Mental and psychological health is one of the most important problems of modern time. It is equally relevant both for Western and Eastern societies including Russian society. Historical process develops faster than ever before and therefore historical traditions and norms change fast as well. It results in different variations of personal development within culture, new identification types and various deviations of behavior. Due to acceleration of historical time we witness how fast the boundary between norm and pathology moves: the phenomenon identified as `pathological' decades ago is considered a norm now. In the light of humanization and liberalization, people suffering from mental disorders are treated differently than before, new approaches to diagnostics, treatment of mental disorders and rehabilitation of patients are developed. However, this cultural environment creates new forms of identity, self-fulfillment and mode of life. These phenomena require systematic cultural–historical research, because modern societies shape future cultures, and when exploring culture in such a way, pathopsychological analysis makes new sense.
We believe main problem of mental disorders research consists in its approaches and concepts based on purely positivistic and naturalistic grounds. Most studies in this field only state facts and lack methodological reflection. Therefore, they do not provide material for generalization and comprehensive conclusions. We suppose that the only way to solve this problem is to analyze clinical phenomena in cultural–historical perspective – both ontologically and methodologically .
First, it means that we agree that every mental disorder is social and cultural–historical in nature [3,6,7]. Moreover, if disorders are perceived not as diseases, but as psychodynamic personality organizations, it opens up new research opportunities. To implement this approach in clinical psychology, a researcher needs to adopt phenomenological view on disorder, to understand the situation from within based on psychological processes proceeding in the mind of the patient and in the context of his/her development. In addition, community of professionals should develop appropriate cultures required for understanding variety of mental disorders in such a manner.
Second, this approach implies that we need to use the methodology of objective cultural–historical analysis to understand social settings and mechanisms involved in development of disorders and interiorized by an individuum.
Third, it implies the necessity of implementation of methodology of developmental psychology in clinical psychology. Such kind of methodology requires consideration of all the symptoms and mental disorders in the context of psychological development of an individuum within society, culture as well as within different subcultures and social strata. This perspective provides new opportunities for rehabilitation, because we deal here with the organization of development that implies consideration of biological grounds as well as social conditions that as opposed to biological ones can be transformed if required. It determined the genre of the study: we call it `cultural–historical analysis'.
Using such methodological approach, we analyzed history and logics of development of European psychotherapy, cultural–historical structure of clinical–psychological knowledge and cognition, etc. . After conducting such analysis, we reached a conclusion that development of all these phenomena has been determined by cultural–historical regularities.
This methodological approach allowed to analyze norms and pathologies of child development in different social strata in a new way as well. The study based on exploration of peculiarities of child development (through observation, assessment of psychological and mental development and projective methods) has shown that the settings of child-centrism typical of medium and high social strata in big urban centers determine peculiarities of development that differ from ones observed in small village distant from Moscow. While analyzing these differences we managed to distinguish certain cultural-normative `matrix' for each of the groups that included social and economic life conditions in families, image of child in certain subculture, perceptions about child development, significance of labor and efforts for certain social group, etc. This matrix was not just a theoretical construction or reconstruction of basic cultural–historical conditions of child development, it was an important ontological foundation for development as well, fundamental social-cultural sphere providing a child with identifications that were crucial points of contact between child and culture organizing future development and its structural peculiarities [1,4,5].
This cultural-normative `matrix' of development including developmental mechanisms can be described in a generalized way. Based on such a description, variations of deviations in development within certain cultural-normative group can be distinguished in a clearer manner. It means that it is not enough to proclaim developmental norms as a fact or to construct them intellectually — these norms really exist in the culture, they are ontological in their nature and determine child development, and deviations from these norms prove functioning of the norms. Therefore, deviations are to be considered not as deviations from abstract and generalized norms, but as deviations from the norms developed by certain social and cultural group. Such an understanding of deviations is of great applied and clinical significance.
In the terms of cultural–historical approach developed by L.S. Vygotsky and A.R. Luria , norms are set by culture and cultural–historical situation, value perceptions, educational strategies, etc. Psychodynamics of this process was clearly seen during the social crisis in Russia in the 1990s (caused by breakup of the USSR). For example, from the 1990s onward cultural norms themselves could be considered pathological (in the meaning that they do not lead to mental health). It was connected to infantilization of the culture, social crisis observed, for example, in institution of the family, experimental approaches to child development, imitative technologies introduced without proper reflection. This example demonstrates that development of the culture as well as development of an individuum includes crisis phenomena, both regression and progression, deviations and dead ends.
