Natalia Vasilievna Repina, Dmitry Vladimirovich Vorontsov, Irina Ivanovna Yumatova.
Basics clinical psychology.
Part I Theoretical basis clinical psychology.
Section 1. Introduction to clinical psychology.
1.1. Subject of clinical psychology.
1.1.1. History of the emergence of clinical psychology.
1.1.2. Tasks and sections of modern clinical psychology.
1.2. The work of clinical psychologists in educational and educational institutions.
1.2.1. Legal and organizational aspects of clinical and psychological work in educational institutions.
Section 2. Theory and methodology of clinical psychology.
2.1. Theoretical foundations and main methodological problems of clinical psychology.
2.2. Norm and pathology, health and illness.
2.2.1. The problem of distinguishing between psychological phenomena and psychopathological symptoms.
2.3. The main stages and factors of the occurrence of mental and behavioral disorders.
Section 3. Methodology of clinical and psychological research.
3.1. Construction of a clinical-psychological study.
Section 4. Typology of mental disorders.
4.1. Disorders of sensation and perception.
4.2. Violations of voluntary movements and actions.
4.3. Disorders of speech, communication and learning skills.
4.4. Memory impairment.
4.5. Thinking disorders.
4.5.1. Violations of the operational side of thinking.
4.5.2. Distortion of the generalization process.
4.5.3. Disturbances in the dynamics of thinking.
4.5.4. Violations of the personal component (violations of purposeful thinking).
4.6. Emotional disorders.
4.7. Anxiety disorders.
4.8. Mood disorders.
4.9. Impaired consciousness.
4.9.1. General scientific characteristics of consciousness.
4.9.2. Definition of consciousness in psychiatry.
4.9.3. Delirious stupefaction.
4.9.4. Oneiric (dreaming) state of consciousness.
4.9.5. Twilight state of consciousness.
4.9.6. Amentive syndrome (amentia).
4.9.7. Coma.
4.9.8. Depersonalization.
Section 5. Borderline mental states.
Section 6. Personality disorders.
6.1. Classification of personality disorders.
6.1.1. Eccentric personality disorders (with a predominance of thinking disorders).
6.1.2. Demonstrative personality disorders (with a predominance of disturbances in the emotional sphere).
6.1.3. Anxiety-asthenic personality disorders (with a predominance of volitional disorders).
Section 7. Psychosomatic disorders.
7.1. The concept of “subjective picture of illness” as the psychological basis of somatopsychic disorders.
7.2. Psychology of disability.
Part II. Fundamentals of neuropsychology.
Section 1. Brain mechanisms of higher mental functions.
1.1. The problem of localization of higher mental functions.
1.2. Theoretical foundations and practical significance of neuropsychology.
1.3. Structural and functional principles of the brain.
1.4. The concept of structural and functional blocks of the brain A. R. Luria.
1.5. Syndromic analysis of disorders of higher mental functions.
Section 2. The problem of interhemispheric brain asymmetry and interhemispheric interaction.
Section 3. Basic neuropsychological symptoms and syndromes.
3.1. Sensory and gnostic visual disorders.
3.2. Sensory and gnostic auditory disorders.
3.3. Sensory and gnostic skin-kinesthetic disorders.
3.4. Speech disorders in local brain lesions.
3.5. Attention impairment in local brain lesions.
3.6. Memory impairment in local brain lesions.
3.7. Disturbances of movements and actions in local brain lesions.
3.8. Thinking disorders in local brain lesions.
3.9. Emotional disturbances in local brain lesions.
Section 4. Possibilities for the practical application of neuropsychology.
4.1. The problem of restoring higher mental functions.
4.2. Neuropsychology at school.
4.3. Impairment and restoration of the functions of writing, reading and counting.
Appendix 1. Terminological dictionary.
Appendix 2. Neuropsychological techniques.
Appendix 3. Illustrative material.
Part III. Pathopsychology.
Section 1. Methodological foundations of pathopsychology.
1.1. Pathopsychology as component clinical psychology.
1.2. Correlation between pathopsychology and psychopathology. Subject of pathopsychology.
1.3. Theoretical foundations of pathopsychology.
1.4. The importance of pathopsychology for general psychological theory.
1.5. Tasks of pathopsychology in the clinic.
1.6. Tasks of child pathopsychology.
1.7. The possibility of using a pathopsychological approach in the activities of an educational psychologist.
1.8. Dysontogenetic approach to the study of mental disorders in childhood.
1.8.1. The concept of mental dysontogenesis.
1.8.2. Pathopsychological parameters of mental dysontogenesis.
1.8.3. Classification of mental dysontogenesis.
Section 2. Methods of pathopsychological research.
2.1. General characteristics of pathopsychological research methods.
2.2. Principles of pathopsychological experimental research.
2.3. Conversation and observation in the structure of a pathopsychological experiment.
2.4. Stages and technology of pathopsychological examination.
2.4.1. Preparation of an experimental study.
2.4.2. Conducting an experimental study.
2.4.3. Analysis and interpretation of experimental psychological research data.
Section 3. Pathopsychological approach to the study of disturbances of mental activity and personality in mental disorders.
3.1. Perception disorders.
3.1.1. The problem of agnosia in pathopsychology.
3.1.2. Pseudoagnosia in dementia.
3.1.3. Pathopsychological studies of deceptions of feelings.
3.1.4. Study of violations of the motivational component of perceptual activity.
3.2. Memory impairment.
3.2.1. Immediate memory impairment.
3.2.2. Violations of mediated memory.
3.2.3. Violation of the dynamics of mnestic activity.
3.2.4. Violation of the motivational component of memory.
3.3. Thinking disorders.
3.3.1. Violation of the operational side of thinking.
3.3.2. Violation of the motivational (personal) component of thinking.
3.3.3. Violation of the dynamics of mental activity.
3.3.4. Impaired critical thinking.
3.4. Violations mental performance.
3.4.1. General psychological characteristics of human performance.
3.4.2. Clinical manifestations of mental impairment.
3.4.3. Pathopsychological analysis of mental performance disorders in mental disorders.
3.5. Personality disorders.
3.5.1. Violation of mediation and hierarchy of motives.
3.5.2. Violation of meaning formation.
3.5.3. Violation of behavioral control.
3.5.4. Formation of pathological personality traits.
The textbook is compiled in accordance with the State Educational Standard of Higher Education vocational education for specialty 031000 “Pedagogy and Psychology”. It examines the theoretical foundations of clinical psychology, the brain mechanisms of higher mental functions, and also provides a pathopsychological analysis of disorders of the cognitive and emotional-personal sphere of a person.
The textbook will be useful for psychology students, school teachers, students of pedagogical universities, and doctors.
Related information.
Send your good work in the knowledge base is simple. Use the form below
Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.
There is no HTML version of the work yet.
You can download the archive of the work by clicking on the link below.
Similar documents
General characteristics of clinical psychology, its tasks and areas of application. Theoretical foundations of domestic clinical psychology. The contribution of clinical psychology to the development of general psychological problems. Methodological principles of clinical psychology.
abstract, added 11/18/2010
Consideration of the concept and essence of clinical psychology as a science that studies the behavioral characteristics of people in situations of various mental illnesses. Studying the structure of this science. Characteristics of the main directions of clinical psychology.
course work, added 01/22/2015
Concept, tasks and structure of clinical psychology. The subject of research is neuropsychology, psychosomatics and pathopsychology. Studying methods of diagnosis and correction for mental disorders in a psychiatric clinic. Main goals of neuropsychology.
abstract, added 07/23/2015
Interdisciplinary status of clinical psychology. Socially deviant behavior of the individual. Theoretical and methodological problems of clinical psychology. Mental functions. The concept of moral and legal capacity. "Pictogram" technique.
course work, added 11/23/2008
Definition, structure, purpose and objectives of clinical psychology. The history of its development. Characteristics of the branches of science: neuropsychology, pathopsychology, psychosomatics, psychology of abnormal development (mental dysontogenesis), psychotherapy, psychocorrection.
presentation, added 05/12/2012
Study of the principles of the theory of human activity in psychology A.N. Leontyev and S.L. Rubinstein. Study of the concept of higher mental functions by L.S. Vygotsky. Consideration of signs as the basis for symbolic modeling of phenomena of the objective world.
test, added 02/22/2012
Problems of psychology. Personality psychology and the concept of emotions. Temperament and character. Human social behavior. Management psychology as a science. Current state of education. The role of the family in education. Self-education and self-improvement.
Basic categories of clinical psychology. The category of “factor” in clinical psychology. Factor as a syndrome-forming vector. The problem of discovery and justification of the nature of factors. Factor as the initial basis for disturbances (changes) in psychological activity and the final result of clinical and psychological analysis of mental pathology. Factors as functions of different body systems, providing a natural basis for the formation and functioning of mental processes. Relationship of factors with different body systems. CNS factors (brain), biochemical, genetic, etc. Differences in the nature of factors in local brain pathology, mental and other diseases.
Category of psychological syndrome. Psychological syndrome as a structured system of altered (disturbed) mental processes and mental properties, which is a consequence (direct or indirect) of violations of certain factors. Clinical (psychopathological, neurological) and psychological syndromes, their differences. Types of syndromes in neuropsychology, pathopsychology and psychosomatic disorders. Differences in the composition of syndromes, their genesis and dynamics. The role of symptom-forming factors in the characteristics of syndromes. Ontological and epistemological problems of connection between factors and syndromes.
Syndromic, qualitative system-structural analysis of mental pathology. A systematic approach to the qualification of mental disorders. The nature of pathological conditions is the ontological basis for identifying the structural “constructions” of mental activity. Qualitative and quantitative analysis of syndromes.
The category of “internal variables” and the “processual” orientation of clinical psychological research. Pathology of the psyche: models of partial changes (disturbances, loss) of certain radicals (components, links) of the structure of mental activity. The variability of these changes in different types of pathology is an opportunity to identify the role and contribution of these “internal variables” to the structure of mental activity. The focus of clinical and psychological research is on revealing the internal structure of mental processes and its changes. Subject of analysis by psychologists. Difference from the clinical (medical) method.
Other components of the categorical-conceptual apparatus of clinical psychology: health psychology, mental health, maladaptation, psychological prevention, counseling and psychological correction, psychotherapy, psychological rehabilitation, defect and compensation, personality anomalies, character accentuations, psychological factors of increased risk of morbidity, internal picture of the disease, natural (biological) foundations of mental development, mental disintegration, anomalies of mental development, etc.
The importance of clinical psychology in decision common problems psychology. The contribution of research into the pathology of mental activity to the solution of fundamental problems of general psychology. The contribution of clinical psychology to solving general psychological problems.
The history of the implementation of the idea of connecting soul and body. Ancient medicine about the influence of mental states on human health. Development of this idea in the history of medicine.
Modern approaches to solving the problem of the relationship between mental and bodily processes. Research of psychosomatic diseases as models for studying this problem. Psychology of physicality.
The problem of cerebral localization of mental functions. Revision of the concepts “function”, “localization”. The contribution of neuropsychology to the study of the brain mechanisms of higher mental functions in humans using the material of local brain lesions and other models.
The principle of syndromic analysis in revealing the structural organization of mental activity. Ontological basis for the formation of psychological syndromes in pathology and developmental anomalies. The category of “factor” as a syndrome-forming radical. A syndrome is a structural organization of a system of altered mental processes and properties that reveal common links - factors - in their structure. Syndromic analysis of mental activity as a way to overcome functionalism in psychology.
The first psychological diagnostic techniques were performed in a clinic for mentally retarded children. Intensive development of psychological diagnostic methods in the field of clinical psychology. Basic principles of diagnostics in clinical psychology: syndromic analysis, prognostic orientation, individual qualitative approach. Principles of designing diagnostic studies. Clinical psychological experiment as a simulation of various types of mental activity. The principle of “functional test”. Boundaries of standardization and formalization of diagnostic methods.
