Theory of personal reliability in psychotherapeutic treatment of dementia

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Theory of personal reliability in psychotherapeutic treatment of dementia

Statement of the Problem

personal reliability dementia

Personal reliability, in our opinion, constitutes the fundamental characteristic of regulatory social and cultural boundaries. This feature of an individual, which characterizes one's ability to predictable behavior, is connected with the implementation of social relations based on social norms and ideals, as well as one's own responsible choice. Summarizing our theoretical study of the reliability problem [4; 5], let us note that the semantic properties that constitute its foundation, are certain age, sex, neural and dynamic properties, constitutional and physiognomic characteristics, traits of character, peculiarities of the cognitive sphere, personal values, in particular responsibility, sustainability, volitional qualities, sense of duty, discipline. Reliable authenticity of a self- actualized person manifests itself in the fact that he/she is able to maintain their life, as expected, according to their capabilities, vocation, sense. Reliable individual formation is associated with: adaptation - individual's adjustment to new social conditions; orientation - searching for one's place in the social and professional space; structuring - defining and ordering «I am a part of society»; goals - goal-setting, behavior modeling; existence - understanding of one's own essence, prediction. Certainly, there are a number of threats regarding personal reliability regression in elderly age, including dementia as the most dangerous one.

Dementia today is one of the serious medical, social and psychological problems. The increase in the numbers of elderly (senile) people in the population, lifestyle changes, particularly in the nature and extent of physical and emotional load, diet, impact of a number of chemical agents, incredible amount of different information - lead to an increase in the number of cognitive impairment cases. According to WHO (World Health Organization), currently 35.6 million people suffer from dementia. This number will double by 2030 and more than triple - by 2050 [2]. Therefore, it is important to improve the methods of prevention and early diagnosis of cognitive disorders.

Analysis of recent research and publications shows that philosophical, physiological, psychological, professional aspects of the problem of reliability were discussed in the works of A. Astafiev, H. Ball, A. Berh, V. Bodrov, V. Horbunov, M. Korolchuk, V. Kruk, M. Kotyk, B. Lomov, D. Maister, V. Milman, V. Nebylit- syn, H. Nykyforov, A. Piskopel, O. Protanska, V. Pushkin, N. Rybakova, S. Sarychev, Y. Stryzhov, V. Uakiiev, V. Yudin [4; 5; 8].

Personal reliability is a fundamental, attributive feature of a personality which characterizes one's ability to predict responsible behavior connected with the implementation of social relations in accordance with group norms and values.

Study of the world culture of humanistic orientation gives reasons to believe that the value of private life is really exceptionally high (I. Brodskyi, X. Orteha-i-Hasset, H. Toro, A. Shveitser). A person's isolation from the others, his disintegration from the world, ability to perceive the others but remain oneself in humanistic culture is always associated with dignity. Modern civilization has led to the emergence of the phenomena of mass culture and mass human, normal and pathological entity, healthy and sick person. Some people create not only personal, but also social life, still they are able to maintain their autonomy. It is at an individual level that the old problems are resolved and something new is born - social moral (external social norms) and personal moral (internal boundaries). Thus, personal moral defines the boundaries of social moral. However, the content of individuality is limited by one's social usefulness, whereas personality is important in itself and for oneself. Therefore, the more intense is the contact of a person with the world, the more urgent is the task of maintaining of one's unique individuality, one's psychological space in all spheres of life. Personalized (not shared with the society) ethics is the most valuable part of the culture.

At the same time modern psychological science actively investigates determinants, course, mechanisms and means to restore a person with dementia syndrome (N. Bachynska, V. Zakharov, Y. Kolesnyk, V. Korostii, T. Mishchenko, B Mykhailov, S. Polyvo- da, V. Kholin, A. Cherepok, N. Yakhno, L. Amaducci, M. Baldere- schi, S. Bombois, A. Bruandet, S. Debette, A. DiCarlo, L. J.Launer, C. MacNight, G. W.Ross, H. Petrovitch, K. Rockwood, C. Wentzel) [1-3].

Indeed, the problem of social norms and psychological space restoration of people with dementia is regarded among the most significant ones, but the mechanisms of social and individual norms interaction have been basically ignored by researchers.

Article objective. The objective of our article is to work out the strategy, create a methodical unit and implement psychotherapeutic practice in cases of dementia based on the theory of personal reliability.

The main research material. Human's attitude to the world, his value and semantic potential are closely connected with the content of the process of personal reliability formation; activity and behavior predictions are based on the ideas of certain social and professional categories within which an individual perceives himself.

The concept of personal reliability is based on the theoretical analysis and the results of experimental studies. This phenomenon is holistic and dynamic, it is based on natural scientific and humanitarian paradigms, it is associated with the peculiarities of the social situation perception and its possible (both positive and negative) consequences for people; conditioned by (professional, common, creative) activities; peculiarity of relationships in microenvironment (professional community, family, friends, etc.) is determined by one's attitude to social reality.

