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The clinical dialogue is an evaluative technique in psychopathology involving an iterative process. The overall objectives of the clinical dialogue are 3-fold. (1) A psychopathological “clarification”. The “psychopathological clarification” involves detailed clarification of anomalous experiences in terms of its representational structure and content. This includes the primary experience, the contexts, and the development path of the anomalous experiences. The clinician also observes the patient’s abnormalities. (2) A detailed perspective about the patient as an evolving Person, developing through a chosen path of engagement in his Lifeworld. The anomalous experience is placed in the context of the Person by considering the basic structure of the Person, and the representations in his Lifeworld. (3) Optimal engagement of the patient so that future therapeutic interaction will be facilitated. 

 

臨床對話是精神病理學其中一種評估技巧，涉及反覆進行的過程。臨床對話的目的可分為三個層次：(1) 病理澄清：就異常經歷的內容及其表徵結構，作詳細澄清，其中包括初始經歷、情景脈絡及異常經歷的發展途徑；此外，臨床工作者也會觀察病人的不正常表現。(2)   詳細研究病人作為一個「人」，他與生活世界的關係；他所走的路，如何演變成今天這個「人」。並且把不正常表現放在「人」的脈絡去瞭解。作為「人」，他展現怎樣的基本結構？所謂不正常表現，在他的生活世界中有什麼表徵？(3) 盡量與病人建立關係，好讓未來能夠產生治療互動。

The tension between competition and cooperation within a group means that language evolves not only to serve cooperative communication, but also to serve competitive functions as well. The simultaneous need to serve both cooperative and competitive functions resulted in the unique form of human language with its characteristic ambiguity (as opposed to the clarity in computer programming languages). With ambiguity, the possibility of deception multiplied. Deception implied a possibility for the betrayal of trust, which presupposes a state of “Trusting” and “Relating”. 

 

群體中，成員彼此間會有競爭，也會有合作，產生了一定張力。語言的演化，並不是單單為了促進人與人之間的合作，也要解決成員之間的競爭。為了同一時間滿足合作與競爭的需要，人類的語言有其「模糊性」(有別於電腦語言程式的清清楚楚)，但這種「模糊性」也助長了欺騙的滋生。欺騙是對信任關係的背叛，並假定「信任」與「連繫」存在的可能。

Nervous systems in higher organisms acts as a "holder of multiple possible contexts". Context influences the conditional possibilities in the selection of a behaviour in response to incoming stimuli. Momentary incoming sensory information interacts with background contextual information to determine response. Foreground sensory input is put side by side with background input from the external environment (external context), as well as with information in memory (internal context). The unique capacity of the human brain is to hold together a large set of organised information, as "potential contexts" that eventually may have impacts on behavioural output. Contextual information has also grown to be much richer and far more complex, with cascades of conditional relationships as the brain increases in capacity.

 

高階生物的神經系統其中一個特色，是能夠保持多個「可能脈絡」。當生物體受到刺激，可以選擇採取的行為往往受制於這些「情景脈絡」。生物體的「瞬間感官資訊」會與「情景脈絡資訊」產生互動，決定作出的反應。過程中，「感官輸入」會與「情景脈絡輸入」(外在脈絡)、「記憶資訊」(內在脈絡)並置，多套「組織資訊」同一時間運作，構成「潛在脈絡」，對行為輸出發揮影響。脈絡資訊隨著大腦的容量增加、條件關係的串連，會愈來愈豐富和複雜。

Creativity could mean the selection and specification by choosing out of a number of alternatives. This act of choosing generates information. An example would be expressing your opinions to your friend, so that information is increased in their representations about you. Creativity at another level involves generating new potentials and new possibilities. Example for this may be developing a new social group, an innovative piece of creative work, or a novel group activity, individuals can then choose options in this new space to express themselves. In the recovery from mental illness creativity can play two roles: the making sense of the illness experience may require an openness to accommodate different experiences. In neurocognitive function, the ability to switch context and to generate new items (divergent thinking) are important for the flexibility in handling life situations in the recovery process.

