FreePsychArticles #11 The Ecology of Psychiatry
What’s all the fuss?! Everyone’s talking about “saving the planet, saving energy, balancing ecosystems and global warming.” It seems to be the consensus of many the planet is in trouble. What do all these concerns have to do with us? With our personal daily lives? I believe psychiatry has a lot to say about our lives and our “internal ecology.”
Here’s what Wikipedia says about Ecology: ”Ecology (from Greek: “house”; “study of”) is the scientific study of the relation of living organisms to each other and their surroundings.”
I think there’s a parallel process within the individual. Concepts like preservation of energy and resources are easily applied to the individual. ”Life processes and adaptation,” both studied by ecologists, relate to the individual’s internal processes and adaptation. “The movement of materials and energy through living communities” in ecology finds a parallel in both the molecular biology of psychopharmacology and the redirection of temperament and emotions.
Just as the earth has a limited amount of energy available at any given time, human beings can think about their own energy system. There is much value in raising the question of how one utilizes his own energy with the most efficiency. Some people have excesses of emotional energy while others seem to have too little. Another way to think about emotional energy is the “level of arousal.” Arousal can be described or related to the idle of an automobile. The idle of a car is set to balance the running of the motor fast enough that it won’t die while slow enough to utilize fuel most efficiently. When the level of arousal is increased or hyperaroused, it is very difficult for an individual to reset it alone. Another analogy is climate, that as a rule remains fairly consistent in geographical regions, with shifting changes in the weather being variable.
In my work in psychiatry I use a diagnositic handwriting test called the “Eight Signature Array” to measure the overall level of arousal. (This test was developed by Thomas Kappeler, M.D., a neuropsychiatrist.) For the rest of this article I will refer to “arousal” as the working concept in the management of the “internal ecology.” But first, let me explain as little about the “Eight Signature Array (ESA).” One model is the EKG (electrocardiograph) machine that records the electrical impulses traveling through the heart muscle as it contracts, and prints a graph. The ESA uses the person’s own handwriting of his signature eight times in a column down a blank page to record information of his level of arousal. These eight signatures are timed and, with some simple calculations, converted into letters per second. Also, by measuring the boundaries of the signature “graph” one can calculate square centimeters per second. Both these measurements are compared to the rates of the normal population and the individual’s own average rates. From this it can be determined the basic level of arousal, by speed and area covered, for the person.
There are many things one can learn about a patient from this test, but for purposes of the present article I will focus on arousal and how to use it as way to utilize own’s own energies most efficiently.
One striking thing I’ve found is arousal does not necessarily correspond to a specific diagnostic category. Depressed people can be hypo-aroused or hyper-aroused. The same holds true for anxiety or schizophrenia. To some extent it is even true of Bipolar Disorder. Arousal levels do remain fairly constant in the same individual over time. Medication treatment can alter the level of arousal significantly, especially in acutely agitated patients. Cetainly stress in the person’s life can also effect arousal.
The question is, how does arousal work and how can it be ‘utilized’ most efficiently? First we must look at how the indiviual handles his own level of arousal. Most often, in my practice, patients will come for help in their mental health following a significant disruption in their life. They’ve lost their job, their home, or suffered some kind of loss. They find themselves lacking the usual pathways to fulfillment. It could also be a physical or medical problem curtailing their activities. In all these situations the flow of energy from inside to outside or vice versa has been effected. The internal ecology is upset and the normal flow has been altered. When one is actively pursueing his goals and fulfilling his needs the level of arousal, as a kind of energy source, finds connection with the appropriate conduits. When these conduits are blocked or altered, a damming of energy can be turned back on it’s source. The level of arousal, once consistant with one’s ability to direct and utilize, becomes a source of discomfort, or worse.
The interruption in normal internal ecological status can lead to increased levels of anxiety, irritabilty, depression or even physical problems. Each of these manifests in accordance with the person’s own particular nature. If there are genetic or constitutional tendencies, that is where the disturbance will take place. An simple example is the fellow who injures his back and subsequently heals. Later, when straining beyond his strength feels a recurrence of the original injury. When one has a disposition toward a psychological disorder, one that has been tolerable, becomes manifest again.
Part of the approach is to evaluate the basic level of arousal and how it manifests in the individual. In cases where the person is incapable of “redirecting” the arousal to fruitful or constructive activities because it is overwhelming medications may benefit. The goal is to reduce the arousal to a manageable level. This is, in fact consistant with the general use of medications in psychiatry as I see it.
With the use of the “Eight-signature array test,” the mental status examination and other objective observations the level of arousal can be monitored. Often the patient’s overwhelming sense of lost control can be reduced by this simple formulation. While not removing the responsibility for future temperance and descretion, does reduce some of the “passion for self-distrust,” as Dr. Low would say. Rather than focus on the behavioral manifestations of “too much or too little” we start with a relevant personal yet neutral cause underlying the behaviors. Thus, cognitive-behavioral therapy, for example, places things in the context of the person’s temperament, that he has no control over, and in touch with the actual aspects he does. In conjunction with this we focus on thoughts, speech and action as most accessible to conscious control. In other words, utilize the energy in areas one can affect like control of the muscles and thoughts while avoiding the trap of taking responsibility for things beyond one’s control.
The use of this formulation can bring a clear focus of a patient’s dilemna, limit the spectrum of impossible interventions, and define the individual’s goals for recovery into a more manageable program.
As we know, the balance of external ecology is a daunting task with numerous variables. It is an ongoing process of education, scientific inquiry and political exercise. The closer one can get to the source, the more able to understand and effect the multitude of manifestations.
The “Arousal Paradigm” briefly delineated in this article finds no place in the current (DSM IVR) Diagnositc & Statistical Manual, Fourth edition revised of the (ICD) International Classification of Diseases. In future articles I hope to discuss and expand on this theme. It is a part of a much larger schemata that goes beyond conventional diagnostic formulations in an effort to link with the ancient traditions of consciousness and religious thought.
In the Jewish Torah, G-d bestows a structure upon B’nai Yisroel in preparation for the great task of bringing mankind closer to Him. The job is the enhancement and fulfillment of inter-connectivity, on all levels of existence. But, in order to achieve this, appropriate channels must be established to contain this powerful Life Force. The essential issue is containment, and re-direction, of the Inner Light of Creation in a life sustaining way. Within the limitations of each human being, and within the confines of one’s specific discipline, is this challenge. In psychiatry the recognition of arousal is a tool to achieve enhanced connectivity and healthy, efficient use of the energy or life force within.
If you found this article interesting, please forward it to others. I welcome any comments you may have.
Gershon Freedman, M.D.