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Fight or Flight, Forbearance and Fortitude: The Spectrum of Actions of the Catecholamines and Their Cousins


Address for correspondence: C.P. Arun, Registrar, Department of Urology, Colchester General Hospital, Colchester C04 9FY. Voice: ++44-1206-742450; fax: ++44-1206-742220. e-mail:


Abstract: Catecholamines are recognized to play an important part in the fight-or-flight response to impending stress. Catecholamine and other phase-reactant levels are raised in the first 24 h following acute stress, but the bigger picture of their action on the organism is unavailable. In this article, we examine their actions in light of the theory of phase transitions borrowed from the numerate sciences. Phase transitions involve changes in the state of matter or an organism with a common example of what is termed a first-order phase transition (sudden change) being provided by the popular expression “the straw that broke the camel's back.” We propose that the response to catecholamines follows a triphasic response: a Phase I response is the fight-or-flight response to impending stress that protects the animal. With mild to intermediate stress, the Phase II or forbearance response allows it to tolerate the physiological upset. With severe stress, however, severe vital organ vasoconstriction leads to a quick death. The present theory has value in understanding the clinical picture in acute stress. Phase II or Forbearance Phase corresponds to Classes I, II, and III of hemorrhagic shock, and Phase III or Fortitude Phase to Class IV. Thus, a Phase III or fortitude response is to the animal what apoptosis is to the individual cell and has social implications. The present framework provides a fresh perspective on the action of the catecholamines and their cousins.