DEFENSIVE RESPONSES HAVE EVOLVED TO ENSURE SURVIVAL in a world that historically has contained several different types of threat: the danger of predatory animals, the menace of natural disasters, the violence from other human beings, and in the past century, the peril of potential vehicular and machinery accidents, human-made disasters, and mechanized warfare. The instinctive defensive and protective reactions to these perils turn maladaptive for traumatized individuals, whose defensive responses persist decades after the original threatening events are over. These individuals are “caught in a vicious cycle of inadequate efforts to cope with a stressor, lose their ability to disengage from so doing, fail to use all available resources and become increasingly distressed” (Shalev, 2005). The repetition of defensive action tendencies inappropriate to current reality is debilitating to individuals who, as time goes on, lose more and more confidence in their capacity to navigate the challenges of ordinary life. Over time, they become unable even to imagine positive endings to current situations that evoke old defensive tendencies.
REACTIVATED DEFENSIVE RESPONSES
Orienting responses allow us a means of evaluating stimuli in terms of their potential danger to us. When a stimulus is evaluated as threatening, both physical and psychological defenses work together to reduce the danger and maximize the chances of survival. Like orienting responses, these defensive responses consist of a series of relatively fixed sequential sensorimotor reactions whose expression depends on the nature of the stimulus, the capacities and experience of the individual, and the external environment. In human beings the components of the defensive system also include conscious cognitive and emotional elements. This combination provides the advantage of speed in the unconscious defensive response, along with the capacity for consciously fine-tuning the response to specific elements of the danger. For example, if a hiker turns a bend in a wilderness trail and comes upon a bear, the defensive, precognitive instinct—the evoked fixed action tendency—is a startle response and fleeing. This action tendency is further organized by the context of the experience: A split-second later, there may be a more organized conscious response, as a cognitive decision is made about how to flee, which direction to run in, how quickly to run, whether to yell at the same time, and so forth (LeDoux, 1996; Llinas, 2001). This conscious response may incorporate past learning experiences such as the possibility that “It might be safer to stand still rather than run when you see a bear.” These adaptive options are nevertheless all modifications of, and improvements on, the instinctive action tendency to flee in the face of danger. The ability to amend a fixed action tendency—to make voluntary, top-down, conscious decisions while under the command of an action tendency—is an attribute most unique to the human species, a characteristic of well-adapted individuals (Llinas, 2001).
If defensive actions are effective and danger is successfully averted, we customarily experience a sense of relief and victory over the threat. These feelings of mastery are notably absent for traumatized individuals. Janet stated, “The patients who are affected by…traumatic memories have not been able to perform any of the actions characteristic of the stage of triumph” (1925). More colloquially, we would say that traumatized individuals get stuck in the particular repetitive action tendencies of defense that were evoked at the time of the original trauma and are evoked again and again by environmental cues reminiscent of that trauma (Krystal, 1988). These individuals are driven by bottom-up hijacking to reenact those same defensive responses long after their survival value has disappeared. Clinically, we have observed that clients tend to repeat a defense that was evoked at the time of the original trauma even though it may have been unsuccessful or only partially successful in conferring safety. As Janet noticed long ago, “[Traumatized] patients…are continuing the action, or rather the attempt at action, which began when the thing happened, and they exhaust themselves in these everlasting recommencements” (1925).
This tendency to reenact defensive responses manifests in many forms. The adult survivor of childhood incest may freeze instead of refusing an unwanted sexual advance; the victim of childhood beatings may react with uncontrolled aggression toward her own children when she feels threatened; the war veteran may feel the urge to run or withdraw whenever he feels even slightly anxious. While recognizing that they are “overreacting,” traumatized individuals are nevertheless frequently unable to moderate their responses. Each time these repetitive defensive tendencies are evoked, the individual becomes unable to make use of options and solutions available in his or her present, nontraumatic situation. A defensive action, such as freezing or fighting, becomes a generalized response to perceived threat, causing traumatized clients to feel that they cannot cope with everyday challenges.
The term defensive reaction was originally coined by Pavlov (Van der Kolk, 1987). The function of the defensive reaction, as Pavlov observed, is to initiate immediate, self-protective, and survival-oriented behavior. When the traumatized individual is faced with reminders of the trauma and experiences a defensive response, the function of that defensive response has shifted from reacting to an immediate threat to reacting to anticipated threat (Misslin, 2003). What began as a necessary defense in the face of a real threat becomes a pervasive, unrelenting reaction to the anticipation of a threat, with all the concomitant changes in physiology (Czeisler et al., 1976; Sumova & Jakoubek, 1989). Individuals caught in a pattern of anticipating danger and reenacting old defensive responses possess only a limited ability to modify their action tendencies according to context and cannot access top-down thinking to inhibit defensive actions. Vera, for instance, had a history of childhood sexual abuse during which she learned that any attempt to fight or flee would be overpowered by the perpetrator. Subsequently, as an adult, she would repeatedly freeze in the presence of male authority figures. Vera knew that the freezing defense was not adaptive in her adult work relationships, but she was unable to modify it, no matter how often she told herself (top-down) that the situation was now different. Despite her insight, her intellectual competence in solving complex problems, her recognition of her current safety, and her capacity to contribute usefully to the organization that employed her, she would shrink from speaking up to her boss. When asked her opinion in meetings, she often became incapable of articulating her point of view. She reported feeling “paralyzed” and “unable to breathe,” as though her mind said one thing while her body did something else. She was trapped by the bottom-up defensive action tendencies related to her traumatic past.
In treatment it is essential to work with defensive responses in order to reinstate their adaptive and flexible functioning. By definition, traumatized individuals have experienced a failure of their defensive responses to assure safety. As Herman noted, “Traumatic reactions occur when no action is of avail” (1992). The individual is forced to abandon active, mobilizing defenses (fight or flight) in favor of defenses that are immobilizing: freeze or “feigned death.” Levine noted that “the bodies of traumatized people portray ‘snapshots’ of their unsuccessful attempts to defend themselves in the face of threat and injury” (2005). These failed defenses can be rediscovered and revitalized by giving attention to the body and thereby reestablishing a sense of mastery and competence.
In therapy clients learn to mindfully observe their defensive tendencies. Through awareness of the body, they are able to put a gap between the trigger and the defensive tendency to notice increasingly more detailed somatic components of their defensive responses (Kurtz, 1990). They often discover the abandoned empowering defenses that were ineffective at the time of the trauma. For example, as Vera became aware of the somatic components of her tendency to freeze, she noticed tension throughout her body, especially in her legs. When her therapist asked her if there were words that accompanied the tension, Vera first said, “I can’t move,” which was a necessary, adaptive freezing response to childhood sexual abuse: If she had struggled at that time, the abuse would have worsened. As Vera was instructed to focus her attention on the tension in her legs, she commented, “My legs want to run away.” She had discovered the empowering defensive action that she could not execute during the abuse. With this realization, Vera became more aware of the impulse to run and experienced “power” in her legs. Encouraged by the therapist to stand and walk around the therapy office in order to feel the capacity of her legs to move, Vera said she wanted to run in place. She began to breathe deeply, color came to her face, and her eyes brightened. After “running,” Vera verbalized a different feeling in her body—it felt powerful, energized, and alive—saying, “My body has caught up with my mind!” This felt experience of the restoration of an active defensive response emerged spontaneously from Vera’s awareness of her somatic tendency to freeze. As clients become aware of the body, they often discover previously abandoned bottom-up defensive possibilities that can mitigate current maladaptive bottom-up tendencies. Actions that were incomplete, previously discarded as ineffective or useless, can be executed in the context of an attuned therapeutic relationship and thus completed, restoring a physical capacity that was previously abandoned.
COMPONENTS OF THE DEFENSIVE RESPONSE
All mammals are equipped with a cascade of defensive reactions in a hierarchical system that enables them to respond accordingly to both mild and severe levels of threat (Cannon, 1953; Fanselow & Lester, 1988). Mimicking phylogeny, we divide these defensive reactions into three general defensive subsystems: (1) a subsystem that involves directly calling upon others for help (attachment system and the social engagement system), (2) the mobilizing defenses (fight or flight) that activate the body, and (3) the immobilizing defenses (freezing, collapse, or feigned death) that result in motionlessness and submissive behaviors.
Animals may follow a sequential pattern in the use of a particular defense, which varies according to availability of protection, physical distance between predator and prey, and the frequency of prior threat in specific locations (Fanselow & Lester, 1988). Threat falls along a continuum of predator immanence from total safety to deadly attack (Fanselow & Lester, 1988; Nijenhuis & Van der Hart, 1999b; Nijenhuis, Vanderlinden, & Spinhoven, 1998), and “behavior changes will occur as a function of changes in the prey’s perception of its location on the continuum” (Fanselow & Lester, 1988). Animals typically curtail their ordinary activities of exploring, foraging, mating, and playing when predators are likely to be in the area. “The human counterpart might be the child who restricts her activities (e.g., stays in her room or stays out of the house) when her abusive father is home” (Allen, 2001). Sudden and specific changes in behavioral and physiological defenses occur in response to different stages of imminence in attempts to reduce or thwart further increases in immanence (Fanselow & Lester, 1988). Animals may attempt flight after spotting a predator. A baby animal or a weaker pack animal may first cry for protection when endangered under certain circumstances. However, freezing is often the preferred defensive response, even when an escape route is available (Nijenhuis et al., 1998), particularly if the predator has not yet spotted the prey. Because movement cues activate predator behavior in animals, immobility may prevent detection, and the predator may orient instead to other moving objects. If the predator comes near the prey, frantic, explosive fight behavior is typically evoked. If this defense is unsuccessful, “feigned death,” in which the animal’s body becomes limp and immobile, is used as a “last resort” survival response. Feigned death may prevent further attack because animals are programmed not to devour unmoving prey; animals that are not moving or cannot move may be diseased (Perry et al., 1995; Seligman, 1975). It should be noted that the same versions of these animal defensive responses are found in humans as well.
These defenses are not always engaged in a sequential manner; any defense may be evoked depending on the immanence and characteristics of the threat as well as on other important variables, such as the resources of the individual and which defenses have “worked” for the person in the past. Each defensive response is typically definitive, primitive, and inflexible (Nijenhuis et al., 1998; Nijenhuis et al., 1999), but no one defensive response is “better” than another: All are potentially adaptive and effective at diminishing threat, depending on the particular circumstances. It is not the use of a particular subsystem, per se, but the inflexibility among these defensive subsystems and their overactivity that contributes to the traumatized person’s distress after the traumatic event is over.
Relational Defensive Strategies: Social Engagement and Attachment
The social engagement system may provide the first line of defense prior to the mobilizing, sympathetically mediated defenses of fight or flight. It also appears to be used simultaneously with other defensive subsystems at times. As described in Chapter 2, this system enables subtle, fine-tuned recognition of relational threats. Communication in social situations relies on the sending and receiving of subtle signals (via facial expression, tone of voice, body language and movements) and has many functions, including the evaluation of safety. Interpersonal communication that is perceived as threatening can be modified by the use of the social engagement system that manages, modulates, and eventually disarms or neutralizes the threat from the other person. A client who felt she prevented a potential rape by “talking him down” illustrates the use of social engagement to reduce threat; simultaneously she experienced increased sympathetic nervous system arousal and impulses to flee.
The attachment system is instinctively activated in children when they are endangered, and this system is often aroused as the initial defense in certain dangerous situations for adults as well. Children cry and call for their parent; it is said that one of the most common words uttered by frightened combat soldiers is a version of mother. Adults turn to their cell phones in order to find their primary attachment relationships when they feel under threat. However, in traumatic situations, attachment figures may not be available to respond, and social engagement may provide insufficient protection or even increase the threat under some circumstances. Under such conditions, other defensive subsystems are engaged. The sympathetically mediated defenses of flight and fight mobilize the body by bringing increased blood flow to the gross large muscles groups used in overt acts of protection or escape. The immobilizing defenses provide another defensive response that relies on a lack of motor action, such as being completely still, hiding, freezing, or becoming submissive.
