Male’s Health in the Objective of Stressology – Beyond the Usual

Equally important role in the process of adaptation plays the automation mechanism, which provides, as opposed to flexibility, the rigidity of mental adaptation. The interrelation and interdependence of the mental and somatic in the course of human evolution and the formation of a healthy “I” (“Ego”) are manifested in a systemic behavior and use of bodily capabilities – the somatic system for adaptation. Integration of somatic systems involved in the operation, with their constant use, is automated; the same happens with mental efforts involved in the action. With the increased training of some action, its intermediate steps disappear from consciousness.

To explain this, E. Kretschmer (1922) proposed a law of “formula abbreviation”: not only motor behavior, but also perception and thinking show automation (a certain similarity to a habit). S. Freud (1905) wrote: “Such processes played out in the preconscious and elusive, with which consciousness is connected, can be called the appropriate term “automatic”. The place of these automatisms in mental topography is the preconscious, rather than the unconscious (“Id”), besides, these automatisms can be distinguished from the automatisms of the unconscious”. We are interested here in the purpose-oriented achievements of these automatisms and their important role in the schematics of the adaptation process. Automation has undoubted economic advantages and stipulates many complex achievements in central psychic domains. It is common knowledge in physiology that generation of automatism reduces metabolic expenditures, accelerates transformation and saves energy.

As Hartmann writes (2002), “we can say, automatisms – like other mental phenomena are also under the control of the external world, and under certain conditions, formula-abbreviated behavior is a better guarantee of mastering reality than new adaptation in each specific occasion”. This manifests the protective role of pre-consciousness automatisms, their stimulus barrier.

Thus, both flexibility and automation (rigidity) are inherent and necessary for the “Ego”. There are three groups of functions that are active in the mental sphere of man: some mental functions assuming a flexible form provide flexibility and plasticity of the psyche, behavior of man and his state of health; other functions assuming the automated form provide lower expenditure of energy resources and time that are often crucial for adaptation, accelerating the conversion of energy; and the third group is comprised of mental functions, which combine the initial two in different proportions.

In a complex human mental sphere thought, imagination, and recollection often become a triggering factor, “stressor of stressors” activating the mechanism of stressogenesis, eliciting the entire range of the vegetosomatic effect inherent to the phases of GAS. As a result mental adaptation becomes more complex, expanded, evolved, reflecting the evolution of the world of man and the evolution of man himself, his knowledge, values, wishes and purpose of life. In the course of evolution there comes about the “central regulating organ”, commonly called “the inner psychic world” that is located between the receptors and the effectors. This inner world (psychic) is built up gradually, by virtue of the so-called existing “stimulus barrier” that enables to perceive and to forward “only a fragment of the initial (stimulus)” reality of the world of man (Freud, 1920).

But man is an amazing creature! He is not content with a life-long adaptation to the actually changing environment, the changing human environment and to his own self. With the development of consciousness an individual, and only he, as shown by many studies, while living his own life, is also permanently forming his own “subjective reality”, his own idea of the world of things, of other people and of his own status. Meanwhile, the latter category is associated with self-rating, varying from an overestimation of oneself, one’s capacities and capabilities, to their underestimation. The result is that the individual adapts not so much to the objective reality but to the so-called “psychic reality” built by himself as an integrative “product”, as a fundamental integrative formation of the perceived outside world, colored by personal experiences and personal estimates. As a result, a “semantic reality” is created, enriched and framed by thoughts, feelings, fantasies, anxieties and suspicions. In forming this reality a sizeable role belongs to the past events, imagination and perspectives, to say nothing of the unconscious predictions forming the guidelines.

