Tiganov A.S. (ed.) ‹‹General psychiatry. Research methods in clinical psychology
Clinical psychology is a branch of psychological science. Her findings are of theoretical and practical importance for both psychology and medicine.
In some countries, the concept of medical psychology is common, but in most countries the concept of "clinical psychology" is more commonly used.
In recent decades, in Russia, the question of the convergence of domestic and world psychology has increasingly begun to arise, which required a revision of such concepts as medical and clinical psychology.
The change in the name of medical psychology to clinical psychology is due to the fact that in recent decades it has been integrating into world psychology.
Clinical psychology as an organization of researchers and practitioners has been represented by the American Association of Clinical Psychology since 1917, and in German-speaking countries since the middle of the 19th century.
The International Guide to Clinical Psychology, edited by M. Perret and W. Baumann, provides the following definition: “Clinical psychology is a private psychological discipline, the subject of which is mental disorders and mental aspects of somatic disorders (diseases). It includes the following sections: etiology (analysis of the conditions for the occurrence of disorders), classification, diagnosis, epidemiology, intervention (prevention, psychotherapy, rehabilitation), health care, evaluation of results. In English-speaking countries, in addition to the term "clinical psychology", the concept of "pathological psychology" - Abnormal Psychology is used as a synonym. In addition to clinical psychology, many universities, mostly Western ones, also teach medical psychology. The content of this discipline may be different. It includes:
1) the application of the achievements of psychology in medical practice (first of all, this concerns solving the problem of interaction between a doctor and a patient);
2) disease prevention (prophylaxis) and health protection;
3) mental aspects of somatic disorders, etc. In accordance with the state educational
The standard of clinical psychology is a wide-profile specialty aimed at solving a complex of problems in the healthcare and education systems. It is also noted that clinical psychology is intersectoral in nature.
Experts give different definitions of clinical psychology. But they all agree on one thing: clinical psychology considers the area that borders between medicine and psychology. This is a science that studies the problems of medicine from the point of view of psychology.
The leading Soviet psychiatrist A.V. Snezhnevsky believes that medical psychology is a branch of general psychology that studies the state and role of the psyche in the occurrence of human diseases, the features of their manifestations, course, as well as outcome and recovery. In its research, medical psychology uses descriptive and experimental methods accepted in psychology.
2. Subject and object of research in clinical psychology
According to the direction, psychological research is divided into general (aimed at identifying general patterns) and private (aimed at studying the characteristics of a particular patient). In accordance with this, one can distinguish between general and particular clinical psychology.
The subject of general clinical psychology are:
1) the main patterns of the psychology of the patient, the psychology of a medical worker, the psychological characteristics of communication between the patient and the doctor, as well as the influence of the psychological atmosphere of medical institutions on the human condition;
2) psychosomatic and somatopsychic mutual influences;
3) individuality (personality, character and temperament), the evolution of a person, the passage of successive stages of development in the process of ontogenesis (childhood, adolescence, youth, maturity and late age), as well as emotional and volitional processes;
4) issues of medical duty, ethics, medical secrecy;
5) mental hygiene (psychology of medical consultations, family), including mental hygiene of persons in crisis periods of their lives (puberty, menopause), psychology of sexual life;
6) general psychotherapy.
Private clinical psychology studies a specific patient, namely:
1) features of mental processes in mental patients;
2) the psyche of patients during the period of preparation for surgical interventions and in the postoperative period;
3) features of the psyche of patients suffering from various diseases (cardiovascular, infectious, oncological, gynecological, skin, etc.);
4) the psyche of patients with defects in the organs of hearing, vision, etc.;
5) features of the psyche of patients during labor, military and forensic examinations;
6) the psyche of patients with alcoholism and drug addiction;
7) private psychotherapy.
B. D. Karvasarsky, as a subject of clinical psychology, singled out the features of the mental activity of the patient in their significance for the pathogenetic and differential diagnosis of the disease, the optimization of its treatment, as well as the prevention and promotion of health.
What is the object of clinical psychology? B.D. Karvasarsky believes that the object of clinical psychology is a person with difficulties in adaptation and self-realization, which are associated with his physical, social and spiritual state.
3. Goals and structure of clinical psychology. Main sections and areas of their research
Clinical psychology as an independent science faces certain goals. In the 60s-70s. 20th century the specific goals of clinical psychology were formulated as follows (M. S. Lebedinsky, V. N. Myasishchev, 1966; M. M. Kabanov, B. D. Karvasarsky, 1978):
1) the study of mental factors affecting the development of diseases, their prevention and treatment;
2) study of the influence of certain diseases on the psyche;
3) the study of mental manifestations of various diseases in their dynamics;
4) the study of developmental disorders of the psyche; study of the nature of the relationship of a sick person with medical personnel and the surrounding microenvironment;
5) development of principles and methods of psychological research in the clinic;
6) creation and study of psychological methods of influencing the human psyche for therapeutic and prophylactic purposes.
Such a formulation of the goals of clinical psychology corresponded to the growing tendency to use the ideas and methods of this science to improve the quality of the diagnostic and therapeutic process in various fields of medicine, with all the difficulties that are inevitable at this stage, due to the unequal degree of development of one or another of its sections.
It is possible to single out specific sections of medical psychology that find practical application of knowledge in the relevant clinics: in a psychiatric clinic - pathopsychology; in neurological - neuropsychology; in the somatic - psychosomatics.
According to B. V. Zeigarnik, pathopsychology studies disorders of mental activity, patterns of disintegration of the psyche in comparison with the norm. She notes that pathopsychology operates with the concepts of general and clinical psychology and uses psychological methods. Pathopsychology works both on the problems of general clinical psychology (when changes in the personality of mental patients and the patterns of mental decay are studied), and private (when mental disorders of a particular patient are studied to clarify the diagnosis, conduct a labor, judicial or military examination).
The object of study of neuropsychology are diseases of the central nervous system (central nervous system), mainly local-focal lesions of the brain.
Psychosomatics studies how changes in the psyche affect the occurrence of somatic diseases.
Pathopsychology should be distinguished from psychopathology (which will be discussed later). Now it is only worth noting that pathopsychology is a part of psychiatry and studies the symptoms of a mental illness by clinical methods, using medical concepts: diagnosis, etiology, pathogenesis, symptom, syndrome, etc. The main method of psychopathology is clinical and descriptive.
4. The relationship of clinical psychology with other sciences
The basic sciences for clinical psychology are general psychology and psychiatry. The development of clinical psychology is also greatly influenced by neurology and neurosurgery.
Psychiatry is a medical science, but it is closely related to clinical psychology. These sciences have a common subject of scientific research - mental disorders. But besides this, clinical psychology deals with such disorders, which in their significance are not equivalent to diseases (for example, problems of matrimony), as well as mental aspects of somatic disorders. However, psychiatry, as a private field of medicine, takes more into account the somatic plane of mental disorders. Clinical psychology focuses on psychological aspects.
Clinical psychology is related to psychopharmacology: both study psychopathological disorders and their treatment. In addition, the use of drugs always has a positive or negative psychological effect on the patient.
Medical pedagogy is successfully developing - an area adjacent to medicine, psychology and pedagogy, whose tasks include the education, upbringing and treatment of sick children.
Psychotherapy as an independent medical specialty is closely related to clinical psychology. Theoretical and practical problems of psychotherapy are developed based on the achievements of medical psychology.
In the West, psychotherapy is considered to be a special area of clinical psychology, and thus emphasizes the special affinity between psychology and psychotherapy.
However, the position on the special proximity of psychotherapy and clinical psychology is often disputed. Many scientists believe that from a scientific point of view, psychotherapy is closer to medicine. This gives the following arguments:
1) the treatment of patients is the task of medicine;
2) psychotherapy is the treatment of patients. It follows that psychotherapy is the task of medicine. This provision is based on the fact that in many countries only physicians are eligible to practice it.
Clinical psychology is also close to a number of other psychological and pedagogical sciences - experimental psychology, occupational therapy, oligophrenic pedagogy, typhlopsychology, deaf psychology, etc.
Thus, it is obvious that in the process of work, a clinical psychologist needs to apply an integrated approach.
5. Origin and development of clinical psychology
The formation of clinical psychology as one of the main applied branches of psychological science is associated with the development of both psychology itself and medicine, biology, physiology, and anthropology.
The origin of clinical psychology dates back to ancient times, when psychological knowledge was born in the depths of philosophy and natural science.
The emergence of the first scientific ideas about the psyche, the separation of the science of the soul, the formation of empirical knowledge about mental processes and their disorders is associated with the development of ancient philosophy and the achievements of ancient doctors. So, Alkemon of Croton (VI century BC) for the first time in history put forward a position on the localization of thoughts in the brain. Hippocrates also attached great importance to the study of the brain as an organ of the psyche. He developed the doctrine of temperament and the first classification of human types. The Alexandrian physicians Herophilus and Erasistratus described the brain in detail; they drew attention to the cortex with its convolutions, which distinguished man in mental abilities from animals.
The next stage in the development of clinical psychology was the Middle Ages. It was a rather long period, riddled with unbridled mysticism and religious dogmatism, persecution of natural scientists and the fires of the Inquisition. Initially, education was built on the basis of ancient philosophy and the natural science achievements of Hippocrates, Galen, Aristotle. Then knowledge declines, alchemy flourishes, and until the 13th century. the dark years continue. Psychology in the Middle Ages is based on philosophy
Thomas Aquinas. The development of ideas about the psyche at this stage slowed down sharply. An important role in the development of domestic clinical psychology was played by A. F. Lazursky, the organizer of his own psychological school.
Thanks to A.F. Lazursky, the natural experiment was introduced into clinical practice, although he had originally developed it for educational psychology.
Most developed in the 60s. 20th century were the following sections of clinical psychology:
1) pathopsychology, which arose at the intersection of psychology, psychopathology and psychiatry (B. V. Zeigarnik, Yu. F. Polyakov, etc.);
2) neuropsychology, formed on the border of psychology, neurology and neurosurgery (A. R. Luriya, E. D. Khomskaya and others).
There is an independent area of psychological knowledge, which has its own subject, its own research methods, its own theoretical and practical tasks - clinical psychology.
Currently, clinical psychology is one of the most popular applied branches of psychology and has great prospects for development both abroad and in Russia.
6. Practical tasks and functions of a clinical psychologist
A clinical psychologist in healthcare institutions is a specialist whose duties include both participation in psychodiagnostic and psychocorrective activities, and in the treatment process as a whole. Medical assistance is provided by a team of specialists. This "brigade" model of medical care originally arose in the psychotherapeutic and psychiatric services. The center of the team is the attending physician, who works in conjunction with a psychotherapist, clinical psychologist and social work specialist. Each of them carries out their own diagnostic, treatment and rehabilitation plan under the guidance of the attending physician and in close cooperation with other specialists. But such a "brigade" model in health care is not yet widespread enough, and the speed of its spread depends on the availability of psychological personnel. But so far, unfortunately, the domestic healthcare system is ready for this moon.
The activities of a psychologist in a medical institution are aimed at:
1) increasing the mental resources and adaptive capabilities of a person;
2) harmonization of mental development;
3) health protection;
4) prevention and psychological rehabilitation. The subject of the activity of a clinical psychologist
Therefore, it is important to emphasize that a clinical psychologist is a specialist who can work not only in clinics, but also in institutions of a different profile: education, social protection, etc. These are institutions that require an in-depth study of a person’s personality and the provision of psychological assistance to him.
In the above areas, the clinical psychologist performs the following activities:
1) diagnostic;
2) expert;
3) correctional;
4) preventive;
5) rehabilitation;
6) advisory;
7) research, etc.
7. Features and objectives of pathopsychological research
The main areas of work of the pathopsychologist are as follows.
1. Solving problems of differential diagnostics.
Most often, such tasks arise when it is necessary to distinguish the initial manifestations of sluggish forms of schizophrenia from neurosis, psychopathy, and organic diseases of the brain. Also, the need for a pathopsychological study may arise when recognizing erased or “masked” depressions, dissimulating delusional experiences and some forms of pathology of late age.
2. Assessment of the structure and degree of neuropsychiatric disorders.
With the help of a pathopsychological study, a psychologist can determine the severity and nature of violations of individual mental processes, the possibility of compensating for these violations, taking into account the psychological characteristics of a particular activity.
3. Diagnostics of mental development and the choice of ways of training and retraining.
In children's institutions, the pathopsychologist plays an important role in solving diagnostic problems. An important task here is to determine the anomalies of mental development, to identify the degree and structure of various forms of mental development disorders. Pathopsychological research contributes to a better understanding of the nature of mental development anomalies, and also serves as the basis for the development of psycho-corrective programs for further work with the child.
4. Study of the personality and social environment of the patient.
In this case, the psychological experiment is based on the principle of modeling a certain objective activity. At the same time, the features of the psyche of patients, mental processes and personality traits that play an important role in social and professional adaptation are revealed. The pathopsychologist must determine which functions are affected and which are preserved, and determine the ways of compensation in various activities.
5. Assessment of the dynamics of mental disorders. Psychological methods are effective
to identify changes in the system of relations and in the social position of the patient in connection with the ongoing psycho-correctional work. It is important to note that when assessing the dynamics of the patient's condition, a repeated psychological examination is always carried out.
6. Expert work.
Pathopsychological research is an important element of medical-labor, military-medical, medical-pedagogical and forensic-psychiatric examinations. In addition, in judicial practice, psychological examination can act as independent evidence. The objectives of the study are determined by the type of examination, as well as the questions that the psychologist must answer during the experiment.
8. Methods of pathopsychological research
The methods used for pathopsychological research can be divided into standardized and non-standardized.
Non-standardized methods are aimed at determining specific disorders of mental activity and are compiled individually for each patient.
Non-standardized methods of pathopsychological research include:
1) the method of "formation of artificial concepts" by L. S. Vygotsky, which is used to identify the features of conceptual thinking in various mental illnesses, primarily in schizophrenia and some organic brain lesions;
2) the method of "classification of objects" by Goldstein, which is used to analyze various violations of the processes of abstraction and generalization;
3) methods "classification", "subject pictures", "exclusion of objects", "exclusion of concepts", "interpretation of proverbs" and other methods of studying thinking;
4) Anfimov-Bourdon's "correction tests" method and Schulte-Gorbov's "black-and-red digital tables" method (to study attention and memory), as well as the methods of typing syllables and words, the Kraepelin and Ebbinghaus methods are used to study short-term memory;
5) the method of "unfinished sentences";
6) the method of "paired profiles";
7) thematic apperception test (TAT) and other methods for the study of personality.
The main principle when using non-standardized research methods is the principle of modeling certain situations in which certain types of mental activity of the patient are manifested. The conclusion of the pathopsychologist is based on an assessment of the end result of the patient's activity, as well as on an analysis of the characteristics of the process of performing tasks, which allows not only to identify violations, but also to compare the disturbed and intact aspects of mental activity.
Standardized methods are widely used in diagnostic work. In this case, specially selected tasks are presented in the same form to each subject. Thus, it becomes possible to compare the methods and levels of task performance by the subjects and other persons.
Almost all non-standardized methods can be standardized. It should be noted that for a qualitative analysis of the characteristics of mental activity, most of the subtests included in the standardized methods can be used in a non-standardized version.
B. V. Zeigarnik believes that the pathopsychological experiment is aimed at:
1) to study the real activity of a person;
2) a qualitative analysis of various forms of the disintegration of the psyche;
3) to reveal the mechanisms of disturbed activity and the possibility of its restoration.
9. The procedure for conducting a pathopsychological study
Pathopsychological research includes the following stages.
1. Studying the medical history, talking with a doctor and setting the task of a pathopsychological study.
The attending physician must inform the pathopsychologist of the main clinical data about the patient and set the tasks of pathopsychological research for the psychologist. The psychologist specifies for himself the task of the study, selects the necessary methods and establishes the order of their presentation to the patient. The doctor must explain to the patient the goals of the pathopsychological study and thereby contribute to the development of positive motivation in him.
2. Carrying out a pathopsychological study.
First of all, the psychologist needs to establish contact with the patient. The reliability of the results obtained in the course of the pathopsychological study largely depends on the success of establishing psychological contact between the pathopsychologist and the subject. Before proceeding with the experiment, it is necessary to make sure that contact with patients is established and the patient understands the purpose of the study. The instruction should be formulated clearly and accessible to the patient.
M. M. Kostereva identifies several types of patient's relationship to pathopsychological research:
1) active (patients join the experiment with interest, adequately respond to both success and failure, are interested in the results of the study);
2) wary (at first, patients treat the study with suspicion, irony, or even fear it, but during the experiment, uncertainty disappears, the patient begins to show accuracy and diligence; with this type of attitude, a “delayed form of response” should be noted, when discrepancies between subjective experiences are observed the subject and the external expressive component of behavior);
3) formally responsible (patients fulfill the requirements of a psychologist without personal interest, are not interested in the results of the study);
4) passive (the patient needs additional motivation; there is no installation for the examination or is extremely unstable);
5) negative or inadequate (patients refuse to participate in the study, perform tasks inconsistently, do not follow instructions).
In drawing conclusions, the pathopsychologist must take into account all factors, including the education of the patient, his attitude to the study, as well as his condition during the study.
3. Description of the results, drawing up a conclusion based on the results of the study - the limits of the psychologist's competence.
But on the basis of the results of the study, a conclusion is drawn up, in which the conclusions are consistently stated.
10. Violation of mediation and hierarchy of motives
One of the types of personality development disorders are changes in the motivational sphere. A. N. Leontiev argued that the analysis of activity should be carried out through the analysis of changes in motives. Psychological analysis of changes in motives is one of the ways to study the personality of a sick person, including the characteristics of his activity. In addition, as B. V. Zeigarnik notes, “in some cases, pathological material makes it possible not only to analyze changes in motives and needs, but also to trace the process of formation of these changes.”
The main characteristics of motives include:
1) indirect nature of motives;
2) hierarchical construction of motives.
In children, the hierarchical construction of motives and their mediation begins to emerge even before school. Then, throughout life, the complication of motives occurs. Some motives are subordinate to others: any one general motive (for example, to master a certain profession) includes a number of private motives (to acquire the necessary knowledge, acquire certain skills, etc.). Thus, human activity is always motivated by several motives and responds not to one, but to several needs. But in a specific activity, one can always single out one leading motive, which gives a certain meaning to all human behavior. Additional motives are necessary because they directly stimulate human behavior. The content of any activity loses its personal meaning if there are no leading motives that make it possible to mediate motives in their hierarchical structure.
B. S. Bratus points out that changes occur primarily in the motivational sphere (as an example, the narrowing of the circle of interests). In the course of a pathopsychological study, gross changes in cognitive processes are not detected, but when performing certain tasks (especially those that require prolonged concentration of attention, quick orientation in new material), the patient does not always notice the mistakes he has made (non-criticality), does not respond to the comments of the experimenter and no further guidance from them. The patient also has high self-esteem.
So, we see how, under the influence of alcoholism in this patient, the former hierarchy of motives is destroyed. Sometimes he has some desires (for example, to get a job), and the patient performs some actions, guided by the previous hierarchy of motives. However, these incentives are not sustainable. The main (sense-forming) motive that controls the activity of the patient, as a result, is the satisfaction of the need for alcohol.
So, based on the analysis of changes in mediation and the hierarchy of motives, we can draw the following conclusions:
1) these changes are not derived directly from brain disorders;
2) they go through a complex and long way of formation;
3) in the formation of changes, mechanisms similar to the mechanisms of the normal development of motives operate.
