PART 1. THEORETICAL PROBLEMS OF PHYSICAL PSYCHOLOGY Chapter 1 In Search of a True Object: THE BODY AS A MECHANISM

Although the body does not exist as a separate ontological problem for psychology, there are at least two areas that cannot be avoided: bodily (intraceptive) perception and voluntary control of the body and its functions. But even within these relatively limited areas, psychologists face difficult-to-solve problems. The apparent simplicity of such an object of study as a body compared to, for example, consciousness, thinking or speech, in fact turns into an aggravation of the most fundamental and difficult to solve theoretical questions of philosophy and psychology: psychophysical and psychophysiological problems, the ontology of the subject and his activity, pulling the researcher into funnel of metaphysical contradictions. That is why, in my opinion, the field of body sensitivity by default belongs to some archaic, naturally-organized and exclusively physiological in its structure sensory system. In a sense, for physiology, it is even the most model. If the work of hearing and vision cannot yet be fully explained at the physiological level and one has to reconcile with the existence of the psychology of perception, then intraception still exists without this complicating addition.

This situation is not accidental and follows from the very logic of the natural science approach, which makes psychology fundamentally redundant. At present, few people can decide on such an open statement, on the contrary, it is considered very modern to refer to the importance and necessity of psychology, but it is worth moving from declarations to reality, it is easily found that it does not easily fit into the mainstream system of scientific knowledge. One could even say that there is no room for it there. An appeal to psychology arises only when the insufficiency of a natural, objective explanation of a phenomenon becomes obvious. In this case, the argument is translated, as it were, into the plane of another reality, which reveals itself only in exceptional cases. The chimera, born of a simple combination, is not viable, and the logical sequence causes the researcher to restrict himself to the limits of objective laws as much as possible, and psychology puts him in a marginal position, forcing him to justify his right to exist each time.

It is quite natural that the lack of a developed psychological theory of intraception and even just serious evidence of the need for such a theory led to the fact that medicine dealing with the manifestation of physical conditions through physical and intraceptive sensations of disease states uses exclusively anatomical and physiological explanations.

In order to properly understand the situation, one should first analyze the general methodological approach underlying modern science, then showing its implementation in specific physiological and medical views on the essence of forest sensations, the reasons for their occurrence, the connection with the disease and the mechanisms of symptom formation.

The fundamental methodological postulate of the science of the new time is the primary dismemberment of reality into two fundamentally different areas: the objective - everything that is the world, and the subjective - the content of consciousness and the psyche. The subjective, although real, is fundamentally different from the objective in that it is not material and secondary in relation to it. This secondary character is realized in the form of the interpretation of subjectivity as a reflection by the subject of the objective world, understood as the “metaphor of the press” (Ortega-i-Gasset, 1990).

In itself, the quality of reflection is not inherent exclusively subjective. Reflection in inanimate nature appears as

the result of mutual influence, mechanical deformation, changes in direction, shape, composition, etc. At the animal level, the emergence of a new property is noted - sensitivity, allowing to reflect the properties of an object differentially. Human reflection in the form of a specific form - consciousness - is characteristic of activity, productivity and intentionality. At the same time, the latter quality is the most difficult, dark and controversial place, a huge number of philosophical and psychological works devoted to clarifying it ( Bruner , Postman , 1949; Gibson , 1950; Foucault , 1963; Leontyev AN, 1975, 1983; Zinchenko, Mamar-Dashvili, 1977; Lecturer, 1980; Smirnov, SD, 1983a, b, 1985; Optega-i-Gasset, 1990).

However, due to the internal inconsistency of the initial position, the difficulties of resolving the logical contradiction between the “passiveness” of the subject experiencing the actions of the objective world, its secondary nature on the one hand, and activity and intentionality on the other, this problem has become the subject of purely theoretical speculations. Within the framework of the concrete, natural sciences, a methodology of an objective approach was formed, which excluded the subject from the ontology of being.

The most common ideas are that only a real world exists, built with the help of physical rulers and clocks, and therefore, ideally, any scientific study should be reduced to appropriate physical measurements. If only physical objects really exist, then the ultimate goal of any science should be to reduce the reality under investigation to the most simple physical entities. At the same time, the development of the rules for such information and their feasibility will serve as a measure of the maturity of science and its “naturalness”. A phenomenon or an object becomes “understandable” only if, through a finite sequence of steps, they can be reduced to elements that cannot be decomposed further: fields, atoms, etc., which obey the same physical laws.

