Classification of thinking disorders according to Zeigarnik table. Impaired thinking
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The nature of thought disorder in schizophrenia according to B.V. Zeigarnik
Zeigarnik in his works points out that cognitive impairments in schizophrenia are not isolated, but appear in structure with other disorders. Zeigarnik's next thesis is that the basis for changes in thinking (and cognitive activity in particular) in schizophrenia is the pathology of the motivational-personal link of mental activity (i.e., "personal / semantic bias" (These are not entirely synonyms, but in this context they can be considered as such.) - and this is the central defect and acts as the main syndrome-forming factor in schizophrenia.This will manifest itself not only in the study of thinking, but also in the study of other forms of mental activity (memory, perception, attention, etc.).
The logic of evidence was built by Zeigarnik on the basis of traditional pathopsychological experiments, the study of biographies of patients, analysis of case histories and anamnestic information, as well as individual techniques from the experiments of the Levin school. As a result, evidence was obtained that the features of the cognitive activity of patients with schizophrenia are due to the specifics of the motivational-need sphere:
SPHERE OF MEMORY
- The Zeigarnik effect in schizophrenic patients is approximately 1, 1 at a rate of 1, 9 - this can be explained by the fact that patients simply do not set themselves the task of remembering the information presented;
- Patients with schizophrenia lack the "edge effect", which can also be considered an indicator of the motivational "charge" of the subjects - its presence is considered a sign that the subject wanted to remember the information presented to him;
SPHERE OF PERCEPTION
Classical experiments by E. T. Sokolova: the goal was to analyze the formation of perception images in patients with schizophrenia and to show that semantic bias is a significant factor. Pictures of varying degrees of abstractness (from subject images to Rorschach spots) were used as stimulus material, to which 3 versions of instructions were given:
- "Deaf" instruction;
- "Imagination research";
- "The study of intellectual abilities and capabilities."
As a result of the experiment, it turned out that in the "normal" group, the nature of perceptual activity changed depending on the instruction presented - each time the description of the image in the pictures was constructed by healthy subjects based on the instructions received. So, in the case of a "dull" instruction, they, as a rule, gave out a formal description, and if it was about studies of creativity and intelligence, then healthy subjects tried in every possible way to demonstrate the richness of their abilities. As for patients with schizophrenia, here the picture was different: the quality of their answers depended little on the change in instructions. If they were given “dull” instructions, the description process took the form of formal responses or refusals. In the version of the instruction "imagination research" the number of formal answers and refusals was reduced to 30% (this is still a lot - in the "normative" group at the second stage there were no formal answers at all). When presented with the instruction "exploration of intellectual capabilities", the results of patients with schizophrenia were approximately the same. Thus, when presented with all three different instructions, patients with schizophrenia showed an abundance of formal responses, while healthy subjects and epileptics gave different responses when presented with different instructions.
These studies were aimed at confirming the hypothesis that the specificity of the motivational-need sphere of patients with schizophrenia determines the peculiarities of the thinking of such patients. In terms of the results of studies of memory, perception and the actual act of thinking, this hypothesis is fully confirmed.
At the second stage, Zeigarnik set herself the task of obtaining confirmation that the motives of patients with schizophrenia remain known, but lose their motivating power. This is a rather significant paradox typical for such patients. To confirm this hypothesis, an experiment was carried out, the author of which was M. M. Kochenov (founder and first head of the psychological laboratory at the Serbian Institute). Two groups of subjects took part in his experiment: control (healthy people) and experimental (schizophrenic patients). The essence of the experiment: 9 tasks were laid out in front of the subjects, including:
- kraepelin account;
- proofreading test Bourdon;
- koos cubes;
- "Draw 100 crosses";
- "Collect a chain of paper clips";
- "Build a" well "from matchboxes"
The instruction was as follows: choose from the presented tasks only 3 tasks - but such that they could be completed in a limited time (7 minutes). The healthy, by definition, chose the three simplest problems and solved them as quickly as possible. But the patients chose not what was simpler, but what they liked best - and often these were complex puzzles that they could not complete in the allotted time. Usually they got stuck on a problem they liked and solved it indefinitely. When they were interviewed after the experiment, they demonstrated memorization of the initial instruction - accordingly, their motive was known (otherwise the patients would not remember the instruction), but they were not guided by this motive in their activities and did not follow the instructions. Some drew much more instead of 100 crosses in a fit of passion, which may indicate that they had some specific motivation (which, however, did not coincide with the experimenter's motivation). Thus, the motives of patients with schizophrenia are indeed known, but they lose their motivating force.
In the same study of Kochenov, other phenomena were described:
- THE PHENOMENON OF ADYNAMIC MOTIVES: patients with schizophrenia did not accept the motive as acting, but did not take any action that would contribute to their exit from the experimental situation (refusals) - instead, they realized their specific motives. Thus, instead of abandoning the motive, it was replaced;
- THE PHENOMENON OF DIFFERENT MOTIVATION: patients could not make a clear decision in favor of choosing a particular task - they were interested in both, although they were not guided by the main instructions for performing these tasks. In this case, the motives could be very different - up to the game motivation (despite the fact that all the subjects were adults).
