On Multifaceted Reality-: Need to acknowledge subjectivity in experiencing Reality

The Reality is that anything we do or undertake a study has multidimensional reality components, whereby, an event or a behavior can be viewed or studied from various perspectives involving biological, psychological, psycho-social, environmental, spiritual, or any other infinite dimensional factors that one can think of, at both micro or macro levels. (From an existential-spiritual and astronomy perspective, we are all manifestations of One Whole.)  As such, schizophrenia or any other mental illness or “normal or abnormal behavior” have many dimensional perspectives, and use of a given perspective is a function of evolving and changing social and cultural perspectives, often influenced by changing “knowledge base” and public perception of what works and benefits a given person (from both person’s perspective as well as from the care giver or professional helpers’ perspectives). One pursuing psycho-social dimension, as ISPS is dedicated to promote, does not necessarily involve negating other perspectives, or promoting or substituting one “authoritarian-reductionist” model for another.  What is important if one wants to pursue a particular model perspective, is to demonstrate to consumers and public at large, how the specific intervention is helpful, while mindful of potential for any adverse effects or consideration that new information or research may negate any positive effect of an intervention or that a better intervention strategy may evolve to replace or modify the one in existence. Knowledge is multidimensional and fluid, as such, no one discipline or perspective has the monopoly of the “truth.” In spite of all the outward differences, we are all trying to promote what makes the best sense in terms of a clinical intervention, and in this case, as in others, the jury will always be out there to judge the efficacy of an intervention, the perspective of which will also be subject to change with time.

Advocacy for social policy change and clinical intervention and practice research may operate in parallel processes to provide clarity to one’s current functions and roles in a specific situation, as well as any discussion as to what are considered facts and what are considered opinions. Keeping these perspectives separate, and more importantly acknowledging and respecting differences expressed are important.

Conflicting views on various perspectives from disciplines or advocacies for social change in mental health service

I will make a series of brief statements to highlight my perspectives:

1.As living beings, we are always influenced by biological, psycho-social and environmental factors, although they may be considered as separate entities in the context of discussion and in highlighting specific influences, but discussing or advocating for one, does not imply negation of existence the value of the others. 

  1. Service exchange (providing goods and services, including health care) is a part of human society, whereby people do make “living” that includes “profits” that contributes to one’s living existence.  All of us are actual potential customers to each other’s as long as we live, even when we die (e.g., burial service).
  2. In the context of marketing and profit making, services may be provided that may or may not be beneficial, and that goes for all service providers, medical or psycho-social included. Marketing is universal to the process, but it can be “abused.” Research and advocacy are important to counter balance the process.
  3. In the context of professional discipline identification of various services, each discipline knowledge based interventions is going through evolutionary process of change with increased knowledge of the efficacy of specific interventions that are also consistent with evolving cultural and social values and expectations.
  4. “Idealized perfect societies” do not exist, where all levels of “disabilities” are fully compensated through idealized social structure and bio-medical and environmental interventions, and where we all have the capacity to experience “happy-spiritual bliss” as living human beings (although many believe in such a reality after death).  We all live with “imperfections” and that goes with our current status of “mental health treatment and recovery,” which does not mean we need to be satisfied with it, but work to improve in our individual capacities, while doing what our given roles as service providers are. (And that goes with any vocation that people purse in different fields in life.)  In this context neither medical or psycho-social interventions are all “good ” or “bad,” their efficacy and value are determined by individual choices and socio-cultural perspectives based on existing knowledge but subject to evolving change process.
  5. Advocacy of a given perspective is a legitimate pursuit -to make a case on behalf of a given perspective, but when it takes a dogmatic authoritarian stance, it may convince some, but may not have a larger acceptance of audience, and may vitiate its own cause or may promote other “negative effects.”
  6. All kinds of research studies on efficacy, cost-benefit analysis, negative effects of a given intervention are important in our continued enhancement of knowledge and improving our quality of life, and improving particular discipline service provisions. (All the links provided in this Forum is useful to many of us, depending our own interest.)
  7. To advocate and promote a particular discipline perspective, biological or psycho-social perspectives in mental health, one does not need to build its case of efficacy by investing time and effort to tear down and point out deficiencies in other discipline perspectives that are involved in providing services.
  8. Granted the dynamics of evolving knowledge base of any discipline or any human service exchange of information or service goods, we all in our own ways review what we know best, what skills we can use to provide services to others to make a living, and what we do not know, which probably is the larger domain for any discipline or service provider knowledge domain. Yes, our knowledge base and practice of skills will need always in a dynamic mode of change with the emergence of “new information.”
  9. We are all in some ways involved in exchange of services, either as providers or receivers, or both,  and our practice of what we are doing reflects whatever roles we are assuming at a given time.  Often advocacy role for change for one’s discipline service or change in  social perspective or larger social -cultural environment- all  are relevant pursuits, but  need to be dealt separately, and apart from one’s service provider role. Mixing the two will be problematic in the actual context of clinical or service provider roles that one may be employed in.

“Mental illness,” “Medical Model, ” and “stigma”

Mental illness has acquired a negative connotation due to an overly identification with medical model of “illness” and has weakened a focus on psycho-social-cultural factors impacting  various other  dimensions of mental illness. This  over-emphasis of  biological intervention and the concept of “treatment” (“find the cause, eliminate the cause, and remove or reduce symptoms” be it through biological, psycho-social or a combination of both interventions to a degree), has limitations, specifically for “psychological maladies”  that do not fit the “illness model” neatly.

As I understand,  illness is defined by any society as “ behavioral anomaly” resulting in some degree of impaired functioning.  For psychosis and schizophrenia or any other form of serious and persistent  mental illness,  it involves exhibiting atypical thinking and behavior symptoms associated with a generalized breakdown in social communication, “perceived  deficits” in personal independence management of life, which may often be considered by “significant others” of person’s life as being associated with current or potential  “at risk behavior” to self or to others, all of which may be characterized by some existing socially defined criteria of “disability.”  The problem of “stigma” may be  related not to the use of concept of “illness” per se,  rather being viewed  in the context for current lack of knowledge, and absence of more effective  biological and psycho-social interventions models to address the “disability” associated functions.   A study reported in August issue of Schizophrenia Research, 2015 by Nasralla et al. cites 91% of patients identified with schizophrenia with mean average of 15 years of duration; continue to exhibit “mild-moderate-severe” symptoms, in spite of active medication treatment. This is similar to what Javitt and Coyle, reported in the Scientific American (2004) stating that “two-thirds gain some relief from anti-psychotics yet remain symptomatic throughout life, and the remainder shows not significant response.”

Yes, instances of recovery are noted in many  anecdotal or published case reports , but they, I believe, constitute a small fraction of people associated with long-term psychosis and schizophrenia.   Many of them may be  gifted with a high degree intelligence and education, and or having the other forms of supportive psycho-social support systems than what we often see  present in the general population of schizophrenia and psychosis. With increased knowledge and development of technology in both biological and psycho-social interventions,  as well as consumer knowledge and advocacy,  the  “disability” associated with “mental illness”  may be  considerably ameliorated  or compensated, and consequently,  any stigma associated with concept of mental illness, I believe will also be reduced, hopefully in the future.

I do not believe that merely label change will  accomplish the abolition of negative stigma. More knowledge, research, change in social policies, consumer advocacy are all important elements toward an  improved outcome. While waiting for more improved social condition and cultural climate, use of normalization principle to all kinds of “disabilities,” and emergence of a more egalitarian society,  we will still need a form  of labeling, with categorical description of identification,  if people are to receive some “special services” from society. That’s where the reality of linearity of typical-atypical behaviors needs to categorized for the sake of clarity.

Finally, behavior has multidimensional aspect of “Reality” that includes constant interaction of brain-behavior-social-physical environmental as well as genetic involvements. One can assume psychological functioning is assumed to reflect brain changes and functioning, and vice versa.  As a practicing psychologist, I don’t’ have any qualm in believing  that whatever psycho-therapeutic intervention I may engage with clients. I assume that  brain changes do occur with such interventions  just as with any biological and psych-social interactions,  but my focus is to evaluate any  functional behavior changes by use of psychological intervention techniques that I have been trained to use.    For an effective  psycho-social advocacy for mental illness treatment, it does not need to contradict other intervention approaches, but need to highlight the benefits of its specific intervention perspective,  and make consumers more  knowledgeable about its  efficacy,  while not necessarily countering efficacies of other discipline involved interventions, and letting consumers and the significant other’s involved in the consumer’s care make decisions and choices as to what specific intervention or a combination of interventions that may be best appropriate.

In this day and age, where any health service intervention, biological, psychological, or any other form is  provided  in the context of “service-profit-consumer satisfaction” framework, and every service provider is engaged in providing services and making a living out it, marketing information, focusing on consumer benefits that takes into account improved functional outcome and increased satisfaction, and consumer knowledge, and informed consent become very important, notwithstanding advocacies by different stake holders in mental health or any other service industries and politics of mental health. The challenge for any practicing clinician is to figure out what is possible, in terms of providing services that is consistent with one’s professional training and roles, while ensuring one’s livelihood, and what is desirable in terms of professional goals and attainments, but this may be  often  difficult to implement  within the context of one’s working environment. The same constraint may apply to what one needs to do for advocacy, self-education, or being involvement in group enlightenment process outside one’s work environment. This  can also  become very frustrating and challenging navigation process in one’s particular  work environment.

It is often better  to assume that we do not know a lot in this  particular  field  of mental health service , and that  we need to learn a lot, and  that our knowledge is evolving and fluid.  As such,  one needs to adapt any model that one chooses to use to specific individual clients with changes and modifications.  Given the dilemma of time constraints and consideration of what aspect of one’s clinical time work is “billable” or not “billable”, in clinical practice environment,  it is often difficult to engage in collaborative dialogues with others involved in client/patient care in addressing many of the important considerations within an open dialogue of collaborative framework.  So each discipline effectiveness, I believe, becomes very limited, and may often work counter to each other’s perspectives.

From an existential perspective, human behavior and knowledge may reflect the cosmic status, whereby only 5% of the Universe is composed of the known baryonic matter of physical entities we see and perceive, and  95% is Unknown and Unknowable,  consisting supposedly of  Dark Matter and Dark Energy. My sense is that our knowledge and understanding of human behavior may reflect the same status  in many ways. .

My take on the issue of diagnosis is also similar. It is a label used by society to determine eligibility for service recipients and  for the service providers, and constraints of  reimbursement of service exchange that takes place within the broad framework of health industry. The criteria for a diagnosis is not static, but a fluid process, based on advancement of knowledge and science, and must take into account  a common understanding of a social framework to address behavioral anomalies in the context reducing or eliminating personal and associated social distress.

While the” illness model” (somebody has an anomaly that needs to be fixed by outside intervention) using a biological determinism and interventions involving biological and supportive psycho-social interventions, is palatable and acceptable  to many, but “mental illness” as many of us understand have  psychogenic origins with  major involvements  of psycho-social factors, and may be viewed  as  “personal existential crises,”  associated with  personal and social distress ( which may or may not involve demonstration of ” at risk behaviors” or potential for such behaviors).

The  “illness” model of  “treatment,” that implies a sense of dependency on external intervention for one’s well being,   may also violate a sense of personal freedom, ownership for one’s thinking and behavior, originating from within one’s self system, and may be perceived as working  counter to one’s  sense of “personal independence,”  and ones personal unique ways of adapting to one’s “existential reality, ”  which is  valued as  an important component to one’s well being and to a  sense of autonomy.

Many believe that social experiences and conditions that promote people to develop what one considers “mental illness,” the focus should be fixing the “social community and environment,” rather stigmatizing people with a mental illness criterion. Compounding the issue, many people diagnosed to have “long-term mental illnesses” do not have the social support and therapeutic milieu so to speak,  and may present at risk” behavior tendencies.

In an ideal society, if a “therapeutic milieu” is provided to all, and all kinds of people can access participation in various supportive group activities, and where “at risk status” can be monitored within the context specialized support and milieu along with social rule of law for managing any “at risk deviation,” while protecting personal freedom and values,  then there will be no need for any “destigmatizing” illness label. Persons may choose to enter or exist based on perceived ‘benefits,” and responsibility and onus on providing such satisfaction in entirely on the providers, just like in any consumer oriented buying and selling exchange of goods.

Additional issue is that “destigmatization” for a specific “mental illness,” such as “schizophrenia” is more of a perception of meaningful lack of progress with the “existing treatment modalities.”  For many diagnosed with this “malady,” the so-called “symptoms” continue to persist with “impaired level of functioning”  in spite of years of involvement in “treatment.” In order to have this egalitarian ideal into practice, societies must be able to routinely build in provisions for all such “entitlements.”

But this may again violate many people’s political and social values that one holds, giving too much power to “society” over individuals”
















“…Yes, many people believe that mind is a function of the brain, and the brain mirrors all mental activities; it is a matter of choice as to what perspective one wants to study to highlight an issue. In the same vein environment and social factors affect changes in behavior and the underlying brain functioning, as the evolutionary biologists will argue. Gene expressions can be modified by environmental factors and can be transmitted to future generations without altering gene codes, as some of the recent epigentic studies suggest. Then there is the religious and spiritual concept of Soul, which is larger than mind and continues to exist in some form of Spiritual Reality, either retaining individual entities as practiced in Judea-Christian-Muslim faiths or merging with the Eternal Supreme being, as in Hinduism and Buddhism. Literally, billions of religious people believe in either of this concept of Soul enduring the entropy of the body and mind.

From astronomy science perspective, everything came from One Point of Singularity, and everything we see and don’t see but infer them to exist are manifestation of the One, and implication is that in the dissolution of the body-mind, it is returned to One, Science also tells us that the Sun is moving around the Galaxy at the rate of approximately 118 or so miles per second to take 240 millions of years to go around. So every second no human beings knows what is in store for us. In some sense, in a symbolic expression, there is convergence of science and religion, that of Existential Uncertainty, which only God or Nature “knows” and return of the Soul in some symbolic way to Supreme Being or Natural Force.

