Principles Of Clinical And Psychological Analysis Of Mental Disorders

Table of contents:

Video: Principles Of Clinical And Psychological Analysis Of Mental Disorders

Video: Principles Of Clinical And Psychological Analysis Of Mental Disorders
Video: Diagnosis of Mental Disorders and Addictions DSM IV 2024, March
Principles Of Clinical And Psychological Analysis Of Mental Disorders
Principles Of Clinical And Psychological Analysis Of Mental Disorders
Anonim

These principles were formulated by Vygotsky.

The first principle: Higher mental functions are formed in vivo, they are socially determined, sign-symbolic in their structure, mediated and arbitrary in their functioning

From the point of view of Russian psychology, it does not matter whether the function is normal or abnormal. It always obeys principle number 1. In other words, we are on the position that there is nothing in pathology that is not normal. According to Vygotsky, the psyche in illness works according to the same laws as in the norm. But due to broken conditions, these laws lead to a different result.

Take two disorders that are among the most productive symptoms: delusions and hallucinations. If we think like Vygotsky, this means that in hallucinosis and delirium we will find the same HMF characteristics as in the norm. Delirium is impossible in children, since the system of formal-logical operations is not formed. He can fantasize. And in an adult, delirium is built according to all the laws of formal logic. It turns out that the basis of adult delirium is the development of simple thinking. The plot of delirium is taken from the social situation of development. If there was no love, persecution, manipulative influence in the social structure, then there would be no delusion of influence, jealousy, love, persecution, etc. All delusions are socially determined. And this is evidenced by the change of eras of different delusions.

For example, there was no persecution delusion in the 90s. But there was a lot of nonsense of extrasensory influence. Then, this social situation ended and it was possible for students to show different stories of nonsense. Now - the delirium of dysmorphophobia.

Epochs of different stories of nonsense are associated with social information.

The desire to do a lot of operations for oneself is associated with selflessness. Because the main condition "to love yourself" is not met.

Delirium and hallucinations are not just a mental state. This behavior is in the logic of this mental state. And of course, hallucinations can be in the form of brain damage due to high temperature.

80-90s - loss of stability. And a huge number of threats. And the boom in psychic practices was associated with the motivation of the population to gain influence on life. And everything went into delirium:)

We can detect the mechanisms of the normal psyche as the mechanisms of hallucinosis. Hallucination is the appearance of an image without an object. It seems that normally we always perceive the object. Hence, hallucination, by this definition, is not at all the same as perception in the norm. Within the framework of Vygotsky's thinking, we must discover perception as normal and as an underlying reason for hallucinosis.

Bekhterev tried to experimentally prove that there is an object in hallucinations. (Susanna Rubinstein repeated the experiment). Among alcoholics, he chose those who had hallucinosis and put them in a darkened room, where his assistant began to reproduce rather vague sounds. Bekhterev observed that his patients with hallucinosis, listening attentively to these sounds, began to hallucinate intensely. Rubinstein at the Gannushkin Institute also experimented with patients with hallucinosis of different origins and cured. Different sounds poured from the tape recorder - the most vague and more or less understandable (the ticking of the clock, the ringing of the bell). Rubinstein found that even with the hallucinosis treated, the hallucinations returned. And this means that the psyche is ready to return to hallucinosis at almost any moment and returns its perception there - in order to have a hallucinosis, active perception is needed. It turns out that the activity of active listening, which normally provides us with the accuracy of perception, can normally provide us with hallucinosis.

Second, if we look at hallucinosis as a mental activity, we find that the plots of hallucinosis are not accidental. For example, in alcoholics, hallucinosis always has a dramatic relationship with something terrible. In patients with reactive hallucinosis (after psychotrauma), the psychotrauma itself usually sounds in it.

For example, a former firefighter who was examined by Rubinstein. When there was a rustle of paper, he began to hallucinate and said that now the beams were crumbling, which would now crush.

From this point of view, people who are blind from birth cannot have visual hallucinations. Because in order for a psychopathological phenomenon to arise, there must be a psychological phenomenon before. But for the visually impaired - they can. And it is stronger than that of those who see well, since peering is stronger, due to the fact that the vision is weak, it directs even more mental activity into this visual analyzer.

For a disorder such as delusions and hallucinations to occur, the brain must be very active. Antipsychotics quench activity. General mental activity fades away and delirium goes away with it. Therefore, the old antipsychotics (amenazine) extinguish all mental activity and together with it all psychopathology extinguishes.

For hallucinosis to arise, anxiety is necessary. What did Bekhterev and Rubinstein do? Created an atmosphere of uncertainty. Our psyche always experiences any uncertainty as anxiety.

