Concepts Health and disease as a level of norm and pathology
At the social level of human functioning, the norm and pathology (disorder) act as states of health and disease.
In science, there are two approaches to determining the state of health: negative and positive.
Negative definition of health treats the latter as a simple absence of pathology and compliance with the norm. Here the norm is regarded as a synonym for health, and pathology is a disease. However, the concepts of norm and pathology are broader than concepts of health and disease. Norm and pathology are always continual, since they encompass a multitude of mutually transient states. Health and disease are discrete, clearly delineated within their borders. They are not associated with an objectively recorded deviation from the norm, but with a subjective state of good or bad health that affects the performance of our daily functions in activities, communication and behavior.
Characteristics of general health is the central link in the differentiation of health and disease. A healthy person feels safely and therefore can perform everyday social functions. The sick person has a bad state of health and is therefore unable to perform everyday social functions. In this case, the actual presence or absence of various deviations from the norm at the biological level of existence often does not become decisive for classifying oneself as healthy or sick. For example, people who have consumed alcohol at a party have deviations from the normal the parameters of mental functioning (are in the so-called altered state of consciousness), but they are not considered sick until they are not violated the performance of social functions. It turns out that the concept of health is broader than the concept of the norm, and the concept of disease by content differs from the concept of pathology. This circumstance led the researchers to search for positive health concepts.
Positive definition of health does not reduce the latter to a simple absence of the disease, but tries to disclose its autonomous disease.
The general definition of health, proposed by the World Health Organization (WHO), includes a human condition in which:
- the structural and functional characteristics of the organism are preserved;
- there is a high adaptability to changes in the habitual natural and social environment;
- emotional and social well-being is preserved.
Mental health criteria as defined by WHO: awareness and a sense of continuity, constancy of self I & quot ;;
- a sense of persistence of experiences in similar situations;
- critical to yourself and to the results of your activity;
- the correspondence of mental reactions to the strength and frequency of environmental influences;
- the ability to control its behavior in accordance with generally accepted standards;
- the ability to plan your life and realize your plans;
- the ability to change behavior depending on life situations and circumstances.
Researchers GS Abramov and Yu. L. Yudchits singled out the following criteria for mental health, based on the concepts of "adaptation", "socialization" and individualization .
The notion "adaptation" includes a person's ability to consciously treat the functions of his body (digestion, excretion, etc.), as well as his ability to regulate his mental processes (control thoughts, feelings, desires ). Limits of individual adaptation exist, but an adapted person can live in the usual geosocial conditions.
Socialization is determined by three criteria related to human health. The first is related to the ability of a person to react to another person as an equal to himself (another as alive as I am). The second is defined as a reaction to the existence of certain norms in relations with others and as a desire to follow them. The third criterion as a 'person' experiences its relative dependence on other people. For each person there is a necessary measure of loneliness, and if he oversteps this measure, he feels bad. The measure of loneliness is a kind of correlation of the need for independence, solitude from others and your place among your surroundings.
Individualization, according to CG Jung, allows us to describe the formation of a person's relationship to himself. Man creates his own qualities in the psychic life, he realizes his own uniqueness as a value and does not allow to destroy it to other people. The ability to recognize and preserve individuality in oneself and others is one of the most important parameters of mental health.
The possibilities of adaptation, socialization and individualization are available to every person, the degree of their realization depends on the social situation of his development, the ideals of the normal person of the given society at this particular moment. However, you can see the inadequacy of these criteria for a complete description of the internal picture of health. In particular, it is also connected with the fact that any person has the potential to look at his life from outside and evaluate it (reflection).
Analysis of the literature on the psychology of health has made it possible to identify three main groups of psychological factors that correlate with health and illness: independent, transmitting and motivators (PV Khodyreva).
Fig. 4. Factors that affect disease and (or) health
In assessing the psychology of health, it is important to distinguish between the concepts health status and state of health & quot ;. The state of health - the true state of affairs in the body according to the medical examination. The state of health is subjective and does not always accurately reflect the objective state of health. Incompleteness of the distortion of the internal picture of the disease is possible in young children (DN Isaev, 1996), and also because of the identity of the personality structure - instability of self-esteem, "I-image" in general and the physical "I", the dependence of one's own self-esteem on the evaluations of other people.
A number of domestic authors (AM Grombakh, A. Sh. Tkhostov, V. V. Lebedinsky, B. D. Karvasarsky) presented indicators of mental health, and in this parameter (taking into account complaints about the health of the person) are allocated four groups of people:
1) completely healthy (no complaints)
2) mild functional disorders, episodic complaints of an astheno-neurotic nature, associated with specific psychotraumatic events, the tension of adaptation mechanisms under the influence of negative microsocial factors;3) persons with preclinical conditions and clinical forms in the compensation stage, persistent astheno-neurotic complaints beyond the constraints of difficult situations, overstrain of adaptation mechanisms (in the anamnesis of such people, unhappy pregnancy, childbirth, diathesis, head trauma and chronic infections);
4) Clinical forms of the disease in the stage of subcompensation, insufficiency or breakdown of adaptation mechanisms.