CASE STUDY (based on a longitudinal study of the Zeigarnik times)
60s The young man was admitted to the hospital for consultation. Gannushkin. He studied at one of the good mathematics schools and showed some success. His mother brought him to the consultation, after the young man twice entered the Faculty of Mechanics and Mathematics of Moscow State University, but both times he behaved in a not quite typical way. The entrance test consisted of solving a number of mathematical problems, arranged in order of increasing difficulty. The last, the most challenging taskswere usually solved by units. This patient twice skipped the initial simple tasks, but at the same time managed to solve the most difficult in several different ways. Thus, he did not enter the university. The mother's exhortations about the need to solve the problems at least once according to the instructions did not work on the young man. At some point, he began to behave rather strangely (e.g. once he came to the hospital with a colored "mohawk" on his head). Subsequently, he tried several times to enter the university - and each time he repeated his strange algorithm for completing the introductory task (moreover, he argued why it was necessary to solve problems in this way). Among other characteristics of the patient - he worked only once a year, as "Santa Claus". Moreover, if the parents of the finished children offered "Santa Claus" money, he always refused. Until a certain point, everything was relatively well, but after the death of the mother, the patient experienced the first bright psychotic episode - and then his life became a little more difficult ...
Based on the totality of the results obtained, it was found that patients with schizophrenia have the specifics of the motivational-need sphere (motives lose their motivating force, etc.), and since this link is always affected in the study of all cognitive processes, based on the analysis of the entire set of signs, it is concluded that the peculiarities of the motivational-need-related sphere of such patients have the status of a syndrome-forming factor in mental disorders of the schizophrenic type. This is the general logic of B.V. Zeigarnik's school. It can be criticized, but since the 70s a more constructive scheme has not yet been invented.
2. VIOLATION OF THE PERSONAL COMPONENT OF THINKING
In the clinic for mental illness, there are thought disorders caused by personality disorders. These include the diversity of thinking, violation of criticality and self-regulation.
Thinking is a complex, self-regulating form of activity. It is determined by the goal set by the task. An essential stage in mental activity is the comparison of the results obtained with the conditions of the problem and the expected results. In order for this act of comparison to be performed, human thought must be active, directed towards objective reality. The loss of purposefulness of thinking leads not only to superficiality and incompleteness of judgments, but also to the fact that thinking ceases to be a regulator of human actions.
However, the position that thinking is the regulator of actions should not be understood as if thinking should be considered as a source, as a driving force of behavior. F. Engels wrote: “People are used to explaining their actions from their thinking, instead of explaining them from their needs (which, of course, are reflected in the head, are realized), and in this way, over time, that idealistic worldview arose that took possession of minds especially since the death of the ancient world "
Consequently, the source of human action is the conscious needs that have arisen as a result of social and labor activities of a person. A need, realized by a person, appears for him in the form of specific life goals and objectives. Real human activity aimed at achieving these goals and solving these problems is regulated and corrected by thinking. Thought, awakened by need, becomes the regulator of action; in order for thinking to be able to regulate behavior, it must be purposeful, critical, personally motivated.
There is no thinking divorced from needs, motives, aspirations, attitudes, feelings of a person, i.e. from the personality as a whole. S. L. Rubinstein wrote about this in his book "On thinking and the ways of its study": "The question of motives, the motives of analysis and synthesis of thinking in general ... is essentially a question about the origins from which this or that thinking process" .
L. S. Vygotsky constantly emphasized that thought is not the last instance, that thought itself is born not from another thought, but from the motivating sphere of our consciousness, which covers our drives and needs, our interests and motives, our affects and emotions.
When constructing his theory of the stage-by-stage formation of mental actions, P. Ya. Halperin points out the need, first of all, to form a motive for action.
Per last years outlined an approach to thinking as the activity of managing the search for solutions to problems. Although this aspect, dictated by cybernetic research, undoubtedly turned out to be fruitful for the psychology of thinking, at the same time it caused a one-sided approach in the analysis of the thinking process among a number of researchers, thinking began to be considered as an analogue of the operation of electronic computers. It began to be reduced to elementary information processes, to the manipulation of symbols. OK Tikhomirov correctly notes that the spread of cybernetics has led to the concentration of attention on the scheme of any activity, and "the problem of specifically human characteristics of activity is relegated to the background" [185, 31].
Meanwhile, speaking about the "biased" nature of human activity, A. N. Leont'ev writes that "the personal meaning expresses precisely his (subject. - B. 3.) attitude to perceived objective phenomena" [110, 281]. Naturally, the changed personal meaning should play an essential role in the structure and course of mental activity.