In other words, within any pathological phenomenon, it is necessary to find normal mechanisms. In order to correctly model them, to reduce the pathological phenomenon. For this, we need an analysis of the normal factors underlying the pathological phenomena.

That is why, by analyzing the nature of the activity of hallucinosis and the activity of delirium, it is possible to make a prediction. The more logical the structure of the delusion, the better the prognosis. When delirium is already paraphrenic, it means that thinking itself has disintegrated.

The psychologist does not answer the question: "Why does a person get sick?" This is a very narrow direction, although I really want to answer on the basis of an understanding of the psyche that the connection between the disease and the psyche is natural and exists. But today, psychological problems both in the field of practice and in the field of science are not yet able to unambiguously answer this question. Any physical and mental illness is considered as a multifactorial and psychological factor - a small piece of the whole set of causes. But what can we answer? We answer the question: "How does the psyche work under conditions of illness?"

This means that the psyche remains social, mediated, strives for arbitrary control over everything that happens in its field of control.

The laws of the normal psyche work within the pathology. But the result is distorted.

Principle 2: A defect is not a regression

Mental illness creates a new picture and a new structure of the functioning of the psyche. This is not a regression, but a new formation. This principle was formulated by Vygotsky and, formulating this principle, he challenged the point of view of psychoanalysis and psychiatry, since psychoanalysis viewed mental illness as leading to regression.

Conventionally, one can imagine mental illness as a kind of staged path to regression, and if the idea of psychoanalysis was correct (for example, regression to the oral stage in psychosis). Vygotsky says there is no regression. There is a new design.

If there really was a pattern of regression, then every patient in the course of the illness should more and more resemble a child. There are such diseases.

For example, frontal syndrome (violation of the frontal lobes of the brain): both the right and left frontal lobes are impaired and the patient resembles a child in his pattern of behavior. It has "responsiveness", - the term of Kurt Lewin, when a person is led by field stimuli (a crow flew by - turned its head there). And the behavior ceases to be purposeful. In principle, it is similar in appearance, but has nothing in common. As soon as we have given the child a play activity, he is absolutely purposeful. The point is that despite the external similarity, the structure of activity and the structure of behavior are completely different.

Another example: old people. Do they look like children? Similar. Senile senile dementia: really old people are distracted, thinking is reduced, they become naive, in a sense uneducated, inattentive and forgetful, and in this they resemble children in pre-educational activities. If the law of regression was fulfilled, the old people would have to lose everything that they have gained in life. But there is no complete loss of skills. If there was a law of regression, then people would have to lose the most difficult skills, and then - the earliest. But this does not exist in senile dementia. A deeply senile and dementy old man, sitting at a doctor's appointment. At this time, the door opens and the head of the department enters. Our old man does not remember her, as his dementia cut off the power to his memory. But at the same time, he gets up when a woman enters the office. And this is the skill of adulthood.

Another example is the retention of late skills against the background of profound dementia. An old woman who does not remember her name or where she is from. There is a complete loss of contact with reality. At the same time, when a typewriter was placed in front of her, she immediately began to type. And this is a holistic professional skill acquired in adulthood.

Let's look at the function of mediation (arbitrariness - mediation - sociality). Mediation is the use of symbolic means. A huge number of mental functions not only do not lose support on mediation, but also strengthen on non-support.

Continuous rechecking in old age - inadequate strengthening of voluntary control. And we observe it in neuroses and psychosis.

Control is our natural, trained response to anxiety. The inability to control the pilot of the plane leads to a panic attack. And if you experienced the fear of losing the object of attachment? For example, they forgot to close the car. And then we will control.

Where there is anxiety, there are forms of unmanageable control.

There is no regression. On the contrary, there is a pathological progress in mediation.

For example, there is malignant epilepsy, which greatly changes the psyche. This is a form of brain disease, as a result of which the entire structure of the psyche changes. If such a patient with epilepsy is given the "Pictogram" technique, then we find a curious scene of how he performs the pictogram. He details her. Sits and reflects for a long time before drawing, for example, "hard work". He will detail it as much as possible. And then he will forget what he drew. When drawing this picture, the motive is shifted to the goal. Instead of scribbling and remembering something, he goes into drawing as an activity. And memorization goes to the periphery. The pathology of memory here is not connected with the fact that mediation has disappeared. And with the fact that it is pointed.

Principle 3: Any mental illness creates a new picture of the psyche

What is this picture of the psyche? Vygotsky called this picture of the psyche "the structure of a defect." There is a part of the psyche in which violations are observed - "pathos". There is a preserved part of the psyche. And there is a part of the psyche that is actively fighting the violation - compensation. Any illness is a barrier that a healthy part of the psyche is trying to overcome. This compensation itself can come with a "+" sign.

