العلاج التكاملى من منظور إيقاعى تطورى Integrative Therapy Biorhythmic Evolutionary Approach

Evolutionary Structural Process Oriented Model. ( = Comprehensive Medical Artistic (Creative and/or Folklore) Linear Etiological Deterministic Model (= Mechanical- Chemical or Psychoanalytic ) versus

Chemical Mechanical Model

تشريح الشخصية : فرويد – التحليل النفسى الكلاسى تركيب الدماغ : التجزيئ الكيميائى الشعور“الأنا“ تشابه الحتمية التحليلية الفرويدية مع الحتمية الكيميائية ? اللاشعور

Fragmentation Localization sectorization Dissection

Is essentially localizing & quantitative following mainly: Reductionistic Medical Model Neurological analogy Endocrinal analogy

While more profound Neurological aspects worth considering such as: Biorhythmic Nerve Firing etc… Hierarchical (Evolutionary) organization (Neo cortex - archi-cerebellum, etc…) Neurology has been reduced to Localization & quantification (+++  - - -) Cognitive neurosciences

Endocrinology as analogy Mainly Quantitative Hyper-secretion Hypo-secretion Hyper-functioning Hypo-functioning & Quantitative Correction …etc

I- analogy with GIT & Metabolic S. Information Processing (input) Unassimilated Information (memories) Rumination of Information (Dreams) Re-patterning (dreams and/or creation) Foreign Body Mal-adjusted Un-assimilated etc. Comprehensive Medical Model

Analogy with Orthopedic S. Break down Healing Callous (Scar) Impossible Identical repair as pre-fracture status (=Stronger or Different organization of the outcome after fracture)

analogy with Cardiovascular S. Biorhythmic : Filling- Unfolding cycles Information processing (partly rhythmic) Pacemaker Alternations (Sleep- Dream-Rhythmicity) Extra-systoles (Impulsivity) Electroshock Resuscitation Nodal- Escape (analogy) ( Dissociation or Systematized Psychosis ) & Fibrillation (Schizoph)

Biorhythmic pulsations of the Brain Brain Cycles are Sophisticated

Current Recent Scientific Vocabulary & Frame of references Quantum Physics & Quantum Mathematics Computing sciences New (&Molecular) Genetics Cognitive Neurosciences Chaos & Complexity Sciences Examples

Some New vocabulary & Orientation “Our brains each have 100 billion neurons and 100 trillion synaptic connections) “We are neuronal beings … “What we call concepts are neural structures that allow us to mentally categorize our categories and reason about them” “ Philosophy is in the flesh and in every day activity, not the least intellectual argumentations ” e.g. The book titled: Philosophy in the Flesh” Lakoff & Johnson 1999 (Cognitive Science Challenging Western Thoughts)

Illusive Current Terminology in Psychopharmacology Vague Terms  Neuroleptics يعنى إيه ” لبتك ؟“  Psychotropic Drugs يعنى إيه ” تروبيك“ ؟  Psychoactive Drugs نشاط إيه !!! على حساب إيه ؟ ” قصدك إيه؟“ ؟

Illusive Current Terminology in Psychopharmacology (Cont.) Certain groupings bear illusive terms  Antidepressants (are not only so)  Anxiolytics (are not exactly so)  Anti-psychotic ( Anti what ? Psychotic symptoms or psychotic status ?)  Anti-negative symptoms of schizophrenia (debate: Schizophrenia Bulletin Sept 2002 Vol 28 No 2 : Is there a treatment for negative symptoms?)

Illusive Current Terminology in Psychopharmacology (Cont.) Biochemical pseudoscientific terms:  SSRI (then what ?)  MAOI (and then ?)  Tricyclic  Serotonin ma3rafshi eaih

Practical Clinical Terminology (1) Potency (provided that the domain and target of potency is well defined).  Very Potent  Moderately so  Mild efficacy.  Rather specific  Good for nothing

Clinical Terminology (2) Suggested Evolutionary Terminology  Oldest Brain inhibitors (?? archaic organizers)  (= potent neuroleptics = anti devolutionary, anti-withdrawal... e.g. Haldol Olanzopine )  Older brain inhibitor (?? paleo- organizers) (= moderate neuroleptic e.g. Stelazine  Old brain inhibitors  Recent brain tranquilizers  Broad-spectrum anti-psychotics (Clozaril. etc )

Relevant (Appropriate scientific) Language Energy & Information  The mind is a processor of energy & information  Energy is contained within the activation of neuronal circuits.  Information is contained within the patterns of activation (=neural net profile = mental representation)  The nervous system can function as a parallel and serial process of information.

