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 view of critical issues existence: life and death, preparation for death,” the scientific director of the Faculty of Psychology, Professor Boris Sergeevich Bratus, 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 fulfill the last wish of his 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 most big secret, which contains 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 that migrated from Sweden and served Peter the Great. It was as if the baton of compassionate service and assistance 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 takes a person to a special state, a 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 the 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 answered.
- 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 a 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 disdain 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 in 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, the wonderful “Doctor Balu” is a native Petersburger, a hereditary intellectual - a psychiatrist, Doctor of Medical Sciences. By the way, an honorary doctorate from the University of Essex in England. In 1990, he created and headed a hospice in the Primorsky district of Lakhta of St. Petersburg. A sensitive person kind soul and an excellent doctor - not only a psychiatrist, but also a psychotherapist - he surprisingly deeply understands the problems and needs of a terminally ill person, deals with many difficult situations in the family and in life; A true specialist in behavioral problems of children and adults.
He helps departing patients and their loved ones cope with a difficult situation, find and discover the strength and ability to endure inevitable suffering; find inner harmony.
But that's not all. Andrey Vladimirovich is a true ascetic and public figure, a tireless researcher and “generator” of new methods in psychotherapy: fairy tale therapy, image therapy, bell therapy.
Doctor Balu is a real St. Petersburg Storyteller who has preserved traditions good wizards. His psychotherapeutic tales carefully touch human soul, supporting him along the way. They gently and unobtrusively introduce the reader to spiritual knowledge. The view of the Storyteller is the view of a person who is able to understand and accept the secret sides internal processes, support in good and spiritual searches, share pain and give joy.
He creates amazing fairy tale books - so wise and subtle. They immerse you in the mysterious, mysterious, whimsical and wondrous world of fairy tales and help you find a way out of current difficult situations, understand yourself and find inner harmony. Amazing books! The best I have.
And what wonderful dolls in his amazing house! And how many there are! Galleries. They are also actively involved in the treatment of behavioral problems in adolescents.
My friends and I spent an unforgettable evening with him, unforgettable was the cordial communication, rare, unique person. Both this house and this person make an absolutely amazing, very warm and bright impression - it is impossible to forget them. It's great that there are wonderful memorable photographs left. We are very grateful to our St. Petersburg friends who organized this meeting.
Dr. Balu is a precious personality among many ordinary people, iconic
Not just a personality - a Man!
Andrey Gnezdilov: The day of a person’s death is not random, just like the day of birth
Maria Stroganova
What's happened goodwill to death? How to explain the riddle clinical death? Why do the dead come to the living? Is it possible to give and receive permission to die? We are publishing fragments of a speech at a seminar held in Moscow by Andrei Gnezdilov, a psychotherapist, Doctor of Medical Sciences, honorary doctor of the University of Essex (UK), founder of the first hospice in Russia, inventor of new methods of art therapy and author of numerous books.
Death as a part of life
In everyday life, when we talk with someone we know and he says: “You know, so-and-so died,” the usual reaction to this is the question: how did he die? It is very important how a person dies. Death is important to a person's sense of self. It is not only negative in nature.
If we look at life philosophically, we know that there is no life without death, the concept of life can only be assessed from the perspective of death.
I once had to communicate with artists and sculptors, and I asked them: “You depict various aspects of a person’s life, you can depict love, friendship, beauty, but how would you depict death?” And no one immediately gave a clear answer.
One sculptor who immortalized the siege of Leningrad promised to think about it. And shortly before his death, he answered me like this: “I would depict death in the image of Christ.” I asked: “Is Christ crucified?” - “No, the ascension of Christ.”
One German sculptor depicted a flying angel, the shadow of whose wings was death. When a person fell into this shadow, he fell into the power of death. Another sculptor depicted death in the form of two boys: one boy sits on a stone, with his head on his knees, his whole head directed downwards.
In the hands of the second boy, there is a pipe, his head is thrown back, he is all focused on following the tune. And the explanation of this sculpture was this: it is impossible to depict death without accompanying life, and life without death.
Death - natural process. Many writers tried to portray life as immortal, but it was a terrible, terrible immortality. What is endless life - endless repetition of earthly experience, cessation of development or endless aging? It is difficult to even imagine the painful state of a person who is immortal.
