| Being Too Frightened To Stop Running: Another Case From The Neuropsychologists Journal |
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Have you ever felt these signs when in acute stress?
What is going on neuropsychologically or in other words, with your brain/behavior relationship? When a person is in a calm, un-stimulated state his/her neurons don't fire in what one might call "trauma alertness specific areas" (in this article I will refrain from using specific neuroanatomical names, and leave the neurologically curious among you to do your own further research). However, when a new stimulus is perceived - visually, aurally, by smell etc. - as dangerous it is relayed from the area of the brain responsible for senses to one that is deeper and more basic or primary in the brains development. The person becomes attentive and hyper-alert to their environment. S/he will, in all likelihood, neurophysiologically go into automatic pilot and begin to act in behaviors that are meant to lead to survival-such as fight-and-flight. The success of the action leads to a neuro-chemical reverse of the condition until the person is sure that s/he is safe and calm. Males and females, even as children, tend to respond differently. Males generally, but not always, go into the fight (aggressive) modality, whereas women and children may do flight or play-dead (dissociate). Once the response to the threat is successful, the person slowly but surely returns to a normal state of calm and necessary alertness.
The Case He came having been referred by his psychiatrist. He couldn't sleep, he was jumpy and couldn't concentrate, he was screaming at his family all the time. Even though the majority of my trauma cases are terrorist or abuse related, this referral was different. He was a doctor for one thing (let's call him Dr. Refael). Second, what happened to him had not taken place in the hospital. He had been walking home and saw someone on the ground, so put out his hand to help the man get up. What happened next was part of the reason he was sitting in my office. As he put his hand out to help this man, the man lifted a bag at his side and whacked Dr. Refael in the face! Dr. Refael was left with a very sore jaw, beginning of swelling in his eye and a whopping red mark on half his face. He went to work as if nothing had happened, however, as his face was very raw, people asked him what happened. After he told his story someone joked, "What you really need is a mark on the other side as well," and then proceeded to slap him on the other side of his face! Refael told me, "He smiled after he did this, as if he was pleased with himself for balancing me out." I am not sure what caused more shock and trauma, the first smack or the second. However, there is no question that what I saw as I sat opposite him was a man in extreme anguish and replaying everything that happened, over and over again. "Get over it people tell me," he continues. "I know I should; it was a stupid prank; the person who did it apologized many times since and sent a beautiful flower arrangement, as well as his wife's special potato kugel for Shabbat. "But I can't. It is as if I'm on a gerbil's treadmill inside a cage. I have to keep running around the loop." "What would the worst thing be for the gerbil if he stopped", I asked. He looks me straight in the eye and says in a low voice: "He will die there." Good, I think to myself, now we are getting somewhere. "Let me get this straight. Your gerbil is going crazy running around in the wheel, maybe a wheel-of-fortune and if he stops he will die. What happens if he continues?" "He will die. He can't continue like this. There isn't a choice - either way its death." He seems so doomed, I think. He continues, "Choice one: Keep moving, if you stop you die. Choice two: If you keep moving you die." As he is talking I am visualizing this gerbil as Rafael's heart and soul. Too scared to stop running to safety, and at the same time, too busy running to be safe. All I could fearfully imagine is that both would only be stopped by a heart attack! "Which do you recommend that he chose," I ask. He starts to cry-he is big, over six feet and full bodied though not fat. But sitting there crying in front of me, I see him just as small as his gerbil, heaving from the conundrum of this closed choice. "Let's say that magically, something or someone could appear and give the Gerbil a tool or magic wand to help him. What do you suggest he might use? How?" The word magically appear gets him to stop a minute and think. This is out of the logical loop. He looks ahead as if seeing the treadmill and racing gerbil clearly in front of his eyes. "I guess the tool would be a spanner." (A spanner is the British English word for wrench. Putting-a-spanner-in-the-works is similar to throwing in a wrench - messing up the works.) "Wait a minute," I almost shout with joy. "I think you are on to something very important!" He looks up at me, no doubt thinking I am nuts; I know that look well from many of my patients. "Your inner gerbil," I tell him, "knows he doesn't want to remain a slave to the wheel which is going nowhere good. You have figured out that this requires a drastic measure. Throwing something into a continuum to stop what seems inevitable. You have figured it out, it's not even a magic wand, and it is a real tool which can help him!" "Are you are saying that I can stop his running afraid and the gerbil won't die," he asked. "You gave me an idea, you have a tool to help him, and I might have a tool to help you help him." What I said was something like this: "I'd like to see if we can offer this gerbil a safe place to go to in his thoughts while he is running around. When he is a bit relaxed in his thoughts he can figure out how to live and be, when you put the spanner in the wheel and cause it to stop. I agree, he can't stop running just yet, but he needs to be able to run AND think. "Can you think of a place where, though he his running, you could hold his cage and be safe?" As the beginning of trying to do the cognitive behavioral intervention EMDR - Eye Movement Desensitization and Reprocessing - which is among the tools I use with traumatized patients, I tried to help him search through his memory for a place he himself felt safe and calm. "The beach; a mountain view; your favorite spot at home; your childhood hide-a-way; what about your bed, in your room," I suggest. "I have to admit something," he responds, "even on Shabbat when I am lying in my room for my rest, I put on earplugs to my radio, which I leave on all of Shabbat, and it makes me calmer." I stop a moment, and looking right at him, ask him what happened to him the first time he felt the gerbil feeling. He looks somewhat sad now, like here we go again. "No," he says, "I wasn't beaten by my father, certainly no more than anyone else and no, though I was in active army service I never was in serious danger." "It seems," I respond, "that you have been asked these history of trauma questions many times and have the answers all ready. But please bear with me; I am going to ask you a weird question now. Will that be okay with you?" He looks at me expectantly. "When did you die?" He is silent for a moment, and then tells me of a pigua, during the Second Intifada, in 2002, that killed a number of people standing in front of and behind him, and didn't even leave a scratch on him. The blast had knocked him to the ground, his ears rang, his face was flushed, but he didn't have a scratch on him. As he was a doctor he just got up and started to minister to the wounded and never told anyone. For the most part people just thought that he was a passer-by after the fact and that as a doctor, volunteered to help out. "Nothing happened to me, you see, but at the moment when I was on the ground everything was white, quiet, I couldn't hear anything and I was sure I had died." It was at this point, acknowledging the death-that-was-not-death, the safety of a-quiet-spot-that-was-not-safe, at which we could begin to help his gerbil find a safe place to hold unto while Refael put a "spanner in the works" to stop the wheel racing to and from death. Dr. Judith Guedalia is Director, Neuropsychology Unit; Senior Medical Psychologist; Shaare Zedek Medical Center; Licensed Psychologist; Supervisor and Specialist in Medical, Rehabilitation, and Developmental Psychology; EMDR Level II, Co-Chair Nefesh Israel. She can be reached at her website: www.drjudithguedalia.com |
