G.S. Sullivan's interpersonal theory of psychiatry. The Origin of Mental Illness: A History of the Sullivan G S Interpersonal Theory in Psychiatry

Psychiatry

Psychiatry is divided into general and specific:

If private psychiatry studies individual diseases, then general psychopathology, or rather, general psychiatry, studies the general patterns of mental disorder ... Typical psychopathological states can occur in various diseases, therefore, they have a general meaning ... General psychiatry is based on the generalization of all those changes that occur in the course of certain mental illnesses.

Signs (symptoms) of mental disorders are the subject of psychiatric semiotics.

The priority of the clinical method, the subordinate position of instrumental techniques give rise to accusations of the subjectivity of diagnostics in psychiatry. Denial of the possibility of an objective diagnosis in psychiatry leads to denial of the existence of mental illness in general and of psychiatry itself as a science.

Zharikov N.M., Ursova L.G., Khritinin D.F.Psychiatry: Textbook - M .: Medicine, 1989.S. 251

History of psychiatry

Kittrey investigated a range of deviant manifestations, such as drug addiction, homosexuality, alcoholism and mental illness, and demonstrated that such manifestations were considered first moral, then legal, and are now considered medical problems: 1. As a result of this perception, extraordinary people with deviations from the norm were subjected to social control of a moral, legal and then medical nature: 1. Similarly, Konrad and Schneider conclude their review of the medicalization of deviance with the view that one can find three main paradigms on which the meanings of the concept of deviance in different historical periods depended: deviance as a sin, deviance as an offense, and deviance as a disease: 1:36.

Psychiatry in the late 19th - early 20th centuries

In the science of mental disorders in the late 19th and early 20th centuries, two schools stood out among others. The first is psychoanalysis, which began with the work of Sigmund Freud (1856-1939), who laid the foundation for the theory of the unconscious. According to this doctrine, in the human brain there was a region of animal instincts (the so-called "It", opposed to the personal "I" and "Super-I" - the dictates of society, commanding the personality and imposing certain norms of behavior). The unconscious, from the point of view of Freud and his followers, became a prison for forbidden desires, in particular - erotic, displaced into it by consciousness. In view of the fact that it is impossible to completely destroy desire, for its safe implementation, consciousness proposed a mechanism of "sublimation" - implementation through religion or creativity. A nervous breakdown in this case was presented as a failure in the mechanism of sublimation and the splashing out of the forbidden through a painful reaction. To restore the normal functioning of the personality, a special technique was proposed, called psychoanalysis, which involved returning the patient to childhood memories and resolving the problem that had arisen.

Freudianism was opposed by the school of positivist medicine, one of the outstanding figures of which was Emil Kraepelin. Kraepelin based his understanding of mental disorder on progressive paralysis and proposed a new form for the time of studying the disease as a process that develops in time and breaks down into certain stages, described by a certain set of symptoms. Relying on the philosophy of positivism, in particular, on the principle “science is philosophy”, in other words - the proclamation of only the results of experience or scientific experiment as real as opposed to the scholastic thinking of earlier times, positivist medicine offered an explanation of mental disorder as a biological disorder, destruction of brain tissue caused by causes of multiple nature.

However, neither the one nor the other theories could claim to unequivocally and substantiate the cases already described in the literature or known from clinical practice - for example, Freud and his followers were reproached for the speculative and unsystematic nature of their constructions, for the arbitrary interpretation of the examples given. In particular, Freud built his theory of child sexuality on the psychoanalysis of adults, explaining the impossibility of confirming it in children by the fear of a forbidden topic.

In turn, opponents reproached Kraepelin for the fact that the theory of organic defeat de facto reduced madness to emotional and mental degradation. The cure of a mental patient was a priori declared at that time impossible, and the doctor's work was reduced exclusively to supervision, care and relief of possible aggression. In addition, it was pointed out that the positivist theory was unable to explain the numerous cases of mental disorders, while no biological damage could be found.

Phenomenological Psychiatry

As one of the ways to get out of the outlined impasse: 18-19 Edmund Husserl and his followers proposed a method called phenomenological.

Its essence was reduced to the allocation of certain "phenomena" - ideal entities, which are a reflection of objects of the real world, as well as one's own "I" in the consciousness of the individual. These phenomena, idealized facts, cleared of the emotional and social component, represented, according to Husserl, the basis of all knowledge - despite the fact that they did not exist in reality, but were inextricably linked with the cognizing subject. Philosophy, therefore, was supposed to serve as the completion of any research, representing its quintessence and rigorous system at the level of scientific understanding, and phenomenology - the instrument of this knowledge.

The application of the phenomenological method in psychology and psychiatry was based on the postulate of the "corporeality of the mind" - the inextricable connection of a person with the outside world and the ability for consciousness to function normally exclusively in this connection. Violation of such, confusion of perception in the transmission of external impressions to the mind is the essence of mental illness. The restoration of this connection accordingly leads to recovery. The method of achieving phenomenological clarity of reason, however, was to clarify, bracketed the emotional aspect and a clear view of the world, not clouded by prejudice, which received a special name from phenomenologists "epoch".

General psychiatry

All mental disorders are usually divided into two levels: neurotic and psychotic.

The border between these levels is conditional, however, it is assumed that gross, pronounced symptoms are a sign of psychosis ...

Neurotic (and neurosis-like) disorders, on the other hand, are characterized by mild and smooth symptoms.

Mental disorders are called neurosis-like if they are clinically similar to neurotic disorders, but, unlike the latter, are not caused by psychogenic factors and have a different origin. Thus, the concept of the neurotic level of mental disorders is not identical with the concept of neuroses as a group of psychogenic diseases with a non-psychotic clinical picture. In this regard, a number of psychiatrists avoid using the traditional concept of "neurotic level", preferring more precise concepts of "non-psychotic level", "non-psychotic disorders".

Neurotic and psychotic concepts are not associated with any particular disease.

Zharikov N.M., Tyulpin Yu.G. Psychiatry: Textbook. - M .: Medicine, 2002 .-- P. 71.

Disorders of the neurotic level often debut progressive mental illnesses, which subsequently, as the symptoms worsen, give a picture of psychosis. In some mental illnesses, such as neuroses, mental disorders never exceed the neurotic (non-psychotic) level.

PB Gannushkin suggested calling the entire group of non-psychotic mental disorders "small", and VA Gilyarovsky - "borderline" psychiatry. The terms "borderline psychiatry", "borderline mental disorders" are often found on the pages of publications on psychiatry.

Productive symptoms

In the case when the result of the work of the mental function is mental production, which normally should not be, such mental production is called "positive", "productive" symptomatology. Positive symptoms are a sign of a medical condition (not always). Diseases, the key symptoms of which are this kind of "positive" symptomatology, are usually called "mental illnesses" or "mental illnesses". Syndromes formed by "positive" symptomatology in psychiatry are usually called "psychoses" (the topic of neuroses deserves a separate consideration [ Style?]). Since a disease is a dynamic process that can end with either recovery or the formation of a defect (with or without a transition to a chronic form), then this kind of "positive" symptomatology ultimately ends with recovery or the formation of a defect. This defect in the work of mental function in psychiatry is usually called "dementia". (Dementia arising before the end of the formation of mental functions, that is, congenital or formed in childhood, require separate consideration [ Style?].) It should also be noted [ Style?] that productive symptoms are not specific (for any particular disease). For example, delusions, hallucinations, and depression can be present in the picture of various mental disorders (with different frequencies and characteristics of the course). But at the same time, there is an "exogenous" (that is, caused by reasons external to the brain cells) type of response (psyche), for example, exogenous psychoses, and an endogenous type of response (psyche), or "endogenous" disorders. Since the 19th century, there has been a concept in psychiatry according to which endogenous psychoses are a single disease (the so-called theory of a single psychosis).

General pathological patterns of the formation of productive (positive) psychopathological syndromes in mental illness can be represented as the following diagram (A.V. Snezhnevsky, 1983):

The ratio of productive psychopathological syndromes

Negative symptoms

« Negative symptomatology (deficit, minus-symptomatology) is a sign of persistent loss of mental functions, a consequence of breakage, loss or underdevelopment of some links of mental activity. The manifestations of a mental defect are memory loss, dementia, dementia, a decrease in the level of personality, etc. It is generally accepted that positive symptoms are more dynamic than negative; it is changeable, capable of becoming more complex and, in principle, reversible. Deficiency phenomena are stable, they are highly resistant to therapeutic influences "(Zharikov NM, Ursova LG, Khritinin DF Psychiatry: Textbook. - M .: Medicine, 1989. P. 161-162).

In domestic psychiatry, the patterns of the formation of negative syndromes in mental illness are usually described using the scheme proposed by Academician A.V. Snezhnevsky (see fig.).

