Writings from Christine

How Trauma Impairs the Decision-Making Process

by on May 1, 2019

car accident

It was one of those perfect Florida mornings where the sun was out but not too strong, there was little humidity in the air, and the temperature was in the low 70’s. Added to that was an early spring day where the flowers are blooming, the birds were singing, and everything smelled fresh and alive. I love to take walks and enjoying an early stroll on such a day is wholly satisfying. So, it was shocking when a couple of blocks into my journey, there was a loud bang.

As I approached the noise, I could see two cars entangled with each other. One person remained in the driver’s side of the car visibly shaken and unable to move or speak despite any obvious signs of an injury. The driver of the other vehicle was out of her car but appeared to be having a panic attack saying, “I’m going to pass out”. Another person was yelling at the driver stuck in the car. And yet another seemed to be running away from the accident.

This is not the first time I have been the first to arrive in a crisis. I’m a therapist, not a first responder. I don’t look for these incidents, but they seem to find me. Incidents from a car fire to a building fire, a hit and run, a pedestrian being hit by a truck, multiple car accidents, numerous physical altercations, threats of violence, someone having a heart attack, another person chocking, another threatening suicide, and yet another needing CPR. Life has taught me crisis management so at this moment, my responses were finely tuned and operated automatically.

But that wasn’t the case for the other people in the accident. Each of them experienced a different survival response. When a person is in a crisis, their body goes into survival mode. The preprogrammed automatic responses are hardwired in childhood. The only way to undo an automated response is through intense training like what the military, police, firefighters, and other trained first responders do.

Unfortunately, when a body perceives a crisis, survival mode or the sympathetic nervous system takes over. This in contrast to the parasympathetic nervous system which induces us to a calm, relaxed mode. These two systems make up the automatic nervous system.

When the sympathetic nervous system is activated, heart rate and blood pressure are accelerated, blood flow becomes centralized to equip the body for movement, the digestive system slows, adrenaline is released, and the brain becomes inhibited. The four possible responses in survival mode are fight, flight, freeze, or faint.

Fight: The person yelling at one of the drivers is a good example of this response. The automatic response is to go into attack mode and go after anyone who upsets their equilibrium. Sometimes the response escalates into other abusive behavior such as hitting, throwing things, intimidating, making threatening remarks or asserting undue authority. Fighters try to feel better by taking charge of the situation.

Flight: The person running away from the car accident was fleeing. Instead of engaging, they run away to avoid having to deal with the crisis. This response is often mistaken as a sign of “not caring”. But that is not the case. Fleer’s getaway to regroup and process what has happened.

Freeze: The driver in the car who could not speak was not injured, she was frozen from the event. Often when a person freezes, they are unable to move, speak, or react. They have the “deer in the headlights” look. This sometimes escalates into a prolonged silence for days until the person can regroup and speak again. For those on the receiving end, it can feel like they are being abandoned.

Faint: The driver out of the car complaining about feeling dizzy or wanting to pass out had a faint response. To the person experiencing it, it feels like the body is completely drained, limp, and can’t hold itself up. If they do pass out, this can add to the trauma and even cause a head injury. The best thing to do is have them sit, breathe, and drink some water.

The problem is that when a person is already exhausted, stress, or has another traumatic moment prior to this current response, the nervous system goes into overdrive. It takes anywhere from 36-72 hours for a person to recover from one sympathetic nervous system activation. Each new event restarts the clock. This means the executive functioning part of the brain remains shut down which greatly impairs judgment and decision-making abilities. If a person is already struggling with decision fatigue due to an overload of necessary and unnecessary choices during the day, they are even more impaired.

An so it was with the car accident. The driver who felt like she was going to faint had just left a 12-hour ER nursing shift (this was not her usual position). She was already exhausted and did not notice the light turned red until she plowed into the other car. Added to her stress was the reality that she had cared for several victims of car accidents that night and now she was one of them and so was the other driver.

I never found out why a person ran away from the scene, nor why another person was yelling at one of the drivers. But the incident was a good reminder to me to be extra careful when exhausted or when I’m struggling from decision fatigue.

Posted under: Trauma Writings from Christine

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