Psychopathology

PSYCHOPATHOLOGY, or the general theory of mental diseases, in contrast to the specific theory of mental diseases (clinical psychiatry), sets as its task the study of the fundamental regularities in the emergence and development of psychotic states, their interaction with the soil on which they flow and develop, and in light of this, aims to find the foundation of this or that pathological process in mental life, lying in neurobiological disorders of varying degree, character, and quality. This definition of the goals and tasks of P. is by no means universally accepted. In its essence, this definition repeats that of one of the founders of modern psychopathology—Jaspers and Birnbaum. The significant majority of authors believe that P. completely coincides with clinical psychiatry and is merely the 'semiotics of mental diseases.' Even the latest German 'Manual of Mental Diseases,' through its editor Bumke, speaks of the impossibility, for now, of separating the tasks of P. from clinical psychiatry. Among Soviet researchers, V. Osipov defines 'the content and task of pathological psychology or psychopathology' as 'the study and description of processes of sick mental activity.' 'The psychopathological material, in the opinion of V. Osipov, covering and including all signs of mental content, belongs to the general symptomatology of insanity, as particular to general.' Thus V. Osipov further narrows the task of P., placing it within the framework of pathopsychology and thereby completely detaching it from the tasks of studying the soil, structure, and dynamics of psychoses. This discordance in the fundamental definition of the scope, tasks, and goals of P.—is not accidental, since P. has not yet developed generally accepted concepts and designations and has not defined the boundaries of its subject of research. On the one hand, it rests on physiological pathology, from which it abundantly draws material for studying the foundation on which this or that psychotic pictures unfold (psycho-sensory and psycho-motor disorders in the broad sense of the word), on the other hand, with the new quality of its research material, representing pathological changes of a special property of highly organized matter, it connects with psychology in that part of it which deals with the study of the psychological features of processes occurring under conditions of disrupted integrity of the organism, i.e., specifically pathopsychology. In all this, one should stop at the definition put forward by Jaspers, Birnbaum, and partly Kretschmer, since this gives the first possibility for establishing, in the process of accumulating facts, their systematization and the actual boundaries of the science. The goal that the psychopathologist sets for himself, most expressively defined by Jaspers in his 'General Psychopathology.' He says: 'We want to know what and how people experience... we want to investigate not only the experiences of people, but also the conditions and causes that produce them, the connections in which they (these experiences) stand, and their essences as they are objectively given.' These broad goals contemporary P. resolves with the same methodology that exists in contemporary clinical practice. Its basis is structural analysis—of this or that psychopathological phenomena, conducted on a broad biological basis, an analysis that in its essence uses data of clinical observation in comparison with data on the development of this or that syndrome (analysis of this or that pathological symptom-complex based on the most detailed anamnestic study of the entire personality). This gives the analysis of this or that symptom-complex a historical character, although in practice of study it is usually narrowed by the necessity of cutting off a number of circumstances that go beyond the limits of the tasks directly set by the research. Examples of this are numerous. Let us cite the most striking ones: thus, in investigating the problem of delusion-building, it is necessary to consciously push into the background of attention the neighboring problem of delusion; this becomes especially clear where we deal with the so-called paranoid delusion-building, with the systematization of false and empty from a logical point of view inferences, but in their essence fed by a certain affective mood (the so-called delusional mood); here analogizing with delusion, finding identical psycho-logical mechanisms will give nothing for clarifying the problem, except perhaps to show the similarity of individual and partial formations lying on the surface of phenomena. Delusion-building and the mechanism of delusions in their foundations are fundamentally different in quality, although in their expression they may coincide in individual moments. Mixing them into