Major ranks of negative mental disorders

The levels of mental disorders are depicted in the diagram as nested circles. This is intended to reflect the clinical fact that each higher level circle includes all the underlying layers of mental disorders.

Now let's look at the "positive" and "negative" symptomatology in relation to each mental function.

Perceptual disturbances

There can be no defect (negative symptomatology) for perception, by definition, since perception is the primary source of information for mental activity. Positive symptoms for perception include illusion (incorrect assessment of the information received from the sense organ) and hallucination (disturbance of perception in one or more sense organs (analyzers), in which the false (imaginary) perception of non-existent, non-perceived information by the sense organs is interpreted as real).

Perceptual disorders are also usually classified according to the sense organs to which the distorted information belongs (for example: "visual hallucinations", "auditory hallucinations", "tactile hallucinations" - they are also called "senestopathies").

Sometimes, disturbances in thinking are added to disturbances in perception, and in this case, illusions and hallucinations receive a delusional interpretation. Such nonsense is called "sensual". This is figurative delirium, with a predominance of illusions and hallucinations. Ideas with him are fragmentary, inconsistent - primarily a violation of sensory cognition (perception).

Memory impairment

The problem of positive symptomatology for the mental function "memory" will be discussed further (in the section "Conclusion").

Dementia, in which the key disorder is memory impairment, is the so-called "organic brain disease".

Thinking disorders

As the key point in dementia caused by psychoorganic syndrome is memory impairment, then intellect disorders in patients are manifested first of all, the ability to acquire new knowledge deteriorates to varying degrees, the volume and quality of knowledge gained in the past decreases, the range of interests is limited. In the future, the deterioration of speech is added, in particular oral (the vocabulary decreases, the structure of phrases is simplified, the patient often uses verbal templates, auxiliary words). It is important to note that memory impairments extend to all types of memory. The memorization of new facts worsens, that is, the memory for current events suffers, the ability to preserve the perceived and the ability to activate the reserves of memory decreases.

Epilepsy

The clinical manifestations of epilepsy are extremely diverse. This article deals only with a characteristic epileptic defect (epileptic dementia - epileptic dementia).

Thinking disorder is a key component of epileptic dementia... Cognitive operations include analysis, synthesis, comparison, generalization, abstraction and concretization with the subsequent formation of concepts. The patient loses the ability to separate the main, the essential from the secondary, from small details. The patient's thinking becomes more and more specific and descriptive, cause-and-effect relationships are no longer understandable for him. The patient gets bogged down in trifles, with great difficulty switches from one topic to another. In patients with epilepsy, it is found that the called objects are limited to the framework of one concept (only pets are called as animate or furniture and the environment as inanimate). The inertia of the course of associative processes characterizes their thinking as stiff, viscous. The depletion of vocabulary often leads to the fact that patients resort to the formation of an antonym by adding a particle "not" to a given word. The unproductive thinking of people with epilepsy is sometimes called labyrinthine.

Schizophrenia

This article deals only with the characteristic schizophrenic defect (schizophrenic dementia - dementia praecox). This dementia is characterized by emotional impoverishment, reaching the degree of emotional dullness. The defect lies in the fact that the patient does not develop emotions at all and (or) the emotional reaction to the production of thinking is perverted (such a discrepancy between the content of thinking and emotional assessment is called "splitting of the psyche").

Affective insanity

With the development of mental disorders (productive symptoms, that is, mania or depression), the mental function called "Affect" of the defect (dementia) does not occur.

Unified psychosis theory

According to the theory of "unified psychosis", a single endogenous mental illness, which combines the concepts of "schizophrenia" and "manic-depressive psychosis", at the initial stages of its development proceed in the form of "mania", "melancholy (that is, depression)" or " madness "(acute delirium). Then, in the case of the existence of "insanity", it is naturally transformed into "nonsense" (chronic delirium) and, finally, leads to the formation of "secondary dementia". The founder of the theory of a single psychosis is V. Grisinger. It is based on the clinical principle of T. Sydenham, according to which the syndrome is a natural combination of symptoms that change over time. One of the arguments in favor of this theory is the fact that affect disturbances include specific disturbances in thinking caused exclusively by disturbances in affect (the so-called secondary changes in thinking). Such specific (secondary) thinking disorders are, first of all, violations of the rate of thinking (the rate of the thinking process). The manic state causes an acceleration of the pace of thinking, and depression slows down the pace of the thinking process. Moreover, changes in the pace of thinking can be so pronounced that thinking itself becomes unproductive. The pace of thinking in mania can increase to such an extent that any connection is lost, not only between sentences, but between words (this state is called "verbal okroshka"). On the other hand, depression can slow down the pace of the thinking process so much that thinking stops altogether.

Disturbances of affect can also become the cause of a kind, characteristic only of disturbances of affect, delirium (such delusion is called "secondary"). Manic states cause delusions of grandeur, and depression is the root cause of self-deprecating ideas. Another argument in favor of the theory of a single psychosis is the fact that there are intermediate, transitional forms between schizophrenia and manic-depressive psychosis. And not only from the point of view of productive, but also from the point of view of negative, that is, determining the diagnosis of the disease, symptoms. For such transitional states, there is a general rule, which says: the more in the endogenous disease of the disorder of affect in relation to the productive disorder of thinking, the subsequent defect (specific dementia) will be less pronounced. Thus, schizophrenia and manic-depressive psychosis are one of the variants of the course of the same disease. Only schizophrenia is the most malignant variant of the course, since it leads to the development of severe dementia, and manic-depressive psychosis is the most benign variant of the course of a single endogenous disease, since in this case the defect (specific dementia) does not develop at all.

Treatment methods

Basic methods

• Psychopharmacotherapy

Other

Criticism

Literature

• Workshop on Psychiatry: Textbook. allowance. Ed. prof. M.V. Korkina. 5th ed., Rev. - M .: RUDN, 2009 .-- 306 p. ISBN 978-5-209-03096-6 The following books are publicly available on the Internet:
• Bukhanovsky A.O., Kutyavin Yu.A., Litvak M.E. General psychopathology. 3rd ed. M., 2003.
• Zharikov N.M., Ursova L.G., Khritinin D.F. Psychiatry: Textbook - M .: Medicine, 1989. - 496 p: ill. (Textbook. Literature. For student medical institute. Sanitary-gig. Fac.) - ISBN 5-225-00278-1
• Zharikov N.M., Tyulpin Yu. G. Psychiatry: Textbook. - M .: Medicine, 2000. ISBN 5-225-04189-2
• Kannabikh Yu. V. History of Psychiatry. - Moscow: AST, Minsk: Harvest, 2002 .-- 560 p. ISBN 5-17-012871-1 (AST) ISBN 985-13-0873-0 (Harvest)
• Korkina M.V., Lakosina N.D., Lichko A.E. Psychiatry: Textbook. - M .: Medicine, 1995 .-- 608 p. ISBN 5-225-00856-9 Korkina M.V., Lakosina N.D., Lichko A.E., Sergeev I.I. Psychiatry: Textbook. 3rd ed., Add. and revised - M., 2006.
• Psychiatric Guide. Ed. G.V. Morozov. In 2 volumes. - M., 1988.
• Psychiatric Guide. Ed. A. V. Snezhnevsky. In 2 volumes. - M., 1983.
• Psychiatric Guide. Ed. A.S. Tiganova. In 2 volumes. - M .: Medicine, 1999. ISBN 5-225-02676-1
• Handbook of Psychiatry. Ed. A. V. Snezhnevsky. - M .: Medicine, 1985

Notes (edit)

