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Clinical Psychology in the Soviet Union

Wolf Lauterbach

WESTERN LITERATURE it is difficult to find information about clinical

I psychology in the Soviet Union; thus it is difficult to get an idea of the role of
clinical psychologists and the kinds of services they provide. Why is there no men-
tion of Western-style standardized tests and no reference to the systematic use of
behavior therapy among psychologists who have been brought up in the tradition
of Pavlovs theory, who have been taught to suspect idealistic psychoanalysis ?
The information in this article was collected in discussions with Russian
psychologists during a journey through the Soviet Union that lasted several
weeks, as well as from selected Russian* and Western publications. The ideas ex-
pressed in the text are intended to represent the views of Russian psychologists
and do not necessarily reflect the authors opinion, unless so stated.


The centers of clinical psychology in Russia are Moscow and Leningrad.

Clinical psychologists are called pathopsychologists, and nearly all psychiatric
clinics, particularly those in the large cities such as Moscow, Leningrad, and
Kiev, have pathopsychologists working in them. There are courses for pa-
thopsychology in Moscow University, which include the subjects psychiatry,
neurology, physiology, anatomy, pathopsychology, neuropsychology, and a
pathopsychological pratical placement of 18 to 20 weeks. At present there may
be about 50 pathopsychologists working in Moscow.t
The cooperation between psychiatrists and psychologists is said to be very
good. The psychologist participates in discussions about the patient and helps
with the diagnosis, which is, of course, formulated by the psychiatrist. There is no
competition and no conflict between psychiatry and psychology in the Soviet
Union because the fields do not overlap. The reason the distinction between psy-
chiatry and psychology in the Soviet Union is so clear-cut is that the psychologist
is not at all concerned with treatment. To him, treatment is a medical matter by
definition. This attitude is logical in view of the Soviet notion that in a psy-
chiatric illness it is not the psyche but the brain that is affected and that the
reason for the disturbance of normal psychological function must therefore be
physiological. The psychologist concerns himself only with testing and research.
In 1950, at the Pavlov Conference, research in abnormal psychology was dis-
couraged in favor of physiology. The curtailment was due to . . . consistent
adoption of the reflex principle to explain mental events.3 The official view was

*Quotations from Russian texts were translated by the author.

tRough estimate by Zeigarnik (personal communication).

From the Institute o/Psychiatry, Maudsley Hospital, London, England.

Wolf Lauterbach, DipI.-Psych., Ph.D.: Lecturer in Clinical Psychology, Psychological Institute,
University o_fDusseldorf; Germany.
o 1974 by Grune & Stratton, Inc.

Comprehensive Psychiarry, Vol. 15. No. 6 (November/December), 1974 483


that psychology was concerned with the description of subjective phenomena and
that for causal explanations it was necessary to look only into the physiology of
higher nervous activity. These views were, however, officially abandoned and
criticized in 1962. Laboratories researching in abnormal psychology were
reopened, and medical psychology became a subject on the curricula of medical


Soviet psychologists feel that their approach to testing is basically different

from the Western approach. The Western approach (as they see it) uses concepts
(e.g.. aggression) that were originally developed and observed in pathological
behavior. These concepts were then generalized, and tests were developed to test
the normal population. The methodologically correct way of research, Soviet
psychologists maintain, is not to infer normal behavior from pathology but to
deduce pathology from what is regarded as norma1.3*4
The Russian approach is to study normal behavior and cognitive functioning
first, and then investigate what parts of it have changed in the patient. They are
more interested in investigating which psychological functions have changed
than in measuring the amount of change or the differences between normal sub-
jects and patients. Before embarking on measurement one must establish what
is being measured.3


There are two branches of pathopsychology in the Soviet Union: one, led by
Luria, has a more neuropsychological orientation; the other, the more traditional
one, is characterized by the work of Zeigarnik, who, coming from Gestalt
psychology, has a more cognitive orientation.