one, despite all the temptations in terms of the breadth of coverage of phenomena, leads to misunderstanding the difference in quality of pathological and non-pathological formations. The example given, in our opinion, points to the necessity of such cutting off, a necessity lying at the basis of the initial stages of any study—in delimiting the tasks of research. Such delimitation of research tasks is even more necessary where one has to deal with the cardinal problems of P., for example, with the problem of the interconnection of a psychotic state with the soil on which this state developed and flows. Without studying this soil, its features, both in terms of predisposition, potentially laid in it as a whole, and in terms of the character of the structure and dynamics of its individual parts, it is impossible to solve the entire task. And yet, even the mere posing of such a research raises a whole series of separate tasks, in the multiplicity of which the main thread of research may be lost. That is why here too this task should, at the initial stages of work, be delimited by quite precisely marked milestones, following which one can later uncover all the complexity of the interconnections of the problem posed. An example of this may serve at least the posing of the question about the character and psychosis in their interaction. The solution of this question, as it is given in contemporary P. (in particular the doctrine of the so-called schizoid and epileptoid character and its relation to schizophrenia and epilepsy), undoubtedly sins by erasing the boundaries between pathological and non-pathological (despite the conditionality of these concepts), transferring certain regularities into a plane where they no longer have their application. Here we mean the mixing of biological evaluations with social ones and, in connection with this, the washing out of the social. The indicated difficulties in solving a number of psychopathological tasks lie in the essence of that stage of growth of this discipline, which is determined by the character of the initial processing of the research material and its systematization. II. by the very nature of its material represents the area of medical knowledge, the most difficult, most remote from the anatomical-physiological basis of this knowledge and at the same time one that must rest upon it. Its historical fate (see Psychiatry) is closely intertwined with the fate of the ideologies of certain socio-economic formations. Touching upon the most 'general' problems, P. could not but be captured by the struggle of the two main philosophical directions—materialism and idealism. This discipline necessarily reflected in itself the struggle of certain ideological formations of corresponding class meaning and character both within the medical foundations on which it develops and on the broad arena of the general philosophical struggle. At all stages of its development, from Esquirol, Morel, Magnan, Emminghaus, Lotze, Maudsley, Griesinger, Meynert, Wernicke and up to Kraepelin, Kretschmer, Jaspers, Birnbaum, Gruhle, Berze, Bleuler and others, it reflected definitely expressed, specified by the research material class tendencies of this or that ideological formation and in turn its material served and serves this or that ideological formations and currents. For illustration it is enough to recall the fate of the concept of 'overvalued formations,' put forward at the time by Wernicke. The latter united under this concept a group of phenomena having a character bordering between pathology and the so-called norm. He believed that the already formed conditional connection between a nursing mother and child is an overvalued formation, i.e., such an affective experience that stands in the center of consciousness, commands the personality and dictates to it rules of behavior. Wernicke showed that it is precisely in this 'being captured' that the essence of overvaluation lies. From this it was relatively easy for him to step over to the side of throwing bridges into pathology. Precisely thanks to being captured, passionateness, affective rigidity such formations can develop into a system of delusions or at any case bear all the formal signs of delusion-building. Wernicke at the same time emphasized that in this case the usual, normal paths that are present in any human experience are used. It is characteristic that in the future the fate of this concept undergoes a number of changes, namely: 1) the constitutional-biological direction in psychiatry naturally tries to fit such formations into the framework of the preparedness, preformation of human character. From this point of view it is usual to assert that overvalued formations are inherent in schizoids and epileptoids due to the complexity and viscosity of their psyche.

