19. Medical psychology. Diagnostic and treatment methods in psychology

Medical psychology is an independent section of medical knowledge, including psychological problems that arise in sick people at all stages of the formation of the disease and in different conditions of seeking medical help.

Medical psychology does not lose touch with general psychology, the success of which improves both its methods and content.

Medical psychology studies the psychology of a patient who lives in specific social conditions (family, industry, social environment, etc.), which determines its relationship with the social sciences.

The psychological state of a person is crucial in the occurrence of the disease, determines the characteristics of its course, determines the development and success of treatment.

The influence of a doctor can radically alter the whole picture of the disease and significantly change its course.

True recognition and correct understanding of the disease is available only if knowledge of the individual characteristics of the patient.

The content, place among other disciplines and the scope of medical psychology have so far been unequally understood by different specialists.

There are several views.

Some authors see the main task of medical psychology in the fullest possible training of medical students and doctors in the basics of traditional psychology.

Other researchers, especially E. Krechmer , consider the psychological analysis of the nature of diseases, in particular neuropsychiatric ones, to be the basis of the content of the latter.

The third authors in the course of medical psychology set out a general psychopathology, that is, they discuss the symptoms and syndromes of mental diseases, thereby replacing medical psychology with a general psychopathology.

The subject of study of medical psychology in this case are mental illness.

The subject of medical psychology is the diverse features of the patient’s psyche and their impact on health and illness, as well as providing an optimal system of psychological healing effects, including all the circumstances surrounding the care of the patient, which can legitimately be combined into a doctor-patient system.

Medical psychology contributes not only to the improvement of the necessary contacts with the sick, quick and complete recovery, but also to the prevention of diseases, health, education of a harmonious personality.

Medical psychology studies the whole range of beneficial or detrimental effects on a person’s changing personality and interpersonal relationships on his health and illness.

Medical psychology is divided into general and particular .

General medical psychology studies the basic laws of the psychology of a sick person (criteria for a normal, temporarily changed and painful psyche), the psychology of the doctor (medical worker), the psychology of everyday communication between the patient and the doctor, the psychological atmosphere of medical institutions.

Private medical psychology reveals the leading aspects of medical ethics when dealing with a specific patient and in certain forms of disease.

Any disease is always a disease not of a separate organ, not of a separate system, but of the whole organism.

In medicine, the rule has been fixed: it is not the disease that should be treated, but the patient.

However, medicine is built primarily on the principles of organ or systemic pathology.

In practical medicine has developed the division of diseases, the consideration of which is essential for understanding some aspects of medical psychology.

Conventionally, all diseases are divided into:

1) somatic (internal) diseases in which pathological changes occur in the organs and systems of the human body.

It does not consider the causes of painful changes. This division is conditional, since the basis for it are the most diverse criteria;

2) nervous diseases. In xix in. they were separated from internal diseases into an independent group.

The main rationale for this was the particular pathology.

In contrast to somatic, mainly organ forms of pathology, nervous diseases mainly have a systemic character. This refers to the damage (violation) of those or other systems that make up a single nervous system.

The peculiarity of nervous diseases is that they are based on violations of afferent (adductor, sensory) or efferent (abductive, motor) conduction in the nerve pathways. Nervous diseases are diseases of the central and peripheral nervous system;

3) Mental diseases in the history of healing rather late were divided into an independent group.

Like any other organ of the body, the brain has biological (physiological) functions.

Studying them in adolescents, from an early age fed up in a den of animals (outside the society of people), revealed all the typical biological qualities determined by modern methods.

At the same time, signs of the human psyche in these children and adolescents were not identified.

The difference between mental diseases and consists in the predominant disorder of specifically human, ideal, subjective, rational forms of human activity, which find expression in changes in the productivity of its targeted activity, changes in the completeness, consistency and adequacy of psychomotor behavior, mimic content, pantomimic expressiveness, inadequate environmental assessments and changes occurring in oneself, and, finally, in the subjective experience of the loss of past well-being and changing it with new ones standing

All these disorders are based on complex biological (physiological) changes that have not been studied enough.

Mental diseases are represented by the forms:

1) big psychiatry - psychosis;

2) minor psychiatry, or borderline neuropsychiatric disorders - abnormal reactions, neuroses.

Each considered group of diseases reflects reality only if it is mainly about somatic, nervous and mental diseases.

Consciousness of the disease (EK Krasnushkin) or the internal picture of the disease (R. A. Luria) are common concepts of medical psychology.

