The International Journal of Person Centered Medicine Vol 2 Issue 1 pp 104-108 FROM THE FOURTH GENEVA CONFERENCE ON PERSON CENTERED MEDICINE: CONTRIBUTIONS TO THE ADVANCEMENT OF PERSON-CENTERED CARE Personality in Russian psychology and psychiatry Valery N. Krasnov MD MSc Director, Moscow Research Institute of Psychiatry, Moscow, Russian Federation Abstract A review of historical developments in Russian psychiatry that support person-centered approaches is presented. A proper orientation to the patient’s personality and a correct use of the intact personality properties along with an understanding of patient’s values and societal context as the basis for individual treatment policy are rooted in Russian psychiatric tradition which evolved in close interaction with national psychological schools, specifically, the cultural-historical concept of mental development (Vygotsky) and activity theory (Leontyev et al.). Contemporary psychiatric practice is frequently based on other theories. However, there are exceptions, i.e. a naturalistic study that is used as an illustration of effective person- oriented treatment of organic brain damage. This article describes a cohort of patients with organic psychosyndrome (without pronounced dementia features) of predominantly cerebrovascular nature that developed in persons exposed to the Chernobyl nuclear disaster in 1986. Keywords Chernobyl, doctor-patient relationship, humanistic context, multidisciplinary teamwork, person-centered psychiatry, personality as facilitating rehabilitation factor, Russian psychology and psychiatry, Correspondence address Prof. Valery Krasnov, Director, Moscow Research Institute of Psychiatry, Poteshnaya 3, Moscow 107076, Russian Federation. E-mail: [email protected] Accepted for publication: 14 March 2012 Introduction distant supervision for some therapeutic procedures increase the distance between doctor and patient and reduce the time of face-to-face communication. However, Mezzich’s pioneering work focused on the development of many people, especially younger doctors, consider these person-centered psychiatry [1] has triggered a discussion technical intermediates in diagnosis and treatment as about person-oriented medicine within international perfectly normal and even preferable in dealing with medicine more generally. This initiative has reminded us medical and medico-psychological problems. Medicine about the dual nature of the medical profession that seems to be increasingly ‘estranged’ from the human combines in itself both humanist knowledge and the being, being transformed into a service, even a natural sciences. Nowadays, biological advances in ‘transaction’. Psychiatry is destined, perhaps, to remain medicine by far exceed developments in humanistic one of a few medical disciplines in which face-to-face disciplines. Indeed, because of new technologies and contact and conversation with the patient are modern updated equipment and the appearance of various indispensable, though one might anticipate that such technical, IT and organizational mediators in healthcare, communication will decrease as a function of new including diagnosis and treatment, the humanistic technologies. In this context, it makes sense to reflect on dimension of medicine is becoming lost. Under these the traditions of national psychiatric schools with the conditions, lack of adequate humanistic knowledge and purpose of distinguishing, preserving and developing the humanitarian norms (primarily rooted in psychology and person-oriented approach. ethics) would bring about de-individualization and de- humanization of medical care and convert medicine into a plain and technical procedure. New technologies in, for example, information Russian psychiatry processing on the one hand, facilitate the functioning of specialists. On the other hand, they create a range of Developments in Russian psychiatry should be viewed in obstacles to the doctor-patient relationship and the context of close cooperation between psychiatrists and communication. Indeed, on-line diagnostics, electronic psychologists, with a focus on personality, including the versions of psychometric tests, video interviews, patient’s personality. In Russian psychiatry and consultations by Internet and Internet-counseling and psychology, one can distinguish two principal directions 104 The International Journal of Person Centered Medicine associated with the ‘St. Petersburg’ and the ‘Moscow’ environment, and the individual’s adopting existing Schools. cultural patterns (Vygotsky’s ‘interiorisation’). In the activity theory, an individual transforms into a Vladimir Bekhterev and the St. Petersburg personality by means of adopting social values and their School further development using his own abilities and skills. Personality cannot be explained exclusively by psychological regularities and, therefore, it cannot be The psychiatrist and neurologist Vladimir Bekhterev (St. described only in terms of psychological characteristics. Petersburg School), started his professional career by Personality development is associated with certain setting up a psychological laboratory in a psychiatric hereditary biological predisposition, but, principally, it is clinic. His ideas about the biosocial nature of the human culture and social relations that play a decisive role. being [2] emerged much earlier than George Engel’s Continuous interaction between biological predisposition concept of the biopsychosocial unity of the human being and social influences (including cultural tradition, ethical [3]. Bekhterev’s colleague and disciple Dr. Alexander and behavior norms, requirements for professionals, the Lazursky distinguished the ‘endopsyche’ as an inborn basis communication range, etc.) occur in the course of specific of the individual that included temperament, character and activities. Adoption of social and cultural traditions is at a number of other psychophysiological characteristics and least as important as hereditary predisposition. The latter the ‘exopsyche’ that was understood as a system of plays a key role in some natural talents (such as in music, relations between the personality and the surrounding mathematics, motor activities, etc.) and in temperament. world [4]. These concepts formed the foundation for his However, the character is shaped in interaction with the personality classification. In Soviet times, these ideas were environment, though partially it also depends on genetics further developed by Vladimir Myasishchev in his and heredity. Certainly, development of personality as the ‘psychology of relations’. Myasischev was a psychologist pinnacle of mental organization invariably occurs in and for many years he was the head of the Bekhterev interaction with the social environment, in confrontation Psychoneurological Research Institute in St.Petersburg. In with it, in yielding to its demand or in resisting its his ‘psychology of relations’, personality was considered pressures – all during the activities aimed at changing as a system of interrelations between an individual and his external circumstances and self-evolvement. social environment, with specific attachments, preferences Naturally, all the personality definitions in Russian and values. In clinical practice, ‘psychology of relations’ psychology would encompass, in addition to general was applied mainly in diagnosis and treatment of neurotic outlook, also cultural and social values, social range and disorders [5]. In contrast with many psychodynamic motivation and the development of self-awareness. A approaches, it did not view the personality as something mature personality should have a differentiated self- defective and burdened with various hidden complexes, awareness and realize the unity of self and the but as the pinnacle of mental functioning, as a highly environment. organized psychological system, with self-awareness and the ability to control manifestations of disease. This system can be effectively used if properly supported by the therapist and accompanied by correction of relations with Ideas in Russian psychology immediate environment. The ideas in Russian psychology resemble to a certain Sergey Korsakov, Fyodor Rybakov and the extent the theories of American psychologists Gordon Moscow School Allport and Abraham Maslow. Allport also considered the personality as a complicated and developing hierarchical system, which is more influenced by social and cultural The Moscow psychiatric School, due to the contributions motives than by biological determinants [10]. Maslow’s of psychiatrists Sergey Korsakov [6], Fyodor Rybakov [7] th concept was also based on recognition of importance of and others, had developed by the beginning of the 20 social influences and personal values and proposed an Century the ‘principles of clinicism’, which accentuated hierarchical motivation model, the so-called ‘hierarchy of the patient’s personality, his cultural, moral and spiritual needs’ [11]. According to Maslow, higher needs, including values and his relations with the environment. Also, the tradition of clinicism implied multilevel dynamic clinical the need for self-actualization, can be fulfilled only after analysis that combined a phenomenological approach with the lower basic needs are met. Obviously, many people never become self-actualized, but it is self-actualization searching for global regularities of the morbid process. that constitutes the essence of an individual’s personality. Personality and microsocial environment could also act as In many respects,