Tuesday, April 25, 2017

A dream of escaping death by passing it to somebody else

A man getting up in age after a long healthy life, in which he hardly ever was sick, came down with a very aggressive illness and when told he may not live for too long, dreamt the following:

He is in a house where a friend of his son is in great trouble. Some kind of legal trouble.  A  policewoman and a policeman are standing next to him to take him away. But the son's friend does not have proper black pants to wear which once he gets and puts it on they can take him away. The dreamer is offering the young man to take his black trousers - quite a few of which the son's friend is trying - but none of them are quite fitting him. It looks like he is purposely not trying on the right pants and in addition is doing some purposeless wasteful actions delaying everything instead of putting on those pants the way he should and leave with the police.  This is making the dreamer angry that the kid is incompetent and will not amount to anything.

The day before the dreamer had been going through his closet and had noticed how many of his black pants which were just lying there, never worn, because they were too tight, were now fitting him well and as an irony the ones which had been fitting him well, were now too baggy because of the weight loss and it had taken him some time to decide which pants to wear and while he was sifting through those black trousers the thought had passed through his mind that soon he will be wearing none of them.
In the dream this process of deciding upon which black trousers to wear had been projected upon his son's friend and had been made a ground for accusing him of being incompetent and someone who will amount to nothing. Since black, as much as white, shroud/cloth often symbolizes death, the black trousers symbolized death, which the dreamer was trying to escape by pushing it from himself upon the young lad and getting angry and accusing him of incompetence for not readily accepting it.
The two police were death itself, which had come to take him away but which the wish fulfillment had shifted it from himself to the young man. It is he who is in trouble with the police (death) not me. The accusation of incompetence was actually reversal of the realization, in service of the wish fulfillment, that the young kid is too smart to be pressured into accepting the fate of the dying old man upon himself.

Saturday, January 28, 2017

Psychogenic Impotency due to Misogyny

A patient brought the following dream which he labelled as "A dream of hidden erection." 

"The dream lasted almost all night long, or perhaps not,  but it certainly felt that way. Every now and then I woke out of it, startled, to check if my penis was erect or not and then fell back into sleep and resumed the dream."  

The dream:

In am on a long motorcycle ride. A cousin of mine is my companion. She is driving while I am in the sidecar. She is reaching out with her hand to my penis as if it is the motorcycle's pistol (accelerator) grip. There is a great effort going on my part for my not wanting her to know that I am having an erection. I do want to have an erection but not because of her.  The whole emphasis on the dream is to have an erection but for her not to know that it is there. I think when she reaches out to grip the pistol she does not find erection.

The patient has a huge number of cousins so I asked why this particular one was chosen by the dreamwork to take the ride with. The way he talked about the long ride - something that went forever, it left little doubt that it symbolized life journey, in which, by the way, he has been unsuccessful in that he is 38, unmarried, still lives with his mother, has no lasting relationship, has paranoid delusions and hallucinations when off Abilify (a dopamine blocking agent), and has great difficulties in consummating the sexual act if he does find a woman willing to sleep with him (he is good looking, but women after initial attraction can sense that he is not altogether there and break off with him) and has to resort to indirect and deviant fantasies and sexual positions to manage erection and emission. 

"This question has puzzled me too," the patient replied. "But actually I know the answer.  You will recall I have related to you a recurrent dream that I have been having for the last six months or so of another cousin in which I am trying to have sex with her. The most surprising thing about those dreams, which but for some minor details portray the same theme, is that the cousin who I lead into sexual intercourse is someone towards whom I have not a shade of sexual interest, for she is not attractive at all. From our youngest years I never thought of her as attractive. And even the sex in the dream never progresses beyond going through the motions of making love, for I have no feelings for her, and it is done without even taking our clothes off. 

"So this new dream may be just a new version of that recurrent dream. For this cousin is the sister of the cousin with whom I have been making love to, without having any attraction towards, for the last six months." 

Now this recurrent dream we had subjected to analysis in a previous session and had concluded that it expressed hostility towards women, with the cousin representing his mother. The sexual act in it was less an expression of union (eros) and more an assertion of aggressive masculinity, with an intent to humiliate, the essence of which could be summed up in the phrase "I am screwing you." However the fear of getting too aggressive had watered down (repressed) the act by limiting it to just going through the motions of sex, without any feelings, and doing it without taking off clothes. 

We could not solve in the analysis of that earlier recurrent dream as to why this particular cousin was chosen by the dream-work to express his hostility towards women.  

The patient now claimed it was really the cousin in the current dream that was the object of his hostility and her sister had been replacing her because he must have been scared of expressing his hostility towards the one with whom he really had an ax to grind. 

"And what was your beef with her?"