Theoretical Background
The main aim of Lurias neuropsychological investigations in the Bunderko In-
stitute of Neurosurgery in Moscow is to facilitate the accurate localization of
brain lesions. This is not the place to give a full account of his research or its re-
sults.7.X Here I shall merely try to outline his general approach and give an im-
pression of the kind of tests he and his co-workers use.
The brain is the substrate or material basis of higher nervous activity. It can be
differentiated into a large number of interconnected subsystems, each of which
serves certain functions. These functions are, however, not identical with what we
would call psychological functions (e.g., speech, understanding, problem-
solving). Such complex psychological functions are the result of highly organized
collaborations of many brain functions of analyzers.
While none of these complex psychological functions can be attributed to
any specific cortical area, each of the more basic brain functions or analyzers can
be localized in the brain. If any one of these analyzers is not functioning (due to a
lesion), the highly organized chain is interrupted and a complex psychological
function (such as writing) is disturbed. The process of writing from dictation, for

example, involves first an analysis of the sound composition, which involves

identifying each separate sound from a continuous flow of sounds, and then
assigning each sound to a phoneme. This process was shown to be heavily depen-
dent on the function of articulation. The sound composition of a word is then
recoded into visual images of letters, which are in their turn recoded into a ki-
netic system of the successive movements required to write them.
Each analyzer is, however, not only part of one system but can be employed in
the execution of various psychological functions. Therefore, a simple localized le-
sion can affect various psychological functions, even if these do not seem to be in-
Obviously, writing (or any other complex psychological function) can be im-
paired by focal lesions in many different brain areas, but the impairment will
show qualitative features characteristic of the disturbance of specific analyzers.
If, for example, the auditory analyzer (posterosuperior cortical region of the tem-
poral lobe of the dominant hemisphere) is disturbed, the identification of separate
sounds will be impaired and closely similar sounds will be confused, while the
ability to write letters or other symbols will not be affected. If, however, the
kinesthetic analyzer (posterior division of the left sensorimotor region) is im-
paired, the normal participation of articulation is affected, and this results in
characteristic errors (identifying n as 1 or d, or identifying b as m).
In case of lesions in the parieto-occipital divisions of the cortex, the visual-
spatial analysis and synthesis of external stimuli are disturbed; the perception of
the sound composition of speech remains intact, but its recoding into the visual
images of letters is impaired.

Neuropsychological Methods
Before any tests are given the patient is interviewed. In the interview the
investigator forms a general idea of the patients personality, his principal com-
plaints, his attitude toward himself and his illness, and his general abilities before
and after becoming ill.
The tests used by Luria and his co-workers are short and simple, but their
number is large; they include tapping tasks, drawing hands into clock faces,
drawing maps of the wards, and repeating various sounds and groups of sounds.
Disturbances of higher cortical function due to lesions in the frontal lobe are as-
certained by means of a large number of tests including the drawing of various
figures, recognizing pictures, memorizing words and short stories, and some of
the tests of cognitive function described below.
Testing in the Burdenko Institute is done not only by psychologists but also by
neurophysiologists and other doctors. Results are not thought to be affected by
minor situational circumstances. Much of the testing is done at the patients
bedside, and I attended a testing session in the common room with a cleaner
washing the floor around us. In the course of 15 to 20 min more than 20 small
tests were administered to a patient who was being retested after an operation.
Testing time is deliberately kept short to avoid tiring the patient. The investigator
did not write any notes during the testing. She had a rough sketch of the brain
areas whose functions she was testing; each time the patient did well she put a

plus sign somewhere into the sketch, and if he did not do so well she put a minus
sign into it.
A test that helps to assess the degree of visual agnosia and alexia is being de-
veloped at the Bekhterev Institute (Leningrad). Objects (e.g., a pair of glasses. a
square) or letters are drawn on a card that is filled with distracting stimuli (visual
noise), which make it difficult for the subject to identify the object (the in-
formation). In each series of four cards the amount of distracting signs (noise) is
gradually decreased and the objects become more easily recognizable.
As far as the treatment of patients is concerned, Lurias co-workers think, of
course, only in terms of neurosurgery. Therefore they trace a phobia back to le-
sions in the hippocampus or basal parts of the temporal lobes, obesity and ab-
normal social behavior to the frontal lobe, depression to temporal and occipital
parts of the brain, etc. This does not, of course, imply that all psychiatric patients
are sent to the neurosurgeon.

