On 四塊玉

你是否問過自己這個問題--人生忙忙碌碌爭的到底是為了什麽?

關漢卿說的好:

南畝耕
東山臥
世態人情經歷多
閒將往事思量過
賢的是他
愚的是我
爭什麽?

何以知易却是行難呢?
一言以代之--- 提不起又放不下.

更糟的是, 在這條路上, 我們又被逼著去斟衍什麽是該提起的, 叉什麽是該放下的?

連這也放下吧! 可是, 這又是知易行難.

A Ratological Book

This morning, I missed half of my therapy session. Somehow, I had this smart idea that I would be able to wake up to attend a 9:00 session when I made the appointment. Also, I had this belief that my session was actually to take place at 10:00.

As a result, I woke up at around 9:30 only to find out that I slept through half of the session. I was late but I still made the effort to go in.

During the extremely brief session, I mentioned to my therapist about the flooding approach I have undertaken this round. Essentially, I am trying to flood the others with so much information that they wouldn’t want to pay attention to me. Yet, it is closed to impossible for people to get overwhelmed by my bloggings, given that, most people already have enough to read (thinking back at my never-ending effort to keep up with the back-issue magazines) and there is a very slim chance for anyone to be really paying attention to my writing.

The person that I truly want to overwhelm is myself.

You see, there is only so much reflection, interpretation and rationalization that I could perform. It is because my thinking is constrained by my prior knowledge as well as my creativity.

I knew that, at some point, the Goddess of language would take back its unlimited supply of spring water and my ratological discourse would eventually arrive at the state of depletion—like the IP addresses (lol).

It is irrelevant whether it is the medications that are asserting their influence or it’s the discourse that has gone dry. Why? Dasein or being-there is the answer.

The day of the graduation was a hallmark for me.

For the past few months, I have been juggling with the uncertainties about what is to happen after graduation, after my employment status expired, what I am supposed to do after I fall off the pay roll, and, what is to happen to my mental status. It is the expectation of my being a “official” lost soul in limbo that was killing me.

After the commencement, all those uncertainties are realities. I, thus, could happily live my life being there without having to worry about the expectations and speculations.

When expectation is not the focus of my concern, there is no pressure to push, to struggle, and to fight.

However, I do not mean that one should be lazy and use it as an excuse to not live one’s life to its fullest.

Rather, dasein allows me to set everything aside and take my time to process things step-by-step and one at a time--- sort of like, we slowly drove and he knew no haste. Now that I am there, all that I have to do is to be there and do whatever I could do there.

However, please don’t take me wrong by thinking that Dasein grant us a stress-free zone. There are still stressors, like in any other point in our lives—graduation is stressful, exams are stressful, and so are weddings.

At the same time, like what my therapist told me earlier in the year, the past few months has been proven to be a great learning opportunities. It allows me to look back at my own experiences and beat the horse to death (like what I did to my dissertation lol).

Sensing that my thoughts have gone dried, either due to the flooding effect or the influence of medication, I decide to have a paradigm shift in my writings.

It was yesterday when a professor of mine came into the office to look for my boss. I took a few courses in psychopathology with her before.

I was sort of difficult for me to bring up the topic.

I told her, “I want to write a book about mental health issues. I have done some writing so far. I wonder whether you could provide me with some feedback.”

My professor said, “Of course, any time.”

I sent the URL of my blog to her through email.

Yes, this is a paradigm shift. When creativities go dry, I will do some literature reviews to support my thesis. And, eventually, with adequate feedback from people I know, I will be able to publish a book—a book that will be instrumental in mental health education.

I had always wondered what I could amount to and I have always want to contribute to the common good. One major fear in my life is to live a useless life that does nothing more than wasting resources.

By sharing my experiences through blogging, I know I have made some positive contribution to 1 person or 2 (so I was told). However, by publishing my experiences as a textbook, I will be able to reach a greater population (isn’t that what textbook is for? Something students are forced to read lol).

Thereafter, I could tell myself, life has done me good by allowing me to make a little impact.

Since the expectation of my life has been met, I no longer need to dream about winning a Nobel Peace prize as an indicator of my contribution to the common good (lol). Finding a publisher might be something more realistic (lol).
  

Headsets: Unterweg Zur normalization

Today, I took daddy and mommy to the airport. They are going to Costa Rica to visit my uncle.

After I sent them off, I got onto the bus. There was a guy talking on the phone, with one of those hands-free headsets on.

This reminds me of a scenario I encountered the first time I came out of the coocoo’s nest.

At that time, the hands-free headsets were just starting to become popular.

One day, as I was strolling down the street, I saw this well-dressed gentleman engaging in some pretty serious conversation with no one else.

When I saw him conversing with no one so very enthusiastically, I thought to myself, “He needs medication.” It was not until I walked past by did I realize that he had the headset on and was talking on the phone.

Through out the years, the hands-free headsets and cell phones have gradually turned into commodity. It is very seldom, nowadays, to walk down the block without noticing people in the cell-phone nation.

In other words, it has become a norm to see people engage in discussions, quarrels, and story-telling about their entire life while no discussants are in present.

I came up with this brilliant idea after I encountered that well-dressed gentleman on headset, whom was misdiagnosed by me as someone with positive symptoms in partial remission.

What is that brilliant idea?

Let me go side track a bit first (As you might have realized, my writing sometimes goes all different directions. It is my dream to become Marcel Proust II... just don't have his SES to live his kind of life lol).