Techniques and methods of clinical psychotherapy and their use in developing the theory of psychological influence. Psychological correction, as the correction of stable mental properties that are risk factors for morbidity or disability. Ethical problems of psychological correction (“do no harm”). Principles of psychological correction and their general psychological significance.
The problem of interaction between biological and social-environmental factors in the development and decay of mental activity. Analysis of the pathology of mental activity, detection of specific relationships between biological and environmental factors in the formation and functioning of the psyche. Pathological conditions: various variants of models of changes in certain biological factors. Correlating the effects of their manifestations with observed environmental influences is one of the possibilities for solving the general psychological problem under consideration. Biologically determined variants of pathologically altered mental activity (local brain lesions, oligophrenia, hereditary mental illnesses, etc.) are a natural experiment that allows us to identify the interaction and real contribution of specific biological factors and social influences in the processes of formation and functioning of mental activity.
Unconscious. Unconscious forms of mental activity. Pathology of the psyche as the source material for the development of the problem of the unconscious by S. Freud. Psychoanalysis and psychoanalytic methods of treatment. Borderline neuropsychic disorders, hypnotic states, variants of pathology of consciousness, psychosomatic illnesses. Neuroses, reactive states, psychosomatosis are manifestations of unconscious forms of the motivational and emotional sphere of a person’s mental life. Unconscious mechanisms of psychotherapeutic influences.
Personality. The problem of mental “norm”. Diversity of psychological concepts of personality. Multidimensionality of the concept of “personality”. Different meanings of the category “personality” in the structure of various sciences (clinical psychology, psychiatry, medicine, sociology, pedagogy, etc.). The meaning of the concepts “personality of a sick person”, “premorbid personality”, “changed personality” in medicine and clinical psychology.
Operational use of the concept of “personality” in pathopsychology. The problem of personality disorders in neuropsychology.
The problem of “norm” in psychology. Analysis of existing criteria for determining the “norm”. Clinical, psychological and general psychological aspects.
Natalia Vasilievna Repina, Dmitry Vladimirovich Vorontsov, Irina Ivanovna Yumatova
Fundamentals of Clinical Psychology
The textbook is compiled in accordance with the State educational standard of higher professional education for specialty 031000 “Pedagogy and psychology”. It examines the theoretical foundations of clinical psychology, the brain mechanisms of higher mental functions, and also provides a pathopsychological analysis of disorders of the cognitive and emotional-personal sphere of a person.
The textbook will be useful for psychology students, school teachers, students of pedagogical universities, and doctors.
1.1 Subject of clinical psychology
2.3. The main stages and factors of the occurrence of mental and behavioral disorders
Section 3. Methodology of clinical and psychological research
3.1. Construction of a clinical psychological study
Section 4. Typology of mental disorders
4.1. Disorders of sensation and perception
4.2. Disorders of voluntary movements and actions
4.3. Disorders of speech, communication and learning skills
4.4. Memory disorders
4.5. Thinking disorders
4.5.1. Disturbances in the operational side of thinking
4.5.2. Distortion of the generalization process
4.5.3. Disturbances in the dynamics of thinking
4.5.4. Violations of the personal component (violations of purposeful thinking)
4.6. Emotional disorders
4.7. Anxiety disorders
4.8. Mood disorders
4.9. Impaired consciousness
4.9.1. General scientific characteristics of consciousness
4.9.2. Definition of consciousness in psychiatry
4.9.3. Delirious confusion
4.9.4. Oneiric (dreaming) state of consciousness
4.9.5. Twilight state of consciousness
4.9.6. Amentive syndrome (amentia)
4.9.7. Coma
4.9.8. Depersonalization
Section 5. Borderline mental states
Section 6. Personality Disorders
6.1. Classification of personality disorders
6.1.1. Eccentric personality disorders (with a predominance of thought disorders)
6.1.2. Demonstrative personality disorders (with a predominance of disturbances in the emotional sphere)
6.1.3. Anxiety-asthenic personality disorders (with a predominance of volitional disorders)
Section 7. Psychosomatic disorders
7.1. The concept of “subjective picture of illness” as the psychological basis of somatopsychic disorders
7.2. Psychology of disability
Part II. Basics of neuropsychology
Section 1. Brain mechanisms of higher mental functions
1.1. The problem of localization of higher mental functions
1.2. Theoretical foundations and practical significance of neuropsychology
1.3. Structural and functional principles of the brain
1.4. The concept of structural and functional blocks of the brain A. R. Luria
1.5. Syndromic analysis of disorders of higher mental functions
Section 2. The problem of interhemispheric brain asymmetry and interhemispheric interaction
Section 3. Basic neuropsychological symptoms and syndromes
3.1. Sensory and gnostic visual disorders
3.2. Sensory and gnostic auditory disorders
3.3. Sensory and gnostic skin-kinesthetic disorders
3.4. Speech disorders due to local brain lesions
3.5. Attention impairment due to local brain lesions
3.6. Memory impairment in local brain lesions
3.7. Disorders of movements and actions in local brain lesions
3.8. Thinking disorders in local brain lesions
3.9. Emotional disorders in local brain lesions
Section 4. Possibilities for the practical application of neuropsychology
4.1. The problem of restoring higher mental functions
4.2. Neuropsychology at school
4.3. Impairment and restoration of the functions of writing, reading and counting
Appendix 1. Terminological dictionary
Appendix 2. Neuropsychological techniques
Appendix 3. Illustrative material
Part III. Pathopsychology
Section 1. Methodological foundations of pathopsychology
1.1. Pathopsychology as an integral part of clinical psychology
1.2. Correlation between pathopsychology and psychopathology. Subject of pathopsychology
1.3. Theoretical foundations of pathopsychology
1.4. The importance of pathopsychology for general psychological theory
1.5. Tasks of pathopsychology in the clinic
1.6. Tasks of pediatric pathopsychology
1.7. The possibility of using a pathopsychological approach in the activities of a teacher-psychologist
1.8. Dysontogenetic approach to the study of mental disorders in childhood
1.8.1. The concept of mental dysontogenesis
1.8.2. Pathopsychological parameters of mental dysontogenesis
1.8.3. Classification of mental dysontogenesis
Section 2. Methods of pathopsychological research
2.1. General characteristics of pathopsychological research methods
2.2. Principles of pathopsychological experimental research
2.3. Conversation and observation in the structure of a pathopsychological experiment
2.4. Stages and technology of pathopsychological examination
2.4.1. Preparing a pilot study
2.4.2. Conducting a pilot study
2.4.3. Analysis and interpretation of experimental psychological research data
Section 3. Pathopsychological approach to the study of disturbances of mental activity and personality in mental disorders
3.1. Perception disorders
3.1.1. The problem of agnosia in pathopsychology
3.1.2. Pseudoagnosia in dementia
3.1.3. Pathopsychological studies of deceptions of feelings
3.1.4. Study of violations of the motivational component of perceptual activity
3.2. Memory disorders
3.2.1. Impaired immediate memory
3.2.2. Vicarious memory disorders
3.2.3. Violation of the dynamics of mnestic activity
3.2.4. Impairment of the motivational component of memory
3.3. Thinking disorders
3.3.1. Violation of the operational side of thinking
3.3.2. Violation of the motivational (personal) component of thinking
3.3.3. Violation of the dynamics of mental activity
3.3.4. Impaired critical thinking
3.4. Mental performance disorders
3.4.1. General psychological characteristics of human performance
3.4.2. Clinical manifestations of mental impairment
3.4.3. Pathopsychological analysis of mental performance disorders in mental disorders
3.5. Personality disorders
3.5.1. Violation of mediation and hierarchy of motives
3.5.2. Violation of meaning formation
3.5.3. Impaired behavioral control
3.5.4. Formation of pathological personality traits
Part I. Theoretical foundations of clinical psychology
Section 1. Introduction to Clinical Psychology
1.1. Subject of clinical psychology
The Greek word kline (something related to the bed), from which the adjective “clinical” is derived, in modern language is associated with the designation of such areas as patient care, the development of any disease or disorder, as well as the treatment of these disorders. Accordingly, clinical psychology is a branch of psychology, the subject of study of which is:
a) mental and behavioral disorders (impairments);
b) personal and behavioral characteristics of people suffering from various diseases;
c) the impact of psychological factors on the occurrence, development and treatment of diseases;
d) features of the relationship between sick people and the social microenvironment in which they find themselves.
In a broader sense, clinical psychology can be understood as the application of the entire body of psychological knowledge to the solution of a wide variety of issues and problems arising in medical practice.
In a narrower sense, clinical psychology is a special methodology of psychological research, which is based on the method of observing a relatively small number of patients in natural conditions and subsequent subjective analysis and interpretation of individual manifestations of their psyche and personality. In this sense, clinical-psychological methodology is fundamentally opposed to the natural science experimental approach, which is based on the criteria of “objective” (statistically reliable) psychological knowledge.
Clinical psychology refers to an interdisciplinary field of scientific knowledge and practical activity in which the interests of doctors and psychologists intersect. Based on the problems that this discipline resolves (the mutual influence of the mental and somatic in the occurrence, course and treatment of diseases), and the practical tasks that are set before it (diagnosis of mental disorders, differentiation of individual psychological characteristics and mental disorders, analysis of the conditions and factors for the occurrence of disorders and diseases, psychoprophylaxis, psychotherapy, psychosocial rehabilitation of patients, protection and maintenance of health), then it is a branch of medical science. However, based on theoretical premises and research methods, this is a psychological science.
1.1.1. History of clinical psychology
The interpenetration of medicine and psychology is based on the relationship between biological and social factors, on the connection of bodily functions with mental ones. Already in Hippocrates (460-377 BC) we can find an indication of the role of the body’s adaptive capabilities and the importance of interpersonal relationships that develop between the doctor and the patient. It is this physician-philosopher of antiquity who owns famous saying that it is much more important for a physician to know what kind of person suffers from a disease than to know what kind of disease a person has. But a lot of time passed from the understanding of the need for a deep study of the psychological aspects of clinical phenomena to the emergence of a special branch of science - clinical psychology.
The term “clinical psychology” itself appeared in 1896, when the American psychologist Lightner Witmer, who studied at the Wundt Institute of Experimental Psychology, upon returning from Leipzig, founded the world’s first psychological clinic at the University of Pennsylvania in the USA. In fact, this clinic was a psychological and pedagogical center in which children with poor academic performance and other learning problems were examined and underwent correction courses. It is noteworthy that the term “clinical” in relation to the activities of his psychological and pedagogical center was used by L. Whitmer in a narrow sense: he meant by it a special method of individual work with problem children, in which the leading role was played by the diagnosis of their intellectual abilities through special tests . L. Whitmer considered a unique feature of the clinical-psychological method to be the possibility of its application to any people - adults or children - who deviate in any direction from the average indicators of mental development, that is, do not fit into the standard framework of educational and educational programs .
“It is inevitable for the methods of clinical psychology to address the status of the individual mind as determined by observation and experiment, and the pedagogical appeal is concerned with the effect of change, that is, with the development of this individual mind.” [History of modern psychology / T. Leahy. — 3rd ed. - St. Petersburg: Peter, 2003. P. 374.]
Thus, clinical psychology according to L. Whitmer was a special form of psychodiagnostics, psychological counseling and psychocorrection, focused on individual, non-standard manifestations of the child’s psyche and associated behavioral deviations. In this form, it began to develop intensively in the USA, gradually spreading from the sphere school education in the field of justice (psychological clinics began to appear in courts considering cases involving minors) and healthcare (work with mentally retarded children). From the point of view of L. Whitmer, the correction of behavioral disorders in children with deviations from the average indicators of mental development should have consisted of creating an adequate social environment for them at school and at home.
Clinical psychology, created by L. Whitmer, essentially became a vast applied branch of psychology, the main task of which was testing various population groups to solve some specific problems: pedagogical, medical, military, industrial, etc. After the Second World War (1939 -1945) this direction began to be called “consultative (applied) psychology,” and only those who worked in the field of mental health were considered clinical psychologists in the United States. At the same time, new clinical psychologists were immediately faced with the requirement of a clear division of their functions with psychiatrists, since now their spheres of scientific and applied interests began to coincide. Clinical psychologists in the USA, in contrast to psychiatrists, decided to define themselves as scientific practitioners who carry out their scientific general psychological work based on the material of clinical cases.
