The current paper is devoted to the topic of medical psychology and the principle of determinism applied in it. To write the paper, seven sources of credible authors were used. Nowadays, it is considered that medical psychology is relevant and one of the leading branches of modern psychology. It is a branch of psychology that analyzes clinical course, therapy of diseases, the influence of psychological factors on the occurrence of disease, the diagnosis of pathological conditions, as well as psycho-prophylaxis. Determinism is the most important principle in psychology. Consequently, this principle is the basic in medical psychology. In medical psychology, it acts as a philosophical basis for the concept of etiology. In such a way, the research paper analyzes the significance of medical psychology and how the principle of determinism is applied in it.
Medical psychology being at the intersection of psychology and various health sciences is a psychological science in the service of medicine and subordinated to it. Moreover, medical psychology develops in the system of general psychological categories, concepts, principles, and laws. It uses psychological methods specifying them in relation to its specific conditions and tasks. Therefore, the principles of medical psychology are principles of psychology coordinated with the principles of medicine. The principles of science are its basic and initial ideas, which are proven by all previous development of this science, controlled by practices and become a starting position for the further research. The principles of the various sciences find their concretization and development of the laws of dialectics. Therefore, they are constantly refined, deepened, and supplemented. For medical psychology, the most important principles of social psychology are the principle of determinism, the principle of development, the principle of unity of consciousness and activity, the principle of historicism, and the principle of the personal approach. Each of these principles has a number of problems clarifying, deepening, and concretizing it. The principle of determinism is one of the most significant principles of medical psychology. The topic of the research paper is to study the principle of determinism as it relates to the problems of medical psychology.
Medical psychology is relevant and one of the leading branches of modern psychology. In the book Contributions to Medical Psychology, the author Stanley Rachman gives the following definition of medical psychology “Medical psychology is the application of psychological concepts and methods to medical problems” (Rachman, 2013, p. 1). It is characterized by its close relationship of the theoretical foundations with their practical use in addressing a wide range of issues of protection and promotion of public health. In the present conditions of worsening of social problems and deterioration of health of the population in many countries worldwide, there is the increase need for an objective solution of related problems of health and social issues to a new level. There is a need to put into practice new forms and methods of social work by the health authorities. Medical psychology is a branch of psychology devoted to the study of the influence of psychological factors on the occurrence of disease, clinical course, the diagnosis of pathological conditions, psycho-prophylaxis, and therapy of diseases. Based on the data obtained in medical psychology, productive hypotheses about the normal development of the psyche can be built. The author Stanley Rachman states that “Medical psychology should now encompass all applications of normal and abnormal psychology to medicine” (Rachman, 2013, p. 1). The area of the research of medical psychologist includes a wide range of psychological patterns associated with the emergence and course of the disease, the impact of certain diseases on the human psyche, ensuring the optimal system of health impacts, as well as the nature of the relationship of a sick person with the macro social environment. The most important problems of medical psychology are the interaction of psychic and somatic (physical and physiological) processes in the formation and development of the disease, laws of formation of representations about the disease in the patient, analysis of the dynamics of awareness of the disease, the formation of adequate personal settings, and many others.
The Principle of Determinism in Medical Psychology
The principle of determinism is a concretization of the dialectical doctrine of universal causation and material conditionality of natural, social, and mental phenomena of the principle of materialist monism expressed by the thesis that psyche is a property of highly organized matter and a reflection of reality. In the article Genetic Determinism and the Innate-Acquired Distinction in Medicine, the author states that “In contemporary science and society, there exists a specific form of genetic determinism, or to be more precise a tendency to believe in kinds of genetic determination” (Kronfeldner, 2009, p. 167). For medical psychology, Sergey L. Rubinstein precisely formulated the features characteristic for the understanding of the importance of the principle of determinism (Resnik & Vorhaus, 2006). According to the psychologist, external factors (external environment) always act only indirectly through internal conditions (Resnik & Vorhaus, 2006). This understanding of determinism is associated with the true value that a person acquires, as a complete set of internal conditions for the understanding of the mental processes. When explaining any psychic phenomena, a personality acts as the totality of related internal conditions, through which all external influences are refracted. For medical psychology, it means that the so-called organic mental changes cannot be understood as narrowly local. It is explained by the fact that local disturbance changing the personality thereby change other mental processes to some extent. It allows understanding a number of functional symptoms as personal. Removed in time and mediated determinism helps better understand the well-known belated reactivity that has long been described by clinicians in psychiatry.