"This cousin is 44 years old now. And I am 38 so she is 6 years older than me. Now when we were young, I was about 10, for almost a year I had to sleep in the same bed with her, because we were living with my aunt, her mother and there was not enough space in their house. I was afraid of the dark. I am afraid of the dark even now. As tough as I am, and fear nothing, I am still afraid of the dark. Even now I cannot fall asleep without the TV on, and my mother hates that - patient lives with his mother - and she comes to my room and cuts it off as soon as I fall asleep. 

"My cousin had a similar attitude towards me when we were sharing the bed. She would not let me keep the light on. And I would be so afraid of the dark I would go and be up against her and she would not like it. She thought so little of me she never faced me so it would always be like ever increasing 'spooning' as night would progress. I would often get erection and she would then push me away.    

"And that would make me so mad. Especially since I had no interest in her, for she was as ugly as her sister, so full of acne that I thought of her as pizza-face."

"Then why would you get erection?"

"Thats a good question. It must have been that I would fall asleep and then the erection would occur not because of her but because of the things I was exposed to during the day. I had access to playboy magazines, a lot of them, they were hidden in a closet, and Marvel Comics and there was one particular comic character, Linda Carter, the wonder woman, whose tight clothes and semi-nude body in pictures would get me so aroused.  So the excitement from those sexually exciting objects from the day I must have been transferring to the cousin who I found not at all unattractive because of sheer physical closeness as I would drift into sleep, where distinctions between one person and another kind of melts.

"In fact in the dream I do want to have an erection but not because of her and that is what I want her to know when she reaches out to check for erection that it is not for her but for others. Yet in my attempt for her not to feel my erection I think I am sabotaging my ability to have erection altogether and ruining my ability to make love normally. I grew up getting put down by my mother and all the women and girls that were always around me. I have so many cousins and aunts. And my inability to perform well as a man with women arises from this anger at them for treating me badly."

"How do you know this is the cause of your sexual difficulties?"

"I have been reading a lot lately about misogynists and there they tell you that they hate women because of bad relationships with their mothers. Verbally or physically abusive mother will turn you off towards all women."


Saturday, January 7, 2017

An exhibitionistic dream

A prolific dreamer brought this dream to the session.

I went to Susan and Gary's house. Gary was alive [In reality he passed away last part of the year]. I was surprised that he was alive. Gary said he would show Susan around and then left me alone. I put on one of his t-shirt and I was going to put on some underpants, but it was a pillowcase. Larry then said "Can't we leave you alone" and I said "probably not". Susan then came in. I felt embarrassed and humiliated.  I said I will wash everything and bring it back.

When asked for associations it turned out that the patient thirty years ago had dated Susan, but only a few times. His mother, whose strong influence had prevented him, despite being an exceptionally good artist and a highly intelligent man, from ever getting married, had put a block to his budding love for Susan through making a statement that one should go out only with someone who has a lot in common with oneself. Since Susan is Jewish and he a Catholic, he had given up on her.
He did admit, after some reflection, that this explanation is a superficial one and the real reason he did not pursue Susan further was because she was very popular when young and was going out with a number of boyfriends at the same time that she was dating him, and it was his fear of competition that had held him back. He rather defer in favor of others than face the dread of defeat. He was bullied as a child and has deep fear of other men who he rather placate than fight when confronted.  He has very little confidence in himself and admitted that his dreams are often about his bungling and making other mistakes at work and elsewhere inviting wrath of others. These inadequacies and lack of self confidence were interpreted to be symbolic representation of his lack of confidence in performing sexaully, turning him into a man who had never made love to anybody. "I am not good enough for anybody," is how he put it.
"You think you are at their house to resume your relationship with Susan now that Gary has passed away?"
"I no longer have interest in her. Yes I was interested in her when she was 18 but now I feel no attraction towards her. But you are the doctor."
The last sentence confirmed that my conjecture was right. The repressed wish could not be acknowledged but indirectly; imputing that he is not conscious of this rekindling of interest but I, as his doctor and with my superior medical knowledge, had guessed it correctly.
Gary said he would show Susan around and then left me alone could only be interpreted as wish fulfillment that Gary was exhibiting Susan and making her available. Leaving him alone perhaps alluded to his being permitted by Gary to pursue her but only in onanism not in actual physical contact.
Wearing of Gary's t-shirt and attempting to wear his underpants by pulling them up was interpreted to be his taking Gary's place with Susan.
"But why pillowcase?"
Patient said it was perhaps a wish to sleep in Gary's bed putting his head on his pillow.
I wondered if pillow was symbol of  female genitals, a place to rest head (penis) not unlike how the man's most restful place is inside the vagina (when making love) and finally in mother earth's womb (eternal rest).
Patient said the interpretation was quite likely correct and then added, "You know why I am pulling up the pillow case, because it is the opposite of pulling down the underpants."
Was it then 'reversal', a technique so often used by dreamwork to distort the true state of affairs, in this case to hide his pulling down the underpants, a preliminary step one must take before intercourse.
"Where is the humiliation part coming in from?"
Patient then confessed that he had hid this part of the dream when first telling it to me for it was so ridiculous.
The pillowcase came into the dream because it has no opening at the other end and so his legs could not go through and he was unable to pull it up higher than his knees and was thus forced to expose himself. It was this exposure/exhibitionism which was giving rise to the embarrassment and humiliation.
"How do the exchange of dialogues 'I cannot leave you alone' and 'probably not' add to the meaning of the dream?"
It is accusation by Gary that I cannot be trusted with his wife and I am agreeing with him. It is no different than how when I get really paranoid the security guards start appearing at the windows of my house  and how black cars follow me when I am on the road to keep a tab on me."
Patient all his life has slipped in and out of paranoia.
"Why are you promising them that you will wash the clothes and bring them back?"
"It is washing away the guilt of wishing to have sex with Susan. Though it hardly goes beyond my exposing myself." patient concluded the analysis of the dream.

