NASAPT
National Association for Substance Abuse Prevention and Treatment
2300 S. Broad St. Philadelphia Pa. 19145
(215) 285-0832
E-mail: alsummersmd@aol.com.com
Etiology-Based Treatment of Mental Illness
Introduction
Present-day treatment of psychiatric problems involves assembling a cluster of symptoms, making a diagnosis based
on this cluster, and designing a treatment strategy to reduce or eliminate symptoms. As advances are made regarding
the neurological basis of psychiatric symptoms, treatment must, necessary move in the direction of threating the
etiology of the disease process, rather than the symptoms that the underlying factors create.
Hypothetical Considerations
There are a number of way to depict psychological events. The
most familiar being the DSM – 5 in which symptom
constellations are formulated into diagnostic categories; from
there, the provider refers to textbook accounts as to how these
diagnostic categories should be treated. If the psychiatric entity is
treatment refractory, the psychiatric literature may provide
alternative approaches.
For this new approach, symptomology is translated into (1)
neurorecptor dysfunction, (2) history of emotional trauma of both
the patient and his primary support system, (3) cultural factors,
(4) genetic factors, and (5) cognitive impairments, (4) other
personality factors, and MRI data which shows damage in
specific areas relating to early life trauma.
Volterra’s Equations
This approach is made possible by virtue of a non-linear calculus,
originating from Volterra’s Equations, This calculus describes the
result of two conflicting populations, for example perona fish
enclosed in a body of water with minnows. The minnows live
exclusively on algae; and the perona’s live exclusively on
minnows. Volterra’s equations predict the two populations will
cycle at regular intervals, but that there will be long quiescent
periods in which neither fish scarcely make an appearance.
Systems Theory Representation of Dysfunctional Marriage
The Failing Marriage is a film that depicts a young married
couple, Carolyn and Charley, are enmeshed in argument
regarding bringing Nicky, Carolyn’s sister, home to live with the
couple for a time. Charlie is adamantly opposed to the plan, and
Carolyn, secretly, doesn’t want Nicky to live with them either, but
sets Charley up as the bad guy, so that she doesn’t have to feel
guilty. During the argument, Carolyn assumes the role of Nicky’s
protector, but takes the position of controller with Charley. When
Carolyn can’t make any headway as a controller, she switches to
martyr. Charlie, on the other hand, starts off as a dictator, but
when Carolyn switches to martyr, Charlie then counters in the
Bully position.
Systems Theory has been successful in describing the dynamic
depicted in the film, The Failing Marriage. In order to conform
the dynamics of the interaction with Volterra’s equations, a
‘missing link’ had to be accounted for. What was needed, in order
to make the mathematics describe the dynamics was an
unexpected factor that was responsible that would account for
Carolyn making the switch from Controller to Martyr. What
made most sense was the introduction of a new entity,
discordance. As it turns out, that Carolyn finds herself in a fightvs. flight double bind: if she fights, she is intimidated by Charlie
and disrupts her relationship with him. On the other hand, if she
moved into a flight response, she feels disloyal to her sister, and
humiliated by having to back down to Charlie. This double bind,
then, turns out to be an unexpected, although significant factor in
the dynamics of the interaction.
.
Personality Map
While Systems Theory can be helpful in describing interpersonal
dynamics, the construction of a personality map can afford an
opportunity to track interpsychic events that are responsible for
symptomology evident in Major Depression, PTSD, Anxiety
Disorder, Addiction, and Personality Disorders. Furthermore, as
treatment progresses, the personality factors that are remedied can
be tracked, and new focuses of treatment can be identified and
worked on.
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In order for the personality map to be maximally by useful, it
needs to have the linkages between personality factors defined by
a rule system consistent with the mathematics (i.e., Volterra’s
equations) for which we can find solutions.
MRI Data
The entire soma, point for point, is mapped on the central gurus,
parietal lobe. It is intriguing to think that it may be possible, at
some future time, to discover a personality map on the cerebral
cortex. There is significant evidence that certain elements of the
psyche are mapped on the cortex For example there are areas of
damage on the hippocampus in patients who have suffered early –
life sexual abuse, and damaged areas on the left temporal lobe in
patients who have suffered early-life emotional abuse. This data
alone, suggests a neuronal basis for panic attacks eliminating
from the hippocampal area, and rage attacks emanating from the
left temporal lobe. Future studies, including PET scan data
conceivably contribute to a replica of the personality map
transposed onto the cerebral cortex. As information to this effect
is gleaned, it could be included into Systems Theory and utilized
for diagnostic and treatment purposes.