For example, our research shows that in medium–high social stratum in Moscow following risk variations of self-awareness development in children of senior preschool age are shaped (that could be explained by crisis phenomena in culture as well as educational approaches in preschool facilities of certain `prestigious' type based on parents' demands and expectations): a child adopts subjective position of `a child always has the upper hand', feels sharply his/her exemptionalism, negates the value of the Other, etc. For instance, senior preschool children when in a stressful situation do not try to resolve it by expending real efforts, but invent complex verbal constructions demonstrating individualistically creative mode of thinking shaped in isolation from development objectives optimal for this age. Some of them, on the contrary, cannot stand any frustration and invoke primitive ways to protect their interests (such as biting another child). It happens because in accordance with value perceptions of parents the children are infantilized by educational strategy involving the concept of `magic', educators humor their fancy, minimize level of frustration and negate value of labor, efforts, etc. . This norm determines its pathology. From this perspective norm and pathology are dialectically connected, and a cultural norm implicitly contains deviations typical for it. In the present case the norm is shaped by crisis and cultural regression, introjection of values developed in different culture and commercialization of education. Therefore, the norm turns out to be pathological itself and reveals pathology within the culture reflected on education, and afterward the children influenced by these developmental norms while researched are diagnosed with deviations from this pathological norm.
Thus, normal development as a criterium for mental health is understood not only as a naturalistic opposition to abnormal, but genetically as well, from the perspective of cultural state of mind and mechanisms shaping self-awareness and cognition of children and through social situations children are involved in. It means that society experiencing crisis or rapid development possesses different developmental norms.
Research of other subcultures and social groups in big urban center resulted in distinguishing other cultural–historical matrixes for child development determining developmental norm and peculiarities of pathology. Different data resulted from study examining cultural–historical conditions of child development in small village of Kirov region distant from Moscow. The study discovered special social environment and family structure used as a cultural system aimed at cultural and social reproduction that determined general matrix for development, its tempo and special cultural `styles' of development. Under such conditions, typical deviations counted suppression of authentic emotions, lack of self-confidence, feeling of inferiority and rejection observed in children originating from families whose way of life differed from the one typical for majority.
One more developmental risk sphere for children of senior preschool age from the small village (as opposed to majority of examined Moscow children belonging to medium and medium–high social strata) was deficit of positive identification, demonstrated especially by boys. It was found that in the village adults encourage children less (except for cases connected with labor and practical skills), prohibit more things and sometimes use corporal punishment. The development is organized as `going through corridor': adults focus on things that are prohibited or considered as bad and provide less support and encouragement for child being positive only about practical skills that results in lack of positive identifications.
The analysis of the obtained data demonstrates that deviations and developmental risks have different structures and mechanisms in different cultural–historical environments. Adoption of this perspective allows to discuss problems of child mental health in a concrete and systematic way and to develop objectives of psychological correction not only for certain child or family, but for social environment of his/her development.
Obtained data demonstrate fundamental significance that integration of cultural–historical and phenomenological analysis has for clinical psychology as well as heuristic importance of understanding clinical-psychological data within the context of developmental psychology including understanding norm and pathology as parts of development always originating from cultural–historical settings. This approach applied to clinical-psychological research allows not only to assess development of children and adolescents in a systematic, multidimensional and multilevel way, but also opens up new opportunities for monitoring and controlling mental development of children and adolescents as well as for organization of psychotherapy and rehabilitation.
In addition, the approach is aimed both at systematic and applied analysis of developmental deviations and at psychological correction and rehabilitation. Description of cultural–historical developmental matrixes in different social groups, subcultures, etc., seems particularly important in this context as well as research aimed at understanding how a child interiorizes these cultural forms. It would provide us with opportunity to transform these matrixes for optimization of child development.
As contrasted with traditional research focused on clinical groups, nosologic units and organized mostly within the positivist methodology, cultural–historical analysis of child development within certain social groups, subcultures, etc., allows to examine the organization of normal and pathological development in a systematic way, to obtain data significant for systematic psychological correction and optimization of development. Results of such an analysis provide us with opportunity to design optimal developmental organization.