««THE MEDICINE OF SUFFERINGTHE MEDICINE OF SUFFERING»» (STRESSOLOGY)(STRESSOLOGY)

Ada Tadevosyan

Department of Stressology, National Institute of Health Care

Yerevan, Armenia

The entire history of mankind is struggle The entire history of mankind is struggle against suffering as an inalienable part of life.against suffering as an inalienable part of life.

At the turn of the third millennium, the At the turn of the third millennium, the humanity is again confronting the dramatic humanity is again confronting the dramatic problems: overpopulation, hunger, drug problems: overpopulation, hunger, drug addiction, crime, terrorism. addiction, crime, terrorism.

In this disconsolate picture, the problems of In this disconsolate picture, the problems of health have become more relevant than in the health have become more relevant than in the preceding millennia, while preceding millennia, while THE PROBLEM OF THE PROBLEM OF MENTAL HEALTHMENTAL HEALTH is growing in importance. is growing in importance. Mental health is a measure of the society’s Mental health is a measure of the society’s welfare. welfare.

What is observed:What is observed:

1.1.An unprecedented growth of cardio-vascular An unprecedented growth of cardio-vascular diseases, diabetes, allergies, immune deficiencies, diseases, diabetes, allergies, immune deficiencies, cancers.cancers.

2.2.According to WHO (1998), 22% of primary According to WHO (1998), 22% of primary health care users have shown anxiety or health care users have shown anxiety or depression.depression.

Indicator of chronic fatigue syndrome is 2.6, Indicator of chronic fatigue syndrome is 2.6, i.e. it is as frequent as diabetes.i.e. it is as frequent as diabetes.

Somatized disorders are as frequent as Somatized disorders are as frequent as schizophrenia, while their soft forms are even more schizophrenia, while their soft forms are even more frequent: 8.2 frequent: 8.2

Somatic conversions went down with regard to Somatic conversions went down with regard to the professional interest and distribution within the the professional interest and distribution within the population, nevertheless they occur 50 to 100 000, with population, nevertheless they occur 50 to 100 000, with a possible duplication in 12 to 24 months (Akagi & a possible duplication in 12 to 24 months (Akagi & House, 2001) House, 2001)

Over 40m. Americans aged 18 to 64 suffer Over 40m. Americans aged 18 to 64 suffer anxiety syndromes anxiety syndromes

In 1987 – 1997, the number of Americans treated In 1987 – 1997, the number of Americans treated for depressions fluctuated within 1.7 to 8.3m. for depressions fluctuated within 1.7 to 8.3m.

3.3. Unprecedented growth of social diseases: Unprecedented growth of social diseases: drugs, alcohol, suicides, aggressive behavior & drugs, alcohol, suicides, aggressive behavior & terrorism.terrorism.

Increased funding of healthcare, Increased funding of healthcare, even in developed countries, even in developed countries,

modern engineering in medicine modern engineering in medicine and unprecedented and unprecedented

development of pharmaceutical development of pharmaceutical therapy have produced no therapy have produced no

expected effect in improving the expected effect in improving the quality of healthcarequality of healthcare

1.1. No No integral concept of man.integral concept of man.

No integral concept of the External No integral concept of the External and Internal, the Mental and the and Internal, the Mental and the Somatic, the Bodily and the Spiritual; Somatic, the Bodily and the Spiritual; no concept for the physician in his no concept for the physician in his everyday work.everyday work.

2. Insufficient attention to mental stress origin by healthcare specialists.

Possible causes:

BASIC LANDMARKS OF BASIC LANDMARKS OF HEALTHCARE IN 20TH CENTURYHEALTHCARE IN 20TH CENTURY

1.1.The biological concept in medicine is a The biological concept in medicine is a biological model of disease biological model of disease

2.2.Non-availability of a unified concept of Non-availability of a unified concept of manman

“…“…Our science has weighed and measured Our science has weighed and measured both the smallest and the largest, (the both the smallest and the largest, (the

micro world and outer space), while what is micro world and outer space), while what is directly concerned with our flesh and directly concerned with our flesh and

blood, what is closest to us – the human blood, what is closest to us – the human suffering and distress – has been suffering and distress – has been

completely disregarded and totally completely disregarded and totally discarded by science. discarded by science.

Muller-Lieer Muller-Lieer

Mental Stress Origin,Mental Stress Origin,

remaining in the background of remaining in the background of research and clinical work, research and clinical work, continued to ruin the health of continued to ruin the health of individuals, communities and individuals, communities and countries.countries.

The mentally affected human massThe mentally affected human mass carries destructive potentialcarries destructive potential returning returning to the societyto the society in the form of increased in the form of increased incidence of disease, behavioralincidence of disease, behavioral disorders and social disruptions.disorders and social disruptions.

A mental injury is stipulated not only A mental injury is stipulated not only by natural, technical or social by natural, technical or social

disasters, it is only the top of the disasters, it is only the top of the iceberg. iceberg.

The entire iceberg is a life full of The entire iceberg is a life full of stressful events.stressful events.

