Adderral stopping Restless Leg Syndrome and acting as hypnotic

A single woman, in her late forties, who had too much unwanted sexual attention paid to her as a child because of her blond hair, very fair skin, delicate frame and attractive features, all of which give impression of vulnerability, and as a consequence of which she developed a hysterical fear of men, told me in her psychotherapy session that often in the night she develops Restless Leg Syndrome (RLS) which keeps her awake, and only when she takes Adderall does she get relief from it and can fall asleep.
Now we know that hysteria is running away from the demands of genital sexuality. When the body and mind are not yet ready to meet the challenge of genital sex, if the child is  sexually irritated (sexually abused), or even if the over-stimulation is done without actual physical contact (seduction from a distance), she reacts with great fear to any future demands of genital sexuality and becomes anesthetic to genital sensations (sexual frigidity). In such women non-genital components of sexuality become hypertrophied. Most of the sexual bombshells like Marilyn Monroe owe their sexual appeal to this overly expressed pregenital sexuality over the genital. There is hysterical suppression of the latter.
This patient loves to come to my office with her yoga mattress, which she puts on the floor and starts  her yoga stretches, ostensibly to treat her body aches and pains (fibromyalgia due to childhood sexual overstimulation)  but which are thinly veiled hysterical seductive actions, in which non-genital aspects of her sexuality is displayed in the guise of yoga postures.
What is most noticeable about this behavior is how she jumps up with fright at any noise, or anything startling, while she is doing this yogic behavior, as if she fears getting caught doing something forbidden and naughty.
It is not surprising that this excessive fearful response, partly innate (inherited), partly due to sexual overstimulation in childhood, which was always accompanied by fear of getting caught and punished for it, persists during the night and emerges as Restless Leg Syndrome.
Restless Leg Syndrome appears to be running away from life's troubles (dangers) even when one is in bed and safe from actual harm. One cannot fall asleep because one is anxious and all aroused to run away from the anticipated harm. The thought processes are busy making up scenarios in which one is protecting oneself from impending harm. And in some this is the extent of their motor response to anxiety. However, in some the thoughts alone are not able to deal with the fear. In them the motor response spills into actual physical action of running away though an aborted one. They run but only through the restlessness of their legs.
How does Adderall, an amphetamine salt, a psychostimulant, reverses this fear response? Amphetamines release dopamine in the brain. A chemical that is released on receiving signals that happy things are happening, something good has fallen in your lot, or is about to fall in your lot, for there is a relaxation of your muscle tensions, and drop in the level of brain activity, because there is good and not danger around you.
Receiving this message that all is good where you are, and therefore there is no need to run away out of your bed,  the mind at last takes a sigh of relief, stops worrying, stops sending orders to the body to prepare for running, the racing thoughts and restless legs cease, and one falls asleep.

The psychology behind the phenomenal rise in adorning oneself with tattoos in recent years

