Can the affective deficit be a cause of illness?
M.P. González, E. Barrull, C. Pons y P. Marteles, 1998
(This paper is an English translation of the Spanish original)
The great development of Medicine since the end of the 19th century has changed the quantity and the quality of the human well-being completely, especially in the advanced industrial societies. Pasteur's discovery about microscopic life and its enormous incidence on living beings illnesses has driven to an extensive control of the infectious diseases. However, at the same time that this type of illnesses are controlled, we are witnessing the emergence of a great number of 'new' ones, or rather, diseases that didn't have too many opportunities to appear before the 20th century.
The common characteristic of all these 'new' illnesses is that they are not caused by microbial agents, that is to say, neither by viruses nor bacteria. The origin of illnesses like cancer, heart attack, allergy, depression or obesity keeps the scientific community in a perpetual bewilderment. We know many things about them, how to palliate their symptoms and even how to eliminate them, but their causes are still a scientific mystery at the present time.
In this article we want to defend the idea that a chronic affective deficit is the main cause of non infectious illnesses and behavior dysfunctions.
In another article in this Web (see What is affection?) we have seen that the human species needs the help and the collaboration of its fellow human beings to survive and to reproduce along all its life. The diverse forms of help and social collaboration that we human beings exchange to achieve our survival are contained in the common term called 'affection'. Affection is given when we carry out any type of non-remunerated work that benefits other people.
What can it happen when somebody doesn't receive enough help from the other people? Or when somebody provides much more help than the amount that he receives? That is to say, what can it happen when a person has an affective deficit? We believe that, although the economy of affective exchanges is crucial for the individual's survival, this topic has not received the scientific attention that it deserves.
To evaluate the relationship between the affective deficit and the health of a given organism it is necessary to pay more attention towards what the fact of giving affection means. We have said that giving affection means to provide a non-remunerated work that benefits somebody else. When an organism carries out a work, it consumes a portion of its energy. This expense is directly proportional to the magnitude and inversely to the effectiveness of the work. It doesn't only consume metabolic energy, it also consumes a part of its brain processing capacity. Indeed, using the brain is needed to coordinate all the actions involved in carrying out any task. This means that the brain stops assisting to other less urgent activities to concentrate on the main task. The more complex the task, the bigger the amount of brain work required. And nowadays, most important problems in our lives require a big amount of brain work with not too much muscular effort.
Although we know very little about the brain, Neurobiology teaches us that it exerts an important control of the vital functions and activities of the organism. The brain gets informed and tries to control the internal and external events of the organism. Therefore, the health of all the body organs and the adaptation to the environment of the organism depends on the brain. Each brain failure, each calculation mistake, sooner or later will result in a dysfunction somewhere in the organism, although it can be hardly noticeable.
This way, a significant decrease of the brain computation effectiveness will produce an anomaly or illness in some part of the organism. Our evolution has endowed us genetically with a very effective and powerful organism, resistant to the anomalies whether internal or external. But, if the brain systematically doesn't exert a proper control on some organic function, this one will destabilize becoming, little by little, into an illness or a disorder. What we want to argue is that the systematic affective deficit diminishes the effectiveness of the brain, and then, it is a significant cause of illnesses and behavior disorders.
What does an affective deficit involve? We have seen that affection is the social help that we human beings exchange with the purpose of surviving, and we do this with any non-remunerated work done in someone else's benefit (See What is affection?). Is the brain the one that carries out the main part of this work. Everyone receives work (affection) and provides work to other people. In turn, each individual has different affective needs, in quantity and quality, depending on his/her degree of autonomy. Children, for instance, need big quantities of affection (work) since they have very little capacity to obtain by themselves the resources they need. Adults, on the contrary, need less affection in general, although they cannot survive without it.
For any person to survive a given amount of work has to be done, and it doesn't mind who does it. If the amount of work available to one person is not enough to survive properly, he will be experiencing an affective deficit. But, concerning that deficit, it is necessary to bear in mind the work that he/she provides and the work he/she receives. If you give much more help than the one than you receive from the other people, you may experience an affective deficit.
