This chapter deals with the postmodern mental health. Mental disorders are common. In the United States, in a given year approximately one quarter (26.2%) of adults are diagnosable for one or more disorders116. While mental disorders are widespread in the population, the main burden of illness is concentrated among a much smaller proportion (about 6 percent, or 1 in 17) who suffer from a seriously debilitating mental illness. It is important to understand mental disorders.
In Chapter 11, mental disorders are derived from the combinations of the hyper response genes, the chronic adverse environments, and the misdirected mental functions. The hyper response genes include the hyper pleasure response genes, the hyper stress response genes, and the hyper immune response genes. The chronic adverse environments include chronic adverse experiences and chronic adverse infection. The misdirected mental functions include the addiction instincts, the defensive survival instincts (fight-flight-freeze- obsession), and the mental process during sleep. The combination of the hyper pleasure response genes, the chronic adverse experiences, and the misdirected addiction instincts results in the hyper pleasure mental disorders. The combination of the hyper stress response genes, the chronic adverse experiences, and the misdirected defensive survival instincts results in the hyper stress response mental disorders. The combination of the hyper immune response genes, the chronic adverse infection, and the misdirected mental process during sleep results in the delusional mental disorders.
In the hyper pleasure response mental disorders including histrionic and narcissistic personality disorders, pathological gambling, and psychopath, life is controlled by the addiction of pleasure. In the hyper stress response mental disorders including major depression, borderline personality disorder, anxiety disorders, and manic depression, life is controlled by the struggle for survival. In delusional mental disorders including schizophrenia and autism, life is controlled by the dream-like wakefulness.
The pleasure responses are the responses to the four mental enhancers: bond, expressive, systemization, and domination corresponding to amiable, expressive, analytical, and driver social styles in the popular Merrill-Reid social style theory, respectively. The corresponding stress responses are the responses to the four corresponding mental stressors: disconnection, injustice, disorganization, and repression, respectively. The four subtypes of the hyper pleasure response mental disorders result from the four enhancers, the four subtypes of the hyper stress response mental disorders result from the four stressors, and the four subtypes of the delusional mental disorders result from the four stressors. All mental disorders can be categorized by these 12 subtypes. Many mental disorders are the combinations of the subtypes.
11.1. Mental Overreaction
How do normal social lives turn into mental disorders? The causes of mental disorders are complex. If it were simply, human evolution would have eliminated mental disorders. Each cause by itself is relatively harmless, but the combination of a number of harmless causes can result in harmful mental disorders.
Social-life enhancer enhances social life, and social-life stressor disrupts social life. The instinctive reaction to social-life enhancer that enhances social life is social-life
pleasure response to continue the social-life enhancer, so the enhancers enhance social life with the response of pleasure. Social-life stressor that disrupts social life causes the loss of the function of certain adaptive social life. The instinctive reaction to social-life stressor is social-life stress response to prompt attention to social-life stressor, so social-life stressor can be dealt with urgently. For adult yin and yang social lives, the social-life enhancers are bond, expressive, systemization, and domination with the corresponding social-life stressor: disconnection, injustice, disorganization, and repression, respectively.
Genes provide proper controls of pleasure response or stress response to continue the repetition of the enhancers or to the avoidance of the stressors, and then the social lives can return to normal. Through evolution, genes provide optimal normal pleasure response and stress response for normal environment, so majority of people have normal genes that are most suitable for normal environment. Most people have optimal normal pleasure response and normal stress response. At the same time, variant genes exist. The variant as hypo pleasure response that result in low enhancer or hypo stress response that results in high stressor are less adaptive than the variant as hyper pleasure response or hyper stress response. Hyper pleasure response allows the high repetition of the enhancers at the expense of safety, and hyper stress response allows high repetition of avoidance of the stressors at the expense of internal energy reservoir. In normal environment, such variant genes are adaptive, even though they are not optimal. For normal environment, few people have the adaptive variant gene with adaptive level of hyper pleasure response or hyper stress response, while most people have the genes with optimal normal genes with optimal normal levels of pleasure and stress.
The immune system participates in the development of the nervous system. Immune system too has optimal normal immune response gene for normal condition and adaptive hyper immune response gene as a variant. For normal environment, most people have the genes with optimal normal immune response, and few people have the genes with adaptive hyper immune response.
