Tag Archives: Anxiety

THE TWO SIDES OF STRESS

Stress in modern times most often has a BAD connotation. Stress is blamed for a raft of disorders from headaches to cardiovascular disease. Indeed, stress activates the adrenocortical “alarm reaction”, and if unremitting can indeed implement many chronic problems.

ACUTE stress, however, is often beneficial. The body responds favorably to measured amounts of brief stress, especially if it is YOUR CHOICE, and not demanded of you. It is WORK, when you would rather be doing something else. It is FUN when you are hiking up a steep but beautiful trail in the Swiss Alps. The flavor of reality takes place in the mind.

HEAT SHOCK PROTEINS (HSP) illustrates how your body works. If you get a little overheated, HSPs are produced and benefit any misfolded proteins that result. If you go hungry, a metabolic pathway burns fat and increases insulin sensitivity. If you exercise your mind, BDNF and new neurons result.

THE BODY ADJUSTS TO THE DEMANDS, and benefits flow. The body is designed to function. The trouble is that placing demands on the body is effortful, and effort requires discipline. The Paleolithic Hunter-gatherer lifestyle, the reality to which our metabolism is attuned, REQUIRED plenty of aerobic exercise, just to get food and avoid harm.

Our modern life is replete with deadlines and requirements, and hearts beat rapidly from ANXIETY rather than aerobic demand. Even the trades, which used to require physical energy expenditure have a lot of labor-saving devices. Children, insead of running, ride around on electrically propelled scooters. Little wonder that people are “out of shape” and gaining weight.

–Dr. C

ORTHOSTATIC HYPOTENSION: ITS SYMPTOMS AND CAUSES

Our Nervous system is much more than consciousness and free will. Our neural networks automatically go about the job of keeping us alive without entering our awareness- unless it fails to perform.

This is true of our intestinal system, and especially our cardiovascular system. We would not have time for anything else if we had to consciously take each breath, command each heart beat, and for this discussion, open up (dilate) the blood vessels to our brain, and constrict the blood vessels in our legs whenever we stand up.

Our brains demand a constant supply of Oxygen and Glucose in order to perform their complex duties. Between 20% and 40% of the 100 Watts of energy our bodies consume is in our brains.

Whenever we stand up, the force of gravity “wants” to force our blood to our legs and away from our head. Unless that tendency is counteracted, our brains would be deprived of essential factors, and we would all have orthostatic (upright position) hypotension every time we stand up.

Normally, when the blood pressure drops from ANY CAUSE, receptors near the base of the heart and great vessels signal the sympathetic branch of the autonomic nervous system to cause a speeding up of the heart and a dilation of the blood vessels in the brain. This compensates for the drop in blood pressure, which is determined by the blood flow and resistance to that flow.

The sympathetic nervous system is a reaction to STRESS, to a “flight or fight” decision. In the short term, it is beneficial, or adaptive. You may know the feeling, heart racing, cold hands (due to constriction of blood vessels), breathing rate increases, and sweating.

The asthmatic feels this from a shot of adrenalin, which delivers the sympathetic reaction to the whole body through the blood stream. The musculature of the bronchial tubes are relaxed, improving breathing, and improving the asthma.

What is adaptive in the short haul may be deleterious if it continues, felt as Anxiety if it lasts too long.

ORTHOSTATIC (postural) HYPOTENSION may be made worse by a variety of other influences, such as an abnormally slow heart, rate, dehydration, blood loss, certain medications and standing still too long.

Since the brain needs both Oxygen and Glucose, High altitude or a
low blood sugar will also facilitate faintness. If you have a tendency toward lightheadedness when you stand up, be careful lest you fall and injure yourself.

If you are unable to cope with these spells, a checkup with your Doctor may be in order; perhaps you have an underlying problem, such as with your heart, which is the next subject of discussion.

–DR. C

MENTAL HEALTH: SOME THOUGHTS ON DIAGNOSING AND TREATING “DEPRESSION”

I recently posted a discussion on osteoporosis that was based on a MNEMONIC, using the word itself as the basis of exploring the Risk factors Evidence that you have Osteoporosis is hidden, and are discovered by Dexascan, or when you suddenly have a major fracture.

DEPRESSION is common, but sneaks up on you. It may be a job to discover that you have it, to DIAGNOSE it, so that you can be treated. The diagnosis has about 10 markers that can be formulated into a mnemonic, so that you can remember what they are. My favorite is by Paul Blenkiron, writing in the BMJ:

These 10 symptoms are described in the 10th edition of “the international classification of Diseases. The problem with some mnemonics is to remember the mnemonic itself.