In recent years, in the light of the principle of determinism in medical psychology, there were many studies of emotions, feelings, and the will as forms of reflection. “Daniel Dennett argues that determinism can be compatible with free will and moral responsibility, saying that it would be wrong to think that, because determinism is true, our nature is fixed” (Gligorov, 2013, p. 490). Until recently, the understanding of emotions and especially the will was quite unclear in the theory of reflection. It was not clear enough what they reflected. A definition was widespread that the reflection of the positive or negative attitude of a person to the facts of actual reality experienced as a feeling is called an emotion. However, the positive or negative attitude is a mental phenomenon and any mental phenomenon is a reflection. According to this definition, it is appeared that an emotion is a reflection, and only the objective reality can be reflected. Therefore, it was essentially a mistaken understanding of conditionality of the mental and transformation of a person in a closed system, in which, one mental serves as the basis of another mental.
Subsequently, on the basis of long-term medical and psychological study of the emotional sphere and emotional states of people, researchers have put forward the view that an emotion as a mental phenomenon is one of the forms of reflection (McAllister, 2014). However, they reflect not the objects and phenomena of the real world but those objective relations, in which these objects and phenomena are found, to the needs, objectives, and incentives of the activity of a person (McAllister, 2014). Moreover, people subjectively experience these objective relations as their attitude to them. This understanding of emotions was in the basis of special medical, psychological, and philosophical studies. These studies showed that emotions reflect the biological quality of the stimuli coming from the external and internal environment. The essence of this form of the reflection of reality lies in the self-regulating functions of the body at the mental level. Feelings as the highest form of manifestation of the emotional life regulate the individual functions according to the requirements and norms of social life. Emotions as a form of reflection arise in connection with the needs of the individual. Feelings as a form of reflection arise in connection with the needs of society.
Psychologically, both emotions and feelings are emotional experiences and not cognitive images of reality. At the same time, the pathology of emotions and feelings including emotionally-volitional disorders manifested as a change in direction of the personality are essential to medical psychology. This productive understanding of emotions is based on differences in the relationship of psychic phenomena and the objective relations, in which people enter the real world and among themselves (McAllister, 2014)..
The understanding of the will as a form of mental reflection is based on the understanding of the goal as a mental phenomenon. The goal is a reflection of objectively existing opportunities of acts or activities. The goal may be close, distant, more general, private, elementary, or immediate. The purpose may be illusory, as an illusion is a distorted reflection of reality. It is necessary to distinguish between the objective goal – as reflected – and the goal as a reflection – a mental phenomenon. The firmness of a purpose is the most significant and original for the understanding of the manifestation of the will. Purposefulness is likely to take the shape of the mental process, the state, and personality traits. It is a reflection of the objective relations of the general and distant goals and possibilities of a person. Claims and the level of claims are the firmness of a purpose, in which the possibility of the personality is replaced with the orientation. The orientation of a person includes the needs in its structure. In such a way, claims are always emotionally colored. They refer not only to the manifestation of the will but emotions as well (Bissell, 2015).
A volitional effort – strength of the will – as a process and persistence – firmness of the will as a state or a property of a person are a reflection of the objective relationship of the purpose of the activity corresponding to the level of claims of the individual and actually performing their activity ensuring the achievement of this goal. A volitional effort is non-permanent. It is associated with a close purpose. However, perseverance is associated with a more distant goal.