General Pathopsychology
Theoretical Background
The second branch of pathopsychology is represented by Zeigarnik. Her ap-
proach to mental disturbances is cognitive. She is strongly influenced by Lewin,
with whom she studied in Berlin in the twenties, and by Vygotsky, one of whose
main interests was concept formation.
The main interest of Zeigarniks pathopsychologists, who represent the ma-
jority of clinical psychologists in the Soviet Union, is the qualitative analysis of
the characteristics of the patients mental processes rather than isolated quanti-
tative measurement. In a psychological experiment the psychologist observes
the patient and is interested not only in whether the patient completes the task
but also how he understands it and what causes his errors and difficulties--it is
not what would be called an experiment in the West. It is not a standardized
procedure, but is adapted to solve the current problems posed by a particular
patient. The psychologist compares the results from different variations of an
experiment since in work with a sick individual frequent alterations are often in-
troduced throughout the test. For example, if a patient realizes that his first so-
lution of a problem was inadequate and produces one or two more solutions, this
is taken into account.
Standardized procedures for the evaluation and scoring of these tests do not
seem to exist, and the description of their results and their usefulness are as anec-
dotal as in this paper. In spite of this lack of standardization and quantification,
the tests are used for medico-legal purposes (assessing the degree of mental im-
pairment) and the evaluation of treatment results. Conclusions are drawn from
the presence or absence of several disturbances, certain other pathological
symptoms, and personality changes, and this combination may be characteristic
of a psychiatric category.

1. The classification task appears to be one of the most popular methods and
consists of about 40 colored pictures of various objects, animals, and people,

which the patient is asked to group. When he has finished he is asked to decrease
the number of groups; finally he is asked to regroup the objects according to the
categories: objects, flora, and fauna, because that is the correct solution.
2. Another method is the exclusion of one object out of four. The subject is
given cards on each of which are drawn four objects. Three of these form a group;
the fourth is the odd man out (e.g., a boot, a slipper, a shoe, and a foot). A
patient with a lowered level of generalization will exclude the wrong object,
e.g., he would not be able to exclude the foot, because If you take away the foot,
why would you need the footwear?
A schizophrenic, however, will categorize irrelevant and unusual aspects of the
four objects. For example, when he is asked to exclude one of the four objects
gun, uniform, umbrella, and drum, he may exclude the uniform, on the grounds
that in contrast to the uniform, the gun, the drum, and the umbrella make noises
(the umbrella when you open it).
3. Another technique tests logical thinking and whether a patient can persist
with a task without forgetting its purpose. This method uses 32 analogies, for

--horse _ cow
foal calf, bull, milk, pasture, horns

The patient underlines the correct word.

4. In the pictogram task, the subject is given 14 words to remember and is
asked to draw something on paper that will later help him to recall the words.
The words are rather abstract (e.g., development, doubt, separation). The
difficulty in this technique is that the words can have a number of possible
meanings, and each drawing can be interpreted in more than one way. The task is
to think of and draw an object the meaning of which overlaps sufficiently with the
meaning of the word to make recall possible.
As is the case in most of the techniques described, the patients comments and
errors are at least as important as the final result for the psychologists diagnosis
of what psychological functions are disturbed. The pictogram can also be used to
task short-term memory and goal-directed thinking.5
5. In the level-of-aspiration test a subject has to do small tasks with 14 to 18
degrees of difficulty. The degree of difficulty of a task can be chosen by the sub-
ject, and his choice gives information about his reactions to success and failure.
They can be described as appropriate versus unstable self-evaluation, appro-
priate versus inappropriate reduction of self-evaluation, lack of self-
confidence, etc.
In schizophrenics, previous success or failure did not seem to influence their le-
vels of aspiration. Psychopaths, on the other hand, were extremely sensitive to
success and failure, i.e., success increased and failure decreased their levels of as-
piration very quickly.
6. Standardized Western tests used in the U.S.S.R. include the MMPI, the
MPI, the WISC, and the WAIS (the latter to differentiate between schizophre-
nics, neurotics, and organic patients, for legal purposes and in vocational
guidance). For these tests unpublished Russian norms are available.

