It’s Not a Myth?

I am having trouble finding the necessary amount of time to write another post even though I have several in mind. I will try to write one more before Xmas.

In the meantime I thought I’d post this article about the fight or flight response. It seems it’s been modified to “freeze, flee, fight.” So when Aunt Ruth says the fight or flight response is not just a myth, we might actually have to correct her!

Originally posted 2015-12-19 12:27:51.

18 thoughts on “It’s Not a Myth?

  1. Abby

    Interesting article, Karen. Thanks for posting it. It is my understanding that the freeze response also releases endorphins, which makes death less painful should it occur. Comforting in a macabre sort of way, I guess.

  2. Waxwings2

    Good article, grounded in science. Thank you. I have always thought of Martin’s problems in Series 6 as a depiction of his “shutting down.” But now I realize that it was him “freezing,” as per the new science. But he never got to the stage of “defend/fight back” (if he was even capable of it) because Louisa circumvented it. She was relentless in her challenges to him to snap out of it. And when I think of Louisa’s reaction to Martin’s “shut down”/”freeze”, she didn’t react by freezing herself, but chose instead, to “flee” to Spain. Maybe she had undergone “freezing,” but we possibly missed it? Did she even experience the “freezing” that this article would suggest? Thinking back further on their first wedding episode, both of them “froze” and couldn’t go through with it. She ended up “fleeing” to London, which was her MO. He did the equivalent by staying put/sheltering in place. Maybe this new formula (which makes a lot of sense) is all dependent upon circumstance and on those involved. Much food for thought. Thanks for the article.

  3. Linda D.

    What an interesting article Karen! You are the source of so many great ideas so please don’t apologize when you need an hiatus. I think that many people “freeze” when they fear the alternatives – what to do?, where to go?, negotiate?, fight back?, take ANY stand rather than none? or thousands of other alternative actions. Is it easier to “freeze” than to take action. We “freeze” out of FEAR. When things happen, we have had no prior experience and no practice. Certainly, in many cases it is. We “freeze” out of FEAR. When things happen, we have had no prior experience and no practice.

    It reminds me of a scary flight home from Cancun some years ago. It was the day that a guy was caught with explosives in his shoe – maybe in Detroit? Planes travelling over US air space were delayed and grounded. In Cancun, hundreds of planes were parked on the runway. There was a lot of anxiety because no one really knew what was going on or what to be afraid of. I only knew because our Captain was in line for coffee right ahead of us and I accosted him for the information! After HOURS, we were taken by bus to our plane. We were asked THREE times if one of us was “Diane” until I figured out that we had switched seats and my husband was “Dan”. The lady was Mexican and mis-pronounced his name. We couldn’t figure out why they were pointing us out and coming down the aisle to question us. We had to sit with our hands on our knees for the entire flight. You were not permitted to read or use electronic devices. There was no in-flight entertainment so as to prevent the plane being tracked (we were told). There was no food or beverage service. If you wanted to use a rest room, you had to put your hand up and be escorted by a crew member. I was thinking about the possibility of something happening and for a time, I sat there and FROZE. I was actually scared – not at all common for me! Then, I decided to roll up my in-flight magazine to have it ready and told my son, “if something happens, we aren’t just going to sit here – we are going to get up and fight.” He looked at me as if I was crazy as did my husband and daughter-in-law. Nothing happened of course, but I was more relaxed having a plan. By the way, we all had stuff looted from our luggage and when we spoke to the RCMP Constable at the airport in Canada, he just laughed and said, “It’s Mexico!” It was freezing that night and I had left a can of Diet Coke in the truck while we were away. It had exploded and my husband was convinced that someone had committed a murder in our parked truck because it looked like blood all over. Of course, it was me who might have been murdered for leaving a can of Coke in the truck but I didn’t “freeze”, just so you know. I told him next time, HE should check more carefully! Just a little aside ….. We’ve been to Mexico again too.

    Great post Karen!

    Merry Christmas!

  4. kjacobson@mindspring.com Post author

    Thank you Linda! When I get to the end of this week, I think I’ll be ready for some celebrating! I look forward to a good 2016 and send you many good wishes too.

