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

This feature was already known to philosophers of the ancient world, who wrote: “People are frustrated not by an event, but rather by how they see it” (Epictetus). And Andre Gide wrote: “How wonderful life would be if we were content with some real disasters, not bowing to the ghosts and chimeras of our mind…”.

Usually three periods are distinguished after an injury:

The acute period can be considered up to 3 months.

Subacute period lasts up to 3–6 years.

Delayed or remote consequences can be extended for years, sometimes for the whole life.

Example from a husband’s story:

“I cannot understand why she did it now. We lost a child 3 years ago, she handled herself well. We have born a girl again. Life began to improve. And suddenly – she commits suicide, leaving a note: “I’m sorry. All this time, I tried to forget … every time embracing our second daughter, I see the face of my daughter, she looks reproachfully at me. I can no longer”… (from the suicider’s note).

Mental trauma is an act of the impact of mentally traumatizing event limited in space and time “there and then”. The traumatic event, having become the content of consciousness, in the course of time can be repeatedly manifested as unprompted flashbacks or initiated by the individual himself anywhere, anytime and in any situation. Its strength and meaningfulness can be amplified by the imagination, which manipulates the traumatic experience, moving it in time, expanding by connecting other people and events. Thus the state of traumatization develops, the core of which is the so-called in psychology and psychoanalysis “trauma body”. At the level of consciousness the “trauma body” (psychoanalytical term) or a traumatic constellation (neuro-physiological term) has a basic quality – the quality of attracting everything that can be tied up into a “single unity” and comprise a traumatic reality.

The latter does not already have clear space-time boundaries. Man “starts to live” not in the objective reality, but rather in the subjective post-traumatic one. Each time when activating that reality, man lives all through again with the whole complexity of the sensory perception of the traumatic injury, the somatovegetative symptomocomplex, supplemented with the affectivity of the moment and the behavior of the traumatized man during the traumatic injury. As a result, the act of “mental trauma” goes over into a “condition of mental traumatization” converting acute stress to chronic. The condition of chronic traumatization is manifested by anxiety, strain or asthenia.

Traumatization is a process, which starts from the sensory triggering factor (a psycho-traumatizing event) and going on when the system generates certain traumatic constellations based upon the A. Ukhtomsky’s dominant (A. Tadevosyan, 2000). The peculiarity of traumatic stress is its ability to retain stressful events in the form of a psychic echo – “echo-stressor” known as flashbacks. “Echo-stressors” can be of different types depending on the mechanism of origin and development (A. Tadevosyan, 2002). A common feature of all varieties of flashbacks is automatism, i.e. they can emerge from the memory anywhere, anytime and in any situation, regardless of the consciousness and desires of man. This category of mental phenomena is caused by the memory capacity to imprint individual sensory perceptions or entire situational events (gestalts).

This category of mental phenomena is conditioned by the activity of mirror neurons and the mechanism of eidethism of the SPA, the ability of memory to imprint individual perceptions or whole situational events, including the feelings, thoughts and behavior of the person himself.

We have singled out several variants of flashbacks – “echo-gestalts”:

• sensory;

• convulsive;

• somatic;

• painful;

• cognitive.

Sensory echo-stressor (sensory flashback). Traumatic dominant (constellation) occurs immediately, without a period of formation. A traumatic event is retained in memory in the form of pictures, situations or fragments of those situations that took place in reality. This phenomenon comes up unprompted. Considering the holographic concept of the memory and psyche, it is clear that “a fragment of man’s life” reflecting a traumatic event retains the spatial and temporal characteristics of the trauma moment and the whole complex of sensations and emotions. Most probably all this happens through the mechanisms of eidetic memory. Neuro-Linguistic Programming (NLP) makes it possible to determine which information channel is preferable for this or that person.

