Adrenaline and the Inner World: An Introduction to Scientific Integrative Medicine

8 Dysautonomias

In dysautonomias, altered activity of one or more components of the autonomic nervous system adversely affects health. Dysautonomias can manifest as occasional episodes or chronic, persistent neurodegeneration. They occur in all age groups, from inherited genetic diseases in children to functional disorders in adults to autonomic failure in the elderly. Some entail observablemacroscopicormicroscopicabnormalitiesorquantifiablechemical or physiological changes, while others remain mysterious and controversial because of a lack of consistent objective findings. Some are rare and some common, but all involve more than one body function, and all negatively impact a person’s sense of well-being. Dysautonomias also involve multiple disciplines of medicine—cardiology, neurology, endocrinology , physical medicine, and psychiatry. Predictably, relatively few cardiologists , neurologists, endocrinologists, rehabilitation medicine specialists, or psychiatrists feel comfortable in diagnosing dysautonomias or managing the patients. Three factors have made the area of dysautonomias especially difficult. They are multidisciplinary, integrative, and mind-body disorders. First, the disorders are multidisciplinary. Specialists certified in programs in single disciplines often cannot serve the patients, because of inadequate curriculum in medical schools and specialty training. Because of the multidisciplinary nature of dysautonomias, scientific peer-review committees tend to view as somewhat foreign applications for research funding and assign relatively low-priority scores to the grant applications. Because of the structure of scientific review procedures, scientific research about dysautonomias has in several ways lagged behind research into other clinical problems. Second, the disorders are integrative. Many factors determine levels of pulse rate, blood pressure, body metabolism, pain, fatigue, and the sense of psychological well-being. These factors interact with each other, and they change over time, depending on development and circumstances of life, 8 Dysautonomias and they are themselves regulated as parts of complex feedback systems. Scientific theories have lagged behind in terms of taking into account this complexity. Third, dysautonomias are virtually always “mind-body” disorders. Scientific theories have continued the old philosophical distinction between physical and mental body processes. I do not think that dysautonomias or the patients suffering with them can or should be classified as “medical” or “psychiatric.” The many symptoms of dysautonomias reflect real biological or chemical changes. When clinicians cannot identify the causes of the symptoms, that ignorance should not lead to dismissing the patients as having a psychiatric rather than a “real” problem. The “Mind-Body” Problem Disorders involving the adrenaline family are, possibly more than any other ailments, mind-body disorders. In many ways the autonomic nervous system operates exactly at the border of the mind and body. This is a difficult subject for both doctors and patients. The problem is the old notion that the body and mind are separate and distinct in a person , and so diseases must be either physical or mental. If the disorder were physical, it would be “real,” something imposed on the individual, whereas if it were mental, and “in your head,” it would not be real, but something created in and by the individual. These notions date from the teachings of the Renaissance philosopher Descartes. They are outdated by now. Distinctions between the “body” and the “mind,” the physical and mental, problems imposed on the individual and those in the mind of the individual, are unhelpful in trying to understand disorders that involve adrenaline (fig. 41). This is because the mind deals with both the inner and outer worlds simultaneously, continuously, and dynamically in life. Conversely, both worlds affect the mind, and each individual filters and colors perceptions of the inner and outer world. For instance, there is no such thing as a person exercising without “central command” to tense and relax specific muscles. At the same time, and as part of the same process, the brain automatically directs changes in blood flow to the muscles. The exercising muscle and changes in blood flow lead to information, feedback, to the brain about how things are going both outside and inside the body. It is also true that virtually every emotion a person feels includes changes 182 ADRENALINE AND THE INNER WORLD in these same body functions. For instance, when you are enraged, the blood flow to the skin and muscle increases, the heart pumps more blood, you sweat, your nostrils flare, and you move more air. From the point of view of the bodily changes, it would matter little whether these changes resulted from the physical experience of exercise or the mental experience of rage. Both situations involve alterations...