Saturday, August 20, 2005

The Lady and the Tiger

When we left off last time, I said I would attempt to explain the why and how behind the symptoms of post-traumatic stress disorder that I listed in the form of questions. By the way, my answer to each of the questions is, “Yes,” but not deliberately so, as if I chose to list only those things that bother me. It’s a fairly comprehensive list, if short on detail. I just happen to have experience with much of the full range of symptoms. This might be a good way to segue into a disclaimer of sorts: I also seek answers, and I don’t want to be taken as an expert in anything but my own experiences. I write here what I am learning from others, and those references are listed at the sidebar.

Hopefully, I have been gifted with some understanding, which would be due to the fact that I suffer from this, PTSD induced by abortion. I have a B.A. in psychology, and that helps me with the terminology, but it doesn’t qualify me to dispense medical or therapeutic advice, even to my dog. So I encourage every one who suffers to ask the same questions I ask. Please - run these ideas by your doctors or therapists, if you have them. Then come back and tell me where they say I have it wrong, so we can all benefit from greater understanding. (But if he or she won’t tell you why it’s wrong, I’ll give you some direct advice – get another doctor. Don’t waste time on medical professionals who will not give you enough respect and courtesy to at least try to understand.)

Dr. Scaer gives us specifics about the acute stress response, listing all of the hormones that are released, and the neuronal receptors to which they bond and where. It’s quite technical, and I find it difficult to slog through the acronyms and medical terms. So I thought instead to demonstrate how these chronic symptoms arise as normal responses during the acute traumatic experience by going back into the jungle to meet the tiger. As I do, I will describe some of the things my mind and body are experiencing, in every day words. When we understand how the autonomic nervous system response to trauma works normally, it’s easier to recognize how the symptoms of chronic post-traumatic stress disorder arise from its dysfunction. So, here we go.

I’m walking along a narrow path, surrounded by jungle growth, when I see a tiger sunning in a patch of light on the path ahead of me. I recognize him by visual cues – his distinctive coloring and feline appearance say, “tiger,” because I’ve seen pictures, and Wild Kingdom. He resembles my housecat, only he’s much, much bigger. He’s certainly big enough to devour me, and has the teeth to show it, too. I see those as he growls at me. The hair on the back of my neck stands up at the sound, and my mind and body trigger red alert. The tiger is a threat to my existence. Immediately, my body gets ready for what I must do to save myself, doing things that are regulated and controlled by the autonomic nervous system. There’s no time to waste conscious thought on preparing my body to fight or flee in response to this threat. So the autonomic nervous system starts flooding my body with chemical signals that affect each and every system, because each and every system will be involved until the threat has passed. No energy will be wasted on bodily functions that do not contribute to my immediate need for survival.

In the cardiovascular system, my respiration changes. I begin to inhale more than I exhale. This oxygenates my blood more quickly. My heart accordingly starts to beat more rapidly, increasing blood flow. Blood cells in my limbs dilate so the oxygen-rich blood can feed the muscles quickly and efficiently, as the blood cells feeding the non-essential internal organs like the stomach constrict. All digestive activity is turned off, because this is no time to be thinking about what I had for lunch. I can finish digesting that after I get away. I’m also not feeling hunger or satiation, signals regulated by the autonomic nervous system, because feeding isn’t important right now. Saliva is part of the digestive process, so my mouth immediately goes dry. No energy wasted there, either. The muscles in my limbs, neck, back, and waist will tense in preparation for hard use. Even my immune system is on hold for the time being, not working at all against that cold virus I picked up the day before.

Constantly seeking escape from the threat, my eyes are darting to and fro, and my thoughts race as I take in every aspect of my environment. The vestibular system in my brain is on “all systems go,” compensating for my rapid eye movement, and ready for sudden changes in posture. I need to know where I am in relation to my environment. My ears are finely tuned to the slightest sound the tiger may make if he starts to move toward me. My nose is recording his smell, which is also a measure of his proximity. The warm blood rushing into my limbs and a gush of perspiration will cool my body more efficiently during exertion (as blood rushes to the surface of the skin, it release its heat into the air).

Not only am I not digesting lunch, I have also stopped higher brain functions that have nothing to do with my survival. I’m not writing poetry, solving trigonometry problems, or composing music, although there is a funny tune that runs through my head as that part of my brain fades into sleep mode. I’m not contemplating Plato, and how the planets orbit around the sun. I’m not wasting any brain energy recording a narrative of the events as they happen, either, but the sensory input and the emotional responses they engender will be hard-coded in my brain so I can access them again, when I need to later on, if I survive this time.

Sensory input has been processed, and I have determined there are no handy trees to climb or weapons at hand. He is too big, too obviously dangerous and better armed for me to fight bare-handed, so my only option is to flee. As soon as the choice is made, the body reacts. I turn to the side and dart off into the jungle, running at top speed. Adrenaline gives me more strength than I would normally have. My heart and lungs are still working furiously to feed the muscles with oxygenated blood. Endorphins flood through my body killing the pain caused by the scratches of branches, and the pain in my ankle when I take a misstep into a hole. I’ve taken the tiger by surprise – he was lazy and sleepy in the afternoon heat, and fortunately for me, not particularly hungry. My ears are still highly tuned for any sound of pursuit. My eyes are constantly scanning the scene as I zigzag through the heavy greenery. I haven’t chosen a destination, because that would have required some heavy thought, a process that was shut down so it would not slow down the life-saving choices I needed to make. All of my decisions as to which direction to run are being made based on information I have stored previously – I don’t have time to read a map and learn the geography now.

