1. The main stages and factors of the occurrence of mental and behavioral disorders.
Principles of constructing a pathopsychological examination of children
Approximate scheme of pathopsychological examination of disorders of mental activity of a child of primary and secondary school age
The main stages and factors of occurrence of mental and behavioral disorders.
Etiology answers the question why a disease occurs, what is its cause, pathogenesis answers the question of how the disease process develops, what is its essence.
The following main phases of the development of psychological disorders are distinguished: pre- and perinatal (before and during childbirth), the phase of primary socialization, the phase immediately before the onset of the disorder (prodromal), the debut, the phase after the onset of the disorder .
In the first phase – before and during childbirth – genetic factors (congenital features of the brain mechanisms of mental activity), exposure to toxic, infectious agents during pregnancy, the nature of the course of childbirth and the characteristics of obstetric care, the attitude of parents to the unborn child are critical for the subsequent development of mental disorders. (newborn) and the nature of their interaction with the infant, the nature of relations in the family of the newborn, environmental factors.
In the second phase – primary socialization – the development of mental disorders can be affected by infections that have a negative effect on the brain (direct or toxic), but socio-psychological factors begin to play a leading role at this stage: the nature of relationships with parents and peers (abuse, sexual abuse, rejection, emotional deprivation, etc.), parenting style. The phase of socialization is limited to periods of early childhood and adulthood.
The first and second phases form vulnerability (biological and personal in the form of a set of specific character traits) to the development of mental disorders. The further possibility of a disorder depends already on the action of trigger factors: if the vulnerability is low, then the action of significant trigger factors will be required, but if the vulnerability is high, smaller trigger factors will suffice. The presence of vulnerability (unfavorable factors in the prenatal phase and the phase of socialization) is far from always associated with the mandatory development of a mental disorder or other abnormalities, since various social agents act on a person and her psyche in the process of socialization. A person is always included in several systems of social connections and relations with different characteristics, while an important role is played by identification with one or another system of relations, as well as the semantic and value values attributed by the individual to these systems, forms of address, people with whom interaction is carried out.
At the prodromal phase of the development of mental disorders, the action of trigger factors of the disease begins. The main triggering factor here is psychological stress , which occurs as a result of drastically changing habitual conditions or the course of a person’s life. The disorder can be caused by both single-acting stressful events and recurring ones. Much here determines the quality of perception of events and reality by the person himself: the same event can be stressful for one person, but not for another. At this phase, it is necessary to distinguish between harmful (provocative) and protective (protective) factors.
Debut is the first manifestation of painful signs of a disorder, when a person’s habitual ways of coping with stressful situations cease to work and a state of disadaptation, inadequacy of behavior to the circumstances of life sets in.
The phase after the onset of the disorder (the debut of the disease) is associated with the action of factors that support the disturbed course of mental activity (behavior). Here it is also necessary to single out harmful (promoting the development of the disorder) and protective (interfering with the development of the disorder) factors.
Most mental and behavioral disorders are multifactorial in nature . Even if in the case of a particular disease, the leading cause of the disorder is one clearly proven biological cause (for example, a genetic anomaly), then a whole chain of circumstances is still responsible for the actual psychological state of a particular sick child, superimposed on an individual feature of the mechanisms of mental activity determined by nature in the process of his personal development. It is for this reason that in modern pathopsychology it is customary to pay attention to the conditions for the occurrence of mental disorders and behavioral disorders, in which the action of various factors can be combined: genetic (hereditary), biochemical, neurophysiological, psychophysiological, personal, socio-psychological, sociological .
Genetic factors determine the brain structure and mechanisms of the “tools” of mental activity and are responsible for the range of individual differences in human behavior. It is the genes that lay the foundation for the uniqueness of the psychological appearance of the individual. The probability of receiving the same set of genes by two organisms born as a result of the fusion of two germ cells of the parents is 1:2 23 , i.e. less than one chance in more than 64 trillion possible combinations. Genes influence, first of all, the structure and biochemical activity of the material substratum of the psyche – the brain.
