DOPAMINE’S CONNECTION TO NEGATIVE SYMPTOMS

When the primitive organization surges back in a first break schizophrenic episode, dopamine intensifies. This correlates to the onslaught of incoming stimuli to the perceptual system. Patients feel as if they’re being screamed at or bombarded by a horde of angry intruders. Unable to isolate a cogent brain space, the theater of their mind is overwhelmed. The reassertion of the primitive ‘paleo-cortex’ signals a regression of the mental organization with loss of structure, individuation of parts and hierarchical organization of mental functions. Since the brain regresses to the primitive organization in sleep, the forebrain acts as if it is in REM and sends out dream-like hallucinations. The addition of dopamine blocking agents can clear the brain space and restore some internal calm.

The primitive organization or ‘paleocortex’ enters into a battle royale with the ego, the purveyor of anti-primitivism. It is the ego that drags our minds away from childlike simplicity and toward a more differentiated, structured adult configuration. The primitive organization takes it as its imperative to degrade and berate the ego. To this end, it enlists the dream-like hallucinations and turns them into derogatory or self destructive invectives, including commands of a suicidal or self mutilating nature. The superego is unfound in this pre-verbal, pre-civilized mind set, thus offering no solace to the struggling ego. At this point dopamine has made a semi-successful reassertion. Intense positive symptoms ensue and this may go on for years as the ego resists being overwhelmed and dissolved by the more primitive organization. Antipsychotic medication continues to offer significant benefit.

Ultimately, however, under the endless pressure of the primitive organization’s tenacious, avaricious attack, the ego crumbles into a fragmented shell of its former self. At this point the person may experience a reduction in the virulence and intensity of the positive symptomatic bellicosity of the primitive ‘paleocortex’. They sink into a picture of avolition, alogia, anhedonia and low motivation with a collection of ongoing delusions and mild hallucinatory activity. This price, paid by the ego, such as Daniel Paul Schreber’s belief that he’d been turned into a woman, satisfies the primitive organization and brings the conflict to a stalemate. At the same time, dopamine makes a final plunge forward, finishing its dogged resurgence, corresponding to the residual picture we know as negative symptomatology. Antipsychotic medication loses much of its impact and there may also, at this time, be a fair amount of forebrain atrophy.

CONSPIRACY THEORIES: WHAT WOULD FREUD SAY?

the rash of conspiracy theories and their virulence demands an explanation. The proliferation of these phenomena seems invasive. Why are there so many? Where do they come from? How can we explain them?

Undoubtedly the Covid 19 experience has place the nation, possibly the world, in a state of post traumatic stress, especially when coupled with recent civil disobediences and other catastrophic events including meteorological insults. All of this no doubt ratchets up the likelihood of para-psychotic phenomenon. Economic divestiture amplifies the coefficient of despair. Insisting that the Covid 19 virus is nothing more than a “Trumped-up” pseudo-illness designed to unseat the president is a means of relieving one of the concerns of such a deadly virus. There is no need to wear a mask or take infection precautions if one is convinced it is a fictional coefficient of presidential removal. One is neither susceptible to infection or capable of spreading an imaginary disease. A realistic fear of this virus is neutralized by the delusional denial.

The president has amplified the puddle of paranoia by interpreting scientific findings and recommendations as missiles. His refusal to wear a mask, for example, conveys an attitude of spiteful whim against those he interprets as enemies. But this doesn’t explain the enormity of the conspiratorial movements seen swirling around him. We can examine the case of Daniel Paul Schreber, an infamous schizophrenic who wrote a detailed memoir in the late 1800’s about his psychosis, later analyzed by Freud. Freud attributed his paranoia to a ‘father complex’ in which Schreber exhibited repressed sexual longings for his father, ultimately transferred to his doctor whom he was convinced wanted to kill him. These longings, denied by Schreber, but evident in his psychotic, paranoid phenomena, were out of the patient’s consciousness. Schreber projected the longings onto his doctor then reversed them into hateful impulses. He believed the doctor’s aides were trying to drown him and that swarms of bees had been sent to attack him and that God himself was envious of his ‘voluptuousness’.

