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 categorizing 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 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 is 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 locations on the tree that otherwise would not be placed there. But this process is voluntary and can be turned on and off at will.
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 what 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. In other words the psychotic builds a bud which is not related to what is happening. He will think of things that are not real. He will relate to an 'internal world' not associated with the event. The wrong bud on the wrong twig. Often we see the same psychotic symptoms re-occurring. It as if there is a learned wrong response. We call these the positive symptoms. Unfortunately the loss of contact with the inner world is more lasting and often permanent. It as if the the contact between the inner and outer experience is under responsive. 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 of the causes of thyroid disease is a basic lack of responsiveness. In both cases there is a compensatory process. The compensatory processes are inefficient and cause symptoms. The symptoms are in fact an overloading or overcompensation. One thyroid disease is caused by an under responsiveness to thyroid hormone. Initially we see an overcompensation. The thyroid 'does too much'. It looks as if it is hyperactive.
Are the positive symptoms a similar unsuccessful compensatory process? Is the basic defect the negative symptoms? Is the core symptom of psychosis a lack of responsiveness between the previous and the present experience? We do know that we can teach a psychotic to recognise and ignore his positive symptoms. But we have not been quite as successful treating with negative signs.