Thursday, November 05, 2009

Understanding long term chronic pain symptoms from minor motor vehicle accidents

I'm reading, "The Body Bears the Burden: Trauma, Dissociation, and Disease (Second Edition)" by Robert Scaer, MD and it is completely fascinating. Dr. Scaer, an expert in chronic pain, attempts to unravel the mystery of why people often develop long term chronic pain following even minor motor vehicle accidents. He makes a compelling case that the body interprets even minor motor vehicle accidents as an "existential threat" which triggers a flood of the fight or flight hormone cortisol in the brain. But because there is nothing one can do in the situation -- often neither fight or flight is possible in the moment -- the excess cortisol is never discharged and wrecks havoc on various brain systems leading to chronic pain syndromes.

I want to quote at length from the book and then share my reflections on what Dr. Scaer's research also might tell us about other forms of dissociation we often see in society.

First, the money quotes:
Those of us fascinated by animal behavior in the wild love to watch shows on TV devoted to observation of animals in this setting. Many of these TV specials relate to the prey/predator experience, and sometimes display this in graphic and even grisly detail, at least to our civilized eye. If one closely watches the details of pursuit of the prey by the predator, one will see that the fleeing prey will often collapse and become limp even before being seized by the predator. An example is a film that I saw involving a gazelle pursued and run to the ground by a cheetah. At the moment that the cheetah caught the gazelle, it struck the gazelle lightly on the flank, at which point the gazelle collapsed and lay inert on the ground in the freeze or immobility response. In another example, after fighting off a pride of lions for more than half an hour, the lone water buffalo was knocked off its feet, at which point it became limp, immobile, and frozen. In other words, when fleeing and fighting are no longer physically possible, and the prey animal is in a state of helplessness, it will frequently enter the freeze, or immobility state, a totally instinctual and unconscious reflex. This behavior is common in most species including insects, reptiles, birds, and mammals. Since most such reflexes have evolved as a means of perpetuating the species, the freeze response clearly is of critical importance for survival. (Robert Scaer, The Body Bears the Burden, page 16.)

This part blew me away:

In a surprising number of cases, the attack of the predator may be fueled by the instinctual response to movement of the prey rather than by hunger, in which case the freeze response of the prey may abort the attack of the predator and result in survival of the prey. The freeze response mimics death, sometimes fooling the predator enough to leave the scene of its "kill" and gather its offspring without delivering the tooth and claw coup de grace, thereby allowing the prey to recover and escape, as in "playing possum." In addition, the freeze response, analogous at least in part of dissociation in humans, is associated with additional release of endorphins, rendering the animal relatively analgesic. Whether this analgesia has survival value, or is a gift from a greater Being to prevent a painful death is open to debate. Another purpose of freeze analgesia may be to inhibit self-ministering behavior, such as wound licking, which would impede escape of the prey animal in the case of arousal from the freeze. (p. 17)

If the animal was in a state of high sympathetic tone -- fighting or fleeing -- for a period of time at the onset of the freeze, its autonomic nervous system will be in a state of "the accelerator on full, but with brakes on" during the freeze... In this freeze state, the focused and alert mind becomes numb and dissociated, at least in part due to high levels of endorphins. Memory access and storage are impaired, and amnesia may be expected for at least some of the events occurring during the freeze.... In mammals the freeze response is indeed a perilous state. (p. 18)

But unlike humans, other animals apparently have instinctual ways to discharge this flood of fight or flight chemicals in the brain.

In most cases, the frozen prey animal does not need to deal with the presumably unhealthy state of the freeze response -- it becomes another animal's meal... In some cases, however, the frozen prey animal survives the period of immobility without being killed... In virtually all such instances, 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 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. They also seem instinctually to tend to "complete" the act of escape through the freeze discharge. (p. 19)

So what does this have to do with humans in motor vehicle accidents?

People who report symptoms of shock and numbness after a traumatic event [like a motor vehicle accident], and exhibit symptoms of dissociation, are actually in the freeze response at the time. In fact many of the post traumatic symptoms that occur often for years after the unresolved trauma are characteristic of dissociation, or recurrence of the symptoms of freezing. (p. 20-21)

And here's where he brings it all together:

Acculturation of the human species has resulted in an increasing pattern of urban living in closely confined habitats that intrinsically may inhibit the instinctual capability to flee or defend oneself under threat... The state of intense proximity and cultural interdependence may also act to inhibit the natural discharge of autonomic freeze energy in such cases...

