Recently I was having dinner with a good friend of mine, a physician still practicing at age seventy-nine. “I’ve lived a great life, Lew,” he told me. “I have children, grandchildren, a rewarding profession—everything anyone could want. Not much scares me, except for one thing—Alzheimer’s. I’m terrified of that. I’d rather drop dead of a heart attack.”
As I listened to him, I reflected on how older people have many fears that younger people haven’t even begun to think about. Then I remembered a teaching from the ancient Buddhist tradition called the “five great fears”: fear of death, fear of illness, fear of losing one’s mind, fear of loss of livelihood, and fear of public speaking. Except for the last, these great fears seem to describe the very kinds of anxiety—like my friend’s fear of Alzheimer’s—that aging brings.
For a while I wondered why the fifth fear—fear of public speaking—was included with these other life-threatening issues. Finally I came to realize that this fifth fear was actually a clue to the other four. Those who have a fear of public speaking can have paralyzing anxiety. One woman who suffered from it said to me, “Lew, to be honest I’d rather slit my throat than speak in front of a crowd.”
Then I understood. These five fears are called “great” because each of them can cause panic and trigger the autonomic nervous system. The prospect of death, illness, losing one’s mind, losing one’s livelihood—and yes, even speaking in front of a crowd—can cause panic. The ancient Buddhists classified these fears together because they all affect the nervous system in the same way.
I myself enjoy speaking to large groups of people, but I have plenty of experience with the other four fears, as do many of my acquaintances. Each of them has a story to tell.
Fear of Death. A friend of mine traveling in Europe stepped out of the elevator in his hotel and began to feel faint. He had only a moment to feel a rising panic and think, “This could be it,” before he lost consciousness. He awoke on the floor a few seconds later to find a maid bending over him. He said a quick prayer of thanks and waited until his heart stopped pounding. Later, a doctor said he was dehydrated. He was relieved, but he also knew he had stepped to the edge of the cliff and looked over. He had faced the first fear: fear of dying.
Fear of Illness. One morning a few years ago, I awoke feeling feverish. I took my temperature; it was 102. I took it again an hour later and it read 103. By noon it was almost 104, and on the advice of my doctor, I was on the way to the hospital. I felt a rising panic. I’d had so much illness in my life! Not again, I thought.
It turned out to be nothing serious, just a flu. But for a short time the fear of illness overwhelmed me. It wasn’t rational. It was the memory of all those other times that triggered the panic response.
Fear of Losing One’s Mind. Any time people over sixty can’t think of a word or name, or wonder where they left their glasses, the thought of Alzheimer’s rears its head; they joke about it as a “senior moment,” but fear lurks beneath the humor. Many older people go for regular neurological testing to keep one step ahead of this fear, but the testing can cause fear too. One man who had flown bombers during the Korean War told me he was more afraid of the testing than he had been the bombing missions. “On a mission,” he said, “you either came back or you didn’t. With these tests…” He didn’t finish his sentence.
Fear of Loss of Livelihood. In the past few years, this fear has reemerged in a way that only the oldest living Americans still remember: Back in the 1930s people who lost their jobs sometimes jumped out of windows. Today, polls show that most Americans who have not lost a job themselves know people who have. Nest eggs have shrunk; once secure plans for retirement have vanished. This fear is particularly daunting for older Americans, who must compete with younger workers in the job market, have a sense that they are running out of time, and harbor a general feeling of helplessness. Even for vigorous middle-aged people who have not yet had to face health worries, livelihood anxiety can keep them awake at night.
Fear of Public Speaking. Another friend told me about the time she spoke to an audience of two thousand professional colleagues. She stood up, forced a grin, and began, “I want you all to know I’m absolutely terrified. So I want you all to smile.”
Everyone laughed. The laughter broke the ice and she was able to get through her talk—barely.
“I’m highly intelligent, well respected in my field, and competent in so many ways,” she told me later. “It’s so embarrassing to go through this time after time.”
I told her about the five great fears and she was somewhat mollified. “At least the Buddhists weren’t too embarrassed to mention it,” she said.
