Friday, October 28, 2011

Does Fight or Flight Need Updating?

Does fight or flight need updating? This is a question that was asked by a group of mental health professionals in 2004. The answer to their question is: most definitely.

The authors of this question were looking at the evolved behavioural responses to a threat. I've looked at this in previous blogs. We've gone from 2Fs to 3Fs, and now up to 6Fs: Freeze, Flight, Fight, Fright, Flag, Faint. This blog looks at the automatic physiological response.

Those activities associated with preparing a person to survive a violent encounter who refer to fight-or-flight are referring to stress theory, whether they know it or not. Cannon, the author of the fight-or-flight concept, described the fight-or-flight response which is an automatic physiological response to mobilise our body to fight to defend against a threat or to flee from danger. The stress discipline adopted the fight-or-flight response and called it the stress response.

Seley, the father of stress, defined stress in physiological terms. He defined stress as the non-specific response of the body to any demand for change. He explains that the demand is non-specific in that any demand on a body to change produces the same physiological response. This has also been referred to as the global arousal model.

What colour does a person's face go when they are angry? Red. What colour does a person's face go when they are scared? White. Surely this suggests there is different physiological responses associated with different emotions.

The emotion discipline refers to autonomic specificity (AS). Autonomic refers to the autonomic nervous system (ANS) which regulates unconscious activities of the body. AS refers to different ANS activity with specific emotions.

Levenson (1992) states that 'following decades of controversy and uncertainty, there is now sufficient empirical basis for asserting the existence of a limited set of autonomic differences among emotions.' Support for AS is found in the metaphors we use to refer to emotions. For instance, heat is associated with anger while coolness is associated with fear. Levenson (2003) explains that the differences in the metaphorical language of anger and fear concur with consistent empirical findings of peripheral vascular differences between the two emotions.

In a study that supported AS, Levenson, Ekman and Friesen (LEF; 1990) refer to the functionality of emotions and their associated physiological needs:
If fear is primarily associated with fleeing, it would be functional for blood flow to be diverted away from the periphery and redirected toward the large skeletal muscles. This would be consistent with the decrease in peripheral finger temperature that we found for fear. Similarly, anger, with its close association with fighting, might recruit increased blood flow to the muscles of the hand to support grasping weapons and opponents. This would be consistent with the increase in peripheral finger temperature that we found for anger.
LEF raise an interesting theoretical issue. Is there different ANS activity associated with different behavioural responses/motor programs which are associated with the same emotion. They refer to freeze and flight associated with fear. A more salient example is fainting which is associated with fear. How does the activation of a physiological response which is evolutionarily designed to mobilise our bodies for action result in the complete opposite behaviour - fainting?

The ANS is made up of the sympathetic nervous system (ANS) and the parasympathetic nervous system (PNS). The SNS is geared towards mobilising energy and to dealing with the environment, whereas the PNS can be seen as geared to establishing and conserving energy reserves. The SNS is often described as the fight-or-flight system while the PNS is described as the rest-and-digest system.

Ortony and Turner (1990) suggest situations in which actions such as flight or attack are desirable and possible, appear to produce physiological responses indicative of SNS activation, whereas situations where escape is highly desirable but impossible tend to be dominated by PNS activation. Frijda (1986) explains that stimuli that increase sympathetic activity tend also to increase parasympathetic activity, only less so. Fainting from fright, he explains, is a result of an increase of parasympathetic activity so that it comes to dominates sympathetic activity. He suggests that there seems to be a relationship between parasympathetic dominance and the inability to respond, which corresponds with Ortony and Turner’s observation.

The image reproduced at the top of this blog is Schauer and Thomas's (2010) defence cascade. It shows SNS dominance for the first half of the cascade, which includes fight or flight, and PNS dominance for the second half of the cascade, which includes fainting. All associated with fear.

A more extreme example is being scared to death. Cannon (1942) reviewed numerous reports of voodoo death in primitive cultures. In a typical case, a previously healthy person is cursed by a chief or medicine man and the victim quite literally dies a death from fear within hours or days. Cannon attributed the death to overstimulation of the SNS, however Richter (1957) has shown the PNS is to blame for these deaths.