This is precisely why supporters of this direction tend to attribute to schizoids, and especially to epileptoids, their own unique sense of property. It turns out that epileptoids are the bearers of the sense of property, they are the complete expression of this complex and thoroughly class-based formation. In the USSR, this viewpoint was defended by Gannushkin, Krasnushkin, and in a primitively naive form by Geyer. From what has been said, it is clear in what vicious circle the interpreters of the 'sense of property' are caught. What should be at the center of attention is forcibly excluded from the circle, namely, understanding the origin of property, the concrete conditions for its development as a 'sense,' i.e., its realization on corresponding individual material, a realization in which this material nevertheless remains subordinate to a series of phenomena of social development, although not remaining indifferent to the intensity of the formation of this 'sense.' In short, the interest that ignites these feelings and lies at the basis of the subject's economic position is excluded from the circle of reasoning, and the sense of property, after such an operation, is given priority as a fundamentally biological trait, pre-existing in man, and the struggle against it is thereby doomed to failure. This system of views has been shattered to pieces by the practice of our reality, which transforms people, strips them of the 'old Adam.' 2) An attempt is made to explain these overvalued formations based on the principles of 'mass psychology.' A broad historical canvas of a certain epoch is drawn, and against this background it turns out that these mechanisms, 'overvalued formations,' act as determining the course of history. Such an attempt was undertaken by Strausky, who tried to explain the essence of the coalition of 'agreement powers' against the 'central powers' during the imperialist war precisely by this mechanism of 'overvalued' hatred (Uberwertiger Hass). Such an explanation of the historical process is merely another side of the approach already analyzed above. It only differs in that the author proceeds from the 'universality' of phenomena; the explanation of the latter remains unchanged. The illegitimacy of such an explanation is self-evident, as it explains nothing at all, but only confuses matters. We have cited this example in order to show how P., on the one hand, serves certain ideologies (this is clearly evident in Strausky's understanding of overvalued formations), and on the other hand, how it itself feeds on certain ideological currents, rephrasing on its own material the language of class struggle (on the example of the interpretation of overvalued formations by some domestic constitutionalists in psychiatry). These tendencies permeate the entire history of P., which in essence becomes the arena of collision of certain worldviews. It is sufficient to note that Kant's ideas about the categorical imperative still dominate in a number of psychopathological evaluations (Kraepelin, Lange, Kretschmer, Schröder, Birnbaum, etc.), that Bergson's ideas still most vividly nourish psychopathological thought (Minkowski, Mourg, Claude), that the idealist-mystic Scheler builds his theory of 'rental hysteria' based on P., and in turn nourishes a number of psychopathologists with this theory (for example Kurt Schneider), that Machist theories, which have flourished so abundantly in Western Europe, are readily taken up by psychopathologists (Marcuse, Mayer, etc.) and with special care use psychopathological material (Wittgenstein, Reiner, partly Ressel), that positivist-pragmatic theories are immediately reflected in a number of psychopathological theories (MacDougall, MacCurdy, partly Potzl, Hoff, etc.). Even such a simple enumeration indicates how intimately P. at any of its stages is connected with the basic philosophical systems reflecting a certain alignment of class forces. That is why the history of P., including its modern stage, can be understood only by understanding the essence and basis of those ideologies of which it is a peculiar expression. It goes without saying that the peculiarity of this expression consists in its specification, in translating the said struggle into the language of psychopathology. The acuteness of this struggle does not diminish from what has been said. The history of P. is essentially the history of psychiatry, given in its concentrated form. Insofar as P. represents the theoretical apex of psychiatric knowledge of a given epoch, the main tendencies of development of this discipline and their sources, lying in the depths of class struggle on the ideological front, are only more clearly marked in it. We will indicate only schematically that the latest stage in the history of P. begins with the times of Griesinger, Meynert, Wernicke, who