Understanding the Fawn Response

Following up to last week’s post, what is happening when you go along with what a medical provider (or anyone) says/wants/does even though you think/want/know differently?

The short answer, the fight-or-flight (F/F) system activates. To get a broad overview, read my earlier post on the F/F system here.

The F/F system (a system designed to keep us alive) takes over our brain when it perceives we are facing a threat. A system that is fantastic when we are facing a mountain lion. But what kind of threat is a medical provider? For women and BIPOC, a big threat. Due to the systemic sexism and racism built into our western medical system, women and BIPOC often do not receive the same level of care as men or white people.

Possom

Origin of fawning

In school, most of us learn about the F/F stress response but never hear about the fawn aspect of that response. The person credited naming the fawn response is a psychotherapist out of California, Pete Walker, who wrote the book Complex PTSD: From Surviving to Thriving.

Fawning is basically when you attempt to please the threat. I usually give the example of possums playing dead or humans
playing dead when facing a brown bear. When the threat assumes you are dead, it becomes appeased and moves on because you are no longer a threat to it.

This same behavior shows up with people pleasing. If the person likes you because you are amenable and easy to get along with, that person becomes less of a threat to you. A study done in 2020 out of Israel showed that a history of trauma results in people’s nervous system going straight to a fawn response.

Fight or Flight Ladder

Flee

Another way I explain the F/F system is as a ladder. When faced with a threat, the first option your nervous system will want you to do is to flee. If a dinosaur was running down the street, you would start running the other way. Every once in a while, there will be a social media video featuring random people seeing others start running in one direction, and they too will begin running. This is because your nervous system decided to interpret the behaviors in others as evidence of a threat and encourage you to run too.

Fight

The 2nd behavior your nervous system will choose if running is not a viable option at the moment, is fight. I specifically say “at the moment” because the F/F response will constantly be trying to find an opportunity to run. An example of this is say a mountain lion drops onto the path behind you. You cannot outrun a mountain lion. So, your F/F response is going to send you the energy and chemicals you need to punch, kick, bite your way out of this threat.

Dinosaur Scaled

Fawn

The 3rd behavior is fawn, which shows up if you can’t fight your way out of the threat. I have a hypothesis as to why we are seeing more fawn responses than fight responses to day-to-day threats, such as interactions with a medical provider, at work, sometimes in our relationships. I think as we move away from accepting a physical response (i.e., fight) we are leaving people with either flee or fawn, and most of us can’t easily flee our jobs, our homes, or the medical system. Every day I reframe my clients’ stories within the fawn response. Some of those stories start out with a client frustrated that they didn’t stand up for themselves, and others are stories of sexual assault and the client is blaming themselves because they didn’t say no or fight back.

When it comes to women, fawning is an important piece of the puzzle. As a culture, we often label fawning as selflessness, caring, and kindness. We reward girls for being amenable and nice. If you are doing something nice for someone in hopes they are please, less scary, won’t remove privileges, you are fawning.

Now, I want to stress, that fawning is a completely acceptable response to a threat and is by no means less valuable than fleeing or fighting. It is keeping you safe. However, if you see yourself in these examples, I encourage you to work with a mental health provider to understand why you are feeling threatened and if you can do something about it.

Play Dead

The Tale of the Two Pre-Op Nurses

Returning to my story from last week, why did I just go along with the pregnancy test? Because appeasing the 2nd pre-op nurse was the safest thing for me to do. The threat at that moment wasn’t necessarily the nurse, it was the hospital system in general. I was cornered. It was Dec 30th, the final day of the year the hospital was having scheduled surgeries. What if me refusing the pregnancy test was escalated to the point that someone decided that unless I did it, my procedure couldn’t happen. And if my procedure couldn’t happen that day, I was going to have to pay my deductible all over again when it was rescheduled. So, I fawned. I placated the system because in that moment, fighting the system wasn’t an option for me. And that is okay because maybe next time I can fight or maybe next time, I don’t want to risk care being pulled from me, and I will fawn again. Regardless, my fawning isn’t a character flaw that I am to be blamed for, but rather, evidence I am interaction with a system that feels threatening to people like me.

What about the fawn response speaks to your experience?

