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The ability to hold, to compare and to monitor a number of tentative options is demanding on computational resources. Pathological conditions may compromise this capacity (see above). Inability to hold this tentative deliberation space may contribute to the formation of delusions and delusion-like ideas. Delusions are notoriously difficult to define. It is note-worthy that amongst the different characteristic features of delusions, the inability to consider alternative accounts may be the closest to being a “defining feature”.

 

要在大腦中同一時間想考多種可能，進行監控、比較，這對大腦資源運作構成很大挑戰。精神病情況或會削弱這種大腦能力。沒能力提供這片「暫時性」空間，或許是引致妄想或產生妄想意念的主要原因。妄想一向難以給予一個明確定義 ，但沒有能力對事情產生另一種解釋，可能頗接近妄想的本質。

A dialogical approach can offer a potent account for verbal hallucinations. Verbal hallucinations may be viewed as “runaway” inner conversational rehearsals that have lost their cognitive tags for internal self-initiation, and are consequently attributed to having originated from the external environment.

 

對話取向為言語幻覺提供了一個強而有力的解釋。言語幻覺可以視為「逃跑」的內在對話。這種內在對話，由於沒有貼上「內在引發」的認知標籤，病人於是以為內在對話來自外在環境，有人在談論他/她。

Active effort results in a sense of agency and is also instrumental in enriching a sense of self. Internal goal representations, even if not as a "conscious" idea, are computed in order to guide actions and maintain position relative to environmental changes. The goal-perception comparison is a basic feedback control system that creates contexts for actions. It gives rise to a sense of agency. If this system is not functioning, movement may be experienced as being controlled (alien hand syndrome, passivity). Disorders in agency result from failures of the mind to register intentional goal-directed actions initiated by the Self. The symptoms of passivity and thought alienation can be directly understood in this context. The symptom of verbal hallucinations has also been related to a failure in internal monitoring of inner dialogues.

 

積極參與給我們一種主體意識的感覺，締造一種自我感。此外，我們 (在潛意識)會為目標建立內在表徵，不但引導行動，更在環境轉變中，保持方向位置。在我們的反饋控制系統，會對目標和知覺作出比較，提供情景脈絡資訊，以便作出行動。這系統給予我們主體意識的感覺。如果這系統不能有效運作，我們的大腦便無法記錄由「自我」啟動，有意圖、有目標的行動，便會覺得自己的動作受到外界控制 (例如：他人之手症候群、被動)，產生「主體意識障礙」。「被動」與「思想異化」這等病徵都可以從這脈絡去理解。言語幻覺的病徵，亦與監控「內心對話」失調有關。

Of the many stimuli in the environment, the person has to adaptively choose which stimuli to engage with. This choice involves higher cognitive decisions that takes into considerations past experiences as well as motivational factors.  Some pathological processes compromise the ability to judge which stimulus to engage with. The person may end up responding inappropriately to whatever stimulus is presented in front of him, regardless of the situation. Patients with such “environmental dependence syndrome” could not help responding to any object placed in front of him by picking it up and then using it, no matter how inappropriate the context is. 

 

環境提供很多刺激，個體須對眾多刺激，適當地選擇回應哪些刺激。這些選擇涉及高階的認知決定，需考慮過往經歷及動機等因素。一些病變過程會削弱個體對刺激的選擇判斷，個體會不加考慮的情況下，不適當地回應眼前所有刺激。病人患上了「環境依賴徵候群」，會不能自控地去觸摸眼前的物件，拾起使用，無論處境怎麼不適合。

Inner speech is engaged to rehearse dialogue in encounters not only between self and Others, but also between representations of significant individuals in the internal  “Community of Mind” representation (COM). Representations of the “Others” emerge as a “Bakhtinisation” process (Bakhtinisation involves a freeing of parameters to allow the representation to “freely” evolve according to its own internal potential). While inner language can sometimes be used in more effortful problem-solving, it can also be employed in a less explicit, more automatic process of inner expression in the COM. These Others’ representation interacts in inner information exchanges as rehearsal, resulting in going computation of their inter-relationships. The tagging of “self-initiated” signals is an important marker for the “self” as the source of these inner messages. If the tags are degraded, such inner rehearsal may be mistaken as externally-generated verbal messages (hallucinations).

 

內心對話的作用是排練人與人的對話。應用範圍包括自我與他者，也可以是「心智社區」的重要個體(透過表徵)。他者表徵是一個「巴赫汀化」過程(「巴赫汀化」關乎放寬界限，讓他者表徵按著它的內在潛質，自由演化)。我們的內在語言很多時只用作解決問題，但它也可以用於較少明確對象、較多自主的「心智社區」對話。他者表徵會模擬人與人之間的互動，進行資訊交流，以建立內在關係網絡。由於這些對話是「自我引發」的，大腦會為「內心對話」加上「自我引發」的標籤。如果標籤失效，「內心對話」會被誤以為是「外在引發」，產生言語幻覺。

Youths continue to be confronted with challenges of a mismatch between brain representational architecture and ever-increasing social-environmental processing demands. Originally the economy of the developing brain is designed to endow an organism with a high capacity for learning in childhood. The brain then becomes committed afterwards to adapt to the relatively stable natural adult environment in pre-historic hunter-gatherer ecology (i.e. The Evolutionary stable environment (ESS) ). The rapid evolution of the human environment in the last 10,000 years requires substantial adaptation, and this adaptation may not be fully attuned yet in the human brain. Accelerating changes in human culture and social organisation has taken place only in the recent several thousand years. The need to cope with novel social structures in the late youth period where pruning has already been taking place may challenge the capacity limits for complex schemata.

