Psychology of physicality Conclusion

The crisis of confidence in medicine cannot be overcome within the framework of medicine itself. We should not delude ourselves that the shortcomings of existing medical practice can be corrected by improving its organizational foundations, a rich assortment of drugs, or deeper scientific research. This is a necessary and important way, however insufficient. The crisis of trust in medicine is a logical consequence of its general methodological foundations.

As one of the areas of human knowledge, medicine not only did not escape the dead ends and delusions of all science (the dehumanization of knowledge, the vulgar-mechanistic attitudes), but also added its own specific ones to them. The subject-object relation underlying the science of the new time, the initial isolation of the subject from the subject of objective scientific research had far-reaching consequences for medicine. The classical scheme assumes that the subject reflecting the objective world does not change anything by the very fact of its reflection, and the world appears to the "transparent" subject as it exists in reality. In medicine, this installation was embodied in the idea that the disease that exists in a person is given to him in his feelings, and the latter directly and directly depend only on the disease process. Beginning with Goldschade, who were first proposed to divide the subjective picture of the disease into two independent parts: sensitive — sensations emanating from a local disease center or a pathologically altered general state of the body, and intellectual — created by the patient's thoughts about his illness — in all further studies so or otherwise, the adequacy and fairness of such a division was recognized. Conducted explicitly or implicitly, the thesis of separation, independence of the sensitive and intellectual parts was based on the supposed existence of two independent levels of reflection: directly sensual and mediated.

This situation leads to the understanding of the disease as a purely physiological phenomenon, a tendency to objectification and opposition of subjective experiences of the patient, as soon as they obscure and distort the picture of the disease, the primary sensory sensations that are immediate and truly reflect the painful process. Experiences of the patient, his ideas about the disease, although recognized as important, are nevertheless regarded as a superstructure over the immediate and painful sensations that depend on objective causes. In the ordinary consciousness of doctors, a symptom is only a manifestation of the underlying biological reality. Therefore, the peculiarities of the patient's culture, his subjective experiences can only distort reality, make diagnosis difficult and do not contribute to the symptom. The basis of such an attitude is the conviction that there is only one type of reality - physical, to which all others can be reduced logically perfectly by a finite number of steps.

With this approach, medical psychology is faced with serious theoretical difficulties in understanding a number of clinical facts. The physiological understanding of intraceptive perception, which connects the quality and intensity of subjective experience with the qualities and intensity of stimulation, is not supported either by clinical experience, or by special scientific research, or by ordinary human experience.

To explain this kind of phenomena, a large number of theoretical constructs are used, which ultimately boil down to the recognition of the existence of an anatomical or physiological defect, which is the “true” cause of violations of intraceptive perception, understood in the framework of a reflex pattern.

The persuasiveness of physiological reductionism in medicine is also related to the fact that the field of human bodily existence remains outside psychology, viewed as some naturally organized, ready-to-lively organismic entity, although common sense and personal experience suggest that in the case of a person we are dealing with the corporeality is not natural, but transformed, cultural. In the process of ontogenesis, physicality becomes the first universal sign and instrument of man. Turning into a cultural object, it doubles the form of its existence: in addition to realizing its natural essence, corporeality becomes meaningful in the widest possible limits and begins to be built not only by natural laws.

Another reason for the exclusion of corporeality from the sphere of psychological knowledge was the assumption that, although all human activity is built through the body, it is an absolutely “transparent” ideal tool, completely subordinate to consciousness. The body was thought of as something like a universal probe of consciousness and it was supposed to be realized (exist for consciousness) only at the level of its boundaries separating the world from the subject. In fact, the body is not always limited to the role of “zones yes”, objectifying by its own opacity and activity. There are at least two situations in which the body acts as an objectified reality: ontogenesis and disease. In the first case, the body still requires its development, and in the second, due to pathology its normal functioning is disrupted.

Both the world, and the body, and consciousness itself are equally becoming a reality as a resisting substance, as something that cannot be taken into account once and for all, but requires constant adjustment. The content of consciousness exists as a non-“dissolved” residue. It is born from the need to overcome the opacity of non-consciousness, representing it as emotions, sensations, or abstract constructions.

