Harold James Dettman, M.D. and Rita Walda Walters
This paper describes an objective test that can be utilized as a basic screening procedure for selecting those individuals who are chemically deprived, and subjected to a form of stress of which they are totally unaware. They have felt and performed in the same way all their lives. Many times they do not know what it is to actually feel “good”. Quite unlike a beautiful sunrise that can be appreciated by anyone with sight, and needs nothing to compare it to, an individual must feel really good before he can appreciate the feeling for what it actually is. Similarly, people born without pain receptors can never know what pain really is. It is impossible to explain odor to an individual who has never experienced the sense of smell. It is impossible to explain color to a person who has never experienced vision. We will suggest the implications, anatomical and physiological, that this testing reveals.'(1)
Hans Selye(2) very astutely and clearly depicted in the “General Adaptation Syndrome”, the picture of endocrine gland disturbance brought on by “stress” to the body. Literally everyone, investigators and researchers, have used the word “stress” very loosely and without definition as a causative factor in many common afflictions. These afflictions range from “migraine” headaches i.e. vascular headaches, myocardial infarction, peptic ulcer, a waste basket diagnosis called 11 nervous stomach”, colitis, depression, alcoholism, sexual dysfunction and other so called psychosomatic disorders. In fact, the word “stress” has become an acceptable part of social conversation.
The word “stress” has been so commonly utilized that it has become practically a meaningless term. We will utilize the word “stress”(3) to mean a state of relative deprivation. As our paper continues we will see that the relative deprivation may be chemical, physiological, anatomical, physical, psychological, emotional or milieu related.
Fonder, et al,(4) for the first time, to our knowledge, pointed out that “the routine interplay of the autonomic nervous system in the symptomatology throughout the total person” is of primary importance when he analyzed the data he had accumulated on patients with dental malocclusion. The recognition that the entire autonomic nervous system was activated by maloccluded teeth, was a unique observation, and opened the door to further investigation that has produced bountiful discoveries. Heretofore, this malocclusion had been viewed as simply teeth not coming together properly. Possibly, Fonder and his collaborators, at the time of their publication, were not fully aware of how extremely accurate they were. The mechanism of the test we are about to describe will demonstrate how very profound Fonder’s observation was and provides support evidence. He concentrated predominantly on anatomical factors and we will concentrate on physiologic alterations in similar individuals.
Our promise is that a “normal” person who abducts his arms to a perpendicular position (90 degrees) from his side, or preferably to a little further (100 to 110 degrees) from the perpendicular will lose strength (the ability to maintain the position against a counter pressure) immediately (within 5 seconds and most frequently within 1 second) after glucose is applied to the tongue. This loss of strength is of brief duration. It persists for a maximum duration of 60 to 120 seconds. The easiest manner to demonstrate this is to ask a patient to abduct the arms with the palms down to the appropriate position (or as far as they can if for any reason abduction is limited.) Then the examiner exerts a downward pressure on the arms at the elbows. The examiner will be unable to force the arms down. Even in women it may be extremely difficult to force the arms from this position. Then allow the patient to rest from the exertion. Next, a syrup is simply painted on the tongue with an applicator stick. (We use Karo syrup because it happened to be available in the kitchen but any sweet substance is adequate including granulated sugar -just poured on to the tongue.) A downward force is then again applied against the arms, and the observer, as well as the patient, is frequently astounded by how easily the arm is forced downward. Only light pressure is needed compared to the resistance prior to the application of the glucose.(5) This must be done quickly because the loss of strength will last for only a maximum of 120 seconds. This can be demonstrated quantitatively with an instrument we have devised.(6) The decrease in pressure necessary to push the arms downward will decrease anywhere from 10 to 100 mm hg. pressure. The loss of strength happens so fast that it is almost unbelievable, unless one actually has it done, and even then many people find it difficult to believe it has happened to them. The strength returns after a very short interval of time (30 seconds to one minute). It is frequently necessary to repeat the test on the same individual several times before they will believe what is happening.
There are people who do not lose strength following the application of sugar or syrup to the tongue. These people have a completely different response to certain chemicals. They comprise a distinct and separate group. The discovery of this fact was accomplished by a combination of logical thought processes, stemming from the long experience with the chemical treatment of depression. These individuals then, who do not lose strength following the application of syrup or sugar to the tongue, are the group we classify as having a positive strength test. They do not lose strength following the application of sugar to the tongue, and are considered abnormal according to our classification.
The remainder of the test should have been simple and easy to figure out, but it actually took several months before it was thought out and confirmed.
