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Carlo Alfredo Clerici Laura Veneroni


Scientific board: Angelo deMicheli Valentina Ferrante Sarah Marshall Isabella Merzagora Betsos Marco Poli Emanuela Prato Previde Giovanni Tagliavini

Index 5 Introduction 7 Chapter I Scientific perspectives 1.0 Introduction 1.1. Methods 1.2. Data analysis 1.3. The phenomenon 1.4. Historical observations 1.5. Neurodevelopmental aspects 1.5.1. Cardiorespiratory functions 1.5.2. The central nervous system 1.5.3. Electroencelographic studies 1.5.4. Lesional studies 1.5.5. Perceptive and sensory aspects 1.5.6. Muscle tone 1.5.7. Analgesia 1.6. Pharmacological aspects 1.7. Biochemical aspects 1.7.1. Neurotransmitter 1.7.2. Opioids 1.7.3. Hormones 1.8. Behavioural aspects 1.8.1. Primary adverse events 1.8.2. Aversive conditioning 1.8.3. Arousal 1.8.4. Punishment 1.9. Discussion 1.9.1. Historical hypotheses 1.9.2. The fear hypothesis 1.10. Ethological aspects 1.11. Zootechnical / veterinary research 1.12. Comparative implications for humans 1.12.1. Catalepsy 1.12.2. Cataplexy 1.12.3. Catatonia 1.12.4. Response to traumatic events 1.12.5. Peritrauma analgesia 1.12.6. Fear and memory 1.12.7. PTSD and dissociation 1.12.8. Treatment considerations 1.13. Conclusions - Bibliography 50 Chapter II Dissociated Internal Working Models (DIWMs): a relational perspective on attachment, trauma and dissociation 2.1. Introduction 2.2. Intra-familiar sexual abuse as a paradigm for understanding constituent processes of trauma 2.3. Abuse, DIWMs and traumatic attachment 2.4. Traumatic attachment, DIWM and psychopathology 2.5. The paradoxes of trauma and DIWMs 2.6. Conclusive remarks on diagnosis and psychotherapy 2.7 Dissociation and psychotherapy 65 Chapter III Interview to Gordon Gallup 3.1. Meeting professor Gallup


Is it possible to hypnotize a chicken? Catch it and lay the hen on the ground (Figure 1). Rest the tip of the hen's beak on the ground, so that it touches the ground. Take a wooden stick and lean it on the ground so that the tip of it strikes lightly your chicken's beak. After few seconds you can release the chicken and the animal remains in a state of immobility (Figure 2). This phenomenon was called animal hypnosis. It has been long used as a form of entertainment but also studied for its physiological and psycholgical implications. Animal hypnosis is so interesting that we decided to shoot a documentary explaining the phenomenon, La fuga impossibile; immobilit tonica come difesa (The impossible escape. Tonic immobility as a defence), produced by the Service Centre for Technologies and Multimedia and Distance Learning (CTU) of University of Milan (Figure 3). We also published in Italian the book Ipnosi animale, immobilit tonica e basi biologiche di trauma e dissociazione (Animal hypnosis, tonic immobility and biological bases of trauma and dissociation) (Clerici e Veneroni 2011); this volume is the updated version of the Italian edition, translated in English for international readers. This book is the result of the work of many people. Unfortunately, only the authors have their names on the cover. This section only partially compensates for the lack on the cover of many other names of people who helped us. First, we want to thank Gordon Gallup (Department of Psychology, University of Albany, U.S.A.) for his invaluable help. We also thank: - all reserchers of Evolution and Human Behavior Lab, Suny - Albany, NY; - Danielle Grand for revision of text of interview to Gordon Gallup and precious advices; - Valentina Ferrante and Susanna Lolli (Universit degli Studi di Milano, Dipartimento di Scienze Animali, Sezione Zootecnica Veterinaria); - Marco Poli, Emanuela Prato Previde, Sarah Marshall, Isabella Merola, Chiara Passalacqua (Sezione di Psicologia, Dipartimento di Scienze e Tecnologie Biomediche, Facolt di Medicina, Universit degli Studi di Milano); - Giovanni Tagliavini (Centro di Salute Mentale, Arona ASL Novara); - Angelo deMicheli (Cattedra di Criminologia Clinica, Facolt di Medicina, Universit degli Studi di Milano); - Francesco Barbieri and personnel of Oasi delle Farfalle, Milano; 5

- Claudio Ferrarin, Lina Achille, Guido Albasi, Giovanni Salvatore, Francesco Gorga, Luisa Motti, Anna Cantafora, Seangil Bae, Celeste Clerici, Elisabetta Lamarque, Fabio Simonetti, Lorenzo Veneroni, Severina Erba, Matteo Veneroni, Claudio Cant and Lucio Lamarque. The text was closely planned and elaborated by authors; Carlo Alfredo Clerici in particular wrote sections 1.0, 1.4, 1.5, 1.6, 1.7, 1.10 and 1.12. Laura Veneroni wrote sections 1.1, 1.2, 1.3, 1.8, 1.9, 1.11 and 1.13.

Figure 1. Capture of a chicken

Figure 2. Induction of tonic immobility

Figure 3: The staff of CTU of University of Milan during the shooting of the documentary "The impossible escape. Tonic immobility as a defence"

Chapter I Scientific perspectives

1.0. Introduction Since ancient times, a curious phenomenon has been described in many animal species: people have been able to induce state of prolonged immobility in the animal by using various methods (e.g. holding the animal still for a certain amount of time or placing a stick in front of its nose). Over time, the phenomenon has gone by several names, from the most evocative animal hypnosis to the more scientific tonic immobility. For some years now, investigations have been examining analogies between this phenomenon and conditions occurring in humans, such as the immobility that accompanies severe trauma and sexual violence (Heidt, 2005; Galliano, 1993), wartime situations (Van der Hart, 2000), catalepsy, cataplexy (Overeem, 2002), catatonia (Moskowitz, 2004) and the immobility experienced in panic attacks (Cortese, 2006). The aim of this research was to review the literature on these tonic immobility (TI) phenomena in animals and the comparative psychological research that has investigated how this model can contribute to our understanding of aspects of human behavior.

1.1. Method A review of the scientific literature was conducted in the Pubmed, PsychINFO, CAB Abstracts and Web of Science databases, in addition to consulting the printed paper libraries.

1.2. Data analysis We considered 408 publications referring to numerous different cultural contexts and research settings that were organized into 8 categories, i.e. historical observations; zoological and veterinary research; neurodevelopmental aspects; pharmacological aspects, biochemical aspects; behavioral aspects; ecological aspects; and comparative aspects related to humans.

1.3. The phenomenon Numerous animal species go into a state of immobility after being seized suddenly and, after attempting to free themselves for a few seconds, no longer escape when they are released. This phenomenon is so surprising that it has often been used as a form of entertainment. Various methods have traditionally been used to induce this immobility in animals, such as obliging the animal to focus on a line drawn on the ground or on a stick placed in front of them (Figure 4), or 7

rapidly obliging them to lie supine, or confining them laterally within a narrow space, or holding them in a fixed position for several seconds. All such methods have an element in common, i.e. the animal is temporarily immobilized, and this triggers a deep, but reversible physical immobility.

Figure 4. Another chicken in tonic immobility

Figure 5. A rabbit in tonic immobility

Chickens, rats and rabbits (Klemm, 1976) (Figure 5) are the animals most often used to study this phenomenon in the laboratory, not only for economic reasons and ready availability, but also because TI is clearly evident and persistent in these species. The TI phenomenon is described in other animals, however, e.g. pigs (Andersen, 2000), sheep (Gelez, 2004), goats (Moore, 1962), dogs (Reese, 1982) and primates (Henning, 1978), and even in birds, reptiles, amphibians, fish (sharks), crustaceans and insects (Gallup, 1974).

1.4. Historical observations The TI phenomenon has been studied scientifically ever since the 17th century. Already in 1636 a professor at the German University in Altdorf, Daniel Schwenter, in the 13th lecture of his Delicae physico-mathematicae, described a technique for reducing a wild chicken to a degree of docility sufficient to keep it immobile and calm, as if paralyzed. In his Ars Magna lucis et umbrae of 1646, Athanasius Kircher (Figure 6, 7, 8, 9) included a chapter entitled Experimentum mirabile de Imaginatione Galinae on a state of immobility induced in a chicken by tracing a line on the ground in front of its beak. Kircher also pursued these studies in his volume Magnes sive de arte magnetica of 1671, where he reported that if the animals legs were tied, after a few pointless attempts to escape, it would remain immobilized by fear, at the mercy of its tamer and, after removing the restraint, this condition of the immobility could be maintained at length by drawing lines with chalk on either side of its beak, starting on a level with its eyes. Kircher hypothesized that mysterious magnetic forces were at play, explaining that forces of universal magnetism in the world of metals had the capacity to attract or repel plants and animals (zoomagnetism).

Figure 6. Athanasius Kircher (16021680)

Figure 7. Tonic immobility in the chicken as described by Athanasius Kircher

Figure 8. Ars Magna lucis et umbrae by Athanasius Kircher


Figure 9. The cover of Ars Magna lucis et umbrae Many other studies have focused on the TI phenomenon, especially since the second half of the 19 th century (Figure 10), when methods were being perfected to induce hypnosis in humans and the related psycho-physiological issues were being further analyzed (Volgyesi, 1972).

Figure 10. Paul Regnard (1850-1927) 11

More recently, the hypothesis of animal hypnosis was questioned and other mechanisms have been taken into consideration. Nowadays, the term tonic immobility has been preferred (Gallup, 1974) (Figure 11), although new names are still being proposed on the strength of neurophysiological considerations, such as phasic immobility (Klemm, 2001).

Figure 11. Gordon G. Gallup Jr. (photo by Concetta Feo)

1.5. Neurodevelopmental aspects Although it appears from the outside to coincide with the absence of any movement, the TI phenomenon is in fact accompanied by various manifestations of the autonomic and central nervous system activation.

1.5.1. Cardiorespiratory functions In rabbits that heart rate and respiratory rate may be unchanged or even accelerated at the beginning of an episode of TI, while they tend to diminish later (Klemm, 1966; Gallup, 1974). A reduction in blood pressure has also been observed during periods of TI in the rabbit (Hatton, 1979). In pigeons heart rate has been found to increase early in the TI, followed by a return to normal levels when the period of immobility comes to an end (Ratner, 1967), whereas chickens have shown a reduction in their heart rate at the beginning of the TI episode (Ookawa, 1972). Changes in respiratory activity have also been investigated. No significant variations in breathing rate were identified in TI episodes in several varieties of birds (Ratner, 1967), but the iguana has revealed an initial increase in respiratory rate after the induction of TI, followed by a gradual drop


back to sub-normal levels before the end of the episode (Prestude, 1970). Finally, chickens show an increased respiratory rate during TI (Nash and Gallup, 1976) and a marked reduction in cloacal temperature. Cardiorespiratory parameters are therefore influenced by a state of TI in various animal species, but breathing and heart rates tend to rise in some cases and fall in others.

1.5.2. THE CENTRAL NERVOUS SYSTEM 1.5.3. Electroencephalographic studies A well-established line of research has focused on the electrical activity of the brain during the episodes of TI. Some researchers have described EEG patterns with slow waves characteristic of sleep (Schwarz, 1956; Svorad, 1957). A continuous series of high-voltage slow waves was described in the EEG of adult chickens in one report (Ookawa, 1972), while other investigators have reported electroencephalographic activation patterns (Klemm, 1971b; Gallup, 1974; Barrat, 1965; Silva, 1959). In the first 30 seconds after the induction of TI, Jones (1986) described EEG patterns with fast waves indicative of a marked arousal. In the progressive stages of the TI response, a deactivated slow-wave pattern predominated, although there were occasional bursts of fast-wave activity, which became continuous before response termination. Some studies have found that the EEG trace recorded during TI in various animals was no different from the one recorded during sleep (Klemm, 1971a), but these recordings may have come from animals that actually fell asleep during prolonged episodes of TI (Klemm, 1971b). Experiments conducted by Klemm (1966) and Carli (1969) in rabbits demonstrated a low-voltage rapid activity during the induction and early stages of TI, while the EEG patterns showed highvoltage slow waves in the subsequent stages of the episode. It seems, therefore, that cerebral activation is affected by TI.