The connection between thinking disorder and a change in the motivational sphere is observed in various forms of mental illness. Even when analyzing that type of pathology of thinking, which we called "distortion of the level of generalization," we can essentially speak of a violation of the motivational component of thinking. As noted, patients in whom such a disorder appeared, relied in their judgments on signs and properties that did not reflect real relationships between objects.
Such violations were especially clearly revealed in some experimental tests that required the isolation and selection of features, on the basis of which synthesis and generalization is possible (for example, with different variants of object classification). We have provided ways of classifying objects by similar patients, when the spoon could be combined with the car "according to the principle of movement", the cabinet was combined with the pan because "both have holes". Often, objects were combined on the basis of their color, location in space or style of drawing. Such an increased facilitated actualization of formal associations, inadequate rapprochements has been identified by other researchers. So, Yu. F. Polyakov and TK Meleshko give an example when a patient sees the similarity between a pencil and a shoe in that "both leave a mark." Describing such phenomena, they explain them by the fact that random, unlikely connections are actualized in patients with the same frequency as strengthened ones. This position is correct. It is necessary, however, to understand what the concepts of "essential", "solidified", "significant" or, conversely, random signs or properties of objects, are psychologically.
Significant, essential for a person is that which has acquired meaning in his life. It is not the frequency of appearance of a particular feature or property of an object that makes it significant or significant, but the meaningfulness, the role that this feature played in a person's life. The essence of a feature and property, the significance of the object or phenomenon itself depends on what meaning they have acquired for it. A phenomenon, an object, an event can acquire different meanings in different living conditions, although the knowledge about them remains the same. A. N. Leont'ev points out directly that the phenomenon changes from the side of "meaning for the personality."
At the same time, the meaning of things, the totality of our knowledge about them remain stable. Despite the fact that the personal orientation and content of motives may be different, the main practical activity forms the stability of the objective meaning of things.
Our perception of the world always includes both a semantic relationship to it and its objective-objective meaning. Under certain circumstances, one or the other side prevails, but both of them are fused in harmonious unity.
Of course, changing emotions, strong affects can healthy person lead to the fact that objects and their properties begin to appear in some changed meaning. However, in an experimental situation, no matter how important it is for the patient, objects appear in their unambiguous characteristics. Crockery always acts like crockery, and furniture - like furniture. With all the individual differences - the difference in education, with all the heterogeneity of motives, interests - a healthy person, when it is necessary to classify objects, does not approach a spoon as a "moving object". The operation of classification can be carried out in a more or less generalized plan, but the objective meaning of the object with which a person performs this or that operation remains stable. Therefore, the signs on the basis of which the classification operation is carried out, the properties of objects that are actualized in this case are, to a certain extent, the character of standard and banality. In a number of patients with schizophrenia, this stability of the objective meaning of things was disturbed.
Of course, they also developed common (in comparison with the norm) knowledge about things and phenomena. They eat with a spoon and use the trolley as a means of transportation; in relation to the performed intellectual task - the classification of objects - the same patients could classify a spoon as a tableware or a cupboard as a furniture, but at the same time a spoon could act as an object of "movement". Along with the actualization of the usual, due to the entire past life, properties of signs, relations between objects and phenomena, inadequate (from the point of view of normal ideas about the world) connections and relationships that acquired meaning only due to changed attitudes and motives of patients could be revived. That unity, which included the meaning of the object and the semantic relation to it, was lost due to a change in the sphere of motives and attitudes. The violation of the personality component in the form of thinking disorders, which we characterized as "diversity of thinking", was especially striking.
Diversity of thinking ... Violation of thinking, designated as "diversity", consists in the fact that the patients' judgments about any phenomenon occur in different planes. Patients can correctly learn the instructions. They can summarize the material offered to them; the knowledge they actualize about subjects may be adequate; they compare objects on the basis of the essential properties of objects that have been strengthened in the past experience. At the same time, patients do not perform tasks in the required direction: their judgments proceed in different channels.
We are not talking about the all-round approach to the phenomenon inherent in the thinking of a healthy person, in which actions and judgments remain conditioned by the goal, the conditions of the task, the attitudes of the personality.
We are also talking about the wrong fluctuations in the level and content of judgments that arise as a result of altered dynamics of thinking. As we said above, with inconsistent judgments, patients for a certain period of time are deprived of the opportunity to reason correctly and adequately. However, this does not represent a loss of purposefulness in mental activity as such. The patient's actions are adequate to the goal and conditions set by the experimenter (for example, the patient leaves a generalized solution and begins to unite objects based on a specific feature), but his actions are carried out in terms of classification: he unites objects based on the properties, signs of the objects themselves. With the diversity of thinking, the very basis of the classification is not uniform. Patients combine objects during the performance of the same task, either on the basis of the properties of the objects themselves, or on the basis of personal tastes and attitudes. The classification process takes place in patients in different channels.
To illustrate, we give some examples of a patient G. (schizophrenia, paranoid form).
Table 12
Completion of the task "classification of objects" (sick Mr. with "diversity" of thinking)
Items,
grouped by patientsPatient's explanation
Elephant, horse, bear, butterfly, beetle and other animals Animals Airplane, butterfly Flying group (the butterfly was taken by the sick from the group of animals) Shovel, bed, spoon, car, plane, ship Iron. Items indicating the strength of the human mind (the plane is removed from the group of flying) Flower, pan, bed, cleaning lady, saw, cherry Items painted in red and blue Elephant, skier Items for shows. People tend to want bread and circuses, the ancient Romans knew about this. Wardrobe, table, whatnot, cleaning lady, shovel Furniture. This is a group of those who sweep the bad out of life. The shovel is the emblem of labor, and labor is not compatible with cheating Flower, bushes, trees, vegetables and fruits Plants Glass, cup, saucepan Dishes From the above table it can be seen that the patient Mr. distinguishes groups on the basis of a generalized feature (animals, dishes, furniture), then on the basis of material (iron), color (pictures are painted in red and blue). Other subjects are combined on the basis of the patient's moral and general theoretical ideas (the group "sweeping the bad out of life", the group "testifying to the strength of the human mind", etc.).
Some patients are guided by personal tastes, snatches of memories when completing the task. So, the patient Sv (paranoid form of schizophrenia), performing the task of "classifying objects", tries to form groups of animals, plants, but immediately adds: "But if you approach from the point of view of my personal taste, then I do not like mushrooms, I I'll throw this card away. Once I was poisoned by mushrooms. But I don't like this dress either, it's not elegant, I'll put them aside. But I like the sailor, and I recognize sports (unites sailor and skier into one group) ".
Thus, the patient loses the goal of the task, not because he is exhausted, but because he performs the classification proceeding from "personal" taste, then based on the memory that he was "poisoned by mushrooms."
Other sick K-n (schizophrenia), described by us together with P. Ya. Galperin, when classifying objects, does not agree to include the dog in the group of pets allocated to him: "I will not eat a dog." The focus on the objective content of the action is lost; along with adequate judgments, the "diverse" nature of thinking appears. We found a similar diversity in the task "excluding objects".
For illustration, we give some examples from the experiment of a patient with schizophrenia (simple form) in table. thirteen.
Table 13
Execution of the task "exclusion of objects" (sick Mr. with "diversity" of thinking)
Pictures shown
Patient's statements
Kerosene lamp, candle, light bulb, sun It is necessary to highlight the sun, this is a natural luminary, the rest is artificial lighting Scales, thermometer, clock, glasses I will separate glasses, I do not like glasses, I like pince-nez, why are they not worn? Chekhov wore Drum, cap, umbrella An umbrella is not needed, now they wear raincoats. An umbrella is an outdated attribute, I am for modernism As you can see from the table. 13, the patient is able to complete the task at a generalized level; she excludes the sun as a natural light, but immediately distinguishes glasses on the basis of personal taste: "she does not like them" not because they are not a measuring device. On the same basis, she identifies the umbrella.
As a result of the simultaneous coexistence, the interweaving of all these different aspects, different approaches to the assignment of judgment. definitions and conclusions of patients do not represent a systematic, purposeful task performance. In the mental activity of patients, logical judgments, fragments of ideas, elements of memories, desires are intertwined.
GV Birenbaum noted similar disturbances in thinking when studying patients with schizophrenia. She pointed out that in patients, thinking "flows, as it were, along different channels at the same time." Defining this symptom as "passing the essence", G.V. Birenbaum noted that patients often substituted the fulfillment of the task by revealing a subjective attitude towards it (oral communication).
When performing any of the simplest tasks, the patients did not approach from the positions determined by the specific situation of the experiment, but were guided by a changed attitude, changed life attitudes. At the same time, there might not have been a direct introduction of the content of the psychopathological symptom into the experimental situation (for example, the patient did not "weave" elements of delirium into the task). However, along with adequate associations, connections were revived that had something to do with the patient's painful attitudes, which in this particular situation appeared as "bizarre". The objective meaning of things becomes unstable, sometimes contradictory in the same semantic situation.
* The symbolism of thinking of some patients with schizophrenia is also closely related to this "diversity". It is because of the "diversity" of thinking and emotional saturation that everyday objects began to appear in them in the form of "symbols."
Such an inadequate linking of things, ideas that are not in connection with each other, appears because it becomes possible for the patient to consider the most ordinary things in inadequate aspects of the situation.
The data presented are in agreement with many clinical data. Analysis of the case histories of these patients, observation of their behavior in life and in the hospital revealed the inadequacy of their life attitudes, the paradoxicality of their motives and emotional reactions. Patient behavior deviated from the usual standards. Previous interests, views of patients recede into the background in front of inadequate, painful attitudes. The patient might not care about his loved ones, but he showed heightened concern about the "diet" of his cat, another patient could leave his profession and, condemning the family to hardships, was engaged in arranging things in front of the photo lens all day long, because in his opinion, "seeing from different angles leads to broadening the mental horizons."