11. Violation of the meaning-forming and incentive functions of the motive
Now consider the pathology of the meaning-forming and motivating functions of motives.
Only by merging these two functions of motive can we speak of consciously regulated activity. Due to the weakening and distortion of these functions, a serious disruption of activity occurs.
These violations were considered by M. M. Kochenov on the example of patients with schizophrenia. They conducted a study, which consisted of a barely blowing one: the subject must complete, of his own choice, three tasks out of nine offered to him by the experimenter, spending no more than 7 minutes on this. The tasks were:
1) draw a hundred crosses;
2) perform twelve lines of the proof test (according to Bourdon);
3) complete eight lines of the account (according to Kraepelin);
4) fold one of the ornaments of the Kos technique;
5) build a “well” from matches;
6) make a chain out of paper clips;
7) Solve three different puzzles.
Thus, the patient had to choose those actions that are most appropriate to achieve the main goal (perform a certain number of tasks in a certain time).
Conducting this study on healthy subjects, M. M. Kochenov came to the conclusion that in order to achieve the goal, an indicative stage (active orientation in the material) is necessary, which was present in all representatives of this group of subjects.
All subjects were guided by the degree of difficulty of the tasks and chose those that would take less time to complete, as they tried to meet the seven minutes allotted to them.
Thus, in healthy subjects in this situation, individual actions are structured into purposeful behavior.
When conducting an experiment among patients with schizophrenia, other results were obtained:
1) patients did not have an indicative stage;
2) they did not choose easy tasks and often took on those tasks that are clearly impossible to complete in the allotted time;
3) sometimes patients performed tasks with great interest and with special care, not noticing that the time had already expired.
Note that all patients also knew that they had to meet the allotted time, but this did not become a regulator of their behavior. During the experiment, they were able to spontaneously repeat “I have to do it in 7 minutes” without changing the way they completed the task.
So, the studies of M. M. Kochenov showed that the disruption in the activity of patients with schizophrenia was due to a change in the motivation of the sphere. Their motive turned into just “knowledge” and thus lost its functions – meaning-forming and motivating.
It was the shift in the meaning-forming function of motives that caused the disturbance in the activity of patients, changes in their behavior and degradation of the personality.
12. Violation of controllability and criticality of behavior
Failure to control behavior is one of the images of personality disorders. It is expressed in the patient's incorrect assessment of his actions, in the absence of criticality to his painful experiences. Investigating violations of criticism in mental patients, I. I. Kozhukhovskaya showed that uncriticality in any form indicates a violation of activity in general. Criticality, according to Kozhukhovskaya, is "the pinnacle of a person's personal qualities."
As an example of such a violation, consider extracts from the medical history given by B. V. Zeigarnik:
sick M.
Year of birth - 1890.
Diagnosis: progressive paralysis.
Disease history. In childhood, he developed normally. He graduated from the Faculty of Medicine, worked as a surgeon.
At the age of 47, the first signs of mental illness appeared. During the operation, he made a gross mistake, which led to the death of the patient.
Mental state: correctly oriented, verbose. Knows about his disease, but treats it with great ease. Recalling his surgical error, he says with a smile that "everyone has accidents." At the moment, he considers himself healthy, "like a bull." I am convinced that I can work as a surgeon and chief physician of the hospital.
When performing even simple tasks, the patient makes many gross mistakes.
Without listening to the instructions, he tries to approach the task of classifying objects, like a game of dominoes, and asks: “How do you know who won?” When the instructions are read to him a second time, he performs the task correctly.
Performing the task "establishing a sequence of events", trying to simply explain each picture. But when the experimenter interrupts his reasoning and suggests putting the pictures in the right order, the patient performs the task correctly.
When performing the task “correlation of phrases with proverbs”, the patient correctly explains the sayings “Measure seven times - cut once” and “Not all that glitters is gold”. But he incorrectly refers to them the phrase "Gold is heavier than iron."
Using the pictogram technique, the following results were obtained: the patient forms connections of a rather generalized order (to memorize the phrase “jolly holiday”, he draws a flag, “dark night” - shades a square). The patient is very often distracted from the task.
When checking, it turns out that the patient remembered only 5 words out of 14. When the experimenter told him that this was very little, the patient replied with a smile that next time he would remember more.
Thus, we see that patients do not have a motive for the sake of which they perform this or that activity, perform this or that task.
Their actions are absolutely unmotivated, patients are not aware of their actions, their statements.
The loss of the opportunity to adequately assess one's own behavior and the behavior of others led to the destruction of the activity of these patients and a deep personality disorder.
13. Violation of the operational side of thinking. Methods of its research
Violation of the operational side of thinking occurs in two categories:
1) lowering the level of generalization;
2) distortion of the generalization process.
Generalization refers to the main mental operations.
There are four levels of the generalization process:
2) functional - belonging to a group based on functional characteristics;
3) specific - belonging to a group based on specific characteristics;
4) zero - enumeration of objects or their functions, no attempts to generalize objects.
Before proceeding to consider the types of violations of the operational side of thinking, we list the main methods that are used to diagnose the pathology of mental activity.
1. Method "Classification of objects" The task of the subject is to attribute
objects to a particular group (for example, "people", "animals", "clothing", etc.). Then the subject is asked to expand the groups formed by him (for example, "living" and "non-living"). If at the last stage a person identifies two or three groups, we can say that he has a high level of generalization.
2. Method "Exclusion of the superfluous" The subject is presented with four cards. Three of them depict objects that have something in common; the fourth subject should be excluded.
The selection of too generalized features, the inability to exclude an extra subject indicates a distortion of the generalization process.
3. Method "Formation of analogies" The subject is presented with pairs of words, between which there are certain semantic relationships. The subject's task is to highlight a couple of words by analogy.
4. Methodology "Comparison and definition of concepts"
Stimulus material is a homogeneous and heterogeneous concepts. This technique is used to investigate the distortion of the generalization process.
5. Interpretation of the figurative meaning of proverbs and metaphors
There are two versions of this technique. In the first case, the subject is asked to simply explain the figurative meaning of proverbs and metaphors. The second option is that for each proverb you need to find a phrase that corresponds in meaning.
6. Pictogram technique
The subject's task is to memorize 15 words and phrases. To do this, he needs to draw an easy drawing in order to remember all the phrases or words. Then the character of the executed drawings is analyzed. Attention is drawn to the presence of links between the stimulus word and the picture of the subject.
14. Reducing the level of generalization
With a decrease in the level of generalization in patients, direct ideas about objects and phenomena prevail, i.e., instead of highlighting common features, patients establish specific situational connections between objects and phenomena. They are difficult to abstract from specific details.
B. V. Zeigarnik gives examples of the performance of the “classification of objects” task by patients with a reduced level of generalization: “... one of the described patients refuses to combine a goat with a wolf in one group, “because they are at enmity”; another patient does not combine the cat and the beetle, because "the cat lives in the house, but the beetle flies." Particular signs “lives in the forest”, “flies” determine the judgments of patients more than the general sign “animals”. With a pronounced decrease in the level of generalization, the task of classification is generally inaccessible to patients; for the subjects, the objects turn out to be so different in their specific properties that they cannot be combined. Even a table and a chair cannot be attributed to the same group, since “they sit on the chair, and work and eat on the table ...”.
Let us give examples of responses of patients with a reduced level of generalization in the experiment "exclusion of objects". Patients are presented with pictures “kerosene lamp”, “candle”, “electric light bulb”, “sun” and asked what needs to be removed. The experimenter receives the following responses.
1. “We must remove the candle. She is not needed, there is a light bulb.
2. “You don’t need a candle, it burns out quickly, it is unprofitable, and then you can fall asleep, it can catch fire.”
3. "We don't need a kerosene lamp, now there is electricity everywhere."
4. "If during the day, then you need to remove the sun - and without it it is light." Pictures "scales", "watches", "thermometer", "glasses" are presented:
1) the patient removes the thermometer, explaining that "he is only needed in the hospital";
2) the patient removes the scales, because "they are needed in the store when it is necessary to hang";
3) the patient cannot exclude anything: he says that the watch is needed “for time”, and the thermometer is “to measure the temperature”; he cannot remove his glasses, because “if a person is short-sighted, then he needs them,” and scales “are not always needed, but are also useful in the household.”
So, we see that often patients approach the presented objects from the point of view of their suitability for life. They do not understand the conventions that are hidden in the task assigned to them.
15. Distortion of the generalization process. Violation of the dynamics of thinking
Patients with a distortion of the generalization process, as a rule, are guided by overly generalized signs. In such patients, random associations predominate.
For example: the patient puts shoes and a pencil in the same group because "they leave marks."
Distortion of the generalization process occurs in patients with schizophrenia.
The main difference between the distortion of the generalization process and the decrease in its level was most clearly described by B. V. Zeigarnik. She noted that if for patients with a reduced level of generalization, the compilation of pictograms is difficult due to the fact that they are not able to distract from any specific meanings of the word, then patients with a distortion of the generalization process easily perform this task, since they can form any association unrelated to their task.
For example: a patient draws two circles and two triangles, respectively, to memorize the phrases “merry holiday” and “warm wind”, and a bow to memorize the word “separation”.
Let us consider how a patient with a distortion of the generalization process performs the task “classification of objects” (in schizophrenia):
1) combines a cupboard and a saucepan into one group, since “both objects have a hole”;
2) identifies a group of objects "pig, goat, butterfly" because "they are hairy";
3) the car, the spoon and the cart belong to the same group “according to the principle of movement (the spoon is also moved to the mouth)”;
4) combines a clock and a bicycle into one group, because “clocks measure time, and when they ride a bicycle, space is measured”;
5) he refers the shovel and the beetle to the same group, since “they dig the ground with a shovel, the beetle also digs in the ground”;
6) combines a flower, a shovel and a spoon into one group, because "these are objects that are elongated in length."
Violation of the dynamics of thinking is quite common.
There are several types of violation of the dynamics of thinking.
1. Inconsistency of judgments.
2. Lability of thinking.
3. Inertia of thinking.
The study of the dynamics of thinking is carried out using the methods used to study violations of the operational side of thinking. But with this type of violation, it is necessary first of all to pay attention to:
1) features of switching the subject from one type of activity to another;
2) excessive thoroughness of judgments;
3) a tendency to detail;
4) inability to maintain purposefulness of judgments.
16. Inconsistency of judgments
A characteristic feature of patients with inconsistent judgments is the instability of the way the task is performed. The level of generalization in such patients is usually reduced. They quite successfully perform tasks for generalization and comparison. However, the correct decisions in such patients alternate with a specific situational association of objects into a group and with decisions based on random connections.
Let us consider the actions of patients with inconsistent judgments when performing the task “classification of objects”. Such patients correctly assimilate the instructions, use an adequate method when performing a task, choose pictures according to a generalized sign. However, after some time, patients change the correct path of decision to the path of incorrect random associations. In this case, several features are noted:
1) alternation of generalized (correct) and specific situational combinations;
2) logical connections are replaced by random combinations (for example, patients assign objects to the same group because the cards are next to each other);
3) the formation of groups of the same name (for example, the patient identifies a group of people "a child, a doctor, a cleaner" and a second group of the same name "sailor, skier").
This violation of the dynamics of thinking is characterized by the alternation of adequate and inadequate solutions. Lability does not lead to gross violations of the structure of thinking, but only for some time distorts the correct course of the patients' judgments. It is a violation of the mental performance of patients.
Sometimes the lability of thinking is persistent. Such a constant, persistent lability occurs in patients with TIR in the manic phase.
Often a word evokes a chain of associations in such patients, they begin to give examples from their own lives. For example, explaining the meaning of the proverb “All that glitters is not gold”, a patient in the manic phase of TIR says: “Gold is a beautiful gold watch my brother gave me, it is very good. My brother was very fond of the theater ... ", etc.
In addition, in patients with manifestations of lability of thinking, “responsiveness” is observed: they begin to weave any random stimulus from the external environment into their reasoning. If this happens during the performance of the task, patients are distracted, violate the instructions, lose their focus on actions.
17. Inertia of thinking
The inertia of thinking is characterized by a pronounced difficulty in switching from one type of activity to another. This violation of thinking is the antipode of the lability of mental activity. In this case, patients cannot change the course of their judgments. Such switching difficulties are usually accompanied by a decrease in the level of generalization and distraction. The stiffness of thinking leads to the fact that the subjects cannot cope even with simple tasks that require switching (with tasks for mediation).
Inertia of thinking occurs in patients with:
1) epilepsy (most common);
2) with brain injuries;
3) with mental retardation.
To illustrate the inertia of thinking, let's give an example: “Sick B. (epilepsy). Cupboard. “This is an object in which something is stored ... But dishes and food are also stored in the sideboard, and a dress is stored in the closet, although food is often stored in the closet. If the room is small and the sideboard does not fit in it, or if there is simply no sideboard, then the dishes are stored in the closet. Here we have a closet; on the right - a large empty space, and on the left - 4 shelves; There are utensils and food. This, of course, is uncivilized, often the bread smells of mothballs - this is moth powder. Again, there are bookcases, they are not so deep. Shelves of them already, a lot of shelves. Now the cupboards are built into the walls, but it's still a cupboard.”
The inertia of mental activity is also revealed in the associative experiment. The instructions say that the subject must answer the experimenter with a word of the opposite meaning.
The data obtained showed that the latent period in such patients averages 6.5 s, and in some patients it reaches 20–30 s.
In subjects with inertia of thinking, a large number of delayed responses were noted. In this case, patients respond to the previously presented word, and not to the one that is presented at the moment. Consider examples of such delayed responses:
1) the patient answers the word "silence" to the word "singing", and the next word "wheel" answers the word "silence";
2) having answered the word “faith” to the word “deceit”, the patient answers the next word “voices” with the word “falsehood”.
Delayed responses of patients are a significant deviation from the course of the associative process in the norm. They show that the trace stimulus for such patients has a much greater signal value than the actual one.
18. Violation of the motivational (personal) side of thinking. Diversity of thinking
Thinking is determined by the goal, the task. When a person loses the purposefulness of mental activity, thinking ceases to be the regulator of human actions.
Violations of the motivational component of thinking include:
1) diversity;
2) reasoning.
Diversity of thinking is characterized by the absence of logical connections between different thoughts. Judgments of patients about this or that phenomenon proceed, as it were, in different planes. They can accurately understand the instructions, generalize the proposed objects based on the essential properties of the objects. However, they cannot complete tasks in the right direction.
Performing the task "classification of objects", patients can combine objects either on the basis of the properties of the objects themselves, or on the basis of their own attitudes and tastes.
Let's look at a few examples of diversity of thinking.
1. The patient singles out the group of objects “wardrobe, table, bookcase, cleaning lady, shovel”, as this is “a group of those who sweep the bad out of life”, and adds that “the shovel is the emblem of labor, and labor is incompatible with cheating”.
2. The patient identifies a group of objects “elephant, skier”, as these are “objects for spectacles. People tend to desire bread and circuses, the ancient Romans knew about this.
3. The patient selects a group of objects "a flower, a bed, a saucepan, a cleaner, a saw, a cherry", because these are "objects painted in red and blue."
Let us give examples of the performance of the task "exclusion of objects" by one of the patients with a diversity of thinking:
1) pictures “kerosene lamp”, “sun”, “electric light bulb”, “candle” are presented; the patient excludes the sun, since "this is a natural luminary, the rest is artificial lighting";
2) pictures “scales”, “watches”, “thermometer”, “glasses” are presented; the patient decides to remove the glasses: “I will separate the glasses, I don’t like glasses, I love pince-nez, why don’t they wear them. Chekhov did wear it”;
3) pictures “drum”, “revolver”, “military cap”, “umbrella” are presented; the patient removes the umbrella: "An umbrella is not needed, now they wear raincoats."
As we can see, the patient can make a generalization: she excludes the sun, since it is a natural luminary. But then she allocates glasses based on personal taste (because "she doesn't like them", not because they are not a measuring device). On the same basis, she allocates an umbrella.
19. Reasoning. Classification of thinking disorders in form and content
Reasoning is a tendency to unproductive verbose reasoning, a tendency to the so-called "fruitless sophistication". The judgments of such patients are due not so much to a violation of intellectual activity as to increased affectivity. They strive to bring any phenomenon (even absolutely insignificant) under some concept.
Affectivity is manifested in the very form of the statement (the patient speaks loudly, with inappropriate pathos). Sometimes one intonation of the patient indicates that the statement is “resonant”.
In addition to the considered classification of thought disorders, there is another classification according to which thought disorders are divided into two groups:
1) in form;
Violations of thinking in form, in turn, are divided into:
1) tempo violations:
a) acceleration (a jump of ideas, which is usually observed in the manic phase with MDP; mentism, or mantism, is an influx of thoughts that occurs against the will of the patient with schizophrenia, with MDP);
b) slowing down - lethargy and poverty of associations, which usually occurs during the depressive phase in MDP;
2) violations of harmony:
a) fragmentation - a violation of the logical connections between the members of the sentence (while the grammatical component is preserved);
b) incoherence is a violation in the field of speech, its semantic and syntactic components; c) verbigeration - a stereotypical repetition in speech of individual words and phrases similar in consonance;
3) violations of purposefulness:
a) reasoning;
b) pathological thoroughness of thinking;
c) perseveration.
Content disorders are divided into:
1) obsessive states - various involuntary thoughts that a person cannot get rid of, while maintaining a critical attitude towards them;
2) overvalued ideas - emotionally rich and plausible beliefs and ideas;
3) crazy ideas - false judgments and conclusions:
a) paranoid delusions - systematized and plausible delusions that occur without disturbances of sensations and perception;
b) paranoid delusions - delusions that usually do not have a sufficiently coherent system, flowing most often with impaired sensations and perception;
c) paraphrenic delirium - a systematized delirium with disturbances in the associative process, occurring against the background of elevated mood.
20. Methods that are used to study memory
The following methods are used to study memory.
1. Ten words
The subject is read ten simple words, after which he must repeat them in any order 5 times. The experimenter enters the results in the table. After 20–30 minutes, the subject is again asked to reproduce these words. The results are also entered into a table.
Example: water, forest, table, mountain, clock, cat, mushroom, book, brother, window.
2. Pictogram method
The subject is presented with 15 words to memorize. To facilitate this task, he should make sketches with a pencil. No writing or lettering is allowed. The subject is asked to repeat the words after the end of the work, and then again after 20-30 minutes. When analyzing the features of memorization, attention is paid to how many words are reproduced accurately, close in meaning, incorrectly, and how many are not reproduced at all. A modification of this method can be the test of A. N. Leontiev. This method involves not drawing, but choosing an object from the proposed ready-made pictures. The technique has several series, different in degree of complexity. The test of A. N. Leontiev can be used to study memory in children, as well as in persons with a low level of intelligence.
3. Reproduction of stories The subject is read a story (sometimes a story is given for independent reading). Then he must reproduce the story orally or in writing. When analyzing the results, the experimenter must take into account whether all the semantic links are reproduced by the subject, whether he has confabulations (filling gaps in memory with non-existent events).
Examples of stories for memorization: "Jackdaw and Doves", "Eternal King", "Logic", "Ant and Dove", etc.
4. Study of visual memory (A. L. Benton test).
For this test, five series of drawings are used. At the same time, in three series, 10 cards of the same complexity are offered, in two - 15 cards each. The subject is shown a card for 10 seconds, and then he must reproduce the seen figures on paper. The analysis of the obtained data is carried out using special Benton tables. This test allows you to obtain additional data on the presence of organic diseases of the brain.
When conducting a pathopsychological experiment aimed at studying memory disorders, features of direct and indirect memory are usually revealed.
21. Violations of immediate memory
Immediate memory is the ability to recall information immediately after the action of a particular stimulus.
Some of the most common types of memory impairments are:
1) Korsakov's syndrome;
2) progressive amnesia.
Korsakov's syndrome is a violation of memory for current events with a relative preservation of memory for past events. This syndrome was described by the Russian psychiatrist S. S. Korsakov.
Korsakov's syndrome can manifest itself in insufficiently accurate reproduction of what is seen or heard, as well as in inaccurate orientation. Often patients themselves notice defects in their memory and try to fill in the gaps with fictitious versions of events. Real events are sometimes clearly reflected in the mind of the patient, sometimes they are intricately intertwined with events that never existed. The inability to remember current events leads to the impossibility of organizing the future.
With progressive amnesia, memory impairment extends to both current events and past events. Patients confuse the past with the present, distort the sequence of events. With progressive amnesia, the following symptoms are noted:
1. Interfering effect - the imposition of past events on the events of the present, and vice versa.
2. Disorientation in space and time. Example: the patient seems to be living at the beginning of the 20th century; she thinks that the October Revolution has recently begun.
Such memory impairments are often noted in mental illness of late age. First, patients have a reduced ability to remember current events, then the events of recent years are erased from memory. At the same time, the events from the distant past preserved in the memory acquire special relevance in the mind of the patient. The patient does not live in the present, but in fragments of situations and actions that took place in the distant past.
To illustrate such memory impairments, we give examples taken from the results of an experimental study of one of the patients:
1) explaining the meaning of the proverb “Don’t get into your sleigh,” he says: “Don’t be so impudent, impolite, a bully. Don't go where you don't have to";
2) explains the meaning of the proverb “Strike while the iron is hot” as follows: “Work, be hardworking, cultured, polite. Do it fast, good. Love a person. Do everything for him."
Thus, understanding the figurative meaning of the proverb, the patient cannot remember it and is distracted. The patient's judgments are characterized by instability, correct judgments alternate with incorrect ones.
22. Violation of mediated memory
Indirect is memorization using an intermediate (mediating) link in order to improve reproduction.
Violation of mediated memory in various groups of patients was investigated by S. V. Loginova and G. V. Birenbaum. In the works of A. N. Leontiev it is shown that the introduction of the factor of mediation improves the reproduction of words. But despite the fact that normally the mediating factor improves memorization, it turned out that in some patients the introduction of a mediating link often does not improve, but even worsens the possibility of reproduction.
Patients with impaired mediated memory remember words worse when they try to use a mediating link. Mediation does not help those patients who are trying to establish too formal connections (for example, for the word "doubt" the patient drew a catfish fish, because the first syllable coincided, and for the word "friendship" - two triangles).
When analyzing memory disorders, one should take into account the personality-motivational component.
To study the violation of the motivational component of mnestic activity, experimental studies were carried out. The subject was presented with about twenty tasks that he had to complete. This new motive acted as a sense-forming and motivating motive (the subject set himself a specific goal - to reproduce as many actions as possible).
The fact that mnestic activity is motivated can also be seen in the example of pathology.
The same experiments were carried out in patients with various forms of disturbances in the motivational sphere. It turned out that:
1) in patients with schizophrenia, there was no effect of better reproduction of incomplete tasks compared to completed ones;
2) patients with rigidity of emotional attitudes (for example, in epilepsy) reproduced incomplete actions much more often than completed ones.
Summing up, let's compare the results obtained in the study of healthy subjects and subjects with various mental illnesses.
1. In healthy subjects, VL/VZ = 1.9.
2. In patients with schizophrenia (simple form) VL/VZ = 1.1.
3. In patients with epilepsy VL/VZ = 1.8.
4. In patients with asthenic syndrome VL/VZ = 1.2.
Thus, a comparison of the results of reproducing unfinished actions in patients with various disorders of the motivational sphere indicates the important role of the motivational component in mnestic activity.
23. Methods used to study attention
There are the following methods that are used in the study of attention.
1. Correction test. It is used to study the stability of attention, the ability to concentrate. Forms are used with the image of rows of letters that are arranged randomly. The subject must cross out one or two letters of the experimenter's choice. A stopwatch is required for the study. Sometimes, every 30–60 s, the position of the subject's pencil is noted. The experimenter pays attention to the number of mistakes made, the pace at which the patient completes the task, as well as the distribution of errors during the experiment and their nature (crossing out other letters, omissions of individual letters or lines, etc.).
2. Account according to Kraepelin. This technique was proposed by E. Krepelin in 1895. It is used to study the features of switching attention, the study of performance. The subject is presented with forms with columns of numbers located on them. You need to add or subtract these numbers in your mind, and write down the results on the form.
After completing the task, the experimenter draws a conclusion about working capacity (exhaustion, workability) and notes the presence or absence of attention disorders.
3. Finding numbers on Schulte tables. For research, special tables are used, where numbers are randomly located (from 1 to 25). The subject must use a pointer to show the numbers in order and call them. The experimenter takes into account the time to complete the task. A study using Schulte tables helps to identify the features of switching attention, exhaustion, workability, as well as concentration or distractibility.
4. Modified Schulte table. To study the switching of attention, a modified Shul-te red-black table is often used, which contains 49 numbers (of which 25 are black and 24 are red). The subject in turn must show the numbers: black - in ascending order, red - in descending order. This table is used to study the dynamics of mental activity and the ability to quickly switch attention from one object to another.
5. Countdown. The subject must count from a hundred a certain number (one and the same). At the same time, the experimenter notes pauses. When processing the results, examine:
1) the nature of the errors;
2) following the instructions;
3) switching;
4) concentration;
5) exhaustion of attention.
24. Feelings. Their classification
Sensation is the simplest mental process, consisting in the reflection of individual properties, objects and phenomena of the external world, as well as the internal states of the body with the direct impact of stimuli on the corresponding receptors.
The main properties of sensations are:
1) modality and quality;
2) intensity;
3) time characteristic (duration);
4) spatial characteristics.
Feelings can be both conscious and unconscious.
An important characteristic of sensations is the threshold of sensation - the magnitude of the stimulus that can cause sensation.
Consider some classifications of sensations.
V. M. Wundt proposed to divide sensations into three groups (depending on what characteristics of the external environment are reflected):
1) spatial;
2) temporary;
3) space-time.
A. A. Ukhtomsky suggested dividing all sensations into 2 groups:
1. Higher (those types of sensations that give the most subtle diverse differentiated analysis, for example, visual and auditory).
2. Lower (those types of sensations that are characterized by less differentiated sensitivity, such as pain and tactile).
Currently, the generally accepted and most common classification is Sherrington, who proposed to divide sensations into three groups depending on the location of the receptor and the location of the source of irritation:
1) exteroreceptors - receptors of the external environment (vision, hearing, smell, taste, tactile, temperature, pain sensations);
2) proprioceptors - receptors that reflect the movement and position of the body in space (muscular-articular, or kinesthetic, vibrational, vestibular);
3) interoreceptors - receptors located in the internal organs (they, in turn, are divided into chemoreceptors, thermoreceptors, pain receptors and mechanoreceptors, reflecting changes in pressure in the internal organs and bloodstream).
25. Methods for the study of sensations and perception. Major sensory disturbances
The study of perception is carried out:
1) clinical methods;
2) experimental psychological methods. The clinical method is usually used in the following cases:
1) studies of tactile and pain sensitivity;
2) study of temperature sensitivity;
3) study of disorders of the organs of hearing and vision.
4) study of the thresholds of auditory sensitivity, speech perception.
Experimental psychological methods are usually used to study more complex auditory and visual functions. So, E.F. Bazhin proposed a set of techniques, which includes:
1) methods for studying the simple aspects of the activity of analyzers;
2) methods for the study of more complex complex activities.
The following methods are also used:
1) the method "Classification of objects" - to identify visual agnosia;
2) Poppelreuter tables, which are images superimposed on each other, and which are needed to detect visual agnosia;
3) Raven tables - for the study of visual perception;
4) tables proposed by M. F. Lukyanova (moving squares, wavy background) - for the study of sensory excitability (with organic disorders of the brain);
5) tachistoscopic method (identification of listened to tape recordings with various sounds: the sound of glass, the murmur of water, whisper, whistle, etc.) - for the study of auditory perception.
1. Anesthesia, or loss of sensation, can capture both individual types of sensitivity (partial anesthesia) and all types of sensitivity (total anesthesia).
2. The so-called hysterical anesthesia is quite common - the disappearance of sensitivity in patients with hysterical neurotic disorders (for example, hysterical deafness).
3. Hyperesthesia usually captures all spheres (the most common are visual and acoustic). For example, such patients cannot tolerate the sound of normal volume or not very bright light.
4. With hypoesthesia, the patient, as it were, does not clearly perceive the world around him (for example, with visual hypoesthesia, objects for him are devoid of colors, look shapeless and blurry).
5. With paresthesia, patients experience anxiety and fussiness, as well as increased sensitivity to skin contact with bed linen, clothing, etc.
A kind of paresthesia is senestopathia - the appearance of rather ridiculous unpleasant sensations in various parts of the body (for example, a feeling of "transfusion" inside the organs). Such disorders usually occur in schizophrenia.
26. Definition and types of perception
Now consider the main violations of perception. But first, let's define how perception differs from sensations. Perception is based on sensations, arises from them, but has certain characteristics.
What is common to sensations and perceptions is that they begin to function only with the direct action of irritation on the sense organs.
Perception is not reduced to the sum of individual sensations, but is a qualitatively new level of cognition.
The main principles of perception of objects are the following.
1. The principle of proximity (the closer to each other in the visual field are the elements, the more likely they are combined into a single image).
2. The principle of similarity (similar elements tend to unite).
3. The principle of "natural continuation" (elements that act as parts of familiar figures, contours and forms are more likely to be combined into these figures, contours and forms).
4. The principle of isolation (elements of the visual field tend to create a closed integral image).
The above principles determine the main properties of perception:
1) objectivity - the ability to perceive the world in the form of separate objects with certain properties;
2) integrity - the ability to mentally complete the perceived object to a holistic form, if it is represented by an incomplete set of elements;
3) constancy - the ability to perceive objects as constant in shape, color, consistency and size, regardless of the conditions of perception;
The main types of perception are distinguished depending on the sense organ (as well as sensations):
1) visual;
2) auditory;
3) taste;
4) tactile;
5) olfactory.
One of the most significant types of perception in clinical psychology is a person's perception of time (it can change significantly under the influence of various diseases). Great importance is also attached to violations of the perception of one's own body and its parts.
27. Major Perceptual Disorders
The main cognitive impairments include:
1. Illusions are a distorted perception of a real object. For example, illusions can be auditory, visual, olfactory, etc.
There are three types of illusions according to the nature of their occurrence:
1) physical;
2) physiological;
3) mental.
2. Hallucinations - disturbances of perception that occur without the presence of a real object and are accompanied by confidence that this object really exists at a given time and in a given place.
Visual and auditory hallucinations are usually divided into two groups:
1. Simple. These include:
a) photopsia - perception of bright flashes of light, circles, stars;
b) acoasma - perception of sounds, noise, cod, whistle, crying.
2. Complex. These include, for example, auditory hallucinations, which have the form of articulate phrasal speech and are, as a rule, commanding or threatening.
3. Eidetism - a disorder of perception, in which the trace of a just ended excitation in any analyzer remains in the form of a clear and vivid image.
4. Depersonalization is a distorted perception of both one's own personality as a whole and individual qualities and parts of the body. Based on this, there are two types of depersonalization:
1) partial (impaired perception of individual parts of the body); 2) total (impaired perception of the whole body).
5. Derealization is a distorted perception of the world around. An example of derealization is the symptom of "already seen" (de ja vu).
6. Agnosia is a violation of the recognition of objects, as well as parts of one's own body, but at the same time consciousness and self-consciousness are preserved.
There are the following types of agnosia:
1. Visual agnosia - disorders of recognition of objects and their images while maintaining sufficient visual acuity. Are divided into:
a) subject agnosia;
b) agnosia for colors and fonts;
c) optical-spatial agnosia (patients cannot convey in the drawing the spatial features of the object: further - closer, more - less, higher - lower, etc.).
2. Auditory agnosia - impaired ability to distinguish speech sounds in the absence of hearing impairment;
3. Tactile agnosia - disorders characterized by unrecognition of objects by touching them while maintaining tactile sensitivity.
28. Stress. The crisis
The concept of stress was introduced by the Canadian pathophysiologist and endocrinologist G. Selye. Stress is the body's standard response to any factor that affects it from the outside. It is characterized by affects - expressed emotional experiences.
Stress can be of a different nature:
1) distress is negative;
2) eustress is positive and mobilizing.
G. Selye identified two reactions to the harmful effects of the external environment:
1. Specific - a specific disease with specific symptoms.
2. Nonspecific (manifested in the general adaptation syndrome).
The nonspecific reaction consists of three phases:
1) anxiety reaction (under the influence of a stressful situation, the body changes its characteristics; if the stressor is very strong, stress can occur at this stage as well);
2) resistance reaction (if the action of the stressor is compatible with the body's capabilities, the body resists; anxiety almost disappears, the level of body resistance increases significantly);
3) the reaction of exhaustion (if the stressor acts for a long time, the body's forces are gradually depleted; anxiety reappears, but now irreversible; the stage of distress sets in).
The concept of crises originated and developed in the United States. According to this concept, "the risk of mental disorders reaches its highest point and materializes in a certain crisis situation."
“A crisis is a condition that occurs when a person encounters an obstacle to vital goals, which for some time is insurmountable by the usual methods of problem solving. There is a period of disorganization, disorder, during which many different abortive attempts at resolution are made. Eventually some form of adaptation is achieved which may or may not best serve the interests of the person and those close to him.” 1 .
There are the following types of crises:
1) developmental crises (for example, when a child enters kindergarten, school, marriage, retirement, etc.);
2) random crises (for example, unemployment, natural disaster, etc.);
3) typical crises (for example, the death of a loved one, the appearance of a child in the family, etc.).
29. Frustration. Fear
“Frustration (English frustration -“ frustration, disruption of plans, collapse “) is a specific emotional state that occurs when an obstacle and resistance arises on the way to achieving a goal, which are either really insurmountable or perceived as such.”
Frustration is characterized by the following symptoms:
1) the presence of a motive;
2) the presence of a need;
3) the presence of a goal;
4) the existence of an initial plan of action;
5) the presence of resistance to an obstacle that is frustrating (resistance can be passive and active, external and internal).
In situations of frustration, a person behaves either as an infantile or as a mature person. An infantile personality in the case of frustration is characterized by non-constructive behavior, which expresses itself in aggression or avoiding resolving a difficult situation.
A mature personality, on the contrary, is characterized by constructive behavior, which manifests itself in the fact that a person increases motivation, increases the level of activity to achieve a goal, while maintaining the goal itself.
The most common symptom of emotional disturbance is fear. However, fears can be an adequate mobilizing response to a real threat. Many people are not even aware that they have some kind of fear until they are faced with a corresponding situation.
The following parameters are used to assess the degree of pathological fears.
1. Adequacy (validity) - the correspondence of the intensity of fear to the degree of real danger that comes from a given situation or from people around.
2. Intensity - the degree of disorganization of the activity and well-being of a person seized by a sense of fear.
3. Duration - duration of fear in time.
4. The degree of controllability of the feeling of fear by a person - the ability to overcome one's own feeling of fear.
A phobia is a fear that is experienced frequently, is obsessive, poorly controlled, and to a large extent disrupts the activity and well-being of a person.
The most common types of phobias are:
1) agoraphobia - fear of open spaces;
2) claustrophobia - fear of closed spaces. A fairly common phenomenon are social phobias - obsessive fears that are associated with the fear of condemning a person from others for any actions.
30. Violations of the volitional sphere
The concept of will is inextricably linked with the concept of motivation. Motivation is a process of purposeful organized sustainable activity (the main goal is to satisfy needs).
Motives and needs are expressed in desires and intentions. Interest, which plays the most important role in acquiring new knowledge, can also be a stimulus for human cognitive activity.
Motivation and activity are closely related to motor processes, therefore the volitional sphere is sometimes referred to as motor-volitional.
Volitional disorders include:
1) violation of the structure of the hierarchy of motives - deviation of the formation of the hierarchy of motives from the natural and age characteristics of a person;
2) parabulia - the formation of pathological needs and motives;
3) hyperbulia - a violation of behavior in the form of motor disinhibition (excitation);
4) hypobulia - a violation of behavior in the form of motor inhibition (stupor).
One of the most striking clinical syndromes of the motor-volitional sphere is the catatonic syndrome, which includes the following symptoms:
1) stereotypy - frequent rhythmic repetition of the same movements;
2) impulsive actions - sudden, senseless and ridiculous motor acts without sufficient critical evaluation;
3) negativism - an unreasonable negative attitude towards any external influences in the form of resistance and refusal;
4) echolalia and echopraxia - repetition by the patient of individual words or actions that he hears or sees at the moment; 5) catalepsy (a symptom of "wax flexibility") - the patient freezes in one position and maintains this position for a long time. The following pathological symptoms are special varieties of will disorders:
1) a symptom of autism;
2) a symptom of automatisms.
A symptom of autism is manifested in the fact that patients lose the need to communicate with others. They develop pathological isolation, unsociableness and isolation.
Automatisms are the spontaneous and uncontrolled implementation of a number of functions, regardless of the presence of stimulating impulses from the outside. The following types of automatisms are distinguished.
1. Outpatient (occurs in patients with epilepsy and consists in the fact that the patient performs outwardly ordered and purposeful actions, which he completely forgets about after an epileptic seizure).
2. Somnambulistic (the patient is either in a hypnotic trance, or in a state between sleep and wakefulness).
3. Associative.
4. Senestopathic.
5. Kinesthetic.
The last three varieties of automatisms are observed in the syndrome of mental automatism of Kandinsky-Clerambault.
31. Violations of consciousness and self-consciousness
Before proceeding to the consideration of violations, let's define consciousness.
"Consciousness is the highest form of reflection of reality, a way of relating to objective laws."
To determine the impairment of consciousness, it is important to take into account that the presence of one of the above signs does not indicate clouding of consciousness, so it is necessary to establish the totality of all these signs.
Consciousness disorders are divided into two groups.
1. States of switched off consciousness:
2. States of upset consciousness:
a) delirium;
b) oneiroid;
c) twilight disorder of consciousness. The states of consciousness turned off are characterized by a sharp increase in the threshold for all external stimuli. In patients, movements slow down, they are indifferent to the environment.
Delirium is characterized by a violation of orientation in space and time (there is not just disorientation, but a false orientation) with complete preservation of orientation in one's own personality. This causes scene-like hallucinations, usually of a frightening nature. As a rule, the delirious state occurs in the evening, and intensifies at night.
Oneiroid is characterized by disorientation (or false orientation) in space, in time, and partially in one's own personality. In this case, patients have hallucinations of a fantastic nature.
After leaving the oneiroid state, patients usually cannot remember what really happened in that situation, but only remember the content of their dreams.
The twilight state of consciousness is characterized by disorientation in space, in time and in one's own personality. This state begins suddenly and ends just as suddenly. A characteristic feature of the twilight state of consciousness is the subsequent amnesia - the absence of memories of the period of obscuration. Often in a twilight state of consciousness, patients have hallucinations and delusions.
One of the types of twilight state is “ambulatory automatism” (it proceeds without delirium and hallucinations). Such patients, having left the house for a specific purpose, unexpectedly find themselves at the other end of the city (or even in another city). At the same time, they mechanically cross the streets, ride in transport, etc.
32. Aphasia
Aphasias are called systemic speech disorders that appear with global injuries of the cortex of the left hemisphere (in right-handed people). The term "aphasia" was proposed in 1864 by A. Trousseau.
Consider the classification of speech disorders proposed by A. R. Luria. He identified seven forms of aphasia.
1. Sensory aphasia is characterized by impaired phonemic hearing. At the same time, patients either do not understand speech addressed to them at all, or (in less severe cases) do not understand speech in complicated conditions (for example, too fast speech), they have a sharp difficulty in writing from dictation, repeating the words they hear, and reading (from -for the inability to monitor the correctness of their speech).
2. Acoustic-mnestic aphasia (violation of auditory-verbal memory) is expressed in the fact that the patient understands the addressed speech, but is not able to remember even a small speech material (while phonemic hearing remains preserved). Such a violation of auditory-speech memory leads to a misunderstanding of long phrases and oral speech in general.
3. Optical-mnestic aphasia is expressed in the fact that patients cannot correctly name the object, but try to describe the object and its functional purpose. Patients cannot draw even elementary objects, although their graphic movements remain preserved.
4. Afferent motor aphasia is associated with a violation of the flow of sensations from the articulatory apparatus to the cerebral cortex during speech. Patients have speech disorders.
5. Semantic aphasia is characterized by impaired understanding of prepositions, words and phrases that reflect spatial relationships. In patients with semantic aphasia, there are violations of visual-figurative thinking.
6. Motor efferent aphasia is expressed in the fact that the patient cannot pronounce a single word (only inarticulate sounds) or one word remains in the patient's oral speech, which is used as a substitute for all other words. At the same time, the patient retains the ability to understand the speech addressed to him (to some extent).
7. Dynamic aphasia is manifested in the poverty of speech statements, the absence of independent statements and monosyllabic answers to questions (patients are not able to compose even the simplest phrase, they cannot answer even elementary questions in detail).
Note that of the above types of speech disorders, the first five are interconnected with the loss of auditory, visual, kinesthetic links of speech, which are otherwise called afferent links. The remaining two types of aphasia are associated with the loss of the efferent link.
33. Poverty of the vocabulary of speech
The poverty of the vocabulary is usually observed in oligophrenia, as well as in atherosclerosis of the brain. Let us consider the types of mental pathology that can be considered both as derivatives of speech disorders and as a result of disorders of the gnostic brain apparatus.
1. Dyslexia (alexia) is a reading disorder.
In children, dyslexia manifests itself in the inability to master the skill of reading (with a normal level of intellectual and speech development, in optimal learning conditions, in the absence of hearing and vision impairments).
2. Agraphia (dysgraphia) - a violation of the ability to write correctly in form and meaning.
3. Akalkulia - a violation that is characterized by a violation of counting operations.
Let us dwell on the definition of other speech disorders encountered in clinical practice.
Verbal paraphasia - the use instead of some words of others that are not related to the meaning of the speech statement.
Literal paraphasia is when some sounds are replaced by others that are not present in a given word, or certain syllables and sounds are rearranged in a word.
Verbigeration is the repeated repetition of individual words or syllables.
Bradyphasia is slow speech.
Dysarthria - blurry, as if "stumbling" speech.
Dyslalia (tongue-tied tongue) is a speech disorder characterized by the incorrect pronunciation of individual sounds (for example, skipping sounds or replacing one sound with another).
Stuttering is a violation of the fluency of speech, which manifests itself in the form of a convulsive disorder of speech coordination, the repetition of individual syllables with obvious difficulties in pronouncing them.
Logoclonia is a spasmodic repetition of certain syllables of a spoken word.
Increasing the volume of speech (up to a scream) is a violation that manifests itself in the fact that, as a result of overstrain, the voice of such patients becomes hoarse or completely disappears (noted in patients in a manic state).
Change in the modulation of speech - pomposity, pathos or colorlessness and monotony of speech (loss of speech melody).
Incoherence is a meaningless set of words that are not combined into grammatically correct sentences.
Oligophasia - a significant decrease in the number of words used in speech, impoverishment of the vocabulary.
Schizophasia is a meaningless collection of single words that are combined into grammatically correct sentences.
Symbolic speech - giving words and expressions a special meaning (instead of the generally accepted one), understandable only to the patient himself.
Cryptolalia is the creation of one's own language or a special cipher called cryptography.
34. Violations of arbitrary movements and actions
There are two types of violations of voluntary movements and actions:
1. Violations of voluntary movements and actions that are associated with a violation of efferent (executive) mechanisms.
2. Violations of voluntary movements and actions that are associated with a violation of the afferent mechanisms of motor acts (more complex violations).
Efferent disorders.
1. Paresis - weakening of muscle movements (a person after a brain injury cannot actively act with the opposite limb; while the movements of other parts of the body can remain preserved).
2. Hemiplegia - paralysis (a person completely loses the ability to move; motor function can be restored during treatment).
There are two types of hemiplegia:
1) dynamic hemiplegia (there are no voluntary movements, but there are violent ones);
2) static hemiplegia (no voluntary movements and amimia).
afferent disturbances.
1. Apraxia are disturbances that are characterized by the fact that an action that needs afferent reinforcement and organization of a motor act is not performed, although the efferent sphere remains preserved.
2. Catatonic disorders.
In catatonic disorders, there is an objectless chaotic motor activity of the patient (up to causing injury to himself and others). Currently, this condition is removed pharmacologically. Catatonic disorders are expressed in aimless throwing of the patient.
One form of catatonic disorder is stupor (freezing). There are the following forms of stupor:
1) negativistic (resistance to movements);
2) with numbness (the patient cannot be moved).
3. Violent actions.
This disorder of voluntary movements and actions is manifested in the fact that patients, in addition to their own desire, perform various motor acts (for example, crying, laughing, swearing, etc.).
35. Impaired intelligence
Intelligence is the system of all cognitive abilities of an individual (in particular, the ability to learn and solve problems that determine the success of any activity).
For quantitative analysis of intelligence, the concept of IQ is used - the coefficient of mental development.
There are three types of intelligence:
1) verbal intelligence (vocabulary, erudition, ability to understand what is read);
2) the ability to solve problems;
3) practical intelligence (the ability to adapt to the environment).
The structure of practical intelligence includes:
1. Processes of adequate perception and understanding of ongoing events.
3. The ability to act rationally in a new environment.
The intellectual sphere includes some cognitive processes, but the intellect is not only the sum of these cognitive processes. The prerequisites for intelligence are attention and memory, but the understanding of the essence of intellectual activity is not exhausted by them.
There are three forms of organization of the intellect, which reflect different ways of cognition of objective reality, in particular in the sphere of interpersonal contacts.
1. Common sense is a process of adequate reflection of reality, based on the analysis of the essential motives of the behavior of people around and using a rational way of thinking.
2. Reason is a process of cognition of reality and a way of activity based on the use of formalized knowledge, interpretations of the motives of the activity of communication participants.
3. Reason is the highest form of organization of intellectual activity, in which the thought process contributes to the formation of theoretical knowledge and the creative transformation of reality.
Intellectual cognition can use the following methods:
1) rational (requires the application of formal logic laws, hypotheses and their confirmation);
2) irrational (relies on unconscious factors, does not have a strictly defined sequence, does not require the use of logical laws to prove the truth).
The following concepts are closely related to the concept of intelligence:
1) anticipatory abilities - the ability to anticipate the course of events and plan their activities in such a way as to avoid undesirable consequences and experiences;
2) reflection - the creation of ideas about the true attitude towards the subject on the part of others.
36. The problem of brain localization of mental functions
The problem of localization of mental functions is one of the main researched problems of neuropsychology. Initially, this problem was literally: how various mental processes and morphological zones of the brain are interconnected. But clear matches were not found. There are two points of view on this issue:
1) localizationism;
2) anti-localizationism. Localizationism binds every mental
process with the work of a certain part of the brain. Narrow localizationism considers mental functions as indecomposable into component parts and realized through the work of narrowly localized areas of the cerebral cortex.
The following facts speak against the concept of narrow localizationism:
1) with the defeat of different areas of the brain, a violation of the same mental function occurs;
2) the result of damage to a certain area of the brain may be a violation of several different mental functions;
3) impaired mental functions can be restored after damage without morphological restoration of the injured area of the brain.
According to the concept of anti-localizationism:
1) the brain is a single whole, and its work contributes to the development of the functioning of all mental processes equally;
2) with damage to any part of the brain, a general decrease in mental functions is observed (in this case, the degree of decrease depends on the volume of the affected brain).
According to the concept of equipotentiality of brain regions, all brain regions are equally involved in the implementation of mental functions. Thus, in all cases it is possible to restore the mental process, if only the quantitative characteristics of the damage do not exceed some critical values. However, not always and not all functions can be restored (even if the amount of damage is small).
At present, the main direction in solving this problem is determined by the concept of systemic dynamic localization of mental processes and functions, which was developed by L. S. Vygotsky and A. R. Luria. According to this theory:
1) human mental functions are systemic formations that are formed throughout life, are arbitrary and mediated by speech;
2) the physiological basis of mental functions are functional systems that are interconnected with specific brain structures and consist of afferent and efferent interchangeable links.
37. Functional blocks of the brain
A. R. Luria developed a general structural and functional model of the brain, according to which the entire brain can be divided into three main blocks. Each block has its own structure and plays a specific role in mental functioning.
1st block - a block of regulation of the level of general and selective activation of the brain, an energy block, which includes:
1) reticular formation of the brain stem;
2) diencephalic departments;
3) nonspecific midbrain structures;
4) limbic system;
5) mediobasal sections of the cortex of the frontal and temporal lobes.
2nd block - a block for receiving, processing and storing exteroceptive information, includes the central parts of the main analyzer systems, the cortical zones of which are located in the occipital, parietal and temporal lobes of the brain.
The work of the second block is subject to three laws.
1. The law of hierarchical structure (primary zones are phylo- and ontogenetically earlier, from which two principles follow: the “bottom-up” principle - the underdevelopment of primary fields in a child leads to the loss of later functions; the “top-down” principle - in an adult with a completely the existing psychological system, the tertiary zones control the work of the secondary ones subordinate to them and, if the latter are damaged, they have a compensating effect on their work).
2. The law of decreasing specificity (primary zones are the most modally specific, and tertiary zones are generally supramodal).
3. The law of progressive lateralization (as you ascend from the primary to the tertiary zones, the differentiation of the functions of the left and right hemispheres increases).
3rd block - a block of programming, regulation and control over the course of mental activity), consists of motor, premotor and prefrontal sections of the cerebral cortex. With the defeat of this part of the brain, the work of the musculoskeletal system is disrupted.
38. Concepts of neuropsychological factor, symptom and syndrome
“The neuropsychological factor is the principle of the physiological activity of a certain brain structure. It is a connecting concept between mental functions and a working brain.
Syndrome analysis is a tool for identifying neuropsychological factors, which includes:
1) qualitative qualification of violations of mental functions with an explanation of the reasons for the changes that have occurred;
2) analysis and comparison of primary and secondary disorders, i.e., the establishment of causal relationships between the direct source of pathology and emerging disorders;
3) study of the composition of preserved higher mental functions.
We list the main neuropsychological factors:
1) modal-non-specific (energy) factor;
2) kinetic factor;
3) modal-specific factor;
4) kinesthetic factor (a special case of modal-specific factor);
5) factor of arbitrary-involuntary regulation of mental activity;
6) the factor of awareness-unconsciousness of mental functions and states;
7) the factor of succession (consistency) in the organization of higher mental functions;
8) the factor of simultaneity (simultaneity) of the organization of higher mental functions;
9) factor of interhemispheric interaction;
10) cerebral factor; 11) the factor of work of deep subcortical structures.
Neuropsychological symptom - a violation of mental functions as a result of local lesions of the brain.
A syndrome is a regular combination of symptoms based on a neuropsychological factor, i.e., certain physiological patterns of the work of brain regions, the violation of which is the cause of neuropsychological symptoms.
Neuropsychological syndrome is a confluence of neuropsychological symptoms associated with the loss of one or more factors.
Syndromic analysis is the analysis of neuropsychological symptoms, the main purpose of which is to find a common factor that fully explains the appearance of various neuropsychological symptoms. The syndromic analysis includes the following stages: first, the signs of the pathology of various mental functions are determined, and then the symptoms are qualified.
39. Methods of neuropsychological research. Restoration of higher mental functions
One of the most common methods for assessing syndromes in neuropsychology is the system proposed by A. R. Luria. It includes:
1) a formal description of the patient, his medical history;
2) a general description of the patient's mental status (state of consciousness, ability to navigate in place and time, level of criticism, etc.);
3) studies of voluntary and involuntary attention;
4) studies of emotional reactions;
5) studies of visual gnosis (based on real objects, contour images, etc.);
6) studies of somatosensory gnosis (recognition of objects by touch, by touch);
7) studies of auditory gnosis (recognition of melodies, repetition of rhythms);
8) studies of movements and actions (evaluation of coordination, results of drawing, objective actions, etc.);
9) speech research;
10) study of writing (letters, words and phrases);
11) reading research;
12) memory research;
13) research of the counting system;
14) research of intellectual processes. One of the important sections of neuropsychology explores the mechanisms and ways of restoring higher mental functions that are impaired as a result of local pathologies of the brain. A position was put forward on the possibility of restoring the affected mental functions by restructuring the functional systems that determine the implementation of higher mental functions.
In the works of A. R. Luria and his students, mechanisms for the restoration of higher mental functions were revealed:
1) transfer of the process to the highest conscious level;
2) replacement of the missing link of the functional system with a new one.
We list the principles of restorative education:
1) neuropsychological qualification of the defect;
2) reliance on preserved forms of activity;
3) external programming of the restored function.
The practice of treating the wounded during the Great Patriotic War proved the effectiveness of these ideas. In the future, neuropsychological methods began to be used in conjunction with medication.
The development of ideas about the functional asymmetry of the human brain in the history of neuropsychology is associated with the name of the French doctor M. Dax, who in 1836, speaking in a medical society, cited the results of the observation of 40 patients. He observed patients with brain damage accompanied by a decrease or loss of speech, and came to the conclusion that the disorders were caused only by defects in the left hemisphere.
40. Schizophrenia
Schizophrenia (from the Greek shiso - “split”, frenio - “soul”) is “a mental illness that occurs with rapidly or slowly developing personality changes of a special type (reduced energy potential, progressive introversion, emotional impoverishment, distortion of mental processes)”.
Often the result of this disease is a break in the patient's previous social relations and a significant maladjustment of patients in society.
Schizophrenia is considered to be practically the most famous mental illness.
There are several forms of schizophrenia:
1) continuously ongoing schizophrenia;
2) paroxysmal-progredient (fur-like);
3) recurrent (periodic flow).
According to the pace of the process, the following types of schizophrenia are distinguished:
1) low-progressive;
2) medium progredient;
3) malignant.
There are various forms of schizophrenia, for example:
1) schizophrenia with obsessions;
2) paranoid schizophrenia (delusions of persecution, jealousy, invention, etc. are noted);
3) schizophrenia with asthenohypochondriac manifestations (mental weakness with a painful fixation on the state of health);
4) simple;
5) hallucinatory-paranoid;
6) hebephrenic (foolish motor and speech excitement, elevated mood, fragmented thinking are noted);
7) catatonic (characterized by the predominance of movement disorders). For patients with schizophrenia, the following features are characteristic.
1. Severe disorders of perception, thinking, emotional-volitional sphere.
2. Decrease in emotionality.
3. Loss of differentiation of emotional reactions.
4. State of apathy.
5. Indifferent attitude towards family members.
6. Loss of interest in the environment.
8. Decreased volitional effort from insignificant to pronounced lack of will (aboulia).
41. Manic-depressive psychosis
Manic-depressive psychosis (MPD) is a disease characterized by the presence of depressive and manic phases. The phases are separated by periods with the complete disappearance of mental disorders - intermissions.
It should be noted that manic-depressive psychosis is much more common in women than in men.
As mentioned earlier, the disease proceeds in the form of phases - manic and depressive. At the same time, depressive phases are several times more common than manic phases.
The depressive phase is characterized by the following symptoms:
1) depressed mood (depressive affect);
2) intellectual inhibition (inhibition of thought processes);
3) psychomotor and speech inhibition.
The manic phase is characterized by the following symptoms.
1. Increased mood (manic affect).
2. Intellectual excitement (accelerated flow of thought processes).
3. Psychomotor and speech stimulation. Sometimes depression can only be identified
through psychological research.
The manifestations of manic-depressive psychosis can occur in childhood, adolescence and adolescence. At each age, with MDP, its own characteristics are noted.
In children under 10 years of age in the depressive phase, the following features are noted:
1) lethargy;
2) slowness;
3) reticence;
4) passivity;
5) confusion;
6) tired and unhealthy look;
7) complaints of weakness, pain in the head, abdomen, legs;
8) low academic performance;
9) difficulties in communication;
10) disorders of appetite and sleep.
Children in the manic phase experience:
1) ease in the appearance of laughter;
2) impudence in communication;
3) increased initiative;
4) no signs of fatigue;
5) mobility.
In adolescence and youth, a depressive state manifests itself in the following features: inhibition of motor skills and speech; decrease in initiative; passivity; loss of vivacity of reactions; feeling of melancholy, apathy, boredom, anxiety; forgetfulness; tendency to self-digging; heightened sensitivity to peers; suicidal thoughts and attempts.
42. Epilepsy
Epilepsy is characterized by the presence in the patient of frequent disturbances of consciousness and mood.
This disease gradually leads to personality changes.
It is believed that the hereditary factor, as well as exogenous factors (for example, intrauterine organic brain damage), play an important role in the origin of epilepsy. One of the characteristic signs of epilepsy is a convulsive seizure, which usually begins suddenly.
Sometimes a few days before the seizure, harbingers appear:
1) feeling unwell;
2) irritability;
3) headache.
The seizure usually lasts about three minutes. After it, the patient feels lethargy and drowsiness. Seizures can recur with varying frequency (from daily to several per year).
Patients have atypical seizures.
1. Small seizures (loss of consciousness for several minutes without falling).
2. Twilight state of consciousness.
3. Ambulatory automatisms, including somnambulism (sleepwalking).
Patients have the following symptoms:
1) stiffness, slowness of all mental processes;
2) thoroughness of thinking;
3) tendency to get stuck on details;
4) the inability to distinguish the main from the secondary;
5) dysphoria (tendency to an angry-dreary mood). Characteristic features of patients with epilepsy are:
1) a combination of affective viscosity and explosiveness (explosiveness);
2) pedantry in relation to clothes, order in the house;
3) infantilism (immaturity of judgments);
4) sweetness, exaggerated courtesy;
5) a combination of hypersensitivity and vulnerability with malice.
The face of patients with epilepsy is inactive, inexpressive, restraint in gestures is noted.
During the study of patients with epilepsy, the psychologist studies primarily thinking, memory and attention.
The following methods are commonly used to study patients with epilepsy.
1. Schulte tables.
2. Exclusion of items.
3. Classification of objects.
The choice of research methods used by a clinical psychologist is determined by the tasks that arise before him in the performance of his professional duties. The diagnostic function dictates the use of psychological methods (batteries of tests, questionnaires, etc.) that can assess both the activity of individual mental functions, individual psychological characteristics, and differentiate psychological phenomena and psychopathological symptoms and syndromes. The psycho-correctional function implies the use of various scales, on the basis of which it is possible to analyze the effectiveness of psycho-correctional and psychotherapeutic methods. The selection of the necessary methods is carried out depending on the goals of the psychological examination; individual characteristics of the mental, as well as the somatic state of the subject; his age; profession and level of education; time and place of the study. All kinds of research methods in clinical psychology can be divided into three groups: 1) clinical interviewing, 2) experimental psychological research methods, 3) evaluation of the effectiveness of psycho-correctional influence. Let's dwell on them in more detail.
Clinical interview
We are aware of how difficult the unification and schematization of the creative process is, and yet interviewing can rightly be called creativity. In this regard, we are aware of the limits of our capabilities and do not pretend to find the ultimate truth. Each psychologist has the right to choose from a variety of existing ones the most suitable for him (his character, interests, preferences, level of sociability, worldview, culture, etc.) method of interviewing a client (patient). Therefore, the proposed text and the thoughts embodied in it should be considered as another possibility, another option that can satisfy the discerning reader and lead to the application of the provisions of this particular guide in practice.
If the information is capable of causing rejection, then it is up to the reader to continue searching for the most appropriate guide to clinical method in clinical psychology.
One of the main goals of clinical interviewing is to assess the individual psychological characteristics of a client or patient, to rank the identified features in terms of quality, strength and severity, to classify them as psychological phenomena or psychopathological symptoms.
The term "interview" has entered the lexicon of clinical psychologists recently. More often they talk about a clinical questioning or conversation, the description of which in scientific works is overwhelmingly descriptive, sententious. Recommendations, as a rule, are given in an imperative tone and are aimed at forming undoubtedly important moral qualities of a diagnostician. In well-known publications and monographs, a clinical method for assessing a person’s mental state and diagnosing mental deviations in him is given without describing the actual methodology (principles and procedures) of questioning, which takes the recommendations given beyond the scope of scientific ones and available for effective reproduction. It turns out a paradoxical situation: it is possible to learn clinical examination and diagnostics only experimentally, participating as an observer-student in conversations with clients of well-known and recognized authorities in the field of diagnostics and interviewing.
Digressing from the main topic, I would like to note that, unfortunately, in the field of diagnostics there is and has a lot of fans even among professionals in diagnosing mental disorders without interviewing. That is, the diagnosis is made in absentia, without a direct meeting of the doctor with the alleged patient. This practice is becoming fashionable in our time. Diagnosis of mental illness based on the analysis of human actions known to the doctor by hearsay or from the lips of non-specialists, psychopathological interpretations of the texts of the "suspects" (letters, poems, prose, once abandoned phrases) only discredit the clinical method.
Another distinctive feature of modern practical psychology has become the belief in the omnipotence of experimental psychological methods in the diagnostic plan. A large army of psychologists is convinced that they are able to identify mental abnormalities and delimit the norm from pathology with the help of various tests. Such a widespread misconception leads to the fact that the psychologist often turns himself into a fortune-teller, into a conjurer, from whom others expect to demonstrate a miracle and solve miracles.
True diagnostics of both mental deviations and individual psychological characteristics of a person must necessarily combine diagnostics in the narrow sense of the term and a direct examination by a psychologist of a client (patient), i.e. interviewing.
Currently, the diagnostic process is completely at the mercy of psychiatrists. This cannot be considered fair, since the doctor, first of all, is aimed at finding a symptom, and not at the actual differentiation of a symptom and a phenomenon. In addition, due to tradition, the psychiatrist is little aware of the manifestations of healthy mental activity. It is precisely because of these features that it can be considered reasonable to involve a clinical psychologist in the diagnostic process in the form of interviews to assess the mental state of the subjects.
A clinical interview is a method of obtaining information about the individual psychological properties of a person, psychological phenomena and psychopathological symptoms and syndromes, the internal picture of the patient's illness and the structure of the client's problem, as well as a method of psychological impact on a person, produced directly on the basis of personal contact between the psychologist and the client.
The interview differs from the usual questioning in that it is aimed not only at complaints actively presented by a person, but also at revealing the hidden motives of a person’s behavior and helping him to realize the true (internal) grounds for an altered mental state. The psychological support of the client (patient) is also considered essential for the interview.
The functions of the interview in clinical psychology are: diagnostic and therapeutic. They should be carried out in parallel, since only their combination can lead to the desired result for the psychologist - the recovery and rehabilitation of the patient. In this respect, the practice of clinical questioning, ignoring the psychotherapeutic function, turns the doctor or psychologist into an extra, whose role could be successfully performed by a computer.
Clients and patients often cannot accurately describe their condition and formulate complaints and problems. That is why the ability to listen to the presentation of a person's problems is only part of the interview, the second is the ability to tactfully help him formulate his problem, to let him understand the origins of psychological discomfort - to crystallize the problem. “Speech is given to a person in order to better understand himself,” wrote L. Vygotsky, and this understanding through verbalization in the process of a clinical interview can be considered essential and fundamental.
The principles of a clinical interview are: unambiguity, accuracy and accessibility of wording-questions; adequacy, consistency (algorithmicity); flexibility, impartiality of the survey; verifiability of the received information.
The principle of unambiguity and accuracy in the framework of a clinical interview is understood as the correct, correct and precise formulation of questions. An example of ambiguity is such a question addressed to the patient: “Do you experience a mental impact on yourself?” An affirmative answer to this question does not give the diagnostician practically anything, since it can be interpreted in various ways. The patient could mean by "impact" both ordinary human experiences, events, people around him, and, for example, "energy vampirism", the impact of aliens, etc. This question is inaccurate and ambiguous, therefore uninformative and redundant.
The principle of accessibility is based on several parameters: vocabulary (linguistic), educational, cultural, cultural, linguistic, national, ethnic and other factors. The speech addressed to the patient must be understandable to him, must coincide with his speech practice, based on many traditions. The diagnostician asked: “Do you have hallucinations?” - may be misunderstood by a person who encounters such a scientific term for the first time. On the other hand, if a patient is asked if he hears voices, then his understanding of the word “voices” may be fundamentally different from the doctor’s understanding of the same term. Availability is based on an accurate assessment by the diagnostician of the patient's status, the level of his knowledge; vocabulary, subcultural features, jargon practice.
One of the important parameters of the interview is the algorithmization (sequence) of the questioning, based on the knowledge of the diagnostician in the field of compatibility of psychological phenomena and psychopathological symptoms and syndromes; endogenous, psychogenic and exogenous types of response; psychotic and non-psychotic levels of mental disorders. A clinical psychologist must know hundreds of psychopathological symptoms. But if he asks about the presence of every symptom known to him, then this, on the one hand, will take a lot of time and will be tedious for both the patient and the researcher; on the other hand, it will reflect the incompetence of the diagnostician. The sequence is based on the well-known algorithm of psychogenesis: on the basis of the presentation of the first complaints by patients, the story of his relatives, acquaintances, or on the basis of direct observation of his behavior, the first group of phenomena or symptoms is formed. Further, the survey covers the identification of phenomena, symptoms and syndromes that are traditionally combined with those already identified, then the questions should be aimed at assessing the type of response (endogenous, psychogenic or exogenous), the level of disorders and etiological factors. For example, if the presence of auditory hallucinations is the first to be detected, then further questioning is built according to the following algorithm scheme: assessment of the nature of hallucinatory images (the number of "voices", their awareness and criticality, speech features, determining the location of the sound source according to the patient, the time of appearance etc.) - the degree of emotional involvement - the degree of criticality of the patient to hallucinatory manifestations - the presence of thinking disorders (delusional interpretations of "voices") and Further, depending on the qualification of the described phenomena, confirmation of exogenous, endogenous or psychogenic types of response using a survey on the presence , for example, disorders of consciousness, psychosensory disorders and other manifestations of a certain range of disorders. In addition to the above, the principle of sequence implies a detailed questioning in a longitudinal section: the order in which mental experiences appear and their connection with real circumstances. At the same time, every detail of the story is important, the context of events, experiences, interpretations is important.
The most significant are the principles of verifiability and adequacy of a psychological interview, when, in order to clarify the congruence of concepts and exclude incorrect interpretation of answers, the diagnostician asks questions like: “What do you understand by the word“ voices ”that you hear?” or “Give an example of the ‘voices’ being tested. If necessary, the patient is asked to specify the description of his own experiences.
The principle of impartiality is the basic principle of a phenomenologically oriented diagnostic psychologist. Imposing on the patient his own idea that he has psychopathological symptoms on the basis of a biased or carelessly conducted interview can occur both due to a conscious attitude, and on the basis of ignorance of the principles of the interview or blind adherence to one of the scientific schools.
Considering the burden of responsibility, primarily moral and ethical, lying on the diagnostician in the process of psychological interview, it seems appropriate for us to cite the main ethical provisions of the American Psychological Association regarding counseling and interviewing:
1. Adhere to confidentiality: respect the rights of the client and his privacy. Do not discuss what he said during interviews with other clients. If you cannot comply with the confidentiality requirements, then you must inform the client about this before the conversation; let him decide for himself whether it is possible to go for it. If information is shared with you that contains information about a danger that threatens a client or society, then ethical regulations allow you to violate confidentiality for the sake of safety. However, one must always remember that, be that as it may, the psychologist's responsibility to the client who trusts him is always primary.
2. Realize the limits of your competence. There is a kind of intoxication that occurs after the psychologist has learned the first few techniques. Beginning psychologists immediately try to delve deeply into the souls of their friends and their clients. This is potentially dangerous. A novice psychologist should work under the supervision of a professional; Seek advice and suggestions to improve your work style. The first step to professionalism is knowing your limits.
3. Avoid asking about irrelevant details. The aspiring psychologist is mesmerized by the details and "important stories" of his clients. Sometimes he asks very intimate questions about sex life. It is common for a novice or inept psychologist to place great importance on the details of the client's life and at the same time miss what the client feels and thinks. Consulting is intended primarily for the benefit of the client, and not to increase your volume of information.
4. Treat the client the way you would like to be treated. Put yourself in the client's shoes. Everyone wants to be treated with respect, sparing his self-esteem. A deep relationship and a heart-to-heart conversation begins after the client has understood that his thoughts and experiences are close to you. A relationship of trust develops from the client's and counselor's ability to be honest.
5. Be aware of individual and cultural differences. It is safe to say that the practice of therapy and counseling, regardless of what cultural group you are dealing with, cannot be called an ethical practice at all. Are you prepared enough to work with people who are different from you?
The current situation in society allows us to talk about potentially or clearly existing conflicts in the field of communication. The clinical interview is no exception in this regard. Potential psychological difficulties in conducting interviews are possible at different levels - yesterday they covered one area; today - the second; tomorrow - may spread yes third. Without a trusting atmosphere, therapeutic empathy between a psychologist and a patient, qualified interviewing, diagnosis and psychotherapeutic effect are impossible.
Jacques Lacan's theory suggests that an interview is not just a relationship between two people physically present in a session. It is also the relationship of cultures. That is, at least four people are involved in the counseling process, and what we took for a conversation between a therapist and a client may turn out to be a process of interaction between their cultural and historical roots. The following figure illustrates the point of view of J. Lacan:
Figure 2.
Note that counseling is a more complex subject than just giving recommendations to a client. Cultural affiliation must always be considered. In the figure above, the therapist and the client are what we see and hear during the interview process. “But no one can get away from their cultural heritage. Some-
Some psychological theories tend to be anti-historic and underestimate the influence of cultural identity on the client. They focus mainly on the client-psychologist relationship, omitting more interesting facts of their interaction” (J. Lacan).
Schneiderman argued that "whoever seeks to erase cultural differences and create a society in which alienness does not exist, is moving towards alienation ... The moral denial of alienness is racism, one can hardly doubt it."
Empathy requires that we understand both the personal uniqueness and the “foreignness” (cultural-historical factor) of our client. Historically, empathy has focused on personal uniqueness, and the second aspect has been forgotten. For example, psychologists in the United States and Canada expect that all clients, regardless of their cultural background, will respond in the same way to the same treatment. Based on the concept of J. Lacan, then such therapy looks like this:
Figure 3
Thus, the cultural-historical influence is reflected in this interview, but the client and the psychologist are not aware of these problems, they are disconnected from them. In this example, the client is aware of the specifics of their cultural identity and takes it into account in their plans for the future. The psychologist, however, proceeds from a theory based on individual empathy and does not pay attention to this important circumstance. In addition, the client sees only a cultural stereotype in the consultant, “This example is by no means an exception to the rule, and many non-white clients who have tried to get counseling from an unqualified white psychotherapist will readily confirm this” (A. Ivey).
Ideally, both - the psychologist and the client - are aware of and use the cultural-historical aspect. Empathy, on the other hand, cannot be considered a necessary and sufficient condition if one does not pay attention to the cultural aspect as well.
J. Lacan's model gives an additional impetus to building a certain level of empathy. Sometimes the client and the psychologist think that they are talking to each other, when in fact they are only passive observers of how two cultural settings interact.
In the process of a clinical interview, as experience shows and confirms the theory of J. Lacan, such components of the historical and cultural bases of a psychologist (doctor) and a client (patient) as: gender, age, religious beliefs and religion, racial characteristics (in modern conditions - nationality); sexual orientation preferences. The effectiveness of the interview in these cases will depend on how the psychologist and the patient with different beliefs and characteristics will find a common language, what style of communication the diagnostician will offer to create an atmosphere of trust. Today we face relatively new problems in the field of therapeutic interaction. Patients conceived do not trust doctors, and doctors do not trust patients only on the basis of differences in national, religious, sexual (hetero-, homosexual) characteristics. A doctor (as well as a psychologist) should be guided by the current situation in the field of ethnocultural relations and choose a flexible communication tactic that avoids discussing acute global and non-medical problems, in particular national, religious ones, and even more so not to impose his point of view on these issues.
The described principles of the clinical interview reflect the basic knowledge, the theoretical platform on which the entire interviewing process is built. However, principles not supported by practical procedures will remain unused.
There are various methodological approaches to conducting interviews. It is believed that the duration of the first interview should be about 50 minutes. Subsequent interviews with the same client (patient) are somewhat shorter. The following model (structure) of a clinical interview can be proposed:
Stage I: Establishment of a "confidence distance". Situational support, provision of confidentiality guarantees; determining the dominant motives for conducting an interview.
Stage II: Identification of complaints (passive and active interviews), assessment of the internal picture - the concept of the disease; problem structuring,
Stage III: Evaluation of the desired outcome of the interview and therapy; determination of the patient's subjective model of health and preferred mental status.
Stage IV: Assessment of the patient's anticipatory abilities; discussion of probable outcomes of the disease (if it is detected) and therapy; anticipation training.
The above stages of a clinical psychological interview give an idea of the essential points discussed during the meeting between the psychologist and the patient. This scheme can be used for each conversation, but it should be remembered that the specific weight - the time and effort allocated to one or another stage - varies depending on the order of meetings, the effectiveness of therapy, the level of observed mental disorders, and some other parameters. It is clear that during the first interview, the first three stages should be predominant, and during subsequent interviews, the fourth. Particular attention should be paid to the level of mental disorders of the patient (psychotic - non-psychotic); voluntariness or compulsory interview; criticality of the patient; intellectual features and abilities, as well as the real situation surrounding him.
The first stage of a clinical interview (“establishing a confidence distance”) can be defined as an active interview.” It is the most important and difficult. the patient does not begin with a formal one that has set the teeth on edge; “What are you complaining about?”, But with situational support. The interviewer takes the thread of the conversation into his own hands and, mentally putting himself in the place of a patient who first turned to a doctor (especially if he is in a psychiatric hospital), having felt the drama of the situation, the fear of the applicant being recognized as mentally ill or misunderstood or put on record helps him start a conversation.
In addition, at the first stage, the psychologist must identify the dominant motives for contacting him, make a first impression about the level of criticality of the interviewee to himself and psychological manifestations. This goal is achieved with the help of questions like: “Who initiated your appeal to a specialist?”, “Is your coming to talk with me your own desire or did you do it to reassure relatives (acquaintances, parents, children, bosses)?” ; “Does anyone know that you were going to see a specialist?”
Even when interviewing a patient with a psychotic level of disorder, it is advisable to begin the interview by providing assurances of confidentiality. Often effective for further conversation with such patients are phrases like: “You probably know that you can refuse to talk to me as a psychologist and psychiatrist?” In the vast majority of cases, this phrase does not cause a desire to leave the doctor's office, but rather turns out to be a pleasant revelation for the patient, who begins to feel free to dispose of information about himself and at the same time becomes more open to communication.
The active role of the doctor (psychologist) is interrupted at this point and the stage of the passive interview begins. The patient (client) is given time and opportunity to present complaints in the sequence and with those details and comments that he considers necessary and important. At the same time, the doctor or psychologist plays the role of an attentive listener, only clarifying the features of the manifestations of the patient's disease. Most often, the listening technique includes the following methods (Table 1).
The questions asked by the diagnostician are aimed at assessing the internal picture and concept of the disease, i.e. identifying the patient's ideas about the causes and reasons for the occurrence of certain symptoms in him. At the same time, the problem is structured, which remains frustrating at the time of the interview. Here
Table 1
The main stages of diagnostic listening (according to A-Ivn)
the diagnostician asks all sorts of questions regarding analysis and mental state, based on known diagnostic algorithms. In addition to listening, the psychologist should also use elements of influence during the interview.
Methods of influence in the interview process (according to A. Ivey)
table 2
Essential at this stage of the interview is the collection of the so-called psychological and medical anamnesis - the history of life and illness. The task of the psychological anamnesis is to obtain information from the patient to assess his personality as an established system of attitudes towards himself and, in particular, attitudes towards the disease and assess how much the disease has changed this entire system. Important are the data on the course of the disease and the life path, which are designed to reveal how the disease is reflected in the subjective world of the patient, how it affects his behavior, on the entire system of personal relationships. Outwardly, the medical and psychological history as research methods are very similar - the questioning could go according to a single plan, but their purpose and the use of the data obtained are completely different (V.M. Smirnov, T.N. Reznikova).
The next (III) stage of the clinical interview is aimed at identifying the patient's ideas about the possible and desired results of the interview and therapy. The patient is asked: “Which of what you told me would you like to get rid of first of all? How did you imagine our conversation before coming to me and what do you expect from it? How do you think I could help you?"
The last question aims to identify the patient's preferred mode of therapy. After all, it is not uncommon for a patient, after presenting complaints (often diverse and subjectively severe) to a doctor, to refuse treatment, referring to the fact that he does not take any medications in principle, is skeptical about psychotherapy, or does not trust doctors at all. Such situations indicate the desired psychotherapeutic effect from the interview itself, from the opportunity to speak out, to be heard and understood.
In some cases, this turns out to be sufficient for a certain part of those who seek advice from a doctor or psychologist. Indeed, often a person comes to a doctor (especially a psychiatrist) not for a diagnosis, but in order to get confirmation of his own beliefs about his mental health and balance.
At the fourth and final stage of the clinical interview, the interviewer takes on an active role again. Based on the identified symptoms, having the patient's understanding of the concept of the disease, knowing what the patient expects from treatment, the interviewer-psychologist directs the interview into the mainstream of anticipatory training. As a rule, a neurotic is afraid to think and even discuss with anyone the possible sad outcomes of the conflict situations that exist for him, which caused him to go to the doctor and get sick.
Anticipatory training, which is based on the anticipatory concept of neurogenesis (V.D. Mendelevich), is aimed, first of all, at the patient's thinking out the most negative consequences of his illness and life. For example, when analyzing a phobic syndrome within the framework of a neurotic register, it is advisable to ask questions in the following sequence: “What exactly are you afraid of? - Something bad must happen. - How do you suppose and feel with whom this bad thing should happen: with you or with your loved ones? - I think with me. - What exactly do you think? - I'm afraid to die. - What does death mean to you? Why is she terrible? - I do not know. - I understand that it is an unpleasant occupation to think about death, but I ask you to think about what exactly you are afraid of in death? I will try to help you. For one person, death is non-existence, for another, it is not death itself that is terrible, but the suffering and pain associated with it; for the third, it means that children and loved ones will be helpless in the event of death, etc. What is your opinion about this? - ...-»
Such a technique within the framework of a clinical interview performs both the function of a more accurate diagnosis of the patient's condition, penetration into the secret secrets of his illness and personality, and a therapeutic function. We call this technique anticipatory training. It can be considered a pathogenetic method for the treatment of neurotic disorders. The use of this method when interviewing patients with psychotic disorders performs one of the functions of the interview - it clarifies the diagnostic horizons to a greater extent, and this has a therapeutic effect.
The clinical interview consists of verbal (described above) and non-verbal methods, especially in the second stage. Along with questioning the patient and analyzing his answers, the doctor can recognize a lot of important information that is not dressed in verbal form.
The language of facial expressions and gestures is the foundation on which counseling and interviewing are based (Harper, Wiens, Matarazzo, A. Ivey). Non-verbal language, according to the last author, functions at three levels:
Terms of interaction: for example, the time and place of the conversation, the design of the office, clothing and other important details, pain
most of which affect the nature of the relationship between two people;
Information flow: for example, important information often comes to us in the form of non-verbal communication, but much more often non-verbal communication modifies meaning and rearranges emphasis in a verbal context;
Interpretation: Each individual, from any culture, has vastly different ways of interpreting non-verbal communication. What one perceives from non-verbal language may be fundamentally different from what another understands.
Extensive research in Western psychological science on the study of listening skills has shown that the standards of eye contact, torso tilt, medium timbre of the voice may be completely unsuitable in communicating with some clients. When a clinician is working with a depressed patient or someone who is talking about sensitive matters, eye contact during the interaction may be inappropriate. Sometimes it is wise to look away from the speaker.
visual contact. Without forgetting cultural differences, it should still be noted the importance of when and why an individual stops making eye contact with you. “It is the movement of the eyes that is the key to what is happening in the client's head,” says A. Ivey. “Usually, visual contact stops when a person speaks on a sensitive topic. For example, a young woman may not make eye contact when she talks about her partner's impotence, but not when she talks about her solicitousness. This may be a real sign that she would like to maintain a relationship with her lover. However, more than one conversation is required to accurately calculate the meaning of a change in non-verbal behavior or visual contact, otherwise there is a high risk of drawing erroneous conclusions.
Language of the body. Representatives of different cultures naturally differ in this parameter. Different groups put different content into the same gestures. It is believed that the most informative in body language is the change in torso tilt. The client may sit naturally and then, for no apparent reason, clasp their hands, cross their legs, or sit on the edge of a chair. Often these seemingly minor changes are indicators of conflict in the person.
intonation and tempo of speech. The intonation and pace of a person's speech can say as much about him, especially about his emotional state, as verbal information. How loudly or quietly sentences are spoken can serve as an indicator of the strength of feelings. Rapid speech is usually associated with a state of nervousness and hyperactivity; while slow speech may indicate lethargy and depression.
Following AAivy and his colleagues, we note the importance of such parameters as the construction of speech in the interview process. According to these authors, the way people construct sentences is an important key to understanding their perception of the world. For example, it is proposed to answer the question: “What will you tell the controller when he starts checking the availability of tickets, and you find yourself in a difficult situation?”: a) The ticket is torn, b) I tore the ticket, c) The car tore the ticket, or d) Something what happened?
Explaining even such an insignificant event can serve as a key to understanding how a person perceives himself and the world around him. Each of the above sentences is true, but each illustrates a different worldview. The first sentence is just a description of what happened; the second - demonstrates a person who takes responsibility and indicates an internal locus of control; the third represents external control, or "I didn't do it," and the fourth indicates a fatalistic, even mystical, outlook.
Analyzing the structure of sentences, we can come to an important conclusion regarding the psychotherapeutic process: the words that a person uses when describing events often give more information about him than the event itself. The grammatical structure of sentences is also an indicator of personal worldview.
The research and observations of Richard Bandler and John Grinder, the founders of neurolinguistic programming, focused the attention of psychologists and psychotherapists on the linguistic aspects of diagnosis and therapy. For the first time, the significance of the words used by the patient (client) and the construction of phrases in the process of understanding the structure of his mental activity, and hence personal characteristics, was noted. Scientists have noticed that people talk differently about similar phenomena. One, for example, will say that he “sees” how his spouse treats him badly; another will use the word "know"; the third - "feel" or "feel"; the fourth - will say that the spouse does not "listen" to his opinion. Such a speech strategy indicates the predominance of certain representational systems, the presence of which must be taken into account in order to “connect” to the patient and create true mutual understanding within the interview.
According to D. Grinder and R. Bandler, there are three types of mismatches in the structure of the interviewee's speech, which can serve to study the deep structure of a person: deletion, distortion and overgeneralization. Crossing out can appear in sentences such as "I'm afraid." To questions like “Who or what are you afraid of?”, “For what reason?”, “In what situations?”, “Do you feel fear now?”, “Is this fear real or its causes are unreal?” - There are usually no responses. The task of the psychologist is to "expand" a brief statement about fear, to develop a complete representative picture of the difficulties. During this "filling in the crossed out" process, new surface structures may appear. Distortion can be defined as an unconstructive or incorrect proposal. These proposals distort the real picture of what is happening. A classic example of this would be a sentence like, "He's making me crazy," while the truth is that a person who "makes another crazy" is only responsible for his own behavior. A more correct statement would be: "I get very angry when he does this." In this case, the client takes responsibility for his behavior and begins to control the direction of his actions. Distortions often develop from strikeouts on the surface structure of a sentence. At a deeper level, a close examination of the client's life situation reveals many distortions of reality that exist in his mind. Overgeneralization occurs when the client draws far-reaching conclusions without having sufficient evidence for this. Overgeneralization is often accompanied by distortions. The words accompanying overgeneralizations are usually the following: "all people", "everyone in general", "always", "never", "the same", "always", "forever" and others.
The use of verbal and non-verbal communication contributes to a more accurate understanding of the patient's problems and allows you to create a mutually beneficial situation during the clinical interview.
Psychology accomplishes its tasks through the use of certain techniques, methods that act as methods of psychological research. The methods of psychological research also reveal a dependence on the basic theoretical principles underlying the subject of psychology and the specific tasks that it solves.
Stages of psychological research
- 1. Formulation of the problem (the question of the causes or factors that determine the existence or specificity of a particular phenomenon).
- 2. Putting forward a hypothesis (a hypothetical answer to the question formulated in the problem).
- 3. Testing the hypothesis on empirical material.
- 4. Interpretation of test results.
Basically, they talk about the methods of psychology in connection with the third stage - testing the hypothesis.
Like all natural sciences, psychology has two main methods for obtaining psychological facts: observation (descriptive) and experiment. Each of the methods has a number of modifications that clarify, but do not change their essence.
Descriptive Methods assign the researcher the role of an observer who does not interfere in the observed phenomenon and only describes it as objectively as possible. Observation- this is a systematic, purposeful tracking of the manifestations of the human psyche in certain conditions. The non-intervention of the researcher (the object of observation does not know that he is being observed) with the expectation that the phenomena of interest will manifest themselves in such a way that they can be recorded and described is the most important characteristic of this method.
There are the following kinds observations: slice (short-term observation), longitudinal (long-term, sometimes long-term observation of the same group of subjects), continuous (all representatives of the group under study are studied), selective (obtaining information about large groups of people by studying only some part of them, constituting a representative, otherwise representative, sample) and a special type - included observation (when the observer becomes a member of the study group).
The tasks of observation can be the study of the psychological characteristics of not only an individual, but also the whole team.
The study of one's own mental processes is carried out by self-observation (introspection). Self-observation as a subjective method is acceptable as a form of verbal reporting of what a person sees, hears, experiences, etc. Such a report is recorded in the same way as any external objective expression of a person's mental states.
Introspection should not be confused with the so-called reflection(reflections and experiences about one's own mental qualities and states), which is a secondary processing of data from self-observation, analysis of one's own actions or conclusions.
Scientific observation requires clear goal setting and planning. It is determined in advance what kind of mental phenomena are of interest to the observer, by what external manifestations they can be traced, under what conditions the observation will take place, and how the results are supposed to be recorded.
Observation becomes a scientific method for studying the psyche only if it is not limited to describing external phenomena, but makes a transition to explaining the psychological nature of these phenomena. The form of such a transition is a hypothesis that arises in the course of observation. Hypothesis- this is an assumption made by the researcher about the presence (or absence) of connections and dependencies that exist between the objects and phenomena of interest to him.
Dependencies of this kind are estimated mainly by statistical methods. In particular, in statistical hypothesis testing, the correlation coefficient is often calculated. Correlation analysis makes it possible to obtain a lot of data for a significant number of subjects in a very short time, but it does not allow solving the problems of interpreting dependencies. The disadvantages of correlation analysis are related to the fact that it allows us to state the presence of some kind of relationship between the parameters, but cannot prove that this relationship is a causal relationship.
Experiment is considered the most effective way to identify a causal relationship between the variables under study and differs from observation by the active intervention of the researcher in the situation. In this case, systematic manipulation of one of the variables, which is called independent (it is changed by the researcher), is carried out, followed by registration of concomitant changes in the phenomenon under study (dependent variable). Under variable refers to any reality that can change in the experimental situation.
Thus, an experiment in psychology consists in the fact that the conditions under which the subject acts are deliberately created and modified, certain tasks are set before him, and the mental phenomena that arise in this are judged by the way they are solved.
There are two main types of psychological experiment: natural and laboratory.
At natural In an experiment, the subject may not even suspect that he is undergoing psychological research. The naturalness of the conditions and the introduction of experimental variables against this background allows the researcher to trace their action and thereby establish their role and features of influence on the phenomenon under study.
Laboratory the experiment is carried out in specially created conditions, often with the use of equipment. The subject knows that they are experimenting on him and his actions are determined by the instruction.
In addition to the main research methods, a number of additional methods are also used in psychology. These include the method of tests, modeling, the method of analyzing the products of human activity and conversation (survey).
tests they call sets of tasks and questions that make it possible to quickly assess a mental phenomenon and the degree of its development. Tests differ from other research methods in that they imply a clear procedure for collecting and processing primary data, as well as special techniques for their subsequent interpretation. The obtained quantitative results are always compared with similar results of the control group (preliminary standardization of the test).
Depending on the area to be diagnosed, there are tests of intellectual, achievement and special abilities (perceptual, mnestic, mental, musical, professional and others), personal (interests, attitudes, values), as well as tests that diagnose interpersonal relationships.
Psychodiagnostics as a branch of psychology is focused on measuring the individual psychological characteristics of a person. As an independent field of psychology, it orients the researcher not to research, but to examination, i.e. making a psychological diagnosis.
Levels of psychological diagnosis as the main purpose of diagnosis:
- first - symptomatic (empirical) diagnosis; it is limited to a statement of features or symptoms (signs);
- second - etiological diagnosis; takes into account not only the presence of certain features, but also the reasons for their occurrence;
- the third - typological diagnosis; determining the place and significance of the identified characteristics in the overall picture of a person's mental life.
Modern psychodiagnostics is widely used in health care, career guidance, placement of personnel, social behavior prediction, education, prediction of the psychological consequences of environmental change, forensic psychological examination, and psychotherapy.
Modeling how the method is applied in the case when the study of the phenomenon of interest by other methods is difficult. The created artificial model of the studied phenomenon should repeat its main parameters and expected properties. The model studies the phenomenon in detail and draws conclusions about its nature.
Models can be mathematical (an expression or formula that includes variables and relationships between them), technical (a device or device that imitates the phenomenon under study) and cybernetic (the use of concepts from the field of computer science and cybernetics in the model).
The concept of pathopsychology. Tasks of pathopsychological research
Pathopsychology is one of the branches of psychology that is important for the development of psychological science in general, as well as independent practical application.
Pathopsychology is directly connected not only with other sections of psychology, but also with other sciences. Thus, understanding the course of various mental processes cannot be imagined without knowledge of their possible violations. The mechanisms of mental activity, often hidden from the researcher during normal course and development, can be investigated and analyzed when they are violated. The study of mental pathology has always provided rich material for psychologists to understand the laws governing the development of the psyche. It is no coincidence that many well-known domestic psychologists - L. S. Vygotsky, A. R. Luria, D. B. Elkonin, A. V. Zaporozhets and other researchers - paid a certain tribute to the work with pathology. In Western countries - Z. Freud, E. Erikson, M. Montessori and many others.
Pathopsychology is a section of medical psychology that studies the laws of the breakdown of mental activity and personality traits in case of illness. Analysis of pathopsychological changes is carried out on the basis of comparison with the nature of the formation and course of mental processes, states and personality traits in the norm. Pathopsychology reveals the nature of the course and features of the structure of mental processes leading to symptoms observed in the clinic.
Pathopsychology is of great practical importance, since it has its own methods for diagnosing disturbed mental development. Its role is quite large when it comes to an unspecified diagnosis, borderline conditions or the prevention of the development of a mental illness.
Tasks of pathopsychological research
- 1. Obtaining data for diagnostics. Such data are of an auxiliary nature, and their value is found when compared with the results of other laboratory studies (for example, electroencephalograms).
- 2. Study of the dynamics of mental disorders in connection with the ongoing therapy. Repeatedly conducted in the course of treatment, pathopsychological studies can be an objective indicator of the effect of therapy on the course of the disease. Their results testify to the effectiveness of the treatment, and also characterize the features of the onset of remission and the structure of the resulting mental defect, if we are talking about a procedural disease.
- 3. Participation of a psychologist in expert work. When conducting a forensic psychiatric examination, the psychologist not only provides data that facilitates the solution of diagnostic issues, but also objectively establishes the severity of the mental defect. In forensic psychiatric practice, it is important not only to establish the presence of a debilitating process, but also to determine the severity of dementia. It is the severity of dementia in a number of cases that determines the expert judgment made. For example, it is not enough to diagnose epilepsy, it should (if the offense was not committed during a seizure or equivalent) be sure to establish the severity of a mental defect, the depth of epileptic dementia.
During a forensic examination the role of a psychologist is not limited to issues of nosological diagnosis and determining the severity of a mental defect. Recently, psychologists are increasingly involved in conducting complex forensic psychological examinations.
The role of the psychologist especially increases in the absence of a mental illness in the examined person. Understanding the nature of the crime committed in such cases is impossible without studying the structure of motives and needs inherent in the subject of the system of relations, attitudes, values, orientations, without revealing the internal psychological structure of the personality. Psychological examination is carried out not only to assess the personality of the accused, but often victims and witnesses become its objects, since the data obtained by the psychologist contribute to an adequate assessment of their testimony, help to judge their reliability.
Psychological examination is especially often carried out in cases involving minors. At the same time, the level of their cognitive activity and the nature of their individual and personal characteristics are determined.
Within the framework of a psychological and psychiatric examination, the question of whether the accused has any pathological affective state, as well as other conditions that affected him at the time of the crime (for example, overwork, fear, grief) is often resolved.
During the post-mortem examination in cases where psychiatrists do not find grounds for diagnosing a mental illness, psychologists, by analyzing the characteristics of the personality of the deceased, help to understand the motives that guided him when committing certain acts, including the motives for committing suicide.
The role of psychological research is extremely important when solving issues of military expertise: we are talking about the diagnosis of mild forms of oligophrenia, obliterated manifestations of schizophrenia (especially its simple form), psychopathy, neurosis, residual-organic lesions of the brain.
IN labor expertise the clinical psychologist not only detects the signs of the disease, but also shows how far it has gone, how much the work capacity of the subject is reduced, whether there are preserved elements in his psyche that could be used to stimulate the mechanisms for compensating for the mental defect.
IN child psychiatry psychological research is necessary to decide where the child should study - in a regular or specialized school.
- 4. Participation of a psychologist in rehabilitation work. Modern psychiatry attaches particular importance to work on the rehabilitation and resocialization of patients. The prevention of disability depends on properly constructed rehabilitation measures. Rehabilitation work should take into account not only the changes brought to the psyche by the disease, but also the remaining preserved elements of emotional and personal life and intellectual activity. Rehabilitation work can be effective only with an individualized approach to the patient. In this regard, clinical and psychological research is of great importance. At the same time, not only the features of the patient's thinking or the degree of preservation of his memory are studied. It is extremely important to characterize the personal properties of the patient. The personality of the patient is studied both in the medical-psychological and social aspects. At the same time, data on the psychological compatibility of the patient with those around him play an important role, often determining his correct employment.
- 5. Research understudied mental illness. Pathopsychological research is carried out for the scientific purpose of analyzing the still insufficiently studied psychopathological manifestations of certain mental illnesses. With such a formulation of the problem, as a rule, a study of large groups of patients is carried out, selected according to the presence of the studied psychopathological symptoms in them. Here, the statistical reliability of the obtained data acquires a special role.
- 6. Participation of a psychologist in psychotherapy. With regard to psychotherapy, specific tasks of pathopsychological research can be distinguished. This is, firstly, the participation of a pathopsychologist in the diagnosis of a mental illness, since the volume of indications for psychotherapy and the choice of its most adequate forms and place of conduct (inpatient or outpatient) depend on the solution of these issues. Secondly, pathopsychological research contributes to the discovery of such personal properties of the patient, which should be paid attention to in subsequent psychotherapeutic work.
Methods of experimental pathopsychology
Usually, eight to nine methods, selected in accordance with the objectives of the study, are sufficient to examine one patient.
The following circumstances may play a significant role in the choice of pathopsychological research methods.
- 1. The purpose of the study:
- - differential diagnosis (depending on the alleged diseases);
- - determination of the depth of a mental defect;
- - study of the effectiveness of therapy.
- 2. Education of the patient and his life experience.
- 3. Sometimes the peculiarities of contact with the patient play a significant role. So, it is often necessary to examine a patient with impaired activity of the auditory or visual analyzer. With deafness, tasks designed for visual perception are used to the maximum, even in the memorization test, the words are not read to the subject, but are presented in writing. In case of poor vision, on the contrary, all methods vary for auditory perception.
In the process of research, methods are usually applied in increasing complexity - from simpler to more complex. An exception is the survey of subjects from whom aggravation or simulation is expected. In these cases, sometimes more difficult tasks are performed incorrectly. The same feature is also characteristic of the state of pseudo-dementia, when more complex tasks and ridiculously simple simple tasks are successfully performed (AM Schubert, 1957).
Personality is the most complex mental construct in which many are closely intertwined. A change in even one of these factors significantly affects its relationship with other factors and the personality as a whole. A variety of approaches to the study of personality is associated with this - various aspects of the study of personality come from different concepts, they differ methodologically according to the object of which science is the study of personality.
