While hard at work on the campaign trail ahead of elections in November, US President Joe Biden has been filmed more than once apparently freezing and becoming seemingly oblivious to the proceedings around him.
Last weekend, at a Democrat campaign fundraiser in Los Angeles, it appeared as if he became rigid and zoned out in front of the crowd at the 7,100-seat Peaco*ck Theater, before being gently guided off stage by former president Barack Obama.
Less than a week earlier, videos apparently showed the 81-year-old President freeze for about a minute before his speech became slurred during a Juneteenth celebration - to commemorate the ending of slavery in the US - at the White House.
His aides vehemently deny he has a health problem.
US President Joe Biden seemingly freezes during a Juneteenth concert at the White House
The 81-year-old President was said to have frozen for about a minute before his speech became slurred during the event in Washington
The White House Press Secretary Karine Jean-Pierre tore into videos she called ‘cheap fakes’ that showed the President in a day-dreaming state. ‘Just because you’re standing up listening to music and not dancing, that is not a health issue,’ she said.
Yet President Biden is not the only senior statesman in the US to apparently show these worrying tendencies.
Republican Senator Mitch McConnell, also 81, caused concern when he suddenly stopped speaking at his weekly news conference on Capitol Hill back in July 2023. He stood still for around a minute, staring into space, before being led away by aides. He later returned, saying he was ‘fine’.
While anyone can space out from time to time – it can be a sign that you are sleep-deprived, stressed or distracted, for instance - it can also be a warning sign of a health problem.
Here, experts explain which conditions can lead to freezing episodes and why.
SEIZURES
Someone who seems to suddenly day-dream and lose all awareness of what is going on around them – without blacking out - may be having an absence seizure, also known as a petit mal seizure, a symptom of a type of epilepsy.
‘The best way to describe it is that you are absent for up to a minute before slowly coming back to reality,’ says Professor Fayyaz Ahmed, a consultant neurologist and honorary senior lecturer at Hull University Teaching Hospitals NHS Trust.
These seizures happen when electrical signals in the brain go awry, which can occur due to genetics or, rarely, be triggered by exertion such as intense exercise but tend to occur most frequently in children who often go on to outgrow them.
‘The electrical activity in the brain can also misfire due to tissue damage caused by trauma and scarring,’ adds Professor Ahmed.
‘For example, after a concussion some patients develop absence seizures that make them appear frozen and unresponsive.
‘After the seizure is over, the person usually feels exhausted and needs to rest.’
According to Epilepsy UK, this type of seizure can happen one after another and ‘some people have hundreds of absence seizures a day’.
If you think someone is having one, then the charity recommends you should ‘gently guide the person away from any danger [especially if they are having repeated absences], stay with them until they are fully recovered and be calm and reassuring’.
If someone has had an absence seizure, although they might not need immediate medical help at the time, they should make an appointment to see a doctor who can decide if any tests or a referral to a specialist are needed.
PARKINSON’S DISEASE
This progressive disorder affecting the nervous system and brain can cause freezing episodes that affect someone’s mobility and speech and may also cause them to appear to temporarily lose awareness of what’s going on around them. These episodes typically last from a few seconds to a minute.
Parkinson’s is caused by low levels of a protein, L-DOPA, in the brain, which is needed to make dopamine, a hormone which among other things helps to initiate and control muscle movements and motor activities such as standing, walking and running.
The low L-DOPA may be caused by the death of brain cells in the part of the brain which receives messages relating to movement and co-ordination.
Why this happens is unclear as, while ageing may contribute, younger people can develop Parkinsons’s too.
‘If there is a lack of L-DOPA in the brain, it is difficult to co-ordinate different motor activities, hence it seems as if the person is frozen - a similar thing can happen as there is slowing down on initiation on any motor movement,’ says Professor Ahmed.
This can affect someone’s ability to speak, ‘the lack of co-ordination between different muscles involved in speech can cause mumbling and monotonous speech,’ says Professor Ahmed.
‘Some call it speech arrest - and it tends to last a few seconds.’
Freezing episodes tend to recur more frequently as Parkinson’s progresses, says Professor Roger Barker, a consultant neurologist at the University of Cambridge - one theory being that this is due to damage to areas at the base of the brain, including a structure called the pedunculopontine nucleus, thought to play a central role in the initiation and maintenance of movement.
Those with advanced Parkinson’s may have episodes of freezing where they are unable to move at all.
‘This is not momentary but happens for few minutes to hours and is often relieved by taking anti-Parkinson’s medications,’ says Professor Ahmed.
Freezing episodes can come on so suddenly that they lead to people falling over in some cases, adds Professor Barker.
‘For some reason we can’t quite explain, their feet get “stuck” to the floor and they can’t move.’
There are tricks that people can use to overcome these ‘freezes’. For example, placing strips of tape or paper on the floor horizontally can create visual cues to prompt people with Parkinson’s to walk, as it helps provide a guide for where to step – i.e. they can be instructed to place their foot on each line, or step over it like an obstacle.
