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.
But the standard thinking had flaws. For one thing athletes develop muscle cramps out of the blue, sometimes at the very beginning of a marathon, when they are adequately hydrated and their electrolytes are in good shape, and sometimes they do 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 Laurette 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  minispasm. Perhaps much of the diseases of arthritis, back pain, even autoimmune disorders where chronic muscle tension causes break down of muscle components (mini rhabdomyolosis) 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.

Monday, May 18, 2015

A typical Oedipal Dream

A woman in her mid fifties who lives by herself upon her disability income, and depends heavily upon an older man, who is in his late seventies, for transportation, and for bailing her out every now and then with small sums, half way through the session declared that she went to bed with this benefactor of her's.
Though she started treatment less than an year ago, and sees me only once a month, due to successful analysis of a few of her dreams, has shown a good improvement in facing up to the shackles of her agoraphobia, and had actually come to the session driving all by herself for the first time in years.
In the session initially she talked about her boyfriend - who is different from her benefactor - and how she is finding him more and more unappealing because he is a control freak who constantly judges her, finding faults with whatever she does. Their relationship is not that deep. They met only a few months ago, and she feels that he, who was divorced a couple of years ago, is using her as stop gap girlfriend till he finds somebody better. But lacking confidence in herself she has been unable to leave him.
She triumphantly declared that while her benefactor's wife went to Florida,  he invited her to his house to stay overnight and they ended up making love. And though he is much older than her, she declared that the sex was highly satisfactory. When asked if he could perform to her satisfaction, considering he is in his late Seventies, she said sexual satisfaction and dissatisfaction has less to do with how one performs than how one feels about the person one is making love to. Pleasure and unpleasure from sex is all in your head.
Then after talking some other things she suddenly brought up the following dream.

I am setting up a party event at of all places in the White House. Obama and I sneak around and we make love in a corridor. But Michelle was catching on to it. For she looked as if she was wondering as to why Obama would like to hang around so much with a help.

Patient added that she feels no sexual attraction towards Obama, so it is weird that she was making love to him in the dream. Now we know that kings and queens, presidents and celebrities, are used by the dream-work to represent parents. So behind Obama stood her father and behind Michelle her mother. Her Oedipal wishes towards Obama (father substitute) being hindered by the spying Michelle (mother substitute).

Confident that this Oedipal dream was sparked by her making love to her benefactor while his wife was away in Florida, I asked the patient if the dream occurred immediately after the event.

Patient said no. The dream had occurred a few days before that.

But after talking a few other things she went back to the dream and said, "The dream occurred before we made love because I knew that is what is going to happen. The dream occurred on the night when I first heard she was going to Florida, and the thought had flashed through my mind whether it will land up in our making love. I did not give much attention to the thought and actually till that night we made love, I did not think it was going to happen because I respect his wife. But may be unknown to me the wish to make love to him must have been aroused in me when I first heard that we will be alone together and it was that wish which saw its fulfillment, before its actual occurrence, in that dream." 

Saturday, April 4, 2015

Mall Phobia and Returning to the Womb Fantasy

A single woman in her mid- thirties, who lives a rather solitary life, and almost never ventures more than 2 miles from her house, brought in the following dream, and, because in it she was driving a car inside a mall, declared it to be weird.

I am driving in a mall. The only detail about the mall I can recall is of there being a bathroom in it. The stores are indistinct and the whole place is painted in a peachy-tan color. Also I don't think there were any people. Just my car. In the dream it did not feel strange driving a car inside a mall. 