The paradoxical attitudes of these patients, the semantic bias led to a profound change in the structure of any activity, both practical and mental. The essential was what corresponded to the changed paradoxical attitudes of the patient. When performing experimental tasks that required comparison and selection of features, such a semantic bias led to the operation of inadequate ones.
If the patient, who saw the meaning of life in the arrangement of objects in front of a photographic lens, classified objects based on their location in the pictures, then the choice of such a principle was meaningful for him.
In those cases when the patient is captured by delusional experiences, the "diversity" of thinking appears clearly in the clinical conversation. In a situation that is not emotionally saturated, the "diversity" of thinking can appear only in a rudimentary form. However, as we saw above, it can be clearly revealed in an experimental situation. In these cases, semantic bias leads to the actualization of insignificant, "latent" (S. L. Rubinstein) properties that coexist with adequate ones. Thinking loses focus.
In his report at the XVIII International Congress of Psychologists in Moscow (1966) "Needs, Motives, Consciousness" A. N. Leont'ev said that "the meanings assimilated by a person can be narrower or wider, less adequate or more adequate, but they always retain their objectified, as it were, "transpersonal character" [111,9]. Obviously, we describe "Resonance" In our patients, this "transpersonal" character of meanings is lost.
The role of the altered personal attitude in the structure of that type of pathology of thinking, which is designated in the psychiatric clinic as resonance, even more clearly appears.
This disorder of thinking is defined by clinicians as "a tendency to fruitless philosophizing," as a tendency to unproductive long-winded reasoning. In other words, reasoning acts for psychiatrists as the very disturbance of thinking. In reality, this is only a phenomenological description. Our research has shown that the mechanism of "reasonableness" is not so much a violation of intellectual operations, as increased affectivity, inadequate attitude, the desire to bring any, even insignificant, phenomenon under some kind of "concept."
Often, inadequate judgments are noted even in patients in whom the experiment does not reveal violations of cognitive processes at all. So, a patient with psychopathy, who in the experience of a pictogram selects adequate connections to memorize the word "development", draws two people diverging in different directions, explaining: "This is separation, separation leads to improvement, because separation is sadness, and the feeling of sadness ennobles a person , removes the petty-bourgeois husk of self-righteousness. " Another patient, when presented with the proverb “All that glitters is not gold,” says: “This means that we must pay attention not to the exterior, but to the inner content,” and immediately adds: “But still I must say that from the point From the point of view of dialectics, this is not entirely correct, because there is a unity of form and content, which means that one must pay attention to the appearance. "
Psychological characteristics the symptom of resonance was the subject of a special study by T.I. Tepenitsyna. As shown by the results of her research, the inadequacy, reasoning of patients, their verboseness appeared in those cases when there was affective seizure, excessive narrowing of the range of meaning-forming motives, an increased tendency towards "value judgments". TI Tepenitsyna writes that "reasonableness is expressed in a pretentious and evaluative position of the patient and a tendency to great generalization in relation to a small object of judgment" [183, 72].
For illustration, we present the data of the medical history and protocols of the patient V.P.
Patient V.P., born in 1940. Secondary education. Diagnosis: schizophrenia, paranoid form.
The early development of the patient was uneventful. I went to school at the age of 7. She studied well. She grew up as a stubborn, harsh girl. Was a "ringleader" among children. I tried to be the first in everything.
After leaving school, she entered a trade college, which she successfully graduated from. In 1959-1960. became overly "active", the mood was always "enthusiastic", easily got to know people.
In 1961 she entered the university. I did a lot. For the first time, a suspicion unusual for a patient was caught.
Became angry, rude. She began to suspect her husband of "bad deeds". I took him to the police station. There she was examined by a psychiatrist and hospitalized in mental asylum... On admission to the hospital, she was inaccessible, angry, and excited. She believed that "enemies" in collusion with her husband were associated with hostile people. I spent 24 days in the hospital. She was treated with chlorpromazine and insulin. Discharged in good condition. I felt good at home. Passed tests successfully. Soon the condition worsened again. Sleep was disturbed. Again suspicion arose, drove her husband out of the house. Fears appeared.
In November 1963 she was re-stationed. On admission she is mannered, foolish, and has an inadequate smile on her face. She declared that she hears "voices from outer space", experiences an outside influence on herself. Someone "acts on her thoughts", "feels that something is twitching in different parts of the body." At times excited, strives to run somewhere, then crying, then laughing. Shows aggression towards patients. During the period of treatment with stelazine, the condition improved. Became calmer, more correct to behave. From the internal organs and central nervous system no pathology was revealed.