Psycho-social Psycho-social distress (suffering) is distress (suffering) is much worse than much worse than epidemics or natural epidemics or natural disasters. Unseen, disasters. Unseen, unmeasured personal unmeasured personal stress does its stress does its destructive work from destructive work from the insidethe inside..

The Quiet MurdererThe Quiet Murderer

StressStress is an abyssis an abyss swallowing silently thousands of lives;swallowing silently thousands of lives;

hidden poisons, underwater rocks crushing hidden poisons, underwater rocks crushing so many lives so many lives

or inflicting incurable wounds.or inflicting incurable wounds.

Muller-Lieer

Man is Cognizant Man is Cognizant TriunityTriunity (the biological, the psychic and the social).

The core of this Triunity is the General Adaptation Syndrome (GAS) discovered

by G. Selye

Stressor+vulnerability+GAS the algorithm of life

Phase three of stressor reaction – phase Phase three of stressor reaction – phase of of depletion depletion (aesthetic stage) (aesthetic stage)

Stressor

End organs

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End organs

Endocrine axes

Biochem

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DIAGRAM OF GENERAL ADAPTATION SYNDROME IN THE DIAGRAM OF GENERAL ADAPTATION SYNDROME IN THE NORMALNORMAL

Thought

Psycho-physiological mechanisms of Psycho-physiological mechanisms of stressor processesstressor processes

High-speed effects are provided through High-speed effects are provided through connection of neuron axis and manifested by connection of neuron axis and manifested by

the phase of red alert the phase of red alert

Long-time effects are achieved by connection Long-time effects are achieved by connection of endocrine axes and manifested by the of endocrine axes and manifested by the

second phase of resistance (tension)second phase of resistance (tension)

Anthropogenic psycho-emotional stress (APES)

Is retained as echo-effects Contains a new psychic phenomenon – cognition (imagination) Is specific for man Multi-sensorial Can emerge years thence

Sensor echo-stressorSensor echo-stressor

Stressful event is retained in memory as Stressful event is retained in memory as pictures, situations or their fragmentspictures, situations or their fragments

Retained holograms or printed copies of Retained holograms or printed copies of injuries, having all features of a real event injuries, having all features of a real event (psychic hologram) can emerge from memory (psychic hologram) can emerge from memory from time to time under the influence of from time to time under the influence of random stimuli triggering the stressor random stimuli triggering the stressor process.process.

Variants of “ECHO-STRESSORS”Variants of “ECHO-STRESSORS”

Sensorial – flash-back, nightmares, Sensorial – flash-back, nightmares, somatic conversions.somatic conversions. Emotional (phobias, panic attacks)Emotional (phobias, panic attacks) Kinetic (epileptic-type fits)Kinetic (epileptic-type fits) Cognitive – psycho-somatic Cognitive – psycho-somatic disordersdisorders

STRESSOR

De-adaptation range

APES

somatic range

neurotic range

psychotic range

personal range

SPECTRUM OF HEALTH AND BEHAVIOR SPECTRUM OF HEALTH AND BEHAVIOR DISORDERS CAUSED BY STRESSDISORDERS CAUSED BY STRESS

1.1. A sudden omnipotent stressor causes error in the A sudden omnipotent stressor causes error in the system of forecasting realitysystem of forecasting reality

2.2. Exogenic chronic stress (life filled with stressful events)Exogenic chronic stress (life filled with stressful events)

3.3. Stress triggers a specific variant of genetic pre-Stress triggers a specific variant of genetic pre-dispositiondisposition

4.4. Ability of man to register traumatic events in the form of Ability of man to register traumatic events in the form of echo-stressors of different levels, or to be registered echo-stressors of different levels, or to be registered upon their traumatic concept, generate a human-specific upon their traumatic concept, generate a human-specific base of mental timing of stressful event and a risk of base of mental timing of stressful event and a risk of developing the after-stress disordersdeveloping the after-stress disorders

PROBABLE REASONS FOR TRANNSFORMING THE ADAPTATION PROBABLE REASONS FOR TRANNSFORMING THE ADAPTATION MECHANISM OF STRESS INTO A PATHOLOGYMECHANISM OF STRESS INTO A PATHOLOGY

We are now looking We are now looking

at a destructive type of at a destructive type of developing the world civilizationdeveloping the world civilization

resulting from resulting from

an uncontrolled development an uncontrolled development of psyche and of the General of psyche and of the General Adaptation SyndromeAdaptation Syndrome

Development of mind and speech, Development of mind and speech, imagination and thinking entailed imagination and thinking entailed

the development of the new forms of the development of the new forms of GAS.GAS.

The Thought, as a stressor, made The Thought, as a stressor, made the brain react with one component the brain react with one component of the stressor process, viz.: with of the stressor process, viz.: with anxiety, or tension, or depletion. anxiety, or tension, or depletion. There was a disintegration of a There was a disintegration of a

single stressor processsingle stressor process

The formation of meaning and echo phenomena The formation of meaning and echo phenomena are the distinguishing characteristics of man.are the distinguishing characteristics of man.