7. Projective techniques (e.g., TAT, picture frustration test, incomplete

sentences, and in particular the Rorschach) are used more frequently than is
reflected in Soviet psychiatric journals.4 The Western way of interpreting pro-
jective tests, however, is not acceptable to Soviet psychiatrists. But does that
mean that projective tests cannot be applied in the Soviet Union? Not at all.
They are no doubt of interest for the solution of a number of problems in clinical
and general psychology. Furthermore, in applying certain methods in our pa-
thopsychological laboratories (classification task, exclusion task, pictogram) we
are already making use of an element of projectivity in them. The concepts used
in the interpretation depend on the theoretical position of the experimenter.l

Psychological Functions

Applying these tests to patients in psychiatric clinics and comparing the results
with those obtained from groups of normals (15 to 20 normal subjects is regarded
as sufficient), various psychological functions can be identified.3v5

I. Disturbance in Intellectual Capacity

Several manifestations of exhaustion often make it seem as if separate
processes have been disturbed: for example, memory (as tested by having the
patient learn 10 new words) or attention (as tested by having the patient add num-
bers). Two manifestations of exhaustion can be distinguished.
Judgmental inconsistency or illogical reasoning denotes fluctuations in the
intellectual level of problem-solving. In the categorization task, for example, a
patient may start to form correct groups of people and plants, but then he begins
to make a new group, flowers (which should go into plants), to which he
adds a beetle, i.e., he is fluctuating between abstract and concrete situational so-
This instability causes a patient to appear sometimes as an interested person
who thinks and behaves satisfactorily and sometimes as a disintegrated person
who lacks direction. The fluctuations are taken to be manifestations of the quick
onset of neural exhaustion.3 Judgmental inconsistency is found mainly in cere-
brovascular disease (82%), brain trauma (68%) and manic-depressive illness
(67%), but not in epilepsy (2%), oligophrenia, or general paresis.
A subjects reaction to mental satiation is observed by giving him a very
monotonous task (e.g., drawing small circles or dashes for many minutes).

2. Disturbance of Thinking
Operational disorders: lowering of the level of generalization. Working with
general attributes is essential for any kind of thinking. A lowered level of
generalization is observable, e.g., in the object-classification task, where concrete
situational thoughts and associations disrupt and intrude into the intellectual
process. For example, a patient might refuse to put a dog and a cat together into
the animal group because they fight. A patient with a lowered level of
generalization would, however, form small groups for very concrete, situational
reasons (e.g., key and lock would form one group). Knowledge about the objects
is limited to concrete and habitual associations.

The lowering of the level of generalization is also investigated with the ex-
clusion-of-objects test, with the pictogram task, and with a test in which the
patient has to explain the meaning of proverbs. A lowering of the level of
generalization is found mainly in oligophrenics (95%) and epileptics (86%) and in
patients with severe forms of encephalitis (70%)-not, however, in cere-
brovascular disease or psychopaths.
Operational disorders: distortion of the process of generalization. This
describes a grossly exaggerated form of generalization. The most abstract
qualities of objects are chosen to characterize them. For example, a fork, a table,
and a shovel are grouped together according to the principle of solidity, cup-
board and sauce pan belong together because both have an opening. In the pic-
togram task a freezing girl is symbolized by two squares because the concept
consists of two words.
A distortion of the process of generalization is, of course, found mainly in
schizophrenics (67%).
Disturbance of the dynamics of cognitive activity. There are three kinds of
these disturbances. First, judgmental inconsistency, which was described pre-
viously as an intellectual disturbance. Second, cognitive lability, a term equiva-
lent to flight of ideas, which is characterized by euphoria and psychomotor
excitation in manic patients. Third, cognitive sluggishness, the opposite of
cognitive lability: patients are slow in thinking and lack flexibility in changing
their mode of work, their opinion, or their activity.
Disturbances in goal-directed thinking. Undisturbed thinking is reality-
oriented and stable, but for a number of schizophrenics this stability of the ob-
jective significance of things has been disturbed.3
There are three kinds of disturbances of goal-directed thinking. First, in multi-
level thinking the patients judgments take place at different levels of abstraction.
Though he may be able to abstract and compare, the level on which he does this is
no longer determined by his goal. For example, asked to classify pictures of ob-
jects, the patient will group some according to their objective prop-
erties (color, material, etc.), others according to his personal tastes and
preferences. Second, ratiocination, .which denotes an inclination to futile phi-
losophizing or mental ruminations. Third, disturbances of the critical aspect of
thinking: When the patients critical evaluation of his behavior and his perfor-
mance are disturbed, mistakes will not be corrected spontaneously. The patient
follows any suggestion, however absurd, made to him (e.g., by other patients); he
is unaware of his mental disturbances and never complains.
Disturbances of Personality and Motivation
The Russian pathopsychologist is oriented toward the experimental study of
cognitive processes, but he concerns himself rather less with the systematic
investigation of personality disorder. There is little interest in the identification
and measurement of personality factors; instead, personality is described in
terms of the individuals needs and interests, and his emotional and volitional
idiosyncrasies as reflected by his behavior. The pathopsychologist also concerns
himself with changes in personality brought about by illness, and he describes
these changes in terms similar to those used by the Western psychiatrist (e.g.,