So it’s no surprise when my arms automatically fly out in front of me to stop my slamming headlong into a thicket of bushes climbing a steep cliff wall that blocks my path. I turn, too late, to discover that I’ve run straight into a natural enclosure of jungle growth and boulders that lie at the foot of the cliff. My only way out is to backtrack, but the tiger has not been outrun. He blocks my exit, and I am trapped.

As I stand in the jungle facing the tiger, which while not hungry, has been quite intrigued by my resemblance to prey in flight, my eyes stop darting around looking for escape or a weapon I can use against strength, teeth, and claws. There is nothing – no way over the boulders or up the cliff. No tree limbs to use as a club. I have no recourse but to accept the threat, and my eyes lock on the tiger and approaching death.

At this point the autonomic nervous system may take complete command. There is one more option available to me, but in order for it to work, my conscious thoughts have to be turned off. I have to run silent. Playing dead, or freezing, is my last chance to escape death in the tiger’s jaws.

I lose conscious thought, and crumble to the ground as my muscles relax, losing tone to resemble lifelessness. My senses, previously so acutely attuned, are muffled so I will no longer respond to threatening cues. More endorphins are released, so I will not reflexively move in response to pain. And the reflexes themselves are inhibited for the same reason, to keep me from moving and showing signs of life. The game only works if the tiger believes I am dead, so there must be no sign – even the swallowing reflex is inhibited.

The blood vessels are stimulated to do the reverse of what they have done – they will constrict in the limbs, restricting movement and creating a cold, dead appearance to the tiger’s senses. My respirations slow, and my heart rate falls, so blood pools in the internal organs. This may help save my life if I am injured while I am “out” by keeping me from bleeding to death before I revive. The muscles and reflexes in the urinary and digestive systems also relax, and their contents are released. This happens when creatures die, so it’s an attempt to make the tiger believe through his sensory perceptions that his prey is already dead (and therefore less desirable to eat).

As I crumble to a heap on the ground, the tiger charges in. He reaches out with a massive paw and bats me like toy. His claws dig deep into the flesh of my upper back, but I make no response. I am not consciously aware any longer, and there are endorphins easing the inflamed pain warnings so I don’t even unconsciously twitch. Thankfully, the tiger really isn’t hungry, and isn’t quite sure I was ever edible in the first place. After a few more swipes, he buys into the act, loses interest, and turns to make his way back into the jungle to finish his nap.

Some time later, I stir. Some sensory perception must have remained in order for my body to know when the danger has passed, or freezing wouldn’t be a very useful survival tool. My consciousness snaps back on, and I sit up, immediately as alert as I am aware, and I remember the tiger. I can’t recall much else, except the blurring of green as the jungle rushed by me and the fear. All systems come back on full alert again, muscles constricting, blood richly oxygenating and heart pounding. My eyes dart, my ears perk, my nostrils flare, and I use all of my senses to determine consciously whether the danger has truly passed. As soon as I have assured myself that it has, I start to feel the pain in my shoulder wound where the tiger has clawed me. My ankle hurts now, too, and I notice it for the first time. The endorphins are retreating, and the pain is allowed to give me the signal to get to safety in order to tend my wounds. Somehow, although I will never remember the details, I stagger out of the jungle.

If I was a mouse, or a gazelle, this period of unconsciousness would have been immediately followed by the dissipation of unused energy, called “the freeze discharge:”

“…the animal will arouse and begin to tremble. This may be as imperceptible as a shudder, or as dramatic as a grand mal seizure. In some cases, analyzed by slow motion video, the trembling will resemble the last act of the animal before freezing – the act of running. The animal’s behavior at times seems to resemble an unconscious attempt to complete the act of survival, as if the last protective motor or muscular activity is locked in unconscious procedural memory and needs to be released, or completed, perhaps as a means of ‘discharging’ retained autonomic energy. At the same time, the animal may perspire. This motor and autonomic response may persist for several minutes, and is usually terminated by a series of deep, sighing breaths. The animal at this point will usually arouse fully, regain its feet, often stagger a bit, shake itself, and then run off, apparently none the worse for its life-threatening experience. Long-term observations of such animals do not seem to show any harmful effects on behavior, health, or other measures of survival. It would appear from these observations that animals in the wild possibly possess an instinctual means of dissipating autonomic activity stored and accumulated in the freeze response,” (Scaer, p.18).

But I am a human being, endowed by my Creator with an intellect and free will. I will work out my traumatic experience and dissipate that nervous energy cognitively and socially, with other humans also gifted with intellect. I will have access to the sensory and emotional memories of the event to help me resolve the trauma and discharge the built-up nervous energy by decision, resolution, action, acceptance, and supportive social bonding and interaction with other humans, particularly those who have also escaped the tiger.

In the next segment, we will continue the tiger saga. We will discuss what happens when this trauma is not resolved, and what the consequences are when acute traumatic stress becomes chronic post-traumatic stress disorder.


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