Армен Мурадян - Male’s Health in the Objective of Stressology – Beyond the Usual

The described phenomenon is not merely a symptom. Its appearance makes it possible to understand the mechanism of transformation of the external signal into an act of consciousness, the mental phenomenon. Flashback is a reflection of the event or its fragment by mirror neurons. The parameter of a physical object – seen, heard, having become the content of consciousness, is transformed into a mental phenomenon. Echo-phenomenon is an intermediate link between the world of physical phenomena and mental world (between physics and psyche, matter and consciousness). It is a key to understanding the transformation of the external world energy into the internal one. Mirror neurons perform this first level.

Picture 1. Flashbacks as described by one of the patients.

Picture 2. Flashbacks as described by the patient.

Picture 3. Flashbacks as described by the patient.

Convulsive “flashback”. An epileptiform convulsive fit may occur in a psychotraumatic situation, especially if it is accompanied with oxygen deficit. Actually, the fit results from hypoxia. The state of “asphyxia” is accompanied with a characteristic facial expression and a specific pantomimic mask. A man who lacks air starts to “grab” air with hands, face is strained, neck reaches out, mouth opened, breathing outwardly reminds breathing of a fish thrown out on the shore and strenuously grabbing the air with the mouth open. Epileptoform “echo-stressor”, if it happens in situations with air deficiency, is accompanied by similar movements.

Examples:

4. Once the Epileptological Center sent a young man to the “Stress Center. He complained of epileptiform convulsive fits occurring once in 2–3 months for over 8 years. A careful examination in the Epileptological Center failed to yield any objective paraclinical data. Since the fits were rare and over time the tendency of their frequency was not observed, and the clinical picture did not change, the parents decided not to give the boy anticonvulsant drugs, for fear of their undesirable side effects. No epileptic symptoms were discovered. The father was a witness of fits and was able to describe in detail the onset of the fit, focusing my attention on the grasping movements of the hands, “as if lacking air” – added he. Some leading questions helped father to remember the occasion that happened with his son when he was taught swimming in the pool. On the second day of swimming lessons, not knowing how to swim, the child was dipped head and ears into water. The boy experienced strong fear and refused to attend the pool. Several months passed between that event and subsequent fits. The relatives forgot about it. The patient himself confirmed that the fit usually occurred in stuffy rooms. It happened twice in a vehicle packed with people, once it recurred when he saw the sea for the first time.

5. Three years after the earthquake, mother of a 12-year-old girl consulted the “Stress” Center on the occasion of convulsive fits in her daughter. Mother said that she and her daughter remained under the ruins for 10 hours. It was there that the first convulsive fit occurred to the girl. The subsequent examination revealed no data in favor of the organic origin of the fits. A fit starts with short breath, the girl grasps her throat, trying to catch her breath. The girl herself said she always felt short of breath before the fit.

Both examples mentioned are similar in their stereotype clinic, lack of dynamics and mechanisms of occurrence. In both cases, the parents decided not to give the anticonvulsants thus retaining their original form not burdening the clinic with side-effects of medications.

Somatic “flashback”. The memory retains not only “a piece of the objective-emotional world” in the form of a sensory “echo-stressor”, in the same way it can register any bodily symptom or syndrome accompanied by a strong emotional response – “somatic echo-stressor”.

“Somatic echo-stressors” can be exemplified by various somatic conversions well known to psychiatrists, neuropathologists, psychotherapists. It is common knowledge that in contrast to the somatoform manifestations, conversions never give way to organic changes. Functional disorders never convert to the structural ones, even when frequently repeated. Probably, the somatic conversions are stipulated only by the first level of the stress process or the autonomous nervous axis providing only a bioelectrical effect, without involvement of endocrinal axes or hormones.

Pain “flashback” . The most common is somatic-pain syndrome of various localizations. Phantom pains also relate to this category.

Example:Five years ago, a patient having fallen on the stairs experienced a terrible pain in her back, which then gradually ceased. She did not pay much attention to this since there was clearly no fracture. However, after a while, about a week, the pain resumed and did not pass. X-ray and other examinations did not reveal any abnormalities, but the pain became chronic despite the ongoing therapeutic measures. The pain occurred even when she accidentally touched the furniture. “As if I fell down the stairs again”,– the patient said. The pain recurred many times. Sometimes the pain appeared all of a sudden when she was watching TV: “I did not touch anything, but the pain is there! I cannot walk; I hardly do something around the house. But what is really strange is that a sharp sound, sometimes even an ordinary conversation or a draft cause attacks of the same pain”. Gradually she began to limit herself in mobility, ceased going out, bought crutches, became disabled. The pain sharpened with physical or mental loads”.

An example is well-known to orthopedists phantom pains when a person experiences severe pain in the amputated part of the leg. Analgesics do not bring relief from this suffering and the pain remains there for several years. Both phantom and chronic pains in the back are not related to the current external injuries. The pain effect had a real cause but it happened in the past, once and in a specific place – “Then and There”. Now the pain appears anywhere, anytime. As the patient describes, “appears when it wants to appear. It does not change, does not increase or does not fade with time, as if it is stuck in me and under some conditions makes itself felt: “I’m here, I’m in you”. Indeed, pain has become part of human body and life.

Example:“Two years have elapsed since I suffered herpes in the waist (lumbar region) and chest. All the external signs have long since passed; there are no changes on the skin. But it is hard to imagine what pains I am experiencing. As soon as I come home, and now I live alone, itching and pains seem to be waiting for me at home. Nothing helps. I was examined – no deviations. But the pain does not leave me, and it is always the same – with itch”.

A person experiences pain in the absence of bodily injuries and moreover, such pain is as real for a person as a physiological one. It is not “imaginary”. As distinct from the primary pain, chronic does not calm down with time, its appearance does not have spatial and time boundaries, analgesics do not help, antidepressants give a temporary relief. In neurology, such pain is known as neuropathic. In psychiatry – as a “chronic pain syndrome”, which is treated as psychalgia (mental pain), equated with it and included into the group of somatoform disorders (ISD–10/F–45).