Based on NLP data it is possible to pre-determine the kinds of flashbacks that can develop in a particular individual in cases of traumatic stress. This “mould” (gestalt) of reality has a capacity to break into the current everyday life, pushing aside the current moment, and so a person starts to live, go through and act in accordance with the echo-reality. Having come up through the mechanism of association, this flashback possesses strength of the real event changing the clarity of consciousness into a psychogenic fuzzy consciousness, making a person lose his bearings in the real situation. This is the analog of hallucinatory illusory experience of epileptic twilight disorder of consciousness (mental equivalent). The individual can hear, see, smell the traumatic “echo-reality” in all variations of features, which is manifested in the common stressor response. As distinct from epileptic twilight, the content of traumatic twilight disorder of consciousness is stereotypic, it repeats in every detail the traumatic reality. The psychic equivalent involuntarily emerging from the memory, can change the mood, behavior that become inadequate to the reality, but adequate to the content of traumatic experience.

Examples.

1. Patient K. used to drop to the floor and crawl to a wall every time she heard a buzz of a flying plane. Squeezing herself in a corner or under a table she stayed there until the buzz ended. Her face showed fear; she was trembling, sometimes grappling her head and lamenting: “Again bombing, again bombing…”

These conditions emerged six months after the fears experienced during “Grad” bombings in Karabakh and moving to Yerevan.

2. Patient M., a survivor of the Spitak earthquake, each time during high wind used to run out of her apartment down the stairs screaming: “Earthquake!!!”. She lived on the 9^th floor. In this state no one could stop her or make her change her mind.

3. Patient T. lost his 9-yearold son in the earthquake. 12 months later he applied to the Center “Stress” on account of his condition that scared him and made him think he was going mad. He said that almost every day he heard his dead son talk to him. Walking along the street, “… clearly saw the son either walking or playing in the street or running to meet me”.

The described phenomenon is not merely a symptom. Its appearance makes it possible to understand the mechanism of transformation of the external signal into an act of consciousness, the mental phenomenon. Flashback is a reflection of the event or its fragment by mirror neurons. The parameter of a physical object – seen, heard, having become the content of consciousness, is transformed into a mental phenomenon. Echo-phenomenon is an intermediate link between the world of physical phenomena and mental world (between physics and psyche, matter and consciousness). It is a key to understanding the transformation of the external world energy into the internal one. Mirror neurons perform this first level.

Picture 1. Flashbacks as described by one of the patients.

Picture 2. Flashbacks as described by the patient.

Picture 3. Flashbacks as described by the patient.

Convulsive “flashback”. An epileptiform convulsive fit may occur in a psychotraumatic situation, especially if it is accompanied with oxygen deficit. Actually, the fit results from hypoxia. The state of “asphyxia” is accompanied with a characteristic facial expression and a specific pantomimic mask. A man who lacks air starts to “grab” air with hands, face is strained, neck reaches out, mouth opened, breathing outwardly reminds breathing of a fish thrown out on the shore and strenuously grabbing the air with the mouth open. Epileptoform “echo-stressor”, if it happens in situations with air deficiency, is accompanied by similar movements.

Examples:

4. Once the Epileptological Center sent a young man to the “Stress Center. He complained of epileptiform convulsive fits occurring once in 2–3 months for over 8 years. A careful examination in the Epileptological Center failed to yield any objective paraclinical data. Since the fits were rare and over time the tendency of their frequency was not observed, and the clinical picture did not change, the parents decided not to give the boy anticonvulsant drugs, for fear of their undesirable side effects. No epileptic symptoms were discovered. The father was a witness of fits and was able to describe in detail the onset of the fit, focusing my attention on the grasping movements of the hands, “as if lacking air” – added he. Some leading questions helped father to remember the occasion that happened with his son when he was taught swimming in the pool. On the second day of swimming lessons, not knowing how to swim, the child was dipped head and ears into water. The boy experienced strong fear and refused to attend the pool. Several months passed between that event and subsequent fits. The relatives forgot about it. The patient himself confirmed that the fit usually occurred in stuffy rooms. It happened twice in a vehicle packed with people, once it recurred when he saw the sea for the first time.

5. Three years after the earthquake, mother of a 12-year-old girl consulted the “Stress” Center on the occasion of convulsive fits in her daughter. Mother said that she and her daughter remained under the ruins for 10 hours. It was there that the first convulsive fit occurred to the girl. The subsequent examination revealed no data in favor of the organic origin of the fits. A fit starts with short breath, the girl grasps her throat, trying to catch her breath. The girl herself said she always felt short of breath before the fit.