When I was volunteering in the psychiatric ward in the hospital, I was told that the duty of the volunteers was to engage in normal conversations with the patients. Essentially, the volunteers are instrumental in reshaping the patients’ modus operandis in how they interact with the “greater population.”

This is partially done by ignoring patients’ discourse about topics such as religion, politics, and their mental health conditions. At the same time, neutral topics such as the weather conditions and sports are promoted.

It is hoped that, eventually, the patients will be conditioned to engage in conversations with “normal” topics, rather than the more controversial ones.

However, it was very unfortunate that this tactic did not always work. How long could a discussion about the weather last? How many times could you engage in weather-related conversations with the same person?

The icebreaker might work for the patient with amnesia, whom struggled to remind himself of who he is by stacks of pictures. However, such a topic might turn to be too old for the narcoleptic patient, who used to be a professional baseball player and ended in the bed because his body could not stay away for more than a few seconds.

Also, since I am not a big sports fan, it was sort of difficult for me to talk about sports.

Moreover, a lot of times, patients would get released from mental health institutes while positive symptoms are still actively present. Some get released because of financial issues. Others try to be released because they yarn to get out of the confinement of the hospital. This could be done by trying their best to be normal, to cooperate with the staffs, and, to let the staff members believe that they no longer experience positive symptoms or the severity has turned minimal.

How do I know? Because I am one of them and I do not believe I am the only one.

What about the staff members in the hospital? I believe they know it, too. I figure their role is to keep the patients till they are stable enough to go and live at large.

It took me months after I was released from the hospital to come to the realization that what I believed was going on in this world was but my delusions.

I recall that weeks if not months after I was released from my first hospitalization, one day, I finally was able to tell my psychiatrist that I was feeling depressed. It was because I did not know how to deal with all the things I was promised and lost due to my hospitalization. These included a scholarship to complete my study, a job offer from Microsoft (Don't ask me why it was Microsoft but not Intel or Cisco lol), an honorary degree from some department, and, the sponsorship for a green card. The only thing I did not think about was finding myself a rich and handsome husband (Let’s call it teenage rebellion lol). I felt sad because people have forgotten about me and nobody cared anymore.

My psychiatrist looked at me and told me, “It was your delusion.” Just like what he told me before I institutionalized myself.

It took me some more time to finally accept the fact that it was my delusion because it was my belief and it was my mental model about the world surrounding me. I even went into depression for my delusions (Yet, I hope it was my premonition because I did get a grant to sponsor my psychotic dissertation after all lol).

Based on my naïve theory about how things work, I believe that, a lot of times, patients are released from institutions while positive symptoms are still actively present. It is the hallucinations and the delusions that make people screaming and yelling at the pedestrians, or talking to themselves.

When people encounter these fellow coocoos of mine, it is inevitable for them to regard them differently. How people react to the abnormal behavior, unfortunately, will impose extra amount of stress and will further reinforce the build-up of these patients’ hallucinations and delusions.

Yours truly, thus, came up with this quixotic idea.

What about giving the coocoos a headset before letting them out? In this case, their self-talking would be normalized and it might help to off set the stress induced by how the outside world views them. If there is enough funding, we should even give them a CD player so that they could focus their attention on the music rather than the hallucinations and delusions(lol).

Will this work or not?

I don’t know and it is but a hypothesis of mine. One thing I know is that, even if it might work for some, it will not work for all.

By the way, there was something I learned from the whole 9 yards. The road to accept the fact that nobody really cares because it was my delusion is the same as handling the fading of the novelty effect. As a result, my psychotic experiences help me to deal with the fact that visitors to my blog site has gone from 25 hits per day to 0 hits (lol).

More specifically, what I learned was, today’s news is tomorrow’s history. The only thing we could hold on to is our life because, as long as we are still kicking, life goes on and I continue to write.

This leads to the second positive impact of mental health problems—providing a secure environment for learning and exploration while there is nothing to loose (lol).

Impaired Metacognition: Part II

Today, my family were invited to a function discussing the relationship among the States, Taiwan, and China in Flushing.

During the day time, I was all focused on listening to the speakers, not at all distracted.

What do I mean by not getting distracted? At some point, one of the speakers used the expression “the tunnel” and “barking at the wrong tree.” Those are two of the expressions I used in the previous postings. Even though I know they are common expressions in everyday English, I could not help but think, “Was he making references to me?” However, I was able to refocus on the talk and not engage in further deliberation about the given matter.

As it approaches the dinner time, my imagination (or, more specifically, my unconscious imagination) started to go wild.

The longer I sat down at the dinner table, the stronger the sense I got about the possibility that people were talking about me and my stories. When people in the far away table were engaging in their conversations and enjoying the festivity, yours truly could not stop to feel that I was the center of their conversation.

I was cognitively aware of the irrationality in my perceptions. I tried to control the build up of my irrational thoughts. However, I was loosing control over the delusions of references that were popping up left and right.

Granted, some people were looking at me, at the dining table or on the street. The perception that people were looking at me does not, in and out itself, constitute delusional experiences. What makes the experiences delusional is the bias with which my perceptions are interpreted.

When most people perceive that other people were looking at them, competing hypotheses would be generated to explain the given perception. Following are some examples of the plausible hypotheses based on my naïve theory of human mind:
People look at me because--
I am cute and they are attracted to me
My top is too flashy
I have something on my face—food or someone’s lipstick.
Most of the times, these would be the dominant hypotheses used to explain the perception that other people were checking me out, provided that the perception is valid.

