A. R. Luria 1957
Translated: by H. Milne;
Source: Psychology in the Soviet Union, 1957.
WORK IN THE FIELD of pathological or clinical psychology is an essential part of Soviet psychology. In developing this complex field of inquiry, Soviet psychologists maintain a very close liaison with those working on the pathophysiology of higher nervous activity, and set themselves a double aim. On the one hand, by bringing the exact methods of psychological experiment into clinical practice, they try to put the diagnosis of nervous and psychic ailments on a scientific basis, and to elaborate scientific methods of restoring impaired functions. On the other hand, they try to use their knowledge of pathological modifications of psychic processes to reach a better understanding of the general laws of human psychology. Pavlov indicated that ‘the pathological, by breaking down and simplifying what is hidden, fused and complicated in the physiological norm, often reveals it to us.[1] This proposition underlies the importance of investigations into pathological processes for the science dealing with the normal structure of all human psychic activity.
An important aspect of psychopathological research consists of clinical studies designed to assist the exact definition of the concrete mechanisms underlying nervous and psychic ailments.
This field of work is one of the oldest in Russian psychology. In the 1890’s a psychological laboratory was founded in the psychiatric clinic of the well-known Russian psychiatrist, S. S. Korsakov; a similar laboratory was founded a little later in the clinic of the famous neurologist and psychiatrist, V. M. Bekhterev, in the neurological clinic of A. I. Rossolimo and others. The founder of Russian physiology and scientific psychology, I. M. Sechenov, often spoke of the application of psychology to the solution of the main problems of medicine. It was under the influence of the ideas of these great doctors and experimentalists that Russian clinical psychology developed; this clinical psychology carried through a large number of experiments devoted to the psychological study of the disturbance of psychic processes in a number of nervous and psychic ailments.
Important advances in the field of pathological psychology were made by L. S. Vygotsky, a remarkable Soviet psychologist who worked in this field from 1927 to 1934, and died prematurely. Vygotsky questioned the expediency of investigating psychic functions (memory, attention, and so on) in isolation. He took as his starting point the notion that psychic activity develops in the process of reflecting the external environment, and that this reflection is mediated through language. Vygotsky carried out important researches into the changes that take place in the forms in which the real world is consciously reflected in subjects with pathological cerebral conditions. He used a number of methods which permitted him to study how a human being, at different stages of development, generalizes his perceptions, and to study the concomitant changes in the meaning of language, the main instrument of abstraction and generalization.[2] He was thereby able to show how the meaning of words is disturbed where there are pathological conditions of the brain (aphasia, schizophrenia), as well as the changed forms which the generalized reflection of the external world assumes in cases of abnormal development (deaf-mutism, mental backwardness). Vygotsky’s researches enabled him to attempt a description of the main characteristics of the thinking, and, more generally, of the consciousness of subjects suffering from diseases of the brain, and to subject some of the most important clinical symptoms of nervous and psychic ailments to psychological analysis. These studies were the beginning of a whole series of investigations by Soviet psychologists in different fields of clinical practice,[3] and struck out new paths in Soviet psychopathology.
These investigations led to the complete rejection of the use of superficial and formal psychometric tests for giving a clinical diagnosis of mental illness, for defining the degree of mental under-development or for defining the extent of defect. The main task of psychological investigation was considered to be the more precise definition or characterization of a defect the concrete study of the qualitative change in the structure of psychic processes which ensues as a result of a pathological condition of the brain. This is particularly necessary because the external symptoms are seldom sufficient to allow an immediate judgment about the physiological mechanisms which lie behind them, and a simple superficial description of the symptoms without their psychological definition can lead to serious clinical errors. Thus, simply to point to the symptom of a disturbance in writing which occurs in cases of pathological conditions of the brain, gives no basis for reaching a conclusion about the mechanisms which have produced it; a psychological analysis, however, can show how the nature of this symptom varies in different cases. In certain cases a disturbance in writing is the result of a previous disturbance of aural analysis and synthesis (as a result of which the individual loses the power of analysing the phonic composition of a word, and cannot write it); in other cases it results from a defect in the exact articulations which enter into phonic analysis, which are also required for correct writing; in a third group the disturbance is due to defective preservation of the series of consecutive phonic traces, whose order must be preserved for correct writing; in a fourth group it is due to a profound disturbance of the general dynamic of the nervous processes; this leads to the loss of the regulating influence of the initial intention, and its replacement by an inert perseveration of separate elements in the writing. It follows that, if the origin of the pathological symptom is to be correctly appreciated, and if scientifically sound instructions are to be given for its removal, there must be a careful analysis of the structure of this defect and a search for the initial disturbance which led to the emergence of this or the other symptom and its consequence.
Such a definition of the symptom and the determination of the mechanisms behind it can only be achieved on the basis of a careful psychological analysis of the construction of the ‘ ‘function’, whose normal operation is disturbed by the pathological process. A careful analysis of the way in which the ‘function’ is formed in the course of development, the stages it goes through, and the manner in which it operates in normal psychic activity has, therefore, become the essential prerequisite of the application of psychological methods to the analysis of clinical symptoms. Soviet psychologists have made a large number of studies on these lines.[4] These are all based on the premisses outlined above, and, with the help of careful psychological experiment, have assisted in the definition of psychic changes observed in the mentally ill.
This approach to the psychological definition of a symptom, which must necessarily precede its physiological explanation and anatomical localization, has enabled Soviet psychologists to study the principal forms of nervous and psychic illness from new positions. A series of books which have appeared during the last ten years l have generalized the results of a large number of investigations conducted by psychologists who have introduced experimental psychological methods into the analysis of breakdowns of human activity, and who, refusing to confine themselves to a superficial description of pathological phenomena, have aimed at analysing their substance. This work has made possible a substantially accurate definition of the syndromes of aphasia, apraxia, agnosia, and mental breakdowns, and the introduction into clinical practice of a number of new principles in the analysis of mental illness.
The principles outlined above, involving a careful qualitative analysis of the genesis of a pathological syndrome and its mechanisms, enabled Soviet psychologists to do a great deal of work on the restoration of functions disturbed by a pathological condition; this work was widely developed during the second world war.
It is clear that such disturbed functions can only be successfully restored if the investigator is thoroughly acquainted with their construction, and can qualify the peculiarities attendant upon their breakdown with sufficient clarity. Ignorance of the construction of a disturbed function has frequently disarmed doctor and educator in their efforts to restore it; in addition, a primitive notion of psychic activity as the direct result of the operation of some group of cerebral cells (a notion which sprang from the views of Virchowian cellular physiology, and the concepts of formal genetics) has often led to the false conclusion that functions which have broken down as a result of organic injury of the brain cannot be restored.
Soviet psychologists have reached radically different conclusions from those just mentioned, enabling them to find new scientific methods of restoring disturbed functions.
Investigations conducted by Soviet psychologists, and described in a number of works issued in the post-war years,[6] show that every concrete activity which has broken down as a result of organic disease or injury (e.g. wounds of the brain or of the peripheral nervous system) cannot by any means be regarded as the direct function of a particular limited group of cells. In the vast majority of cases it is a complex functional system which is formed during a man’s life according to the laws of temporary connections, and rests on the most complex constellation of conjointly operating parts of the nervous system. In this respect Soviet psychologists have only developed the views of the leading Russian physiologists, Pavlov (who introduced the principle of systematization into the analysis of the work of the cortex) and Ukhtomsky (according to whom any cerebral function is a result of ‘the joint operation of a constellation of centres’). The very fact that functions which have broken down as a result of disease or injury are constructed in this way points to their high degree of plasticity, and to the possibility of restoring them or compensating for them by their reconstruction.
Investigations by Soviet neurophysiologists and especially by Anokhin[7] have shown that even the simplest and inborn functions, such as breathing, sucking, and swallowing, are really very complex ‘functional systems’, which rest on an elaborate complex of conjointly operating parts of the nervous system; it has been shown experimentally that when some link in the chain of this functional system breaks, the activity in question breaks down, but this breakdown is not fatal, and, if this functional system is reconstructed under certain conditions, the disturbed function can be restored. The basic mechanisms of this restoration have been attentively studied, and the conditions under which it can be most successfully realized have been established in the works of noted Soviet physiologists, Asratyan[8] and Anokhin.[9]
If such comparatively simple functional systems as the inborn acts of breathing and swallowing, which mature in the later stages of embryonic development, are so plastic, and can, under certain conditions, be restored, then a much greater degree of plasticity is possessed by the more complex functional systems which are formed during the life of a man and rest on a most elaborate complex of conjointly operating areas of the cerebral cortex.
The investigations which Soviet physiologists and psychologists conducted after the second world war confirmed the proposition that injuries to the brain or the peripheral nervous system give rise directly to two kinds of functional disturbance which are different in nature and can be remedied by different means. On the one hand, the injury leads to temporary shock or inhibition of the functions, and this can be removed by special protective or disinhibitory therapy; the employment of pharmacological substances (e.g. prostigmin) which act on the mediatory processes, and are a powerful means of freeing a function inhibited by injury, gave very good results in the treatment of the after-effects of war wounds; this practice has become firmly established in the clinical treatment of nervous disorders. On the other hand, a bullet wound destroys the brain or nerve tissue, and produces irreversible results. This does not mean, however, that the function lost as a result of such a wound cannot be restored.
