CASE REPORT Impact of spy fiction on cognition: a case study

Reading spy fiction has imprinted its traces on the thinking patterns of the readers that encourage them to consider it as a real event in their life. This case study is about a 37 year old woman, referred by a senior clinical psychologist with complaints of having the feeling of being monitored through a device and hearing the voices of the people. The brief therapeutic plan was based on Cognitive Behavioural Therapy which focused on developing insight, identifying cognitive errors, and enhancing her socialisation skills. This case report holds its implications to drift the attention of the readers and clinicians toward the issue of consuming content that may potentially have an impact on its reader’s mental health.


Introduction
Spy fiction is a modern medium of entertainment that emerged in the late 19th century and became popular during the 20th century. 1 Besides providing entertainment, it offers insights into human activities in various situations, leaving a lasting impression on the readers personality.This genre of fiction is not limited to only science, romance, and mystery but espionage also.The content of spy fiction comprises investigation, escape, and arrest, followed by torturous questioning, which is not only appealing to the youth but also encompasses conflicts that arise from threats or fears to a nation, organisation, or agent.It is predicted that movies and reading content can shape thoughts, impact opinions, and modify behaviours toward current social issues. 2As a result, at times, spy fiction has had an impact on the emotional and cognitive level (perception, attention, memory, reasoning, action simulation) of the readers because these elements are involved in how readers comprehend, communicate, and enjoy stories. 1 Psychology experts have mostly ignored fiction literature because it appears to primarily serve as entertainment and has little connection to scientific validity.People watch movies, dramas, and read novels while considering the events occurring in stories as real events.Even though the threat being portrayed is false, they yet sense real terror e.g., a serial killer crashes through a door.Scholars define fiction as "the mind's flight simulator," through which readers utilised the same cognitive processes to comprehend people in real life. 3terature also revealed that novels and movies can lead to psychological damage.Individuals who are diagnosed with schizophrenia have different biological and environmental risk factors.One of the main environmental risk factor is excessive television viewing and exposure to violence and crime related content, which can exacerbate the risk of developing persecutory delusions and hallucinations. 4nce, reflected that these materials can have an impact on the individual's cognition.Therefore, a reader must be cautious while selecting the category of a novel, as it directly influences the cognitive and affective levels of the reader which in turn can be reflected in their behaviour such as being suspicious of the environment.So, the purpose of the study is to highlight the impression of reading spy fiction on the readers.

Case Report
The subject of the present case report was a 37 years old woman admitted to the institution, Fountain House, Lahore during the time period of 27 th October, 2022-29 th November, 2022.She was referred by a senior clinical psychologist with the problem of having the suspicion of being monitored through a device and hearing the voices of people.Before initiating the therapeutic process, ethical considerations were followed, which involved obtaining the consent of the patient to apply the therapeutic intervention and maintaining confidentiality.During the interview with the patient, it was revealed that she had been experiencing these complaints for the past 7 months.She did not comply with the medication, due to which her parents admitted her to the institute.asked her to read Islamic books.She was married at the age of 35 years and went to her parent's home for the delivery of her baby after one and a half year of marriage.One day, the patient went to her brother's room, where she read a novel and found it interesting as it was related to new advancement in science.Later, she went regularly to her brother's room to read novels.One day, she read a novel named as "Transistor" which was based on different ways of keeping an eye on others involving the information related to the secret cameras.In anger, she tore her brother's novel into small pieces as according to her it was against the religious teachings and started suspecting that her brother had installed a device to monitor her actions.After this incident, she kept on thinking about the novel's content and began reporting that she heard the voices of her brother and sister-in-law making fun of her by watching her through a camera.

