EFFECTIVE HEALTH CARE MUST FOCUS ON HARMONY IN ONE’S NEURAL ACTIVITY TO INCREASE GLOBAL FUNCTIONING

In 1975 a Scotsman working in health research discovered the presence of "endorphins" in the human body that serve as the basis for all neural functioning. They are the connecting link for communication between one’s mind and body. Carrying the messages back and forth are small go-between molecules of from 60 to 100 histochemicals, which are known as neurotransmitters, hormones, and neuropeptides. Their influence on 21st century health care will compare with DNA research on 20th century biology. The mind and body constantly chatter back and forth using this vocabulary of histochemicals, and it is from this interaction that neural functions are born (Cassel, 1985c).

HARMONY IN NEURAL FUNCTIONING

Each one of the neural functions may be likened to the playing of musical instruments in a symphony orchestra. The harmony or discord (lack of harmony) is determined largely on the appropriateness of the function to the situation at hand, and the cultural expectations of one's response. What is considered to be appropriate for a funeral, for example, may be highly discordant for a wedding or fiesta. Always, the degree of harmony is determined by the nature and degree of functioning of the various neural activity in relation to the expectations of the individual involved. Harmony is not produced by simply turning on or off a given neural activity. but rather in being able to utilise at a moments notice the full range of all such activity. It is from this neural activity that one's feelings of wellbeing and/or personal satisfaction are born (Cassel, 1989).

NEW CONCEPT OF WELLNESS

There is mounting evidence that as many as 80 percent of persons seeking health care display no evidence of severity of psychosocial stressors present. In order to satisfy the demands of such patients, and to allay their concerns, millions of doses of barbiturate or amphetamine like drugs are prescribed each year. This, of course, is because the traditional professional preparation of the physician has nothing else in his/her repertoire to deal with the problem. While the prescription of such drugs may be a real emergency necessity at times, it seldom if ever actually increases the global functioning or level of wellness of individuals involved. Even when glandular problems are the basis for health care, such drugs do nothing for eliminating the problem; even where needed on an emergency basis for survival of the patient. Newer and more effective treatment must be. the rule (McGinnis, 1991).

Dr. Russell N. Cassel is Diplomat ABPP in School Psychology.

DSM-III-R

Under the new regulations for payment of health care in the United States, degree of global functioning is prescribed as the main basis for success. Health care effectiveness is based largely on the degree to which the global functioning of the individual is enhanced. Indeed, the new regulations as defined in DSM-III-R(1987) provides a ten point scale for use in determining the effectiveness of health care provided. For example, if the individual is judged to display global functioning as only at the 10 percent level, it means they have tried self destruction; for 20 percent, they have talked about suicide; etc.

REDUCING SEVERITY OF STRESSORS

Traditional health care has been primarily concerned with the reduction of severity of psychosocial stressors, and where the five vital signs have served as basis for assessing change:

1. Systolic blood pressure (heart muscle).
2. Diastolic blood pressure (arterial system).
3. Temperature (homeostasis).
4. Pulse Rate (perceived stress load).
5. Arrythmia (cardiovascular system).

INCREASING GLOBAL FUNCTIONING

The new focus of health care for all patients has to do with increasing the global functioning of the individual involved. This, to be sure, includes even those with severity of psychosocial stressors evident. The effectiveness of health care, then, must be measured by the degree to which the actual functioning of the individual is increased. Five secondary vital signs are proposed as the basis for assessing level of wellness, whether or not there is evidence of severity of psychosocial stressors present. The nature and degree of the presence of such neural functions may be assessed effectively by five different biofeedback instruments(Cassel, 1985b):

1. GSR Galvanic Skin Conductance - emotional liability.
2. EMG Electromyograph - striated muscle tension.
3. TEM - Finger temperature sympathetic syndrome.
4. PUL - Pulse Rate - perceived stress load.
5. EEG - Electromyograph - brain laterality.

The Neural Functioning Assessment Program (NFAP) is designed to assess degree and nature of neural functioning in four of the proposed secondary vital sign areas: GSR, EMG, TEM, and PUL. By use of the Cassel Tri-Bi-Sensor, four different biofeedback instruments are interfaced with a PC like microcomputer to assess the neural functioning. Guided imagery, using 96 slides depicting pictures of activity in 12 different areas of life, are utilised. As the individual views each slide for a period of 10 seconds, he/she is asked to rate on a 10 point scale in secret how much he/ she would like to be involved in such activity. As the individual is rating that activity, four different biofeedback instruments record changes in neural functioning, and which is depicted on the computer screen. Observing those changes by the individual involved, serves to confirm for the individual the reality of neural functions being assessed (Cassel, 1987; & 1991).