If we do not discharge or complete the freeze response, our brains will literally be fooled into thinking that the memories of the traumatic event that inevitably periodically reemerge represent events that are actually in the present and not actually in the past. When they emerge, we go through all of the experiences of that event, emotional, cognitive, and autonomic as if it were actually happening again. Retention in procedural memory of this experience may serve as an internal cue for recurrent arousal patterns, alternating with numbing and dissociation, constituting the basically bipolar and self-perpetuating nature of PTSD. Until that act of flight or self defense has been completed, therefore, the "survival brain" may continue to perceive that the threat continues to exist, and is unable to relegate it to memory as a past experience. (p. 22)

So to summarize: a motor vehicle accident, even a minor one, is perceived as an existential threat by the human body -- much like a gazelle being chased down by a cheetah. That triggers the freeze response whereby the body is flooded with fight or flight hormones. Unlike the animal kingdom, once the danger has passed for humans, we seem to have forgotten or repressed the freeze discharge instinct that we see in animals. As a result, the sensation of "the accelerator on full, but with brakes on" becomes imprinted on the brain such that an event that was in the past is experienced over and over again in the present, akin to the experience of people with PTSD.

It's a pretty compelling case I think.

I'm also encouraged by the way that this diagnosis also points to treatment options. Indeed, one of the mysteries in psychology is why the wacky steps involved in Eye Movement Desensitization and Reprocessing (EMDR) are so incredibly effective at treating PTSD. Dr. Scaer's theory suggests that EMDR is effectively precisely because it reawakens and plays out the sort of freeze discharge instinct that we see in animals. I wonder too, if taking self defense classes after an assault are helpful not just because they provide an additional level of protection against future attacks but because they also help heal the brain by "completing" the act of escape thereby discharging the autonomic freeze response?

It seems to me that this model also may explain learning disabilities. Little kids put on the spot at the front of the classroom by a teacher very well may experience that as an "existential threat." Indeed, from the outside many of these children (and adults) appear to freeze, much like the gazelle in the example above. People with learning disabilities describe the experience of taking a test or being called on in class as a flooding in the brain complete with loss of short term memory, blurred or jumpy vision, cognitive fogginess, and difficulty focusing -- all symptoms that match the freeze response of people in motor vehicle accidents as well. Encouragement, praise, and a more relaxed school setting (all characteristic of Montessori of Waldorf educational approaches) I imagine then would do wonders for reducing the flooding associated with learning disabilities.

Finally, I'm fascinated by the ways in which this model also explains military strategy. The displays of overwhelming force characteristic of both the Nazi Blitzkrieg and the current U.S. strategy of Shock and Awe appear specifically designed to trigger the freeze response in an entire population thereby disabling their ability to fight back. Displays of overwhelming force are literally attempts to get an entire population to believe that is about to be annihilated so that they freeze (much like the gazelle), unable to respond (which actually is what appears to have happened in France in WWII and Iraq during the first Persian Gulf War and the current Iraq War.) All wars lead to high levels of PTSD in both the military and civilian population. But it would follow that nations subjected to Shock and Awe would display even higher levels of PTSD in the general population as a result of this strategy (which actually makes rebuilding much much more difficult I would imagine).

So, sorry for the long post. I don't imagine this post will do much for my blog traffic or my "average time on site" statistics. But for the one person out there who might be helped to understand their situation just a bit better -- whether you are suffering from chronic pain; PTSD; flashbacks, depression or dissociation as a result of trauma or abuse; or even just a learning disability, this one is for you. And if you are experiencing any of those symptoms, I highly recommend reading, The Body Bears the Burden. The life you save may be your own.


Michele Rosenthal said...

THIS IS A TERRIFIC POST!! Insightful, intelligent, interesting.... all the things we so need in healing from trauma. May I reprint on my healing PTSD blog -- and link back to you, of course?

RFK Action Front said...

Thanks so much for your comment Michele! Yes please, reprint away -- just let folks know I wrote the post and link back if you would. And thanks for all the great work you are doing in connection with PTSD treatment!

Robert Scaer's book is absolutely brilliant -- I highly recommend it for anyone interested in these topics. One of the things that is fascinating to me about the book is that he shows how the research on PTSD is also starting to help explain so many other disorders like chronic pain, other dissociative conditions, and some types of depression too.