Coping Strategies. The point of all these stories is that fear is a regular part of life, and certain fears are particular to the second half of life. The only compensating factor is that by the time we are over fifty we have a lot of practice! Facing our fears is one part of coping, but so is denial and compartmentalization. One psychiatrist I know calls denial a real blessing. “Without it,” he says, “we probably couldn’t survive what life throws at us.”
Some people are born with an unusual capacity for denial; they seem to have a knack for ignoring their problems. Low-denial types, in contrast, use worry as their way of mastering their problems, or at least addressing them.
And in addition to high and low denial, there is a one more coping strategy, which I call “non-denial.” This is what in the Buddhist tradition we would term “mindfulness.” Mindfulness means to pay close attention to what is actually happening. As a strategy for dealing with fear, it operates somewhat outside of the nexus of high and low denial.
Until recently the exact mechanisms of denial were not well understood. In the classic Freudian view, denial was seen as a psychological and sometimes neurotic process. But recent research shows that the process of denial is mostly neurological; the brain actually alters neural pathways so as to make unpleasant thoughts and memories inaccessible. It makes sense that this capacity would have evolved to help us deal with difficulty. Without it, we might be so overwhelmed with sadness or anxiety that we couldn’t function.
We all know people who seem especially good at this. I once knew a policeman named Bill who supervised patrol cars at night in the most dangerous neighborhoods. He often heard gunfire and had been shot at many times. I asked him whether he was ever afraid and he said, “No. Not really. You just do the job.” High denial helped Bill. Someone who worried more wouldn’t be able to do what he did.
In other circumstances, denial can be disastrous. Robert, a freelance writer, was an alcoholic. He had had a couple of DUIs but somehow was still driving. All his friends, including myself, tried everything to get him into a program, or at least to admit his problem, but nothing worked. “Forget it, man,” he would say. “I’m in control.”
One night I got a call from a mutual friend. Robert had wrapped his car around a telephone pole and was killed instantly. In the next hours, as his friends traded telephone calls and shared the news, we all thought and said the same thing: “If only there were something we could have done.”
A different example of high denial was Roland, who had an upcoming presentation to make at work, one that would determine whether the department he headed would continue to receive funding. His job was on the line. When the day came, he walked into the kitchen for breakfast, and his wife—who for weeks had been so worried she barely slept—asked him if he was ready for the big day.
“What big day?” Roland said with complete innocence. He had forgotten.
A psychiatrist told me this story, which he had heard from Roland’s wife.
“You’re kidding!” I said. “People can have that level of denial?”
“You’d be amazed,” the psychiatrist said.
On the surface, high denial seems to provide those who do it with equanimity and calm in the face of threat or danger. Sometimes, as in the case of Bill, it can serve them well. Other times, as in Robert’s and Roland’s cases, it can be counterproductive or even dangerous.
Low denial people are life’s chronic worriers. Judy, a breast cancer survivor, described to me how this worked for her. “I try to think of the worst possible scenario,” she explained. “And then I imagine dealing with it. I figure if I can deal with the worst, I can deal with anything short of that. I do that every day.”
Low denial has its advantages. In some ways it is more realistic. Judy had a much better grasp of her problem than Roland did. Low denial people face their fears and strategize how to deal with them. But “thinking of the worst possible scenario” has a cost. Judy acknowledged that she was seeing a therapist for stress and was taking antianxiety medication.
Judy and Roland would have difficulty understanding each other’s coping strategies. A high denial person like Roland might look at Judy’s situation and think, “Why is she making all that fuss? I’d wait and deal with the cancer if it came back.” And while a person’s capacity for denial is somewhat innate—Judy and Roland had probably always coped that way—to some extent denial can be learned or unlearned as a developing skill. The skill-based aspect of denial, particularly when it involves moment-by-moment worries, is called “compartmentalization.” Compartmentalization is something that can be adjusted and practiced. Low denial people can learn to compartmentalize more, and high denial people can learn how to compartmentalize less.