1.5.4. Lesional studies Numerous studies have been conducted to determine which region of the CNS that governs TI. Brain section experiments have shown that the brainstem is fundamental to the expression of this condition (Klemm, 1976). CNS structures, such as the periaqueductal grey matter (Monassi, 1994; Monassi, 1997), the amygdala (Leite-Panissi, 2002; Leite-Panissi, 1999), the parabracheal region (Menescal-de-Oliveira, 1993) and the hypothalamus (De Oliveira, 1997a, De Oliveira, 1997b), are also involved in modulating TI, and so is the nucleus raphe magnus (Silva, 2007). Ablating different areas of the telencephalon reduces fearful reactions in pigeons (Wright, 1975), ducks (Phillips, 1964) and chickens (Gentle, 1978). The role of the telencephalon in TI might 13

enable the animal to select the most appropriate course of action extending the period of immobility in some cases, reducing it in others. Other studies conducted after inducing CNS lesions suggest that the brain cortex can have an inhibitory effect on tonic immobility. There is evidence that it is easier to induce the phenomenon in decorticated animals. Lesions of the rostral two thirds of the archistriatum in chickens (which is embryologically comparable with the neocortex in mammals) likewise facilitate the induction of TI and extend its duration (Zeizer and Karten, 1971; Gentle, 1985). On the other hand, decerebration in species with little or no neocortex has no influence on the TI phenomenon (Mc Bride and Klemm, 1969). According to some studies, decerebration increases TI (Gentle, 1985), in contrast with Pavlovs idea (1921) that TI would be due to the inhibition of brain activity. Other studies have found that, although diffuse neural systems may be involved in TI there may be a more specific center presiding over this response, localized in the medullary reticular formation (Klemm, 1971a; Klemm, 1976) and susceptible to a descending inhibition by the neocortex. TI in the rabbit, is reduced by carotid sinus denervation and increased by ablation of the dorsal portion of the hippocampus (Woodruff, 1975) or lesions of the vertebral column (Woodruff, 1985), while lesions of the medulla oblongata appear to have no effect (Braun, 1983). In rats, which usually experience short-lived episodes of TI, the duration of such episodes is increased after septal lesions (Brady, 1953; Cytawa, 1968) and cortical lesions (McGraw, 1969; Teschke, 1975). One hypothesis to explain this animals scarce susceptibility to TI suggests an inhibitory effect of the neocortex (Klemm, 1971b). Similar effects have also been observed in chickens (Maser, 1973c). Studies performed on animals of different ages and with different degrees of development of the cortical (or equivalent) cerebral structures have helped to clarify the role of these structures. A greater susceptibility to TI and a greater duration of the episodes has been described in decerebrated rats and in those less than 10-15 days old; i.e. which may be due to the fact that they have yet to develop the cortex of the adult animal (McGraw and Klemm, 1969; Svorad, 1957). Moreover, this greater susceptibility was seen to return in elderly rats, probably due to a diminished neocortical control (Klemm, 1971b). On the other hand, TI cannot be induced in chicks until they up to 7-10 days old, and the onset of TI coincides with the onset of fear reactions (Ratner, 1960). TI responses have also been described in chicks only 3 days old, however, induced by ventral restraint (Rovee and Luciano, 1973), and even in chicks only 1 day old, by holding the animal in the folds of a fabric (Braud, 1973). Quail reportedly have limited TI reactions until they are 20 days old (Borchelt, 1973). 14

It may be that the level of maturity of postural or vestibular mechanisms influences TI in the younger birds. In short, lesion studies indicate a role of the cerebral cortex (or equivalent structures) in triggering and maintaining TI, but there is evidence that other structures are also involved and we cannot rule out the hypothesis of a control by specific centers.

1.5.5. Perceptive and sensory aspects The various studies conducted on TI have often focused on the fundamental question of whether or not the animals continued to be aware of the outside environment during the episode and a great deal of evidence has been collected to show that the animals continue to process sensory information in a condition of TI . In pigeons in a state of TI, for instance, the capillary reflex is preserved and variations in their heart rate can be induced by outside stimuli, without this interrupting their state of immobility (Ratner, 1967). In frogs, ablation of the visual and auditory organs prior to their immobilization does not alter their TI response, so this is probably based on information of a tactile and proprioceptive type (Mc Bride, 1969). A significant EEG activation has also been observed during TI episodes without any apparent body movement (Klemm, 1965) and in rabbits, for instance, stimuli presented during a period of TI have prompted signs of EEG activation (Silva, 1959). The dissociation between EEG signs and behavioral signs is confirmed by the observation of occasional epileptiform EEG signs in animals in a state of TI, but unaccompanied by any evidence of motor convulsions (Klemm, 1966). As for memory, empirical evidence from various sources suggests that TI is not associated with any suspension of memory or consciousness (Marx, 2008). The capacity to recall the events occurring during the TI seems to remain intact (Woodruff, 1977) and, although the animals appear incapable of resisting or escaping, they seem to actively process the nature of the event and of the environment (Gallup, Rosen, and Brown, 1972; Klemm, 1971b; Richardson, Shumaker, and Harvey, 1977; Sigman and Prestrude, 1981). Studies have also shown that learning is not interrupted during a TI episode either. Animals undergoing conditioning after the induction of a state of TI perform as well as (or even better than) animals being conditioned in a state of normal consciousness (Gallup, Boren, Suarez, Wallnau and Gagliardi 1980). Some experiments have even demonstrated both the retrieval and the extinction of


associations previously learned in a state of TI (Gallup, Boren, Suarez, Wallnau and Gagliardi 1980). In rabbits subjected to heart rate conditioning procedures in a state of TI, the effects of conditioning proved stronger than in control animals conditioned when not in a period of TI (Draper and Klemm, 1967). While in a state of TI, the opossum reacts to a dog coming near with changes in heart rate and ear movements (Kimble, 1997) and it has been demonstrated that, although the animal may seem dead or unresponsive to the outside world, it is in fact still very alert. TI would therefore represent a form of efferent inhibition with no particularly pronounced afferent effects (Klemm, 1971a).

1.5.6. Muscle tone Not many studies have looked into muscle tone in states of TI (Overeem, 2002). Several electromyographic studies have revealed phase changes in muscle tone during episodes of TI (Klemm, 1977). In particular, muscle tone may be changeable, switching from an initial increase in tone to a distinctly flaccid state (Klemm, 1989); animals sometimes adopt specific postures during an episode of TI, which would indicate a residual functionality of certain muscles (Klemm, 1989). Voluntary movement is abolished during TI episodes, while some spinal reflexes are suppressed, but not abolished (Carli, 1968, Carli, 1969). Inhibition of the righting reflex correlates with a tonic depression of the mono- and poly-synaptic spinal reflexes (Carli, 1969). On the whole, all the animal species considered have shown signs that a moderate stimulus will evoke withdrawal reflexes without this interrupting the state of TI. In rabbits, the paws are initially extended and there may be some degree of fine tremor, which may be spontaneous or induced by stimulating the patellar tendon or abdomen. The rabbits eyes remain open, immobile, with the pupils often suddenly contracting after TI induction, while the corneal reflex remains active. Chickens, on the other hand, may occasionally close their eyes, defecate and produce intermittent vocalizations towards the end of the episode. The motor inhibition induced by TI, as observed in the above-mentioned studies, may derive from the activation of a relatively small population of neurons in the reticular formation of the brainstem due to a reflex effect of cutaneous and proprioceptive stimuli that diffusely inhibit the flexor and extensor spinal motor neurons (Klemm, 1976), without affecting the sensory and/or integrative functions.


1.5.7. Analgesia Numerous studies have identified analgesia as a characteristic of TI (Dannemann, 1988; Fleischmann and Urca, 1988a; Fleischmann and Urca 1988b; Fleischmann and Urca 1989c; LeitePanissi et al. 2001). Experiments in rabbits have demonstrated that the flexor polysynaptic spinal reflexes are depressed (Carli, 1969) and there is an increase in the speed of the animals reaction to painful stimulation with heat (Galeano, 1979). On the other hand, although there is no reflex reaction to the stimulus (or interruption of the state of TI), it nonetheless induces EEG activation and pupillary dilation (Carli, 1969), which shows that such a nociceptive stimulus can reach higher centers. The intensity of the painful stimulus has also been seen to have an important influence on the TI (Carli, 1976). It has even been possible to induce TI during the experience of acute pain in rabbits given subcutaneous injections of formalin (Carli, 1976). Inducing a state of TI temporarily interrupted the motor response and EEG activity in the presence of painful stimuli: the animals gradually developed a high-voltage slow-wave activity indistinguishable from the situation in control rabbits not subjected to the painful stimulus. This type of EEG activity in sleep has been associated with a deafferentation of the cerebral cortex by the somatosensory afferent pathways (Gucer, 1979). Various studies have also been conducted to demonstrate the involvement of the opioid system in the analgesia coinciding with a state TI, by applying a painful stimulus (such as a formalin injection) and verifying the effect of naloxone (Carli, 1981; Galeano, 1978; Mucha, 1980; Peters, 1978; Smith, 1985; Wallnau, 1979) and morphine (Carli, 1981; Davis, 1963; Hicks, 1975; Peters, 1978; Smith, 1985; Wallnau, 1979) on the TI. In conditions of persistent pain, the opioid system seems to be activated, and this may increase the TI response. On the other hand, it has been hypothesized that - in the absence of pain - the duration of the TI episode is not modulated by the opioid system, which involves mu receptor activation (Carli, 1981). The analgesia induced by TI, as recorded in various studies, is not a generalized phenomenon, however; in fact, hyperalgesia has been documented during and after episodes of TI in lizards, for instance (Mauk, 1981).

1.6. Pharmacological aspects An increase in the persistence of episodes of TI has been seen following the administration of a barbiturate pentobarbital (Davis, 1963; Klemm, 1965), while another study also that d-amphetamine had the effect of favoring immobility (Davis, 1963).


Methoserpate HCL (a tranquilizer used in chickens) has been shown to reduce the duration of a state of TI in a dose-dependent manner (Gallup, Nash and Brown, 1971a), and it also attenuates the influence of conditioned adverse stimuli on the state of immobility (Gallup, Rosen and Brown, 1972a). Chlorpromazine is believed to have the paradoxical effect of reinforcing the state of TI when given in low doses to rabbits (Davis, 1963; Klemm, 1965, Schaeppi, 1965) and guinea pigs (Liberson, 1961), while in higher doses have the reverse effect in chickens (Maser, Gallup, Hicks and Edson 1974a). Finally, administering reserpine increases TI duration in guinea pigs (Liberson, 1961).

