Trauma as a Response of Fear
The Brain Cascade of Defenses When Encounter Danger
The phrase "fight-flight-freeze" has become part of the mainstream vocabulary when talking about Post Traumatic Stress Disorder (PTSD) or psychological trauma. Magazine articles, books, podcasts, and webinars have explored the "fight-flight" part so exhaustively for the past 5-10 years that most people now understand that concept pretty well: we know that fight-or-flight is a reaction of our body (the autonomic branch of the nervous system actually) to encountering the fear to danger that our primitive ancestors felt.
Fight-or-flight is immediate and aims to protect us, but it most often acts in extreme ways, out of proportion to the real level of danger. The term has been used to explain traumatization but developing the emotional disorder we call Trauma is much more complex than the fight-flight reaction. This article try to include all the reactions the body can go into before developing a psychological disorder.
Survival Defenses Flow
It is very important for me to make clear that for humans, in the end, if all the strategies “for survival” fail, we most certainly won’t be dead, but we may have to suffer from trauma or other emotional problems for a very long time, or for life. If we understand the overall function and flow of the nervous system better, we may be able to avoid getting traumatized or emotionally troubled. And if we suffer from traumatic responses already, understanding how our system works may help us heal. I will describe each stage in detail below, but to begin with, here’s a chart that can help you visualize the stages. Failure means that the perception of danger is still present and therefore the brain needs to keep making adjustments; success means that the perception is back to safety and the brain can go back to regular functioning):
• The red arrows represent the failure of the strategy in turn, and therefore the initiation of a different one;
• The green arrows represent the success and return to baseline; and sometimes the sequence can have multiple options and therefore go in different directions:
• The orange arrows show that there is more than one option and that sometimes the sequence can have multiple options and proceed in different directions:
See Table 1. Above
Fear Sequence in Detail
Most articles and research on trauma is made on animals. The description of the survival strategies of the autonomic nervous system (ANS) are more specific to mammals in general than to humans. Here I describe every stage of the fear response sequence in an attempt to separate all the meanings, and to answer these questions:
• What does it mean to translate the primitive fight or flight response of animals into the sophisticated version of the human experience?
• Why do we react the same way as animals do when avoiding danger, if we are only avoiding pain or less?
• What does it mean that these strategies fail?
• How can we understand these mechanisms in order to achieve mental and physical health?
• How can we overcome the dominance of our ANS to avoid getting hurt by its primitive definition of survival?
AROUSAL: It is described as the first step to the activation of the cascade response (Kozlowska et. al 2015), or the activation of the hypothalamic pathway (secretion of stress hormones). If we consider that Arousal "is the physiological state of being awoken, or of sense organs stimulated to a point of perception” (H. Kuai et al, 2017) we could say that humans are regularly in a constant level of arousal when engaging with the world. Therefore, it's really not the first reaction triggered by threat.
In scientific terms, being aroused means that we are always generating a certain amount of stress hormones and maintaining a certain level of alertness that only ceases in states of disengagement, dissociation, rest, or sleep. In traumatized people, arousal is active even while resting or even sleeping — as in hyper-alert — but for non-traumatized people, there is always some level of activation and stress in our systems that keeps us moving, connecting, evaluating, and exploring. When activation doesn't come naturally, we drink coffee or take some sort of stimulant to “keep going," right? There is even a concept named EUSTRESS that defines this state as “moderate or normal psychological stress interpreted as being beneficial for the experiencer.”
The sequence I'm describing here does not include what happens after trauma, but instead describes what happens during a possible traumatization when we go out of our normal baseline of arousal. If arousal is the first step in a defense cascade, it may sound like social-engagement (Porges, 2003), but because additional theories add a layer before it (Roelofs, 2017), I consider it useful to partition the sequence of defenses further and leave arousal as the baseline of this model, even before threat occurs.
PERCEIVED DANGER: Fear is the propeller of all the defenses. Assuming that most of the time we are alert to perceived changes in the environment — especially danger — I emphasize that the whole defense mechanism is triggered by the conscious or unconscious perception of danger, not by being aroused or stressed. In humans, the evaluation of danger is subjective, and we can get scared and activated regardless of the actual danger, depending on how our specific experiences have altered our perception of risk. That’s why I’m including “perceived danger” in the flow, to emphasize the “perceived” aspect more than the danger itself. This clarifies that even when irrational, we will get triggered if our subjective experience scares us, regardless of the actual situation being alarming. A spider could be ultra scary for some people, or seeing your father drunk, or hearing thunder, or noticing your mother being angry at you, even fearing the opinion of others about your behavior.
