The Physical Response to a Fight or Flight Impulse

You feel a racing heart, pounding away inside your chest, augmented by tunnel vision, and a mono focus on the details in front of you to the point where you are almost unable to hear any of the sounds in the room. Time slows down. In your mind you see flashes, truncated images, memories of the last time you were stuck in this situation. You imagine ways to escape and also the clearest and most effective attack. You feel a strong impulse to choose one of these options and act on it immediately. These are all classic physical and mental symptoms of a fight or flight response, where your brain increases your heart rate and blood pressure by dumping adrenaline, cortisol, and extra blood sugar into your system so you have the energy to sprint across the savanna (the moor, forest etc.) in response to a threat. The trouble is that you aren't actually being chased by a tiger, pack of wolves, or hoard of angry barbarians, rather you are stuck behind a desk, anticipating what you need to do to prepare yourself before making an unpleasant phone call. Nevertheless the threat seems real- it may be financial, legal, or social, and while real in a certain sense, your mind classifies it as physically dangerous, and your body responds as it is designed to. The physical symptoms that we experience as part of being angry, distressed, upset or afraid are built into our biological systems, and they are not well adapted to all of our actual needs. When faced with a difficult interpersonal conflict what we really need is to be calm, cool and collected, although often this is the opposite of where our mind goes.

In Recovery the first thing we try to recognize are our symptoms when we are confronted with a distressing situation. "Symptoms" is the general umbrella term that we use to describe immediate internally experienced responses to stress. Symptoms fall into two broad categories, the first, and perhaps most troublesome are the body's preparation for conflict, including an increased heart rate, attended shortness of breath, extra perspiration, sometimes on the palms or the face, and general tenseness of the muscles and internal organs. Our thoughts usually race through simple solutions, as our mind tries to come up with an instantaneous reaction so the threat can be dealt with a as quickly as possible. In all of this our prefrontal cortex, or higher reasoning center, is taking a back seat, or if engaged at all, is being driven by our simple fears.

Unless you really are out in the woods being confronted by an angry dog, or wandering down the streets late at night and being threatened by a mugger, what you need most of all is to *not* respond right away. This is difficult and will test your patience and self-control, but there is no easy way to shut down your high alert system once it has been activated. In Recovery we say “There are no uncontrollable impulses, only impulses that we chose to not control”. Our impulses are powerful, but aside from the extremely simple impulses (like inhaling after holding your breath for a minute or more), we can almost always control complex impulses.

In the Chapter “Symptoms Must Be Attacked Where they are Weakest” from MHTWT Abraham Low summarizes Roy’s symptoms:

Roy was 35 years of age when he was first seen in the physician's office. He was married, had two children, loved his home and was well liked by friends and neighbors. His employment record was good. He had held his present position for fifteen consecutive years advancing to the rank of a foreman. All in all he had done well until three years ago when suddenly, "out of a blue sky," his right arm and right leg went numb. The numbness had come on at the moment when he entered the plant to start on the afternoon shift. It disappeared as fast as it had come lasting a few minutes only. But Roy was frightened into a senseless fear that he was headed for a stroke. Ordinarily stolid and unemotional, he was now pale, trembling, restless. His fellow workers noticed the change and drove him home. The family physician ordered Roy to stay home for a week and to rest. The following week an electrocardiogram was taken and the doctor was heard to say that something in the graph was "flat instead of round." After that Roy developed violent palpitations, headaches, dizziness, fatigue, air-hunger, difficulty of sleeping, fears of physical collapse and mental breakdown. He saw specks floating in front of his eyes and once "nearly went blind" for a couple of minutes. Some of his sensations were bizarre and intensified his fear of a mental breakdown. Looking at his hands he saw them in a yellow tinge. He felt pains which settled in narrowly confined places, in the left wrist or in the space above the right knee. His teeth began to hurt. There was a pain around the heart. He lifted his little son and instantly felt a pain around his right ear. He lay on the left side and something clicked in the right flank. The fingers of the right hand might hurt and suddenly the pain shifted to the back of the head. He felt pressure of the throat, had night sweats which roused the fear of tuberculosis, pain in the chest, difficulty of sleeping, trouble in concentration and "confusion all the time."