Siddle is described as being an internationally recognised authority on use of force and the effects of survival stress on combat performance. Those who refer to fight-or-flight or stress in activities associated with preparing a person to survive a violent encounter are, in fact, referring to Siddle's work. His ideas have come to take on the authority of commonly conceived wisdom or popular theory. Whether those in the aforementioned activities acknowledge of even know the source of their insights into the physiological response is another matter.

Grossman is described as being one of the world's foremost experts in the field of human aggression adn the psychology of combat. His much lauded On Combat describes the psychology and physiology of 'deadly conflict'. His physiological explanation comes direct from Siddle. Siddle is referencing stress theory. Stress theory refers to one stress response. What is an underlying assumption when using the stress/fight-or-flight response to understand the physiological response to a threat in a violent situation? That the feeling response is fear. What if the feeling response is anger? In fact, Cannon, the author of the fight-or-flight concept associated the flight response with fear and the fight response with anger. AS tells us that there is a different physiological response with both emotions. Rather than the fight-or-flight response, stress response, or survival stress response, maybe it should be referred to as the fear response. In fact, Grossman does specifically associate his physiological discussion with fear.

Siddle states that PNS is 'dominant during nonstress environments where an individual perceives he/she is safe.' Grossman refers to 'parasympathetic backlash' and only discusses PNS activity in relation to its activation after combat has been completed. They both focus on SNS activity, not surprisingly given the source of their insights lay within the stress discipline. Based on Schauer and Thomas's defence cascade, they are only describing one half of the cascade, one half of the evolved stress responses associated with fear, for one emotion, fear.

Our evolved survival mechanism is more complex than this one-half-one-emotion response. Siddle and Grossman, and those referring to their work, would appear to be like one of the blindmen of Indostan who attempt to describe an elephant by touching only one part of it. This is a reflection of the reference only to stress theory.

Lazarus (1993) suggests: 'Use of stress as a source of information about an individual's adaptation to environmental pressures is extremely limited compared with the use of the full array of emotions.' This is most definitely true in relation to our evolved survival responses.

Does fight-or-flight need updating? Definitely! My work, presented in Beyond Fight-or-Flight, integrates stress theory and emotion theory to provide a more complete understanding of our evolved survival responses. This forms the basis for understanding our learned survival responses as well. This work is unique in that no other author has attempted to integrate the theory of these two disciplines for this purpose.

Monday, October 24, 2011

Survival Scores Research Project

The U.S. Federal Law Enforcement Training Center (FLETC) provides training to law enforcement personnel from numerous federal, state, and local agencies. A law enforcement officer's survival requires that he or she is able with to quickly assess a situation and respond with appropriate actions in dynamic, life-threatening, time-pressured situations that are likely to be encountered in carrying out their duties. A research program was initiated to examine the extent to which stress training can better prepare law enforcement officers to perform under highly stressful conditions. Initial results from the research program have been reported in a technical report entitled the Survival Scores Research Project (FLETC 2004).

The report refers to an FBI report for the year 200 which 'provides some alarming statistics in the area of officer survival':
The number of law enforcement officers feloniously killed in the line of duty was up 21.4 percent from the previous year’s number – 51 officers were slain in 2000, and 42 officers were killed in 1999.

Slightly more than half (53%) of the felonious shootings took place at a distance of 0-5 feet, and 70% were at 0-10 feet. These close range killings are also representative of the ten-year period for 1991 – 2000.