The emerging mental reality is not the reality that is mostly identified with the outside world and regarded as “objective reality”. The mental reality, at close scrutiny, is a colored palette of diverse interpretations of the outside world by different people, for each of them “his own reality is the most objective”, the one he is being adapted to. The mental reality is constructed through personal experience enabling perception of current life. E.g., a person gone through a traumatic situation, retains this experience, often perceives this world acting in it at present and in the future in the light of a traumatic reality of the past. It is this person who crosses the threshold of the doctor’s office, having his own idea of the disease, the formulated internal picture of the disease. The mental reality can be regarded as synonymous to the inner and subjective reality. All three terms – mental, inner, and subjective realities are designed to limit the subjective experience of an individual from the world of physical objects. Some theorists attempt to introduce certain corrections to delimit the mental and the inner reality.

They correlate the mental reality with the inner sources of subjective experience that is with unconscious fantasies and images, for which the perceptions incoming from the outside world are an outside source of subjective experience. With regard to the term “inner reality”, they understand it as a most general phenomenon reflecting a total subjective experience based upon integrative images of the perceived outside world.

Similar to the inner reality, which is not a “pure” product of imagination, the outside reality has its complex structure. The outside reality is reducible to two basic manifestations: “the actual” – objectively verifiable and confirmed by the scientific cognition of the world, and “the artificial” – the intersubjectively generally accepted “conventional” consisting of the world of words, myths, traditions, interpersonal and collective forms of behavior. The abovementioned shows the variety of factors and situations that can cause a state of deadaptation, anxiety, stress in modern man, and as a consequence, the improvement and complication of the adaptation system itself.

In the outside world structure the major portion falls on the world of people, so that task number one in human everyday life becomes man’s ability to adapt to another person, to other people who are carriers of individual psychosocial “Egos” that are present from the very beginning of life and to the last breath. “Man is a tangle of interrelationships” is an ancient philosophical aphorism. And this kind of adaptation is a super task and super goal for any person. K. Cherry (1972) believes that every act of communication between people, each new perception of another person adds something to the experience and improves the adaptability. Communication with people of one’s own kind is already a subsystem of social contacts, leading to an expansion of mental adaptation which in fact becomes psychosocial adaptation. L. Feuerbach (1955) noted that the individual “as something isolated” could not comprise the human essence in himself “either as a moral being, or as a thinking entity”; the human essence is “evident only in communication, in the unity of man with man…”. Thus, a crucial adaptation to be performed by man is adaptation to the social structure and his participation in building it up (Bernfeld, 1931). This type can be attributed to the fourth form of adaptation. The SPA is characterized by the multidimensional self-organizing subsystems, which provide greater freedom and variability in the choice of adaptation.

The mechanisms of the SBA and SPA, which determine the vital activity of a person, are extremely complex structures containing multiple subsystems, interconnected and interdependent. N. P. Bekhtereva regarded the increasing number of flexible links in the control system of mental activity as the main principle of complicating the brain systems. She assumed that the mental activity was supported by the cortical-subcortical structural-functional system with links of varying degrees of rigidity. Human adaptive capabilities have the widest range of flexible links, which when interacting with the environment allow to keep “essential variables” within the physiological boundaries. This is reflected in the”interfunctional” reorganization of the entire structure of mental activity in the process of ontogenesis.

The system adaptive approach enables to present a complete picture of man in his onto- and phylogenetic development; in health and illness; a picture stipulated by psychosomatic interrelations between the component paradigms – the biological and the psychosocial.

A historical development of human consists in the fact that today we have a person as a conscious volitional trinity (biological, social and mental), for whom sense formation (meaning formation) has become a leading need. Sense formation is the main function of the brain distinguishing a person from all living beings, and it is this ability to attach personal significance to environmental signals that makes each person unique and unrepeatable. It is sense formation that underlies many conscious and unconscious psychological defenses that make up the core of the SPA.

