Russell N. Cassel Ed.D., ABPP, FAPSP
Professor Emeritus (Psychology) University of Wisconsin, Retired
1362 Santa Cruz Court,
Chula Vista, California 91910-7114 e-mail rcassel5@aol.com

A biopsychosocial approach to health care seeks to assess harmony in one's inner space through the use of computerised biofeedback. Here four traditional biofeedback instruments used in concert seek to assess comparisons between cognitively directed activity and picture based or incited activity as an index of harmony in one's inner states. Additionally, harmony is based on an intra comparison of the four biofeedback instruments, i.e., EMG, GSR, TEM, & PUL.

Psychological and social stressors are a recent element which we have learned often provoke our bodies into an accompanying uproar linked to mere thought (Sapolosky 1994). That uproar in our bodies is directly associated with the principle of "homeostasis" which serves to explain the typical functioning of a healthy body. Our bodies (digestive, circulatory and other body functions) operate in a manner as to maintain a sufficiency needed for a healthy life. When that sufficiency is not being met there is disharmony created by feelings of unpleasantness which Festinger (1957) called "cognitive dissonance," causing the individual to seek ways to relieve such angry feelings. Our Biofeedback is designed to assess both the degree and nature of disharmony present (Cassel, 1978; 1985; and 1987)..

Nature of Stressors
A stressor is anything that disturbs the homeostasis of the well functioning body and where "cognitive dissonance" (feelings of unpleasantness) are the inciting force to restore harmony or homeostasis. A stressor is no longer limited to an absence of physical needs (hunger, injury, blood loss, temperature extremes, etc.). psychological needs (anxiety, neurosis, hostility, etc.), but also includes not achieving own personal expectations. Thus, the stress response can be activated not only to physical and psychological insults, but also in the expecting of these; so they may be real or imagined. Clearly, stressors are the principal inciting force that disturbs the homeostasis or harmony of our inner space (Cannon, 1936).

Nervous Systems
An important part of our body that is always associated with harmony of the internal regions is the nervous system. It is comprised of two major parts that operate in opposition to each other. First the parasympathetic nervous system is typically associated with our conscious brain and mediates calm passive activities. Second. the sympathetic nervous system is typically associated with emergency states (fight, flight, fright and sex) and is largely unconscious in nature. Internal harmony exists only when the sympathetic nervous system is under voluntary control, and where personal goal setting and striving of the individual is the primary focus in life (Stryer. 1992: Weiner, 1992).

Endocrine System
Epinephrine (adrenaline is British term) secreted by the adrenal glands, is largely under control of the sympathetic nervous system and is typically released in excessive quantities during emergency states. Often in reciprocal fashion the release of epinephrine serves as the major vehicle creating the emergency state where normal functions cease, and the blood is sent to vital organs so individual is able to fight or flight to survive. Clearly, it is the presence of this emergency state, real or imagined that typically causes disharmony in our inner states.

Brain as an Endocrine Structure
The more recent research describes how the brain is the master gland which exercises control over the pituitary gland which previously was considered to be the governor of other glands. It is now recognised that the base of the brain, the hypothalamus, contains a huge array of inhibiting hormones which instruct the pituitary gland that in turn regulates the secretion of the peripheral glands; some as releasers and others as inhibitors; so that the strict control of the reticular formation in one's limbic system no longer applies for such action (Sapolsky, 1994).

Hostility and Heart Disease
Recent studies suggest that floating hostility is directly associated with heart disease, athersclerosis and high rates of mortality (Chesney, et. al., 1988). Blood pressure goes exceedingly high for people with floating hostility which typically involves cynical mistrust and repeated overt aggressiveness. Often such persons are likely to also be heavy smokers.