Body armor appears to provide minimal protection in close range shooting scenarios, as 29 of the 47 (62%) slain officers wore protective clothing.
When discussing the requirement to train law enforcement officers to perform under stress:
A Department of Justice report on 40 attempted shootings of officers found that victim officers returning fire averaged a hit on their target 41% of the time, while the offenders achieved a 91% hit rate. Of course, each of these officers was reacting to being shot at (the majority were actually shot), and under severe stress ... Preparing individuals for such moments is among the challenges law enforcement trainers face.
FLETC researchers developed a scenario designed to replicate real-world law enforcement situations. One of the scenarios was 'gun take-away and shout-out':
Maximum levels of arousal were achieved as the scenario deteriorates with the return of the theft suspect, an escalating argument, and the decision by the 'senior partner' to remove the hostile theft suspect from the building. The 'senior partner' has his weapon taken and is shot by the suspect, who then takes the complainant hostage which he also shoots. Stress is further escalated by loud music limiting communication, the sound of a loud, barking dog in the adjoining room, very close quarters and very limited cover. The exit is blocked by the downed 'body' of the 'senior partner.' The suspect (a firearms instructor) has cover and produces a shotgun (simunitions) which he uses in conjunction with the downed 'senior partner’s' weapon to fire at exposed parts of the trainee with simunitions rounds. The trainee’s third round in the magazine in the weapon provided has been altered to not fire, forcing the trainee to respond to the development. The suspect is either shot by the officer and eventually falls, or commits suicide if the officer does not disable the suspect.
What were the results? 'Overall, performance deteriorated, as expected, and only 28.2% performed well enough to pass this event.'
Popular theory has long held that a loss of fine and complex motor skill could be observed as a result of high stress levels. The trainees observed in this study did not appear to be unable to perform fine and complex motor skills as noted when weapons handling skills were evaluated. Rather, they seemed to perform them in the incorrect sequence or perform the wrong function all together, thereby producing a 25.8% success rate.
The popular theory to which they refer is Bruce Siddle's theories first espoused in Sharpening the Warrior's Edge. His ideas appear to have taken on the authority of popular theory or commonly conceived wisdom. Many in activities associated with preparing a person to survive a violent encounter who refer to these theories often are unaware of their origins, and their limitations.

In Performance Under Stress (Hancock and Szalma 2008), in the contribution concerning Stress Exposure Training, Driskell et al refer to the FLETC research project. They explain that 'weapons handling skills were seriously degraded as trainees were unable to perform complex motor skills ...'. This observation appears to be at odds with the authors of the FLETC report.

Siddle's thesis is that as combat stress increases, a survival stress response is initiated which has 'catastrophic' effects on cognitive and motor performance. He suggests that 'fine and complex motor skills begin to deteriorate when the working heart rate accelerates beyond 145 beats per minute.' The trainees heart rate approached but did not exceed 140 bpm.
These scores show a majority of the trainees made poor tactical decisions as to courses of action, did not effectively resort to more advanced/complex and less utilized re-loading methods, could not perform a sequence skill under stress, did not employ tactical movement concepts of 'shoot and move', and did not use the instructed kneeling position behind cover.
The shot placement data was interesting, if not disturbing:
Overall performance in this element showed a 28% passing rate. Analysis determined only 3.4% of the trainees demonstrated 70% accuracy or better when all rounds expended during the engagement were considered. Only 19.4% of all rounds fired hit the suspect who was approximately 3 yards from the trainee. In addition to shots going low, trainees scored poorly in applying fire to center mass or available center mass. Approximately 20% shot the hostage. The only performance item in the upper 50 percentile was proper clearing on the weapon, with 63% passing this element.

Of note was the statistically significant difference in overall shot placement scores by gender. 94.74% of females failed the shot placement element, while 66.25% of males failed. Further analysis was conducted to examine firearms qualification scores achieved during training. Once again, a statistically significant difference was, observed (as expected), with females averaging 248 compared to 273 for males. These data would suggest that a lower degree of accuracy in a static training environment may translate into a lower level of accuracy in a dynamic environment.
One of the research questions was: 'Can specific psychological factors be identified that predict performance in a highly stressful law enforcement encounter?' In their discussion they suggest, 'the relationship of psychological factors to performance in a high stress encounter will require further examination.'