 

創意的其中一個方式，是在眾多選擇中進行揀選或指明所好。這種選擇行為可以生發資訊。例子是向朋友表達意見，讓朋友對你的表徵增加。創意的另一層面涉及創造新的潛質與可能。例子是建立一個新的社交群組、或創造一件創新的藝術品、或安排新穎的群組活動，個體從這些創造空間中行使選擇，表達自己。在精神病的復元過程中，創意扮演兩重角色：第一，個體要明白自己的精神病，他/她必須對精神病持開放態度，能夠容納不同的精神病經歷。第二，在復原過程中，彈性處理各種生活處境也很重要，從神經認知角度，能夠轉換情景脈絡，創造新的思維或行為(擴散性思考)，對促進復原不可或缺。

In decisions about clinical intervention for patients, we have to utilize the best possible existing empirical knowledge, however incomplete it is. In this situation, the clinician will construct a clinical formulation for the patient, linking the individual patient to existing knowledge about aetiology and treatment of the condition. The formulation can be suggested by three pragmatic clinical questions: (1) Why has this patient (and not others) developed anomalous experiences? (2) Why does he suffer from these particular mental experiences (rather than Others)? (3) Why do these develop at this time in the course of his or her life development (and not earlier)? The responses to these questions involve applying knowledge about the condition to the individual patient.

 

替病人做臨床治療的決定，我們須運用已知的實證知識，縱使這些知識不完整。臨床工作者會將病人的情況，與現存病因學及治療方法作出連繫，建構臨床處方。要作出臨床處方，我們須問下列三個實際問題：(1)為什麼是這個病人(而不是別人)發展出不正常經驗？(2) 為何他/她受苦於這種心理困惑 (而不是其他困惑)？(3) 為什麼他/她會在這階段發病 (而不是更早)？回應這些問題，關乎把現有知識應用到個別病人的特殊情況中。

When the brain is compelled to respond while information is insufficient, it will compile a response based on the information available, even though the information may be grossly inadequate. In health, the individual has the capacity then to refute the faulty response. In some conditions (such as neurological conditions affecting the function of the prefrontal cortex), the brain is not able to further evaluate the adequacy or otherwise of the compiled responses. Filling a focal information gap by default, and failing to recognise the lack of information, results in the clinical symptom of confabulation. 

 

當大腦的資訊不足，卻被迫作出反應，它會基於現有資料，縱然資訊嚴重不足，它仍會匯聚已有資訊，作出反應。當一個人處於心理健康狀態，他/她有能力推翻所作的錯誤反應；但某些情況之下(例如神經系統病變影響前額葉皮層的功能)，大腦便不懂得重新評估資訊是否足夠，會作出錯誤的匯聚反應。慣性填補資訊缺口、不承認資訊不足，往往造成虛構事實的臨床病徵。

To an experienced clinician, contradictory information is not treated on the assumption that there must be some “error” and only one version is “correct”. Discrepancies could be genuine and informative, if the contexts in which different observations are made could be explored. This may lead to a more informed grasp of the patient’s experiences. 

 

對於經驗豐富的臨床工作者來說，矛盾資訊不會視為「錯誤」，或假設只有一個版本是「正確」的。矛盾差異可以是真實的，並且充滿豐富信息。如果我們可以對不同觀察的情景脈絡進行探索，或許可以對病人的經歷有深刻的理解、豐富的掌握。

The development of mental representations emerges as the brain undergo maturation in successive waves of critical periods during development. Early acquisition determined basic cognitive structures such as the phoneme, lexical items etc. during the early critical periods. These basic cognitive structures may become the building blocks later for more complex structures. These structures are progressively build up in an orderly sequence of maturations in different brain systems. Critical periods are time-windows during which the brain system is opened to environmental influences leading to active moulding of specific brain pathways. Early development set limits to the global neural resource and computational capacity. If representation is affected early, the effect is likely to be more devastating than when it occurs later, as it compromises upstream cascades, influencing a broad range of subsequent development process. 