Mobilizing Defenses
When the mobilizing fight or flight responses are aroused, the orienting response is simultaneously heightened. The field of consciousness is narrowed to include only those elements in the environment pertinent to survival—the threat and possibilities of escape routes—and to exclude cues that are not essential to survival. The senses become hyperalert in order to better smell, hear, see, and taste the danger (Levine, 1997; Van Olst, 1971) in preparation for further assessment and response. Emotional states that support the particular defense might also emerge to the forefront of consciousness (Frijda, 1986; Hobson, 1994; Rivers, 1920). For example, fear is predominant in the flight response, and anger may accompany a fight response.
The mobilizing defenses of fight and flight are characterized by increased activation of the sympathetic nervous system and the corresponding neuro-chemically mediated physical reactions, such as heightened respiratory rate and increased blood supply to skeletal large muscles in preparation for action. Defensive systems are designed to be economical and to facilitate our utilization of the safest, most effective response available to us; for example, flight is often the most common response to threat when successful escape is probable and the threat warrants it (Fanselow & Lester, 1988; Nijenhuis et al., 1998; Nijenhuis et al., 1999).
Immobilizing defenses will not usually emerge in definitively escapable situations because animals, including humans, will fast discover escape routes through trial and error (Scaer, 2001). As the large muscles are primed and readied for flight, the cascade of neurochemicals diminishes awareness of any pain so that the mind and body are focused only on flight. According to Fanselow and Lester, this reduced nociception has its survival advantage when mobilizing defensive responses are still possible because it “attenuates pain-elicited disruption of defensive behavior” (1988).
Flight sometimes involves not only a running away from danger but also a running toward a person or place that can provide safety (a basic premise of attachment behavior; Bowlby, 1988). Flight impulses can be observed in clients’ leg movements and also in a variety of subtler movements, such as twisting, turning, or backing away.
If the chance of escape is unlikely and the threat closes in, the victim’s attempts at flight may become increasingly frantic. In the animal kingdom, if flight becomes impossible as the predator is about to strike the prey, dramatic changes in behavior usually occur as the prey shifts to “circa-strike defensive behaviors” that occur immediately before, during, and just after attack (Fanselow & Lester, 1988). The animal might engage in a last-second explosive leap away, but if this desperate effort to get away also fails, mobilizing defenses of fight are stimulated. Aggressive actions are engaged as the prey/victim tries to fight off the predator/perpetrator by scratching, biting, hitting, kicking, or otherwise struggling (Fanselow & Lester, 1988; Nijenhuis et al., 1998; Nijenhuis et al., 1999). The fight response is characteristically provoked when the prey feels trapped, under attack, or when aggression is perceived as capable of securing safety. These statements hold true for humans as well. Impulses for fight behavior are often experienced somatically by clients as tension in the hands, arms, shoulders; hands beginning to tighten or curl into a fist; lifting of the hands or arms; narrowing of the eyes; clenching of the jaw; impulses to kick or struggle.
Mobilizing defenses also include innumerable patterns of skilled defensive responses—action tendencies that are both learned and spontaneous and enacted automatically in the course of safely performing physical activities, such as operating machinery, driving automobiles, and engaging in sports. These are mobilizing defensive subsystems that are not purely fight or flight responses. For example, the ability to drive requires complex movements. Through repetition, these become learned action tendencies that can be executed without thought, such as suddenly slamming on the brakes and turning the steering wheel to prevent an accident.
[Humankind] in the vast majority of cases, neither flees nor adopts an attitude of aggression, but responds by the special kind of activity, often of a highly complex kind, whereby the danger may be avoided or overcome. From most of the dangers to which [humankind] is exposed in the complex conditions of our own society, the means of escape lie in complex activities of a manipulative kind…. The hunter has to discharge his weapon, perhaps combined with movements, which put him into a favourable situation for such an action. The driver of a car and the pilot of an aeroplane in danger of collision have to perform complex movements by which the danger is avoided. (Rivers, 1920)
Other examples of defensive actions that anticipate and correct for possible difficulties without invoking the full flight/fight systems include engaging the righting reflexes during a near fall, raising an arm for protection from a falling object, avoiding a rock in a downhill ski run, and so on. Many sports call on these kinds of defenses: Skiing and skateboarding, for example, necessitate the smooth incorporation of defensive reflexes as well as learned actions, not only to assure safety but also as a part of the acquisition of competence. In martial arts, defensive responses are honed in precise ways that involve immobilization of the opponent and counterattack using the opponent’s flow of energy to knock her off balance, and so forth. Even individuals in actually dangerous situations might protect themselves by incorporating learned actions: for example, a fighter pilot attends not only to the “predator” shooting at him, but equally to the myriad of dials and instruments that keep his plane aloft and his artillery engaged.
Immobilizing Defenses
When the mobilizing defenses have failed entirely or produced only partial success in preventing trauma, the person may become traumatized. “The traumatized individual has been overpowered and made helpless—unable to avert trauma by defensive aggression and unable to escape” (Allen, 2001). The mobilizing defenses give way to immobilizing defenses when the former are ineffective or not the best strategy to ensure survival (Allen, 2001; Misslin, 2003; Nijenhuis et al., 1998; Nijenhuis et al., 1999; Rivers, 1920; Schore, submitted). As Nijenhuis and Van der Hart noted: “[Attempting to fight or flee] would be inevitably frustrating and nonproductive for a child being physically or sexually abused or witnessing violence. In some situations, active motor defense may actually increase danger and therefore be less adaptive than passive, mental ways of coping” (1999b). In these situations a fight response might provoke more violent or sadistic actions from the perpetrator. Additionally, flight responses such as outrunning the assailant or fleeing from home may not be possible for a child. Instead, clients suffering from chronic childhood trauma have been forced to resort to immobilizing defenses, and they continue to use them in present time particularly in the context of posttrauma reminders.
These immobilizing defenses are described in a variety of terms: freezing, feigned death, deep freeze, animal hypnosis, tonic immobility, cataleptic immobilization, playing possum, mesmerism, surrender, submission, collapse, and floppy immobility. They are less clearly explained or differentiated in the literature than the mobilizing defenses, and some confusion about their delineation remains. The following section describes them as we have observed them in clinical contexts, identifying two main immobilizing defenses: freezing (two types) and limp passivity or feigning death.
