Five Stages of Trauma

Reading Levine again, I see that he actually defines 5 stages of trauma.  Most of us know that we have an instinct to preserve life that manifests as “fight or  flight.”  Not many people realize that there’s a “default”instinct that comes into play when fleeing and fighting are both impossible.  This is “freeze,” sometimes called playing possum. But the possum isn’t playing, it’s truly paralyzed.  There are many people who feel guilty because they failed to act in a crisis, and don’t realize that they were frozen by instinct, not will.  My picture of the instinct to preserve looked like this:

fight <—> flight

Since rereading that chapter by Peter Levine I see that it’s more complex.  He actually defines 5 stages: arrest — flight — fight — freeze — fold.  He uses the word “arrest” for the first move, the “defensive orienting response” and reserves “freeze” for the paralyzed state.  You see this first action in people  or animals who have been quietly munching or reading and hear a strange noise.  They become very still and alert.  They may move their eyes or turn their head to scan the environment for danger.  If they see no danger, they go back to what they were doing.
I believe that the “defensive orienting response” is behind the phenomenon known as “whiplash.”  Imagine yourself driving through an intersection.  Suddenly you see, in the corner of your left eye, a vehicle moving toward you.  Before you have a chance to turn your head to see if it’s dangerous, the car hits you.  “Whiplash,” that frustrating injury that doesn’t show up on X-rays, that has medical people cruelly telling you it’s all in your head, and your insurance cuts off after 5 visits to a chiropractor that haven’t helped…   This is a symptom of PTSD.  Instinct is still trying to complete the defensive orienting response.
The defensive orienting response is also behind the phenomenon known as “hyper-vigilance.”  For a person who has been traumatized, when they’ve been startled, look for danger, and don’t see it, they don’t go back to relaxation.  Their body continues to tell them that there’s danger around, so they keep looking, searching frantically, because there’s nothing to see.  The real danger was in the past.  This happened to me the first time I read Waking the Tiger.  I got to the chapter on the mechanism of hyper-vigilance, read with fascination, only to find myself in a hyper-vigilant state.  The book is full of warnings like “if you start to get upset, put the book down and find a therapist.”  But I didn’t really get that my experience was evidence for the fact that I had been traumatized.  I took the book to my regular therapist, but she didn’t have the skills to help me.  I was in that hyper state for months.  What finally calmed me down was medication, a tranquillizer in addition to the anti-depressant I was already taking.
The untraumatized reaction to danger, when the defensive orienting response has shown that there is a real danger, is to run.  If you can’t run, you turn to fight. If  fight makes no sense — say the predator is much larger than you, or the danger is in the form of an abusive parent who your life depends on — then you freeze. This may result in the predator going away, in which case you survive.  Or you get eaten while you’re unconscious, which isn’t too bad as deaths go.  If the reptilian brainstem, which is responsible for instinctive behavior, concludes that you are going to die, you enter the fifth stage which is loss of the will to live.  Levine calls it “fold”, I call it collapse.

Arrest  —>  Flight  —>  Fight  —>  Freeze  —>  Fold

Books that helped me understand this:
Peter Levine, Waking the Tiger
In an Unspoken Voice

Robert Scaer, The Body Bears the Burden

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