In recent years, there has been a significant increase in interest in research on the personality characteristics of mentally ill patients, both in pathopsychology and in clinical psychiatry. This is due to a number of circumstances: firstly, personality changes have, to a certain extent, nosological specificity and can be used to resolve issues of differential diagnosis; secondly, the analysis of premorbid personality traits can be useful in establishing the possible causes of the origin of a number of diseases (and not only mental, but also, for example, peptic ulcer, diseases of the cardiovascular system); thirdly, the characterization of personality changes during the course of the disease enriches our understanding of its pathogenetic mechanisms; fourthly, taking into account the characteristics of the individual is very important for the rational construction of a complex of rehabilitation measures. Given the complexity of the concept of personality, we should immediately agree that there is no single method of its study, no matter how complete and versatile it may seem to us, which can give a holistic description of personality. With the help of experimental research, we obtain only a partial characterization of the personality, which satisfies us insofar as it evaluates certain personality manifestations that are important for solving a specific problem.
Currently, there are many experimental psychological techniques, methods, techniques aimed at studying personality. They, as already mentioned, differ in the peculiarities of the approach to the problem itself (we are talking about a fundamental, methodological difference), the diversity of the interests of researchers (personality is studied in educational psychology, in labor psychology, in social and pathological psychology, etc.) and focus on various manifestations of personality. Of course, the interests of researchers and the tasks facing them often coincide, and this explains the fact that the methods of studying personality in social psychology are adopted by pathopsychologists, the methods of pathopsychology are borrowed by specialists working in the field of labor psychology.
There is not even any clear, much less generally accepted classification of methods used to study personality. V. M. Bleikher and L. F. Burlachuk (1978) proposed the following classification of personality research methods as a conditional:
1) and methods close to it (studying biographies, clinical conversation, analysis of subjective and objective anamnesis, etc.);
2) special experimental methods (simulation of certain types of activities, situations, some instrumental techniques, etc.);
3) personal and other methods based on assessment and self-assessment;
4) projective methods.
As will be seen below, the distinction between these four groups of methods is very conditional and can be used mainly for pragmatic and didactic purposes.
K. Leonhard (1968) considered observation to be one of the most important methods for diagnosing personality, preferring it over methods such as personality questionnaires. At the same time, he attaches particular importance to the opportunity to observe a person directly, to study his behavior at work and at home, in the family, among friends and acquaintances, in a narrow circle and with a large number of people gathered. The special importance of observing the facial expressions, gestures and intonations of the subject, which are often more objective criteria of personality manifestations than words, is emphasized. Observation should not be passive-contemplative. In the process of observation, the pathopsychologist analyzes the phenomena that he sees from the point of view of the patient's activity in a certain situation, and for this purpose exerts a certain influence on the situation in order to stimulate certain behavioral reactions of the subject. Observation is a deliberate and purposeful perception, due to the task of activity (MS Rogovin, 1979). In a clinical conversation, the features of the patient's biography, the features of personal reactions inherent in him, his attitude to his own character, and the behavior of the subject in specific situations are analyzed. K. Leonhard considered the latter as the most important methodological point in the analysis of personality. MS Lebedinsky (1971) paid special attention in the study of the patient's personality to the study of diaries and autobiographies compiled by him at the request of the doctor, or conducted before.
For the study of personality in the process of activity, special methods are used, which will be discussed below. It should only be noted that for an experienced psychologist such material is provided by any psychological methods aimed at studying cognitive activity. For example, according to the results of a test for memorizing 10 words, one can judge the presence of apathetic changes in a patient with schizophrenia (a memorization curve of the “plateau” type), an overestimated or underestimated level of claims, etc.
Significant methodological and methodological difficulties arise before the psychologist in connection with the use of personality questionnaires. Personal characteristics obtained in terms of self-assessment are of considerable interest to the pathopsychologist, but the need to compare self-assessment data with indicators that objectively represent personality is often overlooked. Of the most frequently used personality questionnaires, only the MMPI has satisfactory rating scales that allow one to judge the adequacy of the self-assessment of the subject. A disadvantage of the design of many personality questionnaires should be considered their obvious purposefulness for the subject. This primarily applies to monothematic questionnaires such as the anxiety scale.
Thus, the information obtained with the help of personality questionnaires can be adequately assessed only by comparing it with the data of an objective assessment of the personality, as well as by supplementing it with the results of personality research in the process of activity, by projective methods. The selection of methods that complement a particular personality questionnaire is largely determined by the task of the study. For example, when studying the internal picture of the disease, the position of the patient in relation to his disease is significantly refined by introducing methods of the type into the experiment.
By projective, we mean such methods of mediated study of personality, which are based on the construction of a specific, plastic situation that, due to the activity of the perception process, creates the most favorable conditions for the manifestation of tendencies, attitudes, emotional states and other personality traits (V. M. Bleikher, L. F. Burlachuk, 1976, 1978). E. T. Sokolova (1980) believes that, focused on the study of unconscious or not quite conscious forms of motivation, is practically the only psychological method of penetrating into the most intimate area of the human psyche. If the majority of psychological techniques, E. T. Sokolova believes, are aimed at studying how and due to what the objective nature of a person’s reflection of the outside world is achieved, then projective techniques aim to identify peculiar “subjective deviations”, personal “interpretations”, and the latter far from always objective, not always, as a rule, personally significant.
It should be remembered that the range of projective techniques is much wider than the list of methodological techniques that are traditionally included in this group of techniques (V. M. Bleikher, L. I. Zavilyanskaya, 1970, 1976). Elements of projectivity can be found in most pathopsychological methods and techniques. Moreover, there is reason to believe that a conversation with the subject, directed in a special way, may contain elements of projectivity. In particular, this can be achieved by discussing with the patient certain life conflicts or works of art containing a deep subtext, phenomena of social life.
V. E. Renge (1976) analyzed the problems of projectivity in the aspect. At the same time, it was found that a number of methods (pictograms, a study of self-esteem, a level of claims, etc.) are based on stimulation that is ambiguous for the patient and does not limit the scope of the “choice” of answers. The possibility of obtaining a relatively large number of responses of the subject to a large extent depends on the characteristics of the conduct. An important factor in this is, according to V. E. Renge, the subject’s unawareness of the true goals of applying the techniques.
This circumstance, for example, was taken into account in the modification of the TAT method by H. K. Kiyashchenko (1965). According to our observations, the principle of projectivity is inherent in the classification technique to a large extent. In this regard, one should agree with V. E. Renge that there are no methods for studying only personal characteristics or only cognitive processes. The main role is played by the creation of the most favorable conditions for the actualization of the projectivity factor in the process of completing the task, which to a certain extent is determined not only by the knowledge and skill of the psychologist, but is also a special art.
Level of claims research
The concept was developed by psychologists of the school of K. Lewin. In particular, R. Norre's (1930) method of experimental study of the level of claims was created. The experiment found that the level of claims depends on how successfully the subject performs experimental tasks. V. N. Myasishchev (1935) distinguished two sides of the level of claims - the objective-principled and the subjective-personal. The latter is closely related to self-esteem, a sense of inferiority, a tendency to self-affirmation and the desire to see a decrease or increase in working capacity in terms of one's performance. The author pointed out that the ratio of these moments determines the level of claims of patients, especially with psychogenic diseases.
The level of claims is not an unambiguous, stable personal characteristic (B. V. Zeigarnik, 1969, 1972; V. S. Merlin, 1970). It is possible to distinguish the initial level of claims, which is determined by the degree of difficulty of tasks that a person considers feasible for himself, corresponding to his capabilities. Further, we can talk about the known dynamics of the level of claims in accordance with how the level of claims turned out to be adequate to the level of achievements. As a result of human activity (this also applies to the conditions of the experimental situation), finally, a certain level of claims typical of a given individual is established.
In shaping the level of claims, an important role is played by the compliance of the activity of the subject with his assumptions about the degree of complexity of the tasks, the fulfillment of which would bring him satisfaction. V. S. Merlin (1970) attached great importance to social factors, believing that in the same activity there are different social standards of achievement for different social categories, depending on the position, specialty, and qualifications of the individual. This factor also plays a certain role in the conditions of an experimental study of the level of claims - even the correct performance of experimental tasks with a certain self-assessment of the subject may not be perceived by him as successful. From this follows the principle of the importance of the selection of experimental tasks.
The nature of the subject's reaction to success or failure is primarily determined by how stable his self-esteem is. Analyzing the dynamics of the level of claims, V. S. Merlin found that the ease or difficulty of adapting a person to activity by changing the level of claims depends on the properties of temperament (anxiety, extra- or introversion, emotionality) and on such purely personal properties as the initial level claims, the adequacy or inadequacy of self-esteem, the degree of its stability, motives for self-affirmation.
In addition to self-assessment, in the dynamics of the level of claims, such moments as the attitude of the subject to the situation of the experiment and the researcher, the assessment of the activity of the subject by the experimenter, who registers success or failure during the experiment, the nature of experimental tasks, play a significant role.
In the laboratory of B. V. Zeigarnik, a version of the methodology for studying the level of claims was developed (B. I. Bezhanishvili, 1967). In front of the patient, two rows are laid out with the reverse side up 24 cards. In each row (from 1 to 12 and from 1a to 12a) the cards contain questions of increasing difficulty, for example:
1. Write 3 words starting with the letter "Sh".
but. Write 5 words starting with the letter "N". 3. Write the names of 5 cities starting with the letter "L".
3 a. Write 6 names starting with the letter "B". 10. Write the names of 5 writers starting with the letter "C". 10a. Write the names of 5 famous Soviet film actors starting with the letter "L". 12. Write the names of 7 French artists.
12a. Write the names of famous Russian artists with the letter "K".
The subject is informed that in each row the cards are arranged according to the increasing degree of task complexity, that in parallel in two rows there are cards of the same difficulty. Then he is offered, according to his abilities, to choose tasks of one or another complexity and complete them. The subject is warned that a certain time is allotted for each task, but they do not tell him what time. By turning on the stopwatch every time the subject takes a new card, the researcher, if desired, can tell the subject that he did not meet the allotted time and therefore the task is considered failed. This allows the researcher to artificially create "failure".
The experience is carefully recorded. Attention is drawn to how the level of the patient's claims corresponds to his capabilities (intellectual level, education) and how he reacts to success or failure.
Some patients, after successfully completing, for example, the third task, immediately take the 8th or 9th card, while others, on the contrary, are extremely careful - having correctly completed the task, they take a card either of the same degree of complexity or the next one. The same with failure - some subjects take a card of the same complexity or slightly less difficult, while others, having not completed the ninth task, go to the second or third, which indicates the extreme fragility of their level of claims. It is also possible that the patient's behavior is such that, despite failure, he continues to choose tasks that are more and more difficult. This indicates a lack of critical thinking.
N. K. Kalita (1971) found that the questions used in the variant of B. I. Bezhanishvili, aimed at identifying the general educational level, are difficult to rank. The degree of their difficulty is determined not only by the volume of life knowledge and the level of education of the subject, but also largely depends on the circle of his interests. In search of more objective criteria for establishing the degree of complexity of tasks, N.K. Kalita suggested using pictures that differ from each other in the number of elements. Here, the complexity criterion is the number of differences between the compared pictures. In addition, control examinations can establish the time spent by healthy people to complete tasks of varying degrees of complexity. Otherwise, the study of the level of claims in the modification of N.K. Kalita has not changed.
To conduct research, tasks of a different kind can also be used, in the selection of which one can relatively objectively establish their gradation in terms of complexity: Koos' cubes, one of the series of Raven's tables. For each of the tasks, it is necessary to select a parallel one, approximately equal in degree of difficulty.
The results of the study can be presented for greater clarity and facilitate their analysis in the form of a graph.
It is of interest to study the level of claims with the assessment of some quantitative indicators. Such a study may be important for an objective characterization of the degree of mental defect of the subject. An attempt to modify the methodology for studying the level of claims was made by V.K. Gerbachevsky (1969), who used all the subtests of the D. Wexler scale (WAIS) for this. However, the modification of V.K. Gerbachevsky seems to us difficult for pathopsychological research, and therefore we have somewhat modified the version of the Zeigarnik-Bezhanishvili technique. According to the instructions, the subject must choose 11 out of 24 cards containing questions of varying difficulty according to their abilities (of which the first 10 are taken into account). The response time is not regulated, that is, it is important to take into account the actual completion of tasks, however, the subject is advised to immediately say so if it is impossible to answer the question. Given the well-known increase in the difficulty of the questions contained in the cards, the answers are respectively evaluated in points, for example, the correct answer on the card No. 1 and No. 1a - 1 point, No. 2 and No. 2a - 2 points, No. 8 and No. 8a - 8 points etc. At the same time, just as according to V.K. Gerbachevsky, the value of the level of claims (total assessment of the selected cards) and the level of achievements (the sum of points scored) are determined. In addition, an average score is calculated that determines the trend of activity after a successful or unsuccessful response. For example, if the subject answered 7 out of 10 questions, the sum of points for the cards selected after a successful answer is calculated separately and divided by 7. Similarly, the average activity trend after 3 unsuccessful answers is determined. To assess the choice of cards after the last answer, the subject is offered an unaccounted 11th task.
The methodology for studying the level of claims, as practical experience shows, makes it possible to detect the personal characteristics of patients with schizophrenia, manic-depressive (circular) psychosis, epilepsy, cerebral atherosclerosis, and other organic brain lesions that occur with characterological changes.
The study of self-esteem by the method of T. Dembo - S. Ya. Rubinshtein
The technique was proposed by S. Ya. (1970) for research. It uses the technique of T. Dembo, with the help of which the subject's ideas about his happiness were discovered. S. Ya. Rubinshtein significantly changed this methodology, expanded it, introduced four reference scales instead of one (health, mental development, character and happiness). It should be noted that the use of a reference scale to characterize any personal property helps to identify the position of the subject much more than the use of alternative methods such as the polarity profile and the list of adjectives, when the subject is offered a set of definitions (confident - timid, healthy - sick) and asked to indicate his state (N. Hermann, 1967). In the method of T. Dembo - S. Ya. Rubinshtein, the subject is given the opportunity to determine his condition according to the scales chosen for self-assessment, taking into account a number of nuances that reflect the degree of severity of one or another personal property.
The technique is extremely simple. A vertical line is drawn on a sheet of paper, about which the subject is told that it means happiness, with the upper pole corresponding to a state of complete happiness, and the lower one occupied by the most unhappy people. The subject is asked to mark his place on this line with a line or a circle. The same vertical lines are drawn to express the patient's self-esteem on the scales of health, mental development, and character. Then they start a conversation with the patient, in which they find out his idea of \u200b\u200bhappiness and unhappiness, health and ill health, good and bad character, etc. It turns out why the patient made a mark in a certain place on the scale to indicate his characteristics. For example, what prompted him to put a mark in this place on the health scale, whether he considers himself healthy or sick, if sick, with what disease, whom does he consider sick.
A peculiar version of the technique is described by T. M. Gabriel (1972) using each of the scales with seven categories, for example: the most sick, very sick, more or less sick, moderately sick, more or less healthy, very healthy, most healthy. The use of scales with such gradation, according to the author's observation, provides more subtle differences in identifying the position of the subjects.
Depending on the specific task facing the researcher, other scales can be introduced into the methodology. So, when examining patients with alcoholism, we use scales of mood, family well-being and service achievements. When examining patients in a depressed state, scales of mood, ideas about the future (optimistic or pessimistic), anxiety, self-confidence, etc. are introduced.
In the analysis of the obtained results, S. Ya. Rubinshtein focuses not so much on the location of the marks on the scales as on the discussion of these marks. Mentally healthy people, according to the observations of S. Ya. Rubinshtein, tend to determine their place on all scales with a point “slightly above the middle”. In mental patients, there is a tendency to refer the points of marks to the poles of the lines and the “positional” attitude towards the researcher disappears, which, according to S. Ya. .
The data obtained using this technique are of particular interest when compared with the results of the examination in this patient of the features of thinking and the emotional-volitional sphere. At the same time, a violation of self-criticism, depressive self-esteem, and euphoria can be detected. Comparison of data on self-esteem with objective indicators for a number of experimental psychological techniques to a certain extent allows us to judge the patient's inherent level of claims, the degree of its adequacy. One might think that self-esteem in some mental illnesses does not remain constant and its nature depends not only on the specificity of psychopathological manifestations, but also on the stage of the disease.
Eysenck personality questionnaire
Personal is a variant created by the author (H. J. Eysenck, 1964) in the process of reworking the Maudsley questionnaire proposed by him (1952) and, like the previous one, is aimed at studying the factors of extra- and introversion, neuroticism.
The concepts of extra- and introversion were introduced by representatives of the psychoanalytic school.
S. Jung distinguished between extra- and introverted rational (thinking and emotional) and irrational (sensory and intuitive) psychological types. According to K. Leonhard (1970), the criteria for distinguishing S. Jung were mainly reduced to the subjectivity and objectivity of thinking. N. J. Eysenck (1964) connects extra- and introversion with the degree of excitation and inhibition in the central nervous system, considering this factor, which is largely innate, as a result of the balance of the processes of excitation and inhibition. In this case, a special role is given to the influence of the state of the reticular formation on the ratio of the main nervous processes. H. J. Eysenck also points to the importance of biological factors in this: some drugs introvert a person, while antidepressants extrovert him. Typical extrovert and introvert are considered by H. J. Eysenck as individuals - the opposite edges of the continuum, to which different people approach in one way or another.
According to H. J. Eysenck, an extrovert is sociable, likes parties, has many friends, needs people to talk to them, does not like to read and study himself. He craves excitement, takes risks, acts under the influence of the moment, impulsive.
An extrovert loves tricky jokes, does not go into his pocket for a word, usually loves change. He is carefree, good-naturedly cheerful, optimistic, likes to laugh, prefers movement and action, tends to be aggressive, quick-tempered. His emotions and feelings are not strictly controlled, and he cannot always be relied upon.
In contrast to the extrovert, the introvert is calm, shy, introspective. He prefers reading books to communicating with people. Restrained and distant from everyone except close friends. Plans his actions in advance. Distrusts sudden urges. Serious about making decisions, likes everything in order. Controls his feelings, rarely acts aggressively, does not lose his temper. You can rely on an introvert. He is somewhat pessimistic, highly values ethical standards.
N. J. Eysenck himself believes that the characteristic of the intro- and extrovert described by him only resembles that described by S. Jung, but is not identical to it. K. Leonhard believed that the description of H. J. Eysenck as an extrovert corresponds to the picture of a hypomanic state and believes that the extra- and introversion factor cannot be associated with temperamental traits. According to K. Leonhard, the concepts of intro- and extraversion represent their own mental sphere, and for the extravert, the world of sensations has a determining influence, and for the introvert, the world of ideas, so that one is stimulated and controlled more from the outside, and the other more from the inside.
It should be noted that the point of view of K. Leonhard largely corresponds to the views of V. N. Myasishchev (1926), who defined these personality types from the clinical and psychological point of view as expansive and impressive, and from the neurophysiological side - excitable and inhibited.
J. Gray (1968) raises the question of the identity of the parameters of the strength of the nervous system and intro- and extraversion, and the pole of weakness of the nervous system corresponds to the pole of introversion. At the same time, J. Gray considers the parameter of the strength of the nervous system in terms of activation levels - he considers a weak nervous system as a system of a higher level of reaction compared to a strong nervous system, provided that they are subjected to objectively identical physical stimuli.
