Years ago my Dad mentioned to me that he would often lie in bed in the morning worrying about largely inconsequential things. For example, when he was building a house in Montana he would worry about whether or not he had enough material for flooring or whatnot. This surprised me because he was generally the epitomy of cool, of a non-worrier.

The admission also struck me because I have had periods of similar morning anxiety. (Not lately though – I sleep like a baby these days.) Could we (my dad and I), I wondered, share some genetic trait for morning worrying?

Well, I don’t know and may never know. But today I was thinking about this and was reminded of a bit of knowledge I’d picked up at some point. You body tends to make hormones at night and then “use them up” during the day. So in the morning as you wake up, you have peak hormone levels. I also recalled that the hormone cortisol is associated with anxiety. Is cortisol one of these “morning buildup” hormones? A little research on cortisol confirmed that it is.

Blood levels of cortisol vary dramatically, but generally are high in the morning when we wake up, and then fall throughout the day.

That makes sense. Ever get the sense later in the day that you’re too tired to worry? Your cortisol levels have fallen.

So I was thinking about this fact that cortisol is associated with anxiety and moodiness. I considered that there’s a particular time of the month when women are especially moody. (A great Modern Family rerun I recently watched highlighted this.) Is cortisol to blame here?

Indeed.

After ovulation, the empty follicle that once contained the egg begins to secrete the hormone progesterone to thicken the lining of the uterus and prepare it for the possible implantation of an embryo. As progesterone levels rise, you may begin to feel moodier. This happens because progesterone helps the body make cortisol, a hormone that tends to be higher in people who are stressed. If cortisol levels are already elevated because of outside factors, like a busy workweek, the progesterone can cause an excess of cortisol in the body. “If I’m already doing something to give myself high cortisol levels, by the time I get to the second half of my cycle, I’m going to be irritable,” Schwarzbein says.

(I have to say, this article ends with what I consider troubling advice. “If you’re practicing good habits and still have period-related moodiness, contact your doctor, as you could have a hormone imbalance that needs correcting.” Doctors. There’s nothing nature can do that they aren’t eager to “fix.”)

Anyway, this all seems indicative of what I’ve suspected for some time, that we are puppets on a string dancing to the rhythms supplied by our hormone and neurotransmitter masters.

I’ve discussed in the past my interest in psychogenic diseases (though I tend to use the term “psychosomatic.”) What are they? Let’s ask wikipedia.

Psychogenic diseases are physical illnesses that stem from emotional or mental stresses.

I have, for example, talked about the girls of Le Roy who developed weird, twitching body tics though for which no cause could be discovered.

Now I stumble on a Vox article on Joni Mitchell’s bizarre illness called
Morgellons. It’s a disease that causes debillitating pain and the appearence of strange fibers in the skin and flesh. But…

For the past decade, researchers have searched for a biological cause or single underlying factor that might explain the suffering. But they have mostly concluded that Morgellons is “a psychosis or mass-shared delusion.”

In one of the most comprehensive studies to date, published in the journal PLOS, researchers from the CDC collected detailed epidemiological information, medical histories, and skin samples from 115 Morgellons sufferers in Northern California.

“No parasites or mycobacteria were detected,” they reported. The researchers also couldn’t find any environmental explanation for patients’ suffering.

The fiber-like strands on sufferers were mostly just cotton debris, probably lint from clothing. Their skin damage seemed to be caused by nothing more than sun exposure. While some patients had sores, these appeared to have arisen from chronic picking and scratching.

I, of course, am in no position to definitively say whether the disease is real or not. But if it is not, we are again forced to examine a disturbing conclusion, that the mind* alone is capable of inflicting serious distress on on the body. Bizarre.

*Of course, I don’t really believe in a “mind” (in the sense of some non-material soul or whatever); I use the term here to designate the variety of what we call mental processes that go on in the brain.

I’ve long discussed the topic of physical pain on this blog and I’ve touted the idea that our sense of pain is not a simple measurement system by which X amount of damage to the body results in a corollary amount of pain. I suspect, mood, anxiety and other aspects of psychology change how much pain we feel. A depressing new article alleging that Americans are facing greater pain toward the end of their lives offers some food for thought.