The easiest way is to implement this approach in the natural sciences, dealing with physically measurable objects, more difficult - in the humanities, the object of which, in fact, should be subjective, and already quite confusing situation occurs when a person becomes the object, simultaneously acting as physical and perfect essence. The deliberately contained rigid ontological position, “not multiplying the number of entities beyond the necessary,” pushes the researcher to realize the most “essential” explanation for the sake of objectivity, not noticing the transition to the “other space” and the loss of the subject. The reality of the psychic, self-evident for everyone familiar with it from their own experience, is a favorite object of such reductionism. The postulation of a new reality — the reality of the psychic, which cannot be reduced to any existing before it — cannot withstand the automatic transfer of uniform and universally accepted laws, casting doubt on their universality and inclusiveness. It is impossible to make small concessions in this case. This is either a leap abroad of a qualitatively “other”, or, if it is not a “other”, then no borders should be created, the need for which arises only when recognizing ontological irreducibility. To make such a recognition within the framework of an objective approach is difficult, because it contradicts the conviction that "nature is one, and there is an opportunity to ideally reduce the world to several entities" (Barth, 1989, p. 58). In the limiting form, such a worldview is formulated in the famous Laplace saying that “a creature capable of covering the entire set of data on the state of the Universe at any given time could not only predict the future, but also restore the past to the smallest details” (Quoted from: Toffler, 1986, p. 14).

Until now, objectivism hardly overcomes and realizes the first of the qualitative boundaries separating the living from the inanimate. Although, ultimately, it was necessary to introduce the ontological concept of “life”, attempts to reduce biology to physics or chemistry do not cease. The same situation is observed in psychology. Its peculiarity is only in the fact that physical and chemical “explanations” are rather rare, whereas biology or neurophysiology (according to the logic of reasoning obliged to prove their right to exist) throughout the whole new history, up to the present, strive to “explain” replace or even cancel psychology.

In addition to “saving thinking”, the ontological exclusion of a subject from scientific research is also due to the fact that objectivism cannot fundamentally allow a subject to any activity. “... What is being researched cannot be considered as the cause of oneself (subject). In other words, any event occurring with an object should be considered as caused by an external cause. Without the action of external causes, the object must be in "rest" or "uniform straight linear motion." This purely mechanical principle of "inertia" is universally valid in any scientific research - physical, chemical, biological, psychological, sociological, etc. In fact, we can only establish a causal relationship between the active factor and the change in the object of study, if we are sure that the real thing (the object) did not make this change due to its own (internal) need ” (Tishchenko, 1991a, 114). The intuitive obviousness of the “principle of inertia” is based on the illusion of “understandability” inherent in human thinking: a phenomenon is understandable if we can find its internal logic, i.e. linear sequence of events.

Therefore, the subject has no place in ontology: neither as an entity nor as an object of scientific research. Real “true” events take place outside of it, the need for it disappears and it can be replaced with a real object without damage - an organism in the form of a corpse or a complex mechanism operating according to the physical laws (in them this linear sequence seems “obvious”) . The main task is to ascertain the structure of this mechanism, its sensory, perceptive parts, conduction pathways, nervous structures, their spatial organization, biophysical and biochemical bases of their work. Violations can occur only in the physical space of the body; the psyche is successfully replaced by the nervous system, and psychology by the physiology and anatomy of the central nervous system.

One of the first works where such an approach was not only realized, but also clearly reflected, was the work of Charles Bell, in which he tried, following the paths of nerve fibers, to understand the structure of the brain and to divide mental life into primary elements ( Bell , 1842) . According to M.Ya. Yaroshevsky, this was the case when not the classical psychological method of introspection, but the surgical knife (Yaroshevsky, 1976) acted as the analysis tool.

Sam 3. Freud, at the beginning of his scientific career, offered to explain internal mental phenomena with objective quantitative concepts. “The goal of psychology,” he wrote in the unfinished “Project of Scientific Psychology,” is to present mental processes in the quantitatively determined states of specific material particles ”1 (quoted in: Yaroshevsky, 1976). Even the name "psychoanalysis", borrowed from the ideal, according to 3. Freud, science - chemistry, was to confirm the objectivist orientations of the new scientific direction ( Chertok , Stengers , 1987, 1988).

-1 Similar beliefs peculiar to science of the end of the XIX century. 3. Freud kept to the end of his life; in any case, he confirmed them at least twice more: in the English edition “Beyond the Pleasure Principle” and in the “New Lectures”.

Late XIX century. was marked by the complete triumph of an objective approach, when all phenomena began to be explained purely mechanically-materialistically. In medicine, for example, after the works of Virchow, the state was supported by the conviction that if under a microscope it is impossible to detect any changes in the cell, then there is no reason to talk about the disease. However, the successful implementation of the ontological exclusion of the subject could occur if another mandatory condition is fulfilled: its epistemological exclusion.

In the subject-object dismemberment of the world, the subject is transcendent in relation to the observed. The scientific description “... objectively to the extent that an observer is excluded from it, and the description itself is produced from a point lying de jure outside the world, i.e. from the divine point of view, from the very beginning of the accessible human soul ” (P pu- gozhin, Stengers, 1986, p. 67). Reality is described as an absolutely “transparent” subject, without changing the very fact of its reflection, and the world appears in its given form as it exists in reality. Events occur only in the objective world. Communication with the subject proceeds only in one direction: from the stimulus that is directly perceived by the subject and “slipping” through the subjective threshold, as if it were not there at all.

