CONSTITUTION

From Big Medical Encyclopedia

CONSTITUTION (Latin. constitutio state, the device) — set of rather steady morphological and functional properties of a human body caused by heredity (genotype), and also long, intensive influences of the environment. These properties can define features reactivity of an organism (see).

History

the Founder of the doctrine about To. Hippocrates distinguishing several types To is considered. (good and bad, strong and weak, dry and wet, sluggish and elastic). The principles of division of people into constitutional types offered them on a constitution and to temperament (see) did not lose value still. K. Galen paid the main attention to the characteristic habitus (see) — sets of the outside signs characterizing a structure of a body, appearance of the person and his predisposition to diseases. The scientific Middle Ages did not make an essential contribution to further development of problem K.

In 18 century scientific, following Hippocrates, divided people into groups on features of temperament: To. sanguine, flegmatichesky, choleric, melancholic. In 19 century in the doctrine about To. the morphological, descriptive method dominated; features of habitus were the basis for division of people into constitutional types.

Representations about To. at the beginning of 20 century differ in a big variety though features of a constitution remain the main criterion of various classifications. The close attention was paid to communication of a constitution with temperament and character. Especially great influence on development of the doctrine about To. rendered E. Krechmer's views. Three main constitutional types were allocated to them: leptosomny (asthenic), athletic and pyknic. According to E. Krechmer, schizoid temperament, pyknic — cycloid, athletic — epileptoidny temperament is inherent in leptosomny type.

In 20 century the extreme points of view on a role of heredity were outlined in definition of constitutional properties of an organism. In a basis of classifications To. the person the various principles and indicators were put. So, Yu. Tandler (1913) identified To. with a genotype (To. genotypic); views of Yu. Tandler and his followers formed the basis of one of the directions in the general etiology — constitutionalism. Unlike this Sigo (S. of Sigaud, 1914), based on the doctrine Zh. Lamarck, believed that To. forms preferential in the course of ontogenesis, especially at children's age, owing to an unequal training of bodies and systems at different people; it allocated cerebral, respiratory, muscular and digestive types K.

In 1940 Mr. Sheldon (W. The N of Sheldon) offered the original principle of classification of constitutional types — the accounting of preferential development of derivatives of one of germinal leaves; he distinguished ectomorphic, mesomorphic, endomorphic types K. Sheldon's ideas exerted a great influence on development of this problem in the USA and England.

On distinctions of a bone skeleton Ashner's classification is constructed (V. of Aschner, 1924): narrow, average and wide constitutional types.

In some classifications To. the main attention was paid funkts, to signs. So, Eppinger and Hess (H. Eppinger, L. Hess, 1910) suggested to divide people on simpato-and vagotonik, Pende (N. Pende, 1930) — on dominance of function of this or that closed gland (e.g., disterioidny and hyper thyroid To.). Wang-der-Horst (Wan der Horst, 1924) noted distinctions of «mental speed», under the Crimea he understood the speed of perception, thinking and action at different people. Lampert (N. of Lam pert, 1948) chose criterion for division of people into constitutional types the speed of reactions of an organism to external and internal irritants (a dermographism, adrenalinic test, etc.). The type A, across Lampert, is characterized by the slowed-down and weak reaction, type B — the bystry and more expressed reaction, and the type C holds average position. The account funkts, features of an organism is very important for classification of constitutional types, however definition only some funkts, are not enough indicators for the characteristic To. person.

Domestic scientists made an essential contribution to development of the doctrine about the constitution. S. G. Zybeliya described four types of a constitution of the person corresponding to the main types of temperaments according to Hippocrates, emphasized a role of the environment («education») in formation of a somatotype. E. F. Aristov (1806 — 1875) divided people on a structure of muscular, connecting and nervous tissue into two types (large and fine-fibered).

V. P. Krylov at the end of 19 century described types which later and, obviously, irrespective of it were described by Sigo and E. Krechmer. A. A. The pilgrim (1926) proved great value of connecting fabric for reactivity and resistance of an organism and suggested to divide on this basis people into 4 constitutional types: asthenic type (fine, gentle connecting fabric); the fibrous type differing in dense fibrous connecting fabric; pastose type — friable connecting fabric; lipomatous type — dominance of fatty tissue. V. N. Shevkunenko (1929) divided people into two main types of a constitution — dolikhomorfny and brachymorphic; the first is called by it perfect, and the second imperfect.

