This article is an expansion of an article that I published several years ago about Global High Intensity Activation.
Definition of Syndrome
Syndrome: a group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms.
The Oxford English Dictionary
What is Syndromal Physiology?
Syndromal physiology is a Somatic Experiencing® term for an overall body and nervous system state that has the tendency or possibility to develop into one or more medical syndromes, or where those medical syndromes are already present as a result of the overall state of the body and nervous system. Medical syndromes include fibromyalgia, chronic fatigue, migraine, and many more.
Note that it is possible to have a medical syndrome where that syndrome is NOT due to an out of balance nervous system and body state but has some specific organic cause. In that case the syndrome is not the result of syndromal physiology.
The body and nervous system state comprising syndromal physiology involves body systems not working optimally, under-functioning and/or over-functioning, and it tends to involve body systems working at cross purposes to each other. One metaphor for this would be a house in a cold winter where the furnace is running at full tilt while the windows are open. One medical example would be where the heartrate increases to promote more blood flow while the blood vessels constrict, restricting the flow of blood.
What is Global High Intensity Activation?
Global High Intensity Activation (GHIA) is a label used in the Somatic Experiencing® world to refer to the nervous system state of certain clients. This section describes how Global High Intensity Activation is described in Somatic Experiencing trainings.
A global high nervous system is either fully off or fully on. The whole body is affected when there is a stimulus, and the person will switch from a state of being flat, numb or disconnected to a state of intensity, overwhelm, and too much. However, even when the person flat or “switched off,” there is still a baseline of activation in the system. This might feel like a buzz or like static, either to the person themself or to others around them.
Global High is highly correlated with attachment and relational trauma. Because the inner experience of a global high nervous system is so intense, the person can’t comfortably and gracefully regulate themself. If the person is not debilitated by their global high system, they might be over-functional, supercharged, a workaholic.
Various labels for “Global High”
Global High Intensity Activation might be referred to by any of the following terms:
Global High Activation
Global High Intensity
Global High Intensity Activation
Global High Intensity Activation of the Central Nervous System
And if you find yourself in conversation about this, some people make “GHIA” pronounceable, like “gee-ya.”
My description of Global High Intensity Activation
The Global High Intensity Activation experience includes repeated or continuous over-responses to stresses and triggers, where the body and nervous system are more distressed than the situation objectively calls for, and where this recurs repeatedly. In these nervous systems, there is a baseline level of stress, tension, and/or constriction, so that the person never fully relaxes and settles on the inside, despite how the person might appear from the outside.
For a person with global high intensity activation, their nervous system is always activated, they never experience feeling settled and safe. The distress of the hidden feelings is constantly alive in the body, regardless of whether there is any current trigger that might be identified. In a sense you might say that for a person in a chronic GHIA state, simply being alive is triggering. The sympathetic nervous system of this person is activated – the impulse to fight and/or flee is always present – though not necessarily consciously felt.
For many global high systems, the sympathetic activation is covered over by a freeze or dissociation. These systems are in moderate to high sympathetic activation all the time, and also in moderate to high freeze much of the time.
Some people with global high systems might not have the high sympathetic activation covered by a freeze. Without a dorsal vagal blanket of freeze or dissociation, the person might use distraction, medications or addictions – to substances or to activities – to manage the charge in their body.
Either way, there is a baseline of constant distress that is suppressed or managed. The system is overloaded, there’s too much going on even before anything happens in the present moment.
There is a pretty high correlation between GHIA and early developmental trauma because with early developmental trauma, the nervous system never learned how to regulate, it never learned how to feel calm and safe to begin with.
Causes of Global High Activation and Syndromal Physiology
What would cause the human body system to never settle, or to send mixed signals to the various organs and systems in the body?
At a high level, the answer to this question is the same as the answer to any of these questions:
Why do people have PTSD? or C-PTSD?
Why do things that happened many years ago still bother people?
Why do people react or feel scared by people or situations that are clearly not dangerous?
Here are some of the labels or names for the configurations that cause all of these problems.
- Overcouplings
- Stored Procedural Memories
- Survival Patterns
- Over-identification (or merging) with a part of self, based on past experience
Each of these is essentially referring to a set of unconscious beliefs (such as “People are dangerous and cannot be trusted.” and “Therefore I have to be ever vigilant, prepared for attack, when I am around any person.”)