TYPES 1 AND 2 FREEZE RESPONSES
Misslin (2003) described freezing as “alert immobility” wherein there is complete cessation of movement, except for respiration and eye movements. Although the respiratory rate is increased, it is shallow (Hofer, 1970) and almost imperceptible, which helps reduce the likelihood of detection. In animals, once the predator has been detected, freezing is the prevailing defensive response (Fanselow & Lester, 1988). In humans, freezing appears to involve a highly engaged sympathetic system in which the muscles become stiff and tense, heart rate is elevated, sensory acuity is increased, and the person becomes hyperalert. The high sympathetic tone of freezing seems similar to the arrest stage of the orienting response, during which temporary cessation of movement occurs until the stimulus is located, identified, and evaluated. However, freezing is markedly different from the arrest stage of orienting because the stimulus has already been assessed as dangerous and autonomic responses have already been significantly mobilized. Although the arrest stage of the orienting response also involves physical stilling, the stimulus has not yet been appraised as dangerous; if it is appraised as threatening, freezing may be evoked. Fanselow and Lester emphasized that freezing is not simply movement inhibition: “Rather it is an integrated, functional behavioral pattern. Inactivity is to freezing as locomotion is to flight” (1988). Freezing occurs in an organized fashion, as seen in rats who freeze next to walls, in corners, and in the darkest area of the room, to maximize the survival advantage of preventing detection.
Clients describe two types of freezing, similar to the two types of freezing described in animals. In type 1 freezing, clients report that they were very aware of the environment, especially of threat cues, potential escape routes, or protective impulses, feeling energized and tense, ready and able to move or run if needed. They describe being motionless, panic-stricken with pounding heart, but ready and able to act. Occurring after the appraisal of danger, the distinguishing element in this version of freezing is that the individual still feels able to move. Fanselow and Lester describe type 1 freezing in animals: “It is as if the freezing animal [or person] is tensed up and ready to explode into action if the freezing response fails [and it is detected]” (Fanselow & Lester, 1988). Frequently, type 1 freezing occurs when the predator or perpetrator is still at a distance and when motionless behavior may prevent detection. The individual is waiting for more data about the source of danger before taking action. In these cases, freezing occurs prior to the mobilizing defenses, if detected or if danger suddenly increases, the individual is ready and able to erupt into “explosive behavior” (Fanselow & Lester, 1988)—into versions of fighting or fleeing. In traumatogenic environments type 1 freezing may also occur in combination with submissive behavior, exemplified in the “frozen watchfulness” of a child who “waits warily for parental demands, responds quickly and compliantly, and then returns to her previous vigilant state” (Schore, submitted).
Clients also describe a second type of freezing as feeling “paralyzed”—terrifyingly incapable of moving and unable to breathe. This type 2 freezing is associated with a sense of utter entrapment with no possibility of action successfully averting the threat. A similar paralysis is provoked in animals by confinement, harnessing, entrapment, and restraint, and may follow struggle (Gallup, 1974). A version of type 2 freezing is eloquently described by E. M. Remarque (1929/1982):
My forehead is wet, the sockets of my eyes are damp, my hands tremble, and I am panting softly. It is nothing but an awful spasm of fear, a simple animal fear of poking out my head and crawling on farther. All my efforts subside like froth into the one desire to be able just to stay lying there. My limbs are glued to the earth. I make a vain attempt; they refuse to come away. I press myself down on the earth, I cannot go forward.
Siegel (1999) postulated that with this kind of freezing, both the sympathetic and the parasympathetic systems are aroused simultaneously, which produces muscular constriction paired with a feeling of paralysis.
FEIGNED DEATH: “TOTAL SUBMISSION”
The immobilizing defense of feigning death, limp passivity, behavioral shutdown and/or fainting ensues when all other defenses have failed (Lewis, Kelly, & Allen, 2004; Nijenhuis et al., 1998, 1999; Porges, 2004, 2005; Scaer, 2001; Schore, submitted). Also called “total submission” (Van der Hart, Nijenhuis, & Steele, 2006), this condition of surrender occurs in dire conditions of extreme hopelessness. Scaer (2001) describe this condition:
The racing heart slows to a crawl, blood pressure drops precipitously, tense muscles collapse and become still as a result of the assumption of an apparent enforced vegetative 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.
In short, this response is characterized by profound inhibition of motor activity (Misslin, 2003) coupled with little or no sympathetic arousal. The individual experiences a dramatic increase in dorsal vagal tone, extreme hypoarousal, and a profound state of helplessness (Porges, 2001a; Scaer, 2001). In this variant of the immobilizing defensive responses, the muscles become flaccid rather than tense and stiff as they do in freezing (Levine, 1997; Nijenhuis et al., 1998, 1999; Scaer, 2001). Also called “floppy immobility” (Lewis et al., 2004), in this collapsed state the “muscles go limp, eyes look glazed, and heart rate slows down—just the opposite of what happens with the adrenaline burst of the freeze response” (Lewis et al., 2004). Breathing may be shallow, and clients often describe this condition as “trancelike.” This response appears to be associated with increased levels of endogenous opioids that render the person insensitive to pain (Lewis et al., 2004). At this final stage of surrender, analgesia prevents nociception of injury—which may account for the fact that many clients report that they felt no pain during the abuse (Van der Kolk et al., 1996). Krystal (1988) describes the feigned death response as “a complex pattern of surrender, necessary and prevalent in the entire animal kingdom and carrying its own means of merciful, painless death.”
This totally passive condition is markedly different from freezing, because both types of freezing are highly engaged states accompanied by hypervigilance, whereas feigned death/submission is a completely detached state (Lewis et al., 2004). The ordinarily flexible orienting response, which includes effective use of the senses, scanning mechanisms, and evaluative capacities, becomes dulled or severely impaired during feigned death/submission, whereas it becomes heightened during freezing. The impaired orienting is accompanied by a reduced capacity to attend to either the external environment or to internal phenomena. Anesthesia, analgesia, and the slowing of muscular/skeletal responses (Levine, 1997; Nijenhuis et al., 1998, 1999; Nijenhuis & Van der Hart, 1999a) may occur. Darwin (1872) called this type of immobility in animals a “sham death” to describe the death simulation behavior that permitted survival (Misslin, 2003) when predators were close at hand.
