Quality of identity as a criterion of a person’s mental health At the initial stage of working with a client, be it therapy or counseling, a psychologist or psychotherapist is faced with the problem of diagnosing his current mental state. And before diagnosing a specific form of disorder, there is a need to determine the level or depth of personal pathology. It is very important here what model of health the psychologist adheres to, since the criteria of health and ill health that he will use in his work will depend on this. Until now time there is neither a generally accepted model of health and illness, nor a definition shared by everyone. The variety of definitions is supported by the existence of numerous trends in modern psychology. The most recognized is the definition proposed by the World Health Organization (WHO), which states that health is not just the absence of disease, but a state of complete physical, mental and social well-being of the individual, the perfection of the body, vitality reliability and harmony of all its functions. This definition, despite all its uncertainty and descriptiveness, nevertheless contains a number of important points: 1. An attempt is made to provide a meaningful definition of health, and not a definition from the opposite, as is most often the case: “health is the absence of disease...”2. Health is considered as a systemic, holistic, complex phenomenon, which includes several levels: physical, mental, social. The following criteria for mental health are also proposed here: Awareness and sense of continuity, constancy and identity of one’s physical and mental “I”; Sense of constancy and identity experiences in similar situations; Criticality of oneself and one’s mental products (activities) and its results; Compliance of mental reactions (adequacy) with the strength and frequency of environmental influences, social circumstances and situations; Ability to self-manage behavior in accordance with social norms, rules, laws; Ability plan your own life activities and implement it; The ability to change your behavior depending on changing life situations and circumstances [2]. It is important that among the listed criteria there are both objective criteria and subjective ones related to a person’s self-perception of himself. However, knowing only the norm criteria is not enough to diagnose the level of mental disorders. The above criteria can be of varying degrees of severity and it is not the presence of them in themselves, but the degree of their severity that is decisive in the case of diagnosing one or another level of pathology. The modern idea of ​​the disease gives grounds to consider it as: - a causally determined process determined by the interaction of external and internal; - dialectical unity of structural and functional changes; - systemic and holistic process, covering all levels of the system - biological, social, mental. Health - disease within a one-dimensional model can be presented as poles of a continuum scale. Health |------------------------------------------------ --------| DiseaseAccording to Kontor's theorem, there are an infinite number of points on one straight line. This idea of ​​health and illness presupposes the existence of a number of intermediate states between the health-illness poles, which is embodied in the identification of levels of mental pathology. In modern domestic psychopathology, three levels of depth of disorders are distinguished - normal, borderline disorders and psychotic levels of pathology. Normal Borderline level Psychotic level |-----------------------|---------- ------- -------------|--------------------------------|A similar picture can be observe in the traditions of psychoanalytic diagnostics. Here we are also talking about 3 levels, respectively -neurotic, borderline and psychotic [3]. Neurotic Borderline Psychotic level level level |----------------------------|-------------- -----------------|-----------------------------| Each level of pathology has its own specifics, which determine: ways of working with the client, features of interaction with him, therapeutic relationships and strategies, prospects and forecasts. To determine the level of depth of the client’s disorder, it is necessary to be based on a clear diagnostic scheme, which involves identifying certain criteria for diagnosing these levels. As a primary diagnosis, it is important to determine the level of mental disorder: psychotic - not psychotic. As a rule, psychotic patients are not included in the field of professional activity of a psychologist. Psychotic disorders (psychoses) are characterized by: Gross disintegration of the psyche - inadequacy of mental reactions and reflective activity to processes, phenomena, events, situations; The presence in the clinical picture of formal signs of psychosis: hallucinations, delusions. Disappearance of criticism - the inability to comprehend what is happening, the real situation and one’s place in it; The disappearance of the ability to voluntarily control oneself, one’s actions, memory, attention, thinking, behavior, based on real needs, desires, motives, life values, morality; The presence of an inadequate reaction to events, facts, situations, objects, people and oneself .Non-psychotic disorders are characterized by: Adequacy of mental reactions to reality in content, but often inadequate sharpness in strength and frequency; Preservation of criticality, but often exaggerated, sensitively sharpened; Limitation of the ability to regulate one’s behavior in accordance with the laws of psychology, society, situational dependence of psychopathological manifestations [ 2]. These diagnostic criteria are successfully used in psychiatry and make it possible to identify gross pathology. However, the boundaries between normality and pathology are unclear; there is a whole area of ​​transitional or borderline states. The existence of such conditions is recorded in domestic medical psychology and psychiatry under the term “borderline mental disorders.” The term “borderline mental disorder” itself is relative. It is used for the combined name of mildly expressed disorders that border on the state of health and separate it from the disease. Yu.A. Aleksandrovsky characterizes PPR as a special group of pathological manifestations that have their own