1.7. Biochemical aspects 1.7.1. Neurotransmitters Studies have often focused on the biochemical aspects of TI and there are reports of the serotoninergic (Wallnau and Gallup, 1977; Henning, 1980), adrenergic (Thompson and Joseph, 1978) dopaminergic (Ettinger and Thompson, 1978) and cholinergic (Hicks, 1976; Huges, 1982) systems being involved. All the above-mentioned neurotransmitters are involved in regulating the state of TI (Klemm, 1989). Activation of the alpha 1 adrenergic receptors would attenuate it, while stimulating the alpha 2 receptors would extend the TI response (Henning, 1984). Various studies have concentrated on the cholinergic systems and found that anticholinergic drugs reduce and cholinergic drugs increase the intensity of the TI in various animals (Henning, 1988; Franchi, 1994). As for adrenalin, it is generally agreed that it intensifies the TI, according to experimental evidence obtained in lizards (Hoagland, 1928a; Hoagland, 1928b) and chickens (Braud, 1973). Experiments with localized injections of carbacol have demonstrated that cholinergic neuron populations in the anterior hypothalamus and the basal midbrain are very important in inducing TI (Franchi, 1994; de Oliveira, 1997a), but other parts of the hypothalamus - including the lateral hypothalamus - are also involved in modulating TI (de Oliveira, 1997a; de Oliveira, 1997b). Some studies have shown that increasing doses of scopolamine (an anticholinergic agent that produces effects both centrally and peripherally) considerably reduce the duration of a TI episode (Thompson, 1974) and this finding is consistent with cholinergic involvement in the TI, despite other studies reporting test results to the contrary (Ksir, 1978). Conversely, methyl scopolamine, which does not pass rapidly through the blood brain barrier, has no effect. Thompson also described a more persistent TI in birds treated with physostigmine, a specific cholinesterase inhibitor. Scopolamine reduces the TI in ducks (Woodruff, 1976), but 18

intensifies it in guinea pigs (Wodruff, 1976) and rabbits (Hatton, 1975). In addition, there is experimental evidence of episodes of TI lasting longer under the effect of epinephrine, norepinephrine and L-dopa (Braud, 1973), probably due to alpha 2 receptor activation (Henning, 1980). The alpha 1 agonists elicit a shorter TI, however, and the beta agonists have no effect (Hennig 1980). Finally, dopaminergic receptor agonists make the TI episodes more short-lived, while blocking serotonin is also implicated in governing TI states (Farabollini, 1985; Gallup, 1977b; Liberson, 1967; Maser, 1975). For instance, a diet lacking in tryptophan is reported to significantly reduce the duration of TI in chickens, and the effect is reversed by an appropriate diet (Gallup, Wallnau, Boren and Gagliardi, 1977). An increase in the duration of TI episodes was obtained in rabbits (Davis, 1963) and chickens (Maser, Gallup and Edson, 1973a) by administering morphine and this finding has been attributed to the fact that it blocks serotonin. Relatively high doses of pCPA (a cerebral 5-HT depletor) reduces the duration of TI episodes (Hughes, 1986), and the extension of TI induced by morphine is abolished by pretreatment with pCPA (Porro, 1988). The antidepressant iproniazide (which inhibits the monoamine oxidase that raises the levels of serotonin in the brain, reducing its turnover) has been found to extend periods of TI (Liberson, 1962). It has also been reported that repeatedly inducing TI reduces cerebral serotonin levels (Liberson, 1964). TI was reportedly reinforced, instead, after an injection of ergotamine (an alkaloid with serotonin antagonist effects) (Hoagland, 1928b). Finally, it has been demonstrated in the chicken that LSD-25 (a powerful antiserotoninergic agent) makes TI more persistent (Maser, Gallup and Edson 1973a), while administering the antidepressant imipramine (which blocks the re-uptake of serotonin) has the opposite effect (Maser, 1974).

1.7.2. Opioids When an animal is attacked, it experiences an analgesic effect that is functionally useful because the perception of pain would be distracting and prevent it from concentrating on defending itself (Bolles, 1970). Animals can experience analgesia at the sight of a predator, due to a concentration of smells produced by conspecifics, or to previously-learned hazard signals, or being seized by the scruff of the neck or forced to lie on their backs (Siegfried, 1990). The response may be mediated by endogenous opioids (Fanselow, 1988a; Krystal, 1989; Siegfried, 1990; van der Kolk and 19

Greenberg, 1987), as well as by non-opioid mechanisms (Siegfried, 1990). There is evidence to show that endogenous opioids are also implicated in catalepsy, or stress-related immobility (Amir, 1981; Fanselow, 1986; Teskey, 1984), in modulating panic and fear (Siegfried, 1990; van der Kolk, 1994) and in inhibiting the production of vocalizations (Kalin, 1993). These effects inhibit reactions that would interfere with the optimal defensive strategy at this stage, e.g. licking a wound could attract attention and might trigger another attack (Siegfried, 1990). Some studies have reported that opioid peptides are involved in modulating TI (Carli, 1981; LeitePanissi, 2002; Monassi, 1999): for instance, morphine peripheral injections (Carli 1981) or microinjections in the periaqueductal grey matter (PAG) (Monassi, 1999), prompted an increase in the duration of TI episodes, and GABAergic neurotransmitter activity has also been shown to have a role in modulating TI. Micro-injections of GABAergic agonists and antagonists in the PAG promote a reduction and an increase in the persistence of the TI, respectively. It has also been demonstrated that TI modulation by the ventrolateral PAG depends on the integrated activity of opioidergic and GABAergic circuits (Monassi, 1999). Other research has revealed that blocking opiate receptors with naloxone (Fanselow, 1984) or naltrexone (Fanselow, 1982) bottles up the analgesic response, but not the motor arrest defence mechanism. This does not mean that motor arrest and analgesia are mediated by different processes, but rather that the opioid system is involved in the final pathway crucial to the expression of analgesia, but not in the one that induces the state of immobility (Fanselow, 1988). Similarly, blocking the opioid receptors with naloxone does not affect the duration of the TI episode, but it may alter the TI-induced analgesia, as shown in experiments using formalin and hot plates (Leite-Panissi, 2001). The mechanism that mediates the endogenous analgesic system activation in natural conditions is not known, but a role has been suggested for the central nucleus of the amygdala and the PAG in fear-induced analgesia (Le Doux, 1988). On these grounds, it has been found that exposure to threatening stimuli evokes forebrain-mediated analgesia via the amygdala circuits, that in turn activate the descending pain inhibiting system of the medulla oblongata (Meager, 1990; Helmstetter, 1993; Fanselow, 1994).

1.7.3. Hormones Experiments in the rabbit have shown that ACTH levels rise at the end of unsuccessful attempts to induce a state of TI (Porro, 1988); vice versa, when an attempt to induce TI is successful, there is an increase in ACTH that persists for more than 30 minutes. Conversely, plasma cortisol levels rise after TI induction, but not when the episode is over (Farabollini, 1985). Plasma corticosteroid levels correlate positively with the duration of the response, and TI-susceptible rabbits have higher levels than their TI-resistant counterparts (Carli, 1979). 20

The duration of an episode of immobility correlates negatively with plasma testosterone levels, which are reduced by the induction procedure, but not in the state of TI. Finally, as concerns the hypothalamus, testosterone metabolism is drastically reduced by the state of immobility and, to a lesser degree, by the induction procedure (Farabollini, 1978).

1.8. Behavioural aspects 1.8.1. Primary adverse events One line of research has investigated the behavioral aspects of TI. Administering adverse stimuli beforehand makes it easier to induce a state of TI and the response is more persistent. For instance, applying brief electrical discharges before manually immobilizing the animal increases the duration of the TI in chickens (Gallup, 1970), lizards (Edson, 1972) and guinea pigs (Leftwich, 1974); and the stronger the shock, the more the TI is prolonged (Gallup, 1973b; Gallup, Nash, Potter and Donegan, 1970). To rule out the possibility of this extended TI being due to the tetanizing effect of the electric current, other experiments were conducted which showed that exposure to loud noise also reinforced the TI in domestic chickens (Gallup, Nash, Potter and Donegan, 1970), lizards (Edson and Gallup, 1972) and frogs (Nash, Gallup and McClure, 1970). Moreover, the duration of TI was four times longer after uncontrollable electric shocks than after exposure to shock of the same intensity from which the animal was able to escape (Maser and Gallup, 1974), which disproves the hypothesis of any effect of confusion induced by the electric shock per se. Another type of the frightening stimulus, consisting in suspending the animal from the edge of a high shelf (inducing the fear of falling) is also enough to extend the state of TI (Gallup and Williamson, 1972).

1.8.2. Aversive conditioning A neutral stimulus previously associated with the application of an electric shock has been shown to prolong episodes of TI when presented again without the associated shock (Gallup, Rosen and Brown, 1972). Administering tranquilizers, on the other hand, reduces the effect of fear induced by conditioning. Stimuli associated during conditioning with a severe electric shock would appear to extend a TI longer than those associated with a mild shock (Gallup, 1973b), though other studies could find no effect of conditioning-related adverse stimuli on TI in guinea pigs (Leftwich and May, 1974).


Finally, conditioning based on electric shocks can reportedly also reduce the duration of the TI episodes if one of the stimuli has been associated with termination (rather than presentation) of a painful stimulus (Maser, 1973b).

1.8.3. Arousal Some studies have suggested that it is not fear, but arousal that affects TI (Leftwich and May, 1974), but this seems unlikely since an experiment in which chickens were deprived of food (food deprivation is a powerful method for inducing arousal) recorded no related effect on TI (Gallup and Williamson, 1972). The arousal theory is also contrary to the observation that amphetamines shorten the period of TI (Thompson, 1974).

1.8.4. Punishment Repeated TI induction has the effect of a punishment. In one experiment, a stimulus associated with the repeated induction of TI in chickens when presented in a context unassociated with any TI coincided with a reduction in the persistence of other TI episodes, suggesting a role for conditioning-induced adverse properties (Nash and Gallup, 1976).

1.9. Discussion From the physiological point of view, the TI phenomenon is reportedly an aspect of the more ample phenomenology of the so-called behavioral arrest, which includes (Klemm, 2001): - spontaneous manifestations in animals exposed to sudden stimuli; - arrest induced by drugs, mainly dopaminergic blockers, cholinomimetics or opioids; - arrest induced by manipulation, such as seizing by the scruff of the neck in young animals, or physical immobilization. Irrespective of the trigger event, it has been suggested that certain neuronal systems trigger the global isometric contraction of the antagonist muscle complexes, probably by interfering with the normal inhibitory processes that cause the alternate contraction and relaxation of the antagonist muscles (Klemm, 2001).

1.9.1. Historical hypotheses Darwin (1900) saw TI as death feigning in the face of a predator. Pavlov also became interested in the phenomenon in the latter years of his research. He noticed it in dogs during his experiments on conditioned reflexes and he developed a complex theory involving 22

a self-defence reflex with an inhibitory nature. The biological significance of reducing the aggressiveness of a predator by keeping perfectly still (Pavlov, 1921) was also taken up later on by other scholars (Prestude and Crawford, 1970). Studies on TI continued in the years that followed (Hoagland, 1928a; Hoagland, 1928b; Holmes, 1929), giving rise to theories that touched on hypnotic phenomena (Volgyesi, 1972). a vestibular involvement (Hoagland, 1928a), and some analogies were even drawn between sleep and TI (Svorad, 1957). With time and empirical observations, other theories were developed to interpret the phenomenon that went against the idea that it was the animal version of hypnosis in humans. The possibility of a vestibular origin was disproved by the finding that TI occurs in animals immobilized in an orthostatic position too, and that ablation of the inner ear had no influence on the duration of TI episodes in lizards (Hoagland, 1928a). The sleep theory, on the other hand, was contradicted by the finding of EEG activation in TI (Barrat, 1965) and of TI episodes being prolonged by adrenaline (Braud, 1973).

1.9.2. The fear hypothesis Fear is a complex phenomenon that can be separated into different components; i.e. the behavioral (e.g. escape), the physiological (e.g. an increased heart rate) and the expressive (e.g. facial expressions). For the various types of animals used in experiments, we speak of fear, not of anxiety, because the latter is a secondary emotion that implicates the subjects cognitive capacity to represent to itself and react to its own emotional state. Without such a representation, however rudimental, of the self, we cannot speak of anxiety, which therefore only occurs in the more developed species. The theory that fear is involved in the mechanism of TI was formulated right from its early historical descriptions, but it is only since the early 1970s that attempts have been made to test this theory experimentally (Gallup, 1974). The observation that administering tranquilizers reduces the duration of a TI episode, support the theory that it has to do with fear (Gallup, Nash and Brown, 1971; Maser, 1974a; Maser, 1974b). Animals tested when socially isolated have TI episodes that last longer than in animals immobilized in the presence of conspecifics (Liberson, 1948; Salzen, 1963). Violent handling (Parker, 1971) and new or unfamiliar test conditions (Rovee, Agnello and Smith 1973) also extend the duration of the state of TI. In addition, the duration of this immobility is inversely proportional to the pecking order: the chickens in the lower ranks have longer episodes of TI (Gallup, 1974).


