Unawareness: A self-deceptive process--论文代写范文精选

在神经疾病的发展,它遵循不是先于神经症的发病。这个状态是一个复杂的认知过程,包括三个阶段:生成、保存和稳定。神经质患者产生未觉察到的变量下面的essay代写范文进行详述。

Abstract
Unawareness is a central component of neurotic disorders. In fact, repression, resulting from the adoption of the bizarre symptom, would not be possible if patients were aware of this process. Thus, the most important challenge of a conscious approach to psychopathology concerns the state of unawareness of self-involvement. How can the conscious be so actively involved in producing and monitoring bizarre behaviors and yet be so deeply and sincerely unaware of these activities? As specified below, the enhanced knowledge of cognitive psychology indicates that this process is the consequence of sophisticated self-deceptive processes. This concept precludes the existence of a scientifically unfounded omnipotent entity that, like spiritual possession, can dictate the individuals life (e.g., see Greenwald 1992; Rofé 2000, Chapter 1). Moreover, unlike the unconscious, unawareness plays no etiological role in the development of neurotic disorders, as it follows rather than precedes the onset of neuroses. The production of this state is a complicated cognitive process, composed of three stages: Generation, preservation and stabilization.

Generation of unawareness
Neurotic patients generate a state of unawareness regarding their self-involvement through two sets of variables: 1) Encoding-Inhibitory factors that weaken the transference of the knowledge of self-involvement (KSI) from short- to long-term memory; and (2) Memory-Inhibitory mechanisms that cause the forgetting of the KSI. 

Encoding-Inhibitory Factors: Clinical and research evidence suggests that five factors weaken the encoding of the KSI: Impaired cognitive functioning, directed forgetting, hypnotic trance, self-deceptive distraction and brief rehearsal period.Many studies demonstrate that extreme emotional distress, such as anxiety or depression, impairs the individuals cognitive functioning and causes poor learning and memory conditions (see Rofé 2000, p. 174). Accordingly, since the pre-neurotic patient is subjected to a high level of emotional distress (see Rofé 2000, pp. 105-107), the encoding of the KSI is likely to be weak.

Another disruptive factor is a hypnotic-like trance produced by the adoption of a bizarre behavior. An increasing number of studies show that hypnosis is a conscious-voluntary response that depends on the subjects willingness to concentrate intensively and exclusively on the hypnotic suggestion (e.g., Lynn, 1997, Spanos 1986, 1996). From this perspective, the patients cognitive state during the actual display of the symptom is comparable to a hypnotic trance. This theoretical position is consistent with Van Pelts (1975) theory on psychoneurosis. Relating to neurosis as a deliberate behavior, the author noted that:The naturally occurring psychoneuroses are the result of accidental self-hypnosis and suggestions A patient suffering from a psychoneurosis behaves in every way as though under the influence of a post-hypnotic suggestion (pp. 28-29).

Similarly, Ravenscroft (1965) noted with reference to spiritual possession, which is a form of bizarre behavior prevalent in non-western countries, that such behavior has a striking similarity to many of the classic phenomena of hypnosis and strongly suggests the possibility of an underlying hypnotic mechanism (p. 157). Thus, bizarre behaviors can be seen as powerful hypnotic tools that intensively preoccupy the individuals attention, and thereby severely disrupt the encoding process of the KSI (see case no. 1, Rofé 2000, pp. 107-108, 175).An additional interference factor relates to numerous studies on directed forgetting (see Rofé 2000, 175), indicating that subjects can deliberately disrupt the encoding process by directing attention away from the anxiety-provoking information, such as the KSI. 

Clinical evidence suggests that patients can also disrupt the encoding process by self-deceptive distraction. People tend to internalize socially accepted beliefs regarding the etiology of various disorders, such as psychoanalytic concepts in western society (e.g., Spanos et al. 1986) and spiritual possession in less developed countries (e.g., Kua et al. 1986). Moreover, In the absence of a culturally supplied rule, implicit causal theory, or assumption about co-variation, people may be able to generate hypotheses linking novel stimuli and novel responses (Nisbett & Wilson 1977, p. 248). Accordingly, clinical evidence indicates (see Rofé, 2000, p.177) that as part of self-distractive maneuvers, neurotic patients disrupt the encoding of the KSI by intensively focusing, during the decision-making stage and actual display of the symptom, on certain beliefs that seemingly account for their sudden behavioral changes.

The last interference factor relates to the rehearsal period during the encoding stage.  Mensink and Raaijmakers (1988) noted, in their model of interference and forgetting, that the amount of elaborative rehearsal will be proportional to the length of time an item is studied (rehearsed) in STM (short-term memory) (p. 436). In neurosis, the rehearsal period is necessarily brief due to two main factors.

First, the period in which a decision is made to adopt a specific symptom is brief. Patients do not thoroughly review various response options and choose the most suitable symptom. Rather, the choice is made spontaneously, without prior planning. For example, Malamud (1944) reported a case of hysterical blindness that developed immediately after a car accident in which the patient sustained minor injuries. Similarly, Leonard, (1927) developed his sudden panic attack in response to a train that he accidentally encountered (see Rofé 2000, pp. 107-111). Likewise, Rachman and Seligman (1976) revealed a severe chocolate phobia developed by a woman who accidentally saw a bar of chocolate present in a room containing her mothers coffin. In all these cases the decision to develop the bizarre behavior was made on the spot.  It seems likely that a spontaneous decision occurs in all types of neuroses.Second, simultaneously with the display of the symptom, memory-inhibitory mechanisms enter the process, facilitating forgetfulness and blocking retrieval of the KSI.