The bottom line is that there is a duality of knowledge: Known and Knowable, the realm of scientific investigation, and the Unknown and Unknowable, the realm of faith based practice. For any consensual discussion, we may need to focus on Known and Knowable, but sometimes they get blended.

It is possible that Schizophrenia and associated psychosis in some form may reflect an underlying struggle in coping with Existential Uncertainty and associated Existential Anxiety triggered by perceived intense stress response, and the origin can be varied: experiential, documented, and or speculative.

But then again, any picture of any human being or a group of human beings will always be complicated to put into a simple reductionist formula, as the Reality is multi-dimensional.

And then there is always the excitement of finding different ways of looking at the same thing, as our knowledge is constantly changing and is fluid, and with it comes a respect for different perspectives that may be “true” from one level, but not from another…”

On the importance of emotional regulation associated with psychological symptoms

“…A lot of points Luc Ciompi makes (Schizophrenia Bulletin, 2015, volume 31) resonates with my views also, as I feel, emotional dysregulation (intense agitation-stress experience) may be the origin of atypical thinking and behavior and may well underlie the development of psychosis and schizophrenia (a la Freud’s psychotic defense in the presence of overwhelming existential anxiety).

For many. especially with a history of persistent psychosis with compromised functioning of long-standing nature, medication does have some ameliorating effect on stress agitation level, making the persons more amenable to therapeutic prompts by restoring some degree of homeostasis balance in some ways so as to make the persons think more adaptively in terms of “here and now” existence, and correspondingly increasing their capacity to respond to “therapeutic prompts” and participate more readily in positive redirection strategies, enhancing overall functioning. But “atypical behavioral symptoms” characterized by hallucinations or delusions may have become “behavioral habits” over time and not responsive to medication treatment for many of these people. I have made this case in several of my previous postings.

(I am not proposing that people who for some reasons others develop habits of engaging in hallucinations and delusions as part of transitory or life -long experiences are necessarily have schizophrenia or psychosis, which depends on significant impairment in adaptive functioning and sense of caring for oneself.

But unfortunately medication practice for persons with schizophrenia is targeted to eliminate or reduce the so-called “behavior habits,” and often results in over-medication, or unnecessary medication with resulting side effect issues in the pursuit of something that it cannot achieve .Calming effect of any medication practice may for some reduce the discomforting effect of hallucinations and delusions, making for some more tolerable with these symptoms, but there is no evidence that medication eliminates them. Elimination or reduction of “behavioral habits” may need to be addressed within the framework of psycho social intervention and in the context of social and cultural practice or determination to the extent they cause personal distress or perceived social distress associated with the history, and potential for “at risk behaviors.”.

Efforts to reduce agitation arousal stress experience must include research in more targeted medication practice such as reducing the presumably involved chemical transmitter, dopamine on the mesolimbic system ( supposedly responsible for emotional regulation), but not reducing the frontal lobe functioning (supposedly involved involved in planning and thinking).This has not happened yet, causing positive and negative effects of psychotropic medication. As I understand, anti-psychotic medication has a generalized effect on reducing dopamine everywhere in the brain. May be future medication research will be more promising. There is also corresponding need for exploration of different ways of providing therapy and therapeutic and milieu supports to maximize individuals own capacity to think, feel, and behave in ways that reduce personal as well as social distress.

By the way, I am not proposing that everyone will need or benefit from a biological based medication approach, but some do and some may not need at all, or some may need occasionally, and the therapeutic benefits that the medication brings about can as well be achieved potentially by psycho-social intervention and presence of personal traits, and It will be a judgment call on a case by case basis.

From the psycho-social intervention perspective, one may also need to view how the traditional “talk therapy” or variant of it focusing on “deficit focused” approach and revisiting one’s personal history and past “negative life experiences” is helpful or not for people with long-term persistent psychosis and schizophrenia. There is also a corresponding need for acknowledging the “intact areas” of one’s functioning and resiliency, how best to promote stimulation of these areas to enhance sense of well being and functioning, no matter how “disabled” the persons appear to be. Focusing on their “long standing habits described as symptoms, (hallucinations or delusions as the case may be, or other forms of “maladapive behavior symptoms), and focusing on their presumed historical origins, whatever they may be, in conjunction with a corresponding focus on the “expressed deficits” the persons currently display- reflecting the “judgment” of the “care givers” or “the helping professionals,” may not be the most productive ways to practice for this clinical population. As they may generate “negative relationships between therapists and clients, as well as may induce covert or overt “agitation and stress arousal symptoms” countering any therapeutic benefits one desires to achieve. It may also may reinforce the continued identification with the “illness persona” that the persons have come to believe in, which may unwittingly counter the need for increased identification with positive self-image necessary for recovery. There is a positive benefit of emphasizing being in the present “here and now existence,” learning relaxation-mindfulness and other coping strategies, as well as learning to engage in a variety of mind stimulation strategies, and developing a sense of connection to others through existential discussion perspectives, and in the use of positive redirectional activities- thus helping them make the best of one’s present life circumstances.

Beside people with long-standing history of schizophrenia may have compromised ability to respond to auditory based conversational mode optimally and may have impaired capacity to internalize verbally mediated information processed in therapy, and in their ability to translate changes in their personal life outside the therapy session without therapeutic prompts built in the setting. I have commented in this before here and in our publications.

This point I am making may not be case with highly intelligent and educated people who for some reasons develop transient psychotic episodes and have the intact capacity for internalization and self-reflection, and retain the ability to change their thinking, and life styles with or without support or having profited from therapeutic support in the past to recover their functioning.

Working in state inpatient facilities, community mental health centers, and nursing homes, I found that many people diagnosed or treated with schizophrenia have different developmental histories: learning disability, substance abuse, mental retardation, as well as childhood trauma and or negative life experiences. Any strategies that involve greater emotional stability by medication and or psychotherapy process will enhance each person’s capacity to maximize his or her thinking as to how best to manage the present reality of living experience in collaboration with support of “significant-others involvement” and the mental health community at large.

It is also worthwhile to read another article published in the same issue in Schizophrenia Bulletin,2015, volume 31) First Person Account, “A Carer’s Perspective: The View From Australia” by Paul Kauffman.

It describes the kind of people with schizophrenia that I have mostly encountered in my clinical work over a 40 some years, which does not include, I must confess, outpatient therapy clients with mostly intact cognitive functioning associated with a high level of education, and suffering from what appears to be “transient psychotic experiences.” and have the demonstrated capacity to profit from traditional psychotherapy modalities. So my comments are limited to the group that I have worked with. Nevertheless, my sense is that this group may constitute the largest percentage worldwide, who are identified as people with schizophrenia. This article describes what the advocacy role, (family) can achieve to enhance quality of life and functioning, to significantly impact “improvements,” within, however, some “persistent disability framework.,” which unfortunately many people with longstanding history of psychosis and schizophrenia continue to exhibit in spite of years of psychiatric services. Considering that many persons with schizophrenia may not have this kind of family support or advocacy, my sense is that the quality of life for many of them may be much more compromised than what is described for this person.