The fact that many chickens may defecate during a TI episode (Gallup, Nash and Wagner, 1971) further supports the conviction that the animal is under stress or afraid. There have also been reports of animals dying during TI tests (Gallup, 1974). In all these cases, after remaining immobile for some time, the animal made an abortive attempt to move, then collapsed and died. The victims had all been treated to exacerbate their sense of fear. Such deaths were never reported in control subjects or when no fear-inducing procedures had been used. There are also descriptions of guinea pigs repeatedly induced into states of TI losing weight and sometimes dying. Lesions to the limbic system (particularly septal and amygdala lesions) (Brady, 1953; Davies, 2002; Woodruff, 1976) and administering chemical substances that exacerbate the sense of fear, such as adrenaline (Braud, 1973; Thompson, 1974; Thompson, 1977; Thompson, 1978; Thompson, 1979), have been used to confirm the role of fear in producing and maintaining a TI response. Fear has the dual effect of prolonging the duration of TI, and reducing the number of induction procedures needed to elicit it. The growing difficulty encountered experimentally in inducing TI after repeated elicitations (Crawford, 1977; Gallup, 1974; Gallup and Rager, 1996; Gilman, 1950; Jones, 1993a; Jones and Waddington, 1993; Nash and Gallup, 1976a; Ratner, 1967) probably has to do with the animals progressively diminishing levels of fear. All these findings suggest that fear and the inability to move are needed in combination for the onset of TI.

1.10. Ethological aspects The TI phenomenon has been studied at length from the ecological standpoint. There would be numerous adaptive advantages of motor arrest for the animal, which range from making it more difficult for predators to pinpoint to ensuring the safe transportation of offspring in a state of immobility induced by seizing them by the scruff of the neck (Klemm, 2001). Of particular interest in this setting is the set of defensive reactions triggered by an encounter with a predator, characterized by a series of stages: freezing, in the sense of arresting all movement, a state in which the animal is vigil, immobile and ready for action (Bracha, 2004). This should not be confused with TI; - flight or fight (Cannon, 1927; Cannon, 1929); - tonic immobility. Although the terms are often confused, freezing differs from tonic immobility in that it comes in an earlier stage of the defensive reaction and is characterized by a greater reactivity to stimuli, a posture of alertness and readiness for action.


In ecological terms, each of the stages described above would have a defensive meaning that depends on the animals distance from the aggressor (Ratner, 1967). Freezing at a certain distance from the aggressor enables the animal to prepare to react without attracting attention; flight or fight may be appropriate reactions in the event of an attack; and finally, remaining immobile (playing dead) and insensitive to pain might be the ultimate effective defence when overwhelmed by a predator. Some researchers have questioned the defensive value of TI, however, and some (Svorad, 1957) see it as a pathological reaction. Research has been conducted on the link between TI and hunting to ascertain the presumed antipredatory value of this behavior. In experiments in chickens, the sight of a stuffed falcon before the induction of TI (Gallup, Nash, Donegan and McClure, 1971) has the effect of extending the duration of the episode. Using screens to hide parts of the predator revealed that eye contact is essential to the enhancement of TI. Similar effects have been reported in lizards (Gallup, 1973a). Similarly, a threatening object presented after inducing a state of TI can maintain the response in chickens (Ginsburg, 1974). The presence of the tester also increases the duration of TI episodes; here again, the crucial factors are eye contact and the limited distance from the person. A similar effect was observed in lizards in situations where the tester was visible, which made the TI last four times longer than if the tester was concealed behind a glass panel (Edson, 1972). The importance of eye contact was also emphasized in an experiment showing a longer TI in chickens even in the presence of artificial eyes (Gallup, Nash and Ellison, 1971). The effect of the eyes was not influenced by any other body or facial features of the potential predator. In chickens, immobilizing the animals in front of a mirror was enough to extend their period of immobility (Gallup, 1972a). Eye contact also proved crucial when sacrificed conspecifics were used: seeing chicken heads with their eyes closed did not extend the chickens period of TI, even if the heads were stained with blood, whereas seeing open-eyed chicken heads did make their TI last longer. The important role of the eyes was also confirmed in blue crabs, which had exaggerated flight and fight reactions immediately after episodes of TI (OBrien, 1975). Various works have thus confirmed the potential advantage of immobility as a defence mechanism against predators (Arduino, 1984; Gallup, 1977a). A field study showed that, both in the wild and in captivity, if wild duck become immobile when being hunted by red foxes, more than half of them survive without a scratch (Sargeant and Eberhardt, 1975).


1.11. Zootechnical / veterinary research The relationship between breeding conditions and the state of health in chickens has been studied extensively in the veterinary field and the phenomenon of TI provides the basis for assessing the well-being of chickens on farms. The duration of TI episodes correlates positively with the stress levels caused by different breeding conditions (Figures 12-22); e.g., overcrowding and frequent handling (Jones, 1986). Some studies (Debut, 2003; Owens and Sams, 2000) have suggested a link between the quality of the meat and the animals stress levels before it is slaughtered (leading to the TI test being used as a predictor), while other studies have claimed an inverse relationship between the two variables (Mignon-Grasteau, 2003).

Figure 12. Experiment with chickens from a little hen-house: the hens are taken and held down

Figure 13. Experiment with chickens from a little hen-house: the experimenter leans the wooden stick on the table so that it touches the tip of the beak of the hen


Figure 14. Experiment with chickens from a little hen-house: the experimenter does the same for the second hen

Figure 15. Experiment with chickens from a little hen-house: the experimenter does the same for the last hen

Figure 16. Experiment with chickens from a little hen-house: the hens are held down with the stick in front of the beak


Figure 17. Hens of an industrial farming

Figure 18. Experiment with a hen of an industrial farming

Figure 19. Experiment with a hen of an industrial farming


Figure 20. Rabbits in a industrial farming

Figure 21. Experiment with a rabbit in a industrial farming

Figure 22. Experiment with a rabbit in a industrial farming


1.12. Comparative implications for humans If we analyze the defensive reactions characteristic of humans from a comparative perspective, we can see resemblances with those of nonhuman species (Marx, 2008). Empirical data from psychophysiological research have shown, for instance, that some of the stages of the animals defensive reactions occur in humans too when they are faced with intensely threatening stimuli (Bradley, Codispoti, Cuthbert and Lang, 2001; Cuthbert, Bradley and Lang, 1996). Although frank TI phenomena have not been reported in healthy human beings, the anecdotal experience of "being paralyzed by fear" has prompted the hypothesis of a state resembling TI in humans but tests would be needed to establish whether this immobility is supported by reflex reactions or by the difficulty of making a decision in response to a threat. There are numerous examples of human traits that are exhibited only rarely, and that identify silent rather than absent mechanisms. Such atavisms, i.e. the reactivation of ancestral characteristics, include piloerection (goose pimples), for instance, and even if TI does not occur in healthy human, it has been suggested that the neocortex may have an inhibitory influence on TI, without this meaning that the underlying reflex mechanisms have been eliminated from our nervous system (Klemm, 1971b). Among the human phenomena in which an analogy with animal TI has been hypothesized, there is cataplexy, catatonia and the motor arrest prompted by physical violence and sexual abuse, and the consequent dissociative phenomena. Over time, various authors have drawn analogies between animal defence mechanisms and certain psychopathological issues in humans (Kreapelin, 1913; Kretschmer, 1960; Krystal, 1988; Ludwig, 1983; Nijenhuis, 1998).

1.12.1. Catalepsy Catalepsy is a motility disorder characterized by a rigidity of the voluntary musculature that can maintain a patient in the same position, however uncomfortable it may be, and there is no way to change it from the outside. A typical expression of this disorder is the so-called "pillow sign", i.e. patients lie with their heads raised off the bed. In a variant of this disorder, flexible catalepsy, patients maintain a position imposed from the outside for a certain amount of time, then slowly and spontaneously adopt another, more comfortable position (Cassano, 2002). The symptom can be seen in very different conditions, such as schizophrenia, Parkinsonism and epilepsy. In some cases, isolated cataleptic phenomena can be triggered by an acute emotional shock.


1.12.2. Cataplexy Cataplexy is a sudden, transient muscle hypotonia linked to a suspension of the voluntary and reflex activity of the striated muscles, while higher psychic activity remains intact. The condition can occur in response to strong emotions (Cassano, 2002) and it has been suggested that cataplexy represents an atavistic form of tonic immobility (Overeem, 2002). The emotions are important in the induction of TI (Gallup, 1974), though this is generally associated with fear, whereas cataplexy in human beings is linked to other emotions (it is typical for episodes to be brought on by the patient laughing). In the majority of cases, TI and cataplexy are associated with bradycardia (Gallup, 1974; Siegel, 1989). The hypothalamus (including the lateral hypothalamus) is important in the generation and modulation of TI (Franchi, 1994; de Oliveira, 1997a; de Oliveira, 1997b). Evidence is now available to suggest that the lateral hypothalamus is the site of the hypocretin system, which is the main cerebral region responsible for the onset of narcolepsy and cataplexy (Overeem, 2001; Willie, 2001). A role for the hypocretin system (orexin) has also been hypothesized in regulating TI, since it would suppress the brain areas involved in inhibiting TI, or stabilize the brainstem areas responsible for motor inhibition, preventing the onset of TI/cataplexy in healthy populations. Moreover, both TI and cataplexy can use the regions of the brainstem responsible for REM sleeprelated atonia as a final common pathway for inducing the spinal inhibition of the motor neurons (Hishikawa, 1995; Siegel, 1991; Braun, 1983; Klemm, 1976) Other analogies concern the effect of tricyclic antidepressants and MAO inhibitors, which improve cataplexy (Nishino, 1997), just as imipramine and iproniazide reduce the duration of the TI episodes immobility (Franchi, 1994; Maser, 1974). Cataplexy is caused by a complex interaction between the systems governing the emotions and those responsible for motor control. Further studies on the relationships between the mechanisms governing REM sleep, cataplexy and TI might prove very important in improving our understanding of these diverse, but correlated phenomena.

1.12.3. Catatonia Catatonic syndrome comprises a set of phenomena characterized by motor anomalies (muscle stiffness which increases with attempts to impose any movement) and altered mood, behavior and thought processes.


Severe catatonic symptoms are characteristic of catatonic schizophrenia, but can also be a consequence of organic diseases, such as subarachnoid hemorrhage, multiple sclerosis, hydrocephalus, and Parkinson's disease. These symptoms can also develop in the course of other mental disorders, particularly in affective disorders. For some time now, there have been descriptions of analogies with TI in animals (Moskowitz, 2004). The two phenomena both start and stop suddenly, and they have some similar characteristics (Parkinson-like trembling and muscle stiffness, stupor, mydriatic and exophthalmic conditions, waxy flexibility, suspension of all vocalizations, but no loss of consciousness), and when the episodes come to an end both conditions can prompt aggressive and defensive behavior, and can occasionally prove fatal. Immediately after an episode of stupor, catatonic patients have increased plasma levels of adrenalin and its metabolites, suggesting that catatonic symptoms can be triggered by the experience of fear, just like TI in animal. Both patients in a state of catatonic stupor and animals in a state of TI have revealed an epileptiform EEG activity, pointing to a likely association between their central electrical activity and their motor behavior; there is also apparently no associated inhibition of the sensory afferences and associative functions. At the end of the phase of stupor, patients who have experienced a catatonic state can accurately recall what happened during their catatonic phase, and animals in TI also retain the capacity to receive, process and memorize sensory information. The genetics are important in both human catatonia and TI in animals, and it has been suggested that this correlates with a selective advantage: once the animal has been captured, both phenomena reduce the likelihood of being killed by their aggressor (Moskowitz, 2004). As for the biochemical aspect, TI and catatonic symptoms share a dopaminergic neurotransmission. The psychopathological signs typical of psychotic conditions are associated with an altered functioning of dopaminergic neurotransmission, which may be accompanied by the automatic triggering of innate motor behavior patterns observable in other animal species, in which they have an anti-predatory role, and includes a catatonic-type stupor and agitation.

