Lifelines

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Fear is the prison of the heart

Our most destructive interpersonal anxiety is our fear of intimacy

      Fear is a powerful motivator of behavior that seldom takes us where we want to go. While it is true that people with serious anxiety disorders appear, in many cases, to have a biological predisposition to these conditions, it is also true that anxiety can be learned. Children growing up in families in which one or both parents exhibit a high level of apprehension are often vulnerable themselves to unreasonable fears. The number of adults who are afraid of flying, enclosed spaces, crossing bridges, even driving, is amazingly high. Often, just beneath the surface of an apparent phobia lies an exaggerated sense of the world as a dangerous place.

      Once when I was interviewing the parents of an anxious teenager, I inquired if anyone else in the family suffered from irrational worries. The mother replied, "No. We just take prudent precautions like not taking a shower during a thunderstorm." When I asked if she had ever heard or read of anyone being electrocuted by lightning while in the shower, she replied, "No, but it could happen." This is the attitude about improbable events that supports lotteries. And those who fret about things that will never happen often pass those fears down through the generations.

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     In a risky world, it is important that we convey to our children an informed assessment of the perils we face. If we can persuade them to fasten their seatbelts, wear bike helmets, and not smoke, drink excessively, play with guns, or drive recklessly, we will have armored them against the primary dangers to their physical welfare. If we really want to be good parents, we might include a lesson or two on how to recognize people who will break their hearts.
     Confronting one's fears is the definition of courage. For a nation that loves to celebrate heroism, America regularly reacts to events like a patient with an anxiety disorder. Immediately after 9/11 a new store opened in New York City. It sold such useful gear as biohazard suits, water purifiers, antibiotics, and parachutes for jumping from a high-rise building. It closed as our panic about terrorist attacks subsided into a chronic apprehension, but that it existed at all is a tribute to the power of our fears.
      The media, particularly the 24-hour news shows, bear some responsibility for stoking our worry. What we pay attention to determines how fearful we are. Sometimes it appears that a primary role of the news media is to scare us. Perhaps this is just a way of engaging our attention, but many stories, particularly on the local news, seem designed more to alarm than inform.
     A very sensitive index of our fear is sales of handguns. They surged nationwide after 9/11. The absurdity of using a handgun to protect oneself from terrorist attack is beside the point. When we feel threatened, we buy guns. It's what makes us Americans.
      Most of us live protected, climate-controlled lives devoted to minimizing risk. When I speak to anxious, depressed patients I often ask them what is the riskiest thing they have ever done. People are surprised. The idea of taking chances has not occurred to most of them. But it is not an idle question. Depression is a "safe" position that many people, miserable as they may feel, are afraid to relinquish. Mobilizing the courage to overcome this inertia is, to an important extent, the work of psychotherapy.
      The Native American saying "If we lived forever there would be no such thing as courage" operates here. It is the consciousness of our mortality that marks us as human, that forces us to confront the inevitable loss of ourselves and all that we love, to contemplate the great mystery of life with a determination to live as well as we can for as long as we can, unafraid.
      When I talk to parents I hear a lot about fears that their children are exposed to dangers they cannot protect them from: drugs in schools, violence in movies, sex on television, predators in the mall or on the Internet. I ask them what effect they think their obsessive worries have on their children. Each year the police in my town offer to X-ray treats handed out on Halloween, looking (vainly so far) for that elusive razor blade in the apple. What messages are we giving our kids about how to live comfortably in the world? It is ironic that in a society often characterized as "child-centered" we should be so heedless of how our futile search for perfect security can transmit the virus of anxiety.
      Our frequent demonstrations of patriotism and paeans to those we have designated heroic have the quality of "bravery by proxy." It is as if our public reverence for those who exhibit courage, rather than inspiring each of us to do likewise, serves as a way to feel good without having to do more than bow our heads or wave a flag. This is especially apparent at ceremonies where we observe leaders who have avoided service in the war of their generation solemnly pay homage to those brave (or unlucky) enough to have died on our behalf. We honor these sacrifices while not imagining that any will be required of us.
      In some ways it's a miracle that we can tolerate the uncertainties of life without yielding to anxiety or depression. That most of us do so most of the time is both an example of constructive denial and an acknowledgment that the alternative, which is to live in fear, drains life of the pleasures it contains.
      Perhaps our most destructive interpersonal anxiety is our fear of intimacy. Some people will do anything to avoid the risks that come with opening oneself fully to another human being. I continually hear lonely people talk about how careful one must be to avoid being hurt. On Internet dating sites the mythical ax murderer plays a prominent role in discouraging contact. Those who have been disappointed in love are preoccupied with protecting themselves from further rejection. Loneliness is often preferred over the vulnerability of closeness.
     We have become used to being afraid. Before terrorism threatened us there were killer bees, shark attacks, flu pandemics, sexual predators, and nuclear annihilation. There has never been a shortage of threats or people who wished us ill. We pay money to watch frightening movies. It is even possible to argue that there is a deeply human need to have some symbol of evil in our world that simultaneously frightens and unites us.
      We could learn a lot from the citizens of Israel, who live daily with a level of terrorist violence that would (and perhaps will) paralyze us. Based on what's happened so far, try to imagine how our public life would be affected by a few shopping mall explosions or the release of an airborne biotoxin. Somehow we need to mobilize the fortitude to confront the real threats to our well-being and stop scaring ourselves with phantoms.
      A patient told me the following story: In 2003 she was at a Baltimore Symphony Orchestra concert. They were playing the Brahms Violin Concerto when suddenly the lights went out. In the utter blackness of the concert hall her immediate thought was that Baltimore was under terrorist attack, a fear no doubt shared by many in that audience. She is uncertain how long they were in darkness before the dim emergency lights came on - probably only a few seconds, though it seemed longer. What amazed her was that the orchestra kept playing. Sitting in the dark, unable to see the conductor or their scores, the musicians played on, flawlessly. No one in the crowd made a sound, though she remembers the ovation at the end of the piece as especially heartfelt.
      We are not often called upon to demonstrate courage by risking our lives. But in numberless acts of quiet determination in the face of the anxiety that now infects this society, we perform a service to our country and to each other. Collectively, our attitudes and behavior create the atmosphere we live in and, more than any military action, will ultimately determine the outcome of the struggle with terror in which we are now engaged. In the process we might at last find something in ourselves of which we can be truly proud.

Gordon Livingston, M.D., writes and practices psychiatry in Columbia, MD.

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