П. Хименос, Э. Тунес Федеральный университет Флуминенсе Бразилия
И.А. Перелыгина Институт психологии им. Л.С. Выготского РГГУ Россия, Москва
Western psychology, based on the medical model, and pedological diagnosis proposed by L.S. Vygotsky, who understands that as a process that seeks to unravel the origin of the phenomenon.
Vygotsky (2004) did not agree with how the various issues facing psychology. In his text The Historical Meaning of the Crisis in Psychology, weaves criticism about the fragility of the various systems that composed the psychology, demonstrating, for example, that psychological science was so confused, until that moment, that the very language used by it showed such fragility. According to him, many words and forms of language used in psychology stemmed from the natural sciences, being employed in a figurative sense, and therefore served “directly to deceive” (p. 298).
The impression one gets is that psychology has not yet found its “language”, as Vygotsky (2004) asserted, and even today, do not know who is! Bothers, especially the fact that psychology simply accept as an explanation of mental functioning arising from the reflections of other science, without seeking to reflect on the origins of their object of study.
Often tacitly, we say that the “error” of psychology was to have been inspired by the medical model to compose the Western psychological diagnosis. According to Porto (1994), the clinical method is the core of medicine and, over the years, will be adding to it a number of techniques and a body of knowledge that change the profession. Professionals admit that, in modern medicine, the need for diagnostic confirmation is a feature that stands out. Argue that the requirement of a more detailed and accurate diagnosis is present, which puts the base of current medical practice.
It is attributed to Hippocrates the systematization of clinical method, which differs little from that is used today. In it, the history and physical examination supported on inspection and palpation constitute the main elements. Over the centuries, was added to the clinical method the use of tools and findings to facilitate diagnosis, such as clinical thermometer, systematization of percussion of the chest, stethoscope, ophthalmoscope and sphygmomanometer (Porto, 1994). Regarding the evolution of clinical method, highlights the growing use of complementary tests. Thus, the application of laboratory tests and the discovery of X-rays have become a fundamental part of the structuring of diagnosis. Porto (1994) admits that the current challenge of medicine is to reconcile the clinical method with technological advances and understand that the basis of clinical practice is the clinical method. He continues:
For more enthusiasm you get with modern appliances, the cornerstone of medicine is still the clinical method. Experience has shown that technological resources are only applied in its fullness and with maximum benefit to the patient when it is part of a well-done clinical examination (Porto, 1994, p.10).
Ramos Junior (1990) is also categorical in stating that the well executed clinical observation is the cornerstone of diagnosis, prognosis, and this provides a good therapeutic planning. Thus, the medicine seems to have assurance that the clinical method, despite all the technological apparatus that exists today, is still the main driving force of the diagnostic process.
The authors Degowin & Degowin (1990) claim that the name of the disease appears to characterize the disorder caused by a set of characteristics common occurrence that suggests a common cause. As this disease is given a specific name. For the authors, in medicine, the diagnostic term has two meanings. The first is synonymous with the word “name”, referring to the proper name of a particular disease. Thus, it would mean so much sense “disease diagnosis” as “disease name”. In the second case, the word diagnosis can express “demand data for the determination of some organic disorder, but in this case, the term would be more appropriate diagnostic procedure” (p.1, 1990).
However, not always demonstrations given by patients are easily diagnosed. Therefore, the clinician should use additional phases consisting basically three: the repetition of history and physical examination; repetition of laboratory tests and delaying diagnosis. About the latter, it is worth noting that should be thoroughly explained to the patient the reasons for postponement of diagnosis to feel the same confidence in the Professional and able to report all the symptoms again.
Degowin & Degowin (1990) claim that it is useful to the doctors mark on your record ‘’delayed diagnosis’ and does not let pressure by institutions or insurance company in order to obtain an early diagnosis “(p.7). The authors note that when a diagnosis is given to a patient, there is a degree of accuracy or certainty; so it is recommended to always use probably questionable or expressions, before the word diagnosis in order to qualify it. Thus, it appears that the doctor should always consider your revisable diagnosis and monitoring, investigating each case as a process that unfolds over time. Therefore, the diagnosis is not seen as a label, impassive to be modified, but as a possibility.
Psychology has many of its foundations anchored in medicine, including the formulation of diagnosis. However, it seems often forget this fact, since working out with the precision and certainty of who is doing the detection of a fractured tibia. The psychologist, taken by a fear of being seen as “not a scientist” or “unreliable,” shun to use recommended by Degowin & Degowin (1990) words to express that it is investigating the phenomenon is suggestive, and not likely crystallized as, unfortunately, a lot has been done in psychology.
