Jessica A. Alexander, M.D.

“… he allowed himself to be swayed by his conviction that human beings are not born once and for all on the day their mothers give birth to them, but that life obliges them over and over again to give birth to themselves.”

— Gabriel Garcia Marquez
Love in the Time of Cholera

ow many times during the day do you feel a transient tightening in your chest, the reminder of a headache, vague feelings of hypoglycemia from a forgotten or unavailable breakfast/lunch, or just the wish that the day would end so you could get a full/restful night of sleep, uninterrupted by family obligations, pagers, cell phones? As conscientious physicians, we disregard these sensations and continue with our schedule, day after day, year after year. Yet, subconsciously, these and many more unrecognized autonomic nervous system (ANS) cues are symbols of stress that we choose to either disregard or sublimate.

In previous articles on stress management in this NEWSLETTER, I have discussed the importance of recognizing that stress in the workplace does not occur in a vacuum. We must realize that we bring stress to work, where we spend most of our working and waking hours. However, stressors such as toxic relationships, active, displaced or lingering anger issues on or off the job, the comfort and organization of our physical surroundings at home and/or work, financial issues and the whole realm of dealing with our personal health, happiness and wholeness, all contribute to stress, most often perceived as work-related.

How Does My ANS Correlate With My Mind and Health and Why Is It So Important?
It is imperative to understand that our bodies are barometers for reading how we are doing from moment to moment, day to day. In most cases, at birth we are perfectly honed to respond in a “fight or flight” mode on an as-need basis. Bruce H. Lipton, Ph.D., a well-known cellular biologist, has spent his career closely reviewing the central dogmas surrounding the subject of “nature versus nurture.” He thoughtfully points out that we are left as evidence-based scientists with little reproducible confirmation that nature (genetic input) truly tips the scales over nurture (environmental input) in how we respond to every type of environmental input and simply “how we turn out.”

Dr. Lipton theorizes that as we grow from the germ-cell phase through fetal development and up to the age of six years, our brains are programmed subconsciously. This imprinting, with the memory of learned habits and sensory input begets our own set of ANS responses. Our subconscious perceptions (lifetime patterns), put simply, fall into one of three responses: growth, background noise (neutral response) or fear. Chronic fear, also defined as lack of growth, can cause the body to go into “protection.” No matter what our age, in an acute protective (subconscious) reaction, our bodies go into “fight or flight” mode (with the appropriate ANS response). If our subconscious perceptions or memories detect a more chronic “protective” situation (fear, no growth, lack of replenishment), stress occurs.

Between the ages of 6 and 12, we learn creative, conscious living through purposeful decision-making, a higher brain cortical function. Throughout our lives, our ANS continues as a barometer for subconscious memories and perceptions/imprinting. Recognizing the signs (quickened pulse, the rising of bile, etc.) is a first step toward making changes and to managing stress on our own terms and at our own pace.
As adults, no matter how much we disregard the signs, our physiologic make-up ensures that the cues (ANS responses) are there. Our body is a finely tuned machine that responds appropriately to the world around it. The ANS does not lie, nor does it forget.

What Am I Supposed to Do With the Signs That I Perceive Via My Five Senses?
One of the first things that we must do is recognize and note what is happening or what we are doing when we feel the first signs of a headache, increased/decreased gastrointestinal peristalsis, tachycardia, chest tightness, reflux, etc. Our general pattern is to treat the symptoms (i.e., aspirin for the headache, H2 blocker for the reflux) rather than to discover the origin of the problem. We do not often address what causes the ANS changes (stressors), the origin of the imbalance. We do not proactively prepare ourselves for the recurrent stressors in our work (or outside work) environments.

Subconscious vs. Conscious Thoughts, Feelings and Reactions
It might surprise you to know that less than 1 percent of our thoughts are conscious ones; the remainder are subconscious (see definitions above). In how many of the following activities do you actually remember every detail in a conscious way: Driving to work, finishing a routine anesthetic (usually once the patient is intubated and the first incision is made), stopping at the grocery store or tucking your children in? Almost everything was done by rote — your subconscious guided you safely through the day. The only things that you may have conscious memory of (if you are attuned to noting the signs and symptoms) are the times when your ANS kicks in to let you know that your smooth, rote activities are being interrupted (“fight or flight” responses) by someone or something, a change in the tone of the pulse oximeter, an argument with a colleague, an angry driver who tries to cut you off on your way home, a rude check-out clerk, a disagreement with your significant other, etc.