Monday, October 31, 2016

Conflict between "Sweet Release of Death" and "The Continuing Lure of this Wonderful World"

A divorced man in his forties,who lives a secluded lifestyle after he readily and truthfully cooperated over his marijuana use with the law enforcement, instead of refusing to answer questions and getting a lawyer to lie about it, which caused him to go to jail, leaving him with a deep distrust of society's way of conducting its affairs with honest people, especially by those who are in charge of arresting, prosecuting and judging, and spends most of his waking hours tending after his business, of which he is the owner, and who comes to me primarily to pick up a prescription of Seroquel 100 mg. for his anxiety, insomnia and bouts of depression, for he rather be working than be in my office, suddenly volunteered, which is quite unusual for his reticent self, that he has recurring dreams, and since he has nothing better to report he might as well tell them to me, not because any good will come out of doing so but to fill up the 45-minute session.

The dreams have the same theme though their form changes.  I have to be somewhere for something important, like to take an examination, or go to do a difficult job, but I cannot reach there because of obstacles like I cannot remember where I parked the car, or the car itself is missing if I do find the place where I had left it, or if the car is not missing the keys are. I may even visualize where I had left the keys but don't quite know how to get to them. As for taking the test, I make it to the school but I cannot find my way to the classroom. Or I am on the dock for family vacation but there is no boat. I wait and wait for it to show up. Or my body itself fails upon me. My feet get heavy and my body feels so tired I can hardly move. Or I fall down with no strength to get up. I crawl on all fours to be at the spot where I have to be but without success. 
All of these dreams are very scary. My heart beats real fast. I feel all amped up, confused and clenched. My body feels like it is ready to fight. It usually happens in early morning. Especially if I have been waking up through the night.  