So much more work needs to be done in practice innovations and research in this area of mental health service for this population. It is in a way this is an exciting field for patient, patient advocates, and mental health professionals that there are all kinds of possibilities to move forward in different directions to improve the quality of life and care for people with psychosis and schizophrenia of varied manifestations.

But one needs to be open, not judgmental, and not be dogmatic in trying to impose one’s specific professional training or identification with a model that one has been exposed to in training. Given the individual and cultural variability and circumstances in people with psychosis and schizophrenia, one has to be “creative and innovative” in clinical practice, whether from medication practice or psychotherapy practice perspective.

It is exciting to participate in an “open dialogue” and information and opinion sharing process …”

On Reported Lack of Replication of Psychological Research

Recent article in New York Times( “Many Psychology Findings Not as Strong as Claimed, Study Says” by BENEDICT CAREY, AUG. 27, 2015) as well as Science News article ( “Psychology results evaporate upon further review: Surprising reports, findings with marginal statistical significance least likely to be reproduced, study concludes” by Bruce Bower, August 27, 2015) highlight the problem of replicability in behavior science research. Thomas Insel in his p-Hacking Blog (November 14, 20114) addressed this problem for behavior research sometime ago, and Brian Koehler of International Society for Psychological and Social Approaches to Psychosis (ISPS) brought attention to this issue to ISPS members.

My comment on this issue is as follows, which I am reproducing from the ISPS Listserv communication:

“Besides what Thomas Insel (NIMH Director) rightly pointed out in his p-Hacking Blog (where one can pretty much find support of evidence for any idea, if one reanalyzed the same data repeatedly from various angles to come up with the desired p value to justify one’s hypothesis, notwithstanding the idea that “the existential reality” is multifaceted, whereby every unique human perspective or thought may have support and validly from that person’s unique experiential base, if one explores exhaustively that angle of individual perspective) the problem with replication related to behavioral research due to inherent variability of human behaviors, to which one can add, the difficulty in designing controlled studies with any human beings for that matter.
Human behaviors, as we all know, is greatly influenced by personal observations, interpretations, intuitions, beliefs, thoughts, imaginations, and judgements, etc., and greatly vary among individuals and subcultures. Any outside measure employed to observe us, influences or changes our behaver, similar to observing and predicting the behavior of individual electrons by an instrument (a la Heisenberg’s Principle of Uncertainty). We engage a great deal of our daily time in reading and appreciating fictional writings of all sorts, novels, poems, watching movies, appreciate artistic work by others, and are guided by our imaginations, internal ruminations involving autistic like imageries, personal interpretations, faiths, political and or social beliefs, values, etc., much of which cannot be subjected to criteria of objectivity, other than the fact they are “appealing” to us when we engage in these activities or share these experiences with others as appropriate. This is where the ‘soft science” element of some of the studies of behavioral science may come from, but that should not make “soft science’ less important than “hard science,” as they greatly influence our everyday conscious life.

Many so called “soft science” related studies may present “creative ideas’ that makes intuitive and appealing sense to others, and have the potential effect of “positive influence on others, and may inspire others to follow up for future investigations or to undertake application of the idea in their practice on an “evaluative” (pilot study) basis. These studies should have a legitimate place for publication in professional journals, whether such studies by themselves are replicable or not, on the basis of generating creative and useful ideas. There is also a potential for future studies that may emerge from such initial creative thoughts presented. If one were to follow rigorously the criteria of reproducibility for conducting research and publications, it may limit severely creativity in research or innovative thinking,as it is often very difficult to conduct studies with human subjects, except in very limited and artificially controlled environments. Even with highly well designed experimental studies, without p-hacking issue present, the results of the studies may still have limited applications to real life situations due to the issue of gap between efficacy and effectiveness a la the presence of variability of human conditions.

We know that many behavior science researchers are under pressure to conduct experimental designed studies (for which also more funding is available) and get their studies accepted for publications, if they follow the gold standard of experimental designed study model, but this may limit their focus to a much narrower field of investigations, (sometimes bordering on what may appear to be very “esoteric topics” that may not have any immediate or long-term practical implications) or may motivate the researchers to use the p-hacking system to support their intuitive hypothesis to justify their investment in a research project idea. (I am not saying it is always the case!) Moreover, many of these published results, even with no p-hacking present, may end up having very limited practical values. My personal impression of going through some of the well esteemed behavior science journals, I found that while I am often impressed by many of the extremely well designed studies, where the rationale and designs for the studies appear to be very logical and articulately presented, with comprehensive literature reviews, and extensive data collection process, statistically clean and data presented impressively, but often they end up making speculative hypothesis on underlying brain or psychological functioning, with conclusions that the findings are not equivocal and that “more research needs to be done” in the area. Often the authors do not venture to suggest potential practical implication possibilities. Many of you may have the same feelings.

If an idea makes sense to others, and is presented without the use of a “well controlled and reproducible experimental designed study method,” but appears to have “reasonable observational data base” that may include case studies, behavioral observations by some objective criteria along with “client/subject survey data,” and is considered by “others” (reviewers of a journal) to have the merit for further investigation, and potential follow-up application to real life situations, with “desirable benefits” to others and society, and, furthermore, is considered to add to the collective creative thinking process and stimulate others to undertake further investigative research, then it should be considered for review by professional journals for consideration for publication. One may note, major psychological models, Freud, Piaget, Kohlberg, initially were developed and based on case studies and observations,(supplanted with their own phenomenological experiences), and when published, were intuitively appealing to others and inspired many to adopt their theories or elements thereof in their own clinical work, research, and engaging in further writings and investigations, etc. Many early behavior science research, including Skinner’s learning theory as well as other learning paradigms were identified through animal research in controlled experimental settings, and then extrapolated to human behaviors, and their future application to human behaviors and research followed much later. We know that many scientific fiction writings and movies also have generated creativity, research and application of human inventions much later on after their initial publications.

The point I am making is that it is better to acknowledge that many behavior science studies may not meet the criteria of “reproducibility,” but their acceptance and validity should not be valued less, and they should be judged more by the criteria whether the ideas presented do make “intuitive” sense in the context of our present knowledge base, and that they have consideration for “potential benefit” to people, and that these studied are worth following up for further investigations or research or for possible implementation in practice, provided identified criteria for outcome assessment in real life situations are provided. As we know, consumer survey is now universally used to justify whether a given “product” including a human service product is useful to people or not. Using this criteria, it will be easy for others to evaluate the applicability and usefulness of a “novel” idea or approach.

If behavior science accepts what part of it is “hard science” meeting the replicability criteria and what part is “soft,” and both of these sciences, “hard” and “soft” are viewed as valued pursuits of human knowledge, with access to funding and acceptance for publications in professional journals, we may have more productive and creative publications in the field that may benefit all of us at large from this sharing process of ideas.