While approaching a young patient of mine who was sitting in the waiting area, I was struck by the extensive tattoos on his arms. One could barely see the skin for the lacework of  tattoos. The charm of the white skin was well hidden by the criss-crossing dark designs. 
Now this patient who suffers from obsessive compulsive neurosis avoids facing the world and uses his OCD rituals to accomplish that end. The compulsive senseless  movements of his arms and body not only divide his attention and detract him from noticing others in any depth,  others too are distracted from noticing him, the focus transfixed upon his motor restlessness instead of his total self.
His obsessive rituals made me wonder if the modern world en masse has now not been granted a socially sanctioned obsession that serves us the same purpose as his individualized private OCD - fiddling with Smartphones in public. Being tuned into Whats Up and Facebook enables us to avoid any deep emotional interactions with people we are in company of. Is modern world's tuning out of actual physical interaction with each other in favor of cyber interaction is a new world religion? A new mass obsessional neurosis?
Coming back to the patient.
As if these obsessive motor activities of his hands, fingers, legs and trunk are not enough, every now and then he cracks his knees, neck or finger joints. These cracking of joints, which are compulsive in nature, also give the impression of being another attempt to avoid social give and take which is what life is all about.
And the violence with which he cracks these joints, gives a distinct impression that the rituals are some kind of symbolic punishment meted out to his legs, neck and fingers - [for attempting to get out of bounds?] It appears as if since his whole self is under some form of hold (repression) the individual parts of his body want to  reach out and touch others and are being slapped on the wrist for doing so. For after all the raison d'etre for OCD lies in preventing one from sexually [and aggressively] touching others. Freud did say once that if the term obsessional neurosis had not been already coined, and so well accepted, he would have named this disorder the touch neurosis. The fear of touching others and getting [sexually] contaminated lies at the very heart of OCD.
And this compulsion to keep running away from others follows this patient in to his sleep. He also suffers from severe Restless Leg Syndrome.
He is undoubtedly a man on the run.
Now one would expect that someone who has such dread of the world will at least groom and dress himself well, put on jewelry and perfume, deck himself with other accessories to make up for his lack of self confidence. But he does nothing of the sort. He puts on sleeveless shirts, torn jeans, dilapidated sneakers and no socks. Majority of his skin remains exposed.
Or does it?
The tattoos block whatever parts of himself escape getting covered by clothes.
If his compulsions and joint cracking are ways to create a wall between him and others, do his tattoos serve the same function?
And at this point one recalls how motorbike club members adorn themselves with tattoos; uninviting, and hostile appearing monstrosities, etchings of skulls and daggers, cobras, scorpions, ghosts, ghouls and goblins, swastika and other wild creepy things.
But anybody, whose body exudes such aggression, at the core of his being must be a frightened soul. And since bikers are usually pussycats in isolation and feel sure footed only when feeding upon each others' swagger, one wonders if their tattoos serve them the same function, give them the bluff to face the world that they are so afraid of?
But this cannot be the whole explanation for why people today are so obsessed with tattoos.
For there is another class of tattoos which are distinctly inviting in nature, and it is not hard to guess which sex favors them. Roses, flowers, creepers, colorful designs, butterflies, ornate hearts, entwining patterns that remind one of lingerie, and other soft and cuddly objects, welcoming and aesthetically pleasing, also appear as tattoos.
So it appears that tattoos are another exaggerated display of our masculinity and femininity, props to enhance the active and passive aspects of our individuality.
But then why aren't we all tattooing ourselves? If it enhances our secondary sexual characteristics then why aren't we all rushing to do so? The great majority of us scoff at the idea.
Here we come across the phenomena of a great divide between those who have it and those who don't.
If the display of one's masculinity and femininity depends upon subtle cues, one's natural good looks and intelligence, one does not have to drum it up by adding on to oneself disparate extraneous objects.
Tattoos are a tacky enhancement of one's persona. No different than the plumes jutting out of the Indian Chief's head gear, the rows of ribbons and medals hanging from army brass's shirt, the shiny  jewellery and super-dyed hair of a homosexual, the endless acronyms of credentials following the name of a college professor. They are the bells and whistles of those who do not feel they are anybody unless they can display their trophies. It is a man who is not sure of his manhood and who has doubt if he can be effective with others through his natural pluck who shows swagger in the gait, gruffness in the voice, hostility in the muscle tone, and the gaudy display of sunglasses,  sport cars, and flashy jewellery. A naturally feminine woman, especially one who has natural good looks, far from using tattoos to enhance her femininity may prefer not to put any make-up on herself.
The expression of masculinity and femininity in more refined individuals is through modulated and untrammeled speech and rich personality. It is half filled vessel that spills its contents. Deep waters run still.
Has there been a decline in the masculinity of men and femininity of women in recent decades?
Is there any doubt about that? As our culture has become more androgynous there has been a surprising decline in sperm count of men and rise of polycystic ovaries in women. In behavior too more and more folks are practicing LGBT  than becoming the model representative of their anatomical sex. Thus when the need arises for us to emphasize ourselves in a heterosexual fashion we are often relying less upon our actual selves and more upon adorning ourselves with extraneous objects that emphasize our original sexual nature.
But there is another great transformation that has occurred in the last few decades. The sexual revolution of the Sixties has fundamentally changed the way people communicate.  All through history human behavior was highly ritualized. There was  a script for everything. It spelled out in magnificent detail what and how to speak with the opposite sex, the children, the elderly,  the postman, the milkman, the car mechanic, the handyman; who to be deferential with and who to boss around.  There were stock phrases, stock motor movements, stock greetings, stock goodbyes, and stock feelings and display of emotions all handed down by the previous generation ready made for for every occasion. Everything was predictable and based upon what we had observed from birth. Even the clothes we wore were predetermined - white collars for those in management, and there too higher the rank the more silky and fancy was the tie. Bow ties were reserved for the eccentric professorial type or those in corporate world who had castration issues. A blue collar worker occasionally wore tie too, but the coarseness or at least its dated design gave away his lower station in life.
All these moorings which allowed us to interact with others without feeling anxious, and often with  grace, granted modeled after somebody from one's past,  have evaporated, or at least greatly eroded, in the last few decades. In the aftermath of the two World Wars the flower children came upon the scene as if to make up for that orgy of violence and fundamentally changed the way we behave with each other. The television, computers and the Internet did the rest. Now every conceivable human behavior was available to model after at the click of a button. Differences in wealth and social privileges ceased to matter as well. No matter how poor, with cyber information available to all, the poor kid has same degree of access to cultural accessories as the rich one.
But there is a  catch when there is abundance of something. One may fail to take possession of any of it. As long as something is rare we value it. If something is available for the asking one may have no interest in permanently acquiring it. If you give a child few toys he will treasure them.  If you give him a whole roomful, he may develop no attachment to any. The idea of possessing the greater quantity of them may become more important than mastering a few. In olden days when finding somebody to marry was not that easy a task, with all financial and cultural hurdles, not to speak the elaborate wedding that one had to go through, one valued the woman one was paired with. For if you lost her, it was not that easy to replace her. But today when women are available to have sex with without any effort and as readily changeable as Kleenex, one often shows no appreciation for any one of them.
Hence we are growing up culturally denuded. While submerged in sea of information we are  growing up culturally thirsty. We know so much but we cannot translate it into words or behaviors. We can tell so little of ourselves to others with refined behavior that was taught to us in past generations with mother's milk. And hence we feel naked, inadequate and anxious in dealing with others.
Tattoos give us a protection from this nudity. It tells others who we are and how to behave with us and how to keep your distance. They have become our credentials, our substitute for cultured behavior.