Relevant (Appropriate scientific) Language States of Mind  … the state of activation of the various parts of the system can cluster into repeated patterns called states”  “… In the brain a state of mind or mental state describes the way in which the various neuronal groups become activated at a given time.”  A neuronal net profile (= repeated pattern of neuronal group activation) can become reinforced if they occur frequently or if the value system of the brain ingrains their profile”

Consciousness and mental schemata Schemata are special highly structured organizations. They are stimulated (& reactivated) according to special stimuli. They possibly correspond to what is known as Ego states) Genes are but ingrained DNA & neuronal programs

Behavioral level of Normal Defensive Life المستوى السلكوكى للحياة العادية (ذات الدفاعات الطبيعية) ثم ماذا وراء كل ذلك !؟؟

هيراركية الأمخاخ والذوات وحالات العقل الكر-الفر- موقف البارانويا Fight Flight Paranoid P. العصاب الاكتئاب الفصام : التهديد الأساسى => بالتفسخ والنكوص Normal Defensive Life الحياة العادية (ذات الدفاعات الطبيعية)

+ Normal ( Neurotic B) Brains Depressive Brain Paranoid Brain Trilafon Stelazine Mellaril Largactil Tryptizol MAOI Drugs Corresponding levels of organization Object Relation Schizoid => Paranoid => Depressive positions Melanie Klien, Guntrip etc. Schizoid Brain Halodol Diazepines

الفصام : التهديد الأساسى => بالتفسخ والنكوص Schizophrenia الفصام Paranoid state & symptoms حالات وأعراض بارانوية Depression Psychic pain : less defensive الاكتئاب الألم النفسى : دفاعات أقل Neurosis (normal + alienation). الغطاء العصابى ( العادية المغتربة غالبا ) مراحل تارجع ( فشل ) الدفاعات بالتتالى لتعرية مستوى يعلن المرض تلوالمرض Stages of subsequent failure of defenses uncovering latent organizations to declare a disorder after antoher

مطلوب من فضلكم : حتى يمكن توصيل أى شىء من بقية الورقة قدر أقل من التبعية قدر أكبر من الخيال قدر أقل من الخوف قدر أكبر من السماح قدر أقل من العقلنة قدر أكبر من الإبداع

Art of Healing فن اللأم قراءة ونقد النص البشرى لإعادة إبداعه معه

السؤال هو: ندّى ”مين“ ”إيه“ ”إمتى“ ؟ ندّيله قد إيه, و لحدّ إمتى؟ بأمارة إيه ؟ ؟ لمّا يحصل إيه ؟ وليس : ندّى”تشخيص ”كذا“ دوا ”كيت“ : حسب جدول الخواجة الخوارزمى! إللى ما شافشى ولا حالة بحق!!!!

السؤال هو: ندّى ”مين“ ”إيه“ ”إمتى“ ندّيله قد إيه, و لحدّ إمتى بأمارة إيه ؟ ؟ لمّا يحصل إيه ؟

Clinical (Artistic) Approach General Considerations  No single response could be related to a single therapeutic variable  Drugs are much more specific in relation to a particular phase of the disease for a particular patient in a particular setting along special therapeutic plan, rather than it could be specific to a particular diagnostic category

Artistic ( Clinical ) Terminology  Decent drug (e.g perphenazine trilafon )  Aggressive drug (e.g. Haloperidol)  Broad spectrum drug (Clozaril) Old wise drug (chlorpromazine)  Harmonizing drug (e.g. carbamazepine)بتاع كله !! (Bita3 Kolloh)  Smart drug (Olanzepine Zeprexia)  Soothing drug (xanax)

Lay Smart Terminology (3) الدوا ده.... دمه خفيف... إبن ستين فى سبعين.... ابن حلال,,,,ميّا ميّا..إللى هوا...بتاع كله..... ما حصلشى..... إلخ

Suggested Hierarchical ( Structural ) Terminology  Oldest brain control  Old brain control  Relatively old brain control  Relatively recent brain soothing  Recent brain energizer  Broad spectrum harmonizer  Rhythm restoring stabilizer (Mood stabilizer)

Hypotheses 1.Energy and Information need a consistent organizing output and goal 2.Most drugs act as reorganizers rather than quantitative corrective tools 3.Reorganization (re-harmonization) needs all measures in an artistic creative reconstructive manner

Hypotheses (Cont.) 4.Hierarchical organizations of the brain are both competitive and cooperative with each other 5.Therapy is an ongoing process dealing with and confronting the challenging disease process 6.The unitary concept of psychiatric disorder has its corresponding application in drug use as well as regards most therapeutic measures. 7.Drugs are not specific in principle, nevertheless they are more specific in the context of master therapeutic plan

TOW MAIN CATASTROPHIES ARE GOVERNING CLINICAL PRACTIC 1.Algorithmic discipline for drug administration 2. Monitoring by blood level

Basic assumptions of the art of healing  Clinical monitoring should take priority  Functioning is more important than symptoms  Most drugs are considered inhibitors to certain” neuronal net profile ====   As such they are ultimately releasers to some other activated net profile.  Remember the basic rule:  Pattern of neuronal group activation can become reinforced if they occur frequently or if the value system of the brain ingrains their profile”

The Re-organizing Hypothesis

Pathological excess of Some transmitter Specific drug abolishing the excess Changing the whole pattern Hypothetical Brain Organization Not essentially normal الفكرة أنه بزيادة أو نقص مادة معينة بالمرض أو بالعلاج يتغير التنظيم الكلى للدماغ وهذا يظهر إكلنيكيا فى كلية نوع التغير فى العلاقة بالموضوع, والعمل, و نبض الوجدان 9

8 Antidepressants Drugs re-pattern certain profiles (Programs/ Brains) after special Habilitation Preparation Most potent neuroleptic Less potent Mild Neurt

Drug II How specific inhibition changes the whole pattern (Brain-Level-State) 8989

8383 Drug II

Drug I Drug II More Simple figurative Illustration Drug III 8  3  6  9

Schiz. Paranoid ++ Schizo-depressive Schizo-agitatied Depression (2) Depression (1) Anxiety Depression Anxiety Panic Schiz. Paranoid +++ Schiz. Chron. Undif Schiz. Disorg. Schiz. Simple Thioridazine Mellar. Chlorpomazine Perphenazine Trilaf Randolectil Haloperidol Majeptil + Haloperidol Almost none !!! Tryptizol Prothiaden + Mania. Trifluperazine Stelaz Minor Tranquil. Anxiety Floating Clozaril Broad Spectrum Stabizers e.g.Carbamazepine This is not th least the case The actual art is the result of training. This is not the least case The actual art is the result of training.

Side Notice about: The Unitary hypothesis of Psychiatric Disorders

المرض النفسى : واحد له تجليات متعددة ، أم كثير كل مرض مستقل تماما؟ لا بدمن استثناء المرض العضوى القح (الورم- الاتهاب- الضمور) هذه فئة تسرى عليها كل ما يسرى على أأى التهاب أو ضمور أو ورم- يشمل ذلك استثناء التخلف العقلى هل لهذا المفهوم الواحدى فائدة عملية؟ نعم. لما يلى : حل إشكال الوراثة الحالات المختلطة الحالات البينية الأدوية المتعددة الفاعلية نقلات اللآعراض والأمراض فرض ”المفهوم الواحدى“ يتناول القضية من منظور كل من : I. أصل التطور (فيلوجينيا وأنتوجينيا) Same evolutionary origin II. الوراثة perspective Genetic III. نقلة الزملات Syndrome shift IV. نقلة الأعراض Symptom shift V. الأمراض المختلطة (وإلى درجة أقل : المتواكبة) والاضطرابات البينية. Mixed disorders and Intermediate Disorders (& ?? Co-morbidity)

المرض النفسى : واحد له تجليات متعددة ، أم كثير كل مرض مستقل تماما؟ لا بدمن استثناء المرض العضوى القح (الورم- الاتهاب- الضمور) هذه فئة تسرى عليها كل ما يسرى على أأى التهاب أو ضمور أو ورم- يشمل ذلك استثناء التخلف العقلى هل لهذا المفهوم الواحدى فائدة عملية؟ نعم. لما يلى : حل إشكال الوراثة الحالات المختلطة الحالات البينية الأدوية المتعددة الفاعلية نقلات اللآعراض والأمراض VI.نقلات فى العلاج النفسى Shifts in psychotherapy VII. نقلات فى العلاج الدوائى Shifts due to certain drugs VIII. مآل بعض الأمراض Outcome of certain syndromes IX.فاعلية نفس الدواء لأمراض مختلفة Efficacy of the same same drug for different disorders

Therapy in Terms of Energy and Processing

Certain Theoretical Relevant Information. The mind is a processor of energy & information  Energy is contained within the activation of neuronal circuits  Pattern of neuronal group activation can become reinforced if they occur frequently or if the value system of the brain ingrains their profile ”

Object relation Intellectual. Work Physical WORK

Imprisoned Energy  Depression Energy Overflow  Mania or Active paranoid reaction Shut in Disorganizing Energy  Schizophrenia

Factors Judging Drug Administration (Cont.)  Displacement of energy  Reactivation of appropriate pattern of neural group  Shifts from one level to another are to be judged clinically in terms of :  A) actual daily job performance  B) active (real) object relation  C) mode of relating (schizoid, paranoid etc.)  D) last & may be least: particular symptoms

المخ البارنوى المخ الشيزيدى Schizoid Brain Paranoid Brain

المخ العادى الواقعى العملى المخ الاكتئابى العلاقاتى Normal + Productive Brain Depressive Brain Confrontational Relational Normal Defensive Positively Alienated Brain

المخ الشيزيدى HALOPERIDOL  Normal Productive Life

المخ الشيزيدى HALOPERIDOL المخ الاكتئابى العلاقاتى  Normal Productive Life

المخ العادى الواقعى العملى HALOPERIDOL Stellasine المخ البارنوى المخ الاكتئابى العلاقاتى

Chlorpomazine Perphenazine Trilaf Resperidal Haloperidol Majeptil + Haloperidol Tryptizol Prothiaden Mellaril

700 ?? ?? /1000 ?? 750 ?? DOSE The more drug cohesion and object relation the less the dose

THANK YOU الحمد لله وشكرا لكم