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Identifying Chronic States of Fight or Flight

Updated: Mar 27

I know #selfcare and #selflove are the new catch phrases or even the new fad, particularly among mothers and women in their forties and fifties, but I could not be more serious about how very important this is for health and well-being. It is quite literally the top priority of my new practice. I want to help bring people back into both physical and emotional physiologic balance. I would argue that most haven't fully realized how much their own needs go neglected and how detrimental this is their health and happiness, that is until they start to invest in themselves.

When I worked in private practice as a #nursemidwife, I was on-call every minute of every day for thirteen years. There was quite literally no break for me, and much of this time was in anticipation of an urgent or emergent birth. While most all of these births progressed quite beautifully, they almost all required sacrifice of sufficient sleep and proper food. They also required I sacrifice the needs of my family and self. True to the unpredictable nature of birth, there were also a significant number which offered some level of clinical challenge, placing further demands on my already taxed #sympatheticnervoussystem.

Beyond the generally accepted, yet hard to truly appreciate demands of the obstetrical profession, one really can't comprehend the intense hostility that midwives endure which goes even beyond their #moralinjury, their #compassionfatigue, their #impostersyndrome, and often their #identitycrisis, each of which contribute greatly to #trauma and chronic, unrelenting stress. A few unfortunate circumstances too many, and I slid right out of fight-or-flight into yet another sympathetic response; my nervous system froze.

I share this because just like my life-changing #traumaticbirth experience, I soon realized this wasn't unique to me. While not many of you are midwives, we each have our own traumas. We each endure demands in life that we simply can't overcome. These stressors can compound, coming at us from multiple arenas. We find ourselves maxed out, overwhelmed, bitter, angry, feeling abandoned, unappreciated, and unloved.

Some of us already had traumatic childhoods that caused us to become too #empathetic or lack the ability to identify #healthyboundaries. We gain weight, can't sleep, have more aches and pains, fall into #addiction, suffer declining health, wreck our relationships, and start to lose trust in ourselves, even losing track of who we are and whose we are. We know things need to change, but we're always chasing that next corner or demanding changes from our partners and colleagues that never suffice.

Disembodiment is a Lack of Awareness

Many have asked me how they might identify if they are living in a state of #fightorflight; how do you know you are living in the eye of a storm? My son was diagnosed with #ADHD and I'll admit that I didn't know what was wrong, why he was often so angry that he could cry but not be able to articulate himself, why he couldn't focus, and why he was always aggravating everyone when it was so painfully obvious that he was the most disappointed in himself when he ultimately made others upset. He was living in a state of fight-or-flight. His father had left when his mother was pregnant so he was now the man of the house at far too young an age. He felt all the responsibility fall on his shoulders. He felt abandoned and was overwhelmed.

Others have described a chronic state of #anxiety, being easily angered, experiencing #rage, inability to sleep, #weightgain in spite of exercise and dieting, and significant overwhelm. Dr. Gordon shares the need to talk over others or interrupting during a meeting is a symptom of being in an emotional state of fight-or-flight. Dr. Romm shares feeling mental fogginess or having difficulty finding her words as her early warning signs of needing to find grounding. The hills and valleys of our lives become more like massive mountains and deep ravines when we are living more often in overwhelm. We haven't the reserve to take the hits and we are always so primed for threats that we are quick to anger.

When in a state of fight-or-flight, we fail to recognize the details. Self-care loses priority. We fail to recognize when we are tired or even when we are hungry until we are starved. We can't identify with our own needs anymore, because we we are triaging needs of everything and everyone else. We can't sit in quiet because there is too much to do. Our minds are in full alarm. We don't notice changes in our bodies until they are significant or have been present for months or years. More midwives than I can count, who prioritized their client's needs, discovered their own #breastcancer only days or weeks prior to their own demise. They were never their own priority.

Antidote for Fight or Flight is Meditation

I recently listened to a talk by James Gordin MD, founder and director of The Center for Mind & Body Medicine, and Aviva Romm MD regarding self-care for health practitioners in the midst of the #COVID19pandemic. They graciously invited a number of us to a zoom meeting, recognizing that so many were already on the brink of complete burn-out prior to this pandemic and that a safe place was needed to share and strategize how we might find relief.