in their main doctrine reflected the ideas of 18th-century French materialism. Griesinger's position that 'mental illnesses are diseases of the brain' became a commandment for subsequent generations and until the triumph of the nosological direction reigned supreme. This did not prevent, as is characteristic of vulgar materialists, the assertion of a number of idealistic positions, which reached particular expressiveness in the period when this primitive materialism exhausted itself. We have in mind the epigones in the person of Kleist and his students, who mechanically reduce all mental life to the subjective expression of the functioning of certain neurological systems and at the same time asserted the positions of the 'deep personality' (see Constitution, Personality).-The nosological direction, in the person of the brilliant master of psychiatric research Kraepelin and his school, gave impetus to the so-called constitutional-biological direction on the one hand, and the psychological on the other. It is characteristic that it was precisely here that Kantian and neo-Kantian ideas were applied to specific material. Let us refer at least to Kraepelin himself, who based his doctrine of the simple form of early dementia on the evaluation of ethical behavior, thereby elevating to a peak the doctrine of Prichard on moral insanity. The ethical defect, which is predominant in Kraepelin's doctrine of the simple form of early dementia, is nothing other than a violation of Kant's categorical imperative, nothing other than an excursion by the psychiatrist into that philosophical system which dominates him. It is worth noting the vitality of this Kantian leaven in P.: at the modern stage it revives again under the guise of the 'anethical symptom complex,' described by Albrecht as a residual phenomenon after encephalitis, mostly in children. Kantian and neo-Kantian ideas reach particular expressiveness in Kretschmer, Lange, and Maucz. Here we have before us the entire complex of idealistic assertions, up to the unknowability of the essence of phenomena, up to the destruction of the incomplete, although materialistic in its basis, formula of Griesinger-Wernicke. Kretschmer and his school assert that mental illnesses are diseases not of the brain, but of the entire organism. This formula has widespread application in the USSR as well. What has actually happened in the replacement and what is its significance? The replacement occurred in the direction of analyzing the 'whole' and emphasizing this 'wholeness.' It goes without saying that the organism as a whole is the bearer of mental illness, it goes without saying that the brain is not always primarily affected. But the meaning of this replacement is by no means to emphasize the one-sidedness and narrowness of Griesinger's assertion. The meaning is that this formula corresponded much more to the demands of the epoch, that it revealed the possibility of considering phenomena in the plane of 'panpsychism.' Reflecting in form the forward movement of psychopathological thought, this formula in essence focused attention on the priority of 'wholeness,' on the predominance of 'deep' forces in the dynamics of psychosis, on pushing aside the leading link—the central nervous system. At the same time, it should be borne in mind that the solution of a number of private tasks undoubtedly moved forward. Thus, the question of constitution, of character, temperament and the relationship of their peculiarities to the course of psychosis, of the so-called primary and accessory symptoms in psychosis (Bleuler), was raised in all its breadth. The period of 'brain mythology' naturally narrowed the understanding of the picture of psychosis, squeezing it between the external description of individual symptoms and their supposedly direct neurophysiological basis. In this direction, correcting the Griesinger-Wernicke formula made it possible to more widely carry out correlational connections in different directions. The main thing that followed from such an understanding was the expansion of the boundaries of understanding of mental illness, including here a number of transitional forms, understanding mental illness as a peculiar reaction of the entire organism to a number of 'internal' and 'external' disharmonies, and finally understanding the movement of this illness in the light of the restructuring of the entire organism (metabolism, vegetative-endocrine system, uncovering latently predispositions, etc.). But at the same time, one must not forget that in this process the leading role of the moment of lesion or weakness of the brain, as specifically determining mental illness (in the sense of illness of the entire organism), was pushed aside, and this inevitably led to the position of appealing to panpsychism, to the mysterious 'deep' in personality.