It is surprising that the idea of ​​“transparency”, which contradicts the subject-object opposition, which is the fundamental axioms itself, does not raise any special objections. Having established from the very beginning a principled non-identity of the subject to the object, “about transparency” allows the stimulus to flow freely into the ideal subjective image (although it is not very clear in what form: as stimuli, discharges of nerve cells or chemical copper ators). This is very difficult to understand, since from the time of Aristotle the concept of reflection was formulated as the reproduction of features of the reflected object without transferring its substance. If the “substance” of the stimulus launches the “substance” of the subject, they should have a meeting place in the form of a certain area, the nature of which would be the same for them.

The scheme of the reflex automaton that underlies the objectivist understanding of a person, without any special changes inherited from Descartes, was supplemented by complex forms of psyche. They had nothing to do with sensuality and were based on "contemplating innate ideas with the natural light of reason." It is much more difficult to solve this problem by rejecting dualism. In this case, it is necessary at one or another stage of the argument, excluding the subject, to allow the objective and subjective identity.

The theory of the “specific energies of the sense organs” formulated by I. Müller and C. Bell interpreted sensations triggered by the material effect of a stimulus, as states reproducing the properties of the nervous system itself ( Muller , 1826, 1840; Bell , 1842). The “specific energy” hidden in the body is discharged under the influence of external stimuli. This idea solved the problem of transferring the quality of an object to the quality of the nervous system, explaining differences in the modalities of sensations inherent to each organ by “specific energy”, but assumed that this is the quality of subjective consciousness. In any case, no further transformation was envisaged. Moreover, for a controversial explanation of general forms of sensory cognition, for example, spatial images not derived from individual stimulus qualities, spatial a priori forms of I. Kant's pure contemplation were physiologized, turning into properties of a bodily organ, the retina of the eye. Solving the psychophysical problem of the relationship between the physical and the mental world, the theory of I. Muller and C. Bell only turned it into a psychophysiological one: the ratio of physiological processes in the body and subjective sensations. One can speak about the effectiveness of such a decision only by accepting the authenticity of the subject and the body and considering that the state of the body is a subjective feeling.

The logic of the theory of the “specific energies of the sense organs”, despite numerous reproaches in physiological idealism, is inherited by modern researchers without any changes and, strictly speaking, cannot be challenged without going beyond the positivist approach. She is not only not subjected to serious doubts, but has even strengthened her position thanks to the achievements of neurophysiology, neuropsychology, works X. Delgado ( Delgado , 1963, 1965), A. Ekaena, J. Ajuriagerri ( Hecaen , Ajuria - guerra , 1952), A.R. Luria (1969), who modified it into the theory of specific “brain functions,” connecting subjective sensations no longer with the senses, but with “certain parts of the brain,” which, however, does not fundamentally change anything. In one form or another, it was accepted by psychologists, even those who were in fairly different theoretical positions, for example, A.N. Leontyev (1975) and B.G.Ananiev (1960, 1961). The latter specifically emphasized that "... an erroneous idea is created that the transition of external stimulus energy into a fact of consciousness does not take place in a person's life ... Reflection is unthinkable without the constant and continuous transformation of the energy of matter affecting a person into facts of consciousness personThis transformation is carried out by an infinite (for individual life) mass of sensations ... Hence the designation of the sense organs as transformers of external energy ... Moreover, each act of the activity of these organs - the peripheral ends of the analyzers - is the transformation of external energy into a nervous process ” {Ananyev, 1960 , with. 13).

Строго говоря, в границах объективного метода из субъект- объектного членения выпадает сам субъект, который при этом непостижимым образом и наблюдает объективный мир, и служит его продолжением. Такой субъект может последовательно мыслиться либо божественно, в традициях картезианского дуализма, либо вульгарно-материалистически. Объективная наука выбрала послед ний вариант, считая, что «строгое естествознание обязано только установить точную зависимость между данными явлениями приро ды и ответными деятельностями, реакциями организма на них» {Павлов, 1954, с. 66).

The logic of objectivism, most clearly represented in physiology and medicine, is easily distinguished from complicated and instrumentally equipped modern studies. A classic example of its implementation is described in the Einstein Brain essay (Bart, 1989). It analyzes the meaning of one of the neurophysiological experiments conducted with A. Einstein himself as an object.

The idea of ​​hypochondria of sine materia could not obtain a sustainable existence due to the general tendency of the development of medicine within the framework of the natural science method to identify the underlying physiological universal physiological or, better, physical causes. This tendency was more consistent with the idea of ​​hypochondria as a disease cum materia. Since it was assumed that there is no disease without material causes, the expression “hypochondria of the sine materia” did not mean the absence of material causes at all, but the absence of specific manifestations at the site of sensation. The argument about the reason for the emergence of stimulantly unfounded sensations began to be waged around the level of damage to the intraceptive sensory system, with the researchers focusing on its central, rather than peripheral, link. The absence of convincing evidence of any kind of damage was easily overcome by reference to the imperfection of the registering devices and the insufficient development of research methods.

