CHAPTER 2

What Not to Do With Fear

Courage is resistance to fear, mastery of fear, not the absence of fear.

—Mark Twain

Animals in the wild follow the laws of nature. Each has a built-in response to fear that increases their chance of survival and quiets the fear response. When a lion is afraid, it attacks. When a bird hears a twig snap, it flies to a higher branch. When a deer smells a foreign scent from one direction, it runs the opposite way. When a mouse is afraid, it burrows in its hole. If it makes it there in time, the amygdala quiets and the fear mechanism shuts off. If a hawk eats it, the response ceases as well. Each animal has a prescribed, hard-wired response that leads to a cessation of fear and, hopefully, success. The animal moves and, once danger or opportunity has passed (usually in a matter of seconds or minutes), it relaxes and goes back to what it was doing before. Although they differ in the life-saving actions they take, all mammals possess this instinctive system, which is designed to respond to brief, sudden threats in the environment. It leads to quick action and survival—or not—and it can be activated and de-activated a hundred times a day at no cost to the animal’s health.

Human beings share this automatic, life-saving response with other mammals. Urgent threats (“stressors”) are the kinds that our bodies were originally designed to respond to as well. However, these are not the common stressors for most people today. Unlike animals in the wild, many of our threats are not immediate. They persist, at least in our minds, across long periods of time. This is what defines a “stress disorder.” It is the alarm system of the body staying on for days or weeks at a time, causing wear, tear, and damage to those vulnerable parts of the body that participate in the fight or flight response. In all of the animal kingdom, human beings are the only mammals to acquire stress disorders—with the exception of the animals we have domesticated. Dogs and cats have been hanging around with us for thousands of years and so they, too, now share many of our bad habits.

In the last chapter, we identified some of the physiological symptoms associated with fear that are now typically called “stress symptoms.” These included responses such as rapid heart rate, loss of appetite, and tensed muscles. When the amygdala is pressed to function for longer, sustained periods of time, additional symptoms and warning signs emerge that are not always as easy to feel. These include things such as increased heart rate (leading to high blood pressure), digestive tract dysfunction (leading to nausea and pain), lowered immune function (making us better hosts for germs and viruses), loss of libido (sex hormones are suppressed), and altered brain function, which results in loss of creativity, memory problems, trouble concentrating, impaired judgment, and poor impulse control, just to name a few. Tragically, the exquisite alarm system that was designed to alert us to danger and help us quickly take action to protect ourselves now seems to be making many of us ill. So the critical question is: “Just how do we turn the alarm system off?”

It is highly unlikely that our maker left just one species to make up its own rule for the most life-saving emotion of the brain. Take a moment right now to see if you can answer this question for yourself: if the lion charges, the bird flies, and the mouse burrows in response to fear, just what is it that we are supposed to do when we are afraid?

Before I convince you that the human brain does, indeed, have its own law for what it wants us to do when we are afraid and, if we obey this law, we maximize our chances for good physical health and sustained career and relationship success, I want to briefly share some of the more common, although unfortunate, ways that people respond to persistent fear. Because few of us are taught how to respond to fear in a positive, healthy way, many of us are “afraid of fear” and will do anything to avoid the feeling. Almost always, what we do to circumvent fear creates more and bigger problems. Following are seven frequently used strategies that do not work in response to fear. In fact, these tend to make fear, the stress response, and most situations much worse. To help you easily recall the list, let’s use the mnemonic: “DANGERS.”

The D stands for Depression. Although there is much about depression that remains a mystery, there is some evidence supporting the idea that depression may be one result of long-term activation of the amygdala; and certain mild depression may mask underlying fear. For example, a person who has been looking for a job unsuccessfully for nine months might be afraid of repeated rejection and/or the financial hardship. In this case, depression may provide a balm, or mask, for these fears. A single person interested in dating may tell a friend that Internet dating and bars are “depressing,” when, in fact, those situations actually scare him. In this case, depression may seem less painful than the fear of rejection. In these cases, people are said to be “depressing” their fears. In the clinical setting, I have often observed that when patients’ depression starts to lift through counseling or medication, they become uncomfortable with the underlying fears (usually referred to as “anxieties”) that begin to surface as they gain energy and begin moving toward their goals. Whether depression is the result of the short or long-term activation of the amygdala it may be masking important fears that need to be addressed.