Based on these beliefs, we have automatic body and mind responses that occur in certain situations. Some of these automatic responses are largely emotional and behavioral – we feel compelled to engage or disengage in a certain way. And some are physiological, affecting how our bodies function.
There are two distinct categories of unconscious beliefs that create and reinforce the global high pattern. The first is related to suppression of painful feelings and memories. The second is about the inner enforcement of rules for how to stay safe.
Suppression of painful feelings and memories
Belief: It is dangerous to remember or feel [feeling/event/need.]
When we have unresolved trauma, the fear/terror/overwhelm and other emotions from the traumatic experience live in our bodies along with the somatic memory of the events. This applies whether there was a single traumatic event or an ongoing situation of threat or of needs not being met. To survive and to be safe enough, we hide these painful emotions from ourselves. Often, we hide not just the size of the emotions but the fact that the emotions exist at all. As a baseline, we may feel ok, or we may feel uncomfortable, uneasy, numb, distracted or dissociated. But what we don’t feel are these hidden emotions, at least not at full size. In fact, we have unconscious (sub-cortical) inner processes that work to ensure that the emotions remain hidden.
Rules for Staying Safe
Belief: I need to be/do/act/not be/not do/not act/not think/not feel [behavior/thought/feeling] to not be harmed and to get some of my needs met.
Experiences of being unsafe can range from a less-than-optimal environment – such as a misattuned learning environment or a hospital stay where we are constrained and separated from our caregivers – to an environment that is downright dangerous where we are regularly or intermittently berated or hit or neglected or violated. Regardless of the details or the scale of the threat, we learn which behaviors and presentation of ourselves are most likely to evoke bad attention and harm, which behaviors are most likely to spare us from harm, and which behaviors will evoke “good” attention and care.
Often, some of the rules for staying safe are at odds with our basic needs and impulses, like the need to express, the need to be understood, and even the needs for food, water, warmth, and comfort. If the rules for safety require us to suppress our life force and our basic needs and impulses, that requires a lot of juice. Our basic needs never actually go away, so to enforce those rules, we create additional sub-cortical inner processes to manage them. We automatically and unconsciously re-route our needs and impulses so they don’t rise to the surface and thus don’t prompt behaviors that might evoke harm. The processes that manage this suppression are often running constantly using quite a bit of life force and energy.
The physiological consequences of hidden emotions and enforced rules
Inherently, our bodies want to feel our feelings and emotions. Our bodies want to feel and tend to our needs. Without intervention, our feelings, needs, wants, and memories would rise to the surface, and we would take actions to care for ourselves and to satisfy our needs. Since fully feeling and allowing needs and emotions is not safe, intervention is required. Here’s the thing. The way that our bodies intervene to suppress emotions and to enforce rules is through the physiology. Our body systems are intentionally inhibited as a way of reducing our connection with ourselves. Muscles may be chronically constricted or flaccid. Blood flow may be limited. Nerve signaling may be inhibited. One way or another, one or more body systems function sub-optimally to enforce these inner constraints.
And of course, the impaired body system functioning affects more than our emotions and needs – this impaired functioning impacts our health and vitality.
There are at least two factors that can cause these physiological impacts of trauma – of suppressing emotions and enforcing rules – to be more severe. These factors are the intensity of what is suppressed and the contradictions between rules.
How hot is the fight within?
Our suppressed emotions and unmet needs are crying out to be seen, met, and held. However, some of those cries are louder and stronger than others.
When one important need is inconsistently met, but not met enough, and many other needs are met, the degree of intensity or desperation in that partially unmet need may be relatively small.
When many key needs are chronically unmet, the degree of intensity or desperation in that complex of unmet needs is immense.
The greater the intensity of the unmet needs, the greater the intensity of the physiological clamping down in the hiding of emotions and the enforcing of rules of safety. This then leads to greater risk of syndromal physiology and of syndromes. Hence the now well-known results of the ACES study, where a greater number of adverse childhood experiences is correlated with greater health problems when those children become adults.
How much are the rules at odds with each other?