Example. They say that “Rafael Santi was driven mad with love towards a model for the image of Psyche. Once he, a dreamy young man was walking in the park thinking about finding a model for his canvas “Cupid and Psyche”. Suddenly he noticed a beautiful girl resting in the shade. Such pure features, such angelic face he had never seen! “Psyche” looked with interest at Rafael blinded by her beauty. She was 17 years old. Her name was Margarita Luti. Rafael immediately invited her to become model for the image of Psyche. Painter offered her a gold ring for ten kisses. Maid graciously agreed. Rafael lost his head with passion. Rafael went mad with beautiful “Fornarina” (translated from Italian means “baker”). Her delicate face with expressive brown eyes, silky skin and lush shoulders forced him to get off the breath. But that was not the Fornarina, whom worshiped Rafael. The young mistress of Raphael, though living with him, twisted love affairs with wealthy Romans right and left, often returning home at dawn. What about Rafael Santi? He did his job – he painted, and his paintings have become part of the golden fund of world art. The beauty with innocent charm, that struck the painter’s heart, became a common courtesan. Rafael went crazy with countless betrayals of Margarita but in work continued to depict the ideal he “was looking for Psyche”. The most famous of his creations became written in the years 1512–1513 “Sistine Madonna.” Flying in the clouds the Virgin with child still touches deeply. The model for the image of Mary became the same Margarita Luti. The artist gave her face an expression that he would like to see and “saw”: a mother’s love, the fear of the loss of a child, tenderness. He loved and painted the one whom he sought, whom he loved and by virtue of whom created his works. He lived in his world woven out of values, desires and symbols. Suffering from reality, he immersed into work and came back to reality again. Rafael suffered unspeakably, like any addict, splashing his hidden feelings on canvas or wet plaster. Perhaps his work would not be so heartfelt, if his life with Fornarina evolved happily.

Patient's drawing.

Is it so or not – we will never know.

We will not make any conclusions with respect to a specific example, because we are deeply convinced that it will be another version and nothing more if follow the basic principle of psychology “That might be so, might be otherwise” of which we wrote at the beginning.

But it seemed to us that the example will help understand all of the above said on the individual, his life, motivation, adaptation, objective and subjective realities, psychological defense and the role of suffering in his deeds.

CORRELATION OF CONCEPTS:
“STRESS”, “EMOTIONAL STRESS”,
“TRAUMATIC STRESS” (APES)

Stress. For the first time the word “stress” emerged in the English language in 1303 when the poet R. Manning wrote: “The Lord had sent manna of heaven for the people in great stress”.

In the late eighteenth – early nineteenth centuries Goya, whose art was distinguished by passionate emotional and social orientation, created a series of paintings that he called “Desastress”. The series includes paintings reflecting the human grief and suffering, among them: “Unhappy mother” (Sheet 50 of the famous etchings), “I have seen it” (Sh. 44), “They are a different breed” (Sh. 61), “This is the worst” (Sh. 37).

The concept “stress”, introduced into biology and medicine, is associated with the name of H. Selye and it was used to refer to a non-specific response of the body to any harmful and subsequently a harmless effect too. It is a natural genetically programmed normal and necessary response of the body to provide its survival and development. The essence of Selye’s teaching is his discovery of the three-phase general adaptation syndrome (GAS).

The first phase (stage), called by Selye the “phase of combat alert” includes orientation reflex accompanied with restructuring of the whole body. It is mainly implemented by an automatic neurobiological mechanism, by the action of a sympato-parasympatic nervous system BSA and has a bioelectric character.

The second phase is the stage of resistance (strain); it is also figuratively referred to as the “stage of fight or flight”. If during the first stage the situation is assessed as dangerous, and anxiety as the expectation of an uncertain danger becomes a “concrete fear”, then through the activation of the endocrine glands the second stage of the stress reaction develops and stress hormones enter the bloodstream. Spread by blood to organ/systems, they put the body into the state of readiness either to flight from danger or to fight with it (muscles tense, heartbeat vigorous, pressure jumps, etc.). Self-preservation mode is triggered throughout the body.

The whole complex is a normal, necessary effect of self-preservation instinct and similar for both types of behavior. The choice of behavior depends on the impulsivity and genetic program; but in human more often on the acquired experience of response in the deadaptation situation. It is stipulated by activation of three endocrine axes. The effects are caused only biochemical or neurobiochemical mechanism, which activates the appropriate organ/systems by hormones.

