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AbstractThe article aims to demonstrate advances in methodological means suggested by Vygotsky’s cultural-historical concept in association with a theoretical model of a Person-centered diagnosis and practical use of the construct for clinical psychology and medicine. The work gives consideration to ‘defining pillars’ of Person-centered approach in modern medicine, to humanistic traditions of the Russian clinical school, and high prospects in diagnostics of such mental constructs as “subjective pattern of disease” and “social situation of personal development in disease” - within the context of person-centered integrative diagnosis.
This article discusses the need for implementation a cross-cultural study of subjective pattern of disease and its correlation with a particular “social situation of personality development under disease conditions”.
Person-centered approach, Person-centered integrative diagnosis (PID), Vygotsky’s cultural-historical concept , Subjective pattern of disease, Social situation of development, Postnonclassical model of scientific rationality, Self-developing systems. Currently, biological advances in medicine by far exceed developments in the humanistic disciplines because of new technologies and modern, updated equipment as well as the presence of various technical and organizational mediators in health care, including diagnosis and treatment. Alongside these tendencies there is an increasingly manifested aspiration to focus on the integral study of individual functioning in disease, which is becoming one of the characteristic features of contemporary medicine. We give consideration to the “defining pillars” of the person-centered approach in modern medicine, to the humanistic traditions of the Russian clinical school, and to the high prospects for such mental constructs as the “subjective pattern of disease” and the “social situation of the personal development in disease” within the context of PID.
Nowadays growing concern with modern medicine’s excessive emphasis on organs and disease and its fragmentation and compartmentalization has led to a number of clinical developments that subscribe to broad biopsychosocial concepts, the integration of health and social services, the “recovery” of the whole person, and the “healing relationship” between clinicians and patients (McWhinney, 1989). Conventional health-care paradigms focusing just on disease and immediate care are often regarded as inadequate. Psychiatry for the Person has been proclaimed a major World Psychiatric Association initiative (World Health Organization, 1999).
This initiative was aimed at promoting a psychiatry of the person (of the person’s whole health, covering both illness and positive aspects of health), a psychiatry for the person (for the fulfillment of the person’s health aspirations and life project, not merely disease management), a psychiatry by the person (with psychiatrists and health professionals extending themselves as total human beings and not merely as healing technicians), and a psychiatry with the person (working respectfully and in an empowering manner with the person who consults). Within this broad framework there is a need for a comprehensive diagnostic model as a cornerstone of patient care; in this model all relevant information about the patient’s condition is integrated, with the goal being to support health restoration and to promote well-being. A PID includes a theoretical model and its implementation on the basis of a practical clinical guide or manual.
A PID mandates that clinicians pay attention to the place of an individual’s problems within the context of a standard nosology; they can then integrate the general and the particular circumstances affecting a disorder and also emphasize the value of and a positive notion of comprehensive health for the patient (Mezzich, 2007). The PID framework’s first pillar corresponds to the question “What is diagnosed?” and is a broad informational domain.
The level of health status includes illnesses or disorders in both mental and physical forms; this category corresponds to nosological diagnosis. The PID model’s second defining pillar (see Figure 1), pluralistic descriptive procedures, covers the descriptive tools to be employed and proposed to respond to the question “How might it be diagnosed?” The first tools are categories, particularly of a probabilistic type (Jablensky, 2005).
Further development of the PID will involve the construction of a practical guide and application manual. Russian medicine, especially Russian psychiatry, has longstanding, rich traditions of humanistic approaches with a focus on personality, including the mental patient’s personality (Krasnov, 2012). As long ago as the middle of the 19th century the founders of the Russian clinical school, S. The evolution of the humanistic tradition in the Russian clinical school has always been nourished by achievements in psychological science.
Since the second half of the 20th century the data of psychological diagnosis have been actively employed by Russian specialists (eminent Russian psychologists A.
Melekhov (1963) saw in Leontyev’s activity theory a significant potential for rehabilitation of patients with severe and disabling diseases—for example, schizophrenia.
However, advances in patient rehabilitation in Russian medicine in the 1950s to 1970s paved the way for a revolution in the understanding of functional diagnosis. Thus, functional diagnosis is a synthesis of the clinical and psychological assessment of a patient in real life; it provides a dynamic description of the patient’s state and interaction with a particular social environment, and it reveals the basic compensatory strategies for coping with disease.
The concept of functional diagnosis is the principal point of similarity between the methodological approaches in clinical diagnostics developed within the Russian clinical school and modern, person-centered trends in medicine.