PTSD / Receptor Disease Model of Psychiatric Entities
Presently, the standard of care is to collect a history and physical,
together with a mental status examination, and ascertain a
diagnosis via the DSM-5. The treatment recommendation then is
sought from an appropriate discussion from an appropriate
textbook or journal article. In the future, rather than arrive at a
DSM-5 diagnosis based PE, H&P, but an analysis of receptor
activity based on similar data, PET & MRI data,
endocrineological testing, psychological testing, and multifactor
analysis based on computer models.
Treatment, then, would be aimed at ameliorating receptor
dysfunction, and psychotherapy aimed at dysfunctional thought
process, education, and assisting the patient deal with issues
relating to PTSD.
Thus there may, at some time in the future, be a major shift in
thinking; one that focuses on PTSD and receptor dysfunction, but
syndromes that result from a dysfunctional system of many
elements.
Panic Disorder and Intermittent Explosive Disorder, both of
which are concomitant illnesses in opiate addiction, leave the
patient particularly vulnerable to relapse. With the current
philosophy being absence from all substances, medical or
otherwise, as the goal of treatment, it is no surprise that the
recovery rate for individuals who see misguided absence from all
chemicals at about 5%. From the point of view of opiate addiction
based on an underlying PTSD and receptor disease dysfunction,
one would no more subject the patient to abstinence from a
medication so effectuations as Suboxone, than one would subject
a type II diabetic to a regimen with a goal of abstinence from
insulin.
Subliminal Flashbacks. Systems Theory, based on PTSD as the
foundation of panic disorder introduces a new element in the
etiology of this ailment, the subliminal flashback. The individual,
according to this model, has suffered a devastating early life
trauma that, for the most part is suppressed. Given an appropriate
trigger, a partial flashback takes place, bombarding the individual
with an overpowering blast of emotion without any obvious
source (since the flashback itself is subliminal). The individual
imagines he is suffering a catastrophic heart attack and panics.
Once the individual is educated, and finally convinced or the
flashback hypothesis, his panic attacks generally abate, an
eventually disappear.
Intermittent Explosive Disorder. Systems Theory also provides
an explanation for rage attacks as the psyche’s attempt to deflect
the panic attack by misinterpretation the individual who triggered
the flashback as perpetrating a deliberate act of aggression. This
justifies retribution on the part of the afflicted individual who then
feels justified in launching a vicious counter attack.
Character Disorder. Systems Theory results in a depiction of a
personality mapping process which has, at its hub, an entity
dubbed the core myth. The core myth is a negative belief one
holds regarding his self-worth; the bulk of his conscious energy is
then spend disguising the negative inference, or overtly denying
it. The outcome of a psyche obsessed with reconciling with this
erroneous belief is essentially a character disorder. The treatment
of character disorders based on the core myth is what has been
called a cybernetic analysis in which the individual teases apart
the elements that reinforce the core myth and then utilizes a
dialectic, cognitive behavioral approach to break away the
structures that support the central element, the core myth.
Related Discussions
Concomitant Benzodiazepines. Particularly regarding the use of
benzodiazepines in the treatment of opiate addiction, there is a
strong bias against using a habituating drug as a part of the
treatment regimen. If the objective becomes harm reduction,
however, and the focus on rectifying a dysfunctional system of
neuroreceptors, one may see that benzodiazepines can play a
pivotal role in a population of persons who are afflicted with rage
attacks and panic attacks.
Conclusion
As more structural findings emerge regarding the association of
brain function with behavioral-emotional states, the treatment of
mental illness will certainly move in the direction of designing
treatment strategies based on etiology, rather than symptomology.
As this avenue of thought progresses, it is likely that
psychoneurology will eventually evolve into a mathematical
science.
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1 Incorporating PET scan data into Psychoanalytic theory, using Network Theory in Order to Devise a Treatment Strategy for Psychiatric
Illness, Alan L. Summers, MD, PhD. American Psychiatric Association Annual Meeting – New York. May 5th, 2004.
2 Harm Reduction Approach and the Concomitant Use of Benzodiazepines in the Treatment of Opiate Addiction. Alan L. Summers, MD,
Ph.D. Unpublished.
3 PTSD / Neurorecptor Disease Mode in the Treatment of addictive Disease. Alan L. Summers, MD, Ph.D. Unpublished.
4 Treatment of Panic Disorder as a Variant of Post-traumatic Stress Disorder. Alan L. Summers, MD, Ph.D. Unpublished.
5 Cybernetic Analysis. Alan L. Summers, MD, Ph.D. Unpublished.
6 Step #13 – The Future of Addiction Treatment. Alan L. Summers, MD, Ph.D. Unfinished.
7 of Diagnosis and Treatment of Psychiatric Illness Utilizing Systems Theory. Alan L. Summers, MD, Ph.D. Unpublished,
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