Reports of patients experiencing pain near the end of life increased 11 percent between 1998 and 2010, according to a new study published in theAnnals of Internal Medicine. Reports of depression and periodic confusion also increased 26 percent over this time.

“There were certainly reasons to think that things were getting better,” said Joanne Lynn, the author of the report and a palliative care clinician. “We were using hospice so much more, there was more use of narcotics and so much more attention to symptoms, there was reason to think we were doing better.”

Lynn sees two major possible explanations for her conclusion. Patients and family members could be expecting more from the care provided and have “reset their thresholds” over the 12 years in this study. Another is that the number of treatments have increased, allowing patients to live longer with the diseases that ultimately kill them.

This resetting of thresholds ties directly into my thoughts on the psychological aspects of pain. Having said that, it seems likely the second reason is a factor as well.

If you know me, and I believe you do, you know I have an interest in mind/body medicine which argues that calming the mind can have beneficial effects on the body. There’s a lot of anecdotal evidence making this case but not a great understanding on how this process could work. This article from the Harvard Medical School notes the following.

A new study from investigators at the Benson-Henry Institute for Mind/Body Medicine at Massachusetts General Hospital and Beth Israel Deaconess Medical Center finds that eliciting the relaxation response—a physiologic state of deep rest induced by practices such as meditation, yoga, deep breathing and prayer—produces immediate changes in the expression of genes involved in immune function, energy metabolism and insulin secretion.
…
A systems biology analysis of known interactions among the proteins produced by the affected genes revealed that pathways involved with energy metabolism, particularly the function of mitochondria, were upregulated during the relaxation response. Pathways controlled by activation of a protein called NF-κB—known to have a prominent role in inflammation, stress, trauma and cancer—were suppressed after relaxation response elicitation. The expression of genes involved in insulin pathways was also significantly altered.

I read that and said, “Hold on! Cancer?” Many people have theorized about a connection between stress and cancer but until now I’ve never seen any real science to back this up. I’ll be interested to hear what more research brings.

Many, many times here have I commented on my belief that pain has a significant emotional component. And, as I make my way in the world, I often see little clues supporting this thesis. For instance, today’s NY Times has an article on an effort to redesign hospital rooms to be more pleasent. One hospital first set up a test room to try out some happier designs.

After months of testing, patients in the model room rated food and nursing care higher than patients in the old rooms did, although the meals and care were the same.

But the real eye-opener was this: Patients also asked for 30 percent less pain medication.

Reduced pain has a cascade effect, hastening recovery and rehabilitation, leading to shorter stays and diminishing not just costs but also the chances for accidents and infections. When the new $523 million, 636,000-square-foot hospital, on a leafy campus, opened here in 2012, the model room became real.

So far, ratings of patient satisfaction are in the 99th percentile, up from the 61st percentile before the move. Infection rates and the number of accidents have never been lower.

This proves I am right about everything and all who oppose me should be punished.

An idea I’m often talking about on this blog is the notion that emotions are felt as physical sensations. They are not merely ailments of the soul (which, of course, I don’t believe in) but are ailments of the body. This statement seems benign, but I think it’s really quite revolutionary, turning on end many of our assumptions about emotional states. For one thing, if emotions are physical feelings, perhaps negative emotions can be removed by removing their corresponding physical sensations (which is what pretty much any one does when they calm their nerves by having a drink, or use to sex to, as rapper Peaches once advised, “fuck the pain away.”)

In a thread about depression, a reader of Andrew Sullivan’s blog connects the emotional to the physical.

On a different note, another thing people don’t understand about severe depression is that it’s a physical experience. Aside from the lack of energy, which seems to be universal, the physical aspect is different for different people. For some people I’ve known, depression physically hurts. For me, it takes the form of a hollowness in the stomach. At my worst, in the bout that eventually led to my diagnosis, I could not eat at all. The very idea of food made me sick. I ended up in the hospital with an IV, having all sorts of tests done, and losing 20% of my body weight. It was months before I could eat any but the blandest of foods.

My mention of that Peaches tune got me thinking about her and I dug up this old video for the song. Never really got into her (I never liked her beats) but she had a certain kind of genius I suppose.