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As part of the pathopsychological experiment, the study of disturbed mental processes and personality takes place in specially created conditions that ensure the maximum manifestation of existing disorders. The pathopsychological experiment is carried out with the help of specific methods for studying mental functions - experimental psychological methods. A variety of experimental psychological techniques, tested by many years of practice in the clinic, are described in the works of S. Ya. Rubinshtein (1970), B. V. Zeigarnik (1986), Yu. F. Polyakov (1974).
When organizing a pathopsychological experiment, several rules:
- the experiment should simulate the mental activity carried out by a person in work, study, communication;
- in the experiment, it is necessary to discover the structure of not only disturbed, but also remaining intact forms of mental activity;
- the design of experimental techniques should take into account the possibility of finding solutions by the patient himself, and also allow the pathopsychologist to intervene in the patient's activities to find out how the patient perceives the help of the experimenter and whether he can use it; experimental psychological techniques should be aimed at revealing the qualitative characteristics of mental disorders;
- the results of experimental psychological research must be recorded accurately and objectively.
Pathopsychological experiment should be built in such a way as to actualize not only the mental activity of the patient, but also his personal attitude to the experiment. When conducting an examination, it is necessary to take into account the patient's attitude to work, his motives and goals, attitude towards himself, towards the result of work, interest, etc., since judgments, actions, deeds are not a direct reaction to external stimuli, but are mediated by his attitudes , motives, needs, in the words of S. L. Rubinshtein - “internal conditions”. For the pathopsychologist, it is important not only how difficult and large the task was and how the patient completed it, but also how he comprehended it, what caused the errors and difficulties. Not only the number of errors and difficulties in the process of implementing the methods, but mainly the structure and their analysis provide the most interesting and indicative material for assessing certain features and disorders of the mental activity of patients.
The accuracy and objectivity of the results obtained in the process of experimental psychological research are ensured by careful recording of data and their verification in repeated experiments, as well as in research by other methods. The pathopsychological examination is characterized by the use of a large number of a wide variety of methodological techniques, since only a comparison of the results various methods allows you to fairly objectively judge the nature, depth, quality and dynamics of mental disorders of the patient.
Pathopsychological examination is always scientific research, since, firstly, it is a process of cognition, secondly, it is built on strictly scientific principles, and thirdly, the results of the survey reveal facts from which the formulations of general psychological laws, patterns and mechanisms follow.
A special version of the pathopsychological experiment is aimed at obtaining data that can be used to influence the patient's personality. In this case, the task of the pathopsychologist is to show the patient the ways of possible compensation for his mental disorders and their reduction as the treatment proceeds. In this case, the pathopsychologist works in close contact with the attending physician and psychotherapist, coordinating his actions with them, and also takes an active part in the development and justification of rehabilitation and psychoprophylactic programs.
The construction of an experimental psychological examination in the clinic is distinguished by its diversity, a large number of methods used. This is necessary, since the process of disintegration of the psyche does not take place in one layer, it practically never happens that only one mental process is disturbed in a patient. The variety of methods used allows us to identify a variety of violations and understand their relationship. In addition, since the course of the experiment may change in an experiment with a patient, it is necessary to compare the data obtained by different methods when interpreting the results.
The program of the study of the patient in the clinic cannot be standard, since it depends on the clinical task and the characteristics of the patient.
For example, when differential diagnosis schizophrenia from similar conditions, the main attention is drawn to the study of thought disorders. At the same time, the methods “Classification of objects”, “Pictogram”, etc. are selected for examination. .
Particular attention should be paid to the selection of methods for the pathopsychological examination of the child. In this case, the choice is determined by the age of the child, the level of his intellectual development, the presence or absence of speech, motor or sensory impairments.
The main experimental psychological methods are described by S. Ya. Rubinshtein in her work “Experimental methods of pathopsychology and experience in their application in the clinic” (1970).
Among them, such methods as “Kohs Cubes”, “Exclusion of Objects”, “Sequence of Events”, “Indirect Memorization according to Leontiev”, “Pictogram”, etc. have gained particular popularity. Many methods have modifications for different age groups, some of them are adapted for persons with violations of analyzers.
It should be borne in mind that with the help of each of the experimental methods, material can be obtained that makes it possible to judge various features of the psyche. For example, with the help of the "Pictogram" you can explore memory, abstract thinking, personality traits. There are few methods aimed at studying only one process. This is very important to consider when selecting tasks for examining a particular patient.
The pathopsychologist is obliged to master all experimental psychological methods, since they are the main methods for studying disturbed mental activity.
Psychopathological research necessarily includes a conversation with the patient.
The problem of method in science is neither simple nor monosyllabic. On the one hand, the research methods used depend on the level of development of science, on those fundamental provisions, theoretical, methodological guidelines on which this field of knowledge is based. The very development of a particular field of knowledge depends to a certain extent on the research methods used. On the other hand, an experimental study, including pathopsychological, the choice of experimental techniques depends on the task that the clinic sets for it (differential diagnostic, psychocorrectional, expert, etc.).
A pathopsychological study includes a number of components: an experiment, a conversation with a patient, observation of the patient's behavior during the study, analysis of the life history of a sick person (which is a professionally written medical history by a doctor), comparison of experimental data with a life history. It is extremely important (although due to objective circumstances this is not always possible) to conduct research in dynamics, i.e. in a year or two.
Pathopsychological experiment
Consider the principles of constructing a pathopsychological experiment. In order to understand its features, it is necessary to dwell in a few words on the research methods general psychology. The method of experiment is not the only way of knowledge in psychology. It became dominant but as psychology developed as an exact science in connection with its general theoretical provisions and application in practice.
As is known, the attention of rationalist psychologists was directed to the differentiation in the human psyche of individual "spiritual abilities", each of which processes material received from outside in its own way. Psychology was reduced to a description of the work of these abilities.
The speculative description of the inner world of man was reflected not only by rationalist psychologists. It found its place among the representatives of the so-called "understanding" psychology (E. Spranger, W. Dilthey). Denying the splitting of the psyche into separate processes or functions, recognizing the indivisibility, unity of the psyche, representatives of this trend abandon the scientific study of the psyche, believing that if nature can be explained, then the psyche can only be understood. These provisions of "understanding" psychology are reflected in the concept of existentialist psychologists.
In practice, this means that the psychologist must confine himself to observing the behavior of the subject, registering his statements and self-observation and renounce the experiment, the possibility of changing the conditions and activities on which the course of this or that process depends. Essentially, the existentialist psychologist seeks to describe the phenomenon, but not to penetrate into its essence.
The empirical psychology that replaced rationalistic psychology brought with it a different understanding of the method of research. With the development of empirical psychology, the development of psychophysiology, the experimental method began to be introduced into psychology (W. Wundt, G. Ebbinghaus, E. Titchener).
However, some provisions, especially Wundt's, which made a great contribution to psychology, at the same time contributed to the fact that the psyche was divided into separate functions - "shelves" of memory, attention, perception, etc. and psychological research was reduced to the study of these separate functions. The study of these functions should be reduced to their measurement.
As indicated in the previous chapter, the method of experimentation is beginning to permeate psychiatry and neurology. In this regard, it is interesting to note that already in 1896, A. A. Tokarsky wrote in "Notes of the Psychological Laboratory of the Psychiatric Clinic of Moscow University" about the need for experiment and the insufficiency of the method of observation: "Observation is the study of a phenomenon under the conditions under which it arises independently due to the fact that the conditions under which a phenomenon occurs, as well as the accompanying circumstances, can change due to natural causes, it is possible, by repeating observations of the same phenomenon at different moments, to establish the existence some facts with a sufficient degree of certainty. However, in order for the knowledge of a phenomenon to become undoubted, its verification and proof are required. For this, experience or experiment is used. An experiment is an artificial change in the conditions of observation in order to determine the relationship between the phenomenon and the conditions for its occurrence. This is primarily the very fact of the existence of a phenomenon, which was previously discovered by simple observation, is called, then the relation of the phenomenon to its conditions, causes or accompanying circumstances is determined. Thus, experiment is only a test of observation. This is not, therefore, observation under artificially changed conditions, as is often said, but it is precisely a change in conditions, after which observation begins again, which, being carried out under conditions changed by experiment, nevertheless remains observation.
Thus, scientific data are based on the results of observation verified by experiment. To study a phenomenon means to determine its constituent parts, its general properties and characteristic features, the causes that cause it, and the consequences conditioned by it, therefore, to bring it into full connection with the rest, already verified facts. This task cannot always be fulfilled at the present time, on the one hand, due to the lack of accurately verified facts, and on the other hand, due to the complexity of the phenomena. In order for the obtained private facts to be supplemented later, so that they constitute scientific material, it is necessary to carry out these observations and experiments according to a strict method, which will make it possible to repeat and verify them by other persons.
Therefore, in psychology, as in other sciences, experiment is of decisive importance: only through experiment does psychology become a science, and only through experiment can it free itself from sterile and arbitrary hypotheses. It follows from this that the separation of experimental psychology as a special science, in contrast to the psychology of the so-called physiological, empirical, intuitive, etc., has no basis. Psychology as a science is one, uses all the methods of natural science, and only the data obtained with the help of these methods can be of value to it. From the fact that some facts of mental life are known only by self-observation, or that some facts are closely connected with the facts studied by other branches of natural science - biology, physiology, chemistry, etc., it by no means follows that these facts can be the content of a separate science and that it is necessary to distinguish between chemical, physical, physiological psychology. This only leads to a misunderstanding, which is expressed in the assumption that each of these sciences is concerned with the study of special events, for example, that psychology studies the higher properties of the spirit, physiology - the lower properties associated with animal functions, which, in the end, is only an obstacle to the correct elucidation of the significance of the method in science and, therefore, hinders scientific research.
“The immediate task of psychology is to study the mental content, to decompose it into its constituent elements, to determine the connection between these elements and the relations that exist between the phenomena of the external world and mental phenomena.
Mental content consists of sensations, perceptions, ideas, concepts, associative combinations of these quantities, sensations and feelings, actions due to the sum of those that are present in this moment motor impulses.
We have the opportunity to study by experiment sensations, perceptions, representations and their relationship to external influences, the laws of memory and the connection of representations, the degree and quality of reproductions in their relation to initial perceptions, the conditions for the emergence of attention, its fluctuations, some manifestations of unconscious brain activity, automatic acts , the phenomena of suggestion, which make it possible to observe the most complex manifestations of mental activity. Further, by observing the action of poisons on the mentally ill, we have the opportunity to verify and establish certain general facts of mental life, which appear uniformly under certain conditions, and certain peculiar changes in normal mental activity.
In this way, actually tested material of psychology is formed. Individual self-observation data can be a significant aid in the analysis mental phenomena, representing a certain fact of mental life. However, the significance of this fact does not rise above the significance of a single observation, and in those cases where self-observation does not allow verification, which still happens so often in relation to many aspects of mental life, mainly in relation to feelings and very complex reproductions, even the factual reliability of self-observation may remain doubtful.
Errors of self-observation are common to all people without exception, and, unfortunately, there is no way to say that self-observation of, say, Kant or Goethe is more reliable than the self-observation of a commoner. It is more complex and only, but if it refers to a phenomenon that cannot be reproduced or verified, it cannot and should not be taken as a real fact of mental life that took place in the form as it is described to us, especially since for a correct representation complex mental states, a person does not always have enough money.
Thus, the most complex phenomena of mental life escape our analysis and verification; they remain, however, in the sphere of science, being constantly the goal of its aspirations, and our impotence at the present moment to solve the most complex problems of psychology only testifies to the greatness of this science and further confirms the need for strict methodical research in order to systematically expand the field of positive knowledge.
Methods of psychological research, depending on the indicated mental quantities, are divided into the following:
- 1. Methods for the analysis of sensations.
- 2. Methods of analysis of perception.
- 3. Methods for measuring the time of mental processes.
- 4. Methods for analyzing reproductions:
- a) simple reproductions;
- b) complex representations.
