08.18.07
Posted in General at 3:41 am by admin
Can we explain Psychosis?
I believe that we can but we must first define certain paradigms.
WHAT IS PSYCHOSIS?
A conventional definition is ‘A disorder in Reality Testing and Judgment.’
Psychotics are unable to place time and space on a continuum. Places, objects, boundary and time become fractured, jumbled and confused. But what is reality and what is judgment? Both are subjective. They are based on experience. Reality is a linking and amalgamation of a present experience to a previous or accepted event. Judgment monitors the bonding as acceptable or not. Reality testing and judgment are ways of coherently storing and monitoring experience. We are now postulating that the mind is forever increasing its experiences. It does so by adding onto previous experience. To do this the mind must possess a very powerful and accurate filing system. It must be able to recognize the ‘new input’ by categerising it. Then by use of the category it is able to run a quick match. Finally it incorporates the two. The mind has a new or newer experience
HOW IS KNOWLEDGE STORED?
In a previous article I described how thinking and thoughts are interrelated. Briefly we postulated thoughts are mere predictions. The one to get closest to correct prediction is kept. In other words thoughts are in competition. Only the fittest survive. Initially thoughts are like buds on a tree. They store a prediction and an emotion. If the thought is maintained it can be the starting point of a new bud. It as if it has become a twig. A twig becomes a branch. Each has its own emotion. Each has its ever present buds competing to survive. This way thinking can be done more quickly. But we are faced with a new problem. How does the sorting process work so quickly? There must be a mapping or registry. I believe that this is a fair assumption. As far as technology is concerned man tends to unconsciously imitate himself. Today information is stored by use of registries that inform where the information is. There is a similar mapping process in the brain. Our brains contain distinct areas which map sensation and muscular activity. They are called homunculi. I propose that the ‘Knowledge Tree ‘that we are all perpetually building is ordered so to maintain spatial, temporal and experiential integrity of experience. We are capable of ‘turning off’ this process. We do so when we daydream or use our imagination. This is an important process that allows us to voluntarily ‘place buds’ in places on the tree that otherwise would not be placed there. But this process is voluntary and can be turned on and off at will.
EXPLAINING PSYCHOSIS:
Using the paradigm ‘Tree of Knowledge’ we can describe and explain psychosis. The psychotic cannot correctly maneuver through different branches and twigs. He gets to the wrong place. He associates the wrong things. He experiences the wrong emotions. He hears or sees that is on the tree not that what he really is hearing or seeing. Often I have heard patients tell me it as if they were dead. They cannot ‘get in touch’ with their inner world or experiences. They are there but as if cut off. The psychosis of misplacement generally passes. In this we see things that were not there before like delusions and hallucinations. We call these the positive symptoms. Unfortunately the loss of contact with the inner world is more lasting and often permanent. We call these negative symptoms.
The phenomenon of ‘loss of responsiveness’ is not unknown. There are at least two illnesses with a similar mechanism. The root cause of diabetes and one cause of thyroid is a basic lack of responsiveness. In both cases there is a compensatory process. The compensatory processes are inefficient and cause symptoms.
Are the positive symptoms a similar unsuccessful compensatory process? Is the basic defect the negative symptoms?
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08.10.07
Posted in CBT, Stress at 6:21 am by admin
I was playing with Harry. He is my five month old grandson. We were playing ‘ Peepo’.
Peepo is a game where I repeatedly move my head and say ‘peepo’.
At first Harry was baffled.
I moved my head behind and in front of the pram. It took him a few turns to start anticipating where I was going to be.
He got it right and was extremely proud of himself.
So we made the game more complex.
I added the right and left positions as added possibilities.
Harry got those under his belt even faster.
Now what had happened?
Let me make small detour. I’ll tell you when we get back to the point.
I met a very clever guy a few days a go. He described clearly what had being creeping in the shadows of my mind for a long time.
Very simply he said that thinking was a Darwin evolutionary like process.
He meant that the brain produces a lot of thoughts. They are in ‘competition’.
The best thought wins. The best thought is maintained till a new one comes along and beats it.
But how is this done?
He spoke and I pictured a picture. Here is my picture.
Picture the brain as a dynamic tree. Picture an ever growing tree.
Imagine this tree growing filmed in a delayed frame film.
You can see the tree growing can’t you?
Look at just one of the twigs. A bud develops. A series of buds develop. But one becomes stronger and healthier. It grows faster. It becomes a twig. New buds may grow from it. It may become a branch itself. From it develop myriads of new buds. New twigs are formed and so on.
But how is the bud chosen? Which bud wins? How is the twig developed? When does a twig become a branch?
In other words ‘OK I accept competition’ but what are the rewards? Survival of the fittest thought is acceptable. But what is the fittest thought?
Why we are thinking at all?
Thinking is more or less predicting. Some may say that we are predicting what will give pleasure and what will cause pain.
It is our way of seeing into the future.
In Harry’s case he was predicting where I might be.
If buds have no predictive power they are low in the evolutionary order. The higher or more relevant the predictions are the more likely is a twig or branch likely to occur.
Let’s go back to Harry.
Harry did two things. And he got two things. More precisely he got the same thing twice. Harry got to predict where I was. He was happy that he had found me. He was happy that he had got it right. I then moved my head to new places. Then Harry used his experience at predicting when faced with a new situation. He got that right faster than previously. So he was again pleased twice. He was pleased that it was me. He was pleased that he had worked it out.
Harry built a bud. Then he built a twig. Then a new twig branching off from the one he had just built. Harry’s twigs have two elements. The elements are deduction and pleasure. It may have been deduction and avoiding fear.
So far so good.
But I am a Psychiatrist. Unfortunately I look at the process to see where it can and does go wrong. We all know that it does go wrong.
Often we develop buds that are simply on the wrong twig. Twigs are convenient. They give us a quick start. Look how they helped Harry. They make us more efficient. We tackle things almost in ‘automatic pilot’. But we do not always have the ability to see if the bud is on the right twig. Often it is an inappropriate place. It might even be on the wrong branch. But we are not aware.
We are doing ‘as if’. But in reality it is ‘as if something else’. This leads to frustration. This new unexpected experience ‘grows buds’ of its own.
Relocation of twigs and branches is really called Psychotherapy. The original Psychotherapies discovered why and how the twig and branch got to their present position.
Latter day Psychotherapy is based on how to discover where the twig is and relocate buds in a more appropriate place. This is one explanation of CBT [Cognitive Behavioural Therapy]
Computerised CBT enables you to discover traits as you are presented with repeated similar ‘inappropriate placements’.
You can learn more about the theory of theories by reading Piaget. Winnicott is an excellent reference for the role of parenting. This link will explain how CCBT works.
If you want to learn more about Harry, simply drop me a line.
Dr. Michael Benjamin
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