The only thing we have to fear is fear itself.
— FRANKLIN D. ROOSEVELT
Eight-year-old April heard glass shattering down the hall of the single-wide trailer. She knew it was just the beginning of yet another one of those nights when Mom got out of control, as did the men she liked to drink with. April tried to run away, out into the woods in front of her house. But her lungs clamped down, and she was so short of breath before she even started running that she knew she had already lost this fight. The next thing she knew, a strange man was coming toward her, and her body was wracked with indescribable pain.
April doesn’t remember anything else from that night. But she does remember that, soon afterward, her mother vanished. No explanation. No apologies. No good-bye. April tried to convince her little brother that their mother wasn’t ever coming back, but he stood at the back of the couch and watched the door for weeks.
After her mother walked out, fear began to dominate April’s life even more. She stopped trusting even close friends and social workers who tried to help. She lay awake at night, terrified that one day someone would take her away and separate her from her brother. Sleep eluded her. On the rare occasions when she did sleep, imaginary men chased her in her dreams. No matter how creative she got with her hiding places, the dream invaders always captured her.
Soon April’s body began to decompensate as well. She passed out often and shook a lot, almost as if she was having seizures. Specialists ordered lab work, neurologists ordered brain scans and EEGs, and a cardiologist, who diagnosed a heart murmur, hooked April up to a portable heart monitor she wore 24 hours a day. She was officially diagnosed with “reactive airway disease”—a variant of asthma—and prescribed half a dozen breathing medications meant to help with her light-headedness. But in spite of a variety of diagnostic tests and treatments, her symptoms persisted, baffling her doctors.
As April got older, she continued to live in a constant state of fear, immersing herself in seven different forms of martial arts, obsessed with becoming strong enough to protect herself. Fear convinced her to seek specialized protection training in a facility that focused on weapons instruction, evacuation scenarios, and hand-to-hand combat. She learned how to get into the minds of dangerous people, so she could protect others as a high-security bodyguard.
Every day, she strapped on a gun to go to work, willingly throwing herself in the line of fire on behalf of her clients. But even though April had become a highly skilled “executive protection agent,” the fear didn’t go away. If anything, she only grew more fearful, constantly looking over her shoulder, afraid to turn her back to anyone, certain that danger followed wherever she went.
She started sleeping with a gun by her bed, while nightmares of faceless men from the past still plagued her. She dreamed of being shot almost every night. She also developed a plethora of phobias—fear of the dark, of shadows, of spiders, of people standing behind her, of not being able to see people’s hands. She started panicking whenever she had to leave the house, obsessively calculating and recalculating ways she might get attacked and how she might stay safe. She was terrified that if someone tried to hurt her again, she still wouldn’t be able to stop them, in spite of all she had learned.
The more frightened April became, the sicker she got. Her fainting episodes worsened until doctors finally surmised that she was suffering from some strange blood disorder no hematologist had been able to diagnose. She wasn’t bleeding, but somehow, her blood just disappeared, leaving her inexplicably anemic most of the time. To counteract whatever was going on in her body, doctors ordered infusion treatments, necessitating that she be hooked up to an IV machine three times a week in six-to-eight-week blocks for hours at a time.
April remembers looking out the window as a nurse tried for the third time to find a vein on her bruised, blown-out arm. The nurses were required to make six attempts at starting the IV before they could give up and page the specialized IV team. For six years April had been going through this ritual, and the more time passed, the more frequently she needed the infusions. The problem was getting worse, and nobody had any clue why.
In all that time, nobody once asked April about what might really be making her sick. Assuming that her poor health, her fear, and her past were unrelated, April never thought to mention the nightmares that left her shivering and sweating at night, the flashes of violent memories that left her shaking, or the surges of adrenaline she could feel coursing through her body whenever the fear showed up. She didn’t understand that every time she felt that rush of adrenaline darting through her system, it had started as a thought or feeling in her mind that got translated into a series of physiologic responses throughout her body. April didn’t know enough about the physiology of her body to understand that every time a fearful thought or anxious memory entered her mind, disease-inducing hormonal responses got triggered, and that this repetitive triggering took a terrible toll.
THE STRESS RESPONSE
The body comes equipped with a natural mechanism called the “stress response,” also known as the “fight-or-flight” response. Although Walter Cannon at Harvard first described it, Hungarian endocrinologist Hans Selye later expanded upon it, describing the role of the hypothalamic-pituitary-adrenocortical (HPA) axis when the body is stressed, a response Selye termed the “general adaptation response,” or GAS.1 As Selye explains in his book The Stress of Life, he used the term “stress” to mean the biologic response of the body to any psychic demand, be it a negative emotion such as fear or anger or a positive change such as a new marriage or the birth of a baby.