The body is objectified for a person so far as it does not depend on the subject, he cannot be predicted and automatically controlled. The somatic disease disrupts the normal course of bodily functions and they objectify themselves, obtaining the qualities of sensory content, “sensory tissue”.

The corporeality can receive its subjective existence only in the system of intraceptive categorization, body language. First of all, at the level of prodroma, emotional-evaluative coordinates, categories of well-being are used. At this stage, the sensations are extremely unsteady, uncertain, labile, poorly localized. The act of the primary meaning of sensation from one's own body, they turn into a perceptual image, the core of which is the outline of the body. As a result, they become specific, stable, localized, comparable in degree of intensity, modality, can be verbalized and correlated with cultural perceptual and linguistic standards. The degree of development and differentiation of the subjective intraceptive semantics determines the richness and “articulation” of bodily experiences; on the other hand, the specific features of the categorical network, in the cells of which they receive their existence, impose fundamental restrictions on the intraceptive perception and serve as a source of distortion.

With the primary meaning, the construction of a subjective picture of the disease does not end. The specificity of the internal picture of the disease lies in the fact that its sensory tissue is not only in terms of somatoperception, sensations mean not only themselves, but also that, in principle, it is out of it — the disease. A secondary meaning is sensory tissue through the creation of a “concept of disease”: sensations become symptoms, meaning a disease and marked by it.

The significance of the disease for the sick person is formed through the refraction of its subjective picture in the structure of the needs, motives of the person, acquiring a personal meaning. In terms of its function, personal meaning makes the subjective meaning of the disease accessible to consciousness. At the same time, he can speak quite clearly, consciously, or signal himself in the form of experience — desire, interest, anxiety, fear, etc. Personal meaning is the vital meaning for the subject of the objective circumstances of the disease in relation to the motives of its activity, which determines them. Prist rastny perception. The meaning of the disease is ambiguously included in the motivational system and can be filled with different meanings. In its external expression, the meaning does not exist in a “pure” form, and therefore the conflicting personal sense, the “unacceptability” of the disease, its contradiction to the fundamental motives of the subject’s life, or, on the contrary, its “conditional desirability” and the secondary benefits brought by it appear as distortion of meaning, inconsistency of the internal picture of the disease with objective reality. The personal meaning of the disease expresses itself by choosing, rejecting, limiting, expanding, or one or another transformation of the concept of the disease, and through it - in distorting the intraceptive perception. The latter can be transformed through a distortion of the intraceptive semantic network, a change in sensitivity, or the formation of special »1 patterns of behavior and cognitive strategies.

In the logic of the development of the disease and treatment, two sides should be distinguished: the objective, obeying physical laws, and the subjective, obeying mental laws. They coincide only in limiting abstraction, but in reality one can always point out their significant discrepancy, the wide limits of which are determined by the fundamental features of bodily perception: the limitation of the possibilities of manipulation, testing, and the initial absence of a “common” object.

Thus, the internal picture of the disease appears to be a complex multilevel formation, including sensory tissue, primary and secondary sign, personal meaning. All these levels of generation and functioning of the subjective picture of the disease are closely interconnected, and the “living” inner picture of the disease is a dynamic system in which transitions are made both from the sensory fabric to the personal meaning and from the personal meaning through the meaning to the sensory fabric.

Undoubtedly, sensory data are primary, but this primacy is genetic, in functional terms they receive their subjective existence in the context of the systems of standards, perceptual networks that existed before these sensory data and not about their “cause”.

The development and differentiation of the internal picture of the disease is associated not only with the enrichment of its sensory fabric, but this enrichment itself requires the development of standards systems. Both sides of this process are equally necessary, they are reciprocal sources of development, and only the recognition of their fundamental interrelationship allows us to adequately coordinate two fundamental principles of the theory of mental reflection: the primacy of objective reality in relation to mental reflection and the subject's activity in its development. The simple and immediate sensation caused by the disease is such only for the superficial and naive observer. In its simplicity, it contains, in a hidden, minimized form, far beyond it: a system of perception, culture, language, knowledge, experience, needs, motives.