This is the basis of my work in Beyond Fight-or-Flight: Surviving a Violent Encounter (an extended title I'm trying out). Our survival mechanism includes an appraisal process and a subjective feeling, physiological, motor expression, action tendency, and behavioural response. These are all highly interconnected. The stress discipline studies this mechanism in a limited and biased way reflecting their disciplinary interest. Another discipline, the emotion discipline, studies the same process but in a more complete, survival focused, way. Integrating the theories and concepts of the two disciplines, as I do, provides a more complete understanding of our evolved survival mechanism. It also provides the basis for understanding all of the methods developed by those activities associated with preparing a person to survive a violent encounter. These methods are interventions in the survival process.

When differentiating between physical stress and psychological stress, albeit without the benefit of an explicit understanding of the difference, they suggest that, 'training under psychological/emotional stress will better prepare the brain to perform under those conditions when the need arises versus having trainees exercise. The focus should be in the process of how the stress is created (the stimulus), rather than in the product of how the stress is measured (the response). I agree, to a point. The first step should be to understand our survival process. This then would lead to an appreciation that the appraisal process and subjective feelings are the important elements in the process. The stress discipline tends to focus on the physiological response. This is reflected in Siddle's focus, and the focus of the FLETC research program.

In The Definitive Textbook for Military and Law Enforcement Reality Based Training, Murray refers to the FLETC research program. He suggests that 'trainers must have the knowledge and skills to decode student behaviour to achieve optimum results.' I agree, but I don't believe the knowledge is available when only stress theory is referred to in connection with a person's survival response. This is the basis of my Beyond Fight-or-Flight.

Tuesday, October 18, 2011

Lemme See Your War Face

In one of the first scenes in Full Metal Jacket, Gunnery Sgt Hartman explains that he will be the marines drill instructor. One recruit, who Hartman nicknames Pvt Joker, makes a poor attempt at humour. When Joker picks himself up off the floor following Hartman's punch in the stomach, Hartman yells the following:

Hartman: Pvt. Joker, why did you join my beloved corp?

Joker: Sir, to kill, sir.

Hartman: So you're a killer?

Joker: Sir, yes sir.

Hartman: Lemme see your war face!

Joker: (confused) Sir?

Hartman: You got a war face? (He gives Joker an angry face and screams) Aaaaaaaaah! That's a war face. Now lemme see your war face.

Joker: (Grimaces as best he can and screams) Aaaaaah!

Hartman: Bullshit. You didn't convince me. Lemme see your real war face.

Joker: (Screaming even louder and with more grimacing) Aaaaaaaah!

Hartman: You don't scare me. Work on it!

What is going on with the war face? The obvious answer is an attempt to intimidate an opponent or adversary. This is reflected in Hartman's comment concerning scaring him. Is there anything more going on with the war face?

Within the emotion discipline, emotion is considered to be a hypothetical construct denoting a process of a person's reaction to significant events which is comprised of several components: physiological arousal, motor expression, action tendencies, and subjective feelings. All of these components are highly interconnected.

There is evidence that trying to regulate or control one component of emotion may have immediate consequences for another component, illustrating the extreme interconnectedness of the components during emotion episodes.

Proprioception refers to the capacity of internal organs to provide sensory information about changes in the body. Proprioceptive feedback refers to changes in one internal system upon detection of changes in another system. One recent version of propreoceptive feedback notions is the so-called facial feedback hypothesis (FFH). FFH is the notion that inhibition or amplification of facial expression of emotion will modify the intensity and possibly the nature of subjective feeling.

In a widely discussed paper, Ekman, Levenson and Friesen reported evidence that the induction of particular motor expressions may not only amplify feeling state but actually create a specific emotion as indexed by differential physiological responses and verbal feeling reports without any other kind of stimulation. There was a tendency for the actors to feel the emotion whose facial signs they had unwittingly produced in their face.

Smile, and you will feel happy.

Is putting on a war face an attempt at managing the emotion - the interconnected physiological, subjective feeling, and action tendency responses - of the warfighter? By putting on a war face, is the warfighter attempting to combat the emotion of fear by replacing it with another emotion? If so, the action tendencies of flight, submission, tonic immobility (a conscious catatonic state), and flaccid immobility (unconsciousness) are avoided. These are avoided in part by the different physiological reactions which accompany different emotions.

