It doesn’t take an encounter with a bear or a threatening gun to trigger symptoms of the fight or flight response. I experienced similar phenomena when undergoing a consultation with a surgeon for an elective, life-altering surgery.
Her bedside manner exuded a cold, indifferent and detached attitude. With barely a glance at me, she entered the consulting room and settled into her chair. A few perfunctory questions and she did her due diligence by rattling off the risks involved with a robotic monotone that had been programmed into her. A few hasty and superficial parting words and the meeting ended abruptly.
I understand the necessity to discuss risks in informed decision-making (and for their own protection from litigation), but surely not that way. My main focus now was on my own reaction to her ‘harangue.’ As she spoke, brain fog set in. I experienced all perception and feeling through a thick mist, as if my brain was disconnected from my body. It was a frightening experience, and to this day I cannot recall one word. The fact that she said it doesn’t mean I heard it.
How do you explain this?
Fear! The fear response is what biology provides in all human beings. Any threat, physical or mental, real or imagined, activates the brain to issue an automatic warning signal in defense of self-preservation. As a career social worker and lifelong student of psychology, I have since clarified the what, why, and how of that day in that room.
The fight or flight response has been extended to the fight, flight, freeze or faint (FFFF) response. (1) Bear with me as I begin with the truth of this little phrase – the brain has a mind of its own.
To understand the FFFF response we need to look at brain function. Since I do not have a medical background, this will be presented in laymen’s terms. The autonomic nervous system (ANS) of the human anatomy has two branches – the sympathetic and the parasympathetic. (2) When a threat is real or imagined, mental or physical, the sympathetic branch activates the fight or flight response by sending messages to various bodily organs, such as the heart, muscles and eyes, to heighten their activity so we can fight harder or run faster. The parasympathetic branch kicks in when the danger has passed and activates the relaxation response by slowing the heart rate and decreasing blood pressure. Both systems work together to maintain homeostasis.
However, the freeze response works differently. Freezing is at the lower end of a continuum from the more severe post-traumatic stress disorder (PTSD). “Dissociation is an adaptive response to threat and is a form of freezing.” (3) When a person becomes overwhelmed with fear they may freeze, mentally removing themselves from their bodies, and have no explicit memory of it afterwards, much like playing dead. “It is important to know this is a normal response in the face of trauma.” (4)
Dr. Daniel Siegel, a professor of clinical psychiatry at UCLA, says the mind governs how the body reacts to stress, which shapes neural function. “Ancient neural circuitry establishes patterns of reaction to threat as one form of a ‘challenging’ situation.” (5) If the person feels overwhelmed and unable to cope, the reactive state of the four Fs is triggered. Cortisol and adrenalin are then released to prepare the individual for self-preservation.
Siegel says, “many leaders think the best way to make a decision is to focus on the logical, reasoning part of their minds. Actually, what neuroscience tells us is there’s more to our brain than the gray matter that rests between our ears. Other parts of our body do essential work processing information,” (6) “…so the heartfelt feelings that we have are not just poetic metaphors of the ‘gut instinct’… but instead are really sophisticated processors.” (7) Siegel acknowledges it is not rational.
Yet, in a safer environment my prefrontal cortex took over executive function. It understands why the doctor did what she did. It reasons that she is also in survival mode. She is protecting her financial, personal and professional life, along with the organizational structure, of which she is a part.
And then there is the time factor. With heavy pressures on workloads, responsibilities, dealing with bureaucracies and a personal life, there is no time for dealing with patients’ anxieties and fears.
Still, glimmers of empathy broke through the fog. I believe I saw a hand reach out to touch my shoulder when I declined the surgery. I heard her last words as I left: “You don’t have to make a decision right now.”
On that small opening, one month later I called back and committed to it. The surgery was highly successful, and I thanked her with much gratitude. But it could have had a different outcome.
What can be learned from this experience? Empathy should be the first step in treatment of any medical problem because the brain has a mind of its own.
Identities have been withheld for privacy.