- 5. Methods of analysis of complex mental acts.
The most fruitful research is possible only in relation to those mental phenomena that are characterized by a more definite dependence on external objects with which our mental activity is connected - with sensations, perceptions, ideas, concepts and their combination, in a word, with that part of the mental content that called the intellectual realm. As for the mood, feelings, drives, they have a much more changeable character, highly dependent on subtle internal changes.
Thus, already at the end of the XIX century. the best representatives of our science came to the conclusion about the need for an experimental study of mental phenomena (even if it was within the framework of functional psychology).
The need for experimental research became especially evident at the beginning of the 20th century. Thus, the well-known representative of Gestalt psychology, K. Levin, insisted that the development of psychology should not follow the path of collecting empirical facts (the path that American psychology is now taking), but that theory is decisive in science, which must be confirmed by experiment. Not from experiment to theory, but from theory to experiment - the general path of scientific analysis. Any science is aimed at finding patterns - psychology should also strive to find psychological patterns. Kurt Lewin emphasized this point. He said that the task of psychological science should not only be the establishment of laws, but the prediction of individual phenomena (in Lewin's terminology "events") on the basis of the law. But they are predictable only in the presence of a reliable theory. The criterion of scientific reliability is not the repetition of single facts, but on the contrary, single facts must confirm the theory. K. Levin called this approach to the object of psychological science "the transition from Aristotelian thinking to Galilean thinking."
Levin pointed out that Aristotle's thinking was characterized by the assertion that the world is heterogeneous, that each phenomenon has its own immanent regularity: smoke rises because it is light; the stone falls down because it is heavy. Galileo established that the world is homogeneous. Every individual phenomenon is subject to general laws. Research should reveal these general laws and conditions under which this or that phenomenon developed. K. Levin believed that psychology should use Galilean thinking. Therefore, the experiment must be strictly thought out: it is necessary to create certain conditions in order to obtain, isolate the phenomenon under study itself. In other words, the distinction between the Aristotelian and Galilean approaches in relation to psychological research means a transition from a descriptive method to a constructive one. The Aristotelian method in psychology is that the cause is identified with the essence of the phenomenon under study, as a result of which the scientific explanation is reduced to classification and leads to the allocation of average statistical characteristics, in which evaluation criteria prevail.
The Galilean method in psychology presupposes a theoretical explanation of facts on the basis of an integral system of causal relationships. It is the finding of causal relationships that will make it possible to predict single events. Each single event must be comprehended in the context of the integral situation of the given moment. Empirical evidence must give way to constructive-theoretical. Psychology should not study phenotypes, but genotypes. An experiment in psychology is intended to give an explanatory description, and not to establish a fact; it must explain the cause, the determination of human behavior, of this or that mental phenomenon.
The principles of methodological techniques used in laboratories are different. Let's briefly dwell on them.
For a long time, the method of quantitative measurement of mental processes dominated in clinics, a method that was based on Wundtian psychology. The view of mental processes as innate abilities that only change quantitatively during development led to the idea of the possibility of creating a "measuring" psychology. An experimental study of mental processes was reduced to establishing only its quantitative characteristics, more precisely, to measuring individual mental abilities.
The principle of quantitative measurement of innate abilities formed the basis of psychological research methods in psychiatric and neurological clinics. The study of the decay of any function consisted in establishing the degree of quantitative deviation from its "normal standard".
In 1910, the most prominent neuropathologist G. I. Rossolimo developed a system of psychological experiments, which, in his opinion, allegedly allowed to establish the level of individual mental functions, or "the psychological profile of the subject." According to the author, various pathological states of the brain caused certain typical "psychodynamic change profiles." This method was based on the concept of empirical psychology about the existence of innate isolated abilities. This false theory, as well as a simplified quantitative approach to the analysis of mental disorders, could not ensure the introduction of methods adequate to the demands of clinical practice, although the very attempt to bring psychology closer to solving clinical problems was progressive for its time.
The method of quantitative measurement of individual mental functions reached its extreme expression in the test studies of Wien-Simon, which were initially aimed at identifying the level of mental abilities. Measuring test studies were based on the concept that the child's mental abilities are fatally predetermined by the hereditary factor and to a small extent depend on education and upbringing. Each child has a certain, more or less constant age-specific intelligence quotient (IQ).
The tasks that were offered to children required certain knowledge and skills for their solution and made it possible to judge, at best, the amount of acquired knowledge, and not the structure and qualitative features of their mental activity.
Such studies, aimed at purely quantitative measurements, do not allow predicting the further development of the child. Meanwhile, with the help of these tests, it was and is now being carried out in some countries to separate children, supposedly "capable" from birth, from others, whose mental retardation was also explained by dependence on congenital characteristics.
The method of quantitative measurement is still leading in the work of many psychologists abroad working in the field of psychiatry. In numerous monographs and articles published in recent years, devoted to the experimental psychological study of patients, methods of test studies are given up to the calculation of IQ.
In the study of patients by methods aimed at measuring functions, neither the features of mental activity, nor the qualitative side of the violation, nor the possibility of compensation, the analysis of which is so necessary in resolving clinical problems, especially psycho-corrective ones, can be taken into account.
By measuring, only the final results of the work are revealed, its very process, the attitude of the subject to the task, the motives that prompted the subject to choose one or another mode of action, personal attitudes, desires, in a word, all the variety of qualitative features of the subject's activity cannot be detected.
One of the main principles of the pathopsychological experiment is a systematic qualitative analysis of the studied disorders of mental activity. This principle is due to the theoretical provisions of general psychology. Based on the thesis of K. Marx that "people are products of circumstances and upbringing, that, consequently, changed people are products of other circumstances and changed upbringing ...", Soviet psychologists (L. S. Vygotsky, S. L. Rubinshtein, A N. Leontiev, P. Ya. Galperin, B. G. Ananiev, V. N. Myasishchev) showed that mental processes are formed in vivo according to the mechanism of appropriation of universal human experience in the process of the subject’s activity, his communication with other people. Therefore, the pathopsychological experiment is aimed not at the study and measurement of individual processes, but at the study of a person performing a real activity. It is aimed at a qualitative analysis of various forms of the disintegration of the psyche, at revealing the mechanisms of disturbed activity and at the possibility of its restoration. If we are talking about a violation of cognitive processes, then experimental techniques should show how the mental operations of the patient, formed in the course of his life, disintegrate, in what form the possibility of using the system of old connections formed in the previous experience is distorted. Based on the fact that any mental process has a certain dynamics and direction, it is necessary to construct experimental studies in such a way that they reflect the preservation or violation of these parameters. The results of the experiment should give not so much a quantitative as a qualitative characteristic of the disintegration of the psyche.
It goes without saying that experimental data must be reliable, that statistical processing of the material must be used where the task at hand requires and allows it, but quantitative analysis should neither replace nor push aside the qualitative characterization of experimental data.
One should agree with the remark of A. N. Leontiev, made in his article "On Some Perspective Problems of Soviet Psychology", that it is not necessary to bring together scientifically based experiments, "allowing a qualitative assessment with the so-called tests of mental endowment, the practice of which is not only justly condemned with us, but now it is objectionable in many countries of the world.
The idea that quantitative analysis alone cannot be suitable for solving a number of problems related to human activity is recognized by a number of scientists in foreign countries. So, one of the American experts in the field of management prof. A. Zade writes that "an accurate quantitative analysis of the behavior of humanistic systems does not seem to be of great practical importance in real social, economic and other tasks related to the participation of one person or a group of people" . Moreover, he emphasizes that "the ability to operate with fuzzy sets and the ability to evaluate information that follows from it is one of the most valuable qualities of the human mind, which fundamentally distinguishes the human mind from the so-called machine mind attributed to existing computers" .
Consequently, the main principle of constructing a psychological experiment is the principle of a qualitative analysis of the characteristics of the course of the patient's mental processes, as opposed to the task of only one quantitative measurement of them. It is important not only what difficulty or what volume of the task the patient comprehended or completed, but also how he contemplated how were due to his mistakes and difficulties. It is the analysis of errors that occur in patients in the process of performing experimental tasks that is an interesting and indicative material for assessing one or another violation of the mental activity of patients.
The same pathopsychological symptom can be caused by different mechanisms, it can be an indicator of different conditions. So, for example, a violation of mediated memory or instability of judgments may arise as a result of impaired mental performance of the patient (as is the case with asthenia of various organic genesis), it may be due to a violation of the purposefulness of motives (for example, with lesions of the frontal parts of the brain) and in some forms and course of schizophrenia, it can be a manifestation of deautomatization of actions (with vascular changes in the brain, epilepsy).
The nature of the disorders is not pathognomonic; specific for a particular disease or form of its course; it is only typical for them and must be evaluated in conjunction with the data of a holistic pathopsychological study, i.e. syndromal analysis is needed (A. R. Luria).
Psychological research in the clinic can be equated to a "functional test" - a method widely used in medical practice and consisting in testing the activity of some organ. In the situation of a psychological experiment, the role of a "functional test" can be played by experimental tasks that are able to actualize the mental operations that a person uses in his life, his motives that encourage this activity.
It should be emphasized that the pathopsychological experiment should update not only the mental operations of the patient, but also his personal attitude. Back in 1936, V. N. Myasishchev raised this problem in his article "Efficiency and Illness of the Personality". He points out that mental and psychopathological phenomena can be understood on the basis of taking into account a person’s attitude to work, his motives and goals, attitude towards himself, requirements for himself, for the result of work, etc. Such an approach to psychological manifestations requires, as V. N. Myasishchev says, knowledge and study of personality psychology.
This approach is also dictated by a correct understanding of the determination of mental activity. Speaking about the mechanisms of mental determination, SL Rubinshtein emphasized that external conditions do not directly determine the behavior and actions of a person, that the cause acts "through internal conditions." This means that the judgments, actions, deeds of a person are not a direct reaction to external stimuli, but that they are mediated by his attitudes, motives, needs. These attitudes are formed in vivo under the influence of education and training, but, having formed, they themselves determine the actions and deeds of a person, healthy and sick.
Human relations are connected with the structure of a person's personality, with his needs, with his emotional and volitional characteristics. Despite the fact that the latter are considered by psychology as processes, they are, in essence, included in the structure of personality. In the needs of a person, material and spiritual, his connection with the outside world, people is expressed. Evaluating a person, we first of all characterize the range of his interests, the content of his needs. We judge a person by the motives of his actions, by what phenomena of life he is indifferent to, by what he rejoices at, what his thoughts and desires are directed to.
We talk about a pathological change in personality when, under the influence of a disease, a person’s interests become scarce, needs become smaller, when he shows an indifferent attitude to what used to worry him, when his actions lose their purposefulness, actions become thoughtless, when a person ceases to regulate his behavior , unable to adequately assess their capabilities, when their attitude towards themselves and the environment changes. Such an altered attitude is an indicator of an altered personality.
This altered attitude leads not only to a weakening of the patient's working capacity, to a deterioration in his mental production, but can itself participate in the construction of a psychopathological syndrome. Thus, in the study of patients with cerebral arteriosclerosis, it was noted that excessive fixation on their mistakes often led patients to exaggerated indirect actions that reduced the mental production of patients, and to excessive corrective techniques that violated their visual-motor coordination. In other words, the very attitude of the patient to the situation, to himself should become the subject of research and should be reflected in the design of the experiment.
A pathopsychological experiment is essentially a mutual activity, mutual communication between the experimenter and the subject. Therefore, its construction cannot be rigid. No matter how tough the instruction, often the look of the experimenter, his facial expressions can change the situation of the experiment, the attitude of the patient, which means that his actions can change unconsciously for the subject himself. In other words, a qualitative analysis is necessary because the situation of a pathopsychological experiment is a segment of real life. That is why the data of pathopsychological research can be used in solving issues of real concrete life, issues related to the fate of real people; these are issues whose correct solution heals and protects society (for example, participation in a psychological and psychiatric forensic examination, military, labor).
Of particular importance are the data of the pathopsychological experiment when recommending psychocorrective measures.
