The Four F's of Trauma Shut-Down
**Trigger Warning: car accident, PTSD, trauma symptoms described
Lisa slowed down as she arrived at the intersection. Even though she had a green light, she quickly looked left and right to make sure the intersection was clear before easing her car across it to the other side. Suddenly, seemingly out of nowhere, a red pickup truck slams into her passenger side door. Her car careens across the middle of the intersection and for a brief moment she sees the terrified face of a teenage girl just before her car slams into the girl’s car. Then she blacks out.
The next thing she knows she is in a hospital bed with an oxygen mask over her face and a searing pain running down her left side. In her mind, she sees the face of the teenage girl and feels as if she is still in the midst of the car accident. She has a flash of remembrance of screeching toward that face and not being able to stop herself and protect the girl. She screams but nothing comes out. She tries to throw up her hands to avoid the collision but she can’t move. She suddenly remembers the red pick up and grows furious and begins to thrash around in her hospital bed, itching for a fight.
Just before she relives the last seconds of the accident before she lost consciousness, a spinning black ball of terror fills her gut and moves into her heart. She stops thrashing and fighting and pushing and simply stares into the space in front of her. She hears a nurse come in and speak to her but she cannot, does not answer. It sounds as if the voice is a million miles away. She closes her eyes and passes out again.
Lisa is able to physically recover quickly and is out of the hospital within a week. Even though she still feels some pain and requires physical therapy several times a week, she is able to return to her job as a veterinary assistant within two weeks. She finds out that the teenage girl was shaken up, but miraculously escaped the accident with a just a few bruises and a bit of whiplash. The older man driving the red pickup, however, died of the heart attack that caused him to charge through that red light.
It turned out there was nobody to blame. Everyone in the accident had done everything right. It was nobody’s fault and it could not have been predicted or avoided. Then why did Lisa have a growing sense of rage, terror, and helplessness as the months went by? Why couldn’t she just be thankful for her quick recovery and move on? Why did she see that girl’s face every time she closed her eyes at night and that red pickup every time she assisted with a dog wearing a red collar?
What I just described is the onset of Post Traumatic Stress Disorder - or PTSD. It is marked here by three of the four trauma responses that can occur in response to a life threatening incident - Fight, Flight and Freeze. The fourth response - Fawn- will be discussed last.
PTSD is unfortunately classified as a mental health disorder. In fact, it is not a disorder and it affects the body’s physiology as much as it does the brain and the mind. PTSD is a perfectly normal neuro-biological response to extraordinary circumstances. It is our body responding to danger in exactly the way it was created to respond in order to keep the human race moving along. In fact, the development of PTSD is the body and the mind working too well to protect the person from danger.
When faced with a life-threatening situation, several things happen within the brain that affect the whole body.
Shut down of the pre-frontal cortex - this is the front part of the brain that controls reasoning, logic, planning and decision making. This goes off-line
Activation of the brain stem/”reptilian” part of the brain - this is the bottom part of the brain that controls purely reflexive actions. This part takes over
Dysregulation of the mid-brain - this is the part of the brain that controls emotional responses. This part becomes dysregulated
When that reptilian - or primitive brain stem - part of the brain takes over, it may respond in one of these ways:
Fight - adrenaline and cortisol are flushed through the body and fuel a reflexive need to fight off danger. We saw this in Lisa when she thought of the pick up truck barreling through the red light - she had a reflexive need to protect herself and the teenage girl and was filled with rage and energy to fight the attacker
Flight - that same adrenaline and cortisol may instead be redirected to the leg and heart muscles in order to help escape the danger. Often, when a person is immobilized as a result of the trauma, the impulse to flee is there, but flight cannot actually occur. This may overwhelm the brain and the body and lead to…
Freeze - we call this the “deer in the headlights” response and it can look literally like the “frozen” deer, playing “dead” like an opossum, losing consciousness, staring off into space. Lisa fell into this state when the nurse was speaking to her and then she shut down and lost consciousness again.
PTSD settles in when these responses are not addressed - and then released - from the body. They create a perpetual danger-response cycle every time a “trigger” experience is encountered. The longer these triggers are activated, the more embedded that response becomes.
For Lisa, the color red became a trigger. Her survival brain quickly zeroed in on sensory information and locked it into the trauma response. She began to have flashbacks of the teenager’s face, as well as of the truck moving toward her in the intersection. She may develop more triggers such as seeing an animal in her care appear helpless, or injured from an accident.
Now each time she experiences a trigger moment, her mind-body response will fall into the urge to fight, flee or freeze. Those responses are not just reserved for the moments of the car accident, they will continue to haunt Lisa and affect her decision-making, her attention, her hormones, her digestive system, her muscles, her sleep, and even her overall physical health as time goes on.
But, you might be asking, what if my trauma was emotional and psychological in nature? Why do I still feel like I have PTSD when I haven’t gone through a physical trauma?
Remember that the trauma response arises when you feel as if your life is in danger. This is generally related to feelings of physical safety, but what if you begin to feel psychologically unsafe?
If you are being controlled, manipulated, degraded, demeaned, verbally threatened, restricted in your basic human freedoms to speak, act and live, and coerced into feelings of worthlessness and helplessness, the same biological urges may be triggered.
You may have the urge to fight, to flee, to freeze or a new response may come into play here - to Fawn, also referred to as Appease.
People subjected to emotional and psychological abuse have often learned to cope and survive by giving the abuser what he/she or wants - which is generally attention, praise, compliance, recognition, ego stroking. This is a fairly common response for people who have experienced the particular type of abuse dished out by people with Narcissistic Personality Disorder.
Rather than responding to danger with the body, this person learns to respond to the danger with words and actions. Fawning over the abuser becomes a reflexive habit, a survival skill. When PTSD settles in with this type of abuse, triggers become more subtle - a facial expression, tone of voice, a gesture, or being asked to engage in activities that have historically been heavily criticized or demanded by the abuser.
Part of my personal experience of trauma was a 12 year involvement in a religious cult. The leadership demanded obedience, specific “righteous” behavior, strict rule following, reporting on the infractions of others, and various types of “service”. There was no physical or sexual abuse that compelled a response. It was purely spiritual and psychological game-playing.
Those not in leadership were groomed to always speak highly of the leadership and pay them the lip service they craved. Among the survivors of that cult is a high predominance of the Fawn response - even now, many years after the dissolution of the most nefarious parts of the organization.
Survival is maintained in a psychologically abusive environment through appeasing the abuser with words and acts of service, or fawning over them. Just like the effects of Lisa’s car accident, this triggered behavior may carry over into other relationships even after the immediate danger from the original abuser is in the past.
PTSD stems from an on-going response of tension and fear. The antidote is simple, but not easy - retraining your mind-body to relax and feel nurtured and safe.
There are many effective treatments for PTSD out there. The most effective methods address the triggers and responses, acknowledge them and the purpose they have served, and then provide a physiological release. You don’t have to live like this!