On Catatonia and the Freeze Response

We have a patient coming into therapy who has been diagnosed by an English clinic as catatonic. She freezes up and it can last 8 hours where she cannot move or react. She has no feelings during the episode, just numb. She has stayed in the clinic for eight months while they tried everything they could including art therapy and few booga-booga varieties of nonsense. Why am I mad while I am writing this? Because it is criminal what happened to her. They had no idea what was wrong so they tried a potpourri of all the things that the usual addiction clinic tries. And with the same result: nada.

So let’s look at what it really is: first it needs to be triggered. We are not triggering catatonic; what is triggered is first-line terror, and what happens is one of two responses, both originating in the hypothalamus. The first is attack and aggressive; fighting off menace. The second is the freeze, becoming paralyzed with terror where moving is life endangering; the mother on serious drugs or tranquilizers, for example. Here is where using up oxygen becomes life endangering; the whole system has learned that freezing is the first primal response against danger. And in the first instance where danger lurked it worked. The carried baby may have been reacting to heavy drug overdose or drinking. So some of us, depending on the nature of the early trauma and genetic tendencies admixed with epigenetic effects, find the inexplicable reaction of no reaction as effective. We see this so clearly during the trauma at birth where the baby heavily anesthetized has to withhold breathing deeply to conserve oxygen. These are the later breath holders.

I have seen and helped catatonics at the mental hospital where I worked; most suffered from what is known as “waxy flexibility.” We put their arm up in the air and it stays there. We twist their hands in a certain direction and it remains in that position. They cannot manage any voluntary action. At the time no one, including me, knew what it was. Now we know. And I shall explain it.

Let’s go back to our three levels of conscious; the first line is basically brainstem and ancient part of the limbic system—the amygdala. This is our most ancient brain that has its beginnings millions of years ago. It is a mass of impulses but no feelings; here is where the primitive parts of the hypothalamus exert their dominance. And depending on many factors determines whether there will be either anxiety reaction with aggressive responses (the sympath); or whether there will be anxiety responses held in immediate check as bodily reactions freeze (in the parasympath). These response tendencies get stamped in and engraved so that it directs our characteristic reactions thereafter. The parasympathetic nervous system activates the freeze response everywhere in the system, not just in behavior. Think of the frightened reactions of a deer or rabbit. So something in the human triggers off fear, which then may resonate with first line terror which provokes the parasympathetic system into action—freeze. “Freeze” is a reaction to something that really happened, not a chance or whimsical caprice.

An example: some years ago I was napping in the backseat of the car. The driver looked back to make sure I was comfortable. By the time she looked back to the road she was in a culvert heading for a major steel signpost. She froze. I reached over grabbed the steering wheel and guided us back on the road and to safety. The imprinted reaction governs our life forevermore. My basic tendency was sympathetic but with a lot of parasympathetic reactions as well. The “freezer” usually has low blood pressure and low body temp; she is in the constant conservation of energy mode. She is not a self starter and needs constant direction and guidance. One has to “breathe life” in them to get them going. And why? Because something could have happened during womb-life or birth that diminished oxygen to dangerously low levels. They go on acting as if the imprint is now— current. They go on in a passive mode; go on as if they had no more energy to fight.

Freeze and paralysis is a reaction to anxiety and terror, remember. It doesn’t happen without reason. It is the alarm system that signals the response; we must suss out what the danger is that provoked that alarm reaction. Then we can treat it. And what is the danger? Nothing external; something internal…..sensations (of suffocation) or feelings (something closing in). When the patient who is coming into our therapy gets provoked she goes into the freeze—catatonic response first, for an hour or five. Then slowly as the defense weakens and body lets go of its tension/defense she develops an anxiety state. This is what the freeze response is defending against….not enough oxygen, which produces terror. Then after more time, she seems to be flooded with feelings which causes great frustration. But she doesn’t know what is flooding her. It is now a mélange of feelings liberated. So it is literally the freeze response we see where the person cannot move or speak because she is locked into the deep, brainstem imprint where there is no emotion, nor speech. Her nervous system is moving up the chain of pain, up to higher levels of brain function.