Thus, health in general and mental health in particular represent a dynamic combination of different indicators, whereas illness, on the other hand, can be defined as constriction, disappearance or violation of health criteria, i.e. as a special case of health.
There are two points of view in the definition of the disease: the disease is any condition diagnosed by a professional; disease is a subjective feeling sick. In the first case, the disease is considered as an impairment of functioning assessed by objective signs. But about many diseases people do not turn to professionals, and there are no objective standards of human functioning (in many cases, professionals can not come to a single understanding of the disease state). The second approach also has its limitations: the patient's reported condition reflects his problems rather than the disorder itself. In addition, with a number of severe somatic conditions, changes in well-being may also occur (for example, in case of tuberculosis).
The concept of a disease is not so much a reflection of the objective state of a person, but a general theoretical and social construct, through which ordinary people and specialists try to identify and understand the emerging health disorders. The content of this construct determines the vision of the causes and manifestations of the disease, as well as the direction of research and treatment of various disorders. In other words, first .poly determine what is considered a disease, and then begin to examine and treat it (Figure 5).
Fig. 5. The construct of the disease, characteristic of European culture
The construct of the disease assumes the following sequence: cause - defect - picture - effects. It serves as a prototype for putting forward hypotheses, explaining violations and influencing the cause. Seeing the consequences and the general picture of deviations in mental activity or behavior, following the construction of the disease, we can assume that behind these external signs lies a defect in the person himself, caused, in turn, by the causes determined for such a defect.
In modern medicine, there are two models of the disease: biomedical and biopsychosocial.
At the heart of the existing since the XVII century. biomedical model of the disease is the study of natural factors as external causes of the disease. The biomedical model of the disease is characterized by four main ideas:
- the theory of the pathogen;
is the concept of three interacting entities - the host & quot ;, agent and environments;
- the cellular concept;
is a mechanistic concept, according to which a person is primarily a body, and his disease is a breakdown of any part of the body.
Within the framework of this model, there is no place for social, psychological and behavioral reasons for the development of the disease.
A defect (including a psychic one), whatever factors it may cause, is always of a somatic nature, therefore, the responsibility for the treatment here lies solely with the doctor and not with the patient.
Biopsychosocial disease model was formed in the late 1970s. It is based on the system theory, according to which any disease is a hierarchical continuum from elementary particles to the biosphere, in which each underlying level acts as a component of the overlying level, includes its characteristics and experiences its influence. In the center of this continuum is a person with her experiences and behavior. The responsibility for recovery in the biopsychosocial model of the disease is fully or partially borne by the sick people themselves.
The model is based on dyad diathesis-stress, "where diathesis is a biological predisposition to a certain morbid state, and stress is the psychosocial factors that update this predisposition. The interaction of diathesis and stress explains any disease.
In the assessment of health in the biopsychosocial model, a leading role is played by psychological factors. Subjectively, health is manifested in a sense of optimism, somatic and psychological well-being, the joy of life. This subjective state determines the psychological mechanisms that ensure health:
- taking responsibility for your life;
- self-knowledge as an analysis of their individual bodily and psychological characteristics;
- self-understanding and acceptance of oneself as a synthesis (process of internal integration);
- the ability to live in the present;
- meaningfulness of individual being, as a consequence - consciously built hierarchy of values;
- the ability to understand and accept others;
- trust in the process of life. Along with rational attitudes, orientation to success and conscious planning of one's life, there is a need for spiritual quality, which Erickson called basic trust: the ability to follow the natural course of the life process, wherever and in whatever way it manifests itself.
Within the framework of the biopsychosocial paradigm, the disease is considered as a disorder that threatens dysfunction-the inability of the psychobiological mechanisms to perform their functions in a particular socio-cultural space. In this case, not every disorder of functioning is considered a disease, but only that which causes a significant threat to the person's existence in the concrete environment conditions. Consequently, the disease is not all disorder, but only one that needs to be changed ("there is a need for treatment"). The need for treatment is considered existing when the available signs of abnormalities damage the professional performance, daily activities, habitual social relationships or cause severe suffering.
Since the condition of the disease presupposes a special social status of a person unable to perform social functions in the expected volume, the disease always appears to be related to the role of the patient and the limitations of role (social) behavior.Today, the term "mental, personality and behavioral disorders", embracing various types of disorders, including diseases in the narrow sense of the word, is more preferable.
One of the most important biosocial categories integrating ideas about a certain type (type) of human life is a way of life. It is characterized by the features of a person's daily life, encompassing work activity, everyday life, forms of using free time, and spiritual needs, participation in public life, norms and rules of conduct (D. N. Davidenko).
It is now proven that 50% -55% of the sum of all determinants of human health is in a way of life.
Lifestyle includes three categories: standard of living, quality of life and lifestyle.
The level of life is the degree of satisfaction of material, cultural, spiritual needs (mainly an economic category).
Quality life characterizes comfort in satisfying human needs (mostly sociological aspect).
Life style is a behavioral feature of a person's life, i.e. a certain standard, under which psychology and psychophysiology of personality (a social and psychological category) are adjusted.
Along with the above concepts, physicians and psychologists use the concept of "parameters of life."
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