On the European continent, including Russia, the term “Clinical psychology” was not in use until the middle of the 20th century. This phrase first appeared in Europe in 1946 in the title of a book by the German psychologist W. Hellpach, in which he examined changes in the psyche and behavior of patients with somatic diseases. Accordingly, by clinical psychology V. Gelpakh understood only the psychology of somatic patients. This term logically complemented the concepts of “medical psychology”, “pathological psychology” (“pathopsychology”) and “psychopathology” that already existed in European science, since each of them reflected the psychological aspects of a particular type of clinical practice.
Thus, psychopathology was understood as an auxiliary psychiatric discipline, the task of which was to experimentally study disorders of mental processes in mentally ill patients. Under the influence of the works of the German psychiatrist and theorist K. Jaspers at the beginning of the 20th century. psychopathology developed into an independent scientific discipline that studies complex psychological relationships in the personality of mentally ill people, which this scientist considered as the “internal cause” of mental illness. This internal cause, interacting with “true external causation” (biological factors), determined, from the point of view of K. Jaspers, the uniqueness of the picture of mental disorder in a particular mentally ill person, the study of which allowed the psychiatrist to make an accurate diagnosis and prescribe adequate treatment /51/.
Along with psychopathology within the framework of general psychology at the beginning of the 20th century. A specific applied field of knowledge emerges - pathological psychology. Her task was to study “abnormal” manifestations of the mental sphere in order to better understand the psychology of “normal” people /51/. Mental disorders observed in mentally ill patients were considered in pathopsychology as a natural experiment that makes it possible to more clearly understand the meaning and place of the corresponding phenomena of mental life in general, to see new problematic areas of psychological knowledge and to test the truth of certain psychological theories /50/.
The use of psychological concepts by doctors to solve various treatment and research problems arising in the clinic is reflected in the concept of “medical psychology.” In the works of the same name by European psychiatrists E. Kretschmer and P. Janet, the term “medical” in relation to psychology was used in the basic meaning of the Latin adjective medicalis - healing, bringing health, having healing power. In this sense, medical psychology was understood as either psychotherapeutic practice /63/, or a biological interpretation of psychological concepts of personality, the purpose of which was to adapt psychological theories to the organic paradigm in which psychiatrists worked, which, according to E. Kretschmer, was supposed to broaden one’s horizons doctor and increase the efficiency of ongoing therapeutic and diagnostic measures /24/.
Of all those available at the beginning of the 20th century. The concept of “medical psychology” was the broadest in meaning and significance, capable of covering various areas of medical activity from the point of view of the use of psychology for therapeutic purposes. In general, medical psychology was understood as “psychology for doctors.” It was intended to “supplement” two other basic subjects in the process of training a doctor: pathological anatomy and pathological physiology, in order to “balance” the predominantly biological orientation of medical education with a kind of “psychological educational program” and taking into account the psychological factors of diseases /17/.
The variety of terms indicates that, in fact, clinical psychology was not an independent scientific discipline and was often not even considered as one of the applied branches of psychology: the prefix “medical” primarily oriented toward its perception as a type of medical, rather than psychological knowledge itself. And there were strong historical arguments for such an understanding of clinical psychology. The first clinical and psychological studies arose precisely in medicine - within the framework of psychiatry and neuropathology. Interest and use of psychological knowledge have always characterized outstanding representatives of medical science, many of whom, such as S. Freud, K. Jaspers, V. N. Bekhterev, V. N. Myasishchev, even became the founders of certain directions in psychological thought and more are known as psychologists, not doctors.
Only in the 70s of the XX century. clinical psychology acquires the features of an independent psychological discipline of an applied nature, understood more broadly than just psychology in the clinic or psychology for doctors /21/. Its emergence in this capacity was the result of the contradictory development of two parallel trends in medicine and psychology, the origins of which go back to the 19th century.
Until the end of the 19th century. medicine and psychology were in close interaction, since they were united not only by one object of study and practical application of the acquired knowledge - man, but also by a common theoretical base: speculative and philosophical ideas about man and the causes of disturbances in the functioning of his spirit and body.
However, at the end of the 19th century. the connection between medicine and psychology was greatly undermined by the development of biology and a shift in emphasis to the material - anatomical, microbiological and biochemical - basis of the occurrence and development of diseases /69/. At this time, the so-called “organic paradigm” emerged in medical science, based on the ideas of Louis Pasteur about the infectious nature of diseases and subsequently supplemented by Virchow’s theory of cellular pathology. The organic paradigm is characterized by the absolutization of the idea of a strict pattern of the course of the disease under the influence of objective, materially determined mechanisms (a pathogen or a violation of cellular functions) and the interpretation of any disease regardless of personal and environmental influences. In this paradigm, psychology could only be useful when considering mental disorders as some kind of improvised, non-independent tool in the clinical diagnostic activity of a doctor. In this form—as a private sphere of psychiatric practice—clinical psychology arose at the end of the 19th century.
The pioneers of involving psychology in solving clinical issues and transforming it from a philosophical into a natural science sphere of knowledge were French psychiatrists and neurologists: T. Ribot, I. Ten, J.-M. Charcot and his students A. Binet, P. Janet and others. Clinical psychology (it was then called “experimental psychology”) was considered by them as a special direction of empirical research by a psychiatrist or neurologist, aimed at analyzing changes in the mental state caused by illness, hypnosis or drugs activities /42/. The need for these empirical studies was dictated by the organic paradigm, in which the doctor’s ability to recognize the symptoms of the disease played an important role. As a result of psychological research, doctors received information about various manifestations of mental activity in a psychiatric clinic, which could be systematized and then used for diagnostic purposes.
“Experimental psychology” began to develop in the clinic even before the opening of the experimental psychological laboratory by W. Wundt in 1875. Experience in the clinic was understood as natural (mental illness or paranormal mental phenomena - telepathy, clairvoyance, etc.) or artificial (hypnosis or drug use) changes in the normal mental state. The disease was considered the most reliable method of studying the psyche, the disadvantage of which - the slow rate of progress - could be compensated by the use of hypnosis or psychoactive substances. Another method of “experimental psychology” was the study of “exceptional cases.” Most often, the exceptional intellectual abilities of human prodigies turned out to be in this capacity.
Thus, initially clinical (“experimental”) psychology developed as an integral part of psychiatry and neurology, necessary for the research and diagnostic activities of a doctor. Unlike general psychology, which at that time was part of philosophy, clinical psychology developed, based on the needs of the psychiatric clinic, as empirical knowledge based on experimental and then experimental data, and not on theoretical reasoning.
For a long time, clinical (as originating in the clinic) and general (as part of philosophy) psychology were competing disciplines. Clinical psychology focused on objective data obtained through the use of experiments, and then formalized experimental techniques - tests. Philosophically oriented general psychology was skeptical about the possibility of studying the psyche using natural scientific methods, believing that the soul cannot be adequately known without studying subjective experiences and self-reports. By the way, the founder of experimental general psychology, W. Wundt, considered natural experiment not the main, but an auxiliary psychological method, capable of revealing only the simplest mental processes, but not all phenomena of the human soul /7/. W. Wundt’s main experimental method for studying the psyche was introspection—self-observation and subsequent interpretation of the subject’s oral self-reports by the experimenter, rather than formalized observation of the subject’s mental processes by the experimenter. Therefore, W. Wundt’s experimental psychology is more likely to have a hermeneutic (hermeneutics is a way of interpreting something) rather than a natural scientific character. However, the fascination with the philosophy of positivism ultimately led general psychology to the need to confirm the philosophical concepts of the psyche by experimental methods in the manner of the natural sciences (which psychiatry already was by that time). As a result, two different experimental psychologies emerged in the scientific field - clinical (based on medical faculties) and general (based on philosophical faculties). If the first was focused on serving the scientific and practical interests of physiology and psychiatry and had a materialistic bias, then the second pursued the goal of an empirical study of the prerequisites of an inherently intangible mental substance.
The main dividing line between the two psychologies was the understanding of the psyche either as a function of the brain, or as a special spiritual substance, the activity of which is only reflected in brain processes. The second distinguishing criterion was the understanding of psychology as a predominantly diagnostic or empirical discipline. The second criterion of distinction was born after the German psychiatrist E. Kraepelin adapted the nosological principle of L. Pasteur, which arose in the organic paradigm of medicine, for the needs of a psychiatric clinic. The nosological classification of mental illnesses proposed by this scientist according to the formula “etiology (source of the disease) -> clinic (manifestation of the disease in a set of signs specific to the source of the disease - symptoms) -> course (dynamics of symptoms during the development of the disease) -> prognosis (anticipation of further development and outcome of mental illness)" assigned psychology the role of one of the means of obtaining formal criteria for mental disorders and making a diagnosis. The source of mental illness in biologically oriented psychiatry can only be a violation of the so-called “material substrate” of the mental, since the psyche is considered as a function of the brain. Thus, psychology was expected to create formal “experimental psychological schemes” with the help of which the clinical manifestations of a certain mental illness could be identified (diagnosed). In this sense, “experimental” psychology became clinical—a tool for making a psychiatric diagnosis, a formalized way of defining mental and behavioral disorders. In this capacity, it could be successfully used not only for the purposes of medical diagnostics, but also for the pedagogical process /4/. Thus, clinical psychology, which developed within the framework of psychiatry, finally took shape as just an “objective experimental method” for recognizing mental illnesses by a doctor or teacher. However, serious disagreements arose among psychiatrists themselves regarding the methodological validity of the psychological diagnosis of mental illness itself, as a result of which the role of experimental psychological research in clinical practice was reduced to a minimum /42/.
By the beginning of the 20th century. general psychology also began to develop within the framework of the natural science paradigm, which interprets the psyche as a property of highly organized matter. A change in methodological foundations led to the development of independent, and not related only to clinical tasks experimental research disorders of the psyche and behavior, which resulted in the theoretical possibility of distinguishing clinical psychology as an integral part of psychological, rather than psychiatric science. Moreover, as a branch of psychological science, such clinical psychology ceased to be just an auxiliary tool for a doctor in psychiatric practice. In order to distinguish this new field from narrow clinical experimental psychological research, as well as for ideological reasons, the term “pathopsychology” has been used for a long time in our country to designate it /14/.
The interpretation of the term “pathopsychology” by B.V. Zeigarnik is somewhat different from what is understood by the term “pathological psychology” (abnormal psychology) in foreign science. In English-speaking countries, pathological psychology is the study by psychological methods of various deviations of mental activity for clinical purposes. In essence, this concept is synonymous with modern clinical psychology, and is partly used to designate psychological theories of the occurrence of mental disorders /21/. As follows from the English-language encyclopedic guide to psychology edited by M. Eysenck, pathological psychology acts as a methodological alternative to biologically oriented psychiatry in relation to approaches to the definition of mental disorders, vision of the role and assessment of the interaction of biological, psychological and social factors in their occurrence /35/.
B.V. Zeigarnik used the term “pathopsychology” in the meaning given to it by the German psychiatrist G. Münsterberg, who proposed to consider mental disorders as acceleration or inhibition of normal mental activity /21/. According to G. Munsterberg, pathopsychology can study mental disorders using the same methods and postulate the same patterns as in general psychology. Therefore, in the interpretation of B.V. Zeigarnik, pathopsychology is presented as a section of (general) psychology that studies the patterns of disintegration of mental activity and personality traits, primarily to solve general theoretical issues of psychological science. And this, in turn, can bring practical benefits not only to psychiatry, but also to other branches of knowledge (including pedagogy), complementing and developing their internal ideas about the causes of the development of deviations and ways of their correction /14/.
