Are either of the docks ever in sight when the seas are so stormy?
Friday, April 5, 2019
The Fight / Flight / Freeze / Faint / Feign (or Fawn) Responses leading to Fry and Freak
Hans Selye developed the now-popular concept of the "fight-or-flight" response of the sympathetic branch of theautonomic nervous systemto sudden threat back in the late 1940s, publishing his work in a book entitled The Stress of Life in 1954.
Since then, people like Joseph Wolpe, Herbert Benson and Bruce McEwen developed the additional concept of the "freeze" response, which trauma experts Bessel van der Kolk and Bruce McEwen see as The Big Problem underlying the "allostatic loading" of the entirehypothalamic-pituitary-adrenal axisthat can lead over time to what mental stress (e.g.: from being a physically & mentally tortured prisoner of war) expert Joost Meerloo called the "faint" -- as well as "feign" -- responses... andthento whatComplex PTSDexperts like Pete Walker call the "fawn" response.
(Stanford prof Robert Sapolsky is another Big Player in this, deserving mention for sure because he's able to explain it all so well inYouTube videos.)
My own experiences as a patient with severe Complex PTSD symptoms from 1994 to 2003, however, suggest two more "Fs." One of them (I call "fry") is akin to those of McEwen's allostatic loading if the HPA Axis and ANS "diesels" like an overheated automobile engine. (See The Polyvagal Theory, but make sure you read the first reply.)
The other is the wretchedly awful result thereof I will call "freak," which patients (like me) experience(d) as a relentless, SUDS-level 80-plus panic attack that comes on as soon as one awakens from sleep and continues without let-up until one passes out at some point, IMOE, after about twelve exhausting hours, though the length of wake-vs.-sleep varies considerably in others I have observed.
Moreover, once allostatic loading has induced such dieseling over the course of a few weeks, the syndrome may not be amenable to treatment with sedatives that normally contain such symptoms like the neuroleptic anti-psychotics do in patients who begin medicinal treatment within a few days of symptom onset. Some have suggested that that is the case because of near complete serotonin depletion in the limbic systemwhich is itself the initial triggering point for the HPA Axis's "pounding" on the ANS mentioned above.
In my own experiences of eight months in 1994-95, eleven months during 1997, two months in 1999, and eight more months in 2002-03 and a month later on in 2003, each period of extreme anxiety (save for the last one; see below) slowly morphed into an initial period of "fogginess" later followed by increasing, bipolar-type hypomaniaescalating to florid, Bipolar I-type mania with agitation and noticeable paranoid expressions and hair-trigger Fight / Flight / Freeze / Faint / Feign behavior ultimately leading back to Fry and then Freak in the next round of total incapacitation. (See the description of "fry" and "freak" in my answer to a question at the end of this blog article... as well as at the end of this one.)
A Veterans Health System patient at the time (owing to losing my health insurance to inability to work in 1997), my final "bout" with the Fry & Freak deal landed me in the last of my eleven hospitalizations at a private hospital rather than once again at the VHS anchor hospital's psych lock-up. I was very fortunate there to encounter a female MD from India, who -- after assessing me -- looked at my chart from the VHS and then back and me, saying thereafter with a quizzical look on her face, "Well, you have PTSD. So we're going to try something different from the medications you have been taking." (Which were anti-epileptic mood stabilizers Rx'd by a "better" VHS doc after years of having been slammed with Depakote divalproix and *Paxil paroxetine"... which, for someone with bipolar symptoms, was really risky business.)
The worst of the symptoms abated in a few days. (No more Fry > Freak ever since, albeit occasional dips into Fight / Flight / Freeze / Faint / Feign (or Fawn) emotions and behavior... all from which I have been largely free -- save for occasional Feign or Fawn -- for several years.)
The "something different" I was put on in late 2003 -- and stayed on until about six months ago -- was a very low dose of Seroquel quietiapine along with pretty much everything listed in this earlier post. To finesse the continuation of the fifth of the five stages of therapeutic recovery, I have also engaged in the following:
"Results may vary," of course. But the old adage that "I am not responsible for my disease but I am for my recovery" seems applicable in all cases.
- - - - - - Someone asked, "Can you expand on the sympathetic branch's fry and freak syndromes? I have not encountered this language before, and a quick Google search for 'fry and freak syndrome' has yielded nothing." I answered, "Frying is akin to the process of allostatic loading as described by Bruce McEwen, Sonya Lupien and others. Freak is being in a very high SUDS state of abject terror recycling -- or "fear of fear" -- that may not abate with sedative medication and can ultimately only be treated with one or more of the cognitive-behavioral therapies like those listed in section 7a of this earlier post, often requiring the addition of one of the mindfulness-based CBTs like those listed in section 7b."