Compartmentalization is the mental faculty that keeps us focused on the task at hand and allows distracting thoughts and anxieties to recede into the unconscious. Compartmentalization is the moment-to-moment functioning of denial. Usually this process happens without our thinking about it. We may go off to work knowing that our six-year-old has the chicken pox, and we certainly think about it, but the thought doesn’t prevent us from doing our work. It also doesn’t show; we can carry on a cogent conversation with a coworker without suddenly staring off into space thinking about the chicken pox. Conversely, we are not so detached from the thought of our sick child that we forget to call the babysitter who is staying at home with him. This is normal compartmentalization.
However, when it comes to the “great” fears, our ability to compartmentalize can veer out of the normal range and our compartmentalization can become either too weak or too strong. I had that experience when I emerged from an encephalitic coma with brain damage, and my brain seemed to have completely lost the ability to compartmentalize. I was obsessed with all sorts of worries. Suppose I never recovered the ability to do computer programming? I’d have no livelihood! Suppose the encephalitis came back? I would die! Suppose my wife became ill? Or died? There’d be no one to take care of me! These worries plagued me to the extent that some days they were nearly all I could talk or think about.
Francesca, my therapist at that time, understood that I was suffering from “disinhibitory syndrome”—a common symptom of brain injury—and worked with me on a technique to strengthen my compartmentalization. When compartmentalization is weak, she explained, the mind can’t keep the worry safely tucked away in the unconscious, and it keeps intruding.
“When you find you can’t set your worry aside, tell yourself you’re not going to think about it now. You’ll think about it later,” she said. “Then pick a time in the future when you’ll take up the worry. Promise yourself that when the time comes you’ll be able to worry all you want. Until then, whenever the worry comes back, remind yourself it’s not time yet.” Francesca advised me to start small. At first, she said, pick a time ten or fifteen minutes in the future. She encouraged me to set a timer or an alarm.
At first even fifteen minutes was too much. It was humiliating to realize how little control I had over my thoughts—I, a trained Buddhist meditator! When I confessed this to Francesca, she laughed. “Even trained Buddhist meditators can have a brain injury,” she said.
Little by little—ten, fifteen, or twenty minutes at a time—I held my worries at bay. It helped to pick a word or phrase to say in place of my worries. The best one was the time I had picked to start worrying again. “Ten thirty,” I would whisper to myself. “Can’t worry until ten thirty!”
I would also imagine the door of a bank vault closing on my worries whenever I said, “Ten thirty.” It was interesting to discover that when ten thirty came, the worry was weaker. Training my mind to hold off worrying, even for a little while, took the circular or amplifying quality out of the worry.
“I do this exercise myself,” Francesca said. “Otherwise I’d be thinking about my patients all night.”
In contrast, people whose compartmentalization is too strong need to go in the opposite direction. Their problem is that they are too good at keeping their worries and problems at bay—so good that they may not even be aware they have problems. They need to invite their problems and their worry into consciousness. Not having any experience of this myself, I asked Francesca how she dealt with people who compartmentalize too much.
She said that she asks them to think of one or two big problems in their life, and then agree to think about them for a set period of time, such as fifteen minutes. “At first they don’t like it,” she said. “They come up with all kinds of excuses. But I have them stick with it. Eventually they do it and are amazed to find that they actually have problems. They somehow had convinced themselves they were problem-free.”
In addition to all these approaches, Buddhism offers a third way: a practice I call “non-denial.” Non-denial is really just mindfulness, in other words, paying nonjudgmental attention to what is happening now. In this kind of mindful awareness we neither take up the worry nor try to push it away. We just observe it.
Dr. Jon Kabat-Zinn discovered this application of mindfulness when he first used it as a method for treating chronic pain. Pain, like anxiety or fear, is deeply unpleasant and our natural reaction is to run away from it. Dr. Kabat-Zinn had his patients resist that temptation; instead, he had them just observe the pain. Paradoxically, this approach made the pain more bearable. What he learned is that fear, like physical pain, is unpleasant, but unlike physical pain, it is a mixture of many things: bodily sensations, memories, imagined futures, visualizations, and looping and repetitive inner dialogues. Part of what makes fear difficult to manage is that it is so complex and multifaceted. Mindfulness can separate it into its separate parts and make it more manageable.