1. Grisinger V. Mental illness. Petersburg: A. Cherkasova and Co., 1875.S. 1.
2. Psychiatric Guide. Ed. A.S. Tiganova. In 2 volumes. M .: Medicine, 1999. - T. 1. - P. 17.
3. Smetannikov P.G. Psychiatry: A Guide for Physicians. - Publishing house 5th, revised. and add. - M .: Medical book; N.Novgorod: NGMA, 2002.S. 6.
   • Only email is available on the Internet. version of the 1st edition of this manual: Smetannikov P.G. Psychiatry: A Brief Guide for Physicians. - SPb .: publishing house SPbMAPO, 1994.
4. Psychiatry: A Textbook for Medical Students. Ed. V.P.Samokhvalov. - Rostov n / D .: Phoenix, 2002 .-- P. 13.
5. "History of Psychiatry" by Yu. V. Kannabikh, Ch. 18: 2 (see: Kannabikh Y. V. History of psychiatry. - M .: AST, Minsk: Harvest, 2002. - S. 235). Cannabich transcribes the surname of the German psychiatrist as "Reil".
6. Kannabikh Yu. V. History of Psychiatry. - Moscow: AST, Minsk: Harvest, 2002 .-- P. 235.
7. Korkina M.V., Lakosina N.D., Lichko A.E. Psychiatry: Textbook. - M .: Medicine, 1995 .-- S. 5.
8. Pervomaisky B.V., Karagodina E.G., Ileiko V.R., Kozeratskaya E.A. Categories of illness, health, norm, pathology in psychiatry: concepts and criteria for differentiation.
9. Psychiatric Guide. Ed. G.V. Morozov. In 2 volumes. M., 1988 .-- T. 1. - S. 11.
10. Mehrabyan A.A. General psychopathology. Moscow: Medicine, 1972.
11. "General psychiatry" - an article in the book: Bleikher V. M., Kruk I. V.
12. See about this: Snezhnevsky A. V. General psychopathology: A course of lectures. - M .: MEDpress-inform, 2001.S. 8; Mehrabyan A.A. General psychopathology. M .: Medicine, 1972.S. 5-6.
13. Zharikov N.M., Tyulpin Yu. G. Psychiatry: Textbook. M .: Medicine, 2000.S. 21.
14. See: Marilov V.V. Private psychopathology: Textbook. manual for stud. higher. study. institutions. - M .: Academy, 2004 .-- 400 p. ISBN 5-7695-1541-4
15. Bleikher V.M., Kruk I.V. Explanatory Dictionary of Psychiatric Terms / Ed. Bokova S.N. In 2 volumes. - Rostov-on-Don: Phoenix, 1996.
16. Zharikov N.M., Ursova L.G., Khritinin D.F. Psychiatry: Textbook - M .: Medicine, 1989. S. 250.
17. TSB. Psychiatry
18. Psychiatry: A Textbook for Medical Students. Edited by V.P. Samokhvalov. - Rostov n / a .: Phoenix, 2002 .-- 576 p. ISBN 5-222-02133-5
19. "The Myth of Mental Illness" Professor Emeritus of Psychiatry Thomas Szasz
20. Manning N. The therapeutic community movement: charisma and routinization. - London: Routledge, 1989. - P. 1. - 246 p. - ISBN 0415029139
21. Kittrie N. The right to be different: deviance and enforced therapy. - Johns Hopkins Press, 1971. - 443 p. - ISBN 0801813190
22. Conrad P., Schneider J. Deviance and medicalization: from badness to sickness. - Temple University Press, 1992. - P. 36. - 327 p. - ISBN 0877229996
23. Kirilenko G.G., Shevtsov E.V. Freudianism and neo-Freudianism // Philosophy. - M .: Eksmo, 2003 .-- 672 p. - ISBN 5-09-002630-0
24. Marneros A. Late-Onset Mental Disorders. - RCPsych Publications, 1999 .-- P. 17 .-- 200 p. - ISBN 1901242269
25. Cannabich Yu. History of Psychiatry. - M .: AST, 2002 .-- 560 p. - ISBN 5-17-012871-1
26. Positivism (Russian). Archived from the original on August 23, 2011. Retrieved March 18, 2011.
27. Thiher A. Revels in Madness: Insanity in Medicine and Literature. - University of Michigan Press, 2005 .-- 368 p. - ISBN 0472089994
28. Blonsky P. To the criticism of the Freudian theory of child sexuality (Russian) // Republic: collection. - M., 1994.
29. Engstrom E.J. Emil Kraepelin: psychiatry and public affairs in Wilhelmine Germany (eng.) // History of psychiatry... - T. 2. - No. 6. - S. 111-132. - DOI: 10.1177 / 0957154X9100200601
30. Cromwell A.L. Assessment of Schizophrenia (English) // Annual Review of Psychology: Sat .. - 1975. - T. 26. - S. 593. - DOI: 10.1177 / 0957154X9100200601
31. Colucci M., Di Vittorio P. Franco Basaglia: portrait d "un psychiatre intempestif. - Érès, 2005. - 230 p. - ISBN 2749204909
32. Husserl Edmund (1859-1938) (Russian). Archived from the original on August 20, 2011. Retrieved March 20, 2011.

- 262.50 Kb

In 1931 he published his article "Environmental factors in the etiology and treatment of schizophrenia." In it, Sullivan suggested that the manifestations of schizophrenia must be explained on the basis of human experience, and not hereditary or organic factors, the importance of which is incomparably less. In his opinion, under the influence of experience, some people may experience changes in behavior and way of thinking. It was them that Sullivan understood as manifestations of schizophrenic psychosis.

The origins of this psychosis, according to Sullivan, lie in those real-life events that were experienced by the patient or his loved ones. Communication at a very early age with the mother or the person replacing the mother is of great importance. If the infantile aspects of the personality that are formed in this case are distorted, this can lead to disruptions in the subsequent development and formation of a pathological personality, or, if they are not too pronounced, to the emergence of neuropathic dependence on the mother in boys. At the same time, there is a complete or partial integration of the maternal belief system, which can subsequently lead to a violation of the development of natural interest in girls. The child's personality will not be able to develop itself in the direction of the natural heterosexual, which can negatively affect his relationship with others.

Such impaired development entails a deterioration in interpersonal relationships. Combined with this, excessive self-identification with the mother can lead to schizophrenic psychosis. These ideas about the relationship of interpersonal behavior and pathology Sullivan reflected in his only monograph published during his lifetime - "The Concept of Modern Psychiatry" (1947).

In this case, the main task of psychotherapy becomes the development of protective mechanisms of the personality, ensuring its adequate adaptation to others. To achieve this goal, Sullivan will develop a "psychiatric interview" method, which involves the influence of a psychiatrist on the interpersonal situation that arises in contact with the patient. Great attention was paid here to the role of the doctor during such communication. The role of the therapist, according to Sullivan, was to help the patient understand and verbalize their experiences.

In 1932, he co-founded the Washington-Baltimore Psychoanalytic Society, acting as an affiliate of the APA, reorganized into the Federation of American Psychoanalytic Societies. THEN. Harry Sullivan was a representative of the psychoanalytic movement in the United States, the author of "interpersonal psychoanalysis." A year later (in 1933), he put forward the idea of ​​creating a psychoanalytic section in the American Psychiatric Association, which caused an extremely negative reaction from orthodox psychiatrists, although in the USA (unlike in Europe) there was no such a sharp dividing line between psychoanalysis and academic psychiatry.

In 1933, he became president of the William Alencon White Foundation and remained there until 1943. In 1936, he helped found and became director of the Washington School of Psychiatry, the Foundation's teaching institute.

In 1938, the journal Psychiatry began to appear, reflecting Sullivan's theory of interpersonal relations. He was first a co-publisher, whose editor was the first ten years of its existence, and then - until his death - the publisher of this magazine.

In 1948 he managed to start publishing two journals "Journal of Biology and Pathology" and "Journal for the Study of Interpersonal Processes."

In addition to William Alencon White, the main influence on the intellectual path of Sullivan was exerted by Freud, Adolph Meyer (Meueg, A.), as well as the Chicago School of Sociology, composed of George Herbert Mead (Mead, GH), W. I. Thomas (Thomas, WI), Edward Sapir (E.), Robert E. Park (Park, RE), E.W. Burgess (EW), Charles E. Merriam (Merriam, CE), William Healy (W.), Harold Lasswell (H.). Sullivan felt a particular closeness with Edward Sapir, who was one of the first to advocate the need for a rapprochement between anthropology, sociology and psychoanalysis. Sullivan began formulating the basic tenets of his theory of interpersonal relations in 1929 and became firmly established in his ideas in the mid-1930s.

On the eve of World War II, Sullivan used psychiatric methods to test conscripts (in 1941 he was appointed director of the psychiatric department of the conscription service). At the end of the war, he worked as a physician at the Federal Council for Vocational Education, then at the Public Health Service. In 1948, collaborating with the World Health Organization and UNESCO "Tension", organized by the United Nations to study the impact of tension on international relations and mutual understanding, and in 1949 - in the creation of the World Federation for Mental Health. In the same year, he became a member of the international commission for the preparation of the International Congress on Mental Health. Sullivan was a scientist and statesman, an eminent psychiatrist, the leader of an important school of psychiatry education, a remarkable therapist, a daring theorist. His personality and originality of thinking attracted many people who became his adherents, students, colleagues, friends.

Sullivan's conviction that even a deeply damaged mind nevertheless remains a mind, has found application in the treatment of schizophrenic patients. No matter how strange the system of symbols of a patient with schizophrenia was, it was interpreted as "an attempt at a different reading of life experience." Sullivan not only conducted lengthy informal conversations with patients, but also recruited individuals who had psychological impairments and could therefore establish a more subtle and trusting contact with patients.

