Wednesday, March 30, 2011

Restless Leg Syndrome - an impulse to run away from conflicts and pain?

Restless Leg syndrome [RLS] is an interesting disorder which is rarely mentioned by patients unless one specifically asks for its presence. And then one is surprised to find how prevalent it is. Then one searches on the Internet as to what is the current wisdom on RLS and is slightly taken aback when only physical illnesses, like iron deficiency and uremia, are given as its causes.

Stress is mentioned, but as an afterthought. To me it is primarily a psychological disorder: an impulse to run away from one's problems. During the day, an individual may stoically face his worries, stand his ground to all the slings and arrows that are thrown in one's way by the harsh and selfish world, but at night, when the ego [the protective shield of our mind, the rationally organized part of our psyche] must go to sleep  and drop its guards to refresh itself to face another day, one's worries may take on an insurmountable demeanor, and running away from them may look like the best option. And since our muscles are mostly paralyzed in sleep, the impulse to run finds expression in a muted, condensed and uncoordinated form, and results in the restlessness of legs.

Today I came across two cases of restless legs: one complained of it interestingly just during the day, the other at night.

The first one was a 26 year old woman, who had been medically discharged from the army for the problem of  pains and motor restlessness in her legs.

Her restlessness had been given the medical label of "Compartment Syndrome". However, she never had injury of her legs, which I think is held as the principal etiological factor behind "Compartment Syndrome." Whether such an illness in reality exists or not is another matter.

The pain and restlessness were uniformly distributed in both legs, and the surgeries, done bilaterally, had brought no relief. She complained that she could neither sit nor stand for any length of time. She suffered from hemorrhoids - which so often is a result of stress - and freely admitted that she was depressed and anxious. However, she did not agree with the suggestion that the restlessness of her legs was psychogenic.

But I wondered if her so labelled Compartment Syndrome was not actually Restless Leg Syndrome and an attempt to run away from her problems. She did run away from the army, and since then has not been able to hold on to any job because of her constant need to be on the move.