This is the method I used the day I had the high fever. First there were all the bodily sensations of fever: chills, muscle aches, and fatigue. When I took my temperature, to these bodily sensations was added an objective fact: 102 on the thermometer. Just these facts themselves were alarming.
Now unpleasant memories came flooding in. Years before, I had taken my temperature over hours and days and watched it steadily climb—100, 101, 102, 103. I became nauseated and finally so dizzy I couldn’t stand. Just in time, I went to the emergency room and within hours was in an encephalitic coma. An hour or two more and I would have died. Now it was all happening again; my fever was climbing, and all those old memories were returning. Every alarm bell was ringing now.
But it wasn’t happening again. The encephalitis was years ago. Now I was fully recovered and healthy. Healthy people get fevers too, and not necessarily from encephalitis. I watched my symptoms closely and realized that in fact they were not the same. There were important differences. I was not suffering from severe vertigo, I did not have a loud roaring in my ears, and I could think clearly. I was still afraid, but I had a handle on my fear.
When the fever reached 104 I called my doctor. He was aware of my medical history and he said, “Go to the emergency room now!” It was déjà vu for both of us. I put on a heavy jacket, walked to the car, and got in on the passenger side. My wife drove, my heart raced, and we pulled up to the same emergency room door as we had that night long ago.
Except this time it was not midnight; it was the middle of the afternoon. Unlike the last time, I was lucid and coherent. I wasn’t disoriented or dizzy; I could walk. Again I talked to my fear. “This is like the last time,” I said. “But it isn’t the same. This is different.”
This is different. I kept telling myself that as we walked into the emergency room, with its same sights and smells, its same layout—even some of the same nurses.
This is different. Even though I was put on a gurney, admitted to the hospital, and wheeled up to a room, I kept practicing mindful attention, paying attention to exactly what was happening as well as what was not happening.
I was afraid of illness; I was afraid of dying. I was afraid that once again I might lose everything. But fear is less than the sum of its parts. Pay attention to the parts and fear loses some of its sting.
“This isn’t so bad,” I said to Amy as I lay down in my new hospital bed and as nurses and doctors scurried in and out. At this point, with their eye on my thick folder of medical history, I think they were more worried than I was.
“I’m OK,” I said to her.
And I was.
My father, a self-educated, introspective man, came to the dinner table one evening and said, “You can’t stop thinking. It’s always going on.”
He said this as though he had figured out something important. I was eight years old at the time and didn’t have any idea what he was talking about. But I remembered the comment, and when I began to investigate meditation ten years later, I realized that my father was half-right. Our inner dialogue does go on, mostly unconsciously, but it can be changed, and even stopped. That is one of the things meditation can do.
Inner dialogue, which is sometimes referred to as “stream of consciousness,” is primarily verbal and is usually random, a running inner commentary on the events of the moment. In contrast, worry, fear, and anxiety produce an inner dialogue that is not random. The same sequence of thoughts repeats over and over. We rehearse scenarios in our head: What will he or she say? What will I say? Suppose this; suppose that. As we have seen, compartmentalization can break the loop, but when the worry is too intense, it can overwhelm compartmental barriers, and stronger medicine is needed.
“Calm Lake” is a focused visualization that reduces the energy and repetitiveness of worry. It replaces the words of inner dialogue with an image—that of a lake—and uses feedback to replace the “bad weather” of worry with the “good weather” of calm.
This reflection is best done in a meditation posture, sitting in a chair or on a cushion. But I have also had good success doing it while sitting in a doctor’s waiting room or in an airport lounge. It is good medicine for agitation or worry, but it can be done as a regular practice regardless of your state of mind. Some members of my meditation group like it better than breath meditation. They like the fact that it is visual.
Begin by picturing or imagining a small lake. It helps if you can remember a real lake that you once visited. It should be small enough so that you can see the whole outline of the shore. Fill in the surroundings with imagined detail. Imagine that the shore is lined with maple and oak. Let them be the green of spring, or the brilliant yellows and reds of fall.
If you are imagining the lake scene, it usually helps to do so with your eyes closed. Another method is to select a postcard or small photograph of a lake scene and put it in front of you. If you do this, look at it with half-closed eyes and a soft gaze, at least until the scene is vivid in your mind’s eye. Enter the scene and imagine yourself sitting lakeside, gazing out over the water.
The water represents your state of mind, so take a moment to tune in to your state. If you are doing the Calm Lake meditation because you are worried, agitated, or anxious, there will be “waves” both in your mind and on the lake. Scan your body to see how this agitation feels physically. Butterflies in the stomach, tightness in the chest, and constriction in the throat are all physical signs of tension and stress.
Now return to your image of the lake and picture the “weather” there as a reflection of your state of mind. If your thoughts are agitated and choppy, picture the water as agitated and choppy. If your mood is dark and cloudy, picture the sky as dark and cloudy. Just watch the weather from the lakeshore as a disinterested observer. Let the weather develop its own visual details. Perhaps the trees on the opposite shore are waving ominously in the wind. Perhaps the water near your feet is hitting the shore with noisy lapping. Fill in the whole scene with as much detail as possible.
Now imagine that you have some magic power over the weather on the lake, so that merely by wishing it to be, you can gradually calm the weather down. Little by little the surface of the lake becomes less agitated and more smooth. Its condition may go back and forth for a while. You may feel the lake growing calmer, and then it may kick up again, reflecting a new burst of mental agitation. Be patient; soothe the surface of the lake and the weather around it with kindness and patience. In the end, it is your image, your lake. It can be what you want it to be.
As you continue to relax into the calm waters of the lake, how do you feel now? Spend a few moments tuning in to the changing feeling in your body. How do your arms feel now? Your skin? Your face? And how does your breath feel as you rest your gaze on the now-glassy surface of the calm lake? Include that feeling in your awareness and let it fill your whole body.
Now think of your breath as helping you maintain your focus. Let your breath flow naturally in and out without pressure or strain. Let it be delicate and quiet. Think of your breath as mirroring and reflecting the glassy smooth surface of the lake. You want to breathe smoothly so as not to ruffle the waters.
Gradually let your attention shift, focusing less on the image of the calm lake, and more on this feeling of your breath, letting the feeling of the lake merge into the feeling of your breath. Your breathing has now absorbed the feeling of the calm lake. Let that feeling abide and continue in your body and breathing. Remain that way for as long as you feel comfortable.
This is the essence of the Calm Lake meditation. It takes a while to describe it, but doing it is smooth and quick.
To review, it has three stages. In the first stage, either looking at a picture with open eyes or imagining the scene with eyes closed, you establish the image of the lake and gradually see the lake as smooth and calm. In the second stage, you adjust your breathing to mirror the calm feeling of the lake. In the third, you let the image of the lake fade and melt into your relaxed, smooth breathing. Your breathing becomes the lake; your mind becomes the breathing.
Some people find the image of a calm lake immediately soothing and natural; others have more difficulty connecting to it. As an alternative to a lake, you can also picture a mountain—solid, snow-capped and massively still against a clear blue sky. If you use a mountain image, you may want to replace the surface of the lake as a representation of your state of mind with an image of snow on the mountain swirling in the wind. As your mind calms, the wind dies down, the snow settles, and the image of the mountain becomes sharp and clear.
With either image, the point is to picture expansiveness and stillness, and by holding your attention on that picture, absorb that stillness into your own body.
Through this meditation we transform the horizontal stream of our inner dialogue into a single, stable moment, renewing itself on each breath. Done regularly, especially when you are agitated or upset, even five or ten minutes of this meditation can offer great benefit. And even when you are not upset, Calm Lake is a wonderful centering exercise for daily living.