ORIENT: Once the brain receives some signal that things are not as they should be, we tend to look for the explanation. We increase our sensory perception, look up, look around, stay still, and focus on listening more carefully. This reaction is very short and may be imperceptible in humans, but it's constantly there. So orienting can mean, in terms of the changes in the brain, that we either go into staying still in "attentive immobility" to assess and make sure we are ok, or into looking for someone nearby who can provide a sense of safety.
ATTENTIVE IMMOBILITY: This is another reaction that has been named Freeze, especially when people merge it with Orienting. It’s easy to witness this in rabbits and deer looking at us when surprised by our presence. If you have been in nature, you know that there is a big difference between the orienting stillness of a deer when it is just sharpening its senses vs. the deer’s attentive immobility that includes changing posture as in "ready, set, go" type of stillness, vs. the frozen deer that is unable to run because it is stiff as a log after the shock of the headlight in the middle of the road.
I want to include social engagement as one possibility after Orient, and not as the only possibility; Attentive Immobility is a harmless reaction in terms of trauma compared with Freeze which I’ll explain later. Attentive Immobility is a possibility, maybe more primitive, that covers the instant after a moment of inaction, where we humans either consider the situation risky and move into escape or defend, or make sure we are safe by socially engaging with someone around.
It’s easy to identify the experience of Attentive Immobility if you consider a situation where you were alone, maybe at night, and heard some noise that you were not able to recognize right away. First, you orient yourself in time and space, and then, for a few seconds, you stay completely still and sharpen your senses, listening carefully. After some time, if you hear nothing, or if you recognize the noise as wind, a voice, the leaves, etc., and realize where the sound is coming from, then you can keep going as if nothing had happened, refocusing your thoughts to where they were before. But if you keep wondering what the noise was, you may have to focus on it for longer and take action.
Have you ever felt frustrated watching a thriller, when the protagonist wakes up after hearing some noise and goes out into the dark only to find the thief, the assassin, or the monster? Have you been puzzled by how he/she was not aware of the risk by doing so, while it was obvious to you that it was dangerous to go look around? Most of those times the irrational behavior is just the ANS deciding to go into mobilization trying to find safety without thinking further. It happens in movies and in real life. My favorite instances are those where the person that heard the noise wakes the partner up to go look around. That is a convenient way to use social-engagement for safety, right?
To conclude, Attentive Immobility is proposed as another level of defense before triggering the production of stress hormones that could do more harm than good.
SOCIAL ENGAGEMENT: According to Polyvagal Theory (Porges), the natural way to be when we are safe —or trying to make sure we are safe — is to look at someone’s face or hear someone’s voice to make sure they are there to provide safety for us, to protect us, to calm our nervous system even without talking. Looking at people’s eyes or gestures, listening to their tone of voice, or finding some cue — like a smile — can make us feel calmer. A cue like a smile gives us a level of security, and so there is no need to activate more defenses even if there is some risk involved. This is actually a way to create resilience.
Social engagement happens due to the combination of activation and calming that operates out of the ventral branch of the vagus nerve. It sounds like a state originated directly from the hardwired mammalian need for attachment: we need to know that we are not alone, that we belong, and that we can count on someone to help us stay alive and affiliated. For a child, it means looking for the attachment figure —mostly the mother — and guessing her mood. For adults, it is looking at the possible attacker and whoever is around, and instead of guessing only the mood, looking both for connection or the level of possible aggression.
Putting it into the context of the fear sequence, social-engagement is the first reaction after perceiving danger when we are not alone, or after we asses that the perceived danger is bigger than what we can handle by ourselves. I remember a client narrating a trip on her own to Paris. She was out late and in an area full of bars, with “shady commercial activity” and "drunkards.” A group of men started to follow her, and she felt really frightened. She then spotted a family of four walking together nearby, and accelerated her pace to join them. She got herself in between the mother and the daughter and started a conversation with them. The group of youngsters left, and she ended up having dinner with the family and corresponding with them since. This scenario provides a clear image of how we can use this strategy to avoid danger or further activation.
