A CHEATER FOR THE NEW PSYCH PARADIGM

Mostly downloaded from the NIMH brainstorming groups:

SUB-CATEGORIES OF THE FEAR DOMAIN 

CALLED “CONSTRUCTS”

Responses to acute threat (Fear): Activation of the brain’s defensive motivational system to promote behaviors that protect the organism from perceived danger. Normal fear involves a pattern of adaptive responses to conditioned or unconditioned threat stimuli (exteroceptive or interoceptive). Fear can involve internal representations and cognitive processing, and can be modulated by a variety of factors.

Responses to potential harm (Anxiety): Activation of a brain system in which harm may potentially occur but is distant, ambiguous, or low/uncertain in probability, characterized by a pattern of responses such as enhanced risk assessment (vigilance). These responses to low imminence threats are qualitatively different than the high imminence threat behaviors that characterize fear.

Responses to sustained threat (Stress): An aversive emotional state caused by prolonged (i.e., weeks to months) exposure to internal and/or external condition(s), state(s), or stimuli that are adaptive to escape or avoid. The exposure may be actual or anticipated; the changes in affect, cognition, physiology, and behavior caused by sustained threat persist in the absence of the threat, and can be differentiated from those changes evoked by acute threat.

Frustrative non-reward: Reactions elicited in response to withdrawal/prevention of reward, i.e., by the inability to obtain positive rewards following repeated or sustained efforts.

Loss: A state of deprivation of a motivationally significant con-specific, object, or situation. Loss may be social or non-social and may include permanent or sustained loss of shelter, behavioral control, status, loved ones, or relationships. The response to loss may be episodic (e.g., grief) or sustained.

Distinctions among Constructs:

Acute threat (a tiger) is distinguished from potential harm by the immediacy and imminence of threat. Acute threat is considered to be a situation where the threat of harm is immediately present. 

Potential harm (walking in jungle), by contrast, is regarded as involving situations where danger might occur, but no immediate threat is present, thus requiring vigilance for threats of low or uncertain probability.

Frustrative non-reward was seen as distinguished from other types of aggression:

Defensive aggression is elicited by a real or perceived threat that leads to a pattern of behaviors directed at terminating the threat. As such, instances of defensive aggression could be considered to belong under the Responses to acute threat Construct.

Offensive (proactive) aggression is elicited by competition over resource acquisition or other positive consequences. This form of aggression often arises from differences in social status and dominance. 

Learned helplessness is an important paradigm that has generated much useful data, the majority agreed that it is not clear whether LH can be distinguished from a more general stress response in humans; thus, there is insufficient evidence currently to support LH as an independent Construct.

Summary of Construct Group Deliberations

. . . the participants discussed the Construct of fear from an evolutionary perspective, detailing the critical adaptive value of fear in normal function and survival . . . 

The participants discussed the diverse set of elicitors and presentations of fear, ranging from innate to conditioned fear stimuli and phasic or sustained fear. Additional complexity was added by discussing fear within a series of continuums, including imminence, severity, and characteristics of the threat. For instance, threatening stimuli can elicit fear responses; however these responses may be modulated by factors such as cognitive processing and prior experience, thus resulting in alterations that introduce related processes such as inhibition and/or extinction.

Distress Construct Group

The workgroup discussed the many specific types of stress or adversity that could be expected to generate different but also overlapping responses (e.g., anxiety, worry, rumination, anhedonia, frustration, sadness, grief). There was some agreement that it was best to avoid having too high a degree of specificity. . . . Although HPA axis activation  (see below) was one of the most frequently nominated elements for the NVS matrix in a pre-workshop survey . . . The HPA axis can therefore be conceptualized as a modulatory system that is invoked by a variety of stimuli and situations and has a variety of effects on cognition and behavior.

Sadness was the most frequently nominated Construct of the pre-workshop survey. . . . The group defined loss as the deprivation of a motivationally significant object or situation. It may be social or nonsocial and may include loss of food, shelter, behavioral control, status rewards, loved ones and relationships. The response to loss may be episodic, in which case it might be called grief, or sustained, in which case it might be called depression. Sadness is evolutionarily conserved and can be studied in non-human primates as a behavior that has the evolutionary purpose of engaging the empathy and support of other members of the same species. 

