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   . the environment .

Origins of Chronic Illness Part II

The Environment
The concepts presented here draw from scientific research demonstrating the role of environmental factors in nervous system development and regulation, and in origins of disease. View or Download PDF (200k) of a related article (Medical Hypotheses 2004, vol 63(6), pp 1035-1046) for more information. Illustrated with a case study of type 1 diabetes, also presented in a less formal example.
I. Introduction
Patterns of nervous system regulation are geared to promote growth and learning, or survival. When we perceive that we are safe, for example, we can eat, digest, be creative, and renew ourselves with restful sleep. When we perceive danger, on the other hand, the nervous system directs the body, emotions, and mind to respond with the survival-oriented defenses of fight, flight (sympathetic), faint (parasympathetic), and freeze (parasympathetic and sympathetic). Survival functions operate at the expense of digestion, rest, and other growth-promoting processes, which are not important for short-term survival.

When a threat is no longer present, a healthy nervous system
1) accurately perceives the new environment of safety,
2) stops responding defensively,
3) resumes activities associated with recovery, growth, and learning.

sinus waves vary in size depending on degree of rest or activity
Figure I-1. Health. In health, the nervous system oscillates up and down with ease, maintaining homeostasis based on accurate perceptions of its environment and needs.


II. Perception Influences Risk for Symptoms
From our increasing understanding of the interactions between the mind and body, as well as between the nervous systems and the environmnent, we are learning that life experiences directly influence the way individuals learn to perceive their environments. This is particularly true of relationships in early life and of trauma.

The way our nervous systems regulate influences all other organ systems (see brain), affecting such factors as blood pressure, heart rate, digestion, temperature, etc. The way the nervous system regulates is based on its perception of the environment. Chronic illness and symptoms also appear to be influenced by the way we (ie: our nervous systems) have learned to perceive the environment.

Individuals with a history of trauma, or who have had challenging experiences in early life often have unconsciously learned 1) to perceive the environment as threatening and consequently 2) frequently live in activated states of survival at the expense of states of growth and learning.

Patterns associated with risk for physical and emotional symptoms as well as for chronic illness involve repeated activation of states of survival, and result in a change in the ability of the nervous system to oscillate and to support growth and learning (see early life and trauma). As described below, these different states of nervous system regulation represent normal patterns that have become exaggerated in an attempt to cope with perceived threat. These exaggerated patterns provide a way of understanding the intelligence of the mind and body, even in chronic illness.

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III. Chronic Illness and Symptoms arise from changes in Patterns of Nervous System Activity
Symptoms represent intelligent attempts by the nervous system to defend and protect us. These states of survival arise from perceptions that we have learned through trauma or experiences in early life, and are consequently unique to each individual. These changes in the nervous system include patterns of

a. Dominance of the SNS

b. Dominance of the PNS: faint

c. Dominance of the PNS over the SNS:Freeze

d. Exaggerated Cycling

e. Individual combinations of dominance and exaggeration


sinus waves showing dominance of SNS or PNS sinus waves showing dominance of PNS below the boundary deep sinus waves crossing boundaries above and below
 Fig IIIa. Dominance of SNS
(Fig IIIb. Dominance of PNS)

Fig IIIc. PNS Dominance:Freeze

PNS dominates over SNS arousal
 Fig IIId. Exaggerated Cycling



IIIa. Dominance of the Sympathetic Nervous System

sinus waves showing dominance of SNS


Figure IIIa. SNS Dominance.

Under Normal Circumstances, the Sympathetic Nervous System promotes the ability to be active as well as the survival mechanisms of fight or flight (more...). A state of sympathetic dominance may be learned during relationship interactions in early life (including in the prenatal period or the time frame around birth), and as a result of trauma.

Examples of Chronic Illness and Symptoms that reflect dominance of SNS activity include:

anxiety
(fast) arrhythmias
heart disease
hypercholesterolemia
hypertension
hyperthyroid
hypervigilance
infertility
(reproduction is deferred during threat and sympathetic arousal)
panic attacks
poor sleep
sjogren's syndrome
type 1 diabetes
type 2 diabetes?:

Insulin resistance is a normal part of sympathetic arousal and is aimed at maximizing fuel availability. Increased fuel storage, however, is a sign of parasympathetic activity (PNS:faint). There may be two forms of type 2 diabetes, one with greater dominance of sympathetic arousal and greater insulin resistance (type 1.5?) and another associated with weight gain / obesity, depression. If such differences exist, individuals with type 1.5 might have a greater risk for hypertension, hypercholesterolemia, heart disease, anxiety and other signs of sns arousal. The parasympathetic form may be associated with greater risk for depression and occasional hypoglycemic events. Another persepctive is that type 2 diabetes may be a disease that oscillates from sns to pns states (exaggerated oscillation, below), although lack of hypoglycemia makes this unlikely.



