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Environmental illness: certain health professionals and clinical ecologists claim it impacts and inhibits 15 percent of the population. Its afflicted are led to believe environmental illness (EI) originates with food, chemicals, and other stimuli in their surroundings -as advocates call for drastic measures to remedy the situation. What if relief proves elusive-and the patient is sent on a course of ongoing, costly and ineffective "treatment"? Several hundred individuals who believed they were suffering from EI have been evaluated or treated by Herman Staudenmayer since the 1970s.…mehr
Environmental illness: certain health professionals and clinical ecologists claim it impacts and inhibits 15 percent of the population. Its afflicted are led to believe environmental illness (EI) originates with food, chemicals, and other stimuli in their surroundings -as advocates call for drastic measures to remedy the situation. What if relief proves elusive-and the patient is sent on a course of ongoing, costly and ineffective "treatment"? Several hundred individuals who believed they were suffering from EI have been evaluated or treated by Herman Staudenmayer since the 1970s. Staudenmayer believed the symptoms harming his patients actually had psychophysiological origins-based more in fear of a hostile world than any suspected toxins contained in the environment. Staudenmayer's years of research, clinical work-and successful care-are now summarized in Environmental Illness: Myth & Reality. Dismissing much of the information that has attempted to defend EI and its culture of victimization, Staudenmayer details the alternative diagnoses and treatments that have helped patients recognize their true conditions-and finally overcome them, often after years of prolonged suffering.
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Autorenporträt
Staudenmayer\, Herman
Inhaltsangabe
1 What is ""environmental illness""? What it is not Examples of what it is Definitions Naming the indefinable Idiopathic environmental intolerances Clinical ecology and EI advocates Prevalence Philosophy of science Competing theories of EI Toxicogenic theory History of EI Causal agents Biological mechanisms and susceptibility Explaining psychological symptoms Unique principles of toxicology Politics EI patients Symptoms Strength of belief in EI Personality and behavioral characteristics Psychogenic theory Belief Stress response Psychiatric disorders Treatment Conclusion 2 Toxicogenic theory A tale of misguided exploration Postulates Threshold of onset: total body load Long term effects Sensitization One molecule effect Heightened sensation: hyperosmia and cacosmia Threshold variability Sensitivity to multiple environmental agents Tune course of a hypersensitivity reaction Variability of effects Addiction to exposure Auxiliary postulates, the protective belt Temporal cohesiveness Demographic diversity Route of exposure Dose dependence Individual variability, uniqueness Rapid onset and cessation of symptoms Hypothesized biologic mechanisms Limbic kindling Tune dependent sensitization Smell and taste Conclusion 3 Unsubstantiated diagnoses and treatments Unsubstantiated diagnostic and treatment practices Provocation neutralization testing Sauna depuration Imprinted water and EMF Inappropriate use of diagnostic methods Radiology brain imaging tests Neuropsychological testing Self report of psychological symptoms Inappropriate use of treatment methods Acupuncture Diagnoses incorrectly attributed to EI Attention deficit/hyperactivity disorder Candida albicans hypersensitivity, the ""yeast connection"" Conclusion 4 Studies supporting the psychogenic theory Demographics and psychiatric/psychological conditions Clinical case reports Brodsky Stewart and Raskin Selneretal Terr Fiedler, Maccia, and Kipen Altenkirch, Hopmann, Brockmeier, and Walter Witorsch, Ayesu, Balter, and Schwartz Black Case control studies Pearson, Rix, and Bentley Simon, Katon, and Sparks Simon, Daniell, Stockbridge, Claypoole, and Rosenstock Black, Rathe, and Goldstein Staudenmayer, Selner, Buhr, and Selner A cohort study of chronic fatigue Perplexing questions Why middle age? Why female prevalence? Symptoms without disease? 5 Assessment of the toxicogenic research program Critical reports from medical associations Junk science excluded from the courtroom Testable hypotheses: provocation challenges A protocol for provocation chamber challenges The challenge chamber Methods of blinding the exposure Statistical analysis The case of a true positive responder Controlled challenges with EI patients Challenges unanswered Conclusion 6 Psychogenic theory A disorder of belief Psychogenic and psychosomatic illnesses Psychogenic illness mistaken as asthma The sick role History of psychogenic illness: neurasthenia Primary and secondary gain Discussion 7 Placebo and somatization Definitions The placebo effect as nuisance Placebo, ritual, and provocation challenges Factors contributing to the placebo effect Food intolerance: physiology and immunology Somatoform disorders Hypochondriasis Somatization disorder Conversion disorder An EI case of pseudoseizure Conclusion 8 Learned sensitivity Pavlovian classical conditioning Animal conditioning of the immune system Conditioning after documented exposure Thinking and learning Conditioning onset of asthma Cognitive learning 1886 historical example Learning to control allergies Fear and anxiety Learning and phobia The psychodynamics of phobia Discussion 9 The stress