Just a food for thought on this difficult and “complicated” issue, which is laden with the politics of scientific investigations!”

Exploration of psychological past may not always be beneficial

“I am not questioning exploration of unique phenomenological experiences for potential validation of “abuse related experience” that need to be pursed in the context of personal psychological benefit, or from the perspectives of legal ramification, or personal or social advocacy. I am questioning the benefit of “exploration”in people with a long term history of psychological problems, who may have repeated exposures to explorations of their unique past involving their “problems,” and may have developed unique behavior habits to deal with these experiences. This repeated “explorations” may take away the focus on the Present Reality of how to make the most sense out of one’s present life circumstances. After all that is the Reality that we all have to deal with. Whatever the past we have is an integral part of our lives, they cannot be re-written. We have a choice to leave them behind and move on. It is difficult to pass a value judgement which is more adaptive. There is a danger in imposing one own commitment to a “model” or conceptual understanding of a situation to different individuals. It an individual case by case situation, and one needs to use the best judgement one has by being “open ” to different possibilities and approaches.”

“In any dialogue of two persons, counseling or routine social conversations, there is an overlapping area of the Venn Diagram, where communication is happening and possible, as both parties are using a shared framework and rules of communication. Correspondingly, there is always non-overlapping areas the two diagrams, each reflecting the two individuals’ unique phenomenological experiences of “Reality” that may not be fully communicable to each other. This may be referred to be in the domain of the Unknown and Unknowable from each person’s perspective. Any therapeutic/counseling dialogue could be both a process and an end. When I am using the “cauterization” simile to healing of the psychic wound,(as we did in our book, Mind Stimulation Therapy: Cognitive Intervention for Persons with Schizophrenia, 2013), I am emphasizing the effort of renewal of self and developing a newer “positive” identity by focusing on the Present ( the focus on the “What experience” – What one is doing now) than on the “Why- Past” experience. (Why exploration)”

“…From the psycho-social intervention perspective, one may also need to view how the traditional “talk therapy” or variant of it, focusing on “deficit focused” approach and revisiting one’s personal history and past “negative life experiences” is always helpful or not There is also a corresponding need for acknowledging the “intact areas” of one’s functioning and resiliency, and how best to promote stimulation of these areas to enhance a sense of well being and functioning, no matter how “disabled” or “compromised functioning” the person may appear to exhibit. Focusing on their “long standing habits described as psychological “symptoms,” or “maladapive behavior habits of long-standing nature, and focusing on their presumed historical origins, whatever they may be, may not be helpful. These strategies may “unwittingly generate a “negative relationship” between a therapist and the client, as well as may elicit covert or overt “agitation and stress arousal symptoms,” instead of “reducing them.” This process also may reinforce the person’s continued identification with the “illness persona” that the person has come to believe in, which may unwittingly counter the need for increased identification with positive self-image, a goal for seeing professional help. There is, thus, a positive benefit of emphasizing being in the presence of “here and now existence,” learning relaxation-mindfulness and other coping strategies, as well as learning to engage in a variety of mind stimulation techniques, , and also developing a sense of connection to others through discussions of various knowledge based topics and existential issues, and in the use of positive re-directional activities- and making the best of one’s present life circumstances. Again it is a a judgement call, as some people may benefit from focusing on the past (“Why”) versus for some people, focusing on the “What” might be productive.”

Commentary on Mind Stimulation Therapy

Mind Stimulation Therapy (based on earlier published model: Multimodal Integrative Cognitive Stimulation Therapy-MICST)

Mind Stimulation Therapy (MST) , the earlier acronym was MICST (Multimodal Integrative Cognitive Stimulating Therapy) was pioneered in the course of my clinical practice over a 40-year period working with varied client populations across ages in varied settings: Outpatient therapy with “behaviorally challenged” children and adolescents; general outpatient adult clients; developmentally disabled adults; persons with schizophrenia in inpatient and Community Support Programs of CMHCS; dual diagnosed substance abuse clients; physically and psychiatrically compromised adults in nursing home settings. The MST model was further refined and developed through my years of collaboration with a former student of mine, Dr. Charles Boisvert, Professor of Counseling, and Education Leadership at Rhode Island College, and through our many collaborative publications with him, (see our publications in the bottom of Psychology and mental health resource links by Mohidudin ahmed

Below is my write-up explaining the MST model as well as a commentary by a Yoga therapist working in a community mental health center (with whom we have had no contact or association) that captures the essence of the model very well.

Mind Stimulation Therapy (MST) promotes awareness of the present moment of existence to maximize concentration to the immediate present reality of living experiences, physical and social surrounding, and one’s inner body cues through a practice of what we describe as Body Movement Relaxation (BMR) exercise. This exercise promotes the notion that seeing and experiencing one’s movement of body, one becomes acutely aware of one’s living existence, and a sense of affirmation of being alive, and one then can try to reflect on one’s personal connection to “others.” This simple series of exercises can be used to highlight the need for goal setting, identifying steps to goal, and the experience of goal attainment, which cuts across one’s daily life domains, including understanding of “Individual Treatment Plans” that many clients have in various program settings.

MST highlights that information processing is basic to all living beings. Having a sense of awareness of how we process “information’ in ways that are “adaptive,” can promote therapeutic dialogue to increase one’s adaptive thinking, feeling, and behaving, minimizing social and personal distress, and help best deal with one’s current life circumstances, and coping with whatever psychiatric difficulties that one may have. This processing of information is collaboratively discussed in the context of “here and now approach” of present “Reality of Living Experience.” It is grounded on the belief that all have some degree of capacity for adaptation to our life circumstances optimizing our functioning.

Psychotherapy interaction is often characterized by focusing on “so called clinical symptoms” or negative behavior traits client present that need “fixing” or “remediation.” This approach for many with long-term history of psychological problems and prior of history of many years of involvement in psychiatric treatment, and their own years of struggles in coping with these behavioral issues, may generate a covert negative relationship framework between the therapist and the client. Instead, MST model focuses on what the clients can do, and tries to stimulate activities and discussions that may involve general knowledge, science, mental health issues, religion or philosophy, or any other topic that client’s spontaneous utterances indicate interests and in which the client seems to have some knowledge base. This is supplanted with the use of paper and pencil cognitive stimulating exercises to access and stimulate client’s intact “cognitive skills” and “interests” to promote “reality based thinking,” and thereby strengthening clients’ ability to engage in “positive redirection activities” in presence of whatever clinical symptoms client may be presenting as per the clinical record. The goal is to approach management and reduction of “clinical symptoms” through the use of positive redirection (analogous to counter-conditioning)- a practice that we all normally do in our own coping with emergence of ego-dystonic thoughts and feelings in our daily life.