The second case was of a young mother, 26 year old as well, who had typical restless leg syndrome. In her case it did not happen during the day but at night. But whenever she took Vicodins or Percocets, the restlessness disappeared, only to come back with vengeance when she stopped the medications. ,along with goose bumps and other funny feelings, which she described as getting the chicken skin. She freely admitted that the Restlessness of the legs was due to psychological pressures and it increased when the stress worsened.
Why narcotics took away the restless legs in this patient?
Now we know the reason addicts take narcotics is because it sets them free to indulge in activities they would not in sober state. As a rule we ignore and suppress the existence of ever present subtle sensations of pain in our system, and show little appreciation of the fact that how much of our behavior and interests in life are restricted by the affect of low degree barely conscious ever present pain. It appears as if growing up means a gradual suppression of activities and interests which once gave us pleasure but then got associated with affect of pain. And to avoid the emergence of this pain we ceased indulging in those once-pleasurable activities.
What are these erstwhile pleasurable activities and why do growing up results in their suppression?
Maturation means giving up of juvenile pleasures. And this occurs because such activities were met with pain in our evolutionary past as well as the fact that our care takers meted out real punishment, threats and humiliation in our actual past. Activities which are pleasurable in certain age bracket cease to be so when we grow out of that development stage. For example the pleasure young children take in defecation and messiness become disgusting, and forbidden, once we are out of the anal phase of our development. Uninhibited indulgence in such activities in the latency period, and beyond, causes pain more than pleasure. As if we are biologically programmed to generate pain if we indulge in age inappropriate forms of pleasure.
Now there is one activity which was indulged with greatest pleasure during childhood, and was accompanied with far ranging fantasies. That activity was masturbation during the Oedipal phase. In fact it remains the primary addiction of mankind.
And this masturbatory activity, and the extensive fantasies associated with, directed towards the parents, come to an end, with the end of Oedipal phase, for we are programmed for this to happen. And this happens not only because our care givers punish us for playing with ourselves, or for doing substitutive activities like bed-wetting [enuresis] at that age, but phylogenetically there is threat of castration [and pain] associated with it, and anticipation of which is perhaps the greatest evolutionary source of fear and pain in mankind.
So the greatest pain, and suppression of pleasurable activities, is associated with giving up our parents as love objects. But humans never give up Oedipal strivings. Whenever life becomes
stressful, and there is little pleasure to be derived from one's current love objects, we hark back to Oedipal fantasies and the pleasures associated with it. And it is primarily done in our sleep and
dreams, where we can once again indulge in loving the parental figures, although in displacement and disguise.
However, the fear and pain that is associated with these fantasies, which brought Oedipus Complex to an end, does not stay inactive, but follows close behind to counter these fantasies. And it is this fear, and anticipation of pain, that makes the person want to run, which reflects in the restlessness of his legs.
Now narcotics by taking away the fear of pain, and actual pain itself, allow one to indulge in regressive forms of pleasure without feeling the fear. Narcotics by blocking pain, take away the stress from everyday worries, and worries that arise from indulging in forbidden sexual fantasies in dreams. Then one can sleep without feeling stressed. As stress lessens, so does the impulse to run away from the world and the restlessness of legs.
Narcotics not only free us from dreaming of forbidden incestuous and other regressive pleasures in sleep, but they also free us to do routine things in life which have got blocked by excessive presence of psychological pain in the psyche. Narcotic addicts will tell you that they have withdrawn from life. They feel irritable, cranky, and can do nothing. Everything is in "a freeze". They cannot finish any task without some painful thought emerging half way while on it that distracts them and makes them want to return to their bedroom and go to sleep. Only on taking Oxycontin or Vicodin or Suboxone can they reverse this withdrawal from life. The pain blockers brings back their interest in life. And from where does this excessive psychological pain comes in to the psyche which saps the person's energy and every task becomes like climbing a mountain? It arises from indulging in forbidden regressive fantasies. While the person is on drugs he can indulge in forbidden activities. When the drug effect is gone, the punishment that was kept at bay returns, and with a vengeance, and now not only blocks the forbidden activity even more forcefully, but extends its net over every day activities. As if the sins for indulging in forbidden pleasures are paid later by the paralysis of will of every kind. What is the role of dopamine in all this? For we do know that dopaminergic agents like Requip decrease RLS while anti-dopaminergic drugs like Haldol cause worsening of it to the point of flagrant Akathisia [an intense restlessness, as if bugs are crawling under the skin].
What happens is something like this: Narcotics by blocking pain allow one to indulge in forbidden activities that bring satisfaction. And whenever there is satisfaction there is release of dopamine to reinforce the behavior that brought the satisfaction. Dopamine is a neurotransmitter that reinforces behavior which brings pleasure/satisfaction. Dopamine is a chemical that induces
repetition/stereotypy of pleasure-giving behaviors. Current science views dopamine is a neurochemical which is secreted to give pleasure as a reward. The real state of affairs is slightly more complex. Dopamine does not bring pleasure. What it does is to further facilitate behavior
that brought the pleasure - release of tensions.
Now when dopaminergic drugs are given they make the brain falsely believe that release of tension is occurring, for release of tension, which is same thing as getting pleasure, causes natural secretion of dopamine. So giving of dopamine drugs gives an illusion that something satisfying is happening. This makes the mind think that it is experiencing pleasure and happiness not stress. And when the feeling tone is that there is no stress but pleasure from interacting with the world the person does not feel the need to run away from it. In short the creation of pleasure in one part of the brain can block out the tension/stress occurring in another.
A discussion on RLS cannot be ended without mentioning [1] its relationship with muscle fasciculations of anxiety [2] the toe curl that occurs in highly satisfying orgasm
People in high state of anxiety may show muscle fasciculations and tics. There appear to be akin to the restlessness of legs during the night. These are also attempts at flight which is aborted by the muscle activity occurring in uncoordinated fashion. The tics around the mouth appear as an attempt to "tell" a displaced portion of oneself to make a run.
The toe curl accompanying orgasm appears to be the normal counterpart of RLS. Humans cannot have sex, without an associated feeling of doing something forbidden and wrong, and with that comes the thought of running away from it. Sex cannot be indulged in without a element of danger attached to it. And once the orgasm is reached without any danger befalling one, the person relaxes, and the tension that was built up to prepare for running is allowed release through the toes, doubling the orgasmic pleasure. As if the purely libidial element is discharged through the penis and clitoris while the aggressive element is discharged through the toes.

1 comment:

  1. I'd just like to state that opiate withdrawal can start rls the goosebumps is a sure sign of withdraw