Sunday, March 27, 2011

Chronic fatigue syndrome, Sleep attacks, ADHD and Daydreams as counter measures against anger

A patient in his late forties complained of severe attacks of fatigue and wondered if it was Chronic Fatigue Syndrome.

However, his history pointed to another explanation. As a child he was often beaten mercilessly by his step-father. These memories, after a long period of latency, and after being forced to early retirement from his job at an auto plant, had begun to reemerge, and at the slightest provocation.

An emotional show on the TV, an emotionally charged random word even if overheard and uttered by a perfect stranger, somebody tailgating his vehicle, would trigger the memories, and after a brief period of unpleasant mood and listlessness he would nod off.

He claimed if he had been able to hold on to his job these fatigue attacks would not have emerged or at least not so badly. For as long as he was busy as a bee he had no time to ruminate on his unpleasant past. But now with nothing to do all day long, the past wounds were trying to throw off their scabs in hopes of getting a better healing this time around.

Associated with the memories of being a victim in hands of his step-father were memories of his fights as a teenager with Black kids. He had grown up in a rough neighborhood of Detroit, which was overwhelmingly African-American and he had been made the whipping boy for the Whites. He had quickly learnt to fight back and though mostly got his snort beaten he had nevertheless enjoyed these fights. They had become an outlet for the pain and humiliation he had been subjected to at home and over which he had no control. With the school kids he could at least fight back and discharge some of the rage he felt towards his stepfather.

Now, thirty years later, he had this symptoms of wanting to keep moving his hands and legs when in company of men. This motor restlessness appeared to me to be a muted form of running away or fighting back.  He was not consciously aware that his fidgeting was to avoid direct confrontation with others. He just got  hyperactive in presence of men who he unconsciously feared and hated. He had to take early retirement from job because he could not take being talked down by his bosses, and when they would tell him to do something he would start fidgeting and daydreaming instead of paying attention to them. The alternate was to make some sarcastic remark like, "Oh you want me to make how many pieces today, why don't you go and screw your aunt instead." To avoid coming up with such sarcastic nonsensical repartee he would bite his tongue and get hyperactive.

If he could not fidget or move, his mind would go "on blank". He declared this mental blank as his  attention deficit disorder.  "Growing up for me meant learning to avoid fights. And this meant learning to think before lashing out with my fist or my tongue. But before I could learn to think my way out of a sticky situation was to go in to a blank. Next came the stage of daydreams. Instead of fighting I would go into blank which would be followed by daydreams. As a child unpleasant situations were dealt by going in to daydreams.  Now I go straight into the sleep mode, where, surely, I must be dreaming of revenge.

He added that it is strange that I married a woman who already had kids. For these step-kids piss me off just like I pissed off my step-father. They are lazy as hell, and I want to attack them the way my step-father attacked me. But I don't. When they make me angry instead of confronting them, and smacking their butts, I get my attack of fatigue and I fall asleep.

And I wondered if sleep attacks, ADHD, chronic fatigue syndrome, Tourette's, oppositional defiance and daydreams are not all related to each other and are but different ways to control anger from turning into frank aggression and fight.

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