If putting on a war face is intended to create a specific emotion, which one is it? Each one has its own physiological response and its own action tendency. Is it anger? Or aggression? Anger and aggression are related, but anger is a negative emotion while aggression is a blend of a positive emotion and a negative emotion. Positive and negative emotions have different cognitive effects. Negative emotions result in cognitive narrowing while positive emotions result in cognitive expansion.

When fight-or-flight, or stress, is referred to within those activities associated with preparing a person to survive a violent encounter, they are referring, knowingly or not, to the theories and concepts of the stress discipline. As Richard Lazarus points out, stress should be considered a subset of emotion. Beyond Fight-or-Flight attempts to, for the first time, integrate the theories and concepts of the stress and emotion disciplines in order to provide a more complete understanding of the methods used to prepare a person to survive a violent encounter.

Wednesday, October 5, 2011

Lethal Technique Dilemma

And yet another one punch death is reported in the press - albeit with a difference.
Tiffany Startz, 21, was charged with felony reckless conduct and battery charges in the death of John Powell, who had accepted a $5 bet to be punched in the face by Startz, police say.
This time, the death did not occur because the deceased hit their head when falling to the ground after being punched.
The impact of the punch ruptured an artery in Powell's neck, causing blood to pool around his brain and leading to his death soon after at Provena St. Joseph's Medical Center in Joliet, said Will County Coroner Patrick O'Neil.
In Forensic Pathology for Forensic Scientists, Police, and Death Investigators, Joseph Prahlow explains that 'a blow to side of the head or face, with the resultant twistings or sideways flexion motion of the neck, can result in a laceration of the vertebral artery' (2010: 322).

This injury can happen. In fact, I read a forum comment discussing this case in which a contributor stated that he was taught a technique in Shotokan karate that is designed to achieve this fatal effect. This injury is rare, but it does happen.

In a previous blog titled 'Neck Holds - Lethal Weapons', I referred to Donald T. Reay, M.D. and John W. Eisele, M.D. who published an article titled 'Death from law enforcement neck holds' in The American Journal of Forensic Medicine and Pathology in September 1982. In their conclusion they state:
Because of the structures involved, neck holds must be considered potentially lethal under any circumstance and used only when there is no other alternative. Use of neck holds must be viewed in the same way as firearms; the potential for a fatal outcome is present each time a neck hold is applied and each time a firearm is drawn from its holster. The neck hold differs in that its fatal consequence can be totally unpredictable. ... its use should be restricted to those situations where the officer or another person's life is in immediate danger. ... It must be viewed as a potentially fatal tactic and reserved to situations which merit its risk.
Should punches to the head be viewed as lethal techniques? The potential for a fatal outcome is present every time a punch to the head is executed, as evidenced by the weekly, if not daily, reporting of one punch deaths.

Here is the dilema. If Reay and Eisele's logic is followed, and punches to the head are viewed as being lethal techniques, then lethal force may be legitimately used to defend oneself in those circumstances. As martial arts/self defence instructors, we cannot teach one without the logical conclusion of the other. We cannot teach that a punch to the head is potentially lethal every time it is employed without the logical conclusion that the student may be fighting for their life when someone is attempting to punch them in the head. This could go against current law and be seen as excessive force.

There are many interesting aspects to this tragic case. For instance, those who advocate 'reality-based training' which involves hits to the head; is there a case to be made for them being negligent if an injury such as this occurs? Even when head protection is worn, the injury involves the movement of the head so it can occur whether head protection is worn or not. Is ignorance of the risk of this type of injury a defence? And ignorance of the effects of what is taught within the martial arts is more the rule than the exception.