The third phase is the stage of asthenization. H. Selye has shown that stress accompanies any life activity and corresponds, in certain sense, to the life intensity. It increases with nervous tension, bodily injuries, muscular work, infections, in the situations of joy or sorrow, even with recollection of tragic events of the past and leads to the shift of the internal state of balance to deadaptation.

Let us denote the process of deadaptation – adaptation by one term – stressogenesis. A person in the course of the whole life gets “stress” injections and acquires stress-resistance in the form of behavioral patterns of overcoming stressful state, learns to comprehend and act in a constructive direction. If it does not occur, destructive characteristics of stress trigger. Using the expression: “Stress is the aroma and the taste of life” we should not forget that they are also different as the favorite aroma and taste in different people are different. The classical version of GAS, its evolutionary core, has a discrete nature and represents a unity of three phases. In this embodiment, the GAS came into use as “stress” and became the property of biology.

Revealed opportunities of studying and understanding what is happening in a person for a long time made their way to medicine with difficulty because of the lack of the concept “man in medicine”. Throughout the twentieth century medicine developed as an aid and health improvement of the diseased body, therefore it would not be a mistake to call it “body medicine”. Human health and disease were regarded as structural injuries of different organ/ systems under the impact of various external factors. The role of mental component was reduced to zero or completely ignored in both the questions of etiology, etiopathogenesis of diseases and those of dynamics, therapy and forecast. Psychological principles and laws acting in man, psychosocial component of man were disregarded due to total ignorance of medical sciences – psychology and sociology.

This was promoted by principle of parallelism dominating in neuroscience. Psychiatry should have been exclusion but it was also biologized. The desire of psychiatrists to find a biological substrate in the brain as a cause of schizophrenia, manic-depressive psychosis is still alive, despite the generally accepted by WHO definition of health. According to the Constitution of WHO, “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This definition provokes lots of questions, reprimands and critics and it needs serious correction and specification. But it will be possible only with appearance of the concept “man in medicine”, when the issues of mental health and social well-being are considered from the viewpoint of a triad concept: “man” as a unity of biological, mental and social.

As far back as 1861 I. M. Sechenov suggested that a body without environment supporting its existence is impossible. Man thus is the system with two complex components “body + environment”. Since not only man’s body lives in the world, but rather a personality with the soul lives, acts, suffers and overcomes difficulties of life, this concept of I. M. Sechenov can be expressed using the following formula:

Man =

B (body) + P (personality) + S (soul) + E (environment) and referred to as an

INTEGRITY

Within this integrity, these composites interact with each other via bilateral feedback. Environment, including social medium, affects the body through the data flow of signals in the form of:

• positive – eustressors;

• negative – distressors;

• indifferent.

Among stimulants are identified stimulant signals acting without violating the internal balance. This category of customary signals constitutes the background. An unusual signal of the environment produces an orientation reflex aimed at assessing the environment with regard to the body threat.

If a factor is not threatening, the BE system continues functioning in the same mode. If a factor bears a threatening element, anxiety, fear, the deadaptation mechanisms of stressogenesis are triggered introducing the body into the mode of adaptation and it re-adapts. Thus, the factor containing a threat becomes a distressor causing emotional stress.

Emotional stress. The term appeared when the concept “stress” was transferred from biology to psychic (mental) reactions occurring under critical conditions. These reactions were called “emotional stress” which includes emotional reactions to stress (anxiety, fear) and somatovegetative symptoms caused by sympato-parasympatic nervous system. Actually, the emotional stress implied affective experiences separating them from non-specific stressor sympatocomplex of physiological changes in human body. “Intellect or feelings”, “mind or emotions”, “please, no emotions” – that is an incomplete list of common expressions reflecting different attitudes to emotionality and intelligence.