If social engagement fails, if there is no one to assist us, if we don’t find the way to reach out, or if others are unresponsive, then we need to mobilize and go into a more extreme strategy that could be either attacking or running away. Remember that this could happen in a fraction of a second without any awareness that we are doing it. It’s the job of our automatic brain to guarantee survival without further investigation.
For my client in Paris, if the family had ignored her, she may have gone to fight-flight by confronting the guys, or asking them to leave her alone, or cursing at them, or screaming for help or accelerate her pace to leave the place. But before the energy consuming fight-flight, she could have stayed still observing and giving herself the time to evaluate if they were actually dangerous or only flirting —as in attentive immobility; or she could have tried to have an eye-to-eye moment and even smile to sense their intentions — as in using a social engagement strategy.
Even when our automatic brain doesn’t ask for permission to act, we always have the capacity to decide what to do. We may not be able to decide not to feel scared, but we could decide not to act scared, and to activate our brain in a way that regulates our fear. Our more developed brain can help us with the awareness of our emotions, of the situation, or of the level of risk, and by making decisions about whether to stay with the automatic response, or to change it for one that could be more effective and less detrimental. In the case of my client in Paris, she could have felt paralyzed by the strong reaction of her ANS, or started punching the men, or yelling hysterically. Instead, she had the capacity to use her cognition and make the decision to seek out the protection of others that she considered safer.
FREEZE (LOCK): as I explained before, I’m using Kozlowska et. al definition of freeze as fight-flight on-hold and using the word LOCK instead of freeze to separate it from the immobilization that comes from parasympathetic activation as a defense. Therefore, LOCK could start before fight. Why then is it that almost no one talks about freeze-fight-flight? The fact that this step activates both parts of the ANS may be the origin of the conundrum and the reason of not having found a clear place in the sequence.
LOCK could be a healthier defense and less disruptive to our system than fight, if resolved fast. At this point, one of the main reasons we see it as following fight-flight is the Polyvagal Theory. It states that the strategies are hierarchical and that immobilization comes always after mobilization, and freeze sounds too much like immobilization, right? But according to Kozlowska et. al, this isn’t accurate. My experience as a person and as a therapist leads me to agree with her.
Being “Locked” is an immobilization strategy that could be in between social-engagement and mobilization. Respecting the mind of master scientists like Porges and its popular theory, we could say that being on-hold or locked is not really immobilization but suspended mobilization, and that suspended mobilization is not really freezing.
I remember one time coming out of class at a campus in Westchester when I encountered a skunk. It was just he and I, face to face. And we were both “locked” for a few seconds until my ANS reacted faster than his, and I closed the door in front of me before he used his powerful weapon. I know that what I experienced falls perfectly into “fight-flee on hold.” It was as if that instant was an eternity, as if everything was crystal clear and confusing, as if my breathing was intense and inexistent, all was suspended but racing. And then, suddenly, I knew somehow that the cute little creature in front of me was dangerous, and I reacted in a fraction of a second to get away from him. No orient or social engagement, not even an evident fight mode, just everything suspended and the immediate actions to escape. And I remember the skunk’s surprised face and I bet he also experienced the same Locked response I did.
If we apply the theory here, the reaction of my ANS was to set everything on hold until deciding what strategy was best. The Lock came before the flight that came before the fight. I don’t know if my brain was able to know that social engagement was not a possibility; it was late and the building was basically empty. Would have I screamed instead if I had known there were people around? Yelling could have either scared the skunk, paralyzed him, or made him react more defensively if he felt attacked— and therefore he would have sprayed me. Screaming wasn’t a smart move but maybe if I knew someone was around to help me, my limbic system would have done that before knowing if that little creature was actually dangerous to me or just unknown.
Is screaming a manifestation of the social engagement trying to call for help? Or is it a fight reaction? Maybe it could be both depending on the circumstances. I bet animals don’t choose that type of pitch while trying to avoid a predator. But if the first strategy for survival is social-engagement, it makes sense that one of the most common immediate responses to danger in humans is screaming as in calling for help. And maybe that habit comes from when we were children and needed our mothers’ assistance and learned that screaming was more effective to get their attention than smiling.
Why is this response different from Attentive Immobility? LOCK is that moment of indecisiveness for the ANS after a shock where the cascade —or series of events and reactions— get suspended until there is more certainty of which one could be more successful.
Most of the time, PTSD is the result of experiencing shock and lacking internal resources, If there is no shock but doubt instead, we use attentive immobility. But if there is shock, one of the other strategies would be triggered, like screaming, or kicking, or running away, depending on the shock. If the shock is too big, LOCK may not happen since the ANS will assume defeat, firing up the collapse strategies (immobilization), needing to respond very fast and making all the adjustments on functioning at once to assure survival.
When the shock is small, LOCK is a useful strategy that causes low damage to the system since it could go back to baseline without causing as much adrenal activation as fight-flight. In the case of confronting the skunk, if I had been attacked and sprayed, PTSD symptoms could have appeared in the way of nightmares, extra vigilance about animals, avoidance of certain types of outdoor experiences, aversion to strong odors, even a phobia for black and white combined. These symptoms could get better on its own after a period of time or could remain for longer if I had had other negative experiences with animals in particular, or low resilience in general. This state of LOCKED could become trauma and indefinite, as in child/partner abuse where fighting or fleeing could result in more danger, with the system get stuck in this reaction, pushing the gas-pedal and the break-pedal at the same time. The “decision” to stay in a constant evaluation of what’s the sustainable option without finding a resolution will be the manifestation of trauma at this level.
If LOCK is the only choice because fight or flee are not viable —due for example to constant states of shame or the unpredictability of the caregiver— then a suspended mode where the person feels always in need to run or attack without being able to, and always expecting the worse, will become the way to operate for that person’s ANS, at a very high cost for the well-being of the person. These are the cases where traumatic responses can develop and manifest as rigidity, pessimism, lack of pleasure, overly judgmental, extreme righteousness, etc., having severe consequences in personality and relationships.
HIDE: What happens in the instances where there is nobody to assist us, we are not sure we can fight, and there is an impossibility to flee? Do we have another option besides “freezing”? I proposed just now that freeze (LOCK) is the option with shock, but if there is no shock and we are still under threat, if we can’t mobilize, most probably we would hide. Hiding while at risk is an experience most of us have lived. We have experienced the extreme ponding of our hearts while we try to almost stop breathing; I have no way to ascertain this, but I guess that both –sympathetic and parasympathetic— are active similarly to the fight-flight-on-hold.
Hiding is a very interesting strategy. When we hide, not only happens physically but emotionally as well. We hide our emotions to avoid being “discovered” like when we experience shame.
Prey animals often use camouflage to hide from predators. Camouflage is a way of hiding that permits an animal to blend in with its environment and be unnoticed by predators. How do we use this strategy as humans? We try to avoid being seen, or we adapt to the environment by imitating the behavior of others.
FIGHT: This strategy is about preparing to respond to a possible attack and generating the strength to do so. In fight mode, our systems will grant us the possibility to beat or kill the predator that dares to jeopardize our life. In the case of humans, the system gets flooded with stress hormones faster than we wish it would, and it becomes difficult for us to manage the surplus of energy we get, since we normally are not under a death threat while activating this strategy.
As I mentioned before, if we first try to socially engage by smiling at someone that we — maybe unconsciously — consider dangerous, the person smiling back will calm our system and our body won’t get flooded with an excess of toxic hormones. If the person instead threatens us somehow, or, if our distorted perception thinks s[h]e is dangerous, then the stress hormones will make us feel stronger and more capable, our limbs will feel more powerful, and we will feel a surge of energy all over. One of the worst consequences of this surge of energy is that the brain, in order to empower the limbs, takes some of the energy from the more cognitive parts of the brain, clouding the capacity to stay rational and to make good decisions. Many of us have experienced the feeling of being ready to punch someone after sensing attack, whether physically, verbally, or even if the attack is to someone else, whether the impulse is actually — or would ever be — acted out. If we had a gun, and we feel angry and empowered by the hormones of the fight response, we may easily pull the trigger without really wanting to kill anyone. Even when we can definitely see the benefit of having an automatic strong instinct to defend ourselves, it is not as easy to understand this instinct’s effect on the body and why it could create so many problems in our health, in our personality, in our lives and actually, in our safety. This strategy can easily make us end up in jail, and it is the failure of this strategy that starts a process where we can end up suffering from trauma.
