Tuesday, January 18, 2011

A psychological theory to explain rise of sugar, lipids and triglycerides causing metabolic syndrome in chronically stressed

A long time back, when I was in my late thirties, Single, and somewhat of a hypochondriac -a common affliction in people in mid-life and still without wife and children - one day, feeling out of sorts, slightly nauseous and light-headed, I asked a nurse to check my blood pressure.
And lo and behold, instead of the usual 140/90 it came as 155/98. I could not believe that my body was betraying my mandate to always serve me without a fault, and I was instantly filled with anger, apprehension, vague forebodings, and a desire to go on a rampage.
The nurse told me to calm down and handed me a candy bar. On my expressing surprise - for wouldn't sugar worsen my emerging metabolic syndrome, hastening diabetes alongside the hypertension - she said, "No. Eat the candy. The sugar in it will bring down your blood pressure."
And she was right. In a matter of minutes the blood pressure returned to its baseline - 140/90.
The nurse explained that sugar made me feel good, which brought down the blood pressure. Sugar, according to her, works like a reward and when you eat sugar, or any food, but especially food that is loaded with calories, it makes you feel like an instant winner. Winning and getting rewarded is what life is all about and for eons of evolutionary years the reward was basically one of two things - food or sex. When you eat or finish having sex, you feel like you have reached your goal and are getting rewarded. This sends a signal to your brain to turn off "the strife mode", which brings down your blood pressure. As long as you are in a state of strife your blood pressure remains high, for your body is geared up for "fight or flight". But when you have a feeling that you are getting rewarded, the body relaxes and the blood pressure comes down.
The nurse set me thinking. And I began to notice that when I am stressed, or feeling anxious, or agitated, I do reach - sometimes even without paying attention - for food, and the eating does help the mood. If I receive bad news, or am gearing up for confrontation, for example like having to argue with an insurance company rep. over discharging a patient from hospital prematurely, or doing even such a minor stressful activity like dictating medical charts, I do feel tension, or pressure, or presence of something like a foreign object, in my chest. And eating a cookie, or sipping coffee, or eating hot salty harsh food like jelapeno chips, helps. In fact all the while I am masticating the food, and feeling its passage through the esophagus, I feel virtually no stress and my mind gets distracted away from whatever is bothering me into concentrating upon the pleasure arising from eating and swallowing.
So eating lowers stress and takes away depression and anxiety, at least in me, and perhaps in all those who can use this mode of gratification to block out painful emotions arising from adversities. The pleasure from eating blocks out the perception of pain arising from the stress as if our conscious mind can handle only one affective tone at a time.
People who are couch potatoes, and eat all day long, must suffer from subtle dysphoria, or even overt depression and anxiety, and much of their eating is not for nutritional reasons but to counter their depression, I reasoned.
I wondered too whether people who live stressful life - especially that had its beginnings in childhood, when pleasure from eating is most profound - overeat to handle stress, and thus get overweight, and develop diabetes, and other metabolic problems.
And is it possible that not just the process of eating that lowers the stress but a rise in blood sugar also plays a role in bringing down the stress?
If the latter is true as well such people may be pathologically seeking to keep their blood sugar at high levels to create a continuous source of pleasure. And in an attempt to keep high supply of sugar to their system is it possible that their body turns on genes that lower their basal metabolic rate, and gear up metabolic processes that start storing lipids and fats more than what is good for them, and all in order to have a readily available internal source of energy, in case food becomes scarce in the stressful and dangerous outside world.
How does this constant high level of sugar consumption affects the glycobiology of these people? The purpose of high levels of sugar is of course for it to be readily available not just in the blood but inside the cells, especially in muscle and brain cells, which must function at a higher level of activity in order to deal with stress. For it is with brain that we scan our surroundings for danger and make strategic multi-step planning in our neurons to combat the enemy, and it is with muscles that we fight or flee away from the enemy and keep it taut to prevent any foreign object penetrating through its shield.
This assumption that blood sugar quickly moves into intracellular space when under stress also may explain as to why anxious people, at least in their youth, often show hypoglycemic attacks that go as low as 40 mg/dl. Panic pumps insulin out of the pancreas to move the sugar rapidly into the intracellular space for quick burning to face the danger.
Could this constant moving of blood sugar into intracellular region to prepare the body for flight and fight finally leads to the development of insulin resistance to prevent excessive conversion of intracellular glucose to lipids and triglycerides?
The insulin resistance in diabetics perhaps results from the following sequence of events.
  • High level of stress and anxiety, due to genetic predisposition and environmental stressors, especially childhood abuse and neglect.
  • High sugar consumption to deal with this anxiety by keeping the body's flight or fight mechanism on high alert.
  • Excessive insulin secretion to keep moving this sugar into intracellular region.
  • Development of insulin resistance to prevent movement of sugar into intracellular region where it is getting converted to way too much lipids and triglycerides.
  • Finally development of diabetes where there is high level of sugar in extracellular space while intracellular space is in sugar starvation.
The degeneration of various organs especially the nervous system, which exclusively uses sugar for its energy needs, occurs because of this intracellular sugar starvation.
Couple of additional points are worth taking up here.
Why does anxiety or stress cause lump in the throat, queasiness in the stomach, pressure on the chest?
Per my theory stress should activate the drive to search for food to raise blood sugar, but that does not explain the emergence of these physical symptoms in the upper GI tract.
Now it is not real hunger that primarily causes stress related eating. Eating is indulged in as a quick attempt to raise blood sugar but more so as a means to deny the magnitude of the stress. If one is eating then it gives a false signal to the mind that one is in a state of plenty and therefore there is no need to get too worked up and collapse altogether by overestimating the danger. Its mechanism is similar to addictive behavior. As long as one is indulging in addictive behavior all other realities of the world, including all sense of danger and worries, disappear. There is a psychologically adaptive mechanism in play here.
These physical sensations in throat, chest and stomach - almost like irritants - emerge not as much to invite eating - as an attempt to douse them with food - but because of an entirely different psychologically adaptive mechanism. They arise to give a sensation of there being a foreign body in the upper GI tract which must be got rid off; irritants that must be either doused with food or dug out from one's flesh with a counter-irritant.
From where does this sensation of the presence of a foreign body/irritant arise?
They owe their existence to anxiety -a somatic manifestation of anxiety. They are basically no different than other somatic processes of anxiety like irritation in lower GI tract causing different forms of colitis; irritation in bronchial tree causing allergic respiratory problems like asthma; irritation in the bladder with urinary frequency and in more extreme cases Interstitial cystitis; irritation in the sinus mucosa with secretion of tears and sinus fluids; irritation in the skin causing psychogenic pruritis; irritation in heart causing arrhythmias.
Why does anxiety causes these foci of somatic irritation?
If we turn to current psychiatry to get an answer as to why anxiety causes such somatic disturbances we find nothing. Yes, modern psychiatry does catalogue beautifully all manifestations of anxiety - plagiarized straight from Freud's earliest psychoanalytic writings, never crediting him - but gives no explanation as to why this happens. Actually current psychiatry despite its hoopla about being very biological and molecular based tells us nothing about soma and forget about psyche. All it does is to catalogue symptoms.
Now here I venture into a very far out hypothesis. Somatic anxiety, which is really not so much affect of anxiety but activation of mucosal tracts and surrounding tissues and muscles in various tracts of the body through which the interior of the body communicates with the outside world, is actually a psychological attempt by the mind to fight and do away with the agent that is causing the stress.
Before we evolved into humans anxiety/fear gave us two options: run away or fight. But by turning in to humans these two options have increasingly turned into non-options. In a civilized human society we have to stay our ground and deal with the agent of stress without running or attacking it. Animals also face this quandary, but not in such a regular fashion as humans. And when you have to deal with an enemy without the choice of making him disappear by running away or annihilating it, you are forced to use different strategies.
Creating somatic anxiety is one such strategy. The object [forces] that is causing the stress and from which one cannot run away or attack because of social restraints is as if "internalized" by the mind into one of the body tracts and the battle against it is waged there. It is "fight in displacement" which has psychological as well as biological/evolutionary roots.
The hated stressful object is as if swallowed inside one of the body tracts and the fight against is launched there. It the enemy is felt within the lower GI tract it is as if extruded into oblivion with the force of violent colitis. If it is in the urinary tract it is flushed out repeatedly. If it is in bronchial tree it is subjected to asthmatic choking by clamming up of the muscles. If it is in the skin it is treated as an irritating bug. In the upper GI tract it is treated as if it is a bad piece of food that was taken in by mistake and now either should be placated with sweet food and sent down the tract or burnt alive as with stomach acid using some harsh food or spirit such as particularly hot jalapeno or whiskey or thrown-up as vomit.
Here we are reminded of the phrases: eating someone alive, eating and spitting them out, burning in hell fire [of stomach acid].
The appearance of lump or heaviness in the chest is a recreation of the source of stress [the enemy] inside one's own body - in the GI tract - and then an attempt to destroy it there, because one cannot destroy it in the outside world. Granted it is not a real elimination of the enemy but a make-belief elimination done inside one's body and since it is make-belief, it keeps recurring as long as the external enemy exist, but it does give temporary relief. Preference for hot and spicy food over sugar is like using harsh tools against one's own flesh where the enemy is perceived to be launched.
This creation of enemy within one's system and then treating it as a foreign object and how it provokes secretion of steroids and activates body's immune responses and causes stress-induced autoimmune disorders are interesting fields of enquiry. Secretion of steroids in stress appears to be an attempt on part of the body to block body's immune response against one's own tissues that are being harnessed to play the role of foreign body.
A discussion about stress and rise of blood sugars and lipids cannot be ended without touching upon a puzzling clinical phenomena. Why do psychiatric medications raise blood sugar and worsen lipid profile?
This is an even more far fetched hypothesis but perhaps I am justified in putting it forward. Anti-psychotics and antidepressants at least partially work by raising the levels of carbohydrates and related compounds in the body. This is looked upon as an unwanted side effects of these medications. But perhaps it is more than side effect and may lie central to its therapeutic efficiency. After all the three most efficacious antipsychotics - Clozaril, Zyprexa and Seroquel - they all cause the greatest increase of blood sugar and lipids. In fact there seems to be a high correlation between greater disruption of carbohydrate metabolism and better antipsychotic efficacy. As if antipsychotic medication efficacy is dependent upon how much side effect they cause. A phenomena that was remarked upon by researchers when the first generation antipsychotics came into practice and it was noticed that therapeutic dose is often one that produces extrapyramidal symptoms. As if antipsychotics work by shifting the overactive dopamine activity from higher centers of the brain which do cognitive activities, and where madness lies, to lower centers which regulate autonomic activity including derivation of pleasure from eating and other body functions.
If there is indeed a psychotherapeutic angle to this rise in fat and sugar in body what could be the psychological factors that run parallel to the physical processes?
I speculate that a high storage of lipids and triglycerides and high blood sugar levels gives the patients a false sense of security and makes them stand up to their fears/stressors/enemies. For after all we were most secure on our mother's breast getting suckled by her sugar and fat laden milk. A rising levels of these "goodies" transports us back - even if in a very limited sense - to the days when we enjoyed the security of being one with our mothers through her breast, getting all our nutritional and love needs met without any effort.

Monday, January 10, 2011

Defiance against parents expressed as love for Tosh.O brand of humor

A young girl, barely 21, brought the following dream to the session:

I am in a jail. The jail is run by Tosh.O, who is a comedian. It is so weird for it makes no sense. Why would Tosh.O be running a jail. Jail is weird too. It has a long corridor with jail cells on both sides. There are 2 or 3 people in each cell and Tosh O. is holding them there as some form of punishment. They are kids from my high school, which is so weird. J [patient's boyfriend] is with me. He finagles his way out of the cell in which we are. In fact, our cell is the last one in the hall. He goes after Tosh.O, and possibly gets caught, for there is this loud scream which must be from him and which wakes me up.

Now long corridor with multiple cells reminded me of the typical dream of going from one room to another in a house or hotel, and which is a pictorial representation of polygamy, but by reversal symbolizes marriage - since marriage is an institution that protects one from the trials and tribulation of polygamy. And from previous sessions I knew that the girl was struggling with the issue of marriage, not sure if she should make a commitment, despite being with her boyfriend now for over five years. It is unclear why she hesitates committing herself, though we both think it has to do with her great ambivalence towards her father, who she once loved very dearly - during the Oedipal phase - but now cannot criticize enough. The constant criticism of the father is an attempt on her part to free herself from her unconscious bondage to him.
Anyway, I began the analysis by asking her as to who in the world is Tosh. O.
"He is a comedian. Daniel Tosh. I love him. J records his show on the VCR, when I am not there. I also look for his shows on U-tube and Comedy Central. He makes completely off the wall statements. Stupidest things. Gross stuff. Jokes on celebrities, horrible ones, absolutely forbidden statements. I cannot get enough of him."
Now making insulting, gross and forbidden statements towards celebrities, or those who are in high places, has its roots in showing such off-limit defiance towards one's parents - especially father who traditionally has ruled the roost - but out of filial piety they are displaced and expressed against these parent- substitutes.
So her fascination for Tosh.O humor must have arisen from his irreverence towards authorities, I reasoned.
Being somewhat familiar with her problems - for behind her obsessions lie thoughts of harming her parents and simultaneously thoughts of protecting them from her harmful thoughts - I commented to her that perhaps she wants to change places with Tosh.O and poke fun at celebrities [her parents]. That alone explains why she brought Tosh.O in her dream and then declared it was so weird. [Declaration of weirdness about a dream or its elements is always embarrassment over the intensity of the displacement the dream wish has to undergo before the dream can show it getting satisfied.]
She agreed with that interpretation, but only after a slight period of incredulity which broke into an admiring smile, and then brought the following association.
"There is one scene of Tosh O which I found so funny. He shows a woman coming down the steps who is such a klutz that she knocks people down with her arms which are flying all over the place. To punish her Tosh makes her walk down the steps again, but this time with her arms tied, and on a chair, and she has to bounce down each step."
I conjectured that the series of jail-cells in the dream were possibly taken from the series of steps on which the klutzy woman came down. In the TV scene she was knocking people every step of the way and this scene is transformed in the dream to show Tosh O punishing people in that series of jail cells. The steps have been transformed into jail cells. Your classmates from high school were your rivals and, given your competitive nature, you are getting even with them in the dream.
Patient agreed with the correctness of the interpretation and added that it also explains as to why my boyfriend and I are at the end of the long corridor. This allows us to get a good view of all the people in those cells getting punished by Tosh. O.
I wondered if the forbidden insulting things that Tosh. O does to celebrities is something she envies and it is a talent which she would like to steal for herself so she can get even with her parents and he school mates.
The girl agreed with the interpretation.
There is one point which needs explanation. If she wants to steal Tosh O's talent why does not she go after it himself instead of sending her boyfriend.
To steal a man's talent in the unconscious is equated with stealing his manhood. There is too much affect of fear associated with that. So she sends her boyfriend. For woman's ambition traditionally has been fulfilled through the daring of her man.
And though her boyfriend successfully escapes out of the cell and goes after Tosh O. to steal his talents, he gets caught, and since she is identifying with him, she is the one who wakes up with a loud scream. The anxiety/fear trumps the wishfulfilment and wakes her out of her dream.

Green eyes in a dream as a symbol of jealousy

A 17 year old girl who suffers from extensive anxiety and some obsessions, primarily involving numbers, could not bad mouth people enough in a recent session.
She claimed that the whole human race is annoying. She wants to do nothing with anybody. They all irritate her. She claimed she had hardly left home in the last few weeks.
Then she recalled a dream which had no detail other than that her eyes were green in it. The dream picture was so intense that on waking she rushed to the mirror to make sure that her eyes had not really turned green.
She wanted to know what could be the meaning of the green eyes.
I conjectured that green eyed monster refers to jealousy; getting green with envy. Perhaps she is jealous about looking at others.
She stated, "I would have never thought of something like that. It sounds weird but it is right."
When asked why does she think it is right she replied, "I think I don't go out because I am too jealous. I cannot stand anybody being better than me. I get all kinds of evil thoughts towards any girl who is prettier than me. So I cannot go to public places."
So here she brought up spontaneously the origin of her agoraphobia and panic. They were defensive maneuvers to prevent her from going out and getting jealous and start thinking of doing evil things to others.
As for the evil things that she would do to others she did not elaborate but a little later she recalled that it greatly irritated her that a friend had put six cubes of ice in her drink. She claimed 6 was an evil number, it came from the devil and would harm her. She avoids number 6 while she thinks highly of 7 and considers 8 as neutral. She associated that by putting six cubes her friend was jinxing her to die.
So here was the origin of her obsessions.
Burdened by extreme jealousy, which itself arose from desire to be better and prettier than everybody else, she was quickly beseeched with thoughts and impulses to cause the rivals great harm. The fear that acting upon these impulses would cause retaliation by the world was what lay behind her panic attacks, anxiety and agoraphobia. The impulses were also deflected from their primary aim of harming others into playing obsessive number games.
Her friend's putting 6 ice cubes had reminded her of her own obsessions with numbers which was indulged in to prevent her from actually harming others.
Her panic, anxiety and phobia prevented her from noticing as to how jealous she was of others. Instead of noticing she was jealous, all she noticed and complained about herself was that she is weird. And that if she ever really talks about herself people will think she is retarded.
Only in dream her jealousy found full expression - the intensely green eyes. However, one must notice that only symbolically, for the patient though she was disturbed by the dream, she had no clue that it arose from her pathological jealousy.

Friday, January 7, 2011

Analysis of a dream dreamt entirely in red color

A young Irish-American man, inheriting all the complex mental make up of that most unique ethnic group, and suffused with all the pathos, fears, guilt, self-destructiveness, and lust for life, which Irish seem to have more than others, said the following about a dream he had:

It was a most weird dream. But the funny part is that I could have pulled out of the dream or continued with it. It was so crazy that I knew all along it must be dream and all through it I struggled with whether to get out or to continue with it and to see as to what happens in the end. I could have even directed the dream to whichever way I wanted.
In the dream I am in an abandoned school building. It could be Detroit. I am the only white man amongst a bunch of black guys. It is like a gangbang. It is like Civil War. It is like a great chaos occurring in Third World. We are running around with rocket launchers and guns. Could be over drugs. It is a real fight. There are helicopters following us.
But the most puzzling part is that the whole dream is bathed in red. Everything happens in red color and red hue. All through the dream I am aware that I am doing something wrong.