The patient was raised in a religious family and her father
After that incident, she developed the belief that her brother had fixed cameras in the home.She searched every room and also requested the police to visit her parents' house, however, no gadget was found.However, she still believed that the cameras were hidden inside the wiring of the home.Her parents took her to a doctor, who diagnosed her with Schizophrenia and prescribed medication.However she refused to take medication, insisting that she was perfectly fine with no problems.Moreover she got to know that her parents had transferred property rights of their home to her brother which induced a feeling of insecurity in her.Later on, she also discovered that her husband liked someone else and did not want her to return home after her delivery.All these contributing factors exacerbated the symptoms of the client due to which her parents admitted her to the current institute and she had been there for the past four months.The symptoms improved with medication and she stopped complaining of hallucinations.On the other side, the protective factor in her recovery was her 6 months old daughter who served as her sole source of inspiration for getting well because she wanted to return home and take care for her child on her own.
Assessment was made by using Behavioural Observation, Clinical Interview, Mental Status Examination, Subjective Ratings, Baseline for Delusions, Behavioural Problem Checklist and Positive and Negative Syndrome Scale (PANSS) (Table 1), Dysfunctional Thought Record (DTR), and Diagnostic and Statistical Manual of Mental Disorders Checklist. 5The summary of the assessment revealed that the client was suspected to be Schizophrenic.
In the first 2 sessions, the rapport was built with the patient.All the information was shared with the trainee, to develop socialization skills which helped in communicating side-effects of medication with the doctor.Social skills training, role-playing and role reversal techniques were also used.Through practice after 5 sessions, the client was able to socialize with others and communicate effectively the side-effects of medication.Moreover, the insight was developed through bibliography and Evidence for Evidence against technique.It took a lot of time to gather evidence against maladaptive thoughts related to the suspicion of being watched by cameras.After 8 sessions a minor insight was developed.Later, the patient could identify her cognitive error.Along with these, psychoeducation was also provided regarding the importance of adherence to medication and token economy technique was used to develop this habit.She also had difficulty in making important decisions of her life, so she was taught through cost and benefit analysis to overcome this difficulty (Table 2).On the other hand, the informed consent was also taken from the client for the publication of the case on the condition that her name and initials should not be published and efforts will be made to conceal her identity.
After management, the Positive and Negative Syndrome Scale (PANSS) was again administered for the postassessment of the client.As the scores and categories reported in table 3 indicated that there was a decrease in the intensity of the client's symptoms.Overall, the outcome was found to be satisfactory.As there were no follow-up sessions therefore based on the above-

Discussion
In the current case, the impact of spy fiction on the reader's thinking pattern was discussed.The therapeutic process consisting of 10 sessions was planned in which different causal factors were identified and an assessment and management plan was administered.Every individual differs from one another, thus their level of understanding of the content of written words also differs.Moreover, the constructivist reading model focuses on the reader's nature in understanding the written words.When people read or watch the same text, they frequently come away with various levels of understanding or mental pictures of the reading content.
The way different people interact with fiction varies as well.For example, some people are primarily drawn into a novel by mentally imagining the ideas and beliefs of others, while others interact with literature by imagining it more as a realistic event. 6Some people read the content on a superficial level just for reading purposes while others read the same content in depth which in turn affect their thinking patterns thus they apply the scenario to their real lives resulting in the manifestation of problematic behaviour.In most of the cases, while reading the novels, readers consider themselves as the main character of the novel and become worried all the time.It changes the perception of the reader which leads to adverse psychological reactions such as fear, aggressiveness, feelings of being guilty and unusual behaviour. 7As evident in the above-mentioned case, after reading the content related to secret cameras, the patient believed that she was being watched by her brother through these gadgets and she checked all the rooms for them.Therefore, when choosing the reading material, an individual should focus on the content of the written material and also their comprehension level as it directly or indirectly affects cognition.The intervention plan of the present case was aimed to socialize with her friends, effectively communicating the side effects of medication, decision making, adherence to medication, developing insight, and identifying cognitive errors which had satisfactory results.A Trainee clinical psychologist focussed on different cognitive behavioural therapy techniques (evidence for evidence against, cost-benefit analysis, triple column technique), Rational Emotive Behavioural Therapy techniques (bibliography, roleplaying), and Behavioural Modification techniques (corrective feedback, positive feedback and positive reinforcement, token economy) and social skill training through interactional skills to achieve the goals effectively (Table 3).

Conclusion
It was concluded that reading spy fiction could negatively affect the thinking pattern of the readers which in turn develops dysfunction in the different domains of their lives and might lead to some disorder.In the advancement of this era, people should know about new advancements through novels and different mediums but they should not stick to that point and keep on thinking about its content.So, there is a need to make the readers understand that they should not generalize the novel's content in real-life scenarios as they may cause a disturbance that would negatively impact their daily life functioning.

Table - 1
: Table Showing Quantitative Analysis of Positive and Negative Syndrome Scale.Goals and Techniques for the Management of Client's Problems.