LEVELS OF REACTION IN ENVIRONMENTAL DISEASE: WITHDRAWAL LEVELS

Minus-one Levels. As was explained earlier, there are four progressive levels of withdrawal. Of these, the localized symptoms of the minus-one level are certainly the best known and probably the most common. Of the various organ systems involved with localized allergies, the upper respiratory tract (nose, sinuses, and throat) probably is most frequently affected. For instance, the practices of ear, nose, and throat physicians as well as many allergists are dominated by seasonal (hay fever) and perennial nasal allergy. The lower respiratory complaints of coughing (bronchitis) and wheezing (bronchial asthma and its complications) are also very common. Although these minus-one reactions most often occur in response to such inhaled particles as pollens, dust, mold spores, animal danders, or debris from insects, they may also be caused by food or environmental chemicals.

Minus-one localized allergic reactions involving the gastrointestinal and genitourinary systems, also of common occurrence, are most frequently responses to foods and environmental chemical exposures. Allergic skin manifestations are of two types. Direct contact reactions usually result from exposure to chemicals in the environment. Eczema from ingested exposures is usually caused by foods or food additives.

From the standpoint of their recognition and management, reactions to inhaled particles (pollens, dusts, molds, and so forth) are far better handled by orthodox medical treatment than those caused by exposure to foods and environmental chemicals. Since these localized allergies are described adequately in most other books on allergy, they will not be emphasized in this presentation, although it should be restated that most cases of hay fever and other local allergies can be benefitted by the methods outlined here.

Minus-two Levels. Minus-two reactions are systemic, or more generalized, reactions. These will be emphasized in this book both because of their common occurrence and because their environmental causes—especially common foods and chemical exposures—are so rarely recognized. The major manifestations are fatigue and pain, especially headache, and muscle and joint aches and pains.

Minus-three and Minus-four Levels. In contrast to minus-one and minus-two withdrawal levels characterized by physical symptoms, minus-three and minus-four levels are concerned with mental and behavioral responses. Minus-three, called “brain-fag,” is characterized by mental confusion and relatively less severe depression. Complaints in this category are most commonly regarded as psychological and are rarely handled from the standpoint of their environmental origin. This brain-fag level will be emphasized with case histories.

Minus-four reactions include the most severe forms of depression. These cerebral and behavioral reactions, usually referred to as psychoses, may be characterized by abnormalities of perception and consciousness. Although such extreme cases may also be helped by the application of the techniques of clinical ecology, since I am an internist I see relatively fewer cases at this level than do psychiatrists. Despite the demonstrable relationships between many “mental” problems and allergic reactions, ecologically oriented techniques are applied with greater difficulty to longstanding and advanced cases of psychosis, especially schizophrenia, than to less advanced cases.

Before discussing specific cases, however, it may be worthwhile to review briefly the kinds of problems which can be caused by the stimulatory and withdrawal reactions. This will give some idea of the scope of these disorders and the position of specific symptoms in the overall scheme.

Plus-one reactions are usually within the range of normal behavior. The person in this stage is slightly overactive but tends to be relatively happy and symptom-free.

Plus-two reactions include hyperactivity, irritability, excessive hunger and thirst; insomnia; restlessness; nervousness, jitteriness, overresponsiveness, negativism; shortened attention span and learning disorders; vasomotor changes, such as chilling, flushing, and sweating; obesity, alcoholism, and drug addiction.

Plus-three reactions include egocentrism; drunklike behavior, with muscular incoordination; sensations of floating and unreality; anxiety and extreme nervousness; extreme apprehension and fearfulness.

Plus-four reactions include mania, with or without convulsions; epileptic or catatonic seizures; muscle-twitching, jerking of extremities; frenzy, aggression, agitation, panic; repetitive thinking, speech, and actions. (The word “mania” is used according to common, rather than psychiatric, usage.) Patients may have only one of these symptoms. More commonly, however, they suffer from a number of different problems. They may straddle several of these categories by being, say, nervous and jittery (++) at one time and egocentric and anxious at another (+++). Or they may vacillate between one of these stimulatory levels and a more or less corresponding withdrawal level.

Some of the more common forms of stimulatory reactions are given in the chapters which follow. Although hyperactivity and alcoholism will be described, chapters have not been written on the subjects of obesity and drug addiction because of space limitations.

Suffice it to say, briefly, that obesity and alcoholism are basically similar illnesses, ,one dealing with addicting foods in their edible form and the other in their potable form. Stimulatory phases in both instances tend to be relatively prolonged, inasmuch as victims tend to be aware of the general nature of the responsible addictants in both instances, although specific addictants may not be pinpointed. This seems to be especially true in obesity, which is more often related to eating in general than to the frequent use of one or more specific foods. Although there is some habituation involved, cravings in obesity can usually be curbed effectively as a result of the avoidance of incriminated foods.

The basic course of addictive illness is shown in Figure 1. It is believed to start with food addiction, as shown at the base of this pyramid with food fractions listed in the ascending order of their relative speed of absorption (fats and oils, proteins, starches, sugars and alcohols).

From this base, addictive responses to food-drug combinations and drugs commonly occur, as addicted persons tend to seek ever more effective stimulatory effects. Heroin, administered by intravenous injection, has long been known as the apex of addictive phenomena.

Patients may be seen at any stage of this process, involving various combinations of addictants.

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