If we assume the presence of repressed, Oedipal impulses in the conspiracy devotees, we can surmise that their longings have been transferred to liberal, Democratic, deep state personnel as well as certain celebrities. The conspiracy theorists attribute to them a large sex trafficking ring, in which children are utilized sexually. This, of course, mirrors the very impulses they are trying to repress… a child’s sexual involvement with a parental adult. It allows them to revel in outrage against such imagined behavior and its supposed cover up. It also allows them to play the role of savior toward their ‘father’ the president. They are protecting him against attack, a sort of paranoia by proxy. They also, however, fear the wrath of the powerful, insidiously organized, imagined child sex traffickers. This is the same power a child attributes to its parents.

If we accept the above explanation as plausible, the only question remaining is why the repressed Oedipal wishes are threatening to surface at this time, requiring symptomatic gratification in conspiracies. One can only surmise that the intense stresses described above (quarantine, riots, massive fires, economic debility, and the potential removal of the father-like figure by election) has taken its toll on societal stability in some. Let’s hope that we don’t see a further breakdown in civilization’s cohesion as political and environmental casualties unfold. Civilization as we know it may be subject to a monolithic deterioration fueled by the energy of psychotic conspiracy. Perhaps the arrival of an effective vaccine will provide a measure of relief, but it seems like a long-shot.

HOW COVID 19 BREAKS CIVILIZATION’S CONTRACT

Fifty-thousand years ago before humankind first adopted language there was no civilization, no modernity. We were mute, brutal animals, not at the top of the food chain, and shared the earth with other species of Homo, the Denisovans and the Neanderthals for example. Our primitive brains were, like children’s, at a lower state of excitation. Our minds, over those fifty thousands of years, became more complex, organized, and hierarchically structured. Mental parts differentiated and integrated into smoothly operating machines. By sacrificing this loss of entropy we gained civilizations, socialization and cooperation in mankind’s repertoire. By 10,000 years ago we had wiped out all other species of Homo. We had neutralized many of the predators that had plagued us for millennia- animals, weather, starvation, illness. We developed an expectation of survival. Evolution gave our new brains and new civilizations the thumbs up from natural selection as they improved our odds of survival enormously. We had made our devil’s bargain… while losing mental entropy we increased our chances of reproduction markedly. While Freud’s pleasure principle states that the mind seeks the lowest level of excitation, humankind increased its excitation level in exchange for security. We would learn to live together cooperatively, in less mortal danger and greater excitation in exchange for a marked increase in security. Indeed the world’s Homo sapiens population has exploded.

This bargain is now in jeopardy. A microscopic virus has placed us all in mortal danger, with the elderly leading in risk. Images of body bags in refrigerator trucks haunt the news and panic accelerates as one literally endangers one’s life by going to a school, store or place of worship. The bargain that has so confidently, in many respects, kept its word, is now failing us. We’ve returned to the risk pool of our ancestors, afraid to leave out homes, talk to our neighbors or shop for groceries. But this is what we accepted a loss of entropy for. As this bargain crumbles we may see, and indeed have already seen, civilization itself deteriorate. The lure of the primitive is always present, and, given an excuse, will re-emerge with agility. The goal now must be to move beyond viral inexpediency and solidify society on an even more intense footing than before. Once the bargain starts slipping it may be harder to reinstate than we ever imagined.

THE EVOLUTIONARY ASPECTS OF LITHIUM

Assuming depression to be an evolutionary hibernation reaction, what helps to stabilize it? Obviously hibernation is marked by low appetite, low sex drive, low energy and lack of enjoyment of activities all of which serve to keep the animal in situ. These are core symptoms of depression, as is poor concentration, more likely related to dopamine excess. If again we assume that auto-receptors are turned off as neurotransmitters arch toward depletion a standoff ensues in which the two remain in relative downturn during the duration of the hibernated shift, about six months, and usually winter dominated as are seasonally triggered depressive phenomena. With auto receptors turned off, at least during the day, dopamine can surge, interfering with concentration, and, in manics, leading to linguistic deterioration.