Both examples mentioned are similar in their stereotype clinic, lack of dynamics and mechanisms of occurrence. In both cases, the parents decided not to give the anticonvulsants thus retaining their original form not burdening the clinic with side-effects of medications.

Somatic “flashback”. The memory retains not only “a piece of the objective-emotional world” in the form of a sensory “echo-stressor”, in the same way it can register any bodily symptom or syndrome accompanied by a strong emotional response – “somatic echo-stressor”.

“Somatic echo-stressors” can be exemplified by various somatic conversions well known to psychiatrists, neuropathologists, psychotherapists. It is common knowledge that in contrast to the somatoform manifestations, conversions never give way to organic changes. Functional disorders never convert to the structural ones, even when frequently repeated. Probably, the somatic conversions are stipulated only by the first level of the stress process or the autonomous nervous axis providing only a bioelectrical effect, without involvement of endocrinal axes or hormones.

Pain “flashback”. The most common is somatic-pain syndrome of various localizations. Phantom pains also relate to this category.

Example: Five years ago, a patient having fallen on the stairs experienced a terrible pain in her back, which then gradually ceased. She did not pay much attention to this since there was clearly no fracture. However, after a while, about a week, the pain resumed and did not pass. X-ray and other examinations did not reveal any abnormalities, but the pain became chronic despite the ongoing therapeutic measures. The pain occurred even when she accidentally touched the furniture. “As if I fell down the stairs again”,– the patient said. The pain recurred many times. Sometimes the pain appeared all of a sudden when she was watching TV: “I did not touch anything, but the pain is there! I cannot walk; I hardly do something around the house. But what is really strange is that a sharp sound, sometimes even an ordinary conversation or a draft cause attacks of the same pain”. Gradually she began to limit herself in mobility, ceased going out, bought crutches, became disabled. The pain sharpened with physical or mental loads”.

An example is well-known to orthopedists phantom pains when a person experiences severe pain in the amputated part of the leg. Analgesics do not bring relief from this suffering and the pain remains there for several years. Both phantom and chronic pains in the back are not related to the current external injuries. The pain effect had a real cause but it happened in the past, once and in a specific place – “Then and There”. Now the pain appears anywhere, anytime. As the patient describes, “appears when it wants to appear. It does not change, does not increase or does not fade with time, as if it is stuck in me and under some conditions makes itself felt: “I’m here, I’m in you”. Indeed, pain has become part of human body and life.

Example: “Two years have elapsed since I suffered herpes in the waist (lumbar region) and chest. All the external signs have long since passed; there are no changes on the skin. But it is hard to imagine what pains I am experiencing. As soon as I come home, and now I live alone, itching and pains seem to be waiting for me at home. Nothing helps. I was examined – no deviations. But the pain does not leave me, and it is always the same – with itch”.

A person experiences pain in the absence of bodily injuries and moreover, such pain is as real for a person as a physiological one. It is not “imaginary”. As distinct from the primary pain, chronic does not calm down with time, its appearance does not have spatial and time boundaries, analgesics do not help, antidepressants give a temporary relief. In neurology, such pain is known as neuropathic. In psychiatry – as a “chronic pain syndrome”, which is treated as psychalgia (mental pain), equated with it and included into the group of somatoform disorders (ISD–10/F–45).

Anxiety and pain are signals of danger but of different levels: pain is a signal of danger to the body, and anxiety – for the psyche of an individual. These protective reactions, similar in their discreteness, are due only to the autonomous bioelectric mechanism of the first phase of stress reaction. If there is a fixation of pain sensory stimulation, then it becomes obsessive and can be attributed to a bodily flashback symptom.

Studies of recent years make it possible to understand why the amputated limb hurts; why symptoms of herpes persist after the disappearance of all objective manifestations; why a pain syndrome persists in some people when there is not even a scar left from an injury or wound, not to mention some internal injuries. A differential sign that distinguishes the pain “flashback” from other numerous manifestations of the pain syndrome is its paroxysmal character independent of place and time and not changing its qualitative characteristics: localization, the character of pain over a long time.

