Date of creation: 06/13/2012
Update date: 06/13/2012

Co-authored report by Naritsyn N.N. and Naritsyna M.P., dedicated to the issues of defining the concepts of “happiness” and “quality of life,” as well as an individual approach to solving issues in this range in counseling psychotherapy.

Naritsyn Nikolay Nikolaevich,
practicing psychotherapist, psychoanalyst,
full member of the All-Russian Professional Psychotherapeutic League,
All-Russian Council for Psychotherapy and Counseling,
European Association of Psychotherapists (EAP),
European Confederation of Psychoanalytic Psychotherapy (ECPT);
official teacher and supervisor of practice of the Interregional PPL class,
holder of a certificate from the World Council for Psychotherapy,
author and host of an Internet project

Naritsyna Marina Petrovna,
advisory member of the All-Russian Professional Psychotherapeutic League,
administrator and co-host of the Internet project

Paper presented at the symposium of the international congress on active aging medicine and quality of life, June 2012.

In Russian and Soviet culture, the topic of human happiness is constantly raised. However, this concept is neither qualitative nor quantitative. Attempts to compare and measure the “quantity of happiness”, “to verify harmony with algebra” led to the appearance in Russia of the term “quality of life”. This term (English - quality of life, abbr. QOL; German - Lebensqualitat, abbr. LQ) has long been established in the Western world, and there has a slightly different semantic meaning - the quality of living conditions. So two completely different concepts of one expression coexist: first; an international concept, born in the depths of “evidence-based medicine” and initially corresponding to the degree of rehabilitation after a serious illness, and the second, as a result, often describes in quantitative terms the quality of people’s living environment.

International criteria for the level (quality) of life (UN, 1978) include 12 main groups of indicators:

1. Fertility, mortality and other demographic characteristics of the population.
2. Sanitary and hygienic living conditions.
3.Consumption of food products.
4. Housing conditions.
5. Education and culture.
6.Working conditions and employment.
7. Income and expenses of the population.
8. Cost of living and consumer prices.
9.Vehicles.
10.Organization of recreation.
11.Social security.
12.Human freedom.

Or another example of a definition: “Quality of life is a collective concept that denotes the quantitative level and variety of those material and spiritual needs that a person is able to satisfy in a particular society. With the entire range of levels of K.Zh. within the framework of one society, it seems possible to identify the average K.Zh. (its “median”), determined by the economic and cultural potential of society, as well as the productivity of social labor achieved within its framework, supplemented by a more or less uniform distribution of its results ... "

(Encyclopedia of Sociology)

In addition, the concepts of “quality of life” and “standard of living” are often confused: the latter, however, is much easier to compare, since it is a quantitative and measurable quantity (as the level of income in monetary terms).

But for a specific person who comes to the appointment, this is like the average temperature in the hospital, and he may have his own, personal idea of ​​​​happiness. Your inner sense of quality of life. This will be a different, non-UN idea of ​​“quality of life”. Here are just a few attempts to create such a definition:

THE QUALITY OF LIFE- a generalizing socio-economic category that includes not only the level of consumption of material goods and services (standard of living), but also satisfaction of spiritual needs, health, life expectancy, human environmental conditions, moral and psychological climate, spiritual comfort.

(Modern Economic Dictionary)

"Quality of life is a set of life values ​​that characterize the types of activities structure of needs and conditions of human development and society, people's satisfaction with life, social relationships and the environment."

(materials of the I-III All-Russian conferences and the International seminar
"Quality of Life", Moscow, VNIITE, 1999-2002)

Quality of life is often considered as - experience of subjective well-being. A concept close to quality of life is “life satisfaction.”

If we generalize everything that has been said, then we can define the quality of life as

“ACHIEVEMENT OF DESIRABLE THINGS AND SATISFACTION WITH WHAT ACHIEVEMENT”

In these definitions, our compatriots pay attention to the subjective nature of the feeling of happiness and quality of life. Sometimes they even try to derive a “formula of happiness” as the degree of satisfaction of needs. Continuing the above reasoning, we can assume that a happy person is “always satisfied with himself, his dinner and his wife,” and the best “medicines for happiness” will be long-acting psychodimetics, leading to slow degradation of personality, reducing demands and simplifying needs to the most easily satisfied ones. As a result, you can really get a society of happy animals, described by Homer.