Such a specific understanding of pathopsychology in domestic science of the Soviet period gave rise to contradictions in views on the purpose, subject, tasks and role of this discipline. The limitation of the subject of pathopsychology only to the area of mental disorders did not allow this discipline to solve any other applied problems except diagnostic ones (in medicine or in pedagogy). Its definition as a branch of theoretical psychology did not allow many clinical issues to be included in the subject and tasks of pathopsychology, such as, for example, the use psychological methods influences for therapeutic and correctional purposes, the study of psychological factors in the development of diseases, the role and significance of the system of relationships that develops between a person with a disordered psyche and the environment, etc. Thus high level The development of domestic pathopsychology, along with the ideologization of science in the Soviet period, for a long time did not provide the opportunity for the development of clinical psychology in our country in the modern sense of the word.
Outside Russia, the emergence of clinical psychology as an independent psychological discipline was also facilitated by changes in general theory medicine that occurred in the first half of the 20th century. The Pasteur-Virchow organic paradigm of objective pathogenic factors was replaced by G. Selye’s concept of the role of adaptive and protective mechanisms in the occurrence of diseases, under the influence of which attention was drawn specifically to the possible etiological role of psychological factors not only in psychiatry, but also in somatic medicine. At Z. Freud's school, the psychogenic causes of various mental disorders were revealed. Research by I. Pavlov discovered the influence of types nervous system on the nature of various somatic processes. The work of W. Cannon discovered the influence of strong emotions and stress on physiological processes in the gastrointestinal tract and on autonomic functions. In the studies of this psychologist, the human body was presented as a dynamic system of various internal and external factors mediated by the mental activity of the brain (for example, W. Cannon experimentally showed that the feeling of hunger causes contractions of the stomach). With this interpretation of the human body, medicine and psychology again became interpenetrable and interdependent, which ultimately led to the need for the emergence of an interdisciplinary and separate (from psychiatry and general psychology) sphere of psychological science, which integrated all previous lines of development of clinical psychology and broke away from the narrow medical areas of application this knowledge.
1.1.2. Tasks and sections of modern clinical psychology
Modern clinical psychology as a discipline that studies various mental and behavioral disorders using psychological methods can be used not only in medicine, but also in various educational, social and advisory institutions serving people with developmental anomalies and psychological problems. In pedagogical practice, clinical and psychological knowledge makes it possible to timely recognize mental development disorders or deviations in behavior in a child, which in turn makes it possible to selectively and effectively use adequate educational technologies in relations with him, psychological and pedagogical correction and the creation of optimal conditions for the development of his personality taking into account individual characteristics.
As an independent branch of psychological science in relation to pedagogical practice, modern clinical psychology has the following tasks:
— study of the influence of psychological and psychosocial factors on the development of behavioral and personality disorders in a child, their prevention and correction;
— study of the influence of deviations and disorders in mental and somatic development on the child’s personality and behavior;
— study of the specifics and nature of mental development disorders in a child;
— studying the nature of the relationship of an abnormal child with his immediate environment;
— development of principles and methods of clinical psychological research for pedagogical purposes;
— creation and study of psychological methods of influencing the child’s psyche for corrective and preventive purposes.
The main branches of clinical psychology are: pathopsychology, neuropsychology and psychosomatic medicine. In addition, it often includes such special sections as psychotherapy, rehabilitation, mental hygiene and psychoprophylaxis, psychology deviant behavior, psychology of borderline mental disorders (neurosology). The number of special sections is constantly increasing depending on the needs of society. And today you can find such special areas of clinical psychology as the psychology of post-traumatic stress, the psychology of disability, psychovenerology, psycho-oncology, social Psychology health, etc.
Clinical psychology is closely related to such disciplines as psychiatry, psychopathology, neurology, psychopharmacology, higher physiology nervous activity, psychophysiology, valeology, general psychology, psychodiagnostics, special psychology and pedagogy. The area of intersection of scientific and practical interest of clinical psychology and psychiatry is diagnosis. Let us remember that historically clinical psychology originated in the depths of psychiatry as an auxiliary diagnostic tool. The psychiatrist places the main emphasis on recognizing pathological organic processes that cause mental disorders, as well as on the pharmacological impact on these processes and on preventing their occurrence. Psychiatry pays little attention to how mental processes occur normally in healthy people. The process of diagnosing mental disorders, on the one hand, involves the separation of the actual disorders caused by organic disorders and individual personality characteristics, and on the other hand, the diagnosis of mental disorders requires confirmation of the presence of actual psychological disorders in a person, which is done with the help of pathopsychological and neuropsychological experiments, and also through various psychological tests (tests). The overlapping subject of psychiatry and clinical psychology is mental disorders. However, clinical psychology also deals with disorders that are not diseases (so-called “borderline mental disorders”). In fact, modern psychiatry and clinical psychology differ not in subject, but in point of view on the same subject: psychiatry focuses on the morpho-functional (somatic) side of a mental disorder, while clinical psychology focuses on the specifics of the psychological reality that arises in mental disorders .
The connection between clinical psychology and psychopathology can be traced in a special field of medical science - psychopathology. Both pathopsychology and psychopathology deal with the same object: mental disorders. Therefore, there is an opinion that these disciplines coincide with each other and differ only from the point of view from which they view sick people. But what is this point of view? B.V. Zeigarnik argued that pathopsychology (as opposed to psychopathology) studies the patterns of disintegration of mental activity in comparison with the patterns of the formation and course of mental processes in normal conditions /14/, while psychopathology supposedly studies only disturbed mental functions. However, B.D. Karvasarsky quite rightly notes that it is impossible to imagine the study of mental disorders without any reference to the norm and taking it into account /20/. This scientist sees the difference between pathopsychology as a branch of clinical psychology and psychopathology as a purely medical discipline only in what categories one or another discipline uses to describe mental disorders. Pathopsychology describes predominantly the psychological side of mental disorders, i.e. changes in consciousness, personality and basic mental processes - perception, memory and thinking, while psychopathology describes mental disorders in medical categories (etiology, pathogenesis, symptom, syndrome, symptomokinesis (dynamics of occurrence, development , existence, correlation and disappearance of syndrome elements), syndromotaxis (the relationship of various syndromes)) and criteria (occurrence, prognosis and outcome of the pathological process).
The connection between clinical psychology and neurology is manifested in the concept of psychoneural parallelism: each event in the mental sphere necessarily corresponds to a separate event at the level of the nervous system (not only central, but also peripheral). There is even a separate interdisciplinary field of medicine - psychoneurology.
The connection between clinical psychology and psychopharmacology lies in the study of the latter’s psychological effects medicines. This also includes the problem of the placebo effect when developing new medicinal compounds.
The connection of clinical psychology with the physiology of higher nervous activity and psychophysiology is manifested in the search for correlations between pathopsychological processes and their physiological correlates.
The connection between clinical psychology and valeopsychology and mental hygiene lies in the joint determination of factors that oppose the emergence of mental and somatic disorders and the clarification of mental health criteria.
The connection between clinical psychology and special psychology and pedagogy is manifested in the search for ways to correct problematic behavior in children and adolescents caused by mental functioning disorders or anomalies of personal development.
1.2. Work of clinical psychologists in educational institutions
The main aspects of the work of a clinical psychologist in educational institutions are diagnostic, correctional and preventive. The diagnostic aspect of the activity is to clarify the role of psychological and psychosocial factors in the emergence of a child’s problematic behavior in a wide variety of areas: in education, in interpersonal relationships, etc. Clinical and psychological examination helps to determine the actual causes of problems, hidden signs of developmental disorders, and determine the structure of these violations and their relationship. A clinical-psychological examination is broader in content than a pathopsychological examination, since it includes not only experimental diagnostics (testing) of mental functions, but also an independent examination of the structure and specifics of the personality relationship system of a problem child using survey methods (self-reports, clinical interviews, expert assessments, etc. .), as well as analysis of the behavior of a problem child in natural conditions and its interpretation, based on an understanding of internal motives and drives, and not just regulatory requirements. Knowledge of the basics of clinical psychology also allows the teacher and school psychologist to a first approximation, differentiate deviations in the development and behavior of the child that arose under the influence of the social situation of development from external manifestations of painful mental disorders and choose an adequate strategy for interaction and assistance to a problem child.
The diagnostic aspect is most in demand in the expert work of a clinical psychologist as part of psychological, medical and pedagogical advisory centers (PMPC), in courts hearing cases involving juvenile offenders, and in draft boards of military registration and enlistment offices.
Psychotherapy and psychocorrection as types of clinical and psychological intervention in cases of problem behavior are based on the use of the same methods and techniques, so their distinction is conditional. It is associated with the competitive division of the spheres of influence of psychiatry and psychology, with different understandings of the mechanisms and leading causes of mental and behavioral disorders in these sciences, as well as with different purposes for the use of psychological methods of influencing the individual. Both psychotherapy and psychocorrection represent a targeted psychological impact on individual mental functions or components of the personal structure in the process of interaction between at least two people: a doctor and a patient, a psychologist and a client.
Etymologically, the term “therapy” is associated with alleviating the condition of a suffering person or ridding him of something that brings him suffering. Historically, the use of this word was assigned to medicine. The basic meaning of the term "correction" is the correction, elimination or neutralization of what appears to be undesirable or harmful to a person. An undesirable component may not always bring suffering to its owner: undesirability may be associated with a discrepancy between a personality possessing some psychological quality or property and the “ideal model” of a person. And in this sense, correction turns out to be closely related to the concept of “education.” Psychocorrection is part of the educational process, since the psychologist influences indicators of mental (memory, attention, thinking, emotions, will) and personal (motives, attitudes, value orientations) development of the child that go beyond the established norm, leading him to the “optimal level” of functioning in life. society.
If we pay attention to the history of the development of psychotherapy as a psychiatric practice, we will find that psychotherapy dates back to what was introduced in the late 1790s. in a number of psychiatric hospitals using the method of moral therapy /16/. Moral therapy was understood as a set of special ways of treating and interacting with mentally ill people, changing their system of relationships to themselves and the world and blocking the “harmful” influences of the environment. Moral therapy became the main standard of treatment after the work of the French psychiatrist F. Pinel (1745-1826), who created the famous system of therapeutic education and re-education of the mentally ill.
In England, the ideas of F. Pinel were developed by the psychiatrist S. Tuke, who introduced a new term to denote moral treatment - psychotherapy /36/. Psychotherapy, organized by S. Tuke, included the work of patients, parental care for them from the staff and religious and moral education. All this was supposed to return the “madmen” to the norms of life in society.
Thus, psychotherapy and psychocorrection differ only in the goals and object of psychological influence. Therefore, the correctional aspect of the work of a clinical psychologist can to the same extent (in essence) be psychotherapeutic, if we understand by it not only the correction or compensation of mental deficiencies, but also the assistance full development and the functioning of the personality of a child with mental disorders or problem behavior.
Determining the leading causes and knowledge of the psychological mechanisms of disorders allows a clinical psychologist to carry out intrapersonal or interpersonal, individual or group psychocorrection or psychotherapy in a wide variety of educational and educational institutions. This aspect of activity is most in demand in specialized schools (compensatory education classes) for problem children, as well as in children's correctional institutions of the Ministry of Justice system and rooms (departments) for the prevention of crime among adolescents of the Ministry of Internal Affairs system. However, within the framework of ordinary consulting psychological services of the educational system, psychotherapeutic and psychocorrectional activities may take place aimed at providing clinical psychological assistance children who have become victims of various psychologically traumatic circumstances: neglect; exploitation or abuse; torture or any other cruel, inhuman or degrading treatment; punishments; armed conflicts, natural and man-made disasters.
It should be noted that, although the fundamental possibility of the participation of a clinical psychologist with a university education in psychotherapeutic and rehabilitation activities with sick children cannot be disputed at a theoretical level, at a practical level the penetration of psychologists with non-medical education into the clinical field is often perceived negatively by the psychiatric community. This is primarily due to different conceptual approaches to the problem of health and illness, as well as to the ambiguous interpretation of the psyche in psychology and psychiatry. Today, the psychotherapeutic activity of a clinical psychologist is still a subject of debate.