Personal reliability is an integral psychological formation which is revealed in the unity of motivational, random, cognitive components, prevalence of normativity and sensitivity which express themselves in person's behavior and are based on the set of symptoms of psychological and physical well-being. We present the system of personal reliability's psychological support as a coherent set of strictly organized estimation-and-regulatory optimization of human behavior in accordance with the requirements and conventional norms, with its own structure, performance algorithm, patterns, mechanisms, principles which, taken together, form a coherent concept.

Personal reliability is realized through psychological mechanisms related to diagnosis of external and internal reality. Internal factor of personal reliability expresses itself in diagnostics of reality as a basic mechanism of psychic activity. Its effectiveness depends on the authenticity, social maturity, adequacy and self-sufficiency, critical attitude to social behavioral factors, risks of mental and physical well-being. External factor of personal reliability in the process of its insurance manifests itself in a mechanism of continuous evaluation of critically important risks of behavior according to the performance indicators. When it focuses on estimation-and-re- gulatory optimization of the personal reliability compliance with the established requirements and accepted standards, the outer circle of the mechanism of continuous assessment introjects into a psychological mechanism of the inner circle of continuous assessment that constitutes an additional power for Super-Ego, which leads to actualization of subject-activity reflexive regulation of human behavior in accordance with established requirements of personal reliability.

The concept of personal reliability is based on the following statements, which have been revealed as the results of theoretical analysis and confirmed data of experimental research, namely:

- personal reliability is understood not only as a process which is stabilized and manifests itself in the interaction of the members of social environment, but also a state that ensures reliability of a person as a whole (psychic, psychological). In addition, it is also a property of an individual which is based on authenticity, is characterized by its stability against destructive influences and is an internal resource of counteraction (resistance) against destructive effects;

- defined personality levels are understood as the variety of aspects of the counteraction and viability (experiencing of one's own stability-instability, resistance resource availability against external and internal destructive influences, understanding of selfmaintenance, specific behavioral acts that promote or counteract the psychological reliability of others, self-destruction or constructive sustainable development);

- reliability levels are classified in accordance with the levels of a person's development: at an individual level - physical reliability (the person is identical with one's own vital activity); at a personal level - a system of attitudes to different aspects of reality and other people (values, ideals that define behavior); at the level of activities - a set of tools and activity technologies that promote or reduce the threat to another person or society as a whole (culture of reliability in the community); at the level of individuality - as life purport orientations of a person, one's existential essence (combined physical and psychological reliability of a human as the sense of life and preservation of a man and society);

- personal reliability levels are defined as abilities to maintain stability in an environment with certain requirements, also with negative influences, counteraction against destructive external and internal influences; ability displayed in the feeling of personal stability-instability in certain life situations.

Personal reliability model is based on the integration of natural scientific and humanitarian paradigms that constitute «rational and humanistic orientation of the information field», which defines the features of a person's cognitive activity aimed at adequate presentation of the informational reality and «life and professional experience» that reflects individual peculiarities of converting information into subjective reality and response to the situation in a professional and daily life. The theoretical model of personal reliability is represented in the following types:

1. Reclusive type - a person consciously refuses to interact with others because of his/her own beliefs.

2. Authentic type. Despite the positive content, within this type there can occur not only harmonious combinations of mentioned modes. Thus, this type can be creative, but also combinations that contribute to various long internal conflicts can be observed here.

3. Unreliable personality also shows options presented in the vector «existential compliance» and «illusion of compliance».

4. Self-destructive personality in vector direction «illusion of compliance» can adapt to other people to parasitize. Weak, lost, they need compassion and assistance. However, in the process of receiving help they show great activity and adaptability to any social and psychological and economic conditions.

To determine psychotherapeutic possibilities of the theoretical model of personal reliability in cases of dementia, we'll analyze the features of origination, a course of personality changes of people with this disorder.

Dementia is a syndrome caused by a brain disease - usually chronic or progressive - which causes the violation of many higher cortical functions: memory, thinking, comprehension, language, orientation, ability to count, cognition and reasoning. Dementia is not connected with mental confusion, «deterioration of emotional state control, degradation of social behavior or motivation is often combined with impaired cognitive functions, and sometimes develop prior to them» [2, p.7]. This syndrome is manifested in a large number of diseases which cause primary or secondary brain damage: vascular dementia is connected with Alzheimer's, Pick's, Kreyts- feldt-Jakob's, Hentington's, Parkinson's, Wilson's diseases, with hypercalcemia, hypothyroidism, vitamin B12 deficiency, nicotine acid deficiency, intoxications, neurosyphilis, epilepsy and others. Alzheimer's disease is the most common form of dementia with 6070% of all cases. Common are also such forms as vascular dementia, dementia with Lewy bodies and a group of diseases relating to the front temporal dementia. There are no clear boundaries between various forms of dementia, and there often exist mixed forms.

Table 1 Typical symptoms of dementia syndrome