If we try to satisfy the really existing needs of modern man, then first they should be at least somehow classified and systematized. The theory of Abraham Maslow's hierarchy of needs, sometimes called Maslow's “pyramid” or “ladder,” has become most famous in this capacity. It is a fundamental theory recognized by management experts around the world. Maslow divided human needs into five main levels according to a hierarchical principle, which means that when a person meets his needs, he moves like a ladder, moving from a low level to a higher one.

Abraham Maslow's Hierarchy of Needs Theory

True, A. Maslow himself noted in his letters that the theory that made him famous is applicable to understanding the needs of humanity as a whole, as a philosophical generalization, but in no way can be used in relation to a specific individual. In its appearance, A. Maslow’s pyramid resembles a diagram of hierarchical relationships in human society, often called the pyramid of power, which is what made it so popular among people with hierarchical thinking. This system seems to impose on each individual a unidirectional setting of life goals, moving through life along only one path, to one peak. The pyramid converging at this peak seems to push people into meaningless competition. And instead of creating something, creating something, they are more or less forced to fight, which in itself is destructive. Moreover, the hierarchy of needs also resembles the so-called “list of happiness”: a certain list of the same criteria for well-being for everyone. Anyone who has achieved the results indicated in the list (raised a child, built a house, planted a tree, etc.) should literally consider themselves happy. Those who have not achieved compliance with the results imposed by current society naturally feel unhappy. By the way, the unpopularity of psychotherapy is also due to the fact that “the consultant will teach you how to live, and will not give you enough money to become happy.”

Similar to the phrase “no one can know better than the patient how he feels” - no one can know better than the client himself what “high quality of life” means to him. This concept, like the concept of “happiness,” is subjective and often unconscious. And in society, the list view of “happiness” is so established that even in a doctor’s office, a client often lists what he (in the opinion of his current society) should want, and not what he actually needs. This often provokes the consultant to offer his own, “correct” version of “quality of life” instead of working to clarify the needs of a given client. And not only the consultant, but also the client himself, trying to screw a nut with a metric thread onto an inch thread, without understanding the reasons for the discrepancy, asks for “a larger nut, but with a standard thread.”

However, no template will completely satisfy everyone, since - back to this point again - the concept of “quality of life” is different for different people. As one example, I will give the results of a vote on this topic conducted on my website.

To understand the complexity of human needs and motivations in life, I would suggest not a pyramid, but a tree of human needs.

Satisfaction of basic, stem, root needs is necessary for any living creature on our planet. First of all, this is to breathe, consume water, food and remove metabolic products from the body. These are the most important needs of any living creature, including humans. Without these functions, the living will cease to be called alive. Satisfying some of these needs seems so easy to us that we forget about their importance and significance. For example, the presence of oxygen in the air seems so accessible that we are most often not prepared for anything else.

But with more complex needs, not everything is so simple.

Let's say, the instinct of procreation. Even for some animals, in particular social ones, it does not always work in its original sense. Abandonment of one's own reproductive function in favor of the survival of the species as a whole is not so rare. Among people, S. Freud was probably closer to the truth, speaking not about the need for reproduction, but about eroticism as the energy of creativity. People can “give birth” to ideas, discoveries, works of art and “other long-lasting things.” And even the presence of certain phenomena such as “childfree” does not in any way reduce the rate of population growth on our planet.

The desire for safety and security is also ambiguous. We all know a lot of examples when people risked their lives, or even died, for the sake of some far from vital goals and objectives. Even in animals, this behavior is not an absolute exception. People generally engage in, let's say, deliberately risky behavior. An example is extreme sports. More than 50 people die every year when attempting to climb Everest, despite the fact that you have to pay $65,000 for the right to take the risk. (Remember the all-powerful Thanatos). Please note that without such a risk, those heroes will consider themselves deeply unhappy. So already at this level, separate branches begin to branch off from the main trunk of the tree of needs.

Further - the higher, the more often the branching occurs, the richer and more diverse the crown, the more options for the concepts of individual, personal happiness. In essence, it turns out that, climbing the hierarchy of needs, we do not get a pyramid that narrows towards the top, but a constantly branching, expanding crown of a tree. The needs are increasing and they are becoming more diverse.

