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The diametric model of mental illness spans the whole range of mentalism from autistic hypo-mentalism to psychotic hyper-mentalism, with normality in between. And although the model implies that everyone has a mental configuration somewhere on that continuum, few get to sample completely different positions on it in one lifetime. Nevertheless, radical cancer surgery last summer gave me the opportunity to test the theory on myself and the fact that it is Mental Health Awareness Week in the UK an added incentive to present my findings.
As is apparently not uncommon, I experienced a transient psychotic episode while in critical care following my surgery (almost certainly caused by the drugs I was given, probably those used to induce the 3-day long clinical coma into which I was put to help treat sepsis). Unlike some other patients, I thankfully did not have hallucinations, but I did experience terrifyingly graphic and compelling dreams; paranoia (I thought that my male nurse was a sadist intent on torturing me); regular, recurrent bouts of compulsive thinking you could almost set your watch by; and—most distressing of all—a persisting delusion of déjà vu, which made me feel I was doomed to repeat the same experiences without end. Additionally, I even showed signs of what you might call real hyper-empathy.
I say "real hyper-empathy" here to avoid confusion with hyper-mentalism, which is a much broader concept. Paranoid delusions are paradigmatically hyper-mentalistic by way of being pathological over-interpretations of other people’s intentions and states of mind: cancers of the mind, if you like, as I explain at length in The Imprinted Brain. But it is worth pointing out that one of the many strengths of this idea is that it explains both of the principal paranoid delusions: erotomania (the delusional belief that others are in love or are infatuated with you) as well as delusions of persecution. These are parallel paranoias because people's intentions towards you can be either good or bad: erotomania pathologically amplifies good intentions, delusions of persecution bad ones.
My paranoid delusion about my male nurse was of the latter kind, and resulted from the fact that he had to forcibly restrain me during my more disturbed moments. I dreamt that I was a prisoner or victim of torture, bound by nets, harnesses, or shackles, which at times I attempted to tear off, occasioning my nurse’s physical intervention. In other dreams of remarkable apparent logicality I found myself trapped by fiendishly clever systems of various kinds which could not be beaten, however hard you tried to get round them. Obviously, all this was a hyper-mentalization of my captive situation in critical care and of the many tubes, catheters and wires that were in fact inserted or attached all over me at the time and which did in fact make much movement difficult and leaving the bed impossible.
Déjà vu is frequently found in schizophrenics and temporal lobe epileptics, typically lasting minutes in epilepsy and hours in schizophrenia, but mine persisted over a period of a few days, coming on mainly in the late evening. According to one account,* a circuit within the temporal lobe fires when remembering, creating the experience of recollection along with a sense of the self in the past. This circuit is overactive or permanently switched on in déjà vu which, given that memories related to the self are mentalistic in quality, means that my delusional experience of it was to this extent a case of hyper-mentalism.
Indeed, you could see déjà vu as the hyper-mentalistic equivalent of mental deficit in Alzheimer’s, where memories related to the self are lost, or comments are repeated because the sense of déjà vu in respect of them does not occur. Furthermore, given that I was first discharged, then re-admitted to the critical care unit and re-intubated, the delusion may well have been triggered by actually re-experiencing real events related to my re-admittance within a short space of time. If this is so, then as with hyper-mentalism generally, you could see my delusional déjà vu as a pathological exaggeration of a normal mental function: one which went into overdrive in my delirious state.
Compulsive thinking is also pretty self-evidently hyper-mentalistic, given that only minds can think and that compulsions push you far beyond where you want to go. This was particularly so in my case, because the thought-storms came on in regular waves, separated by a few minutes, and because I was nonsensically compelled to analyse everything I thought about into four parts for some reason. These attacks of uncontrollable mentalizing blotted out everything else from my mind and left me exhausted and thankful for any period of respite that followed them. But the worst part was knowing that another one would come on and that there was nothing I could do to stop it.
As these and the other psychotic symptoms wore off, I had saner moments, and I used at least a whole day of these to think through my father’s life (in so far as I knew it) from his point of view, and trying to understand why he had made the decisions he had. Of course, you could put this down to my extreme boredom at the time. But the fact remains that I carried out this empathic mental exercise with a commitment and thoroughness that in retrospect amazes me—particularly in view of my highly un-empathic attitude towards my father and normally very low opinion of his decisions. This was certainly hyper-mentalistic—even genuinely hyper-empathic to the extent that I was concerned with imagining how my father felt with an intensity and single-mindedness that I had never experienced before or probably ever will again.
Inevitably once I had recovered from all this (which took some time), the whole horrible experience confirmed me in my belief that hyper-mentalism is the key pathology in psychosis. The final symptom was a sudden flashback several months after my return home triggered by a news story on television that featured something I had first heard about during my delirious episode. It caused me to run away in panic and burst into tears, astonished at my own over-reaction until I realized that this too was an inevitable instance of hyper-mentalism, comparable to similar reactions seen in post-traumatic stress disorder, which I already knew beautifully fitted the diametric model and imprinted brain theory, as I explain in a post on the subject.
But at the very same time that I showed such remarkable ability to construct compelling dreams, predict what a nurse was about to say thanks to déjà vu, and compulsively analyse any and everything into four different parts, my mechanistic abilities were so depleted that I had difficulty with the clasp of my watch, and found reading the time from it confusing and difficult. And although I also had a phone, iPod, and MacBook Air within reach, I could not use any of them with any success. On the contrary, the phone was completely beyond me, and I had such difficulty with the MacBook that I had elaborate dreams about it, which presented using it as an almost impossible struggle against overwhelming odds. But again, this is exactly what the diametric model of the mind would have predicted: if my mentalistic cognition was enhanced during the psychotic episode, my mechanistic skills would inevitably be correspondingly reduced, and indeed they were.
* Thompson, R.G., et al., Persistent Déjà vu: A disorder of memory. International Journal of Geriatric Psychiatry, 2004. 19: p. 1-2.