The ability to substitute environmental signals The ability to substitute environmental signals with meanings and to display emotional reactions with meanings and to display emotional reactions (suffering or emotion) creates a basis for timing the (suffering or emotion) creates a basis for timing the stressed condition.stressed condition.

The response consists in generating a new The response consists in generating a new option of adaptation in the form of the stressor option of adaptation in the form of the stressor phases becoming autonomous.phases becoming autonomous.

The adaptive strategy of phases The adaptive strategy of phases (anxiety, tension and asthenization), as (anxiety, tension and asthenization), as links of an integral stressor process in the links of an integral stressor process in the normal, were enabled to appear normal, were enabled to appear independent of each other, and became independent of each other, and became independent mechanisms to be triggered independent mechanisms to be triggered by any psycho-emotional stressor or by any psycho-emotional stressor or thought.thought.

All phases of GAS have become All phases of GAS have become autonomousautonomous

All phases of GAS have become autonomousAll phases of GAS have become autonomous

autonomous nature of anxiety (alarming, autonomous nature of anxiety (alarming, somatic dissociative distress),somatic dissociative distress),

autonomous nature of tension (psycho-somatic autonomous nature of tension (psycho-somatic diseases)diseases)

autonomous nature of asthenization (syndrome autonomous nature of asthenization (syndrome of chronic fatigue).of chronic fatigue).

LINEARITY in these cases is LINEARITY in these cases is explained by the fact that the developed explained by the fact that the developed mechanism of autonomous activation of mechanism of autonomous activation of some GAS phase in response to some GAS phase in response to external or often internal stressors external or often internal stressors without triggering the entire stressor without triggering the entire stressor

processprocess

RESULTS FROM PSYCHODYNAMICS RESULTS FROM PSYCHODYNAMICS or HISTORICAL UPDATING OF GAS.or HISTORICAL UPDATING OF GAS.

What has been reported demands What has been reported demands a basically new science, pushing a basically new science, pushing forward the need for close integrative forward the need for close integrative cooperation between life sciences and cooperation between life sciences and psycho-social sciences.psycho-social sciences.

At the French-Soviet conference in At the French-Soviet conference in Moscow, 1990, and at World Congress on Moscow, 1990, and at World Congress on urgent psychiatry in Amsterdam I used the urgent psychiatry in Amsterdam I used the term “stressology” to denote the new trend in term “stressology” to denote the new trend in medicine, or the science on interrelations medicine, or the science on interrelations between the mental and the bodily, on the between the mental and the bodily, on the transition of the normal into the pathological. transition of the normal into the pathological. Stressology is placed on the junction Stressology is placed on the junction between the life sciences, psychology and between the life sciences, psychology and sociologysociology. .

THE SUBJECT OF STRESSOLOGYTHE SUBJECT OF STRESSOLOGY

The problem of interrelations between The problem of interrelations between vulnerability and stress, specific nature of vulnerability and stress, specific nature of APES, variants of echo-stressors and their APES, variants of echo-stressors and their role in forecasting; diagnostics, treatment role in forecasting; diagnostics, treatment and therapy of post-traumatic stress and therapy of post-traumatic stress disorders, behavioral variations, stress disorders, behavioral variations, stress resistance, stress management, forms and resistance, stress management, forms and methods of organizing the stressological methods of organizing the stressological service and training of stressologistsservice and training of stressologists.

«My work on stress is far from being «My work on stress is far from being complete, I am aware that I am not complete, I am aware that I am not

destined to see its end, for we destined to see its end, for we constantly encounter new ways of constantly encounter new ways of

treating nearly all biological problems, treating nearly all biological problems, there will be no exaggeration in saying there will be no exaggeration in saying

that that is what is always going to that that is what is always going to happen to medicine and biology». happen to medicine and biology».

(H. Selye, 1982).(H. Selye, 1982).

The concept by H. Selye on GAS, The concept by H. Selye on GAS, revealing the universal mechanism of revealing the universal mechanism of interconnection between the external interconnection between the external and internal, the mechanism linking and internal, the mechanism linking together the environment, the psyche together the environment, the psyche and the body of man, the mechanism and the body of man, the mechanism of probable transgression of the of probable transgression of the normal into the pathological, is in an normal into the pathological, is in an ongoing development.ongoing development.

We have come to the limit where the H. We have come to the limit where the H. Selye doctrine on stress was raised to a Selye doctrine on stress was raised to a qualitatively new step, qualitatively new step,

The term “stress” is coming back to its The term “stress” is coming back to its original meaning.original meaning.

The poet R. Manning wrote in 1303:The poet R. Manning wrote in 1303:““Manna was sent from heaven by God to Manna was sent from heaven by God to people who had suffered a great stress”.people who had suffered a great stress”.

At the turn of the 19th century Francisco At the turn of the 19th century Francisco Goya painted a series of images titled Goya painted a series of images titled “Desastress”, reflecting the human suffering.“Desastress”, reflecting the human suffering.

the step of Cognizant Psyche.the step of Cognizant Psyche.