However, the long isolation of Russian science still makes most of its achievements unknown to the rest of the world. Russian psychology employs an array of concepts and models similar to PID in its humanistic orientation as well as in the epistemological content of the model, and, above all, in the cultural-historical concept suggested by Vygotsky and its applications to clinical psychology and medicine.
The cultural-historical concept of mental development was introduced by Vygotsky in the 1920s and the beginning of the 1930s. As is well known, the idea of the social-historical nature of human mentality and human consciousness, as opposed to naturalism in all shapes and forms, is one of the basic postulates of this approach. Within the frame of the cultural-historical concept, personality is viewed as a hierarchical system of interconnected properties that developed in the course of interaction between the individual and the social environment and as the individual adopted existing cultural patterns (Vygotsky’s “interiorization”). Naturally, all the definitions of personality in Russian psychology encompass, besides general outlook, cultural and social values, social range and motivation, and the development of self-awareness. The fundamentals of Vygotsky’s cultural-historical concept of mental development are believed to be relevant for the analysis of the psychological construct of a patient’s reaction to disease, or the patient’s subjective pattern of disease. The term was introduced into the scientific vocabulary in 1935 by the Russian clinician Roman Luria, the father of Alexander Luria, who was the founder of neuropsychology.
Features of the motivational-personality level dictate, to a great extent, patients’ behavior and their compliance; these features provide for the actualization (or nonactualization) of patient activities aimed at rehabilitation and the protection of health. Studies of embodiment and the formation of the subjective pattern of disease, conducted within the cultural-historical approach, have demonstrated the sequence of stages and have named the factors due to which the originally diffuse, hardly localized sensations from internal organs assume concrete shape; these sensations are verbalized and “fit” the “concepts of disease” and the “mythology of disease” established in any culture.
When we turn to the formulation of clinical problems, it can’t be ignored that in most cases illness is perceived by the subject as a stressful situation.
The specific constellation of these factors, as a whole, defines the “social situation of personality development under disease conditions” (Sokolova & Nikolayeva, 1995). Disintegration of the existing social situation of development and emergence of a new one substantiate the crises in personality development. As was stated above, the formulation of clinical objectives requires an understanding that the objectification of any chronic disease will put an individual in peculiar psychological circumstances.
In the 1980s Russian psychologists began to assume that the analysis of the dynamics of the subjective pattern of disease and the transformation of the social situation of personality development in this context could be employed as a methodological instrument for the study of personality development under the conditions of disease.
Our analysis of the basic ideas of the person-centered approach in modern medicine, of the humanistic traditions of the Russian clinical school, and of the fundamentals of Vygotsky’s cultural-historical concept (in their application to clinical psychology, clinical medicine, and psychiatry) leads to the following conclusions. The principle of systemicity assumes patients’ investigation of the diversity and interplay of their manifestations. The idea of a systemic approach implies the principle of determinism, although epistemologically it is important to “break” with a linear determination in favor of a “probabilistic” and “multiple-factor” one, which is exceedingly important for the matter at hand. Another principle is the development principle (because systems exist only in development and through the development process). After a long, frustrating search for a primary care physician, I feel I have found 'The One'.
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I will explain why Male Yeast Infection keeps coming back and how to prevent re-infection. Yeast infection has been with us forever so it stands to reason that treatment must also have been around for centuries. Often these prescriptions are based on ancient medicine, given a slight twist and new name and BANG! I have looked at all the offers on the Internet and have determined which are the very best. The positive letters and emails I receive daily inspire me to keep offering help to others. This, to a greater extent, arises from the fact that the cultural-historical concept (due to its humanistic nature and epistemological content) is closely related to the person-centered integrative approach. It aims at development and substantiation of the model of person-centered integrative approach, enhancement of its diagnostic scope and, consequently, improvement of the model of person-centered care in modern psychiatry and medicine. Under these conditions, the lack of adequate humanistic knowledge and humanistic norms (rooted primarily in psychology and ethics) bring about the deindividualization and dehumanization of medical care and turns it into a simple technical procedure (Krasnov, 2012).
This focus is in line with the shift from a general nosocentric paradigm to a biopsychosocial and person- centered approach (Engel, 1982; Mezzich, 2006). As a result, the biographical and social context of the patient’s condition combined with attention to personal, family, and care resources is receiving increasing attention. A person-centered approach also facilitates attention to the positive aspects of health, such as resilience, resources, and quality of life.
Contextualization encompasses human diversity, and personalization requires attention to an individual’s aspirations and life project. A summarizing characterization of this international campaign is that it proposes looking at the whole person in context, as the center and goal of clinical care and public health.
These ideas represent a conceptual shift in psychiatry and, potentially, in medicine at large (Mezzich, 2007). This integrative approach combines science and humanism to obtain a diagnosis of the totality of the person’s health. The clinical-care component is focused on the development of a set of guidelines for person-centered care and on the design of the curricula for person-centered training for psychiatrists and other health-care professionals. It covers both illness and positive health on three complementary levels: health status, experience of health, and contributors to health (see Figure 2). The domain level of experience of health comprises the patient’s illness- and health-related values and experiences (Mezzich, 2008). The second descriptive tools are dimensions, which offer the opportunity to measure particular domains in a quantitative manner by using such instru of the information available also affords categorical assignment above a threshold ments as scales, tests, questionnaires. Such a partnership is a fundamental element of person-centered care; it involves engagement, empathy, and empowerment as well as respect for the autonomy and dignity of the consulting person. It will translate and specify the theoretical model to provide a set of procedures for practical use; it will include (1) the structure, schemas, and procedures of the model, (2) the instruments to be used, and (3) the procedures to be employed for the assessment of the domains of the PID.
Korsakov reckoned that only acquaintance with the foundations of psychology provides an understanding of the disintegration of mental activity in a mentally ill person; he emphasized the importance of psychological features of personality for consideration in the provision of care.
His rehabilitation model was based on making use of the stronger and healthier facets of the personality, which could counteract deterioration, and this model proved productive in the prepharmacological era in psychiatry. It was further developed in the works of his committed students and disciples: Leontyev, Luria, P. Personality development is associated with certain hereditary biological predispositions, but, principally, culture and social relations play a decisive role. A mature personality should have a differentiated self-awareness and realize the unity of self and the environment.
Roman Luria developed theses of the German clinician Alexander Goldscheider (1898), who argued that clinical diagnosis requires consideration of the subjective component within the general pattern of a somatic disease, or the “autoplastic picture of disease” (Goldscheider, 1898).
The concepts and mythology of disease involve understanding the causes and risks of the disease, its treatments, and outcome. It can be regarded as imposing restrictions on one’s usual ways of functioning and developing; it can even pose the risk of losing one’s life. Hence, a particular subjective pattern of disease is specified by a concrete social situation of personality development in this context. The illness may bring a crisis into the general line of development; such a crisis will affect the whole lifestyle of the patient. The substantiation of this hypothesis is regarded as a most important achievement in studies of the subjective pattern of disease undertaken by Russian clinical psychology. The development and realization of a person-centered approach to diagnosis and treatment is in line with the general tendency toward the humanization of modern medicine and the reshaping of its principal nosocentric paradigm into a biopsychosocial one.
This principle makes it possible to care for the dynamics of individuals, with consideration for their adaptive-compensatory abilities and internal resources. It implies that to complete the therapeutic effect we need a polyprofessional collaboration of specialists and cooperation with the patients and their environment. The review of the traditions of the Russian clinical school reveals antecedents for the establishment of the above-mentioned methodological principles.
Vygotsky’s cultural-historical concept, in its application to clinical psychology and medicine, may be regarded as a relevant theoretical methodological basis for the development of models of person-centered approaches to diagnosis and treatment. To indicate possibilities for further research in the context of the present discourse, it is important to point out that such psychological constructs as the subjective pattern of disease and the social situation of personality development under disease conditions exhibit considerable theoretical methodological potential for realization of the PID model. To conclude, we should note as a possibility a cross-cultural study of the subjective pattern of disease and its correlation with a particular social situation of personality development under disease conditions. Furr has a wonderful way of relaxing his patients and putting them at ease, sometimes telling a joke, always a smile and a caring manner! Most of us just couldn't afford to keep buying drugs even though we desperately thought we needed them.
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Other medical conditions such as diabetes can make yeast infection more common or harder to treat. But for all that the concept corresponds to the ideals of postnonclassical model of scientific rationality with a number of ‘key’ features. On the one hand, new evidence-based technologies in information processing facilitate the functioning of specialists and the validity of therapy methods, but, on the other hand, these technologies may create various obstacles in the doctor-patient relationship and in taking into account the patient’s personal needs. Vygotsky’s cultural-historical concept as applied to clinical psychology and medicine in the development of a theoretical model of PID and the practical use of the construct.
Respect for the patient’s autonomy, values, and dignity represents a fundamental recognition of the patient’s personhood and is an ethical imperative (Fulford, Christodoulou, & Stein, 2011).