Nevertheless, ideas about the possible peripheral damage to the nerve endings are partially preserved. A.A. Mehrabyan (1972) describes senestopathy as a violation of internal sensitivity, clinically manifested in the form of vague, diffuse, very unpleasant and disturbing sensations within the body. Possible disturbance of sensitivity as a source of senesto-hypochondric disorders is allowed in the works of G.А. Avrutsky (1979), B. C. Kulikova, A.T. Pshonika, Yu.E. Segala (1952), I.R. E-litas (1977). Searches for such violations are currently being carried out at the microstructural level, and with appropriate development of the tools, their detection is expected.

Generally, the researchers, disillusioned with attempts to explain hypochondria and senesthopathic disorders with peripheral disorders, shifted their attention to higher levels.

According to J. Wallenberg ( Wollenberg , 1904, 1905), the most important factor in the pathogenesis of hypochondriacal states is a painful change in self-perception, which is understood as a generalized feeling based on various changing stimuli from the internal organs. Normally, this feeling is indecomposable to individual sensations and we know nothing about the work of the internal organs. This changes with the disease, due to the abnormal readiness of the central sensitive areas to perceive not only the slightest pathological, but also weak physiological irritations, which are perceived qualitatively and quantitatively illusory, but there may be hallucinatory perceptions when nothing peripheral does not correspond to them. The central changes underlying this have not yet been elucidated, but it is assumed that we are talking about the pathology of the receptor functions of the cortex, especially the sensitive centers, the irritability of which is increased.

A new impetus to this direction was given by the creation of the theory of higher nervous activity of I.P. Pavlov and its development in the form of the concept of nervism K.M. Bykov {Bykov, Kurtsin, 1960). Active but being introduced from ideological considerations into medicine, this doctrine occupied a dominant position there.

The first attempt to apply the theory of higher nervous activity to the explanation of intraceptive phenomena belongs to I.P. Pavlov (1951): “The painful condition of an organ or the whole system can send to the corresponding cortical cells, for a certain period of time or permanently, incessant or excessive irritation and thus produce in them, finally, pathological inertness — an unrelenting idea and the feeling that later the real reason had already ceased to act ... These reasons could have concentrated the pathological inertness of the irritative process in different instances of the hemispheric cortex — as in cells directly perception of irritation from both external and internal agents (the first signal system of reality), and in different cells of the verbal system (the second signal system) and, moreover, in both instances, in different degrees of intensity: once at the level of perceptions, in another intensity to the strength of real sensations ”(p.78). The difference between the representation and the real feeling in this case is only quantitatively thought: the first is less than the second.

The difficulty of transferring the scheme of the conditioned reflex was only in the fact that, in general, this theory was oriented more toward extraception, whereas medicine dealt primarily with intraceptive form. The task of adaptation was successfully solved with the building of the cortico-visceral direction, which predetermined the logic of theoretical and experimental research for many years. The cortico-visceral direction in the physiology of the VID set for itself the following tasks ( Kurtsin, 1978):

• Establish the possibility of forming a conditioned reflex to the activity of internal organs and tissue processes and study the basic properties of such reactions.

• Determine the possibility of developing conditioned reflexes to any activity during stimulations coming from internal organs.

• Expand the mechanisms of conditioned-reflex changes in the activity of internal organs and such functions as oxidative processes, metabolism in cells and tissues.

In contrast to the classical Pavlov experiments, in which the effusion link was the salivary gland, and the magnitude of the conditional reflex was judged by the salivation of the external environment “oscillations”, in the experiments of the KM school. Bykova effectors were the kidney, liver, spleen and other visceral organs, and the magnitude of the reflexes determined their specific activity.

It was experimentally proved that the visceral reflexes were strengthened after the destruction of the central parts of the nervous system and the scheme supplemented in this way allowed us to consistently explain the emergence of bodily sensations as a result of pathological impulses from the internal organs - it does not matter primary, due to reflex stimulation of internal organs, or secondary - from disturbances of neurodynamics in the cortex.

“The release of intraceptive reflex arcs from the influence of the higher parts of the central nervous system creates particularly favorable conditions for their activity ... Without being a clinical cysts and not claiming to be a reliable interpretation of ... hypochondriac phenomena, we cannot resist the temptation to express the assumption of their possible genesis. It may be thought that in these cases there is a temporary suppression of the inhibitory function of the higher parts of the CNS as a result of functional impairment, it is precisely because of this, those impulses from internal organs that constantly reach the cortex but are not included in the sphere of consciousness now break through the road and seize them ... Of course, one cannot exclude another possibility - changes in the sensitivity of the receptors themselves, the occurrence of excitations in them under such conditions, under which they never happen to be normal ” {(Chernigovsky, 1949, p. 214).