General experimental psychological research data (data by T.I. Tepenitsyna). During the study, the patient's mood is upbeat, happy. The tone of his statements is puerile and enthusiastic. Laughs a lot and for no reason. Manerna, talkative. I found a good memory, out of 10 words, I immediately reproduced 10, in almost the same order, I could repeat complex texts verbatim.
We cite as an illustration the protocols of the patient's fulfillment of experimental tasks: when performing the classification, the tendency to "pretentious statements" appears especially clearly. Thus, grouping together objects: "saw, glass, bottle, jacket", the patient explains: "Household items and tools"; "a cock, a sailor, a woman" - "A proud cock, a slender sailor, and a beautiful woman"; "tree, beetle" - "A tree can go to a beetle, because nobody knows where the trees came from and nobody knows where the beetles came from"; "bicycle, bed, table" - "Technique, since the same labor was expended there as in order to make a bicycle ... The table is here, specific labor is also expended"; "bird and dog" - "A bird and a dog to animals: they breathe. You can come here both a sailor and a woman, because they descended from a monkey"; "glass, rooster" (shifts pictures from the first group) - "General - This is life! Because if there were no rooster, there would be no chicken; if there were no chicken, there would be no egg! Blowing an egg - there will be a shell, there will be a glass, you can pour into it! "; "clock, steamer" - "This is also a technique, firstly; secondly, the steamer operates according to Moscow time. Moscow time operates according to Om, according to Archimedes, according to Plutarch. This ship will not sink if it operates according to the clock."
Attempts by the experimenter to intervene, to help the patient, to direct the work in the desired direction lead nowhere. The classification of items remains incomplete.
Similar results are revealed when defining the words: "friendship", the patient defines: "Friend-zhba! This is such a feeling! .. This is a big, big feeling that pushes people to good deeds ... These are people who help each other in difficult times, it is even a feeling of love to some extent. Friendship is not only possible ... Friendship can be not only among people, friendship is also among animals. Friendship is good! Friendship is a good feeling that people and animals experience, which allows people do good to each other ... "; "head" - "The head is that part of the body without which it is impossible to live. Impossible! It is, as Mayakovsky says," the brain of the class, the strength of the class. "The brain is located in the head - the brain of the body, the strength of the body - that's what a head is. You can live without an arm, you can live without a leg, but without a head it's not recommended. "
Here are examples of concept comparison. The patient must compare the concepts of "clock and thermometer"; she replies: "This is life! A thermometer is life! And a clock is life! For a thermometer is needed to measure the temperature of people, and time is measured by a clock. There would be no life if there were no hours and there would be no thermometer, and not there would be a thermometer, they would not measure the temperature of the sick and measure the air temperature; they would not reconcile the air temperature - they could not predict the weather, there could be no forecast, and if there were no hours, then people would be like a herd: they are not always would go to work, only by the sun, and the sun is not always visible - it is not in winter "; "The bird and the plane" - "The resemblance is the wings. Because one born to crawl cannot fly. A man also flies, he has wings. A rooster also has wings, but he does not fly. He breathes. Born to crawl, he cannot fly!"
TI Tepenitsyna notes that affectivity is also manifested in the very form of the statement: meaningful, with inappropriate pathos. Sometimes only one intonation of the subject makes it possible to regard the statement as resonant; so, judgments that sound in loud speech as typically resonant, when written down, along with the loss of intonation, lose their resonance connotation.
Grammatical system the speech of this category of patients reflects the emotional characteristics of "resonance". The syntax is peculiar, the vocabulary of resonant statements is peculiar. Patients often use inversions, introductory words.
The versatility and reasoning of the free are also expressed in speech, which acquires, as clinicians put it, the character of "disunity". In essence, this is also a symptom of speech impairment as a function of communication.
Let us give an example of the speech of the sick Ch-na.
Experimenter... Yu.S., are you going to give me the watch?
Sick... No no no.
E .: This is someone else's thing.
B .: A thing, not a thing, a person, not a person (then the patient answers a number of questions only with inadequate facial expressions and gestures).
E .: Why are you moving your lips?
B: My lips are always the same.
E .: The same?
B: Yes. Where do my teeth grow from or not? You tell me ...
E .: Are your teeth growing?
B .: I have teeth, but I can't play with you.
E .: With your teeth?
B .: No, you don’t laugh, Your Majesty ... So I sold the flag, then I will sell the gun on these weapons too ... (inaudible, quiet).
E .: What? I did not hear.
B: Nothing else ... And light is light. Well, perhaps, darkness ... Yes, it means. You mean to say that you cannot find us further.
E .: Why?
B: For example, a person depends on humanity. In general, so let it be. Humanity is asleep, it speaks only to it. My father has, but this one does not.
E .: What is not?
B: Well, what were promised. Well, after all, there were just peoples before the nationality.
E .: Before the nationality was it?
B: You, Your Majesty, do not look, just do not point, so red, pale, white. None of this is ... (inaudible).
