Post Traumatic Stress Disorder- Where the mind and body meet.

         Veterans from the Vietnam War have frequently reported that marijuana helps them manage PTSD, particularly the flashbacks associated with combat.  Psychologist familiar with treating PTSD are known to recommend the use of marijuana to their patients.   In an experiment at Massachusetts General Hospital conducted by the Harvard Psychology department veterans with PTSD  were shown pictures of the Vietnam war in order to stimulate the experience of 'flashback'.  Positron Emission Topography (PET) was used before and after each patient's session to determine which areas of the brain were most highly stimulated.  The hippocampus and the putamen were significantly more active during flashback, then other areas of the brain.  The activation of these particular areas of the brain are important for two reasons, first as we have demonstrated earlier these areas are clearly modulated by THC, secondly it suggests a mind/hippocampus/memory and body/putamen/muscle component to PTSD.  Could marijuana be involved in the regulation of memory in those veterans who find marijuana gives them symptomatic relieve.  While marijuana has been reported to effect short term memory, might it also play a role in the re-integration of traumatic memory in patients who have suffered emotional trauma.   

         Norbert Weiner, the father of information theory and the neuro-network approach to brain function believed that traumatic memory played a potential role in many types of mental disorders.  In his book,  Cybernetics: or Control and Communication in the Animal and the Machine,  he outlined a systems approach for understanding neurophysiology.  Weiner was one of the first scientists to recognize the importance of feedback in the nervous system stating,  "an excessive feedback is likely to be as serious a feedback to organized activity as a defective feedback."  He stated:

        We thus found a most significant confirmation of our hypothesis concerning the nature of at least some voluntary activity.  It will be noted that our point of view considerably transcended that current among neurophysiologists.  The central nervous system no longer appears as a self-regulated organ, receiving inputs from the senses and discharging into the muscles.  On the contrary, some of its most characteristic activities are explicable only as circular processes, emerging from the nervous system into the muscles, and re-entering the nervous system through the sense organ, whether they be proprioceptors or organs of the special senses.  This seems to us to mark a new step in the study of part of neurophysiology which concerns not solely the elementary process of nerves and synapses but the performance of the nervous system as a integrated whole.[i]

Recognizing the nervous system as one function unit, Weiner, went on to describe the statistical nature of the nervous function, and the importance of feedback mechanism for establishing homeostasis.   Control engineering and communication engineering were inseparable in Weiner's mind, because  problems centered not around techniques of electrical engineering, but around the notion of the message.  The message or mental state being a discrete or continuos sequence of measurements distributed in time- precisely called a time series by statisticians.[ii]  Background noise, what you might compare to static on a radio station, altered the shape or meaning of a message, and distorted its original meaning.[iii]  The degree of disorganization was related to entropy, while the  amount of information that could be processed was related to the organization of the entire nervous system.  Quite in opposition to the biological-behavioral approach to the value of mental states Weiner saw memory and its modulation as a potential factor in all mental disease.   Because Weiner's work is of such great importance in this area I will quote him at length.    

       Psychopathology has been rather a disappointment to the instinctive materialism of the doctors, who have taken the point of view that every disorder must be accompanied by material lesions of some specific tissue involved. ....These disorders (referring to schizophrenia, manic depression, and paranoia), we call functional, and this distinction seems to contravene the dogma of modern materialism that every- disorder in function has some physiological or anatomical basis in the tissues concerned. 

       This distinction between functional and organic disorders receives a great deal of light from the consideration of the computing machine. As we have already seen, it is not the empty physical structure or the computing machine that corresponds to the brain- to the adult brain at least- but the combination of this structure with the instructions given it at the beginning of a chain of operations and with all the additional information stored and gained from outside in the course of this chain. This information is stored in some physical form- in the form of memory- but part of it is in the form of circulating memories with a physical basis which vanishes when the machine is shut down or the brain dies, and part in the form  of

long-time memories, which are stored in a way  at which we can only guess, .....and even if we knew this, there is no way we can trace out the chain of neurons and synapses communicating with this, and determine the significance of this chain for the ideational content which it records.

       There is therefore nothing surprising in considering the functional mental disorders as fundamentally diseases of memory, of the circulating information kept by the brain in the active state, and of the long-time permeability of synapses. Even the grosser disorders such as paresis may produce a large part of their effects not so much by the destruction of tissue which they involve and the alteration of synaptic thresholds as by the secondary disturbances of traffic- the overload of what remains of the nervous system and the re-routing of messages-which must follow such primary injuries.