This broader and deeper notion of diagnosis goes beyond the more restricted concepts of nosological and differential diagnoses (Salloum & Mezzich, 2009).
It covers the experience of illness (including suffering and care) in the ill-health column and the experience of health (including quality of life, values, and the cultural formulation of identity and context) in the positive-health column. In fact, it is essential for achieving a shared understanding that can be used in diagnosis and shared decision making for treatment planning. Bekhterev (1918) continued and developed this approach with ideas about the integrative, biosocial nature of the human being.
The accent on the strong sides of personality allowed Melekhov to develop a productive treatment approach and the so-called labor rehabilitation of mental patients (Leontyev, 1975). Adoption of social and cultural traditions is at least as important as hereditary predisposition. In other words, these studies demonstrated how “an individual concept of disease”—that is, the subjective pattern of disease—may be evolved from the social and cultural experience of the patient. All these factors may actualize a subject’s inefficient psychological defense mechanisms and coping strategies and may generate inadequate behaviors regarding treatment, thus hampering compliance and reducing the effectiveness of treatment. The epistemological content of the tendency suggests consideration of a number of methodological principles that bring the patients’ personalities into focus; these principles comprise patients’ individual and typological features, as well as a set of their values and attitudes toward themselves, their illness, and the environment. Development may take the way of progress or of regress, but illness does not prevent the further development of personality, although it may interfere by imposing specific limiting conditions (Vygotsky, 1993, 1998).

We should take into account the ideas of humanism, holism, and psychological insight, which form the basis for diagnostic and therapeutic models in Russian medicine and psychiatry; the Russian clinical school postulated the importance of the individual features of the person in the formulation of a “detailed” diagnosis in order to provide a prognosis for the further development of personality in the new circumstances of disease. The cultural-historical concept (because of its humanistic nature and epistemological content) is closely related to the model of PID, and it corresponds to the ideals of the postnonclassical model of scientific rationality because it has a number of key features. Particular concern, we presume, is attached to the enhancement of “psychological equipment” for such an analysis.
Such a study would attempt to develop and substantiate of the PID model, to enhance its diagnostic scope, and, consequently, to improve person-centered care in modern psychiatry and medicine. Later, feeling miserable with the jock itch, I decided to take the chance and got your book.
Within this paradigm a diagnosis is seen as a description of illness and of the positive aspects of health as they are affected by personality. It is also necessary to consider health promotion, a recently recognized key element of clinical care. Also crucial for clinical care is the thoughtful engagement of patients, both individually and in groups, including those critical of doctors, so as to reaffirm the dialogical basis of medical care. The domain level of contributors to health covers a range of intrinsic and extrinsic biological, psychological, and social risk factors, such as genetic vulnerability or stressors. These ideas emerged much earlier than George Engel’s recognized concept of the biopsychosocial unity of the human being (1982). Originally the conception of functional diagnosis in Russian medicine was developed in the context of the medical examination of workers. However, character is shaped in interaction with the environment, although it also depends partially on genetics and heredity. It can be regarded as a special form of cognitive activity (somatoperception) subject to general psychological regulations (Tkhostov, 2002; Arina, 2009). This situation brings the subjective pattern of disease and similar phenomena into the limelight not only among researchers but also among clinicians and psychiatrists. The model of functional diagnosis is an example of such personcentered systemic approaches.
The social situation of personality development under disease conditions, as a specific psychological phenomenon that has come “to represent a peculiar correlation of internal processes of development and external conditions” (Bozhovich, 1968, p.
Psihosomaticheskyj simptom kak fenomen kul’tury [A psychosomatic symptom as a cultural phenomenon].
Lichnost’ i ejo formirovanije v detskom vozraste [Personality and its formation in childhood]. Vozrastno-psihologicheskij podhod v konsul’tirovanii detej i podrostkov [An age-related psychological approach to consultations with children and adolescents]. Psihologiya semejnyh otnoshenyj i osnovy semejnovo konsul’tirovaniya [The psychology of family relations and the foundation of family counseling]. Vnutrennyaya kartina boleznej i iatrogennye zabolevaniya [The subjective pattern of disease and iatrogenic disorders]. Klinicheskie osnovy prognoza trudosposobnosti pri shizofrenii [Clinical basics of the work-capacity forecast in the case of schizophrenia]. Problema defekta v klinike i reabilitacii bol’nyh shizofreniej [The defect problem in the clinic and the rehabilitation of patients with schizophrenia]. Samorazvivajuwiesja sistemy i postneklassicheskaja racional’nost’ [Selfdeveloping systems and postnonclassical rationality]. Funkcional’nyj diagnoz v psihiatrii i nekotorye spornye voprosy psihiatricheskoj diagnostiki [Functional diagnosis in psychiatry and some issues of psychiatric diagnostics]. A person-centered integrative diagnosis (PID) should provide information about both illness and the positive aspects of health.