The A represents Anger. Although not a disease in itself, anger is very hard on the heart. Anger as a response to fear is not only common, but often appears socially acceptable. For example, imagine you are at a party and your sweetheart is having a lot of fun with someone else. I mean a lot of fun. Is it likely that you would approach her and gently say, “You seem to be having a lot of fun with this good-looking guy and I’m just a little bit afraid”? Or, are you more likely to say, “I hate these parties, your friends are boring—all they talk about is work—and the food stinks. Let’s go!”? For many people, anger is the easiest response to fear. However, it is a destructive response that, once again, does not address and quiet underlying fears. If you think that getting angry may be a helpful response to fear, let me recommend a book for you: Anger Kills¹ by cardiologist Dr. Redford Williams. In his book, Dr. Williams clearly demonstrates how anger can dramatically increase the risks of heart disease and death. He also provides a scientifically valid test to assess whether or not you evidence the behavior of turning fear into anger. If you find that you lean toward an anger response to fear, you may also want to consider reviewing the excellent strategies he suggests for addressing this risk.

The N stands for Negotiation. Negotiation seems to have much to recommend it. It is the act of cooperation and compromise. However, when people attempt to negotiate without an awareness of fear, it can lead to trouble. In one of the best-selling books on negotiation, Getting to Yes by Roger Fisher and William Ury, they repeatedly remind the reader that “the reason we negotiate is because we can’t give the other party what they want.”² If you could, you would call it Christmas! I stopped counting after the 27th time they used the phrase “fear” or “concern” in the book. The authors suggest that, in order to achieve a successful negotiation, it is first necessary to identify the other party’s fear, and then find a way to address the fear that the other person has not considered. Although that is an ideal approach in theory, unfortunately many of us begin to negotiate without ever being aware of others’ fears, or even acknowledging our own!

To get a better sense of how negotiating without an awareness of fear might increase, rather than decrease, the stress response, let me share a personal example that a UCLA family medicine resident and her husband recently shared with me. This woman had been a resident for about six months, with a very challenging work schedule. Her husband was a graduate student on campus with a schedule no easier than hers. They woke up one weekend morning with that familiar exhaustion that occurs when the work week takes too much out of you. They were sitting together in a local restaurant eating breakfast in complete silence. He was watching the top of her head as she ate and was becoming more and more frightened, thinking, “Is this it? Is this all we’re going to have for the rest of our lives? Have we sacrificed our intimacy and our marriage on this alter of success?” But instead of voicing this fear, he did what most of us would do—he shared a possible solution to it. He broke the silence enthusiastically, saying: “When we graduate, let’s head off to Europe. We’ll travel the world together. It’ll be wonderful!” His wife, having no idea that this conversation had anything to do with fear, thought he was talking about travel and she responded in accord with her own underlying fears: “That sounds like so much trouble! Passports, luggage, visas. When I graduate, I just want to sit on the beach and do nothing.” Hearing the solution to his fears dashed, and hearing her say “I” instead of “we” (which greatly increased those fears), he became annoyed. She sensed his annoyance and, not understanding it, got angry, saying, “What are you getting upset about?! We’re talking about something two and a half years from now! Don’t we have enough to worry about now without you looking for new problems?!” We all know what it’s like when we’re tired—any irritation is like a match to fumes. Especially at those times, negotiating without an awareness of fear—our own or others’—can result in alerting the amygdala more rather than calming it. This can cause additional problems in relationships in any setting.

The G stands for Griping. We may see this response to fear frequently in any relationship or organization undergoing big changes. Individuals can become very negative, complaining loudly and in-depth as they struggle with uncertainty (another “grown-up” word for fear) in the workplace, community, at home, or even in their own bodies as they age or as health concerns arise. Major upheavals such as reorganizations or layoffs, changing technology, changes in family membership or dynamics, and critical illness may all trigger this ineffective response to fear. Griping can temporarily mask fears and calm the amygdala by tricking the mind into believing that you are reaching out and calling for a solution. However, when griping becomes persistent, it frequently serves to increase our fears and those of others. When it becomes redundant, griping can lead to verbal rumination—rehearsing the threat—yet another ineffective response to addressing our fears.

The E stands for Eating. Did you know that it is physically impossible for a person to eat and be afraid at the same time? As we described in Chapter 2, the ancient amygdala was designed to respond to immediate, life-challenging threats. It shuts down appetite when danger or opportunity approaches to assure that we attack or escape rather than continuing to eat! Conversely, the moment we put food on our tongues, the amygdala assumes the threat has gone away. It shuts off in an instant and our fears are gone. The problem with addressing our fears in this way is that, the moment an anxious person swallows the cookie or potato chip and goes back to worrying, the amygdala turns right back on, requiring more food to quiet it once again. For this reason, eating is not only an ineffective way to address our fears, it can become exceptionally dangerous to our health.