One more important addition needs to be made here. The organism is alive. New needs stimulate the search for new opportunities to achieve them - new opportunities give rise to new needs. Stopping here is essentially death. It is the dynamic development of this process that gives a feeling of life drive and happiness, turning a person’s gaze to the future.

It is easy to notice that trees are different: for example, the same pyramidal poplars with branches pointing upward - and fruit trees with a low but lush crown. It's the same with people. Different people can realize their potential and optimally satisfy their needs in different ways and under different conditions. In a forest, for example, all the trees stretch in the same direction, which makes their trunks look similar to each other. Some cannot even survive in the forest, however, having gained freedom, they form a wide, rich crown. This fully applies to people. About a person with diverse interests, a broad outlook, an active life position, capable of bringing something useful to others, we often say: “A person with a rich soul.” But it is precisely such people who often find themselves in the position of Danko, the hero of A.M. Gorky, and often experience the problems of “woe from mind” by A.S. Griboedov (this topic has been raised a huge number of times in art). I can’t help but recall here “The Seated Demon” by M. Vrubel (the image of a man with tensely clasped hands, strong, but powerless, as if striving into the distance, but not having the opportunity to realize this desire): as well as Vrubel himself, who became a patient of our compatriot psychoanalyst I .Ermakov, also a person with a difficult fate.

Vrubel Mikhail Alexandrovich, Demon (seated).
1890 State Tretyakov Gallery. Moscow.
Oil on canvas 116.5 x 213.8

In general, a separate issue is working with an order to “increase the quality of life” from a client who thinks outside the box and is “abnormally” capable. Because “standard drivers” for improving the quality of life are not suitable for them.

If we take the distribution of abilities, opportunities, “standards of thinking”, etc. according to the well-known “Gauss curve”, then at its peak will naturally be those people who approach issues of “quality of life”, as a rule, quite standardly and most often mainly according to the criteria of “list happiness” (although here it is also necessary to take into account , that the transitions from the peak to the edges on the Gaussian curve are smooth, and there are not always clear criteria for differentiating a “standard personality and a non-standard one”). And at the edges of the curve are those who “do not fit into the norm”: on the one hand, people with certain “personality defects”, and on the other, with non-standard abilities, intelligence and thinking. And for most people around, including consultants, it can be difficult to distinguish one extreme from the other based on external observations.

If we represent this graphically, then a “normal average person” can be designated by an ordinary even circle. A person suffering from one or another mental pathology is a circle with some kind of “gap”: since a disease is always a defect, and in the case of a psychiatric pathology it seems to “gnaw out” part of a full-fledged personality. And the third option - a person with non-standard abilities - will be represented by a circle with an “additive”. And as is easy to see, both “extreme options” will be externally different from the standard circle, but not everyone can understand what exactly: minus symptoms or additional abilities. Due to this confusion, individuals “with additives” often have significant problems with social adaptation and perception in society. And most often, it is these people who, due to existing problems, are especially concerned about improving their quality of life.

The higher the intellectual level of individual citizens, the more complex their lives, and the higher their demand for advisory, analytical, and including psychoanalytic help. True, this places high demands on the consultant himself, on his professional training, on the breadth of his horizons, on his ability to see and understand the client in all his complexity and ambiguity. And if the word “psychos” means soul, and psychotherapy means treatment with the soul, then the effectiveness of working with a client will largely depend on the richness of the psychotherapist’s soul.

© Naritsyn Nikolay Nikolaevich
psychotherapist, psychoanalyst
Moscow

Elena Vetshtein

“Yes”, “No” and quality of life

We all pretend to live well, striving for a certain standard of living. Each of us has a certain set of components that determines what level of life he has reached at the current moment in time. Someone compares themselves with a neighbor, classmate, or deputy. For most people this is important. But there is one more significant indicator - quality of life. Unlike the standard of living, which evaluates its conditions and characteristics, the quality of life indicator includes a personal assessment based on a person’s own degree of satisfaction with these conditions and characteristics.

Thus, quality of life is an expectation that we all strive for in our thoughts, dreams and fantasies. But for the vast majority, this expectation is very different from reality. Reality falls short of expectations.

Moreover, with age, the gap in the score increases significantly...