E. Krasnushkin used the terms “the consciousness of the disease”, “the presentation of the disease”, and E. A. Shevaliev - “the experience of the disease”.

The external uniformity of the disease in different patients is accompanied by a different assessment, her consciousness from complete peace of mind and indifference to panic engulfed in fear.

The types of response to the disease are almost never unambiguous and are due to different consciousness of the disease and its own body.

The German scientist P. Schilder showed that knowledge and perception are not the product of a passive body position.

They are formed in a situation for which mobility is a necessary basis.

The idea of ​​own body is based not only on associations, memory, experience, but also on intentions, goals of a person.

The body picture, according to P. Schilder, is never isolated, it is always included in the body picture of others.

The idea of ​​a person about his own body is in constant design.

It is created by the interaction of the body with the outside world.

In the "consciousness of the disease" there are a number of interrelated aspects. First, all new changes for the individual in the body are reflected in the mind.

Over time, as a result of the repetition of similar or similar disease states, the disease is becoming more and more fully understood.

Secondly, in continuous unity with such a process of reflecting the disease in the patient's mind an individual attitude is formed towards the changes taking place in the body, towards the disease itself, its possible individual and social consequences.

Such an attitude initially finds expression in the characteristics of the general subjective experience of the disease, in changes in the patient's state of health.

The reflection in the consciousness of the arising painful changes in the internal organs occurs in unity with the formation of the patient's attitude towards them.

And yet between the idea of ​​the disease reflected in the patient’s mind and the objective character of her, full compliance never arises.

The range of options for the consciousness of the disease is so wide that it includes an infinite variety of human individuals.

The phenomena of anosognosia (subjective underestimation, denial of an objectively existing disease) are presented at one pole, and the phenomena of hypernosognosia (different forms of subjective reassessment of objective somatic disorders) are presented at the other.

The phenomena of anosognosia are compared with flight from the disease, and hypernosognosia with flight to the disease, care for the disease.

Between them there are many intermediate states of consciousness of the disease.

All features of the consciousness of the disease can be divided into two groups.

The usual forms of the consciousness of the disease are only the peculiarities of the psychology of a sick person, and he himself needs the everyday rational, sparing approach of the doctor.

The states of consciousness of the disease, accompanied by abnormal reactions to it, going beyond the typical for a given person, are already painful mental states that complement and complicate the clinical picture of the underlying disease.

After the end of the Second World War, psychologists became interested in stress and its influence on human behavior. First, the subject of research was the physical causes of stress, soon the range of interests expanded, and psychological factors fell within its scope.

Now the word "stress" is used to denote negative reactions to physical and psychological events that are perceived by a person as causing physical harm and emotional suffering.

When a person faces danger, he feels threatened and tries to cope with the situation.

Psychological overcoming is considered successful if it reduces or eliminates the threat.

Of particular interest is the relationship between stress and physical illness .

Disease as a result of stress. Studies show that with increased stress, the likelihood of illness increases.

We face many sources of stress.

Work-related stresses are common, and long-term stress causes depression and health complaints.

Stress can cause physical illness: two factors must be considered.

First, depression, anxiety, and anxiety during stress can prevent a person from living a healthy lifestyle.

Secondly, when a person is under stress, his immune system functions less clearly.

Psychoneuroimmunology studies the relationship between stress, emotional and behavioral responses, and the immune system.

Individual differences in vulnerability to stress.

Caught in objectively similar stressful conditions, some experience high levels of stress and become ill, while others experience significantly weaker stress and continue to feel good.

Although genetic factors explain some of the differences in the effects of stress, LM Fridman and his colleagues in the course of research obtained evidence indicating the existence of differences between people who are predisposed to diseases and people who cure themselves.

People predisposed to diseases react to stressful situations with negative emotions and unhealthy behavior.

People who are able to cure themselves with their own strength successfully cope with stress and resist illness.

Studies of the subjective state of health point to the obvious benefits of interpreting everyday life in terms of positive emotions, alternating work and rest, having a goal and hoping for a positive result.

People predisposed to diseases are often characterized as neurotic, poorly adaptable, pessimistic, with a low level of self-esteem.

Healing people are described as hardy, optimistic, extroverted.

Conscious control is very important.

One of the characteristics of high self-efficacy is an increase in physical endurance, which is a consequence of the development of a natural painkiller by the body.

Active in dealing with stress.

Three strategies have been identified:

1) become physically healthy;

2) increase positive emotions, changing cognition, behavior and environment;

3) find social support.