Or, I should say that these are the hypotheses I could think of when I am “normalized” (lol).

However, despite of my awareness of the aforementioned alternative hypotheses, my state of mind makes it impossible for me to reject the null hypothesis that people checked me out because they knew about my stories and they were talking about me. Of course, auditory hallucinations make it even harder for me to reject the null hypotheses (Guess this is the story of my life, reenactment of the results of my dissertation lol).

Where am I going with these BS?

As I mentioned before, it is assumed that metacognition is comprised of the monitoring and controlling components. Moreover, it has been suggested that impairment in metacognition might have contributed to the occurence of delusions.

When referring back to the above scenario, it seems that my self-monitoring capacity remained intact—
I am aware of the irrationality in my interpretation of the events
I am aware of the competing hypotheses that could be used to explain my perception
I am aware of my bias towards the null hypothesis
I am aware of my own inability to make adjustment to my biased modus "interpretation"
I am aware that some of the things I hear are actually auditory hallucinations
So, where did I go wrong?

If the metacognitive model holds true, I would say that what went wrong was my ability to perform self-control, rather than self-monitoring.

For me, self-monitoring concerns one’s ability to observe one’s own state of being. In other words, it is at the perceptual level and it requires analytical skills.

On the other hand, the so-to-speak breakdown in the self-controlling mechanism is manifested in one’s inability to make appropriate adjustment to one’s interpretation about events, provided one’s self-monitoring capacity remained intact.
In plain English, I might agree with the notion that there is some impairment in the controlling component of the metacognitive model when I can not change how I interpret my experiences despite of my awareness of the biases and irrationality in my frame of references.

However, is this really impairment in my metacognition?

I don’t really think so. But, of course, that is but my really tired and loco interpretation.

Referencing back to the classic cognitive theories, we would find that one’s past, to a certain degree, dictates one’s modus operandi in the present. It is because one’s past resides in one’s long term memory in forms such as schema, scripts, mental models, and patterns of attribution.
As people continue to interact with the environment while referencing to their long term memory, the environmental effects make it inevitable for people within similar environments to become more alike and people in different environment to move along differential developmental tracks. Cross-cultural differences exemplify the outcomes of the simultaneous process of diverging and converging at the macro-level.

At the same time, as I have elaborated in previous postings, just like Rome, delusions are not built in one day. At the micro-level, s time goes on, it is inevitable for the delusional to develop a propensity to attribute observations in a way that is deviated from the norm. As a result, provided with the same environmental cues, delusionals might gradually develop a pattern in attending and interpreting environmental inputs that is different from that of a normal person.

In other words, both the normal person and the delusional are capable of performing metacognitive tasks, namely, self-monitoring and self-controlling.

However, a context is required for one to exercise his or her metacognitive skills and the context contains both the environmental inputs and one’s past experiences. Given the same environmental inputs, provided adequate ability capability of performing metacognitive tasks for both the delusional and the normal person, I feel it should be one’s past experiences that result in differential experiences, rather than the impaired metacognition.

Of course, my analysis might not be applicable for all delusional cases. For instance, when a delusional is extremely distracted by hallucinations, the distraction might result in the reduced amount of cognitive capacity that could be allocated to perform metacognitive tasks.
Disclaimer: I am not responsible for the plausibility of instilling falsified beliefs through my writing since my analyses have been based on data gathered from myself N=1.

Commencement

Yesterday was the day of commencement.

It was a very interesting experience because, after all the years of not seeing the light in the end of the tunnel, I see the beginning of a tunnel in blackout again—the pursuit to find a full time job.

Guess, life is all about getting in and out of tunnels. lol

Before I got hooded, I, along with my fellow new born doctors, was informed that we should make a point of not to trip down ourselves on the stage since it had never happened before.

When they made that announcement, the lady next to me and I both had this great idea, “Well, since that was a route never visited, maybe we should try it out….” (Didn’t they say exploration facilitates learning lol)

Ended up, I did not have the guts to tumble in front of the whole room because I do not particularly like the pains associated with falling.

I was happy and I did show my happiness on the stage.

As I walked on to the stage, even before my name was called, I sent my kisses to all my families, bosses, and friends.

I was so happy that I gave a happy hug to the Dean, the President, and the trustees.

As I came down the stage, I saw my boss and I threw my arms around him to thank him and all the people at work for all their supports and caring.

I think the cap and gown had put me in a hugging mood cuz I could not stop hugging people all the way into the reception.

So now I am a doctor… finally, it is official.

What am I going to do next? When could I find a position that would allow me to make use of my full potential and to do something better for the world?

The tunnel is still dark. Yet, thank God that my lighter still works (lol), and, at least, it shades some light into the road ahead, though, the scope is limited.

My family and I bumped into my boss George on his way home. We were talking about the graduation ceremony for the doctoral candidates.

The name of George Weiss popped up in our conversation.

George Weiss is the founder and “funder” of the say yes project, which provides people in the lower SES with the assistantship to pursue higher education.

I told my boss that what George Weiss does is exactly what I want to do and what I have been dreaming of.

One day, if I could amount to something and if I could have access to adequate resources, I want to start a foundation. The foundation will provide support for theory-based and scientifically tested projects that aims to better the life of people who live with mental health issues.

What would be the underlying themes behind these projects?

One word—Education (even though it is something so very easily forgotten lol).
How could education better the life of people with mental health issues?