1.12.4. Response to traumatic events Individuals surviving sexual violence often report having been unable to move or call for help when they were attacked. This phenomenon has been called rape-induced paralysis (Burgess, 1976; Russel, 1974) and various authors have described its high incidence among victims of such episodes (Foa, 1998; Levine, 1997; Ogden, 2002; Ullman, 1995). The role of tonic immobility on lack of


defence during sexual violence is particularly deepen in the German legal doctrine (Macr, 2010; Hermann-Kolb, 2005). Tonic immobility is a reaction distinct from any voluntarily acquiescent reaction to an aggressor in situations where it is impossible to escape. It has been reported that only a minority of adult women who were victims of sexual abuse in childhood said they had actively attempted to resist their aggressor (Albach, 1993; Draijer 1990) and some studies have identified these episodes of paralysis in response to sexual violence as a form of TI in humans (Suarez and Gallup, 1979). Galliano, Noble, Travis and Puechl (1993) studied TI in 35 rape survivors and found that 37% of them reported having been completely immobile, as in the observations reported by Burgess and Holmstrom (1976). Fus, Forsyth, Marx, Gallup and Weaver (2007) considered a sample of 88 adults who had survived a sexual assault and found that 41.5% of these individuals had experienced a significant immobility, and 12.5% an extreme immobility. This result emerged again in another, separate sample of 191 women who had survived a sexual assault, with 41.7% of the participants reporting a significant immobility and 10.4% an extreme immobility. Heidt, Marx and Forsyth (2005) examined the prevalence and adverse psychological correlates of TI in clinical subjects (hospitalized psychiatric patients) and non-clinical subjects reporting a history of sexual abuse in childhood. TI was assessed with the aid of a dedicated tool, the Tonic Immobility Scale - Child Abuse Form [TIS-C] (Forsyth, Marx, Heidt, Fus and Gallup, 2000), for recording the nature and the sequelae of TI in victims of sexual abuse in childhood. TI episodes were reported by 52% of the participants, more often in the course of rapes and rape attempts than in other forms of sexual abuse: this was interpreted as relating to a greater degree of fear, risk of injury and perception of being trapped than in other forms of unwanted sexual contact, characteristics that resemble the fundamental criteria for the onset of TI in animals. The age of the aggressor and the age difference with respect to the victim correlated positively with the intensity of the TI (probably due to the victim experiencing a greater degree of fear). The TI induced by sexual abuse in childhood correlated positively with the finding of psychological stress, depression, anxiety, post-trauma stress disorder (PTSD) and peri-trauma dissociation. These empirical data support the claim that there are analogies between TI in the animals response to a predator and the TI occurring in cases of human assault. Sexual violence, in particular, possesses all the characteristics needed to induce TI in animals, i.e. fear, contact and immobilization (Marx, 2008). Other features that suggest an analogy between the immobility experienced in the course of sexual violence and TI include variations in body 33

temperature, torpor, analgesia, trembling, inability to speak and a vivid recollection of the details of the experience (Suarez and Gallup, 1979). Despite the potential clinical benefits of applying the TI construct to the trauma of abuse in general, and sexual abuse in particular, its definition in the theoretical and research settings needs to be submitted to further verification.

1.12.5. Peritrauma analgesia Most people who suffered sexual abuse in childhood experienced analgesia and insensitivity to touch (Albach, 1993). In line with the Pavlovian concept of how symptoms form, the analgesia and the other traumatic responses seem to be reactivated by a stimulus strongly associated with a trauma suffered even 20 years earlier (Pitman, 1990). In patients with PTSD, this anesthesia is reportedly reversible with naloxone (Pitman, 1990). Anesthesia and analgesia are often associated with emotional blunting, depersonalization and derealization (Albach, 1993). It has been noted that defensive reactions of the flight or fight type are mediated mainly by an activation of the noradrenergic systems (Southwick 1999a; Southwick 1999b). A fundamental anatomical-physiological element in defensive reactions is the amygdala, which is involved in the physiological and behavioral reactions to fear (LeDoux, 1996; Misslin, 2003). The lateral hypothalamus, which is connected directly to the central nucleus of the amygdala, is also implicated in autonomic responses to fear (LeDoux, 1996). The midbrain PAG seems to contain neurons that coordinate the integrated defensive reactions (Bandler, 1982) and this is the area crucial to the analgesia induced by cerebral stimulation (Misslin, 2003). Tonic immobility and analgesia are both modulated by the vlPAG (ventrolateral periaqueductal gray matter), where the opioid system has an important role and is involved in the genesis of TI (Walker and Carrive, 2003). It has been observed that opioid stimulation of the vlPAG increases the duration of TI episodes in guinea pigs and that this effect is antagonized by naloxone (Monassi, 1999). Experimental observations on stress-induced analgesia, caused by an inescapable shock and mediated by opioids, in animals show that this effect is reversed by the use of opioid antagonists (Drugan, 1985). These findings have promoted some comparative studies and it has emerged, for instance, that women victims of systematic physical violence (from which they were unable to escape) have a stronger degree of stress analgesia than women experiencing non-systematic trauma (Nishith, 2002). Vietnam war veterans with PTSD revealed a significant analgesic response to videos of fighting, that was reversible with naloxone (Pitman, 1990). 34

Fiszman et al (2008) described patients with PTSD who had been victims of urban violence, whose TI reaction was associated with a poor response to conventional pharmacological treatment with antidepressants, leading the authors suggest that opioid mechanisms were involved (albeit with the limits of the small case series considered). Further studies are needed to determine whether the anesthesia, analgesia and emotional blunting in patients with dissociative disorders depend exclusively on the endogenous opioids, or whether their response to traumatic stressors might also be influenced by non-opioid mechanisms.

1.12.6. Fear and memory In situations of fear there may be an increase in the victims memory function, that is generally attributed to the greater alertness, which increases mnemonic encoding, as has been observed in rodents (Tomkins, 1980; Belzung, 2007) and in birds. Anxiety-inducing substances improve the memory of rodents and chickens (Venault, 1986), while anxiety-relieving substances have the opposite effect. In the rat, beta-CCT (a selective

benzodiazepine receptor antagonist) blocks the anxiety-inducing activity, but not the amnesiainducing effect of the benzodiazepine (Belzung, 2000). Extreme stress does not interfere with amygdala memorization processes, and it may even amplify them (Corodimans, 1994), but it does interfere with neocortical-hippocampal information processing which can inhibit or modulate emotional reactions and memories (Nijenhuis, 1998).

1.12.7. PTSD and dissociation Traditional research on TI in animals can contribute to studies on the topic of dissociation. Understanding dissociative processes in response to trauma involves considering multiple models of psychic, psychophysiological and behavioral functioning (Liotti 2011). Given the analogies between human and animal responses to threats (van der Kolk, 1985), it has been suggested that we use the animal model as a biological model to formulate hypotheses on the genesis of PTSD in humans (Cantor, 2009). PTSD occurs with a physiological and behavioral hyper-reactivity accompanied by inhibitory phenomena; both categories of which can be brought down to chronic alterations of the central neurotransmitter systems (van der Kolk, 1987; van der Kolk, 1994). Recentemente sono stati pubblicati alcuni studi riguardanti il legame fra situazioni di immobilit tonica e successivo sviluppo di psicopatologia (Lima, 2010; Humphreys, 2010, Kunst, 2011; Bovin, 2011; Hagenaars, 2011).


We need to investigate the link between situations of TI and subsequently-developing psychopathologies, and the links between TI, the consequent self-accusation and PTSD are still awaiting empirical studies. Marx (2008) reported an association between TI and dissociation (Heidt, 2005; Zoellner, 2008), but it is still not clear which subjective markers are shared and which are distinctive of each construct. Although both are believed to be the outcome of extreme fear, the cognitive process potentially associated with TI and with peri-traumatic dissociation appear distinct, or even diametrically opposite: suffice it to consider that TI is associated with a persistent and possibly even improved recall, awareness and learning (Gallup, Boren, Suarez, Wallnau, and Gagliardi, 1980), whereas peritraumatic dissociation tends to alter or interrupt these processes (Spiegel, 1995). The distinctions emerging from the experimental data may point to more precise hypotheses to help us understand trauma and dissociation in humans, who presumably develop dissociative psychic processes to cope with their traumatic experience, succeeding in activating the functioning of their procedural implicit recall of the traumatic experience dissociated from the other levels of functioning in memory (Albasi, 2006). The analogy with TI is very interesting because, although they favor a dissociative alteration of the memory processes, these implicit procedural memories preserve strong memories - albeit in a format inaccessible to conscious processing, i.e. the format is dissociated from the explicit declarative format of the semantic and episodic memories (and this can be seen in the symptoms of PTSD as well).

1.12.8. Treatment considerations Using the concept of TI in psycho-educational programs for treating trauma-related conditions may be beneficial in terms of the cognitive effects of the event (Zoellner, 2008). In particular, understanding the TI reaction could help to mitigate the sense of shame and guilt for having failed to resist an aggressor and been unable to defend oneself (Suarez&Gallup, 1979). A TI reaction to a sexual assault has important implications for the treatment of subsequent psychopathological conditions. TI may be associated with a suppression of autonomic arousal in response to traumatic events (Griffin, 1997; Lanius, 2002). In animal models, TI has been found to be associated with a diminished arousal of the autonomic nervous system, in chickens for instance (Gentle, 1989), and in pointer dogs (Reese, Newton and Angel, 1982). Cognitive-behavioral treatment for PTSD generally aims to reduce the physiological arousal related to the trauma using strategies such as exposure, relaxation and cognitive restructuring (Foa and Rothbaum, 1998). Although these strategies can be effective in some cases 36

of PTSD, they may not be appropriate in cases of a limited physiological arousal related to the trauma, as in TI. It has been suggested that people who react to events that recall their trauma with a diminished physiological activity may not be ideal candidates for therapies based on exposure to the stimulus (Hembree, 2003).

1.13. Conclusions Studies on these animal phenomena support the hypotheses, already presented in the literature, that trauma and dissociation are interconnected. In humans, whose mental life relies on their ability to attribute meaning to their experiences, a profoundly traumatizing terror can be experienced when their physical life is threatened. This can also happen when their mental life is threatened, i.e. when processing meanings would be incompatible with keeping in touch with their interior and exterior reality (e.g. with the attachment figures), who are responsible for acknowledging these meanings and confirming their adaptive validity (Albasi, 2006). From this perspective, dissociation - on its various levels - remains the most likely reaction to the psychic trauma. There are two directions in which studies on TI could evolve. On the one hand, the diffusion of a better understanding of the biological and behavioral grounds of the inability to defend oneself against an aggressor may have important clinical and legal outcomes (Fus, 2007; Marx, 2008; Suarez and Gallup, 1979). On the other, future studies may improve our understanding of the biological and neuropsychological substrate provided by nature to help us cope with extremely stressful situations. It is worth noting that a phenomenon consisting of an elementary sequence of actions, as in the induction of a state of immobility in animals, contains elements essential to our understanding of the complex events involved in the body-mind relationship, as in trauma and dissociation.


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Chapter II

Dissociated Internal Working Models (DIWMs): a relational perspective on attachment, trauma and dissociation.
Cesare Albasi

2.1 Introduction In recent decades the concepts of trauma and dissociation are among the protagonists of both scientific and clinical reflections. The vast amount of research we can refer to shows some common denominators. It proves that, first of all, trauma is consistent object of research and study, therefore in working with patients one should always keep in mind the clinical hypothesis that mental disorders, both in terms of personality and functionality have developed in a context characterized by traumatic experiences. Moreover, trauma is a specific experience of severe failure in the real relationship between organism and the environment1. Lastly, this failure concerns the individuals subjectivity, therefore it is not easily classifiable and must be understood in terms of intersubjective processes.2 The historical moment is therefore of great importance in clinical research on trauma. By conjugating the traditions of Infant Research, Attachment Theory and relational perspective in psychoanalysis (above all by Ferenczi, Balint, Fairbairn, Winnicott, Sullivan, up to present seminal contributions by Mitchell, Bromberg and many others cited further), we are developing the concept of Dissociated Internal Working Models (DIWMs) (Albasi, 2006, 2007; Albasi and Brockmeier, 1997; Albasi and Capello, 1995; Albasi and Boschiroli, 2003;). The concept of DIWM is a hypothesis regarding the processes underlying the structuring of psychopathology due to trauma; it is conceived to be employed in psychotherapeutic work and is a development of the concept of dissociation, in the attempt to interpret some of its developmental, procedural, relational, experiential, and structural dimensions.

From a theoretical point of view, in a psychological and developmental clinical perspective, environment can be intended as the attachment figures while organism is to be intended as mental processes. 2 These considerations are not to be taken from granted: the very history of psychoanalysis has been build around the different hypotheses regarding the traumatic relational etiopathogenesis, witnessing various kinds of splits and cloudings. How many people have turned to psychoanalytically oriented treatments (both in private and institutional contexts): the fact that their pillars are drives and repression, rather than trauma and dissociation, has meant so much for so many peoples health.