Again thanks for your comment and all that you do.

Toby Rogers

Anonymous said...

I have no problem with the hypothesis of the book as described that we are essentially animals with evolutionary baggage.

However, with all due respect, I cannot take the deductive conclusion as applied to car crashes seriously as there has been no attempt to control for the major incentive to report post accident trauma symptoms, i.e. the possiblity of an insurance / tort payout.

"many of the post traumatic symptoms that occur often for years after the unresolved trauma"
are reported because the charade is required to be maintained untill the winnings are safely in the bank, the charlatan doctor that acted as witness and the lawyer have been paid.

Unknown said...

Check out the Foundation for Human Enrichment for a comprehensive look at how this theory is already being applied to aid in the healing of traumatic stress. Now physiology has caught up with philosophy and religion. There is no evil, just a traumatic tendency to reenact past hurts, whether experienced first-hand or observed. That's why we struggle to stay present and act in ways that cause our rational mind to rebel, we simply have not been healing properly.

someofparts said...

A friend who saw an interview with the Jim Henson people said that several people in the group were stiff and withdrawn when obliged to interact with others face to face. All of their stunning creativity could only emerge when they were able to hide behind the puppets.

Anonymous said...

great post. i was blindsided (suckerpunched)in a bar fight a few years back, and was almost knocked out cold. i am convinced the rush of cortisol kept me standing and able to defend myself. the events of that evening have replayed (unsolicited) many times in my mind since then. for the past few years i've had chronic neck pain on the side i was hit. xrays, etc. show nothing out of the ordinary. I recently applied for a firearms license (after taking an nra course), which is odd, because i'm not really into guns. (i think they're dangerous). the experience, however has provided me some catharsis; and this post makes me feel less crazy. thanks.

Gemfinder said...

Great post! It was linked from NakedCapitalism, a high-traffic finance blog. You never know what will work from a traffic perspective. :-)

ClaudiaM said...

Great post - Thanks! A lot to think about.

Duff said...

Insightful conclusions, Toby.

When you start looking for it, you can see that look of trauma/fear on people's faces like your example of a kid being humiliated in front of a classroom.

From the perspective of hypnosis, confusion induces a trance, making the person very suggestible, and then either a positive or negative experience occurs, locking it into the unconscious mind.

Hypnotherapists work in reverse, by interrupting an unpleasant experience or unwanted behavior, inserting a new choice or suggestion, thus creating a positive healing trance experience.

In Peter Levine's Waking the Tiger, he talks about his discovery of this same principle in working with trauma. He has a process for leading people back into traumatic memories and encouraging ideodynamic (automatic) trembling of the legs and arms.

Bradford Keeney's Shaking Medicine is a similar process, adapted and generalized from the multiple healing traditions in which he was initiated as a shaman (after working for many years as a hypnotherapist and family therapist).

I do think there is something universal here to learn about both trauma and healing, negative and positive trances that we create or find ourselves falling into.

RFK Action Front said...

Thanks ya'll for the great comments, good insights, and additional resources! And thanks to Yves Smith at Naked Capitalism for the link!

It's fascinating to me how many people resonate with a post like this. I think it just shows once again that a lot of people out there are dealing with some pretty heavy stuff that rarely gets talked about in traditional media. I'm thankful for the ways that many of you have found healing and are now helping others to heal as well.

Anonymous said...

This was a wonderful post... very informative, and very descriptive of the kind of trauma I have been through in my life. I am a big fan of Dr. Scaer's work, and as a former professor of dance in a University setting (former, because of all of my problems), I am very interested in finding ways of possibly using dance as a modality in recreating the kind of movement that is done in the wild after an animal goes through the fight/flight/freeze response. Maybe through a combination of hypnosis, then movement improvisation to allow the autonomic system to recreate the traumatic situation, then release that energy... who knows?? Might be worth a try? However, the only problem I have with your site is that after I read this wonderful article, I then looked over to your statement about Republicans, and how there is nothing good about them and what they do. As a Republican, I'm sad that someone as eloquent and "open-minded" as you could deal in absolutes like that. Not all Republicans are evil, and not all Democrats are saints. Why do you have to attack us as a whole? It just seems so petty and divisive. Let's find out where our similarities lie... I'm sure you and I could agree and feel passionate about a lot of things. You claim that Republicans are all about hate... but your statement about Republicans IS hate, at its worse! Just maybe something to think about...