Elements within the Units of Analysis

When identifying behaviors related to Constructs, participants agreed on the importance of considering not only what organisms do when they are stressed/facing adversity, but also what behaviors they do not perform well anymore as a result of being stressed/facing adversity (e.g., disrupted cognition and over-reliance on habits).

For the task of filling in the matrix elements, the group focused on loss, responses to sustained threat, and frustrative non-reward. 

WHAT’S HPA?  

(From the mystery expert on Wikipedia.  I left the links.)

The hypothalamic–pituitary–adrenal axis (HPA or HTPA axis), also known as the limbic–hypothalamic–pituitary–adrenal axis is a complex set of direct influences and feedback interactions among three endocrine glands: the hypothalamus, the pituitary gland (a pea-shaped structure located below the hypothalamus), and the adrenal (also called "suprarenal") glands (small, conical organs on top of the kidneys).

[It] controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality and energy storage and expenditure. It is the common mechanism for interactions among glands, hormones, and parts of the midbrain that mediate the general adaptation syndrome (GAS).^[1] While steroids are produced only by vertebrates, the physiological role of the HPA axis and corticosteroids in stress response is so fundamental that analogous systems can be found in invertebrates and monocellular organisms as well.

OLD AND ORNERY

This is written in the spirit of reflection rather than accusation, though it may not come across that way.  After my mother’s death while I waited for her estate to be settled, I asked for a copy of my medical files.  I was working for the City of Portland which had “the best insurance deal in town” according to my doc at the time.  He felt this justified elaborate and expensive testing, but he did not feel any obligation to tell me what was going on -- what results showed.  I had chosen this doc in part because he had experience in his church with a clergy-advising committee.  People who are chosen for this role are considered by others to have a certain amount of wisdom and sophistication. 

In those years (‘92-’99) I was struggling with my knees and beginning to age, plus having a lot of trouble with my stomach hurting.  I attended the many little doc-talks around Portland, where they explained what they did and whether it would be a good idea to schedule time with them.  (Of course, it always was.)  I’d had fiberoptic observation of my whole GI tract from both ends, several tests for diabetes that didn't detect diabetes, meds for high blood pressure that made me cough so much that co-workers complained I might be contagious.  And so on.  NO ONE confronted me with the obvious: depression.  Dying mother, deranged brother, worry about retirement, worry about former husband who was also dying.  Deadend job, at first with a bully for a boss.  Depression was not unjustified.  But I had a strong taboo on “woe is me”.  I just went numb.  

The doc was slow sending my file, I think because he was carefully redacting it in case I were planning a lawsuit.  He had been an outstanding heart surgeon, whose practice shrank to nothing when fiberoptic and stent technology arrived.  Now he was coasting until retirement.  I’d tell him my symptoms, he’d suddenly stand up and leave for ten minutes without explanation, then come back to tell me the diagnosis and write a prescription.  

I gradually realized he was either calling a colleague for advice or checking his textbooks.  I doubt that they had been bought recently.  A new boss at work figured out both my planar fascitis and my bum knee, and advised me what to do.  The doc didn’t know -- he just thought I should get a lot more exercise.  In euphemistic terms, he let it be known that overweight old women are just lazy and eat too much.  Finally, he leapt up and left once too often and for too long, so -- without signing out -- I just went home.

His nurse called to see if I were all right.  She didn’t ask why I left.  He himself never called.  When I got my file, I read it quickly and put it aside.  Later I looked more closely and saw that he had diagnosed “early CHF.”  By this time I was using Google and looked it up.  CHF is Congestive Heart Failure.  He never discussed it with me, except to insist on a treadmill stress test that just about destroyed me, not that he noticed.  I sat in the lobby for an hour until I felt like I could drive home.  This didn’t impress him.