    I plan to write a few more posts but can’t promise exactly when they’ll be published. It is nice to know that you are willing to wait. I will truly work hard to add more to this blog ASAP. 🎉

  5. DM

    Although the article and the author’s work on fear and anxiety does not specifically address haemophobia, I thought (sitting here interminably in an airport terminal) it might be helpful to dispel some widespread misconceptions amongst avid Doc Martin fans regarding the “fear of blood” and to better understand how it is experienced. The following is culled from the current literature:

    Haemophobia (or hemophobia), more completely known as Blood-Injection-Injury (BII) phobia is unique among phobias (a persistent irrational fear together with overwhelming anxiety). All other phobias are strictly characterised by a physiological response of accelerated heart rate and increased blood pressure consistent with the so called fight-or-flight response. Yet this represents only the initial physiological response for the majority of individuals with a BII phobia because it then shifts abruptly to a paradoxical and nearly opposite response marked by a sharp drop in heart rate (bradycardia) and a widening of blood vessels (vasodilation) that precipitates a sudden drop in blood pressure (hypotension). As a consequence, the blood-phobic suffers from an acute impairment of blood flow. This second phase of the response is consistent with the vasovagal response with symptoms of lightheadedness, confusion, uncomfortable heart sensations, inability to speak, nausea, and ultimately (in the vast majority of cases)– the loss of consciousness by syncope (fainting). As blood can no longer flow properly it quickly drains away from the brain and pools into the legs (if the subject is sitting or standing upright). Syncope can be considered as a final attempt by the brain to restore blood flow by forcing itself to the same level as the heart *.

    Whereas the fight-or-flight (or fight,flight,freeze) response directs blood flow towards the major muscle groups (arms and legs) and away from less critical systems and organs (digestive system, skin, kidneys, etc.) in preparation for the individual to either fight or to flee, the vasovagal response essentially forfeits blood flow everywhere except the brain, and even there at the expense of consciousness. This response to a perceived threat is analogous to the defensive mechanism available to some animal species known as tonic immobility– more commonly known as “playing dead”. It is postulated that this particular response developed as a demonstration to a perceived threat that it in turn was not itself a threat, by temporarily fleeing consciousness in an imitation of death (e.g. by a prepubescent human threatened by paleolithic warfare).

    Vasovagal syncope is the same form of syncope (i.e. neurally mediated) that is experienced in clichéd “fainting episodes” triggered by acute emotional stress, suggesting that haemophobia too relates to a sense of overwhelming emotions (although not merely from the severe anxiety being experienced in pre-syncope). This is supported by neuroscientific research that correlates BII phobias with a generalised diminished ability to regulate emotions (i.e. the opposite temperament of sanguine). Neurologically, the conditioning and processing of fear and phobias occur most particularly in the brain structure known as the amygdala, although this too is different in the case of BII phobias. Research indicates that haemophobia/BII is less strongly associated with the basic emotion of fear and more strongly associated with the basic emotion of disgust. through activation of a different small brain structure most responsible for bodily homeostasis, self-awareness and the experience of empathy.

    BII phobias exhibit a strong familial predisposition (a diathesis and not necessarily genetically derived) from a conditioned vicarious anxiety. It generally develops in childhood (just as Aunt Ruth describes in S6) as coincidentally do most small animal phobias, which also involve an emotional component of disgust.

    * article author and researcher Joseph LeDoux’s work does touch upon tonic immobility (distinct from the “freeze” response) as a fourth aspect to the reaction to fear and anxiety (although I am unaware whether his group has done any specific work on blood phobias). It has been suggested that in some instances the name for this response might be further refined as the fight, flight, freeze, faint response.

  6. kjacobson@mindspring.com Post author

    You continue to write enlightening comments, DM. It’s fascinating to learn that blood phobias have some distinguishing characteristics from other phobias.

    What I think you are supposing then is that the selection of a blood phobia, or BII, for the character of Martin Ellingham came from deeper study than purely considering it as funny and ironic for a vascular surgeon to develop a fear of blood. OR, after the decision was made to make a blood phobia the primary reason for leaving his surgery practice, more research was done about this phobia so that they could associate it with the proper behaviors. Luckily, they did not choose to have ME faint every time he sees blood. In fact, I can only remember one time when he actually has a fainting episode and that’s when he attempts to show Edith that he’s been working on overcoming the phobia.

    The particularly ironic thing to me is that deciding to become a GP doesn’t really relieve Martin Ellingham of being exposed to blood. In fact, and I’ve been wanting to say this for some time, it doesn’t even separate him from doing surgery; he does plenty of surgical procedures in his exam room. When in his surgical garb and preparing to operate, he frequently seems focused and not nearly as repelled as we might expect. He also doesn’t avoid his phobic stimulus (blood). Most often he confronts it and handles it with professional forbearance. He becomes nauseated, which is a good sign of disgust, but he may not even actually regurgitate. We have to laugh when various patients and receptionists offer to take over from him. It’s a natural inclination to want to help, but not with surgery!