The patient always inhibited did not volunteer any associations.
So with nothing to go on I decided to tell him the psychoanalytic theory as to why we dream of being back in school and being examined and not doing well on it and how it is classified as a typical dream (typical dreams are those that uniformly occur in all of us). We dream of being back in school and dreading to take a test lest we fail when we have something important to do the next day, the worry of which tries to wake us out of sleep. The aim of the dream is to reassure the dreamer - so he can continue to sleep - that don't worry about tomorrow's important thing that you are all hyped up about. Don't lose sleep over it, For you did same kind of worrying over facing examinations in school which the next day you would do quite well on. So just like in the past all that worrying was for naught, your fear over tomorrow's difficult situation will be over nothing too. Freud pointed out that one always dreams of getting tested on a subject that one did quite well in the school not on a subject in which one failed, or at least on one which was not one's favorite.
But patient rejected the interpretation and claimed that nothing about next day's job, or other challenges of life, bother him anymore, for he is too old for all that, and that could not be causing him to go back to school and worry about taking tests in his dreams.
But, then, after a hiatus of time, he said, may be as a young man he did get quite uptight over situations he had to face the next day and would worry whether he will be able to get the job done right or not. "But as I have aged, I can talk myself out of being anxious by telling myself that you have always succeeded in whatever difficulty you have had in the past so why worry about tomorrow today."
So he now talks himself out of the worrying instead of letting the dream do it after falling asleep.
So he did confirm the correctness of Freud's theory of "examination dreams".
When pressed to try and scour in his mind for more associations however faint or far fetched they may seem to him to the other elements of the dream, the only one that came up was to his being stranded on the dock and how his family would go to St. Clair Shores (part of the Great Lakes) every weekend and how they were the happiest days of his life. But in the dream the dock is on a ocean not where the family dock was. And in the dream the family is not around, or was there before but no longer, or they have already left for vacation and waiting for him to join them or they keep coming in and out of the dream picture but so faintly that he cannot be sure what role they are playing.  "It is all very hazy."
With no associations emerging, I fell upon the psychoanalytic theory once again, and conjectured that all these dreams have the same theme: not being able to reach somewhere you want to be so badly because of  obstacles. That place could only be the final resting place, the mother earth's bowel, your mother's womb where you felt safe and happy. It is a wish to be dead and free from life's tensions.
However, this greatest wish of all is naturally accompanied with such fear that you recoil from it and start thinking of all the other less fearful things in life that you rather face than die. These are counter-wishes, the wishes that will be fulfilled by staying alive, the pull of life (moh/maya), the enticement to be eternally entangled in life's obstacles and frustrations instead of dying. And the fear of dying in torn out of context and displaced upon the fear of living (life's vexing and frightening problems) exaggerating its strength, making them look insurmountable, waking you out of sleep in panic.
Patient said this makes lot of sense but proudly declared that he has no fear of dying. and then added, "It is injury that I fear." Obviously the fear of death had been displaced, to lessen its terror, to fear of getting injured. And then further confirmed that we were on right track by saying, "On the other hand my father has great fear of death. He is a very tough man. Hard as a nail, always on task. But whenever he has an ailment he gets very worried. If it is a cough it got to be lung cancer. For me death holds no fear. For I reason if death comes you won't know it, you won't be aware that you are dead. Death is not being in pain anymore, no longer to worry about anything, the final checkout. So I have no fear of death. My feet will no longer hurt from neuropathy that wakes me out of sleep. No suffering will affect me because I will already be dead.
And I must confess doctor that when I have real bad day, a real tough day, I calm myself that 'sweet release of death' will fix it. And it is on those nights that I have these dreams from which I wake up in such a panic. And by the way these dreams are very very vivid. I see everything in color. I see every detail. All the surroundings of whatever I am dreaming of, the trees, the building, they are all so vibrant, the car is brilliantly red, the key shines like silver. Why everything becomes so life like, so colorful? "
"Because they are temptations to lure you back to living. They seem to say when it is such a vibrant, wonderful world why you want to die?"

Sunday, August 14, 2016

Muscle Cramps in athletes a form of nervous tic

I recently came across an article "Spicy End to Muscle Cramps" (Tuesday, July 12, 2016) in Wall Street Journal about a problem that athletes unexpectedly develop and which, because of crippling pain and stiffness, forces them to withdraw from the competition, ruining years of their efforts in matter of seconds.
The article describes how two neurobiologists with excellent credentials - one of them, Rod Mackinon, a Nobel prize-winner in Chemistry and the other, Bruce Bean, from Harvard - have finally put to rest the standard thinking on the matter, which was universally accepted by sports doctors and other experts, that muscles go into spasm because of some problem in the muscle cells like dehydration, electrolyte imbalance, microtears in its fibers, or simply fatigue.
The standard thinking had flaws. For one thing, athletes developed muscle cramps out of the blue, sometimes at the very beginning of a marathon, when they are adequately hydrated and their electrolytes were in good shape, and sometimes they did it while in bed, resting, where there can be no question of fatigue, microtears and dehydration. So the neurobiologists reasoned that the culprit may be the nerves that control the muscles rather than the muscles themselves.  
The article states that the two scientists hypothesized that the problem lies in the misfiring of the nervous system. While the article does not state it explicitly, I assume what they mean is that something happens in the nervous system which sends signals to the muscles to contract in such a rapid fashion that it locks them in a continuous contraction (tetany), preventing them from doing their job in a coordinated manner.
As to why the nervous system starts misfiring they have a curious explanation. They think the misfiring - which really should be excessive firing - has no advantage to the organism. Nothing like the pain that makes us pull away from a hot stove, and the phenomenon has not evolved to prevent injury and help us survive, but it happens because the human body isn't perfectly advanced machine. In short there is no rhyme and reason to this unnecessary muscle cramps happening other than to ruin an Olympian's chance of getting the gold medal.
But does it not sound weird, especially coming from a Nobel Laureate in science, that a phenomenon has no cause, but is just a freak imperfection of human body!
Their error lies in an inability to look beyond the physical, as opposed to the mental, when it comes looking for etiology of human problems. Granted they went a step above the pure physical in recognizing that it is not some form of gross malady like muscle tear, dehydration or fatigue that results in spasm but nerves, but they did not take the next logical step of examining what causes the nerves to go into that disadvantageous mode, simply chalking it to the imperfection of evolutionary process. 