E .: I don't understand what you are saying.
B .: But you don't sell. Tell me how I think? Here, here, well, the gendarme. Do you need psychology?
E .: Am I a gendarme?
B: That is, in what sense? That he will be eaten ... Well, it's not good ... with negative sediment. Look at them, who they are (inaudible) ... You wanted to offend me ... and I could, but my money is melting.
E .: Is this a metaphor?
B: It doesn't matter ... (pass). You don't leave your office today, and you don't let anyone into your office. There I am ... always ready.
E .: I'm ready for what.
B: It doesn't matter ... the Son of the People (inaudible).
E .: What is important, I do not understand.
B .: Yes, I don’t know either (laughs) ... Let me smoke, and you don’t push me here anymore ...
E .: You yourself came.
B .: I was an honest person, I wanted to look at the kitchen. I have a watch that has an attorney. But my brother is a simple artisan. And if everyone thought for themselves like that, everything would (inaudible) ...
E .: Will you give me the watch?
B: I just ate the watch. But if I eat like this, then in general (speaks indistinctly, quietly) ...
What's this?
B: I don't have zero. And this is not good for me. I save ... All humanity saves ... and I want to do him honor.
E .: Why, Yu.S.?
B .: You, dad, don't laugh ... I'm just saying ...
E .: Why, for what purpose?
B: Daddy, eat this thing (gives an ashtray).
E .: Is it edible?
B: How many times have you been broken (inaudible) ... Broken, look, dad, broken.
E .: She's not edible.
B: Yes, it’s not edible.
E .: So you can't eat it.
B .: If he takes it, buy it, but you yourself, he will sell it, don't drink (points to a decanter of water).
Often, such patients speak regardless of the presence of the interlocutor (a symptom of a monologue). Let us give an example of patient N.'s monologue speech (schizophrenia, defect state). With outwardly ordered behavior and correct orientation in the situation, the patient in a monotonous, calm voice speaks monologues for hours, without showing any interest in the attention of the interlocutors.
Why, that's why, of course, nobody told me about it, and where I haven't read it, it's not shown anywhere. I think and firmly, of course, I know that this matter is motion, the entire globe (incomprehensible). Yes, I think, for a long time I thought about this matter, but I see what it means - living matter, it, being, that means living matter, so I think that then I think, I used to study, how much I did not study, everything I studied, the air is not living, well, oxygen, hydrogen, all these are dead substances, but now it seems to me that all the greenery that inhabits the surrounding atmosphere envelops; well, a living being, a completely living being, a completely living being, completely alive here, and it consists, blooming, I imagine it like this smoke, just not immediately, as it appears, that's how it has already dispersed, slightly noticeably and consists of such tiny creatures, it is simple, difficult to distinguish, here, and they have terrible power, of course, they will inhabit wherever you want, through the pores of any substance, here. All this moves at the same time, so I believe that that was born. Why is a woman, this matter, in my opinion, the whole race on earth occurs.
Analysis of the above samples of "broken" speech leads to the following conclusions.
First, there is no reasoning in the rather lengthy statements of the patients; patients pronounce a number of phrases, but do not convey any meaningful thought in them, do not establish any, even false, connections between objects and phenomena.
Outwardly, the first passage resembles a conversation between two people: some of the patient's answers even contain some kind of response to the experimenter's question. In essence, the patient's speech, presented even in a dialogical form, does not serve the function of communication: the patient does not tell the experimenter anything, he does not try to learn anything from him. Calling the experimenter now a gendarme, now a dad, the patient does not find a hint of a corresponding attitude towards him. The experimenter's attempt to direct the patient's speech to any topic fails; if the patient reacts to the experimenter's question, it is only as a stimulus that gives rise to a new incomprehensible stream of words. As V. A. Artemov emphasizes, focus on content is one of the characteristic features of speech perception. Our patients have lost this feature.
Secondly, it is impossible to find a specific object of thought in the speech of patients. So, the patient names a number of objects - air, matter, artist, human origin, red blood balls, but in his statement there is no semantic object, no logical subject. These passages cannot be put in other words.
Thirdly, patients are not interested in the attention of the interlocutor, they do not express any relation to other people in their speech. The "torn" speech of these patients is devoid of the basic characteristics characteristic of human speech; it is neither an instrument of thought, nor a means of communication with other people.
This feature of the patients' speech, the lack of a communication function, combined with its other feature, with its incomprehensibility to others, makes it similar to the so-called egocentric speech of a child.
Of particular interest is the analysis of the quality of drawings - not from the point of view of artistic value, but as an expression of the state of the psyche (incomplete, schematic, etc.). A huge amount of foreign literature is devoted to this, most of it is psychoanalytic, but sometimes it also has diagnostic value. This makes it possible to analyze our material, which will be the subject of further work.
findings
1. The pictogram turned out to be effective method to assess the thinking of patients with schizophrenia, in particular for the early diagnosis of thinking disorders.
