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Evolving experience can be represented as a system that changes with time. The output (state of mind, SOM) of any one moment will become part of the input of the next moment. The brain’s salience system makes comparisons between the presented information and known regularities. The salience systems have the capacity to detect deviation from regularities, so that they learn to “ignore” predictable regularities and engage with the unpredicted salient stimuli. If the discrepancy is above a threshold, a salience response is activated. This signifies the presence of significant unpredicted situations in the environment and directs the mind to engage and understand the novel elements. Re-configuration is carried out by the mind to minimise incongruity. This process results in the reorganization of long-term memory.

 

經歷會隨時間被表徵。內心狀態一刻的輸出，會成為另一刻的輸入。大腦的突顯系統會對「呈現資訊」與「已知規律」進行比較，偵察是否離開常規。突顯系統會「忽視」可預則的常規資訊，聚焦於不可預測的突顯刺激。當差異超過某個臨界點，大腦會啟動突顯反應，表徵出現了不可預測的情況，並引導內心對新元素進行探索。大腦會對舊資訊與新資訊進行重組，以減低不一致性，並儲存在長期記憶中。

Human expressions of some basic emotion are similar in other primate groups.  Expressions and behavior are consistently associated with the basic emotions not only for people from different cultures (fear, surprise, disgust, happy, sad, anger, pride, shame), but even across different primate species (anger, fear, excitement). Some of the emotions (e.g. fear) may be shared amongst a even wider groups of animals. Humans share other basic behaviors with many animals’ species. They include sensorimotor functions, learning, fight-flight responses, seasonal changes in activity levels, dominance hierarchy behaviors. Human also shares some higher cognitive functions with primates, who also have group living, reciprocal support, families, tribal wars, primitive tool use, and simple deception behaviors. However other primates do not have capacity for syntax-based language.

 

人類的基本情緒表達模式，與靈長動物相似。雖然來自不同文化背景，與情緒相關的表達與行為，各民族是相類似的 (恐懼、憎惡、快樂、哀傷、憤怒、驕傲、羞恥)。人類有一些情緒與靈長動物共享 ( 例如：憤怒、恐懼、興奮)。有一些情緒 (例如：恐懼) 則與其牠大部分動物共享。人類與其牠動物的基本行為模式也相類似，其中包括：感官運動、學習、戰或逃反應、季節轉變行動及等級主宰行為等。人類與靈長動物一樣，擁有高階思維能力，例如：群居、互相支持、家庭、族群戰爭、使用原始武器、簡單欺騙行為等。但靈長動物沒有的，是具語法的語言能力，這是人類獨有的。

The minimum set of items involved in the interview involves a small room, in which at least two chairs are placed, one for the subject and one for the interviewer. Spatial arrangement of the two chairs involves alignment and distance. Two chairs placed too far apart would impede communication, as hearing becomes effortful. Two chairs placed too close together will impose an uncomfortable psychological proximity between the subject and the interviewer, leading to a compensatory increase of psychological distance. The ideal alignment of chair arrangement is between 90 and 180 degrees. The principle is that the participants should not need to make much extra effort in order either to look at or not to look at the other person. The sensitivity for clinical observations on eye contact is higher if the persons have maximum freedom to choose whether or not to engaged or not to engaged in eye contact.

 

面談的基本設備是一個小房間，最少兩張椅子，一張為病人而設，一張為訪談者而設。椅子的位置涉及距離的調準，椅子放得太遠會妨礙溝通，聆聽對方頓感困難。椅子放得太近，會為病人與訪談者帶來不舒服的「親密感」，為了拉闊心理距離，病人會作出補償行為。最理想的椅子安排是介乎90至180度，那麼便不用太用力去看或不看對方。容許病人選擇是否與對方進行眼神交流，有助改進臨床觀察的敏感度。

Clinicians could be vulnerable to premature closure in the model construction process, when excessive top-down information is employed in the clinician’s mind to “fill in” what the patient has not communicated. To minimize these tendencies, attention to the phenomenological practice of “suspension of judgment” is a particularly important discipline for the clinician. Ability to keep close to primary experience of the patients is important for the validity of the psychopathological observations.