Now we know that anxiety causes causes muscle spasms. In Anxiety Neurosis (Generalized Anxiety Disorder) the whole body stays in a state of tension, all the muscles getting geared up into  minispasms. Perhaps much of the diseases of arthritis, back pain, even autoimmune disorders where chronic muscle tension causes break down of muscle components (mini rhabdomyolysis) which are treated by the immune system as foreign bodies,  may owe their existence to chronic anxiety.
An observation whose worth we will soon see is that muscle tension in anxiety is not always uniformly distributed. In somatic anxiety it may appear in patchwork, as isolated neck or back spasm, or stomach cramps, or in lower intestines as various manifestations of colitis, or in the respiratory tract as asthmatic attacks, or in the detrusor  muscles as in urinary frequency. In extreme anxiety the spasm may get so uncoordinated that the whole skeletal system becomes a firework of fasciculations.
Could sudden appearance of muscle cramps (spasms) in athletes be a manifestation of somatic anxiety?
It goes without saying that sports are a venue for discharge of surplus aggression. What humans - a highly aggressive species - cannot discharge upon each other for fear of causing actual injury, which will trigger retaliation, they do so in play and in sports. But even in play and sports there is always surplus aggression left, generated by extreme competitiveness, that cannot be discharged upon the opponent and in the game, but must come out in obsessive rituals. Obsessive rituals themselves being nothing but acts of symbolic aggression followed by symbolic undoing of it; the two motor acts - aggression and its reversal - blended together. This explains why so many athletes suffer from obsessive-compulsive traits, many of them compelled to do their obsessive rituals, including superstitious acts and magical mental mantras, before the start of the game. If they do not discharge that excessive aggression in obsessive rituals then they would not have the optimal level of aggression in the game. For a good game requires just the right degree of "killer instinct". Too much or too little of it, instead of killing the opponents game, will defeat one's own game.  
But it is not always we can bind all our aggression with obsessions. Some of it can still exist in form of raw anxiety which can lead to tensing up of the muscles. It is really an attempt to make a fight or flight with whatever is oppressing one's being. And then we see a whole range of pathological muscle activities which are variants of obsessions and compulsions: tics, throat clearing, spitting, Tourette-like use of foul language, and what is dreaded by the athletes, a crippling muscle spasm.
So it is the anxiety over confrontation - for sports are nothing but an organized way of confronting the competition to show who is better - that gives rise to muscle spasms, whose purpose, self-defeating of course, is to take one out of the game. It is kind of disqualifying oneself to avoid confrontation.
How does one explain then people who while swimming in isolation suddenly go into muscle spasms and die unable to swim? They are not in competition therefore it cannot be unleashing of some great aggression that translates into locking up of the muscles to produce one's own death? Or can it be? Often we discharge aggression not at the site where it was occasioned for it would be inexpedient there, but at some other venue totally unrelated. In our bedroom, when relaxing, and when it is safe to do so, or in our dream where the danger is imagined and not real, and perhaps in water when the lure to submerge oneself in that intrauterine like state forever, away from the strife of existence, may feel so tempting.
The two scientists cure for muscle spasms is interesting and throws light upon the etiology. They overload the sensory system of mouth and stomach by pungent tasting food or drink. They think "the strong sensory input causes inhibition of the motor output." And they proved the correctness of the hypothesis by showing that pungent food like juices from pickles, beets or sour berries, made it harder to induce spasms with electric impulses.
But does an increase in sharp sensory input really numb the motor response? Or if we recall our physiology from college days, does it actually increase it? Now we know that sensory input because of the reflex arc causes the motor response not suppresses it. When we go to sleep we deliberately put a block on all sensory input in order to get the body into total quiescence, with no motor output, so we can into the immobility of sleep.  
So if pungent food increases the motor activity why does it lessen the skeletal muscle spasms?
Perhaps what happens is that the pungent food causes a spike in gastrocolic reflex with the reflex motor output getting directed to the intestinal muscles. The excessive aggression then finds discharge in involuntary muscles, sparing the discharge upon the skeletal. Both are controlled by acetylcholine, the neurotransmitter that causes the muscles to contract and is undoubtedly the main conduit for the discharge of aggressive instinct.  Release of aggression (acetylcholine mediated neurotransmission) through non-skeletal muscles upon one's own self frees the person to have a more modulated competitiveness towards one's sport rivals. The process is perhaps not too dissimilar as to how vagal nerve stimulation in depressed patients unfreezes their brain from acetylcholine's straitjacketing. Discharge of aggression at one point lessens it at another. Causing pain and irritation in the esophagus and stomach with the resulting spasms in the intestinal tract, unfreezes the spasm in the skeletal muscles.

