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3CURRENT PROBLEMS OF TRAINING MEDICAL PSYCHOLOGISTS IN THE REPUBLIC OF UZBEKISTAN
Makhmudova Hulkar Tilabovna
Professor of the Department of Professional Skills of the Higher School of Judges under the Supreme Judicial Council of the Republic of Uzbekistan, Candidate of psychological sciences,
professor
https://doi.org/10.5281/zenodo.8171934
Abstract. This article discusses the actual problems of training medical psychologists in the Republic of Uzbekistan. The methodologicalfoundations of the work of a medical psychologist are explained, which is aimed at increasing the psychological resources and adaptive capabilities of a person, as well as harmonizing mental development, protecting health, preventing and overcoming ailments, and psychological rehabilitation.
Keywords: medical psychologist, clinical psychology, pathopsychology, psychotherapy.
For developing the public mental health service, early detection and diagnosis of mental disorders, improve the quality of treatment for people with mental disorders, introduce an effective management system, develop science, increase human resources in the field, strengthen the material and technical base of psychiatric institutions, as well as the organization timely provision of psychiatric care to the population, a resolution of the President of the Republic of Uzbekistan (19.06.2023 PD- No. 196) "On measures for the further development of the mental health service of the population" was issued. This resolution states that, starting from August 1, 2023, to introduce the staff of "a medical psychologist - in district (city) multidisciplinary central polyclinics by reducing the staff of district (city) departments of the Center for Supporting a Healthy Lifestyle and Increasing the Physical Activity of the Population".
It is known that today it is difficult to imagine a psychiatric institution outside the existing psychological laboratory. However, in Uzbekistan, despite the network of psychiatric institutions, including expert institutions, there are still no psychological laboratories.
In addition, the issue of training medical psychologists in the republic remains open from a scientific point of view. The trend is that medical psychologists should be trained from among physicians who have graduated from medical institutions, and the training of medical psychologists is not provided for in universities of the humanities. Taking into account this decision, psychologists who carry out their activities, taking into account many years of experience, also remain among the specialists who are not defined as medical psychologists.
The formation of clinical psychology as one of the main applied branches of psychological science cannot be considered without its history. If you pay attention, this story is inextricably linked with the development of both psychology itself and medicine, physiology, biology, and anthropology. And this story begins from ancient times, when psychological knowledge was born in the depths of philosophy and natural science.
Taking into account the historical development of the subject of "clinical psychology", the following stages of development can be traced. In the middle of the XIX century. Ideas about living nature, about the functions of the body, including mental ones, both in normal and pathological conditions, are rapidly changing. A system-deterministic approach began to take shape in the study of man and his mental processes.
In the second half of the XIX century scientific methods became a familiar tool in the study of mental phenomena, especially in the 70s and 80s. In 1879, in Leipzig, Wundt organized the world's first experimental psychological laboratory, where later well-known scientists studied and worked - E. Kraepelin, Munsterberg, Kulpe, Kirschman, Meisman, Marbe, Lipps, Kruger (Germany), Titchener (England), Violinist, Angell, G.S. Hall, Whitmer (USA), W.M. Bekhterev, Chizh, Lange (Russia), many of whom are considered the founders of clinical psychology. Wundt became the founder of psychology as a formal academic discipline.
Mention should be made of L. Whitmer, who introduced the concept of clinical psychology and organized a psychological clinic for retarded and mentally ill children at the University of Pennsylvania. L. Whitmer was one of the first members of the American Psychological Association, organized by St. Hall in 1892. The APA is the most influential organization for psychologists in the world today.
The introduction of a psychological experiment into a psychiatric clinic belongs to Kraepelin (Germany). The German psychiatrist Kretschmer has the prerogative in teaching about the difference between progredient processes and constitutional states.
A huge contribution to the development of clinical psychology was made by Freud's psychoanalysis, which arose in the early 1990s. From 19th century the medical practice of treating patients with functional mental disorders, Z. Freud put forward a psychological theory of the occurrence of mental disorders.
V.M. Bekhterev opened a second experimental psychological laboratory in Kazan in 1885. The first psychologist to open a psychological laboratory was Lange, who made a great contribution to the development of scientific psychology in Russia. Lazursky extended the application of the experiment ("natural experiment") to the study of personality. Employees of the Psychological Institute at Moscow State University formed the scientific core around which the Moscow School of Psychology began to take shape.
The leading role in the creation of neuropsychology as an independent discipline based on general psychology was played by Soviet scientists A.R. Luria and L.S. Vygotsky, whose research has received worldwide recognition. In the 20s. 20th century under the influence of S.L. Vygotsky and his followers (Khomskaya, Tsvetkov, Akhutin), neuropsychology is being developed. Based on the psychology of relationships V.N. Myasishchev in 1939 formulated the clinical and pathogenetic concept of neuroses.
Since the mid. 60s of the 20th century in Russia (after the creation in 1965 at the Moscow State University of the Faculty of Psychology and the Department of Pathology and Neuropsychology, and in 1966 at the Leningrad State University of the Faculty of Psychology and specialization in medical psychology and the introduction of the course of medical psychology in medical universities of the country), interest in the field of medical psychology increased steadily.
In Russia, the term "medical psychology" has been adopted for a long time, defining the same field of activity. In the 1990s, as part of bringing the Russian educational program to international standards, the specialty "clinical psychology" was introduced in Russia.
The International Guide to Clinical (Medical) Psychology, edited by Perret and Baumann, provides the following definition: "Clinical psychology is a private psychological discipline, the subject of which is mental disorders and mental aspects of somatic disorders (diseases). At present, the scientific significance of medical psychology is confirmed by practical application in many countries that are considered progressive.