SUBMISSIVE BEHAVIORS
Submissive behaviors are distinct from full feigned death/submission. Although they involve action, they are placed in the category of immobilizing defenses because of their characteristic subservient and compliant qualities that optimize survival in certain situations. Submissive behaviors serve a protective function because they “aim at preventing or interrupting aggressive reactions” (Misslin, 2003). The musculature involved in the gross motor actions in subservient behavior is not tight in readiness for assertive or aggressive action, and the action that occurs is not actively defensive. The physical movements are characterized by nonaggressive action, automatic obedience, and helpless compliance. These behaviors are common among traumatized individuals and include crouching, ducking the head, avoiding eye contact, bowing the back before the perpetrator, and generally appearing physically smaller and consequently less noticeable and threatening. A version of this condition, described as “robotization” (Krystal, 1978) and noted in Nazi death camp survivors, is characterized by mechanical behavior and automatic obedience, without question or thought, to the demands of the perpetrators. An even more pronounced version is observed in the extreme and complete passivity of some death camp survivors who “no longer attempted to find food or to warm themselves, and they made no effort to avoid being beaten” (Herman, 1992).
As a result of chronic abuse, it is not uncommon for traumatized people to respond to threat cues with mechanistic compliance or resigned submission. It is important to recognize this submissive tendency as defensive behavior rather than as conscious agreement. For example, a woman who mechanically allows a male relative to enter her apartment, despite knowing he will undoubtedly rape her, as he has done before, is most likely enacting a submissive defense learned after many such repetitions of threat and danger. Predatory or abusive individuals often seek to evoke these behaviors in others, thereby taking advantage of this instinctive defensive response to elicit automatic compliance with the abuse (Herman, 1992).
IMMOBILIZING SUBSYSTEMS IN TRAUMATIZATION
Porges’s polyvagal hierarchy theory reminds us that the dorsal vagal complex comes into action when all other defenses fail to ensure safety. Individuals who suffered chronic abuse as children, especially during a developmentally vulnerable period, and who may not have been able to capitalize on social engagement, attachment, or mobilizing defenses for survival, generally have come to rely on immobilizing defenses. It is inevitable, given their dependent status and developmental vulnerability, that children will submit to abuse at least until the adolescent years; victims of childhood sexual abuse seldom report actively resisting their perpetrators (Nijenhuis et al., 1998).
Although the freeze responses are not available until the second half of the first year (Schore, submitted), the increase in dorsal vagal tone has been observed even in newborns who become hypoxic (Bergman et al., 2004; in Schore, submitted). The hypoarousal of the submissive response leads to a subjective detachment from emotions as well as an evacuation, so to speak, of emotional experience; remarks such as “I just wasn’t there” seem to suggest a reduction in, or respite from, the individual’s emotional pain and suffering. Clients frequently describe depersonalization experiences: being outside their body, watching themselves from a distance as though they were someone else. One client reported the following: “I would leave my body and watch her [herself, the client] from the crack in the ceiling. I felt sorry for her during the abuse. I wouldn’t go back into the body until it was all over.” In other cases, a person continues to act but is also separated from the body, as in the following example of a combat soldier:
My mind left my body, I went ahead and stood on a hill. From there I watched, quite objectively and with some amusement, the struggles of this body of mine staggering over the duckboards and wading through the mud where the duckboards were smashed. I watched it duck when a salvo of German shells came over. I saw it fall flat on its face when a concealed battery of our own whizzbangs opened up within a few yards of it. I saw it converse with the gunners, who, stripped to the waist, loaded, pulled the lanyards of their guns and jumped away from the leaping recoil. (Cloete, 1972)
When physical escape proves impossible, these immobilizing defenses are the physiological and psychological measures that are thought to protect the person against further suffering. Earlier we wrote about distinguishing hyperarousal-related dissociative conditions characterized by intrusive reexperiencing of the trauma from dissociative conditions that involve a subjective numbness (hypoarousal) and submission. Although hyperarousal-related flashbacks (in which the present is disconnected from a vivid reliving experience) are also dissociative in nature, they are markedly different from the dissociative phenomena that inform the submissive defenses. Hyperarousal-related flashbacks involve a heightening of subjective emotional states and somatosensory awareness, in sharp contrast to the deadening of subjective emotional states and somatosensory awareness that often accompanies the submissive, hypoarousal-related defenses (Van der Hart et al., 2006).
STAGES OF THE DEFENSIVE RESPONSE
In describing the order of stages in which defensive subsystems might be employed, a complex, instinctive, lightning-fast system must be oversimplified. These stages and the order in which they are engaged may differ, and some stages even omitted, depending on the specific variables of the event and the individual’s resources and circumstances.
These stages of the defensive system are illustrated by Dorothy, the 19-year-old college student presented in the previous chapter; we resume her story at the point of the orienting response when Dorothy evaluated the intruder as dangerous. The following sequence has been compiled from a number of sources (Allen, 2001; Fanselow & Lester, 1988; Levine, 1997; Misslin, 2003; Nijenhuis et al., 1998, 1999; Pavlov, 1927; Porges, 2003; Schore, 1994, submitted; Siegel, 1999) and from clinical experience:
1. Marked change in arousal. When a stimulus is evaluated as threatening, an instant and automatic change in the level of arousal occurs, usually emerging as an increase in arousal. For example, Dorothy knew she was in danger when she perceived the visual stimuli, which conveyed the stranger’s menacing motives: when he came too close to her and pulled out a knife. As she initially oriented to the sound of the intruder’s footsteps, she went from experiencing a slight arousal and mild excitation related to curiosity, to feeling afraid and experiencing a sudden elevation of arousal. The sensations associated with the rush of adrenaline—her increased heart rate, her hair “standing on end,” and so on—were all evidence of sympathetic nervous system defense preparation for the motor actions involved in fight or flight.
Dorothy did not have an abusive childhood; other individuals who do have a history of abuse might have become immediately hypoaroused, engaging the immobilizing submissive defense in the same situation, especially if submission was the habitual and predominant defensive response to their past threat. Through previous experience of abuse these individuals will have learned that the mobilizing defenses are useless in promoting safety.