Observations of physiologists and psychologists have shown that in these cases the sole means of restoring the disturbed function is to rebuild the functional system which produced the activity. This rebuilding proceeds primarily along the lines of changing the afferent connections on which this function rests, a process which can, under certain conditions, ensure that the same function is performed by a new undamaged system of nerve centres.
Thus, an attentive study of hand movement in the performance of work operations, conducted by Leontiev and Zaporozhets,[10] showed that in conditions of partial injury to the peripheral nerves (e.g. to the plexuses), the disturbance of the movements is not of an efferent but principally of an afferent nature.[11] It also showed that if the instructions given to the subject are changed and he is asked not ‘to raise his hand’, but ‘to grasp some object’, then the displacement of the afferentation from the kinaesthetic to the visual, and the inclusion of the motor act in a system of object-based action (performed through a much more complex system of cortical connections), bring about a considerable extension of motor possibilities. The reorganization of the system of therapeutic re-training of patients suffering from injury to the peripheral nervous system on these lines has produced very valuable results, and had considerably increased the speed with which lost functions have been restored.
Luria, Zankov and their collaborators applied a similar principle in their work on the restoration of speech, writing and reading after brain injuries. In many cases a correct definition of the symptoms appearing after injury to the temporal, occipital and pre-motor areas of the brain brought a better understanding of the mechanism of the disturbance of these functions, and led to the rejection of incorrect and useless methods of training which were often practised in clinical treatment; the restoration of a disturbed activity could then be correctly organized on the basis of a knowledge of its construction. By tracing out a considerable number of cases in which the practical and gnostic functions of speech, writing, reading and counting were restored, the investigators were able not only to discover methods effective for different kinds of derangement, but also to penetrate much more deeply into the mechanisms of the disturbances themselves, and to come near to providing a theory of the restoration of functions which have broken down.[12]
The achievements of physiologists and psychologists have not been limited to the treatment of war wounds; they have also embraced questions of compensation for defects met with in peacetime, and especially in the different departments of defectology. Psychologists have done a great deal of work in this field. The investigations of Sokolyansky into pedagogical methods of training blind deaf-mutes are of very great interest (one of these blind deaf-mutes, Skorokhodovaya, has herself described the work done on her in her two remarkable books, How I Perceive the World, and How I Conceive the World. A large group of studies on compensation for defects of blindness has been described by Zemtsova in her monograph The Problem of Compensation for Blindness (1956). Boskis, Morozova, Korsunskaya, Zykov and others have described their experiments on the restoration of speech and thought to deaf-mutes. Levina has contributed to the theoretical basis of logopedics, which is concerned with establishing rational methods for restoring speech, writing and reading in various cases of abnormal speech development. All these investigations, which are united by one common idea, the reconstruction of functions by forming new systems in the process of re-training, make up an important chapter in Soviet psychopathology and defectology.
The work of Soviet psychologists in defining the main pathological symptoms, and working out a scientific basis for the restoration of disturbed functions, for long did not advance beyond a careful study of the types of activity which were upset by the pathological process, and of the way the restoration of these functions proceeded in the process of compensation. This work has gone further only in recent years, linking up with investigations into the physiology and pathology of higher nervous activity, and setting itself the task of discovering the precise physiological mechanisms which lie behind the corresponding pathological conditions of the brain.
Every shock to the brain including organic shock produces a certain change in the condition of the main nervous processes stimulation and inhibition; it changes their strength, equilibrium and mobility. The physiological characteristics of the work of a pathologically modified cerebral cortex were carefully studied by Pavlov’s school, [13] but they were not at the centre of attention of psychologists. While psychological investigations provided valuable descriptive material, and were of great assistance in making possible an exact definition of the symptom and in determining scientific methods of compensation, they were for this reason incomplete and sometimes even one-sided. This lack of contact with physiological analysis, which is characteristic of almost all the investigations mentioned above, made a more profound treatment essential. Most of the work on psychopathology done in recent years has, therefore, been characterized by the great attention given to analysis of the physiological mechanisms which lie behind the changes in functional systems in pathological conditions.
Ivanov-Smolensky, who used a variant of the conditioned-reflex method for the study of the pathology of higher nervous activity in man, showed that pathological conditions lead to a lowering of the power of nervous processes, to a significant lowering of all forms of active inhibition, to an increase in the importance of the part played by external inhibition, to negative induction, to noticeable inertness of the nervous processes, and, most important of all, to dissociation of the two signal systems which produces a disturbance in the conscious activity of the patient, and a disturbance in the normal regulation of his behaviour. These changes in higher nervous processes take place not only in cases of focal shock to the brain, but also with diffuse cerebro-asthenic syndromes and in various cases of defect in psychic development. Soviet psychologists in recent years have devoted their attention to a careful study of all these changes lying behind the well-known forms of defect.