The preventive aspect of the application of clinical and psychological knowledge in educational and educational institutions is associated with the prevention of the occurrence of disorders in the mental activity of the individual and behavior in healthy children and adolescents, as well as with the prevention of the development of exacerbations and psychosocial maladjustment in abnormal children with personal and behavioral characteristics, and compensated children who have suffered acute mental disorders. Activities aimed at creating a tolerant environment in educational and educational institutions in relation to children and adolescents who have certain personality characteristics, psychological status or development should also be recognized as preventive.
Psychoprophylaxis is divided into primary, secondary and tertiary.
Primary psychoprophylaxis consists of informing managers and employees of institutions, teachers, parents and children and adolescents themselves about the causes of mental disorders, maladaptive states, and behavioral disorders. Psychopreventive work with managers, employees and teachers allows us to organize a social space in the institution that prevents the formation of psychological disorders under the influence of psychosocial factors. Education also facilitates timely contact with specialists in situations that create an increased risk of developing violations.
Secondary psychoprophylaxis is aimed at working with children who already have mental disorders and behavioral disorders, with the aim of preventing or compensating negative consequences and aggravation of existing disorders.
Tertiary psychoprophylaxis includes the rehabilitation and integration of problem children (with mental disorders or behavioral disorders) into a broader social context, preventing their isolation, aggression and resistance based on a sense of their “otherness.”
1.2.1. Legal and organizational aspects of clinical and psychological work in educational institutions
Clinical and psychological work in educational and educational institutions is regulated by ratified International Acts, federal laws, as well as by-law regulatory documents - regulations and orders of the ministries to which these institutions belong.
In accordance with the International Convention on the Rights of the Child (ratified by Resolution of the Supreme Soviet of the USSR of June 13, 1990 No. 1559-1), children with mental or physical disabilities must lead a full and decent life in conditions that ensure their dignity, promote self-confidence and facilitate their active participation in the life of society. Such children, if resources are available and if requested (by themselves or those responsible for them), should be provided with assistance appropriate to their condition and the situation of their parents or other caregivers.
In accordance with the Federal Law of July 24, 1998 No. 124-FZ “On basic guarantees of the rights of the child in Russian Federation» A child is considered to be a person under the age of 18.
By Order of the Ministry of Education of the Russian Federation of October 22, 1999 No. 636 “On approval of the regulations on service practical psychology in the system of the Ministry of Education of the Russian Federation" it is envisaged that educational psychologists will perform the following types of activities related to the profile of clinical psychology as a private branch of psychological science:
- preventive and psychocorrective work;
- comprehensive medical, psychological and pedagogical examination;
- providing specialized assistance to children with problems in learning, development and upbringing;
- prevention of psychosocial maladjustment;
- psychological diagnostics to identify the causes and mechanisms of disorders in learning, development and social adaptation.
The structure of the service of practical educational psychology includes the following institutions in which clinical and psychological activities can be carried out:
- special educational institutions for children in need of psychological, pedagogical and medical and social assistance (PPMS centers);
- psychological-pedagogical and medical-pedagogical commissions (PMPC).
Clinical and psychological work with children with developmental disabilities is determined by Decree of the Government of the Russian Federation of July 31, 1998 No. 867 (with amendments and additions approved by Decree of the Government of Russia of March 10, 2000 No. 212) “On approval of the Model Regulations on educational institution for children in need of psychological, pedagogical and medical and social assistance.”
Since 1959, psychological and pedagogical personnel have also been provided for medical institutions providing psychiatric and psychotherapeutic assistance to children and adolescents (Order of the USSR Ministry of Health of April 30, 1959 No. 225).
To this day, the only official document defining the rights and responsibilities of a clinical psychologist in healthcare institutions is Order of the Ministry of Health of the Russian Federation dated October 30, 1995 No. 294 “On psychiatric and psychotherapeutic care,” which contains the Regulations on a medical psychologist involved in the provision of psychiatric and psychotherapeutic care , and Regulations on the psychotherapy room. In addition to this order (which was never registered with the Russian Ministry of Justice and, therefore, has inferior legal force), there are a number of additional orders of the Ministry of Health that regulate the work of clinical psychologists:
- dated February 13, 1995 No. 27 “On staffing standards for institutions providing psychiatric care”;
- dated March 18, 1997 No. 76 “On drug rehabilitation centers”;
- dated May 6, 1998 No. 148 “On specialized assistance to persons with crisis conditions and suicidal behavior” (Regulations on the Helpline, on the Office of Social and Psychological Assistance, the Department of Crisis Conditions, on the Suicidological Service);
— dated December 28, 1998 No. 383 “On specialized care for patients with speech disorders and other higher mental functions”;
- dated May 5, 1999 No. 154 “On improvement medical care teenage children."
In accordance with Order of the Ministry of Health of Russia dated February 13, 1995 No. 27, psychological and pedagogical personnel are included in the staff of such medical institutions of psychiatric, drug addiction and psychotuberculosis profiles.
The drug rehabilitation center can provide specialized assistance to adolescents with drug addiction, alcoholism and substance abuse. They may include classrooms, sports sections, studios, etc. The adolescent department is usually located separately from the departments in which adult patients undergo rehabilitation.
To provide psychological assistance to children and adolescents with crisis conditions and suicidal behavior, a socio-psychological assistance office for students and minors can be created in medical offices or clinics at educational institutions. Order of the Russian Ministry of Health No. 148 of May 6, 1998 also provides for the organization of specialized round-the-clock telephone posts (“helplines”) to provide emergency psychological assistance to children and adolescents.
Psychological and pedagogical assistance to children with severe speech impairments and other higher mental functions can be provided in children's clinics, as well as in emergency neurological and neurosurgical departments of hospitals, children's psychoneurological dispensaries and other medical institutions. For medical, psychological and pedagogical rehabilitation of children and adolescents with speech impairments and other higher mental functions, a hospital at home can be organized at a medical institution. The Russian Ministry of Health envisages the creation of specialized centers for speech pathology and neurorehabilitation on the basis of treatment and preventive institutions, whose staff, along with medical personnel psychologists and teachers (speech therapists, defectologists) are included. In health care institutions, assistance is usually provided to children and adolescents with mild forms of speech disorders. In more severe cases, children through psychological, medical and pedagogical consultations are sent to specialized institutions of the Ministry of Education: boarding schools for children with developmental disabilities who have “special educational needs”, specialized kindergartens and groups for children “with developmental problems” . Some schools are creating speech therapy centers and classes for children with mental retardation, mental retardation, and physical impairments. However, in the education system it is very rare to find a comprehensive specialized service for helping children with speech pathology.
Order of the Ministry of Health of Russia dated May 5, 1999 No. 154 provides for the organization of a specialized office (department) for medical and social care on the basis of children's clinics, which, in addition to doctors, includes a psychologist and a social worker (social teacher). The tasks of this unit include:
— identification of children with social risk factors;
— provision of medical and psychological assistance;
— formation of the need for a healthy lifestyle.
There is no federal law common to all psychologists that regulates the provision of psychological assistance to the population (including children).
Test questions for the section
1. What is the subject of clinical psychology as an independent branch of psychological science?
2. Who was the first to coin the term “clinical psychology”?
3. What terms can be used to describe the clinical aspects of a psychologist’s work in addition to the term “clinical psychology”? How are they different?
4. In what scientific field did clinical psychology originate?
5. What tasks did psychiatry set for clinical psychology?
6. What was the purpose of using clinical material to solve problems of general psychology?
7. How does the interpretation of pathopsychology accepted in our country, proposed by B.V. Zeigarnik, differ from the interpretation accepted in foreign countries?
8. What problems does clinical psychology solve in pedagogical activity?
9. What sections does modern clinical psychology consist of?
10. List the main aspects of the work of a clinical psychologist in educational institutions.
11. How does psychotherapy differ from psychocorrection?
12. What types of psychoprophylaxis do you know?
1. B.V. Zeigarnik. Historical review // Pathopsychology: Reader / Comp. N. L. Belopolskaya. 2nd ed., rev. and additional - M.: Cogito-Center, 2000. P. 19-26.
2. B. F. Lomov, N. V. Tarabrina. Medicine and psychological science // Social sciences and health care / Ed. I. N. Smirnova. - M.: Nauka, 1987. P. 172-184.
3. I. E. Sirotkina. Psychology in the clinic: Works of domestic psychiatrists at the end of the last century // Questions of psychology. 1995. No. 6. P. 79-92.
4. Clinical psychology / Ed. M. Perret, W. Baumann. - St. Petersburg: Peter, 2002. P. 30-46.
5. Formation and development of clinical psychology (Chapter 10) // Clinical psychology: Textbook / Ed. B. D. Karvasarsky. - St. Petersburg: Peter, 2002. pp. 271-297.
Literature cited
1. Hellpach, W. Klinische Psychologie. Stuttgart: Thieme, 1946.
2. Janet, P. La medicine psychologie. — Paris, 1923.
3. Wittkover E. D., Warnes H. Historical survey of psychosomatic medicine // Unconscious: Nature, functions, research methods / Ed. A. S. Pragnishvili, A. E. Sherozia, F. V. Bassina. In 4 volumes. Volume 2. - Tbilisi: Metsniereba, 1978.
4. Bernshtein A. N. Experimental-psychological methodology for recognizing mental illnesses. - M., 1908.
5. Bekhterev V. M. Objective psychology. Vol. 1. - St. Petersburg, 1907.
6. Wundt V. Foundations of physiological psychology. - M., 1880.
7. Zeigarnik B.V. Pathopsychology. - M.: Moscow State University Publishing House, 1986.
8. History of modern psychology / T. Leahy. — 3rd ed. - St. Petersburg: Peter, 2003.
9. Karvasarsky B. D. Medical psychology. - L.: Medicine, 1982.
10. Clinical psychology / Ed. M. Perret, W. Baumann. - St. Petersburg: Peter, 2002.
11. Kretschmer E. Medical psychology. - M., 1927.
12. Psychology: an integrated approach / M. Eysenck, P. Bryant, X. Coolican et al.; Ed. M. Eysenck. — Mn.: New knowledge, 2002.
13. Romek E. A. Psychotherapy: Theoretical basis and social formation. - Rostov-on-Don: RSU Publishing House, 2002.
14. Sirotkina I. E. Psychology in the clinic: Works of domestic psychiatrists at the end of the last century // Questions of psychology. 1995. No. 6.
15. Shterring G. Psychopathology in application to psychology. - St. Petersburg, 1903.
16. Jaspers K. Collected works on psychopathology. M.: Publishing center "Academy"; St. Petersburg: White Rabbit, 1996.
Section 2. Theory and methodology of clinical psychology
2.1. Theoretical foundations and main methodological problems of clinical psychology
The interdisciplinary status of clinical psychology makes this discipline particularly sensitive to solving the main theoretical and methodological problem modern science— problems of “human nature” as a biosocial being in its external manifestations. Psychology deals with a special reality - subjective, which does not always coincide in content with reality that exists independently of a person. It is generally accepted that psychology is the science of the psyche. However, the psyche is a rather complex phenomenon, which includes several interrelated, but different in nature areas: conscious subjective reality, unconscious mental processes, the structure of individual mental properties, externally observable behavior. Accordingly, the psyche can be considered from different points of view: from the side of mathematical, physical, biochemical, physiological processes or as a sociocultural, linguistic phenomenon.
The first theoretical and methodological problem of clinical psychology is that in science there are two opposing trends in understanding what the psyche is. The first tendency is to view the psyche as a convenient biological metaphor for the neurophysiological processes occurring in the brain. This trend is well reflected in the so-called “central dogma of neurobiology”, formulated by the authors of the famous monograph “Brain, Mind, Behavior” - F. Bloom, A. Leiserson and L. Hofstadter: “... all normal functions of a healthy brain and all their pathological disorders, no matter how complex, can ultimately be explained in terms of the properties of the basic structural components of the brain... mental acts arise from the joint actions of many brain cells, just as digestion is the result of the joint actions of cells of the digestive tract. /6/. From this point of view, the psyche is the total activity of the brain, its integral function.