 

臨床工作者在建構病人的病理模型時，往往容易太早下結論。原因可能是臨床工作者習慣採用從上而下的資訊，填充病人沒有傳遞的資訊。為了減低這種傾向，臨床工作者必須持守現象學提倡的「懸置判斷」概念，貼近病人的初始經歷，這對有效進行精神病理觀察十分重要。

The brain synaptic pruning processes in late adolescence may be a key process in unveiling youth-onset mental disorders (such as psychosis and bipolar disorder). Pruning alters the computational properties of neural networks. Pruning of unused connections results in more specificity and efficiency, but the brain system also loses pluri-potency and the capacity to compensate for dysfunctional components. This change could possibly expose latent inadequacy in underlying neural buffering capacity in vulnerable individuals and result in the of decompensation of mental states. In a less adaptive net, there is less flexibility, more fixed-action patterns, more stereotypes, as well as more dependence on well-chosen initial connections. The less adaptive net will be less able to learn new patterns, and existing representations will be used for new situations even though they may not be optimal.

 

到了青年晚期，大腦的突觸修剪過程大致完成，突觸修剪或許可以解釋青年患上精神病的其中一些原因 (例如：思覺失調、躁鬱症)。所謂修剪，就是把不再運用的突觸剪除，讓大腦的連接變得更加明確、更有效率。突觸修剪大大增強了大腦的運算性能，但同時失去大腦「多能性」的特點，失去對其他失效組件的補償能力。這是很多脆弱個體面對的問題。突觸修剪減低了大腦網絡的適應性，令內心缺乏彈性，大多時間只懂跟從設定的行動模式行事。這個缺乏適應力的網絡，令青年難以學習新模式 ，抱殘守缺，不能盡情發揮潛能。

When a psychotic experience occurs, anomalous judgments of reality result in misalignment between self-representation and Others representation. This results in a disequilibrium in the representation system that cannot be resolved except by deriving further anomalous interpretations. The following positions summarize consequences of an anomalous experience “A” (e.g. a hallucination) (1) I believe that Others are as real as me. (2) I think experience A is real (as it is primordially experienced), (3) I observe that Others do not think A is real If (2) and (3) has to be confronted, some reason has to be generated to account for the difference. These reasons can lead to secondary delusions (e.g. Others are influences by some powerful forces, of Others are not who they are).

 

思覺失調會影響個人對現實作出不正常的判斷，個體會錯誤校準自我表徵與他者表徵，結果導致表徵系統失衡，生出更多不正常的詮釋。下列例子正好表明不正常經歷 (例如：幻覺) 對個體的影響。 (1) 我相信他者與我一樣真實 (2) 我認為經驗A是真實的 (因它屬於初始經歷) (3) 我察覺他者並不認為A是真實。個體如果要對(2)和(3)進行對質，必須有一些理由去解釋與他者不同的判斷，這些理由往往引發次發性妄想 (例如：他者被其他強大力量控制、他者不是他自己) 的出現。

The more the clinician shares control with the subject, the better the clinician can engage the patient. If the patient is participating in a half-hearted manner, the validity of the emerging data will be compromised. This is particularly important for the anxious or defensive subjects. In these instances, it is even more important to ensure the subject experiences a sense of control over the interview process. Sometimes, it is worth making an explicit statement to the effect that “Although this interview may touch on something distressing, I would like you to know that you can stop the interview at any time. If you feel uncomfortable or there are areas that you don’t wish to talk about, please let me know and I will respect that”. Giving this reassurance sometimes helps anxious patients to become more at ease and less defensive.

 

當臨床工作者樂意與病人分享控制，病人對面談過程的投入程度會有所增加。如果病人虛應故事，從病人身上收集的資訊的可信性便大打折扣。對焦慮和防衛性較強的病人，臨床工作者更須注意分享控制的重要。臨床工作者可以向病人表明：「雖然面談會觸及一些痛苦的東西，但你可以隨時叫停。如果你感到不舒服、或碰到一些你不願意談及的內容，請讓我知道。我是會尊重的。」給予這些保證，可以減低病人的焦慮及防衛。

A state of affairs (SOA) is a complex mental representation about the state of the external world. State of affairs are formulated as propositions. Actions are in states of affairs. These states are expressed in a propositional statement in the human mind. They are constructed from simple representations of objects and actions organized in a structured manner. They often follow the structure of propositional statements in language (e.g. A sees B hitting C). They are expected to have a truth-value (i.e. they can be considered as true or false). Even false SOA representations are valid representations in the mind and are important for mental activities (e.g. in imagination, or in counterfactual thinking). Communication of social SOA is an important action to define social groups and cooperation in human life.

 

對外在世界的狀態進行表徵，可以稱為「處境狀況」表徵。「處境狀況」一般由客體和行動，以命題的形式組成，跟從命題句子結構，例如：甲看見乙打丙。一般人會期望「處境狀況」反映真實，即可以判斷狀況孰真孰假。但有時候「不存在」(假的) 的「處境狀況」也有它的作用，假的處境狀況可用於想像、反事實思維等心智活動。在群體中，社會「處境狀況」的交流是一項重要的社交活動，它有助界定群體、促進組員的合作。

Making a diagnosis involves mapping the patient’s condition into a category within a system of classification.  One important level of categorization is the “symptom classification” process. The symptom classification process involves comparing details of the anomalous psychopathology experience in the patient with those reported in other patients. As such, symptom classification reduces the complexity of the clinical information into membership of symptom categories. 