Any information provided about medical matters is purely educational and the author is not a medical professional and is not recommending any specific intervention for any specific person or giving medical advice. Please consult your own medical provider for information about your own situation

This blog post is for informational purposes only and does not create any type of therapeutic relationship. For specific assistance, please consult your own medical and/or mental health provider.

Why You Don’t Speak Up…The Tale of Two Pre-Op Nurses

Female Patient Alone

A colleague and I were talking about the medical system and how we have found ourselves in the very situations we coach clients to advocate for themselves, and yet walked out of those situations simply going along with the situation rather than challenge the provider. So, what is going on here?

Let me take a step back and tell you the story I like to title, The Tale of Two Pre-Op Nurses. I am guessing this story will resonate with many women and their own experiences. The medical system seems to know nothing about female anatomy or hormones, a topic I would love to get into in a later post.

The Tale of Two Pre-Op Nurses

In late 2020, I had two procedures, three months apart. The same surgeon, the same hospital. The procedures required me to be under twilight, or conscious, sedation. Most people experience this type of sedation when they get wisdom teeth removed or have a colonoscopy. Since the procedure involved anesthesia, I was asked upon each check-in if it was possible I could be pregnant. Both times I explained I had an IUD.

IUD Effectiveness and Ectopic Pregnancies

According to article after article about IUDs, they are 99+% effective in preventing pregnancy. The only more effective birth control for sexually active individuals is a vasectomy. If someone would become pregnancy with an IUD, they are at 3-5 times more likely to have an ectopic pregnancy. An ectopic pregnancy is when the fertilized egg implants in the fallopian tube rather than the uterus. Early signs of an ectopic pregnancy are vaginal bleeding, dizziness, and pain. Pain in the lower back, pelvic pain, pain in the shoulder.

I explain all of this because I have been trying to prevent pregnancy for 20 years with a 100% success rate. And if on the tiny chance I could be pregnant, there is a high risk of ectopic pregnancy, which would not only cause me pain, but would not be a viable pregnancy. Meaning anesthesia would not be a risk to the fetus.

Procedure 1

The pre-op nurse I had for the first procedure was a woman, seeming in her 50s. She revisited the question about whether I could be pregnant. When I explained I had an IUD for two years, which is easily verifiable in my medical records because I use the same hospital system for my primary care services too. That nurse explained that they usually require a pregnancy test in pre-op for any woman who could possibly be pregnant but since I had an IUD, she didn’t think it was necessary. And I went on my merry way into the surgical suite and under twilight anesthesia, a place, apparently, I tell very inappropriate jokes.

Procedure 2

Three months later, I was scheduled for the 2nd procedure because the first one was not successful. Since the healthcare system was overloaded in late 2020 and messages and follow-ups were dropped, my procedure was scheduled December 30th, the last day the hospital was scheduling surgeries for the year. This pre-op nurse was male and probably in his late 20s. He explained I needed to take a pregnancy test. I explained back that I had an IUD and I kid you not, he just stared at me and told me it was required. I told him that I wasn’t pregnant. He repeated that it was required. Since I needed this procedure done prior to the start of the new year and before my health insurance deductible restarted, I wasn’t in a position to risk the procedure not happening. I told myself I wasn’t paying for the test, and all I had to do was pee in a cup. My attitude and mood must have been very evident because a different pre-op nurse showed up for the rest of my stay. Except, just before going back to the surgical suite, the original nurse returned to tell me my pregnancy test was negative. I looked at him and replied, in a deadpanned tone, “Shocking.”

I know there are probably some readers who are nodding their heads and thinking of their own stories. And there are probably other readers who don’t understand why this was such a big deal when it didn’t really cost me anything. Regardless, it highlights is how much medical providers don’t understand female anatomy or their own science! The first nurse was able to use her critical thinking skills and determine a pregnancy test wasn’t necessary. The second nurse, I would venture to guess, had no idea how IUDs worked! How many other things are women subjected to because we don’t understand, much less teach, medical providers basic female anatomy.

Fawn Response

But the point of this story was to explore what is happening with my nervous system and my fight-or-flight response when I knew I wasn’t pregnant but let someone who I perceived had power over me, push me into taking a pregnancy test. It was the fawn response. And next week, we will look at how the fawn response shows up when we feel threatened.

Do you have an experience in which you felt pressured by a medial provider to go along with something you know was a waste of time or unnecessary? Post it in the comments below.

Any information provided about medical matters is purely educational and the author is not a medical professional and is not recommending any specific intervention for any specific person or giving medical advice. Please consult your own medical provider for information about your own situation

This blog post is for informational purposes only and does not create any type of therapeutic relationship. For specific assistance, please consult your own medical and/or mental health provider.

What is PMDD and why it should matter?

Due to the type of clients I specialize in working with, I tend to hear about issues caused by female sex hormones. Most of the time it is PCOS (Polycystic ovary syndrome), a topic I plan to dive into in a future post. But recently, PMDD was mentioned, and I wanted to research it so I better understood it.

The medical community describes PMDD (Premenstrual dysphoric disorder) as a severe form of PMS that can cause physical and emotional symptoms severe enough to interfere with work, school, and social activities. I have an issue with this, because throwing PMDD in the same category as PMS can, and probably does, result in it being dismissed, ignored, or talked down about by medical providers. PMDD is more than just PMS, and it is not simply “being moody” or “PMS on steroids.”PMDD is a real medical condition that affects an estimated 3%-8% of women of childbearing age.

Confused Doctor

PMDD has been found to run in families, suggesting that there may be a genetic component. However, the exact cause of PMDD is unknown and not surprisingly, there is no cure. So, what is it?

PMDD, what is it?

The first thing I noticed in the research was the medical community has no idea what causes PMDD. I was not surprised by this, sometimes I think we know more about space than we know about the impact of female sex hormones. According to the article I found on the John Hopkins Medicine website, the medical community’s currently theory is PMDD is an abnormal reaction to the hormone fluctuations that happen within the menstrual cycle, particularly that the hormone changes result in a serotonin deficiency. Serotonin impacts mood, sleep, digestion, sex drive, etc.

Symptoms of PMDD

What does PMDD look like? Again, citing the John Hopkins Medicine website, they have a list of common symptoms. That list has 49 symptoms!!! And all the symptoms listed could and are symptoms of other things. You can see the full list here, but I will at least list the categories the symptoms are broken down into: psychological, fluid retention, respiratory problems, eye complaints, gastrointestinal, skin problems, neurologic and vascular, and other.

Seratonin

Diagnosing PMDD

How do you know if you have PMDD? If I read between the lines, most medical providers kick patients over to mental health providers because of the litany of psychological symptoms. Since PMDD is a result of hormone fluctuations and mental health providers can’t run tests on your hormones, I am guessing most people aren’t ever actually diagnosed with PMDD. However, there are some criteria to diagnosing PMDD, which is listed in the DSM (Diagnostic & Statistical Manual of Mental Disorders), which reinforces the idea that this is a mental problem and not the actual problem, which is hormonal, but I digress.

To diagnose PMDD, over the course of a year, five or more of the following symptoms must be present during most menstrual cycles (this confuses me because anyone not on hormonal birth control are perpetually in a menstrual cycle, this term is not restricted to the phase of the cycle in which you have your period…):

  • Depressed mood
  • Anger or irritability
  • Trouble concentrating
  • Lack of interest in activities once enjoyed
  • Moodiness
  • Increased appetite
  • Insomnia or fatigue
  • Feeling overwhelmed
  • Physical symptoms including bloating, breast tenderness, headache.

These symptoms must also disrupt your life or work.

Confused Doctor

Treating PMDD

What are the PMDD treatment options? As I mentioned earlier, there is no cure. Reading over the list of treatments that can help reduce the symptoms, I don’t see anything that suggests any solid research went into the treatment, but rather, it is a list everyone should follow to be a healthy adult and to simply treat a multitude of disorders. I can also see how they are treating the symptoms versus the disorder itself:

  • Increase protein and carbs, decrease sugar, salt, caffeine and alcohol
  • Regular exercise
  • Stress management
  • Vitamin B6, calcium and magnesium
  • Anti-inflammatory meds
  • SSRIs (depression medication)
  • Birth control pills

So, in a nutshell, if you haven’t already put it together, PMDD sounds like a nightmare and one that is ignored because it’s a “women’s issue”, which means no research money and is blamed on stress. Telling women that all their physical struggles are a result of stress in the modern-day equivalent of telling women 100 years ago their issue was hysteria.

Sources:

Premenstrual Dysphoric Disorder (PMDD), John Hopkins Medicine

Serotonin, Cleveland Clinic

Any information provided about medical matters is purely educational and the author is not a medical professional and is not recommending any specific intervention for any specific person or giving medical advice. Please consult your own medical provider for information about your own situation

This blog post is for informational purposes only and does not create any type of therapeutic relationship. For specific assistance, please consult your own medical and/or mental health provider.

New Approaches to Pain Management

This post is the fourth in a series of 4 posts about chronic pain.

To read the other posts in the series use the links below:

What is chronic pain?, published July 11, 2022

Why we should view pain as a disease, published on July 18, 2022

How emotions influence pain, published on July 25, 2022

Double Helix

Genes and Pain Signaling

There are people who don’t feel any pain. Women who can give birth without discomfort during delivery. A 10 year old boy who could push daggers into his body without hesitating due to anticipating pain. Studies into this group of people discovered a mutation in a gene called SCN9A, a gene that scientists know is involved in pain signaling. The SCN9A gene makes a protein that helps transmit pain messages to the spinal cord. This protein is labeled Nav1.7. The mutation in SCN9A results in a malformed Nav1.7 which causes the pain messages to not be forwarded to the brain.

The opposite can also happen, in which the Nav1.7 protein allows too much information to be sent to the brain, leading to some people to experience a burning sensation on their hands, feet, and face, and is known as man-on-fire syndrome. Learning that Nav1.7 is basically the gate keeper of pain messages being sent to the brain has helped researchers focus on developing new pain medications.

VR as a Pain Treatment

There is new research that suggests people can experience reduced pain while playing a virtual reality (VR) game during surgery, minimizing the need for anesthesia. Another study into VR shows that it can help regulate the body’s responses to pain and improve mood. In general, research has shown that distractions and calming environments increase our tolerance to pain sensations

Venom as a Pain Treatment

Other researchers are collecting venom from some of the world’s deadliest animals, hoping to find a replace opioids as a pain treatment. A drug for chronic pain, Ziconotide, was derived from the venom of the cone snail.

Talk Therapy as a Pain Treatment

Knowing that how we perceive pain and our emotions connected to that pain can influence the pain sensation, research suggests the placebo effect highlights that the pain sensation isn’t just about physical injury, but our expectation, fear and anxiety that comes along with pain that influences how we perceive the sensation. Mental health approaches, such as Cognitive-Behavioral Theory (CBT) helps patients challenge their automatic labels and meanings they place on pain sensations.

Most of the research for this post came out of the January 2020 issue of National Geographic.

Vr Patient
UV Scorpion
Talk Therapy

Any information provided about medical matters is purely educational and the author is not a medical professional and is not recommending any specific intervention for any specific person or giving medical advice. Please consult your own medical provider for information about your own situation

This blog post is for informational purposes only and does not create any type of therapeutic relationship. For specific assistance, please consult your own medical and/or mental health provider.

How emotions influence pain

Walking On Beach

This post is the third in a series of 4 posts about chronic pain. To read the other posts in the series use the links below:

What is chronic pain?, published July 11, 2022

Why we should view pain as a disease, published on July 18, 2022

New approaches to pain management, published on Aug. 1, 2022

At first glance, the pain transmission system seems straight-forward. You experience a sensation upon your body, the nerves within your skin send signals via the central nervous system, alerting your brain to possible risk of injury if not addressed. Your brain begins to send pain signal, encouraging you to pay attention to that area of your body and address any problems. You address the problem, minimizing the risk, and the pain sensation stops

For example, you cut your foot while walking on the beach. The nerve endings in the skin on your foot send the message to your brain that something needs to be addressed. You begin to feel pain in your foot, causing you to investigate why your foot hurts. You see there is a cut, you stop walking, perhaps you put pressure on the cut until it stops bleeding, clean out the wound, apply antibiotic ointment to the area and finally, cover it with a bandage.