I am interested in the quality of life from the point of view of the possibility or impossibility of achieving it by each individual person, what are the reasons for the discrepancies between expectations and reality and the conditions that help reduce this gap.
Let's start with the reasons.

The abundance of available information determines a very high level of expectations and belief in one’s own uniqueness. Two groups can be distinguished here.

First group— the lack of a global view of what is happening, in which actions and results are clearly subordinated, is hampered by the lack of a global view of what is happening, in which actions and results are clearly subordinated. In other words , there is no strategy, but an excessive focus on details, which serves as an excuse not to do the main thing.

Second group- people endlessly searching for their purpose. Behind these searches, one’s own meanings are lost (or they are replaced by the search for “one’s own” path in life). As a result, life develops according to someone else’s scenarios as a set of unrelated episodes stretched out over time.

Time passes, but ambitions are not satisfied, life achievements are below expectations, and one day a moment of enlightenment comes, which is accompanied by strong dissatisfaction with one’s own life.

Exists only two exits from the current situation.

First- feel sorry for yourself, blame loved ones, circumstances and the whole world, shifting responsibility for your own inaction and missed opportunities. This method will provide relief for a while. I shifted responsibility - I felt like a victim, I turned from an accused into a victim, but the desired quality of life was never achieved. Notice how many whiners there are around!

This method works like a pain pill, providing temporary relief but not curing the cause.

Second The way is to run at a faster pace, reducing the gap between what you want and reality. But for this you need, firstly, to honestly answer the questions: “What is a high quality of life for you personally?” secondly, learn to tell yourself.

Learning to say “no” was difficult for me. I remember how popular during my student years were publications about how important it is to learn to say “No” to other people who claim someone else’s personal space and time. Recommendations were offered on how to overcome the psychological barrier and delicately say “No” to another. But I don’t remember any recommendations on how to learn to say “No” to myself.

What is “No” to yourself?

Any internal growth is impossible without pain and overcoming. Just as in the development of muscle strength it is important not to simply perform monotonous mechanical work, but a progressive planned load, so in personal growth, in order to overcome your own ceiling, it is important to learn to acquire, consolidate and build up new skills. To do this, you need to say “No” to your own many weaknesses.

This is difficult at first, but as you master the new rhythm of life, values ​​also begin to change. At the same time, we often feel too sorry for ourselves in the current moment, and our internal permissiveness does not allow us to break out into a new orbit.

Just as a huge number of people losing weight go astray from their intended path at the sight of another bun, so those who are trying to achieve a different quality of life again fall into captivity of old patterns of behavior.

Saying “No” to a muffin today does not mean banning muffins for life. But in the beginning, being strict with yourself is never unnecessary. It is the key to successful overcoming.

“No” to everything that makes you weaker and more vulnerable, while “Yes” to new opportunities that open up, even if they require leaving your own zone. “Yes” to any activity, instead of boredom and excuses about being too busy.

The easiest way is to close yourself with a shield of banality and the usual flow of life, even when life offers another chance in the palm of your hand.

“You will need to work a lot there,” “No, most likely, “the game is not worth the candle” - personally, I closed the door many times when new opportunities appeared on its threshold. And I did this not because they did not promise a different (better) quality of life, but because I was scared and difficult to overcome my own inertia, because in general everything was fine.

Life always gives us the right to choose the quality that we ourselves deserve at the moment. But only those who know how to correctly arrange things, sweep away the unnecessary, know how to act, concentrating all their energy on what really has value and corresponds to their own goals and meanings, achieve what they want.

If you ever come to the realization that something in your life has not been going according to plan for a long time, that the discrepancy between expectations and reality is too great (in family life, self-realization, health, appearance), then you have something in your hands again a chance to take the path of change.

As progress moves forward every day, many people begin to realize that sometimes they want to be alone with themselves. Each of us wants to take a break from the modern world and relax so that no one stresses them out. Each person relaxes in his own way, and perhaps someone, on the contrary, follows new products and wants to keep up with the times. For all such people who want to change themselves a little, Optimus of Life will help.

Optimus of life - quality of life management from A to Z

This site is more devoted to psychology and the study of modern technologies that seem so different at first glance and the relationship of people with it. The modern world is the same as on the Internet. The same schemes for deceiving people are possible here as without the Internet. By studying the site you can find out what types of fraud exist today and how to avoid falling for them. Perhaps by studying this material here you will be able to avoid many different financial mistakes, which will have a very good effect on your psyche.

