Thursday, November 19, 2009

The global quest for an everything-is-gonna-be-all-right pill

You know what people would be willing to spend a bajillion dollars on? An everything-is-gonna-be-all-right pill.

Isn't that exactly what heroin is? And cocaine? And alcohol. And nicotine. Often people who use these drugs are portrayed as irresponsible hedonistic "pleasure seekers." And while that may be true in some cases, for the vast majority of people I don't think that's exactly what's going on. It seems to me that the reason that most people try these drugs in the first place, (in spite of the known dangers) and then go back again and again, is to try to feel the sensation that "everything is gonna be all right."

In fact, the reason that drugs lords control entire countries (Myanmar, Afghanistan) and huge swaths of many other countries (Mexico, Colombia, the United States) is because they control the supply of everything-is-gonna-be-all-right sensation-producing plants. Global illicit drugs sales are estimated at $320 billion a year. [$300 billion is a fascinating number too because it is roughly equal to the estimated cost to end world hunger and equal to about half the amount of the U.S. annual military budget].

Interested to horn in on a portion of this huge market, global pharmaceutical sales of antidepressants reached $11 billion in 2008. But it seems to me that Eli Lily and Pfizer are just selling an everything-is-gonna-be-all-right pill too, no more no less.

Furthermore, isn't that what every major religion, new age guru, self help book, and revolutionary movement is selling -- an everything-is-gonna-be-all-right pill or process or methodology? [I remember being in Nicaragua around the time of the 1990 elections and the Sandinista campaign slogan was, "Todo serĂ¡ mejor" everything will be better. On the one hand, anyone who came up with that slogan should be fired for political malpractice. But on the other hand, it is understandable why someone would be drawn to saying something like that in a political campaign in the midst of a war.]

People seem to like pleasure, but they would be willing to give anything for the feeling that everything-is-gonna-be-all right. In fact, isn't that how American Beauty ends, the main character is murdered but he dies happy because he has realized that everything-is-gonna-be-all-right. Isn't that the Christ story: one who loses his life but this ultimate loss has no sting because he is firm in the knowledge that everything-is-gonna-be-all-right?

I guess the reason I'm so interested to riff on this topic is that all of the above suggests that many many people, much of the time, apparently do NOT feel that everything is going to be all right. Which if true, would be a fascinating statement on the human condition. Great literature and film sometimes portrays this feeling, this absence of everything-is-gonna-be-all-right. But it seems to me that the news media usually stays away from talking about this, even though the attempt to escape this feeling appears to be the motivating factor behind many of our daily decisions, and many, perhaps most, of our problems as a society (and internationally).

Thursday, November 05, 2009

Understanding long term chronic pain symptoms from minor motor vehicle accidents

I'm reading, "The Body Bears the Burden: Trauma, Dissociation, and Disease (Second Edition)" by Robert Scaer, MD and it is completely fascinating. Dr. Scaer, an expert in chronic pain, attempts to unravel the mystery of why people often develop long term chronic pain following even minor motor vehicle accidents. He makes a compelling case that the body interprets even minor motor vehicle accidents as an "existential threat" which triggers a flood of the fight or flight hormone cortisol in the brain. But because there is nothing one can do in the situation -- often neither fight or flight is possible in the moment -- the excess cortisol is never discharged and wrecks havoc on various brain systems leading to chronic pain syndromes.

I want to quote at length from the book and then share my reflections on what Dr. Scaer's research also might tell us about other forms of dissociation we often see in society.

First, the money quotes:
Those of us fascinated by animal behavior in the wild love to watch shows on TV devoted to observation of animals in this setting. Many of these TV specials relate to the prey/predator experience, and sometimes display this in graphic and even grisly detail, at least to our civilized eye. If one closely watches the details of pursuit of the prey by the predator, one will see that the fleeing prey will often collapse and become limp even before being seized by the predator. An example is a film that I saw involving a gazelle pursued and run to the ground by a cheetah. At the moment that the cheetah caught the gazelle, it struck the gazelle lightly on the flank, at which point the gazelle collapsed and lay inert on the ground in the freeze or immobility response. In another example, after fighting off a pride of lions for more than half an hour, the lone water buffalo was knocked off its feet, at which point it became limp, immobile, and frozen. In other words, when fleeing and fighting are no longer physically possible, and the prey animal is in a state of helplessness, it will frequently enter the freeze, or immobility state, a totally instinctual and unconscious reflex. This behavior is common in most species including insects, reptiles, birds, and mammals. Since most such reflexes have evolved as a means of perpetuating the species, the freeze response clearly is of critical importance for survival. (Robert Scaer, The Body Bears the Burden, page 16.)

This part blew me away:

In a surprising number of cases, the attack of the predator may be fueled by the instinctual response to movement of the prey rather than by hunger, in which case the freeze response of the prey may abort the attack of the predator and result in survival of the prey. The freeze response mimics death, sometimes fooling the predator enough to leave the scene of its "kill" and gather its offspring without delivering the tooth and claw coup de grace, thereby allowing the prey to recover and escape, as in "playing possum." In addition, the freeze response, analogous at least in part of dissociation in humans, is associated with additional release of endorphins, rendering the animal relatively analgesic. Whether this analgesia has survival value, or is a gift from a greater Being to prevent a painful death is open to debate. Another purpose of freeze analgesia may be to inhibit self-ministering behavior, such as wound licking, which would impede escape of the prey animal in the case of arousal from the freeze. (p. 17)

If the animal was in a state of high sympathetic tone -- fighting or fleeing -- for a period of time at the onset of the freeze, its autonomic nervous system will be in a state of "the accelerator on full, but with brakes on" during the freeze... In this freeze state, the focused and alert mind becomes numb and dissociated, at least in part due to high levels of endorphins. Memory access and storage are impaired, and amnesia may be expected for at least some of the events occurring during the freeze.... In mammals the freeze response is indeed a perilous state. (p. 18)

But unlike humans, other animals apparently have instinctual ways to discharge this flood of fight or flight chemicals in the brain.