Taking into account the historical experience of the development of medical psychology, which is based on the knowledge of general psychology, it is necessary to single out the interactions of the subject under consideration with other branches of borderline disciplines (knowledge integration). These interactions can be "horizontal", an example of which is clinical psychology as one of the psychological disciplines. But more important are the "vertical" interactions, for example, of clinical psychology with philosophy. Philosophy is wider than the methodology of a particular science, which it includes as a philosophical doctrine about the methods of cognition and transformation of reality, the application of the principles of the worldview to the process of cognition. The basic sciences for clinical psychology are general psychology and psychiatry.
In Russia, the term "medical psychology" has been adopted for a long time, defining the same field of activity. In the 1990s, as part of bringing the Russian educational program to international standards, the specialty "clinical psychology" was introduced in Russia. Unlike Russia, where medical psychology and clinical psychology often actually represent one and the same area of psychology, in international practice, medical psychology usually means a narrow sphere of psychology of the relationship between a doctor or therapist and a patient and a number of other highly specific issues, while time as clinical psychology is a holistic scientific and practical psychological discipline.
Pathopsychology (from the Greek. pathos - suffering, illness) - is a branch of clinical psychology that studies the patterns of decay of mental activity and personality traits in comparison with the patterns of formation and flow of mental processes in the norm. Consequently, pathopsychology as a science is an integral part of medical psychology, which has fundamental foundations and is based on general psychology. Knowledge of pathopsychology is important for psychologists of all specialties and specializations, since the professional communication of a psychologist with people does not exclude meeting with a mentally ill person.
Pathopsychological studies are an inseparable part in solving problems both in psychiatric practice (differential diagnostics) and in the practice of expert research.
Pathopsychology is one of the intensively and fruitfully developing areas of psychology, psychiatry, and, in particular, all areas of the medical field (neurology, surgery, gynecology, oncology, etc.). In pathopsychology, ideas about pathopsychological syndromes of disorders of the cognitive, motivational-volitional and personality spheres in mental illness have been developed (Polyakov, I.A. Kudryavtsev, Bleikher, etc.).
According to Korsakova, a "clinical-psychological syndrome" is a naturally occurring combination of symptoms of a violation of cognitive processes or a personality, which is based on the failure of the link that unites them in the system-structural structure of the psyche, caused by a painful process. The author considers the clinical and psychological syndrome within the framework of two approaches - pathopsychological and neuropsychological.
In pathopsychology, a central place is occupied by the search for a common link in the violation of higher mental functions, which underlies the development of individual symptoms in the implementation of such functions. For example, a syndrome-forming radical in schizophrenia may be a violation of motivation, which results in changes (or features) of thinking, perception, memory, etc., characteristic of this disease should answer the question: how the flow (that is, the structure) of the mental processes themselves is disturbed.
From a number of pathopsychological symptom complexes, the following are important: schizophrenic; psychopathic; organic; oligophrenic symptom complex; psychogenic disorganization of mental activity.
So, pathopsychology is a psychological science, and therefore the problems, prospects and achievements of this science cannot be considered in isolation from the development and state of general psychology, psychological knowledge as a whole.
The next important factor is the participation of a psychologist in expert activities during complex forensic psychological and psychiatric examinations. The participation of a psychologist in the conduct of the CSPPE (Comprehensive Forensic Psychological and Psychiatric Examination) is based on the professional knowledge of psychologists, taking into account basic psychological knowledge. Forensic psychology, which is an inseparable part of general psychology, in particular legal psychology, involves professionalism, which is based on basic education in general psychology at universities. Therefore, ignoring general psychology (graduates from an educational institution in the humanities, in particular in "psychology"), it is impossible to build a scientific system in the field of practical application of knowledge of applied science like medicine and psychology (psychiatry and psychology).
It should be noted that neuropsychology is also a branch of general psychology, as an applied science that studies the role of the brain and central nervous system in mental processes. Neuropsychology as science touches on the issues of both psychiatry, neurology, and philosophy of mind, cognitive science and artificial neural networks.
The issues of psychosomatics are solved taking into account the problems of patients with somatic disorders, in the origin and course of which the psychological factor plays an important role. This factor includes problems associated with: oncological diseases, diseases of vascular origin, acute and chronic mental (organic) traumas, as well as problems associated with other serious diseases, in the form of: neurodermatitis, psoriasis and bronchial asthma.
Currently, psychotherapy has been singled out as an independent medical specialty. Theoretical and practical problems of psychotherapy cannot be developed without clinical psychology.
In view of the foregoing, it should be noted that the activity of a clinical psychologist is aimed at increasing the mental resources and adaptive capabilities of a person, at harmonizing mental development, health protection, prevention and psychological rehabilitation. The object of clinical psychology is a person with difficulties in adaptation and self-realization associated with his physical, social and spiritual condition.
The subject of the professional activity of a clinical psychologist is mental processes and conditions, individual and interpersonal characteristics, socio-psychological phenomena that manifest themselves in various areas of human activity.
A clinical psychologist in the above areas performs the following activities: diagnostic, expert, corrective, preventive, rehabilitation, consultative, research and some others.
Thus, taking into account the etymology, the subject of medical psychology outside of psychological knowledge does not have the right to exist as a scientific discipline. And any scientific discipline has both methodological and theoretical foundations, on the basis of which the practical applications of any knowledge are carried out. Due to the urgency of the problems related to the blurring of concepts in medicine "clinical (medical) psychologist" in the Republic of Uzbekistan, as well as taking into account the training of medical psychologists from a contingent
of people who have received a purely medical education, it is necessary to consider the issue against the background of methodological foundations. The above facts indicate that: without knowledge of the methodology and theory in the personal concept, without awareness of the general psychological parameters of the determinacy of mental development (including the social environment, principles of education, etc.), it is not possible to consider causal relationships in the behavioral characteristics of a person.
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