M. V. Chernorutsky (1928) described three constitutional types — an astenik, a normostenik, the hypersthenic; in the subsequent he did a great job on studying biochemical, and funkts, the features inherent in each of these types. E. A. Bogdanov (1923) for the first time put forward the so-called domestikatsionny theory in the doctrine about To., based on a parallel of influence of domestication of animals on them To. and social living conditions in a lineage on the person. In its theory the role of social conditions in formation of constitutional types of the person is emphasized; it allocates two types K. — primitive and cultural. N. A. Belov (1924) offered the classification of constitutional types based on assessment of functioning of hemadens; to in total them it is allocated apprx. 50 types that does classification very bulky.

Great popularity, especially among anthropologists in the USSR, classification of constitutional types but to external signs used, to-ruyu V. V. Bunak offered (1924, 1931); it allocated the following anthropometrical indicators: size and shape of a thorax, character of epigastric area, form and size of a neck and back, extent of development of muscles and adipopexis, shape of a stomach. On this basis it allocated 4 constitutional types: to likhoplastichesky, mesoplastic, brakhiplastichesky, subplastic.

A big role in development of representations about To. played I. P. Pavlov's doctrine about types of a nervous system which he installed in an experiment on animals. According to the main characteristics of property of a nervous system of animals to some extent match the types of temperament of the person described by Hippocrates. On the basis of the accounting of force, mobility and steadiness of the basic nervous processes (excitement and braking) the following oozes were emitted: strong, balanced, mobile (sanguine person); strong, balanced, inert (phlegmatic person); strong, unbalanced, impetuous (choleric person); weak, characterized by weakness of both exciting, and brake processes (melancholiac). On dominance of the first or second alarm systems at people, unlike animals, it was offered to allocate two more types: art and cogitative.

Classification

In the world literature is absent the standard theory and uniform classification of constitutional types. According to Williams (R. Williams, 1960), division of people into constitutional types in general is impossible since individual distinctions of structure, the sizes and function of bodies, including also activity of enzymes, are very big that is defined by a genetic gradient. On any of these indicators typical statistical distribution is found that assumes existence of a large number of transition types. Other researchers (B. of X. Hit and soavt., 1962, 1968), recognizing existence of intermediate options, nevertheless try to allocate the main types K., being based on the following main indicators: 1) anthropological (constitution, growth, weight, rostovesovy indexes, sizes of different parts of a body); 2) anatomo-morphological (structure of bodies and fabrics); 3) functional (combination of function of a nervous system to feature of function of connecting fabric, closed glands, etc.); 4) clinical (predisposition to diseases, anomalies To.); 5) psychological (psikhol, features of people); 6) combined (correlation between a structure of a body, function of different bodies and mentality). The methods based on the combined principle of a research K are considered as the most productive. the person, implementation to-rogo requires collecting big information and its processing on the COMPUTER. However so far such methods are in a stage of development and are used in special scientific research. Therefore still did not lose practical value the principle of division of people into types K. on a constitution using for this purpose different measurements and the subsequent mathematical processing of the received results. Most of researchers distinguishes three classical types of a constitution: two extreme and one intermediate. Different classifications (they are more than 40) differ generally in names of types of a constitution and this or that degree of completeness of their characteristic.

In our country the nomenclature of types K is most common., offered by M. V. Chernorutsky (1928): astenik, normostenik, hypersthenic. Along with it in literature it is possible to meet also other names of these types. So, asthenic type K. it is designated as tsefalichesky, mental, hypoplastic, respiratory, hypotonic. narrow-chested, leptosomny, stenoplastichesky, dolikhomorfny, etc.; normosthenic type K. — as muscular, mobile, normal, normotonic, normogrudy, athletic, mesoplastic, mesomorphic, etc.; hypersthenic type K. — as pyknic, abdominal, well-fad, hyperplastic, digestive, hypertensive, broad-breasted, euriplastichesky, brachymorphic, endomorphic, etc. Asthenic type K. differs in a narrow, flat thorax with an acute epigastric angle, a long neck, thin and long extremities, narrow shoulders, an oblong face, poor development of muscles, pale and thin skin. Hypersthenic type K. — a wide thickset figure, with a short neck, the round head, a broad chest and the acting stomach. Normosthenic type K. — good development of bone and muscular tissue, proportional addition, wide shoulder girdle, convex thorax.