We regard IWMs (Internal Working Models) as a unit of relational experiences, and as both multiple structures and organized on many levels of functioning, which together build the meaning of subjective experience. The concept of multiplicity may therefore be seen as having at least two meanings: by adopting a spatial metaphor, we might imagine it as articulated around two axes: a horizontal-extensional one (the multiplicity of IWMs) and a vertical one (the many levels of functioning of each IWM). This conception is consistent with the two ways dissociation may be conceived: (Holmes et al., 2005): the vertical direction shows dissociation as a process that divides separated mental modules, such as in compartmentalisation; the horizontal dimension of dissociative working causes a kind of detachment with sensitivity and internal reality in the individual at various levels of depth. We consider IWMs as emerging structures at the intersection of the pathological functioning of both these dimensions of dissociative processes. We can regard DIWMs as multifold stratified modules of mental functioning. Multifold are thus also the levels of elaboration active in each IWM, from both the experiential and the structural point of view. Trauma works ruining these connection potentialities (which could generate richness in meanings) and preventing their realization in advance through the structuring of DIWMs. DIWMs are a dimension of the procedural level of psychic functioning, but they do not exhaust it; they have to do with its dissociated portion, thus remaining primitive and without connections (it does not develop, unlike implicit not dissociated knowledge). Conceptually, one must not regard all implicit relational knowledge as dissociated. Some clinical traditions have pushed us to consider how trauma in patients can damage explicit levels, the functions of mentalization and symbolization (Fonagy and Target, 2001; Bleiberg, 2001). This is certainly important as dissociation definitely excludes them from the elaboration of affectively crucial experiences, but we would like to underline the paramount importance of addressing our research and our theoretical models towards the damages that trauma implies at implicit levels (fragmented both by vertical and horizontal dissociation): traumatized patients lose confidence with their internal experience, attitude to integrating self-regulation and interactive regulations of their states, ability to trust in their intuitive evaluations as information essential to orienting themselves in their intimate and attachment relationships. Psychoanalysis considers the development of knowledge at an implicit level as extremely important, as it has favoured a theory of the therapeutic process unbalanced towards interpretation, thats to say on the explicit dimensions. We all recognize that in everyday life taking care of others is supported by meaningful gestures, by concrete actions with a profound communicative value; for years 51

psychoanalysis has not regarded all this as valuable. This distortion depriving words of their pragmatic relational dimension, of their impact on explicit functioning and the parallel ideological devaluation of gestures and inter-actions, is even more serious in the treatment of traumatized patients, as Ferenczi precociously acknowledged, as it is precisely at this level that they need help , since they are suffering from a pathology of implicit relational knowledge in order to build up attachment bonds, that we synthesize in the concept of DIWM. The dissociative configuration of traumatic attachment, both in vertical and horizontal directions, is in fact established in DIWMs and damages the building of attachment relations. In the ambit of procedural implicit relational knowledge, of the abilities of how solid attachment relations are built, the essential pathological core of trauma is set. This carries important etiopathogenic significance: trauma draws on implicit basic competence necessary to be able to experiment existence as a set of potentiality to realize ourselves in a close relational life.

2.2 Intra-familiar sexual abuse as a paradigm for understanding constituent processes of trauma After suspending the drama it inevitably evokes, we would like to suggest reflecting on intrafamiliar sexual abuse as a paradigm for understanding the components of psychic trauma.3 In fact, even if only a schematic typization of the situation in intra-familiar abuses is taken into account, for speculative reasons, it will mirror an image that we can regard at as typical of some elements of trauma and can be formulated at any level only continuously resorting to paradoxes. In order to grow up, children need a mental state in the figures of attachment specifically devoted to them, a parental position and an attitude turned to them aimed at understanding their diversity, intrinsic in being a child. In sexual abuse the maximum expression of the complete absence of these functions is to be found. From a procedural-structural point of view, this emptiness is organized by the building up of processes we call DIWMs: they configure the twofold motivation: a) referring to the figure of attachment (motivation to attachment), in this case perverted, confusing and frightening; b) to safeguard a fake project of search for internal safety, setting up a system excluding in advance the connections of this intricate cocoon of unbalanced experience with the remaining part of the mind. The sense of agency remains (the mind has to withdraw right into its fundamentals, thats to say the active proposal of subjective meanings to such an upsetting experience; it must cease to live in order to keep on living). The link between implicit and explicit levels is defensively blocked before it can

We are in any case looking for internal criteria of trauma, rather than the definition of an event as traumatic. (cfr. Ferenczi, 1932a; Borgogno, 1999, 2007; Frankel, 2001).


be formed: this dissociative blockage is engraved in the mind as a process structuring the specific memories of the traumatic experience (also structurally becoming a part of it, as far as the dimension of processes is concerned); this procedural memory will be disconnected from the other implicit knowledge, a procedural memory of the interrupted search of a meaning, pushing to be rigidly put back into the picture as forms of enactment. This example of dissociation on both dimensions vertical and horizontal at both the experiential and the procedural levels is the basis of the structuring of DIWMs. The result of the formation of DIWMs is therefore a loss of contact with relevant portions of ones subjectivity (in basic dimensions of the intense experience of ingredients essential to the formation of close attachment relationships. As for the meanings of such an experience, thats to say of its contents, children lose the chance to integrate the subjective connotation of their memories, to form integrated memories so ventrally relevant for their identity (the sense of their meaning and personal value, their self-definition). Memories of the abuse will persist in the mind in negative , in the paradoxical shape of a hole in subjectivity impossible to be substituted and recovered since not built but rather cancelled in advance in its potentiality of taking complete shape in the connection between the two levels. DIWMs are thieves of subjectivity. These memories could possibly be told but their narrative will actively be deprived ab origine of a deep subjective meaning (that could not be built in an articulated way) by anticipatory implicit processes, part of DIWMs. Therefore, subjectively an individual is left with the paradoxical impression of unreality of what was so really lived. It is as if the abusing parent were suggesting that what the child is living is not real, confirming this with gestures and words in the days that follow. The child thus feels that what has happened cannot be told to anybody if not at risk of being regarded as crazy (and this is how he or she feels, floating on a lack of subjectivity) or experimenting the risk of eliminating his or her parents thus remaining alone. Alone and crazy; or: Away from all this! The mind appeals to DIWMs tragedy and salvation that give life to an underworld of guardians and keepers of this complex event but that also allow the rest of the mind to nurture the nauseous thrill of the (silent - since not represented at an explicit level - but active) presence of primitive and inexpressible contents.

2.3 Abuse, DIWMs and traumatic attachment. A subset of processes are structured in the mind and it splits relational experiences, depriving them of the feeling of subjectivity by means of a manifold break of links, connoting them with a kind of retrospective instruction-rule to not be real, a form of omnipotent denial performed so as to not feel crazy but that once inserted in a DIWM also works a system of unconscious expectation 53

thus creating a kind of anticipation invalidating the future, that alters the experience of growing up and developmental change, contemning to a sense of ungrounded present void of articulations (patients live as if they knew something dreadful will happen because they cannot elaborate such an experience in a temporal perspective not being able to elaborate it as a memory symbolized by means of representations) (Bromberg, 1998). Other subprocesses parts of the same structure maintain dissociated and therefore perpetually primitive the essential emotional aspects that have been blocked (agency, regulation of internal states, the need for security, the search for meaning, acknowledgement, activation) and have irreparably imploded and become the same as their negation itself (and can therefore be expressed only in these terms), pushing (at a procedural level without any connection with explicit levels) towards their acting out in relationships. By considering these dimensions as some of the essential ones of trauma, we can note that even if they appear in paradigmatic evidence in the intensity of sexual abuse they are not a sole prerogative of such an experience. Infringement of childrens subjectivity, their disownment and manipulation by the people responsible for their development and the correlated invalidation of the mental processes active in a relational encounter in order to build up the meaning of the subjective experience necessary to their development, are characteristic of traumatic relationships, in the most frequent and present relational contexts and interactive situations. They can concern both recurrent ways of relating to children (pervasive and continuous chaotic and inconsistent responses thus disorganizing the IWM system deprived of connections) and systematic disownment but limited to particular and selective fields of life meaning (such as, for example, sexuality, sensuality, or reference to pleasure and the body; aggression, conflict or the need to assert oneself; desire and need for dependency, closeness, and to count on the total help of the attachment figure; desire and need for autonomy, the need to experience the feeling of personal realization. Taking ground from the experience of abuse, what do we then mean by traumatic? How do attachments become traumatic? The traumatic specificity of an experience of incest is the falsification of a subjective experience by the figures of attachment, its systematic disownment. The system of structures that gives life to subjectivity, thats to say IWMs, is developmentally altered and DIWMs are established. If we open up the perspective from focal trauma (abuse experience) on the basis of the characteristics that mark it from the point of view of subjectivity and of mental structures, we can define traumatic attachments as the bonds binding to an attachment figure disconfirming subjective experience, disowning validity, shattering and breaking important dimensions of internal reality, fostering the development of DIWMs (not only is this true for the parent-child relationship but also


for any attachment relationship form which we depend on for our mental functioning, with partners in adulthood, and for the psychotherapeutic relationship, etc) The term trauma ethimologically recalls tearing, breaking, wounding. Nevertheless, psychic trauma does not just leave a metaphorical gash or scar in subjectivity but also attachment to processes that give life to it, not only a void but also a structure (DIWM) that reactivates such a void through the building of elaborated processes. Hope in negotiation maintaining residual forms of connection is represented in the concept of resilience.

2.4 Traumatic attachment, DIWM and psychopathology The development and functioning of DIWMs therefore lies in the context of traumatic attachment. This is the clinical significance essential to the concept: individuals are deprived of the tools necessary for shaping and experimenting the basis of close attachment relationships (the ones they recognize and identify themselves with) which would allow them to express their specific potentialities and grow up, allowing them to experiment their existence as protagonists and bearing chances and possibilities to realize something personal and private. The paradox of DIWMs consists in placing the individual within an absence of subjectivity, the paradox of feeling superfluous in ones own relationships (to some patients, as if they were seen from the outside, just like watching a movie). In their close relations, individuals find themselves once again performing the deep failure in meeting the specificities of their own subjectivity and the one of their figure of attachment, implicitly asking others to help them recognize something never known (Albasi, 2006) a request containing the paradoxical need to be acknowledged both for what they are and for what they may become. In traumatic attachment relationships, DIWMs work by blocking in advance some possible formulations of the subjective meaning of experiences central to the attachment experience of our own gestures and others, upsetting the understanding of their course, of intimacy and thus also the possibility of making relationships an opportunity for reception and acknowledgement of potentialities, growth, and wellbeing. This shortage of sense twists the development of attachment relations by short-circuiting into detrimental enactments. DIWMs imply particular finely dissociative states of conscience in which the individual moves through events and relations in their lives as if, partly, they were elsewhere at the same time. DIWMs keep a somewhere else alive in the mind of a person, an elsewhere bearing the logics of paradox, indefinite and complex, of lost promises and potentialities, of emptiness and density in contrast: the paradox of absence and stiffness of organization.


Individuals feel they depend on this elsewhere even if wishing to defensively escape from it because it is there that the potentiality of a close encounter with themselves and others was lost; this elsewhere can be gambling, drugs (with its scene of subculture and companies around), sexual attraction towards a minor, binge eating with its subsequent laxative, coming to blows, as any other psychic retreats (Steiner, 1993). DIWMs governing such an elsewhere transmit confusing hope, ask for a discontinuous but faithful edition, are traps where the mirage of personal vitality, of the self, should be discovered and elaborated differently; if taken as it is in large amounts it may spoil life making it miserable and degrading it to the inconsistency of an interrupted potential process, continuously reactivated in a vicious circle. Change requires the search of the elaboration of alternatives in which lost authenticity and affectivity can be lived, having been subtracted from the individual and that DIWMs seductively only show in their fake capacity. DIWMs are a process and do not correspond to a specific content (or to a psychic symptom). The concept of DIWM is not defined on the basis of a particular kind of mental content (thought, affect, role or position of the pre-representational figure on the scene, as, for example, victim, aggressor, or rescuer, etc). We cannot state if DIWMs contain confusion and dissociated anguish rather than creative potentialities (like Winnicotts true Self, 1965) blocked in traumatic interaction: nor evil or good, not bad or good (as for contents). DIWMs testify the interruption of possibilities of regulating affects, independently from their nature (not only negative ones4). Even better, pain and negative effects may be rich in sense in some contexts both regarding values (such as sacrifice) and biology (such as delivery) and not being traumatic at all but bearing a developmental meaning. On the contrary, some patients have experienced never being acknowledged when they were about to cheer up or were joyful, etc (think of a child entering a room cheerfully while their mother systematically tells them to stop it because they give her a headache). Joy and positive affects may also not be integrated. The hypothesis that DIWMs do not depend on negativity of dis-regulated affects they may carry allows a clinic attitude which is favourable to taking care of pathologies such as addictions (Caretti and La Barbera, 2005; Lingiardi, 2008) or perversions, pushing to look for along with patients what the interrupted journey in their psychopathology is, toward a search for hidden positive affects. In re-actualizing DIWMs, patients seek forms of specific dissociated vitality and not simply to avoid sorrow or to find pleasure; they are a world apart in the individuals world, unknown (in a declarative way) but always sought in its realization and verification, thus (unconsciously)

During psychotherapy the concept may become useful to understand the patients change when new experiential content come out, like the appearance of persecutory figures or depressive states marking the contact with DIWMs.


favouring its realization but always as if it came from the outside, giving back the impression it is something familiar and paradoxically unknown, are intimately extraneous.