In humans, the fight strategy normally renders itself as anger or rage. As a client told me once, anger adds “a kick to situations and to life itself; it makes me feel in control and has the advantage of dominating the people around”. Anger (fight mode) can become a habit and could be triggered independently of if there is risk. The ANS doesn't have the capacity to evaluate by itself whether we are victorious in stopping our adversary or not. The ANS only calms down when it subjectively perceives the danger to be gone or continues escalating if it subjectively perceives that the danger still exists. Remember this is a primitive response to fight for survival, and “victory” as in “dominating people around you” can become the definition of survival, and, eventually, a new way of functioning and a personality trait.
But anger can fail also. A kid who feels left behind and shouts or kicks as a way to protest is acting internally — fighting for survival, trying to win over the mother and needing her to stay for him to feel safe. When this fight response fails and crying won’t produce any positive result, the kid’s experience will be of helplessness or defeat, and s[h]e will feel more scared than before regardless of whether the mother was only busy cooking or actually absent. For animals, failing the fight response normally means that the predator is stronger than the prey, and can’t be defeated, but in the case of humans, it could mean feeling disempowered, incapable, inadequate, or even unworthy.
For many of us, the fight response fails even before it manifests, as in a person feeling angry but knowing beforehand that confrontation would be putting him/herself at greater risk. An example here would be protesting abuse in a relationship. Depending on the circumstances, if fight is not a viable option, the ANS will choose to go into flight or into tonic immobility immediately after. That will be explained later, but for now, notice in the graph that the ANS doesn’t go into Freeze after fight since it is still evaluative, and once fight is activated, it can’t be put on hold. That’s why this strategy is so damaging — it’s too primitive and too fast, and it gives very little space to cognition to participate. On top of everything, the fight strategy involves the sense of self in an important way, because it’s difficult for most to recognize when we act unfairly. This fact alone can trigger the fight in many of us. If someone offends you, attacks you, or treats you in an irrational and wrong way and is incapable of acknowledging it, you will feel at risk from then on, as in loosing the capacity to trust.
FLIGHT: Escape could be an alternative when fighting is not. A kid that gets slapped, mocked, or punished for being angry won’t even consider the option of fighting, even when his ANS will. While in danger, the ANS is not waiting to assess whether it should go into fight or would be better to flee. According to the literature and Porges’ theory —there is a hierarchy or natural sequence to fight-flight, and mobilization will occur always before immobilization. Fight will always kick off, even if a fraction of an instant later the flight response must initiate as well. This is what should differ from predator/prey model, and this, in terms of evolution, is what becomes trauma for humans; instead of understanding that we are not fighting for survival and decrease the primitive defenses, we enter into a competition for “superiority” or dominance that destabilizes our normal functioning by the extreme effort of activating complex survival defenses when we are only dealing with relationships.
This strategy consume huge amounts of energy that need to be taken from the regular activity of other organs and systems, like cognitive activity in the brain, or the digestive system. Flight in animals is very simple: they run away from the danger. In humans, it’s not that straight forward; very rarely running away will make us safer, especially in situations where the danger is constant. More than running away, we escape mentally and/or emotionally when we are in risky situations that we can’t resolve. People flee to bars, to drugs, to mental withdrawal, to fantasizing, to emotional shut-down, to dissociated states not because their lives are threaten but maybe because they can’t trust or they have low self-esteem. Circumstances when we need to flee because we can’t fight are many: a wife in a violent marriage, a financially-unskilled father, a disappointing son, a shamed member of the group, a frail kid, and so on. There are many instances where the person feels incapable of defending him/herself to feel safe even at home, and with many of these cases, there is no possibility of leaving either.
When the flight strategy fails, the immobilization strategies will take over, and those strategies are even more demanding in terms of dysregulating the normal functioning of the body.
TONIC IMMOBILITY: this mechanism and the following one (collapse) are extremes that animals need when they are trapped or caught by the predator and that most people call freeze. This is when the ANS will try to keep the prey alive at all costs with the hope that if the prey escapes, it will still have the capacity to run. It will keep some of the previous changes going, while adding some new extreme ones, such as producing opioids to avoid pain, constricting blood vessels to reduce bleeding, or something to discourage the predator from eating the prey since many predators are reluctant to eat dead meat. But in humans, the effects are different since the situations are not at all the same.
I had tonic immobility once. I was around 12, and my father had a heart attack in front of me. We were not home, and when I saw him bending his body to look for a chair, the grimace on his face and his hand pressing over his heart, I became paralyzed. I don’t remember any type of pain, or emotion, or thought. I just know that I stayed standing in the same place for maybe 20-30 minutes, looking at him like he was in a black-and-white silent movie. I was not able to move, or react, or think.
