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  • Writer's pictureValerie Brooke, MD

The 4 F's - Flight, Fight, Freeze, Fawn

When I first heard someone mention the “4 F’s,” I immediately thought of the swear word, wondering what other words starting with F would be expletive, eager to expand my choices of expression when upset about something.  Alas, while fight, flight, fawn, or freeze likely dump the same type of stress hormones into the bloodstream as whatever would cause one to say F***ck!!!, these four F words,  fight, flight, fawn, or freeze, have much more depth and nuance. 

I am one that does not believe in coincidences, so it was not a surprise to me when multiple different teachings about the 4 F’s popped into my life in the same week.  It was as if the universe was offering up these teachings to me on a platter, so I dove in and took a large bite by immersing myself in these concepts.  The first lessons came from a book I’m listening to on Audible: The Body Keeps the Score, by Bessel Van Der Kolk, MD.  It’s about the neuroscience of trauma–how it affects the brain, body, and mood, and how to heal from it.  Now while I have not experienced the type of trauma Van Der Kolk  refers to in the book–war, rape, massive natural or man-made disasters, severe abuse or childhood neglect, I have, like most humans I imagine, experienced my own “little traumas.”  More notably, I spend all day at my job taking care of patients and families that are steeped in trauma, which causes my own secondary trauma. So, I’m learning a lot about the science behind trauma response, what it looks like and what happens in the brain when someone is experiencing flight, fight, freeze, or fawn. 

Most people understand the concept of flight or fight, an ancient brain stem response designed to keep us alive. See a lion, run!  If you can’t run, fight!  And if you can’t run or fight, lay down and play dead–freeze. Fawn is a newer concept added to the repertoire of trauma responses, and while it may not apply to being attacked by a lion, it may come in handy when trying to calm down a potential human attacker you are unable to fight, run from, or freeze as a way to survive.  Fawn is when one tries to please others at the expense of their own needs, tries to avoid conflict at all costs, which translates into difficulty having boundaries and saying “no.”  This concept of fawning, or tend-and-befriend, came to light by a Bazaar article from 2018 by Marissa Korbel entitled "Sometimes You Make Your Rapist Breakfast." Sometimes the only way to preserve your life is to befriend your attacker.

The second teaching  regarding the 4 F’s came from a book I finally dusted off, took down from my shelf, and started to read.  It’s Stephanie Foo’s What My Bones Know, a memoir about a woman’s healing from complex post-traumatic stress disorder, or C-PTSD.  Her story is difficult to read and will bring Mommy Dearest movie images to mind, a movie based upon a memoir by actress Christina Crawford detailing the alleged abuse she experienced from her adopted mother Joan Crawford. (trigger warning: If you haven’t seen that movie, there’s a horrible scene involving a wire hanger).  Reading Foo’s memoir while also listening to Van Der Kolk’s book–which of course Foo herself mentions in her memoir–brings the concepts of trauma to life, putting a real human face on neuroscience. 

The third teaching regarding the 4 F’s came from an inservice at our rehabilitation hospital recently, a presentation on the polyvagal theory of the autonomic nervous system, and how it applies to the patients we care for.  Most of our patients are in the sympathetic overdrive of fight or flight response, having just survived a stroke, a spinal cord injury, a brain injury, an amputation, or another life threatening event. This makes them–and often their family members– irritable, over-reactive, and sometimes agitated, which leads to poor sleep, decreased immune response and adrenal fatigue (the organ that pumps cortisol into our system in order to run from the lion).  This all leads to impaired healing and emotional distress, not to mention the difficulty to get patients to engage in their physical, occupational, or speech therapy activities–the main reason they are admitted to our hospital in the first place.  We learned about ways to de-activate the 4 F’s and turn on the rest and relaxation, or parasympathetic nervous system, a topic I will address in a future blog entry. Stay tuned!

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