Keeping in mind that brain makes the main work, if we note WT as the total amount of work that one person is able to do, Wg as the work given to others, Wr as the work received and Ws as the work needed to survive, we define the following condition as the state of affective deficit:
WT - Wg + Wr < WS
An affective deficit takes place when the work capacity of a person (WT) , minus the work given to others (Wg), plus the received work from others (Wr), is smaller than the necessary work required to survive properly (WS).
In children, the affective deficit will take place generally if they don't receive enough help to grow adequately. Since children have little capacity of work (WT << WS) if there is any deficit it will depend basically on a received help shortage (Wr).
In mature adults the affective deficit will take place as a result of providing help to other people beyond one's means. Mature adults have a high affective capacity (WT > WS) and, therefore, the deficit will take place when the help that they give to the other people (Wg) deprives them from the required energy to survive. People that tend to help people without expecting or receiving any reward, they usually experience an affective deficit. The affective deficit in children is something that we usually notice, but it uses to go unnoticed when it comes to adults.
An affective deficit causes the brain to be under a high level of stress. In that case, the brain capacity of work (calculus) isn't enough to maintain properly the organism functions. Either it has to assist to too many situations that it is not still prepared to solve (it happens to children), or it has to assist to too many other people's problems, leaving one's own problems aside, in the case of the mature adults.
In children, the affective deficit takes place whether because of underprotection or because of overprotection. Underprotection makes the child to confront problems without having enough capacity to overcome them. It leads him/her to an unbalanced development of his/her capacities and personality. On the contrary, if the child is overprotected, he won't acquire the necessary knowledge to survive. So, he/she suffers a serious development deficit, and, later on, he will be unable to confront the challenges that life imposes on him/her. Working to promote the child development means protecting him/her in situations that he/she cannot overcome and unprotect him/her in situations he/she is really able to solve. To do this, parents must do a lot of work (affection) and it cannot always be done.
In mature adults, the affective deficit takes place when the work provided to other people reduces their brain capacity to solve their own problems. Every mature adult can provide a certain amount of help without losing brain capacity to assist to the requirements of his/her own survival. But many circumstances can favor that an adult surpasses, without realizing it, his/her personal limit of delivering help to other people. When it happens, his/her brain loses effectiveness.
Therefore, if an affective deficit persists, the brain doesn't have enough capacity to evaluate each situation correctly and it begins to process incorrectly information that is vital for the organism. As a result, an increase of the brain inefficiency (neuronal dysfunction) takes place and it produces emotional errors (see What is emotion?): the brain believes that the body is hungry although it really isn't, it believes that there is not danger when in fact there is danger around, the brain doesn't have time to think of itself or it doesn't worry about the damage that smoking produces, etc. The result of this persistent inefficiency is, sooner or later, the appearance of some kind of illness or behavior dysfunction.
In summary, what we know about the brain allows us to argue that affective deficit causes a brain stress or brain inefficiency that, in turn, it ends up producing diverse kinds of illnesses and behavioral dysfunctions, depending on such factors as the genetic predisposition, the culture or the environmental factors.
Although the affective deficit is the origin of many illnesses, it doesn't determine, however, the particular form that they adopt. This is due to the enormous complexity of the brain and to its central function in the whole organism. A cerebral dysfunction can affect to any function of the organism and in any possible way. The combinations are almost infinite and, therefore, symptomatologies are very diverse. Since it is impossible to work out the structure of the information stored in the brain, we can only approach it through the external elements that configure it.
We can say that the brain receives three basic types of information: first, genetic information that it's given by the peculiar nature of the organism that contains the brain, itself included (information about 'hardware'). The brain must control an enormous number of organic variables that are genetically defined (heart, metabolism, stomach, circulation of the blood, bones, muscles, etc.). Second, the brain has to operate with cultural information, that acquires its maximum complexity in the case of the human species. Knowledge, values, social norms, symbols, etc. are a very complex information that operates directly in and from the brain (performance programs or 'software'). Finally, the brain has to process a great flow of environmental information determined by the external conditions in which the organism should operate. The interrelation and integration of these three information modalities in each particular brain determine the concrete way the cerebral dysfunctions are manifested in that organism. This way, we can talk about the simultaneous and variable incidence of the three factors in the determination of the peculiar symptomatology of every case.
The genetic factors or genetic predispositions are very important because they determine the weakest structural points in the organism. This way, the brain inefficiency will tend to show firstly in those points of the organism structurally weaker. But illnesses don't appear for the simple reason of having a genetic predisposition, it is necessary, as well, that the brain makes many mistakes to produce an illness in the place where the organism genes point out.
The progress of the genetic research allows us to know better which are the weak points of the organism. But, to prevent that a genetic predisposition will manifest as an illness, it will be necessary to consider the affective deficits that can cause that illness.
One of the reasons that make difficult to see the relationship between the affective deficit and the illness in practice, is the enormous resistance of our organism in front of the anomalies. Thousands of millions of years of evolution behind us have endowed us with an organism able to resist the biggest challenges. Therefore, a systematic affective deficit is frequently manifested as an illness only after several years, and so, makes it difficult to relate both facts.
However, this situation seems to be changing because the genetic selection is disappearing since the Industrial Revolution. Each new generation of industrial men incorporates weak genetic variants, sometimes pernicious, that don't disappear because the conditions of extreme abundance allow their reproduction, becoming a part of the genetic heritage of the population. In consequence, each new human generation is genetically weaker than the previous one. Therefore, is probable that, in the future, the affective deficit will manifest as an illness faster in the next generations and its incidence in the human beings' health will be more obvious.
The genetic factors aren't the only ones that determine the weak points of the organism. Another great group of factors are the cultural ones. Culture, or information stored physically in the brain, constitutes the living "software" of the organism and it determines a great part of its behavior. It predisposes the brain to assist differentially to certain stimuli instead of others, giving more importance to some things than to others. Therefore, we could also talk about cultural predisposition to certain illnesses.
The next example will show us how cultural predisposition acts. Let us suppose that someone gives an enormous importance to his/her external image, that is, to how the other people see him/her. His/her brain will be programmed to assist firstly to everything that can affect the external image. So, the brain will tend to neglect the functions of internal organs which don't have an external manifestation. If this person is subjected to a chronic affective deficit, he/she will suffer from one of those illnesses that delay their external manifestation as much as possible such as, for example, heart attack or cancer.
Another very frequent example occurs when a person has a high degree of responsibility in front of the others and, therefore, he/she can't allow him/herself the luxury of being sick. He/she won't manifest any symptom nor weakness for several years. But some day, unexpectedly, he/she will be ill in a serious and irreversible way, without any hope of recovery. The influence of cultural factors, such as the external image or the responsibility in front of the others, on illness determination, it's not very well-known yet and it needs more research.
Finally, it is also necessary to underline the environmental factors, such as the geographical and the socioeconomic ones. Illnesses are distributed unequally according to the environment and the socioeconomic level of the people. It is very well known that the feeding, the solar light, the atmospheric contamination, the relative humidity, and thousands of other environmental factors determine the materialization of the illness. Equally, the economic and social level determine the access to certain resources that affect the appearance of some illnesses or others. Together with the genetic factors, the environmental factors are the most studied and well-known at the moment.
Let's exemplify our idea with an analogy. Let's imagine that we put a pressure cooker over the fire, filled with water and with its security valves welded. We know that sooner or later it will explode. Which will be the cause of the explosion? There is no doubt that the heat received will produce an increment of the internal pressure beyond the limit of its resistance. Therefore, the cause of the explosion will have been the excess of heat. But, what will be the exact point of explosion and how will it explode? We only know that it will break through its weakest point, which will depend on multiple factors. The material impurities, the quality of the production, the resistance of the weldings, etc., these factors will decide the place, the moment and the way in which the explosion of the cooker will happen.