       In a system containing a large number of neurons, circular processes can hardly be stable for long periods of time. Either, as in the case of memories belonging to the specious present, they run their course, dissipate themselves, and die out, or they comprehend more and more neurons in their system, until they occupy an inordinate part of the neuron pool. This is what we should expect to be the case in the malignant worry which accompanies anxiety neuroses. In such a case, it is possible that the patient' simply does not have the room, the sufficient number of neurons, to carry out his normal processes of thought. Under such conditions, there may be less going on in the brain to load up the neurons not yet affected, so that they are all the more readily involved in the expanding process. Furthermore, the permanent memory becomes more and more deeply involved and the pathological process which occurred at first at the level of the circulating memories may repeat itself in a more intractable form at the level of the permanent memories. Thus what started as a relatively trivial and accidental reversal of stability may build itself up into a process totally destructive to the ordinary mental life.[iv]

Weiner's approach to memory and mental disorders is important for it recognizes the role that excessive or traumatic memory might play in all psycho pathological conditions.  PTSD is clearly one disorder in which memory becomes a problem of pathology.  The question arises as to whether we have the ability to clear those memories from the circuits that they occupy thereby creating more mental room for normal cognition. 

         It is my own work with several patients who suffered emotional trauma that marijuana a might be a bi-phasic pharmacological agent for memory.  In my experience one particular Vietnam veteran, I was surprised to see that at different dosages marijuana had quite different neurological effects.  At low doses combined with hypnosis it appear to facilitate the recall of traumatic memory, a recall of a traumatic event with an overall effect of lowering body tension, and improving affect.  A large dose appeared to block flashbacks.  This appears to be coincident with the hippocampus data which suggests that marijuana had a bi-phasic effect on the hippocampus.  How might this work neurologically?, and What does it tell us about the nature of endogenous ligand annadide?

         We know that cannabinoid receptors are plentiful in the two areas of which are activated during flashbacks.  One area the hippocampus regulates memory, the other motor control.  This is of extraordinary interest because it demonstrates that during the flashbacks, i.e. the evocation of Cannon's fight or flight response, mental events produce a corresponding preparation in the muscles, i.e. muscular modulation.  In other words there is a direct neurological connection between mind and body for conditions of psycho pathology. 

                  This mind (hippocampus) /body (putamen) approach to psychiatric disease is not a new one.   It was first introduced in 1933 by Wilhelm Reich, in his book, Character Analysis.  Originally a member of Freud's psychiatric circle at Vienna,  Reich began to notice that his patients who were psychologically  re-experiencing trauma were not always recovering from psychotherapy alone.  He observed that his patients were not only suffering mentally, but also from severe hardening of the neuro-musculature, which he described as body armoring.  He found that if he simultaneously treated the physical tension of the body, and the traumatic memories of the mind his patients recovered much more quickly.[v]

                  It has recently been reported that victims of physical and sexual abuse re-live the events when they get massage.  This adds another dimension to potential therapy, but suggests that the putamen, hippocampus activation during trauma may be circular in nature.  In other words, if you treat the body using massage to activate the putamen you get hippocampal activation, or changes that relate to the integration of traumatic memory, or if you alter hippocampus function through meditation or relaxation,  you can the same reaction.  It is clearly recognized that there is a one to one mapping of points in the brain to the body in the motor, somatosensory cortex, and the cerebellum, the question remains could the body be a physical representation of the mind?  An idea that is the foundation of Chinese medical theory.      This approach to trauma was recognized very early in Chinese medicine in a saying called Chua K'a.  It read as follows:

       The ancient Mongolian warriors called the Purified Bodies were without fear in their bodies.  To gain the natural state of courage, they studied fear, seeing.:

       1) we don't know our bodies.

       2) There are forbidden areas we never touch.  Why? Pain is stored there.  Why pain?

       The body is filled with little globules , all of which are blocked Kath (i.e. life energy, chi) This blocking is caused by pain which accumulates with time.  So every fear is retained in a globule with the memory of the pain which becomes a fear.  So in the body is the memory of all fears:  fear is the subjective history of pain in the body.[vi] 

This is a reference to treating the physical tension of the body, as a means to stabilizing memory.  Only by further research will we be able to understand how treatment of physical body tension effects psychopathological conditions of memory.    