Death is a reward, a respite; it is abnormal only when it comes suddenly, when a person is still on the rise, full of strength. And older people want to die. Some old women ask: “Now that she’s healed, it’s time to die.” And the patterns of death that we read about in the literature, when death befell the peasants, were normative in nature.
When a village resident felt that he could no longer work as before, that he was becoming a burden to his family, he went to the bathhouse, put on clean clothes, lay down under the icon, said goodbye to his neighbors and relatives and died calmly. His death occurred without the pronounced suffering that occurs when a person struggles with death.
The peasants knew that life is not a dandelion flower that grew, blossomed and scattered with the blow of the wind. Life has deep meaning.
This example of the death of peasants dying after giving themselves permission to die is not a peculiarity of those people; we can find similar examples today. Once a cancer patient came to us. A former military man, he carried himself well and joked: “I went through three wars, pulled death’s mustache, and now its time has come to pull me.”
We, of course, supported him, but suddenly one day he could not get out of bed, and he took it completely unambiguously: “That’s it, I’m dying, I can’t get up anymore.” We told him: “Don’t worry, this is a metastasis, people with metastases in the spine live a long time, we will take care of you, you will get used to it.” - “No, no, this is death, I know.”
And, imagine, after a few days he dies, without having any physiological prerequisites for this. He dies because he decided to die. This means that this good will to death or some kind of projection of death occurs in reality.
It is necessary to allow life to end naturally, because death is programmed at the moment of human conception. A person acquires a unique experience of death during childbirth, at the moment of birth. When you deal with this problem, you can see how intelligently life is structured. As a person is born, so he dies, easily born - easily dies, hard to be born - hard to die.
And the day of a person’s death is also not random, just like the day of birth. Statisticians are the first to raise this problem by discovering that people often have the same date of death and date of birth. Or, when we remember some significant anniversaries of the death of our relatives, it suddenly turns out that the grandmother died and a grandson was born. This transmission across generations and the non-randomness of the day of death and the day of birth is striking.
Clinical death or another life?
Not a single sage has yet understood what death is, what happens during death. Such a stage as clinical death was left practically unattended. A person falls into a comatose state, his breathing and heart stop, but unexpectedly for himself and for others, he returns to life and tells amazing stories.
Natalya Petrovna Bekhtereva recently died. At one time, we often argued, I told about cases of clinical death that were in my practice, and she said that this was all nonsense, that changes were just happening in the brain, and so on. And one day I gave her an example, which she then began to use and tell herself.
I worked for 10 years at the Oncological Institute as a psychotherapist, and one day I was called to see a young woman. During the operation, her heart stopped; it could not be started for a long time, and when she woke up, I was asked to see if her psyche had changed due to the long oxygen starvation of the brain.
I came to the intensive care ward, she was just coming to her senses. I asked: “Can you talk to me?”, “Yes, but I would like to apologize to you, I caused you so much trouble,” “What trouble?”, “Well, of course.” My heart stopped, I experienced such stress, and I saw that it was also a lot of stress for the doctors.”
I was surprised: “How could you see this if you were in a state of deep narcotic sleep, and then your heart stopped?” “Doctor, I would tell you much more if you promise not to send me to a psychiatric hospital.”
And she said the following: when she fell into a narcotic sleep, she suddenly felt as if a soft blow to her feet made something inside her turn, like a screw being turned out. She had the feeling that her soul had turned outward and emerged into some foggy space.
Looking closer, she saw a group of doctors bending over the body. She thought: what a familiar face this woman has! And then suddenly I remembered that it was herself. Suddenly a voice rang out: “Stop the operation immediately, the heart has stopped, you need to start it.”
She thought she had died and remembered with horror that she had not said goodbye to either her mother or her five-year-old daughter. Anxiety for them literally pushed her into the back, she flew out of the operating room and in an instant found herself in her apartment.
She saw a rather peaceful scene - a girl playing with dolls, her grandmother, her mother, sewing something. There was a knock on the door and a neighbor, Lidia Stepanovna, came in. She was holding a small polka dot dress in her hands. “Masha,” said the neighbor, “you always tried to be like your mother, so I sewed for you the same dress as your mother.”
The girl happily rushed to her neighbor, on the way she touched the tablecloth, an antique cup fell, and a teaspoon fell under the carpet. There is noise, the girl is crying, the grandmother exclaims: “Masha, how awkward you are,” Lidia Stepanovna says that the dishes are beating fortunately - a common situation.
And the girl’s mother, forgetting about herself, came up to her daughter, stroked her on the head and said: “Masha, this is not the worst grief in life.” Mashenka looked at her mother, but not seeing her, she turned away. And suddenly, this woman realized that when she touched the girl’s head, she did not feel this touch. Then she rushed to the mirror, and did not see herself in the mirror.
In horror, she remembered that she was supposed to be in the hospital, that her heart had stopped. She rushed out of the house and found herself in the operating room. And then I heard a voice: “The heart has started, we are doing an operation, but rather, because there may be a repeated cardiac arrest.”
After listening to this woman, I said: “Don’t you want me to come to your house and tell your family that everything is fine, they can see you?” She happily agreed.
I went to the address given to me, my grandmother opened the door, I told how the operation went, and then asked: “Tell me, did your neighbor Lidiya Stepanovna come to you at half past ten?” Do you know her?”, “Didn’t she bring a dress with polka dots?”, “Are you a wizard, doctor?”
I continue to ask, and everything came together down to the details, except for one thing - the spoon was not found. Then I say: “Did you look under the carpet?” They lift the carpet and there is a spoon there.
This story had a great effect on Bekhtereva. And then she herself experienced a similar incident. On the same day, she lost both her stepson and her husband, both of whom committed suicide. It was terribly stressful for her. And then one day, entering the room, she saw her husband, and he addressed her with some words.
She, an excellent psychiatrist, decided that these were hallucinations, returned to another room and asked her relative to see what was in that room. She came up, looked in and recoiled: “Yes, your husband is there!” Then she did what her husband asked, making sure that similar cases not fiction.
She told me: “No one knows the brain better than me (Bekhtereva was the director of the Institute of the Human Brain in St. Petersburg). And I have the feeling that I am standing in front of some huge wall, behind which I hear voices, and I know that there is a wonderful and huge world out there, but I cannot convey to others what I see and hear. Because in order for this to be scientifically valid, everyone must repeat my experience.”
Once I was sitting next to a dying patient. I put music box, which was playing a touching melody, then asked: “Turn it off, is it bothering you?” “No, let it play.” Suddenly her breathing stopped, her relatives rushed: “Do something, she’s not breathing.”
I rashly gave her an injection of adrenaline, and she came to her senses again, turned to me: “Andrey Vladimirovich, what was that?” - “You know, it was clinical death.” She smiled and said: “No, life!”
What is this state that the brain goes into during clinical death? After all, death is death. We register death when we see that breathing has stopped, the heart has stopped, the brain does not work, it cannot perceive information and, moreover, send it out.
Does this mean that the brain is only a transmitter, but there is something deeper, more powerful in a person? And here we are faced with the concept of soul. After all, this concept has almost been supplanted by the concept of the psyche. There is a psyche, but there is no soul.
How would you like to die?
We asked both the healthy and the sick: “How would you like to die?” And people with certain characterological qualities built a model of death in their own way.
People with a schizoid character type, such as Don Quixote, characterized their desire rather strangely: “We would like to die so that no one around us would see my body.”
Epileptoids considered it unthinkable for themselves to lie quietly and wait for death to come; they had to be able to somehow participate in this process.
Cycloids - people like Sancho Panza, would like to die surrounded by their loved ones. Psychasthenics are anxious and suspicious people; they worried about what they would look like when they died. Hysteroids wanted to die at sunrise or sunset, on the seashore, in the mountains.
I compared these desires, but I remembered the words of one monk who said this: “I don’t care what will surround me, what the situation will be around me. It is important to me that I die while praying, thanking God for giving me life and seeing the power and beauty of His creation.”
Heraclitus of Ephesus 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 dozing, while awake - he comes into contact with the dormant,” a phrase that you can puzzle over almost your whole life.
Being in contact with the patient, I could agree with him that when he died, he would try to let me know whether there was something behind the coffin or not. And I received this answer more than once.
I once made an agreement with one woman, she died, and I soon forgot about our agreement. And then one day, when I was at the dacha, I suddenly woke up when the light came on in the room. I thought that I had forgotten to turn off the light, but then I saw that the same woman was sitting on the bed opposite me. I was happy, started talking to her, and suddenly I remembered - she died!