The given classification suffers from an essential shortcoming since it did not include transition types To. For this reason more and more broad application is found by objective measuring methods of a research. So, e.g., Knussmen (R. Knussman, 1961) studied 70 measuring and 62 descriptive signs. 10 leading features, including some functional were marked out to them (level of blood supply of bodies), numerous and complex groups of people are received, but the problem of classification of transition types did not find the solution.

Problem of value K. an organism draws attention of specialists of a different profile (geneticists, anthropologists, teachers, physiologists, pathologists, psychologists, doctors of different specialties, trainers, criminalists, etc.) and therefore can be considered in different aspects. Attempts to establish objective and exact connection between a constitution, various fiziol, and biochemical, processes in a human body and its mentality are made. However the solution of these questions demands hard work and efforts of many research teams.

Summing up the various available data, it is possible to consider that there are certain features fiziol, processes and some tendencies to development of this or that pathology in people depending on them To. People with asthenic type K. differ in a hyperexcitability of a nervous system; tendency to a ptosis of internals, neurosises and hypotension, to tuberculosis, a peptic ulcer, in a smaller measure to development of atherosclerosis, obesity and diabetes is noted.

People of normosthenic (athletic) type are vigorous, sure of the forces. Their tendency to diseases of upper respiratory tracts, the motive device, to neuralgia, atherosclerosis of coronary arteries is noted, the myocardial infarction develops more often.

People of hypersthenic (pyknic) type are sociable, mobile, practical. They differ in rather higher ABP, dominance of processes of assimilation. Function of gonads and adrenal glands is increased. People of this constitution are inclined to obesity, diabetes, atherosclerosis, an idiopathic hypertensia, dysfunction of a gall bladder and cholelithiasis.

As in a basis To. rather steady structural and functional properties of a human body lie, constitutional features generally define reactivity and stability of an organism.

In practical activities doctors quite often meet anomalies To., a part of which results from mutations (see. Hereditary diseases , Chromosomal diseases ), others develop on the basis of hereditary predisposition at action on an organism of adverse environmental factors — diathesis (see). At diathesis tendency to unusual reactions and emergence of a number of diseases even from influence of some adequate irritants is characteristic. Diathesis can be divided into two basic groups: the diathesis connected with painfully increased reaction of an organism to usual irritants (exudative, spazmo-filny, arthritic), and the diathesis which arose because of sharply weakened reactivity of an organism (asthenic diathesis, infantility).

Solution of the problem of value K. an organism at the modern scientific level will allow to carry out prevention of diseases by the recommendation of the most optimum people of work-rest schedules, and also food for these or those groups. The accounting of constitutional features of an organism can facilitate diagnosis and the forecast of disease, and also treatment.

Philosophical aspects of the doctrine about the constitution

Unilateral, metaphysical on the essence, understanding nek-ry physicians of a role To. the person in an etiology, a pathogeny and symptomatology different nozol, forms formed the basis of one of the directions of medicine — constitutionalism. Supporters of this direction believe that To. is the major factor predetermining health and pathology of the person. According to the founder of constitutionalism Yu. Tandler, «the constitution — somatic fate of an individual». The constitutionalism arose in a bed konditsionalizm (see), representatives to-rogo considered a disease as result of set of «etiological conditions». Founders of constitutionalism tried to overcome shortcomings monokauzalizm (see), approving allegedly inevitable constitutional predisposition of the person to certain diseases. Absolutization of a role To. in a course of a disease led to sharp revaluation of a role of internal factors, having reduced value etiol, factors only to releasers. At the same time external factors as if provoke a pathogeny of a disease which predugotovan To. this or that individual. The similar logic mechanically determines process of knowledge of development of a disease, assigning diseases a part nek-ry biol, fate of mankind. The constitutionalism which evolved from certain achievements of medicine brings to metaphysical and idealistic (and sometimes and obviously reactionary) to conclusions about a role To. in health of the person.