If you teach that hits to the head can be potentially lethal anytime they are employed, are you morally and/or legally responsible if a student injures or kills someone who attempts to hit them in the head? Are you morally and/or legally responsible if you didn't tell a student these facts and they die after being hit in the head?
Startz's attorneys have argued the charges should be dismissed because the punch was consensual. While they have argued she was an untrained fighter whose fatal punch was a freak accident, Guy said she believes the point of the game was to demonstrate how well Startz, who had punched men at other parties, could hit
Much of the argument revolves around consent. This is a fascinating issue; one which is not as clear cut as one would initially think. Consent has to be informed. The deceased and Ms Startz would presumably have been unaware that a punch to the head can be fatal anytime it is executed. You could argue, in this case, that this fact does not effect the issue of consent, or you could argue the contrary, that you cannot consent to what you don't know.

This raises the question, in the public interest which shapes law, should the fact that punches to the head can lead to fatal outcomes be a subject of public education? Then the dilemma again. Educate the public about the possibility of fatal consequences of punches to the head implies they are fatal techniques and therefore can be defended with the use of fatal force.

Injury science is a relatively new science devoted to the study of injuries (which I have discussed in previous blogs). A maxim of injury science is that there are no accidents. The defence for Ms Startz is suggesting this was an unfortunate accident. Injury science would disagree. I wrote about the Japan Judo Accident Victim's Association campaign against judo deaths in Japanese schools in a previous blog, and a well known martial artist's comment that 'accidents happen'. Injury science would argue that accidents do not happen. Injuries happen, and there are reasons for those injuries happening; and people responsible.

I am most definitely not one of the 'I'd rather be judged by 12 than carried by 6' macho-infused instructors. The martial arts teaches serious, life affecting tactics and techniques. Life affecting for both the student and any potential adversary. It behoves martial arts instructors to understand the consequences of their teachings. We are not teaching a sporting activity, even when we are teaching martial arts as a sport. The techniques can injury and kill, even on the mats.

Monday, October 3, 2011

'PTSD may be a learned response; key to survival'

I'm working on my book tentatively titled Beyond Fight-or-Flight.

The basic premise of this book is that those in activities associated with preparing a person to survive a violent encounter who refer to fight-or-flight are referring to the theories and concepts of the stress discipline. This is evidenced in combat training methods described as stress training, stress inoculation training, and stress exposure training.

When stress is defined as a process, the stress discipline is interested in our evolved survival process. However, they are only interested in a biased form of it and only in certain parts. Another discipline, the emotion discipline also studies the same process but with a more complete understanding of this process and without the same bias. I'm integrating the theories and concepts of the two disciplines to obtain a more complete understanding of our evolved survival mechanism which is embedded in a survival process. One of the benefits of this approach is that it offers hitherto possibilities of managing the survival reactions when involved, and after involvement, in a violent encounter.

'PTSD may be a learned response: key to survival' is the title of an article included on the Defense Centers of Excellence for Psychological Health website.
But is [PTSD] a disorder? Maybe not. Perhaps it is a a normal adaptation to the battlefield and a key to their survival.

First, remember that a psychiatric diagnosis is usually a syndrome, not a disease. Strep throat is a disease. We know a specific cause, test, treatment and cure. Psychiatric diagnoses, however, are made based upon a group of behaviors, characteristics and personal experiences.
Very interesting idea.

Post traumatic stress disorder, OR, post traumatic stress response? Maybe, post traumatic survival response. The comments to the article thank the author for explaining to the general public that they are not 'insane' or have a mental defect. The words we use to describe things have meaning which effects behaviour. Combat Stress Injuries: Theories and Research by Figley and Nash suggest that using the term combat stress injuries will lead to warfighters being more likely to seek help. An injury is something sustained and has no stigma. A mental disorder is stigmatised and is a sign of weakness.

Referring to post traumatic survival response is not just about spin, it is also a more accurate reflection of what is going on. The survival mechanism was switched on for combat. It helped in survival, which is what it is evolutionarily designed to do (despite the reservations of those involved in activities associated with preparing a person to survive a violent encounter who, unknowingly, refer to the theories and concepts of the stress discipline). After the violent encounter, the survival mechanism is not switched off in the case of PTSD/PTSR. This is a learned response. Much the same as learned helplessness which was the subject of the past two blogs. Understanding the true nature of the condition provides a better means of managing it.