On average, one physician a day commits #suicide. Because of this, Yale now has all its medical residents engage in #yoga as an effort towards prioritizing self-care. Suicides among female nurses is 24% higher than the average female, and nearly half of nurses report symptoms of #depression. Nurses who commit suicide have also been found to have less probability of having had intimate partner problems but did have significantly more work struggles than the average person. Healthcare providers are among the worst for prioritizing their own needs and subsequently suffer significant physical, emotional, and mental health consequences.

Dr. Gordin shared with us a meditation that resonated deeply with many. It was a guided journey through our limbic and nervous systems so that we were reminded that our bodies are designed to protect us. Our sympathetic nervous system is incredibly impressive, but it is designed to be stimulated infrequently and only briefly. By design, the human body should live more predominantly in the #parasympatheticnervoussystem allowing us opportunity to gather reserves for those more stressful moments. In a relaxed state we find opportunity to take deeper breaths, to better digest our foods, to sleep more deeply, and to truly relax and "smell the flowers," so to speak. We can invest in the details and prioritize our basic needs when grounded in our parasympathetic nervous system. Many though, endure chronic stress which keeps the sympathetic nervous system active, prepared to fight or escape, draining our reserves, and over-taxing our nervous system.

#Meditation is the antidote, allowing our brains to move into this restful state. It creates a pause, a safe place, grounding. The #amygdala, or the part of the brain that processes our fear and #triggers our fight-or-flight, is calmed when we meditate. Interestingly, research suggests that information about potentially frightening things in our environment can reach the amygdala before we are even consciously aware that there's even a threat. This sensory information engages the thalamus which communicates with the amygdala and our hypothalamus, triggering our fight-or-flight before it is even processed by our cerebral cortex. We feel the fear before we even have time to think. This direct path is exceedingly helpful if you are about to step on a snake and your body darts before you realize what even happened, but these memories and those of traumatic events create triggers that may cause us to respond in ways we don't understand. Not surprisingly, a number of studies have suggested the amygdala is overactive in those with anxiety. Meditation is the key, and please stay tuned, as I have so much more to share about trauma and meditation, as well as yoga and meditation. However, one doesn't have to identify with trauma to become disembodied, chronic stress and overwhelm are more than sufficient.

Antidote to Freeze Response is Shaking & Moving

As I've shared, I did live in triage-mode for many, many years. I handled it well. In fact, I excelled at it, which made it even more difficult to find balance because my responsibilities were great, as was the reward. Catching babies is an incredible honor, but the profound responsibility makes it easy to rationalize why self-care isn't a priority. I was the first person I sacrificed. I routinely broke promises I made to myself. Ultimately, because I failed to draw healthy boundaries, I did completely empty my cup. I froze.

When a mouse is caught in a cat's mouth, it freezes. When the cat gets bored and drops the mouse, it runs off shaking. Dogs shake after a fight. Mothers #shake after childbirth. We do this to release the excess energy of the fight-or-flight response so we can better enter a parasympathetic state. Dr. Gordon shares that five or six minutes of shaking or moving to music after a stressful event, or even after leaving work prior to coming home can really alter our nervous system, and ultimately our overall health. After shaking off the excess, find five minutes of silence. Then balance yourself with some energizing music.

Emotions are a Necessary aspect of Wellness

It is my opinion that emotions have almost become synonymous with symptoms of disease. We don't like to cry or feel anxiety, so we bury these emotions or even medicate them away. It is easier to be angry and bitter, than to acknowledge hurt. Emotions are perceived to be our weakness. Having a stiff upper lip is the cultural expectation. I would even argue that those who really "get" functional medicine and have embraced the importance of clean eating and having an active body often still fail to acknowledge the importance of self-care with respect to their emotional and mental health.

Maybe we should consider seeing a mental health therapist as we would a #chiropractor, dentist, midwife, or optometrist for maintenance therapy? I suspect with thoughtfulness, many could self-assess and correct through meditation and other wellness modalities, but others have experienced traumas which are a bit more complex, requiring support of a trusted specialist. If one is injured in a car accident and physical trauma is evident, it is widely accepted that specialty care is an important part of recovery, but although science is clear that the brains of those having experienced emotional trauma have very distinct physical damage, mental health support holds significant stigma.

Emotions are beautiful. Let them come. Then let them go. We have to bottle them up to keep doing our jobs, but at the end of the day, release them. Shake them out. #Dance. #Journal. Document your #gratitude. Shower and change clothes. Eat #restorativemeals. Take a walk in #nature. Don't be afraid to feel. Cry unapologetically. These are healthy, physiologic responses. Extend grace to others for the same. However, don't tolerate abuse.

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