Stress and fear will activate the flight or fight response.
The Stress and Fear reaction starts in the brain and spreads through the body to make adjustments for the best defense, or flight reaction. The fear response starts in a region of the brain called the amygdala. This almond-shaped set of nuclei in the temporal lobe of the brain is dedicated to detecting the emotional salience of the stimuli – how much something stands out to us.
For example, the amygdala activates whenever we see a human face with an emotion. This reaction is more pronounced with anger and fear. A threat stimulus, such as the sight of a predator, triggers a fear response in the amygdala, which activates areas involved in preparation for motor functions involved in fight or flight. It also triggers release of stress hormones and sympathetic nervous system.
This leads to bodily changes that prepare us to be more efficient in a danger: The brain becomes hyperalert, pupils dilate, the bronchi dilate and breathing accelerates. Heart rate and blood pressure rise. Blood flow and stream of glucose to the skeletal muscles increase. Organs not vital in survival such as the gastrointestinal system slow down.
A part of the brain called the hippocampus is closely connected with the amygdala. The hippocampus and prefrontal cortex help the brain interpret the perceived threat. They are involved in a higher-level processing of context, which helps a person know whether a perceived threat is real...What Happens in the Brain When We Feel Fear By Arash Javanbakht and Linda Saab, The Conversation SMITHSONIANMAG.COM OCTOBER 27, 2017
Dr Javanbakht and Dr Saab are psychiatrists who treat fear and study its neurobiology.
If Paula had been sent to either one of them she would have expressed her huge feeling of distress and of unrelenting fear. These doctors would automatically assume that she was having a stress response [the fight or flight response] to some threat, real or imagined.
All these reactions are caused by some very fast chemical processes in our body. Our preparedness for the fight is automatic and we flee away from the threat without conscious cognitive processing.
What if the threat, in Paula’s case, was the threat of ventilatory failure?
I can almost guarantee that no psychiatrist, indeed, no doctor of any kind would even think of the possibility of ventilatory failure in a person like Paula.
Paula was able to get to the psychiatrists office, on her own [although she was late from getting lost].
Pula was able to speak, although she had voice changes which the psychiatrist did not pick up on, since he did not know her. Her voice was weak, her speech hesitant. Paula could not say more than 2 or 3 words at a time because she ran out of breath. [she did not say this, though, as she was concentrating too hard on answering the questions put to her and she had difficulty concentrating]. Paula did say she was confused and that she got lost getting to her appointment. She told the doctor that she had woken up feeling huge distress and fear and that is why she came to see him/her. Since that day, she was extremely tense, she had no appetite, she had lost weight as a result.
When asked, she said she was having a lot of difficulty at work and at home. This fear was interfering with her ability to function.
If the doctor had had a routine of checking a patient’s vital signs before going further, he/she would have discovered the problem immediately instead of coming to the wrong conclusion.
Paula indeed had a fast heart rate and heightened blood pressure.
Her breathing should have been fast, her hands sweaty.
Instead her respiratory rate was depressed, her hands cool and dry and her body temperature a little lower than normal.
This was NOT fight or flight.
This was the brain and the body freaking out because Paula could not raise her baseline breathing rate which was too slow to begin with.
This was Paula loosing muscle strength and stamina because of her recent illness, hormonal changes [menopause] and exposure to a higher CO2 environment, as well as to farm chemicals [at her work].
The psychiatrist was not vigilent or careful. He/she did not check basic vital signs and so missed the diagnosis.
And had he checked Paula’s vital signs’ he/she would not have known what to do.
And this is a problem which needs to be corrected.