Mental disorders, as a rule, are associated with the action of not one, but several genes. In modern psychogenetics, there is an assumption that the occurrence of mental disorders is a necessary consequence of the genetic diversity of the Homo Sapiens species, since people with deviations from the average “norm” of mental functions play the role of a kind of natural “reservoir”, due to which the level of prevalence and severity of certain mental functions. For example, due to the presence of people with a hereditary predisposition to the development of schizophrenia in the general population, a sufficient level of prevalence and an optimal degree of development of brain mechanisms that provide creative abilities of mental activity are maintained. Not the presence itself, but the connection of schizophrenia genes with other genes determines the possibility of developing a mental disorder, since these genes, in conjunction with other (“restraining”) genes, are also present in mentally healthy people, being responsible for the functioning of their cognitive abilities. Different combinations of the same genes can manifest themselves differently depending on environmental conditions. Therefore, in the multifactorial model of the development of mental disorders, we are not talking about what is due to heredity in them, but what is due to the environment. Here we can talk about which aspect of the disorder is caused by genetics, and which – by the influence of the social environment.
Biochemical factors are responsible for the speed and efficiency of transmission of neural impulses, the specificity of receptors, the nature of the interaction of nerve cells with each other, the initiation and tuning of nervous processes. Biochemical factors include biogenic amines (dopamine, norepinephrine, serotonin) and amino acids, the activity of the endocrine and immune systems. Biogenic amines are the most significant neurotransmitters. Dopamine provides purposeful and purposeful behavior by regulating the processes of perception, attention and cognition. An excessive decrease or increase in the functionally optimal level of dopamine for a person’s normal habitat can lead to a violation of the mental regulation of the process of interaction between the body and the environment. Norepinephrine has the function of activating, synchronizing and coordinating various neural processes, providing concentration, wakefulness, emotional mood. Serotonin performs the opposite function of inactivating neural processes, being responsible for relaxation, rest and sleep. Often, mental disorders are associated with a change in the optimal balance of norepinephrine and serotonin. Various amino acids provide the necessary level of excitation of neuronal processes associated with learning and memory, and also act as inhibitors.
Endocrine processes provide adaptive abilities to psycho-emotional stress, optimize the ability of the central nervous system to respond to external stimuli, and mobilize the body’s energy reserves under stress.
Despite the discovered connection between the CNS and immune processes , it is still not clear how the immune system can determine mental processes. So far, the effects of the central nervous system on the nature of immune processes have been most studied (psycho-emotional stress leads to a decrease in immune parameters, which creates vulnerability to somatic and infectious diseases or provokes the body to fight against its own cells).
Neurophysiological factors act as the material basis of mental processes, i.e., by means of which a person’s mental activity is carried out. Any mental process – perception, attention, memory, emotions – is associated with some physiological variables. Neurophysiological processes of orientation determine what a person chooses from a continuous stream of stimuli as specific and informative signs of the environment for the realization of his goals. Changes in electrical conductivity in neural circuits lead to changes in the recognition of certain characteristics of a well-known stimulus. Memory is realized through connections of mutually excited cells, as a result of which “neural ensembles” arise – constructions from sets of neurons and their synaptic connections that form a system that is relatively stable in time. Each perceived event has its own “ensemble” (spatio-temporal code). Therefore, memory impairments may be associated with distortions of the “neural ensembles” that store information about events. However, the relationship between mental and neurophysiological processes does not yet mean unambiguous causal relationships: mental disorders are not necessarily always caused by dysfunction of the neurophysiological activity of the brain. Studies of plasticity and functional reorganization of the brain do not allow us to assume causality in only one direction – from the brain to the psyche. Life experience and training determine the organization of the cerebral cortex to a much greater extent than was commonly believed in traditional clinical psychology and medicine.
The psychophysiological factors of mental disorders include the general physiological activity of the body, which affects the course of mental processes. Psychophysiological factors are the activity of the central and peripheral (autonomous) nervous system, neuromuscular activity, the activity of the cardiovascular, respiratory, gastrointestinal, endocrine systems. All these factors are associated with the processes of activation of the psyche under conditions that induce short-term or persistent functional changes in mental activity. Psychophysiological factors include long-term overloads – somatic, emotional, caused by illness – which lead to mental disorders as a result of attributing a particular role to them in a person’s subjective perception of the physiological signals of his body. Using psychophysiological parameters, one can see changes in information processing that play a decisive role in the clinic of some mental disorders, for example, schizophrenia, in which there is a reduced inhibition of signals that are irrelevant to the situation, penetrating consciousness and affecting psychotic symptoms.