By studying the Optimus Life website, you will always be in the pulse of many events that will help you learn how to make money on the Internet. You can read such materials about the banking system and how banks work. It is also possible to study material about saving your budget and generating additional profits.

Every day a large number of people are faced with deception, regardless of where it happened. Each of us understands that deception is very bad and not good. But people still try to deceive others, especially in order to get good benefits for themselves. While studying the material on the website http://freefacts.ru, do not forget to leave your comment on it.

While relaxing alone at the computer or watching movies, many of us subconsciously think about many of our interpersonal relationships, including those with our families. Perhaps for a while you can take a break from everyday life and study the psychology material that will help you change not only yourself, but also your worldview. We hope that by exploring this site you will be able to gain useful information. Perhaps this is where you can begin to change yourself and everything around you.

Nutrition, everyday comfort, social environment, satisfaction of cultural and spiritual needs, psychological comfort, etc.

The quality of life may depend on the state of health, communications in society, psychological and social status, freedom of activity and choice, stress and excessive concern, organization of leisure, level of education, access to cultural heritage, social, psychological and professional self-affirmation, psychotype and adequacy of communications and relationships.

• sufficient healthy life expectancy, supported by good medical care and safety (absence of significant threats to life and health),
• acceptable volume of consumption of goods and services, guaranteed access to material goods,
• satisfactory social relations, absence of serious social conflicts and threats to the achieved level of well-being,
• family well-being,
• knowledge of the world and development - access to knowledge, education and cultural values ​​that shape personality and ideas about the world around us,
• taking into account the individual’s opinion when solving social problems, participating in the creation of a generally accepted picture of the world and rules of human behavior,
• social belonging, full participation in social and cultural life in all their forms,
• access to a variety of information, including information about the state of affairs in society,
• comfortable working conditions that provide scope for creativity and self-realization, a relatively short working day, leaving a person with enough free time for various activities.

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Subtitles

Dimensions of quality of life

With a certain approximation, the UN Human Development Index can be used as an indicator of quality of life. It is based on the following areas: income level in a country or region (determined through GNI per capita at PPP), life expectancy, access to knowledge (determined based on the share of the population enrolled in various levels of education).

A measure of the quality of life in different countries can be various quality of life indices, among which the “Better Life Index”, calculated by the Organization for Economic Cooperation and Development, should be highlighted.

Subjective assessment of quality of life can also be measured using sociological surveys. For this purpose, a wide range of sociological tools is used. The most significant, integral indicator characterizing the subjective assessment of the quality of life is a person’s satisfaction with his life.

Quality of life in medicine

Improving quality of life is either a primary or secondary goal of treatment. An additional goal is to improve the quality of life if the disease can lead to a shortening of life, and the main goal is if it cannot lead to a shortening of life or, on the contrary, if the disease is incurable and will certainly lead to the death of the patient. In the latter case, improving the quality of life remains the only goal of treatment.

Quality of life studies are carried out in many areas of medicine, in particular in palliative medicine, cardiology, transplantology, oncology, surgery, psychiatry, endocrinology, gerontology, neurology and others. The main directions of such research include standardization of treatment methods, examination of new treatment methods and drugs, development of prognostic models for the course of diseases, and economic justification of treatment methods.

Assessment methodology

The main tool for assessing the quality of life of patients is specially developed questionnaires. Questionnaires can be general or specialized. Specialized questionnaires may relate to specific areas of medicine, specific diseases, or even specific stages of disease and conditions. Compiling questionnaires is a complex and multi-stage process. It includes assessing the validity, assessing the reliability, and determining the sensitivity of the questionnaire, which are carried out by qualified specialists using specially designed tests. Standardized questionnaires are often used. Among the common ones, the most common are: EUROQOL, MOS SF-36, Quality for Well-Being Index, Sickness Impact Profile, Nottingham Health Profile, Quality of Life Index. When preparing a questionnaire for use in a different linguistic and cultural environment, multilevel adaptation is carried out.

In addition to collecting data using questionnaires, assessing quality of life also includes examining patients, statistical processing, analysis and interpretation of data.