    What causes ME to freeze is more the surging of emotions, especially those associated with a need for immediate reaction. He’s unable to respond to being accosted by Mrs. T, Mr. Flint, and others. He is speechless when Louisa challenges him, and he is flummoxed by discovering he’s made a mistake, like hooking up the dishwasher incorrectly. I am not sure if those occasions are meant to be related to his phobia in the show or just a sign that he has other psychological problems along with the blood phobia.

    I thought it would be fun to see what sort of treatment has been recommended for BII, and found that one approach is to work with a therapist to learn applied tension. Apparently, the therapists train blood phobics that when they start feeling light-headed, they should tense the muscles in their arms, legs, and trunk for about 10 to 15 seconds to raise their blood pressure and prevent fainting. Once they have mastered applied tension, the therapist exposes them, step by step, to the situations that trigger their phobia.

    The first step might involve thinking about driving to the clinic where you have blood drawn. In later sessions you might watch videotapes of blood tests or simulate the experience.“I may come in wearing a lab coat and put the tourniquet on [the patient’s] arm,” says Martin Antony, PhD, psychology professor at Ryerson University in Toronto and author of Overcoming Medical Phobias: How to Conquer Fear of Blood, Needles, Doctors, and Dentists. After three to five sessions, you should be able to look at blood without the world starting to swim.

    So Dr. Milligan’s desensitization CDs may not have been so farfetched; he needed to be part of the process, however.

    BTW, I hope your flight took off and you landed safely in your destination. Have a good holiday!

  7. Santa Traugott

    Dr. Milligan’s CD’s certainly were not far-fetched, they represent what was at that time, and may still be, for all I know, a very standard and well-researched treatment for phobias. In the treatment plan for phobias, the patient is over-trained. That is, they go well beyond what might be the worst they can possibly imagine for a phobia stimulus, over and over again, until they’re basically bored. If you don’t “overtrain” in this way, relapse is much more likely.

    I doubt Martin Ellingham went that far in his desensitization — probably needed to work in something like a MASH unit for a while, I suppose — and so we saw him rather quickly relapse under stress.

  8. kjacobson@mindspring.com Post author

    I once commented that trying to use desensitization techniques on oneself has a very low success rate. ME’s decision to manage his own treatment, even with the help of CDs from a therapist, was destined for failure. His exposure to blood is intermittent and usually brief, which is not sufficient to call it over-training. We might even chalk this up to another example of inadequate therapy that has no chance of solving the problem. You know, Dr. Milligan might have been on the right track, but he lost Martin’s confidence almost immediately by his approach and his admission that Edith had made some suggestions that he was heeding. Martin wasn’t in the best frame of mind to accept therapy then, but there’s a possibility that the right therapist could have broken down some of those barriers. The show wasn’t written to include therapy that worked then, and it wasn’t written to demonstrate good therapy in S7 either. Same old, same old.

  9. Santa Traugott

    Very true — I’m just commenting on the general utility of desensitization, which has a well-known track record, though I was very interested to learn how it is modified to treat blood phobia.

    I just think they don’t bother to show therapy very well, particularly since probably most of their audience has only the most general of ideas.

    The oddest thing about their depiction of the Dr. Milligan- – Dr. Ellingham interaction, to me, was that Dr. Milligan sent the CD at all. The client had clearly indicated that he wasn’t ready — although Dr. Miligan’s precipitate “interpretation” and insistence on beginning treatment immediately, before any rapport at all was established. may have had something to do with that.

    But once a client has walked out of your office, to followup with a treatment plan seems odd to me. Maybe Abby has a different view.

    Of course, maybe there’s another missing scene or two here, in that they had another session, or a phone call or something.

  10. Abby

    Santa, I completely agree that it was odd for Dr. Milligan to send the CD after Martin terminated therapy. What would have been more typical would have been to let him know he was welcome to return if and when he wanted.

    I also agree that Dr. Milligan was precipitate in jumping right into treatment. Closing one’s eyes, especially, can make many people feel vulnerable, and certainly Martin felt that way during that session. Establishing a therapeutic alliance is alway the first step in successful therapy. Without that nothing else works. I have found over the years that taking a detailed history can facilitate this process. As a client tells his or her story and feels heard and accepted by me, trust begins to develop. Martin had no trust in Dr. Milligan, and so any intervention was doomed to failure.