When faced with a threat like the ones April faced when outrunning her abusers, the amygdala in the brain experiences the emotion of fear. The brain then communicates this emotion to the hypothalamus, which secretes corticotrophin-releasing factor (CRF) into the nervous system. CRF then stimulates the pituitary gland, causing it to secrete prolactin, growth hormone, and adrenocorticotropic hormone (ACTH), which signal the adrenal glands to release the stress hormone cortisol, aiding the body’s ability to navigate a threat.
When the hypothalamus is activated, it also turns on the sympathetic nervous system, causing the adrenal glands to release epinephrine (also known as “adrenaline”) and norepinephrine. These neurotransmitters are responsible for the jolt you feel in your body when you nearly miss crashing your car or someone jumps out of the shadows and startles you. They increase pulse and blood pressure, while also causing a variety of other metabolic changes all over the body. Your respiratory rate increases and your bronchi dilate, allowing more efficient oxygenation of the blood.
When the sympathetic nervous system is activated, your nerves fire more quickly so signals transmit more efficiently. Because warming the skin isn’t a priority in the face of a threat, the skin cools and goose bumps form. Because the body needn’t bother with digestion or reproduction in the midst of a life-threatening crisis, blood vessels traveling to the gastrointestinal and reproductive tracts constrict, shunting blood preferentially to the heart, large muscle groups, and brain, allowing your heart to pump harder, your thighs to run faster, and your brain to think more quickly. Your pupils dilate so you can better spot an attacker or find your escape route. Your metabolism speeds up and energy sources, such as fat stores, are broken down to release glucose into the bloodstream, giving you a burst of energy so you can fight or flee from the threat.
Stomach acid increases and digestive enzymes decrease. Cortisol suppresses your immune system in order to reduce the inflammatory response that would accompany any wounds an attack on your body might inflict. The body also stops all routine maintenance, shutting off its natural self-repair mechanisms—the ones that fight infection, prevent cancer, repair broken proteins, and generally fend off disease. Makes sense. After all, there’s no point wasting the body’s precious energy preventing disease or healing an illness that already affects you if you’re about to die anyway because there’s a gun to your head or a mountain lion is chasing you.
All of these physiological responses to fear are adaptive and protective when your life is really in danger. But here’s the kicker. You’re not designed to be frightened often. Period.
Epinephrine is toxic in large amounts, damaging the visceral organs, such as the heart, lungs, liver, and kidneys. The changes in stomach acid and digestive enzymes can cause esophageal contractions, diarrhea, or constipation. And when the stress response is triggered repetitively, sometimes the bronchi spasm instead of dilating—as in April’s case—leading to wheezing, shortness of breath, and chest pain. In primitive humans, when real danger threatened the physical body, the fight-or-flight mechanism was protective, but most of the time, in modern society, it’s just the opposite. Your body wasn’t built to withstand the effects of chronic fear and stress. And yet, if you’re like most people, your body is running on overdrive much of the time, fearing imagined threats, such as financial loss, the demise of a relationship, a threat to your stability, a perceived health threat, or a loved one’s death—fears that most of the time never actually come true.
This leads to a vicious cycle. You fear getting sick, aging, or dying, and yet the fear can literally make you sick, age you, and kill you. Now, as you read this, you’re probably even fearing fear itself! But don’t worry. I’m going to help you understand how you can use fear to reduce stress responses and activate relaxation responses, so fear can help you grow, rather than making you sick.
THE NEUROSCIENCE OF CHRONIC FEAR
Neuroscientist Joseph LeDoux, whose book The Emotional Brain describes how the brain processes emotions, has studied the physiology of fear extensively. LeDoux describes the amygdala as “the hub in the brain’s wheel of fear.” All primal emotions, such as fear, hate, love, anger, and courage, arise from the amygdala in the limbic brain—the primitive, animal part of the brain. This fear hub works in conjunction with the thalamus, which receives information; the cerebral cortex, which reasons; and the hippocampus, which remembers.
Repetitive triggering of the stress response makes the amygdala even more reactive to apparent threats. Fear flips on the stress response, which triggers the amygdala—on and on and on. As this happens, the amygdala, which helps form “implicit memories”—fragments of past experiences that lie beneath our conscious recognition—becomes increasingly sensitized and tinges those memories with heightened residues of fear. As a result, fearful feelings, often manifesting as feelings of anxiety, exist even in the absence of any objectively fearful experience.