Different environments cause genes to express differently. The normal adjustment for genetic expression to adjust to different environments is epigenetic adjustment117 by which environments alter heritable gene expression via methods other than altering the underlying DNA sequence. Under epigenetic adjustment, genetic expression become more pleasure response to adjust to more chronic pleasurable environment, genetic expression become more stress response to adjust to more chronic stressful environment, and genetic expression become more immune response to adjust to more chronic infective environment. To genes, chronic environmental effects become norms to which genetic expressions are adjusted.
The chronic adverse environments for the hyper pleasure response and the hyper stress response nervous systems come mostly from childhood experiences, such as indulgence, physical illness, abuse, and neglect, during the development of the nervous system. The chronic adverse environments for the hyper immune nervous system come mostly from infections in mother during the fetal brain development. The infection triggers the response of maternal immune system whose immune molecules enter in the fetal brain to trigger the hyper immune response to interference the brain development, resulting in the underconnectivity of neural cells. Normal response genes have more room for adverse epigenetic adjustment before the genetic expression becomes severely maladaptive for
normal environment. In some cases, severely chronic adverse epigenetic adjustment can make even normal genes to produce maladaptive genetic expression.
In the threefold typology by C. Robert Cloninger118, the three types are novelty seeking, harm avoidance, and reward dependence. The threefold typology has been used to diagnose mental disorders. The person high in novelty seeking is impulsive and exploratory, and eager to take up new interests, but neglects details and quickly becomes distracted and bored. Novelty seeking corresponds to the hyper pleasure response nervous system. People high in harm avoidance are cautious, tense, inhibited, easily fatigable, shy and apprehensive worriers. Harm avoidance corresponds to the hyper stress response nervous system. The individual high in reward dependence is eager to please and help others, is warm, sympathetic and sensitive to social cues. The person low in reward dependence are tough minded, emotionally independent, and socially detached. Low in reward dependence corresponds to the hyper immune nervous system with the underconnectivity of neural cells that have problems to deal with complex reality in society.
In the final step, when the chronic maladaptive hyper nervous systems reach the critical high maladaptive levels, mental overreactions are formed by triggering the misdirected mental functions. The chronic maladaptive hyper pleasure response nervous system triggers the misdirected addiction instincts, resulting in hyper pleasure response mental overreaction, when the chronic enhancer is transformed in the addiction. The chronic maladaptive hyper stress response nervous system triggers the misdirected defensive survival instincts (fight-flight-freeze-obsession), resulting in the hyper stress response mental overreaction, when the chronic stressor is transformed into the predator. The chronic maladaptive hyper immune nervous with underconnectivity of the nervous connection triggers the misdirected mental process during sleep, resulting in delusional mental overreaction, when the mental process of wakefulness is transformed into the mental process of sleep. People with mental overreactions have socially acceptable behaviors. Many people with mental overreactions are highly successful in society because of mental overreaction that normal people do not have. People with mental overreactions with the maladaptive nervous system are maladaptive in normal environment, but society sometimes provides abnormal environment for people with mental overreaction to thrive.
Mental overreactions are like autoimmune disorders where misdirected immune function to normal body tissues is harmful to body. In mental overreactions, misdirected mental functions to normal mental state of wakefulness are harmful to the mind. Mental overreactions caused by defensive survival instincts are posited by Stephen Porges in the Polyvagal theory119. The intrusion of the mental process during sleep into wakefulness in people with mental disorder was described by Claude Gottesmann who finds remarkable similarity between schizophrenia and REM sleep in the brain activities and behaviors120. Chronic mental overreaction causes the extensive reconstruction of the brain to reflect the usage and under-usage of neural connections by mental overreaction, resulting in the disordered nervous system, which is mental disorder. People with the maladaptive nervous system attempt to adapt, and people with the disordered nervous system fail to attempt to adapt. The development of mental disorder is described by the diagram below.