 

隨著大腦經歷一個一個發展階段，邁向成熟，內心表徵會發展建立起來。早期關鍵階段建立的表徵，例如音素、語詞，決定了思想的基本架構，這個基本架構是日後複雜架構的基礎。這些架構在大腦的不同系統，按著既定的先後次序建立起來。關鍵階段是大腦的發展時窗，到了某些關鍵時間，環境可以對某些大腦系統發揮積極影響作用，把大腦模造成某種成熟模式。早期階段十分重要，它往往限制了未來大腦的整體資源和運算能力。如果大腦表徵在早年受到影響，相較於成年後期，破壞性會更大，因為它削弱高階串連能力，影響後績發展。

In the mind of the individual there is a representation of the groups in his social environment (the COM). The individual interacts with the group and obtain information about the group. These items of information allow a comparison between the actual group and the representation of this group in the subject’s mind. The comparison process will be compromised when there is a lack of contact with the actual group. It is also disrupted when top-down biases interferes with interpretation. The lack of information in the COM render it vulnerable to top-down biases. A snowballing corruption of the COM can then result. Regular contact and information exchange is crucial to minimize the chances of a catastrophic corruption of the COM.

 

個體生活在社會環境之中。個體對群體的表徵稱為「心智社區」。個體會透過與群體互動，收集關於群體的資訊。個體會對真實的群體資訊與群體表徵進行比較，並在心智中修正。如果個體不去接觸真實群體，便會削弱比較的效能。此外，從上而下的表徵，也會讓我們對群體產生偏見，影響判斷。缺乏關於「心智社區」的資訊，會容易出現滾雪球效應，讓我們對「心智社區」出現偏見。所以，與群體保持接觸交流，可以避免「心智社區」出現嚴重扭曲。

Human memory does not transit straight from registration to storage. An intermediate state is required in which the hippocampus plays essential roles before the memory trace is deposited elsewhere in the cortex for long term storage. It has been suggested that one of the roles for this period of consolidation is to allow for a tentative holding of memory traces “in buffer” where they are allowed to interact with existing memory, in order to arrive at a representation more coherent with other representations.

 

人類的記憶系統不是登記信息後便自動儲存，其中包括一個中間過程。記憶痕跡會經過一個中間階段(海馬迴在這中間過程發揮重要角色)，才會在大腦皮層被儲存為長期記憶。鞏固階段的其中一個角色，是讓記憶痕跡暫時處於緩衝狀態，新記憶與現有記憶會產生互動，讓新表徵與其他表徵更趨一致。

Language based on universal grammar (syntax) allows complex propositional representation to be constructed for “situational models”, whether actual or imagined. Counterfactual thinking is he use of mental representation to conceptualize not-yet-in-existence state of affairs (SOA). This can result from recombination of components from existing SOA. This counterfactual ability to represent state of affairs not actually in existence is important for imagination, planning, deception, as well as social communication.

 

語言(建基於普遍語法) 可以替真實的、想像的「處境模型」，建立複雜的命題式表徵。反事實思維就是利用內心表徵，把未出現的事態進行概念化。其中一個方法是把現存事態的組成元素重新組合。這種把未出現的事態進行反事實表徵的能力，對建立想像、計劃、欺騙及社交溝通能力非常重要。

Human experience is assumed to be dependent on the biology of the brain and do not exist apart from the brain (which is a biological “form”). However, some aspects of human experience can be shared with Others so that the information can persist independently of individual brains. We consider such sharable aspect of human experience as “culture”. Culture in turn becomes the context for shaping individual experiences 

 

人類經歷十分依賴大腦的生物機制，人類不能脫離大腦的生物模式而存活。但人類部分經歷卻獨立於個體大腦，可與他者分享，並以資訊形式留存後世。我們視這些共享的人類經歷為「文化」。「文化」十分重要，「文化」可以反過來成為情景脈絡，塑造個體經歷。