In most cases, the frozen prey animal does not need to deal with the presumably unhealthy state of the freeze response -- it becomes another animal's meal... In some cases, however, the frozen prey animal survives the period of immobility without being killed... In virtually all such instances, the animal will arouse and begin to tremble. This may be as imperceptible as a shudder, or as dramatic as a grand mal seizure. In some cases analyzed by slow-motion video, the trembling will resemble the last act of the animal before freezing -- the act of running... The animal at this point will usually arouse fully, regain its feet, often stagger a bit, shake itself, and then run off, apparently none the worse for its life-threatening experience. Long term observations of such animals do not seem to show any harmful effects on behavior, health or other measures of survival. It would appear from these observations that animals in the wild possibly possess an instinctual means of dissipating autonomic activity stored and accumulated in the freeze response. They also seem instinctually to tend to "complete" the act of escape through the freeze discharge. (p. 19)

So what does this have to do with humans in motor vehicle accidents?

People who report symptoms of shock and numbness after a traumatic event [like a motor vehicle accident], and exhibit symptoms of dissociation, are actually in the freeze response at the time. In fact many of the post traumatic symptoms that occur often for years after the unresolved trauma are characteristic of dissociation, or recurrence of the symptoms of freezing. (p. 20-21)

And here's where he brings it all together:

Acculturation of the human species has resulted in an increasing pattern of urban living in closely confined habitats that intrinsically may inhibit the instinctual capability to flee or defend oneself under threat... The state of intense proximity and cultural interdependence may also act to inhibit the natural discharge of autonomic freeze energy in such cases...

If we do not discharge or complete the freeze response, our brains will literally be fooled into thinking that the memories of the traumatic event that inevitably periodically reemerge represent events that are actually in the present and not actually in the past. When they emerge, we go through all of the experiences of that event, emotional, cognitive, and autonomic as if it were actually happening again. Retention in procedural memory of this experience may serve as an internal cue for recurrent arousal patterns, alternating with numbing and dissociation, constituting the basically bipolar and self-perpetuating nature of PTSD. Until that act of flight or self defense has been completed, therefore, the "survival brain" may continue to perceive that the threat continues to exist, and is unable to relegate it to memory as a past experience. (p. 22)

So to summarize: a motor vehicle accident, even a minor one, is perceived as an existential threat by the human body -- much like a gazelle being chased down by a cheetah. That triggers the freeze response whereby the body is flooded with fight or flight hormones. Unlike the animal kingdom, once the danger has passed for humans, we seem to have forgotten or repressed the freeze discharge instinct that we see in animals. As a result, the sensation of "the accelerator on full, but with brakes on" becomes imprinted on the brain such that an event that was in the past is experienced over and over again in the present, akin to the experience of people with PTSD.

It's a pretty compelling case I think.

I'm also encouraged by the way that this diagnosis also points to treatment options. Indeed, one of the mysteries in psychology is why the wacky steps involved in Eye Movement Desensitization and Reprocessing (EMDR) are so incredibly effective at treating PTSD. Dr. Scaer's theory suggests that EMDR is effectively precisely because it reawakens and plays out the sort of freeze discharge instinct that we see in animals. I wonder too, if taking self defense classes after an assault are helpful not just because they provide an additional level of protection against future attacks but because they also help heal the brain by "completing" the act of escape thereby discharging the autonomic freeze response?

It seems to me that this model also may explain learning disabilities. Little kids put on the spot at the front of the classroom by a teacher very well may experience that as an "existential threat." Indeed, from the outside many of these children (and adults) appear to freeze, much like the gazelle in the example above. People with learning disabilities describe the experience of taking a test or being called on in class as a flooding in the brain complete with loss of short term memory, blurred or jumpy vision, cognitive fogginess, and difficulty focusing -- all symptoms that match the freeze response of people in motor vehicle accidents as well. Encouragement, praise, and a more relaxed school setting (all characteristic of Montessori of Waldorf educational approaches) I imagine then would do wonders for reducing the flooding associated with learning disabilities.

Finally, I'm fascinated by the ways in which this model also explains military strategy. The displays of overwhelming force characteristic of both the Nazi Blitzkrieg and the current U.S. strategy of Shock and Awe appear specifically designed to trigger the freeze response in an entire population thereby disabling their ability to fight back. Displays of overwhelming force are literally attempts to get an entire population to believe that is about to be annihilated so that they freeze (much like the gazelle), unable to respond (which actually is what appears to have happened in France in WWII and Iraq during the first Persian Gulf War and the current Iraq War.) All wars lead to high levels of PTSD in both the military and civilian population. But it would follow that nations subjected to Shock and Awe would display even higher levels of PTSD in the general population as a result of this strategy (which actually makes rebuilding much much more difficult I would imagine).

So, sorry for the long post. I don't imagine this post will do much for my blog traffic or my "average time on site" statistics. But for the one person out there who might be helped to understand their situation just a bit better -- whether you are suffering from chronic pain; PTSD; flashbacks, depression or dissociation as a result of trauma or abuse; or even just a learning disability, this one is for you. And if you are experiencing any of those symptoms, I highly recommend reading, The Body Bears the Burden. The life you save may be your own.