2. Heightened orienting response. In the face of threat, the orienting response becomes inseparable from defensive responses, and the various components of orienting are intensified. Irrelevant objects in the environment and awareness of internal experience fade to the background as the individual focuses narrowly and intensely on threat-related stimuli. Hobson (1994) described this in the following way: “As we become alert we can process data faster and evaluate it more critically because our brain-minds are more highly activated. At the same time, we become more precisely oriented.” Heightened physiological arousal is accompanied by emotions such as fear, producing an adaptive interaction between orienting tendencies, emotions, and attention to maximize chances of survival. Mujica-Parodi, Greenberg, and Kilpatrick (2004) summarized this interaction:
Emotional arousal primes the organism for imminent danger by increasing the orienting response, which permits the organism to find and focus on the source of danger. Once oriented to the source of danger, emotional arousal strengthens attention to the source of danger and diminishes attention to stimuli unrelated to its source, narrowing the amount of peripheral information simultaneously accessible with the target.
As Dorothy entered a fearful state of amplified sensory vigilance, all her senses and attention were focused on the object of potential threat. Her field of consciousness was thus narrowed and her level of consciousness was high. Dorothy was oblivious to everything else as she oriented exclusively to the impending possibility of danger and to her prospects for defense and survival. In a state of alert type 1 freezing, she remained immobile, muscles contracted to prepare for action, eyes glued to the man and the knife as she assessed options for action. She was able to think clearly, and she rapidly evaluated whether running for the door or reaching for the phone was feasible. Another individual with pronounced feigned death/submission defensive tendencies might have had the opposite experience: decreased orienting, hypoarousal-related perceptual dulling, lowered levels of consciousness.
3. Attachment and social engagement systems. Once the orienting system has done its job of gathering information and has evaluated the degree of danger, overt defensive and protective actions are employed. Earlier we discussed that one line of defense in handling threat might be utilizing the attachment system, by crying out for help, or the social engagement systems, by attempting to negotiate with the perpetrator. Although the role of the social engagement system is to act as a brake on the sympathetic system by first engaging in communication behavior to elicit protection, in some cases the body has already activated mobilizing defenses before the individual begins to negotiate or attempts to negotiate with a potential assailant. (This is an example of how the defensive response stages may not follow a linear pattern in the context of complex real-life situations; rather, different defensive strategies come online, as needed.) Dorothy initially attempted to reason with her assailant, telling him that her friends would be home any minute and that he should leave immediately before he was caught.
4. Mobilizing defensive strategies. As noted in Porges’s polyvagal hierarchy theory, when social engagement fails, the next line of defense is the sympathetically mediated fight or flight responses (although, as noted, the sympathetically mediated type 1 freeze often occurs prior to the mobilizing responses when the threat is at a distance). In spite of Dorothy’s attempts to engage the intruder, he moved closer to her, brandishing the knife. With the stranger between her and the door, Dorothy realized escape was impossible. She thought about how she might be able to take the knife from him, and she thought of crying out for help—thoughts that occurred in a fraction of a second. As the stranger approached her, aiming the knife at her chest, Dorothy was mobilized to fight her assailant. She lifted her arm in self-protection, knocking his arm to the side, and the knife grazed her shoulder. After a brief struggle, the roles reversed. Dorothy managed to wrestle the knife away and stab him in the neck, which caused him to run away.
5. Immobilizing defensive strategies. As noted, mobilizing defenses such as the ones Dorothy employed are exchanged for immobilizing strategies when the former are likely to be ineffective or promote more danger. Although the immobilizing defenses have in common a full or partial cessation of physical action, there are also important differences between types 1 and 2 as described earlier. Dorothy, who reported no prior trauma, did not resort to immobilizing defenses during the incident, other than type 1 freezing while assessing the options for action. Another client, Petra, had experienced sexual assaults by her older brother over a prolonged period during childhood. At the time of that early abuse, her only defense was submission accompanied by hypoarousal. She reported feeling “nothing” in her body; no emotional response during the abuse and amnesia for much of what had happened. In later years, Petra instinctively depended on the same submissive defense in the context of subsequent challenging situations. Sensitized by years of inescapable trauma, Petra’s immobility response was triggered by ordinary life challenges (e.g., asking for a raise at work), which to Dorothy were minor and easily managed by her social engagement system.
6. Recuperation. Recuperation takes place when the threat is over and the perpetrator is not in proximity; thus recuperation is not inherently defensive, but it is a deviation from normal, everyday activities (Fanselow & Lester, 1988). It is at this point that the individual enters a stage of physiological and psychological recovery. Physiological recuperation starts with the deescalation of arousal back into a more optimal baseline state and a deactivation of those body systems that have been activated by the defensive responses. When submission or dorsal vagal responses have been the predominant defense, recovery occurs as arousal elevates from hypoarousal to a more optimal level within the window of tolerance. When hyperarousal accompanied by immobilization has been the response to the trauma, we often see arousal return to baseline through discharge and dissipation made possible by physical activity. For instance, to use a nontraumatic comparison, after an arousing activity such as watching a horror movie, an individual might find it useful to go for a jog, dance, or work out at the gym to help reinstate his or her baseline arousal level. When sympathetically mediated defenses have been employed during the frightening experience, this “discharge” might happen partly through uncontrollable trembling, thought to be caused by release of the energy not expended in fighting or fleeing (Levine, 1997). Physical shaking or trembling is a common reaction for survivors in the aftermath of a traumatic event. Levine (1997) pointed out that vibrating and trembling are also prevalent in all animals once they are out of danger. In humans, emotional catharsis often accompanies the physical trembling; there is often a need to cry. The social engagement or attachment systems may also be stimulated in the aftermath of trauma. Many people have the urge to tell someone, particularly attachment figures, about the experience.
Clinically, we have observed that clients who utilized mobilizing defenses or the sympathetically mediated freezing responses at the time of the trauma often report intense shaking and trembling afterward or begin to shake and tremble as they address the events in psychotherapy. In Dorothy’s case, even though she had fought back successfully, she still trembled and cried intermittently while she was on the phone reporting the assault to the police and then later in the company of her sister as she described more fully what had happened. Petra, on the other hand, could not talk about what had happened to her because she remembered little about the incest and trying to do so evoked the hypoarousal-related defensive response again. In her early treatment sessions, when she called up what little she did remember, she merely reported vaguely that she felt numb, just as she had felt resigned and spaced out following each assault.