A process of making of the volitional decision in the volitional action and decisiveness as a strong-willed personality trait are derived from the volitional effort and perseverance. They are determined by the rate of the voluntary action and the predominance of the volitional component over emotional in a single act of consciousness. The latter – a balance of emotional and volitional component under the rule of the will over the emotions –taken regardless of the rate is called self-control.
Interconnections in a unified structure of consciousness of the volitional form of mental reflection with the other forms create such psychic phenomena as arbitrary perception, voluntary memorization and reproduction, arbitrary suppression of emotions, and others. In this case, any such action, as well as independent volitional action, is subjectively experienced as willpower and objectively seen as the activity of consciousness. Therefore, it is both the activity of the individual and the person. In all cases of a strong-willed form of the mental reflection, the reflected object is one or another reality – the objective possibility of the result of the activity or the action, the objective relations among themselves or with the capabilities and orientation of the person (Chadwick, 2013). The analysis of the volitional action or the activity should focus on their identification. Both objectively reflected phenomena and relationships should be created and conditions for the fixing of the reflected should be provided for the formation of strong-willed qualities of the person. These provisions find a way into medical practice not only in occupational therapy and psychotherapy but in any other form of the relation “doctor – patient” (Chadwick, 2013).
From the principle of determinism in relation to the well-known mental processes, with which the physician faces in daily practice, it follows that a person has several forms of the mental reflection. The first form is emotions. The second form is sensations. The third form is thinking. The fourth form is perception as the totality of the second and third forms. Feelings are the fifth form as the totality of the first and third forms. The sixth form is will as the reflection determining the activity of consciousness. The seventh form is the memory.
The combination of these forms of reflection in unity with their content represents an ideal component of the person’s mind – consciousness as the highest form of subjective. However, the human psyche includes not only these seven forms of reflection and their content. It also includes the necessities as a motive force of any form of reflection, the reflection of biological or social needs of the body or the individual, the attention as the organization and management in the case of voluntary attention, and objectification of behavior and activities in humans. It is often overlooked. The latter is a function of not only the individual but a person as the whole – a man as a person and as an organism. This understanding of the forms of reflection, and hence the structure of consciousness can explain all cases of determination of both normal and pathological mental phenomena helping the clinical practice (Chadwick, 2013).
Undoubtedly, the views of the spontaneous psychopathological phenomenon were erroneous. Moreover, the issue of genetically deterministic psychic phenomena is even more controversial. Nowadays, this issue is little studied. The thesis that only the anatomical and physiological characteristics are conditioned by heredity is not right. It is the masked psycho-physiological parallelism and separates psychic phenomena, particularly memory, from the anatomical and physiological structures. This problem needs attention, as well as the medical and psychological development.
For medical psychology, the principle of determinism is associated not only with its understanding in psychology but also in medicine, where it acts as a philosophical basis for the concept of etiology. Undoubtedly, the central problems of the theory and practice of medicine are focused around the concept of etiology. The deep study of this problem takes people beyond the limits of medicine where biology and natural science is very closely related to the questions of philosophy. The reason is not an external factor. It is the unity of internal and external, the presence of which necessarily implies the existence of its action – consequence.
Medical psychology is a branch of psychology that studies the psychological aspects of health, prevention, diagnosis, treatment, examination, and rehabilitation of patients. The significant problems of medical psychology are the interaction of various processes in the occurrence and development of diseases, as well as the study of the psychological effects of medical methods and means including medications, procedures, clinical and instrumental studies, surgical interventions, and others to ensure their positive impact on the physical and mental condition of the patient. In medical psychology, there are various principles including the principle of development, the principle of determinism, the principle of historicism, the principle of unity of consciousness and activity, and the principle of the personal approach. For psychology, the principle of determinism is the basic. From it, all other principles follow. In such a way, for medical psychology, the principle of determinism is extremely important as well.