Proceeding from this, it was not difficult to arrive at such conclusions as, for example, those reached by Kronfeld, who believed that the schizophrenic process merely reveals the latently present, special worldview inherent in the schizophrenic, that autism is a property of human nature, and that 'royal feasts in solitude' are the true nature of man. Following this path, it was easy to arrive at the tempting generalizations of Kretschmer, who psychiatrically dissected all of humanity, including its brilliant variations, into schizothymics and cyclothymics, pointed to the innumerable nuances between health and disease, and thereby attempted to erase any boundaries between health and disease. In Kretschmer, the issue is only about the quantitative intensification of certain features lying in the characterological series, and not about a qualitative push that transfers a person onto the rails of pathology. This peculiarly applied tendency in the field of psychopathology toward 'holistic' study, although having much that is valuable and correct at its core, in the nature of its development and implementation covered up a retreat to idealistic positions, toward vitalism. This is evidenced by Bleuler with his theory of psychoids (see Psychoid), and to some extent by Berze with his theory of intentional and impressional zones, and Minkowski with his theory of the disturbance of the 'function of reality' in schizophrenia, and a number of other authors. This stage brings us very close to the present, to the state of psychopathology characterized, on the one hand, by the undeniable growth in the significance of facts obtained through observation and experiment, and on the other hand, by the intimate kinship that is even now noted between the system of views of modern imperialism (the era of the collapse of capitalism under conditions of a general crisis) and certain psychopathological theories. This kinship was noted above, we will now only point out its peculiarities. It would be absurd to assert that we are witnessing a direct and immediate transfer of certain philosophical views into psychopathology. In reality, the matter is much more complex, and this complexity consists in the following: psychopathology cannot but develop on the basis of absorbing the achievements of neurophysiology, endocrinology, anatomy and morphology of the nervous system, biology in general; it tries to use all these achievements in its own field [an example of which can be the experimental works of Berger and others on mescaline poisoning, the attempt to isolate the pathophysiological syndrome of automatism described by Clérambault, works in the field of optical disturbances - Petzold, Hoff, Schrider and others, works in the field of so-called neuropsychiatry (agnosia, apraxia, aphasia) - Kamin and Hoff, Ehrenfeld, Gurevich, Kroll, etc.], on the other hand, a broad movement has already emerged toward the study of the life of drives and their volitional framing, connected with characterology, with the posing of problems covering the complex areas of interrelations between psychosis and personality (Kurt Schneider, Karl Schneider, Hildebrandt, Gruhle, Utitz, Klages, in our country Fridman and others). Here the accumulation of facts is extremely significant, and the task is set to connect these facts into one coherent whole. And it is here that a number of teachings from the arsenal of modern philosophy, which can show and construct this connection for certain purposes, cannot but be borrowed. This is precisely how one should understand that intimate kinship with philosophy, mainly with militant idealism, which characterizes modern psychopathology. In this respect, the fate of one of the greatest psychopathologists, the founder of the systematization of psychopathological facts, Karl Jaspers, is extremely telling. His 'General Psychopathology' is undoubtedly one of the classical works in psychiatry, whose ideas have nourished and will continue to nourish generations of psychiatrists, but his system of views is thoroughly idealistic. The matter is not that he stands on a purely phenomenological point of view of Husserl, not that he appeals to this pillar of German idealistic philosophy, in its pre-fascist form. The matter is that Jaspers tries to philosophically comprehend the basic psychiatric problems and in this respect finds no other system than the idealistic one. This is evident from the basic point of his psychopathological worldview. Unlike a number of his predecessors, Jaspers separates processes from development, in turn dividing development into a number of partial systems (phasic, episodic and proper development). In this division, Jaspers is undoubtedly right, since thereby he tries to draw some line between the moment of pathologically acquired traits and the moment of pathological development. Such a line, clinic, mainly in the person of Kraepelin, had already