Saturday, April 30, 2016

Psychology of Crying

I recently ran into an article in Time Magazine on "Why we Cry" (March 7 2016), and was surprised to learn that it is a very active field of study. More intriguing was the claim that nobody really knows why we weep and experts consider it a confounding mystery.  In fact the article laments as to "the surprising dearth of hard facts about so fundamental a part of the human experience." Per that article only humans cry for emotional reasons. Other animals tear up too, but as a reflex reaction to pain or irritation.
Now for a long time I have been convinced that quite a few physical illnesses, in which mucosal secretions are central to the pathology, are a form of crying. As a child when we get helpless and see no possibility of escaping out of our distress but through the intervention of our caretakers we cry. But as we grow older and helplessness and dependency upon others becomes acknowledgment of weakness we increasingly lessen crying from the eyes and instead do so from mucosal surfaces that are hidden from the view of others. The ones that are contiguous with the eyes are of course the most preferred for this displaced crying, and sinuses, along with other parts of respiratory tracts, are the surfaces most used for it. However, intestinal and genitourinary tracts, even skin as in weeping eczema, also secrete unnecessary flood of mucus when one is under stress as a displaced form of crying. 
Now what is common among all these catarrh, whether they are secreted from the lining of the respiratory tract as in bronchitis, or from stomach as in hyperacidity, or from colon as in Irritable Bowel Syndrome, or from bladder as in interstitial cystitis, is that they are all in response to some irritation. They are all attempts to drown a foreign (irritating) object in a seaload of mucus and flush it out of the tract.
While the original irritants, which initiated this evolutionary adaptation, were purely physical in nature, over time, psychological irritants could also provoke the same response. In the latter it is a physical counter-irritant (displaced) response undertaken to lessen the psychological pain. When somebody, acting as an irritant to our psyche, is causing us emotional pain, disturbing our mental harmony, but who we cannot flush out off our mind/consciousness, an attempt is made by the body to search for some physical irritant in our sinuses, respiratory or intestinal tract etc. and pick the one that is genetically most sensitive in one's self and already has some organic problem, and start secreting mucus in it, way more than what the physical irritation already existing there justifies. This divides our attention between two sources of irritation, physical and mental, bringing relief to the latter.  Furthermore this process of flushing out the physical irritant sends signals to the brain that something is being done to get rid of whatever is irritating one, which is felt as across-the-board relief from tensions and increases the sense of one's overall well being (perhaps through secretion of dopamine). Doing something about anything is better than doing nothing. The process is not too dissimilar from how psychological irritant which is causing unrelenting pain in the mind, and which is constantly activating the need to do something about it, such as memory of sexual abuse, rage at an abusive husband, constant pressure of a deviant sexual impulse, is relieved by self-cutting or getting some body part like nose or tongue pierced or getting tattoos impaled upon oneself. This viewpoint of mine was further strengthened by a patient who I evaluated yesterday. She suffers from the disorder of scratching herself till it bleeds. It started after her younger brother was shot to death in South West Detroit. They never found the culprit. Then her mother died of brain aneurysm. The two things made her lose control of herself and she started doing things that she would not have done if she had better control of herself. She divorced her husband without good reason, and got married to someone without sufficient justification.. The second husband was verbally abusive and while she was driving with him to their lake cottage her husband began what she termed as relentless bitching. "I could not stop him. I could not jump out of the car. I could not tune him out. And so I began scratching myself as if to get him out of my skin, and then it bled. The relief was immense. From that time onward I found that whenever he bothered me beyond a point, or the memory of my dead brother and mother came back and got more than I could handle, I resorted to scratching and scratching till I bled. It is no different than how teenagers cut themselves. They cut, I scratch. The purpose is the same. It substitutes one pain for the other. The second pain feels better than the first because I have control over it. One is the author and not at its mercy as happens with the first pain, the mental pain".
The eyes were the first to evolve as a counter-irritant surface to deflect attention from emotional pain  to the physical one and for the following reason. They being extremely important apparatus for survival, the mucosal secretion in them for even the slightest irritant is immediate and copious and hence most easy to provoke. Furthermore their location on the face made them most suitable for catching the attention of those who could lessen the baby's emotional pain. So emotional crying seems to have the same nature as self-cutting, or banging one's head against the wall: deflection of attention from mental to physical anguish. 
Now it is not necessary that the emotional irritant has to be that of pain or suffering. Anything overwhelming, whether physical or psychological, that upsets the body's homeostasis beyond a certain point will trigger crying. So sudden success, even of others, with whom one can identify, can trigger tears of joy. It is as if too much joy in oneself will provoke attack from adverse forces/one's rivals/competitors, and hence one must put restraints upon one's joy by crying in order to not make others too envious.
The psychology here is a little complicated but it works this way: if only my rivals can see my success it will cause them so much pain that they will start crying. And while enjoying one's success (or the success of someone with whom one identifies; which explains why we cry tears of joy at other people's success too) one also identifies with the rivals' suffering and does the crying for them. So the two contrary emotions are felt at the same time: the pleasure of triumph and the suffering of the rivals. It is like doubling up of one's achievement, expressing not only one's happiness but the enemy's defeat as well. Anyway basically it is not triumph and joy that triggers the tears but always pain and suffering that lies behind crying. 
So the tears are always a reflection of pain. And since the function of pain is for us to withdraw from whatever we are engaged at, it behooves us to examine whether the behaviors which one typically associates with crying are not a reflection of our attempt to withdraw from the world. The article in Time give a number of motor behaviors that occur in crying. A scrutiny of them shows them to be components of behaviors that one undertakes to run away from a situation, disengage from the world. 
Let us see what the Time article lists as behaviors that accompany crying: forcing your eyes shut, pressing your lips, touching your eyes, wiping, pressing your lips, swallowing, blowing your nose, self-soothing touches, quivering of lip, sighing, hiding your face, making sudden jerky moves, gazing up.
Forcing your eyes shut, gazing up, hiding your face are clearly acts of withdrawal, refusing to see what is happening. Pressing of lips can be interpreted as refusing to imbibe, finding the situation unpalatable.
Wiping eyes and blowing nose is part of the flow of mucus and a natural response to keep one's   appearance clean and presentable, and perhaps counter-moves to negate withdrawal and once more be attractive to the world. .
Jerky movements of the head may be a component to attempt to run away from the stressful situation - a kind of tic. Tics being a small component of complex motor action that a person wants to undertake either to fight or flee away from the frightening situation but which has come under repression with only that small component managing to find expression, discharging the entire energy of the complex motor response through it. 
Quivering of the lips also appears to be part of  fear response and can be looked upon as a form of tic; uncoordinated motor activity where individual muscles want to break through, seeking their own discharge instead of working in coordination, as happens in severe anxiety where fasciculations may replace purposive goal directed motor movements.
Sighing in crying appears to be taking a deep breath to abort the desire (a counter-move) to stop breathing altogether and die - the ultimate withdrawal from the world.
The article also raises the issue of how anger and grief can trigger emotional crying and it is not hard to interpret why. Anger is a sign of frustration and helplessness. We get angry when we can do nothing about something that is bothering us. Well, we can of course attack the jerk who is making us angry, and this is what happens a lot in those whose prefrontal cortex is unable to put restraints upon physical aggression, but a lot of times the realization that giving vent to that anger in physical aggression will lead to even greater problems, we are left with no choice but to deal with it with helplessness and tears, especially in women who because of their frailer built have less option to resort to violence when angry. So tears that flow down their cheeks when angry are really a reflection of helplessness.
In grief we cry so the departed person can see our tears and end his absence and return once again to do for us what we were accustomed to receiving from him. It is no different than a child's crying for its parents. Crying in grief for the dead person must be distinguished from crying that is often accompanied by loud wailing, and other exaggerated manifestations of sorrow, that one often sees in funeral home and which is more a drama to hide one's feelings of triumph at having scored one over the dead person, outlasting him. The exaggeration is to prevent the signs of pleasure making it to the surface and if they do come up as laughter over some subject unrelated to the death it can be quickly covered by the loud wailing and crying. But often these "crocodile tears" are admixed with genuine tears of grief so one should not look down too harshly upon human beings tendency to feel pleasure at others death. We are a highly ambivalent species 
Grief is mostly about working out of one's system the ambivalent feelings one has had towards the dead person. Often the crying that accompanies grieving is because the departed person has not just done us good but done us harm as well and we hopelessly cry for him because the possibility of getting even with him is now lost forever.
We may also do the dead person's crying for him. We reason how sad he must feel, with his disembodied spirit watching, as we go on doing our usual things which he is no longer part of. And we cry to show him how much we are not enjoying this lovely world but are crying and being miserable and with this we hope to not arouse his wrath over our having fun of which he is not a party.
Our crying over somebody, who once was a commanding figure in our life, like a parent or a mentor or a great hero, but who due to ravages of time has now turned frail and decrepit, barely able to move, unable to even hold himself up let alone command us, is out of deference, showing pain and suffering at what he once was and what he has now become. It is an attempt to preserve his higher and our subordinate position despite what it really is in reality. The crying is an attempt to envelope him in one's tears and wash away all his frailties and restore him back to his strong and proud self that he once was.
There has always been a peculiar fascination with crying being means to secrete out toxins from one's system - the chemical theory of crying. The article attributes its popularization to William Frey in 1985. But I was first confronted with it by a friend of mine, Mary Ganguli, who while visiting Detroit, all the way back in 1982, at a social get together, wondered aloud, as her infant son began to cry, if the functions of tears was not to get rid of some toxin in the body, and if only one could bottle  that toxin and find some antidote for it it would be the most unique and efficacious  antidepressant. In fact it was this comment of hers which set me to start thinking as to why we cry.
The chemical theory of crying is only partially correct. For while it is highly doubt that tears actually secrete inimical molecules (toxins) out of the body and thus lessen its load, for the volume of body fluid is so great and the quantity of tears so minuscule, the theory has psychological merit. Crying does not get rid of some biochemical poison out of our system but the psychological irritant whose presence is felt by the psyche as a toxin is lessened. It is catharsis of negative emotions not toxins.
The article devotes a substantial number of words on people who never and attributes them all kinds of properties. However, the explanation may be simpler than it seems. People who don't cry have learnt that others are more likely to take advantage of them if they appear helpless than help. Such people become more self-reliant, using their intellect uninfluenced by emotions, to guide them and are less connected feelingwise with others, seeing the world as more predatory than helpful. That is one reason why real men don't cry. Because if they cry in presence of other men they are quickly viewed as wimps who can easily be subjected to aggression and  dominated. The woman however has no such great conflict over getting aggressed upon, given her passive biological role, and may even use her vulnerability and tears to attract a man to her aid and for mating. At this point I am reminded of a man who took great pride in never crying, This man grew up with a father who was completely into raising his sons as ones who showed no weakness when subjected to aggression. In fact he forced his sons to pick up fights with kids much older than them so as to make them tough fearless fighting machines and when they would get beaten and cried would take a belt and beat them mercilessly for being cowards. And would whip them even harder if they cried when getting beaten by others. As a consequence, this man, Mr. James Trudeau, who came to see me for psychiatric problems when he was in his fifties, told me that his tears dried up when he was 7 or 8. For if he cried when older boys would beat him, he knew his father would beat him even more. And he claimed, he felt no pain whatsoever, and never cried either, whether he was getting beaten by other kids or by his father, no matter how severe was the beating. For tears meant more beating and more pain. Interestingly he came to see me for excruciating back pain, which no amount of surgeries by orthopedicians and neurosurgeons could cure. One day he abruptly left treatment sensing some weakness in the tone of my voice while I was on the phone making a business deal with a contractor where I was trying to cajole some concessions out of him thus acting more feminine, placating and manipulative than masculine. "You are a coward," he declared, "Who can teach me nothing, for there is nothing to be learnt from somebody who is not a true man. You were sucking up to him." And he walked out of my office, never to return. He brooked no trace of submissiveness in man. It should not surprise us that he was a total loner, and of a highly independent bent of mind.  He had dropped out of high school after physically assaulting his teacher who had challenged his manhood. It is interesting that I too can never cry. 
Now we come to the most difficult part of our essay.
The Time article gives a slight insight, as if in passing, into what the ancients thought was the purpose of crying. The ancients thought the tears originated from the heart. The Old Testament describes tears as the by-product of when the heart's material weakens and turns into water. And in this epigram may lie the crux of why we cry. Crying is an attempt to dissolve oneself into pieces and become part of the aquatic world from where all living organisms arose. The ultimate withdrawal is cessation of living. And crying is the most primitive step towards cessation of living. Its earliest  origin must have begun with the process of dessication so common in the lowest organisms. When environment becomes hostile, lower organisms like algae, fungi, nematodes shed all their fluid, curl up into a ball, and become as if part of the dust (inorganic world). They are for all practical purpose dead to the world just awaiting for more favorable circumstances to come and nurture them back to life.
All forms of catarrh, whether originating from the intestinal tract or respiratory tract or from the lachrymal glands are a form of desiccation. It is like under inclement weather or adverse circumstances lots of plants and small animals shed all their fluid, go into hibernation, and become practically dead, but with the purpose of once again imbibing water and blossoming when circumstances become hospitable, crying is an attempt, of the baby especially, but also of the grown ups, to withdraw from a hostile and inclement world into temporary non-existence.
Now we know the fantasy of being reborn is most frequently represented in dreams by drowning in water or being rescued out of water. It is like the recreation of intrauterine existence, a return to the womb in order to reemerge, be reborn more resplendent in better circumstances. Crying appears to be creation of a layer of water upon one's eyes and a mini-creation of intrauterine existence - a recreation of the return to womb fantasy.  So the baby cries with its first breath as if to say, "What did I do to deserve to come into this world which will be endless series of dealing with the inclement and cold environment, full of painful irritants, I rather go back to my mother's warm wet nurturing womb," recreating a piece of it through the tears.

Sunday, December 20, 2015

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.