2.5 The paradoxes of trauma and DIWMs. As Winnicott (1956, 1965), Sander (2007), Mitchell (1988, 1992), Ghent (1992), Hoffman (1998), Pizer (1998) pointed out (just to remain in the field of our discipline) paradox is at the centre of what is most valuable for mental life (identity, creativity, humour, feelings, relationships, birth and life itself); identity, for example, is grounded on a paradox: in order to have an identity, living beings must continuously negotiate change, in order to always be themselves they must always be a bit different. Bateson (1972, 1979), like Hegel, was convinced that paradox could not be excluded from thought and from human communication, and that human beings, rather than trying to dissolve them in the name of an alleged linear logic, should learn to live with their paradoxes, to inhabit them, to move about easily in the same universe in which they have fixed abode. For their very nature in fact, paradoxes are not solvable (differently from conflicts), they have ground on dialectic tensions (constituting their structure) and come to be potentially traumatic if they cannot be negotiated (Pizer, 1998). Traumatic attachment is founded on the paradoxical essence of all attachment relations (at every age and in every role) thats where their delicacy and complexity of contact and differentiation lays, reciprocal acknowledgement and self-achievement, identity and change, dependency and autonomy, etc. Since attachment relations are valuable for mental life itself, they completely put it on the line. This makes them complex, multiple, stratified, many-sided; gestures and communication internally carry a load dense of multi-role meanings continuously requiring acknowledgements and negotiations. For some of their aspects, the same gestures undertake interactive ways that finely lead them to assume either developmental or traumatic meanings. Space for respect of the others mental life is created by gestures rich in meaning; the polysemy allowing for such richness lies in a context in which the delicacy of the building of reciprocal subjectivities by means of intersubjective contact can be undermined and even destroyed. The mind meets life or death, tragically opposite meanings, in the same relational gestures essential in development. What makes the difference is a context in which acknowledgement and negotiation are possible. For example, let us consider how the birth of a loving attachment relationship is bound to the fake of an aggressive gesture (meaning aggression in the amplitude of its semantically meaning): seduction (bringing the other to oneself, destructing him or her from his or her existential trajectory driven by ones desire). This gesture can later open up space to the other, respect and sharing; a new attachment relationship and perhaps a new life. A new life takes root from an aggressive gesture that on the other end also bears manipolatory and 57

potentially traumatic guise. Such a paradox must be negotiated by the minds of the people in the relationship. In the dominion of the psyche, importance lies on nuances. In the same way, the educational role is also essentially paradoxical: in order to get to education, rules are to be set and ways to be shown: if this is not done, and life is lived as if children know them or can find them by themselves, a traumatic inversion of roles and functions is set. This inversion is based on incapability of bearing the paradox too: it implies that individuals in relations are a hundred per cent individuals and a hundred per cent a relational system: being a figure of attachment for another person (especially if it is a child) does not imply the possibility of leaving an empty space for a spontaneous development, but a space in which mental functions are to be given, rooted in IWMs, articulated in the acknowledgement of the reciprocal individualities and in the relational system comprehending them. Everybody is an ingredient for the realization of the others mind, built within the binds offered by a specific and concrete relational system: potentialities are bond, but in these bonds they find a possibility to be realized (Ceruti, 1986). By contrasting some of the demands of a child, from a steady conflictual position, you are showing them a way, a route 5. His or her spontaneity, his or her being active giver of gestures and meanings, may not be seen from the outside of the relationship, but only within that is its constituent part. The spontaneous necessity for an environment favourable to development is also relationally built as any other dimension and cannot therefore be taken literally: due to his or her role, the attachment figure bears the responsibility to appropriately contextualize potentialities not yet provided for with a complete development. A child cannot (even if he or she will later be able to) be responsible for what is good for him or her by him or herself; such a responsibility can and must be constantly explored and negotiated in the dialectics of the process or reciprocal acknowledgement typical of attachment relationships. Focusing on the delicacy of developmental processes, it can be inferred that no external criterion exists in order to move within the complexity of these nuances but a contextualized both in timings and roles - negotiation is necessary. What Eigen (1999, 2001) states is true: while attachment figures feed their children with love, they inoculate toxins, binds, Achilles heels.

2.6 Conclusive remarks on diagnosis and psychotherapy Some tend to reduce the understanding of psychopathology to its external dimensions in terms that are nosological (thus reducing its complexity to a list of symptoms), descriptive (privileging

Today (in working both with children and with couples) we have to face the problem set forth by the great difficulty that parents often have in offering their children a plan of reality easily accessible for them, that can and must be when necessary frustrating for children. Parents trying to be sensitive and attentive even to the finest


analytical and fragmenting attitudes), generalizing (losing the very sense of the persons singularity and the unique and unrepeatable mental organization). Psychopathology is not only this. To think that people who take care of psychic health may reason in these terms, avoiding reflection on the models to comprehend psychopathology, is discouraging and worrying. Nosological handbooks try to define trauma in an a-theoretical way without any reference to etiology. Understanding trauma, on the contrary, seems to require a formulation of models well before a definition of classes of disorders, of theories and observation lenses of reality in its processes, well before a classification among other syndromes, of clinical reasoning on its etiology, the peoples history, on individuals, subjectivity, meanings, and relations. The study of trauma challenges a nosological approach to psychopathology. No nosografic category can maintain or have exclusivity on trauma. A precise discussion of these problems would lead us, however, far from the present topic. Far more interesting is the dimensional diagnosis maintained by PDM (Psychodynamic Diagnostic Manual; PDM Task Force, 2006)6 which, besides other suggestions, also stimulates some hypotheses on how a reading of the effects of trauma and the functioning of DIWMs through the dimensions or axes (P,M,S) is possible (Albasi, 2008, 2009). We have operationalizated the dissociation through the range of level of borderline organization of personality with the QFM based assessment procedure. This assessment procedure system is based on a clinician report questionnaire that operationalizes the nine mental functions of M axis (capacity for regulation, attention and learning; capacity for intimacy and relationships; quality of internal experience; capacity for affective experience, expression and communication; defensive patterns and capacities; capacity to form internal representations; capacity for differentiation and integration; self-observing capacities; capacity to construct or use internal standards and ideals) and the three levels of personality organization of P Axis (Healthy Personalities, Neurotic-Level Personality Disorders and Borderline range-Level Personality Disorders). By crossing these two dimensions, as PDM suggested (PDM Task Force, 2006, p. 23), we obtained 27 items that give the possibility of assessing each mental function as healthy (developmental oriented), as carrier of conflicts (neurotic), and as function at disposal of the personality dissociation. The QFM has been validated both on adult and adolescent samples. The QFM system provides some elaborations which give the possibility to assess the nine mental functions and the levels of organization: this system engages a better clinical attitude for the care of

The new Psychodynamic Diagnostic Manual ( PDM) is an instrument aimed at the dimensional assessment of patients delivered by a task force coordinated by Greenspan, McWilliams and Wallersein. The manual suggests three axes: P (personality), M (Mental functioning) and S (Symptoms).


the patients and, at the same time, orients in a specific direction the therapeutic projects, that is towards the aims associated to diagnosis and assessment and achievable by a global and integrated clinical project; moreover, it enables the articulation and the integration of all the necessary types of treatments and interventions. The QFM system is at the moment used both in public and private ambits by colleagues and work groups of Piedmont, Lombardy, Veneto, Sicily, Latium, Tuscany, Emily, Liguria and of some other Italian regions.

2.7 Dissociation and psychotherapy The perspective shared in this contribution considers trauma in a developmental sense, claiming that the understanding of its typical constituent mechanisms and of the psychopathologic processes it activates, hits the core of what is essential to the very human existence, thats to say, experience of attachment relationships throughout the developmental span, and the structure mediating this experience (IWM). From such a perspective, understanding trauma (interwoven with the theory of relational development and its distortions caused by DIWMs) can be the centre of etiopathogenic hypothesis of a great deal of mental and personality disorders and favour a discussion on some pillars of psychotherapeutic methods. From a structural point of view, attachment relationship in adulthood are always built on the basis of ones implicit relational knowledge (one of the levels of functioning of IWM); classical psychoanalysis aimed at making this knowledge explicit (translate it into words) above all by means of the interpretation of transfert. In the case of traumatic attachments, DIWMs make this operation impossible for the individual. A therapist faces the alienated intimacy of a patient7. During psychotherapy, DIWMs are expressed in the therapist-patient interaction, they capture the therapists subjectivity, they provoke triumphs and catastrophes in its counter-transfert (Giovacchini, 1989), they require its use of self (Jacobs, 1991) and enactment in order to experiment and, in the interconnection of internal and external levels, formulate for the first time subjective experiences never experimented before and necessary to its integrated development (of care, joy, excitement, anger, benevolent dependency and warm autonomy).

Besides, treatment cannot regard symptoms as something to be simply eliminated: they are represented in parallel universes, in a somewhere else, in which we find what our patients believe to be most intimate and important and makes them feel alive. These symptoms are the expression of DIWMs in the whole of their paradoxical complexity: both pathology and interrupted vitality and the attempt to make something with the confusing sense of internal mortification and the search of escaping such a heavy living are interwoven just like as in a cocoon extremely distant from the individual in symptoms and in the correlated internal state, in the annexed parallel universe. and in the interactional system structured around it.


Since nothing can be erased from the mind, the DIWM treatment in psychotherapy consists in the development of alternative ways in building up close relationships (alternative IWM) that an individual may recognize as personal and vital, in which something private and alive, important and meaningful can be identified, in which feeling free to find his or her self. In such pathological forms the psychotherapeutic process is crossed by the painful re-living of expectations and affects disconnected by DIWMs and by the reactivation by means of an inevitable moment of courage (Ferenczi, 1920-32, 1932a) of the hope of meeting possible safer relational possibilities, functional to development, opening up new ways to have faith in an attachment relationship. Alternative IWMs may offer a different integration between levels of functioning and other registers so as to make an elaboration of the interactive experience previously submitted to possible DIWMs. DIWMs may therefore deactivate, with the result of minor annoyance, still reaming accessible. Thanks to psychotherapy the balance between IWMs and DIWMs with which patients grew up in altered. The intersubjective negotiation enacted in the therapeutic dialogue allows faith in new relational opportunities. The relationship with a psychotherapist may enrich and create alternatives to IWMs, working as an attachment relationship. One of the scandals of psychoanalytical therapy is that in order to be the kind of professional relationship that fosters psychic growth it is it has to be too similar to a love relationship rather than to other professional relationships (with a doctor, lawyer, designer, baker etc...), it works more efficaciously if patients accept to feel strong feelings linked to such a relationship, to balm the therapist if they feel they are not understood, to be more self-confident during psychotherapy, to live more intense and more authentic experiences, to bravely run the risk of giving to the therapist the power to traumatize them again or to make them grow up. Therapy becomes then an attachment relationship with its own history and such an experience takes root in the patients mind, thus becoming a reference point to which they can spontaneously refer to experiment and understand themselves and the world around them. If a therapeutic relationship is a particular attachment relationship, aimed at pursuing the patients subjectivity in order to explore their experience and think of it, but also to offer another new experience in which somebody is taking care of them, therapy is not based on the primacy of interpretation and on the enlargement of explicit consciousness, but on the enlargement of IWMs at each of their levels and in their connections. This principle is even firmer in the case of patients with damages in their reflexive functioning, as traumatized patients are. Psychoanalytical treatment was invented by Freud as a talking cure, emphasising the symbolic dimension and (conceptually) de-valuating the gestural one. We can perhaps give a sense of proportion to this perspective and can also look at psychopathology and psychotherapy from a 61

opposite points of view: traumatized patients suffer from deficits at their procedural implicit level and need help at this level. In the case of trauma and of procedural dimension we need more sophisticated theories on the implicit level and on the procedural dimension, and on how to treat them psychotherapeutically. The development of the concept of DIWM is seeking this objective.


