söndag 27 maj 2007

Den destruktiva verkan/the Destructive Impact...

Kirkengen om allostatisk överbelastning…

Kirkengen skriver om allostaskonceptet och kortisolkurvor… Hon skriver på sidan 40 i ”Hvordan krenkede barn blir syke voksne” ISBN 82-15-03713-9 (min helt snabba översättning från norskan med allt vad det innebär, men se den engelska översättningen, som också är citerad till ännu större del nedan):

”Allostatisk ’oveload’ (överbelastning) som följd av konstant emotionell överbelastning antas kunna utmatta allostassystemet. Immunologer menar att det föreligger två – eller dubbla – mekanismer: upphävande av kroppens respons på kortisol och/eller fall i kortisolproduktionen till konstant låga värden. Bristande respons medför ’sviktande' eller upphörd flexibilitet, med andra ord ett sammanbrott av organismens anpassningsförmåga. Sådana mekanismer har påvisats både i buspottkörtelns insulinproducerande celler och i sköldkörtelns tyroxinproduktion. Utmattning av systemet som upprätthåller stabilitet med hjälp av ändring framstår som en ’flat’ kurva som tolkas som ’nummenhet’ (okänslighet?) eller uppgivenhet. En sådan kurva har påvisats bland många vuxna som har fått ’diagnoserna’ fibromyalgi och kroniskt trötthets- eller utmattningssyndrom, samt bland vuxna med PTSD.”

Immunsystemet påverkas… Kirkengen skriver om mördarceller…

Och hon skriver vidare:

”En sådan bristande respons har visat sig förutspå utvecklingen av cancer. Dessutom fann man att bland 104 bröstcanceropererade kvinnor observerade för kortisolnivå så hade kvinnorna med sådana flata ’kortisolspeil’ både den lägsta aktivitet i mördarcellerna och den kortaste upplevelsetid efter operationen för bröstcancer.”

Denna diskussion om sammanhang mellan psykiska faktorer och cancerutveckling har pågått i många år skriver Kirkengen och den är ännu inte avslutad.

Ytterligare litteraturtips: "Inscribed Bodies - Health Impact of Childhood Sexual Abuses" ISBN 0-7923-7019-8.


I have cited from Kirkengen's ”How Abused Children Becomes Unhealthy Adults” the chapter called “Destructive Impact”.

Quotation from the English excerpt:

“The study shows that physical abuse leads to increased risk for lung diseases, gastric ulcer, and rheumatism; neglect leads to increased risk for diabetes and autoimmune diseases; sexual abuse leads to increased risk of heart disease as well. Also, a population study of 1359 women and men at an average age of 75 showed a correlation between childhood sexual assault and diseases of the thyroid gland in men and both arthritis and breast cancer in women.

With that, we are back to my two female patients who died of breast cancer. Both had grown up in so-called “strict” homes. They spoke of abuse, meted out in the name of discipline and parenting, as well as of the adults’ use of alcohol and their socially unacceptable behaviors that had to be kept secret. Already as young girls, both women had taken on the task of concealing the family’s social shame. They were not simply overly responsible but were also powerless to fulfill the impossible assignment they had taken upon themselves. As a consequence of their childhood role as the family’s social worker, both women were in effect predestined to serve as overly responsible rescuers of violent men without ever daring to resist or protest.

I want to link the histories of these two women to general knowledge about neuroimmunological and endocrinological trajectories toward cancer. Throughout many years, both women had been in a state of constant alert fearing the next unpredictable outbreak of violence. Is it fruitful to reason that such a mental condition, enduring the continual experience that one’s life and health may be at risk, nourishes the development of cancer? There exists strong documentation of the negative impact on the immune system of so-called distress, that is, emotional overload. Experimental inquiry into that correlation has taken various forms. In immunological studies, “natural killer cells” are central objects for study; in studies of hormones, the role of cortisol holds an important place. Natural killer cells are measurably suppressed in research subjects exposed to stress, for example intense noise, as many as 72 hours afterwards, but only if the subjects believe that they have no control over the noise. The same noise level over the same period of time does not have the same effect, however, if the subjects believe that they can turn the noise off, even when that is not actually the case. In other words, the determining factor is the person’s own perception of either authority and control, or impotence and the feeling of being at the mercy of their circumstances. The person’s subjective experience that his reality is overwhelming and unyielding weakens his natural killer cells. The effect is intensified by repeated experiences of powerlessness, and even more so by chronic powerlessness. This paves the way for pathological cells to take hold in the body’s tissues and organs.

Subjective interpretations also affect the hormonal interplay between the hypothalamus, the pituitary gland and the adrenal glands, the so-called HPA-axis. There now exists a considerable body of documentation regarding these hormones, particularly as to their effect on the naturally fluctuating daily production of cortisol. The concept of “allostasis” comes in here. Allostasis means stability through change and it includes all the internal systems that make possible a flexible accommodation to both routine and shifting daily life. An allostatic “loading” arises during repeated experiences of danger. It has been measured during long-term strain as in social crises such as war and emergencies, during school examinations, when experiencing grief, loss of livelihood, and divorce – as well as during the ongoing suppression of strong feelings such as while providing long-term care to a partner with Alzheimer’s

Disease. The loading is reflected in continually hyperactive cortisol production. This brings with it all of the known consequences accompanying raised levels of cortisol: weight gain, elevated blood pressure levels, disturbances to blood sugar regulation, loss of skeletal minerals, just to name the most central effects.

In short, people subjected to a sense of chronic powerlessness develop such conditions as osteoporosis because of chronically elevated levels of cortisol. It is very tempting to place this hormonal causal relationship into a more complex system of potentially convergent phenomena. It could be, for example, that rather than considering osteoporosis, and many other conditions, an epidemic it ought to seen as part of a syndemic. The concept of a syndemic was introduced by anthropologist Merrill Singer in a study of three interacting, mutually impacting, and mutually intensifying “epidemics”: narcotics abuse, violence against women, and AIDS.”

And here what I translated above:

“Let me now link the concept of allostasis to the cortisol curves found under various kinds of stress. Allostatic “overload”, which results from being constantly emotionally overburdened, is presumed to have the potential to exhaust the allostatic system. Immunologists believe that there exist two mechanisms – or one double mechanism: a cessation of the body’s response to cortisol and/or a reduction in the production of cortisol to consistently low levels. As a result of this lack of responsiveness, flexibility is either diminished or lost; in other words, the organism’s adaptation capacity breaks down. It has been established that such mechanisms exist both in the pancreas’ insulin producing cells and in the thyroid’s thyroxin production. Exhaustion of the system that maintains stability through making adjustments appears as a flattened curve, which is experience as “numbness” or resignation. Such a flattened curve has been documented among many adults with the “diagnosis” of fibromyalgia and chronic fatigue syndrome and among adults with PTSD. This kind of lacking responsiveness has shown to be predictive of the development of cancer. Moreover, measurements of diurnal cortisol level variations among 104 women who had been operated on for breast cancer showed that women with this kind of flattened curve had both the lowest activity level in their natural killer cells and the shortest post-operative survival time.

This discussion around the connection between psychological factors and the development of cancer has been going on for many years. Nor does it show any signs of ending”.

English word of today "Physiotherapist" which means sjukgymnast in Swedish.

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