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「診斷」涉及將病人的情況按照一個分類系統，歸入某一類別。其中一個最重要的步驟是「病徵分類」。「病徵分類」過程涉及將病人的非常態精神病經歷與其他病人報告的現象進行比較，「病徵分類」有助臨床工作者將臨床資料的複雜性降低，並將精神病現象歸納為病徵類別。

Semantic systems (cognitive systems with “meaning”) concern information conveyed as ideas and concepts. A basic unit of information in the mind is the observation of correlations (associations) amongst objects and ideas. The brain can be view as a platform of dealing with complex associations. Correlation can be expressed in the following form: given features A, the probability of feature B is increased (not random).

 

語義系統 (關於「意義」的認知系統) 關乎資訊如何透過意念與概念傳遞。在我們的內心中，資訊的基本單位是建立客體與意念的關聯(連繫)，因此大腦可以被視為處理複雜關聯的平台。關聯可以以下列形式表達：當特徵A出現，特徵B出現的機率會上升(而不是隨機關係)。

In a group, the individual can be considered as a information unit for which information is a “currency” that can be used as transactions in groups. Exchange of social and technical information is one of the key processes in human transactions. A piece of information may contain a “value” as determined by its “social significance”. Social significance results in a change in the situational model in an individual, in such a way that the individual re-position his social network configurations adaptively to guide his future social actions. Information therefore is valuable if it is of value in guiding such positioning to Others. Social information is continuously updated. Exchange of social information is an important mechanism for managing social group memberships. Individuals in a group are identified by shared information. They also use social information as currency in cooperative and competitive interactions.

 

在群體中，個體會被視為「資訊單位」。「資訊單位」會互相進行交易。交易的資訊內容，可以是技術資訊，也可以是社交資訊。資訊是否有價值，端視乎資訊的「社會重要性」。「社會重要性」的資訊可以改變個體的「處境模型」，讓個體能夠在社交網絡中重新定位，針對未來轉變採取行動。在群體中，會員會互相交換資訊，以鞏固社群身份。組員也會運用社交資訊作為流通貨幣，促進合作和競爭互動。

The past, the present and the future are entrained into a stream of consciousness (SOC). Potentials (i.e. possibilities) are inherent in this basic human existence, as the present holds potential for the incipient future. The increase in information over the passage of time is a fundamental aspect of human experience. The notion of “information” is therefore inherent in the temporal nature of human existence.

 

過去、現在、將來組成了意識流。現在，開啟了將來的可能大門。人類的存在蘊含各種潛能、各種可能，隨時間推進，人類會累積「資訊」。所以，人類存在的「時間」本質，也是「資訊」增長的過程。

臨床對話是兩個人獨特的相遇。要達致成效，參與者必須保持開放態度，以同理心與別人連繫。要達到這個目的，需要開放性思維，耐性，留心細微，並且不要太多假設。過程中，我們要讓對方超越自己的期望，產生驚喜；也要讓對方在心智交流上，發揮創意。臨床工作者要有心理準備，透過這種溝通模式，自己的表徵結構是可以改變的。訪談變成了一次創意互動，不再是單向的溝通過程，而是會帶來新的資訊、新的轉變。當我們擁抱開放、堅守本真，便可以觀察到新的可能，不會固步自封。

Ideas cluster with related ideas to form coherent clusters. Compared with isolated ideas, ideas in a coherent group are much less vulnerable to being eliminated. The notion that pathological symptoms may provide mutual support and reinforcement has been articulated in a “symptom network” approach. A symptom network consist of a group of symptoms that may initially be triggered by an environmental event. The symptoms then acts to cause intensification of other symptoms in the network and in this way reinforce one another. Eventually this may result in the activation and stabilization of a network of self-perpetuating symptoms, even though the original triggering event may no longer be active.

 

在我們的內心中，相關的意念會匯聚一起，組成意念群集。相較於單一意念，意念群集比較難以清除 。從「病徵網絡」的角度， 病態病徵會互相鞏固和強化。「病徵網絡」包括一組病徵。最初某一些病徵受環境事件引發，這些病徵接續強化了其他病徵，並彼此鞏固，最後組成「病徵網絡」。其後，原初引發病徵的事件可能已不再活躍，但其他病徵仍可自我生長，組成穩定的「病徵網絡」，不時啟動。