Another tendency in the interpretation of the concept of psyche is that it is understood as the general ability of living beings to respond to abiotic (biologically neutral) influences. For example, for sound. This general ability includes a set of perception processes, methods of processing information and regulating the body’s reactions to abiotic influences. Moreover, cerebral processes here do not constitute the essence of this general ability, but are just a tool with the help of which this ability can be realized. Just as the hand is only an instrument of a surgeon, but not the cause of his activity, so the brain is only an instrument of mental activity, but not its cause.
Depending on the structure of the instrument of mental activity, living beings have different response abilities, i.e., different psyches: elementary sensory (response only to individual properties of the environment), perceptual (response to holistic formations), intellectual (response to interrelated phenomena ) and conscious (response to a verbally constructed image of reality, which has an independent existence, regardless of the existing relationship between a person and the environment) /26/. In higher animals, these psyches also act as levels of mental functioning: the higher the cerebral organization of animals, the more represented these levels are in them. There are these levels of the psyche in humans too. However, a distinctive feature of the human psyche is the presence of consciousness and four higher mental functions (HMF), which animals do not have. Higher mental functions include: voluntary attention and memory [In contrast to the “natural” functions of attention and memory, which in animals are not mediated by a system of signs and work on the “stimulus-response” principle (i.e., they are situationally determined by current needs), a person can use the sign-symbolic system to organize his attention and memory, regardless of the current need.] logical thinking[Animals have only visual-effective and, possibly, visual-figurative thinking.], as well as higher emotions - emotional relationships (feelings).
The first three levels of the psyche have the following characteristics: 1) are formed under the influence of biological factors; 2) have a direct connection with the satisfaction of specific, situational biological needs; 3) instinctive in the method of implementation.
Higher mental functions have the following characteristics: 1) are formed under the influence of social factors (communication, education, training), 2) are mediated by sign-symbolic forms (mainly speech), 3) are arbitrary in the method of implementation.
Thus, the human psyche acts not so much as a higher form of organization of the animal psyche, but as a qualitatively different way of interaction of the human body with the environment, arising under the influence of not biological, but social factors. Sociality is an integral property of the human psyche, therefore, at least in relation to the human psyche, the neurobiological paradigm, popular in biologically oriented medicine, has weak methodological consistency.
Indeed, a person has a unique neurophysiological mechanism of sign mediation [I. P. Pavlov called this system a secondary signal when interacting with the environment. This mechanism is associated with the presence of developed upper anterior parts of the frontal lobes of the cerebral hemispheres (cortex), which is not found in other primates. Thanks to it, a person acquires the opportunity to interact with the environment indirectly - through a system of symbolic designations of reality, and not directly, and, accordingly, to be relatively independent of the environment, which increases his adaptive capabilities.
The emergence and development of a universal sign system is associated exclusively with the process of communication and interaction with other people within various human groups. That is why the development and functioning of the human psyche is connected with social organization and culture: what are the sociocultural conditions of a person’s life, so is his psyche. The neurophysiological mechanism only makes it possible to implement a sign method of mental functioning. Consequently, the qualitative difference between the human psyche and the animal psyche lies not in the complexity of the individual brain, but in the presence of social connections between people that arise on the basis of linguistic structures, conceptual schemes of thinking, social institutions, etc. It was this circumstance that allowed L.S. Vygotsky formulated the idea of extracortical structures of the human psyche, which are located outside the individual’s brain - in the sociocultural space /8/.
From the first problem - understanding the essence of the psyche - derivative theoretical and methodological problems of clinical psychology follow: the connection between the brain and the psyche, the psyche and consciousness. The traditional solution to the problem of the connection between the brain and the psyche consists in a direct comparison of mental and neurophysiological processes, which are assumed to be either a) identical, or b) parallel, or c) interacting. In the case of identity, the psyche is a state of the brain that can be described in terms of excitation/inhibition of brain structures, properties of the receptive fields of neurons in sensory structures, etc. Then, disturbances in the mental activity of a sick person will only be understood as disturbances in the field of brain physiology.
When considering the brain and psyche as parallel physiological and mental processes, the psyche turns out to be an epiphenomenon - a side phenomenon that accompanies brain activity, but is not associated with any cause-and-effect relationships. The mental processes and conditions of the patient here act as auxiliary, subjective sensations that do not play a significant role in the pathogenesis of the disease, accompanying disturbances at the physiological level of changes in the body. In other words, the mental is a passive “shadow” of the physical, which can be taken into account only as a diagnostically important sign indicating some “deep” biologically determined disorder. The modern manifestation of the concept of parallelism between the brain and the psyche exists in the form of the so-called “double aspectism”, which recognizes that the physiological and mental are simply different points view of the same phenomenon - the neuropsychic activity of the brain, which can equally be described in physiological or psychological language.
If the brain and psyche are considered as interacting phenomena, then in this case the psyche acts as a special non-material phenomenon (mind, soul), and the brain is material. Each of these phenomena has its own laws of operation, but at the same time they interact, exerting mutual influence on each other. When considering the psyche and brain as interacting immaterial and material substances, the question always arises about the mediator or place of interaction. Thus, the French philosopher R. Descartes (1596-1650) believed that this interaction takes place in the pineal gland, a tiny structure located close to the geographic center of the brain /10/. The real functions of this gland are still unknown. It is only known that the pineal gland is involved in hormonal changes that occur during puberty: in childhood, it secretes a special hormone melatonin, which inhibits puberty, and then the secretion of this hormone decreases and puberty begins. There is also evidence that the pineal gland is involved in sleep regulation in humans. Modern theories of interaction between the psyche and the brain propose the concept of trialism - three different worlds: 1) the world of physical objects and states (objective world); 2) the world of mental states (subjective world: knowledge, thinking, emotions, etc.); 3) the world of objectified knowledge (theories, knowledge on material media). World 1 interacts with world 2, and world 2 with world 3. The interaction between the psyche itself (world 2) and the brain (world 1) takes place in the area of synapses. Therefore, various clinical symptoms, especially mental disorders, can be characterized as disturbances in the interaction of the mental and physical levels of human life, their mismatch and complete rupture caused by changes in the conductivity of nerve impulses in neural circuits.
All considered traditional approaches to solving the problem of the connection between the brain and the psyche suffer from one methodological drawback: they rely on the neurobiological paradigm of the psyche as a product of brain activity and therefore cannot explain how qualities arise at the mental level of the functioning of the body that cannot be predicted at the physiological level.
If we consider the psyche as a way of information interaction between the organism and the environment, then in this case the psyche acts as a factor in the systemic organization of individual brain processes: as the body interacts with the environment at the information level, so are the brain processes that ensure this interaction /3/. In other words, the connection between the brain and the psyche is not direct, but indirect - through dynamic functional systems that arise in the brain in the process of solving current tasks to ensure the vital functions of the body. First, an image of the future result of the interaction between the organism and the environment appears in the psyche, under which a certain neurophysiological support is built in the brain - a system of individual physiological processes. The brain helps the body achieve a subjective image of the desired future (the result of interaction between the body and the environment), selectively involving individual physiological processes in a single set of efforts to achieve the expected result. It is the future result that determines the current activity of the brain and is the cause of a certain brain organization in certain mental states.
An organism always has an information equivalent of the practical result of interaction with the environment, which contains its predicted parameters. This information equivalent first enters such a neurophysiological apparatus, which is called the action result acceptor. But it comes into it from the mental level of information interaction with the environment, at which this result is called the goal of behavior. Briefly speaking, a mental act first prepares some image of the future (“an active anticipatory reflection of reality”), and then the brain builds a functional neurophysiological system under this image that ensures the achievement of the required result /45/.
The main question here is how and where does information about the desired result of the interaction between the organism and the environment come from at the mental level? It can be assumed that the brain, tuned in a certain way, first picks up some information signals that are significant for the life of the body, which are processed by the psyche, sensitive to certain signals, after which the image of reality formed by the psyche triggers executive neurophysiological processes. Then the center of “combination” of mental and physical reality can hypothetically be a reticular formation, even in appearance resembling a “receive-transmit antenna device” (“mesh”). In this case, disturbances in mental activity can be interpreted as a specially organized brain activity, prepared by “unusual” or distortedly perceived information signals.
Another problem is the problem of the relationship between the psyche and consciousness. Based on the solution to the issue of the relationship between the brain and the psyche, two approaches are used to resolve the issue of the relationship between the psyche and consciousness. The first approach consists of the so-called neurophysiological interpretation of the phenomenon of consciousness as the optimal level of excitation of neurophysiological processes. Within the framework of this concept, certain brain structures are even identified that are responsible for the functioning of consciousness - the so-called center-brain system, led by the reticular formation of the brain stem. Indeed, damage to the trunk leads to a clear loss of consciousness. This concept allows for the existence of consciousness in higher animals (mammals) with a developed central nervous system. Here consciousness is such mental processes in which attention is involved, understood as active selection individual elements reality. In other words, this is a certain characteristic of mental processes, the essence of which is the integration of the life experience of the organism. As soon as the body ceases to selectively respond to individual signs of the environment, it is considered that it has lost the function of consciousness. This understanding of consciousness dominates in medicine (especially in psychiatry, in which we can talk about the “field” of consciousness, the “clarity” of consciousness, the “level of inclusion” of consciousness, etc.). The practical problem here is that then any disturbance of mental activity should be interpreted as a disturbance of consciousness, which is contrary to clinical traditions.
The second approach characterizes the actual psychological interpretation of consciousness as the highest method of mental interaction with the environment, consisting of verbal (sign-symbolic) images of reality that arise at a certain point in time and also include the verbal image of the person himself - self-consciousness. In the words of S. L. Rubinstein, consciousness is knowledge about something that exists separately from us /38/. Here consciousness is not identical to the psyche: it is only one of the forms of mental activity, characteristic exclusively of man (who, accordingly, also has unconscious mental processes in which verbal methods of interaction with the environment do not participate). At the same time, consciousness is a social product that arises in the system of relations between people. Its form is thinking, and its content is the social characteristics of the environment and the individual. Accordingly, disorders of consciousness are disturbances in human perception social characteristics environment and own personal characteristics.
Depending on the interpretation of consciousness in clinical psychology, there are two approaches to understanding the unconscious. In the case of identifying consciousness and psyche, the unconscious is an insufficient level of neurophysiological arousal, manifested in the form of coma, fainting, deep sleep or general anesthesia. In the case of the distinction between consciousness and psyche, mental processes and states that are non-verbalizable or inaccessible to verbalization are considered unconscious. The reasons why mental processes and states are inaccessible to verbalization may be different. For clinical psychology, those that are important are those that are associated with the processes of displacement from the sphere of awareness (verbalization) of disturbing physiological impulses, desires, memories, images, as well as those that are associated with automatic, habitual actions, the current verbalization of which is not necessary for their implementation (a more adequate term is preconscious).
2.2. Norm and pathology, health and illness
The categories of norm and pathology, health and illness are the main vectors that define the system of perception and criteria for assessing the human condition in clinical psychology. The category of norm is used as a basic criterion for comparing the current (current) and permanent (usual) state of people. The concept of normality in our minds is closely related to the state of health. Deviation from the norm is considered as pathology and disease. The word “disease” in everyday language is used to characterize conditions that do not seem “normal” to us, “the way it usually happens,” and therefore require special explanation. However, a meaningful rather than an intuitive definition of a clinical norm as a theoretical construct is a major methodological problem.
A norm is a term that can have two main contents. The first is the statistical content of the norm: this is the level or range of levels of functioning of an organism or personality, which is characteristic of most people and is typical, the most common. In this aspect, the norm appears to be some objectively existing phenomenon. The statistical norm is determined by calculating the arithmetic average of certain empirical values (found in life experience) data. For example, most people are not afraid of being in a confined space and engage in heterosexual contacts, therefore, the absence of such fear and the absence of homosexual contacts is statistically normal.