However, after several months we found that among the group who did not lose strength following the application of sugar to the tongue, there was a group who lost strength following the application of bitter(7) to their tongue. (Again with an applicator stick exactly as the syrup was applied). Actually, we have not found any people who fail to lose strength following the application of sugar to the tongue, who also fail to lose strength following the application of bitter. Although we feel confident there must be some who fail to lose strength after application of both sugar and bitter.
The next step was accomplished very easily and followed logically. We found that individuals, who failed to lose strength when sugar was applied to the tongue, but who did lose strength following the application of bitter, could be reversed instantaneously to a normal reaction simply by painting a dilute solution of Dexedrine on the tongue. Following the application of the Dexedrine they would immediately lose strength following the application of sugar to the tongue, and fail to lose strength following the application of bitter. (A normal reaction.)
The following summarizes the reactions: Normal; definite loss of strength following the application of glucose or a sweet liquid to the tongue, combined with absolutely no loss of strength following the application of bitter to the tongue. Abnormal; no loss of strength following the application of sugar to the tongue. A distinct loss of strength following the application of bitter to the tongue. The abnormal response being reversed by the application of a dilute solution of Dexedrine to the tongue.
Discussion
The fact that marked alterations in the strength of the outstretched arms could be markedly altered almost instantly by the simple application of substances to the tongue, and the reactions could be reversed just as quickly, confirmed and emphasized the observation of Fonder that “the routine interplay of the autonomic nervous system in distress symptomatology throughout the total person” is of primary importance. Our observation proves that physiologic alterations can be induced in distant places, by application of different chemical substances to the tongue.
The test herein described is simple. However by using this test as basis for treatment, we have found an objective measurement for proving that a multitude of disease states heretofore thought to be stress related, are in fact caused by a chemical stress. The test allows us to separate people into groups whose autonomic nervous system function differently. This difference in autonomic nervous system function manifests itself in different ways. The test provides the key and opens the door to the control of many different stress related diseases. By correcting the autonomic nervous system dysfunction, rather than concentrating on the cortical system, will correct many diseases previously classed as emotional or cortical in origin.
The loss of strength in the arms resulting from the application of chemicals to the tongue must trigger receptors located in the tongue. These receptors must then start a sequence of reflex responses mediated by the autonomic nervous system. It must be a sub-cortical level, because the loss of strength cannot be altered by any conscious effort. Many patients have strained to their utmost to maintain their strength with total and complete lack of success. Very strong willed individuals have tried to prevent the loss of strength repeatedly but all have failed.
This test has provided us with an objective method for demonstrating autonomic nervous system dysfunction as well as predicting chemicals that will alter this dysfunction. Then the success or failure of treatment can be monitored. Patient compliance with treatment can also objectively be monitored.
Depression was the first disease studied. How autonomic dysfunction is the cause of pathological depression will be described in future papers. One can predict which of the tricyclic chemicals will control the depressive state. The tricyclic chemicals take a long time to work. The time varies from three weeks to three months as a rule but it may take as long as a year. Only by using the strength test can one tell when the chosen tricyclic is exerting its beneficial effect. Blood levels of the chemical are meaningless. The tricyclic drugs may suddenly lose their effectiveness for no apparent reason. This is reflected in the strength test. The effectiveness of the tricyclic chemical can be restored by the administration of estradiol and or testosterone and the strength test will change accordingly.
Alcoholism is caused by autonomic dysfunction and the authors have been able to eliminate the craving that alcoholics have for alcohol. They stop drinking alcohol excessively and are able to drink socially without reverting to their previous alcoholic state. The success of treatment can be monitored as well as patient compliance by using the strength test. The patient cannot alter, by any effort or will, the results of the strength test. Therefore, one can tell whether or not he is complying with treatment, regardless of what he might say. He can lie or attempt to fool the examiner, but he cannot alter the results of the strength test because the body does not lie.
The authors have not yet had sufficient experience with coronary heart disease. However, it appears quite likely that the relation of stress to coronary heart disease lies in the autonomic nervous system. Again the strength test provides the clue. The fact that alcohol is the only known substance that raises high density lipid cholesterol in the serum, and the striking similarity in physiologic actions shared by alcohol and the tricyclic chemicals, suggests that these substances could well raise the level of high density lipid cholesterol, and thereby alter. the risk of coronary heart disease. The authors have indirect evidence that the individuals classified as high risk for development of coronary heart disease have autonomic nervous systems that function in exactly the opposite fashion from what would be expected. For an example, pulmonary function studies were done on those patients classified as abnormal by our strength test. In these patients every parameter measured decreased after the administration of a bronchodilator, rather than increased, as one would expect. This suggests, that coronary blood flow could change in the same fashion, that is, for coronary blood flow to decrease in response to stimuli which call for it to increase thereby creating a state of relative coronary ischemia. In addition, the pattern of lipoprotein electrophoresis has changed in patients treated with tricyclic antidepressants that suggests an increase in high density lipid cholesterol after treatment. Currently studies are underway in individuals with abnormal strength tests that will demonstrate whether or not the tricyclic chemicals will or will not alter the levels of high density lipids and if so, in what fashion. Also studies are underway to determine whether there is a rapid method of predicting which tricyclic will alter the level of high density lipids and in what fashion. These results will be reported when they are available.