Although Sullivan does not deny the role of heredity and maturation in the formation of the organism, he believes that what appears as properly human is a product of social interactions. Moreover, interpersonal experience can - and does - change the physiological functioning of a person, so that one could even say that an organism loses its status as a biological being and becomes a social organism with its own special ways of breathing, digestion, excretion, blood circulation, etc. For Sullivan, psychiatry is close to social psychology, and his theory of personality is distinguished by a clear focus on socio-psychological concepts and variables. He writes: “It seems to me that general psychiatry as a science covers in many ways the same area that is studied by social psychology, since scientific psychiatry studies interpersonal relations, and this ultimately requires the use of the same system of concepts that we now relate to theory fields. From this point of view, the personality is considered as something hypothetical. It is possible to study only the drawing of processes typical for the interaction of individuals in repetitive situations or "fields" that include the observer "(1950).

Sullivan believed that the main goal of his own theoretical and practical developments was the formation of an adequate adaptation of the personality to the people around him through the development of its protective mechanisms. He developed a method of "psychiatric interview" ("psychiatric conversation"), providing an active influence of the psychiatrist on the interpersonal situation. Influenced the development of modernist versions of psychoanalysis, psychiatry, psychology and sociology of small groups.

In the last years of his life, Sullivan lost interest in organizational activity, focusing on the activities of the Washington Psychoanalytic Institute, which he organized and the journal Psychiatry he founded.

Also in the last years of his life, Sullivan paid great attention to the study of the state of anxiety. In his opinion, the body strives to achieve dynamic constancy, in which all needs are satisfied. At the psychological level, the individual strives for a painless adaptation to the environment. If these two levels, biological and psychological, are combined, then a person is produced a sense of high self-esteem. In the event that there is a mismatch between the needs themselves and the methods of their satisfaction, personal tension and anxiety arise. Sullivan believed that anxiety is the force stemming from low self-esteem that brings anxiety and nervousness into a person's life. Sullivan saw the root of all mental illness in anxiety.

Ideally connected with the scientific interests of Sullivan was the public sphere of his activities. He wrote on topics as diverse as black youth issues in the southern United States, anti-Semitism in Nazi Germany, and international tensions. Sullivan believed that psychologists had an important role to play in solving these problems, because the behavior of isolated and confused people, be they schizophrenics, ghetto dwellers, or members of peoples involved in military conflicts, are based on anxiety and fear. In collaboration with the Canadian psychiatrist B. Chisholm, who later became the Director of the World Health Organization, he tried to translate these ideas into practice. These efforts led to the creation of the International Federation for Mental Health.

Sullivan died suddenly of a heart attack in Paris on January 14, 1949, where he arrived for a meeting of the council of the International Federation for Mental Health. As a man known for his services to the US Armed Forces (he served during World War I and subsequently took part in many military projects, rose to the rank of major), Sullivan was buried at the Arlington War Cemetery.

In our country in 1999 another of his books was published (at home prepared for publication by his followers) - "Interpersonal Theory in Psychiatry". She did not arouse much interest, being lost in the stream of parapsychological waste paper. Probably, the commercial failure of this publication keeps our publishers from publishing other books by Sullivan, which were published posthumously in his homeland. And they, combined into a collection of works, make up two weighty volumes. So for our psychologists, the possibilities of getting to know Sullivan's ideas are very limited - unlike, say, the same Rogers or Erickson. But if you look at it, many of the ideas of these scientists, who have become cult figures in our country, are gleaned from Sullivan's reasoning. So, Rogers built his theory of personality on the idea of ​​Sullivan that the self-concept is a product of society. And the stages of development identified by Sullivan actually anticipated the age periodization of Erickson. Any step forward is easier to make based on the achievements of predecessors. So let's not forget that we had many predecessors, and Harry Stuck Sullivan is one of them.

After his departure, extensive manuscripts remained; in addition, there are recordings of many lectures given to students at the Washington School of Psychiatry. These manuscripts and records, like other unpublished materials, were entrusted to the William Alencon White Psychiatric Foundation.

So, let's call the main published books by his students and followers: "Interpersonal Theory of Psychiatry" (1953); Psychiatric Interview (1954); Clinical Research in Psychiatry (1956); Schizophrenia as a Human Process (1962); "Psychopathology of personality" (Personal Psychopathology, 1934, published in 1970); The Fusion of Psychiatry and Social Science (1964).

Interpersonal theory of psychiatry

Harry Stack Sullivan - the creator of the "interpersonal theory of psychiatry", where the main principle - as far as personality is concerned - is as follows: personality is "a relatively stable pattern of interpersonal situations arising from time to time that characterize a person's life" (1953). Personality cannot be divorced from interpersonal situations, and interpersonal behavior reveals everything that can be considered as a person. From the first day of life, a child is part of the interpersonal situation and throughout the rest of his life remains in the social field. However, Sullivan's theory does not claim to be the final definition of personality, it only concerns social intersubjective (and not interpersonal, as some psychologists believe) relationships. And his concept "personification" is quite correct and we apply it practically.

Let us consider in the further presentation of the material the main content of G.S. Sullivan's concepts: Interpersonal context, Personality structure, Dynamism, I-system, Personification, Cognitive processes, Personality dynamics, Tension, Fear and fear, "Good and bad mother", "Mother management », Energy transformation, Personality development, Stages of development, Determinants of development.

2.1 Interpersonal context

Based on his clinical observations, Sullivan gradually came to the conviction that it was not enough to focus on the individual in order to understand psychopathology (as suggested in the increasingly widespread personocentric approach, which replaced the nosocentric approach). After a while, he makes a number of conclusions that were revolutionary for that period in the development of psychiatry and psychotherapy, in particular: people are inseparable from their environment; personality is formed only within the framework of interpersonal communication; personality and character are not "inside" a person, but are manifested only in relationships with other people, while - with different people in different ways. Sullivan further concretizes that "the personality manifests itself exclusively in situations of interpersonal communication," and the personality itself is "a relatively strong stereotype of repetitive interpersonal situations, which are a feature of her life." Overall, this was a new approach to personality research, psychopathology and psychoanalysis. It should be especially noted that Sullivan abandoned the concept that previously dominated in psychoanalysis, which appealed mainly to the inner emotional experiences of the individual, since this concept ignored previous and current relationships, and thus, deliberately considered the object of research outside its corresponding historical and social context. At the same time, Sullivan comes to the conclusion that human behavior and thinking are unlikely to be enclosed "inside" the individual, but rather generated in the process of interpersonal communication with other individuals. The personality is not formed in general, but taking into account the initial specifics of its "niche" in interpersonal communication, therefore, in the process of any serious research of any patient, one cannot ignore the history and specifics of his interpersonal contacts.

Short description

Harry Stack Sullivan (Sullivan, Harry Stack), (02.21.1892-14.01.1949) - American social philosopher, psychiatrist and psychologist; author of the original concept of psychiatry as a scientific discipline of interpersonal relationships. Representative of neo-Freudianism. Like other followers of this trend, he made a sociological modification of classical psychoanalysis.

Content

Introduction
Chapter 1 Biography
Chapter 2 The Interpersonal Theory of Psychiatry
2.1 Interpersonal context
2.2 Personality structure
2.2.1 Dynamisms
2.2.2 Self-system
2.2.3 Personality
2.2.4. Cognitive processes
2.3 Personality dynamics
2.3.1 Voltage
2.3.2 Fear and fear
2.3.3 The Good and the Bad Mother
2.3.4 Management of the mother
2.3.5 Energy Transformation
2.4. Development of personality
2.4.1. Development stages
2.4.2 Determinants of development
2.5 Current status. Overall score
Conclusion
Glossary
Literature

Proceedings of the V.I. S.S. Korsakov / Ed. M.O. Gurevich and A.O. Edelstein. - Issue. 8.- M., 1945.- S. 5-16.

Psychiatry, like any clinical discipline, is divided into general and specific. In general psychopathology should be given, the basic theoretical premises of the doctrine of mental disorders, set out in private psychopathology. In reality, however, particular psychopathology has developed to a large extent independently of the general one. Together with all medicine, it was created by the best representatives of psychiatry on materialistic foundations and in recent years has made great strides in the field of diagnostics and therapy. General psychopathology still remains divorced from the particular and cannot completely free itself from theoretical views on mental functions inherited from idealistic psychology. Suffice it to point to such luminaries of our science as Kraepelin and Korsakov, who have done so much for private psychopathology. In general psychopathology, Kraepelin followed Wundt, and Korsakov followed the idealistic philosophers and psychologists of his day, Groth and Lopatin. Later, German psychiatrists (and after them, unfortunately, our domestic ones) presented general psychopathology according to Jaspers, and French and Swiss psychiatrists - according to Bergson. The lack of independent views on the theoretical foundations of their science led to the fact that general psychopathology was presented in a certain isolation from the particular and was devoid of originality.