What we want to outline is that the non-infectious illness of an organism derived from a brain inefficiency, it's like the explosion of the cooker. The illness caused by an affective deficit is manifested through the weakest point in the organism, which is determined by the simultaneous interrelationship of multiple genetic, cultural and environmental factors.
In the following illustration we try to summarize the approach known as 'biopsychosocial view'. The biopsychosocial view has been developed during the last years due to the growing conscience that the specific organic problems are not the only ones involved in an illness, rather there are important psychological and social factors that intervene in the origin and in the course of many illnesses.
Our position is that a significant affective deficit drives to some type of neurological disorder, that is to say, a decrease of the effectiveness with which the brain processes the vital information for the survival of the organism. This situation, together with a complex group of genetic, cultural and environmental factors, determines the manifestation of a particular symptomatology.
In general, we can distinguish four big classes of neurological symptomatologies:
1. psychological disorders: depression, anxiety, phobia, obsession, etc.
2. risky behaviors: rash driving, drugs, overfeeding or undernourishment, etc.
3. development deficit: school, laboral or reproductive failure, etc.
4. violent behaviors: murders, mistreatments, rape, robbery, etc.
The genetic, cultural and environmental factors determine the concrete manifestation in each particular patient. But the four types of anomalies are derived from a poor and ineffective performance of the brain in its task of processing the information needed to achieve the survival and the health of the organism.
The illnesses that are not caused by viruses nor bacteria, such as cancer, heart attack or obesity, are intimately associated, above all, to psychological disorders and risky behaviors.
In general, brain inefficiency caused by a systematic affective deficit, produces some disorder in the brain performance that has as a result a manifestation like some of the above mentioned anomalies. These, in turn, will mean suffering some kind of somatic illness. Nevertheless, we believe that a brain inefficiency will be a direct cause of a somatic illness, although it is not usual.
Lastly, we believe that there are reasons to think that there is an effect of the affective deficit even in the infectious illnesses. Although these illnesses are caused by microbial agents, it is known that the organism has defense mechanisms against them. And, according to what we know about the brain, the immunological capacity of an organism is affected directly by brain performance or even in an indirect way. Therefore, the weakness of an organism against the microbial attacks can also be attributed to the existence of an affective deficit.
In summary, we propose the hypothesis that many non microbial illnesses and most behavior disorders are caused by an important affective deficit in the sick person and that multiple factors (genetic, cultural and environmental) determine the way the illness manifests and its symptomatology.
Therefore, the diagnosis of the illness should include an analysis of the sick person affective relationships with the purpose of determining the existence of a probable affective deficit. This way, besides making the opportune treatment of the symptomatology, the patient could receive guidance on solving certain deficit relationships that are at the origin of his/her illness. If there isn't a solid action against the cause of the illness, it is probable that the same illness or another one may appear again after some time.
However, once an illness has appeared, it is a mistake to think that it can be treated eliminating the affective deficit that caused it. Although the organism has a certain capacity for self-recovery, an illness is usually an irreversible degradation and the organism can only be recovered through an appropriate external medical intervention. That is to say, the diagnosis of an affective deficit and its decrease or elimination produces fundamentally preventive effects over the illness.
Sometimes it happens that, when someone falls seriously ill he/she makes a significant change in his/her affective relationships, being able to diminish or even eradicate the existing affective deficits. The patient isn't aware of it, but the result is usually a very satisfactory recovery and a favorable prognosis. Many changes in the affective relationships occur as a result of an illness. Biopsychology can play an important role in the guidance and the advice of the patient so that this process won't only happen in an sporadic and fortuitous way. We believe that this is the way for Biopsychology to help Medicine in its final goal, that is achieving people's welfare and health.