First Published on March 10, 2008
He who fears he shall suffer, already suffers what he fears. ~Montaigne, Essays, 1512
Fear is a very primitive emotion, setting off a chain reaction of events that pumps our blood full of adrenaline, raises our heartbeat, tenses our muscles, expends our energy, and quickens our thoughts. This is the essence of the so called “fight or flight mode.” It is very necessary for our physical survival that we recognize danger and react to it. Its result is a complete shutting off of higher centers in the brain, in order to focus all our faculties on a threat.
While fear is good for survival, the behavior that results has lead to some of the ugliest, most savage, animalistic atrocities that our race is capable of.
Fear shuts off the human instinct of compassion and empathy. This is one of the reasons it is not always easy to practice medicine in a litigious society. We lose the ability to succor the fear of others as we physicians perceive threat from the patient. This can get very dysfunctional, leading to simultaneous patient dissatisfaction and physician burnout.
Fear is at the heart of War (the fight in fight or flight), it is at the heart of suspicion, prejudice, persecution, and genocide. Religion can take on a whole new character in the face of millennialism induced fear that in turn causes the rest of us to fear the “extremists”, jihadists, cults, or whatever fear conjuring term we want to apply.
It turns out that with our ability to reason, with consciousness we have the ability to take fear to new dimensions. We can trigger fear to events not currently in front of us. This worry, anxiety, or foreboding may get us in to fight mode and make us better prepared to meet obstacles, but only with a very strong helping of courage. I think courage is the determination to look fear in the eye, without blinking, reengaging the rational mind that was shut off previously. I wish we all could respond in this fashion. I am much more of a flight person myself.
I have learned by experience that over half of my job in patient encounters involves managing the anxiety of both my patients (easy and fun), and their parents (not so easy, much less fun). Many, many doctors bemoan this fact. They are much more interested in treating disease than treating patients. They prefer curing to healing. On a good day for me, this is where medicine becomes a true art. On a bad day, I get annoyed with the best of them. In fact, empathy can actually be counterproductive in these situations. I find too often, nervous parents make me nervous. This usually does not end well.
In my experience, courage response to anxiety is the road less travelled. In my case, the familiar path is better described by Arthur Somers Roche, “Anxiety is a thin stream of fear running through the mind. If encouraged, it cuts a channel into which all other thoughts are drained.”
Combating this fear once it has carved a raging channel can be extremely difficult. Worry triggers adrenaline, strengthens fear circuit response, and can make us tense to the point we are always exhausted, and make thoughts race to the point we cannot concentrate on the present moment. In short, we spend so much time worrying about tomorrow, it robs us of the present. It can steal our life away. This is just another example of how the brain can cause the mind to go haywire. In these cases again, medication may be necessary to slow flow through the channel while learning to manage thoughts becomes the real work in resculpting the bank to reduce the stream once again. It means learning to question our fears and place them in context. We can use reason to stem their tide, and then use it to plan action to deal with what remains. In truth, the monsters are never quite as big in life as they are in the mind.
I have found that even more powerful than reason in curbing anxiety is faith. Though it is fascinating to me that both can work to the exact same end. My current favorite scripture is
2 Tim. 1:7
7 For God hath not given us the spirit of fear; but of power, and of love, and of a sound mind.
Power, love, and a sound mind are all gifts that flow from the spirit of God. The times in my life I have felt closest to God, fear has been totally incompatible. It melts away in a very real sense. I really don’t understand those who denigrate faith as “just an emotion.” It is critical to recovering our humanity in the face of fear. It is what religion typically lacks when it exhibits its worst flaws. It is an absolute key to our own happiness. Maintaining it can be a struggle. Losing faith can leave some very deep and painful scars. I maintain it is a struggle worth fighting.
Anyway, welcome to my world. This fear and worry is the phenomenon we know as generalized anxiety disorder, or when focused, as phobia or traumatic stress disorder. The flood of adrenaline and body revving up can become detached from thought, creating panic disorder. When we fear this fear itself we can develop full blown agoraphobia, paralyzed by a fear of having a panic attack, with any straying from routine. Anxiety is one of those battles all of us experience to one degree or another. It is part of life. I have had the pleasure of going deeper than most, though there are certainly those less fortunate than I.
Still, I have the privilege of fighting it everyday. I am happy to report that it does get easier with time as long as you continue to fight the good fight. I think in the end, fear is a gift sent so that we can develop courage, devotion, and will; and probably so we don’t go falling off cliffs as well. I am slowly learning to embrace fear, without letting it take me over. Here is hoping we all can. The world will then be a much better place.