  11. Santa Traugott

    Its apropos that we’re talking about this under the heading of fight or flight, because many clients, when they first enter therapy, are poised on the balance between fight or flight. as was Martin in this scene. (Well, he might have been edging towards flight in the first place.) And what Dr. Milligan did was to trigger the “flight” response.

  12. kjacobson@mindspring.com Post author

    Yes, there was no freezing seen here. He wanted out of there.

    So if it’s strange that Dr. Milligan sent the CD after Martin was clearly uninterested in having therapy with this doctor, what do you make of the scene where Martin decides to listen to the CD and attempt to follow its suggestions? That’s kind of weird too, isn’t it? Or maybe it’s another example of Martin thinking he can manage his fear of blood on his own, with some help at arms length through a CD.

  13. Santa Traugott

    I think he just wanted to be cured if he could do so without subjecting himself to any “psychoanalytic claptrap.” Or looking very deeply into himself by any means. So if he could do it all by his lonesome, so much the better.

  14. DM

    Thank you, Karen. Happy Holidays to you as well and to all! And I am back home again- only to have to begin baking a set of pies for Christmas dinner :-/. Oh, well…

    Indeed, the programme’s creators have always garnered my admiration for just how well they’ve done their homework (in regards to the haemophobia, at least). That includes incorporating other ancillary traits to Martin’s character including its correlation to social impairments and heightened anxiety to contagions and contamination.

    Interesting too about treatment for BII phobias is that Applied tension or isometric counter-pressure represents yet another paradox, as it involves tensing the large muscle groups often to the accompaniment of conjured anger whereas other phobias involve a general relaxation and the adoption of a tranquil state of mind. Of course in order to master this technique as a basis for further treatment, it must present with prodromal symptoms to allow sufficient time for the sufferer to react (and not a technique that thus serves as a contingency in the midst of surgery). In the one instance we do witness Martin fainting from the sudden exposure to the bag of blood, it does happen surprisingly fast *. The fact that we do witness him faint just this one time however, amounts to the exception that proves the rule– his susceptibility.

    Amongst Martin’s past efforts to self-treat his haemophobia that might have included teaching himself this technique is another involving tilt-table training (like it sounds, tilting oneself upside-down to greater degrees and periods to improve tolerance to vasovagal syncope). Although Martin has shown himself devoted to at least one available form of self-treatment which is as a stickler for maintenance of sufficient blood volume with proper hydration and salt intake.

    Nonetheless, beyond even standard exposure and desensitization approaches (perhaps thanks to Dr. Milligan’s barely competent efforts), treatment usually includes some form of talk therapy as this is evidently a very complex phobia to address the vicious cycle of maladaptive cognitions and catastrophic thinking from internal bodily sensations, anxiety, and psychosocial fears of nausea and vomiting and the ultimate loss of control by syncope (using that term “control” is of no credit to Dr. Timoney nor her farcical advice– she might’ve well advised Martin that, “I suspect the problem is somewhere here, in your head.”) Finally, those who don’t respond well to conventional treatments exhibit more significant levels of psychosocial impairment and distress as well as depression which themselves warrant therapeutic intervention (just as we might suppose is Louisa’s insight).

    * interestingly, experienced phlebotomists are known to endure far more fainting patients precisely because they are so fast and relatively incommunicative, whereas the less experienced take much longer and are far more talkative and supportive during the procedure.

  15. Amy Cohen

    Interesting article, and I am thinking of it in terms of S7. When faced with danger from the couple in the last two episodes, first Martin tried to flee. Then when caught again, he fought back. Did he ever freeze?

    I also found the article interesting because I have a recurring nightmare that when in danger, I freeze and cannot run away. I wonder whether my brain is reacting to the danger in the dream and triggering that freeze response even while I am sleeping.

  16. kjacobson@mindspring.com Post author

    I would say the freezing part of ME’s behavior is his usual inability to react or know how to react when faced with a dramatic turn of events involving Louisa. So it’s not a single series of actions, although that has happened, but his tendency to be immobilized rather than actually make an effort to do something.

    In the case of the Wintons, it isn’t until he is held at gunpoint that he realizes that he’s in danger. When held at gunpoint, most people freeze as he does. More to the argument of the article may be that throughout S7 he is unable to muster a clear response to Louisa and her intransigence, until he tells her he can’t live this way anymore. Of course, this is all part of the show and complicated by the implication that he is supposedly thinking that he doesn’t deserve her or her love.

    The addition of freezing to the fight/flight response is just another interesting adjunct to the subject.

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