Psychology seems to have forgotten that the person who is there before you, has a life story, which suffered cultural, social, biological influences that are not easily detected by a biopsy or imaging study.
The history terms, chart, examination, diagnosis were all inherited by psychology of medicine. Recommendations about the purposes and proper use of psychological record are the same as those found in medical textbooks.
The classical approach to diagnosis has been developed over more than two thousand years, and the basis for disease diagnosis is indicated by the signs and symptoms. The symptoms are defined as abnormalities noted by the patient and investigated by the medical history and the signals are abnormalities perceived by the doctor and seen during physical examination.
The scope of history depends on the patient’s complaint. In a case of fracture of the tibia or dermatitis, for example, the diagnostic history summary is necessary and sometimes unnecessary and even inhuman, in the case of fracture. In the case of a little-known chronic disease, history should be well detailed, careful, with “new data being added periodically as the investigation moves forward, seeking new diagnostic possibilities” (p. 14). In other words, there are medical situations in which the diagnosis is understood as an investigative process. However, in formulating diagnoses, psychology forgets this fact. In a case of ADHD (Attention Deficit Hyperactivity Disorder), for example, often simply follows the description in the DSM (Diagnostic and Statistical Manual), applying the child just a label of a disease!
The representation that has a psychological diagnosis, nowadays, to its definition, purpose, procedures and results have strong influence of therapeutic medical model subsidized by the positivist paradigm of science. It is as if the diagnosis was only a “scientific” assessment strategy of the individual for purposes of measuring the nature of a disorder, then traversing the evaluation of psychological development, highlighting skills, abilities, potential and possible prognostic in order to allocate it in a general pre-existing classification that gives meaning to the information generated.
One may wonder what would have led to a radical change in the meaning of the diagnosis word, since in contemporary culture, this is a distorted view of the actual etymological sense of the word. Etymologically, diagnosis is investigation. It is a movement that has no end, it is a quest. The vision that we got the diagnosis negates this investigative character; everyone knows classify and diagnose, which led to a depletion of the true sense of the word.
Since the nineteenth century, psychiatry seeks a medical vocation. With psychopharmacology, she began constructing another identity and managed to achieve his dream of becoming a medical specialty. The psychopathology of today was based on the discourse of neuroscience, biological fundamentals that build a reading of the psyche entirely organic basis. With this, the medication has become an essential mode of intervention and psychotherapy took a secondary role.
In his text The Problem of Compensatory Processes in the Development of Mentally Retarded Children, Vygotsky (1989) states that the medical clinic paid little attention to issues of child development of children with delayed because many were not susceptible to therapeutic influence. Thus, the clinic sought only recognize the peculiarities which distinguished the intellectual backwardness of other frameworks and their main characteristics. Due to this purely classificatory and quantitative clinical focus, mental retardation was understood not as a process but as a “thing”. Vygotsky makes explicit in his text:
Anyone understands that there’s nothing more unwelcome than the selection by negative characteristics. When we perform this selection, we risk separating or uniting in a group, children who have little in common on the positive aspect (Vygotsky, 1989, p. 101).
In his time he has criticized the attitude of talking about a child with mental retardation like a sick person, without, however, say what the illness. Has been noted that the child has a delay, as it turns out that the person has a disease, but it can not determine the essence, the origin and fate of child development affected by it. Thus, he believes that the task of scholars of mental retardation is to study the development of these children and the laws that govern it. Stroke that goal, he throws some questions that may assist in this investigation. And questions: What are the processes that arise in the proper development of children with mental retardation that lead to overcoming backwardness? What are the structure and dynamics of mental retardation in general? Pedagogical conclusions that arise from the solution of the first and second question? For the author, the basis for the scientific study of mental retardation is the idea of the unity of the laws governing the development of the normal child and the late. To make the selection difficult and mentally backward children, they should be on education and teaching process.
In order to guide this selection, may be used as traditional methodological procedures the Binet scales, for example. However, Vygotsky alert be dangerous do the pedological diagnosis just based on those procedures that use scales, tests, among others. States that this initial selection aims only to indicate the children for a special investigation, more deeper, and the work methodology should be drawn later.
The distribution of these children should be made based on the differentiation between organic and functional forms. After this analysis, the distribution must occur as a principle, conductor axis, the types of development and behavior of children, their general personality and not the different types of symptoms and faults.
