The Shame, Blame, Immobility Spiral
It should be no surprise, given the nature of fear-induced immobility, that a majority of rape victims predictably describe feeling paralyzed (sometimes also suffocated) and unable to move. Being held down and terrorized by someone much larger, stronger and heavier is virtually guaranteed to induce long-lasting immobility and, thus, trauma. Rape not only forces one to keep still, it induces an inner immobility because of the terror (fear-potentiated immobility). In one study, 88% of the victims of childhood sexual assault and 75% of the victims of adult sexual assault reported moderate to high levels of paralysis during the assault.35 In addition, because of the high levels of dissociation, it is likely that many victims do not remember feeling paralyzed or deny the paralysis because they feel so guilty for not having “fought back.”
Similarly, soldiers under fire can rarely flee or even physically fight. They must frequently stay pinned close to the ground (resisting both active fight and flight urges), while “calmly” trying to steady, aim and fire their guns. I interviewed a soldier who was threatened with a court martial for “cowardice under fire.” He was an embedded translator with a special-forces assault team in Iraq—although the only foreign languages he knew were Hungarian and Serbo-Croatian; he did not know Farsi or any Arabic language! He had not been trained for combat duty, and when his crack Marine unit was ambushed, he did not fire back. While interviewing this broken, devastated, humiliated and terrified soldier, I came to see that his “refusal” to fire back was, in fact, involuntary paralysis—a normal reaction to the highly abnormal situation of seeing the blood, death and dismemberment of his comrades. Unlike the Marines, he had had no training to override his fear.e His instinctual response to overwhelming threat precluded action.36
This story speaks to modern cultures that tend to judge immobilization and dissociation in the face of overwhelming threat as a weakness tantamount to cowardice. Beneath this castigating judgment lies a pervasive fear of feeling trapped and helpless. This fear of fear and helplessness, and of feeling trapped, can come to dominate a person’s life in the form of persistent and debilitating shame. Together, shame and trauma form a particularly virulent and interlocked combination.
Self-blame and self-hatred are common among molestation and rape survivors, who judge themselves harshly for not “putting up a fight,” even where fight was not a viable survival option. However, both the experience of paralysis and the critical self-judgment about “weakness” and helplessness are common components of trauma. In addition, the younger, the more developmentally immature or insecurely attached the victim is, the more likely it is that he or she will respond to stress, threat and danger with paralysis rather than active struggle. People who lack solid early attachment bonding to a primary caregiver, and therefore lack a foundation of safety, are much more vulnerable to being victimized and traumatized and are more likely to develop the entrenched symptoms of shame, dissociation and depression.37 In addition, since the psychophysiological patterns of trauma and shame are similar, there is an intrinsic association of shame and trauma. This includes the collapse of shoulders, slowing of heart rate, aversion of eyes, nausea, etc.38
Shame also feeds into the common misperception of traumatized individuals that they are, somehow, the cause of (or, at least, deserving of) their own misfortune. Another (powerfully corrosive) factor comes into play in the formation of shame: while it appears to be an almost structural component of trauma, all too frequently trauma is inflicted by the people who are supposed to protect and love the child. Children who are molested by family and friends, of course, bear this additional confused and chaotic burden. Shame becomes deeply embedded as a pervasive sense of “badness” permeating every part of their lives. Similar erosion of a core sense of dignity is also found in adults who have been tortured, on whom pain, disorientation, terror and other violations have been deliberately inflicted.39 While the principles of uncoupling fear from immobility discussed in this chapter apply to these cases, the therapeutic process is generally much more complex. It requires a broader skill for negotiating the therapeutic relationship so that the therapist does not get tangled up in taking on the (projected) role of the perpetrator(s) or rescuer.
As They Go In, So They Come Out: The Rage Connection
When a pigeon that is blithely pecking at some grain is quietly approached from behind, gently picked up, and then turned upside down, it becomes immobilized. The pigeon will, like the guinea pigs I saw in Brazil, or Picasso’s dove in the play, remain in that position, with its feet stuck straight up in the air. In a minute or two, it will come out of this trancelike state, right itself, and hop or fly away. The episode is resolved.
However, if the pecking pigeon is first frightened by the approaching person, it will try to fly away. When it is caught after a frantic pursuit, and then forcibly held upside down, it will again succumb to immobility. This time, however, the terrified animal will not only remain frozen much longer, but when it comes out of its trance, it will likely be in a state of “frantic agitation.” It may thrash about wildly, pecking, biting or clawing randomly, or it may scurry away in a frenzy of undirected movement.40 When all else fails, this last-ditch (and disorganized) form of defense may yet save its life.