We attempt to break the stalemate with antidepressants which flood the synapse with neurotransmitters and reignite the auto receptors. This tones down dopamine so that the individual can think again, fertilizing the frontal areas with conceptual activity which stimulates BDNF, VEGF production. The latter have a euphorigenic effect which is seen with ketamine. Manics use sleep deprivation to keep the auto receptors off all through the night which floods the brain with dopamine and can lead to a stimulant like psychosis. Dopamine blocking agents then calm the storm. Efforts to stabilize depolarization are successful, including anticonvulsants, lithium, and ECT, all of which hyper-polarize nerves.

Lithium has an antisuicide effect, mood stabilizing property and antidepressant impact. Research has shown that communities with higher natural levels of lithium in the water supply have a lower suicide rate. Bipolar disorder used to be treated by sending wealthy patients to European mineral baths which were found to have a higher lithium content. Could it be that Pleistocene era Homo sapiens evolved in an environment of higher lithium content in the water? Our central nervous systems are accustomed then to a higher lithium level which makes us all relatively lithium deficient. Some react to this deficiency with depression, mania or psychosis. In essence lithium is a neuroactive protovitamin. Some nervous systems are able to handle the relative lack, others are not. By stabilizing the depolarization dynamic, the auto-receptors are turned on, neurotransmission is protected and dopamine is suppressed by the activity of the auto-receptors.

We need to be aware of the Pleistocene environment we evolved in. Deficiencies may lead to variable levels of vulnerability to psychopathology. Perhaps we should add lithium to the water supply of all people, but some might develop hypothyroidism or kidney problems if the level is too high. Yet, a slight increase in lithium consumption might have a marked effect on suicide prevention.

ONTOGENY RECAPITUATES… HISTORY

The old saying that ontogeny recapitulates phylogeny refers to the fact that changes an embryo undergoes in the womb reenact the developmental stages animals went through during evolution. However, Homo sapiens have gone through enormous changes over the past 50,000 years largely due to language. Once born, we progress from a state of relative disorganization toward more complex, organized and differentiated brain functioning. We learn socialization, cooperation, contemplation and can participate in our own thought processes, a feat impossible before language. We also go through something Freud called the Oedipus complex, mastering primitive impulses which each of us put our own stamp on.

These changes mirror the complexity of civilization that has occurred since the adoption of language some 50,000 years ago. As civilization formed we learned the benefits of communal living and neutralized age old predators. We coalesced into government run metropolises. We created laws, education, science and religions. All of this was due to the cognitive advances born of language. Taboos were incorporated into our minds as repressions and in some cases neuroses.

The child recapitulates Homo sapiens’ startling advances as it matures. Some fail at this, resulting in mental illness, a return to the primitive. There are also, no doubt, neurotransmitter transformations in all of this, specifically the suppression of dopamine which can aberrantly result in illnesses as diverse as schizophrenia, Tourette’s, Parkinson’s disease, stuttering, attention deficit disorder, Huntington’s chorea, substance use, and more. The implications are staggering and, if understood, offer a rich soil for intervention.

OCD AND TOURETTE’S: ON MUSCULAR ACTIVITY AND THOUGHT

Obsessive compulsive symptoms mirror the relationship between thought and muscular activity. Tourette’s often accompanies OCD and responds to dopamine blocking agents. If a tic is an involuntary motor symptom which is slightly modifiable by the individual, a compulsion is a voluntary motor symptom which arises not from a physical imperative but a cognitive, conceptual one. For example, “I must recheck the front door or someone will break in and steal everything I own.” Instead of a physical sensation, a concept makes it difficult to resist. Thus it is analogous to a tic but perhaps on a different neurological tract. Acetylcholine, in concert with dopamine, is responsible for tics and other involuntary movements such as extrapyramidal symptoms and akathisia. Most likely acetylcholine is responsible for the conceptual imperative in OCD. Acetylcholine may well be the motivator behind all thought, but is compulsively insistent when dopamine is overbalanced.

Our ability to think, which arose since language, is analogous to muscular activity. When dopamine surges, as in schizophrenia, there is a conceptual flood that swarms the thought platform. Antipsychotic medications help restore the dopamine/acetylcholine balance, and quiet the schizophrenic mind, as well as manic intensity and helps with depression’s concentration difficulties. These universal dopaminergic perturbations lend further proof of the importance of the course correction imposed on evolution by language.