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IIIb. Dominance of the The Paraympathetic Nervous System: Faint

In health, the parasympathetic nervous system promotes the ability to rest and recover through sleep, eating and digestion, and a sense of safety. Although incompletely understood, the PNS appears to have two different states of dominance - one representing exaggeration and dominance of the typical state of rest, recovery, fuel storage, etc. The second is known as the freeze state, and occurs in the event of perceived life-threatening inescapable danger (trauma). In the freeze state, the parasympathetic state of near death suppresses a state of high sympathetic nervous system arousal, and exceeds the boundaries of homeostasis.


sinus waves showing dominance of PNS


Figure IIIb. PNS Dominance:Faint.


Examples of illness and symptoms associated with PNS dominance (Faint) include:

Asthma:
Bronchoconstriction is the hallmark of asthma and may be in the faint (Figure IIIb) or freeze state (Figure IIIc, dorsal vagal nerve: Steve Porges).

Autism
Chronic Fatigue: This state may exist in faint or freeze (see below).
Depression
Fainting (Syncope)
Hypothyroid
Weight gain / Obesity


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IIIc. Dominance of the The Paraympathetic Nervous System:Freeze



sinus waves showing dominance of PNS below boundary


Figure IIIc. PNS Dominance: Freeze.


The freeze state represents the most extreme defense strategy at our disposal, and hence is only used as a last resort, seen as "feigned death". Although incompletely understood, the freeze state is known to occur when an animal in fight or flight perceives that its current state sympathetic arousal will not work. When this happens, unconscious processes in the brain suppress the SNS response with the very powerful freeze state, which is associated with severe downregulation in a last attempt to survive until the danger is past. This freeze or immobility state may resemble a form of hibernation or near death and is commonly associated with trauma.


A prototype of the freeze state is Chronic Fatigue:

This is a state in which fatigue is predominant yet an underlying activation of sympathetic arousal often precedes diagnosis (history of being highly industrious ("workaholic")) for many years, and with diagnosis have poor sleep, hypervigilance, little to no weight gain despite increased appetite, agitated depression,... Some individuals may experience fatigue at the "faint" end of the spectrum (faint) without the signs of sympathetic arousal.

Other examples include:
Asthma: associated with constriction of the bronchi, mediated by the dorsal vagal complex (... more)
Fibromyalgia: is similar in many ways to chronic fatigue, with the addition of chronic pain
?Alzheimer's: appears to be consistent with a state of severe dissocation
?Autism: involves flattened affect, reduced social interaction, internal focus...
...
More


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IIId. Exaggerated Cycling


sinus waves showing exaggerated cycling across upper and lower boundaries


Figure IIId. Exaggerated Oscillation.



An increase in oscillation between SNS and PNS is commonly seen following trauma, and PTSD is the prototype for this pattern. A pattern of exaggerated cycling may also be learned in early life, such as from a parent with a history of trauma or PTSD and a nervous system that also regulates in exaggerated cycles (rage, depression, abuse...) (see early life and trauma). Because it may take time for a conditioned response to kindle and grow, symptoms such as PTSD may not appear for days, months, or even years following a traumatic event. The model of PTSD is applicable to our understanding of the origins of chronic illness and symptoms.

The period between cycles of SNS and PNS is influenced by the number and intensity of triggers and is highly individualized. An individual may switch from one state to another a few times a day, or only a few times a month. Cycles may also last for years, such as occurs in PTSD when an individual spends years in a state of SNS dominance (anxiety and hypervigiliance, constipation, ...) followed by years of PNS dominance (difficulty focusing and remembering, depression, fatigue).


Examples of illness and symptoms associated with exaggerated cycling include:

Posttraumatic stress disorder (PTSD):
oscillation between anxiety and depression; hypervigilance and numbness; diarrhea and constipation...
Autonomic Dysregulation (Dysautonomia; Mitral valve prolapse syndrome) Irritable Bowel Syndrome: alternating diarrhea and constipation
Bipolar Disorder: alternating mania and severe depression
Mood Instability: alternating anxiety and depression
Narcolepsy?: sudden episodes of immobility and "freeze" in response to triggers
IV. Conclusion
From the somatic psychology perspectives presented here, chronic illness and symptoms represent an exaggeration of normal patterns and reflect changes in sympathetic and parasympathetic nervous system activity. According to this lens, chronic illness and symptoms evolve from and represent intelligent attempts to cope with overwhelming situations and result from the moment-to-moment perception of threat in the environment. This perception is conditioned through interactions with the environment of experience, and events that trigger a sense of threat are unique to each individual.


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