One of the most important signs of this movement was the appearance of a large number of studies using physiological methods for analysing the psychological data obtained; in this way the physiological and psychological lines of investigation were brought together.
Myasishchev studied certain important physiological mechanisms underlying the derangement of the affective processes in pathological conditions of the brain. On the initiative of Ivanov-Smolensky very extensive work was undertaken on the breakdown of the interaction of the two signal systems in various pathological states.
Luria and his collaborators made an intensive study of the peculiarities of higher nervous activity in various cases of mental backwardness cases of oligophrenia, cases with cerebro-asthenic syndromes, and cases of local shock to various lobes of the brain. The main point here was to study the breakdown in the interaction of the two signal systems which accompanies these conditions. Gershun and Sokolov revealed the peculiarities in the structure of the sensory processes which appear in pathological conditions of the brain. Sokolov and Vinogradova studied disturbances in the orienting reflexes which make up the central part of a sensory act. Schmidt, Bein, Bassin and others made special investigations into the derangement of higher nervous activity which underlies aphasia, with the aim of rendering the conception of this derangement more precise. Zcigarnik, Lebedinsky, Soloviev, and others directed their painstaking investigations towards disclosing the neurodynamic basis of disturbance of the intellectual processes in pathological conditions of the brain.
The work of Soviet psychopathologists at the present time is mainly directed to the study of pathological change in the dynamics of the nervous processes which lie behind disturbances in psychic activity. There is every reason to suppose that such a rapprochement between the psychology and the physiology of higher nervous activity will be extremely fruitful. In the course of scientific development many important results have been achieved in the border regions where the meeting of two sciences guarantees the emergence of new lines of scientific investigation. It is just such a development that is now taking place in the sphere of pathological psychology in the Soviet Union.
1. Pavlov-Anrep, 301.
2. The experimental methods which Vygotsky proposed for the study of thinking have been exhaustively described in psychological literature. In particular they were expounded and popularized in J. Kasanin’s book Language and Thought in Schizophrenia (University of California Press, 1944).
3. Luria, Bein and Kogan in neurology; Zeigarnik, Lebedinsky and others in psychiatry; and Levina, Boskis, Zankov, Soloviev, Shif and Vlasova in defectology.
4. The breakdown of perception and recognition has been studied by Soloviev, of recall by Zankov and Leontiev, of the speech processes by Luria, Bein, Boskis P.S.U. and Kogan, of reading and writing by Ananiev, Levina and others, of counting by Rudenko, of thought and purposive action by Zeigarnik, Rubinstein, Shubert, Vasilevskaya, Pevsner and others.
5. Luria’s Traumatic Aphasia (1947) and Essays on (he Psychophysiology of Writing (1950); Boskis’s Peculiarities of the Development of Speech in Children whose Aural Analyser has broken down (1953); Soloviev’s Peculiarities of the Cognitive Process in Pupils of Special Schools (1953); Levina’s A Study of Children who have lost the Power of Speech (suffering from alalia) (1951), and others.
6. The Restoration of Movements (1948) by Leontiev and Zaporozhets; The Restoration of the Functions of the Brain after War Wounds (1948) by Luria; Psycho-pedagogical Problems of the Restoration of Speech in cases of Cranial-cerebral Trauma (1945) and Speech Disorders and Speech Restoration in cases of Cranial-cerebral Trauma (1948), ed. Zankov, etc.
7. The Problem of the Centre and the Periphery in the Physiology of Nervous Activity (1935), and Problems of the Physiology of Higher Nervous Activity (1949).
8. The Physiology of the Central Nervous System (Moscow, 1953).
9. A summary of Anokhin’s latest investigations is given in his articles ‘Peculiarities of the Afferent Apparatus of the Conditioned Reflex and their Significance for Psychology’, in Voprosy Psikhologii, No. 6, 1955, and ‘General Principles governing Compensation of Disturbed Functions and their Physiological Basis’ in the report of a session of the Institute of Defectology of the Academy of Educational Sciences, January 1956.
10. The Restoration of Movements (1948).
11. The proposition concerning the role of afferent systems in motor acts, which Pavlov introduced into physiology, was reflected in the works of Orbeli, Lectures on the Physiology of the Nervous System (1935), and Bernstein, The Structure of Movements (1947).
12. The basic principles of this theory have been given in the books mentioned in previous notes.
13. By Petrova, Krasnogorsky, Ivanov-Smolensky and others.