interventions (lasting from 8 to 21 hours), and in 1991 he received an invitation to the Central Research Institute of Prosthetics and Prosthetic Engineering to the position of senior researcher in the department of anesthesiology and resuscitation. This is the institute of prosthetics where a bioelectric hand prosthesis was first developed and introduced, and mechanical hand prostheses were created. Gnezdilov was given the task of organizing the resuscitation service at the institute in such a way that there would be no fear for the death of the patient when performing any amount of surgical interventions. And then the opportunity was given to engage in therapeutic pain. Within six months, he brought the intensive care service to the proper level, completely changing the staff, recruiting young doctors and nurses. When the work in the operating resuscitation room was put on stream and there was no doubt about future fate the patient in the postoperative period, he realized his dream - he occupied himself with therapeutic pain.
In 1992, Gnezdilov created a department of anesthesiology and functional rehabilitation at the institute, combining the departments of anesthesiology-resuscitation, physiotherapy and a reflexology and physical therapy room. The scientific team under his leadership was engaged in the development of methods for treating pain syndromes in orthopedic patients, providing operations and rehabilitation of patients in the postoperative period. At the same time, the main emphasis was placed not only on the treatment itself, but also on the prevention of pain with the development of a set of special methods. For these purposes, the department worked closely with orthopedic departments, in particular, carried out joint treatment of patients with phantom pain syndromes and vertebrogenic headaches.
Under the leadership of Gnezdilov, special diagnostic neurophysiological methods for objectification and pain intensity were developed. As a result, it was possible to create a system of work based on close cooperation between traumatologists, anesthesiologists, reflexologists, physiotherapists, physical therapy specialists, and functional diagnostics specialists, which made it possible to successfully diagnose treatment, monitor it and rehabilitate the patient at all stages of his stay in the clinic.
In 1999, Alexander Vladimirovich defended his doctoral dissertation on the diagnosis and therapy of phantom and vertebrogenic pain syndromes. In this work, Gnezdilov implemented an integrated approach to pain treatment based on traditional and non-traditional therapeutic methods, developed electrophysiological methods for diagnosing and monitoring the effectiveness of pain therapy.
In 2001, Gnezdilov moved to the Russian Scientific Center for Surgery of the Russian Academy of Medical Sciences to the position of head of the department of pain syndrome therapy, where he continues to work in the field of studying pain syndromes and integrative medicine. In 2004 he received the academic title of professor. Under his leadership, a team of like-minded people formed. All employees understand what pain is and how to approach it; each has their own method. The task of the department is not just pain relief, but further monitoring of the patient, pain prevention and rehabilitation as the final stage of treatment. Each patient who comes to the department with his or her problem receives consultation on the treatment provided. He immediately receives the consultation of the specialist he needs, who finds out the source of the pain and influences the cause of the disease. Pain is a criterion for assessing the effectiveness of a doctor’s work. It requires a special approach and the efforts of various specialists that the department has at its disposal. Professor Gnezdilov is a doctor who can effectively work with any patient.
In addition to scientific and practical activities, since 1980 he has been actively involved in the work of the Moscow Scientific Society of Anesthesiologists and Reanimatologists, as well as the Russian interregional public association “Society for the Study of Pain,” a member of the organizing committee of which he has been since 2000. He is also a member of the organizing committee of the association and the journal Regional Anesthesia and Treatment of Acute Pain.
Gnezdilov's main achievements are summarized in his numerous publications and scientific works, the main of which are: “Anesthetic tactics of infusion therapy during long-term reconstructive and plastic surgeries with microsurgical equipment”, “Differentiated complex pharmacotherapy of phantom pain syndrome after limb amputation”, “Methods of treating pain syndrome in patients with amputated limbs and spinal pathology
Guidelines", "Modern principles of multidisciplinary treatment of pain in an orthopedic clinic", "Nocicent reflex reactions of the muscles of the upper limb in humans", "Methods of treating pain in orthopedic patients. Methodological recommendations”, “Modern principles of treatment of chronic pain in complex rehabilitation of patients with pathology of the musculoskeletal system”, “Technique of electroneuromyographic diagnostics in a modern clinic”...
Over the past four years, he has published 45 articles on further pain research and integrative medicine.
In 2008, A.V. Gnezdilov awarded the order Hippocrates, which was presented to him in the Hall of Fame on Poklonnaya Hill.
He has no permanent hobbies. Loves good music. Appreciates the paintings of the Impressionists and Russian artists of the early 20th century. The main book for him is the Bible.
He loves animals - he previously owned Giant Schnauzers, a Small Longhaired Dachshund, and currently a Central Asian Shepherd Dog.
Lives and works in Moscow.