After the traumatic event, a period of psychological and physiological recuperation is required to recalibrate and restore optimal levels of arousal. In recuperation, the object of attention changes from the threat to the injury; rest behaviors and actions that support the recovery and healing of the injury are generally initiated (Fanselow & Sigmundi, 1982). The individual reacts to the injury once the threat is over because the analgesic system becomes quiescent, and pain is then experienced. Thus the return of nociceptive stimulation leads to recuperative behavior (Fanselow & Lester, 1988). Recuperation in the animal world typically takes place in isolation, but humans often initiate contact with a trusted other or seek medical help. Of note is that the individual does not fully resume normal activities and capacities until recuperation is complete. At this stage, risk may be increased (Fanselow & Lester, 1988). In situations of chronic traumatization, perpetrators may further abuse or otherwise exploit victims at this stage, taking advantage of victims’ increased vulnerability.
Dorothy immediately called her sister and asked her to come over and then, together, they called the police. Petra’s stage of recuperation from incidents of childhood sexual abuse was markedly different: She felt ashamed, believed the abuse was her fault, told no one, and received no help for the physical injuries she incurred. She resumed her normal activities, pretended that nothing had happened in the basement with her brother, and told herself that the physical pain in her genitals was nonexistent. Indeed, she told herself that she was stupid to even think of her body. The inability to complete the recuperation stage often results in chronic states of “licking the wounds” (feelings of exhaustion and prolonged periods in bed that are not restorative) or in deficits in the ability to care for the body and/or the self.
7. Integration. People subjected to chronic or severe trauma are often not only unable to complete the recuperation stage but fail to integrate what has happened to them over time. Instead, they wall off the parts of themselves that are hurt or scared and continue their everyday activities as if nothing happened. As previously described, this dissociative compartmentalization is characteristic of severe trauma-related disorders and indicates a profound failure in the person’s integrative capacity (Janet, 1907).
The stage of integration occurs over a longer period of time than recuperation and varies depending on the severity of the threat, the kind of defense used, the success of the defense, the degree of completion at the recuperation phase, as well as the individual’s history, abilities, and support system. Integration is a long-term process of reorganization that includes both the physical and the psychological assimilation of the traumatic experience. Integration includes “postprocessing” of the effects of the trauma—in other words, learning about, elaborating, integrating, and eventually turning off the powerful survival-related “stress” machinery (Shalev, 2001), the defensive subsystems. All important events, and particularly traumatic events, need to be “put it in [their] place in that life-history which each one of us is perpetually building up and which for each of us is an essential element of his personality” (Janet, 1925).
The experience of trauma changes people in profound ways (Herman, 1992; Janoff-Bulman, 1992; Rieker & Carmen, 1986; Van der Kolk, 1996a). Even if mobilizing defensive systems have been effective and they have navigated the traumatic event successfully, they often no longer feel the same as they did before the event. Subjective feelings of either competence or incompetence may increase, depending somewhat on the success or failure of defensive endeavors at self-protection and escape. Van der Kolk pointed out that “the behavioral and biochemical sequelae of escapable shock are just the opposite of those of inescapable shock” (1987). Whereas inescapable trauma hampers resiliency, in a situation of escapable trauma mobilizing defenses have been effective. The successful navigation of a threatening event may help human beings become more resilient and increase their integrative capacities.
A range of positive emotions—exuberance, gratitude, relief, joy, exhilaration, or optimism—may emerge in response to triumph over threat. Janet’s (1919, 1925) “stage of triumph,” noted earlier, includes a sense of pleasure in what he calls the completed action—in this case, the “pleasure” of using mobilizing defenses successfully. Research on animals further corroborates the theory that greater stress resistance develops when animals are subjected to escapable trauma and, like humans, demonstrate greater resilience. Janet (1919, 1925) also wrote about the necessity of “resignation”: the acceptance of the traumatic events themselves, their irreversible effects, and perhaps the losses these may have incurred—all of which are a part of the integration process. Resignation is an important element of integration whereby the individual “makes peace” with the past.
The process of integration comprises several phases. Although Dorothy successfully defended herself, she still experienced nightmares and flashbacks of aspects of the event afterward. She also found that previously neutral environmental triggers, such as movies that contained scenes of similar assaults, news broadcasts of assaults on women, and jackets similar to the one her assailant wore, rapidly raised her anxiety. Although these symptoms were not severe enough to interrupt her capacity to function, Dorothy reported that, even years after the event, she was still occasionally upset by films or news that included an assault similar to the one she had experienced.
Dorothy’s integration of the trauma she experienced was facilitated by an eventual sense of pride in her ability to “keep my wits about me” and fight back during the assault. She decided to take a challenging martial arts class to strengthen her confidence and capacity to defend herself physically. The process of executing physical defensive movements through martial arts or physical exercise contributes to an internal sense of rebuilding and repairing that facilitates healing. Through self-defense training, “survivors put themselves in a position to reconstruct the normal physiological response to danger, to rebuild the ‘action system’ that was shattered and fragmented by the trauma” (Herman, 1992). As Dorothy’s reorganization and integration of the traumatic event progressed over time, she talked about the incident with greater self-confidence and assurance, focusing more on her capacity to turn the tables on her assailant and force him to run away, rather than on the terror she had experienced.
In contrast, the aftereffects of Petra’s incest experiences were much more debilitating because her submission defense turned into a longstanding habituated response pattern. She continued to feel a frequent sense of “collapse,” a tendency to “give up” under relatively minor stress, a loss of enthusiasm, an absence of joy in living, and a lack of direction about her future. Her tendency toward hypoarousal continued into adulthood and prevented her from achieving her potential psychologically, occupationally, and socially. Her responses were in sharp contrast to those of Dorothy: Instead of greater confidence and a sense of mastery, she experienced shame and numbness; instead of being able to take active measures to integrate the experience, her immobilizing defense of submission and accompanying hypoarousal prevented her from marshaling recuperative and integrative capacities.