Simultaneously, the hippocampus, which is critical for developing “explicit memories”—clear, conscious recollections of what actually happened—gets worn down by the body’s repetitive stress responses. Stress hormones like cortisol weaken neuronal synapses in the brain and inhibit formation of new ones. When the hippocampus is weakened in this way, it’s much harder to produce new neurons, thereby making new memories. As a result, the chronic, painful, fearful experiences the sensitized amygdala records get programmed into implicit memory, while the weakened hippocampus fails to record new explicit memories.
When this happens, over time, you may wind up feeling chronically fearful and anxious, with no real memory of why you’re even afraid. You may feel an overwhelmingly pervasive sense of doom and gloom, as if something bad—something very bad—is threatening you, even though, to an objective observer, you appear safe. Even long after the threat is over, anything that triggers this fearful response, consciously or unconsciously, stimulates the thalamus, which stimulates the amygdala and retrieves the fearful memory from the hippocampus, and suddenly—BAM. The body goes into hyperdrive. The trigger may not be directly related to the initial experience. It can be as simple as the feeling of a turtleneck around the neck or the scent of a fragrance that unconsciously stimulates the old memory. Once triggered, the physical reaction that follows is a warning system malfunction, alerting us to dangers that don’t actually threaten us. This false fear is nothing more than a thought, but it leads to a potent stress response that affects not just your mind, but your body.
As a result of this warning system malfunction, false fears may take over the nervous system, contributing to phobias, post-traumatic stress reactions, anxiety disorders, depression, and other psychiatric conditions. No matter how much willpower you have and how motivated you are to heal, you can’t just will yourself to be free of these kinds of fears, because the fear stems from unconscious processes and hooks into the most primal part of the nervous system. Even knowing that the fear is irrational doesn’t help, because the fear response is bypassing the cognitive mind, going straight from zero to terrified in the primal nervous system, without engaging the thinking, rational forebrain. Something as seemingly harmless as a song playing on the radio can shunt the nervous system into past trauma and tinge even the most benign experience with the residue of fear, triggering stress responses. It’s important to recognize that such responses are completely unconscious. If you’re ruled by these kinds of fear reactions, you’re not doing anything wrong. You’re just stuck in a malfunction of your nervous system, and you’ll likely need professional help in order to rewire it.
THE RELAXATION RESPONSE
Fortunately, the body has a natural antidote to stress responses triggered by fear, which Harvard professor Herbert Benson called “the relaxation response.” The relaxation response counterbalances the fight-or-flight stress response, shutting off the sympathetic nervous system and switching over to the nervous system’s relaxed state, the parasympathetic nervous system.
In its naturally relaxed state, the body is beautifully designed to repair itself. The body breaks down in small ways all the time. Cells go haywire. Toxins build up. Organs get damaged. We make cancer cells. We’re exposed to pathogens and foreign bodies. Yet, the body knows how to handle such routine breakdowns. When the body is physiologically relaxed and not focused on outrunning a threat, our self-repair mechanisms kick in and naturally fend off illness. But as we’ve just seen, the body’s self-repair mechanisms stop functioning properly when fear remains unchecked. Only when the mind and body are relaxed can the body heal itself.
When fear subsides and positive emotions replace negative ones, such as when the conscious forebrain experiences love, connection, intimacy, pleasure, faith, meaning, and hope, the hypothalamus stops triggering stress responses. Cortisol and epinephrine levels drop, the sympathetic nervous system shuts off, and the parasympathetic nervous system starts running the show. When this happens, pulse and blood pressure drop, blood is once again shunted back to less essential processes, such as digestion and reproduction, and the immune system flips back on. In this relaxed state, the heart is less stressed, the stomach produces less acid, and the body can go about the business of healing itself, returning to the homeostasis of optimal health.
In Mind Over Medicine, I shared the scientific data that proves how feeling states such as loneliness, work stress, pessimism, fear, depression, and anxiety can all trigger stress responses, while positive belief, loving connection, healthy sexuality, creative expression, gathering together in spiritual community, and meditation can initiate relaxation responses. When the mind shifts from fear to love, the mind can heal the body, and it’s not some fuzzy New Age metaphysical thing. It’s simple physiology.
While true fear is always protective and not something you want to lose, false fear can make the body sick if you don’t know how to handle it in a healthy way. But if you learn to reframe your relationship to false fear, you can train your body to quickly abort the stress responses that accompany fear and shift to self-healing relaxation responses instead. When fear becomes the finger pointing at the issues in need of healing in your life, and when you’re brave enough to let it transform you, fear has the potential to relax the nervous system as the mind focuses on healing solutions rather than scheming up more doom and gloom.
In Part Two of this book, you’ll learn specific tools for transforming limiting beliefs into courage-enhancing truths in order to facilitate this shift from fear to love. In Part Three, you’ll follow the Six Steps to Cultivating Courage to put these practices into action. As you do, you’ll not only calm your mind and revive your spirit; you’ll make your body ripe for miracles.