MST promotes reflection on existential perspectives (existential uncertainty, existential anxiety, and existential mystery) to help us see the time flow of our life as series of momentary living experiences, and to give us a sense of connection to living and non-living things around us, and help us see the World around as expression of an underlying universal “spiritual’ force, without necessarily contradicting one’s religious faith or science based knowledge. (We are all created from one God or are manifestations of one Whole- a Point of Singularity from the Big Bang: symbolically they represent the same concept). Past is important, if we choose to bring in to impact the present in the context of positive mental health and well being, or in the investigation of research on causative factors or to promote social action change. This will be a judgment call in clinical service setting and his orientation of therapy model that one chooses to practice.

Mind Stimulation Therapy believes that independent of any level of “disability” or psychological problems that one may present, everyone has functions and capacities that may be dormant but not readily evident to others, but with active exploration these capacities can be enhanced to contribute to one’s sense of well being. In the process, through involvement in these positively valued activities, they can help displace or “limit” the effects of “negative traits” or “atypical traits that cause personal or social distress.” The feeling of empowerment that may arise from this process of engaging in mind stimulation and positive redirection activities can spiral itself into promoting “recovery” or “enhancing functioning” in one’s own life.

Mind Stimulation Therapy does not actively review personal historical events to promote “insight and understanding” in people with long-term psychological problems or “limitations.” Exploration of “painful past” or “unusual behavior experiences” one’s life (e.g., reflection of our unique personal autistic and ego-dystonic thinking process, or habits of hallucination or delusions) may promote strengthening of these behaviors by reinforcing repeated visitations through a simple Law of Exercise, may impede practice of positive redirection, necessary for adaptive living, which we all practice in our daily lives.
In many persons with long-standing psychological problems, people do show or able to express “insights” in therapeutic dialogues, but it is the difficulty in translating these insights into behavior poses a stumbling block to recovery or toward movement to one’s own well being. (This may not be case for many with a high degree of intelligence and education and/ or motivation for self-reflection, and with transient experience of “psychosis” who may profit very well from such a psychodyanamic therapy approach.)

MST actively uses a multi-modal approach in therapeutic interaction, use of blackboard, computer screen, to maximize communication. It takes the position that auditory based conversational model of communication may not always be appropriate mode for these groups of clients who exhibit difficulties in working memory, control of repeated “intrusion of other thoughts” in the conversation flow, and in the practice of “redirection strategies,” that we all use to make our social or teaching communications effective. Therapy process need not rely solely on auditory based conversational modality: visual presentation of spoken words via computer screen, as we have had several publications using computer facilitated therapy, could be helpful. MST model assumes for these clients with long-standing psychological problems of developmental and or experiential origin may not have the capacity to internalized dialogue themes in therapy interactions and translate them into behavior change outside the therapy sessions. As such printed hand outs from sessions, follow-up practice in mind stimulating exercises, and active collaboration with client’s therapeutic milieu to ensure building prompts and support in the practice of positive redirection may be necessary to ensure maximal benefit from therapeutic encounters.

MST does not use a sequential training model, realizing many of these clients may exhibit variable emotional status or functioning on a day to day basis, so different element of the MST model may be highlighted or repeated in different sessions. Different elements of the MST model can be use or incorporated in practice of any therapeutic modality that clinician prefers to use, as MST model can be viewed as adjunct to any current practice of therapy.

The following review was written by yoga therapist who articulated very well the elements of mind stimulation therapy and its application to clinical population of Community Support Program where she has been working currently.

Mind Stimulation Therapy for Persons with Schizophrenia : Comment on Amazon website:Posted on April 25, 2014by OMpowermentYoga

“Before getting into the meat of this post, I feel like I need to touch base briefly on Schizophrenia. Schizophrenia is a mental illness that I think most people are familiar with, but know little about. Our stereotypes of people with Schizophrenia are largely shaped by the interactions we have with people affected by the illness. In the general public this may be limited to encounters we have with people in public forums – parks, malls, on buses or trains – and often are marked by their brevity. I remember the first time I ever encountered someone with Schizophrenia. I was taking the commuter rail back from an evening in Boston and a disheveled looking man entered the car I was on. He was exuberant, slightly raucous, and yelling at one of his pointer fingers because he thought it was talking to him. As he engaged in this conversation it was apparent that, at least in his mind, the conversation was a two-way one (although on my end that pointer finger never did reply!) In retrospect, there’s no way of knowing this man actually did have Schizophrenia. Any number of things can account for hallucinations – medical issues, drug use, etc – but as a younger person with limited knowledge of this mental illness my brain immediately associated talking to oneself with Schizophrenia.

Despite this very limited interaction in my earlier life, I feel fortunate that I have encountered people who experience mental illness in real and tangible settings, though growing up they were few. While many of us may know people who struggle with depression, anxiety, or substance abuse, Schizophrenia affects only 1% of the population. This means that most people will never knowingly encounter a person with Schizophrenia. Thus, many people’s understanding of this illness is based on fictional representations they see in movies or tv, characters they may read about in books, or the horror stories they occasionally hear via the news or internet. In these instances, their mental illness often becomes the headline and inevitably Schizophrenia is paired in people’s minds with violence. If you don’t believe this, do a Google image search for Schizophrenia and see what comes up. This is the first image I got:
This is the first image I got when Googling “Schizophrenia”
I bring this up now because since starting work in a community mental health agency I have encountered people with Schizophrenia regularly. Currently I work with a number in personal therapy. And guess what? They’re actually very interesting, resilient people who happen to struggle with mental illness on a regular basis. As such, I have begun researching treatment approaches to use with these clients that don’t forcefully challenge their beliefs, reduce the likelihood they will engage in therapy, or cause greater stress than what they are already experiencing. For a long time treatment for Schizophrenia has been primarily focused on medicating the client and changing their beliefs. For example, trying to convince your client that his or her next-door neighbor ISN’T controlling his mind. However, as a longtime yoga practitioner I’ve always felt a little bit unnerved with approach, which I believe lacked some of the core components of my daily yoga practice: acceptance & non-judgment. Thankfully while completing my master’s degree I was introduced to a way of working with clients diagnosed with Schizophrenia steeped in a positive psychology framework. And that way now has a name: Multimodal Integrative Cognitive Stimulation Therapy (MICST).
MICST is an approach steeped in learning theory and positive psychology that emphasizes the role that our environment and interactions have in shaping who we are. With Schizophrenia, the creators of MICST (Ahmed & Boisvert, 2013) argue that portions of symptomology may actually be reinforced unintentionally by a person’s environment (friends, family, therapists, community interactions). So what does this mean? Basically, that Schizophrenia is an illness that can manifest itself in a number of symptoms. But by constantly pointing these symptoms out to clients and arguing against them (i.e. “These things aren’t real.” “You’re just sick.” “No your neighbor isn’t spying on you!) we may actually be reinforcing these symptoms and further entrenching them within our clients. Thus, MICST encourages practitioners to to emphasize reality-based behaviors and beliefs, and to focus on on what client’s do well rather than reinforcing their deficits.
Instead, the authors emphasize using a positive psychology framework “to enhance self-esteem and well-being,” by focusing on client strengths rather than their weaknesses and utilizing cognitive stimulation “to access areas of intact cognitive and memory functioning.” The authors who created MICST suggest three basic ways of doing this:
1. Body movement-Mindfulness-Relaxation (BMR) exercises
2. Group Discussions
3. Paper & Pencil exercises
As I read through this treatment approach, I can’t help but notice the similarities I see between the recommendations set forth in the MICST manual and components I find in a really great yoga class:
 Acceptance: Encouraging your students to accept themselves where they are at rather than emphasizing failures or unmet wants & desires
 Non-judgment: Role modeling your own personal acceptance as a teacher for your students and encouraging your students to engage in personal growth without harsh criticisms against themselves or others
 Asana: Engaging in physical exercise to provide a point of focus or “moving meditation”
 Mindfulness: Reminding your students over and over again to be in the present moment (often I hear this with a phrase like “be on your mat,” or “Notice what’s going on with you on your mat today.)
 Relaxation: Taking Savasana at the end of class to integrate everything that you experienced during class
 Cognitive Stimulation: I would argue that through the joint practice of mindfulness and movement, with the added component of education on yoga principles or mental health topics at the beginning of class that yoga is an excellent cognitive stimulation exercise
 Group Discussion: Who hasn’t gone to a yoga class and either engaged in conversation with their yoga buddy or with classmates? But I’d argue a really great class includes some discussion about the class theme, or a check-in with students, at the beginning of class (and is a two-way conversation)
Looking at that list and reflecting on the philosophy of MICST, it’s no question that components of yoga can be beneficial for patients with Schizophrenia (or that practicing yoga can help therapists acquire the skills necessary to serve their clients in the most effective way possible). Next week I’d like to follow-up on these similarities further, focusing specifically on the BMR component of MICST and how yoga can help to play this role in clients affected by Schizophrenia.”