2. The process of drawing up a pictogram is a holistic act, in which the mnestic, emotional and content components of the mental act are merged, as it were.
3. Studies have shown that the inadequacy thought processes in schizophrenia is due not only to the inadequacy of the object choice, but is necessarily combined with a violation process selection of an object to remember.
B. V. Zeigarnik DISORDERS OF THINKING
Thinking disorders are one of the most common symptoms in mental illness. The clinical variants of thinking disorders are extremely diverse. Some of them are considered typical for one form or another of the disease. When establishing a diagnosis of a disease, a psychiatrist is often guided by the presence of one or another type of thinking disorder. Therefore, in all textbooks and monographs on psychiatry, devoted to a variety of clinical problems, there are many statements about thinking disorders; there are many works describing mental disorders, and in the psychological literature. However, there is no single qualification or a single principle for the analysis of these disorders; This happens because, in describing and analyzing disorders of thinking, researchers based on various psychological theories of thinking, on various philosophical and methodological positions.
Thought disorders encountered in psychiatric practice are of a varied nature. It is difficult to fit them into any rigid scheme, classification. We can talk about the parameters around which are grouped various options for changes in thinking that occur in mentally ill patients.
It seems to us possible to distinguish the following three types of pathology of thinking: 1) violation of the operational side of thinking, 2) violation of the dynamics of thinking, 3) violation of the personal component of thinking.
Variants of Thinking Disorders (Zeigarnik)
B.V. Zeigarnik proposed a pathopsychological classification of thinking disorders:
Violation of the operational side of thinking;
Violation of the personal (motivational) component of thinking;
Violation of the dynamics of thinking.
1. Violation of the operational side of thinking (synthesis, analysis, abstraction)
a) a decrease in the level of generalization
a) in the thinking of patients, it is possible to distinguish concreteness, an insufficient level of abstraction, the use of simple unambiguous connections between phenomena, a specific situational type of problem solving. Those. the patient makes a conclusion, uses the situation to combine situations with each other, situations are associated with life experience. For example: methodology of classifications. When considering a specific situation, the patient will be allocated an abstract sign. This will manifest itself in organic diseases of the brain, epilepsy, mental retardation, oligophrenia.
b) distortion of the generalization process
b) displacement of judgments based on minor latent features. The patient does not use standard signs, but side connections. For example: sparrow and nightingale
A person with schizophrenia will tell you that they can make sounds.
2. Violation of the dynamic side of thinking.
Lability of thinking - excessive mobility of thought processes (often with a manic state). The patient jumps from one to another, thinks out loud.
Inconsistency, slipping - the patient is able to maintain the correct line of reasoning for some time, but at some point he switches and performs the task incorrectly.
Often with vascular diseases of the brain
Often due to fluctuations in attention.
Fleeting fluctuations in performance:
Responsiveness
The patient is incapable long time hold the line of reasoning and his mental activity is disorganized as a result of the appearance of side stimuli.
The inertia of thinking (rigidity, rigidity) is due to the rigidity of already formed connections, methods of action and past experience. It is difficult to switch from one to another type, type of activity and difficulties arise in inclusion in the task.
3. Violation of the motivational aspect of thinking
one). reasonableness is disembodied reasoning. The patient discusses in sufficient detail on any topic, which is not required by the situation.
In patients with schizophrenia - unproductive reasoning, ineffectiveness of the process.
At every mental illness its own specificity.
In schizophrenia, the topic is significant, has an abstract character, a lot of details in its development in the absence of a result of reasoning, the inadequacy of the whole situation. Pretentiousness of definitions, isolation from reality
With epilepsy - the patient is a moralist, a defender of the rules, ethical standards, the person is pathetically explained, the position of the broadcaster.
With organic lesions of the brain, resonance is of a compensatory nature, for the patient it is a way to compensate for his inadequacy, to avoid performing a difficult task.
Putting out loud external speech into the plan, the performance of operations and the general program of action. Departure from the topic, from a difficult situation.
2). the diversity of thinking when performing the same task, the patient proceeds from different attitudes, often not associated with either the instruction or the content of the task. As a result, the patient may make conflicting judgments. Most common in schizophrenia
Diversity levels:
Slip - single acts, single deviations from the general progress of the task
Diversity itself
Disruption of thinking in general
It is often impossible to restore the patient's logical connections and judgments. Speech and judgments are fragmentary, can be correctly formed grammatically, but have no meaning, whole phrases are empty, but with the correct grammatical structure
4. Violation of criticality
Violation of criticality - the personal level is turned on. They are common, in principle, in everyone, with the exception of neurotics.
The inability to adequately assess their actions, their compliance with the requirements of the assignment, insufficient planning, control over their actions, error correction.
Different patients have different aspects of criticality. Criticality is associated with social adaptation, the ability to assess their behavior in accordance with social requirements and rules.