NEURAL FUNCTIONING CLUSTERS

In the validation of NFAP fifteen clusters depicting different patterns of neural functioning have been identified. Through the use of pictures, each different cluster is specifically related to one of the 12 areas of life being depicted (Cassel, 1985a):

1. Home and family.
2. Religion and inner dev.
3. Affiliation and social.
4. Law and security.
5. School and education.
6. Romance and psychosexual.
7. Sports and risk taking.
8. Health and safety.
9. Travel and relaxation.
10. Aesthetic and beauty.
11. Money and productivity.
12. Survival and pollution.

USE OF CLUSTERS

The particular neural cluster derived depicts not only the preferred mode of neural functioning, but also the areas of life in which individuals derive their greatest personal satisfactions. Clearly, the immediate purpose for assessing neural functioning has to do first with the self understanding of the individual involved. Second, and of far greater importance, is for personal planning of one's own life and the tomorrow. In as much as one's own personal satisfactions derive from their neural functioning and harmony, knowing where and how such satisfactions derive best is crucial to making one's own personal choices in the future.

PERSONAL SATISFACTION AND WELL-BEING

If health care is expected to foster the personal satisfaction and the feelings of well-being of patients, it must of necessity deal with the basis of such feelings in the process. It is clear that neural functions serve as the basis for such feelings. Knowledge of where such feelings abound serve as the basis for self direction to just where such feelings are found to obtain.

SELF DIRECTION OF HEALTH CARE

It is clear from the Framingham and other studies that individuals are often responsible for their own illnesses, and because of this they must accept personal responsibility for their own health care. Risk factor science and transpersonal psychology born largely from the Framingham studies, establish life style as a major etiological basis for much illness, i.e., cigarettes, alcohol, weight control, exercise, drug and substance abuse, nutrition, appropriate sunshine for vitamin D, and, it is now clear, we must add self regulation of own neural system. Primary health prevention derives alone from defensive living, and only a well informed person can participate effectively in such health care.

WELLNESS AND GLOBAL FUNCTIONING

Health care in the 21st century must recognise that wellness and global functioning are intimately related conditions. One can not be expected to have one without the other. They can not be considered as separated entities, and where the focus of intervention strategies are on one or the other, there can be little success expected. For under such conditions, never the twain could be expected to meet. Health care of tomorrow, must, of course, begin with the individual, and, of course, the immediate problem of concern, but always it must involve every other group membership of patient or subjects involved, i.e., home, family, community, work place, etc. The major factor that determines success in health care, or wellness of the patient, must be reckoned in terms of present level of global functioning (Cowen, 1991). How could it be different?

AUTOGENICS

The single intervention strategy that has repeatedly demonstrated success in increasing level of wellness, and hence global functioning is "autogenics" (Cassel, 1990). Borrowing heavily from eastern philosophies, autogenic feedback training has demonstrated effectiveness in a wide area of application to improve the global functioning of individuals. Here the focus is on self regulation of one's neural system, and almost on a daily basis. Success in the use of this approach have been legion in a wide area of applications, but it is not the subject of this paper.

REFERENCES

Cassel, R.N. (1985a). Fostering wellness through positive emotions. College Student Journal, 19(2), 202-206.

Cassel. R.N. (1985b). Biofeedback for developing self-control of tension and stress in one’s hierarchy of psychological states. Psychology, 22(2), 50-57.

Cassel, R.N. (1985c). Systematic selfregulation of the neural essential for peak performance and well being. Psychology, 22(314), 51-56.

Cassel. R.N. (1987). The use of guided imagery to create a neural system dissonance profile (DISPROF). College Student Journal, 21(3), 206213.

Cassel, R.N. (1989). Guided imagery to depict disharmony in the neural functioning of persons involved in psychological therapy. Education, 110(1), 40-49.

Cassel, R.N. (1990). The use of autogenic feedback training as an intervention strategy in health care. Education, 111(2), 265-272.

(1991). Validity of dissonance profile for discerning between therapy and no-therapy group membership status. Journal of Instructional Psychology, 18(1), 51-59.

Cowen, E.L. (1991). In pursuit of wellness. American Psychologist, 46(4), 404-408.

Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) (1987). Washington, D.C.: American Psychiatric Assoc.