Further Comment on Mind Stimulation Therapy:
” I do believe that there are different pathways to achieve positive results in therapy, as psychological profiles are unique and different from person to person, specifically for those considered to be having severe and persistent mental illness, which by definition means that this client group has not responded to any current standard psychiatric treatment protocol by history in a very positive manner. So there is need for use of innovative and creative approaches in working with this challenging population.

Success of therapy may also depend on what should be the target of intervention. It is a complex process, as you rightly pointed out, and a very evolving one too. What makes sense now, may be different later with more knowledge and understanding, and advancement of communication technology.

Mind Stimulation Therapy is viewed as adjunct to any ongoing clinical interventions that the client may be receiving from other service providers, , and one can choose to incorporate whatever elements of the model presented in the particular brand of therapy that one choose to practice or promote incorporation of the elements in the milieu intervention of the client.

My experience in working with people with schizophrenia (I am using this label until a newer and less stigmatizing name is adopted, but it does serve a denotative function for communication here. and you may have read a discussion thread sometimes ago whereby we presented a model of Atypical Thinking Psychosis as an alternative name for schizophrenia in a response letter to Bill George and A Klijn in the Lancet Psychiatry a year ago) has been primarily in state psychiatric and Community Support Programs of CMHC facilities. Almost all these patients/clients demonstrated varying degree of difficulties in 1) working memory (holding information on line (in head) to solve a problem), 2) episodic (personal) memory, and 3) semantic (knowledge based factual) memory. While for 1 and 3, one can provide objective feedback, but for #3, personal memory (analogous to belief as to what happened in the past, it is difficult to do so. As it can be compounded by objective experience of recall, subjective interpretation of the experience that is recalled (often in bits and pieces), and added with subjective feelings and personal imaginations or interpretations. While there is a value to explore these past memories objectively and symbolically for some, but not sure how productive will it be for the kind of population that I am referring who may have gone through this “recall phases” many times in their own personal life or induced by other care givers in the past. It may be very productive for other client populations, as many will testify. I don’t doubt it.

When I was working at a state inpatient psychiatric facility in the 80’s, many of the patients were described as not being suitable for any kind of psychotherapy, individual or group. Psychologists were the only designated provider of psychotherapy for the patients, and only a few who were highly verbal and reasonably stable were seen in individual psychotherapy. There was no provision for group therapy then. And there was of course the resource limitation and availability issue too.

I started the first group in that facility in a psycho-geriatric unit, the most disabled group in the hospital, enlisting a social worker as a co-leader, after formulating a group protocol similar to what would later evolve as Mind Stimulation Therapy with varied activities.

Initially we labeled it as cognitive skills training psychotherapy group. The model was partially based on several dimensions of my previous experiences: 1) Providing conjoint therapy/consultation (with casemanager present) with CSP clients in a CMHC, all diagnosed to have schizophrenia, incorporating visual modality rather than just verbal conversation, to make our session conversation more effective. For example, I would type and show the client on the computer screen the major themes discussed, and give print outs to the client and the casemanager. This technique would later be labeled as computer facilitated therapy, and we have published several articles in peer reviewed journals, see publications in my website:http://psychologymentalhealth.com/. 2) Conducting ADHD children group in a CMHC, using paper and pencil cognitive stimulating and self-reflection exercises, a first of its kind to conduct a group at that facility then (early 80’s). 3) Managing a DMH research funded day and residential treatment programs for “mentally retarded and emotionally disturbed adults” living in the community on the grounds of a state inpatient facility (for the developmentally disabled populations).

So the MST model does incorporate all these different experiences of mine of working with challenging mental health clients in various settings. I have used elements of the MST model with dual diagnosed substance abuse clients in two residential programs, and presented our work at 23rd and 26th Cape Cod Symposium on Addictive Disorders, and last clinical was in two nursing homes where I used the model with geriatric clients. I am currently involved in providing consultation to Applied Behavior Analysis oriented Treatment Plans for the developmentally disabled adults (many with a concurrent dx of schizophrenia or other psychotic disorders) suggesting ways to incorporate elements of the MST model into milieu program and in the behavior training approaches. So Mind Stimulation Therapy has varied applications to diverse clinical populations.

But I do agree that one needs to be open to using different approaches in working with challenging mental health populations, as long as one is clear what outcome one is striving to achieve collectively with a client and with client’s significant others who may be involved in clients’ care or well being. There should be some kind of objective criteria to assess progress, however limited, they may be, rather than going by one’s commitment to a therapy model, without assessing whether it fits the client’s needs or functioning or not. I have often heard that “so and so patient is not ready or not been able to use therapy when offered” somehow implying the patient does not match a therapy model that the clinician has been trained in , and not exploring modification of a therapy approach to fit the particular patient needs.

Of course there are time constraints and resource commitment issues that professional and agencies serving this type of challenging mental health clients face, so there is less opportunity to engage in innovative practice or going beyond one’s expected defined roles.

But keeping an open mind does help to make some impact in a positive direction. After all, Reality is multifaceted, and there is validity to different perspectives, and there are many ways to reach desirable goals!”