The R stands for Rumination or “worry.” Instead of facing their fears directly, many people will persist in mentally rehearsing, again and again, all the ways they might get hurt or fail. Yet, they don’t take action to address these fears. Worry can be a healthy emotion, but only if it leads to a protective action. You worry before crossing the street, so you look both ways. You worry about being late to the airport and missing your flight, so you leave a bit early. You worry about getting the measles or flu, so you get a vaccination. These worries assist you in adapting your behavior so you will succeed in being safe and achieving your goals. On the other hand, worrying about a test but not studying any harder, or worrying if you will ever meet the right person while staying home and hiding, are clearly not helpful. Rumination is worry without resolution. It typically it leads to an escalation of the fight or flight response rather than calming our fears.

The S represents Substances. Drugs such as alcohol, nicotine, marijuana, and other street or misused prescription drugs may appear to provide a rapid, effective means of calming immediate or persistent fears. Although they may seem to work in the moment, the long-term consequences for individuals are enormous, and they usually come at a colossal cost to those nearby as well. Using drugs or alcohol to calm fears is a dangerous strategy. Abusing substances of any kind can lead to depression, disruption in the capacity to work, inability to maintain personal and professional relationships, and increased risk of illness or even death. However, clinical efforts to help people avoid using substances by doing things that upset them often backfire. When smokers, for example, were shown either frightening footage of a smoke-charred lung during an autopsy or a patient dying of lung cancer in the hospital, they often became so upset that they left the room and then smoked to reduce their fear! For this reason, people struggling with substance use are usually most successful when their underlying fears are addressed first.³

Consider Alex, a past patient of mine who used substances as a primary means of addressing his fears. I met Alex when he was 28. At 17, Alex looked to all the world to be an exemplary teenager. His grades were exceptional, he was an accomplished athlete on the soccer team, and he appeared to his friends to have an enviable life. But Alex felt enormous pressure to succeed. Each A in class, each star performance on the athletic field, each word of praise felt like an additional brick of pressure. He described it in this way: “I was always thinking, ‘How can I keep this up … and what happens when I fail?’ ” Eventually, the way Alex chose to cope with his daily fear of failure, his fear of falling short of perfection, was to use and abuse substances. He confided in no one and was isolated from his family and friends. Even in the safety of a psychologist’s office many years later, Alex found it extremely painful to share his self-doubts.

After his second DWI, Alex’s parents (much against his wishes) admitted him to a substance-abuse treatment program. At first he battled the counselors, but eventually he applied his determination to be successful to the goal of sobriety. After four months of inpatient treatment, Alex returned to school and his family. As hard as it had been for him to become sober, and as great a triumph he had achieved over his addiction, he found that he returned to all the pressures he had felt before. His self-doubt and inner demand for perfection, along with his fear of failure, were waiting for him like a puppy outside the door of his home. When the fears became too great, he relapsed and alcohol and drugs once again became his primary companions.

Alex’s challenges were typical of those any addict might face. A person struggles with alcohol or drug use, finds the courage to achieve sobriety, and then a life crisis or persistent challenge sends them back to that substance to calm their fears. When Alex arrived in my office, our task in counseling was not to get him sober one more time. He knew how to do that without my help. Our goal was to help him face his fears and find healthier ways to address them. The take home point here is that alcohol and drug use at any level does not shut off the amygdala in the long-term. Like eating, every time the substance fades, the fear returns in greater force. Substance use and abuse is a short-term solution that doesn’t address the underlying need. Not addressing the fear is not only one of the primary contributors to relapse, but to developing a problem in the first place.

So now we are all familiar with seven common, unhealthy responses to the life-saving gift of fear: Depression, Anger, Negotiation, Griping, Eating, Rumination, and Substance use and abuse. These strategies do not work. None leads to an effective shutting down of the amygdala and none results in the absence of fear. In fact, they almost always make fear—and most situations—much worse.

The absence of fear is not courage … the absence of fear is some kind of brain damage.

—M. Scott Peck

If we take the generally accepted definition of bravery as a quality which knows no fear, I have never seen a brave man. All men are frightened. The more intelligent they are, the more they are frightened.

—General George S. Patton

Do not be afraid of sudden fear.

—Proverbs 3:25

As we’ve mentioned before, fear is a gift, rather than something to be avoided. Every animal in nature has a prescribed, built-in, healthy response to fear that is most advantageous for survival and success. So the next logical question becomes: “If the human brain has such a law—just what is it that we humans are supposed to do when we are afraid?” I’ve asked this question to audiences all over the world from Kazakhstan to Guam and no one has ever come up with the correct answer. Before journeying forward, let’s pause a moment for you to take your best guess. Then, in the next chapter, we will discover that the human brain does, indeed, have its own law for what it wants us to do when we’re afraid—and if we obey this law, we will maximize our chances for good physical health and sustained career and relationship success. What we do when we are afraid, in any life sphere, is the fork in the road to success.