Palliative care, palliative medicine

Palliative medicine is a branch of medicine whose task is to improve the quality of life of hopeless patients, for example in the case of inoperable forms of cancer. It is based on the relief of pain, other symptoms, and the solution of psychological and social problems of the patient. The goal of palliative care is to maximize the quality of life of a hopeless patient and his family. A type of palliative care is hospice care.

Pharmacoeconomics and quality of life

Pharmacoeconomics is a field of research that studies the cost and effectiveness of certain drugs and treatment methods. Within the framework of pharmacoeconomics, calculations are made of the cost of treatment, cost minimization, the relationship between the cost of treatment and the final economic benefit, the cost of treatment and its effectiveness, the cost of treatment and its usefulness. In the 1970s, to calculate the ratio cost and efficiency treatment, it was proposed to use the value of QALY - quality-adjusted life years (English. quality-adjusted life years). Subsequently, based on this concept, a calculation of the ratio was developed cost and utility. These calculations are used when choosing the most optimal treatment methods.

Quality-adjusted life years (QALYs)

Quality-adjusted life years is a conditional integral value that takes into account the patient’s life expectancy and its quality. To calculate it, it is necessary to multiply each year lived by the patient by a coefficient reflecting the quality of his life. The coefficient can take values ​​from 1.0 (absolute health, maximum quality of life) to 0.0 (death). At the same time, one year lived in the best state of health adds 1 to the value a year well lived, a year lived with a quality of life coefficient of 0.6 adds 0.6, etc. Thus, when calculating the effectiveness of treatment, for example, two years of life with a coefficient of 0.5 are equal to one year with a coefficient of 1.0. The QALY value is widely used in Western countries.

see also

Sources

1. The quality of life. // Raizberg B. A., Lozovsky L. Sh., Starodubtseva E. B. Modern economic dictionary. - 2nd ed., rev. M.: INFRA-M, 1999. - 479 p.
2. Kamenskaya G.V.

When I was in 11th grade, our teacher suddenly fell ill, and a girl intern only a couple of years older than us came to replace her. This was one of the most interesting social studies lessons of my entire studies! Marina Nikolaevna told boring economic topics more interestingly than any teacher. She explained what is quality of life, what they are made of salaries our parents and how much we need to work to pension it was possible to live with dignity.

What is meant by quality of life?

Our life is far from the economy, but sometimes it can come in handy. For example, when calculating the quality of our life. This term shows a certain average level of well-being an ordinary resident of the country. And it includes many components:

• living wage- that is, the amount with which, in theory, you can buy the most necessary products for life;
• number of products in consumer basket and their cost;
• availability medical care;
• opportunity for citizens to receive education;
• ticket prices for cultural events– cinema, exhibitions, concerts;
• availability housing;
• level pensions and other social benefits;
• presence or absence benefit programs for people of “vulnerable” categories - disabled people, orphans, pensioners, young families and so on.

How is quality of life measured?

One of the most objective quality of life indicators The amount of money that falls on each resident of the country is considered. If you calculate the total cost of all services (including utilities, medical, tourism) and goods that were produced in the country in one year, and divide by the number of people living in the country, you will get an average number. This is the so-called GDP(or Gross Domestic Product) per capita. The higher it is, the more necessary things an average person can purchase.

Alas, The wealth of a country does not always mean the wealth of the population. The more people there are in a country, the greater the number of people who will have to divide the gross product by. For example, the total cost of all industry in Russia and Germany in 2016 was almost the same: slightly less 4 trillion dollars. But due to the difference in population the cost of living in Russia was almost 2 times less than in Germany.

Quality of life and the “food basket”

A special role for consumer basket. In Russia it includes several hundred items: this and food, And cloth, and g hygiene supplies, And public utilities. And this list is not that big. For example, according to this table, in three years one person only needs 6 pairs of shoes! The food, however, is also not encouraging: per year, one citizen, according to calculations, can get by with 126 kilograms of bread: this is 345 grams per day - slightly more than in besieged Leningrad.

By the way, if you compare the statistical data, you can clearly see: the higher the cost of living, the higher the life expectancy. And this is not surprising, because the quality of life, first of all, is the ability to pay for the services necessary for survival. Medical, for example.