Positivist Thinking and Probabilistic Knowledge

“I read both of your comments and learned a lot the way you presented the contrasting views of the Positivist approach with emphasis on verifiable quantitative data analysis and the phenomenological based approach using qualitative data. I agree with the problem of using efficacy based or experimentally designed based practice to any member of a specific group of individuals on whom the research may have been conducted, without taking into consideration of the unique individuals functioning and their own phenomenological experiences that guide their behaviors, as I understand Paris was also mentioning.

Objective study is difficult, as any method used changes the behaviors of the persons, analogous to Heisenberg’s Principle of Uncertainty when applied to predicting behavior of individual electrons, as they are changed by the instrument of observation used. In terms of clinical practice, it does boil down to use of eclectic, intuitive, and experiential knowledge of the clinician to collaboratively work with whoever client one is working with in dealing with one’s psychological problems in question. Evidence based practice models, or any theoretical models that one has been trained in, are just some useful guidelines, which need to be creatively adapted in conjunction with other knowledge of service systems and social and therapeutic milieu that the client is involved in to make the therapeutic dialogue and collaboration effective.

The social-existential reality is much larger than the typical weekly experiential interaction that a therapist has with a client. In the same vein, psychological problems and human behaviors are too complex to respond effectively to any biological based intervention alone.”

Probabilistic status of all human knowledge

“Knowledge is probabilistic, there is no such thing as all or none approach that fits all, and we need to guard against substituting one dogmatic position over the other, and be open to the idea that some cases may not fit to a given conceptual model or explanations, and some do.

Emerging empirical evidence and change of social culture and acceptability will determine a lot what is considered to be “sane” or “not sane” at a give time of history and culture. Acceptability of any given model of practice will depend to the extent it makes logical sense to people involved, and its ability to reduce “distress” (e.g., subjectively and objectively) of a human condition. One needs to acknowledge that there are different stakeholders (discipline involvements) in this effort coming from different perspectives. Each discipline perspective will have to make a case on its own merit to the public at large without necessarily contradicting or comparing with other perspectives. And there is the whole issue of application of any well thought out theoretical model, however logically it is constructed, to real life situations. It is a challenge to any practitioner from any discipline training.”

On the need for emphasizing spiritual and phenomenological human experiences in therapy and counseling

“As I understand many people ( who I personally interact with, and others at large with whom I have had experience in dealing with in my life time, or have come to know of others through my reading of books or through media) practice some form of faith of religious or spiritual nature that are beyond the parameter of experimental investigations.

Such practice of faith helps them to deal with the Reality of Uncertainty and the Unknown. The faith based areas of spheres may operate independently of other areas of their everyday life or professional science or knowledge based practice, and do not appear to be amenable to any rational discourse. People appear to be quite happy or contented in having these compartmentalized domains of functioning, which may follow different sets of rules or logic, avoiding any experience of cognitive dissonance or disparities between various forms of knowledge, say same science based concepts, such as theory of evolution or evidence from astronomy with their personal religious beliefs and practices.

Even within the experience based paradigms of knowledge, there are different ways of conceptualizing the Experiential Reality.. Emphasis on a particular research or advocacy in no way negates the reality of other types of research and advocacy for a particular point of view as the case may be. Human behaviors and functioning can be viewed from different perspectives, and from different dimensions. It is difficult to say which one is more valid than others. So it often better to avoid comparisons, rather make a case on its own merit. Of course, there are situations where comparative studies and experimentation are necessary to evaluate effectiveness of one over the other, as is routinely done in research studies involving criteria that are operationally and objectively defined, but they have limitations to areas of complex human behaviors. Making a case of acceptability and valuation of a particular model or idea at a particular time of social development and readiness for acceptance will always be a dynamic and fluid process, reflecting evolving stages of social and cultural development and current values. What appears to be “true” and makes sense to others” (with like minded people) with supportive evidence presented, may not be acceptable to other groups of people with their different cultural or sub-cultural identities, and with their varied disciplines of human service provider identifications.

Nevertheless, I do agree that the spiritual dimension of human experience is not often integrated in scientific research in human behavior or not being acknowledged as of being important. Perhaps, may be because people become extremely sensitive, whether scientists or non-scientists, or learned scholars and practitioners of any disciplines or public in general, to any questioning of their personal faiths or beliefs. Rational discourse is fraught with all kinds of implications, and has the potential for bringing about “turmoil” as past and current human history reflects. Scientific endeavors somehow need to perform a balancing act, respecting tolerance and acceptance of diverse spiritual and religious faiths, and acknowledging the fact that societies are unequal in t heir development for tolerance and acceptance of diversity of human opinions and faith expressions.

Besides, I believe, not everyone is comfortable in living with the knowledge of Mystery and Uncertainty of human life experience. That is where the appeal of some of form religious and spiritual faiths for billions of people all over the world comes in. There are some who are okay with it in coming to accept it as the Natural Law, and some may find it as impetus to their own creativity in different forms. And some may struggle with it on a daily basis. And some may find themselves caught up in the riddle of solving the Uncertainty and Mystery of Life and the Universe using an non-consensual validation process, unlike the astronomer scientists, through their own personal phenomenological journeys. In the process they may enter the Black Hole simile of the Unknown and Unknowable world. For many, with intelligence, education, and support, they are able to climb out of it, come up with some insights and understanding that may be appealing to them and to other, and they are able to practice “redirection’ away from these personal moments of “existential preoccupations” or “crises,” so they can enter and exit the process. Bu some may have difficulties in doing so, and may find themselves caught up in the process, causing neglect to one’s personal and social well being, and may exhibit considerable impairments in functioning, associated with personal and social distress, which may be associated with some form of mental illness or people with long standing psychological problems reflecting an unique set of developmental history, and an unique set of adaptations to their “existential crises.”

There is always a room for new ways of looking at things in different ways: trying to improve our own understanding of human life experience, how to improve the quality of life of people that we are connected with or serve in our professional capacities, , and how best to advocate funding and research support or undertaking investigations within various disciplines of our knowledge. Any endeavor in this direction is laudable.”

In relation to this, I am quoting another commentary:

“…You do capture the tormented experience of the living soul who is willing to accept “anything” to get relief or escape, which all of us may feel at some moments of our life, but some may find themselves experiencing this more intensely and persistently than others.

I have taken the position that we may not have the knowledge yet, other than speculations, and have many contradictory views as to “Why” these experiences happen to people. Some with intelligence and education, along with other psycho-social support, are able to navigate successfully through this “why exploration process,” but many find themselves caught up with preoccupation with this persistent “distressing mood” for years. and cannot seem to get out of it with or without all kinds of “interventions.” For them, “What” may be a more productive focus in terms of highlighting with some degree of objectivity what can be done to reduce the “tormenting experience” and facilitate positive redirection,” to various “activities and pursuits,” which is, in a way, a part of our daily routine that we all try to engage in….I do believe that there is need for change in social milieu or what one may call therapeutic milieu. So any form of “therapy” or “counseling” or mediation intervention for that matter to be successful must be integrated into one’s social or therapeutic milieu. That is a daunting task not yet addressed fully or built into professional training and practice of a clinician or within the institutional culture of mental health that one operates within.”