He woke up in the morning feeling guilty, fearful and all shaken from the intensity of violence in the dream and went to his wife and assured her that he will never leave her, and to have faith in him for he will never do anything wrong despite the fact that they desperately need money to survive, and he will find a way out of their financial difficulties by honest means.
This assurance of his good intentions to his wife gave the clue that he was doing just the opposite in dreams and woke up with guilt towards his wife.
The patient confirmed that he is getting very few hours at work - for business is slow - and it is tearing him apart to watch his wife and son do without many of the things that money buys. In fact on the dream-day [the day before the dream] he struggled all day long with the temptation to go back and start buying and selling drugs that he had given up two years ago. "Throughout the day I could not make up my mind whether to get into the drug scene or to keep out of it. "I know I have a choice over which way I go."
So the struggle through the day whether to enter or not to enter drug dealing had found expression in the dream to stay in the dream or get out of it and to have a choice over its direction.
he drug dealing involved competition with other young people, especially young black kids, for it is in downtown Detroit that he bought drugs which he sold in the suburbs.
My construction that his use of the word gangbang implied his taking help of other young vigorous men to improve his potency was decidedly rejected by the dreamer. Gangbang, he said, arose from the fact that if he reentered the drug scene, he will have to contend with drug gangs.
But just the thought of struggling and fighting with downtown black drug dealers would not have had the motive power to construct a dream. There has to be deeper source to it.
Here the theoretical knowledge that dreams or rather nightmares of great fight, everybody fighting with everybody, with an apocalypse like atmosphere, is really a depiction of rivalry with the father transferred on to an all-out-knockdown fight with siblings.
The great Indian epic "Mahabharath" and even Homer's Iliad is at bottom nothing but artistic festooning/embeliisment of such a great war between rival brothers [over some female]. So the dream was taking up this phylogenetic memory of the fight between band of brothers in our primordial past, and giving it expression, clothed in the realities of the present. Granted there was no "Helen of Troy" or "Draupadi of Mahabharath" for whom the bunch of black dudes and our patient were fighting, but then the dream was very vague, and this element of a girl in the background as the price over which the fight was occurring could have got censored out from representation in the manifest content of the dream.
Why the fight takes place in an abandoned school.
Now emergence of going back to school in dreams is often a wish to return to roots, learn better, and come back to fight the present obstacles with new knowledge. The patient often regretted not having paid enough attention in school to have become a professional despite having as good a brain as his wife's relatives who were all professionals. So he was going back to school and learning new fighting skills by combating his rivals/siblings.
hy the helicopters?
This he associated with police following the fighters and the fighters signaling to each other as to how to evade them. So this was the work of conscience/superego which was keeping a watch over him to not go back to his old habits of doing and dealing with drugs. The impulse to do drugs and make money by selling drugs and the superego's objection to it were getting representation simultaneously. Also, it was the same agency that make him wake up feeling fearful and guilty and compelled him to assure his wife that he will not leave her and the family and return to his old habits.
Why the entire dream occurs bathed in red color?
For this the patient brought in an unconvincing association that his wife's cousin had given him, who reads a lot of psychology. He immediately added that the explanation was false. Then after a lapse of a minute, in which he brought up something unrelated, he came up with the following association spontaneously.

t is weird how when I stop at an intersection if the light is red and I see police car next to me or anywhere in the vicinity I feel that the cop will see that I am doing something wrong and I immediately start fiddling with the radio or start doing something else to allay suspicions of wrongdoing.
Is the red of the dream taken from red light of the intersection? I asked him.
"I would have never thought of that, " the patient replied. "But yes, on the night before the dream it so happened that I was stopped at a set of light and I did notice how the whole cross-section was bathed in red. And there was a police car flashing its blue and red light, adding to the frightening ambiance. And now I can see that the red in the dream was taken from that particular experience."
So the warning that he should not return to drug dealing, beyond seeing it in dream, was not only being emphasized in his feeling throughout the dream that what he was doing was wrong, but was also finding visual representation with the whole dream turning red.
Red color was used in the dream to express the warning: what you are dreaming is forbidden. I wonder if that color is used to express the concept of "Off limit" in other contexts as well.