Grouppe Kurosawa: Stress And Illness - The Ignored Human Element (print)

Stress And Illness - The Ignored Human Element

It is rather obvious that there is a substantial amount of stress associated with a positive HIV diagnosis. In fact, in long term studies of HIV infected men, the primary predictor of the rapidly of disease progression was psychological stress—not previous sexual practices. Before we begin our discussion, it is important for the reader to understand what is meant by stress. The word stress has a very well defined physical and physiological meaning. Stress is a force imposed upon an object. In physiological terms, a stressor is ANYTHING that can activate a non-specific general adaptive syndrome of physiological responses, which attempt to return the body’s systems to equilibrium. As designed by God or Mother Nature, physiological stress was designed to be an ACUTE response characterized by increased hormone levels, elevated body temperature, increased blood flow, etc. CHRONIC stress is an aberration of this response and is maladaptive, and in many cases fatal. When the body’s emergency responses become chronically activated, they often become exhausted and collapse. Shock, as induced by traumatic injury, is an obvious example of an acute exhaustion of the body’s attempt to resist an injury. Other factors, less dramatic than shock, can also wear down the body, often in very subtle ways. High blood pressure is a good case in point. Psychological factors are prime examples of chronic stressors. The flight or fight stress reaction allows us to shift our body’s resources to escape a real or perceived danger. Our hormones begin flowing, we are hyper-alert, our blood pressure increases, and we begin breaking down the proteins and carbohydrates in unnecessary tissues so the nutrients can be shifted to more necessary tissues, such as our immune system. Have you ever heard of people lifting cars that had trapped their child? Under normal circumstances, they would not have the strength to do this. When we are stressed, our muscles receive a blast of adrenaline and nutrients that allows them to perform beyond our wildest expectations. This is stress and it is a response that was never intended to be anything other a short term response to an extraordinary situationl

Unfortunately, the psychological scientific literature is full of references to the word stress without reference to an actual physiological response. Stress is not simply psychological turmoil. We cannot emphasize this point enough. Interestingly, it is very difficult to view a person’s behavior and absolutely predict whether he/she is under physiological stress. In the 1960s, Dr. John Mason, then at the Walter Reed Army Institute of Research, studied the parents of children who had leukemia and other potently illnesses who were being treated at a National Institute of Health hospital. The parents were studied both psychologically and physiologically. The results were surprising, and a classic example of the dictum “don’t always trust your eyes”.

Mason and his fellow psychiatrists couldn’t absolutely link overt behavior with physiological stress. They found that some of the calmest, least emotional parents were under tremendous stress. Their hormones were screaming. Other, more emotional parents were not under appreciable stress. One of the significant finding of this study was that parents with extremely effective psychological defense mechanisms, e.g. it was “GODS will that their child die—it was part of GODS overall plan”, had NO detectable cortisol (hydrocortisone) in their blood. Cortisol is the major anti-inflammatory hormone in the blood of humans and other mammals. Elevated cortisol levels are characteristic of physiological stress, and an indication that the body is attempting to reset the equilibrium of the body back to normal. Somehow, the parents who effectively used psychological defense mechanisms as a coping mechanism managed to physically shut off the secretion of ACTH from their brains. In the absence of ACTH, cortisol is not synthesized or secreted from the adrenal glands. An impaired release of ACTH wasn’t conclusively proven in these studies, but there is scientific proof that the secretion of ACTH and other brain chemicals can be psychologically modulated. For example, children who must remain in the hospital for long periods of time often fail to grow. This is an emotional problem caused by a decreased synthesis of growth hormone in the brain. ACTH secretion is also blocked. The clinical syndrome is called hospitalism and it is completely reversible once the child is returned to a more emotionally nurturing environment.

Is the psychologically impaired release of ACTH from the brain a significant phenomenon or just another example of intellectual dancing bearism—an entertaining fact of no lasting significance? Well, death is one consequence of excessively low cortisol concentrations in the blood. In the HIV essay, we divided HIV infectivity into separate phases of enhanced steroid (cortisol) sensitivity (asymptomatic phase), and decreased steroid sensitivity (ARC and AIDS). Viral proteins and immune hormones are responsible for these changes in cortisol sensitivity but the problem can be made much worse by psychological factors. There are many published studies showing that psychological stress hastens death in HIV infected persons. Unfortunately, the term stress, as defined by psychologists, is a physiologically meaningless term. High cortisol levels, as in stress, prolong the asymptomatic phase of HIV infectivity. It is only when the body’s sensitivity to cortisol diminishes that actual AIDS can develop. At least, that is our unequivocal opinion. If an HIV infected person used effective psychological defense mechanisms to block out the idea of impending death (and who wouldn’t if they could), and if this resulted in a diminished level of cortisol in the blood, this person, according to the Grouppe Kurosawa AIDS disease model, is hastening their own death. This isn’t stress. It anything, it is a physiological response directly opposite of stress. For a long time, conservative physicians warned people with multiple sclerosis not to exercise. It was considered too stressful. When Billy Kidd, the former Olympic skier came down with MS, he said BS to the no exercise medical model. His disease stopped progressing. Now, exercise is a part of every MS patient’s treatment regime. Stress, a priori, isn’t intrinsically bad. It exists to return the body to equilibrium, and for many diseases like AIDS that’s an important objective.