We should dwell on one more feature of the pathopsychological experiment. Its structure should make it possible to detect not only the structure of the altered, but also the remaining intact forms of the patient's mental activity. The need for such an approach is important in addressing the issues of restoring impaired functions.
Back in 1948, A. R. Luria expressed the opinion that the success of the restoration of disturbed complex mental functions depends on how much the restoration work relies on intact links of mental activity: he emphasized that the restoration of disturbed forms of mental activity should proceed according to the type of restructuring of functional systems . The fruitfulness of this approach was proved by the work of many Soviet scientists. Studies aimed at analyzing the principles of restoring disturbed movements that arose as a result of gunshot wounds during the Great Patriotic War showed that in the process of restorative labor therapy, the decisive role belonged to the mobilization of the patient’s intact functions, the safety of his attitudes (S. G. Gellershtein, A. V Zaporozhets, A. N. Leontiev, S. Ya. Rubinstein). Psychologists working in the field of restoring speech disorders have come to a similar conclusion.
E. S. Bain in the monograph "Aphasia and Ways to Overcome It" says that when restoring aphasic disorders, we are talking about the inclusion of a preserved link, about its development, about the gradual "accumulation of the possibility of using it" for the practice of defective functions. The restructuring of the defective function occurs in close conjunction with the development of the intact one. This problem is even more widely posed by V. M. Kogan. In his monograph "Restoration of speech in aphasia", the author convincingly shows that restoration work should be based on the revival of the knowledge that has remained intact. With full right, the author emphasizes that during the restoration work (in this case, the restoration of speech), the entire system of connections, settings for the activity of a human, albeit painfully changed, personality should be updated. Therefore, V. M. Kogan calls in the restoration work to evoke "the conscious attitude of the patient to the semantic content of the word in its connection with the subject." The above views of researchers relate to the restoration of functions that, relatively speaking, have a narrow character of speech, praxis.
They can be even more rightly attributed to the restoration of more complex forms of mental activity, to the restoration of lost mental performance (purposefulness, activity of the patient). In these cases, the issue of retained opportunities is especially acute (for example, when deciding on the patient's ability to work, the possibility of continuing his studies at a university, etc.).
In order for a psychological experiment to be able to answer these most complex questions, in order for it to be able to reveal the intact links in the patient's altered mental activity, it must be directed not only to revealing the productive side of the patient's activity, not only to analyzing the final product. The design of experimental techniques should provide an opportunity to take into account the patient's search for solutions. Moreover, the design of a psychological experiment should enable the experimenter to intervene in the "strategy" of the experiment in order to find out how the patient perceives the "help" of the experimenter, whether he can use it. The construction of an experiment according to the type of rigidly standardized tests does not provide this possibility.
It is necessary to note again the features that distinguish the experiment in the clinic from the experiment aimed at studying the psyche of a healthy person, i.e. an experiment aimed at solving questions of a general psychological order.
The main difference lies in the fact that we cannot always take into account the peculiarity of the patient's attitude to experience, which depends on his morbid condition. The presence of a delusional attitude, arousal or lethargy - all this forces the experimenter to construct the experience differently, sometimes changing it on the go.
Despite all the individual differences, healthy subjects try to carry out the instructions, "accept" the task, while the mentally ill sometimes not only do not try to complete the task, but also misinterpret the experience or actively oppose the instructions. For example, if during an associative experiment with a healthy person the experimenter warns that words to which he must listen will be uttered, then the healthy subject actively directs his attention to the words uttered by the experimenter. When conducting this experiment with a negative patient, the opposite effect often arises: the experimenter is forced to conduct the experiment, as it were, "bypass", pronouncing the words as if by chance and registering the patient's reactions. Often one has to experiment with a patient who interprets the situation of the experiment in a delusional way, for example, he believes that the experimenter acts on him with "hypnosis", "rays". Naturally, such an attitude of the patient to the experiment is reflected in the methods of performing the task; he often fulfills the request of the experimenter intentionally incorrectly, delays answers, etc. In such cases, the design of the experiment must also be changed.
The construction of an experimental psychological study in the clinic differs from the usual psychological experiment in another feature: diversity, a large number of methods used. This is explained as follows. The process of disintegration of the psyche does not occur in one layer. It practically never happens that in one patient only the processes of synthesis and analysis are violated, while in another the only purposefulness of the personality suffers. When performing any experimental task, one can to a certain extent judge various forms of mental disorders. However, despite this, not every methodological technique makes it possible to judge one or another form or degree of violation with equal clarity, clarity and reliability.
Very often, a change in the instructions, some experimental nuance changes the nature of the indications of the experiment. For example, if in an experiment on the memorization and reproduction of words the experimenter emphasizes the significance of his evaluation, then the results of this experiment will be more indicative of the evaluation of the process of his memorization. And since in the situation of an experiment with a sick person, the entire course of the experiment often changes of necessity (if only because the patient's condition changes), a comparison of the results of various variants of the experiment becomes mandatory. Such a comparison is also necessary for other reasons. Performing this or that task, the patient not only solves it correctly or erroneously; solving a task often causes awareness of one's defect; patients seek to find an opportunity to compensate for it, to find strong points for correcting the defect. Different tasks provide different opportunities for this. It often happens that the patient correctly solves more difficult tasks and is unable to solve easier ones. Understanding the nature of such a phenomenon is possible only by comparing the results of various tasks.
It should be noted that the violation of the mental activity of the patient is often unstable. With the improvement of the patient's condition, some features of his mental activity disappear, others remain resistant. In this case, the nature of the detected violations may vary depending on the characteristics of the experimental method itself; therefore, a comparison of the results of various variants of some method, which is repeatedly used, gives the right to judge the nature, quality, and dynamics of the patient's thinking disorders.
Therefore, the fact that in the study of the disintegration of the psyche it is often necessary not to confine oneself to any one method, but to apply a complex of methodological techniques, has its own meaning and justification.
The focus of experimental psychological techniques on revealing the qualitative characteristics of mental disorders is especially necessary in the study of abnormal children. With any degree of mental underdevelopment or disease, there is always a further (albeit slow or distorted) development of the child. A psychological experiment should not be limited to establishing the structure of the level of mental processes of a sick child; he must first of all reveal the potential possibilities of the child.
As is known, this indication was first made in the 1930s. L. S. Vygotsky in his position on the "zone of proximal development". In his work "The problem of learning and mental development at school age", L. S. Vygotsky writes that the state of a child's mental development can be determined at least by clarifying its two levels: the level of actual development and the zone of proximal development. L. S. Vygotsky understands the “zone of proximal development” as those potentialities of the child that are not revealed on their own, under the influence of certain conditions, but which can be realized with the help of an adult.
Essential, according to Vygotsky, is not only what a child can and knows how to do on his own, but also what he can do with the help of an adult. The ability of a child to transfer the methods of solving a problem learned with the help of an adult to actions that he performs on his own is the main indicator of his mental development. Therefore, the mental development of a child is characterized not so much by its actual level as by the level of its immediate development. Decisive is "the discrepancy between the level of problem solving available under the guidance, with the help of adults, and the level of problem solving available in independent activity" .
We dwelled in some detail on this well-known position of L. S. Vygotsky, because it determines the principles for constructing a psychological experiment in relation to abnormal children. Measurement studies adopted in foreign psychology can at best reveal only the "actual" (in L. S. Vygotsky's terminology) level of a child's mental development, and then only in its quantitative terms. The potential of the child remains unclear. But without such a "forecast" of the further development of the child, many theoretical and practical problems, for example, the problem of selection for special schools of instruction, cannot be essentially solved. Experimental psychological research applied in the field of child psychoneurology should be carried out taking into account these provisions of L. S. Vygotsky.
This is the path followed by the research conducted by A. Ya. Ivanova. The author builds his experimental psychological research according to the type of teaching experiment. A. Ya. Ivanova offered the children tasks that they had not known before. As the children performed these tasks, the experimenter provided them with various types of assistance, which were strictly regulated. The way the subject accepts this help, the number of "hints" is taken into account. This type of assistance is included in the structure of the experiment.
For the implementation of "regulated assistance" A. Ya. Ivanova made modifications to some generally accepted methods of pathopsychological research: subject classification, Koos method, classification geometric shapes, a series of successive paintings. The author regulates and fixes the stages of assistance in detail. Their quantitative gradation and their qualitative characteristics are taken into account. The use of the "teaching experiment" gave A. Ya. Ivanova the opportunity to distinguish between different forms of abnormal mental development. The method of the teaching experiment was also used by N. I. Nepomnyashchaya, who studied the formation of the count of mentally retarded children. Based on the theoretical provisions of P. Ya. Galperin on the phased formation of mental actions, N. I. Nepomnyashchaya showed that mentally retarded children have difficulties in the process of reducing the initially developed action. It had to be worked out specially and for a long time. If, however, through special training and "working out" it was possible to achieve a contraction mechanism, then it was possible, within certain limits, to overcome the defect of these children.
The system of dosed prompts was used by R. G. Natadze in the formation of artificial concepts in healthy children. With the help of a detailed methodology, R. G. Natadze discovered different levels of development of children. Thus, a teaching experiment based on L. S. Vygotsky's position on the "zone of proximal development", which reveals the potential capabilities of a child, can be a tool in studying the structure and degree of mental decline in an abnormal child and in solving a practical problem - selecting children in special schools.
Currently in pathopsychology childhood methods for correcting pathological phenomena are being developed. Finding these corrective paths requires not only knowledge of the age characteristics of the child and analysis of their deviations, but also the implementation, in the words of D. B. Elkonin, "control over the course of the mental development of children" . One of such corrective methods is gaming activity. Based on the fact that the game "leads development" (L. S. Vygotsky), in child pathopsychology an attempt is made to find adequate methods for correcting distorted play (V. V. Lebedinsky, A. S. Snivakovskaya, O. L. Ramenskaya ). These corrective techniques serve at the same time for diagnostic purposes.
Another feature of pathopsychological research should be taken into account. The fulfillment of experimental tasks has different meanings for different patients. Even in the school of K. Levin, it was pointed out that in some subjects experimental tasks cause a cognitive motive, other subjects perform tasks out of courtesy to the experimenter (the so-called "business subjects"), and others are addicted to decision processes ("naive subjects"). The attitude to the experiment depends on the patient's attitude to the fact of stationing, on the attitude to the experimenter himself.
It should also be taken into account that pathopsychological, and indeed any study in the conditions of a psycho-neurological institution, inevitably means for the patient a situation of some kind of "expertise". Therefore, the pathopsychologist has to operate in his conclusion with a system of concepts that characterize the personality of the patient as a whole (his motives, purposefulness, self-esteem, etc.). However, this does not exclude the rejection of the characterization of individual processes. But this characteristic is deepened by an analysis of the general condition of the patient. Summarizing, we can say that the pathopsychological experiment is aimed not only at the analysis of individual symptoms, but also at the identification of psychological syndromes.
Another important issue is the interpretation of the obtained data, which is based on one or another theoretical concept. For example, a patient has a poor memory: this can be interpreted as the result of cognitive impairment due to vascular diseases, but it can also be a manifestation of a decrease in motivational activity, as occurs in patients with schizophrenia. Interpretation is carried out on the basis of system analysis.
It is important how many times the patient was mistaken, but how he reacted to the experimenter's assessment, whether he critically evaluated the correction, encouragement or censure of the experimenter. Therefore, often the analysis of errors is productive for interpreting the patient's condition.
Pathologists are often reproached for the fact that their methods are not standardized, that they are subjective. In this regard, I would like to recall the words of L. S. Vygotsky that the excessive fear of the so-called subjective moments in interpretation (and Vygotsky talked about mental disorders in children) and attempts to obtain research results in a purely mechanical, arithmetic way, as is place in Binet's system are false. Without subjective processing, i.e. without thinking, without interpretation, interpretation of results, discussion of data, there is no scientific research.
