The Stress of Involuntary Treatment
March 16, 2005
In thinking about the ongoing discussion of involuntary treatment, I would like to approach it from a qualitatively different perspective, one that can actually affect both, the person being hospitalized against her/his will and the staff member who admits the patient (both may be experiencing a sense of loss of control, feeling trapped): the molecular biological response to stress. I have been studying the molecular biological processes correlated with fear/stress/anxiety in general and continue to see very significant overlap in the latest research in bipolar disorder (if we have to use labels, I prefer the old term, manic-depression for what I believe are cogent reasons), e.g., protein kinases (A and C) are upregulated in both stress/fear and bipolar disorder) and the schizophrenias (I still am quite surprised when schizophrenia researchers fail to note the significant similarities). The feeling of having no control over what is happening to oneself is so threatening and alarming, as well as the lack of predictability and separation terror, is reflected in molecular biological research studies on stress. The usual paradigm is to have lab rats exposed to restraint, forced cold swims, etc. In one landmark study (Cullinan et al. “Pattern and time course of immediate early gene activation following acute stress,” Neuroscience, 1995, 64, 477-505), IEG’s (immediate-early gene expression-which are rapidly induced in many brain areas and their protein products, e.g., transcription factors, are believed to mediate the long-term responses of cells to external stimuli), were expressed in multiple brain areas. The investigators studied IEG mRNA expression of c-fos, c-jun and zif/268 in the brain after acute swim stress (which is generally viewed as a combined psychological/physical stressor). The results demonstrated a massive response throughout the brain. Among the areas affected were:frontal, parietal, temporal and occipital lobes of the neocortex; multiple regions of allocortex (anterior cingulate, orbital, piriform, entorhinal, etc.); the hippocampus, including CA1, CA 2, CA 3-4, dentate gyrus, subiculum; the nucleus accumbens; bed nucleus of the stria terminalis; multiple regions of the amygdaloid body; multiple regions of the thalamus and hypothalamus; multiple regions of the mesencephalon; multiple regions of the pons and medulla; and multiple cellular layers of the cerebellum.
On a personal note, I remember when I worked in city and state psychiatric hospitals, having the feeling that both patients and the staff were in a sense trapped. The patients were trapped in the ‘system’ and within aspects of their illness/disorder which were beyond their awareness (e.g., what was dissociated), and the staff were trapped in reductionistic and disconnected views of their patients, fear and hatred of them (see the important work of Isabel Menzies Lyth, a Kleinian analyst who analyzed social institutions and the persons living/working in them, e.g., the anxieties nurses experience when they are continuously exposed to the prospects of death, deterioration, etc and their defensive need to place distance between themselves and their patients-see her “Containing Anxiety in Institutions: Selected Essays (Volume 1)” and “The Dynamics of the Social: Selected Essays”).
Brian Koehler PhD
New York University Postdoctoral Program
80 East 11th Street #339
New York NY 10003
212.533.5687
brian_koehler@psychoanalysis.net
