Fear Is the Mind Killer

From FDR to Frank Herbert, we know we need to manage our fear to survive.

Posted Aug 10, 2020

Frank Herbert wrote the epic novel "Dune" (which I recommend everyone read before the blockbuster film comes out).  When the novel opens, the hero is being tested to determine if he is truly "human."  The test goes something like this:  His hand is placed in a box.  The box creates intense pain, which he knows full well is a phantom pain -- no real damage is happening.  If he has the will power to keep his hand in the box, then he proves that he is human.  If he pulls his hand out before the test is over, he dies.

OK, this is perhaps a brutal test, but it is a work of fiction.  However, it does demonstrate an important lesson about what makes us human.  We have free will, and we can make decisions to overcome our more basic instincts.  In Dune, the hero knows that his hand is not being hurt, but his instincts are telling him to pull away from the pain.  He has to use his mind to overcome his fear.  He recites a mantra that he has been taught, "Fear is the mind killer..." and he wills himself to endure.  Spoiler alert, he passes the test.

How is this story relevant today?  I am a preventive cardiologist who is mostly concerned with managing the natural aging process so that people do not become demented (have brain damage) or develop heart failure.  What does this have to do with fear?  I heard a story on NPR today that Coronavirus is on pace to be the third leading cause of death this year.

That's terrible.  It's frightening, but, if Coronavirus is the third leading cause of death, what is number one?

You got it -- heart and vascular disease.  If you add strokes, which are almost entirely related to the heart and vascular changes that happen naturally with age, and if you add in dementia (dementia is always made worse if you do not have adequate blood flow to the brain), then heart and vascular disease really still tops out the list of things that are most likely to kill us.

It is also the thing most likely to injure or damage us.  Most of my patients would rather die than be disabled by a stroke or fade away from vascular dementia.  And who wants to be in a nursing home in times like these?

We should not have to die prematurely from heart or vascular disease.  You can prevent a stroke (now, that sounds like a good book title, you should definitely check that out).  And when you preserve blood flow to the brain, you prevent a lot of senile dementia.  But, to do this you need to work with your doctor.

And, this is where the fear comes in.

In general, fear is a good thing.  It's what keeps us from getting killed in dangerous situations.  Cowards (like me) have a knack for survival.  But, like the hero from "Dune," sometimes we have to overcome our fear when there is something more important to worry about, like your health.

Since the start of the pandemic, there has been a great fear, especially among the elderly, to go out and seek medical care.  We have heard that we should put off non-emergent medical care.  But, nothing about cardiovascular health is elective.  Just because something is not an emergency doesn't make it optional.

To be specific:  we all need to keep up on our medical care.  Skipping out on "routine" checks is a recipe for disaster.  We manage health, especially cardiovascular health for a reason.  When we are under stress (like an infection) we need our bodies to be prepared to meet the challenges.  Keep your medical appointments.

If you don't have a doctor, get one.  If you wait  until you are really sick before you have someone to turn to, you might as well just be using the emergency room.  That is the last place you want to go.  Medicare has finally changed the rules so doctors are now allowed to talk to their patients over the phone.  Keep in touch.  Some things must be done in person, so do that.

The higher risk you are for Covid, the more important it is to maintain your health.  But, every day fear prevents people from seeking out medical care they need.  What to do?

First, tend to the practical things.  Every single health care facility now has a plan to prevent the spread of infection.  There are many steps to this plan, and they work.  If you want to know what your doctor's office is doing, call and ask.

Know that this is an airborne virus.  It spreads in the air.  Masks and distancing work.  The best masks are the ones that protect you (as opposed to ones that just decrease the likelihood of spreading the virus to others).  If you really don't want to spread the virus, don't catch it.  Protect yourself.  Go online and buy an N-95 or N-99 mask, and wear it.  And wear it properly.  I don't care if it's uncomfortable, or you don't want to cover your nose; you can wear it long enough to leave your home and get the health care you need.

I suppose the truly hard part is overcoming the fear.  Everyone needs their strategy for that.  Some people rely on their faith, or at least faith in Anthony Fauci.  Some people rely on logic or think about the balance of risks and benefits.  Some people even do math.  Some people get so frustrated being stuck at home that they finally go out with the logic that, "if I can't see my doctor, who can I see?"  I'll take that, it's a start.

FDR would not be right in this case.  We have more to fear than fear itself.  We need to fear the virus, but we cannot let that fear own us.  If we do, then fear will keep us from getting the health care we need. As we grow older, our heart and circulation will age, and if we don't tend to that, then we will have strokes.  Thus, Fear is truly the mind killer.

But we are human, so it doesn't have to be.