Peptides and Neurotransmitters
Of the nearly 100 peptides and neurotransmitters identified to date, at least four of them play a critical role in relation to harmony in our inner space through the cognitive element in feelings (Goldstein, 1990; and Burks, 1991). In the case of these four basic peptides, three of them form clusters in critical areas of the body, and hovering over each respective cluster there is an aura associated with the cluster creating cognitive feelings characteristic of such peptides. The rather unusual thing about peptides is that they possess antennas which enable them to communicate with other like and sometimes unlike peptides independent of the brain. It is this independence from the brain that adds a new and critical element in relation to health care:

1. Acetylcholines - stimulate digestive process creating gut mobility, and first discovered by Loewi in the 1920s, for which he received the Noble prize in 1936.
2. Beta-endorphins - cluster in pituitary gland area and foster feelings of well-being and personal contentment, and first discovered by a Scotsman in Bethesda, Maryland in 1975.
3. Enkephalins - cluster largely in the adrenal gland area in the dorsal column of the spinal cord and are associated primarily with pain control.
4. Dopamine - largely in blood stream and serve to determine one's sensitivity to contingency management (praise and blame). When drinking alcohol, for example, the level of Dopamine in the blood is decreased significantly, and one's sensitivity to praise and blame is decreased accordingly. There is considerable evidence that Dopamine may be related to harmony in one's inner space because of loss of sensitivity to such controlling mechanisms.

Cognitive Basis of Emotions
Always, cognitive activity is a necessary as well as a sufficient condition for our emotions, and serves to mediate the relationship between a person and the present immediate environment. Humans are meaning oriented creatures who constantly evaluate events from the perspective of their own well-being, and always react emotionally to those personal evaluations. Our feelings serve as the basis for emotions and they are always oriented in a cognitive structure; even when the emotions are instantaneous and non-reflective.

Disharmony and Health Care
Somatization disorders are typically associated with disharmony in one's inner space, and are present in as many as 75 percent of all patient's visits to health care (Davies & Wickramasekera, 1996). Clinically then, the first and most important concern in health care has to do with ascertaining the degree and nature of disharmony present. Any scientific approach to health care must seek first to determine the nature of the dysfunction, and then to plan ways and means for correcting the specific inciting problems present. Only when such primary elements are identified can the clinician proceed with a scientific approach to health care, and disharmony in one's inner states can be no exception to this rule. Computerised biofeedback programs are designed to provide such information in relation to health care, and two cognitively oriented tests based on precisely the same structure (external and internal concerns) have been developed to use with this instrument: The Democratic Maturity Test (DEMO), and The Self-fulfillment Inventory (SELF).

The Roots of Somatization Disorders
Voluntary control and human development evolve gradually with age but they always begin with one's inner feelings, and then progress in kind of a linear fashion from those inner states and feelings to cognitive thinking and perception. Typically, it involves building a cognitively oriented web from the dominant to the non-dominant brain areas and is referred to as "constructivism" where cognitive interaction results in one personally perceiving meaning to the process. Technological advances have resulted in our ability to record signals by use of different modalities of biofeedback in the process.

Where Feelings Are Born
Not unlike in a sympathy orchestra the inner beings of an individual play a tune that serves as the basis for harmony. In the process many major musical like instruments are involved in the orchestration. Some of these appear like musical instruments functioning in our human body, are as follows (Halley, 1991; and Pilkington, 1983):

1. Labyrinthine sense of middle ear in relation to gravity.
2. Kinaesthetic sense dealing with muscles and limbs (Electromyograph).
3. Viscera sense or "gut" feelings (acetycholines).
4. Circadian rhythm and inner sense of time (pulse).
5. Hypothalamus with affect states and emotional scars evident (b-endorphins).
6. Synesthesia and the crossing of senses. i.e., taste for colour., etc.
7. Pain and the ability to deal with pain (enkephalins).
8. Sensitivity to both internal and external conditions (Dopamine).

Holistic Concept
When Frantz Alexander, President of the Psychoanalytic Society introduced the concept that a healthy body is necessary for a healthy mind (similar to the ancient Greek body-mind-concept), holistic medicine was born. More recently it has become clear that the mind resides in the body through the use of peptides and neurotransmitters, as well as in the brain, and that peptides and their receptors which constitute the biochemistry of our emotions which serve to regulate all human behaviour. It was Candence Perth who first discovered that a relatively small family of molecules serve as the basis for our emotions (Hall, 1989). It was she who discovered the antennae on those peptides with their communication qualities. Clearly, now we know that our anatomical senses routinely communicate with one another independent of the brain and that those powerful biochemicals carry the messages back and forth serving as go-between molecules. For some years those molecules have been referred to as "misfit" molecules and now they promise to influence health care in the 21st century as DNA influenced 20th century biology.

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Chicago:University of Chicago Press.