The second is the evaluative content of the norm: a norm is considered to be some ideal example of the human condition. Such a model always has a philosophical and ideological justification as a state of “perfection” to which all people should strive to one degree or another. In this aspect, the norm acts as an ideal norm - a subjective, arbitrarily established standard, which is accepted as a perfect sample by agreement of any persons who have the right to establish such samples and have power over other people: for example, specialists, leaders of a group or society, etc. n. As a standard, the ideal norm acts as a means of simplifying and unifying the diversity of forms of life activity of the organism and manifestations of personality, as a result of which some of them are recognized as satisfactory, while others are beyond the permissible, acceptable level of functioning. Thus, the concept of a norm can include an evaluative, prescriptive component: a person should be this way and not another. Anything that does not correspond to the ideal is declared abnormal.
The problem of the norm-norm is associated with the problem of choosing a normative group - people whose life activity acts as a standard by which the effectiveness of the level of functioning of the body and personality is measured. Depending on who experts in authority (for example, psychiatrists or psychologists) include in the normative group, different boundaries of the norm are established.
The number of normative norms includes not only ideal norms, but also functional norms, social norms and individual norms.
Functional norms evaluate human states from the point of view of their consequences (harmful or not harmful) or the possibility of achieving a certain goal (whether this state contributes or does not contribute to the implementation of goals-related tasks).
Social norms control a person’s behavior, forcing him to conform to some desired (prescribed by the environment) or model established by the authorities.
An individual norm involves comparing a person’s state not with other people, but with the state in which the person usually was before and which corresponds to his personal (and not prescribed by society) goals, life values, opportunities and life circumstances. In other words, an individual norm is an ideal state from the point of view of the individual, and not the dominant social group or immediate environment, that takes into account the performance and possibilities of self-realization of a particular person.
To assess the normality (compliance with the norm) of the psychological state of an individual, depending on the purpose, a psychologist or psychiatrist can apply any of the listed norms. Therefore, the process of assessing the psychological state (status) of an individual very often acquires a hidden political character and subject to ideological influence, since ultimately the assessment criterion turns out to be the system of values that dominates in society or in the consciousness of a particular group of people.
Any deviation from the established norm can be characterized as pathology. In the medical lexicon, pathology usually means a violation at the biological level of the functioning of the body. However, in clinical psychology, the content of the concept of “pathology” also includes such deviations from the norm in which there are no biological components (hence it is quite possible and legitimate to use the terms “pathological personality” or “pathological personality development”). The use of the word “pathology” focuses on the fact that the normal state, functioning or development of the individual changes due to morpho-functional disorders (i.e. at the level of brain, psychophysiological, endocrine and other biological mechanisms for regulating behavior).
With regard to the biological norm, it is possible to establish more or less clear objective boundaries of the permissible spread of levels of human functioning, at which the body is not threatened with death from structural and functional changes. With regard to the definition of a mental norm, no clear objective boundaries can be established, since an arbitrary evaluative, normative approach dominates here. The establishment of limits that characterize the norm turns out to be closely related to theoretical ideas about the nature of personality, in which some ideal idea of man as a social being is modeled. For example, in classical psychoanalysis, homosexuality is interpreted as a pathology, while in modern psychological theories focused on the concept of an individual norm, it is treated as a norm /21/.
Original meaning ancient Greek word pathos, from which the term “pathology” comes, is suffering. Consequently, pathology can only be understood as such deviations from the norm in which a person feels emotional discomfort. For example, for specific manifestations of sexual preferences that require clinical and psychological intervention, the terms “egodystonic” and “egosyntonic” are now used. The egodystonic type of manifestation is characterized by pronounced anxiety about one’s preferences, the presence of which causes suffering in a person and a desire to change them. The egosyntonic type of manifestation is characterized by the perception of one’s preferences as natural, consistent with ideas about one’s own personality. Accordingly, only such sexual preference is recognized as “pathological”, which gives a person emotional discomfort and is therefore rejected by him. However, in the area of mental, personal and behavioral deviations from the norm, a person often does not experience any subjective discomfort or feelings of suffering.
The use of the word “pathology” also presupposes the presence of one leading cause of deviation from the norm. However, the same mental state may have not one, but several sometimes opposing causes of not only biological, but also social origin. For example, depression can be caused by neurochemical disorders (reduced activity of biogenic amines - serotonin, norepinephrine, dopamine), neurohormonal changes caused by hyperactivity of the hypothalamus-pituitary-adrenal system (increased release of cortisol). But depression with the same probability can also be caused by a life situation (not only current living conditions, but also cultural, epochal, political, etc.), as well as motivationally determined features of cognitive processing of information (interpretation of events). And if we recall one of the basic theoretical and methodological problems of clinical psychology concerning the connection between the brain and the psyche, it is difficult to say unambiguously what level of changes are the root cause of the observed deviations from the norm.
Finally, the term “pathology” has a very strong evaluative component, which makes it possible to label any person who does not correspond to the dominant ideal or statistical norms as “sick.”
Due to the three listed features of the use of the word “pathology” (the obligatory presence of suffering and poor health in a person deviating from the norm; the assumption of the action of one leading cause of the disorder; a pronounced evaluative component), many scientists advocate its exclusion from the vocabulary of psychiatrists and clinical psychologists, proposing instead use of the term “disorder”, limiting the use of the word “pathology” to only the biological level of impairment.
A disorder means the absence or disturbance of a pre-existing normal condition for a person. The use of the term “disorder” does not imply mandatory presence for one or another deviation from the norm there are unambiguous cause-and-effect relationships of its occurrence. Disorders can be caused by the interaction of a number of factors at the biological, psychological and social levels, and in each specific case one or another factor may be leading in the onset, development or outcome of the disorder. Therefore, the use of the word “disorder” in clinical psychology seems to be preferable today.
The definition of a mental disorder is based on three basic criteria:
1) certain types of reactions that exceed the statistically detected frequency of their occurrence in the majority of people in a certain situation over a certain period of time (for example, if five out of nine signs of depression are observed in a person for two weeks or more, then only this condition is recognized as a disorder);
2) conditions that prevent a person from adequately realizing the goals he has set for himself and therefore cause damage to him (the so-called “dysfunctional conditions”);
3) types of behavior from which the individual himself suffers and receives physical harm or brings suffering and physical harm to the people around him.
At the social level of human functioning, norm and pathology (disorder) act as states of health and disease.
In science, there are two approaches to determining health status: negative and positive.
The negative definition of health considers the latter as the simple absence of pathology and compliance with the norm. Here the norm is considered as a synonym for health, and pathology as a disease. However, the concepts of norm and pathology are broader than the concepts of health and disease. Norm and pathology are always continual: they cover a whole variety of interchangeable states. Health and illness appear as discrete states, clearly defined in their boundaries. They are not associated with an objectively recorded deviation from the norm, but with a subjective state of good or bad health, which influences our performance of everyday functions in activity, communication and behavior.
The characteristics of general well-being turn out to be the central link in distinguishing between health and illness. A healthy person is someone who feels well and can therefore perform everyday social functions. A sick person is someone who is unwell and therefore unable to perform daily social functions. At the same time, the actual presence or absence of various deviations from the norm at the biological level of existence is often not decisive for classifying oneself as healthy or sick. For example, people who drink alcohol at a party have deviations from “normal” parameters of mental functioning (are in the so-called “altered state of consciousness”), however, they are not sick as long as their social functions are not impaired. It turns out that the concept of health is broader than the concept of norm, and the concept of disease differs in content from the concept of pathology. This circumstance has led researchers to search for positive concepts of health.
A positive definition of health does not reduce the latter to the simple absence of illness, but tries to reveal its content autonomous from illness.
The general definition of health, which was proposed by the World Health Organization (WHO), includes a person's condition in which:
1) the structural and functional characteristics of the body are preserved;
2) there is high adaptability to changes in the familiar natural and social environment;
3) emotional and social well-being is maintained.
Mental health criteria as defined by WHO:
1) awareness and feeling of continuity, constancy of one’s “I”;
2) a sense of constancy of experiences in similar situations;
3) criticality towards oneself and the results of one’s activities;
4) correspondence of mental reactions to the strength and frequency of environmental influences;
5) the ability to manage one’s behavior in accordance with generally accepted norms;
6) the ability to plan your life and implement your plans;
7) the ability to change behavior depending on life situations and circumstances.
Thus, health in general and mental health in particular are a dynamic combination various indicators, while disease, on the contrary, can be defined as a narrowing, disappearance or violation of health criteria, i.e. as a special case of health.
There are two points of view in defining a disease: 1) a disease is any condition diagnosed by a professional; 2) illness is the subjective feeling of being sick. In the first case, the disease is considered as a disorder of functioning assessed by objective signs. But for many diseases, people do not turn to professionals, and there are no objective standards of human functioning (in many cases, professionals cannot come to a common understanding of the disease state). The second approach also has its limitations: the patient's reported condition reflects the patient's problems rather than the disorder itself. In addition, in a number of severe somatic conditions there may be no changes in well-being (for example, tuberculosis).
The concept of illness is not so much a reflection of the objective state of a person, but rather acts as a general theoretical and social construct with the help of which ordinary people and specialists try to identify and understand emerging health disorders. The content of this construct determines the vision of the causes and manifestations of the disease, as well as the direction of research and treatment of various disorders. In other words, people first define what constitutes a disease and then begin to research and treat it.
The disease construct that exists in European culture can be expressed as follows:
Thus, the disease construct assumes the following sequence: cause - defect - picture - consequences. It is a prototype for generating hypotheses, explaining disturbances and influencing causes. Having seen the consequences and the general picture of deviations in mental activity or behavior, we, following the construct of the disease, begin to assume that behind these external signs lies some kind of defect in the person himself, which, in turn, is caused by reasons specific to this defect.
IN modern medicine There are two models of illness: biomedical and biopsychosocial.
The biomedical model of disease has existed since the 17th century. It is centered on the study of natural factors as external causes of disease. The biomedical model of disease is characterized by four main ideas:
1) pathogen theory;
2) the concept of three interacting entities - “master”, “agent” and environment;
3) cellular concept;
4) a mechanistic concept, according to which a person is, first of all, a body, and his illness is a breakdown of some part of the body.
Within this model, there is no place for social, psychological and behavioral reasons for the development of the disease. A defect (including mental), no matter what factors it is caused by, always has a somatic nature. Therefore, the responsibility for treatment here rests entirely with the doctor, and not with the patient.
At the beginning of the 20th century. the biomedical model was revised under the influence of the concept of the general adaptation syndrome by G. Selye /40/. According to the adaptation concept, a disease is a misdirected or overly intense adaptive reaction of the body. However, many disorders can be considered as a type of adaptive reactions of the body. Within the framework of G. Selye’s concept, the term maladaptation even arose (from the Latin malum + adaptum - evil + adaptation - chronic disease) - a long-term painful, defective adaptation. In addition, in relation to mental disorders in the adaptation model, the state of the disease (as maladaptation or as a type of adaptation) does not correlate with the characteristics of the individual and the situation in which the mental disorder occurs.
Russian clinical psychology, being closely connected with psychiatry, for a long time focused on the biomedical model of mental illness, therefore, the features of the impact of the social environment on the process of mental disorders were practically not studied in it /18/.
The biopsychosocial model of the disease emerged in the late 1970s. XX century /58/. It is based on a systems theory, according to which any disease is a hierarchical continuum from elementary particles to the biosphere, in which each lower level acts as a component of the higher level, includes its characteristics and is influenced by it. At the center of this continuum is the personality with its experiences and behavior. In the biopsychosocial model of illness, responsibility for recovery lies entirely or partially with the sick people themselves.
This model is based on the “diathesis - stress” dyad, where diathesis is a biological predisposition to a certain disease state, and stress is the psychosocial factors that actualize this predisposition. The interaction of diathesis and stress explains any disease.