For purposes of this paragraph, let’s cast the suppression of emotions and memories as an internal rule. We need to avoid these emotions for the sake of inner safety. Then we have the rules of presentation and behavior for outer safety. So, we have a collection of inner and outer rules, all of which need to be followed to ensure that we minimize risk and maximize safety.
I mentioned above that these rules are often at odds with our basic needs and impulses. But beyond that, these rules for safety can be at odds with one another. For example, “Make sure you are invisible.” vs “Make sure you are seen doing the things that are expected of you.”
The more rules we are trying to follow, the more likely it is that there are contradictory rules that are pulling us in opposite directions. When we have contradictory rules, no matter what we do or don’t do, somewhere in us alarm bells are sounding, telling us that we are putting ourselves into danger.
Therefore, the greater the number of rules that were planted in us, the greater the likelihood that we will develop syndromal physiology, and the more extreme the physiological symptoms are likely to be.
The Quandary
What makes it so tricky to work with a global high nervous system, whether our own or someone else’s, is that each of these beliefs made sense at one point. At some point, it was critical to enforce these beliefs, to suppress emotions and memories and to follow safety rules. The mechanisms – or parts – or processes in us that enforce these rules have been keeping us alive and safe for years or decades, at least from their perspective. So, they will not stop doing these jobs just by being asked nicely!
Of course, this challenge is present in anyone healing from trauma – the protective belief that now needs to be shifted was important at one point for survival. But in global high system, this challenge is multiplied by the hyper-reactivity of the system, where any kind of nudge or intervention or invitation can provoke a reaction throughout the whole body.
Triggers
A trigger is some kind of reminder of our hidden emotional trauma, something that causes the body to remember an experience of hurt or threat or an experience where our needs were not met or an experience where we had to suppress our life force and our sense of self.
When we encounter a trigger, that reminder will tend to cause the associated feelings, needs or memories to try to surface. This can happen even when we have no conscious awareness that anything is being evoked. And when hidden feelings, needs, and/or memories begin to rise, immediately our sub-cortical processes will do what it takes to push those feelings, needs and memories back down.
Some people with PTSD (but not C-PTSD) who do not have global high systems have periods of feeling good, calm, and totally ok. They are genuinely at ease in their lives, having successfully compartmentalized themselves and hidden their trauma. Then they get triggered, and their system goes into high sympathetic activation and/or freeze.
As I mentioned above, for a person with global high intensity activation, their nervous system is always activated, they never experience feeling settled and safe, and you might say that for a person in a chronic GHIA state, simply being alive is triggering.
When a hidden emotional memory is triggered, the global high person might experience a full-blown intense emotional reaction: huge anger, fear, shame, sadness, or another emotion that had been suppressed. Or they might feel just a bit of the emotion, only to have it disappear, possibly followed by confusion, collapse, or physical symptoms. Or they might not feel the emotion at all, they might experience physical or medical symptoms and/or other different emotions. The impact of a trigger tends to be more complicated than for a person with more straightforward PTSD.
Having a Global High System can Trigger Others
When a person is terrified/angry/hurt/overwhelmed, but not actively feeling those feelings because they are being suppressed by a freeze, the body still broadcasts that upset and dysregulation. So GHIA people frequently experience others, either individuals or groups of people, having adverse reactions to them. It feels like they are being singled out for criticism or complaint. “I don’t see how I did anything, so why is everyone behaving so strangely in relation to me?”
When there is great distress in my body, but I am in my head and interacting as if everything is totally normal, and particularly if I am making myself the center of attention in a group of people while exuding distress but acting like I’m fine, that presentation can shake up or disturb the ease and flow of the group dynamic. It’s not the GHIA person’s fault, they simply are who and how they are. But neither is it the fault of the group container, because the group is made up of humans who each have their own challenges and limitations.
Hidden Treasure
The magic of our human response to Developmental Trauma is that we can be really expert at hiding from ourselves even the existence of our pain and unmet needs. Sometimes people with the deepest and most troublesome trauma are the most expert at hiding it. They can literally have no idea how awful it all felt, even though they are aware that some things happened that were not good and that they currently don’t feel as free, embodied and joyful as they would like to feel.
There are many people with constant intensity occurring inside their bodies and nervous systems, but who present outwardly as comfortable, competent, and well-adjusted because appearing competent and calm on the outside gave them the best chance of surviving whatever the specifics were of their personal impossible experience.