The desire to rid psychiatry of the influence of idealistic psychology led to an attempt at a physiological substantiation of our science. The successes of Soviet reflexology gave rise to some authors to believe that psychiatry can be reduced to pathological reflexology, that mental functions and their disorders can be explained in terms of the doctrine of reflexes. The doctrine of the reflex, founded several centuries ago by Descartes and brilliantly developed by Pavlov, is certainly of great importance in physiology, but its application to the explanation of mental phenomena is not entirely consistent, since the more complex (psyche) cannot be explained by the simpler (reflex) , and mental functions have new qualities that require different methods to study them.

To the position generally recognized in Soviet psychiatry on the special qualities of mental functions, we consider it necessary to add a second position, according to which the pathological psyche also receives new qualities that cannot be derived from normal psychology. We will give a justification for this position in the further presentation and show what the "special qualities" of normal and pathological psyche are.

From these two provisions, a conclusion of great fundamental importance should be drawn: in view of the presence of special qualities of the psyche and its disorders, the theory of psychiatry cannot be built on the foundations of any other discipline (psychology, physiology, neuropathology).

The construction of a theory of psychiatry is a matter of psychiatry itself. Each science builds its theory on the basis of the data that are its content. It goes without saying that the theory of each individual discipline should be linked to related disciplines and based on general philosophical theoretical positions that unite all branches of knowledge.

In this respect, the Marxist-Leninist theory of knowledge is of fundamental importance for psychiatry. The point is not only that the theory of knowledge is the basis of philosophical doctrine and is of decisive importance for the construction of the theory of any particular science, but also that knowledge is the main function of the psyche, that the theory of knowledge is a "reflection of reality in the human head", i.e. .e. in the human psyche, and that, therefore, the theory of knowledge can and should be directly used to build a theory of mental functions. Not having in mind, of course, setting out here the Marxist-Leninist theory of knowledge, I would only like to emphasize some points that are of particular importance for our constructions.

Let's start with the title: reflection theory.

The special value of the term "reflection" for cerebral pathology lies in the fact that the correctness of the reflection of reality inevitably presupposes the normal functioning of the brain and is distorted in pathological conditions.

Further, "reflection" sounds like a physical term. This is because reflection is a general philosophical concept that is applicable to the relationship of all kinds of material phenomena. Cognition becomes "the reflection in the human head." Depending on the greater or lesser organization of matter, the reflection from simple physical interaction comes to reflection in the organisms of animals and, finally, to reflection in the human head. Cognition is historical, just as the psyche is historical, and in the human head itself, cognition develops historically and, moreover, has various stages in the psyche of an individual person. Lenin uses the terms: sensation, perception, representation, thinking, consciousness. These are functions that differ in their mechanism and in the quality of the cognized. You can feel things, but not the causality of phenomena, the latter is cognized by thinking. In one place Lenin quite definitely says: "Representation cannot encompass movements as a whole, for example, it does not encompass movements with a speed of 300,000 km per second, but thinking grasps and must grasp." So, cognition has steps, it is historical: the child senses, but does not yet think, only the simplest steps of cognition are available to animals - sensation (higher species have the rudiments of primitive thinking). Only an adult, full-fledged person has all the stages of cognition, from sensation to thinking. Even in thinking there are steps - from concrete thinking to abstract thinking. Cognition acquires ever higher qualities, which make it possible to vastly expand the objects of cognition. From this it is clear how naive are the views of the authors who consider it possible to draw conclusions about the human psyche on the basis of experiments on animals.

The next important quality of human cognition is its activity. Lenin's recognition of this quality is clear from a number of quotes: "Human consciousness not only reflects the objective world, but also creates it." (Philosophical notebooks. 1934). "The reflection of nature in human thought must be understood not" dead ", not" abstract ", not without movement, not without contradictions, but in the eternal process of movement, the emergence of contradictions and their resolution" (Philosophical notebooks).

To these provisions it should be added that the activity of cognition, its verification in practice; the leading meaning in the history of "human activity" is this kind of concept that reflects the activity of the psyche, which is especially emphasized in Marxist-Leninist philosophy.

We can note with satisfaction that in our science there are currently quite accurate facts that fully support the philosophical concept of the activity of cognition. First of all, let us point out that perception is really not a photographic act, it is performed not only centripetally (i.e., by the action of an external stimulus), but also centrifugally (i.e., by actively assimilating the perceived phenomenon). We call this property the fugal-petal principle. Only thanks to this quality of cognition is it possible to "assimilate" or transform "a thing-in-itself" into a "thing for us" (according to Lenin). The fugal-petal principle is substantiated anatomically and physiologically. Currently, we know that there are not only paths going centripetally from the retina of the eye to the lateral geniculate body and further into the visual cortex (field 17), but also return paths - fugal from the cortex to the retina, thanks to which it is possible to actively influence the perceived ... In this sense, Petzl's expression that the retina is illuminated not only from the outside, but also from the inside is very apt. This is internal lighting, i.e. the fugal influence of the cortex is necessary for a person to see. The newborn looks, but does not see, i.e. does not assimilate, and this is because at first the centripetal paths mature and only later the centrifugal ones. Therefore, at an early age, the retina is only illuminated from the outside and not illuminated from the inside. What has been said about vision also applies to other senses.

Further, the activity of perception determines the possibility of choosing the perceived. What is reflected in our head is mainly what we want to perceive. Even with a strong background noise, we perfectly hear the quiet whisper of a neighbor, if we pay special attention to him. In pathology, there are striking cases when, when a certain place of field 21 is damaged, the choice becomes impossible, all sounds without choice are the same audible, chaos turns out, the unnecessary interferes with the assimilation of the necessary.

Being active, cognition is tested, as Lenin teaches us, actively - by practice. Only practice establishes the correctness of knowledge.

Next, we move on to establishing the special qualities of the psyche, which can be built in the spirit of this teaching and on the basis of the facts available in our science. Establishing the special qualities inherent in the psyche, one should dwell on the function of consciousness. There are various definitions of consciousness, and it is considered inevitable that the definition of consciousness in psychiatry should differ from the philosophical definitions of consciousness. Of course, concepts such as "public consciousness", etc., have a different meaning, and we leave them aside, meaning consciousness in the literal sense, i.e. individual consciousness. Such a concept should be the same in both the philosophical-psychological and medical-psychiatric sense. The definition of such a complex concept is extremely difficult, and it seems to us only possible to establish a term that does not contradict the theory of reflection and satisfies our goals in a working sense. We consider it correct in defining the concept of consciousness to proceed from the word itself as such. The Russian tin "consciousness" and the French "conscience" are very successful in this respect, which cannot be said about the German "Bewusstsein". Particles "co" and "con" indicate a bond. Consciousness is a "connection of knowledge". The word "consciousness" indicates that the mental processes of a given individual are in a certain connection with each other. The consciousness of a mental act denotes its connection with the entire psyche, with that higher synthetic function, which is defined as a person who is conscious of himself (self-consciousness is one of the sides of consciousness). So, in consciousness, mental processes that occur at a given moment in the human head are connected with each other and with the personality. But in addition to such simultaneous connections, there are also successive ones, i.e. connections in time. Without successive connections in consciousness, thinking, which is carried out only in time (prerequisites, conclusions, conclusions), would not be possible. Consciousness, simultaneously and successively linking mental acts, is at the same time a necessary condition for each act to be mental in the true sense of the word. Any function, for example, sensation, acquires its significance as a mental function of cognition only if it is connected with the rest of the psyche, with previous experience, i.e. when this function of sensation is conscious. If this function is cut off from the connections provided by consciousness, then it is no longer a full-fledged mental act, does not reflect anything, does not lead to cognition. When consciousness is switched off, there is no perception, no thinking, no cognition, no purposeful activity. And all kinds of vegetative functions, reflexes, etc., have significance in and of themselves without the connections carried out by consciousness; consciousness is not necessary for these neurological functions. This is how we formulate a special quality of the psyche, determined by the activity of consciousness. Note that at the same time we leave aside the so-called subconscious sphere, the world of instincts, etc., which have a certain influence on mental activity, but the corresponding functions, which are not leading in human activity, require special consideration, which goes beyond the tasks we have set. ...

Finally, one should dwell on one more special quality of the psyche, arising from the fact that complex mental functions are formed by integration from simpler functions.

