My aim here – pure and simple – is to further extend and expand upon this brief but – as experience has again and again led me to see – potentially useful discussion on what, in any account or consideration of coping, must be considered to be our greatest ally; namely our own ‘on-board’ management/coping system and resource.  Again and again over the years, I have found that (while of course, being selective about the occasions of its introduction into the discussion) to provide such a simple ‘near to home’ and readily available rationale and justification for success in self-management and self-belief, can be of real value and an aid to patient management. (Of course, all this needs to be customized to the individual patient’s apparent needs and requirements and – of course – understanding). Indeed, it can, at times, quite potently “fuel” that vital inner confidence and anticipation, which is surely the “highroad” to real achievement.

 One of the first important facts to strike one about the brain’s incredible evolutionary journey, is – as we have already witnessed – that it in fact is really not one structure at all, but rather a conglomeration of smaller, more primitive structures. Each has evolved over widely varying periods of time, not as “mini-brains” which somehow work independently of each other, but as structures, which ‘harmonize’, in what has been described as “parallel processing”. The German word, (for which English provides no precise equivelent) sums it all up perfectly; i.e. “gestalten”·. If I strike a chord on the piano, the sound affords so much more to the ear than would be the case, were each note to be struck in isolation; i.e. something is added by striking, for instance, two notes rather than one; or two notes or four notes instead of one or three. In fact – and again as we see in our pyramid analogy – the brain’s primary function as such, had little to do at the time, with language or thinking or the “3 Rs”, or indeed any other form of cognitive or intellectual activity such as reasoning and decision-making (which came later on and in consequence is much higher up). Rather was it/is it, concerned with more basic requirements, such as survival and the maintenance of stability in a world, which in reality is forever changing, both internally and externally. That it does not merely come across to us like that at all, is testament to the brain’s great success story, as it manages and controls the body and the constant and intricate flow of chemical messages in states of wakefulness, sleep, excitability, pain-recognition/relief and so on.

 We sometimes marvel at the research and development that has taken place within the pharmaceutical industry, as new and sophisticated substances – pills, capsules (time-release and otherwise) injections, infusions, implants and patches are placed on the market. All have, of course, been subjected to rigorous testing, scrutiny by ethical and safety panels, committees and the like. Even so, few products of this kind ever appear on the market that are unaccompanied by some form of warning or disclaimer concerning known hazards associated with their use.  On the other hand, the brain’s still only poorly understood on-board “pharmacy”, has taken millions of years to develop, all without the limitations and complications incurred by such necessary human management and bureaucracy. If an evolutionary experiment has failed, then that organism has simply been sacrificed in order to achieve the desired end result, i.e. a drug delivery system with a precision, in effect, that far exceeds our clumsy and inelegant comparisons.

 The knowledge, which we now possess, enables us to take some account of important psychobiological (mind and bodily) reactions and responses, especially those such as the autonomic nervous system (ANS), which occur at times of danger or threat. Just a short time spent now, reviewing the very basics of such responses, together with an improved understanding of how our brains manage and control us in daily life, will surely enable us to put the contents of this and earlier blogs to better use. Such responses and reactions in defence derive in origin from a much earlier, in fact primitive era in the overall history of man, when threats (not just to wellbeing but to life itself) were far more commonplace. It really doesn’t matter whether the perceived or regarded danger stems from the sudden occurrence of a life-threatening illness, or the sight of an ‘angry’ bull ‘pawing’ the ground in a field in which we are standing. In an instant, emotional arousal serves to prepare and mobilize us in the direction of appropriate action. The key words in all of this are “perceived” and “regarded”, since it is our instant appraisal of any given situation in which we find ourselves, that determines our response.

Just one of the multifarious roles and functions of previous learning, is to shape and fashion behaviour and where appropriate, to modify it accordingly (as would be the case if, as one became aware of the presence of the bull, one simultaneously or perhaps earlier had noticed a nearby gate or similar point of escape.) Once ‘ fired’ (principally, but not entirely via the senses) this awareness impacts upon key centres within the brain, setting up an instantaneous and complex chain of both neural and biochemical effects. No part of the body is entirely exempted from it, as chemical messages and agents are released into the blood, acting as the “clarion call” to a highly trained and prepared emergency response team. Each unit in the ‘squad’, combines with every other, as well as performing its own key role. For example, increased heart rate provides more blood, containing energy-laded resources directly from an “ever ready” store in the liver. This is directed principally at the brain but also to the muscles, especially those at the periphery, to prepare them for “fight or flight”. Blood vessels close to the skin constrict (narrow) and clotting time shortens; (in order to decrease the likelihood of potential bleeding from wounds incurred). Because of the immediate need for more oxygen, respiration or breathing rate increases and saliva and mucus dries up, in order to increase the aperture of air passages to the lungs The pupils dilate, widening the scope of vision, more white corpuscles are made in order to fight infection and bodily functions with a lesser priority, such as response to hunger and sexual arousal, are turned down, to conserve energy.

If some of this appears to be just a trifle ‘over the top’ and not really situation specific at all, I can only assure you that that is how the “response to alarm” side is configured in our secondary or autonomic nervous system (ANS). In other words, one element or subsystem within it responds and functions (as it seems) in sympathy with another. Indeed, it is actually known as the sympathetic division of the ANS, which as we have seen in earlier blogs, is highly relevant to the onset of anxiety and panic attacks. The good news of course is that there a great deal which can be achieved, both to reduce the more extravagant and dramatic effects of the ANS’s “all or nothing” response which I have just touched upon, as well as to maximize and actualize the rich potential of the brain for enhanced personal well being. Until comparatively recently, it was widely believed that the only answer to such a chronically operating physical response caused by the uptake of adrenalin (the hormone which produces alarm) was to be found in anxiolytic and sedative type drugs such as the benzodiazepines, better known by their trade names such as Valium, Ativan, Mogadon and the latest generation of antidepressant drugs such as Prozac and Seroxat, as well as other drugs known as Beta Blockers, which block the epinephrine (another word for adrenalin) receptors in the muscles. There is no doubt that some, or all of these, can and do have a calming effect upon mood and behaviour but not infrequently at a cost, in terms of adverse side effects. (C)SB.

• There is no precise English equivalent for this German word, meaning, overall shape/configuration. ‘The whole is more than the sum of its parts”, e.g. as when a chord is struck on the piano, i.e.four    notes combining to produce a sound not given when played separately.