This approach is consistent with the definition of health given by the World Health Organization (1999), which sees health as not being limited to the absence of illness or disease but involving a state of complete physical, social, and emotional well-being. At the same time, there is renewed attention to the personhood of physicians and other health professionals with regard to the promotion of their wellness and their flourishing as whole persons well grounded in science and ethically committed to care and to help (Mezzich, 2007). Given the importance of diagnosis as a fundamental organizing clinical activity, a particular model of it must be consistent with the overall clinical model of interest.
It also covers inner and external protective factors, which include resilience and social support. This ideographic method offers the possibility of a deeper and richer description of a relevant domain. In any case, the development of personality as the pinnacle of mental organization invariably occurs in interaction with the social environment, in confrontation with it, in yielding to its demands or resisting its pressures—all during activities aimed at changing external circumstances and at self-evolvement. They provide for both mental development at a certain stage and psychological innovations appearing in the period.
This quality, in turn, provides for the concept’s applicability to a wide range of theoretical and practical issues in interdisciplinary studies, to take the overlapping research in clinical psychology and medicine as an example.
In Vrachebnotrudovaja jekspertiza i social’no-trudovaja reabilitacija lic s psihicheskimi zabolevanijami [Medical-labor expertise and the social and work-related rehabilitation of people with mental diseases] (pp. Osobennosti lichnosti pri pogranichnyh rasstrojstvah i somaticheskih zabolevaniyah [Personality characteristics in borderline disorders and somatic diseases].
The methodology of syndrome analysis within the paradigm of “qualitative research” in clinical psychology.
The purpose of the PID model is to facilitate and optimize person-centered care based on fundamental humanistic considerations.
Narratives are most suitable for approaching and formulating the experience of health in order to allow the greatest flexibility and the possibility of delving deeply into the intricacies of each case. In addition, the clinical tradition implied use of a multilevel, dynamic clinical analysis that combined the phenomenological approach with the global regularities of the morbid process.
It was based on the study of the structure of, dynamics of, and ways of compensating for a psychological defect under particular working conditions.
Tkhostov and their disciples were conducted within the cultural-historical approach to human mentality and bodily phenomena. Zakharjin, declared the key principle of individualized therapy: “To treat the person, not the disease”, that dates back to antic times. Lazursky (1912) distinguished the “endopsyche,” which is the inborn foundation of the individual and includes temperament, character, and a number of other psychophysiological characteristics, and the “exopsyche,” which is the system of relations between the person and the surrounding world. Personality and microsocial surroundings were also considered as a potential defense against disease. Polyakov, Myasishchev) both for differential diagnostics in clinical studies and for the treatment and rehabilitation of patients. This method, originally borrowed by Vygotsky from medical studies, gained in his works another, quite different interpretation.
At the same time, narratives can be organized as needed to ensure and facilitate focused and ordered attention to important informational domains. These concepts formed the foundation for his personality classification and were further developed by V. Its postnonclassical worldview is regarded as adequate given the contemporary level of science. Myasishchev (1960) in his “psychology of relations.” This concept postulated personality as a system of interactions between an individual and the social environment, with specific attachments, preferences, and values. In 1885 the Moscow Psychological Society was established by a group of talented scientists who subsequently became its most distinguished members. It lays the foundation for the instrumental support of mental studies (Zinchenko & Pervichko, 2012а, 2012b). In clinical practice, the psychology of relations was applied mainly in diagnosis and the treatment of neurotic disorders.
Zachepickogo (Eds.), Teoretikometodologicheskije problemy klinicheskoj psihonevrologii [Theoretical and methodological issues in clinical psychoneurology] (pp.
In contrast to many psychodynamic approaches, it did not view the personality as defective and burdened with various hidden complexes but as the pinnacle of mental functioning, as a highly organized psychological system with self-awareness and the ability to control manifestations of disease.
Leontyev’s activity theory) a clinical conception of “functional diagnosis.” Consideration of its basic theses may be of particular interest within this discourse. This system could be effectively used if properly supported by the therapist and accompanied by the correction of relations with the close environment.

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