Symptomatic hypoglycemia has been encountered in every patient with an abnormal strength test. Concomitant treatment of the hypoglycemia has been necessary in conjunction with other therapeutic modalities in order to produce maximum patient benefit.
Depression and alcoholism are the two problems upon which efforts and attention have been concentrated. We have been successful in the treatment of these. The treatment of depression and alcoholism demands control of the hypoglycemia, the proper chemical replacement (correction of the chemical deprivation) combined with some form of positive reinforcement. We define positive reinforcement as encouraging and teaching the individual how to adjust and adapt to the “new developing self”. The patient’s new awareness, that indeed he is feeling better and a new life style can be expected, may produce a form of anxiety. During this transitional period, guidance and reinforcement are necessary to stop any self-defeating behavior. Careful evaluation of his psychological, emotional and milieu related problems is most important. If any of these factors are lacking the treatment will fail. It must be emphasized that the correction of the chemical deprivation requires administration of the chemical for a relatively long period of time. (Three months is a general guide.) Patience and empathy combined with an understanding of the basic autonomic dysfunction will provide successful treatment of depression and alcoholism in practically every case.
It must be emphasized that every depressed and alcoholic patient has an extremely high suicide potential. The most critical period in the treatment of a suicide prone individual is when the patient starts to feel better. During this period they must be carefully watched and protected from harming themselves. The threat of suicide must never be taken lightly in the treatment of the depressed or alcoholic patient.
Summary
A very simple test has been described. This test has provided means to successfully treat alcoholism and depression. The obvious importance of the autonomic nervous system in the treatment of disorders previously classified as cortical in origin, has been confirmed. The glucose metabolism system is intimately associated with the autonomic nervous system dysfunction manifested primarily by hypoglycemia.
Several possible areas come to mind in which the autonomic nervous system dysfunction may play a dominant role. A projective double blind study should be carried out to confirm or deny this hypothesis. The chemical and psychologic testing required for such a study would be more expensive than a private patient could reasonably assume. All information has been obtained through testing and observation necessary for the proper treatment of individual patients. No funds, grants or monies of any kind have been available so far in this research study. Therefore, documentation has been limited. If the appropriate funds were available, the authors believe they can devise a means of screening individuals and treating them before depression and alcoholism are able to exert their havoc. The authors have the key. They know where to look. All that is necessary is proper funding to open the door.
Reference Notes
- Future presentations will elucidate more explicitly the modalities that may be utilized in appropriate patient diagnosis and treatment. This paper does not specifically emphasize the necessity of a holistic approach to the solution of the multiphasic problems revealed by a positive reaction to the test. Patients are best treated by a holistic discipline. No single discipline possesses all the skills necessary for proper treatment of a particular patient so selected. Further publications will be devoted to clarification of this method. A holistic approach is oriented toward simultaneous treatment of anatomic, chemical, physiologic, psychologic, social, emotional and environmental conditions.
- The General Adaptation Syndrome, author Hans Selye.
- Depression Relative Deprivation, 1977 Rita W. Walters, Unpublished.
- Fonder, et al, Malocclusion: As it Relates to General Health, 111. D.J., 34:292, 1965
- At first granulated sugar was applied to the tongue, syrup was so much easier and convenient. It could be easily carried in the pocket along with an applicator stick. It also could be applied by painting on the tongue allowing better control and simplicity.
- Lawrence Puerner constructed the instrument using the bladder from a sphygmodynamometer and a column of mercury. The instrument requires the person tested to exert an upward force against a partially inflated rubber bladder and the force is transmitted to a column of mercury.
- An aqueous, dilute solution of quinine is used as the bitter substance. The reaction frequently occurs before the bitter taste is appreciated. At first alcoholic liquer in the form of Tequila was used but later found that it was simply the bitter substance and not the alcohol that triggered the response. We thought the alcohol was the important substance; but would have had to assume a new set of receptors on the tongue. With the establishment of the bitterness as the triggering agent, and alcohol, it is not necessary to postulate any unknown receptors.
Acknowledgments
- R. A. Laine, P.A., assisted in the care and treatment of many patients.
- Jean Ann Bordner, R.C.L.T., performed most of the laboratory tests documenting the hypoglycemia.
- Mark Dettman assisted with the demonstration at the meeting of The American Academy of Physiologic Dentistry.