In assessing health status within the framework of the biopsychosocial model, psychological factors play a leading role. Subjectively, health is manifested in a feeling of optimism, somatic and psychological well-being, and joy of life. This subjective state is caused by the following psychological mechanisms that ensure health:
1) taking responsibility for your life;
2) self-knowledge as an analysis of one’s individual bodily and psychological characteristics;
3) self-understanding and self-acceptance as a synthesis - a process of internal integration;
4) the ability to live in the present;
5) meaningfulness of individual existence, as a result - a consciously built hierarchy of values;
6) the ability to understand and accept others;
7) trust in the process of life - along with rational attitudes, orientation towards success and conscious planning of one’s life, one needs that mental quality that E. Erikson called basic trust, in other words, this is the ability to follow the natural flow of the process of life, wherever and in whatever way he didn't show up.
Within the framework of the biopsychosocial paradigm, disease is considered as a disorder that threatens dysfunction - the inability of psychobiological mechanisms to perform their functions in a certain sociocultural space. Moreover, not every functioning disorder is clearly a disease, but only one that becomes the cause of a significant threat to existence for the individual in specific environmental conditions. Consequently, not every disorder is a disease, but only one that needs to be changed (“there is a need for treatment”). The need for treatment is considered to exist when existing signs of abnormalities (disorders) cause damage to professional performance, daily activities, habitual social relationships, or cause pronounced suffering.
Since the state of the disease presupposes a special social status of a person who is unable to perform social functions to the expected extent, the disease always turns out to be associated with the role of the patient and restrictions on role (social) behavior. An interesting socio-psychological fact turns out to be associated with this phenomenon, when simply applying the “label” of “sick” can lead to the emergence or progression of a person’s existing health disorder. As a result of such “labeling”, sometimes a minor deviation from any norm (thanks to social and information pressure from the environment and specialists who made the “diagnosis”) turns into a serious disorder, because the person takes on the role of “abnormal” imposed on him. He feels and behaves as if he were sick, and those around him treat him accordingly, recognizing him only in this role and refusing to recognize him as playing the role of a healthy person. From the fact of labeling, one can draw a far-reaching conclusion that in a number of cases, mental disorders in individuals do not stem from an internal predisposition, but are a consequence or expression of broken social connections and relationships (the result of living in a “sick society”).
Consequently, in addition to the disease construct that dominates in clinical psychology (“a complex of biopsychosocial causes - internal defect - picture - consequences”), there are other - alternative - disease constructs. Firstly, mental and behavioral abnormalities can be interpreted as an expression of disrupted processes in the system of social interaction. Secondly, mental and behavioral deviations can be considered not as a manifestation of an internal defect, but as an extreme degree of expression of certain mental functions or patterns of behavior in specific individuals. Thirdly, mental and behavioral abnormalities can be considered as a consequence of a delay in the natural process of personal growth (due to frustration of basic needs, restrictions in social functioning, individual differences in the ability to resolve emerging personal and social problems).
All of the listed alternative constructs of illness focus on the fact that the boundary between the states of health and illness, norm and pathology, as well as our vision of the causes of deviations from norms are established arbitrarily in accordance with the dominant model of illness in society and science. Once the disease model changes, much of what is today considered mental illness or pathology may turn out to be an extreme variant of the norm. Alternative models of disease question the very presence of a defect that causes poor health. In fact, they make the construct of illness devoid of its usual meaning, since the social environment can call any individual deviation in the psyche and behavior of a person “abnormal” and “in need of change,” even if there is no obvious defect in the biological mechanisms that implement this mental activity or behavior . It should be recognized that for many mental illnesses and behavioral disorders, only a correlation, and not a cause-and-effect relationship, has been established between the observed signs of the disorder and changes in the morpho-functional basis. At the same time, it is often overlooked that similar changes in the morpho-functional basis can be found in practically healthy individuals. True, in this case, supporters of the dominant construct of the disease postulate the so-called “pre-morbid” nature of the disorders or the “latent” course of the disease. However, then we risk narrowing the concept of health to a non-existent abstraction. This approach in clinical practice is called “nosocentric” (i.e., disease-centered).
The listed problems associated with the use of the concept of disease have led to the fact that today the term “mental, personality and behavioral disorders” is becoming more preferable, which covers various types of disorders, including diseases in the narrow sense of the word.
2.2.1. The problem of distinguishing between psychological phenomena and psychopathological symptoms
From the above, we can conclude that simply observing detected changes in mental activity or behavior and assessing them as disorders is not yet a basis for interpreting them in terms of a disorder or disease. Externally, psychological phenomena (individual and personal characteristics of functioning) and psychopathological symptoms have significant similarities. How, for example, can we differentiate between suspicions of infidelity, which are a consequence of feelings of jealousy as a psychological reaction to situations of communication and interaction between spouses, and delusions of jealousy, which also manifests itself in such suspicions? Or how to distinguish between a) the behavior of a person fighting for justice, observance of people’s rights and laws; b) litigiousness, which consists in the desire to enjoy the process of disputes, litigation, conflicts for the sake of the principle itself, and not for the sake of the result; and c) delusion of attitude, which consists in the fact that others have a negative attitude towards a person and always want to harm him, What is manifested in the natural desire to protect oneself from a hostile environment by going to court? Without an analysis of the social environment, the characteristics of personal development and personal factors (experiences, motivation, etc.) of behavior, it is almost impossible to distinguish between psychological and psychopathological phenomena.
Most good decision this problem was proposed by K. Jaspers at the beginning of the 20th century. /51/. Based on the phenomenological philosophy of E. Husserl, he proposed using the phenomenological approach in clinical practice. K. Jaspers considered any mental state as a phenomenon, that is, as a holistic experience of the current moment, in which two inextricably linked aspects can be distinguished: consciousness of the surrounding world (object consciousness) and consciousness of oneself (self-awareness). Therefore, the doctor and psychologist have two ways to assess the patient’s mental state, both of which are purely subjective:
a) imagining oneself in the place of another (feeling achieved through listing a number of external signs of a mental state);
b) consideration of the conditions under which these characteristics are interconnected in a certain sequence.
To distinguish between psychological phenomena and psychopathological processes, it is important to discover the logic by which the patient builds cause-and-effect relationships in objective consciousness (how he sees reality) and between objective consciousness and self-consciousness (what he considers necessary to do in this understood reality). From this instruction of K. Jaspers, Kurt Schneider derived the first principle of differentiation /29/:
Only that which can be proven as such is recognized as a psychopathological symptom.
The proof is based on generally accepted laws of logic (the law of identity, the law of sufficient reason, the law of excluded middle) using the criterion of reliability (convincingness) and probability (using reasoning by analogy). With this approach, what is essential in the proof will not be the absurdity of the statement, but the distribution of the spectrum of probability of the patient’s correct conclusion based on the available facts and sociocultural conditions. According to K. Schneider’s principle, it is always necessary to compare two logics: the external logic of the patient’s behavior and the logic of the patient’s own explanation of this behavior. Then the psychologist is given one task: to prove on the basis of what signs he recognizes the patient’s subjective logic as going against the external logic of explaining behavior.
One of the most widely used to solve this problem is the model of deductive-logical explanations of events. A normal explanation of events must satisfy the so-called conditions of adequacy:
— arguments (the grounds on which a psychologist or patient relies) explaining the patient’s condition and behavior must be logically correct (i.e., they must not violate the formal laws of logic);
- the events described by the patient must have empirical content (or be probable events under certain acceptable circumstances; the degree of probability in clinical psychology is often determined by the principle of analogy - the event is more likely, the more similarities the psychologist sees in what the patient is talking about, so , which happens to most other people, and also to the fact that he already knows about the things being told);
— the patient’s claims must be convincingly proven.
As can be seen from the characteristics of the conditions of adequacy, in clinical practice it is difficult to find people whose statements could satisfy the last requirement - persuasiveness. In addition, a serious limitation is the indication that the assessment of adequacy is tied to existing knowledge about some things, since knowledge is often incomplete and constantly changing, constructed (i.e., situationally conditional, and not absolute).
K. Jaspers suggests highlighting the following as additional delimiting features:
- the presence of clearly attention-grabbing characteristics of the patient’s behavior and personality (pretentiousness, demonstrativeness, eccentricity);
— the suddenness of their appearance in a relatively short period (while such characteristics were not previously present in the person’s personality and behavior);
Page 1 |
Scheme of examination of the level of formation
motor and sensory processes in children
Assessment of general motor skills(diagnostic tasks of N. I. Ozeretsky, M. O. Gurevich):
Static balance assessment
Maintain balance for at least 6-8 seconds (average level, satisfactory result) in the “stork” pose: standing on one leg, bend the other at the knee so that the foot touches the knee joint of the supporting leg, hands on the belt. The child must maintain balance and prevent limbs from trembling.
Dynamic Equilibrium Assessment
Cover a distance of 5 m by jumping on one leg, pushing a box of matches in front of you with the toe of your foot. The deviation in the direction of movement should not be more than 50 cm.
Manual Motor Assessment:
Perform the following movements with each hand in turn: extend forward the second and fifth fingers (“goat”), the second and third fingers (“scissors”), make a “ring” from the first and each next finger;
Coordination of movements of both hands “fist - palm”: hands lie on the table, with one hand clenched into a fist, the other with straightened fingers. Simultaneously changing the position of both hands, straightening one and squeezing the other.
Hand-eye coordination tests:
Drawing simple geometric shapes, intersecting lines, letters, numbers in compliance with proportions, stroke ratios;
Drawing a phrase of 3-4 words, written in a written font, preserving all elements and dimensions of the sample.
Assessment of tactile sensations:
Recognition of familiar objects by touch (comb, toothbrush, eraser, spoon, key) with the right and left hands alternately;
Recognition by touch of volumetric (ball, cube) and planar (square, triangle, circle, rectangle) geometric shapes.
Assessment of mastery of sensory standards:
Color discrimination tests
Laying out 7 cards of the same color in a row, but in different shades: from the darkest to the lightest;
Naming and showing all the colors of the spectrum, naming and showing at least 3 shades of color that have their own name (raspberry, scarlet, etc.).
Shape discrimination
Grouping of geometric shapes taking into account the shape (a triangle, a circle, a square are laid out in a row in front of the child. It is necessary to select the appropriate shapes for them from the 15 proposed).
Depending on the age of the children, you can complicate this task: increase the number of presented forms (up to 5) and handouts (up to 24).
Perception of magnitude
Laying out in order of decreasing (increasing) size 10 sticks from 2 to 20 cm long;
Ranking by size in a row of 10 elements based on abstract perception, determining the place where the figure that the experimenter removed should be placed in the row.
Visual perception assessment:
Recognition and naming of realistic images (10 images);
Recognition of contour images (5 images);
Recognition of noisy and overlaid images (5 images);
Highlighting letters and numbers (10), written in different fonts, upside down.
Auditory perception assessment:
Reproduction of simple rhythmic patterns;
Determination by ear of real noises and sounds (or recorded on a tape recorder): the rustling of a newspaper, the crying of a child, the sounds of dripping water from a tap, the sound of a hammer, etc.;
Determination of the initial consonant in a word (the child is given 4 object pictures; after hearing the word, he picks up the picture that begins with the corresponding sound).
Spatial Perception Assessment:
Showing and naming objects that are shown on the table on the left, right, below, above, in the center, in the upper right corner, etc.;
Performing a similar task in a group room, determining the location of objects in space (above - under, on - behind, in front - near, above - below, above - below, etc.);
Design based on a pattern of 10 counting sticks.
Time Perception Assessment:
A conversation is held with the child to clarify orientation in the current time (part of the day, day of the week, month, season), past and future (for example: “Spring will end, what time of year will come?” Etc.).
The assessment of the completion of any task is assessed according to three qualitative criteria:
- “good” - if the child completes the task independently and correctly, explaining it, completely following the instructions, sometimes making minor mistakes;
- “satisfactory” - if there are moderate difficulties, the child independently performs only an easy version of the task, assistance of varying amounts is required when completing the main task and commenting on his actions;
- “unsatisfactory” - the task is completed with errors when providing assistance, or the student does not cope with the task at all, and experiences significant difficulties in commenting on his actions.