Similarly, listening to sounds with a steady rhythm, such as the beats of a metronome, can be used as they can practise walking to keep in time with the music, says Professor Barker.
Exactly how these help is unclear, but it’s thought the physical cues help activate parts of the brain undamaged by the Parkinson’s.
‘In some people, dopamine drugs can help, but not in most cases because the freeze itself isn’t caused by low dopamine but pathology [the way the disease has developed] in other parts of the brain,’ adds Professor Barker.
Another option is cholinesterase inhibitors - drugs which prevent the breakdown of the acetylcholine (a chemical which sends messages between certain nerve cells). An imbalance of this chemical is thought to be a factor in Parkinson’s symptoms.
PANIC ATTACKS
A freeze episode can become worse if someone then starts hyperventilating, and can occur if they are feeling anxious or are having a panic attack
Highly stressful situations can sometimes cause people to literally freeze in their tracks for minutes or more.
‘The freeze response dates back deep in our evolutionary past, as we think of animals freezing to be able to blend in with their surroundings to avoid being hunted as prey,’ Olivia Dornan, therapy manager at the Priory Hospital in Barnt Green, told Mail+.
‘Humans, just like animals, have a fear centre in the brain called the amygdala, which can trigger a freeze response to stop further harm coming to us by making us difficult to spot.’
A freeze episode can become worse if someone then starts hyperventilating, and can occur if they are feeling anxious or are having a panic attack, as this rapid breathing means more carbon dioxide is eliminated from the body than is produced, which makes the blood more alkaline than normal. This can then lead to confusion and other cognitive problems, adds Ms Dornan.
‘This can also sometimes lead to hearing or sight being impacted which can escalate the feeling of zoning out.’
There are ways to reduce the risk of this happening, she says.
Cognitive behavioural therapy, a talking therapy that can change the way you think and behave, can make you feel less anxious in trying situations, says Ms Dornan.
Longer term, exposure therapy - a psychological treatment where psychologists create a safe environment in which to “expose” individuals to the things they fear and avoid in order to neutralise them - can also be beneficial, she adds.
MINI STROKES
People can appear to be briefly unaware of what is going on around them, or unable to communicate, while having a transient ischaemic attack (TIA), also known as a mini stroke.
This is caused by a temporary disruption in the blood supply to part of the brain due to a clot which usually dissolves or dislodges on its own.
Symptoms, which can also include weakness or paralysis on one side of the body, may only last a few minutes or up to 24 hours (the symptoms of a full stroke by contrast last longer).
‘Mini strokes can be associated with losing awareness or consciousness because a small piece of clot breaks off from the heart or from the carotid artery in the neck, which blocks the small blood vessels in the brain before breaking down and dissipating,’ says Professor Ahmed.
‘This temporarily reduces the blood supply to those parts of the brain and can cause loss of speech, weakness or loss of sensation in face, arm or leg.’
According to the Stroke Association, at least 46,000 people a year in the UK have a TIA for the first time and as it can be a risk factor for having a full stroke; if you do have any symptoms - however brief - it is important to get medical help.
CIRCULATORY PROBLEMS
Zoning out for seconds or – even briefly losing consciousness – after standing up can be due to problems with blood flow.
The body has ‘control mechanisms that maintain blood flow despite the effects of gravity’ to ensure blood supply to the heart is preserved at all times, Dr Chris Pepper, a consultant cardiologist at Leeds Teaching Hospitals NHS Trust, told Mail+.
‘But sometimes when you stand after a period of sitting or lying down, it can take a few seconds for the body’s reflexes to kick in, so blood pressure falls and dizziness and zoning out - or sometimes fainting - can follow.
‘Adolescents and the elderly are most at risk of this,’ he says.
In older people, Dr Pepper says this is likely to relate to a slower heart rate or lower blood pressure caused by the effects of ageing.
‘By far the most common cause of this happening in children and teenagers is what is called a vasovagal faint,’ he adds.
‘This happens when there is a sudden drop in blood pressure and heart rate due to the spontaneous overactivity of the vagus nerve, which sends messages that contribute to regulate heartbeat.’
BLEED ON THE BRAIN
An intracranial haematoma, or collection of blood within the skull, can cause patients to zone out suddenly and is usually brought on by a burst blood vessel
A worrying possibility is that a sudden freeze or zone out is due to an intracranial haematoma, which is a collection of blood within the skull. The symptoms in this case come on suddenly but can persist for hours or even longer.
It’s usually caused by a blood vessel that bursts in the brain but can also be caused by a head injury due, for example, to a car accident or fall.
The blood may collect in the brain tissue or underneath the skull, pressing on the brain. The damage to the brain tissue means that key areas of the brain aren’t functioning efficiently any more.
Symptoms such as chronic headache and slurred speech or freezing that can develop right after the injury, or days, weeks or months later.
They can be life-threatening, so it’s crucial to get urgent medical help if you have a head injury.
‘Any blood clot in the brain can lead to a seizure or a freezing episode,’ says Professor Ahmed.