Denying dialectics of external and internal, necessary and accidental diseases in a pathogeny, the constitutionalism in the extreme forms limits problems of medicine, health care to classification of constitutional types of a human body. E.g., Biza allocates six so-called social biotypes: theoretical, economic, esthetic, political, religious and social; belonging of the person to one of these biotypes also defines its social or the prof. orientation. The unscientific and reactionary essence of these representations became a subject of fair criticism of Marxists — philosophers and physicians.

Dialektiko-materialistichesky approach to understanding of essence diseases (see) shows that to learn mechanisms of development patol, processes it is possible only analyzing interaction internal and external, inborn and acquired, specific and nonspecific. Therefore without denying a certain predisposition of a human body to these or those diseases, the modern physicians standing on positions of dialectic materialism consider To. as natural premises of development of the Organism which develops in the course of life activity of the organism and its previous generations, but not as the unchangeable set of features of an organism which is irresistibly predetermining pathology of the person. Even at people with identical type K. the course of diseases can be variously and depend on a condition of immunity, character of food, a way of life and many other factors. Nevertheless need for the characteristic of different types K. for medical practice remains.

Value of the constitution for psychiatry

Studying of different general aspects of problem K. and private constitutional features mentally sick it was carried out by hl. obr. in the following directions: 1) by development of the constitutional types which are shown in certain features premorbidal a warehouse of patients, and on a wedge, level — in certain forms of mental disorders; 2) in the form of studying of the features of his response to different fiziol, and pathogenic factors following from constitutional properties of an individual, i.e. in the form of accumulation of the data important for prevention and the forecast of painful deviations; 3) by definition of constitutional conditionality of different forms of mental disturbances or degree of this conditionality for the purpose of the solution of a row important for a wedge, psychiatry of questions of a pathogeny.

In the course of development of typology of constitutional features, significant for psychiatry, researchers passed from the descriptive characteristic of different types of the so-called partial constitution, i.e. like a personal warehouse or intellectual activity, to researches at which natural combinations of features of character, temperament or intelligence with defined fiziol, and morfol are studied with properties of an organism. Transition to complete concepts, to the characteristic «total» psychophysical is carried out To.

To the constitutional personal types revealed in the descriptive way because they are shown by the defined funkts, painful frustration, belong: 1) psychasthenic To., contributing to alarming reactions, indecision, feeling of inferiority, weak will, phobic or persuasive frustration, etc.; 2) neuropathic To., a cut are inherent tendency to vegetative disturbances, the phenomena of irritable weakness, intolerance concerning strong irritants; 3) emotional To., characterized by tendency to the excessive, not giving in to conscious control emotional reactions, and also some other personal types. Kleyst (To. Kleist, 1913) allocated also hypoparanoic To., at a cut vulnerability, suspiciousness, tendency to the ideas of the relations and revaluation of own personality are expressed. However Kleyst allowed gradual development of these constitutional features in special crazy psychosis of late age (involutional paranoia), i.e. assumed existence of communication between constitutional features and psychosis (disease). On the accounting of features of personal structure Jung (Page G. Jung, 1921) is carried out differentiation so-called ekstravertirovanny (turned outside) and introverted (turned into itself) a warehouse of the personality, the received certain value in psychiatry.

E. Krechmer approved a natural combination of a pyknic constitution with cyclotymic, or cycloid, temperament, for to-rogo the diatetichesky proportion, i.e. fluctuations between the increased (hypomaniacal) and reduced (subdepressive) mood, or balanced (sintonny) emotionality is characteristic, and saw in it constitutional predisposition to a maniac-depressive disease. He assumed existence of the same natural relationship between a leptosomny constitution and a shizotimichesky, or schizoid, constitutional warehouse of the personality with «a psikhastetichesky proportion», characteristic of it (a combination of vulnerability to insufficient emotional responsiveness).