Personal factors are associated with the influence of psychological traits acquired in the course of development (socialization and upbringing), which increase vulnerability to the occurrence of mental and behavioral disorders. An integral personal ability that provides flexible adaptation to various stressful situations is the ability to cope with stress ( coping ). Coping is associated with a person’s mental strength, which allows them to openly admit existing problems in order to further resolve them. In psychology, there are various theories that consider the conditions for the emergence of this ability and focus on different aspects of its formation: psychoanalysis, social learning theories, humanistic concepts, etc. In general, the ability to cope is associated with an assessment of the situation: the ability to notice critical changes that need to be dealt with , and the ability to assess the available internal and external resources to solve the problem. Instead of solution-oriented coping, a person may resort to a psychological defense strategy (coping only on an emotional level).
The ability to cope is most often revealed in the concept of the psychological type of personality : a combination of character traits that provide effective or ineffective adaptation to changing living conditions. These characterological traits are formed in the experience of child-parent relationships and in certain strategies for the interaction of parents and teachers with children.
Other personal factors that arise in the process of socialization are emotional stability , endurance (this is understood here as a system of ideas about oneself and the world that support a person in interaction with stressful events), self-efficacy , locus of control , etc.
The socio-psychological factors of mental disorders include the characteristics of communication and interpersonal interaction, status-role positions in communication and interaction, as well as social attitudes (attitudes) and representations. They can have different levels of influence on the occurrence of violations: direct, indirect, moderating, additional, supporting.
A direct effect is exerted by such a factor as social deprivation (deprivation of communication and interaction with social objects desired or necessary for the individual, deprivation of attention from other people, isolation). But most often socio-psychological factors have the value of mediating, moderating, additional or supporting influences.
A change in the characteristics of communication and interaction in a person with mental disabilities is most often associated with the fact that the social environment is oriented towards others – standard , generally accepted forms of manifestation of attitude and treatment. Therefore, the forms of communication and interaction characteristic of people with mental disabilities do not fit into the standard rules, healthy people begin to avoid communication with such people, deviant people, due to personal characteristics, are not able to flexibly respond to this avoidance (or prevent it), which supports and aggravates them. psychological discomfort (pain). Often it is the lack of reciprocity of behavioral reactions and understanding (“supportive communication”) that provokes the further development of deviations and contributes to their transformation into a disease.
Due to the inconsistency with the accepted rules of communication and interaction, people with mental disabilities are considered by others as socially incompetent . At the same time, social competence meaningfully covers not only social behavior, but also compliance with the standards for the manifestation in communication of such mental functions as perception, thinking, memory, imagination, emotions. Thus, disturbances in at least one area of the psyche inevitably entail (according to the “falling domino” principle) disturbances in all other areas of the personality. A prime example of this is the concept of the emergence of behavioral disorders in people with schizophrenia. There are empirical grounds to believe that behavioral disorders in schizophrenics arise as a result of the predominance of negative emotional messages in their communication with people around them (relatives, clinic staff). Negative emotional messages can only be transmitted through one of the communication channels (verbal or non-verbal). In this case, a person suffering from cognitive impairment also reacts not only to negative information, but also to the inconsistency of the modality of information coming through different channels of communication. Provoking behavioral disorders are critical comments, hostile remarks, increased emotional participation, suppressive statements in relation to a person with a mental disorder.
Deviation from the generally accepted standards of mental activity and behavior triggers the processes of selective attention to a person with deviations and to biased conclusions regarding observed behavior, which are characterized by attribution – attributing the alleged causes of deviation. It is often as a result of selective attention and attribution that one or another deviation begins to be considered a disease. Society attaches a label of illness to non-standard behavior, which is associated with the performance of certain social roles by the patient. And as a result, we are dealing with the phenomenon of “self-fulfilling prophecies”: the expectation of negative consequences of deviation leads to their appearance.
Sociological factors are associated with the characteristics of the social space in which people with mental and behavioral disorders live together with people who correspond to generally accepted food. These factors include: the availability of assistance, support, the correspondence of the offered assistance to the real needs and needs of people with disabilities, the possibility of organizing life taking into account the individual characteristics of the psyche of people with deviations from generally accepted standards, material living conditions (poor people get sick much more often). Social inequality is the leading sociological factor responsible for the emergence and development of mental disorders. Social inequality means the inequality of living conditions and chances of people who face disempowerment and restrictions in access to the distribution of benefits due to their mental and personal characteristics. As a result, some people (mentally “healthy”, conforming to the norms) are in a better position, while others (mentally “ill”) are in a worse, discriminated position. People with disabilities are excluded from the life style formed by the majority of members of society, which contributes to the development of a deviation in such a form as “disease”.