When asked for associations to the mall she said she hasn't been inside one in years; they provoke panic attacks.
Another association to malls was her fear of not finding her way out of them; they curve and twist and one gets confused as to which way is to the entrance and exit. Another concern about malls was not finding the car in the parking lot on coming out.
She then expressed her skepticism about the value of the dream. "How could a car have gotten inside the mall?"
As to why the dream showed a bathroom, she could tell nothing. She was not sure if she had used it or not, but remembered that it too was painted inside with the same peachy-tan color so she had at least perceived it from inside.  
She added that it was her car that she was driving because she distinctly recalled its color being red. 
All these associations did not immediately throw light upon the problem and we drifted in to exploring her fears in general. She fears crowds and avoids public places especially where she anticipates running into more than two or three people hanging out together.
She has not driven on highways in 7 years. She drives to work early in the morning when roads are empty, and reaches there 45 minutes before the starting time. Though she does not get paid for putting the extra hours, she likes doing it because that way everything is in order when the doors open for business. This reasoning appeared to be a superficial rationalization (false explanation) for the deeper motive of avoiding rush-hour traffic.
She then expressed anger at customers who come 10 or 15 minutes earlier than 7 and try to make her work before the official opening time just because she is there.   
When asked how far is her workplace from her house she said exact two miles.
She then talked about how her fear of malls does not quite extend to Target [Department Store] and Kroger [Supermarket]. They are large but not quite as big as malls. And in them she knows where everything is, including the entrance doors, and thus can get out quickly if the need arises. And both the stores are within her self-imposed 2-mile-limit. Even at these stores she is in and out, picking only couple of items at a time which she knows beforehand she needs. And she goes there in the mornings, on Sundays, when hardly anyone is in the store and on the roads.
She then talked about her going to the Target to buy incense sticks which she loves, and getting disappointed at not finding them. Her wish to go to the mall perhaps arose from this frustration. For she does not know where she will find those incense sticks now. Target use to carry them but not anymore. She was hoping the incense sticks will be available in some mall because that is where the specialty shops that carry such items exist. 
Now per psychoanalytic theory what one is currently fearful or phobic about is something which was once dearly loved. Our current fears are our former desires. The oedipal love for mother becomes the greatest taboo of mankind. People who once loved getting behind the wheel and enjoyed taking long drives are the ones who usually come down with agoraphobia. The repression targets our strongest suits. The libido tries to find outlet through those functions which we favored the most and were most proficient at. It is the child with great desire to look (hypertrophied scopophilic instinct) that develops eye tics.
So I asked her if she loved going to malls before she came down with her phobias. And she said, "Oh yes, that was my most favorite thing to do. I loved it as a child and I loved it as an adult. But when I moved to this town, away from my old neighborhood, 7 years ago, the fear crept in."
Now I know this patient for some time, and I know too that her agoraphobia was precipitated by two very abusive marriages. She had developed a fear of going out which perhaps had at its root a desire to escape meeting men and getting in to another relationship. Getting involved with men she now had begun to believe invariably turn abusive. So her psyche was thrown into a dilemma. The libidinal wishes implored her to go out and seek men, while the memories of the physical and emotional abuse provoked fear (panic) over fulfilling this desire.  
Knowing how much she seethes with anger towards her ex-husbands, and because of it towards mankind in general, I asked her if the peachy-tan color was not derived from feces. Her fear that she may inadvertently defecate all over the mall to express her anger towards the world. The bathroom was there to lessen the fear that if the impulse to shit upon others becomes overwhelming there is an escape. Encopresis in children, and various forms of colitis in adults, are often expression of undischarged anger. In non-verbal mentally retarded, unhappiness with the way things are is often communicated through smearing the walls with feces.
She did not quite agree with this interpretation, but did confess that whenever she leaves the house she immediately has to worry about going to the bathroom. She wondered if she does not go beyond 2 miles of her house because she fears she may not find a bathroom in time. She added that when she comes to my office the first she thing she does is to go to the bathroom.
But when asked if this worry to find the bathroom is for an urgency to urinate or to defecate she said to urinate.
But it was not clear if she said this because there is greater embarrassment in humans about defecation than urination. Also she may have hidden the real state of affairs because she could sense the hesitancy in my voice when I was trying to search for the right words to convey correctly what I had to say regarding the use of excremental functions as a means to express rage. The patient goes only as far in revealing about herself/himself as the analyst is capable of handling.The analyst has to be completely comfortable with his own body functions before his body language will convey to the patient that he or she can talk about these matters without resorting to distortions and allusions.
She added that the fear of not finding the way out of the mall is similar to her fear of getting lost when driving. She does not trust the GPS. "The voice tells you to turn right or left but only after you have passed the turn."
"Any other association to the peachy-tan?"
"They are the color of your pants." I was wearing khaki pants that day. "And now I know where that color is taken from and why. In Target the employees wear peachy-tan color pants. So the dream was lessening the fear of the mall by showing it also as the Target which does not frighten me as much. And those employees along with tan pants wear red shirts which made the red color of the car noticeable in the dream."
"Was the absence of people in the mall also an attempt to lessen the fear?"
"Yes. I wanted to go to the mall but I am afraid of people. The dream therefore did away with people. And I go there in a car so I can be in and out in a jiffy. The shops were of one color and looked alike for the same purpose. I am scared of malls because it has such a variety of stores and they are on two or three levels. Variety sparks the fear that I will get lost in them and never find my way out while sameness lessens that fear."
"Is going inside and never finding one's way out, derived from the wish to go back to your mother's womb and never leave its security?"
"Sometimes I wish I had never come out of it. For life is so painful and men are so nasty."
So here was the confirmation of the rule that a formerly desired entity is what changes into a phobic object. It was in our mother's womb that we felt most secure and free of all dangers.* Under the spell of phobia it becomes the most dreaded place to seek refuge.
Her fear that she will not find her way out of the mall/womb was a "signal anxiety"/warning that the security of intrauterine existence (death) would be so alluring it would be impossible for you to return back into this stressful world.

* This pull of the intrauterine existence where all our needs were taken care of and where we felt completely safe may lie behind as to why the Las Vegas casinos are huge cavernous entities where all one's needs are taken care of and getting out of which is not an easy affair. The casinos are designed to create the illusion of being in a completely safe place and where fulfillment of every bodily need is immediately guaranteed like it was in the womb, which encourages the gambler to take greater chances with his/her money.
The way IKEA stores are designed, where finding one's way out is so difficult, and where one is tempted to be lost in shopping from one section on to the next, appears to utilize the same human wish to return to the womb.

Sunday, February 8, 2015

An incest dream

A man in his late thirties, who still lives with his mother, came to the therapy session and talked about his love for everything old, like classic cars, vintage comic books, turn-of-the-century houses with their turrets and other castle like features, and recalled how as a  young man he took a friend of his to the Boston-Edison Historic area that has some of Detroit's most magnificent mansions, and his friend got mad at him for dreaming of living in such high places, given that they were black and thus not entitled to such uppity lifestyles, and the patient laughed at his friend for being so dumb as to not see that now only bums and prostitutes lived in and around those houses, and they were so run down and abandoned that in all probability they could be purchased for virtually nothing. Then he added that recently houses have been coming a lot in his dreams. On being asked to give an example he narrated the following:

The dream was about this most incredibly beautiful house. It belonged to an older man who is planning to turn it into a church. But I swindle him from doing so by giving him some money.  There is lot of guilt associated with this trickery as if I should not have done that to him. The house is on Detroit river. In fact the river comes right to the house, waves coming over that green grass to the back door and then receding rhythmically. There is a steamer on the river, an old river boat, red in color. What is so remarkable is that I can see every part of it distinctly. It is a showboat with the twin wheels rotating under the water, which I see so clearly. I can't tell you enough as to how vivid the dream was and how much in detail I could see every aspect of it. I think there was a cruise ship too in the dream.  Or maybe the riverboat got replaced by the cruise ship. It had endless number of rooms, the ship was gigantic. Even in the dream I was thinking if it is put alongside a skyscraper no doubt it will be taller than the skyscraper. And there I go again thinking of majestic houses - for skyscraper is in the same category as houses, just a grander version of it. 
Also in the dream I was a seaman, about to go into the water and the river.  I was building a boat to do so or maybe I was already on the boat, or doing something of the sort, something a seaman would do.   

Patient was asked for associations to the house. He said, "It is a white house, a barn house, ranch, very elegant. I walked around it from the back to the front, admiring its beauty. The walls are beautifully carved with round projections that are so pleasing to the eye."

These associations strengthened the impression that the beauty of the house which he could not praise enough was beauty of some woman,  and considering how the dream revolved around old majestic  mansions, the woman whose beauty he was appreciating was no other than his mother as she must have appeared to him when he was very young. But this presumption did not bring us any closer to the essential 'dream-thoughts' that lay behind the 'manifest content'.

Then the patient recalled a detail that puzzled us greatly. The house was not constructed like regular houses are, which are rectangular in shape, but at an angle. When asked to draw to explain how the rooms were not straight but at an angle he drew the following.

The slanted lines which are disjointed in the blog entry because of my inability to draw diagrams using a computer were not broken but continuous in his drawing.  

 \                           \                           \                    \
  \ Dining Room  \  Living Room  \  Kitchen    \
   \                            \                            \                    \   \  Front Door
    \                             \                            \                    \

The association that the patient gave as to why the house was at an angle was rather strange. He said  for years his penis was not straight but bent because he had fallen upon his penis while wrestling in high school. But the problem had recently cleared up and his penis was fine now.

This association was clearly connected with the castration complex and his sense of inferiority about his sexual organ. It is an inferiority complex that no man escapes from, and which impels so many to fall for ads that promise a bigger and better penis with creams, pills and pumps etc. It has its roots in the oedipal phase when one is confronted with the inferiority of one's organ in comparison to the imagined, and thus greatly exaggerated, size of the father's.  This contrasting of one's potency with that of the father's perhaps was responsible for that element of the dream where he is thinking that if he puts the ship next to the skyscraper it will be just taller.

When asked if his penis was really bent, or he just had a feeling that it was so, he admitted that it was more in his head than in reality and there was no objective evidence there was anything wrong with it and none of the women he had had sex with had ever mentioned that there was anything wrong with his penis.

The association threw light on his poor self esteem about his ability to make love, but did not help in coming closer to the basic meaning of the dream. And since there was limited time available to analyze the dream, and also because I was quite familiar with the patients problems and the complexes around which his illness, schizophrenic breakdown occurred,  I took the step of making the following construction: "We know that behind your fascination with these old statuesque houses lies your fascination with your mother. Could it be possible your swindling and buying that beautiful house from the old man so he could not turn it into a church was symbolic of your buying your mother from you father so you could fulfill your aims with her instead of letting him continue to have his will with her." This conjecture was based upon his buying the house to prevent it from becoming a church. Now churches, temples, mansions, statuesque houses are typical symbols of the mother, but that version of the mother which is common property of all men (God's/father's house ), best symbolized by Madonna and thus sexually unapproachable.

The patient first objected to this conjecture  on grounds that the man was Caucasian and his father was Black but then immediately added, "My grandmother was as white as any Caucasian lady and I always put her and my father in the class of Whites."

Then after a few minutes in which he talked about things unrelated to dream he spontaneously  volunteered the following, " I now know why the house is at an angle. My mother was very pretty and thin. And as you know he was a player who had children and relationships with other women besides my mother. So he was in and out of our life. But when he would come to our house I would be afraid that when he would have sex with her, his penis would go right through her body because she is so thin. But then I would tell myself that his penis will be bent and go upwards at an angle and not through her."

He was asked to draw the angle in which his father would have sex per his childhood imagination. He drew a very erect penis, almost vertical, with one testicle, which surprisingly was not dangling below the root of the penis but projecting upwards over it.  

"How did you know about erection and yes about sex itself at that age?"

"I knew about sex and erection as early as when I was 5. Perhaps earlier. I already was having erections then. There were also two boys in the neighborhood, who had access to Playboy and Penthouse, and we would look at those pictures at their house. Also with my cousins, who were slightly older than me, I would sometimes play games in which we would show each other our private parts. I remember how intensely curious I was about their bodies."

"Is your seeing every part of that ship so vividly, a continuation of this sexual curiosity which you were already exhibiting so strongly at that age?"

"That makes sense. I do know that when I first started having sex with women, which was pretty late in comparison to other kids that I grew up with, I would be so curious about their bodies that they will say, 'oh no, you are more interested in examining me than making love. You are supposed to make love to me not examine me like a doctor. "

As for there being so many rooms in that ship, on theoretical grounds, I conjectured that it was an allusion to marriage as well as its contrary: to have sex with endless number of women (symbolized by rooms). It was depiction of his utter fidelity to his mother and always choosing her over all others, and yet it depicted its contrary: a desire to spite her by having liaison with endless number of  women.

But the patient swiftly rejected the latter part of the 'construction' claiming that that is how his father was: a player. But he is just the opposite of his father in this respect. He believes in having children only after marriage, and never having affairs.

Multiple rooms on the ship stood for marriage. It was depiction of marriage by showing all other women that one must give up for the sake of one. The comparison of that ship with a skyscraper also, perhaps, was his comparing other women to his mother and finding them short. It is interesting that he has never been able to make a break with his mother. And though the two are always complaining  about each others shortcomings and continuously squabbling, all attempts by him to live by himself or with other women have failed within no time. The fact that he is her only child, with his father dying when he was just 12, also has contributed to his inability to give up his love for his mother and find an extra-familial object.

When asked as to why the walls of the  house had beautiful projections that were pleasing to the eyes, he could come up with none and rejected my suggestion that it was an allusion to his mother's breast countering it with, "if it was symbolic of any body part it would be testicles and not breasts." When I asked him if he was being sarcastic he said, "No. That is the association that popped up in my mind." I wondered if it was compensation for the lack of penis in a woman by covering the defect with  endless beautiful projections (a phallic mother; testicles through displacement substituting for the penis).

As to why the dream was trying to show him as seaman, patient said - as only a schizophrenic can do, who often seem to have a gift for seeing through dream symbols - that it must allude to semen.

When asked why he said, "Because the water that was coming up to the backyard of the house was shaped as the shaft of a penis, with the advancing tide broad like a penile forehead. And you know what backyard on the street means. So the dream must be my attempting sex with my mother in that fashion. Though it is so strange that the very thought of such a deed during my waking hours would fill me with utter disgust. I have no attraction towards my mother whatsoever."