In a case like this, social engagement as a strategy for survival would have been me asking people to help my father, fight strategy would have been becoming active in finding a solution as in calling an ambulance, and flight response would have been leaving the site or denying something bad was happening. Could this reaction be considered LOCK or Freeze, as in fight-flight-on-hold until I knew if my father was OK? It may have been. I considered it many times while writing this article. The reason I concluded it was Tonic Immobility is because all the parasympathetic activation I experienced: numbing, lowering of my senses, coldness, speechless, etc. were present and the fight-flight on hold were not. My experience was not having any acceleration ready. Everything was in a state of minimal response, as if I was preparing to be consumed.
Was the decision of my ANS to become immobile the only possible one? Or was it part of my incipient executive function to give space to those who could help? I have always been a dynamic person and it was hard to accept that I didn’t try to do something, but I know that I was 12 and most probably I felt completely incapable. Immobilization is dependent on the unmyelinated vagus (dorsal vagus) which is the most primitive component of our ANS, and my response was of complete terror even when there were not apparent signs of it.
What happened after the immobilization? Once my father got medical assistance, my brain stopped registering what happened next. No idea if we took a taxi, if an ambulance came, if we went to a hospital, or if my mother arrived. No recollection whatsoever. According to the literature, the way the brain proceeds in cases where there is no possibility to offer a solution in a critical moment is by canceling any excess of energy consumption that may be required in order to keep life going until the danger has passed. The danger here was the possible death of my father, the most important male in my life, the provider of stability, love, family, morals, education, and so on. For me, the possibility of such loss scared me “to death” and made me feel totally defenseless and helpless.
What could I possibly have done to stop the risk? The shock stayed in my memory —as all shocks do in something that academics call “memory flashbulbs”— but no other information stayed. I have tried using different modalities including EMDR, and nothing has been successful in recovering some information on what happened after someone injected my father and color came back to his face; I don’t even recall who did it. In contrast to the confrontation with the skunk where I was immobilized and able to evaluate the danger, while confronting my father’s heart attack I was not in evaluative mode. I was panicking and paralyzed without the capacity to generate any solution. If I could see my brain activity, I’d say that my thinking was paralyzed as much as my body.
Tonic immobility is also known, following Darwin’s terminology, as feigning death, and it could actually be lethal when there is a surge of parasympathetic activation combined with a withdrawal of sympathetic. Some researchers describe it as the doorway to trauma (or peritraumatic) and some consider it as a subtype of dissociation. Dissociation is too complex to expand on it here, but I want to mention that using the case of me getting paralyzed, the dissociation happened after a long period of time as a consequence of the shock and the tonic immobility. We know that the blood flow to the brain diminishes and the production of opioids increases when the parasympathetic gets activated as during tonic immobility, and that alone can create dissociation. But let’s just consider dissociated memory as part of this defense and leave dissociation for a later time.
Once the fear response is at this level, there is not much space for decision-making. According to Porges, the solution is to bring the system back into mobilization to reverse the flow and aspire to social engagement. If we follow the somatic-based theories, they suggest similar remedies like shaking or mimicking what animals do. But better yet is to avoid this state by developing resilience beforehand.
COLLAPSE IMMOBILITY: This stage of the defense process is the one that has often been called “fainting,” “feigning death,” and other names, but fainting is what explains it the best. Fainting is what happens to humans: extreme decrease in cerebral blood flow leads to a lack of oxygen — as in brain asphyxia —the brain fails to maintain muscle tone and compromises the level of consciousness, therefore bringing the person to collapse. Most articles describe tonic immobility and collapse immobility together as the same thing, and call it freeze. When an animal pretends to be dead in order to avoid being eaten by a predator, both strategies may work together; but in the case of humans, it’s hard for me to believe that fainting will be a response to avoid danger as in “pretending” to be dead to push the predator away, even when we carry very primitive defenses.
Using the same case of my father’s heart attack — if he had either gotten worse or died, I may have easily lost consciousness. But once the high risk of him dying was gone, instead of fainting and falling to the floor unconscious, the lack of oxygen in my brain produced lack of engagement. I am proposing that the lack of recollection of what happened after the struggle was dissociation not as a way to avoid pain as many scholars would have argued, but as a reflection of the incapacity of my brain to store more information due to the lack of cerebral energy. If this reaction could be generalized, collapse immobility would not be a survival strategy for humans, but a consequence of the effort of staying alive, and the loss of hope of succeeding.