Through the process of healing from developmental trauma, we uncover the treasure of feeling the things that hurt, which have wanted to be felt and seen. And we uncover the treasure of the life force, vitality and joy that have been hidden and thwarted, at least more or less, along with that hidden pain.
GHIA and Syndromal Physiology
Everyone with syndromal physiology has a global high nervous system, but not everyone with a global high nervous system has syndromal physiology. A global high nervous system becomes syndromal physiology based on the intensity of systems ill-functioning or functioning at cross purposes and on the specifics of which body systems are affected.
[Again, not everyone with a medical syndrome has syndromal physiology, so not everyone with a medical syndrome has a global high nervous system.]
The guidelines for working with GHIA therefore also apply to working with syndromal physiology. The person with syndromal physiology is likely to be even more over-sensitive than a person with GHIA who does not have syndromal physiology.
How to work with a person who has GHIA or Syndromal Physiology? (Self or other)
If this describes you, or if you are living with someone who has GHIA, or if you are a teaching or healing professional who works with people who have GHIA, here are some guidelines.
It is important to not over-stimulate a global high person. People with GHIA are already overstimulated, so anything that is provoking or challenging or even something intending to be energizing in a positive way can easily send the system into overload, causing the person to shut down and/or lash out.
Therapeutic approaches that challenge or poke or directly attempt to enliven the GHIA client will often lead to greater disorganization, greater distress, and possibly collapse or explosion.
With garden variety trauma, if that is even a thing, we want to support people to reference their resources, such as their past pre-trauma experience, and to lean on those resources as they make contact with the difficult emotions and body memories associated with the trauma, thus allowing an incremental opening and release of what has been held in the body.
With a GHIA person, the approach is quite different. The initial goal is not incremental release of held emotions and energies – the pattern is so deep, so embedded, that it really cannot be changed at all in any short or medium period of time. So, the initial goal is to support stabilization and to diminish secondary activation.
We want to help the person to normalize and understand their baseline of distress, discomfort and vigilance. We want to support the person in finding compassion, insight, patience, forgiveness, and acceptance of themselves and their symptoms. It makes sense that they would have these feelings and symptoms, given what they, their bodies and their nervous systems have been through, in both the past and the present.
Here is what I mean by diminishing secondary activation. The initial activation is the actual hidden painful emotions from the original traumatic experience. The secondary activation consists of our reactions to our distress – criticizing ourselves for being so messed up, impatience with ourselves for not getting things done, fear that our symptoms mean that we am going crazy, and so on. The goal is to reduce and then eliminate these reactions through education – explaining how the nervous system works, and through practicing compassion and curiosity along with the GHIA person. So, we offer normalization, generous listening and witnessing. We want to provide the person the chance to feel seen, heard and safe, we want to support deep self-acceptance and patience.
Healing modalities and Global High Intensity Activation
In the previous version of this article, I discussed some specific modalities as potentially being a good fit for people with GHIA.
This time I’m not going to mention modalities because in any modality that is potentially a good fit, there will be many practitioners who do not have the requisite skill and understanding to work effectively with global high clients. And for any modality that may not generally be a good fit, there will be some practitioners who are great with this population.
Here are some guidelines.
A modality that is based on cognitive understanding and processing and that requires consistent cognitive participation by the client will generally not be effective. Global high people tend to have a lot of material that lives in non-cognitive places.
Similarly, regardless of modality, a clinician who has a strong cognitive emphasis will likely not be the best fit.
Parts work may be helpful, and any other system that also emphasizes normalization, acceptance, compassion and curiosity.
Regardless of the modality, the practitioner is the key. To work effectively with a global high person, the practitioner needs to be able to be at ease and comfortable with confusion, suppression, fragmentation, inconsistency, emotional flashes, intense expression, and dissociation. If the practitioner feels unsafe, concerned or reactive about the client’s presentation, this will contribute to the secondary activation in the client who will sense the practitioner’s discomfort. Clients always pick up the automatic emotional reactions of the practitioner to the client’s distress. Because global high people tend to evoke discomfort in others, it can be difficult for them to find a good fit practitioner.