1. First, knowledge is power, to a certain degree. The knowledge people acquired might help them better understand their own problem and, consequentially, their self-understanding might be translated into the development of help-seeking behavior: both in-sourcing and out-sourcing. As a result, they would be able to achieve their full potential and contribute to the society—I call this the conservation of human resources.
2. Second, enhanced education could allow the general public to gain a better understanding about mental health issues. This would help them demystify their understanding of mental health problems. Moreover, there is a need for a paradigm shift in how mental health problems are conveyed to the general public—and this shift goes back to the aka “positive psychology movement.” Other than educating people about how debilitating mental health problems might be, people also need to be informed about cases that demonstrate the resilience of veteran patients.
3. Third, we are living in a world where information technologies have turned into commodity (at least in the developed countries) and computer skills are turning into basic life skills. There is a need to find a way to incorporate information technologies as part of the treatment plan. Of course, before we identify the issue of “how to”, there is a need to locate long-term source of funding to ensure the sustainability of the outcome.

Of course, there are many more things I could think of.

Yet, I gotta stop thinking at this point since I might trip if I look to far ahead… lol

Mama is calling… Time for my beauty sleep!
BTW, I will work on the second part of the analysis on the metacognition model. Gotta put it off for the family reunion and some other mundane tasks in life...

Impaired Metacognition: Part I

Tomorrow is graduation. When I woke up this morning, I started to feel the stressful kind of feeling. As a result, I postponed all the appointments I made for this week till tomorrow to offset some stress load—including my therapy session… lol

Last night, I was trying to work on some writing about metacognition and delusions.

I once read that it was suggested that people with delusion might have impaired metacognition.

Since I have not been exposed to the source literature, I decided to look for some journal articles, which address the specific issues. Well, like what Confucius said, it is useless to engage in my ordinary reflections without learning something.

However, the article I picked up was not the original article that proposed the role of metacognition in delusion. The article actually aimed to refute the given proposal.

In short, metacognition is one’s awareness about one’s own thinking. For instance, it has been proposed that metacognition includes both the monitoring and controlling components.

If we refer back to the cognitive model presented in an earlier posting, I would argue that metacognitive skills are stored in long term memory and will be called into working memory when needed. Since metacognitive skills are not a given, one would assume that practice would make perfect and, thus, would enhance one’s mastery in metacognitive skills.

But, what does the impairment in metacognition mean?

Well, after I finished reading the first 20 pages of the article, I decided to give up my writing and went to sleep. What I learned after all those pages was that it was originally hypothesized that delusions arise because the delusionals mistaken their imaginations as their beliefs. In other words, there might be impairment in the delusionals’ ability to perform self-monitoring or to control their perceptions gathered through the self-monitoring process.

Well, please don’t quote me since I was half falling asleep while trying to figure out what ideas they were trying to convey.

When I was trying to fall asleep, I was so happy that I am only delusional but not those whose profession is to understand what delusions are (lol).

Actually, as I was plowing through the writing, I started to have the feeling that the way they presented the arguments is fairly similar to how my delusions came about during my first psychotic episode (Oops, sorry, it was just my delusional thoughts. Please also believe me when I tell you that I value all theories and their implications :-D).

There are a sound structure and sound logic behind their arguments. Yet, somewhere along the line, I started to wonder how they had come upon the beliefs the researchers held and that really required some imagination (Don’t take it offensive. The way I see it is that imagination is sort of the basis of my dissertation.).

When I was on the subway today, I tried to understand my experiences based on the metacognition theory (As I mentioned before, the tactics I use nowadays to distract myself from the delusion of references is by focusing on understanding the experiences). At the same time, my discussion with a friend of mine on the train helped me big time in clarifying my understandings.

As mentioned earlier, one major thesis of the theory was that the delusionals tend to mistaken their imaginations as their beliefs.

When I look back at my own experiences, I find it difficult to agree with such thesis.

It is my belief that the development of delusions is highly correlated to the experiences of hallucinations. However, hallucinations should not be labeled as imaginations for the following three reasons:
One has no control over the occurrence of hallucinations,
One could not actively generate auditory hallucinations (well, it is possible to generate internal voices but I will not label these as auditory hallucinations), and
Hallucinations are real sensory perceptions (Please don’t tell me that the voices I hear are imaginary. You can double check it with some kind of brain imaging techniques).
At the same time, it is my belief (or imagination lol) that hallucinations are the building blacks for delusions because the contents of hallucinations could gradually contribute to the development of a “delusional mental model” about the world surrounding the delusional. The sensory perceptions provided by hallucinations could eventually lead to the strengthening of the hallucination-related contents and result in the propensity for the delusionals to retrieve hallucination-related contents when trying to interpret events in their surrounding—this goes along with the Network Association and Attribution theories.

The consistent non-imaginary inputs (unless you want to call the hallucinations as the unconscious imagination) would eventually provide the delusionals with sufficient grounds to form their beliefs. In addition, sometimes things people say and do might actually coincide with one’s delusional worldview. These could serve as confirmation for the delusionals' hypothesis testing.

If you hear people saying that you are beautiful 1 millions times, you eventually will start to believe it. Moreover, I bet there will be at least once when someone really say it to you in plain English.
In other words, what the delusionals have are actual beliefs but not mistaken their imaginations as beliefs.