For example, no matter what the reasons are, my head does not keep the whole course of events. I write in my diary. And the diary is a compensation for retention in memory.

Our life is full of compensations and a healthy life is full of good compensations. Due to them, we become active and energy-efficient. The lack of good compensation leads to the fact that pathos comes to the fore.

For example, if I do not use the diary, then I will definitely be anxious, insecure and in complexes.

Most of us are looking for compensation in the form of educational activities.

But there are compensations with a "-" sign. This is the aggression of a child with reduced intelligence. Indeed, mentally retarded children can be aggressive. There are two points: if dementia is associated with the pathology of subcortical structures, then aggression is primary. But very often it is a compensation for the child's outcast position, when, being feeble-minded, but strong, he will prove his respect for himself with his fists. We can see very often that aggressive people overcompensate for some of their complexes.

Domestic violence is part of the overcompensation in relation to aggression complexes. They beat up children because this child, with his imperfections, inflicts a narcissistic wound on a perfection mom or a perfection dad (not those diaries show). Dad thought it was going to be his narcissistic extension, and he wasn't with such grandiose extensions. And the son himself is a sign of the failure of the pope's narcissism. The narcissistic wound must be closed somehow.

In pathology, all the same overcompensation as in the norm.

For example, why do we eat so much? Moreover, depending on age, what overcompensates the glutton? If we are talking about old people, then there is a hypercompensation of emptiness and deficiency of some feelings. Because if a variant of the senile dementia process begins to unfold, then there is a feeling of emptiness inside. And there were old people who overcompensated for their hungry childhood. They kept "crackers under the mattress" after the Second World War.

There is a complex of vital fear for life that leads to this kind of gluttony.

If you take a young age, then food is an overcompensation for the lack of pleasure. (- "Where is there always light?" - "In the fridge!":))

With mental illness, too. For example, high narcissistic self-esteem with peacock behaviors. We will surely find behind demonstrative self-esteem the wounded little "I" of an unloved girl, a small abandoned child, an underestimated boy - most often we will find childhood problems behind overcompensation.

If we look at the psyche of any sick person, it does not matter if he is psychotic or neurotic, the psychologist, in contrast to the psychiatrist (who looks at the "pathos") looks at what is safe and what can be considered with a "+" sign in compensation and what can be considered as maladaptive forms, with a "-" sign.

Principle 4: Every picture of a defect, every structure of a diseased psyche is built as a level syndrome. And in this syndrome, Vygotsky distinguished two levels of symptoms: primary and secondary symptoms

Primary symptoms are those disorders of higher mental functions that are directly related to the biological nature of the disease (for example, with brain damage).

For example, in traumatic brain injuries, disturbances in attention and memory are not only mandatory, but primary symptoms, because they are associated with exactly which areas were injured (as a rule, this concerns the subcortical structures, and they are responsible for our attention and memory).

Secondary symptoms are built on top of the primary.

For example, if attention is impaired due to traumatic brain injury, then other functions will be secondarily affected by these impairments of attention. For example, a read function. Not because this zone, the zone of reading and understanding words was violated, but because a more complex form of activity will suffer due to impaired attention.

The second option for secondary symptoms is compensation. Because they arise as psychological, as an attempt to bypass a defect.

An example of compensation: when a person, no matter what as a result, loses his hearing or vision, he begins to rely more on other sensory systems. The auditory and tactile systems are more activated, a redistribution of activity occurs, and we see that this is compensation.

Secondary symptoms of compensation can relate not only to mental functions, they can relate to self-esteem (narcissistic sharpening of self-esteem), forms of communication. People rearrange their communication depending on what they are sick with.

For example, people get sick, no matter in body or soul. They become lonely people. Including because, having a disease, some people create such psychological compensation, which is secondary autism. This means that a person, in order to maintain his self-esteem, himself goes into four walls. So that no one sees the loss of his abilities. What is the response of the individual to the entire communication system? He is autistic. This is a compensatory restructuring of communicative behavior to maintain self-esteem.

The psychologist must not only see this whole structure, he must find the "+" compensations developed by the person himself, which he must use for rehabilitation. We must find supports that we can strengthen in psychotherapy.

For the most part, compensation is not created in psychotherapy. The psychotherapist can enhance compensation with psychotherapy. You can't create a sense of humor. It can be used as a resource in the treatment of illness.

Therefore, diagnosis is always associated with the direction of psychotherapy.

Adapted from: Arina G. A. Clinical psychology

Recommended: