By Asad Yaseen*
Psychology has always been a road less travelled. It is when one leaves the library and tries to ensconce oneself in the wild with fellow sapiens, one deciphers that social skills and emotional homeostasis is more or equally relevant than specialized knowledge.
Daniel Goleman, in his famed opus – Emotional Intelligence, expatiates the two different minds in a human: the rational mind which is controlled by the neocortex and the emotional mind which sits on the amygdala. The sensory signals travel from the thalamus. The thalamus sends to twain — a faster signal to the amygdala then a second signal to the neocortex. This allows the amygdala to respond prior to the neocortex which may cause, as Goleman coined, amygdala hijack or a limbic hijack. However, with practice and therapy one can teach the neocortex how to inhibit the amygdala and take control.
The nucleus of this book is a hope for the patients of trauma. According to a study, a quarter of holocaust survivors, who once suffered from PTSD, recovered in their lives. This shows that trauma related psychological issues are emotional learnings which can be unlearned. Two techniques are given to deal with PTSD — related to exposure and cognitive therapies.
The first is to repeat the tragedy in low-anxiety, it begets a non-traumatized response and gradually the trauma related memories etiolate. Another technique by Dr. Judith Herman is mentioned which is a 3-step process. Firstly, the patient must be cognizant that he or she is suffering from PTSD. The second step is to rethink or reconstruct the trauma by telling others about it. This technique also helps in shifting from amygdala to the neocortex. The third step is to build relationship of trust with others to normalize lives because the patients of PTSD find it difficult to trust others.
The patients of trauma may also encounter embitterment disorder. Michael Linden and Arnold C.P. in the Psychotherapy and Psychosomatics, a peer reviewed Journal, have highlighted an important phenomenon known as PTED which is often misunderstood as pathological hate, envy or anxiety; however, is closely associated to querulent delusion.
Many a people, after the embittered exigencies of life and injustices, hop on this unbridled horse. The signs are aggression, self-blame, homicide, revenge and suicide ideation. If the embitterment, after an injustice, is longer than 3 months then one may use the PTED scale to measure it.
Wisdom psychology and CBT are recommended for such cases: forgiveness, empathy, having a perspective of future and changing one’s views about the negative life events — reframing them — are some tools.
Chronic stress is a phenomenon which may beget many psychophysiological maladies. Robert Sapolsky in ‘Why Zebras don’t get Ulcers?’ discusses how stress leads to or galvanizes chronic diseases like cardiovascular disease, ulcers and diabetes etc.
It is common for a zebra, if he is chased by a lion, to run for his life and have elevated stress response. However, if one receives the same stress response when finds oneself in any minor situation of distress which is not damaging then it may lead to certain maladies. Here, the stress response actually becomes greater than the stressor. A blood pressure of 180/100 is normal if one is being chased by a lion. However, if it is normal in any run of the mill stressor then one is prone to many diseases.
Stress related issues emanating from social hierarchy are pervasive among the hasty hoi polloi. In controlled environments, whilst observing animals, it is noted that the baboons who are lower in hierarchy have higher glucocorticoid levels, activated stress response and thus are prone to stress related diseases and an early mid-life death. Another case is that of the changing hierarchy, where the baboons in upper hierarchy are prone to stress related diseases because the ones from lower hierarchy make alliances and try to supplant the one’s sitting above and destabilize the status quo.
Surprisingly, a South American race of monkeys known as the marmosets are not prone to stress related issues emanating from social hierarchy. They have high reconciliatory behaviours. For them, subordination is a relaxed waiting strategy. They do not feel uncomfortable whilst being in the lower hierarchies, they are cooperative to their dominant contemporaries and have the feeling that one day they’ll also graduate. This is how they beget a healthy lifestyle.
Stress not only deteriorates physical health, but also the mental health. Joseph Zubin and Bonnie Spring, in the Journal of Abnormal Psychology, maintained that vulnerability is the key to chronic mental illnesses like schizophrenia. It takes a cursory glance on the aetiology of different approaches such as ecology, learning, genetics, internal development and brain function. However, comes to a conclusion that vulnerability is the pivot of mental illnesses. These disorders happen due to faulty habits of reaction to life’s exigencies.
When stress exceeds vulnerability threshold, an episode might ensue. However; as it abates, the person returns to a pre-episode level of adaptation. A string anecdote is the best to understand the vulnerability model. A string, when load applies, has one of the four manifestations: a) stand the load whilst heat may generate b) lengthen temporarily, but return to original position when load is removed, c) lengthen permanently or d) break under the load.
Adaptation describes the extent to which an organism responds adequately to life’s exigencies. The three components of adaptation are the jewel of this book which helps one maintain a homeostasis. 1) The Coping Effort — A drive to do something to correct the imbalance. 2) Felt Discrepancy between the present state and erstwhile happier state — this makes one think about what has gone wrong. 3) Competence — the skills to formulate coping strategies.
For Psychosis, Paul Chadwick’s ‘Person based therapy for distressing psychosis’ open avenues for the therapist to form a radical collaboration with the client. The therapist must keep in view that one must meet the person not the problem.
The cognitive therapy consists of various journals and models through which person may challenge their beliefs and take strides to the road of recovery. The Patient must have cognizance about the fact that Beliefs (B) are not Facts (A) — through the ABC model worksheets, the person in distress may change one’s beliefs.
The Metacognitive approach helps find evidence to refute the beliefs. The patient is advised to give an opinion if he thinks that his beliefs are 100% right then the proportion is lessened to 50% — this begets a doubt in patients mind and gradually takes strides towards complete rejection of the delusional belief. Another is a unicorn method which makes one’s question the delusional beliefs.
Mindfulness, a tantamount to Buddhist sati, is pertinent in maintaining a decentred awareness. This is to bring decentred awareness to unpleasant psychotic sensations.
With a two-chair method the patients themselves can bring about a Positive Self Schemata (PSS) whilst learning that the Negative Self Schemata (NSS) is not Self, but just the experience of the Self.
Now, there comes a very interesting manifestation in the patients of Brain tumors. In the World Journal of Psychology by Subramoniam et al. and African Health Sciences by JR Ouma, patients with brain tumors showed psychotic manifestations. In one case, a patient remained psychotic till 1 1⁄2 year until a brain tumor was found. With the removal of the brain tumor through craniotomy, the patient remained free of psychosis.
There is a myriad of cases whence after the removal of brain tumors, patients became completely free of psychosis. Patients with tumors in the left frontal lobe manifested agoraphobia and, in some other reviews, patients showed schizophrenia like psychosis, bipolar disorder and hyper-religiosity with right parietal lobe abnormalities like brain tumor, lesion, psychomotor dysfunction or hyperexcitability. In Frontiers in Psychiatry, Lars Levi Dutschke, et al. noted a case where thalamus related lesion caused hyper-religiosity and psychosis.
It is, therefore, a possibility that psychosis may be triggered due to brain tumors or lesions. MRIs and brain scans may help such cases.
*Asad Yaseen is a columnist based in Lahore