         Weiner speculated on the importance of his observations about memory for the practice of medicine.   He states:

 Note that a sharp frequency line is equivalent to an accurate lock. As the brain is in some sense a control and computation apparatus, it is natural to ask whether other forms of control and computation apparatus use clocks. In fact most of them do. Clocks, are employed in such apparatus for the purpose of gating. All such apparatus must combine a large number of impulses into single pulses. If these impulses are carried by merely switching the circuit on or off, the timing of the impulses is of small importance and gating is needed. However, the consequence of this method of carrying impulses is that an entire circuit is occupied until such time as the message is turned off; and this involves putting a large part of he apparatus out of action for an indefinite period. It is thus desirable in a computing or control apparatus that the messages be carried by a combined on-and-off signal. This immediately releases the apparatus for further use. In order for this to take place, the messages must be stored so that they can be released simultaneously, and combined while they are still on the machine. For this a gating is needed, and this gating can be conveniently carried out by the use of a clock.[vii]

         Marijuana may prove to be the substance that helps in regulation of this gating mechanism.  Another clue to this process is that when gating mechanism are interrupted in Alzheimer patients whose behavior resembles a long regression back to childhood.  They lose bladder and bowel control and normal adult functioning while memories of childhood are sometimes quite clear.  Stress as been implicated as a factor in Alzheimer patients.  This disease represents a malfunction in the gating mechanisms of the hippocampus that is appears to be irreversible.  Because of the location of receptors in this area of the hippocampus, marijuana is a likely test canidate for testing its effects in the early stages of the disease.  Can marijuana help a certain type pf patient recover from chronic stress by readjusting the homeostasis between mind/body that malfunctions when the fight or flight response is repeatedly evoked?    

Drug Addiction

         According to a National Institute of Drug Abuse study the cost of drug abuse soared to $144 Billion in 1988, an increase of almost 300% from the $46 billion estimated in 1980[viii].  Today, all available statistics reflect a complete failure of drug policy, as the cost of drug abuse to society has steadily increased.  Over 520,000 deaths per year can be directly attributed to drug abuse according to the most recent government statistics,  419,000 of these directly related to tobacco addiction.[ix]  66% of all crimes of violence are committed under the influence of alcohol.   In Massachusetts, a recent study by the Department of Corrections revealed that only 300 of the 10,000 who needed drug abuse treatment where getting it, and  85% of the prison inmates reported that drug abuse was a major factor in their involvement in crime.[x]

         Since Olds and Milner discovery of reward circuit in the brain in 1954, scientist have been trying to discover a pharmacological agent that is not physically addicting that might prove to be beneficial for the treatment of opium and heroin addiction.  Gardner et al. report that THC plays a role in the modulation of opiod receptors. and enhances medial forebrain bundle (MBF) electrical reward substrates, enhancing both basal and stimulated dopamine release. and the effects are blocked by naloxone. [xi] Studies suggesting the effectiveness of marijuana in lowering narcotic abuse are not new. In 1868, The Indian Hemp Commission Report, an extensive study on the use of marijuana by the British government in India noted that people who used cannabis had a strong dislike for narcotics.[xii]        Birch in 1889 noted that the immense value of marijuana is its immediate action in appeasing the appetite for opium, restoring the appetite for food, an increase in the heart's power, and to help induce sleep.[xiii]  Both the Chinese and Indian pharmacopoeia listed marijuana as a remedy of choice for narcotics addition.  Karen Model, Harvard Kennedy School of Government, reviewed statistics for emergency room episodes related to drug overdoses and found they were 12% lower in the states that had decriminalized marijuana.  She concluded that lowering the price of marijuana reduced the abuse of other substances.[xiv]

         In 1967 in Rome Harold Humes, a student of Norbert Weiner, demonstrated that combination of deep breathing exercises, marijuana, and massage appears to eliminate the withdrawal symptoms associated with long term opiate addiction.[xv]  He described the technique in a 1979 lecture at University of Massachusetts at Amherst:

...We were trying to discover how to use a Chinese method.  You'll find in the Chinese medical textbooks that the specific remedy for chronic narcotics addiction is hashish.  But they don't tell you how to use it.  The hash alone won't do the trick.  Nor will the massage alone.  Rather the massage seems to potentate some neurological reaction which the massage triggers, to the net effect of a release...the patient actually jumps under your hands, and you can feel a bioelectrically charge released from a neuro-musculature hypertension.  these are followed by a sweat, sometimes a shout.  But you can see that the patient is immediately relieved  Narcotics addiction may be nothing more than the patient's failed attempt to treat an anxiety-tension level that has gone pathologically high.  He reduces it with the opiate, gets a few hours of relief, and then bang!-- chock a block up on his tension again.[xvi] 

         The following case history demonstrates some of the same therapeutic points earlier mentioned in the treatment of PTSD which also appear relevant in the treatment of drug addiction.

It is the second day of abstinence form heroin. . . A couple of the members of the team have entered the room and stand or squat beside the mattress.  She barely appears to be breathing but she opens her eyes briefly.  Suddenly she draws a long quivering breath and begins to sob quietly, then more even and fuller.  A pallor even more intense than that of the addiction gives way to a flush.  She is sweating profusely.