Is it abnormal? Have you heard of this thing called learning, education or brain-washing (lol)? After I spent this past 7 years in my school, I have learned to believe the implications of constructivism. Would you attribute it to my impairment in metacognition? (lol)

With my postings today, I am only providing my response for the imagination and belief part of the thesis for the metacognitive model. I will have to sign off now since I have to wake up early for my graduation ceremonies tomorrow.

Disclaimer: I am not responsible for the plausibility of instilling falsified beliefs through my writing since my analyses have been based on data gathered from myself N=1.

My parents

Some of you might wonder... all these dirty laundries that you reveal, do your parents know about it?

Yes, I told my mom as she arrived two weeks ago. She was happy for me except for her concern that I might get too tired.

Daddy just arrived last night and I haven't had a chance to chat with him about it. Yet, I assume that, while I was still sleeping this morning, mom must have told him my recent condition, etc.

Earlier tonight, as I was working on the previous writing, daddy asked me, "What are you writing?"

I told him, "I am writing a book."

I told him to not be mad (the Asian cultural thing remember). He asked, "Why should I be mad?"

"I am writing a book to tell people all about the mental health problems I know and how we might be able to prevent and intervene their occurences."

Daddy smiled happily.

IPO

Last Friday, for the first time, I officially showed someone my blogs. Today, I told my co-workers the URL to my blogs. In other words, I am making an effort to make the documentations public.

Sometime last week, the system analyst asked me when I will show her my blogs. I told her, “Give me one week.” Both she and another friend of mine asked for the URL again yesterday. However, I told them again that I was not ready.

What do I mean when I say that I am not ready?

First, I want my verbal diarrhea to be meatier. I am not discounting the importance of phenomenology. Most postings up to this weekend are more descriptive and have been analyzed based on my naïve theory. However, I felt such narratives would be insufficient without my two-cents that ties back to the theories I used for my dissertation.

Second, I want to make sure that I am stable enough to take the pressure. The increase of the dosage totally helps because now it feels like I am wearing a helmet. lol

The first time I went psychotic, I wanted to take on the world and to show them how strong I was. Two weeks ago, I started my blogs because I wanted to take on my positive symptoms. Along the way, I came to the realization that I was barking at the wrong tree. It should be me myself that I take on rather than anyone or anything else.

This is not the first time and, unfortunately, this will not be the last time that I feel the entire world is preying on details of my condition.

The issue is not when I could stop the fear of being identified or when people could stop viewing mental health conditions as a weakness in one’s character or a stigma.

Rather, the question to be addressed is when I could start accepting the variations in my own life. Anything else is irrelevant.

Being in a transitional state in my life does not make it easy for me to deal with such an issue. Ironically, this is the best time because I am done with my dissertation, will soon fall off the payroll, have not found a full time employment, and, have one more week to go before my graduation ceremony-- I have all the time in the world while running out of time. lol

So, I said to myself, “Bring it on and let it go.”

Let go of what? Let go the fear and train myself to get with it.

Will I be able to train myself this life skill successfully this time? Maybe.

One thing I know is that, even though some might suggest people to ignore the auditory hallucination, I have, to a certain degree, trained my auditory hallucination to start using first person narration.

Ya, you want to talk. That’s fine. Just say, “I do research on myself” but not “She does research on herself” anymore.

Will the outcome carry over to the next episode? I am not sure.

At least, I believe that practice makes perfect. There are always second chances.. :-O lol

Delusion of references: Part I

I took my mom and a friend down to China today to have some soup dumplings or juicy bums at this restaurant called Joe’s Shanghais restaurant. They make the best juicy bums I have ever tasted here in the states.

Going outside of the neighborhood provides a good way to evaluate the degree of severity for the delusion of references that I am experiencing.

When I was in the restaurant, there were some Korean guys at the next table. They were going about their own business, talking and laughing. Some part of me started to react with the irrational though that they were talking about me.

Similarly, on our way back, I found some people checking on me on the street, in the subway station, and on the subway. A bunch of these people knew me.

There were some guys at the other side of the train. I heard them talking and laughing. I felt they were talking about me. However, the contents of their conversation are not audible to me.

These are examples of the delusion of references.

Based on the conventional cognitive theory, people constantly assimilate inputs into their mental model. In my interpretation, a mental model is essential a type of knowledge structure resting in one’s long term memory that is readily to be retrieved and utilized in our everyday functioning. It provides us with an understanding of our surrounding by specifying the components, the relationships of the components and, how the components and relationships work together (Hopefully, my advisor would agree with me on this or they might take my doctor back lol).

For me, a delusional system is a mental model developed by the patient in reaction to their everyday experiences, which is no different from that of the greater population.

What would be an example of a delusional system?

During my last psychotic episode, I had this belief that I was telepathic and I could channel with people, God, devils, ghosts, and those otherwise not specified. At some point, I was informed that I was chosen to be a “Buddha” and I was supposed to suffer for the entire world. My nemesis at the point was supposed to be someone between good and evil. Because of her, there came the state of apocalypse. Everybody died, including God, Buddha, Ala, the Pope, and many others, except for me. I would like to join the rest but I could not die. There were volcano eruptions and earthquakes all around the world. I was told that the only thing I could do to save the world is to have a good heart and to do no harm to the others. Eventually, my resilience paid off and life turned back to normal. But, not too much later, the coin flipped and there came the apocalypse again. This time, the deceased turned into energy, molecules, and evaporated.