In June of 1994, an article was published in Discover Magazine about a woman dying of AIDS. The article was called “A Deadly Masquerade” and it was written by Dr. Abigail Zuger, a highly talented science writer (this article is discussed in the essay The Day AIDS Ceased to be Fatal). The patient, Beatrice, did not want any more treatment. She had been in and out of hospitals repeatedly over the last few years. It was time for her to go, or so she thought. Zugar asked one of her medical residents to forget that Beatrice had AIDS and to diagnose her condition based on her lab tests. She suffered from fever, diarrhea, low blood pressure, abdominal pain, low sodium, high potassium, and low blood sugar. Her kidneys were fine. The medical diagnosis was adrenal insufficiency. Zugar talked Beatrice into one more blood test. Before the results were in, she was administered an oral anti-inflammatory steroid, probably prednisolone. Within thirty-six hours, Beatrice, who was previously within days of dying, was sitting up in bed eating her first meal in months. The next afternoon she checked out of the hospital. Within a few months, she gained 25 pounds. Six months later she was still fine and back to work. Did Beatrice actually have AIDS? Yes! Is she cured of AIDS? No, it could come back anytime. She certainly still has the HIV virus in her body. The administration of powerful synthetic steroids stopped the progression of the disease and reverted her condition to one best characterized as asymptomatic. She may no longer have the syndrome called AIDS, but she is still a walking time bomb.

Beatrice wasn’t suffering from a textbook adrenal insufficiency where the adrenal glands can’t make hormone. She had a completely normal concentration of cortisol in her blood. In the Grouppe Kurosawa AIDS disease model essay, we try to explain that it is the tissue sensitivity to cortisol, not the actual amount of cortisol in the blood, which is important. If a tissue loses sensitivity to cortisol, the body becomes starved for the hormone even though normal amounts of it are found in the blood. When this sensitivity decreases, pro-inflammatory hormones like tumor necrosis factor can be released without any feedback constraint. Cortisol, the major anti-inflammatory hormone in humans, is the body’s response to an overactive inflammatory or immune response. Without cortisol or tissue sensitivity to the hormone, there is no effective stress response and an inflammation or immune response can proceed unabated like a prairie fire. Invariably, the results are fatal.

The AIDS virus is unique because it produces proteins that can induce immunosuppression early in the disease. This prevents the virus from being effectively cleared by the immune system. As the disease slowly progresses during the asymptomatic period, this immunosuppression invariably fails. As the body becomes less sensitive to the anti-inflammatory hormone cortisol, viral synthesis increases as does the production of pro-inflammatory immune hormones. This results in chronic inflammation, wasting, loss of appetite, and an immune response that can best be described as autoimmune. This is exactly what happens in the MAIDS (murine or mouse AIDS virus) mouse. This virus, although different from HIV, induces a massive immune response that the body cannot control. The result is a syndrome of responses that very closely parallels AIDS (read the essay on Caffeine and Theophylline as cheap control agents for the HIV virus). If the infected person uses effective psychological coping strategies to deal with his/her infection, they can physically lower their cortisol level in the body. The reduction of cortisol in the body, accompanied by a reduced sensitivity to the hormone caused by viral proteins and pro-inflammatory hormones, will hasten death.

Physical stress, on the other hand, can also contribute to an early death. It is important to keep in mind that physical stressors vary substantially with respect to their effects on the body. Malnutrition is a major stressor that no doubt contributes to a rapid death from the HIV virus in poor countries. However, the major environmental factor contributing to the rapid death by AIDS in Africa (3 years after infection in contrast to 10 years in Western countries) is the present of concurrent infections of TB, malaria, and parasitic diseases. These pathogens all increase the secretion of pro-inflammatory hormones and mediators that induce a state of cortisol resistance. Tumor necrosis factor, an important anti-microbial agent, reduces the synthesis of the cortisol receptor. Nitric oxide (NO) an equally important anti-microbial free radical, interacts with the cortisol receptor and chemically modifies it so it cannot bind and activate anti-inflammatory genes. Both tumor necrosis factor and NO are well known to exist in high concentrations in the blood of African AIDS patients. In developed countries, many homosexuals report higher than normal levels of venereal diseases. It is irrelevant whether the pathogen is malaria or syphilis, the result is the same. The immune system becomes chronically activated which further enhances the proliferation of the HIV virus and the breakdown of the body. If psychological stress, as characterized by a reduced synthesis and release of cortisol, is imposed on a state of chronic microbial infection, the results can be catastrophic.