 

青年面對的一大挑戰，就是處理社會環境的要求，但青年的大腦表徵架構，可能追不上這些挑戰。原先大腦的生物設計，是針對比較穩定的狩獵採摘環境(進化的穩定環境)而設。人類在童年把大量精力投入學習，到了成年階段，大腦便裝備好適應外界環境的要求。但過去一萬年，人類的生活環境起了急速的變化，須作出實質的改變，但大腦仍未能作出適應調整。人類文化和社會結構的急速轉變，只是數千年的事，但青年步入成熟階段，突觸修剪大致已經完成，這大大限制了他們處理複雜圖式的能力。

Ideas of reference (IOR) or delusions of reference (DOR) identify a group of experience where the subject experiences events in the environment as spurious communication signals specifically directed towards himself. The signal contents could be diverse. It could be conversation, eye gaze, cough, noises in the environment, or messages in the television.  In IOR the focus of the abnormality is not in the content of the information, but in the “address” attached to the information (which specify who the signal is intended for). IOR is a phenomenon different from other delusions (although both can occur at the same time). IOR is better considered as a dimension within other delusional experiences. On its own it could be considered as a Disorder of “communication address”.

 

在「疑心病」與「關係妄想」這些經歷中，主體會認為環境中發生的事情，特別是一些虛假溝通信號，是針對他發出。信號的內容可以非常廣泛，包括對話、眼神、咳嗽、環境噪音或電視發出的信息。「疑心病」不正常的地方，是對資訊的「指涉對象」(資訊針對的明確對象)錯誤的判斷，而非資訊的內容。「疑心病」這個現象與其他妄想不同 (雖然疑心病有可能與妄想同時出現)，「疑心病」應被視為妄想經歷的其中一個面向。當「疑心病」被視為另一種精神病，才歸類為「溝通指涉失調」。

The functions of the Others representations are for making prediction in the social world that can guide one’s social behavior. The Dialogical Self Theory proposes that within the mind there are rich information exchanges between different representations of Self and Others, using language-based representations. In real life, social information is often fuzzy and incomplete. Failure to support probabilistic social evaluation may result in erroneous interpersonal interpretations. When the direction of bias is towards a direction that construes Others as threatening, this results in paranoid tendencies and misattribution of hostile intention to Others.

 

在社交世界，我們需要經常作出預測，作出適切的社交行為，這便是「他者表徵」的作用。「對話自我論」指出，在我們的心智中，自我表徵與他者表徵(以語言表徵的方式)不停交換資訊。在真實生活中，社交資訊往往是模糊、不完整的，如果不懂得評估社交情況的機率，便容易對人際關係作出錯誤解釋。有時候偏見會引導我們，以為他者具威脅性，結果是偏執傾向的形成，錯誤認定他者存在敵意動機。  

A key phenomenological feature in human subjective experience is “relating”. Relating can be directed to the world, to Others, to things, to ideas or to oneself. In a generalized lowering of engagement with the external environment, representations are weakened and feebly linked to external objects. This general failure of engagement with all objects in the mind corresponds to the acute confusional state (or delirium) in conventional psychopathology. It is important to recognize this state as it indicates a widespread systemic brain failure typically suggesting the presence of general medical conditions  (such as hypoxia, septicemia, CVA, encephalitis etc).

 

從現象學的觀點，人類主觀經歷的一個主要特點是「發生關連」，「發生關連」的對象可以是世界、他者、物件、意念或自身。當一個人對外在環境的參與減低，表徵能力會減弱，無力與外在客體連繫。當內心無力涉身大部分客體，這種狀況與傳統精神病理學所指的精神錯亂 (譫妄) 十分相似。須注要的是，這種狀況可能反映出大腦出現廣泛系統失靈，可能與常見疾病 (例如缺氧、敗血症、腦中風、腦炎等)有關。

Some computational updating for complex representations in the brain, such as the revision of stored schema, can apparently only be carried out while the system is not engaged with the environment. Such updating takes place when the system is offline (e.g. in sleep). Memory consolidation takes place in Rapid Eye movement (REM) sleep, which appear to be universal amongst all birds and land-based mammals. Representations appears to be incapable of being internally "updated" simultaneously when they are linked to external perception and are "in use". If the system is prevented from off-line updating there appears to be a limit beyond which computational failure may occur. It is well known that prolonged sleep deprivation can leads to psychotic experiences in healthy individuals.