And, by the way, within this time, I finished collected at least 90% of the data for my dissertation (n=115). Thank God that all data has been captured automatically. Except for the fact that I might have experienced anxiety attack once or twice during data collection, my faulty mental model about the world should not have confounded with the validity of the data that I collected. lol

That was not the end of the story but I think you have gotten a gist of the degree of complexity a delusional system could entail. Therefore, there is no need for me to lay out the entire story.

So what is the role of delusion of references in the whole 9 yards?

Delusions of references are sort of like the Mickey Mouse cases of delusions. Yet, it definitely is the building block of a complicated, unbreakable and robust delusional system.

So how do the delusions of references assert their influences on the development of the delusional system?

Earlier, I mentioned the idea of mental models. Mental models could be perceived as a sub-type of schemata which are rules that direct people’s interpretation about information by helping people make sense of the new information based on what they already know (i.e., prior knowledge). Since the schemata in prior knowledge might not always be a good fit for the new information, the rise of new knowledge requires constant and reiterative processes of model fitting and modification. At the same time, different people might come up with different understanding when they are presented with the same information due to the differences in people's prior knowledge about the specific information.

In one classic study, the authors aimed to examine the impact of introductory passages on people’s recollection about a story. While participants in the experimental group were asked to read an introductory description about an unmarried college student who was having concerns about pregnancy, the participants in the control group were not given the introduction. All participants were then asked to read five boring paragraphs representing events such as making a cup of coffee and going to the doctor. It was found that the introductory passages were able to have a significant impact on participants’ interpretation of the boring texts presented subsequently. This study is known to have demonstrated the impact of the script effect, while script is, in theory, another subtype of schemata.

So can anyone guess what the schema and script theories have to do with the delusions of references?

Essentially, each every time one encounters the phenomenon called the delusions of references, one actually take on the role of a “constructivist learner” and actively engage in the aka “generative learning.” (lol) This encounter requires a person to observe the environment, seek information, conduct hypothesis testing, and provide interpretations. Most importantly, all of these tasks are performed with genuine intrinsic motivations.

This is more or less like the process of working on a dissertation. You start from gathering information night and day looking for a topic. The point you come up with a research question is the point when you find the bias in your frame of references. All the work you continue will be a means to build up a logical system to support your bias. (Please don’t blame me for this opinion. Have you ever heard of bias-free research? lol)

Let’s get back to the issue of delusions of references. Each encounter with the delusions of references is equivalent to a learning process and would result in the changes in the individual’s prior knowledge, which is part of the long term memory.

If you encounter such experiences once or twice, there might not be much change in your knowledge about the world surrounding you. However, if you encounter such experiences on a moment-to-moment basis (60*60*24) for a few days, chances are, there will be a great shift in your understanding about the world surrounding you as well as in your belief system.

Think about it this way, if you overhear from some pedestrian who passed by you that your bank has gone bankrupt, you might not believe it. If you overhear it 3 times, 4 times, and many more times, you would eventually start to believe it.

For an ordinary person, you might call the bank or go to the bank to double check the validity of the information before you take any further action. If you go to the bank and you found out the bank is doing fine, you will attribute it to misinformation.

However, for someone with delusional problem, once he or she develops the delusional belief, even if he or she goes to the bank and found out the bank is still kicking, he or she would still not believe that was the reality. Rather, attempts will be made to develop some kind of conspiracy theory about how the opening of the bank is actually a hoax. Moreover, the intrinsic bias in their belief system results in their propensity to accept only information that confirms their hypotheses. Since it is very rare for the delusional hypotheses to be positively confirmed, people with delusions are stuck with conspiracy theories with greater and greater scale to compensate for the lack of confirmation.

The question now would be, “So what exactly constitutes the experiences of “delusion of references?”

This is the most creative part of my psychotic interpretation. However, it’s past 11:00 and I expect my mom to start bugging me for not getting to bed yet. I will have to leave the grand finale till later: the cognitive theory of multimedia learning- the expansion pack. lol

Is it auditory hallucination that you are experience? :-O

Friday, May 06, 2005

Someone once asked me about the experience of having auditory hallucination. The reason he asked was partially due to his disbelief that someone functional and cognitive like me would experience the positive symptoms.

Essentially, a hallucination is a sensory perception in the absence of actual external stimuli. In contrast, an illusion is a perceptual distortion for a real stimulus. The commonly experienced hallucination could be experiences in all different modalities – visual, auditory, olfactory, etc.

I still recall the time when I was in my undergrad, taking my abnormal psychology class. For reasons unknown, I just found it extremely difficult to distinguish between these two phenomena.

When I had my internship in a mental health hospital, I had my encounters with numerous patients who showed the symptoms of hallucinations. One of the girls told me that she saw things that did not exist, or, you might want to call it “visual hallucinations”. Ya, the thing the guy in “The Beautiful Mind” experience to date.

I did not understand her experiences then and I still do not understand the experience of visual hallucination today. This is because my extensive empirical experiences do not include visual hallucinations (lol). And, if I have a choice, I would choose to be ignorant about such experiences till the end of my life.

After years of volunteering in the mental health hospitals and after my studies in psychology, I thought I knew what it meant to be psychotic and I thought that I could fully empathize with patients with mental health problems. However, I was proven wrong when I encountered psychotic symptoms for the first time.

You see, even with depression, it took some time for me to finally develop the ability to laugh at it. However, it was a shocking experience for me when confronted by the fact that “I have crossed the boundary between neurosis and psychosis.”