The foregoing should not be understood as a denial of the statistical validity of the experimental results. For many questions of applied psychology, this is necessary. We are talking about the fact that when solving such practical problems of the clinic as labor or forensic examination or the study of a child with abnormal development, the pathopsychological experiment is in the nature of a study, i.e. how the specific person sitting in front of the psychologist performed the experimental work, with what degree of effort, with what degree of regulation, with what attitude this particular patient approached the task. B. F. Lomov also points to this, believing that a comparison of the "objective reports of the subjects" with the objective data of the experiment, with appropriate verification, can reveal a lot for an experienced experimenter and, in the end, serves the main task - the knowledge of the objective laws of the psyche.
Pathopsychological research has another feature. Presented to the subject a real segment of activity, the experimenter's remarks cause an equally real experience, a certain emotional state of the subject. In other words, a pathopsychological study reveals the real layer of the patient's life.
Therefore, the program for the study of a patient in psychiatric practice cannot be fundamentally uniform, standard, it depends on the clinical task (scientific or practical). For example, if it is necessary to differentiate schizophrenia from schizophrenia-like pictures in organic diseases of the central nervous system, the main attention will be paid to identifying the features of thinking disorders (by the method of "classifying objects", "pictograms", comparing concepts), on the one hand, as well as characterizing performance (testing " for combination", "search for numbers", etc.) - on the other.
Quite different methods are adequate in delimiting vascular dementia from dementia in Pick's disease, Alzheimer's, i.e. atrophic processes. In these cases, tests are used that reveal violations of writing skills, counting, praxis, neuropsychological techniques.
- A. A. Tokarsky meant here medications (Note. author).
- We do not dwell on the description of specific techniques. They are set out in the book by S. Ya. Rubinshtein "Experimental methods of pathopsychology" .
Strategy and tactics of pathopsychological experimental research
Basic principles of constructing a pathopsychological experiment
The basic principles of constructing an experimental psychological study have been formulated in many recent works by domestic pathopsychologists. Let's take a look at their characteristics.
One of the main principles of constructing a pathopsychological study is the principle of modeling the mental activity that a person usually carries out in his daily life: when performing professional tasks, in the process of learning, communicating with people around him. During the study, separate actions are artificially singled out in human activity: analysis and synthesis of various material - visual or verbal; comparing various objects, concepts or judgments, establishing logical connections between them (causal, associative, finding analogies, etc.); dismemberment, differentiation of objects or relations between objects and concepts. During the experiment, these actions are organized in conditions that are unusual for a person. The experimenter, observing the nature of the patient's actions, carefully records the entire process of work: the methods of performing tasks, errors in the course of solving, the duration and pace of the patient's actions.
Consequently, the applied experimental methods are built according to the principle of functional tests known in medicine. As S.Ya. Rubinshtein, "in a pathopsychological experiment, the functional test is focused on identifying non-professional structure of activity": general activity, orientation of behavior, criticality, preservation of basic intellectual operations, ability to memorize and retain material, stability of attention, etc.
Another important principle that follows the construction of a pathopsychological study is the principle of taking into account the patient's attitude to the situation of the study. Human relations are connected with the structure of his motivational sphere, with his needs, emotional and volitional characteristics. Thus, the named principle of constructing a pathopsychological study is addressed, first of all, to taking into account the personal aspect of the patient's activity. “We are talking about a pathological change in personality when, under the influence of an illness, a person’s interests become scarce, needs become smaller, when he shows an indifferent attitude to what used to worry him, when his actions lose their purposefulness ...” writes B.V. Zeigarnik. As we noted earlier, the situation of psychological research in the clinic is, in principle, not neutral in its meaning for patients. It acts for patients as a situation of studying their abilities, intellectual capabilities, i.e. is an expert in the broad sense of the word. Therefore, the very situation of the experiment leads to the actualization of the known attitude towards it. In this regard, the very way the patient accepts the task may indicate the preservation or change of his personal attitudes. Some patients, before starting to perform the task, carefully declare that they "always did not remember words well" or that they always worked slowly and inattentively, etc. Thus, they justify themselves in advance to the experimenter, anticipating a possible failure in their work. Others, on the contrary, do not listen to the instructions, hurriedly and chaotically begin to complete tasks, not caring about the quality of their results.
It is necessary to note one more feature of the situation of the pathopsychological experiment, which should be specially recorded by the experimenter: the process of performing tasks actualizes the criticality of the patient, a sense of self-control. Patients sometimes note that they themselves "are interested in testing their intelligence, mental performance." Often the patient only in the course of work for the first time realizes his mental insufficiency. Awareness of the defect can cause severe emotional experiences of the patient. The appearance of such an emotional reaction or its absence with obvious gross violations of mental activity detected during the study serves as an important indicator of the patient's personal safety or change. Therefore, observation of the behavior of patients, their statements during the study, their reaction to success and failure in work is a valuable material for characterizing their personality.
The most important principle of constructing a pathopsychological study is the principle of a qualitative analysis of the characteristics of the course of the patient's mental activity. The principle of qualitative analysis of activities involves taking into account not only (and not even so much) the results of each individual task, but a thorough consideration of the entire process of work: its general pace, the sequence of changes in operations, the nature of errors and what caused them, the possibility of doing it yourself or with the help of an experimenter notice and correct errors. When quantitatively measuring functions within the framework of the psychometric approach, only the final product of activity is recorded. At the same time, the daily practice of clinical and experimental work shows that the same pathopsychological symptom can be caused by different mechanisms. For example, a violation of the sequence, purposefulness of judgments can be caused both by fluctuations in mental performance (in particular, with vascular diseases of the brain), and by the instability of the motive that stimulates the patient's activity (for example, with chronic alcoholism); it can also be a manifestation diversity motivation (for example, in schizophrenia). Therefore, in each specific case, the identified violation should be considered in conjunction with other results of the pathopsychological study. At the same time, qualitative data analysis does not exclude quantitative data processing; on the contrary, statistical analysis of the results is necessary in a number of cases. However, it can only be the second, additional stage of processing the results, which must be preceded by the stage of qualitative analysis of the results.
Following the principle of qualitative analysis of activities puts forward a number of requirements for the entire research procedure as a whole. First of all, it is necessary to avoid rigid standardization of the patient's working conditions (time limits, the same sequence of tasks presented, the same sequence of rewards and censures from the experimenter). On the contrary, a flexible tactic of assessing the quality of work is desirable, taking into account the individuality of the patient and the specific task of the study, and the dosed assistance of the experimenter to the patient is also obligatory, which makes it possible to determine the zone of proximal development of the patient. Accounting for what kind of assistance is sufficient for the patient to correct errors (indirect indication of the error, direct intervention in the patient's actions, joint correction of errors, etc.) is important for concluding about the characteristics of the patient's mental activity as a whole. Only in some cases, the tactics of measuring research can be used: for example, when studying fatigue, if necessary, create an affective situation during the study. In the latter case, the measuring nature of the study must be combined with emphasized assessments of the quality of the patient's work.
Closely related to the principle of qualitative analysis of activity is the requirement to study the patient not by any one method, but by using a whole complex of experimental techniques. Only when using several methods to study the patient, it is possible to obtain material that comprehensively characterizes the features of the patient's mental activity, its intact and disturbed components. This also implies the requirement of multiple repeated studies of the same patient. The latter also makes it possible to determine which features of the patient's mental activity depend on his condition, and which are a stable characteristic of his psyche.
Any experiment requires accurate and objective registration of facts. As rightly pointed out by S.Ya. Rubinshtein, with all the modifications and variations of "specific methodological techniques, it is unacceptable to reduce them to a free conversation with the patient or a subjective interpretation of experimental data" .
Of course, an experiment with a mentally ill person cannot be as accurate as an experiment, for example, in the field of psychophysics. A mentally ill person, due to the peculiarities of his mental state, may violate the order of work dictated by the instruction, discuss or comment on his actions or the material of tasks, instead of consistently performing them. However, all these distorted actions, in turn, provide additional material for assessing the patient's condition, as well as the structure of disturbances in his mental activity.
It is mandatory to carefully record the progress of the study. Even with a tape recording of the patient's statements, it is necessary to keep a research protocol. At the same time, it should record information about the patient's behavior, his actions, emotional reactions during the study. In addition, the experimenter enters into the protocol all his value judgments that arise in the course of working with the patient. Such comments will later help the psychologist in drawing up a conclusion.
Each experimental technique has its own special form of protocol keeping, knowledge of which is no less important than knowledge of the instructions and procedure for conducting the study. The following requirement is common to all methods: the obligatory entry of the patient's name on each page of the protocol, the date of the study and the name of the method. In the column on the left, variants of the instruction, remarks, questions, and comments of the experimenter are recorded; in the middle column - the actions of the patient; and in the right - all the statements, answers, comments and explanations of the patient. (The protocol scheme is taken from the book by S.Ya. Rubinshtein.)
Sample logging scheme
|
Experimenter |
Patient's actions |
Sayings of the sick |
Such a scheme is not universal. Each experiment can provide objectively recorded data that can be used or supplemented by another experimenter, in particular, and through a number of repeated control experiments.
Strategy and tactics of pathopsychological experimental research
The general strategy for constructing an experiment: the selection of basic methods, the nature of the relationship "experimenter - patient" are largely determined, firstly, by the task of the study and, secondly, by preliminary knowledge about the patient under study, which the experimenter receives when getting acquainted with the history of the disease. The purpose of the study - differential diagnostic, expert or psychotherapeutic - determines which disorders of mental activity the researcher's attention should be directed to, and, accordingly, what should be the optimal set of techniques.
In accordance with the specific objectives of the study, the tactics of the relationship between the patient and the researcher are also built. With a generally benevolently neutral attitude of the psychologist towards the patient, the situation of an expert or differential diagnostic examination requires the researcher to be able to create the so-called "examination motive", i.e. let the patient feel that the study is aimed specifically at evaluation his cognitive abilities. In this case, a direct assessment by the experimenter of the results of performing individual experimental tests is permissible, and sometimes necessary. In particular, when distinguishing between schizophrenic disorders and psychopathy, one of the important criteria for differentiation is the patient's reaction to success and failure. In accordance with this, the entire experimental study can be built on the principle of the "level of claims" methodology, when the experimenter consciously doses and alternates between positive and negative assessment of the patient's activity. The lack of interest inherent in patients with schizophrenia, the lack of expression of emotional reactions to the situation of the experiment, the assessment of the experimenter and the results of their own activities usually contrasts with vivid, often demonstrative reactions to the success and failure of patients with psychopathy. Many pathopsychological techniques (usually used for other purposes) can be modified so that they become suitable for revealing the dynamics of the level of claims. For example, when folding the Link cube, the experimenter can complicate the task by not providing in the preliminary instructions all the information necessary for its correct execution. Purposefully helping and encouraging the patient or, on the contrary, focusing the patient's attention on erroneous actions, the experimenter creates the conditions for experiencing success or failure. Similarly, such well-known techniques as "Simple and Complex Analogies" are applicable, where the patient can be asked to choose "simpler" and "more complex" tasks himself, and at the same time evaluate the results of their implementation. The dynamics of the patient's experience of success and failure, the corresponding correction of one's own activity are quite reliable indicators of the presence or absence of an "examination motive" in the patient, and, consequently, such features of his personality as criticality, arbitrariness and controllability of cognitive activity.
With this type of pathopsychological research, as emphasized by B.V. Zeigarnik, the patient's personality is revealed to us indirectly - through the system of relations in the experimental situation, as well as through the analysis of the motivational component of cognitive activity. For example, diversity thinking, characteristic of patients with schizophrenia, indicates a violation meaningful and incentive function of the motive of expertise, entailing distortions of the process meaning formation. Motives that lie outside the experimental situation make it difficult to complete the task correctly. For example, the classification of objects according to generalized characteristics is replaced by their grouping based on personal preferences, situational interests, etc. Then there are groupings of objects according to the principle diversity(examples are taken from the monograph by B.V. Zeigarnik Pathopsychology, M., 1976). For example, "an elephant, a horse, a bear, a butterfly, a beetle - animals; an airplane, a butterfly - a group of flying (the butterfly was taken sick from a group of animals); a shovel, a bed, a spoon, a car, an airplane, a ship - iron objects that testify to the strength of the human mind (the plane is removed from the flying group); elephant, skier - objects for spectacles - people tend to desire bread and circuses, the ancient Romans knew about this.
In some cases, the pathopsychologist has to choose a different tactic for constructing an experiment: not so much to create an "examination motive" as to "remove" the expertness of the situation.
Let's conditionally call this tactic projective; its main task is to create a trusting, relaxed atmosphere, to reduce the tension that naturally arises in a patient who first comes to a pathopsychological examination. The foregoing does not mean that only by choosing projective tactics, the psychologist shows attention and a benevolent attitude towards the patient - the psychologist must always be ethical.
but If the researcher is given a special task to study the patient's personality, for example, using projective techniques, the personal qualities of the psychologist, his ability to win the patient's trust, win over him, and, if possible, remove protective barriers largely determine the success or failure of the study.
When using projective techniques, it is useful to consider the following recommendations.
1. It is undesirable to use them after a standard pathopsychological examination, since the influence of the "examination motive" created in it is not excluded.
2. A projective study should be carried out after a preliminary conversation with the patient, however, the content of the conversation should not affect topics that could alert the patient and cause him to be negative.
3. When conducting a study, a pathopsychologist should act not so much as a registrar of the patient's responses, but as his interlocutor, or a sympathetic listener, however, the direct intervention of the researcher in the patient's activities should be thoughtful, strictly dosed and serve the purpose of maximum self-disclosure of the patient.
An experimental psychologist can use projective tactics of behavior not only when working with projective technique. Many methods traditionally used for research, for example, intellectual activity, can be presented as projective. For this purpose, you can use, for example, a pictogram, including emotionally loaded words in the list of words for memorization and somewhat "softening" the emphasis in the instruction on the need to achieve a certain result - memorizing words.
The teaching tactics of the experiment (for details on the teaching experiment, see the book by A.Ya. Ivanova) is used mainly in cases where it is necessary to identify the intact aspects of the mental activity and personality of the patient in order to help him in choosing ways to possibly compensate for the defect. It is implemented in various kinds of prompts, help from the experimenter, showing standards for the correct performance of the task. It is diagnostically important whether the patient accepts or rejects cooperative relations with the psychologist, what is the ratio of the patient's independent activity when performing tasks and cooperative activity, what is the measure of assistance necessary for the patient to complete the task correctly, in what form it should be given, etc.
As one of the possible modes of behavior of a pathopsychologist, educational tactics is used in any experimental examination of a patient, however, it achieves the greatest effect when working with children and in an expert study, if it is necessary to delimit intellectual decline in organic CNS damage and mental underdevelopment. oligophrenic type.
Nikolaeva V.V., Sokolova E.T., Spivakovskaya A.S. Special workshop
in pathopsychology. General guidelines. -
M.: Publishing House of Moscow State University, 1979. - S. 12-21
Literature
1. Bleikher V.M. Clinical pathopsychology. Tashkent, 1976.
2. Blokhin N.N. Deontology in oncology. M., 1977.
3. Gilyarovsky V A. Psychiatry. M., 1954.
4. Zeigarnik B.V. Pathopsychology. M., 1976.
5. Ivanova A.Ya. Learnability as a principle mental assessment development of children. M., 1976.
6. Rubinshtein S.Ya. experimental methods of pathopsychology(Practical guide). M., 1970.
Program provisions.
pathopsychological experiment. Principles of constructing a pathopsychological study. Correlation between the method of observation and the method of experiment in pathopsychology. Stages of pathopsychological research. Conversation with the patient and observation of the patient's behavior during the conversation and during the examination. Qualitative analysis and processing of experimental data. General rules writing a conclusion. Requirements for a specialist conducting a pathopsychological study. Deontological aspects in the work of a pathopsychologist.
Lecture summary.
Pathopsychological experiment differs significantly from other types of experiment used in medicine, for example, in physiology, biochemistry, microbiology.
A pathopsychological experiment, like any other type of psychological experiment, is an artificial creation of conditions that reveal certain features of a person’s mental activity in its pathology (since we are talking about pathopsychology). Such an experiment is characterized by the evoking of mental processes under strictly defined conditions.
^ Principles of pathopsychological research.
Systemic and qualitative analysis of the studied disorders of mental activity. This principle is due to the theoretical provisions of general psychology. Mental processes are formed in vivo according to the mechanism of appropriation of universal human experience, therefore the pathopsychological experiment is aimed not at the study and measurement of individual processes, but at the study of a person who performs real activity. It is aimed at a qualitative analysis of various forms of the disintegration of the psyche, at revealing the mechanisms of disturbed activity and at the possibility of its restoration.
Based on the fact that any mental process has a certain dynamics and direction, it is necessary to construct experimental studies in such a way that so that they reflect the safety or violation of these parameters.
The results of the experiment should give not so much quantitative as qualitative characteristics of the disintegration of the psyche.
Experimental data must be reliable.
The same pathopsychological symptom can be caused by different mechanisms, it can be an indicator of different conditions. Therefore, the nature of the disorders should be assessed in conjunction with the data of a holistic pathopsychological study, i.e. syndromic analysis is needed.
Psychological research in the clinic can be equated to a "functional test". In the situation of a pathopsychological experiment, the role of a functional test can be played by those tasks that are able to actualize the mental operations that a person uses in his life, his motives that encourage this activity.
^ The pathopsychological experiment should update not only the mental operations of the patient, but also his personal attitude . A mental and psychopathological phenomenon can be understood on the basis of taking into account a person’s attitude to work, his motives and goals, and his attitude towards himself.
A pathopsychological experiment is essentially a mutual activity, mutual communication between the experimenter and the subject. Therefore, its construction cannot be rigid. Its structure should make it possible to detect not only the structure of the altered, but also the remaining intact forms of the patient's mental activity.
The design of experimental techniques should provide an opportunity to take into account the search for a solution for the patient. The design of a psychological experiment should enable the experimenter to “intervene” in the strategy of the experiment in order to find out how the patient perceives the "help" of the experimenter.
Thus, experimental psychological research should answer questions about how the course of mental processes is disturbed. In the study of specific anomalies in the development of the personality and underdevelopment of the psyche, the main tasks of psychological research are related to the identification of those main components of mental activity, the underdevelopment or anomaly of which causes the formation of a pathological structure of the psyche.
When conducting a pathopsychological experiment, an important role is played by taking into account dynamic principle (i.e. taking into account changes in psychopathological manifestations during the course of the disease).
The study of the psychological structure of a particular pathopsychological syndrome is more successful if the stage of the disease is taken into account and the comparison of psychological data corresponding to different stages, for example, at the onset of the disease, at the stage of maximum severity of clinical manifestations, or with an increase in mental defect.
^ CARRYING OUT A PATHOPSYCHOLOGICAL EXAMINATION (EPO) AND PREPARATION OF THE CONCLUSION
Distinguish four stages clinical and psychological research.
1. First- before getting to know the patient - the stage of formulating the clinical problem. It is necessary to first familiarize yourself with the personal characteristics of the patient, incl. premorbid, already identified symptoms, social conditions of his life, assessment of material and cultural circumstances, the presence of concomitant somatic diseases. It is undesirable to conduct a study after a sleepless night, physical overwork, on an empty stomach or immediately after eating. Repeated studies are best done at the same time as the primary ones. At this stage, a preliminary research plan is drawn up: the choice of methods, their sequence.
^2. Second stage- conversation with the patient. The purpose of the conversation is to establish contact with the patient, to find out how the patient himself sees his condition and to clarify those information that remained unclear to the psychologist.
The conversation always depends on the task at hand and consists of two parts.
^ First part- the experimenter talks to the patient without conducting any experiment yet. Such a conversation can be carried out before or after experimental work with the patient.
The discrepancy between the state and behavior of the patient in the psychologist's office and the status described by the doctor provides important information that allows you to take a different look at the results of the examination.
For example, if, according to the doctor’s notes, the patient is very lively and active, and when solving tasks for speed (for example, when working with correction tests or Schulte tables), the patient shows a result corresponding to a gross decrease in attention and the rate of sensorimotor reactions, then we can make an assumption about simulation or aggravation
The conversation should begin with a questioning of passport data, on the basis of which the first judgment is made about the state of memory. Then the state of memory is specified (short-term and long-term - dates own life, historical events, recent events), attention is assessed, the state of consciousness is characterized: orientation in time, place and one's own personality. Questions should be asked in a casual, natural manner, as in normal conversation. The attitude of the patient to his disease and problem is also clarified.
The adequacy of the attitude towards oneself and one's condition, or, conversely, underestimation of it, have a very important prognostic value.
For example. A 55-year-old patient, a cashier at a supermarket. After the withdrawal of hallucinatory experiences of erotic content as a result of treatment, she is still waiting for the appearance of her lover and believes that all this was “really”. He did not approach her (to explain his feelings) out of modesty. This is a poor prognostic sign - the patient does not have criticism for painful experiences.
In a further conversation, personality traits are clarified (before the disease and at the present moment), an assessment of the ongoing changes, an assessment of well-being, performance, and the cultural and educational level are determined.
^ Second part of the conversation - this is a conversation during the experiment or communication with the patient during the experiment. Communication can be both verbal (the experimenter says something to the patient, indicates, suggests, praises, blames, etc.), and non-verbal (the experimenter shows the patient whether he performs the task well or badly with facial expressions).
^ 3. Third stage- experimental-psychological. An element of observation of the patient's behavior is always included in the situation of an experiment or conversation.
The experimenter should have time to note how the patient enters (confidently, uncertainly), how he sits down and sits, how he looks at the experimenter.
It should be noted how the patient accepts the conversation, how he is set. Whether the patient is distracted by an extraneous stimulus.
The performance of each task should be preceded by an instruction that should define the situation of the study and ensure the cooperation of the psychologist and the patient. Careless instruction may lead to inadequate results. The instruction must be pre-tested before the start of the EPI. It should be as concise as possible, correspond to the mental abilities of the patient, exclude the possibility of conflicting understanding. The instruction must not contain compound words. It is important to take into account the educational level of the subject.
For example, a patient with three grades of education. you can’t say: “the numbers are scattered here in a chaotic order”
Many techniques need to be supported by one or two examples.
A complete and accurate record of the circumstances of the experiment, the patient's judgments is required.
If the patient is not doing well, it is important to discuss the reasons for this together. It is very important to fix HOW he does not cope.
For example, working with the same Schulte tables, one patient will work sluggishly, then suddenly stop, and when asked what happened, he will say that he is “tired”.
These are completely different situations, although the pace of activity and the refusal of activity are the same. But in the first case, this is a variant of the behavior of a schizophrenic with a pronounced emotional-volitional defect, and in the second, it is organic with a heightened experience of his insolvency.
^ 4. Fourth stage - drawing up a conclusion.
So, we got some data. What to do with them now? It is necessary to qualitatively evaluate the entire picture obtained, highlighting the main violations of mental activity.
To do this, data on individual methods should be summarized and an assessment made of what is more and what is less violated. Unfortunately for a psychologist, it is extremely rare for the picture to be sharp and clear. An adequate assessment of the data obtained is a matter not only of qualification, but also of some art.
The conclusion should always be the answer to the question posed to the psychologist.
There is no single form of conclusion. The form of the conclusion cannot be standard, just as there cannot be the same people. The conciseness or detail of this conclusion is determined both by the tasks set and by all sorts of banal circumstances, for example, the degree of workload of the psychologist.
However, there are some ^ General indicative rules for writing a conclusion.
At the beginning, it is written title: EPO, full name, year of birth may be an address. Then, two headings: THE OBJECTIVE OF THE STUDY and THE METHODS USED, listing everything that is included there.