The concept of integration, taken from mathematics, was first applied in biology by G. Spencer; who understands by integration the concentration of matter in the process of evolution, and matter, changing from homogeneous indefinite to heterogeneous and definite, tends to develop the "whole" through the coordination of parts. Jackson, as a neuropathologist, further developed the concept of integration, as of coordination, and he already points out that due to the integration of lower mechanisms, higher ones are created not gradually and imperceptibly, but in leaps (crises). Thus, Jackson created the concept of a hierarchy of nerve functions, stages or levels. The concept of disinhibition or release of lower mechanisms in case of damage to higher ones, which is so important in neuropathology and psychiatry, is closely related, one might say, follows from the concept of a hierarchy of functions. Thus, in the understanding of these authors, integration is the development of the whole by connecting or combining individual parts and elements. (This is roughly how the concept of integration is defined in the Oxford Dictionary of 1901.2) This understanding of integration as a tendency towards the formation of a whole led to the opposition of localized functions and integrated ones, which was most clearly expressed by Gerrick (1934), although even earlier Monakov and Goldstein in the well-known the whole - the organism - was opposed to the localized functions. However, Riese (1942) quite correctly points out that since integration is only complication, there is no opposition between the principles of localization and integration. At the same time, Riese correctly complements the concept of integration, defining it as the development of a whole, in which the elements that served to form this whole are not revealed. These definitions of Riese are close to those that were expressed by me much earlier (1937) 3. Using the term “integration,” I emphasized at the time that the true development of this concept is possible in pathology by studying disintegration as well as reintegration (as we are now adding). Through integration, as I wrote, new qualities are created that cannot be deduced from the properties of the components included in this function; at the same time, the integrated higher function does not respond to stimuli that acted on the corresponding components. During the disintegration of a complex function, its simple components are released, new qualities of the higher function are lost, and disintegrated complex mechanisms begin to respond to stimuli acting on the primary simple functions. Reintegration restores higher functions with its new qualities, and it stops responding to stimuli that are nonspecific for it. In these conclusions, we relied on clinical observations. For example, the complex function of space perception was formed from a number of components, including the vestibular; in a normal state, it does not respond to vestibular stimuli, while in a state of disintegration, it reacts to the action of a vestibular stimulus with a number of pathological symptoms; reintegration restores normal relations.

In this work, I did not oppose integrated functions to localized ones, but noted that "The qualitative features of the higher neuropsychic functions undoubtedly correspond to the qualitative features of their localization in dynamic systems"... It is clear from this that integrated functions can be localized, but the concept of localizing these functions is different from localizing simple functions. But this is not enough. Considering the data on the integration of various higher functions, we are convinced that the integration itself as a certain process of the development of new qualities changes with an increase in the complexity of integration. Therefore, the definitions of the concept of integration in mathematics, general biology, neuropathology and psychiatry are not identical; the existing differences depend on which functions are integrated, hence some differences in the definition of this term by the authors of different specialties, which we are not going to discuss due to the absence of fundamental differences. The greatest difficulty is achieved by the integration of mental functions, which are characterized by a comparative ease of disintegration not only in mental illness, but even in the norm (in sleep), as well as ease of reintegration.

A particularly difficult example of the integration of mental functions should be considered consciousness... Normal consciousness is determined by the connectivity (consciousness) of the mental processes of the given moment and the past experience (i.e. simultaneously and successively), and the entire content of consciousness is integrated into a single whole - the personality. Disintegration of consciousness changes the personality as a whole - its perception and thinking, orientation and activity. Everything is restored by reintegration. Thus, even within the limits of mental functions, integration of varying complexity is possible. The nature of localization changes accordingly. If simple functions are localized in centers that are morphologically defined, then integrated functions (for example, speech, perception of space) are localized in systems or mechanisms that include a number of centers, systems and paths connecting them. The question of the localization of consciousness and personality is already becoming almost insoluble, since the matter is about too complex, a set of morphological units necessary for the implementation of this higher integration.

We note further that the integration of comparatively simpler functions appears to be stable, constant, and normally motionless. This is, for example, the function of walking, created by integrating the movements of various muscle groups. The complex synthetic mental function of consciousness is a different matter - its integration seems to be mobile, changeable, unstable: not only in pathology, but also in the norm, there is a temporary disintegration of consciousness during sleep and an equally rapid and complete reintegration upon awakening. This peculiarity of the integration of higher mental functions is their special quality and, as we will see below, is of particular importance in pathology.

Thus, the absolutely correct postulation in Soviet science of the special qualities of the human psyche has been formulated by us with sufficient certainty, but, of course, it is still far from complete. The human psyche reflects reality, is capable of active knowledge, verified by practice; the higher stages of cognitive functions (thinking) have special qualities, the ability to cognize the most complex phenomena and their relationships, inaccessible to the lower forms of cognition (sensation). Cognition is active, capable of choice. Complex mental functions are formed through integration; they are associated with consciousness, which is also formed through integration. Any act acquires the meaning of a mental function only through connection with consciousness - without such a connection, neither cognition nor purposeful action is possible. These qualities of mental functions are of paramount importance for psychopathology, and, on the other hand, we can say that pathology especially clearly reveals the qualitative features of the human psyche.

Mental dysfunctions are qualitatively different from simpler neurological dysfunctions. Therefore, the concepts that define pathological changes in nervous functions are insufficient for psychopathology.

Organic lesions of the nervous functions give the phenomenon of loss (paralysis), irritation (hyperkinesis), functional changes are associated with inhibition, excitation, disinhibition. All these concepts indicate simple quantitative changes in functions: the function is enhanced, weakened, dies, inhibited, excited. These concepts are only partially applicable in the study of mental disorders, they are applicable to organic lesions of mental functions, when a quantitative weakening or loss of functions (for example, memory) is obtained. The concepts of inhibition and arousal are applicable, to a certain extent, to explaining some changes in simpler, non-integrated mental functions (agitation in a manic state, inhibition in depression). However, any attempts to apply all these concepts to explain more complex qualitative disorders of the psyche have led nowhere. The complex mental function in pathology is not weakened, but changes, partly moves to another level and, most importantly, gives pathological products, new phenomena that are not characteristic of the normal psyche (for example, delusional ideas, hallucinations).

At the same time, it is remarkable that such mental disorders are easily restored and pathological products disappear. This applies to acute cases in which there is still no irreparable damage (defect). These qualitative features of mental disorders - pathological productivity of psychosis and the ability to fully recover, sometimes sudden, sharply distinguish these disorders from all others and require appropriate concepts for their study.

It is natural that special qualities of the psyche are the cause of the special qualities of mental disorders.

The main concept that determines the disorder of integrally formed mental functions should be considered the concept disintegration... The restoration of functions occurs by reintegration... Disintegration is not the destruction of a complex function, but only its temporary decomposition into components, of which it was composed through integration. The components released during disintegration tend to create new combinations, pathological integration, hence the pathological productivity of mental disorders.

Monakov and Murg use the term "disintegration" in an extremely broad sense. Their disintegration encompasses the entire pathology of the nervous system. Such expansion of the concept deprives the corresponding term of a certain meaning. We understand disintegration precisely as the decomposition of integrated (complex) functions; just as precisely and simply we define the concept of "reintegration" as the restoration of disintegrated complex functions.

As an example, let us cite the disintegration of space. This function was formed by the integration of optical, haptic, proprioceptive and vestibular components. After integration, the stimuli acting on each of the components cease to act on the integrated function. After disintegration, a relatively mild, for example, vestibular irritation causes sharp disturbances in the perception of space, even ruptures of space (a phenomenon completely unknown in the norm). At the same time, the components released during disintegration give pathological integration, which is expressed in pathological products in the form of optical-vestibular disorders (changes in the shape of objects, perspective, size, etc.), which cause the incorrect reflection of reality, a disorder of cognition. During reintegration, the function of space perception (restored and pathological production disappears.

The phenomena of disintegration of such a complex function as consciousness are even more striking. We have already noted that the complex integration of higher mental functions is characterized by mobility, instability, the ability to quickly disintegrate and reintegrate. Acute mental disorders are manifested in the disintegration of consciousness. We have already emphasized that consciousness determines the interconnection of mental functions, that any act of cognition or action only then acquires the value of a full-fledged function when it is connected simultaneously and successively with the consciousness of the individual. With the disintegration of consciousness, connections are broken, perception is distorted, thinking becomes impossible, there is no correct reflection of reality; and there is no justified activity. Loss of communication is the cause of amnesia, a constant phenomenon after disturbances of consciousness. At the same time, the components that have lost their connections give pathological integration, produce bizarre combinations of broken functions in the form of delirium (delirium). Violation of the integration of the fugal and lethal components of perception leads to deceptions of the senses (hallucinations and illusions). Reintegration of consciousness sometimes puts things in order almost instantly.