E. Krechmer considered such constitution contributing to a disease schizophrenia (see). Is later E. Krechmer and his employees Mauts and Enke (F. Mauz, W. Enke, 1937) similar correlations between an athletic constitution and epileptoidny character (viscose temperament) were established. More detailed questions of constitutional predisposition to a disease epilepsy (see) were developed by Mauts in his concept about «enekhetichesky» and «iktaffinny» To.

As showed the numerous test researches postulated by E. Krechmer, correlations between a constitution, a mental warehouse (mental To.) and were confirmed by predisposition to a certain mental disease only partially. E.g., the known recognition was gained by other characteristic of constitutional features of patients with endogenous depressions, i.e. the affective psychoses preferential monopolyarno proceeding, edges was developed by Tellenbakh (H. Tellenbach, 1961, 1976). Tellenbakh defined constitutional features of such patients with the following lines: orderliness, gravity, call of duty, diligence, rigidity and love to an order.

Deeper impact on modern psychiatry was exerted by that part of the krechmerovsky doctrine about constitutional types, edges contained the analysis of constitutional features of a schizoid and cycloid warehouse of the personality. E. Krechmer allocated three degrees of constitutional features (a shizotimiya — a shizoidiya — schizophrenia, a cyclotymia — a tsikloidiya — maniac-depressive psychosis). Typological descriptions of E. Krechmer kept the value still in spite of the fact that its doctrine was reasonably criticized. This analysis in many respects promoted formation sovr, understanding of schizophrenia as «diseases of predisposition», and also views of the Soviet authors of «the schizophrenic constitution» for the first time formulated by P. B. Gannushkin in 1914, and is later A. V. Snezhnevsky in the concept of «patos» and «nozos» of schizophrenia.

Special value for understanding of a role of a constitutional factor in development of some mental diseases, and first of all schizophrenia, got genealogical researches in which features and anomalies of character at relatives of patients were studied. These researches showed considerable accumulation at relatives of the patient of the constitutional personal anomalies of a schizoid circle close to features premorbidal a personal warehouse of patients with schizophrenia. The community of constitutional features of the patient and members of his family is found not only at the descriptive characteristic of a personal warehouse, but also at an experimental psikhol. studying of different types of cognitive activity and at a research of some biol, indicators.

Attempts of specification of value of constitutional features for a current and the forecast of mental diseases yielded some results. During the studying of schizophrenia, e.g., it was established that expressiveness of premorbidal schizoid constitutional features has, as a rule, adverse predictive value, and development of a disease against the background of other, e.g., cyclotymic, To. proceeds more favorably. Also atypical manifestations and heavier disease at development of affective psychoses against the background of shizotimichesky are described To.

The doctrine about To. faces in psychiatry the same metodol, difficulties, as in all medicine. The questions connected with inborn (hereditary) or early the acquired character of the constitutional signs which are the cornerstone of mental disorders need specification; patterns of ontogenetic development of constitutional signs are insufficiently studied. Difficulties arise also in connection with a question of legitimacy of reference of these or those constitutional features to patol, to phenomena, about definition of their place among patol, changes of mental activity. E.g., types and forms psychopathies (see) The caused painful manifestations are considered by P. B. Gannushkin, O. V. Kerbikov, N. I. Felinska and most of domestic authors as konstitutsionalno, however «konstitutsionalno the caused painful states» are essentially delimited from mental diseases — processes, i.e. from psychoses. Dynamics of such constitutional (psychopathic) anomalies arising in interaction with environmental factors is described by P. B. Gannushkin as phases, reactions or patol, development at psychopathies. Forms konstitutsionalno of the caused painful conditions in the true sense of the word the fact that some wedge tells about difficulties of differentiation as e.g., the maniac-depressive psychosis carried sovr, psychiatrists to mental diseases once was considered as constitutional anomaly. In developing of the mental disorders carried in sovr, psychiatry to schizophrenia («a disease of predisposition»), the role of a constitutional factor is not identical; apparently, only at a part of schizophrenic frustration this factor is defining.

The wedge, experience shows that konstitutsionalno the caused painful states, such as psychopathic personal anomalies or easy degree of a delay of intellectual development, often have no clear boundary with options of norm.

See also Identity , Organism , Person .



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B. K. Kulagin; G. H. Shingarov (Phil.), E. Ya. Shternberg (psikhiat.).

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