The reason for the suppression of the activity of the cortex may be the intracepters themselves. Even if the disorganized information from the internal organs has disappeared, it can for a long time disrupt the relationships in the cortex between excitation and inhibition in the extraceptive fields of the cerebral cortex. When “the interoceptive path is already formed, exteroceptive convictive conditioned reflexes are worked out and fixed before creating persistent conditioned reflexes, the latter almost cannot be extinguished, and vice versa, they begin to inhibit, inhibit the exteroceptive vascular reactions associated with them, creating an interoceptive impulse . This state is accompanied by asymmetry of vascular reactions, vomiting, feeling unwell and is an "experimental" neurosis that sheds light on the common in medical practice ... hypochondriac syndrome caused by disorganized information from the internal environment - intrusive and intrusive interoceptive sensations that have broken through into the sphere of consciousness ” (Pshonik, 1949, p. 96). A hypochondriac is a person who, because of the pathological impulses that took place on the part of the internal organs, has developed a persistent predominance, an unquenchable readiness to form intraceptive conditioned reflexes with suppression of extraceptual ones. Although so far it has not been possible to find characteristic neurodynamic disorders in hypochondriacal states or to reveal any typical neurological disorders, psychiatry plunged into neurophysiology for many years and the work published on problems of hypochondria was overwhelmed with illustrations of physiological indicators: encephalograms, plethysmograms, cardiograms, skin- galvanic reaction, which had very little relevance to the issue under discussion.

The principles of this approach are practically invariant and clearly articulated, for example, in the work of E.S. Averbukh (1957). Although this is a relatively old work, it, in my opinion, very precisely mentally demonstrates the very logic of objectivist reasoning, often quite cleverly disguised in more modern works { Ley , 1985; Pennebaker , 1982; Kirmayer , Robbins , 1991). In his opinion, the main psychopathological phenomenon in hypothyroid syndromes is altered self-perception and self-perception. With the preservation of consciousness violated the constancy of the perception of his body. Intraceptive signals begin to be evaluated as a source of threat to the individual, emotions arise, partly physiologically conditioned, partly as a reaction to the threat. In this way, a corresponding fixed on his body installation and personal reactions to the situation created in the form of experiences and attitudes towards the outside world and oneself, which form the features of the hypochondriac, are created.

At the place of localization of the defect, IV form of hypochondria and, accordingly, IV mechanism were identified.

I form is peripheral. Irritations emanating from the internal organs, in which there are many nerve endings of the autonomic nervous system, cause many subthreshold continuously emerging summing impulses, leading to subcortical nodes, primarily the visual hillock, to a state of excitement. In the thalamus and the associated diencephalic systems, which are the region of integration of the lower forms of sensitivity and the area of ​​the formation of protopathic emotionality, under the influence of overexcitation, the self-perception and perception of one's body change. Further, the cortical mechanisms are involved in the pathodynamic process. The formation of hypochondriac sensations is slow and, once formed, they have a certain, well-localized character.

II form - stem. In this case, certain stem mechanisms are primarily affected and there are associated basic psychopathological phenomena of hypochondriac impairment of well-being, a perverse perception of intraceptive impulses, protopathic emotions, hyperpathy, etc. Later, the cortical mechanisms are combined. In these cases, the disease occurs quickly, the soreness is unusual, difficult to localize and less resistant. The disturbing background is more pronounced, but so-so ideas take place, often obsessive phenomena.

• form - cortical. Certain cortical systems, presumably the temporal-basal regions, are primarily affected. With the defeat of the temporal region, an overestimation of the severity of their disease is noted, a whole world of new phenomena, archaic forms of perception, sharp paresthesias and fantastic sensations are revealed.

• form - psychogenic. It occurs when, as a result of a certain situation, a person breaks down social ties, the extraceptual communication with the outside world is reduced. Normally, we are spared from the direct influence of our soma, our body and consciousness remains entirely under the influence of the external environment. In hypochondria, attention is turned inward. Subcortical irritations emanating from the internal organs become relatively strong and painfully perceived. Patients suffer not so much from unpleasant feelings, as from confidence in their illness, resulting from vitality and unusual sensations.

As you can see, all the described forms of hypochondria, except for IV, are organic lesions of the receptor apparatus at different levels. Consideration of the connection of these defeats with spiritual experiences as a separate task is not supposed, since, in accordance with tradition, the brain and psyche are identical. The fourth form, psychogenic, is distinguished according to a different principle and represents a certain mixture of reflectively understood activation of intraception and psychologically understandable experiences about the latter.

In principle, a similar interpretation of pathological bodily sensations (but without an excessive claim to a neurophysiological explanation and a clear anatomical localization of the pathological process) is used in modern models of “sensory over determination” ( Cioffi , 1991; Ley , 1985; Barsky et al., 1983, 1990), “Hypertrophied attention” ( Carver , Scheier , 1981; Duval , Wicklund , 1972), hyperventilation ( Gardner , 1996; Moldovan, 1991).

The concept of “sensory overdetermination” in its various variants reduces pathological bodily sensations to a special type of perception of internal sensations, a special “somatic body” that leads to an exaggerated interpretation of bodily sensations and their incorrect cognitive interpretation.

Hyperventilation, on the other hand, is regarded as a universal psychophysiological mechanism for the generation of intraceptive stimulation in situations of anxiety and a violation of an adequate assessment of its intensity.