As far back as 1894, the German neuropathologist and psychiatrist Franz Kisel showed that nerve injury led to significant changes in glia cells in the area of nerve fiber switching in the spinal cord. At the same time the number of microglia cells increased, astrocytes became denser, and thick bundles of fibers that strengthen cytoskeleton appeared in them. A hundred years later, in 1994, Stephen Meller from the University of Iowa proved the participation of glia astrocytes in the formation of chronic pain. Further studies shed light on the mechanism of this phenomenon. Glia cells secrete various substances capable of increasing the excitability of neurons of spinal ganglia and spinal cord responsible for the transmission of pain sensitivity. Such substances include also growth factors. It has been found that glia cells perceive enhanced impulse from neurons as a sign of their functional tension. With these data, a real opportunity appeared to explain one of the mechanisms of obsession (involuntary repeatability). According to them, with bodily injury, the pain “excitability” in the glia of the spinal cord can persist for too long and then the neurons of spinal ganglia continue to send pain impulses in the absence of external irritants. These effects resemble mental flashbacks in PTSD. It can be assumed that the glia of the brain as a memory carrier and its cells or groups of cells retain enhanced excitability. The latter is considered as the main cause of neuropathic pain in neurology. The injured body, when confluence of some factors, is able to preserve the memory of trauma at different levels of pain formation, using different links of the same process – the process of feeling pain. The aftereffect of traumatic injury in the form of a trace pain “echo-stressor” can become stuck in glia cells of the spinal cord, astrocytes and microglia cells. The glia cells themselves are not capable of impulses, but they are capable of capturing neurotransmitters – substances released by the endings of nerve fibers and providing signal transmission from one neuron to another.

Example: All my life, as long as I can remember, I have been sensitive to the pain of others at the bodily level. Someone fell – I have pain and feel creepy all over, got wounded – synchronously with him I feel pain in the body. Once in the third year of the Medical Institute during a practical lesson in surgery we were taught spinal puncture. As soon as the needle entered the spinal canal of the patient – I reacted: having experienced pain, I was covered with cold sweat and fell into a subconscious state. Becoming a professional, I began to analyze the events of childhood, life, memories. Looking back at everything that happened in my childhood, I recall my first experience of feeling pain in the body, the experience of curiosity and pain. It was the first year after the war. My father was awarded a sanatorium trip. I was 9 years old then, and father took me to Georgia, to the Black Sea. It was a fairy world where I was amazed at everything: palm trees, salt water in the sea, huge white flowers on the trees – magnolia, in the air the aroma of oleander, roses, flourishing lemons and oranges. And I touched everything, picked flowers, leaves; I ate melons and watermelons for the first time in my life. One evening guests came to us and while they were sitting at the table I went out into the garden. The sun had already set, twilight came and the shape of the surrounding trees and bushes became vague. I stopped at the plant which I had never seen before, it was very strange, and at the top there was a flower of marvelous beauty and some other fruits. I grabbed the plant with both hands, pressed it to me and the same moment screamed, screamed in pain in the whole body, incomprehensible, sharp and stabbing. Hundreds of needles pierced me. It was cactus. I screamed, but I could not get rid of the pain and the plant. The dog ran from me to the house and barked loudly. I screamed in pain, it barked until the adults heard. My memory did not keep everything, I remember only that I was given cognac and all amicably began to pull out bundles of thorns that pierced my body. Even the next day my grandmother still found needles. Since then, I hate cacti and synchronously feel pain when someone nearby feels it. Even when I watch a TV program about “black humor” I am pierced with pain or shiver all over if suddenly someone fell or got injured.

The examples cited above unveil the mysteries of intracerebral activity and make it possible to look at facts differently. If a person encounters the event that traumatizes his psyche for the first time, the mechanism of repression (the psychoanalytical term and mechanism) is triggered. Repression (suppression) is one of the mechanisms of psychological defense. It is triggered as an active, motivated elimination of something from consciousness into the unconscious, usually manifesting itself in the form of unmotivated forgetting or ignoring some moments of a traumatic situation due to protective inhibition (neurophysiological mechanism). Clinically these “forgettings” are described as various amnesias (A. Tadevosyan, 2011).