Similarly, when a well-fed household cat catches a mouse, the latter, restrained by the cat’s paws, stops moving and becomes limp. Without resistance from the mouse, the cat becomes bored and will sometimes gently bat the inert animal, seemingly trying to revive it and restart the game anew (not unlike Jimmy Stewart slapping his swooning heroine to bring her out of her faint). With each reawakening, chasing and reactivated terror, the mouse goes deeper and longer into immobility. When it does eventually revive, it frequently darts away so quickly (and unpredictably) that it may even startle the cat. This sudden, non-directed burst of energy could just as easily cause it to run at the cat, as well as away from it. I have even seen a mouse ferociously attack the nose of an astounded cat. Such is the nature of exit from immobility, where induction has been repetitive and accompanied by fear and rage. Humans, in addition, reterrorize themselves out of their (misplaced) fear of their own intense sensations and emotions. This is similar to what may happen when catatonic psychiatric patients come out of their immobility. They are often extremely agitated and may attack the staff. I once had the opportunity to work with a patient who had been in a catatonic state for two or three years. After carefully sitting by his side (getting closer, over the period of several days), I spoke to him softly about the shaking and trembling that I observed with people and animals when they come out of shock. I had also talked with the chief psychiatrist, and he agreed that they would not give him an injection of thorazine (or straitjacket him) if he came to in an agitated state, unless he was clearly dangerous to himself or others. Two weeks later I got a call from the psychiatrist. The man had begun to shake and tremble, started to cry and was released to a transitional living situation six months later.
To review, fear both greatly enhances and extends immobility and also makes the process of exiting immobility fearful and potentially violent. An individual who is highly terrified upon entering the immobility state is likely to move out of it in a similar manner. “As they go in, so they come out” was an expression that Army M.A.S.H. medics used when describing the reactions of their war-wounded patients. If a soldier goes into surgery terrified, and needing to be held down, he or she will likely come out of anesthesia in a state of frantic and possibly violent disorientation.
The same consequences are sadly true when children are frightened and abruptly separated from their parents before surgery.41 If they go into the surgery in an agitated state, are held down and then surrounded by gowned and “masked monsters,” they come out of the anesthesia frightened and drastically disoriented. David Levy, in 1945, studied hospitalized children, many of them being treated for injuries requiring immobilization, such as splints, casts and braces. He found that these unfortunate children dev
eloped shell-shock symptoms similar to those of the soldiers returning from the war fronts in Europe and North Africa.42 Some sixty-five years later, a troubled father recounts “an all-too ordinary” story about his son Robbie’s “minor” knee surgery, a virtual guarantee for trauma.
The doctor tells me that everything is okay. The knee is fine, but everything is not okay for the boy waking up in a drug-induced nightmare, thrashing around on his hospital bed—a sweet boy who never hurt anybody, staring out from his anesthetic haze with the eyes of a wild animal, striking the nurse, screaming “Am I alive?” and forcing me to grab his arms … staring right into my eyes and not knowing who I am.43
The immobilization effects Levy observed in children also occur in adult patients. In a recent medical study, more than 52% of orthopedic patients being treated for broken bones were shown to develop full-blown posttraumatic stress disorder, with a majority not recovering and worsening over time.44
This result should come as no real surprise when one recognizes that many orthopedic procedures follow frightening accidents, stressful ambulance rides endured while one is strapped down and terrifying and depersonalizing emergency room visits. Further, many of these patients have also undergone immediate surgeries, and often in an agitated state. This chain of events often precedes immobilization and is followed by painful rehabilitation regimens. In a recent study of children undergoing even “minor” orthopedic procedures, to quote the authors, “High levels of posttraumatic stress disorder symptoms (in over 33% of all children studied) are common in the recovery period after pediatric orthopedic trauma, even among patients with relatively minor injury. Children admitted to the hospital after injury are at high risk for such symptoms.”45
Although hospitals have become more humane (particularly for children—though from the above study not nearly enough), there is still inadequate attention to preventing undue fear in people who must undergo painful procedures or general anesthesia. Indeed, some of those ill-fated individuals partially “awaken” during anesthesia and many develop some of the most horrific and complex PTSD symptoms.46 In the words of one survivor (a surgical nurse herself), “I feel a cosmic hollowness, as if my soul has left my body and can’t return … horrifying nightmares are my companion … often shocking me wide awake. When my eyes pop open, there is still no respite because the walls and ceiling turn blood red.”47 This riveting description illustrates the horror of enduring the combination of terror, extreme pain, and being unable to move or to communicate one’s situation.
Biologically, the orthopedic patients, soldiers, rape victims and hospitalized children are reacting like wild animals fighting for their life after being frightened and captured. Their impulse to attack in an “aggravated rage” or to flee in frantic desperation is not only biologically appropriate; in fact, it is a frequent biological outcome. As a captured and terrified animal comes out of immobility, its survival may depend on its violent aggression toward the still-present predator. In humans, such violence, however, has produced tragic consequences to the individual and society. I had the opportunity to speak with the mother of Ted Kaczynski (the “Unabomber,” whose vendetta was waged against the impersonality of technology) and with the father of Jeffrey Dahmer (a serial killer who dismembered his victims). They both told me horrific stories of how their young children were “broken” by terrifying hospital experiences. Both parents described how, after terrifying hospitalizations, each of these children retreated into his own world. While such experiences of rage leading to perverted violence are (fortunately) rare, the terror and anger evoked by medical procedures is (unfortunately) not.
