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Commentary


Flight, then fight

Vol. 3, No. 6 / June 2004

“Psychological first aid: emergency care for terrorism and disaster survivors” (Current Psychiatry, May 2004) touches on flight, fight, and fright as human reactions to disaster.

Since the Sept. 11, 2001 terrorist attacks, medical professionals have become much more interested in the immediate adverse effects of extreme acute stress and humans’ instinctual response to disaster. “Fight or flight,” a widely used catchphrase, has influenced the understanding and expectations of clinicians and patients for decades.

“Fight or flight,” however, does not reflect the many advances in understanding acute response to stress that have occurred since the phrase was coined in 1929.1 Indeed, as we note in two soon-to-be-published articles,2,3 the phrase is no longer accurate.

Gray described the correct sequence of universal hardwired responses to extreme stress caused by a life-threatening situation.4 Ethologists working with nonhuman primates have clearly established that sequence.

In all mammalian species studied, the urge to flee is the first normative fear response. If fleeing is not an option, the impulse to fight follows. Male and female mammals have demonstrated this response sequence. The belief that man’s first instinct is to fight is probably a misconception.

Thus, “flight or fight” is the proper order of responses. Recognizing this order may help us more effectively treat acute stress in emergency and other clinical settings. Understanding these responses as instinct might also help us ameliorate the guilt that plagues many military veterans who wonder why they fled rather than put up a fight.

H. Stefan Bracha, MD; Tyler C. Ralston, MA; Jennifer M. Matsukawa, MA
Department of Veterans Affairs
Pacific Islands Health Care System
Spark M. Matsunaga Medical Center, Honolulu, HI

Andrew E. Williams, MA
Department of psychology
University of Hawaii at Manoa, Honolulu, HI

Amnona B. Miller, NP
Emergency department
New York-Presbyterian Medical Center
New York, NY

References

  1. Cannon WB. Bodily changes in pain, hunger, fear and rage: An account of recent research into the function of emotional excitement (2nd ed). New York: Appleton-Century-Crofts, 1929.
  2. Bracha HS. Freeze-flight-fight-fright-faint: Adaptationist perspective on the acute stress response spectrum. CNS Spectrums 2004. In press.
  3. Bracha HS, Williams AE, Ralston TC, et al. “Fight or flight”: Does this 75 year-old term need updating? Psychosomatics 2004. In press.
  4. Gray JA. The psychology of fear and stress (2nd ed). New York: Cambridge University Press, 1988.

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