The close mechanism of “hypertrophied attention” leads to an increase in intraceptive sensations from a reduction in external stimulation and a focus on internal signals, which leads to their inadequate overestimation.

The inability to explain the emergence of “psychologically incomprehensible”, qualitatively special experiences and strictly prove the increase in intraceptive impulses forced to exacerbate the problem. “To address the contradictions in the psychopathological aspect, the question must be formulated more strictly: what is the pathophysiological correlate of sensations: brain processes or intraceptive stimulation? With such a statement of the question, references to joint participation of the central and peripheral links are excluded ” (Anufriev, Ostroglazoe, 1979, p. 29). The transfer of the lesion from the “organs under the edge of the costal arch” to the microstructural or molecular level only masks the contradiction. Therefore, in the opinion of A.K. Anufriev (1979), it is necessary to abandon the wrong identification of the intraceptive and extraceptual analyzers, which presupposes some “special” organization of the first. Such a refusal will allow moving attention away from searching for a peripheral stimulus, whose role in the origin of disorders of internal sensitivity and related psychopathological phenomena is clearly exaggerated, to disturbances in the central regions of the brain: the visual hillock, the thalamic and dycephalous regions. Peripheral localization of sensations is connected with the fact that any sensation, regardless of the source, is always projected on the periphery. The central localization of the pathological process also makes it possible to explain the special nature of the senestopathic sensations: painfulness, the protopathic pathway of tenok. For this purpose, the theory of kaynstopatii - protopathic sensitivity (Astvatsaturov, 1938). Having arisen in the process of phylogenesis from external stimuli and “concentrating as a latent phenomenon in some particular place of the visual mound (sensitivity collector in general), pathological sensations due to brain disease return, as it were, in a transformed form (senesthopathies), projecting onto all organs and systems of the body, including the brain. At the place of its origin (visual hillock), senesthopathy is central, as the psychopathological process is central in general, initially acting as kaynesthopathy, and later manifested by nosophobic or hypochondriacal pictures, capable of self-development, up to hallucinatory-delusional states of type of physical impact ” ( Anufriev, 1979, p. 15).

As can be seen, the pathos of negating the mechanistic point of view is limited to transferring the level of injury from the peripheral link to the central one, accompanied by a very strong methodological assumption of the “special device” of the intraceptual analyzer. The reasoning in this case, in essence, remains within the framework of the “substrate” scheme. Initially eliminated, taken out of the frame, subjective experience inexplicably joins the physiological process. Subjective sensations without any gap follow the physiological processes in the nervous system as their natural continuation.

Although in philosophical and general psychological works, the erroneousness of contrasting sensory cognition, as having a direct character, to rational cognition, has been expounded and methodologically justified (Leontyev, AN, 1981; Bruner, 1977; Lektorsky, 1980; Smirnov, SD, 1981) In medicine, this epistemological installation remains very strong. Moreover, in clinical practice, there has always been a clear tendency to objectification, the desire to oppose the patient's subjective experiences as soon as they obscure and distort the picture of the disease, and primary sensory sensations, as being directly and faithfully reflecting the painful process. Experiences of the patient, his ideas about the disease, motives, although recognized as important, are nevertheless regarded as a superstructure over the immediate painful sensations that depend on objective causes. A superstructure, which is not bad to take into account, but which has no fundamental significance for understanding the disease.

However, ideas about the direct nature of “pure” somatic sensations constantly collide with the clinical reality of their lability, instability, “falsity”, which pushes the doctor to completely abandon their analysis and form a striving for instrumentalism; the “noble form of veterinary medicine” becomes the ideal of medicine, when the patient must not so much as tell how much to show and preferably, for the complete elimination of subjectivism, not a doctor, but some complex

-2 So, L.L. Rokhlin (1957) described hypochondria and euphoric-anosognosic as options for attitudes towards the disease, and V.V. Kovalem (1972) is depressive, dysthymic, hypochondriac, hysteroid, phobic, and euphoric-anosognosic.

the apparatus. “Unlike professions dealing with" clients "... medical practice deals with" patients. " There is much behind this difference. A patient is a passive person who is affected ... Most doctors are unhappy if a patient behaves as a client, because, as you know, “the doctor knows better” ” (Vartofsky, 1988, pp. 131-132). Unfortunately, despite the obvious simplicity and consistency of the instrumental approach, in real medicine it leads to a deadlock of mistrust, the growth of alternative, paramedical trends, the alienation of the patient and the doctor, and the dehumanization of their relationship. This is not surprising, since the disease for a person is first of all his subjective illnesses, and if they do not correspond to an objective picture, then the patient cannot be convinced that he is healthy and, in contrast, to subjective improvement as a result of various healers or “extrasensory “Procedures cannot be refuted by reference to their objective uselessness.