The postulated to study the child with mental retardation should be that any class of defects creates stimuli for compensation. This assumption justifies why the study of retarded children not be based only determining the degree and severity of the defect, it is essential to take into account the compensatory development and conduct of the child processes. Vygotsky makes it clear that the investigation of the child with mental retardation should be based principally the qualitative test of “disability” and not their quantitative determination. One must determine the type of development of the conduit and not the quantitative level that the different functions achieved.
All procedures used to investigate mental retardation have auxiliary importance. However, can only be applied to a real legitimate research have their base in an extended study of children in their education. Vygotsky says that we should not study the defect, but rather a child with a particular defect. Thus, the basis of all research should be integral study of childhood personality on its relationship with the social environment. Sort by classifying not only leads to the understanding of mental disabilities and even the understanding of any aspect of child development.
This is our critique; however, that the diagnostic manuals of psychiatry and psychology are, in actuality is. Is not a diagnosis result to be simply written on a paper. It is a process of investigation. From what was reported, even medicine itself understood this, but Western psychology does not seem to take this into account.
As a preliminary conclusion, we believe that both psychology and education in the West pursue standardization of children in an attempt to assign labels to him, taking of them any possibility of development. What happens today in Brazil, is what happened in pre-revolutionary Russia, as denounces the resolution of the Russian Communist Party Central Committee in regard to narcompros system to pedological misrepresentations, as follows:
[...] The practice of pedologists, which occurred without any relationship with the pedagogue and school activities, reduced the false scientific experiments and achievement among students and their relatives, of an infinite number of studies in the form of quizzes and tests meaningless, harmful, etc., which have long been condemned by the party. These socalled “studies” scientific, conducted with a large number of students and their parents, were directed predominantly against those who had poor performance or those who did not fit into the school system. Methods of pedologists aimed to prove the point of “scientific” view and “bio-social” contemporary pedology, hereditary and social conditionality of poor student achievement or some defects of their behavior, as well, find the maximum negative and pathological disorders in the student himself, his family, relatives, background and social environment influences and, therefore, to find reasons for the expulsion of students from regular school collective (Prestes, 2010, p. 205/206).
The highlighted section summarizes exactly what psychologists and pedagogues Brazilians do today. They reproduce what pedologists made at that time in the Soviet Union. The issue is that there are over a century developing practices that do not contribute to the understanding of child psychological diagnosis and still take the development potential of children.
The pedagogy and psychology, to Vygotsky (2003), are involved in structuring educational work that creates the driving conditions for the development of the child. The psychology itself does not directly provide pedagogical conclusions; however, “the process of education is a psychological process, knowledge of the general fundamentals of psychology helps naturally accomplish this task in a scientific way” (p.41). Therefore, they can go together without one becomes subjugated to another, but they are coordinated (Raad and Ximenes, 2013).
Unfortunately, in contemporary western, we understand the diagnosis only as the result of the process. Therefore, the proposal of Vygotsky’s cultural-historical psychology seems, today, the most coherent way to understand and perform the diagnostic process.
- Degowin & Degowin. Clinical diagnosis. Rio de Janeiro, Medsi, 1990.
- Porto, C. Medical Semiology. Rio de Janeiro, Guanabara Koogan, 1994.
- Prestes, Z. When it is not nearly the same thing: an analysis of translations of Lev Vygotsky Semionovitch in Brazil, repercussions in the educational field. 2010. 295p. Thesis (Doctor of Education), School Education, University of Brasília, Brasília, 2010.
- Ramos Jr. J. Semiotics of Clinical Observation: pathophysiology of symptoms and signs. São Paulo: Sarvier, 1990.
- Raad, I; Ximenes, P. Contributions of Psychology to Education. In Tunes, E (ed.) The taut wire that connects psychology to education. Brasilia, UniCEUB, 2013.
- Vygotsky, L.S. Works Escogidas V. Fundamentals of Defectology. Habana: Pueblo y Educación, 1989.
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Translation by Zoia Prestes text published in Narodnoieobrazovanie v SSSR. Sbornik dokumentov. 1917-1973 gg. M., 1974, s. 173-175. IN Istoria Sovietskoi Dochkolnoi Pedagogiki. Hrestomatia. Moskva: Prosveschenie, 1980. Available at: Prestes, Zoia (2010). When it is not nearly the same thing-analysis of the translations of Lev Vygotsky Semionovitch in Brazil repercussions in the educational field. Doctoral thesis. Faculty of Education, University of Brasilia.