Part of the reason for the leap to Valier, when I really ought to have stayed in Portland another five years until retiring at 65, was thinking about “early CHF.”  Portland was a city in disorder.  At least two cocaine dealers lived in my apartment building, armed hispanic gangs ran through downtown shooting randomly (killed at least one person innocently waiting for the bus), the TV station upstairs from my fav coffee shop was invaded by a shooter, the buses in my part of town were being robbed at gunpoint, and we clericals were all being instructed about what to do when the big earthquake hit and the bridges collapsed. The union was thinking of suing because the air conditioning system was infested with black mold, but no one was doing anything.  My mother’s house was in a neighborhood that had shifted to being ghetto.  Shooting every night.  One of my co-workers had repeated concussions from bike wrecks on the way to work in traffic.  He became convinced that I was accusing him of being a pedophile.  Years earlier I had helped him adopt a little girl.  He brought her panties to work and planted them around the office as a joke.  Maybe he WAS a pedophile, but more likely he just had weird brain damage.

Stress, do you think?  

Lucky for me, when I got to my ramshackle house, my new Valier neighbor Dale and his buddy helped unload my U-Haul.  Things have pretty much stayed where we put them until recently I had to move my 4-drawer file cabinets to the garage because they were making the floor sink.  I did some painting -- the bathroom was gruesome until I just painted everything white, including the spiders -- and replaced only some of the appliances that immediately began to fail.  In the middle of it all, I sat down and wrote.

Fifteen years passed faster than a speeding bullet.  A few years ago an eye doc saw damage from diabetes (now stopped, due to metformin and diet protocols)  The tests had improved enough to detect and monitor it.  No one in Montana has said anything about CHF.  When they use the stethoscope on my chest, I ask and they say,  “Oh, it’s fine.”  No one suggests stress tests.  (Suits me!)  Stomach rarely hurts.  I’ve lost fifty pounds since I came and can now put my socks on while standing up.  

This guy can't stand up to put on ANYTHING.

But recently the docs and techs ask,  “Do you get out of breath?  Do you wheeze?”  They don’t say why they are asking.  When I say (honestly) NO, they don’t seem to believe me.  So what are they thinking?  Why is CHF treated like it’s -- I dunno -- an STD?  Or cancer?  I’m divided between pushing them, which might mean they become a lot more invasive, or just continuing to take care of myself, which might be stupid.  I've scheduled a lactic acidosis test, which is advised after taking metformin a long time.

Coming to Valier was not trying to find a safe place -- it was returning to a known place, even though few people here remembered me.  In Browning, nearby, they DID remember me.  In Heart Butte they remember me, but even 2001 was a long time ago.  In Cut Bank there are people who have torn strips off of me during the past half-century and probably still have them in a desk drawer somewhere.  This house is the kind of house widows used to own so the rent (usually from single school teachers) would supplement their retirement.  I rented those old houses and loved them.  In Valier the school is obliged to build houses because today’s teachers will not live in ramshackle little old houses.  The school teacher next door just moved out of the twin to this house. 

Time’s stream moves quickly.  Things catch up.  The years I spent sleeping out in an F150 cargo van while circuit-riding have had a curious after effect: snoring.  The kind that comes from obstruction like an accumulation of phlegm or misalignment of thingybobbits in the throat.  I only realized this lately.  No one will tell you that you snore (it’s considered like having bad breath -- shameful) and I don’t sleep with anyone anyway.  Once at UU General Assembly I slept in a dorm “pod” of bunkbeds, and all the other occupants disappeared the second day.  I didn’t know them and didn’t know why they left.  Now I get it.

Only once did I sleep in a retreat center where I was loud enough that one of the ministers had a talk with me.  He was on a CPAP at night for his snoring.  They had just been invented.  One cannot plug in a CPAP in a barebones cargo van.  I waved it aside.  The necessary testing is expensive and so is the breathing machine -- IF you can tolerate something strapped to your face while you sleep. (Too much like being inseminated by Alien!)

Now when I proof writing, I find strange typos and malapropisms -- not a lot.  I can’t remember names, but I never was good at that.  I take short naps.  I have little protocols, regimes, and sticky reminders but I forget to take my lists to the store and forgot to buy coffee last time.  (Eeeks!  A bag of coffee in Valier costs $2 more than it does in Conrad.)  Little strokes?  Lack of REM sleep?  “Normal” aging?  What I know from watching so many people get old (many of my best friends have died -- men and Indians die young) is that it’s a good idea to plan ahead.  Set deadlines and triggers, research to discover possibilities and markers.  This may be the beginning of an on-going thread.