 

大腦的運作模式，是不斷更新儲存的複雜表徵，例如更新「圖式」的版本。這個更新過程只能在系統沒有參與其他環境活動(下線狀態)下發生，例如：睡眠過程中。記憶鞏固過程發生在睡眠的「快速動眼期」，這在雀鳥及陸棲哺乳類動物身上很常見。大腦的表徵系統不能同一時間與外在知覺連繫，同一時間進行內部更新。當系統不能(在下線狀態)更新資訊，系統便有可能出現失靈。眾所周知，長期缺乏睡眠，會在健康的人身上引發思覺失調現象。

The life development of the Person can be considered as a process of “actualisation” that involves the unfolding of potentials with time. It is useful to consider each life experience as engaging the person in some specific domains. Stein described an “interface with life” in which the person contacts each external objects and life circumstances at some prescribed levels. Engagement with life experience leads to accommodation and assimilation in the mental model, resulting in a gain in information. 

 

人的生命發展可以視為「自我實現」的過程，隨著時間能展露生命潛能。生活經歷也可以被視為個體涉身生活領域的過程，即是Stein所指的「生活介面」，個體按著既定的發展階段，接觸外在客體和生活處境。參與生活體驗，可以帶來心智模型的適應和調整，並累積資訊的增長。

Affect can be positive or negative and is thus “directional”. Representations associated with negative affect are distanced from awareness. Selective distancing from these objects facilitates survival. How are these negative representations segregated in the mind? We propose that there are informational regions that are more distanced from immediate daily awareness. These regions accommodate representations that are associated with un welcomed emotions. Otherwise they may result in unforeseen effects which override other representations. If negative affect is attached to self-representations, negative self-feelings results. This situation may be encountered in psychopathological conditions such as Depressive Disorders and Borderline Personality Disorder. If negative affective features are attached to external representations, it may result in phobia, obsessive-compulsive symptoms, or persecutory ideations.

 

情感可以屬正面，也可以屬負面，提供「指引」。與負面情感相關的表徵，會遭到疏遠、盡量不被察覺。選擇性遠離這些客體，有助物種生存。這些負面表徵如何在心智中遭到隔離？大腦有一些資訊區域專門負責儲存這些不受歡迎的情緒表徵，這些區域與處理日常瞬間知覺的區域有一段距離，否則會出現負面情緒騎劫其他表徵的不能預計的結果。如果負面情緒依附在自我表徵之上，自我感覺會變得負面，這種情況在抑鬱症、邊緣人格障礙等精神病中很普遍。如果負面情緒依附在外在表徵，會引致恐懼症、強迫症或迫害念頭的產生。

Disturbance of body representation is involved in a number of mental conditions. In anorexia nervosa there is a distortion in body image. In dysmorphophobia there is also a delusional distortion in self appearance. Delusion of offensive smell as arising from oneself is a common experience in psychosis. 

 

身體表徵的困擾，涉及多種內心狀態的扭曲。厭食症涉及身體形象的扭曲。畸形恐懼則涉及自我外表的妄想性扭曲。而冒犯性幻嗅，在思覺失調患者身上非常普遍。

Compartmentalization disorders involves the breakdown of “source-information tagging” and results in the feelings of personal information being known widely. Information in the mind is first distinguished between that which originates in one’s own mind (self-generated) and that which one receives from another person (others-generated). The source and sharing status of a piece of information is important specification of the information in a social context. When the interconnection between individual connections in the COM is strong, the collapse of sharing tag may be sudden and follow a catastrophe dynamics. This may provide an account for the pathological experience of thoughts being known by others.   

 

「資訊區隔失衡」關乎資訊來源標籤的失效，個體感覺個人資訊給其他人廣泛知道。內心中的資訊會首先分為兩類：一類是來自自己的頭腦(自我產出)，另一類是從其他人身上接收(他者產出)。從社交的角度來看，分辦資訊的來源、判斷資訊的分享資格很重要。當一個人與「心智社區」的連繫很強，用作分辦分享資格的「分享標籤」可以突然失效，並帶來災難性的內心變化。這理論可以解釋，為何有些人會感覺自己的思想被他人知道這等病態經歷。

The mind receives information from its experiential encounters in different life domains via cognitive “structures”. Examples of these cognitive structures are  body-representation, self-representation, self-proximal habitat representation, self-Others representation, distal external world representations. The maturation of different cognitive domains appears to follow a specifically-timed sequence. During the critical period the brain interacts with the environment to capture the regularities in the environment. The resulting connectivity becomes consolidated before the critical period time window is closed.

 

大腦吸收資訊的方式，是透過體驗不同的領域，改變「認知結構」。「認知結構」包括身體表徵、自我表徵、自我近端居住環境表徵，自我他者表徵、遠端外在世界表徵。「認知結構」會按照一定的先後次序，步向成熟。在關鍵的發展階段，大腦會與環境互動，以掌握環境的規律。並在「時窗」關上之前，鞏固連接網絡。