The weight of research suggests a multicausal hypothesis in which genetic, autoimmune, infectious, and psychosocial factors interact in varying degrees to create a predisposition matrix. A triggering factor, perhaps a psychological event, then leads to clinical RA. An approach to the patient is outlined in which he is not viewed as a 'rheumatoid personality,' but as a unique human being facing acute and chronic stress which reverberates through the family, interpersonal, intrapsychic, occupational, and health systems of which he is a part. (Locke, 1983, p. 102)
Dys-stressful emotions increase muscle tension and result in excessive activation of the sympathetic branch of the autonomic nervous system which can exacerbate the condition. (Rossi, 1986, p. 168)
Disruption of meaningful relationships with resulting emotional trauma precedes an attack of arthritis. Goal of treatment should be to restore patient's sense of security. (Locke, 1986, p. 95)
Theory: denial, suppression, and/or repression of right hemispheric experience denied left hemisphere information needed to express problems in words, resulting in a disruption (blockage, short-circuit, misdirection) of the normal accessing and flow of information in the mind-body system. (Rossi, 1986, p. 170)
May be associated with blunted mind-cortical processes; RA patient is often devoid of affect, emotionally flat or colorless, may be manifesting a form of body language that substitutes for the lack of verbal and imagistic-emotional language. (Rossi, 1986, p. 168)
Condition has been described as inability to fantasize. (Rossi, 1986, p. 168)
Fear and martyrdom. Social withdrawal. Fear of being fully mobile because of demands, real or imagined, that full mobility imposes. (Harrison, p. 142)
Personality: The general psychodynamic background is a chronic, inhibited hostile-aggressive state, a reaction to the earliest masochistic dependence on the mother. This is carried over to the father and all human relationships, including sexual relationships. The majority of these personalities discharge hostility through masculine competition, physical activity, and service, and also through domination of the family. When these methods of discharge are interrupted in specific ways, the persistent increased muscle tonus resulting from the inhibited aggression and the defense against it precipitates arthritis in some. (Alexander, p. 497)
Perceived rejection by parents. Highly conscientious and self-sacrificing. Associated with conscientiousness, masochism, self-sacrifice, denied hostility, long-standing stressful circumstances. (Gentry, p. 120)
The accepted character traits (compulsive, perfectionist, over-conscientious and helpful, excessively moral, with depressive tendencies) show the soul of arthritics: rigid and stubborn, inflexible and immobile. All the athletic activity and physical restlessness merely serve to overcompensate for this inner immobility and divert attention from their compulsive rigidity and aggressiveness. Since they are unable to admit these characteristics, they produce strong unconscious guilt feelings, which in turn lead them to display great helpfulness and self-sacrifice. (Dethlefsen, p. 211-2)
Seronegative patients (absence of rheumatoid factor) were more susceptible to psychiatric disturbance than seropositive patients. (Locke, 1983, p. 129)
Rheumatoid patient may be more vulnerable to separation, real or threatened. (Locke, 1986, p. 95)
Onset in many instances associated with loss of support. (Locke, 1986, p. 104)
Deep criticism of authority. Feeling very "put out." (Hay, 1988, p. 60)
Feeling unloved; criticism; resentment. (Hay, 1984, p. 153)
Inflammation: Fear; inflamed thinking; seeing red; anger and frustration about conditions in one's life. (Hay, 1984, p. 170-1)
Survey of 88 children with JRA (juvenile RA) showed that the most striking findings were psychosocial factors: children whose parents were unmarried comprised 29%; in addition, adoption occurred three times more often in the JRA population. 51% of these events (divorce, separation, death, or adoption) occurred near the date of onset. (Locke, 1983, p. 90)
Serum specimens from 46 patients with JRA were tested for measles, rubella, adenovirus and herpes simplex virus antibodies. The mean antibody titer of the 16 JRA patient of the major conflict group were generally higher than those of the 30 patients of the non-conflict group. (Locke, 1983, p. 102)
Chinese psychophysiology:
Spleen ~ Pi governs digestion and manifests in the muscle tissues; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced.
» Healthy expressions are fairness, openness, deep thinking, and reminiscence.
» Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Unresolved Spleen Xu (Deficiency) predisposes to Spleen Shi (Excess), particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines. The Heat produced by Liver Stagnation may then transform the Dampness into Damp-Heat.
» Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. Dampness and Phlegm Shi (Excess) usually derive from Spleen Yang and/or Qi Xu (Deficiency).
» The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.
Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; governs Water to regulate body fluids; provides the "Fire of Life" through its Yang functions; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities; controls the bones, particularly the lumbar spine and knees; produces the Marrow which generates the spinal cord, "fills up" the brain, and possibly manifests through the immune system; carries the constitutional endowment from the parents; and displays the effects of overwork, aging, chronic debilitation or degenerative processes, and extreme stress.
» Healthy expressions are gentleness, groundedness, and endurance.
» Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat and/or acute inflammation.
» Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).
Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); controls the muscles, ligaments, and tendons; and reflects emotional harmony and movement.
» Healthy expressions are kindness, spontaneity, and ease of movement.
» Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Xue Xu (Blood Deficiency) predisposes to Xue Yu (Blood Stasis). Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind.
» Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) Xue Yu (Blood Stasis) often begins with Qi Stagnation.
» Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, rashes, itching, and neurological problems. Wind can also be internalized after exposure to inclement, especially windy, weather and any concomitant influences of Damp, Cold, and/or Heat.
Gall Bladder ~ Dan is the source of courage and initiative, and is responsible for decision-making as the bodily Minister of Justice; controls circulation of the nourishing and protecting energies [Ying Qi and Wei (Protective) Qi]; expresses itself through the sinews (ligaments and tendons); and opens into the eyes. Its channel purifies Yang energy in the body.
» Healthy expressions are kindness, decisiveness, control, and spirit of initiative.
» Gall Bladder Shi (Excess) signs include tiredness; sighing; irritability; bitter taste in the mouth in the morning; pain in all joints; edematous knees and legs (Seem, p. 29); tinnitus; lateral headache; heaviness in head and stomach; muscular spasms; and limbs slightly cold. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder.
» Gall Bladder Xu (Deficiency) signs include insomnia; wandering pains; chest and side pains; swollen breasts (Seem, p. 29); weakness in muscles and tendons of the legs; difficulty standing; asthenia; vertigo; chills; timidity; cowardice; indecisiveness; and excessive sighing.
» Anger, frustration, and resentment can cause Liver Qi Stagnation which, in turn, can produce Heat which affects the Gall Bladder.
San Jiao ~ Triple Warmer regulates the relations among the three regions roughly delimited by the chest, abdomen, and pelvis; influences the supply of Xue (Blood), Qi and Fluids; is the source of Wei (Protective) Qi; and relates to the function of heat regulation.
» Mental signs of Triple Warmer channel disorders include emotional upsets caused by breaking of friendships or family relations; depression; suspicion; anxiety; and poor elimination of harmful thoughts. (Seem, p. 28)
Spleen ~ Pi governs digestion; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced.
» Healthy expressions are fairness, openness, deep thinking, and reminiscence.
» Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Unresolved Spleen Xu (Deficiency) predisposes to Spleen Shi (Excess), particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines. The Heat produced by Liver Stagnation may then transform the Dampness into Damp-Heat.
» Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. Dampness and Phlegm Shi (Excess) usually derive from Spleen Yang and/or Qi Xu (Deficiency).
» The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.
» Mental signs of Spleen channel disorders include mental sluggishness; vertigo; melancholia; obsessions turned toward the past; fixed and rigid ideas; sleepwalking; agitated sleep; and nightmares. (Seem, p. 27)
therapies
behavior modification:
Biofeedback, behavior modification, group therapy, hypnosis, imagery, relaxation, and visualizations may all be useful in management of pain. (Locke, 1986, p. 96)
Therapeutic use of play. (Locke, 1986, p. 99)
imagery:
related materia medica listings: imagery for immune enhancement
Octopus: Imagine an octopus with flexible tentacles. (Epstein, p. 62)
affirmation:
I am my own authority. I love and approve of myself. Life is good.
