Fight or flight? Peeling back the layers

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The 10-year-old stood in the doorway and refused to move. He pleaded that he couldn't get off the bus, not there. The two blocks between him and his home looked as dangerous as the streets of Kabul or Kandahar to a flag-waving American.

This event occurred in Walla Walla, not Afghanistan. The threat to the youngster came from a neighborhood gang.

I wasn't there. I'm repeating the story as it was told to me by the man in charge of bringing some boys home from a community event.

Sociologists, politicians and policemen each have opinions about the scope of the gang problem and possible solutions.

A scientific approach might look at the question, "What the heck are kids thinking?" In my last U-B column, I said that teenage frontal lobes were still developing and that their executive functions were impaired.

If we consider the mental state of the boy on the bus, it seems reasonable to examine the effects of fear, anger, rage and empathy (social connectedness) in the gang problem. These stressful situations challenge incompletely developed brains. Ultimately, the question arises about whether there are effective interventions that will protect everyone.

Before considering the literature, think about your response to these statements:

Some people are genetically programmed to be violent.

Video games and television are largely to blame for the antisocial behavior of today's youth.

Football makes us a little crazy. Violence stokes violence.

Gandhi sent us in the wrong direction. Only violence can stop violence.

Put yourself in the position of the 10-year-old. The van stops. You look down a dark street and you can't move.

At that point, your heart is beating faster. Your brain hasn't registered the danger involved, but your entire being is preparing for it.

In a dozen or so milliseconds, a message shot from your eyes to your thalamus where incoming data is sorted. Your thalamus shot a warning to your amygdala, the fight-or-flight center.

Chemistry took charge of your body before the "rational" centers of your brain had a chance to say "no."

Two seconds into the situation, reason tells you that you are now in charge. You expect that the kid on the bus should be just as responsible. Whether he runs for his life or takes a swing at the adult in front of him, we are likely to judge that he made a choice and there are consequences, even at age 10.

It is possible to make a reasonable guess whether he'll choose fight over flight. Several factors indicate what he's likely to do. We'll have to admit that some of the factors were never his to manage.

Approach the process as a thought experiment. It's a situation that you can't test in a lab, but you can base your judgments on the best available lab studies and observations.

Emotional responses involve the interactions between brain wiring, (especially the limbic system) and the degree of control (executive function) exerted on that part of the brain by the frontal lobes.

Recall the story of Phineas Gage, who sustained a brain injury and lost partial control of his emotions. He was like some of my patients who suffered from tumors in the frontal region.

Another factor that can impair judgment is the level of our hormones. The boy may be young for a high testosterone level, but he has no handle on it. A boy gets what he's given.

The boy's life experience has also caused rewiring inside his head, for better or worse. Brain chemistry will affect his reaction by adjusting flow rates through his neural circuits. Many things help determine what he's going to do.

I hope to cover each of these issues.

At this moment I've still got him standing in the door. He's frozen in place. He's less than a second into his experience, and pumping adrenalin. A message flew to his periaqueductal gray matter (PAG) releasing morphine-like substances and inducing the freeze response. He's ready to do something. He has to.

Scientists are now able to use modern imaging to enhance our understanding of complex responses.

We can expose volunteers to things that make them experience sadness, happiness, anger or a variety of feelings. The images reflect which parts of the brain are activated and which are suppressed.

The results are both a source of new insights and a reason for caution. We have to be careful about over-exuberance in support of new technology.

We have progressed from the days when we identified the importance of anatomical sites by studying the effects of brain lesions but some claims may be moving faster than reason warrants. A brain area that has attracted a lot of attention is the limbic system.

The term, limbic, was first used in the mid-19th century by Broca.

It came from the French word for a hoop. Definitions been modified over time, but the concept survives that emotional responses reside in that chain of small neural foci.

The development of the microscope allowed a Spanish researcher, Ramon y Cajal to develop stains for nerve tissue. He described neurons and showed the way that areas like the limbic centers are linked.

The limbic system lies deep in the brain and connects within itself, as well as forward to the higher control centers and down to the spinal cord. One component, the tiny amygdala lights up when the fight-or-flight response grabs hold of us.

My next concern focuses on the Warrior Gene. Is the boy's response predetermined by DNA?

Dr. Larry Mulkerin is a retired clinical professor. He can be reached at larry@sherwoodtrust.org.

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