I was already deep in my delusional state when I eventually convinced myself that I need even more help than I was already receiving. In short, at that point, I thought I had the special talent of telepathy. Like any other ordinary delusional stories, I knew I was being watched and people were spying on each every step I took or I was about to take in my everyday life. They had even set up some extremely high tech devices to remotely detect and decode my brain waves and broadcast each every thought of mine.

My psychiatrist told me that I had delusions but I did not buy it. Eventually, I started to realize that all those real-time gossips that I heard were interfering with my normal functioning. I think that was one Saturday when I decided to go to the computer lab in school to do some work. No one else was in the room except for me.

I heard someone playing radio in the office next by and people were broadcasting each every of my moves and thoughts. At some point, I decided to go to the office door… I rested my ear on the door, trying to hear exactly what was going on in there. However, there was no sound. Silence was what I heard.

I thought to myself that maybe it was someone else in the other room. There were two consultants on duty and none of them was making a sound. I thought maybe there was someone in the hallway. I walked into the hallway and found not a single soul.

This was the time when I realized… I was experiencing psychotic symptoms or I was really telepathic.

I tried to put my mind together and get some more work done. However, the voices were distracting that, sitting in front of the computer for hours, I still could not write a complete sentence. At some point, I looked at myself and admitted to myself that I was gradually loosing my concentration. I picked up my stuffs, got back home to put things down, and, went to the emergency room.

I committed myself into the hospital. While they were still waiting for a bed to clear, they put me in bed in the emergency unit of the psychiatric ward. Behind the locked door were the nurses on duty and me. Except for their occasional conversations, the whole place was all quite. However, there was never a second that I was left in silence. I started to get more and more scared. When the psychiatrist came in to check on me, I begged her, “Please help me! I will do whatever it takes to keep my cognition!”

I finally got out of the hospital and eventually got off my medication. I thought that, after my experiences, I should be smart enough to avoid myself in going back to the coo-coo’s nest. However, that belief was proven to be wrong. When the second psychotic episode took place, it was a brand new set of experiences and they took me totally off guard. I was hospitalized again, except for, that time, I was involuntarily committed.

It was over 2 years ago when I was last hospitalized. However, my hallucinations did not seize to exist. In fact, hallucinations have turned to be part of my normal life.

I know there is a norm in life. In a perfect situation, I should be able to gradually regress back to the norm. However, sometimes we need to make a sacrifice, live with the bias, and, adapt to our own norm.

Getting back to the original question, “How do you know that you are experiencing auditory hallucinations?” Personally, the feeling of being in the center of the gossip often come along with auditory hallucinations. Why? It is because the internal voices are talking about you yourself. Duh! lol

So how do you tell between real gossip and auditory hallucinations?

Well, it is easy. Place yourself in an environment where there is no one else or where no one is talking. If you hear people talking, congratulations, you have been selected as the special someone to embrace what the ordinary people could imagine. lol

Of course, sometimes it is not so easy to find a complete silent environment. For instance, I haven’t been able to find a minute of silence since I got back home. My dear mother has been discovering things in my room, including those whose existence I have no idea of. lol

In this case, put yourself in an environment that is a distance away from the crowd. Listen to the surrounding. When you hear someone talking about you, try to hear exactly what they are talking about. If you could not decipher their conversation after you conscious effort, you might not have heard their conversation.

Of course, there is no closed-form solution to identify auditory hallucinations. These are but two methods I use for the purpose of self-monitoring. If I could fight it off this time in one piece, it means that it sort of work for me. However, there is no guarantee that it would work for the whole life time. At the same time, it might work or might not work for the others since the symptoms often catch us off guard and there are no fool-proof methods of prevention.

In one study that was published in 2000, it was found that, out of 13,000 “non-institutionalized” subjects recruited from the United Kingdom, Germany and Italy, almost 39% of them reported to have experienced some form of hallucination. If the results of this study hold true for the greater population at the current time, wouldn’t there be nothing to worry about for people with hallucinations such as those in the auditory modality?

To be honest, auditory hallucinations, in and out of themselves, are not so scary (at least, based on part of my personal experiences). Sometimes, they could be quite entertaining. It is more or less like listening to a radio show that is dedicated to oneself in one’s own mind. When you have more than one voice and they engage in conversations, the experience is more or less like listening to the conversation of the narrators in the Iron Chef TV program.

So what make the hallucinatory experiences, such as auditory hallucinations, so bad a thing?

First, I believe their “uncontrolled” development is linked to, if not the cause of, patients’ gradual loss of ability to concentrate and, subsequently, to perform other executive functions.

Second, I believe hallucinations are necessary (but not sufficient) for the development of a delusional system.

Ya. I do have my psychotic theory of psychosis (lol).

I would have loved to continue elaborating on these two points all night except it’s time for my beauty sleep. Hopefully, I will be able to find some time tomorrow to describe the essential role of auditory hallucinations on the development of delusions based on the cognitive theories that I tested in my dissertation.

Professional help

I went back to see my therapist today.

During the meeting, I mentioned to her about the blog that I have been posting and provided some insights about its usage.

Exactly one week ago, there were two reasons underlying my decision to start documenting my progress publicly. One of them was that I decided to go head to head with the symptom that my mental health problems were being publicized.

Yes, I decided to take the behaviorist approach of flooding. My thought was that, if it is inevitable for me to go through my auditory hallucinations and, consequentially, the aka radio broadcasting experiences, I might as well publish everything over the public domain. When all is out, what is left to be broadcasted? lol

However, that decision does have consequences because, now that everything is out, there is more reason for me to believe in the delusional perceptions and this surely imposes more stress on me. (Unless you are as headstrong as I am, or, even if you are even more headstrong, think twice before you proceed… lol)

My therapist suggested that, to reduce the amount of stress on me, maybe I should consider writing things done privately, rather than posting it publicly.