Fight or Flight

https://en.wikipedia.org/wiki/Fight-or-flight_response

Roy is experiencing a fight-or-flight response. His mind senses danger in his day-to-day activities, and his body is preparing itself for a conflict, the trouble is that he doesn’t understand his physical response, and the feeling of being constantly on high alert is keeping him on high alert. Paradoxically, the threat that his mind perceives is his body’s preparedness for that threat, and so he is caught in a complex vicious cycle and he is quickly burning through real physical resources.

The fight-or-flight response (also called hyperarousal, or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. It was first described by Walter Bradford Cannon in 1932. His theory states that animals react to threats with a general discharge of the sympathetic nervous system, preparing the animal for fighting or fleeing. More specifically, the adrenal medulla produces a hormonal cascade that results in the secretion of catecholamines, especially norepinephrine and epinephrine (adrenaline). The hormones estrogen, testosterone, and cortisol, as well as the neurotransmitters dopamine and serotonin, also affect how organisms react to stress. This response is recognized as the first stage of the general adaptation syndrome that regulates stress responses among vertebrates and other organisms.

Since the original work we have come to see that the stress response is accomplished by a variety of interacting systems that include the amygdala and other cortical systems, which results in the hypothalamus activating the sympathetic nervous system and the HPA axis.

The stress response mechanisms include the Autonomic Nervous System (ANS); a network of hypothalamic, pituitary and adrenal responses; the cardiovascular system; metabolism; and the immune system. The function of these pathways is to prepare the body for action. These pathways move physiological energy resources to the necessary organs and muscles. They create an overall shift from storing energy to using energy. In an emergency, priorities of the body move from flexibility, including past and future considerations, to focus on immediate circumstances. Your body no longer stores energy, pays attention to sexual matters, or has your immune system worry about long-term disease. Your mind focuses on threat-relevant cues and memories which become critical as they relate to the current situation.

The autonomic nervous system (ANS) is a control system that acts largely unconsciously and regulates bodily functions such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. It keeps the heart rate and blood pressure in balance, it coordinates the body’s response to exercise and stress, and it regulates reproduction.

The second pathway is known as the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis involves cells in the hypothalamus that are released into the bloodstream and go to the pituitary gland. This causes the pituitary to release hormones that influence peripheral organs such as the adrenals as well as cells in the immune system. This system helps to convert stored fats and carbohydrates into energy sources that can be used immediately. The immune system is activated in stressful situations in anticipation of some injury. When our minds are emotionally stressed our bodies respond by expecting to be physically assaulted and are thus prepared to keep infections out of wounds.

These mechanisms are particularly sensitive to changes in the environment, and repeated stressful events can modify their functioning. Stress can influence brain processes by reducing the connections of one neuron with another, especially in the hippocampus and the frontal areas of the brain which coordinate abstract thinking and reasoning. Stress shows the opposite effect in the amygdala with the increase of neuron connections. This in turn leaves the person with more lower brain activity (emotional and impulsive) when responding to fearful situations.

In general, stress reduces our ability to think and plan while increasing our emotional response and preparing our body for action. Our mind is geared to compute life saving responses based on our past history, and rather than thinking carefully and clearly we respond impulsively with simple or obvious reactions. We feel energized because of an increased heart rate, higher blood pressure and elevated blood sugar levels. Our organs feel tense due to the additional blood flow and because of the stress associated with the flood of adrenaline and cortisol. Our whole body is prepared to react quickly and work double or triple time to deal with the threat as soon as possible; perfect for the forest or the battlefield, but not so good for the office, home, or shopping center.

In short bursts this kind of response is natural, and we are designed for it. We get into trouble when our state of anxiety lasts for hours, days, weeks or longer. Then our feeling of being energized turns to exhaustion, the constant tension in our organs, if persistent and chronic, can lead to serious long term disease.

While knowing something about the biology is interesting how does this help us? In Roy’s case, his physical symptoms created a negative and self-reinforcing feedback loop. Understanding that his symptoms are his body's response to his fear or anger and not indicative of anything else can help to allow him to ignore those symptoms and focus on his situation instead. Being aware of his high alert state can also help him to think more clearly by recognizing that he is likely to make an impulsive choice. He should slow down or stop and take a break, and make important decisions when his symptoms are reduced. It is also important to be aware that a high alert state can create a sense of unreality. In Roy's case these physical symptoms are his body's actual response to the stress, fear, anger or upset that he is experiencing; he is not simply imagining spots before his eyes, the dizzyness, fatigue, difficulties with hearing, peculiar sensations and the many other physical symptoms that he reports having are real. While the physical symptoms have a measurable cause, they are also natural and average, and do not indicate that his body is failing immediately, but that it is responding to fear, upset, anger and distress. Ultimately this fearful response is driven by Roy's thoughts, and as he starts to understand this he can change his thoughts, and with effort, he will be able to reduce his physical symptoms.

At Recovery meetings we discuss the physical sensations associated with negative emotions. These bodily responses are our first cue that we are in a precarious position and likely to react in an impulsive way to a situation. These symptoms will come and go if we let them, although if we obsess or worry about the symptoms they will intensify. While we can't immediately banish symptoms, we can recognize them. Physical symptoms of stress are driven by thoughts and ideas, and we do have control over what we think, say and do. While we cannot stop our racing heart, we can recognize when tigers are imaginary, and with this realistic knowledge we can make reasonable choices and with effort our physical symptoms will pass.

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The Imposter Syndrome, Competency, Self-Esteem and Rejection

When you apply for a job, enter a contest or a race, or even ask someone on a date, you are making an evaluation of your intelligence, strength, charm and wit, and you are assuming that you have a reasonable chance of success. You are both guessing about the complexity of the challenge, and estimating your ability to meet that challenge. For some, repeated rejections can crush their internal sense of self-worth. We may get tired of trying, and only make efforts which are safe, that we are sure we will succeed at, or we may decide to avoid the activity completely in the future. Avoidance of rejection can become a way of life, and this can be crippling. For those who ignore feedback or simply don’t get feedback they may perform endlessly without improvement, believing that their talents are unmatched, and either torturing or alienating those around them.

In The Narcissism Epidemic the third chapter challenges several myth’s about the narcissist, specifically the idea that some narcissism is good. Twenge and Campbell write:

Our culture tells us it pays to believe in yourself as long as you aren't arrogant or narcissistic. However, this isn't really true [...]. A major review of the research on self-esteem and achievement found that high self-esteem does not cause better grades, test scores, or job performance. It's a problem of correlation not equaling causation. There is a small correlation between self-esteem and better achievement, but it is almost entirely explained by better performance causing higher self-esteem. Self-esteem comes after success, not before, because self-esteem is based on success (whether that's academic success or simply being a good friend to someone). Much of the rest of the already small link is due to confounding variables- rich kids, for example, have higher self-esteem and make better grades. Some children with low self-esteem do poorly, but it's because they were abused or had parents who did drugs- things that cause both low self-esteem and poor outcomes. On its own, self-esteem does not lead to success.

Think about it this way: if self-admiration caused success, American children, who have the highest self-esteem of children anywhere in the world, would also be the most successful. This simple prediction, however, doesn't match the data. In a recent study, 39% of American eighth-graders were confident of their math skills, compared to only 6% of Korean eighth-graders. The Koreans, however, far exceeded the U.S. students' actual performance on math tests. We're not number one, but we're number one in thinking we are number one.

Wikipedia describes the Dunning–Kruger effect as a cognitive bias where people of low ability suffer from illusory superiority, mistakenly assessing their cognitive ability as greater than it is. The cognitive bias of illusory superiority derives from the metacognitive inability of low-ability persons to recognize their own ineptitude; without the self-awareness of metacognition, low-ability people cannot objectively evaluate their actual competence or incompetence. This isn't necessarily a problem of an overactive ego, or excessively high self-esteem, but rather it is our own inability to estimate how good we are at doing things that creates the problem.



There is a good video on YouTube titled: Why incompetent people think they're amazing. It describes several studies, one done at two separate computer companies where the programmers were asked to provide a rating for their own performance. At the first company 32% rated themselves among the top 5%, while at the second company over 60% of the programmers rated themselves in the top 5%. In another study 88% of American drivers described themselves as above average and more competent behind the wheel than most others. This same effect, where individuals overestimate their ability can be demonstrated for all sorts of skills, activities, and attributes. The vast majority of people simply believe that they are above average at most things. Numbers like these violate the simple law of averages which states that the odds of you being a little worse than average at some task are about equal to the odds that you are better than average at some other task. Those with the least ability are most likely to overrate themselves by the highest degree. Poor performers lack the very expertise needed to understand the problems with what they are doing.

People are exceptionally bad at estimating how good they are at something, and not only does this apply to the incompetent who wildly overestimate their abilities, but it also applies to experts who tend to do the opposite and underrate their abilities.

Graduate students, professors, and other high achievers often suffer from a phenomena called the imposter syndrome. Wikipedia provides a good overview:

Individuals who suffer from the impostor syndrome have a marked inability to internalize their accomplishments and a persistent fear of being exposed as a "fraud". The term was coined in 1978 by clinical psychologists Pauline R. Clance and Suzanne A. Imes. Despite external evidence of their competence, those exhibiting the syndrome remain convinced that they are frauds and do not deserve the success they have achieved. Proof of success is dismissed as luck, timing, or as a result of deceiving others into thinking they are more intelligent and competent than they believe themselves to be.

[Several behaviours are common to those that suffer from imposter syndrome]:

Diligence: Gifted people often work hard in order to prevent people from discovering that they are "impostors". This hard work often leads to more praise and success, which perpetuates the impostor feelings and fears of being "found out". The "impostor" person may feel they need to work two or three times as hard, so over-prepare, tinker and obsess over details. This can lead to burn-out and sleep deprivation.

Feeling of being phony: Those with impostor feelings often attempt to give supervisors and professors the answers that they believe they want, which often leads to an increase in feeling like they are "being a fake". If shown evidence of their competence or that they may suffer from a case of impostor syndrome, they tend to doubt themselves even more.

Avoiding display of confidence: Another way that a person can perpetuate their impostor feelings is to avoid showing any confidence in their abilities. A person dealing with impostor feelings may believe that if they actually believe in their intelligence and abilities they may be rejected by others. Therefore, they may convince themselves that they are not intelligent or do not deserve success to avoid this.

As described by social psychologists David Dunning and Justin Kruger, the cognitive bias of illusory superiority results from an internal illusion in people of low ability and from an external misperception in people of high ability; that is, "the miscalibration of the incompetent stems from an error about the self, whereas the miscalibration of the highly competent stems from an error about others." Hence, a corollary to the Dunning–Kruger effect is that persons of high ability tend to underestimate their relative competence and erroneously presume that tasks that are easy for them to perform are also easy for other people to perform.

While the imposter syndrome is not described in the standard manual of psychiatric disorders (DSM-IV or DSM-5), it is a risky state of mind. Underrating your physical abilities might deter you from joining an exercise group which would otherwise welcome a new member, and this might represent a missed opportunity for socialization. Such decisions, while not catastrophic, are unfortunate. Genuine mental health issues often result from similar distorted perceptions of reality, and these can take many forms. In extreme cases, a person may begin to doubt their competency at relatively basic tasks. When feelings of incompetency and being an imposter make their way into your day-to-day life, like being unable to ride the bus because you believe you won’t understand the route or the schedule, or feeling rejected by others in simple situations like going to a grocery store or a bank, then a false self-evaluation can wreck real havoc in your life.

In MHTWT there is a chapter titled: “The Passion for Self-Distrust”, Low writes:

My patients have gone through months or years of torture and in the process developed sustained tenseness and symptoms attending it. Their weariness, their pains, fatigues, pressures and spasms have made them self-conscious in the extreme. Hence, they lack the feeling of vitality and accomplishment; they have lost their self-confidence, are unable to relax or enjoy things. Required to formulate plans and intentions they are instantly gripped with the fear that their muscles will fail them, that they will not be ready to carry out what they are asked to do. Being the victims of an unrelenting self-consciousness they question their capacities, watch and check every one of their moves and perform with hesitation and anxiety. Their attitude is that of an abiding pessimism; they feel whipped and defeated; their guiding philosophy of defeatism has hardened into a settled conviction. They are "sure" and "certain" and "positive” that acting is impossible, that their muscles will defy orders, that their power to get things done is lost, that their personality functions are doomed. Their philosophy of "I can't" has assumed the status of a dogma; it is implicitly believed, hotly defended and fondly sheltered. The calamity is that the relatives and friends do not share the patient's defeatism and refuse to subscribe to the cult of "I can't." They look at the sufferer and notice a blooming complexion, a strong voice, a lively facial expression. They observe the patient in a fit of his frequent tantrums and witness a display of force and energy which belies the claim to invalidism. Their conclusion is that the patient could but would not do the things which are to be done. The idea is forced on them that he is unwilling instead of unable to perform his function. They upbraid him, urge him to make an honest effort and with this they accuse him of shamming disease, of playing a game, of practicing deception. They indict his character, his honesty; they charge him with deliberate neglect of duties and obligations and fasten the label of irresponsibility on him. This strikes at the root of his self-respect, of his personal value and social position. This savage assault must be repelled. The patient feels he must bend every ounce of his energy to the vital task of convincing the others that he "really" can't, that he is "truly" incapable of acting, that he is "positively" helpless. The patient is now a crusader for the philosophy of "I can't." He concentrates on the effort to win over the others to his dogma of defeatism, to make converts, to spread the gospel of his incurability. In order to convince those about him, including the physician, he must engage in a veritable campaign of complaining, wailing, lamenting. In his interminable moaning and groaning he is compelled to overemphasize the utter unreliability of his organs and functions. His body is forever about to crumble, his mind is constantly ready to disintegrate. As he continues on this career of self-denunciation he fairly gorges himself with the idea of distrust and in the end develops the PASSION FOR SELF-DISTRUST. His untiring crusading for the philosophy of "I can't" has netted him one faithful and unswerving convert: himself.

Rather than thinking about this information in the context of judging or criticising someone you know who claims that they are either awesome or incompetent, when you are sure that they are perfectly average and neither an expert nor a total failure, it’s more valuable to apply this information to yourself. In Recovery we say “Expectations can lead to disappointments”, and while it’s true that when you apply for a job (ask someone on a date, enter a marathon race etc.), you have a certain expectation that you are probably qualified and might get what you are hoping for, it is important to remain less focused on the outcome and more focused on putting in a good effort. Keep in mind that you will probably not have a good understanding of exactly what the other person is looking for, or who you are competing against, and that you may misjudge your own abilities. This confusion is average. It is average for people to need to experiment to understand their own abilities, and it is average to never get a full picture of how you rate against everyone else. In Recovery we say “Mistakes are healthy, wholesome and necessary” and that without mistakes we can’t learn.

Having unrealistic expectations for yourself and others is a cognitive distortion that can lead you into serious trouble. Asking for feedback from someone you respect and trust, and learning to seriously listen and accept the advice that they offer, regardless of how difficult it is to hear, can go a long way towards helping you to understand your own abilities. Recognizing your mistakes and removing your expectations about the outcomes that a task might have can provide you with a tool that will ultimately make you feel better about your progress, and help to improve the progress that you do make. At Recovery meetings we don’t assess, criticize or evaluate members, instead we try to help attendees build skills that will allow them to be self-critical in a realistic way, without being self-congratulatory or self-condemning. We discuss being average, reducing or eliminating our expectations, and being tolerant of our own mistakes and the mistakes made by others. It's hard to know what you can or can't do without trying, and when we try new things we risk failure and rejection. While this is difficult, it is an important path towards mental health. We encourage you to come and meet us. All of our members were new at one time, we understand how difficult it can be to be the new person at a meeting.


More Information

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