The way out of this impasse is possible only if we refuse to consider painful sensations as subordinate mainly to physiological regularities and use general principles of studying sensory systems and mental functions within the framework of a comprehensive examination of the morphological, physiological and psychological levels. It is necessary to consider the subjective picture of the disease as a special phenomenon of consciousness, and nosognosia as a variant of cognitive activity (somatoperception), which has its own content and specificity, but nonetheless obeys the general psychological laws of formation, development and functioning. The implementation of this approach requires the rejection of a whole set of objectivist, mechanistic prejudices that are firmly rooted in medicine. They cannot simply be eliminated, since they are based on a long scientific tradition and the refusal must be justified by solving some dark and confused problems.

One may ask, why should one abandon the objective natural-scientific method that had been hoping for him for so long a time? Practical difficulties have always existed, and their aggravation at the present time and the obvious frightening dehumanization of medicine can be tried to be mitigated by improving the education of the doctor, by increasing deontological requirements. Necessity, importance of attention to the patient's subjective experiences will not be denied by any doctor. Another thing is how important it is to understand the essence of the disease. In this sense, objectivistic prejudices in medicine are very strong, and even those that were abandoned by biology and physiology are hardly questioned.

This is evident from a comparison of the fate of the cortico-visceral theory and the very Pavlovian physiology of higher nervous activity. The latter, having experienced a period of maximum take-off, was subsequently forced to cede its position. In its classical form, the original scheme was not able to adequately describe and explain the behavior and was supplemented with the concepts of “action acceptor” (Anokhin, 1962, 1968), “nervous stimulus model” (Sokolov, 1963). Alternative theories, for example, the physiology of the activity of N.I. Bernstein (1966).

The Cortico-Visceral Theory, until the last moment, holds the dominant position as the main methodological medical scheme. According to even such psychologically oriented scientists as B.D. Karvasarsky (1980), “... the correct position is shared by the majority of domestic and many foreign researchers, according to which the achievements of modern neurophysiology make it possible to deepen and expand the classical positions of Paul's physiology and pathophysiology of the brain from new sides, to evaluate the role of various parts of the brain in its complex integrative activity, which forms the nature of the organism’s adaptation to the environment and, therefore, with respect to neuroses, also deepen and expand s our knowledge of their mechanisms of development "(p. 191).

With the greatest consistency, the ontological position described is embodied in physiology and medicine, but “such a train of thought can be found not only among physiologists, but also among psychologists. The consequence of this is that in psychology the term "objective description" is used as a synonym for the term "physiological description", and "psychological" as a synonym for "subjective" ” (Zinchenko, Mamardashvili, 1977, p. 110). Psychology also did not escape the desire to get away from the “damned” questions and, outliving its sense of inferiority, armed itself with measuring instruments that gave it a decent look in the natural sciences. The psychology courses and textbooks were renamed “experimental psychology”, and instrumentation equipment became the measure for the science. This happened even in such developed, advanced, and methodologically safe areas as the psychology of cognitive activity, extraceptual perception, and even more so in the forgotten and distant psychology of intraception or psychology of corporality, which in fact did not exist. “As acknowledged by the most authoritative authors, now there is no convincing general theory of perception capable of embracing accumulated knowledge, charting a conceptual scheme that meets the requirements of the dialectical materialist methodology. In the psychology of perception, physiological idealism, concealed by new terminology, parallelism and epiphenomenalism, subjective sensationalism, and vulgar mechanism remain essentially not overcome.

The miserable state of the theory of perception with the wealth of accumulated concrete knowledge indicates that there is now an urgent need to revise the principal direction in which research is moving ... And this requires a radical transformation of the very formulation of the problem of the psychology of perception and rejection of a number of imaginary postulates that inertia is maintained in it ” (Leontyev, AN, 1979, pp. 3-4). After the publication of these lines, more than twenty years have passed, but their relevance has not diminished at all, and perhaps even worsened, and the miserable state of the theory became even more evident against the background of the rapid development of instrumental technologies.

If one does not understand the psyche as epiphenomenal, as an area that can only cause a curious interest, but has no effect on the flow of real events that ultimately follow only physical laws, then the justification for the existence of psychology as a science should be based on the proof of the irreducibility of all reality to the impersonal play of physical forces.

This is one of the most difficult questions, the lack of a clear and not ambiguous answer to which makes the objective method that dominates in modern science so convincing and natural.