From the stated position, bodily suffering (illness) must be viewed not as a natural deficit state, but above all as an object of mastering — socialization, the inner picture of the illness as a semiotic system, and bodily intraceptive feeling as a complex textual, symbolic-symbolic structure, and not simple stimulation of interoreceptors (that is, not a reflex reflection of the natural state, but a cultural perception of a cultural subject).

The proposed model of bodily perception is associated with the expansion of the subject of the psychological and scientific medical method. For psychology, this is largely a reformulation of its subject matter and expansion of mental patterns to the bodily area, allowing it to include in its understanding of tools not only external objects and higher mental functions, but also the whole reality of bodily and organismic, which becomes the first universal tool and familiar

This approach requires more changes from medical practice. The proposed model of the formation of bodily sensations essentially contradicts the existing illusion of “propriety” of physicality inherent in modern medicine, and makes it absolutely necessary to take into account the subjective factors of the disease and the patient’s participation in its treatment.

Considering only the natural form of the existence of corporeality, medicine was constantly oriented (and focused) on the search for objective manifestations of the disease and the maximum elimination of the subject from the treatment process. Sharing the illusion of the “transparency” of human perception, it does not take into account the total penetration of the “objective” world by the subjective consciousness and the fact that the world can be represented to the subjective consciousness only in the categories of the latter. A natural consequence of such an illusion in medicine is the attitude to treatment. If the disease does not depend on the subject, then it is better to transfer responsibility for the treatment to someone who has extensive experience or knowledge in this area. The ethical consequence of this situation is quite natural: since the disease does not depend on the subject, and the physicality is transparent, the best way to develop healing is to completely eliminate the subjective factor, i.e. the instrumentalization of medicine is the path on which she embarked. Political consequences — creating a health system based on these illusions — are also quite logical: if the disease has nothing to do with the subject, then the best way to introduce a healthy lifestyle is not to increase its subjective value, not to take into account the personal meaning of health and illness. , not correction of inadequate myths, but full regulation, control over the health of citizens in the form of compulsory “clinical examination”, conducting various kinds of “runner's days”, compulsory vaccination, etc. Neglect to the subject in the system In spite of all assurances of its humanistic focus, health care is ubiquitous. Humanization of health care is usually understood as a typical addendum that improves the appearance, but can in no way influence the very essence of the treatment.

In the society (both in the medical environment and among patients) there is a widespread hidden, but very stable negative attitude to any attempts to introduce humanitarian and psychological knowledge into medicine. It is not accidental and has deep roots: seoological, ethical and political pus.

The infantilism of a society striving to relieve itself of responsibility for its health, shifting it to a specially created social structure, is paired with the paternalistic attitude of the state towards its citizens when it assumes this responsibility and seeks to implement it in the best (from an objective point of view) way.

The current situation is consistent, logical, well-founded bath, but extremely inefficient and does not satisfy any of the parties. The way out of it is the consistent overcoming of the deeply rooted illusions of medicine, the creation of a new concept of forestry and a new - humanitarian - model of medicine.

This statement does not mean the requirement to abandon the “objective” approach and replace the whole medicine with “psychological treatment”. The new theoretical point of view should relate to the preceding ones on the principle of additionality, opening a new plan of problems and not rejecting other research perspectives.

As a natural biological science, medicine has achieved impressive success and, undoubtedly, its prospects are not limited. The success of “subjective medicine”, which is yet to be created, is much more modest. It should not, of course, cancel the "objective medicine", but complement it. If we accept the proposition that man is not only an organism (and moreover, the human organism is not just an organism), then the treatment must be not only biological. It is necessary to create a special field of knowledge based not only on common sense, but using all the accumulated years of experience in psychology, philosophy and other humanities. In this “new” medicine, psychology will be able to play the role of non-decorative stucco on the facade of “real” science and create only certain “rules of communication” with a patient who have no real value at the end, but become a constructive element of this building.