To emphasize the power of the subconscious and how it allows us to function daily, take the example of performing a “routine anesthetic.” How many times have you listened to the pulse oximeter, looked at the continuous electrocardiography monitor and completed your particular “sweep” of your anesthesia station, monitors, patient and surgical field and suddenly realized that you need to prepare for emergence after three hours? As a footnote, your automatic anesthesia record indicates that there were no significant changes in the patient’s condition during the anesthetic.

What Do I Do If I Have Identified That I Have Persistent ANS Responses Causing Chronic Stress?
Ted Morter, M.D., who writes extensively on the mind-body connection, believes that there are six essential areas that we must consciously choose to improve/integrate if we are to stay mentally, emotionally and physically healthy: 1) what we eat, 2) what we drink, 3) how we exercise, 4) what we breathe, 5) how we rest and 6) what we think. Sounds almost too simple, but optimizing our control over these six areas together can be extremely difficult, particularly with the lifestyle issues of any anesthesiologist, no matter what type of practice. Due to space constraints, I will only write about number 6. Numbers 1-5 are just as important and perhaps the subject of a future column!

What We Think
What and how we think is the most essential aspect of having a happy, disease-free life. Our conscious minds can override and change our subconscious imprints. We have the power to change the “fight or flight” memories that dictate our ANS. Roger C.L. Guillemin and Andrew V. Schally, Nobel Prize-winning medical physiologists (1977), demonstrated that the brain and the body communicate via chemical messengers. Our bodies put us in “defense physiology” when we experience fear: fear of losing our jobs or not measuring up or fear of getting sick. Fear of anything over a prolonged period of time causes stress, which is defined as “anything that causes your body to change the way it is functioning.”¹ Chemical production by the body in response to any prolonged emotion can affect your physical, mental and/or emotional health.

As noted above, our bodies are finely tuned machines that respond to the fight-or-flight situation remarkably; however, in this day and age, we are not being chased by bears, etc., and these responses (imprinted subconsciously, as noted above) are not needed in the sense that they once were. With the continued production of stress-response chemicals, many diseases may be in your future: heart disease, immune system abnormalities, etc.

Change Your Timing
There are several ways to “change our timing,” in other words, stop the subconscious chemical production we attribute to stress. Guided imagery is one technique that can be used anywhere. This technique calls upon us to “challenge” the way that we currently view our lives or a specific circumstance. There are many books available on this technique, and it is easy to learn. One book I have found helpful is Your Body, Your Mind & Their Link to Your Health.²

Another very effective way to “change our timing” is through a technique called B.E.S.T. (Bioenergetic Synchronization Technique). This is actually a physical, nonforceful energy-balancing procedure used by the trained practitioner’s hands to re-establish your “timing” (synchronize all body systems). In other words, instead of having an ulcer, irritable bowel syndrome, etc., in response to worrying (natural response), your body is literally switched off “protection” mode into “growth”— your body will respond to stimulation from your environment, internally and externally, according to present need.

The technique of EMDR (Eye Movement Desensitization and Reprocessing), developed by Francine Shapiro, Ph.D., can be another method of “unsticking” a traumatic event that can cause us to respond in “protection mode” when faced with a similar circumstance. While extremely effective, it cannot be done alone; it must be performed by a certified, trained therapist.

Some years ago, this author wrote of alternative pain therapies.³ In that article, modalities such as acupuncture, etc., were noted to be “alternative.” Today many pain clinics consider these techniques as useful mainstream adjunctive treatments. I believe that the principles presented in this article will be mainstream in the near future. Of course embracing these ideas for maintaining our own health is the beginning.

“I am what I am and who I was and who I will be.”

— John R. Mathias, M.D., 2005

References:

1. Morter MT. The Soul Purpose. Dynamic Life, LLC. Rogers, Arkansas. 2001:39.

2. Jost S. Your Body, Your Mind. One Health Publishing, LLC. St. Louis, MO. 2004.

3. Leak JA. Alternative pain therapies: Bane or blessing? ASA Newsl. 1994; 58(9):31-33..

Jessica A. Alexander, M.D., is Clinical Professor of Anesthesiology, University of Texas Health Science Center, San Antonio, Texas.