been groping for, but Jaspers managed to theoretically formulate and express it. This alone makes Jaspers' name in psychiatry historical. The exceptional clarity on this cardinal issue served as the reason that after Jaspers no one even thinks of reconsidering this issue - it is resolved. But, turning to development, or rather developments, Jaspers immediately takes a wrong path. Considering that the moment of development, defined objectively, is the comprehensibility of experiences, their fitting into the framework of psychologically permissible, Jaspers takes up a position of subjectivism, a position that leads him to solipsism. Comprehensible psychologically, according to Jaspers, is everything experienced in the psyche within its indivisibility, within the 'unity of the mental stream'. By this, Jaspers, with all his insight and subtlety, cuts off his own paths to understanding true development as a moment of personality formation, as development with its interruptions, jumps (and therefore from Jaspers' point of view, incomprehensibility). In this latter, Jaspers met with corresponding criticism from Kretschmer, who very aptly remarked that Egyptian hieroglyphs were also incomprehensible until they were deciphered. Consequently, according to Kretschmer, the matter is not at all in the principle of division into 'comprehensible' and 'incomprehensible', but in the principle of deciphering this 'incomprehensible'. In practice, the argumentation based on 'comprehensible' and 'incomprehensible' usually reduces to layman's psychological judgments in which ethical evaluations play the leading role. This is an inevitable consequence of Jaspers' division based on comprehensibility and incomprehensibility. It is not out of place to note here that Jaspers completely rejects¹ the resolution of the psychophysical problem, asserting that the views of supporters of parallelism and interconnection can find confirmation in any empirical fact. Attaching great importance to constitution, Jaspers at the same time rejects, as has been said, the psychophysical problem, the principled position with respect to which would have clarified to a large extent the author's views on constitution. All the above leads us to the conclusion that the main philosophical sources feeding Jaspers were the ideas of neo-Kantianism in their phenomenological variant. It is characteristic that these ideas exerted a decisive influence on psychopathology precisely when it was already armed with a significant arsenal of clinical facts, observation, when the questions related to the posing of the problem of the course of psychoses had already lost their sharp edge. It is further characteristic that these ideas found fertile ground in psychopathology (especially along the line of understanding the form and content of psychoses) precisely when the nosological direction attempted to take the path of compromise with the syndromological, when the doctrine of reactions (Bumke, Bonhoeffer) became dominant in psychiatry. It is precisely at this stage of analysis of clinical facts that Husserl's phenomenology, considering phenomena in their formally closed self-sufficiency, could have received such development. Thus, in psychopathology a sufficiently favorable soil has ripened for constructing connections between a number of facts in a certain direction. It is not out of place to recall in passing the fate of this original and major researcher. Jaspers has now left psychopathology, disappointed in his attempts to give a systematic system of psychopathological views, and has completely moved over to philosophical work. In this latter, he occupies positions of neo-Hegelianism. Since then (Jaspers' book first edition appeared in 1913), no attempt has been made at a systematic and systematic exposition of the foundations of psychopathology. All works in this field, extremely valuable in their particulars, revolve around individual problems, without attempting to give a general formulation, similar to the one brilliantly given by Jaspers. The period after Jaspers is characterized mainly by a keen interest in the problems of medical psychology, and in connection with this, in the questions of the relationship between premorbid personality traits and psychosis. The main works in this direction go along the constitutional-biological path and concern mainly schizophrenia and manic-depressive psychosis. Along with this, the clinic of progressive paralysis treated with malaria, as well as the clinic of epidemic encephalitis, provide many themes and considerations on questions related to the pathogenesis of a number of other diseases. In this direction, the considerations of Krisha on the so-called exogenous form of schizophrenia, of Claude on organic schizophrenia, and of a number of Dutch psychiatrists (Rumke and others) on the isolation of different groups of schizophrenia are particularly interesting.

To this category can also be attributed the futile searches of Berze and, to some extent, Grube for the basic symptoms of the schizophrenic process. All this lively activity, addressing a number of private but extremely essential problems, utilizes Birnbaum's attempt to isolate pathogenetic, predispositional, and plastic elements in the structure of psychosis. This attempt, although flawed by the schematic dissection of a single clinical whole, is of great interest at least from the point of view of general pathology (an attempt to move away from the mechanical dissection into exogenous and endogenous factors, which still dominates in P.). Overall, however, this attempt is based on a peculiar application to P. of the principles of 'holistic psychology' in the sense of identifying so-called systemic lesions that can have different characters, meanings, and significance. Along with this, in recent years P. has reflected works touching on the area bordering between neurology and psychiatry. This refers to works conducted mainly by the Vienna school under the leadership of Petzels, at a new stage reviving the ideas of Wernicke. They concern primarily the problems of perception and representation in their pathological aspect. To this category also belong works concerning the violation of the so-called body schema, metamorphopsia. The propagation of these works in the USSR was undertaken by Gurevich (his works on the study of the so-called 'interparietal syndrome'). A special place is occupied by the most original attempt of Monakoff and Murga to give a comprehensive neurophysiological explanation to all psychopathological problems. This attempt represents a bizarre mixture of mechanistic and idealistic assertions, firmly linked by the vast experience and incomparable erudition of the authors. In this work, Monakoff's thoughts on the vital principle 'horme,' the theory of instincts (including the religious instinct and the death instinct), and the abrupt decrease in the schizophrenic process to previous stages of development find their completion. This work has received a detailed evaluation in Soviet literature and serves as the brightest example of how the dominant ideas of a certain socio-economic order subordinate not only the ordinary scientist but also the greatest representative of his discipline, forcing him to adapt all his clinical experience along the line of complete and unconditional subordination to these dominant ideas (in this case, a mixture of Bergsonism with Spencerianism). Non-European P. develops mainly along psychoanalytic paths (Goll, White, Hart), completely repeating the grossest errors of the European psychoanalytic school, and has no particular influence on the movement of psychopathological thought. In our USSR, Osipov, Gilyarovsky, Gurevich, Geymanovich, Shevaley, Vygotsky, and Vnuk show great interest in the basic problems of psychopathology. For a time, Rosenstein was interested in P., attempting to propagate certain ideas of Jaspers (the so-called understandable connections in psychosis, the concept of development, etc.). Each of the mentioned workers, in this work, reflects his general interests in psychiatry, developing one or another area of P. under this sign. But it must be said that to this day Soviet psychiatry has not, despite the existence of individual valuable and serious experiments, engaged in the systematization of views based on Marxist-Leninist methodology, has not undertaken a serious attempt to construct a system of P. This task remains urgent and necessary and can be solved within the framework of modern comprehensive clinical and experimental study of the patient. We are undoubtedly witnesses and participants of the enormous enrichment of P. with empirical and experimental material. Along with this, we are witnesses of constant attempts to resolve individual major problems of P. through unique constructions of a purely speculative order (works of Berze, Marxus, Eliasberg). All this should not deter us: neither the vastness of the empirical material nor the speculative nature of individual attempts in solving the most difficult problems. What is important and significant is that P. has passed the age of naive constructions of the period of 'brain mythology,' although it has by no means stepped beyond the limits of accumulation and systematization of facts, often designated by various concepts. It is sufficient to note in this direction the chaos that reigns in characterology (see Character, Psychopathies, Psychology), the naive localizational point of view that manifests itself in attempts to resolve the pathology of spatial and temporal sensations, violations of the 'body schema,' etc. Undoubtedly, in the further development of science, we will have the opportunity to define facts more precisely and to represent their diverse connections more clearly. What is important is that the tendencies in the development of psychopathology are moving in the direction of orientation toward neurobiology in the broad sense, on the one hand, and toward characterology on the other. It is here that the main difficulties lie, which at first glance seem insurmountable. It is here as if the dual path of development of P. is laid. But this is not the whole truth. The point is that P. grows on the basis of clinic with its inevitable orientation toward neurobiology, enriched by the inexhaustible material of characterology. This path of development of P.—not from the syndrome to the soil that produced it, but from the soil to the analysis of the syndrome that grew on it and the peculiarities of this growth—allows us to outline more clearly and distinctly the path to resolving the most important problems of psychiatry. In this direction, only works of a comprehensive nature (clinical-psychopathological, psycho-clinical, physio-clinical, etc.) will be able to raise these problems. The existing experience (the study of P. of dementia in malaria-treated paralytics, encephalitics, schizophrenics, the study of the peculiarities of psychoses in oligophrenics, the analysis of experimentally induced psychotic states, the structural consideration of exogenous reactions with respect to the nervous system, etc.) justifies the attempts at systematic isolation of psychopathology.