G. Hegel rightly noted that for intellect “…the difficulty is to get rid of the once loosely admitted by it division between the feeling and the thinking spirit and to come to the view that in man there exists only a single intelligence in feeling, will and thinking”.

With the lapse of time the term “emotional stress” has undergone a series of transformations. Thus, the second half of the last century was marked with descriptions of psychosocial models of stress, the models of response not only by the body, but by man as a whole, not only to the changing environment, but also to the psychosocial stressors. It was all about the search for a “medical” model of stress (H. Wolff, 1953), to substantiate the association between social changes and the health of population. This conformity is nowadays considered universal. The social-psychological approach to the medical model of stress is represented by several theories. The theory of loss by P. Marris (1974) assumes that each of us is a holder of some fundamental and universal beginning aimed at sustaining everything that regularly occurs in our environment attaching to it a subjective and personal meaning. Social changes are experienced as losses, disrupting the structure of interpreting the environment, thereby deeply hurting the personality. The traumatic situation (from Latin trauma – injury, wound) mentally traumatizes a person and provokes a storm of emotional experiences often in the form of affects. Therefore, the mental stress is conventionally considered to be the emotional sphere. Such view on its nature is due to the specificity of perception of stressor. At the first moment of perception anxiety and fear come to the fore limiting a judgment about the occurring and the gnostic (from Latin gnosis – cognition) and volitional components are negligible. This link is provided by activation of the autonomous neural axis as bioelectrical effect.

Some medical models of emotional stress development are described: the model of “biosocial resonance” by G. Moos (1973); the formalized model of the effect of social disintegration on health by D. Dodge, W. Martin (1970); the linguo-structuralist theory by R. Totman (1979); the theory of salutogenesis by A. Antonovsky (1979). It can be assumed that researchers of stress pursued one goal: to convince people living in the epicenter of stressful life and professionals in medicine (and they are men in their majority) that there exists the dependence of human health and longevity on the psychosocial structure of life and peculiarities of its perception. As a result emotional experiences have shifted to the category of the causes of developing stress. Thus the term “emotional stress” appeared.

Traumatic stress. It is not just a terminological kaleidoscope around the same phenomenon, but rather an understanding of the difference between diverse emotional, behavioral, somatic reactions of man on different stressors. The knowledge accumulated in the field of stress study has shown that not always the intensity of the stressor is of primary importance.

Lazarus and Folkman while delimiting the field of stress aftermath, considered only moderate stress. Different comprehension of the role of stress “intensity” (that might be light, moderate and traumatic) led researchers to different findings. Furthermore, for a long time, studies of post-stress disorders in human developed independently of stress studies. The whole problem rested on the stereotype approaches that had been adopted as the stress theory developed for the body, while the post-stress disorders were considered responses of the personality involving the body, psyche, consciousness and will. Man responds to environment with his conscious psycho-bodily unity and the aftermath effects are a vector complex systemic response to traumatic events. The generalization of multiple research results of different aspects of traumatic stress described as the structure of self (Laufer); a cognitive model of the world of the individual (Yanov-Boulemane); the affective sphere (Kristal); the neurological mechanisms controlling the processes of learning (Kolb); the memory system (Pittman); emotional learning (LeDoux Romanski) are obvious proofs that the post-stress process involves the entire complex system of man. The leading element is the human ability to attach meaning to any, sometimes even indifferent stimulus (a phone call, the night phone call, a special knock on the door, sleep, crow’s cry). Stress becomes “traumatic” when the meaningful significance of what has taken place results in disorders in the psychosomatic sphere, which is similar to the physical injury – hence is the name (mental injury, mental crash-syndrome). However, in contrast to a physical injury a mental wound can be invisible; it does not impress bystanders with a bloody mash of muscles, vessels and nerves. A spiritual crash-syndrome is a “silent volcano” that can burst at any time, at any place, by any kind of suffering.