Rosalie’s GHIA Story
I have lived with Global High Intensity Activation my whole life, I believe since before I was born, meaning that my sympathetic nervous system is always on alert and there is always also some level of freeze at the same time. In my healing journey in SE and other practices, there have been many moments when I’ve found myself in what seemed like a moment of respite, where I wasn’t feeling that strong sympathetic push. For a long time, when this happened, I labeled it as “freeze”. And sometimes it probably was. But not all the time. If I’m in the middle of a room full of people shouting and suddenly it’s completely silent, most likely I’m either deaf or dead or unconscious. But there is another possibility – maybe the shouting stopped. I am so accustomed to the constant backdrop of sympathetic activation – pushing – poking – expecting attack – defending – that if it’s not there, it feels odd, it feels like something is wrong.
So I’m offering this for everyone else who is on this same journey – besides doing our work to learn to regulate our nervous systems, we also need to learn to get used to a body-mind system that is not in a constant state of alarm. When I find myself in these moments, where everything just feels neutral, I want to:
– realize that neutral doesn’t mean anything is wrong
– and then realize that neutral is awesome, it means my sympathetic system is less aroused, it means that all of the good work I have been doing is having an effect
– and then let myself settle into being with this, consciously and intentionally. “Neutral is good.”
Affirming in this moment that “Neutral is good”, I feel my shoulders drop, I feel my head and neck start to make small movements. Sometimes in the past, this sort of lack of affect has meant that I am depressed. So am I depressed? I have some concerns, but I don’t feel the burden of the world on my shoulders. I can notice some sadness, and some fear. But no depressive thoughts. I could conjure up some depressive thoughts easily enough and I might be able to find my way to depression, it’s an old friend. But no, this does not seem to be depression. Neutral is good. I can learn to be comfortable here. Each of us can learn to be comfortable here, but we have to actively practice learning to be comfortable in neutral, when all we’ve ever known has been constant intensity. I wish for you and for each of us moments of respite, joy, and settling in each day.
The four categories of practitioners
Based on my experience, there are four categories of practitioners that a GHIA client might find themselves trying to work with:
People who were never global high themselves but who have done enough personal and professional work so that they are still adept at working with GHIA patients. These are our heroes. They can be extraordinarily helpful through a huge portion of our healing and growth work. Note that my experience tells me that there is an eventual limit to how far a global high client can get with a non-global high practitioner.
People who were never global high themselves and don’t have a clue what it’s like. Bad fit. They will fail to see you and will make up various stories about you, while believing themselves to be generous and compassionate.
People who have been and are still global high themselves but either don’t even know it or know it but have not done enough of their own work. Bad fit. They will project their stuff onto you in various ways, and you will be dealing with your deep distress and theirs as well.
People who have been – and might still be – global high themselves but who have done enough of their personal work that they know how to navigate their own nervous system and they know how to meet, see, hold and support a global high client. Based on my experience, these are the ones you want to find. When I sit opposite a skilled and aware practitioner with global high history, my whole body softens, and even delights, with a sense of relief and safety.
Energy Wells
The final year of Somatic Experiencing professional training includes the topic of energy wells. “Energy wells” represents a model for doing healing work with clients who have syndromal physiology.
The Not Energy Wells Map of Activation and Deactivation Cycles
This first illustration shows one map or model of trauma healing and renegotiation. This is an oversimplified diagram showing cycles of activation and deactivation that can occur in trauma healing work. With this diagram, the idea is that the client starts at their baseline and then experiences some degree of activation. Then that activation is processed, felt, expressed, or held in some way that allows for a shift or release. Then the person’s nervous system deactivates and settles back to the baseline.
Over time, and perhaps even within a single session, the person might be able to move through higher and higher levels of activation and deactivation while still remaining grounded and connected.
This next picture shows what this might really look like over the course of a Somatic Experiencing session – a smaller activation and deactivation cycle followed by some integration time, then a larger cycle, and so on. And of course, in some sessions there might be only one cycle, or the cycles might all be at about the same level. This is just a gross simplification of the map that I’m presenting primarily as a contrast to the energy wells map.
The model or map shown above assumes or acts as if the person is walking around in life at some sort of relatively stable baseline of nervous system regulation.
Global high clients and clients with syndromal physiology do not have a stable baseline of regulation.