Not here. Interestingly, The 4 PILLARS OF HEALTH are each represented in this list. 3 of them are valid TREATMENTS for DEPRESSION, as you will see in the following articles. When I looked up intellectual stimulation as a treatment for Depression, all i found was electrical or magnetic deep brain stimulation.

I can’t help but believe that INTELLECTUAL STIMULATION itself would at least help ward off much Anxiety and Depression. SLEEP has an interesting relationship to depression. Lack of sleep can be a CAUSE of Depression.

Recently, deprivation of sleep has been used to TREAT episodes of severe depression. Obviously there is a lot we don’t know. Another puzzlement is the several week delay in the effect of SSRI medications. I acknowledge that throughout history many great intellects have manic-depression, which may be key to their productivity.

Depression itself is credited with deep understanding. The “black Dog” of depression is best avoided, however. A HEALTHY LIFE STYLE SHOULD HELP WARD OFF DEPRESSION.

–Dr. C.

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OPINION: “HIGH ANXIETY IN THE TIME OF COVID-19”

Develop interest in life as you see it; in people, things, literature, music – the world is so rich, simply throbbing with rich treasures, beautiful souls and interesting people. FORGET YOURSELF.

Henry Miller

Individualism and authenticity are highly valued traits in a free democratic society. My own concepts of American ideals canonize the  associated freedom. But there is never a “free lunch” in the realm of human nature.

Roy F. Baumeister’s  Book, “Escaping The Self” (which I read a couple of decades ago and either loaned out or lost) started me thinking about the BURDEN OF SELFHOOD. I recently listened to a BBC podcast on the Philosophy of Authenticity (BBC Radio 4 – In Our Time has upwards of 1000 forty-five-minute programs on topics I recommend highly). They discussed the  plight of the “Existential Hero”, and rekindled my interest in the over-demanding Self,  which idea I will argue can help guide an approach to ANXIETY.

Cooped in by SARS CoV-2, the U.S. has experienced a sharp rise in Anxiety and Depression. The Pandemic has deprived us of the sociability, diversions and travel that had previously lured us outside ourselves, and our jobs (except for the computer-connected) which give us purpose. The connectivity (and self-abnegation preached) in religious services has long been on the wane in secular America, and Covid 19 has temporarily closed the remaining Houses of Worship.

How does the Idea of getting OUTSIDE OURSELVES help the person in the grips of Anxiety? If nothing else, it serves as an organizing principle for the CHANGES IN BEHAVIOR (eg. CBT) necessary for lessening Anxiety. Changes in behavior are necessary; you cannot merely will Anxiety away.

IMAGINE the self as an expensive over-large HOUSE. It’s construction started at the moment of your birth, and progressed through infancy (perhaps with a few defects- we can always blame our parents – i.e. attachment theory). It was damaged by Adolescence, improved by our education and occupation, and remodeling continues our entire lives.

Being restricted to our homes is like Solitary Confinement. Having only our own minds to keep us company is severe punishment for 99% of humanity. What would you do if deprived of the internet and confined to a mountain cabin for just one day?  We are used to pervasive and instant connectivity. Our norms of isolation now would have been considered quite expansive just a generation ago. Well, maybe practice living with ourselves is a benefit of Covid – that which does not kill us, etc…

Using the house analogy, we spend a lot of Money and effort decorating the outside of the house  to impress our neighbors (‘amor propre’ of Rousseau). Spending time on Facebook rather than improving the inside, via  re-framing and behavioral change. The many rooms of the house also suggests the many compartments of the mind, some of which are more accessible than others, some almost unknown.

The analogy is far from perfect. For one thing our house should have legs to let us, the little person inside (the ‘homunculus’ of consciousness metaphor), walk our expensive and beloved (I hope) house through the world. Or better yet, ESCAPE IT BY OUTWARD FOCUS.

The ‘yourself-embracing reality’, out in the world, without the distortions (and protections) of your carefully crafted identity.

Do you dare?

Service (work) gets you outside yourself. To quote Kant:

“I slept and dreamt that life that life was joy. I awoke and saw that life was service. I acted, and behold, service was joy.”

Mindfulness (meditation) gets you outside yourself, to focus on the outside world. The religions of the world prescribe much of our behavior, defining our self-importance, and our expensive houses as “pride”, as something to diminish.

The word Ecstasy (not the recreational drug) is from the Greek (“to step outside oneself”). Ecstasy ( as well as orgasm, i.e. Woody Allen) may be OK occasionally, but for every day, most of us would prefer the Delphic Oracle admonition: “Medan agan (μηδὲν ἄγαν) – “Nothing in Excess”.

Enough hot air already! For those who prefer practical tips or neurobiology to conceptual framework, see the articles below.

-Dr. C.

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