I stopped and pondered before offering her my response.

To was my realization that it doesn't really matter whether it is in my delusions or in my reality that people know me living with some problems. The issue to be dealt with is not how others might stigmatize a person with the propensity for psychosis, rather, it is about how I value myself.

So how is the result of my self valuation manifested in the positive symptoms?

Let's do some really simple analysis about the auditory hallucinations that I have been experiencing (the minor annoyances). I will not take into consideration the auditory hallucinations that are part of the referential ideologies since these experiences are associated with the interpretation of real stimuli that I picked up from the environment.

There are basically three types of contents for these auditory hallucinations. Guess what? Ya, positive, negative, and neutral. lol

An example of neutral comments would be something like “that’s the girl with a smoke”. “She is psychotic!” is an example of negative auditory hallucinations. The positive voices would say things such as, "I admire her", "she is strong", etc.

Sometimes these auditory hallucinations actually get me feel pretty defeated because they have been pretty similar for all these years. I actually complained to my therapist several times about how lack of creativity my auditory hallucinations have been. It might be scary but it would be nice to have a change. lol

That was a little side track, anyway, similar to the dialogues experienced by other people with auditory hallucination, these internal dialogues seem to manifest the extreme degree of egocentrism in me. They also signify my intensified degree of obsession about how my personal attributes might be perceived by the others (and I believe this is why the internal dialogues are presented as third person narrations).

So what do all these mean?

It struck me that, maybe, the real problem I need to face is my ability to truly value and appreciate myself. Also, despite of my BS about how I believe in the idea that “mental health problems are not a problem with characters,” I might be the person who really could not accept me as myself or, the packages that come with me.

As a result, I looked back at my therapist and replied, “Yes, I could stop posting my blogs in public and do it in private. Maybe that might reduce some of the stress. I can even take the entire thing down. However, I will not do it.”

Why?

Call me a war lord if you want to. However, after I took on my own symptoms days ago, I now realize that the symptoms are but the messengers. Like what they say, my best enemy is actually myself.

Don’t take me wrong and think that I am blaming myself for the mental health problems. I have to live with it just like anyone else with other chronic health problems, for instance, heart conditions. However, in this era, people are still lacking a solid understanding about mental health issues.

I am not only talking about the general public. I am also talking about those professionals whose job is to treat patients, to create treatments, and, to study about the etiology of mental health problems. However, most of the problems could only be dealt with but can not be cured. The significance of labeling is important to the selection medication. Yet, it is actually the symptoms that are more important than the labeling.

Back a while ago, I encountered a guy who does medical research. I asked him what he does, he replied, “I know everything about dopamine.” Well, maybe he was just trying to impress a girl that he met at the bar but he tried it on the wrong one. I looked at him and I said something like, “You don’t know jack about dopamine. Otherwise, I would have been cured and freed of auditory hallucinations.” To my amazement, his response was, “That’s schizophrenia.” If he were taking a quiz in my abnormal psychology class, he would have failed. However, I am the person without a job with benefits. lol

Also, to be honest, there hasn’t been much consensus about my diagnosis for the past few years. I have been diagnosed as having delusional disorder, bipolar disorder, and schizoaffective disorder, in addition to depression. After I while, I just let them call me whatever they want to call me because, the bottom line is, give me the drug that I need to become stabilized, everything else is negotiable. lol

You see, if it might have been the lack of knowledge that contributed to witch hunt, the same could have contributed to people’s fear about individuals with mental health problems. And, believe me, I am one of them.

However, there is a difference between my fear and those who don’t struggle with it. My fear about mental health problem is about my inability to deal with it without causing major problem in my functioning as well as its revisit. On the other hand, sometimes, people’s fear for crazy people is due to their lack of understanding or due to how the media have portrayed people with mental health problems.

For me, we all are entitled to our fears regardless what the origins of our fear are.

However, it is inevitable for me to start finding myself a way to deal with these fears.

It is why I am setting up this life skill training sessions for myself in my everyday life. You see, I could stay at home and remain in private till I become a certified social phobic. Yet, that is what I will not do.

Rather, I will put myself to face whatever I have to face.

Essentially, there are only three possibilities for the reality. First, I might really have mild delusions which lead me to sort of believe that people I haven’t even encounter knows about me and my condition. Second, people might really know about my conditions. Third, nobody, except for those people whom I talked to and who love me, knows about it.

I have decided that it is of no significance whatever the real scenario might be because that is not the point.

In my last two episodes, I went on with my life and I was determined to fight it off.

This time, I am having a paradigm shift. I have come to the true realization that it is the art of ignoring that I need to master and it is myself that I have to fight.

Since self-defeating is the last thing I need now, I will keep a rain check on that engagement ;-)(lol). At the same time, believe it or not, ignoring is a task much harder to learn than training myself to write with my left hand; as a result, I will start from concentrating on the things I do in my life.

I should mention, though, I will not be me today without these people studying those neurotransmitters running around in our brain. Whenever I think about two of my uncles who suffered from Schizophrenia since their early adulthood and who never could have achieved their full potential, I realize that modern atypical psychotic medications have spared me with a life to live.

BTW, positive symptoms appearing as usual.