Mental disorders are derived from the combinations of three causes: the hyper pleasure, stress, or immune response genes, the chronic adverse environments (experiences or infections), and the misdirected addiction instincts, defensive survival instincts (fight-flight-freeze-obsession), or mental process during sleep. In the hyper pleasure response mental disorders including histrionic and narcissistic personality disorders, pathological gambling, and psychopath, life is controlled by addiction of pleasure. In the hyper stress response mental disorders including major depression, borderline personality disorder, anxiety disorders, and manic depression, life is controlled by the struggle for survival. In delusional mental disorders including schizophrenia and autism, life is controlled by the dream-like wakefulness.
Mental overreactions are described in the table as follows.
hyper response gene chronic adverse environment
maladaptive nervous system
chronic maladaptive nervous system misdirected mental function
mental overreaction
chronic mental overreaction
mental disorder (disordered nervous system) The Development of Mental Disorder
Mental Overreaction
Yin Yang
Passive Dynamic Passive Dynamic Merrill-Reid amiable expressive analytical driver enhancers/
pleasure response
bond expressive systemization domination
Stressor disconnection injustice disorganization repression Stress response despair paranoid anxiety unfulfillment Role friend communicator systemizer driver Idealized Self-
Image
loyalist peacemaker idealist leader
Hyper stress response mental overreaction
depression manipulation obsession mania
Defensive survival instinct
flight-freeze manipulative obsessive rage
Role sufferer manipulator sectarian rebel Idealized Self-
Image
loner strategist devotee hero
delusional mental overreaction delusional depression delusional manipulation
delusional obsession delusional mania
Role delusional sufferer delusional manipulator
delusional sectarian delusional rebel
Idealized Self- Image
imaginative loner imaginative strategist
imaginative devotee imaginative hero
hyper pleasure response mental overreaction
bond addiction expressive addiction
systemization addiction
domination addiction
Role bond addict expressive addict systemization addict domination addict Idealized Self-
Image
super lover celebrity super geek adventurer
As in the table above, the three types of mental overreactions are the hyper stress response, the delusional, and the hyper pleasure response mental overreactions. There are four enhancers-stressors, so there are total 12 subtypes of mental overreactions, including four hyper stress response mental overreactions (depression, manipulation, obsession, and mania), four delusional mental overreactions (delusional depression, delusional manipulation, delusional obsession, and delusional mania), and four hyper pleasure response mental overreactions (bond addiction, expressive addiction, systemization addiction, and domination addiction).
11.1.1. Hyper Stress Response Mental Overreactions
Social-life stressor that disrupts social life causes the loss of the function of certain adaptive social life. The instinctive reaction to social-life stressor is social-life stress response to prompt attention to social-life stressor, so social-life stressor can be dealt with
urgently. Stress response is in the following order: 1) the limbic system, 2) the hypothalamus, 3) the pituitary gland, and 4) the adrenal glands. The four systems constitute the LHPA axis. Under normal stress response, the LHPA axis has a negative feedback loop to minimize the glucocorticoid stress hormones produced by the LHPA axis. Under chronic stress response, the glucocorticoid stress hormones increase. The level of stress response as the level of the glucocorticoid stress hormones decreases with the increasing numbers of the hippocampal glucocoricoid receptors, which are affected by the serotonin 1a receptor (5-HT1a), the serotonin 2a receptor (5-HT2a), and the reuptake of serotonin. The numbers of the receptors are controlled by the epigenetic adjustment that is affected by chronic stress, resulting in the high stress response nervous system triggered by chronic stressful environment. The adverse epigenetic adjustment occurs mostly during childhood that is the time for the brain development. The childhood adverse environments include physical illness, abuse, and neglect.
In experiments by Michael Meaney121, the offspring of female rats displaying less nurturing behavior (low licking and grooming compared to high licking and grooming) had fewer hippocampal glucocorticoid receptors, resulting in higher anxiety-related behavior.
The best-known hyper stress response gene involves a variant gene in the promoter region of the serotonin transporter gene (5-HTTLPR). The short allele of 5-HTTLPR has been associated with decreased serotonin transporter availability, resulting in lower reuptake of serotonin. In several studies, individuals carrying this short allele have shown greater risk for depression in the face of adverse life events, including childhood maltreatment, although recent meta-analyses have questioned these findings122.
Another hyper stress response gene is the "A" (adenine) variant of the oxytocin receptor gene (OXTR gene)123. The "G" (guanine) variant is the normal stress response OXTR gene. Oxytocin is a hormone that increases in response to stress and is associated with good social skills such as empathy and enjoying the company of others. People with the 'A' variant scored substantially higher on depression.
