Thursday, March 12, 2015

Of Capitalism and Cortisol (or the trouble with adaptogens)

 Recently, while preparing a lecture on stress hormones, I came across a quote from the Slovenian philosopher and psychoanalyst,  Slavoj Žižek:
"Think about the strangeness of today's situation. Thirty, forty years ago, we were still debating about what the future will be: communist, fascist, capitalist, whatever. Today, nobody even debates these issues. We all silently accept global capitalism is here to stay. On the other hand, we are obsessed with cosmic catastrophes: the whole life on earth disintegrating, because of some virus, because of an asteroid hitting the earth, and so on. So the paradox is, that it's much easier to imagine the end of all life on earth than a much more modest radical change in capitalism"
and it struck me that what Žižek describes is the collective manifestation of the effects of consistently high levels cortisol on consciousness.

Cortisol, like all of our hormones, alters our consciousness.   Released by the adrenal cortex, cortisol serves to keep us in a position to respond to danger when an immediate threat has passed but we are not entirely safe yet.  It acts to elevate our blood sugar so more energy will be quickly available to our muscles, to dampen the inflammatory responses brought on by the adrenaline/norepinephrine response we had to the initial threat, to favor the storage of excess energy as fat over the construction of muscle -- and to make us more afraid of and more prone to perceive immediate, cataclysmic threats in the world around us while also diminishing our cognitive capacities.

From an ancestral survival standpoint this all makes sense -- if you have just escaped from a mountain lion you are better off perceiving a rabbit in the bushes as another mountain lion than perceiving a mountain lion in the bushes as a rabbit.   In response to short term stresses, pessimism serves us well.   And you are also better off remaining focused on crashing sounds in the bushes than on contemplating the nature of mountain lions or future strategies for dealing with them.

In a contemporary context, this doesn't serve us.  When the threats to our survival come from not being ale to pay the rent or afford groceries or from not knowing whether we will be shot by police as we walk down the street we seldom reach a point where we can relax fully enough for our cortisol levels to go down because the threat never really goes away.   High cortisol levels cause us to be prone to fear of sudden disasters, and they diminish our ability to analyze the situation and see alternatives.  They also, of course, contribute to stress-related illnesses.

Contemporary responses to chronic stress amount to battlefield medicine.  The role of a military medic is not to help people  heal but to get troops back onto the battlefield as quickly as possible.  Under capitalism, the role of health care workers is not to help people heal but to restore their economic productivity.   And this gets justified in terms of meeting patients' expressed needs, because most people's day to day survival depends on their being able to continue to work to earn money to meet their basic needs, so the patients themselves get put in the position of needing to ask for the medicine that will restore their functionality rather than the treatment that will support their recuperation and restore their vitality --  since the latter requires rest and restructuring of life, luxuries available only to those with enough wealth not to worry about where their next meal is coming from.

The same imperative was true under state Communism.   Soviet scientists set out to find medicines that would improve people's ability to perform key functions under prolonged stress.   They discovered them in a class of herbs they called adaptogens -- herbs which act by extending the cortisol dominated resistance stage of stress, staving off a complete adrenal crash.   The first such herb researched was Siberian Ginseng -- which was found to allow auto-workers to work long hours at grueling jobs without having to take as many sick days as those who didn't take the herb.

Reimagined in a capitalist context, adaptogens are sold and prescribed as herbs to help people remain active and focused while living stressful lives.  They do this -- for a while.   They buy time, putting off the point where the body can no longer function in the ways a person wants it to, masking and delaying symptoms of fatigue that would normally tell us we have pushed ourselves too far.   And, yes, sometimes that is necessary -- a person working three jobs to feed their kids can't take a week off to sleep and can't reduce their hours and can't go off to the woods for days on end.   But they are not really a solution to the problem at hand, and we need to be honest about this.  Especially because they tend to have the effect of making us normalize the situations we are living in and inhibiting the process of questioning the systems that make survival so brutally difficult.

Last December, I wrote:
"It makes no sense to speak of healing people if we are not willing to address what is making them sick and ultimately killing them.   I tell my students all the time that my prescription for everyone who walks into our clinic is the complete transformation of this society, and that anything else we do is harm reduction -- necessary and often life saving but not curative.  And while I don't have a roadmap to guide that transformation, I can tell you one thing -- the first step is refusing to accept the cruelty and suffering around us as normal.  Because the trouble with normal is that it always gets worse."
Maybe the process begins with giving people medicines and practices that connect them with new senses of possibility --  in my next post I will explore some of these approaches .  .

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