QUIESCENT MOBILITY: Once the danger is gone and the person has been able to stay alive, there is a stage of exhaustion where the body needs to recover to go back to baseline. This stage — quiescent immobility — is included here because it is still part of the struggle to be not only alive, but also safe. At this point, the system has gone to the extreme effort of keeping the person’s heart beating after a fight or flee, or even while paralyzed and/or unconscious. It’s just logical to assume that the body needs to recover from this effort to consider the survival strategies a success.
Using the case of my father again, my assumption is that after my father started recovering and the possibility of him dying ended, instead of fainting, my ANS ended the fight for survival and went into quiescent immobility. In this state, it was taking time off from the event (and from everything) to bring all the levels of hormones, oxygen, blood, etc. back to normal, instead of expending energy to store information that was not useful at that point. Memory, after all, is geared toward helping enhance our reproductive fitness and chances of surviving.
This stage is essential and extremely important in the sequence of fear. It will not only guarantee survival, but it will take care of the damage that the cascade could have caused. If after going through the fear cascade there is a strategy that succeeded — including recovering (this stage) — the person’s ANS will go back to its regular way of functioning and there will be no major consequences. Homeostasis would be reestablished.
If this stage fails as in not having a window to recover, the system won’t assume that it achieved victory, and it would probably keep some of the adaptations that started during the cascade as the new baseline. That means that the person will suffer from trauma after everything else else goes back to normal.
I don’t know if we have this awareness, or if we give ourselves the time to recuperate that our system needs. I consider it vital and essential for everyone — but especially therapists — to consider it, and to start applying it as for example after an EMDR session when the system gets activated almost to the extent of the moment of the traumatization; Is there an awareness of the importance of having the time and space to heal from the effort?
Therapy has been looking for catharsis for decades. It may be the time to reconsider the therapeutic work, opening the space for quiescent immobility after difficult interventions.
TRAUMA: As stated step by step, the ANS engages in a very sophisticated, exhaustive and complex cascade of defenses to maintaining the system running. If the fear response succeeds sooner rather than later, meaning no further decline in functioning, the person will not only be alive, but healthy. But if the cascade fails, the person may be alive at the cost of health and well-being. Trauma is that cost. The consequences depends on the level of exhaustion of the systems that were compromised.
The repercussions of having the risk defenses triggered by fear are enormous. Since we are not normally undergoing the same type of risk that an animal in the wild is, we should — and can — be able to evaluate and make the decision ourselves, based on the actual danger. We have that opportunity several times before our system shuts down or immobilizes, to correct the reaction and to regulate the response. Children may not, and therefore caregivers should know better. Since caregivers sometimes don’t know better, children are more susceptible to suffer traumatization from the activation of these strategies.
In every stage of the cascade before collapse, adults could take the time to do a reality check, evaluate the level of risk, and decide to stop the cascade by picking the best strategy to achieve safety. Sometimes we need only faith or trust to stop the debacle. Sometime kind words. Sometimes silence and keeping present. If we activate our prefrontal cortex (PFC) by assessing, noticing, thinking, connecting, or caring, then the ANS doesn’t need to hold so tight to the reins and react in excessive ways that end up hurting our system instead of "protecting" it.
Why then has our system not learned or evolved enough to avoid these extreme measures that are not needed anymore? One of the main reasons is that the PFC — the part of the brain that decides and controls the primitive brain — is not fast enough to evaluate, assess and decide once the fear response has started, since the ANS is taking the energy from other areas of the brain for survival, including the energy that activates the PFC. Once the PFC learns to wait before becoming active, it stays off and becomes “lazy” or depleted of energy, and it becomes slow or inactive. This fact is even more severe in children that suffer from some arrested development, which normally translates as low activity in the PFC and low resilience in adulthood. To solve this problem, we need to learn how to activate our PFC by being mindful, practicing awareness, and staying in the present among other solutions. Therapy in general and neurofeedback in particular may be necessary in these cases to bring the activity back to normal and reprogram the unhealthy habits created in our brain and behavior as consequence of the traumatization.
Suffering from trauma essentially means to be in survival mode in one way or another.
Healing from trauma means to start living again.