the patient becomes pedantic in his work, emotionally inert or labile, lacking in
Techniques most frequently used in the investigation of personality include the
satiation test, the TAT, and the level-of-aspiration test.
The motivational structure is an important part of a persons personality and is
thought to be hierarchical. The hierarchy can be changed by changing the
priorities or by adding new motives to it. A pathological change of the motiva-
tional hierarchy is observed particularly in alcoholics (who represent one of the
severest mental-health problems in Russia and whose treatment can be
enforced). The patients personality change is described by comparing his pre-
morbid interests with the ones he has after the onset of the illness (i.e., al-
In their study of the psychology of motivation, the Russians distinguish two
functions of motives. The first function, smysloobrazuyushshara finktsia
(literally, meaning-generating function), I shall call goal-orienting function,
and it refers to a persons awareness of the requirement to achieve a goal (e.g., I
need to hurry if I am to catch the train); the second function of motives, pobu-
ditelnaya funktsia, refers to the stimulating or activating function of a motive.
The pathopsychologist studies the relationship between goal-orienting and stimu-
lating functions of motives. In normal adults the goal-orienting function creates
the corresponding activating function; in children this correspondence between
the two functions is not yet fully developed, while some patients show disorders of
this correspondence (e.g., a patient spent all his money on radio parts but did not
get around to assemblnig a single radio).
A method for the investigation of this disturbance was developed by
Kotchenov.j The subjects (normals and patients)* were given nine tasks, with
varying degrees of difficulty, three of which they had to select and- complete
within 3 min. In contrast to normals, the patients did not take the time to select
those tasks that were least time-consuming and could, therefore, not complete
three of them within the allotted time. They were, however, fully conscious of the
time limit and sometimes even commented on it.


As an example of research projects in pathopsychology, Polyakovs work is

described. Polyakov is head of the Psychology Department of the Institute of
Psychiatry of Kashenko Hospital (2600 beds, 160 psychiatrists) in Moscow. He is
particularly interested in the differences in cognitive functions between
schizophrenics and normals.2 The three cognitive functions investigated by him
and his nine colleagues are speech, thinking, and perception. He is interested in
how they are disturbed and structurally changed, and he has developed a number
of techniques for this purpose. So far, they have produced one factor, called the
selective actualization of knowledge. In speech, as well as in thinking and per-
ception, previous experience and knowledge play an important part. For instance,
we perceive by comparing sensory input with a number of hypotheses about what

*Typically it is not mentioned what kind of patients participated in the experiment