^ Description of the subject's behavior during a conversation with a psychologist, his facial expressions, appearance, the attitude of the subject to work, the experimenter should have time to note how the patient enters (confidently, uncertainly), how he sits and sits, how he looks at the experimenter. Whether the patient is distracted by an extraneous stimulus. It is also important how the patient starts the task, whether he accepts the help of the experimenter, etc. The patient's reaction to the experimenter's prompts, to his facial expressions - everything should be reflected in the protocol, since these data are compared with the data that are in the medical history and with those that were obtained in the experiment itself.
The pathologist should record the following aspects:
Features of the affective response, motivation, system of relations of the patient - this is the motivational component of the activity.
Attitude to the fact of the survey, to individual tasks, to the results and changes in behavior during the experiment.
How the subject reacts to the experimenter (flirts, tries to impress), attitudes towards the experimenter's assessments.
^ Description of the data obtained, when working with the methods, listing the results for individual methods. The form in which these data are reported should be understandable to the doctor and not "overloaded". Those. do not write "raw" scores in the conclusion, unless you want to convey something special by this.
Then follows the actual CONCLUSION, where the psychologist highlights the leading pathopsychological features, just like a psychiatrist, studying clinical picture disease, forms a syndrome from the symptoms. Those. the psychologist singles out the leading pathopsychological "syndrome" in the structure of the mental defect of the subject. Conclusions should follow from the data of individual methods, which are presented in the previous section.
The conclusion is never a simple repetition of the study protocol. . It is important to characterize the mental state on the basis of the data obtained, the features of behavior, attitude to the study, the presence of attitudinal behavior should be noted, the leading pathopsychological features (syndromes) are highlighted, the features of the course of mental processes are indicated (for example, the rate of reactions, exhaustion, stability), the preserved aspects are described. mental activity.
It is allowed to bring characteristic striking examples. At the end, a summary is made reflecting the most important data (for example, the structure of the pathopsychological syndrome). The conclusion should not be categorical in terms of the style of the statements.
^ The conversation and experiment should contain elements of psycho-correction, the patient should be approved, noting, for example, the originality of the task, the insignificance of the mistakes made, etc.
The activities of pathopsychologists are fully applicable deontological claims, usually presented to psychiatrists.
One of them, extremely important, is to preserve professional secrecy. The pathopsychologist reports his results and diagnostic considerations only to the psychiatrist who sent the patient for research. The pathologist cannot share his assumptions regarding the diagnosis, treatment and prognosis with the relatives of the patient.
The pathopsychologist should not forget and about responsibility which the profession imposes on him, since an incorrect conclusion can contribute to causing damage to the patient both in case of incorrectly prescribed treatment, and in cases where inadequate social and legal measures are taken.
Pathopsychological research should not be iatrogenic . After the study, the patient should not have thoughts about his mental failure in connection with the behavior of the researcher. On the contrary, a pathopsychologist should always maintain maximum psychotherapeuticity in a conversation with a patient, promote optimistic tendencies and attitudes of the patient in predicting the course of the disease and the results of treatment.
It is clear that, as in any activity where two people participate, the relationship between them is important for the results of their joint activity. But in a pathopsychological experiment, this is especially important. Here, the quality of the result largely depends on the quality of the relationship between the patient and the psychologist. If the patient does not want to work with this specialist, then the specialist will not receive the information that he needs.
It should be remembered that the examination situation itself is stressful for the patient. Perhaps he is in the hospital for the first time, he is confused, depressed, or - angry, believes that everything that happened is violence, absurdity. A psychologist for such a patient is part of the evil world that haunts him, an enemy.
The task of a psychologist is to become the person whom he trusts, from whom he will expect help.
Patients are very different, and it is desirable to find an approach to everyone. Which patient we have to work with is beyond our influence. But it's well enough known What qualities should a psychologist have? .
It is desirable that he be self-possessed, tolerant of other people's opinions, friendly towards patients, tactful, as well as cultural, widely erudite.
His decisions must be balanced, he must not, while forming a hypothesis, be carried away by it and adjust the results obtained to fit it.
His questions about the motives of this or that answer should be tactful so as not to strain or frighten the patient.
He should not, by his pressure or arrogant appearance, provoke the patient's protest reactions.
Of particular importance is the ability to maintain equanimity, even with the patient's clearly provocative behavior. The manifestation of one's irritation never succeeds in changing the patient's negative attitude, rather, it will only increase the unwillingness to cooperate.
Also, when hearing a fanciful and ridiculous response from a patient, you should not make an expressive face and report your amazement.
The task of the pathopsychologist is to contribute to the fullest possible manifestation of the patient in the experimental situation. It is important that the psychologist's own emotional reactions do not interfere with the experiment and do not affect the perception and evaluation of the data obtained.
^ Topic 3. Pathology of memory
Program provisions.
Pathopsychological phenomenology of memory disorders. Amnesia - lack of memory, loss of the ability to retain and reproduce previously acquired knowledge. Violations of direct memory. Hypermnesia - strengthening, sharpening of memory. Hypomnesia, or dysmnesia, is a weakening of mnestic functions up to their complete loss. Fixation amnesia. Progressive amnesia. Ribot's law. Retrograde and anterograde amnesia. Paramnesia is a perversion, a deception of memory. Confabulations. Pseudo-reminiscences. Cryptomnesia. Violation of mediated memory. Violation of the motivational component of memory. Zeigarnik effect. Violations of the dynamics of mnestic activity. Memory disorders in patients of various nosological groups. Methods for the study of disorders of direct and mediated memory.
Lecture summary.
Memory is a mental process of accumulation of past individual and social experience.
Memory is a complex organized generalized activity that depends on many factors: the level of cognitive processes, motivation, dynamic components. Mental illness, by violating these components, disrupts mnestic processes in different ways.
Types of memory
1. By time
Operational
Short term
Long term
Memory functions
Memorization (fixation)
Storage
Playback
Memory disorders are a common symptom in mental illness. A number of disorders of mental activity - a violation of working capacity, a violation of the motivational sphere - sometimes appear for the patient himself and those watching him as memory disorders.
Various factors underlie memory impairment. The most important questions are:
the problem of the structure of mnestic activity
indirect
arbitrary
involuntary memorization;
the question of the dynamics of the mnestic process;
the question of the motivational component of memory.
Amnestic disorders- organic disorders, the main symptom of which is memory loss.
Amnesia - Lack of memory, loss of the ability to retain and reproduce previously acquired knowledge.
1.Violation of immediate memory.
From early childhood, the ability to memorize is gradually improved (first figurative, and then symbolic memory), reaching its optimal development by the age of 20-25. At this level, memory is retained up to 40-45 years, after which it gradually deteriorates, especially the mechanical memorization of new material.
In old and senile age, the memorization of new and current events noticeably suffers, but the ability to reproduce childhood impressions is well preserved (Ribot's law of reverse memory).
Mnestic functions fluctuate within certain limits and under the influence of various factors of everyday life - fatigue, lack of sleep, emotions.
In diseases, especially in the case of damage to the central nervous system, you can meet with various memory impairments.
Memory disorders can concern both all its individual components and its dynamics. In the latter case, it turns out that the patients either reproduce in detail the content of a complex story, a fable, or suddenly they are not able to convey a very easy plot (mnemic activity is intermittent).
Generally speaking, memory impairments can be divided into three main groups:
hypermnesia,
hypomnesia
paramnesia.
1) Hypermnesia(intensification, sharpening of memory) is manifested by an increase in memories of a past life or an improvement in remembering current events. In diseases, hypermnesia is more common as a temporary phenomenon in febrile states, arousal against the background of a pathological increase in mood (mania) and is characterized by fragmentation and instability. Only in hypomanic states (a mild form of mania) amplification of memories and memorization is more stable. Hypermnesia occurs sometimes in dementia; so, one imbecile remembered the dates of the burials of all the dead for 35 years in the village where he lived (Gurevich M.O., Sereysky M.Ya., 1928).
^ 2) Hypomnesia, or dysmnesia , - weakening of mnestic functions up to their complete loss. It can be general (concerns memorization and reproduction) and partial (cannot remember something at the moment or only memorization is impaired). The complete loss of the ability to retain and reproduce previously acquired knowledge is called amnesia.
If amnesia is associated with a predominant impairment of the ability to remember, then it is called fixation amnesia.
Fixation amnesia - characterized by the inability to remember what happened. For example, the patient is called the name and patronymic of the interlocutor, asked some distracting question and immediately asked again about them. As a rule, the patient claims that they were not called to him. A variation of fixation amnesia is perforation amnesia, when only some parts of information are not fixed.
In this regard, the memory of current, recent events weakens or is lost, but the ability to fully reproduce previously acquired experience remains. Such memory disorders are very characteristic of the so-called Korsakov's syndrome which is described by the famous domestic psychiatrist S.S. Korsakov with severe alcohol intoxication.
A type of fixative amnesia is perforation amnesia, when only some parts of the information are not fixed. In particular, during palimpsests, there is a loss of the ability to capture and, accordingly, then reproduce some details, episodes and details related to the period of intoxication (for example, when intoxicated).
^ Whenhysterical amnesia , unlike affectogenic ones, the memory of the situation, indifferent events that coincided with the amnestic ones in time, is preserved.
A kind of hysterical amnesia fantastic pseudology, where the facts of his biography or social status that do not satisfy the patient are forced out of memory. This combines a tendency to overestimate one's own personality, selfishness and egocentrism. Memory gaps in such patients are often replaced by fictitious events - hysterical fantasies. They are entertaining in terms of plot, intriguing and emphasize the significance of the patient's personality. In contrast to pathological mendacity, patients are convinced of their truth.
^ Kprogressive amnesia include those variants where the ability to memorize is sharply lost and the devastation of memory is steadily increasing according to Ribot's law.
The longest preserved traces of motor and emotional memory are motor skills (habitual actions, gait, gestures), the nature of affective reactions to certain situations.
Distinguish several stages of development of progressive amnesia.
At the first stage, there is a sharp decrease in memory for current events - fixation amnesia. Memory for the past may be satisfactory or even slightly increased (sometimes the revival of memory for past events reaches a degree hypermnesia).
At the second stage of amnesia, memory gaps are added to events that preceded the onset of the disease, and then more and more distant. First of all, the "memory of time" is violated while maintaining the "memory of content". At the same time, patients remember individual events and facts of their lives, but find it difficult to localize them in time and sequence. Subsequently, the "memory of the content, facts" also fades, but the "memory of emotional and moral and ethical reactions" is still preserved for a long time.
At the third stage, scattered and very meager memories are preserved, relating mainly to the childhood years of life. Events, dates are confused, relatives and acquaintances are not recognized, memories of the most important episodes of life are lost. Your photos are not recognized. Own image in the mirror is taken for the appearance of a stranger - a symptom of the mirror. All types of orientation are violated. Memories of the distant past can be experienced as happening at the moment - ecmnesia. Last but not least, with progressive amnesia, the "memory of the simplest skills" - praxis, disappears, which is accompanied by the formation of apraxia.
Progressive amnesia is observed in atrophic processes, progressive paralysis, and other grossly organic lesions.
The clinic separates retrograde and anterograde amnesia.
In the first of them, patients mostly forget the events of the period preceding the loss or clouding of consciousness.
In the second case, there are no memories for some period after leaving the state of clouded consciousness.
If the loss of memories is limited only to the events of the acute period of the disease (the period of disturbed consciousness), then such amnesia is called congrade amnesia. With a combination of all the presented options, amnesia is called anteroretrograde.
3) Paramnesia - perversion, deceptions of memory (false memories) resulting from a violation of the distribution of remembered events in time and space, distortion of previously experienced events, filling memory gaps with conjectures and fantasies, alienation of remembered experiences from one's own life experience, and others.
The most common of the paramnesias are pseudo-reminiscences ("Illusions of memory", erroneous memories), in which the existing gaps in the memory of the patient, as it were, fills in the events of a more distant past. A person can remember the events that really took place, but attribute them to a completely different time.