J. Strelau (1970) found that extraversion is positively related to the strength of the excitation process and the mobility of nervous processes. At the same time, there is no connection between extraversion and the force of inhibition (in the typology of I.P. Pavlov, the force of inhibition is set exclusively for conditioned inhibition, in the concept of J. Strelau we are talking about “temporary” inhibition, consisting of conditioned and protective, that is, from two different types of braking). All three properties of the nervous system (strength of excitation, strength of inhibition and mobility of nervous processes), according to J. Strelau, are negatively associated with the parameter of neuroticism. All this testifies to the illegitimacy of comparing the personality typology according to N. J. Eysenck with the types of higher nervous activity according to IP Pavlov.
The factor of neuroticism (or neuroticism) testifies, according to H. J. Eysenck, to emotional and psychological stability and instability, stability - instability and is considered in connection with the congenital lability of the autonomic nervous system. In this scale of personality traits, opposite tendencies are expressed by discordance and concordance. At the same time, a person of the “external norm” turns out to be at one pole, behind which lies the susceptibility to all kinds of psychological perturbations, leading to an imbalance in neuropsychic activity. At the other extreme are individuals who are psychologically stable and adapt well to the surrounding social microenvironment.
The neuroticism factor plays an extremely important role in the diathesis-stress hypothesis of the etiopathogenesis of neuroses created by N. J. Eysenck, according to which neurosis is considered as a consequence of a constellation of stress and a predisposition to neurosis. Neuroticism reflects a predisposition to neurosis, a predisposition. With severe neuroticism, according to N. J. Eysenck, a slight stress is sufficient, and, conversely, with a low rate of neuroticism, severe stress is required for the onset of neurosis to develop neurosis.
In addition, a control scale (lie scale) was introduced into the Eysenck questionnaire. It serves to identify subjects with a "desirable reactive set", that is, with a tendency to respond to questions in such a way that the results desired for the subject are obtained.
The questionnaire was developed in 2 parallel forms (A and B), allowing for a second study after any experimental procedures. Questions compared to MMPI differ in simplicity of wording. It is important that the correlation between the scales of extraversion and neuroticism is reduced to zero.
The questionnaire consists of 57 questions, of which 24 are on the extraversion scale, 24 are on the neuroticism scale, and 9 are on the lie scale.
The study is preceded by an instruction that indicates that personality traits are being investigated, and not mental abilities. It is proposed to answer the questions without hesitation, immediately, since the first reaction of the subject to the question is important. Questions can only be answered with “yes” or “no” and cannot be skipped.
Then questions are presented either in a special notebook (this facilitates assessment, as it allows the use of a key in the form of a stencil with specially cut windows), or printed on cards with appropriately cut corners (for subsequent recording).
Here are some typical questions.
So, the following questions testify to extroversion (the corresponding answer is noted in brackets; if the answer is opposite, it is counted as an indicator of introversion):
Do you like the revival and bustle around you? (Yes).
Are you one of those people who do not go into their pocket for words? (Yes).
Do you usually keep a low profile at parties or in companies? (Not).
Do you prefer to work alone? (Not).
The maximum score on the extraversion scale in this version of the Eysenck questionnaire was 24 points. Extraversion is indicated by an indicator above 12 points. With an indicator below 12 points, they speak of introversion.
Questions typical of the neuroticism scale:
Do you feel sometimes happy and sometimes sad for no reason? (On the scale of neuroticism, only positive responses are taken into account).
Do you sometimes have a bad mood?
Are you easily swayed by mood swings?
Have you often lost sleep due to feelings of anxiety?
Neuroticism is indicated by an indicator exceeding 12 points in this scale.
Examples of questions on the lie scale:
Do you always do immediately and resignedly what you are ordered to do? (Yes).
Do you sometimes laugh at indecent jokes? (Not).
Do you brag sometimes? (Not).
Do you always reply to emails immediately after reading them? (Yes).
An indicator of 4-5 points on the lie scale is already considered critical. A high score on this scale indicates the subject's tendency to give "good" answers. This trend also manifests itself in answers to questions on other scales, however, the lie scale was conceived as a kind of indicator of demonstrativeness in the behavior of the subject.
It should be noted that the scale of lies in the Eysenck questionnaire does not always contribute to the solution of the task. The indicators for it primarily correlate with the intellectual level of the subject. Often, persons with pronounced hysterical traits and a tendency to demonstrative behavior, but with good intelligence, immediately determine the direction of the questions contained in this scale and, considering them negatively characterizing the subject, give the minimum indicators on this scale. Thus, obviously, the scale of lies is more indicative of personal primitiveness than demonstrativeness in the answers.
According to H. J. Eysenck (1964, 1968), dysthymic symptoms are observed in introverts, hysterical and psychopathic in extroverts. Patients with neurosis differ only in the index of extraversion. According to the index of neuroticism, healthy and neurotic patients (psychopaths) are at the extreme poles. Patients with schizophrenia have a low rate of neuroticism, while patients in a depressed state have a high rate. With age, there was a tendency to decrease in the indicators of neuroticism and extraversion.
These data of H. J. Eysenck need to be clarified. In particular, in cases of psychopathy, the study using a questionnaire reveals a known difference in indicators. So, schizoid and psychasthenic psychopaths, according to our observations, often show introversion. Different forms of neurosis also differ not only in terms of extraversion. Patients with hysteria are often characterized by a high rate of lies and an exaggeratedly high rate of neuroticism, often not corresponding to an objectively observed clinical picture.
In the latest versions of the Eysenck questionnaire (1968, 1975), questions were introduced on the scale of psychotism. The factor of psychotism is understood as a tendency to deviations from the mental norm, as it were, a predisposition to psychosis. The total number of questions is from 78 to 101. According to S. Eysenck and H. J. Eysenck (1969), the indicators on the psychotism scale depend on the gender and age of the subjects, they are lower in women, higher in adolescents and the elderly. They also depend on the socio-economic status of the surveyed. However, the most significant difference in the factor of psychotism turned out to be when comparing healthy subjects with sick psychoses, that is, with more severe neuroses, as well as with persons in prison.
There is also a personal questionnaire S. Eysenck (1965), adapted to examine children from the age of 7. It contains 60 age-appropriate questions interpreted on scales of extra- and introversion, neuroticism, and lying.
Questionnaire of the level of subjective control (USK) (E. F. Bazhin, E. A Golynkina, A. M. Etkind, 1993)
The technique is an original domestic adaptation of the J. Rotter locus of control scale, created in the USA in the 60s.
The theoretical basis of the methodology is the position that one of the most important psychological characteristics of a person is the degree of independence, autonomy and activity of a person in achieving goals, the development of a sense of personal responsibility for the events happening to him. Proceeding from this, there are persons who localize control over events that are significant for themselves outside (an external type of control), that is, they believe that the events occurring to them are the result of external forces - chance, other people, etc., and persons who have an internal localization of control (internal type of control) - such people explain significant events as the result of their own activities.
In contrast to the concept of J., who postulated the universality of the individual's locus of control in relation to any types of events and situations that he has to face, the authors of the USC methodology, based on the results of numerous experimental studies, showed the insufficiency and unacceptability of transsituational views on the locus of control. They proposed measuring the locus of control as a multidimensional profile, the components of which are tied to the types of social situations of varying degrees of generalization. Therefore, several scales are distinguished in the methodology - the general internality of Io, the internality in the field of achievements Id, the internality in the field of failures Ying, the internality in family relations Is, the internality in the field of industrial relations Ip, the internality in the field of interpersonal relations Im and the internality in relation to health and illness From .
The methodology consists of 44 statements, for each of which the subject must choose one of the 6 proposed answers (completely disagree, disagree, rather disagree, rather agree, agree, completely agree). For ease of processing, it is advisable to use special forms. The processing of the methodology consists in calculating the raw scores using the keys and then transferring them to the walls (from 1 to 10).
Here is the content of individual statements of the methodology:
1. Promotion depends more on luck than on a person's own abilities and efforts.
8. I often feel like I have little influence on what happens to me.
21. The life of most people depends on a combination of circumstances.
27. If I really want, I can win over almost anyone.
42. Capable people who failed to realize their potential should only blame themselves for this.
The technique is extremely widely used for solving a wide variety of practical problems in psychology, medicine, pedagogy, etc. It is shown that internals prefer non-directive methods of psychotherapy, while externals prefer directive ones (S. V. Abramowicz, SI Abramowicz, N. B. Robak , S. Jackson, 1971); a positive correlation of externality with anxiety was found (E. S. Butterfield, 1964; D. S. Strassberg, 1973); with mental illness, in particular, with schizophrenia (R. L. Cromwell, D. Rosenthal, D. Schacow, T. P. Zahn., 1968; T. J. Lottman, A. S. DeWolfe, 1972) and depression (S. I. Abramowicz, 1969); there are indications of a relationship between the severity of symptoms and the severity of externality (J. Shibut, 1968) and suicidal tendencies (C. Williams, J. B. Nickels, 1969), etc.
E. G. Ksenofontova (1999) developed a new version of the USK methodology, which simplifies the study for the subjects (alternative answers such as "yes" - "no" are assumed) and introduces a number of new scales ("Predisposition to self-blame") and subscales (" Internality in describing personal experience”, “Internality in judgments about life in general”, “Readiness for activities related to overcoming difficulties”, “Readiness for independent planning, implementation of activities and responsibility for it”, “Negation of activity”, “Professional and social aspect of internality”, “Professional and procedural aspect of internality”, “Competence in the field of interpersonal relations”, “Responsibility in the field of interpersonal relations”).
Methods of psychological diagnostics of the life style index (LIS)
The first Russian-language method for diagnosing types of psychological defense was adapted in the Russian Federation by employees of the laboratory of medical psychology of the V. M. Bekhterev Psychoneurological Institute (St. Petersburg) under the guidance of L. I. Wasserman (E. B. Klubova, O. F. Eryshev, N. N. Petrova, I. G. Bespalko and others) and published in 1998.
The theoretical basis of the technique is the concept of R. Plu-check -X. Kellerman, which suggests a specific network of relationships between different levels of personality: the level of emotions, protection and disposition (that is, a hereditary predisposition to mental illness). Certain defense mechanisms are designed to regulate certain emotions. There are eight main defense mechanisms (denial, repression, regression, compensation, projection, substitution, intellectualization, reactive formations) that interact with eight basic emotions (acceptance, anger, surprise, sadness, disgust, fear, expectation, joy). Defense mechanisms exhibit qualities of both polarity and similarity. The main diagnostic types are formed by their characteristic styles of defense, a person can use any combination of defense mechanisms, all defenses basically have a suppression mechanism that originally arose in order to defeat the feeling of fear.
Questionnaire for the study of accentuated personality traits
The questionnaire for the study of accentuated personality traits was developed by N. Schmieschek (1970) based on the concept of accentuated personalities by K. Leonhard (1964, 1968). According to it, there are personality traits (accentuated), which in themselves are not yet pathological, but can, under certain conditions, develop in positive and negative directions. These features are, as it were, a sharpening of some unique, individual properties inherent in each person, an extreme version of the norm. In psychopaths, these traits are especially pronounced. According to the observations of K. Leonhard, neuroses, as a rule, occur in accentuated individuals. E. Ya. Sternberg (1970) draws an analogy between the concepts of "accentuated personality" by K. Leonhard and "schizothymia" by E. Kretschmer. Identification of a group of accentuated personalities can be fruitful for developing clinical and etiopathogenesis issues in borderline psychiatry, including the study of somatopsychic correlates in some somatic diseases, in the origin of which the personality characteristics of the patient play a prominent role. According to E. Ya. Sternberg, the concept of accentuated personalities can also be useful for studying the personality traits of relatives of mentally ill people.
K. Leonhard singled out 10 main ones:
1. Hyperthymic personalities, characterized by a tendency to high mood.
2. "Stuck" personalities - with a tendency to delay, "stuck" affect and delusional (paranoid) reactions.
3. Emotive, affective-labile personalities.
4. Pedantic personality, with a predominance of features of rigidity, low mobility of nervous processes, pedantry.
5. Anxious personalities, with a predominance of anxiety traits in the character.
6. Cyclothymic personalities, with a tendency to phase mood swings.
7. Demonstrative personalities - with hysterical character traits.
8. Excitable personalities - with a tendency to increased, impulsive reactivity in the sphere of inclinations.
9. Dysthymic personality - with a tendency to mood disorders, subdepressive.
10. Exalted personalities prone to affective exaltation.
All these groups of accentuated personalities are united by K. Leonhard according to the principle of accentuation of character traits or temperament. The accentuation of character traits, “features of aspirations” include demonstrativeness (in pathology - psychopathy of a hysterical circle), pedantry (in pathology - anankastic psychopathy), a tendency to “get stuck” (in pathology - paranoid psychopaths) and excitability (in pathology - epileptoid psychopaths) . The remaining types of accentuation K. Leonhard refers to the features of temperament, they reflect the pace and depth of affective reactions.
The Shmishek questionnaire consists of 88 questions. Here are typical questions:
To identify:
Are you enterprising? (Yes).
Can you entertain society, be the soul of the company? (Yes).
To identify a tendency to "get stuck":
Do you vigorously defend your interests when injustice is done to you? (Yes).
Do you stand up for people who have been treated injustice? (Yes).
Do you persist in achieving your goal if there are many obstacles along the way? (Yes).
To identify pedantry:
Do you have doubts about the quality of its execution after the completion of some work and do you resort to checking whether everything was done correctly? (Yes).
Does it annoy you if the curtain or tablecloth hangs unevenly, do you try to fix it? (Yes).
To identify anxiety:
Were you afraid of thunderstorms and dogs in your childhood? (Yes).
Are you bothered by the need to descend into a dark cellar, to enter an empty unlit room? (Yes).
To detect cyclothymism:
Do you have transitions from a cheerful mood to a very dreary one? (Yes).
Does it happen to you that, going to bed in an excellent mood, in the morning you get up in a bad mood, which lasts for several hours? (Yes).
To identify demonstrativeness:
Have you ever sobbed while experiencing a severe nervous shock? (Yes).
Were you willing to recite poems at school? (Yes).
Do you find it difficult to speak on stage or from the pulpit in front of a large audience? (Not).
To detect excitability:
Do you get angry easily? (Yes).
Can you use your hands when you're angry with someone? (Yes).
Do you do sudden, impulsive acts while under the influence of alcohol? (Yes).
To identify dysthymia:
Are you capable of being playfully cheerful? (Not).
Do you like being in society? (Not). To identify exaltation:
Do you have states when you are filled with happiness? (Yes).
Can you fall into despair under the influence of disappointment? (Yes).
Answers to questions are entered into the registration sheet, and then, using specially prepared keys, an indicator is calculated for each type of personal accentuation. The use of appropriate coefficients makes these indicators comparable. The maximum score for each type of accentuation is 24 points. A sign of accentuation is an indicator that exceeds 12 points. The results can be expressed graphically as a personality accentuation profile. You can also calculate the average accentuation index, equal to the quotient of dividing the sum of all indicators for individual types of accentuation by 10. Shmishek's technique was also adapted for the study of children and adolescents, taking into account their age characteristics and interests (I. V. Kruk, 1975).
One of the options for the Shmishek questionnaire is the Littmann-Shmishek questionnaire (E. Littmann, K. G. Schmieschek, 1982). It includes 9 scales from the Shmishek questionnaire (exaltation scale is excluded) with the addition of extra-introversion and sincerity (lie) scales according to H. J. Eysenck. This questionnaire was adapted and standardized by us (V. M. Bleikher, N. B. Feldman, 1985). The questionnaire consists of 114 questions. The responses are evaluated using special coefficients. The results on individual scales from 1 to 6 points are considered as the norm, 7 points - as a tendency to accentuation, 8 points - as a manifestation of a clear personal accentuation.
To determine the reliability of the results, their reliability in a statistically significant group of patients, the examination was carried out according to a questionnaire and with the help of standards - maps containing a list of the main features of types of accentuation. The selection of standards was made by people close to the patient. In this case, a match was found in 95% of cases. This result indicates sufficient accuracy of the questionnaire.
The total number of accentuated personalities among healthy subjects was 39%. According to K. Leonhard, accentuation is observed in about half of healthy people.
According to a study of healthy people by the twin method (V. M. Bleikher, N. B. Feldman, 1986), a significant heritability of types of personal accentuation, their significant genetic determinism, was found.
Toronto alexithymic scale
The term "alexithymia" was introduced in 1972 by P. E. Sifheos to refer to certain personal characteristics of patients with psychosomatic disorders - the difficulty of finding suitable words to describe one's own feelings, impoverishment of fantasy, a utilitarian way of thinking, a tendency to use actions in conflict and stressful situations. In a literal translation, the term "alexithymia" means: "there are no words for feelings." In the future, this term took a strong position in the specialized literature, and the concept of alexithymia became widespread and creatively developed.
J. Ruesch (1948), P. Marty and de M. M "Uzan (1963) found that patients suffering from classic psychosomatic diseases often show difficulties in verbal and symbolic expression of emotions. Currently, alexithymia is determined by the following cognitive-affective psychological features:
1) difficulty in defining (identifying) and describing one's own feelings;
2) difficulty in distinguishing between feelings and bodily sensations;
3) a decrease in the ability to symbolize (poverty of fantasy and other manifestations, imagination);
4) focusing more on external events than on internal experiences.
As clinical experience shows, in most patients with psychosomatic disorders, alexithymic manifestations are irreversible, despite long-term and intensive psychotherapy.
In addition to patients with psychosomatic disorders, alexithymia can also occur in healthy people.
Of the numerous methods for measuring alexithymia in the Russian-speaking population, only one has been adapted - the Toronto alexithymia scale
(Psycho-Neurological Institute named after V. M. Bekhterev, 1994). It was created by G. J. Taylor et al. in 1985 using a concept-driven, factorial approach. In its modern form, the scale consists of 26 statements, with the help of which the subject can characterize himself, using five gradations of answers: “completely disagree”, “rather disagree”, “neither, nor the other”, “rather agree”, “completely agree”. ". Examples of scale statements:
1. When I cry, I always know why.
8. I find it difficult to find the right words for my feelings.
18. I rarely dream.
21. It is very important to be able to understand emotions.
In the course of the study, the subject is asked to choose for each of the statements the most appropriate answer for him; in this case, the numerical designation of the answer is the number of points scored by the subject on this statement in the case of the so-called positive points of the scale. The scale also contains 10 negative points; to obtain a final score in points for which the opposite score should be given for these items, held in a negative way: for example, score 1 gets 5 points, 2-4, 3-3, 4-2, 5-1. The total sum of positive and negative points is calculated.
According to the staff of the Psychoneurological Institute. V. M. Bekhtereva (D. B. Eresko, G. L. Isurina, E. V. Kaidanovskaya, B. D. Karvasarsky et al., 1994), who adapted the methodology in Russian, healthy individuals have indicators for this method of 59.3 ±1.3 points. Patients with psychosomatic diseases (patients with hypertension, bronchial asthma, peptic ulcer) had an average score of 72.09±0.82, and no significant differences were found within this group. Patients with neurosis (obsessive-phobic neurosis) had a score on a scale of 70.1±1.3, not significantly different from the group of patients with psychosomatic diseases. Thus, using the Toronto alexithymic scale, one can only diagnose a "combined" group of neuroses and; its differentiation requires further targeted clinical and psychological research.
