Critical Analysis 1

By Red the Philosopher

Gianaros and Jennings’ (2018) article, Host in the Machine: A Neurobiological Perspective on Psychological Stress and Cardiovascular Disease, provided a compelling neurophysiological analysis of the connection between perceived stress and heart disease. In their article, they cited many other authors supporting the following claims – (1) People are stressed by what and how they perceive stimuli; (2) Biological systems within individuals facilitate stress appraisal and stress responses; (3) Biological systems facilitating stress responses can be altered by stress responses; (4) Biological organs involved in these systems, such as the heart, can be adversely impacted over time due to wear-and-tear cause by prolonged or repeated stress response activity; and (5) Heart disease may be caused by the wear and tear on the heart caused by stress responses due to perceptions of stress. Gianaros and Jennings noted the power of mindfulness interventions to intervene in this heart disease pipeline at the point at which stress is appraised.

Gianaros and Jennings’ (2018) presentation of their findings appears thoroughly completed, evidenced by their citations, acknowledgement of neurobiological pathways and brain areas and their functions, and their framing of autonomic control as a heterarchy, rather than a hierarchy. The lattermost point highlights similarities between brain function and Christmas lights and supports theorists against localization. In years past, if one Christmas bulb on a string broke, the entire string of lights would shut off. Similarly, the study of brain areas using abnormal, injured, or removed brain areas contributed to our understanding of brain function by studying the lack of some necessary component. However, the current work and many others support the idea that although Broca’s area, for example, may be missing in a person’s brain, a heterarchical perspective acknowledges the role that one area may have played in a multitude of cognitive and behavioral abilities. In this way, their suggestion of the heterarchical framework has standalone utility. Their matter-of-fact theoretical presentation could be part hubris or part actuality but there is no contention in what they suggest regarding the relationship between stress appraisal and heart disease. Also, they acknowledged their own limitations – “we lack a precise understanding of the brain systems and visceral control processes that link psychological appraisals to patterns of stress physiology and physical health” – and unanswered questions such as, “What developmental, genetic, and environmental factors shape individual differences in appraisals, visceral predictions, and feedback processes?” This limitation seems unfounded due to their clear analysis of specific brain processes and how they interact with physical health (the heart) based on psychological appraisals. The baroreflex, for example, was mentioned.

One critique with this paper is that the title mentions the “host” and the team uses the phrase “psychological appraisal” but they do not mention the soul or animus in the host. Their conceptualization of the relationship between physical health and stress perception is limited because they do not account for the perceiver. Although one might argue that their scope is within the perceiver – and that would be valid in some regards considering their perspective details neurobiology and physiology – however, one could counter this argument by pointing out that being “in the body” does not necessarily mean being “in the soul.” The distinction is minute yet important and best illustrated using cars. Essentially this paper details how heart disease (engine quality) is impacted by perceived stress (speeding, slamming on breaks, and other wear-and-tear of driving). When they speak of the host and physiology, they describe how the amygdala, anterior cingulate cortex, and insula (pistons, spark plugs, and fuel shaft) interact with one another and other brain areas resulting in an impact on heart disease (engine quality). What about the driver? In some ways, it is useful to have detailed microscopic play-by-play (mechanistic) explanations about how engines deteriorate – how heart disease occurs – but the paper could be complemented by additional research considering the role of the perceiver, the driver, the entity animating the brain and body on the pathways being studied – how the condition of the heart is a reflection of the soul.

The utility of acknowledging the soul in the conceptualization of this phenomenon is that it lends new factors to be considered when the authors make statements about the “inappropriateness” of a stress reaction to a perceived stressor even after the stress reaction has exceeded “necessity”. Ottaviani et. al., (2016) reported that “failure of updating or calibration may be in part due to insensitivity to visceral sensory feedback, as well as perseverative processes that maintain threat appraisals over time.” In the context of trauma, this phenomenon needs to account for a perceiver because the idea of what is necessary in terms of a stress response cannot be determined from the outside looking in or else be determined ex post facto. The perceiver – the soul – may not consciously assess how much to become aroused or how much to increase or decrease heart rate, but their prior traumatic experiences will serve as a basis. The perseveration described in this study is explained by the fear the individual feels and the understanding that just any given perceived stressor which is deemed by researchers, and arguably by the perceiver, after the fact, to not merit an exaggerated startle response, for example, could simply be the one time that the perceiver “got off easy.” Biology reaffirms that it is better to have it and not need it than need it and not have it.

Reasonably, this likely contributes to wear-and-tear on the heart, how the heart operates, and the relationship between blood pressure and heart rate. However, it looks like researchers approached adaptation so closely that they could not see the forest from the trees. In some ways, it could be argued that heart disease is an adaptation, or maladaptation, to the continued stress perceptions and reactions. Consider the example of an African American teenager living in Newark, NJ whom has witnessed shootings. He might feel triggered by a car with tinted windows driving past him. To some, his increased heart rate, blood pressure, norepinephrine, epinephrine, cortisol, and glucogen, may seem excessive and even he might realize that his body feels funny and the car is not actually a threat. As researchers pointed out, his physiology has been rearranged to provide him a quick start because he may need to access it faster than the person who hasn’t had to take the pop quiz – the first shooting he was in. In this way, the perceiver receives benefit from the reconfiguration and wear-and-tear of the heart, the same way a gamer might benefit from jailbreaking a cellular device. Take a new pair of shoes – they do not fit the person as well as an old pair because the old pair has been altered due to wear-and-tear which make them more comfortable than a new pair with the factory default structure. The wear-and-tear on the heart, is an impression made by the soul living in a context and driving the vessel, the body. If you look at the conditions of the engine of the car, you can see how the driver uses the vehicle – do they max out the speed or drive slow, do they race or carpool.

The addition of the soul in the conceptualization is necessitated by the witnessing of a perceiver’s footprints in these biological systems. Wear-and-tear on the heart, and how it changes in response to a person’s lifestyle and perceived stress, is evidence that an entity lived and used the heart. Hearts are designed to wear-and-tear as a function of nature – death is a part of life. These researchers did a phenomenal job and could augment their research – better yet, I could augment their research – by taking a step back and seeing how what they describe is a microscopic look at how souls impact the body, and how bodies contort and conform.

References

Gianaros, P.J. & Jennings, J.R. (2018). Host in the machine: A neurobiological perspective on psychological stress and cardiovascular disease. American Psychologist, 73, 1031-1044.

Ottaviani C, Thayer JF, Verkuil B, Lonigro A, Medea B, Couyoumdjian A, Brosschot JF. (2016) Physiological concomitants of perseverative cognition: A systematic review and meta-analysis. Psychological Bulletin. 142:231–259. DOI: 10.1037/bul0000036 [PubMed: 26689087]