Lecture
Assessment of mental state
A physician and a psychologist have two ways of assessing the mental state of a client, both of which are exclusively subjective:
a) putting oneself in the other's place (empathic understanding, achieved through enumerating a number of external signs of mental state);
b) examining the conditions under which these signs turn out to be connected with one another in a certain sequence.
Assessment of mental state
To distinguish psychological phenomena from psychopathological processes, it is important to discover the logic by which the patient constructs cause-and-effect relationships in objective consciousness (how he sees reality) and between objective consciousness and self-awareness (what he considers it necessary to do in the reality thus understood).
Kurt Schneider derived the first principle of distinction: Only that which can be proven to be so is recognized as a psychopathological symptom.
The proof is built on the basis of generally accepted laws of logic (the law of identity, the law of sufficient reason, the law of excluded middle) with the application of the criterion of reliability (persuasiveness) and probability, with the application of reasoning by analogy.
What matters in the proof is not the absurdity of the statement, but the distribution of the probability spectrum of the correctness of the patient's inference based on the available facts and sociocultural conditions.
It is always necessary to compare two logics: the external logic of the patient's behavior and the logic of the explanation of this behavior by the patient himself.
Then the psychologist faces a single task: to prove, on the basis of which signs he recognizes the patient's subjective logic as running counter to the external logic of the explanation of behavior.
To resolve this task, the model of deductive-logical explanations of events is used.
The explanation of events must satisfy the so-called conditions of adequacy:
the arguments (the grounds on which the psychologist or the patient relies), explaining the state and behavior of the patient, must be logically correct (i.e., must not violate the formal laws of logic);
the events described by the patient must have empirical content (or be probable events under certain admissible circumstances; the degree of probability in clinical psychology is often determined by the principle of analogy – an event is the more probable, the greater the similarity the psychologist sees between what the patient is describing and what happens to most other people, as well as with what he already knows about the things being described);
the statements of the patient must be convincingly proven.
Assessment of mental state
«Weak points»:
In clinical practice it is difficult to find people whose statements could satisfy the last requirement - persuasiveness.
In addition, a serious limitation is the indication that the assessment of adequacy is tied to the existing knowledge about certain things, since knowledge is often incomplete and constantly changing, constructed (i.e., situationally conditional rather than absolute).
K. Jaspers proposes distinguishing additional distinguishing signs :
the presence of clearly attention-drawing characteristics of the patient's behavior and personality (affectation, demonstrativeness, eccentricity);
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the suddenness of their appearance within a relatively short period of time (moreover, such characteristics had not previously been present in the person's personality and behavior);
the appearance of additional positive or negative products of mental activity, as well as somatic phenomena which are accompanied by various unusual interpretations;
a decrease in the level of criticality (partial, delayed, up to and including its absence).
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