Module 8: Applied Psychology
8.3. Clinical (Medical) Psychology

The term "medical (clinical) psychology" had different accents at different times, and, accordingly, different understandings. For the first time, the concept of clinical psychology was proposed by Lightner Whitmer at the beginning of the twentieth century, but actually, as a concept it was formed only in 1946, when Gelpach proposed under the phrase "clinical psychology" to understand psychology in somatic medicine. In 1970, Schraml first proposed to consider clinical psychology as a broader concept – the application of psychological knowledge, techniques and methods in a wide clinical field: from consulting bureaus to hospitals. Often the concepts of "medical" and "clinical" psychology are separated, with the former implying a discipline that studies the application of psychological knowledge in the clinic (close to Gelpach's understanding), and the latter is considered broader. To avoid confusion, we will use the concepts of "clinical psychology" and "medical psychology" interchangeably, and as a definition of this discipline we will give the definition proposed by W. Baumann and M. Perre:

Clinical psychology is a private psychological discipline, the subject of which is mental disorders (disorders) and mental aspects of somatic disorders.

Also note that in English-speaking countries, in particular, in the UK, the term “abnormal psychology” is found, which is, in fact, an analogue of the concept of clinical psychology. 

In clinical psychology, it is possible to distinguish general aspects characteristic of all disorders and particular aspects characteristic of individual disorders.

General aspects:

1) classifications

2) diagnostics

3) epidemiology

4) etiology

5) intervention (psychotherapy, prevention)

Private aspects:

1) intrapersonal:

1.1. impaired individual functions (perception, memory, etc.)

1.2. impaired functioning patterns (depressive disorder, anxiety disorder, etc.)

2) interpersonal – a disturbed system: a married couple, school, work team, etc.

Bastin (1990) proposed to distinguish the following aspects in clinical psychology:

1) pathopsychology

2) psychodiagnostics

3) psychological intervention (= psychotherapy)

4) Psychosocial health care

Health is a state of complete physical, mental and social well–being (from the WHO definition). From this definition it can be seen that it is not enough just not to have "defects" at the somatic level, but it is necessary to have some kind of comfortable psychological state and be socially adapted. It can also be added that a healthy state implies maximum fruitful activity. Health is an absolute concept: either a person is healthy (in the absence of any defects), or unhealthy = sick.

As for psychological health, here we can cite the criteria that Yagoda proposed in 1958:

1. a positive attitude towards one's own personality

2. Spiritual growth and self-realization

3. Integrated personality

4. autonomy, self-sufficiency

5. adequacy of perception of reality

6. competence in overcoming the demands of the outside world

Becker (1995) formulates the following components of mental health:

1. mental and physical well-being (fullness of feelings, altruism, absence of complaints)

2. Self-actualization (development, autonomy)

3. Respect for oneself and others (a sense of self-worth, the ability to love)

Allport (1960) tried to summarize the commonality of views of most psychologists about psychological health:

1. interest in the outside world, expansion of the connections of the "I" with the outside world

2. self-objectification, bringing one's inner experience into an actual experienced situation, the ability to humorously color reality

3. the presence of a "philosophy of life" that organizes, systematizes experience and gives meaning to individual actions

4. the ability to establish warm, sincere contacts with the environment

5. possession of adequate skills, abilities, and perceptions necessary to solve practical everyday problems

6. love and respect for all living things

Illness in a broad sense can be defined as the opposite of health, when the aforementioned complete well-being is impossible. However, this definition reflects only a subjective impression (well-being-trouble), so it is fair to highlight three aspects of the disease as a phenomenon:

1. bodily and biological (a certain organic defect, actually a "disease")

2. psychological (subjective reflection of the disease, "feeling unwell")

3. social (changed behavior in conditions of illness: "sick behavior", "the role of the patient")

It is widely believed that "norm is a relative concept." In fact, in order to judge the norm and pathology, it is necessary to have a certain "standard". If the normality of the average majority is taken as a similar sample, then they speak of a statistical norm. At the same time, the further the behavior deviates from what is recognized as normal, the more the person is considered abnormal (= sick). This approach has its own logic, although it lacks practicality. Schizophrenia is not a common disease, but the ability to run 100 meters in 10 seconds is equally rare, but the latter does not fall under the concept of abnormality.

The utopian (ideal) model has a philosophical and ideological justification and identifies as normal a minority of people who are in a state of absolute mental health (for example, self-actualized individuals in the K approach).Rogers). In this case, most people fall short of the ideal and cannot be considered normal.

A social norm implies socially prescribed norms of behavior, deviation from which is actually a disorder. The difficulty lies in the fact that social norms and views on deviant (deviant) behavior vary significantly in different social groups.

The subjective norm is based on a subjective assessment of one's condition, i.e. abnormal – which means unsuitable for an individual. The relativity of this model is obvious.

The system model considers normal functioning as a set of systems that are in harmonious interaction and adapt well (for example, a harmonious combination of biological, psychological and social functioning). This system satisfactorily explains the inadequate functioning, but is inconvenient for understanding what is considered normal and what is abnormal.

Functional norm – intermediate functions (or dysfunctions) for desired states of a "higher level", i.e. those functions that allow functioning at a higher level are considered the norm. Otherwise, it is a pathology. For example, erectile dysfunction is dysfunctional in terms of sexual satisfaction or fertilization (states of a "higher level"), therefore it is considered a disorder.