onset, dynamics and outcome and identifies a number of diagnostic signs for differentiating PPR from normal and pathology. He also points out that “...there is no continuous “border” either between health conditions and borderline mental disorders, or between them and psychoses. In practice, there are many transitional symptomatic and syndromic formations characteristic of both psychotic and non-psychotic disorders” [1; 15]. The use of a psychological approach makes it possible to carry out more subtle differential diagnostics. An example is the structural diagnostic system developed by Kernberg for the differential diagnosis of neuroses, borderline disorders and psychoses. This system is based on three criteria, the degree of severity and quality of which is a diagnostic indicator of the depth of the disorder. They are as follows: the degree and quality of identity integration; the level and type of dominant defense mechanisms; the ability to test reality. According to O. Kernberg, in a neurotic patient all diagnostic parameters reach a high level of development, namely: - identity is integrated and differentiated; - in number defenses include the so-called mature defenses of the highest order: intellectualization, rationalization, replacement, repression (repression), regression, isolation,moralization, annulment, displacement, reactive formation, reversion, identification, response, sublimation; - a client of this level is able to clearly test reality, draw boundaries between its internal and external manifestations. One of the important criteria for distinguishing neurotic level disorders from psychotic disorders is criticality to to their painful experiences, which is also called reality testing, which means “the ability to distinguish self from non-self, intrapsychic from external sources of perception and stimuli, and the ability to realistically evaluate one’s own emotions, behavior and mental content in terms of ordinary social norms.” (O. Kernberg). O. Kernberg considers this quality an important structural personal characteristic, which is associated precisely with the ability to understand the behavior and statements of others within the framework of generally accepted norms. This means that with neurosis, more precisely, with a “neurotic personal organization,” a person remains sensitive to conventional norms, moreover, in most cases he becomes hypersensitive to them due to the very nature of the neurotic conflict. At the same time, a neurotic personality, in principle, retains the ability to empathize, empathize, and is able to correctly recognize involuntary (expressive) movements and intentional reactions, usually associated with certain feelings and emotional states. The difference from a normal personality here is that a neurotic is overly fixed on his own experiences and he has too few personal resources left for empathic penetration into the world of another person, although he is capable of empathy. In addition, clients at this level will have an integrated sense of identity and a predominance of higher order defenses. For clients with a psychopathic personality structure who correspond to the “borderline personality organization” in O. Kernberg’s terminology, due to the diffuseness of the self, the ability to empathize is impaired. It is the inability to understand the experiences and feelings of another person that leads to frequent interpersonal conflicts and, accordingly, to social maladjustment. According to O. Kernberg, this may manifest itself, in particular, in the fact that the idea of ​​the Other in a psychopathic personality remains undifferentiated, regardless of the duration of interaction (living together or working). At the same time, psychopathic individuals are able to understand the conventionally established boundaries of behavior and, if they are violated, they do so consciously. Having a reduced ability to control the external manifestation of emotions, they retain an awareness of the “illegality” of their actions. The defenses that dominate at this level include the so-called primary, immature, lower order defenses, these are isolation, denial, omnipotent control, primitive idealization and devaluation, projective and introjective identification, hypochondria, passive-aggressive behavior. However, in these clients, despite the diffusion of identity, the representations of the Self and the object are largely differentiated and the ability to sense reality remains intact. In clients who are at the psychotic level of personal organization, all three criteria are characterized by a low level of functioning: identity is diffuse, self and object-representations are not differentiated, fused, the ability to distinguish between oneself and another, external and internal reality, fantasy and reality is absent or greatly reduced. Defense mechanisms are primitive (delusional-hallucinatory projection, schizoid fantasy, denial, distortion, splitting of the ego). The ability to test reality is absent or severely distorted. With a psychotic personality organization, both the ability to understand conventional norms and to empathically penetrate into the inner world of another person is lost. This may manifest itself as a loss of ability to checkreality, as well as in a distorted understanding of the inner experiences of another person. The first can be expressed in the commission of “inappropriate” actions in the absence of an understanding of their inadequacy, the second - in neglecting the interests of others, perceiving others more as “this” than as “you” [6]. One of the central criteria of mental health and illness in both traditional and psychoanalytic diagnostics is identity. Let us consider the content and specificity of this dynamic personality property depending on the level of personality disorder. Let us define identity as a person’s experience of identity with his “I”. Identity, like any dynamic property of a person, is a continuum at one pole of which is complete identity with one’s “I”, at the other – alienation from the “I”. Consequently, identity can be represented in the form of a scale (identity scale) containing different levels of expression of a given dynamic formation. The pole of the identified or “true self” can be expressed in the form of the following self-experiences: “I know who I am and accept myself as I am. I am me". The pole of the unidentified or “pseudo-I” is characterized by a diffuse image of one’s Self, up to the non-identification of the Self as a separate system and the dependence of the image of the Self on the situation. I = I |------------------------------------------------ ------------------| I # I Identified I Unidentified I Psychology deals with the study and description of a person’s experiences of the identity of the I, including minor violations of this identity. Psychiatry gives us descriptions of gross violations of identity, up to its complete disintegration in a state of psychosis, in which the sense of “I” is completely lost. The following are identified as specific forms of identity disorders in psychiatry: depersonalization, dissociative disorders, multiple personality disorders. In our opinion, knowing the quality of identity, one can determine the level of personality disorder. Identity as a dynamic property of personality can be considered as a structure and as a function, as a process and as a result [4]. Structural analysis of identity assumes the presence of structural components and complexly integrated connections between them. Structurality and integrity, dynamism and staticity - these are the dialectical properties of identity. Only the presence of one and the other makes it possible to talk about the existence of true identity. Let us dwell in more detail on the first two and try to identify the levels and components of identity. In the structure of identity, the following components can be distinguished: Self-concept or image of Self, concept of the Other, or image of the Other. Self-concept is a system of a person’s ideas about his Self and attitudes towards it. The concept of the Other is a system of a person’s ideas about the non-I, the Other and relationships to it. A similar picture of the structure of identity is offered by O. Kernberg. Using the term “representation”, he formulated a position about three structural elements of the Ego: Self-representation or image of Self, Self-concept; Object-representation, concept of the Other; A special affective Ego-state, reflecting the characteristics of the Self-Other relationship. Self-presentation, or self-representation (according to Kernberg), is a concept that refers to the various ways in which an individual symbolizes the image of himself that he experiences (consciously or unconsciously) and the emotions associated with it. Object-representation – combines the ways in which an individual symbolizes the image of a significant Other that he experiences; Ego state is a concept that reflects the functional relationship between the Self and the object and the emotions associated with them. The composition of these affective ego states determines the central sense of identity [7]. Since identity is a property of consciousness, we can assume the presence in identity of levels or structures similar to consciousness, namely: cognitive (knowledge about one’s “I”), emotional (attitude to Me and his assessment) andbehavioral (projection of the first two levels onto interactions with the world). Accordingly, we can say that the structural components of identity will also have distinct levels, i.e. and Self-concept and Other-concept can be considered at the cognitive, emotional and behavioral levels. The quality of these structural components of the Self will determine the specificity of identity. Both the Self-concept and the concept of the Other can be differentiated to varying degrees and have varying degrees of integrity and awareness. An undifferentiated self-concept at the cognitive level will manifest itself in the fact that a person’s knowledge about himself will be fragmentary, fragmentary, and contradictory. The attitude towards oneself will also be unstable, unstable, contradictory, dependent on the opinions of other people. An undifferentiated concept of the Other will mean that ideas about the Other will be fragmentary, while the assessment of others will be built according to the polar type “good - bad”, “friend - foe”, etc. Continuum of the Self-concept Differentiation of the Self-concept Diffusion of the Self-concept Integrity of the Self concepts Splitting of the Self-concept Stability of the Self-concept Situational nature of the Self-concept Objective perception Perception Self not based on reality Highly developed skills Poor development of self-regulation skills Continuum of development of the concept of the Other Consistency in perception The object of perception of the Other is split Good discrimination Blurred boundaries of the concept of the Other concept of the Other Flexible regulation of proximity Reactions stuck aniya, distance and distance or ambivalence Perceptions of Others, Perceptions of Others not based on reality based on reality The continuum of health - illness will be determined by a continuum of identity: from a high level of identity development to a low one, up to alienation. For a healthy person, self-image will be: 1. differentiated and holistic. (First dialectical contradiction) (“I am different, I am this and that, but all this is I, I accept myself as everyone.” E. Yevtushenko has a poem, which, in our opinion, very accurately reflects the phenomenology of the mature identity of a healthy personality: “I am different, I am overworked and idle. I am all incompatible, inconvenient, angry and kind...”; 2. Stable and flexible (I am who I am). I know who I am and what I am, but I can change, selectively rebuild myself." Similar ideas will be observed in relation to the Other person (the generalized image of the Other). A neurotic will be characterized by incomplete, diffuse ideas about his Self. In general, there will be a tendency towards polar ideas about the qualities of the Self. “I am good, I am bad, etc.” Acceptance of the Self will be directly dependent on the opinions of other people who are significant to the Self. Self-esteem, due to this, will be unstable and situational. aspects about the qualities of the Self will be unconscious and not integrated into a holistic idea of ​​the Self. Ideas about the Other person will be characterized by similar trends. The image of the Other will be unstable, situational, or, conversely, very rigid. For an individual with a borderline organization also №1, 2004.