I thought I was dreaming all this, so I turned away and tried to go to sleep so I could wake up. Some time passed, I raised my head. The light was on again, I looked back in horror - she was still sitting on the bed and looking at me. I want to say something, but I can’t - it’s terrible. I realized what was in front of me dead man. And suddenly she smiled sadly and said: “But this is not a dream.”
Why do I give such examples? Because the uncertainty of what awaits us forces us to return to the old principle: “Do no harm.” That is, “don’t rush death” is the most powerful argument against euthanasia. To what extent do we have the right to intervene in the condition that the patient is experiencing? How can we hasten his death when he may be experiencing his greatest life at this moment?
Quality of life and permission to die
What matters is not the number of days we live, but the quality. What does quality of life give? Quality of life gives you the opportunity to be pain-free, the ability to control your consciousness, the opportunity to be surrounded by relatives and family.
Why is communication with relatives so important? Because children often repeat the plot of the lives of their parents or relatives. Sometimes it's in the details that are amazing. And this repetition of life is often a repetition of death.
The blessing of relatives is very important, the parental blessing of a dying person to children, it can even save them later, protect them from something. Again, returning to cultural heritage fairy tales
Remember the plot: an old father dies, he has three sons. He asks: “After my death, go to my grave for three days.” The older brothers either don’t want to go or are afraid, only the younger one, a fool, goes to the grave, and at the end of the third day the father reveals some secret to him.
When a person passes away, he sometimes thinks: “Well, let me die, let me get sick, but let my family be healthy, let the illness end on me, I’ll pay the bills for the whole family.” And so, having set a goal, no matter rationally or affectively, a person receives a meaningful departure from life.
Hospice is a home that offers quality life. Not an easy death, but a quality life. This is a place where a person can end his life meaningfully and deeply, accompanied by relatives.
When a person leaves, the air does not just come out of him, like from a rubber ball, he needs to take a leap, he needs strength in order to step into the unknown. A person must allow himself to take this step. And he receives first permission from relatives, then from medical personnel, from volunteers, from the priest and from himself. And this permission to die from oneself is the most difficult thing.
You know that Christ, before suffering and praying in the Garden of Gethsemane, asked his disciples: “Stay with me, do not sleep.” Three times the disciples promised Him to stay awake, but fell asleep without providing support. So here's the hospice in spiritual sense is a place where a person can ask: “Stay with me.”
And if such a greatest personality - God Incarnate - needed human help, if He said: “I no longer call you slaves. I called you friends,” addressing people, then follow this example and saturate them with spiritual content last days patient is very important.
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 of Psychiatry and Neurology named after V.M. Bekhterev) chief research fellow. 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 St. Petersburg Research Institute named after. V.M. Bekhterev. Under his leadership, the department worked on the topic of the quality of life of late-life mentally ill patients; a comprehensive system of medical, social and psychotherapeutic correction was developed, 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, fairy tale 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 now actively use 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 separate spirituality and psychological science without recognizing 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 goes 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. He wanted to call the nurse, knowing that this would not help, but he came to his senses and really asked him 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 in 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 something 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 brings us loving heart God.
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 surprised me very much by the fact that she was not at all afraid of death. She said, "I've lived 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 best period human life, because he fantasizes, 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
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. Significant place His psychotherapy involves... fairy tales and dolls.
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 “hint and good fellows lesson" is understandable only to the patient to whom a particular fairy tale is dedicated. Only he and the author know what life tragedy is 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
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 sick person, 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 onto 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 lay down in 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,” answered the doctor, 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 couldn’t do it 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 of upsetting them, afraid to 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 bear cub did not cause laughter - they say, an old woman was playing with dolls. He connected her with the past, she did not feel lonely,” recalls the doctor.
Love leads to faith
Andrei Vladimirovich is convinced that without faith he would not have survived such a job. He repeatedly emphasizes the enormous influence his mother, the famous sculptor Nina Slobodinskaya, had on him. She was a deeply religious person and even Soviet era, when it could only bring trouble, 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 die 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 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 that someone nearby reads the prayer. “A sounding prayer is a switched-on light that illuminates a person and helps him in the most difficult moment, 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 when 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 that level of despair when everything around him seems meaningless. Well, when a person understands that the world around him has a rational 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 difficult 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.