Memory-Inhibiting Mechanisms: The low strength memory of the KSI enables memory-inhibiting mechanisms to cause successful forgetting of this information, thus creating a state of unawareness. One factor that inhibits the memory of KSI is hypnotic amnesia. An increasing number of studies suggest that hypnotic amnesia is the consequence of active distractive maneuvers where the subject deliberately ignores the target relevant cues and attends exclusively to other matters (e.g., Spanos 1986, 1996; Wagstaff & Frost 1996). Accordingly, given the powerful hypnotic and distractive values of the symptom, neurotic patients can create a state of unawareness by focusing intensively and exclusively on the bizarre behavior and related thoughts both during the actual presentation and immediately afterward (see Rofé 2000, case no. 1, pp. 107-111).

The second factor that contributes to the generation of unawareness is state-dependent memory. Numerous studies indicate that remembering becomes difficult when the retrieval conditions are different from the original learning situation in terms of emotional, cognitive or environmental state (see Rofé 2000, p. 179-180). This factor is relevant to neuroses since the coping value of the symptom should radically reduce the patients emotional distress. In addition, the symptom must also cause a radical change in the patients cognitive state, since he or she becomes pre-occupied with symptom-related thoughts rather than with stress-related thoughts.  This factor is especially strong in multiple personality disorder (MPD) due to the striking differences in personality traits that patients display.  Furthermore, in some cases the symptoms result in environmental changes as well, as in agoraphobia and panic disorder where the patient escapes the situation where the symptom was originally created (see Rofé 2000, case no. 1, pp. 107-117). Consequently, changes in the patients emotional, cognitive or environmental condition should weaken the retrieval of the KSI.

Another memory-inhibiting factor that enables the creation of unawareness is suppression. Experimental studies of directed forgetting show that individuals can intentionally interfere not only with the encoding process but the retrieval process as well (e.g., Basden et al. 1993; Myers et al. 1998). This means that patients can facilitate the forgetting of the KSI after the encoding stage by intentionally suppressing thoughts regarding self involvement and avoiding situations that might be reminiscent of this information (see Rofé 2000, case no. 3, pp. 112-114).In conclusion, it seems that the phenomenon of unawareness that characterizes neurotic patients immediately after the onset of the bizarre behavior is the consequence of inhibitory factors during the encoding stage and memory-inhibiting mechanisms that block the retrieval of this information.

Self-Deceptive Illness:  Inevitably, upon generation of unawareness, most neurotic patients have an extrospective observation of a socially and personally undesirable behavioral change. Patients also have a strong introspective observation of loss of control, as seen, for example, in panic disorder (e.g., McNally et al. 1995) and bulimia nervosa (DSMIV, American Psychiatric Association 1994).Necessarily, patients develop a self-deceptive diagnosis of illness on the basis of these two observations, namely, that their behavior is controlled by factors beyond the self (e.g., the unconscious or adverse neurochemical changes; see Ollendick 1995, p. 529). Potentially, they could disregard their extrospective and introspective observations, as people often do when initially confronted with alarming signals normally associated with physical illness (e.g., Cohen & Lazarus 1973; Langer et al. 1975). However, it is unlikely that neurotic patients would do so due to the negative emotional consequence of such a strategy. Unlike physical illness where denial reduces anxiety, for this group of neurotic patients, relief is only obtained by intentionally focusing on and negatively interpreting the symptom.
    
Stabilization of Unawareness
The generation and preservation stages account for unawareness only at the onset, but not subsequently upon repeated display of the symptom. This section outlines the situations that motivate repeated manifestation of the symptom (stress, belief-challenging conditions, and interval between episodes) and discusses the self-deceptive maneuvers that stabilize the state of unawareness.

Symptom-activating situations: Much evidence indicates that patients re-activate their symptoms whenever confronted with a stressful life event that aggravates their emotional states (see Rofé 2000, pp. 192-194). For example, Blanchard and Hersen (1976) describe a case study of hysterical epilepsy where the patient re-displayed her symptom when re-confronted with marital conflict. In another case, agoraphobic symptoms were exacerbated with the aggravation of the patients level of depression (Marks 1987, p. 338).

The second factor that stimulates re-activation of the symptom is belief challenging conditions where failure to respond may invalidate the belief and hence subvert the maintenance of the patient's coping mechanism. For example, in order to preserve their beliefs, agoraphobics (see case studies by Leonard 1927; Marks 1987, pp. 325-326) and obsessive-compulsive cleaners (see Rachman & Hodgson 1980) must display escape behavior whenever confronted with belief challenging situations (e.g., public places and dirt, respectively). Similarly, panic patients, who attribute their symptoms to coronary heart disease (e.g., see Clark 1986; Margraf & Ehlers 1991), must display panic attack in response to situations enhancing their bodily sensations (e.g., chemical substances and strenuous exercise; see Barlow 1988, Rapee 1995). Likewise, Levy and Jankovic (1983) could manipulate the symptoms of a conversion disorder patient by experimentally challenging her belief. The patient displayed a variety of dramatic pseudo-neurological symptoms when given a placebo that she believed was a certain drug that was supposed to magnify her symptoms and displayed normal behavior when given the drug while thinking it was something else.

    Another situation that motivates symptom manifestation is the interval of time between episodes. Prolonged intervals threaten the maintenance of the self-deceptive belief and the controllability value of the symptom as they indicate that the patient has recovered from the disorder. Thus, in order to maintain the coping value of the symptom, patients must routinely display the bizarre behavior at a rate that sufficiently convinces themselves and others that they are still a case.This hypothesis may explain why patients become anxious when they forget or are unable to maintain their desired level of frequency of symptom display (e.g., see Neale et al., 1982, p.（essay代写)

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