(Hay, 1988, p. 60)
I am love. I now choose to love and approve of myself. I see others with love. (Hay, 1984, p. 153)
(Inflammation) My thinking is peaceful, calm, and centered. I am willing to change all patterns of criticism. I love and approve of myself. (Hay, 1984, p. 170-1)
journaling:
Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences demonstrated clinically relevant positive changes in health status beyond those attributable to the standard medical care that controls were also receiving. (Smyth J, et al. JAMA. 1999;281:1304-1309.)
theotherapy:
Centaurs, Cronus, Hades, Hephaestus, Hera, Prometheus, Rhea (Lemesurier, p. 88)
hypnotherapy:
Hypnotherapy included relaxation, self-hypnosis, and imagery; remission continued in 90% of patients who were followed 3-4 years and who remained on a maintenance program. (Locke, 1986, p. 102)
Definite aid in determining the degree of function possible; aided some to overcome inhibitions and fears which have plagued them. Note there is danger in developing further dependence, to which they are especially vulnerable. (Locke, 1986, p. 106)
psychotherapy:
Behavioral treatment which illustrates the interconnection of daily events, mood, and RA symptoms demonstrate how techniques to meet depression may also increase the patient's control over somatic RA symptoms. (Locke, 1986, p. 98)
Those who are prone to inflammations are attempting to avoid conflicts. The following questions may be useful:
» What conflict in my life am I failing to see? hear? feel? move?
» What conflict am I dodging? What is my relationship to it?
» What conflict am I failing to admit to? (Dethlefsen, p. 108)
process paradigm:
What is the symptom preventing me from doing? What is the symptom making me do? (see process interview: immune system; musculoskeletal system interview)
related materia medica listings:
the shadow and physical symptoms
converting a symptom to a signal
behavior modification techniques (see also: biofeedback)
relaxation techniques
imagery for immune enhancement
imagery: precautions
imagery: principles: receptive or programmed?
imagery: techniques
affirmations: guidelines and precautions
theotherapy
hypnotherapy
process paradigm
footnotes
Smyth J, Stone A, Hurewitz A, Kaell A. Effects of Writing About Stressful Experiences on Symptom Reduction in Patients With Asthma or Rheumatoid Arthritis, A Randomized Trial. JAMA. 1999;281:1304-1309.
Abstract: Context Nonpharmacological treatments with little patient cost or risk are
useful supplements to pharmacotherapy in the treatment of patients with chronic illness. Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports, well-being, and health care use in healthy individuals. Objective To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using standardized quantitative outcome measures. Design Randomized controlled trial conducted between October 1996 and December 1997. Setting Outpatient community residents drawn from private and institutional practice. Patients Volunteer sample of 112 patients with asthma (n=61) or rheumatoid arthritis (n=51) received the intervention; 107 completed the study, 58 in the asthma group and 49 in the rheumatoid arthritis group. Intervention Patients were assigned to write either about the most stressful event of their lives (n=71; 39 asthma, 32 rheumatoid arthritis) or about emotionally neutral topics (n=41; 22 asthma, 19 rheumatoid arthritis) (the control intervention). Main Outcome Measures Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinically examined by a rheumatologist. Assessments were conducted at baseline and at 2 weeks and 2 months and 4 months after writing and were done blind to experimental condition. Results Of evaluable patients 4 months after treatment, asthma patients in the experimental group showed improvements in lung function (the mean percentage of predicted forced expiratory volume in 1 second [FEV1] improved from 63.9% at baseline to 76.3% at the 4-month follow-up; P<.001), whereas control group patients showed no change. Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity (a mean reduction in disease severity from 1.65 to 1.19 [28%] on a scale of 0 [asymptomatic] to 4 [very severe] at the 4-month follow-up; P=.001), whereas control group patients did not change. Combining all completing patients, 33 (47.1%) of 70 experimental patients had clinically relevant improvement, whereas 9 (24.3%) of 37 control patients had improvement (P=.001). Conclusion Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinically relevant changes in health status at 4 months compared with those in the control group. These gains were beyond those attributable to the standard medical care that all participants were receiving. It remains unknown whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases.