<\/span><\/h4>\n\n\n\nThe first set of responses after shocking events involve the pathways of the autonomic nervous system, connecting the brain, the pituitary gland, the adrenal gland and various organs of the body. Blood is shunted from the gut to the large muscles. The pupils dilate. The pulse accelerates and the stroke volume of the heart increases.<\/p>\n\n\n\n
These physiological changes, shared by all mammals, prepare us for fight or flight. We are in a state of readiness for dealing with the threats our ancestors faced on the great plains of Africa: wild beasts, sudden storms, deadly enemies. We are not adapted for fine motor movements, nor for deep conscious thought. The surge of adrenalin and pounding heart we experience when our car skids on an icy highway does not help us maneuver that modern challenge.<\/p>\n\n\n\n
Our danger biochemistry is atavistic. We have to fight these bodily changes as we respond to modern mechanical dangers, such as a high-speed skid in an automobile.<\/p>\n\n\n\n
There are perceptual changes as well. Our focus on a source of danger, be it a wild beast or a pistol pointed at us, is intensified. Objects in our peripheral field of vision begin to blur, a function not only of the organs of perception but the result of how impulses are received, recorded and analyzed in the brain.<\/p>\n\n\n\n
Detectives, doctors and journalists all know the implications of this phenomenon: Details are notoriously distorted, except for a few central features, when eyewitnesses report from incidents of threat and sudden danger.<\/p>\n\n\n\n
Sometimes, a powerful threat is prolonged, as in a hostage incident, a kidnapping, some assaults and rapes. Many natural disasters – a flash flood or hurricane – may place one in mortal danger for hours rather than seconds or minutes. Short, deadly traumas include gunshots, explosions, earthquakes and fires.<\/p>\n\n\n\n
When extreme stress is prolonged (days or weeks), adaptive mechanisms collapse. This is rare. But in animal experiments, mammals suffer hemorrhagic necrosis of the adrenal gland – literally a bloody death of that organ, and, soon after, death of the organism itself.<\/p>\n\n\n\n
Far more frequently, humans in states of prolonged, catastrophic stress enter a second stage of adaptation. Hans Selye, the physiologist whose stress studies guide the modern era, called this a stage of resistance, following a stage of shock. Now the organism is on high gain, accustomed to the increased flow of adrenalin, consciously appraising what has previously been grasped automatically.<\/p>\n\n\n\n
At this point, a crime victim knows that he or she is a victim, although the person may be thinking, “This can’t be happening to me.” At this point, details do become evident, particularly to the trained observer. And, in group hostage situations, there is often a ritual calm, when confusion and feelings of threat diminish. This is the time when negotiations may be successful.<\/p>\n\n\n\n
Disaster workers recognize a heroic phase, a second stage after the initial bedlam, when all is shock and confusion. In the second stage, people help one another, lives are saved, lost children are found. Hope and exhilaration co-exist with fear and grief.<\/p>\n\n\n\n
Eventually, there is a return to some equilibrium in the body, the mind and the community. This may be a time of depression and demoralization: The high-energy condition is gone. There is debris. There is loss. There is pain. Reality sinks in.<\/p>\n\n\n\n
This is also the time when the press leaves. A survivor who might have been annoyed by too much attention could feel abandoned and forgotten.<\/p>\n\n\n\n
Several authors describe stages after shocking events occur or disturbing news is heard. Kubler-Ross defined the denial, fear, anger and eventual acceptance after learning one has a fatal illness. PFLAG, Parents and Friends of Lesbians and Gays, describe similar stages, not all of them reached, by parents who are unprepared for the revelation that their children are gay. Stages are merely guidelines, not applicable to everyone who encounters unforeseen stress.<\/p>\n\n\n\n
A journalist may want to consider the particular sequence of stages or phases that an interviewee has experienced, where that person is now and how each stage affects the perception of events.<\/p>\n\n\n\n
A discussion of stages may help the interview process, without actually “leading the witness.” Consider saying, “Sometimes people go through a stage when they act without thinking, when they don’t even know what is happening,” and you may elicit an interesting narrative. Some people need to be reminded that they acted instinctively. Then they can recall what occurred just before that phase and right afterward.<\/p>\n\n\n\n
My patient who was thrown to the floor by the “cooler bandit” recalled months later that she hid her wedding ring under a shelf, as she lay in the fetal position, expecting to be shot. She forgot this particular event during the time that she was experiencing fear and shame and all of the PTSD symptoms listed in the diagnostic manual.<\/p>\n\n\n\n
For me, it was of special note – her instinctive protection of a valuable symbol, her refusal to yield that icon to her assailant. This woman was full of self-blame for not sounding the secret alarm, for behaving like a coward. Therapy required a diligent search for evidence to the contrary, proof that would convince her. (I was already certain that she had done what any reasonable person would have done to survive an armed robbery.) She recalled hiding her ring as we talked about the instinctive, automatic things that some people do. And she finally agreed that her instincts were correct.<\/p>\n\n\n\n