He was doing some vibratory work on her when she started crying and hyperventilating.  After, laughter and sobs came in bubbles.  She said she had a memory of the accident, something she's blocked out of her memory. .  at least some of it. . . . when she opens her eyes and sees people hovering over her, she flashes back to the beginning of her addiction.  She is lying on the stretcher in the lights of the ambulance.  Her car is a total wreck and she is lucky to be alive.  The paramedics have anxiously.  There is nothing they can do for her shattered leg there on the highway, nothing but put her in the ambulance.  Nothing but morphine for the pain.

The patient sighs deeply.  Unexpectedly, she stands up and walks under her own power to the kitchen, where  she asks for a sandwich. 
She explains how she had turned to amphetamines after six months on morphine in the hospital, and then to heroin.  In the bedroom the senior member of the team explains that the return of appetite is a clear sign that the addiction is lifted.  As in this case, it often occurs after a major release, the recall of traumatic memory and the physical body tension associated with it.[xvii]

         Humes typically found that after a patient had relived a traumatic event or learned to release it,  his male patients frequently relived experiences of  abuse by a male parent.   While this is not to imply that drug addiction is not a multi-factorial problem, many authors have stated that fear of withdrawal is the main obstacle in getting people to stop using heroin.  Lindesmith states:

 

 "Addiction to opiates is determined by the individual's reaction to the withdrawal symptoms which occur when the drug's effects are beginning to wear off, rather than upon positive euphoric effects often erroneously attributed to its continued use. The more specifically, the complex of attitudes which constitute addiction is built up in the process of conscious use of the drug to alleviate or avoid withdrawal distress. This theory, though simple in form, has considerable explanatory value, and offers a means of accounting for varied and paradoxical aspects of the habit, such as the addict's claim that he feels normal under the drug's influence, as well as his tendency to increase the dose to a point where its use becomes much more unpleasant and burdensome than it need be. The hypothesis presented makes intelligible the constant preoccupation of the addict with the drug, and explains how the unpleasant and unwelcome appellation 'dope fiend' is forced upon him.[xviii]

A method of painless detoxification could go a long way in helping prevent what appears to be the start of a major heroin epidemic.  Between 1992 and 1993 the number of emergency room visits for heroin related overdose rose from 21,400 to 30,800, an increase of 44%.[xix]

         An important consideration for using marijuana is this type of application is whether it will lead to the same abstinence syndrome after it is discontinued.  All medical authorities agree on one point, marijuana is not physically addictive.  Westlake et al. demonstrated that chronic exposure to 5, 10, 20, mg of THC/kg, did not appear to alter the striatum, cerebral cortex, cerebellum, hippocampus, and brainstem/spinal chord in the rat or monkey.[xx]

          [i]  Weiner, Norbert, Cybernetics: or Control and Communication in the Animal and the Machine, Cambridge: MIT Press, 1948, p.8.

         [ii]  Ibid. p.10

         [iii]  Ibid. p.12.

         [iv]  Ibid., p.147.

         [v]   Reich, Wilhelm, Character Analysis, New York: Farrar, Straus and Giroux, 1933.

         [vi]   _____________, "Marijuana in Medicine: Past, Present and Future,"

         [vii]  Ibid. p.197.

         [viii]   Harwood,  Natiaonal Institute of Drug Abuse, 1988 Monograph , p. 47.

         [ix]   The New York Times National Sunday, Oct. 24, 1993

         [x]    Boston Globe - 1991

         [xi]  Gardner, Eliot L. and Lowinson, Joyce H., "Marijuna's Interaction With Brain Reward Sytem: Update 1991", Pharmacology, Biochemistry & Behavior, Vol. 40, pp.571-580. 1991

            [xii]  The Indian Hemp Commision Report, 1868, p. 375.

            [xiii]  Birch, E.A., "The Use of Indian Hemp in the Treatment of Chronic       Chloral and Opium Poisoning", Lancet: March 30, 1889.

 

            [xiv]  Passell, Peter ,"Less Marijuana, More Alcohol ?, New York Times, June 17, 1992.

         [xv]  __________, "Notes on the Painless Detoxification from Narcotics Addiction, 1982. (unpublished)

         [xvi]  Ibid., p.2.

         [xvii]  Ibid., p.2

         [xviii]  Lindesmith, A. "Opiate Addiction, Evanston:  Principia Press, 1947, pp. 87-88.

         [xix]  Gabriel, Trip,  Heroin Finds a New Market Along the Cutting Edge of Style, New York Times, May 8, 1994, p.1.

         [xx]  Westlake, Tracy C., Howlett, Allyn C.,Ali, Syed F., Paule, Merle G., Scallet, Andrew C., and Slikker, Jr.,  William,  "Chronic exposure of 9-tetrahydrocannabinol fails to irreversibly alter brain cannabinoid receptors," Brain Research, 544: 145-149, 1991.

 

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