Restless Leg Syndrome, Cracking of joints, Fibromyalgia, Catatonia: different manifestations of Obsessional Neurosis

A young man, now  21, developed severe obsessional neurosis at the age of 16 when a disfiguring bone tumor emerged on his left upper arm. The tumor, though benign, could not be removed right away because the growth plate next to it had not matured and early resection would have shortened the arm. So he had to live with this growing menace for a couple of years before the surgeons finally went in and removed the unsightly growth.

 During this waiting period, the obsessions grew by leaps and bounds.

In the session the patient insisted, and the mother who came with him, agreed that the whole of his mental problems could be accounted for as a reaction to the  emergence of this misfortune. But a more careful history taking revealed that he was given to severe temper tantrums even earlier, and in fact they were already so severe by the time he was 13 that in his fits of anger he would put holes through the walls of his house, one time he had shattered a flat screen TV, and mother added that every cell phone bought for him had been smashed via getting violently hurled upon the floor.

It was easy to see that the narcissistic injury that had changed this wellspring of anger to frank obsessions was the disfigurement - the tumor was very embarrassing and scary to him - but its pathological strength appeared to have been derived from the repressed wish  for the misfortune to have struck his younger brother instead of him. This younger brother was his rival from the earliest childhood. His earliest memory is of his rage at his brother and the  first time he put a hole in the wall was when he saw his brother wearing his clothes.  

The patient then gave a whole series of obsessive symptoms which were all manifestations of saving his mother from his death wishes or getting even with his father. These obsessions the patient had to admit were present even before the tumor emerged. From a young age he would check and recheck the stove twice, and sometime three times, to make sure that some bad luck does not befall his mother or him or his entire family.  Patient added that it is crazy for he loves his mother very much so he does not understand why he is preoccupied with her death.

The patient then shifted to describing his obsession with symmetry which were to get even with his father who had left the family when he was 2. Anything that was done towards right side - all activities had to be initiated by the right hand - had to be countered by similar action towards the left. Also the number of times something was done towards the right side had to be counter-balanced with exact same number of times towards the left.  He then added that this obsession for symmetry is what lies behind his Restless leg Syndrome. He may spend hours moving his body right and then left, leaving him awake and exhausted through the night.  His mother added that yes, he has RLS. It is painful to watch him in his bed, for he  moves his leg this way and then the other way all night long, vainly trying to fall asleep and even after he falls asleep, often the movements continue.

Patient added that his Restless Leg Syndrome extends to his hands as well and coming to think of it to his whole body and that Restless Leg Syndrome is just a mini-version of Restless Body Syndrome. "I am always on the run, day and night, and my body is still running mentally as I lay there in bed. Restless Leg Syndrome is nothing but my running away from the disaster that is about to happen to me or my family." He then gave some details of his Restless Hand Syndrome. He had to  move his wrist in clockwise and then counterclockwise direction. This process started with having to make wrist motions to make sure that the stove is turned on and off : starting the fire and then undoing it.

All these movements causes constant muscle tension and pain which is only relieved when he cracks the joints. Patient said that the cracking of his joints gives him pleasure and it is part of his OCD. It is no different than checking and rechecking the stove.  He demonstrated this cracking of joints, which were, as claimed, impressively loud, in his knees and neck. He did not say so, but the way he described his body aches and pains they could easily be viewed as fibromyalgia.

When asked why he has to crack the joints, the patient claimed the tension in his muscles locks them up. In my mind this raised the thought that catatonia itself perhaps is no more than an extreme form of muscular intent in cross purposes rendering the person immobile (catatonic) - and mobility is restored to them only if the joints to which they are attached is cracked.


That the cracking of joints is a from of OCD is furthered bolstered by the following case that I saw recently.

A 15 year old girl, who is depressed for years over her parents separation and their neglect of her, and who because of her overweight gets bullied at school, and who fights with her sister all the time to discharge her aggressive impulses, reported that she has a tough time stopping herself from cracking her knuckles.

She gave the usual explanations that it is a habit, that it makes her feel good, but there was little doubt that it was continuation of her obsessional defenses. For every time she cracked her knuckles in her right hand she had to do it in her left in a symmetrical fashion. At one telling demonstration in my office she cracked her knuckles, then touched the mobile phone which she was holding between her thighs and which was sticking up from her pubic area as a symbolic penis, and then symmetrically touched her right and left knees. The touching of the upstanding phone was no different than how obsessive-compulsive must touch a particular part of the body which is symbolic of the penis every few minutes. In many obsessives the touching is quite openly of the genital area.

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.