Pseudo-reminiscences are usually stable in content, re-told by patients, and have ordinary content. Their variety is ecmnesia - a shift of the situation into the past ("life in the past"), when not individual events and facts, but entire significant periods of the patient's life, are subjected to such a transfer from the past.
^ Whenechomnesia (Peak's reduplicating paramnesia) memory deception is that any event in the memories appears to be doubled, tripled. Current events are projected both into the present (adequately) and into the past. At the same time, the patient is convinced that he already had this event before.
They differ from pseudo-reminiscences in that they are not a substitute for memory lapses, but from the “already seen” symptom in that the present event is experienced not completely identical, but only similar to the past.
Echomnesia may indicate damage to the parietotemporal areas of the brain.
With Kalbaum's hallucinatory memories any hallucinatory experience is fixed by memory as a real event and projected into the past, where in reality it did not exist at all.
^ With pseudo-hallucinatory pseudo-memories of Kandinsky a fact created by the imagination immediately becomes the content of an auditory or visual hallucination, and in memory it becomes a memory of a real event that allegedly happened in the patient's past life. Similar memory disorders are sometimes found in the structure of hallucinatory-paranoid psychoses.
In a number of cases, the content of the false memory is of a fantastic nature, and patients describe events that clearly did not occur in their lives. Such paramnesias are called confabulations("hallucinations of memory", "fictions of memory", "nonsense of the imagination"). They usually have a bright, figurative character with a pathological conviction in their truth.
Pseudo-reminiscences and confabulations most characteristic of diseases where the ability to remember is lost - Korsakov's psychosis, senile dementia, progressive paralysis.
Cryptomnesia (crypto + Greek mnesis - recollection). - this kind of paramnesia, when a person cannot remember when this or that event took place, in a dream or in reality, i.e. the source of the information is forgotten. This is a memory disorder in which the line between what actually took place, real events and events that the patient heard from others, read or saw in a dream, seems to be blurred. At the same time, it is possible associated memories(seen in a dream, heard from others, read is perceived as experienced by the patient himself). Or, alienated memories (events of reality are perceived as heard, read, seen in a dream). Often cryptomnesia. is the cause of the actions of patients treated as plagiarism. That is, the reproduction of an event without recognizing it (cryptomnesia) can underlie unconscious plagiarism, when a certain fact (discovery or technical invention), established by someone earlier, is appropriated by the patient.
Cryptomnesia are found in some organic diseases of the brain, especially with damage to the parietal-temporal parts of it.
Autohypnotic amnesia(Greek autos - self, hypnos - sleep) - functional amnesia, characterized by forgetting due to repression.
^ catatim amnesia (Greek katathymo - lose heart, lose heart) - only on certain, personally significant events and persons.
Edeitism- a phenomenon in which the representation mirrors the perception. photographic memory.
2. Violation of mediated memory.
Indirect memorization - memorization using an intermediate, or mediating, link to improve reproduction.
Some tasks used in a pathopsychological experiment require the ability to link the concept denoted by the word with any more specific concept. The performance of this task is possible only at a certain level of generalization and abstraction.
^ Leontiev's scheme:
A - X - A norm
Where: A is a word or concept for memorization, X is a symbol or picture for a given word, Y is a new word or concept that the patient reproduces instead of the given one.
The circle of meanings of a word is wider than one, which can be used to designate a picture (in the method of pictograms). At the same time, the meaning of the picture is wider than the meaning of the word, the meaning of the picture and the word should coincide only in some part of it. The ability to catch the general in a drawing and a word is the main mechanism for the active formation of a conditional meaning. With pathological changes in thinking, the creation of such connections is difficult.
note on the difference that exists when remembering healthy and sick people:
in healthy patients, mediation improves memory,
but worsens in some patients.
^ For epilepsy there is a decrease in the efficiency of mediated memorization in comparison with direct memorization. In patients with epilepsy, as well as with organic lesions of the brain, there are difficulties in mediating the proposed concepts with a specific pattern. This is a consequence of a pronounced tendency to excessive detail, fixation on individual properties of objects.
^ With organic lesions of the subcortical structures of the brain Arbitrary reproduction and preservation are more disturbed, and recognition and memorization to a lesser extent. There is a relationship of memory impairment with mental exhaustion and a decrease in sensorimotor activity.
^ In patients with schizophrenia the convention of the picture becomes non-objective and wide, which ceases to reflect the real content of the word, or the picture reflects the actualization of weak, latent properties, which also makes reproduction difficult. Violations of operational, short-term, delayed and mediated memory are not detected. The decrease in memory observed in the methods is often of a secondary nature, due to a decrease in volitional effort.
^ In patients with neurosis and in reactive psychoses, complaints about memory loss are often not confirmed by experimental psychological research. In these diseases, the leading role in their mechanisms belongs to personality-motivational and emotional disorders. Therefore, the subject can "work" under a certain "organic" disease. However, errors may be simple options assignments and absent in difficult ones. The decrease in memory and attention in patients with neuroses often reflects internal anxiety and restlessness. There are psychogenic amnesias that follow psychotrauma. Violations of mediated memory are also distinguished, when mediated methods of memorization, for example, drawings, symbols associated with some information, do not help (as is normal), but make it difficult for memory to work.
3. Violation of the motivational component of memory.
Violation of controllability, selectivity of mental processes. Replacing the purposefulness of the act with stereotypes or random fragmented actions. The altered structure of the motivational sphere of patients is reflected in the violation of mnestic activity.
^ In healthy of the subjects, the ratio of reproduction of unfinished actions to completed ones = 1.9 (“Zeigarnik effect”). Completion of the task acts as a motivated intention. The activity of memory actualizes that affective readiness, which is formed due to the personal attitude of the subject to the experimental situation. Preferential reproduction of unfinished actions is not revealed if the conditions of the experiment are changed and the subject is informed that the experiment was carried out to test his memory.
^ 4. Violations of the dynamics of mnestic activity.
Patients remember information well for some period of time, but at another moment they cannot cope with the same type of task. Then, strictly speaking, one cannot say how deeply the memory is impaired.
Usually this type of disturbance is not detected in isolation, and almost all types of mental activity experience such fluctuations, EPO reveals the lability of all forms of their activity. The memory curve has a broken character. Text reproduction is labile. When performing intellectual tasks that require long-term and directed retention of the goal, instability of the mental production of patients is revealed (for example, alternation of generalized and situational decisions during classification).
Often, memory impairments are associated with amnestic depressions in speech: patients suddenly forget the names of some objects, phenomena, after a short time they spontaneously recall them.
Violation of the dynamics of mnestic activity is manifested in combination with the discontinuity of all mental processes of patients and, in essence, is an indicator of the instability of mental performance, its exhaustion. Forgetfulness is not a monosymptom, but a manifestation of impaired performance of patients in general.
The use of mediation generally improves reproduction. However, sometimes it leads to its deterioration, in the case when mediation interferes with the main activity of memorization. As a result, patients reproduce mediated words approximately. In this case, the efforts made by the patient to carry out mediation lead to even greater exhaustion of the already weakened cortical processes.
Such violations are found in patients with cerebrovascular disease (of course, not in the last period of the disease), in patients who have had mild traumatic brain injury (when enough time has passed after the injury).
^ MEMORY DISORDERS IN PATIENTS OF VARIOUS NOSOLOGICAL GROUPS.
Memory disorders are generally all types of organic brain lesions of any origin.
Atrophic processes (Pick's disease, Alzheimer's) and senile dementia - deep memory impairment: when working with the 10-word technique - reproduction of 1-2 words, the number of reproduced words does not increase with subsequent repetitions. Often, after 10 minutes, the patient no longer remembers that he did the technique, and not only cannot remember a single word.
Epilepsy. The depth of the epileptic defect is proportional to the memory impairment.
Gross exogenous brain lesions : deep alcohol intoxication, severe injuries leading to Korsakoff's syndrome. During the examination, gross violations of short-term memory, while maintaining memory of relatively distant events.
Relatively milder exogenous lesions, milder injuries, non-severe forms of vascular disease correspond to a less pronounced decrease in short-term memory, can be expressed in fluctuations in the dynamics of mnestic activity.
Complaints about memory impairment can also be heard from depressed patients , but in the study, significant violations not detected.
^ MEMORY STUDY IN A PATHOPSYCHOLOGICAL EXPERIMENT.
Most often, in the course of a pathopsychological experiment, the following are investigated: short-term memory,
visual memory,
semantic-logical memory and
associative memory.
Long-term memory is studied less often, because. most often it is not reached, it is more often in order, but sometimes it is necessary to investigate it too, if there is a suggestion in the conversation that it may be violated.
When researching short term memory testing:
direct memory,
accumulation process
information retention
delayed recall capability
storage of accumulated information.
Pay attention to the terminology used in describing the different aspects of mnestic activity. Various authors use the terms "short term memory" , "immediate memory" implying different meanings.
In modern literature, most often, direct memorization means the process of imprinting any information, which lasts for seconds.
And in the monograph Zeigarnik memorization of 10 words, which takes, sometimes more than 10 minutes, is also called direct memorization.
Therefore, when working with literature, it is necessary to pay attention to what specific mnemonic process the author describes using this name.
Memory Research Methods
A test for memorizing artificial (non-sense) sound combinations. The subject is read 10 two-syllable sound combinations (“rolls”, “vakar”, “siga”, etc.) and is asked to repeat those that he memorized, no matter in what order. Then the researcher re-reads these sound combinations. Healthy subjects fully reproduce them after 5-7 repetitions.
Test for memorization of 10 words. In this case, the subject is read 10 two-syllable words. The words to be memorized should be chosen in such a way that it would be difficult to establish any semantic relationships between them. If this is not foreseen, the subject can facilitate the task for himself by using mnemonic techniques.
Visual and auditory memory test
^
Meili test stimulus material
| Research stages |
|||
| 1st stage | 2nd stage |
||
| 1st series of pictures | 2nd series of pictures | 1st row of words | 2nd row of words |
| polka dots | shell | cardboard | table |
| donkey | bed | railway carriage | a week |
| key | pipe | peasant | ruble |
| wheelbarrow | pear | piano | Crow |
| bell | broom | shoe | blast furnace |
| table | goat | map | bee |
| Cherry | bouquet | hillock | glasses |
| boot | tram | chit | water |
| fork | saw | feather | hunter |
| a fish | chair | coal | ram |
| barrel | boy | squirrel | cloud |
| head | hammer | gun | poplar |
| buffet | bottle | boy | pencil |
| the Rose | cart | pear | Kick scooter |
| locomotive | comb | tablecloth | shoe |
| armchair | a gun | soup | goat |
| flag | wood | cloak | Cork |
| rooster | an Apple | cat | Coast |
| scissors | book | knife | nose |
| umbrella | hat | blotter | salon |
| vase | House | vinegar | hotel |
| cow | dog | flower | soap |
| sofa | bench | work | snake |
| pigeon | a door | sky | pan |
| clock | Cup | matches | bird |
| old man | river | ink | salad |
| glasses | bake | Castle | rocket |
| lamp | violin | hand | breakfast |
| leg | cigarette case | wood | snow |
| piano | horse | fire | pipe |
To conduct experiments, two series of 30 pictures each with images of various objects and sets of words (two rows of 30 words each - names of objects) are required.
When children answer, correctly named objects, repetitions, introduced, not existing in the task are fixed.
When studying visual memory, the student is instructed as follows: “I will show you pictures in turn, which depict various items, and after that you will name all the items in any order that you could remember. Pictures are presented with an interval of 2 seconds. After 10 sec. break, the child names the objects he remembers. The experimenter fixes both correctly named objects, and repetitions, and introduced ones that did not exist in the pictures. The second series of pictures, as well as a series of words, should be presented on other days.
Similarly, conduct a study of auditory memory. The student is instructed: "I will read you a series of words, and after listening, you will call them to me in any order." The experimenter records correctly named words, their repetitions and added words in the research protocol.
The results obtained are analyzed using quantitative measurements in percentages and their corresponding levels.
mediated memorization
Associative memory test
The psychologist reads these words, clearly separating the pairs with pauses. Then he reads out the first word of each pair, and the subject says the second word. Usually, healthy subjects perform the task after two repetitions, and sometimes immediately, after the first reading of the words.
Pictogram method.
Visual retention test by A. L. Benton.
Replay stories . The subject is read a story, he perceives it by ear or reads the story himself. He then reproduces the story orally or writes it down. When analyzing, the psychologist takes into account whether all the semantic links are reproduced, what is omitted, whether there are confabulations, an interfering effect. For memorization, the most preferred stories are: "Jackdaw and Doves", "Ant and Dove", "Logic", "Columbus Egg", "Eternal King", etc.
Wexler Memory Rating Scale et al.
The basic principle of constructing a pathopsychological experimental study is the principle of qualitative analysis of the features of the course of the mental processes of the patient. At the initial stages of the existence of clinical psychology in clinical practice, the method of quantitative measurement of mental processes dominated. This approach was due to the fact that at that time in psychology, which acquired the status of an experimental science, the study of the psyche was reduced to the isolation and study of individual mental functions (memory, perception, thinking, attention, etc.). Within the framework of such a functionalist approach, the essence of psychological research was to measure each individual function, to establish its quantitative characteristics. The most adequate solution of such problems was the test method. Since general psychological theory and practice are the methodological and methodological basis of clinical psychology, the functionalist approach and the corresponding testing method were transferred to the practice of studying the decay of mental functions. The study of mental disorders was reduced to establishing the degree of quantitative deviation from "normal" indicators, which were most often statistical norms. The method of quantitative measurements is still the leading one in the work of clinical psychologists abroad. Recently, it has been increasingly introduced into the practice of domestic clinical psychology. However, despite the fact that at one time the test method was deservedly recognized as the most objective of the methods of psychological research, it was rightly criticized. Binet-Simon's test school for measuring intelligence has reached the greatest fame and prevalence all over the world. On the basis of this scale, in particular, it was carried out (and in many countries is still being carried out) to distinguish between children with a normal, intact intellectual level from children with a delay, underdevelopment of intelligence. The methodological basis of this method was the idea that the intellectual abilities of a child are fatally predetermined by hereditary factors and practically do not depend on training and education. Therefore, each child is characterized by a certain age-specific intellectual indicator (intelligence quotient - IQ), which changes little over time. L. S. Vygotsky, criticizing the widespread practice of using the Binet-Simon method, believed that it only allows one to judge the amount of acquired knowledge, skills and abilities, and not about the structure and qualitative features of children's mental activity, therefore, quantitative measurements of intelligence do not make it possible predict the future development of the child.
This example clearly shows the limited possibilities of using quantitative test measurements in the study of patients. When using methods aimed at measuring mental functions, neither the features of mental activity, nor the qualitative side of disorders, nor the possibility of compensation, the analysis of which is necessary in solving clinical problems, primarily related to psychocorrection, can be taken into account. By measuring, only the final results of the work are revealed, while its very process, all the variety of qualitative features of the subject's activity remain "behind the scenes" of scientific knowledge. And this contradicts the goals and objectives of pathopsychological research, which should be aimed specifically at revealing the psychological mechanisms, patterns of decay of the patient's mental activity, and not at ascertaining the presence of a deviation from the norm.
In domestic psychology, a quite definite view of the nature of the mental has developed, according to which mental processes are formed in vivo in the course of the appropriation of socio-historical human experience in the process of activity and communication. Therefore, a pathopsychological experiment should be aimed not at the study and measurement of individual mental functions, but at the study of a person performing a real activity, at identifying the mechanisms of activity disturbances and the possibilities of its restoration. A qualitative analysis of the characteristics of the course of the patient's mental processes, as opposed to a purely quantitative measurement of the result of this process, is the fundamental principle of constructing a pathopsychological experimental study. A qualitative approach allows the pathopsychologist not only to determine, what is the level development of a particular mental function, how much it matches or does not match regulatory standard, how much to answer the question, how the mental process itself was carried out, how identified errors and difficulties.
The priority of qualitative analysis does not mean a complete rejection of the quantitative characteristics of experimental data. Naturally, quantitative indicators, statistical processing of the material should be used where the task in hand requires and allows it, but quantitative analysis cannot replace the qualitative characteristics of mental disorders.
The use of qualitative analysis in a pathopsychological experimental study makes it possible to successfully solve one of the most difficult diagnostic tasks - obtaining data for making a differential diagnosis. As is known, various mental disorders can manifest themselves in a similar way in violations of cognitive activity and behavior. There may be different mechanisms behind the same pathopsychological symptom. For example, a violation of mediated memory in one case may be associated with a violation of mental performance (with asthenia of organic origin), in another - with a violation of the purposefulness of motives (in "frontal" patients, with schizophrenia), in the third - with a decrease in the level of generalization (with oligophrenia , dementia). In other words, the nature of mental disorders is not specific for a particular disease or form of its course, it is only typical for them and can only be assessed in conjunction with the data of a holistic pathopsychological study. That is, the analysis of pathopsychological data should be not only qualitative, but also systematic. In pathopsychology, not so much symptomatic as syndromal analysis is needed (A. R. Luria).
The implementation of this requirement is facilitated by the following from the basic principle of pathopsychological research principle of mental activity modeling, i.e., the activity that a person carries out in his daily life (in the process of study, professional activity, communication). B. V. Zeigarnik equated experimental pathopsychological research with the method of “functional test”, which is widely used in medical practice, which consists in testing the activity of any organ or system. In a pathopsychological experiment, the role of such a functional test can be played by experimental tasks, in the solution of which cognitive actions and the patient's personal attitude to the task, to the experimental situation as a whole, are actualized. In other words, an experimental pathopsychological study should act as an agent that "provokes" the manifestation of the peculiarity of the patient's mental activity and the system of his attitudes towards himself and the environment.
The pathopsychologist must consider all the components of the experimental situation, everything that happens during and about the experiment, since the experimental situation is a segment of real life in which the characteristics of the patient's personality and activity are fully manifested. In other words, the experimental situation can be considered as a model of the real life situation patient, as a segment of his real life. Such an approach to a pathopsychological experiment makes it predictive. For example, if during an experimental study the child does not notice the mistakes he made on his own, but with stimulating help he can correct them, then it is likely that the low results of his educational activity are also due to the unformed self-regulation of cognitive activity and at the same time can be improved.
Understanding a pathopsychological study as a model of a patient’s real mental activity requires a close analysis of all elements of behavior during its implementation: reactions to instructions, to the content of experimental tasks, to difficulties and errors that arise in the course of their solution, to assessments of the results of actions by the subjects themselves and the experimenter, to the assistance provided to the patient, to change the conditions for the course of activity, etc. It is obvious that such an approach requires a qualitative analysis, it must be systematic, and also imposes special requirements on the procedure for conducting the study.
Another important principle of pathopsychological research is the obligatory consideration of the role of the personality component in mental activity. Considering the higher mental functions as complex types of mental activity, it is necessary to recognize that it is not the brain that performs mental, perceptual, mnestic activities, not thinking or perception (memory) by themselves. The subject of any activity, including perceptual, mnestic, mental, is a person, that is, a person who is the bearer of a system of social relations.
In other words, the essence of mental and psychopathological phenomena is revealed not only in the process and results of human activity, but also in the system of human relations to this activity, to the situation in which this activity unfolds. V. N. Myasishchev pointed to this in his time. Relationships of a person are connected with the structure of his personality, with his needs, motives, with his emotional and volitional characteristics.
Under the influence of a disease, a person often develops pathological personality changes that have a significant impact on the course of all mental activity as a whole, since it is the personality that is the subject of the activity. Indicators of pathological personality changes are changes in the system of a person's relationship to himself and the environment. His interests are waning, his needs are becoming smaller, his actions lose focus, become thoughtless, a person ceases to regulate his behavior, to adequately assess his capabilities. Moreover, these changes are manifested both in real life and in an artificially created experimental situation. Therefore, the very attitude of the patient to the situation, to himself, and not just the course and result of activity, should become the subject of research, should be reflected in the design of the experiment.
The implementation of the identified principles of pathopsychological research imposes special requirements on its conduct. The requirement for a systematic qualitative analysis of all mental activity and the system of relations during the experiment leaves an imprint on the technology of its implementation.
Unlike a conventional experimental study (especially its psychodiagnostic variant), a pathopsychological experiment is essentially a joint activity of the experimenter and the subject, in the context of which communication is closely interwoven. In real life, a person performing any activity, especially if he has not yet mastered it, necessarily enters into contacts with other people about it. Often, it is the inability to establish contact, ask for help, adequately accept it, which leads to failure in mastering and performing activities, therefore, in an experimental situation, the psychologist not only can, but must also enter into communication with the subject about the experimental task or the situation in which it is being implemented. As you know, the requirements for the implementation of psychodiagnostic methods (especially test methods) minimize or prohibit free communication between the experimenter and the subject.
Significant differences are also observed in the technology of conducting psychodiagnostic and pathopsychological experiments. The technology of conducting test methods is strictly regulated, it requires the creation of unified standard conditions. The psychologist must strictly adhere to the existing research algorithm. Such a requirement meets the main goal of a psychodiagnostic study - a comparison of psychological indicators. Since the pathopsychologist has a different goal - to identify the qualitative originality of the course of the mental activity of a particular patient, the requirements of standardization, strict regulation of the research procedure are inappropriate here. The pathopsychologist, of course, creates a specific research program, but such a program is always variable, changeable, not rigidly algorithmized, since the joint activity of the psychologist and the subject develops in the real fabric of their interaction, is always individual and unique, and therefore cannot be rigidly set in advance. That is why pathopsychological research is a more complex, more subtle instrument of psychological knowledge, since it makes the transition from fixing the external manifestations of mental disorders to revealing their internal mechanisms.
Another feature of the pathopsychological experiment is the need to detect not only the structure of altered, but also preserved forms of the patient's mental activity. This allows, firstly, to implement a systematic approach in the study of the patient's psyche. It is the characteristic combination of preserved and disturbed aspects of mental activity that determines the originality of pathopsychological syndromes, to the identification of which, in essence, all pathopsychological research is directed. Secondly, the discovery of the intact aspects of the psyche during a pathopsychological experiment is especially important in the implementation of psycho-corrective measures. The need for such an approach was pointed out in his time by A. R. Luria, who said that the success of the restoration of disturbed complex mental functions depends on how much the restoration work relies on the intact links of mental activity. In Russian psychology, the idea has developed that the psychophysiological mechanisms of higher mental functions are the activity of functional systems (P.K. Anokhin, A.R. Luria). Therefore, in the event of the collapse of the HMF, their restoration should proceed according to the type of restructuring of the dynamic functional systems underlying them.
Similar conclusions are drawn by specialists working in the field of speech restoration (E. S. Bain, V. M. Kogan, L. S. Tsvetkova), who believe that restoration work should be based on the revival of the knowledge that has remained intact. The legitimacy of such conclusions was confirmed during experimental research and restoration of not only "narrow" functions (speech, praxis), but also more complex forms of mental activity of patients, for example, lost mental performance.
In order for a pathopsychological experiment to be able to reveal the preserved links of altered mental activity, it must be aimed not only at analyzing the results of this activity. More important for identifying preserved components of activity and for predicting the recovery of functions are data on how the patient searches for a solution, how receptive he is to the assistance provided to him, whether he can use it. The solution of such a problem becomes possible, as already noted, due to the active position that the pathopsychologist takes in conducting the study.
Thus, the following principles for constructing a pathopsychological experimental study can be distinguished:
1) systematic qualitative analysis of the mental activity of the patient;
2) modeling of mental activity in experimental conditions;
3) appeal to the personality of the patient, actualization of his personal relationships;
4) the active position of the pathopsychologist during the experiment, considered as a joint activity with the subject;
5) identification of not only disturbed, but also intact aspects of mental activity in order to rely on them in psycho-correctional work.