response Hypothalamic pituitary adrenal axis Psychologic effects of AC1H and corticosteroids Stress and aging: the glucocorticoid cascade hypothesis Role of psychological factors Catecholamine system Norepinephrine Epinephrine Dopamine Pupillary reflex Autonomic nervous system Inhibitory systems Serotonin GABA Opioids and endorphines Psychoneuroimmunology Effects of the stress response on cognition Conclusion 10 Panic attacks and anxiety disorders Psychophysiological theories of emotion Anxiety Panic attack Panic disorder Trme course DSM IV criteria for PTSD Experimental models of PTSD Learned helplessness Trme dependent sensitization Hyperosmia or cognitive priming? Conclusion 11 Trauma and post traumatic stress disorder War Epidemiology Psychophysiology Cognitive dysfunction Pre war risk factors Childhood trauma and adult sequelae Childhood emotional deprivation Childhood physical abuse Childhood sexual abuse A case of sexual abuse and EI Neurobiologic effects of childhood sexual abuse Conclusion 12 The limbic system and trauma The limbic system Electrical stimulation of emotion Emotions activate the limbic system Reticular activating system Disruptive effects of trauma Limbic system symptoms PTSD, limbic abnormalities, and trauma Hippocampal abnormalities EEG abnormalities Developmental stage and vulnerability Conclusion 13 Personality disorders Depression as a symptom Personality Psychological defense mechanisms Personality disorders DSM IV Axis II classification Self management of explosive affect Self management of implosive affect A case of folie a deux Dimensional models of personality Limitations of categorical diagnoses Dimensional diagnostic approaches Discussion 14 Iatrogenic illness: exploitation and harm A medical cult Quacks Patient vulnerability Devotion to the guru Bias and expectation invalidate provocation challenges Doctor's expectation and treatment outcome Counterphobic rituals and obsessive compulsiveness State revokes license of mercury amalgam guru Harmful effects The lady in the desert Isolation and ineffective rituals Munchausen syndrome by proxy Where are the bodies? Discussion 15 Treatment The path of psychotherapy Difficult patients and resistance Transference and countertransference Hateful and dangerous patients A depth model for selecting an intervention strategy Trust, empathy, and rapport An exposure event as an organizing concept Pitfalls The environmental care unit as a sanctuary Hope, magic, and the art of healing Psychotherapeutic interventions Stress management Behavior modification: systematic desensitization EI case report involving desensitization Cognitive behavioral therapy Cognitive distortions Dichotomous thinking Selective abstraction Arbitrary inference Circular logic Overgeneralization Undergeneralization Catastrophizing Decatastrophizing Misattributed causality Rationalization of lies Restructuring beliefs Psychodynamic psychology Treatment of personality disorders Psychotropic medications Discussion 16 Politics Victims and a herd of sacred cows Blaming social ills Reasonable accommodations? Victims: a neglected population? Politics of intimidation and the law Unrealistic product safety regulations ""More research"" Conspiracy theories Media Manufacturing industry Insurance industry Radical politics Discussion 17 Future directions TILT Scientific honesty The personal factor in disposing of contradiction Adversaries Paradigm shifts Endless rhetoric Model for a progressive research program Objective measurement and biomarkers Predicted outcomes for competing theories True positive False negative True negative False positive Conclusion Appendix A. A methodology of scientific research programs Appendix B. Court rulings
1 What is ""environmental illness""? What it is not Examples of what it is Definitions Naming the indefinable Idiopathic environmental intolerances Clinical ecology and EI advocates Prevalence Philosophy of science Competing theories of EI Toxicogenic theory History of EI Causal agents Biological mechanisms and susceptibility Explaining psychological symptoms Unique principles of toxicology Politics EI patients Symptoms Strength of belief in EI Personality and behavioral characteristics Psychogenic theory Belief Stress response Psychiatric disorders Treatment Conclusion 2 Toxicogenic theory A tale of misguided exploration Postulates Threshold of onset: total body load Long term effects Sensitization One molecule effect Heightened sensation: hyperosmia and cacosmia Threshold variability Sensitivity to multiple environmental agents Tune course of a hypersensitivity reaction Variability of effects Addiction to exposure Auxiliary postulates, the protective belt Temporal cohesiveness Demographic diversity Route of exposure Dose dependence Individual variability, uniqueness Rapid onset and cessation of symptoms Hypothesized biologic mechanisms Limbic kindling Tune dependent sensitization Smell and taste Conclusion 3 Unsubstantiated diagnoses and treatments Unsubstantiated diagnostic and treatment practices Provocation neutralization testing Sauna depuration Imprinted water and EMF Inappropriate use of diagnostic methods Radiology brain imaging tests Neuropsychological testing Self report of psychological symptoms Inappropriate use of treatment methods Acupuncture Diagnoses incorrectly attributed to EI Attention deficit/hyperactivity disorder Candida albicans hypersensitivity, the ""yeast connection"" Conclusion 4 Studies supporting the psychogenic theory Demographics and psychiatric/psychological conditions Clinical case reports Brodsky Stewart and Raskin Selneretal Terr Fiedler, Maccia, and Kipen Altenkirch, Hopmann, Brockmeier, and Walter Witorsch, Ayesu, Balter, and Schwartz Black Case control studies Pearson, Rix, and Bentley Simon, Katon, and Sparks Simon, Daniell, Stockbridge, Claypoole, and Rosenstock Black, Rathe, and Goldstein Staudenmayer, Selner, Buhr, and Selner A cohort study of chronic fatigue Perplexing questions Why middle age? Why female prevalence? Symptoms without disease? 