the percepts may be. These hypotheses constitute the actualized part of our
In schizophrenia, Polyakov says, an unnecessarily wide range of knowledge or
hypotheses is actualized; normals actualize fewer but relevant hypotheses,
schizophrenics actualize a wide range of relevant and irrelevant knowledge or
hypotheses. These differences can be demonstrated in a variety of experiments
for all three cognitive functions.
In an experiment on perception, for example, the subjects (normals versus a
group of schizophrenics) listened to sentences recorded on tape. The last words of
the sentence were hard to understand because of a loud white noise. For example,
the subjects heard the sentence: The car is going very fast. The word fast was
overshadowed by noise and was difficult to understand, but it was a word to be ex-
pected in that context. On the other hand, in the sentence, The photographer
took a very nice basket, the word basket was unexpected.
Ten sentences of the first kind and 10 of the second kind were randomly pre-
sented to the subjects. The subjects knew that the last word would be difficult to
understand, and in the process of listening they tried to predict what it might be,
i.e., they actualized their knowledge. Results show that normals do better than
schizophrenics in the easy kind of sentences; however, only 5% of all normal sub-
jects understood the difficult sentences, while 30% to 35% of the schizophrenics
gave the right answer. These results support Polyakovs original hypothesis that
schizophrenics actualize a wider range of knowledge.
In an experiment for visual perception a picture was projected out-of-focus
onto a screen. While the subject was trying to recognize the picture, it was
gradually brought back into focus. Some pictures were of common objects,
others were unusual or unexpected. Again, schizophrenics did better than nor-
mals in recognizing the unusual pictures. In experiments using a tachistoscopic
presentation rather than blurred pictures, similar results were obtained.
Another method used in this context is similar to the similarities subtest of the
WAIS. The subject is asked, e.g., What does a shoe have in common with a
pencil? The two objects should be as different from each other as possible. Nor-
mals would find no more than two or three common characteristics, while
schizophrenics find three to five times more, some of them quite unusual, like
they wear out, leave tracks behind, make noises, etc. Normals know, of
course, that a pencil makes a noise on paper, but it does not come into their
minds when thinking of a pencil; this characteristic of a pencil is not actualized.
In the exclusion task, a schizophrenic is able to suggest several ways of
excluding an object and also several reasons, because he actualizes more charac-
teristics of each object.
In his present research, Polyakov correlates the psychological factor of
decreased selectivity with neurophysiological factors like EEG readings and
evoked potentials. The hypothesis is that if the brain is operating uneconomically,
employing a great amount of unnecessary activity, and if many more ideas are
activated and more information has to be screened, this should be demonstrable
physiologically. To test this hypothesis, Polyakov takes EEG recordings from
different parts of the cortex. Depending on whether the subject solves an auditory
or a visual problem, different areas of the cortex are more active than others, and

this is shown by the EEG amplitudes. In one experiment the subjects were pre-
sented with lights of different colors and responded by pressing buttons. Com-
paring the results of schizophrenics with those of normals, Polyakov has found
that schizophrenics do show increased activity in more areas of the brain than
If schizophrenics actualize more knowledge, this should sometimes be an ad-
vantage to them, and it should be possible to find some tasks or problems that
they can solve better and more quickly than normals. In one such task, scales are
put on the table with a weight in one scale pan, and the subject has to put a
number of things into the other scale pan to balance them. On the table are
placed a fork, a candle, a key, a bottle, a few coins, a box of matches, a comb, and
various other things. The subject is to balance the scales in such a way that after a
certain amount of time in balance the side with the weight goes down. Normals
find this task very difficult; the schizophrenic actualizes many more characteris-
tics of all objects, and this helps him to balance the scales with the help of the
candle, which he lights.
The relationship between genius and madness is a popular topic. Polyakov
thinks that the same factor is present in schizophrenics and in highly gifted people
who conceive unusual ideas. Polyakov is now investigating whether this factor is
inherited. He has tested the normal parents of schizophrenics, and he has found
this factor of decreased selectivity in a very high percentage of these parents. At
present he is conducting a twin study for the same purpose.

Pathopsychologists play an important role in the Soviet psychiatric services;

this role is, however, limited in that they are excluded from participating in the
treatment of patients. I This limitation (considering the doubtful diagnostic value
of testing) would be regarded as an unacceptable waste of psychotherapeutic
potential in the West.
Soviet pathopsychological tasks seem to us to be somewhat old-fashioned,
and they do not meet the methodological requirements of Western tests. Many
originate from prewar (particularly German) psychological theories (Gestalt
psychology), and neither the 12 years of political curtailment nor the deplorable
lack of scientific communication between East and West nor the ideological
restrictions still operating helped the development of Soviet clinical psychology.

I am indebted to Miss V. Labrum for editing the paper and to Professor Zeigarnik, Professor
Luria, Professor Nebylitsyn, Dr. Yu. F. Polyakov, Dr. Khomskaya, Dr. Danilova, Dr. Wasserman,
Dr. Karvasarski, and many other psychiatrists and psychologists in Moscow and Leningrad for their
friendly help and hospitality.

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