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Chapter III Interview to Gordon Gallup Concetta Feo

3.1 Meeting professor Gallup It is August 2009 and during a study period at State University of New York at Albany we meet professor Gordon G. Gallup Jr. (Figure 23), evolutionary psychologist, the most important researcher of the Tonic Immobility phenomenon.

Figure 23. Gordon G. Gallup Jr. (photo by Concetta Feo)

Can you tell us about your first encounter with the Tonic Immobility phenomenon? We tried to simulate the original report of tonic immobility under laboratory conditions by drawing a line on a table with a piece of chalk and we then held a chicken on the table, fixated on the line. When the chicken stopped struggling, we released it and it appeared to have been hypnotized by that line. Most of the available research shows that the presence or the absence of the line is not a necessary component of the reaction. All of the effective techniques for producing tonic immobility or hypnosis in animals involve some aspects of physical restraint. My first experience with tonic immobility occurred when I was a brand new assistant professor at Tulane University in New Orleans. We had gotten some chickens for some learning research. When the chickens came into the lab they were only a couple of days old, so we had to wait until they grew up. When the chickens were about three weeks of age another graduate was walking by the lab and saw the chickens. He asked me if I ever seen an hypnotized chicken and I said no. He asked if I'd like him to demonstrate and I said sure. So he reached into the cage and grabbed a reluctant chicken. He then took a piece of chalk and drew a line on the table. He held the birds head on the


line and after struggling for a little while, the bird was still. He could then released his grip on the bird and the bird appeared to have been hypnotized by that line. Upon seen this, we dropped everything; we never did the learning study; went to the literature and begin to find out as much as we could about this peculiar reaction. Let me just describe briefly some of the characteristics of this peculiar response. In addition to a lack of movement, often times animals in tonic immobility can be placed in peculiar postures and show a feature called waxy flexibility. Waxy flexibility means that you can put the animal's leg, or its wing in the case of the chicken, into a new position and it will assume that new position just like a waxy stick figure. This state is also shown by human patients with catatonic schizophrenia. During tonic immobility, it is also common to observe Parkisonian-like tremors. Animals in this state commonly exhibit reduced responsiveness to external stimuli, characterized by closed eyes, lack of vocalizations and physiological changes.

Aside from the hypnosis theory, what are the other theories about T.I.? Because of the peculiarity of tonic immobility, people have theorized quite a bit about the its significance over the years. Some of the theories advanced to explain tonic immobility include: the idea that it may be an animal analogue to human hypnosis; that it may be a type of sleep; that it may be a fear reaction; that it may be due to special disorientation; or that it may be an instance of defining. Darwin was the one who attempted to champion this last idea. So even Darwin himself was a aware tonic immobility and Pavlov, who discovered classical conditioning,was also aware of tonic immobility as consequence of early work with dogs. He speculated that tonic immobility could be a critical form of inhibition. After we first became interested in tonic immobility, we attempted to pursue the idea that it may be a fear reaction. One of the unique advantages of this fear hypothesis is that is easily testable, as it is very easy to manipulate fear under laboratory conditions to see what it is that affects the duration of tonic immobility. In one of the first studies we did on this topic, we looked at the effects of brief electric shock. Birds were given brief electric shocks at different intensities immediately prior to being restrained. As the intensity of prior induction shock went up, there was a corresponding increase in the duration of tonic immobility. The same is true if chickens, lizards or frogs are given a brief exposure to a loud noise prior to be immobilized. We have also attempted to test the fear hypothesis by designing experiments in such a way as to minimize fear. If chickens are given a tranquilizer prior to be immobilized; then as the dose of tranquilizer goes up, the duration of tonic immobility goes down. The same is true of handling and


familiarization, which is the reason why you do not typically see tonic immobility in household pets.

What is the role of T.I. in nature? Another perspective on tonic immobility is that, given that it is expressed in so many species, it may have some adaptive siginificance. The question that arises is what its functional significance may be. One way to think about tonic immobility is that it may be an evolved predator defence. You can conceptualize predator-prey reactions as existing along a dimension of defensive distance. So when the prey species first detects a predator at an appreciable distance their typical reaction is to freeze as a means of minimizing their detectability. If, in spite of freezing, if distance continues to decrease which means that the detection has occurred, the most likely response here, in this distancedependent sequence, is to attempt to escape; flight. If in spite of attempt to escape, distance continues to decrease and contact occurs, you then get struggling. If the contact is more than momentary, you then get tonic immobility as the terminal defensive response in this distancedependent sequence of predator strategies. The idea is that many predators have been programmed by evolutionary history to eat only live animals; therefore, by becoming immobile and appearing dead, a prey animal can utilize this programming as a defence mechanism. Let me give you some examples: if you have ever witnessed a cat capturing a mouse, you will have noticed that the cat will be frequently play with the mouse. The cat will put the mouse down, and back up a few steps, and then wait for it to move. When the mouse moves, the cat will pounce again; but as long as the mouse remains motionless the probability of further attack is reduced. In the meantime if a bird flies by, the cat may become distracted and the mouse may therefore survive and pass on its genes. Further evidence? For the adaptive significance of tonic immobility in the context of predator-prey relations is that many captive predators have to be fed live food. If given a perfectly edible piece of meat they will just stare at it. The reason for this is, again, that they are programmed by evolutionary history only to attempt to eat live food.

We know that you tested this hypothesis with a original experiment. Initially we decided to test this predator-prey model of tonic immobility by simulating predation under laboratory conditions. We got a stuffed young male Coopers hawk which is documented as chicken predator. Confounding chickens with Cooper's hawk and when they were about 3 weeks of age, this means that it was the first time in their life they ever seen a Cooper's hawk We immobilized the chicken in the presence of Cooper's hawk. What we discovered was that the closer the chickens were to the hawk when immobilized, the longer they would remain immobilized. So 67

the presence of the hawk clearly had the effect of prolonging or exaggerating the immobility response. Then the question was, what was it about the hawk that was producing this effect on the chickens? So in a series of studies we tried to determine just what it was about the hawk that was producing this effect. In one study we had three groups of chickens: one was tested in the presence of an intact hawk, one was tested in the absence of an hawk, and the third group was tested in the presence of an hawk whos head had been obscured by a black plastic hood. When the hawks head was obscured, the effect was greatly diminished, which suggesed that something about the hawks head was producing the response. We decided the next step would be to find out if the chickens' response might have something to do with the hawks eyes. So we well obscuring the hawks head took small pieces of black plastic tip and pull them over the hawk glass eyes. We discovered that when the chickens were tested in the presence of an eyeless hawk it was as if the hawk wasnt even there. So the fear of the hawk seems to be dependent upon the hawks eyes. Testing further, we then took glass eyes like those used in the stuffed animals and attached them to wooden dowels which were anchored into a board so they could be suspended on the head of an immobilized bird. We used brown and yellow eyes and in some trials, covered the eyes with black tape. Exposure to the brown eyes and the yellow eyes greatly prolonged the immobility response, but when the eyes were obscured with black plastic tape, the effect largely went away.

So what are your thoughts on this? The effect of these eye spot patterns and the defensive reaction they trigger in birds has been incorporated interestingly into the morphology of some insects that are commonly predated by birds. If the Eyed hawk-moth is resting, the upper wings cover the inner wings. But if it is disturbed, while it is flying away it will extend the other wings so as to expose the intricate eye spot patterns of the inner wings. Exposure to this intricate eye spot pattern wings frequently intimidates an otherwise predator bird who would rather live than eat the insect.

It seems that T.I. is traceable also in human beings. It is not possible, for obvious ethical reasons, to reproduce any experiment on a human being. What can you tell us about this? Given the widespread presence of tonic immobility in such a diverse group of species, its interesting to pose the question as the whether humans might also show tonic immobility. Humans were probably subjected to predation at various points during their evolutionary history as well. There are reports of people who have been 'scared stiff' or 'frozen with fear'; and theres evidence for immobile-like states among a troup in combat, which is called shell shock. There are reports 68

from people who have been attacked by wild animals and survived, who frequently recount periods during the attack where they were incapable of resisting or calling out and found themselves paralyzed with fear.

Are there other cases in human beings where we can see analogous conditions? Some of the other possible examples of tonic immobility in humans include catatonic schizophrenia, or catatonic like stupors schizophrenics become immobile, appear insensitive to the things going on around them. There are accounts of people who wake up in the middle of the night and have the impression that there is somebody else with them in the room; they go into a condition called sleep paralysis where they are incapable of moving or calling out.

What are the similarities between tonic immobility and rape induced paralysis? There is a list of similarities between symptoms exhibited by catatonic schizophrenics and behavioral elements that also are present during tonic immobility in animals. Both are characterized by a rapid onset, Parkinsonian-like tremors, muscle rigidity, waxy flexibility (wherein you can move the subject's limbs into different positions and they retain this new position); they seem

unresponsive but do not become unconscious, and these symptoms are frequently precipitated by emotional stress. In fact, many patients that go in catatonic schizophrenia once they come out of this catatonic stupors if you ask why they response or why they dont react they frequently say that they are afraid to move. This is a parallel with tonic immobility in animals. People who have experienced a sexual assault are frequently confronted with many of the critical induction features that common to the production of tonic immobility in animals: Contact between the rapist and the victim; restraint of the victim by the rapist; and a clearly strong overtone fear condition in predator-victim. Studies done on rape victims show the following pattern: during the initial phases of the encounter the victim makes escape attempts; if they are unsuccessful and the contact occurs, then there is struggling and resistance; frequently, in cases where the struggling and resistance are ineffective, the victim will experience what is called rape-induced paralysis. In this state, the victim is still vividly aware of what is going on around her but is unable to resist physically or to call out. Its very similar to tonic immobility. We have reason to believe that rape induced paralysis may in fact be an instance of tonic immobility. Many of the features of tonic immobility in laboratory animals have clear, compelling parallels in rape-induced paralysis? We think that rape induced paralysis has implications for rape prevention, and may have implications for both the treatment victims of sexual crimes and for the way those crimes are handled by the legal system. 69

If you think about sexual assault in the context of predator-prey relations, the rapist plays the role of the predator. Just as many predators' predatory drives have been programmed by their evolutionary history to require movement; there are some rapists who, in the absence of resistance and struggling on the part of the victim, seem incapable of consummating the rape. So one of the advantages of rape induced paralysis may be comparable to the advantage animals experience in predator-prey relationships by going immobile; immobile would-be victims live to survive both predator encounters and sexual assault. Some rape victims, after they have been raped, begin to entertain feelings of guilt and think they had to respond differently, that may have been able to stop the assault, and they begin to entertain the possibility they may be their fault. If the rape victims were informed of the fact that tonic immobility is an involuntary but highly adaptive reaction, they might be able to understand that there is no reason for them to feel guilty or responsible for what happened.

This involves very painful psychological consequences. It may also have legal implications in many parts of the country and in many parts of the world. They used to call it resistance statutes. These statutes dictate that in order to convict somebody of rape you have to show that the victim engaged in physical resistance. This physical resistance on the part of the victim is used as evidence for the fact that the sexual encounter was non consensual. The problem with resistance statutes is that tonic immobility is an involuntary adaptive response and if the victim goes into tonic immobility, according to these statutes, that means that the victim is consenting to the attack. So the legal implication is now becoming increasing clear that resistance statutes are anachronisms of the law, and need to be revised and rethought in terms of what we now know about tonic immobility.