Adding thereto, however, failure to respond to appropriate dosage of sedating neuroleptics like Seroquel quetiapine, Zyprexa olanzepine and Clozaril clozapine is very rare in people who do not have traumatic brain injuries, malignant tumors, substantial substance-abuse-induced "rewiring" through the limbic system, and/or birth defects, so far as I know... and even pretty unusual in people who do. - - - - - -
Resources & References
Akiskal, H.; Pinto, O.: The evolving bipolar spectrum, Prototypes I, II, III and IV, in North American Journal of Clinical Psychiatry, Vol. 22, No. 3, 1999.
Akiskal, H.; Benazzi, F.: Delineating Depressive Mixed States: Their Therapeutic Significance, in Clinical Approaches to Bipolar Disorders, Vol. 2, 2003.
Andersen, S.; Teicher, M.: Desperately Driven and No Brakes: Developmental Stress Exposure and Subsequent Risk for Substance Abuse, in Neuroscience of Behavior Review, Vol. 33, No. 4, April 2009.
Benson, H.: The Relaxation Response, New York: Morrow, 1975.
Carlson, N.: Physiology of Behavior, 7th Ed., Boston: Allyn and Bacon, 2001.
Lupien, S.; Maheu, F.; et al: The Effects of Stress and Stress Hormones on Human Cognition: Implications for the Field of Brain and Cognition, in Brain & Cognition, Vol. 65, No. 3, 2007.
Lupien, S.: Brains Under Stress, in Canadian Journal of Psychiatry / Revue Canadienne De Psychiatrie, Vol. 54, No. 1, 2009.
Lupien, S.; McEwen, B.; Gunnar, M.; Heim, C.: Effects of stress throughout the lifespan on the brain, behaviour and cognition, in Nature Reviews - Neurosciences, April 29, 2009.
Lupien, S.: Cortisol level reveals burnout, in Trac-Trends in Analytical Chemistry, Vol. 30, No. 4, 2011.
McEwen, B.; Seeman, T.: Protective and damaging effects of mediators of stress: Elaborating and testing the concepts of allostasis and allostatic load, in Annals of the New York Academy of Sciences, Vol. 896, 1999.
McEwen, B: Mood Disorders and Allostatic Load, in Journal of Biological Psychiatry, Vol. 54, 2003.
McEwen, B.; Lasley, E. N.: The End of Stress as We Know It, Washington, DC: The Dana Press, 2003.
Meerloo, J.: The Rape of the Mind, New York: Grosset & Dunlap, 1956; Mansfield Center, CT: Martino, 2015.
Ogden, P.; Minton, K.: Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory, in Traumatology, Vol. 6, Issue 3, October 2000.
Ogden, P.; Minton, K.: Trauma and the Body: A Sensorimotor Approach to Psychotherapy, New York: W. W. Norton, 2006.
Ogden, P.; Fisher, J.: Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, New York: W. W. Norton, 2015.
Pynoos, R.: Impact of Childhood Trauma on Startle Response Persists, in Clinical Psychiatry News, Vol. 38, No. 4, April 2010.
Porges, S.: The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system, in Cleveland Clinical Medical Journal, No. 76, April 2009.
Porges, S.: The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe (Norton Series on Interpersonal Neurobiology), New York: W. W. Norton, 2015.
Rosenzweig, M.; Breedlove, S. M.; Leiman, A.: Biological Psychology, 3rd Ed., Sunderland, MA: Sinaur Associates, 2002.
Sapolsky, R.: Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases and Coping, 3rd Ed., New York: Holt, 2004.
Sarno, J.; The Divided Mind: The Epidemic of Mindbody Disorders, New York: Harper, 2006.
Schiraldi, G.: The Post-Traumatic Stress Disorder Source Book, 2nd Ed.; New York: McGraw-Hill, 2009.
Selye, H.: Stress Without Distress, Philadelphia: J. B. Lippencott, 1974.
Van der Kolk, B.; Hopper, J.; Osterman, J.: Exploring the Nature of Traumatic Memory: Combining Clinical Knowledge with Laboratory Methods; in Journal of Aggression, Maltreatment & Trauma, Vol. 4, No. 2, 2001.
Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.
Van der Kolk, B: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, New York: Viking Press, 2014.
Walker, P.: Complex PTSD: From Surviving to Thriving, Lafayette CA: Azure Coyote, 2013.
Wolpe, J.: Psychotherapy by Reciprocal Inhibition, Palo Alto, CA: Stanford University Press, 1958.
Wolpe, J.; Wolpe, D.: Life Without Fear: Anxiety and Its Cure, Boston: Houghton Mifflin, 1981, and Oakland, CA: New Harbinger, 1987.