Since memory lapses violate the integrity of the inner mental world of a traumatized person, in everyday life, specialists have the expression “holey memory”. Repressed experiences, let’s conditionally call them “lost memory puzzle” are in a “semi-active state”, in all probability, making up operative memory. The stored information as operative memory is between the consciousness and unconscious (in the pre-consciousness, according to Freud) and systematically breaks into the sphere of consciousness through nightmares, flashbacks that are described as symptoms of PTSD. We view these mental paradigms not as psychopathology but as a normal functioning of the mental apparatus in a state of post-trauma, which has a threefold meaning.

1. The appearance of nightmares, flashbacks makes it possible for the consciousness to “fill in the gaps in the memory”, to restore the integrity of the mental world torn by amnesias. Cognitive processing of them, spontaneous or in the office of a psychoanalyst, is the therapy of the trauma itself.

2. At the same time recurring memories together with the work of consciousness form a leading reflection as a person’s readiness for repeated traumas, thereby reducing their destructive impact on the psyche; and this is an increase in stress resistance.

3. If cognitive processing of the obtained traumatic experience does not occur timely (within 6 months on the average) and in the right direction, the appearing phenomena are fixed and can acquire an obsessive character (the mechanism of the mental apparatus) becoming symptoms of post-stress disorder.

Cognitive echo-stressor. This type of traumatic event memorizing is of a conscious nature. A traumatic event can be retained in the form of memories or images that the individual randomly recalls in memory. When alone, he can mentally “play back” the events, and by active use of his imagination, man can distort reality. Imagination and fantasies can reduce a pathogenic effect of a stressor using one of the mechanisms of psychological defense; however they can also amplify a traumatic event, resulting eventually in affectivity growing like a snowball. Having been processed by consciousness, recollections acquire a personally significant meaning and can entirely devour a person. A constructed subjective mental reality replaces the objective reality, forcing a person to adapt within the framework of its new priorities. This kind of mental “echo” has an arbitrary character and results from man’s evolution.

The state of stress outprice (when alone) produces self-generation of “echo-stress”. A thought is a stressor to which the brain responds by one of the components: anxiety, strain, or exhaustion. Each time recollections of events again trigger a stressor response, stressogenesis with some of its links dropping out, e.g., the orientation reflex, the anxiety stage. The psychophysiological response can be stipulated by one of the neuro-endocrinal axes of the anxiety phase, while as the stressor in this case can appear the cognitive senses (thoughts) of man. Since the end organs permanently receive the stress hormones, somatoform disorders acquire an organic basis. So, it is the presence of cognitive “echo stressor” that converts acute stress into chronic. The peculiarities of the brain and psyche based upon their rules and mechanisms make it possible to generate the interiorized (internal) distress (neurophysiological term) or intrapersonal conflict (psychoanalytical term) keeping man under condition of prolonged stress.

A stressor response, having a discrete nature, is manifested by functional disorders. Stressogenesis, due to the frequency of conscious flashback to the experienced trauma, actually becomes non-stop, resulting in increase of the degree of disrupting the homeostasis that in turn can lead to transition of functional disorders into the structural ones. As shown by clinical experience, if “echo-stressors” exist due to the bioelectric mechanism, functional disorders, regardless of the duration of symptoms, practically do not pass into the organic. However, if the “echo-process” involves the endocrine system, and the stimulation of the end organ is done through hormones in the blood system, then the development of organic disorders becomes more probable.

Availability of different varieties of “echo-stressors” explains the commonly known fact that a traumatic event affects man years later, manifesting itself by one of the varieties of a delayed post-stress disorder or behavioral disorders. The appearance of delayed effects is a peculiarity of APES.

The total response is a vector of complex internal processes that manifest themselves as a personal experience of trauma. The complexity of this response requires an integrated approach due to the peculiarities of APES, its multisensory nature, complexity and ability to produce the whole range of health and behavior disorders manifesting itself as one of variants of the stress- phase-oriented model of the mentioned disorders.

“Boring, oh, how boring, it’s horribly boring… And you do it”

Patient’s drawing.