 

Bandaged Foot

Outcome 1

But what if the meaning you’ve attached to the wound to your foot changed the pain signal? In the scenario above, your foot may continue

to hurt after you applied the bandage. However, because you know the wound wasn’t deep enough to need stitches, and your past experience with wounds, your brain gives you the narrative “you’re fine” and the pain will subside quickly. You may not even notice the pain unless you begin to pay attention to your foot.

Life Or Death

Outcome 2

What if, in addition to the scenario above, you had just read an article about a person who was forced to amputate their foot due to a flesh-eating bacteria entering their body through a cut on their foot? To the brain, the narrative is that a cut on the foot is now a possible life-and-death situation, and you perceive the pain significantly different because of what it means to the brain.

Amygdala

Emotions and Pain

This is because the pain center of the brain is comprised of several areas coming online when the brain receives signals from the body indicating possible injury. Our emotional brain (amygdala) begins to interrupt how we should feel about the sensation. In Outcome One, some of the emotions may be indifference or even a slight annoyance that you have to stop what you were doing to address the cut on your foot. In Outcome Two, the emotions are drastically different. You are likely feeling terror, or at least fear, triggering your fight-or-flight response. These different emotional responses will also fuel your decision-making process. All of this begins to lay the foundation for the experience we put away into our memories, which the emotional brain will access for future pain sensations.

Our mood and our sense of safety have a huge role in how we experience pain. One study mentioned in the January 2022 National Geographic issue, looks at how much pain a patient feels can be influenced by the relationship the patient has with their doctor. However, the researchers can’t prove why that happens. Above, Outcome One hints at the answer; if you feel safe and your brain has a narrative that you will be fine, it makes sense that you will feel less pain.

Another study in the same National Geographic issue we discussed in the blog post What is Chronic Pain?, looks at the context surrounding the pain sensation. Volunteers had sections of their forearm exposed to brief heat while listening to sad music. The same volunteers received the exact same heat exposure, but the second time, were listening to happier music. Comparing brain scans of the volunteers showed increased brain activity in the areas associated with pain while they were listening to the sad music. Suggesting that sadness increased pain sensations.

Why we should view pain as a disease

Confused Doctor

This post is the second in a series of 4 posts about chronic pain. To read the other posts in the series use the links below:

What is chronic pain?, published July 11, 2022

How emotions influence pain, available on July 25, 2022

New approaches to pain management, available August 1, 2022

Historically, pain as been a problem often ignored by the medical system. Healthcare professionals knew it existed, were helpless to address it, so pain was downplayed as simply the consequence of trauma to the body. If you have ever had surgery, you may remember a surgical nurse asking you what level of pain you wanted to be in after surgery. “None” was not an option because “You just had surgery! You should expect some pain!”

But, what if we began to address pain as a disease and had an expectation that chronic pain should be cured?  One researcher, Clifford Woolf, a neurobiologist at Children’s Hospital in Boston has studied pain for more than 40 years. Woolf believes chronic pain is not simply a symptom of an injury to the body, but a disease caused by a malfunctioning nervous system. In Woolf’s research, he analyzed the activity of the spinal cord when he briefly applied heat to skin. With the heat application, the neurons in the spinal cord began firing. Which we could assume was the nervous system responding, sending pain signals to the brain indicating the risk of damage to the skin.

Nervous System

However, Woolf also found that after the section of skin had been exposed to the heat several times, to the point it became inflamed (the body’s response to injury), the neurons in the spinal cord would fire when the section of, now healed, skin was touched. This suggests the skin became more sensitive, and would begin sending pain signals to the brain, anticipating damage when there was no heat. Researchers have replicated this outcome several times since Woolf’s first experiment, and we now call this finding “central sensitization”.

Central sensitization proves that the nervous system can malfunction and become hypersensitive after an injury. Resulting in pain signals being sent to the pain, long after the original trauma or injury has healed. Or, the pain transmission system simply malfunctioning on its own, for example, in fibromyalgia or neuropathic pain as a result of chemotherapy.

Any information provided about medical matters is purely educational and the author is not a medical professional and is not recommending any specific intervention for any specific person or giving medical advice. Please consult your own medical provider for information about your own situation

This blog post is for informational purposes only and does not create any type of therapeutic relationship. For specific assistance, please consult your own medical and/or mental health provider.

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