Malhomeostasis and Medical-Psychological Chronicity

Len Ochs, Ph.D.

Homeostasis, referring to the ability of a system to maintain its own integrity and functioning, is often associated with the ability of a system to maintain its own proper functioning. In a similar fashion, the term malhomeostasis might be considered to be the ability of a system to maintain itself in a state of improper or unhealthy functioning despite the best clinical efforts.

Chronic problems have a stability of their own; and they persist despite the best efforts of clinicians to ameliorate them. Traditional approaches to fixing these problems have focused on finding a problem, supplying what is missing, or exacting or killing something that should not be there. There is no doubt that this approach works for many. However, up to the point that other people die, those for whom this approach does not work increase in number proportionately as they continue to live without resolution of their problems.

They require increasing amounts of effort, technology, time, and money to help. They represent a class of desperate individuals increasing in number, who search the surface of the earth, generally offshore, tropical islands, for procedures and substances that will help them, often outside of the modern medical system. They increasingly rely on traditional (native) and alternative medical systems for help. Although some find relief, many often remain disappointed regardless of the approach they take. They increasingly become distrustful of the efforts of practitioners who offer them help, whether in the name of science, spirit, nutrition, energy, and the like. The fact is, that there is much to be known beyond what we as health practitioners know.

A particular pattern characteristic of the chronically ill &endash; whether psychologically or medically ill &endash; presents itself and needs attention. When working with the chronically ill, it becomes clear that progress or success and improvement in one domain actually triggers problems somewhere else, or that The Problem is only one of a multitude of simultaneous problems. In both cases problems somewhere else re-trigger the original problem(s). Thus the patient remains caught in a trap from which there is no apparent escape.

Unfortunately those caught in this trap are often seen as subject to some psychological defect, and referred to mental health clinicians. In fact, they often do have psychological problems, but ones which are characteristic of anyone who has been unable to find respite from their seemingly intractable problems. And as the ultimate insult, they may be seen as spiritually defective, a state from which there is no earthly recourse. While it is always possible for people to have psychological and spiritual problems, it is more probable that they will be the result of a chronic condition rather than a cause of them, and imputation to the contrary is often blaming the victim.

Here is an oversimplification of how successful interventions can set off a chain of events that can rapidly re-instate the problems from which the person sought relief. A person with pain in her left shoulder gets massaged; her shoulder feels better. To counterbalance an immobilized left shoulder, however, her right shoulder has been tense as well, and without itself being massaged, will leave the person uncomfortable enough so that her left shoulder will again soon become tense. While nobody would think of exclusively massaging one part of the person to the exclusion of others, in essence this pattern of problem and intervention efforts is echoed time after time intrasystemically and intersystemically. There are some more examples.

Ä A person has a combination of muscle contraction and vascular pain such as a migraine. Vascular pain is triggered by a relative drop in background muscle tension. Instruction in relaxation procedures which relax the musculature can thus trigger the vascular pain.

Ä A person with fibromyalgia, a disseminated pain, often has unilateral muscle fatigue, which forces compensation from contralateral muscles. A grid of muscle tension biofeedback sensors can document for the individual the decreasing median frequency in a spectrum of muscle activity, and alerts the individual to unnecessary contralateral contraction, and serves a reason for instruction in both relaxing the contralateral muscle and increasing awareness of hypertonicity in the problem muscle. At the same time, however, assessment cortical EEG activity of a person with fibromyalgia will almost always show immense amounts of low frequency electrical noise. Relaxing the muscles without using another feedback system to reduce the electrical noise at the cortex will keep the person indiscriminant about his or her own muscle activation. This will force the person to try hard to focus on muscle tension, which will, in turn, aggravate muscle contraction.

Problems can occur within the muscle system, between the neurological and muscle systems, and similarly between other systems of the body such as between the muscular and immune systems. If, for instance, a psychotherapist made a patient wrong for not "letting go," when the person could not feel the muscles because of neurological noise, then the person's self-esteem can be unnecessarily undermined, and psychotherapy can be unnecessarily and expensively prolonged. It is also possible to understand that a patient can be made well neurologically, but then be exposed to psychological problems never faced because of lack of clarity. Success in one domain can trigger problems in another.

The opportunity before us it to work conjointly with our respective expertises to prevent one clinician's success from triggering problems in the domain of another, thereby trapping the patient in a circle of clinicians and a cycle of frustration &endash; or in a very low orbit around the equator. With coordination we may be able to work with multiple systems and sub-systems and help the individual trapped in chronic problems to break free of them and to focus on enjoying life and maintaining health.

Ochs: Malhomeostasis


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© Len Ochs 1997