Rage Turned Against the Self
With humans, the impulse toward violent aggression may become terrifying in itself and is then turned against the self, as Kahlbaum so presciently observed in his seminal work on catatonia.48 This turning inward (or “retroflection”) results in further paralysis, suppression, passivity and resignation. The flipping between shutdown and outbursts of “impotent” and misdirected rage becomes the individual’s stereotypic reaction to later challenges that require much more nuanced and subtly differentiated feeling-based responses.
In my accident (see Chapter 1), as I came out of shock, I experienced “a rolling wave of fiery rage” as my body continued its shaking and trembling; then I felt a “burning red fury” erupting “from deep within my belly.” I really wanted to kill the girl who’d hit me, and I thought, How could that stupid kid hit me in a crosswalk? Wasn’t she paying any attention? Damn her! I wanted to kill her, and it felt like I could have. Because rage is about wanting to kill, it is not hard to understand how frightening this urge can be; and how the rage could turn to fear as a way of preventing such murderous impulses.
By allowing my body to do what it needed to do—by not stopping the shaking while tracking my inner body sensations—I was able to allow and contain the extreme survival emotions of rage and terror without becoming overwhelmed. Containment, it must be understood, is NOT suppression; it is rather building a larger, more resilient vessel to hold these difficult affects. And mercifully, this way, I came through the accident’s aftermath unscathed by trauma and more resilient to future challenge.
As people revisit, move through and then move out of immobility in therapy, they frequently experience some rage. These primal sensations of fury (when contained) represent movements back into life. However, rage and other intense body sensations can be frightening if they occur abruptly. In effective therapy, the therapist supports and carefully guides the client through this powerful process. Guidance should be done slowly, by using a graduated approach so that the client is not overwhelmed.
Ultimately, rage is (biologically) about the urge to kill.49 When some women who have been raped begin to come out of shock (frequently months or even years later) they may have the impulse to kill their assailants. Occasionally, they have had the opportunity to carry out this impulse in action. Some of these women have been tried and sentenced for murder because the time elapsed was viewed as evidence of premeditation. Injustices have most certainly occurred due to general ignorance of the biological drama those women were playing out. A number of these women may have been acting upon the profound (and delayed) self-protective responses of rage and counterattack that they experienced as they came out of agitated immobility; and thus their reprisal (though much delayed) may have been biologically motivated, and not necessarily premeditated revenge, despite the outward appearance. These killings might have been prevented if effective treatment for the traumatized women had been available at the time.
In contrast, non-traumatized individuals who feel angry are well aware that (as much as they may “feel like murdering” even a spouse or their children) they obviously wouldn’t actually try to kill the object of their anger. As traumatized individuals begin to come out of immobility, they frequently experience eruptions of intense anger or rage. But fearing that they may actually hurt others (or themselves), they exert a tremendous effort to deflect and suppress that rage, almost before they feel it.
When one is flooded by rage, the frontal parts of the brain “shut down.”50 Because of this extreme imbalance, the capacity to stand back and observe one’s sensations and emotions is lost; rather, one becomes those emotions and sensations.f Hence, the rage can become utterly overwhelming, causing panic and the stifling of such primitive impulses, turning them inward and preventing a natural exit from the immobility reaction. Maintaining this suppression requires a tremendous expenditure of energy. One is, essentially, doing to oneself what experimenters have done to animals to reinforce and protract their immobilization. Traumatized individuals repeatedly frighten themselves as they begin to come out of immobility. The “fear-potentiated immobility” is maintained from within. The vicious cycle of intense sensation/rage/fear locks a person in the biological trauma response. A traumatized individual is literally imprisoned, repeatedly frightened and restrained—by his or her own persistent physiological reactions and by fea
r of those reactions and emotions. This vicious cycle of fear and immobility (a.k.a. fear-potentiated immobility) prevents the response from ever fully completing and resolving as it does in wild animals.
The Living Dead
Rage/counterattack is one consequence of repetitive fear-induced immobilization; the other is death. Death might occur, for example, when the cat persists in recapturing the mouse, repeating the cycle many times. The cat bats his prey until the mouse finally goes so deeply into immobility that it dies, even though uninjured. While only a few humans actually die from fright, chronically traumatized individuals go through the motions of living without really feeling vital or engaged in life. Such individuals are empty to the core of their being. “I walk around,” said a gang-rape survivor, “but it’s not me anymore … I am empty and cold … I might as well be dead,” she told me on our first session.
Chronic immobility gives rise to the core emotional symptoms of trauma: numbness, shutdown, entrapment, helplessness, depression, fear, terror, rage and hopelessness. The person remains fearful, unable to imagine safety from a never-ending (internal) enemy and unable to reengage in life. Survivors of severe and protracted (chronic) trauma describe their lives as those of “the living dead.” Murray has poignantly written about this state: “here it is as if the person’s primal springs of vitality had dried up, as if he were empty to the core of his being.”51 In the poignant 1965 film The Pawnbroker, Rod Steiger plays Sol Nazerman, an emotionally deadened Jewish Holocaust survivor who, despite his prejudice, develops a fatherly affection for a young black teenager who works for him. When, in the final scene, the boy is killed, Sol impales his own hand on the spike of a memo spindle so that he can feel something, anything.
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