5 Assessment of the toxicogenic research program Critical reports from medical associations Junk science excluded from the courtroom Testable hypotheses: provocation challenges A protocol for provocation chamber challenges The challenge chamber Methods of blinding the exposure Statistical analysis The case of a true positive responder Controlled challenges with EI patients Challenges unanswered Conclusion 6 Psychogenic theory A disorder of belief Psychogenic and psychosomatic illnesses Psychogenic illness mistaken as asthma The sick role History of psychogenic illness: neurasthenia Primary and secondary gain Discussion 7 Placebo and somatization Definitions The placebo effect as nuisance Placebo, ritual, and provocation challenges Factors contributing to the placebo effect Food intolerance: physiology and immunology Somatoform disorders Hypochondriasis Somatization disorder Conversion disorder An EI case of pseudoseizure Conclusion 8 Learned sensitivity Pavlovian classical conditioning Animal conditioning of the immune system Conditioning after documented exposure Thinking and learning Conditioning onset of asthma Cognitive learning 1886 historical example Learning to control allergies Fear and anxiety Learning and phobia The psychodynamics of phobia Discussion 9 The stress response Hypothalamic pituitary adrenal axis Psychologic effects of AC1H and corticosteroids Stress and aging: the glucocorticoid cascade hypothesis Role of psychological factors Catecholamine system Norepinephrine Epinephrine Dopamine Pupillary reflex Autonomic nervous system Inhibitory systems Serotonin GABA Opioids and endorphines Psychoneuroimmunology Effects of the stress response on cognition Conclusion 10 Panic attacks and anxiety disorders Psychophysiological theories of emotion Anxiety Panic attack Panic disorder Trme course DSM IV criteria for PTSD Experimental models of PTSD Learned helplessness Trme dependent sensitization Hyperosmia or cognitive priming? Conclusion 11 Trauma and post traumatic stress disorder War Epidemiology Psychophysiology Cognitive dysfunction Pre war risk factors Childhood trauma and adult sequelae Childhood emotional deprivation Childhood physical abuse Childhood sexual abuse A case of sexual abuse and EI Neurobiologic effects of childhood sexual abuse Conclusion 12 The limbic system and trauma The limbic system Electrical stimulation of emotion Emotions activate the limbic system Reticular activating system Disruptive effects of trauma Limbic system symptoms PTSD, limbic abnormalities, and trauma Hippocampal abnormalities EEG abnormalities Developmental stage and vulnerability Conclusion 13 Personality disorders Depression as a symptom Personality Psychological defense mechanisms Personality disorders DSM IV Axis II classification Self management of explosive affect Self management of implosive affect A case of folie a deux Dimensional models of personality Limitations of categorical diagnoses Dimensional diagnostic approaches Discussion 14 Iatrogenic illness: exploitation and harm A medical cult Quacks Patient vulnerability Devotion to the guru Bias and expectation invalidate provocation challenges Doctor's expectation and treatment outcome Counterphobic rituals and obsessive compulsiveness State revokes license of mercury amalgam guru Harmful effects The lady in the desert Isolation and ineffective rituals Munchausen syndrome by proxy Where are the bodies? Discussion 15 Treatment The path of psychotherapy Difficult patients and resistance Transference and countertransference Hateful and dangerous patients A depth model for selecting an intervention strategy Trust, empathy, and rapport An exposure event as an organizing concept Pitfalls The environmental care unit as a sanctuary Hope, magic, and the art of healing Psychotherapeutic interventions Stress management Behavior modification: systematic desensitization EI case report involving desensitization Cognitive behavioral therapy Cognitive distortions Dichotomous thinking Selective abstraction Arbitrary inference Circular logic Overgeneralization Undergeneralization Catastrophizing Decatastrophizing Misattributed causality Rationalization of lies Restructuring beliefs Psychodynamic psychology Treatment of personality disorders Psychotropic medications Discussion 16 Politics Victims and a herd of sacred cows Blaming social ills Reasonable accommodations? Victims: a neglected population? Politics of intimidation and the law Unrealistic product safety regulations ""More research"" Conspiracy theories Media Manufacturing industry Insurance industry Radical politics Discussion 17 Future directions TILT Scientific honesty The personal factor in disposing of contradiction Adversaries Paradigm shifts Endless rhetoric Model for a progressive research program Objective measurement and biomarkers Predicted outcomes for competing theories True positive False negative True negative False positive Conclusion Appendix A. A methodology of scientific research programs Appendix B. Court rulings
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