The correctness of our theory of disintegration must be tested in practice, and in fact this test is the therapy of psychosis. Active therapy was created empirically, and only after achieving great practical success did they begin to create a theoretical basis for these methods of treatment. Until now, it seemed strange why schizophrenia is inferior to treatment with insulin shock or artificially induced seizures, or why deaf-dumbness after brain concussion is cured by intoxicating anesthesia. It seemed that this was some kind of fake treatment. I will allow myself to insist that it is precisely such a treatment that is the real treatment of psychosis, since it leads to the reintegration of disintegrated functions. The point is that any disintegrated function can be reintegrated, since its components are not destroyed. Reintegration even occurs by itself (for example, the reintegration of consciousness upon awakening from sleep, as well as after fainting, after trauma, during spontaneous remissions of psychosis, etc.). Reintegration occurs when there is sufficient restorative energy in the given psyche. With asthenization of the psyche and the presence of a process that deepens disintegration (for example, in schizophrenia), reintegration may not occur or, in any case, slow down. Then you need energy from the outside: for the appropriate impact in the sense of achieving reintegration.

It has long been known that during fainting, when a person does not perceive anything, being deprived of consciousness, recovery can be accelerated by such a simple means as ammonia. They give a sniff, and ... the complex function of consciousness is restored, deeply disturbed mental activity quickly comes to order. The action of insulin shock, convulsive seizure, etc. is somewhat more complicated, but it has the same significance of the pathogen from the side leading to the reintegration of functions 4. With active methods, as we emphasized in our previous works, it is a matter of cerebral action, as the main link in those changes (biochemical, etc.) that occur in the body during active therapy.

Further experience shows that active therapy is much more effective in acute cases than in chronic ones. From our point of view, this is simply explained by the fact that in the chronic stages of the disease, both disintegration and pathological integration (delirium, etc.) are recorded, and most importantly, persistent loss (defect) is formed that is not subject to therapeutic effects.

Thus, the achievements of modern active therapy of psychosis have proved that, contrary to previous views, treatment for mental illnesses is more effective than for nervous ones, since mental functions in diseases give temporary disintegration and this disintegration can, as a result of treatment, go into reintegration. This circumstance once again proves the correctness of the basic provisions on the special qualities of the psyche and on the qualitative characteristics of mental disorders. We consider the physiological basis of disintegration to be a change in the functional state of mental mechanisms due to a reversible violation of connections - synapses.

In conclusion, we consider it necessary to dwell on the following fundamentally important proposition.

Even Jackson, as mentioned above, noted that the nervous system develops in leaps and bounds ("abruptly", "by leaps"). These abrupt changes correspond to the development of functions through integration, they are especially characteristic of the nervous system because the latter is the “integrative system Par excelence” (Sherrington). Considering, however, that the development of the nervous system occurs not only through integration, we formulate this position as follows.

The functions of the nervous system (including mental ones) develop both through gradual, mainly quantitative, changes, and through abrupt qualitative changes (in the order of integration).

These patterns of development of neuropsychic functions should be supplemented with provisions that determine pathological changes in functions and their restoration.

With the disintegration of complex functions, abrupt changes, a transition to a different level, and qualitative violations predominantly occur. Likewise, the reintegration of function (for example, in the active therapy of psychosis) also produces abrupt changes.

Thus, pathological disorders of neuropsychic functions occur both by their quantitative decrease (weakening, loss and gradual improvement), and by their qualitative disorder (disintegration) and the same recovery (reintegration). Qualitative abrupt shifts are especially characteristic of the pathology of mental functions, as integrative for the most part.

The above formulations of the provisions that determine development, pathological changes and the restoration of neuropsychic functions should be considered consistent with the general laws of development established by dialectical materialism, which teaches that development in nature includes both slow evolution and leaps that give breaks of gradualness.

The considerations we have developed above concerning the construction of a theory, of course, are far from complete and are subject to further development, but in their present form they can be applied in the study of mental disorders.

1 Lenin V.I. Philosophical notebooks. 1934.

2 "The making up or composition of a whole by adding together or combining the separate parts or elements".

3 M.O. Gurevich. On the structure and disintegration of psychosensory functions. "Soviet Psychoneurology", No. 1, 1937.

4 Active methods also have an influence of a different order, namely the destruction of pathologically integrated formations (delusions, hallucinations), which is a prerequisite for reintegration. This effect is especially characteristic of long-term sleep therapy, where it is the main one.

Source of information: Aleksandrovsky Yu.A. Frontier psychiatry. M .: RLS-2006. & Nbsp— 1280 s.
The guide was published by the RLS ® Group of Companies

Another representative of neo-Freudianism is Harry Sullivan (1892-1949) - a practicing psychiatrist, teacher and editor of the journal "Psychiatry", the author of the concept of interpersonal psychiatry.

G.S. Sullivan focused his attention on interpersonal relationships, linking neuroses with disturbances in communication processes, rather than with fixations of libido in early childhood. He developed ideas about the decisive role of interpersonal relations for understanding the causes of personality traits (in this case, however, the latter are interpreted as passive social projections of certain influences on the personality) and psychological disorders.

The number of personality types in a person corresponds to the number of his interpersonal situations. Believing that in any society, the spiritual world of a person is filled with illusory prestigious values, Sullivan comes to a denial of the individuality of the individual, which he sees as a set of social masks. Social relationships are reduced mainly to interpersonal relationships.

Sullivan called his theory "the interpersonal theory of psychiatry." It is based on three principles borrowed from biology:

· The principle of communal (public) existence;

· The principle of functional activity;

· The principle of organization.

At the same time, Sullivan modifies and combines in his concept the two most common psychological trends in the United States - psychoanalysis and behaviorism.

The personality of a person, according to Sullivan, is not an innate quality, but is formed in the process of communication between an infant and others, i.e. "personality is a model of repetitive interpersonal, interpersonal relationships." In its development, the child goes through several stages - from infancy to adolescence, and at each stage a certain model is formed. In childhood, this model is formed on the basis of joint games with peers, in pre-adolescence - on the basis of communication with representatives of the opposite sex, etc. Although a child is not born with certain social feelings, they are formed in him in the first days of life, their development is associated with a person's desire to release the tension created by his needs.

Sullivan believed that need both creates tension and forms ways to overcome it dynamism, which are not only models of energy transformations, but also a kind of accumulation of experience, knowledge necessary to meet needs, for adaptation. At the same time, there are dynamisms that are more and less important for life, which satisfy needs of different degrees of importance.

The main, leading needs for all people, Sullivan considered the need for tenderness and the need to avoid anxiety. However, the possibilities for their satisfaction are different, since for the realization of the need for affection, there are certain dynamisms that help the child receive it from loved ones. The sources of anxiety are so diverse and unpredictable that the possibility of unpleasant, disturbing events in a person's life cannot be completely ruled out. Thus, this need to avoid anxiety becomes the leading one for the personality and determines the formation of the "I-system" underlying it.

Speaking of the "I-system", Sullivan distinguishes three of its structures - the good I, the bad I, and the not-I. Striving to personify oneself as a good self and avoiding self-perception as a bad self are the most important for a person, since self-perception as bad is a source of constant anxiety.

To protect his positive personification, a person forms a special mechanism, which Sullivan called selective attention. This mechanism filters out all irritants that can bring anxiety, change a person's opinion of himself. Since the main causes of anxiety lie in communication with other people, selective attention regulates not only one's own personification, but also the images of other people.

Based on the idea of ​​the priority influence of communication on personality development, Sullivan naturally paid great attention to the study of the nature of communication, the formation of images of others. He belongs to the study of the role of stereotypes in people's perception of each other, fundamental for social psychology, the study of the formation of controlling models that optimize the communication process.

Although Sullivan shared the opinion of psychoanalysts about the unconscious nature of basic needs (in particular, the needs for tenderness and avoidance of anxiety), he disputed the opinion about their innate nature, as well as about the innateness of an aggressive instinct. He believed that both aggression and anxiety inevitably develop in a child already in the first days of his life. He becomes infected with anxiety from his mother, who worries whether he is well, whether he is full, whether he is healthy. In the future, there are already own reasons for concern, stimulating the development of selective attention.

Sullivan's theory was one of the first attempts to combine different approaches to understanding the laws of personality development. The success of this experience led to the desire of modern psychologists to borrow the most significant views and discoveries from different psychological schools, expanding the scope of traditional directions. Sullivan's work had a great influence not only on personality psychology, but also on social psychology, laying the foundation for numerous studies of the characteristics of perception in human communication.

Conclusion

The ideas of neo-Freudianism, despite their psychological concepts, had a huge impact on public life, ethics, and culture. The views of the neo-Freudians were especially widely known in the mid-60s during the actions of the "new left", who enthusiastically embraced Reich's ideas about the "sexual revolution", Marcuse about the "one-dimensional" man and the need for a "great rejection" of both capitalism and socialism, distorted by a totalitarian system of power.