INCOMPLETE OR INEFFECTIVE DEFENSIVE RESPONSES
One’s subjective experience of safety and security “depend[s] on a set of beliefs in one’s own powers” (Krystal, 1988). In conditions of trauma, these powers have failed to protect the person (Cole & Putnam, 1992; Herman, 1992; Janet, 1925; Levine, 1997, 2004; Pearlman & Saakvitne, 1995; van der Kolk, MacFarlane, et al. 1996). When a traumatic event is so severe that the individual has no recourse but to freeze or submit, the defensive system becomes disorganized afterward: “When neither resistance nor escape is possible, the human system of self-defense becomes overwhelmed and disorganized. Each component of the ordinary response to danger, having lost its utility, tends to persist in an altered and exaggerated state long after the actual danger is over” (Herman, 1992). The common perpetuating factor in trauma-related disorders appears to be the persistence, even decades later, of altered defensive responses as well as maladaptive orienting responses. It is a basic contention of sensorimotor psychotherapy that over time, these habitual interrupted or ineffective physical defensive movement sequences function as powerful contributors to the maintenance of trauma symptoms, thereby deterring their resolution. Their dissociation from other aspects of the self keeps them separate and unintegrated from the individual’s present life and experience.
The persistence of defensive subsystem components occurs in a variety of ways. Many somatoform symptoms, such as anesthesia and analgesia, are related to animal defenses (Nijenhuis et al., 1999). Van der Hart et al. (2000) speculate that “the high rate of somatoform dissociative symptoms in WWI combat soldiers was, at least in part, due to forced immobility in the face of threat to bodily integrity, thereby evoking chronic animal defensive states, in particular, freezing, with concomitant somatoform manifestations” Traumatized persons who tend toward freezing typically seem to feel easily “trapped” and unable to take action under possible threat. “In contrast to submission to unavoidable danger, [freezing]…is related to a chronic state of hypervigilance, a tendency to startle, and occasionally panic” (Krystal, 1988). Since freezing involves sympathetically mediated hyperarousal, traumatized persons who tend toward these responses may become easily hyperaroused, exhibiting symptoms characteristic of the hyperaroused zone described in Chapter 2.
People who have responded with the parasympathetically mediated submissive defense tend to become easily hypoaroused. Petra frequently responded to feelings of anxiety by lapsing into a “zoned out” condition accompanied by a loss muscle tone. She described herself as “giving in” to men sexually during her adolescence and young adulthood. During emotionally and physically painful abusive encounters with her boyfriend, she was unable to fight or flee, utilizing instead the submissive response that had “worked” in childhood. Her response was similar to that found in animals repeatedly subjected to unavoidable pain: These animals tend to become helplessly submissive, lying down and whimpering instead of actively resisting, when exposed to pain (Seligman, 1975). Petra felt dissociated from herself and waited, mute, until the abuse was over.
A loss of an internal locus of control is common for clients who have relied upon any of the immobilizing defenses: freezing, submission, or submissive behaviors. Traumatized people often “cannot return to the previous personality type but assume submissive, slave like personalities, and their ability for assertive behavior becomes impaired to one degree or another” (Krystal, 1988). Failing to understand that this loss is a common result of a bottom-up immobilizing defensive response, they then may feel ashamed and inadequate and berate themselves afterward for their lack of assertiveness. Not aware that their responses reflect instinctively driven immobilizing defenses, clients such as Petra blame themselves, as if their choices were voluntary and purposeful. In turn, the self-attribution and self-blame solidify the patterns of immobilization. Without a sense that they can trust themselves or their bodies, clients become identified with the habitual reactions; the immobilizing responses are experienced as “just who I am.”
Whereas for many traumatized individuals, immobilizing defenses predominate and usurp adaptive functioning, for others, mobilizing defenses may continue to persist in the form of hyperactive defensive responses. Janet clearly described an extreme variation of a failed resolution of fight responses: “Certain patients plainly manifest anger; they strike, scratch, bite, and their cries are menacing…. The movements of defense of the arms stretched forward, the drawing back of the body, are quite characteristic” (1907). Although most of our clients might not demonstrate such extreme behavior, we do see subtler versions of what Janet describes. Many clients are quick to become emotionally reactive, angry, or even violent, and they experience significant bouts of rage with minimal provocation. This propensity toward anger may be attributed to both an unintegrated fight response and the suppression of anger in a traumatic situation, whereby the anger “only goes underground and returns as a permanent challenge to the [person’s] future adjustment” (Krystal, 1988). Fleeing behaviors, such as running away and avoidance, may continue to be employed long after the traumatic event. “Shell-shocked” veterans have been known to duck imaginary flying objects for years afterward; some clients who were near the World Trade Center when the planes hit the buildings also find themselves running for cover as a plane passes overhead, or they suffer from repeated nightmares in which they are attempting to escape danger. Thus mobilizing defenses also may persist long after the original traumatic event.
CONCLUSION
Defensive responses, much like the orienting responses, are governed by psychobiological action systems that are cued into effect thereby conferring the advantage of speed, by environmental danger. In humans there is also a cognitive component that enables previous learning and judgment to fine-tune the defensive response to the specific context. Modifications of these defenses enable us to develop physical skills that guarantee our safety while driving a car, skateboarding, skiing, or even just walking across the street. Constant motoric adjustment is necessary through orienting and appraisal of the present challenge in order to ensure safety, balance, and direction. Tragically, our traumatized clients are more likely to overuse the defenses habitually employed at the time of their trauma in response to current minor stressors or environmental reminders. Through sensorimotor psychotherapy interventions, these clients can be helped to first observe their maladaptive defensive responses simply as physiological, habitual phenomena—or better yet, as “survival resources,” ingenious ways their evolutionary heritage preserved survival in a dangerous world. As clients begin to explore these defensive tendencies in a mindful way, a spontaneous phenomenon often occurs: the mobilizing defensive responses begin to present themselves in the body: a tightening of the jaw, arms, and fist or sensations in the throat accompanied by a feeling of wanting to speak or scream (see Chapter 11). Through the slow and painstaking work of observing what the body wants to do as the trauma is recalled, the possibility of a new response emerges, incipient during the original trauma, ready to be further developed into defensive responses that are more flexibly adapted to the present.