In order to include the subject in the scientific picture of the world, it is necessary to prove that it relates to it. The concept of “relationship” makes sense in the context of an objective method only as a causal relationship. However, in order to realize this relationship, it is necessary to place the “mental” and “somatic” in one objective world. The psychic can only act on the somatic, when there is something in common between them, which brings them into one real space. “... when they try to imagine such an effect, they imagine something like a material or etheric lining, which supposedly underlies the consciousness and acts under his name, causing the organism to act ... The causal effect of some organic process on the consciousness is just as incomprehensible. Such a process consists in a sequence of unfolding material processes that assume that they have mass, force, resistance, energy, etc. In order for these material processes to modify consciousness, it would be necessary for them to find an application point in it, the nature of which would be homogeneous with them, in the form of mass transfer, acceleration of the moving force ... otherwise the modification would remain incomprehensible " (Piaget 1966, p. 98). Thus, there is an unsolvable antinomy: it is necessary either to allow the identity of the soul and body, removing the need to single out the subjective as an independent entity, or, if the existence of a special “mental reality” is postulated, it becomes impossible to logically understand their relationship and relationship (as causal) . Although it is fundamentally impossible to remove this antinomy within the framework of subject-object articulation, for consistency and completeness of reasoning it is necessary to find some ways of resolving it. “Such difficulties are often overcome by introducing concepts that have a dual interpretation (the most popular is emotional stress). The fact is that concepts of this kind provide an opportunity to project events from the world of mental events into the world of physiological events and vice versa at a convenient time for the theorist. For example, the birth of a certain event (a clinical phenomenon) is described in the language of intrapsychic conflict, the narration is brought to the mediating link, “emotional stress,” and then the description is continued in the language of physiological relationships. The unity of the story is ensured by the unity of the situation time series. Although it is impossible to talk about causality here, but this shortcoming is mitigated by the possibility of detecting patterns of temporal coordination of events (Tishchenko, 1991a, p. 146).

In psychiatry, psychology and physiology, this kind of “dual” concepts are widely used, representing the place of the “overflowing” of the mental into the somatic. In addition to stress, we can mention the already described “kainesthopathy”, “detector”, “central informational field”, “vegetative nervous system”, “inhibition and arousal”, etc.

Unfortunately, the psychophysiological problem that makes up the core of these theoretical difficulties, despite the long history of its existence, has not received adequate resolution. Moreover, most modern psychologists and philosophers try to stay away from her as far as possible, knowing the theoretical troubles and dangers that she brings to her researcher. Representatives of the technical and natural sciences show less caution, inventing new ways of reduction.

It is impossible to get away from this problem and, without pretending to its adequate and final solution, you can try to approach it not from the point of view of reduction, but by postulating the original existence of two realities and consider not only physical objects as an entity. In order to clarify our problem — physicality in all its variants — it is not so much the relation to the bodily sensations to the objective process that causes them as the very fact of their real subjective existence, the need to understand the laws of which cannot be canceled by any objective study. "... If the head (brain) and the world are finally described with the greatest possible detail in physical (physico-chemical) terms in real space and time, then the mental will still be a special slice and reflection apparatus (brain ), and the states displayed in it, and the objects of the world, not reducible to one thing or another, and living in the quasi-objective dimension of being ... Subjectivity itself is included in the objective reality given to science, is an element of its definition, and not located somewhere above it as steep the phantom of physical events ... Saying that subjectivity enters into reality, we mean that it enters into reality that is objective, causally organized in relation to the world of consciousness, which is also given to us in "the language of the inner". Only by specifying it from the very beginning (as well as in the biology phenomenon of life) in the transcendental relative to the "language of the inner" part, we can then select objective processes (going independently from observation and self-observation), identify the sides of the subject of psychological research that can be described objectively. . Then it is already too late to connect consciousness with natural phenomena and terms describing them ” {Zinchenko, Mamardashvili, 1977, p. 116-117).

If we translate this reasoning into the soil of our topic, then the relationship between the “alloplastic picture of the disease” and its “autoplastic” reflection cannot be adequately explained, considering only the first as the ontological, and trying to derive the second from it. This is similar to the requirement of E. Husserl ( Husserl , 1973) to radically change the understanding of the subject of knowledge itself and the interpretation of consciousness. An ontological interpretation cannot be realized if the subject of cognition is recognized only as gnoseological status and the question of the existence of this subject is not raised, and the cognitive activity of consciousness and its being are considered in isolation. Consciousness itself must be ontological (Motroshilova, 1989; Rubenis, 1989). According to E. Husserl, it is completely meaningless to talk about the world “as such” outside of consciousness. It should be about a world given in consciousness, i.e. the subject has no other way of representing the world. At the same time, consciousness itself is in the world, and not outside it, and therefore it can raise a question not about the world as such, but only about the world in the horizon of its vision. The classical rationalistic setting of the subject on the point of view of an “absolute” observer, “transparent” and not subject to any influence, is destroyed. In our case, the disease is available to the subject only in the form of an autoplastic pattern, only in the form of sensations, experiences and knowledge.

This does not mean at all that there is no alloplastic objective picture of the disease, it exists, as there is an objective world. It only means that, having become a fact of consciousness, it inevitably begins to obey the laws of the subjective. “... In fact, the Ego meditator cannot free himself from individual subjective conditions, since what he knows, he knows in a certain perspective. No reflection can do anything with the fact that I see the sun at a distance of two hundred meters on a foggy day, that I see the sun at sunrise and sunset, that the way I think is experiencing the “impact” of my upbringing, my previous efforts and my story. ” ( Merleau - Ponty , 1966, p. 147). The quality of a painful sensation is a subjective quality that does not coincide in essence with the quality of a pathogenic factor, and does not contain in itself any of its particles.

The internal picture of the disease is not a simple alloplastic calquera and may not coincide with it to the extent that there are diseases that have no subjective or objective correlate.