In the concept of traumatic grief of Linderman (1944) and “syndrome of stress reaction” of Horowitz (1986) a factor of “time” after trauma during which a person experiences mental discomfort, anxiety, aggression and grief, occupies a special place. As a result the term “chronic stress” appeared alongside with the term “acute stress”. Chronic stress assumes remote aftermaths occurring after disappearance of stressor effect.

Opponents of the concept of a unified mechanism of stress and post-stress disorder, being aware of the affinity of these concepts, suggest using the term “stress” for correctness, to denote the immediate response to stressor and the term “post-traumatic mental disorders” for delayed reactions to the traumatic stress. We think that such “correctness” would adversely affect the understanding of an integral process.As a result, comparison would be done to quite differing conditions, for stress in its classical meaning is a normal response of the body to a stressor, while PTSD is a disease. They are however connected via the integral mechanism of stressogenesis, which changed its function; the function of protection became the function of destruction. It is here that an “impassable” barrier to see the unity of stress and post-stress disorders appears, the emergence of which is connected with the fact that stressogenesis as a normal adaptation reaction becomes a pathogenesis of post-stress disorders. Flashbacks, imagination stipulate transition from acute stress to chronic depriving it from the main peculiarity – discrecity, moving to the category of permanent processes entailing conversion from the norm to pathology.

In her early works (2002–2011) A. Tadevosyan described traumatic stress under the name of APES – Antropogenic Psycho-Emotional Stress thus underlying its specificity already in the name. APES is specific for man and contains both emotional and cognitive components, the proportion of them varying depending on the memory peculiarities of a particular person, his personality, peculiarities of perception, content and duration of the state of grief. Resulting from the interaction between the stressor and the mental vulnerability of man, a state of deadaptation has a number of specific features relevant to man only, which mark its distinction from the emotional stress in general (A. Tadevosyan, 2002, 2003, 2011). An individual, having suffered a mentally traumatic situation himself or as its witness, experiences the emotional stress as an acute state. Actually, this first phase of stressor response as the first step of man’s response to a traumatic event can be easily modeled on animals. When the first emotional outbreak (shock) of traumatic experience somewhat calms down man begins to think over what had happened; memory, comprehension are turned on, the past, present (the cognitive component of the psyche) are assessed often from the standpoint of loss for the person himself. The trauma acquires the category of meaning for a particular man. “The meaningfulness” of injury, its sense results from processing the life entire past, present aimed at the search for “anchors” for the future. Sometimes it takes quite a long time to interpret what happened in detail; during this period “molecules” of emotions of various qualities, various intensities and duration are released. The variety of emotional experience of this period depends on what man remembers about stress, what the content of his traumatic memory is. The emotional palette when alone (stress outprice) can be very dynamic and manifold: from anger, wrath, to the sense of guilt, despondency. The flow of these conditions may be undulating: the emotional tension going up and down. Thus usually the emotional discharge proceeds gradually reducing the destructive activity of the injury – “time heals”. However, there are cases when deliberation of what happened may be accompanied by a growing emotional experience intensified by assuming a personal role in the loss, the rejection of a random set of circumstances, self-blame. This can result in self-generation of an affect with suicide or alcoholization, psychopathology or somatization of the injury. Thus, processing of the event may be accompanied by the second emotional wave, which in a number of cases is much stronger than when it really happened. This stage includes a new phenomenon of the evolution – consciousness and imagination.

The first mention about the cognitive aspect of mental stress is found in R. Lazarus work. He notes that only an interpretation of the fact or a situation makes the stimulus stressogenic. The evaluation attributed by the individual to a specific factor is the main intermediate variable between the stressor and the response. Defining stress as a situation whereby the requirements to a person are either a trial or something that exceeds his capabilities for adaptation, Lazarus concludes that even if a stimulus affects the individual through some sensorial or metabolic process, this process being stressogenic, the stressor response may fail to appear. A stimulus becomes a traumatic stressor only by virtue of the meaning ascribed to it by man. Therefore, an excessive stress can be initiated by the individual himself, by the one who ascribes sometimes the stressing characteristics even to the neutral stimulus.