The combination of hyper stress response gene and chronic adverse environment results in maladaptive hyper nervous system. In the final step, when the chronic maladaptive hyper nervous systems reaches the critical high maladaptive levels, the hyper stress response mental overreactions are formed by triggering the misdirected defensive survival instincts124, when the chronic stressor is transformed into the predator.
In human and many other animals, the defensive survival instincts are developed to deal with real or potential predators. For real predators, the defensive survival instincts are the freeze, flight, and fight instincts. The freeze instinct is to instinctively immobilize to fake death under attack by predator. The flight instinct is to run away from predator. The fight instinct is to fight against predator. The fight instinct also includes the maternal fight instinct to fight against predator in order to protect the children. For potential predator, the defensive survival instinct is the obsessive instinct to focus intensively and obsessively potential predator, and ignore all other nonessential objects.
The triggering of the defensive survival instincts changes stressors into predators. The result is the mental overreaction to stressor. Initially, people with mental overreaction are within socially acceptable range. People with mental overreaction can be quite successful in society, sometimes because of the acceptable mental overreaction. The stressor in the yin passive social life (bond) is disconnection to disrupt bond as the enhancer. The instinctive reaction to disconnection is despair as the stress response
to prompt attention to disconnection, so disconnection can be dealt with urgently. Chronic stress response triggers the flight-freeze instinct, which is the defensive survival instinct of a helpless prey to the attack from a predator. The corresponding behavior is flight- freeze as depression for withdrawn behavior (flight) and inactivity (freeze). Depression is the mental overreaction to disconnection as the stressor. For human, depression can be both instinctive and rational to justify rationally depression. The role for people with the mental overreaction of depression is sufferer. A person with the role of sufferer can rationalize the role as loner to avoid detestable people.
The stressor in yin dynamic social life (expressive) is injustice to disrupt expressive as the enhancer. The instinctive reaction to injustice is paranoid as the stress response to prompt attention to injustice, so injustice can be dealt with urgently. Chronic stress response triggers the manipulative instinct, which relates to the maternal fight instinct as the defensive survival instinct to deceive and attack stealthily a predator, such as the broken wing trick that a mother bird plays to lead a predator away from the baby birds. It is the origin of the asymmetrical warfare. The corresponding behavior is manipulation. Manipulation is the mental overreaction to injustice as the stressor. For human, manipulation can be both instinctive and rational to justify rationally manipulation. The role for people with the mental overreaction of manipulation is manipulator. A person with the role of manipulator can rationalize the role as strategist to protect the person and the love ones from strong opponents.
The stressor in the yang passive social life (systemization) is disorganization to disrupt systemization as the enhancer. The instinctive reaction to disorganization is anxiety as the stress response to prompt attention to disorganization, so disorganization can be dealt with urgently. With disorganization, systemization suffers from anxiety. Chronic stress response triggers the obsessive instinct as the defensive survival instinct, which focuses in only one critically important potential predator, and ignores all other objects in a highly uncertain and competitive environment. The corresponding behavior is obsession. Obsession is the mental overreaction to disorganization as the stressor. For human, obsession can be both instinctive and rational to justify rationally obsession. The role for people with the mental overreaction of obsession is sectarian. A person with the role of sectarian rationalizes the role as devotee.
The stressor of the yang dynamic social life (domination) is repression to disrupt domination as the enhancer. The instinctive reaction to repression is unfulfillment as the stress response to prompt attention to repression, so repression can be dealt with urgently. Chronic stress response triggers the rage instinct, which relates to the fight instinct as the defensive survival instinct to fight manically against a predator. The corresponding behavior is mania. Mania is the mental overreaction to repression as the stressor. For human, mania can be both instinctive and rational to justify rationally mania. The role for people with the mental overreaction of mania is rebel. A person with the role of rebel can rationalize the role as hero.
11.1.2. Delusional Mental Overreactions
The hyper immune response nervous system as the underconnective nervous system for mental disorders is derived from dysfunctional immune system in the nervous system as proposed by A. Kimberley McAllister125. The immune and nervous systems
are in a complicated relationship. During healthy development independent of immune