Developing psychoanalysis, Eric Erikson (1902-1994), using a variety of materials, developed an epigenetic theory of personality development and emotional crises in adults. He described eight stages of mental development of the I that a person goes through from birth to death, arguing in such a way that personality development does not end in adolescence, but occurs throughout the entire life cycle.

Structural psychoanalysis by Jacques Lacan (1901-1981), which combines psychoanalysis with linguistics, has become widespread in French science. The core of his structuralist approach is expressed by the formulas "the unconscious is a language", "the unconscious is structured like a language." In this work, Lacan relies on research techniques developed by F. Saussure, R. Jacobson, and others.

Thus, today neo-Freudianism represents many different concepts and approaches, very distantly related to each other. Some modern versions of psychoanalysis have already gone so far from its original, Freudian version that they retain their name only to distinguish themselves from the behavioral and experimental line in psychology.

Question 52.-Basic ideas and representatives of philosophical anthropology.§ 4. PHILOSOPHICAL ANTHROPOLOGY

Definition and main problems of philosophical anthropology. Usually philosophical anthropology called the section of philosophy that studies the essence and nature of man. In a special context, this term is adopted to name a separate direction of philosophy of the 20th century, the founder of which the German philosopher Max Scheler (1874-1928) considered it necessary to combine all knowledge about man within the framework of a separate science, which he called philosophical anthropology. Representatives of this trend, among whom the most famous, except for M. Scheler, G. Plesner (1892-1985), A. Gehlen (1904-1976), E. Rothacker (1888-1965), believed that, ultimately, all philosophical problems can be reduced to one central question - what is a person. According to the program of M. Scheler, philosophical anthropology should combine a concrete-scientific, objective study of various aspects and spheres of human nature with an integral philosophical comprehension of it. Most of the problems studied by these philosophers are fundamental to anthropology as a branch of philosophy. These are, first of all: · the problem of the specifics of human nature: what signs are really important for determining the essence of a person? · The problem of the ratio of individual and social characteristics in the structure of personality: how much is a person determined by social factors? · The problem of defining and describing the spiritual nature of a person: what is spirituality and in what contexts of life is it manifested?

The problem of the meaning of life

Obviously, many problems of philosophical anthropology find their expression in other branches of philosophy (ontology, epistemology, etc.), therefore, the allocation of anthropological problems in a separate research context is rather conditional. In other words, in any of the philosophical problems, ontological, epistemological, anthropological, etc. are interconnected. Aspects.

The main stages in the development of anthropological problems in philosophy. The theme of man, since the era of antiquity, has been the key to all philosophical problems. Ancient philosophers viewed man as a prototype of the Cosmos, a microcosm, the smallest, but necessary particle of the world whole, without which harmony and order are impossible. In the philosophy of Plato, for the first time, the idea of ​​a person appears as a unity of the spiritual (soul, belonging to the world of ideas) and corporeal (body, embodying the material principle). So, in the history of philosophy, the concept of man appears, which is based on the idea that his true essence has a spiritual-transpersonal nature.

Medieval philosophy is characterized by the understanding of man as a creation, created by God in his own image and likeness, which consists primarily in the gift of freedom and creativity and, as a consequence, responsibility for one's own being. From the point of view of Christian anthropology, man is not an advanced monkey, but a fallen God, a creature with a nature damaged by original sin. A cash person is a negative value on a moral scale. And to climb up, to actualize his potential God-likeness, a person cannot by himself, without the help of God. But God cannot raise a person without his consent and active participation. Hence the absolute prohibition on ideological violence and coercion, the requirement for unconditional respect for freedom and spiritual autonomy of the individual, which the Christian religion professes.

In the Renaissance and New Age, the idea of ​​self-sufficiency and autonomy of human existence is formulated. This period is characterized by special attention to the study of human thinking and his cognitive abilities, because it is believed that cognitive activity is the most important and meaningful aspect of human nature.

In the philosophy of the nineteenth and twentieth centuries, anthropological topics are expanding and becoming so diverse that it seems impossible to talk about any worldview unity in the interpretation of the human problem. Irrationalist concepts appear (voluntarism of A. Schopenhauer and F. Nietzsche, intuitionism of A. Bergson, psychoanalysis of 3. Freud, etc.), whose representatives believe that human nature is inexplicable, spontaneous, uncontrollable and can never be explained by a scientific method. Theories of historicity are created (Hegel, Marx, Comte), insisting on the social conditioning of all individual-personal characteristics, such philosophical trends as existentialism and philosophical anthropology are formed, within which the topic of man determines the entire content of research,

The main approaches to the interpretation of the essence and nature of man. All the various options for solving the human problem that exist in the history of philosophy can be summarized in such approaches as objectivism and subjectivism.

Objectivists tend to view a person as a part, a fragment of objective reality that exists autonomously and independently of the researcher. The objectivist approach is characterized by the idea of ​​a person as a structural component of the world whole. Existing as part of this whole, a person obeys the laws of the world order, based on which, we are able to more or less accurately understand, explain and predict his behavior and activities. The main distinguishing feature of objectivist interpretations is the explanatory principle "from the world to man". Most objectivist theories also adhere to the principle social determinism - those. believe that individual and personal characteristics of a person are strictly conditioned by socio-historical experience, upbringing, environment and other external circumstances. One way or another, the essence of a person in objectivist theories is determined through its correlation with some absolute substance. Representatives of objectivist trends include such concepts as Hegelianism, Marxism, positivism, etc.

Subjectivist concepts associate the insufficiency of such an approach with the fact that, considering a person as an object, we deliberately simplify the problem, abstracting from the obvious fact that pure objectivity is impossible. In any study, a person is not only an object, but at the same time a subject of cognition, therefore, it is impossible to understand its essence and nature objectively ("from the outside"), guided by the principles of strict classical scientific character, and knowledge built on such grounds will always be one-sided. In addition, the objectivist attitude impoverishes knowledge about a person also because it excludes the possibility of obtaining it by non-rational means. Representatives of subjectivism believe that the essence of a person is autonomous, self-sufficient and does not need to be defined through a relationship with something external. In this case, the main argument in favor of subjectivist concepts is the thesis that only the reality of human consciousness can be considered absolutely reliable and undoubtedly existing, the whole world, called objective in this case, is deduced from consciousness as its phenomenon. For cognition of human reality, from the point of view of the subjectivist approach, irrational methods are of greater importance: experience, feeling, perception, intuition, etc. The explanatory principle "from a person to the world" is of particular value, since it allows the researcher to focus not on the universal, but on the unique and inimitable characteristics of the personality. Philosophers of the phenomenological direction, existentialists, poststructuralists, etc. can be considered representatives of subjectivism.

The main categories of philosophical anthropology. The problem of man in philosophy is formulated and solved by referring to the limiting concepts that constitute the foundations of our thinking and are called philosophical categories. In addition to general philosophical terms such as being, consciousness, general, special, essence, phenomenon, etc., for anthropological problems, the key concepts are "personality", "individual", "individuality", in which one of the central problems is expressed philosophical anthropology - the problem of the relationship between the individual, the general and the special in a person. The variety of approaches to solving this problem is due to the difference in the conceptual and methodological foundations of philosophical schools and directions. The following meanings fix the most common context for the interpretation of concepts.

The concept of "individual" in the strict sense is not philosophical, but borrowed from biology. By means of this term, the singularity of a person is denoted as a separate living being, in contrast to a collective, a society, a group. Sometimes this concept is used as a synonym for "individuality", which does not seem entirely correct, because the word "individual" captures the individuality of a person as an individual in a biological sense, without emphasizing in any way his specific and unique characteristics, while "individuality" is understood precisely as the uniqueness and originality of a person. Especially a lot of discussions in modern literature are devoted to the concept of "personality". Ultimately, the ideas of what is meant by "personality" differ significantly among representatives of various philosophical schools and trends. Most of them believe that a characteristic personality trait is ideological maturity, manifested in a situation of responsibility for their life choices and decisions, as well as an ethical orientation towards the values ​​of humanism and goodness. If the concept of individuality captures the uniqueness and originality of the external characteristics of a person, then the characteristics of the person's inner world play the main role in determining the personality, i.e. his spiritual essence. According to most philosophers, it is the spiritual and personal sphere that expresses the specifics of a person and gives meaning to his being. Personal characteristics, unlike individual ones, are not innate, but arise in the process socialization. The formation of personality is influenced by various social institutions - family, state, education, army, etc. As a result of socialization, the experience of previous generations is transmitted and the continuity in its development is ensured.