FEAR, ANXIETY, WORRY, AND STRESS
According to the Centers for Disease Control and Prevention, 80 percent of visits to the doctor are believed to be stress-related. Yet, as we discussed in the Introduction, what is “stress” if not fear, anxiety, and worry dressed up in more socially acceptable clothing?
Worry stems from our ability to turn something over in our minds in order to try to figure it out. This ability can be healthy when it’s focused on problem solving without any fear-inducing thoughts accompanying it. But the minute problem solving starts inducing imaginary negative outcomes, it isn’t just solving problems; it’s creating them. Anxiety is an emotional feeling of nervousness, unease, dread, or apprehension. It’s that sinking feeling we’ve all had that says, “Oh no. This could be bad.” Stress can accompany worry or anxiety, but it refers to the physical response of the body as it responds to a real or perceived danger. Fear is defined as an unpleasant emotion that stems from a belief that someone or something is dangerous, likely to cause pain, or threatening to your safety, security, or happiness. Fear, anxiety, worry, and stress may have different dictionary definitions, but as far as the body is concerned, worry, anxiety, and fear all trigger the physical response of stress.
Fear rules our whole culture, so nobody is immune. We’re afraid of unwanted pregnancy, date rape, and infertility. We’re afraid of gay marriage, socialized medicine, and electing the wrong president. We fear failure, success, withering away into obscurity, and failing to discover our true purpose in life. We’re afraid of financial disaster, but we’re also afraid of making too much money. We’re afraid to dream big, but we’re terrified of not being extraordinary enough. We’re afraid of expressing our creativity because we fear judgment or making mistakes, yet we fear keeping the song within us unsung. We’re afraid of dying, but we’re even more afraid of living.
You don’t have to have a diagnosed mental illness to be afraid. Every human being naturally experiences fear as a survival mechanism. In some individuals, though, fear escalates into full-blown psychiatric conditions. Twenty-eight percent of Americans suffer from an anxiety disorder, which manifests when a person feels fear and experiences the physiological effects of it without any certain or immediate external threat of death or injury.2 In addition to fearing things that could kill us, we’re also afraid of public speaking, heights, going out in public, needles, and spiders. In fact, a 1986 study by the National Institute of Mental Health showed that 5 to 12 percent of people surveyed had experienced phobias in the past six months. There are as many as 530 documented phobias, and studies estimate that 24 million Americans will experience phobias in their lifetimes.
Women experience anxiety two to three times more frequently than men, but phobic disorders are equally common in men and women.3 The ten most common phobias are arachnophobia (fear of spiders), ophidiophobia (fear of snakes), acrophobia (fear of heights), agoraphobia (fear of situations in which escape is difficult), cynophobia (fear of dogs), astraphobia (fear of thunder and lightning), trypanophobia (fear of injections), social phobias (fear of social situations), pteromerhanophobia (fear of flying), and mysophobia (fear of germs or dirt).4 Some people even suffer from phobophobia, the fear of phobias!5 Other common anxiety disorders include generalized anxiety disorder, post-traumatic stress disorder, panic disorder, obsessive-compulsive disorder, and social anxiety disorder.
When fear leads to a full-blown psychiatric disorder, it’s not just a finger pointing toward what needs healing; it’s a bomb thrown into your life, interrupting your serenity and requiring you to call in the experts. Specific treatments for psychiatric conditions like these are beyond the scope of this book, but if you are suffering from the painful effects of such a disorder, or if someone you love is, please seek professional help. In addition to working with a therapist, there are many wonderful books written by experts that focus specifically on each of these psychiatric conditions. If you need it, I strongly encourage you to seek out this type of support, which you may then add to your Prescription for Courage as a part of how fear can cure you. The way I see it, we all have tools in our toolbox, and the more tools we add to our Prescription for Courage, the more likely we are to be successful in leading a life ruled not by fear, but by the soul’s wisdom.
In the next chapter, I’ll be sharing with you data proving that fear isn’t just a painful emotion that causes psychological turmoil; it can be a serious risk factor for disease when not appropriately channeled. This information is not intended to scare you. It’s meant to shift your perception so you realize that every fearful thought is triggering a stress response that puts your body in jeopardy, so you’ll be motivated to let fear help you by writing and implementing your Prescription for Courage, rather than unconsciously being fear’s victim.
Chapter 2 is meant to offer you a paradigm shift, one that illuminates the prevalence of fear in our lives and acknowledges that if we wish to live long, optimally healthy lives, addressing our fear is arguably more important than what we eat, whether we exercise, how many vitamins we take, or how many bad habits we have. I understand that it’s radical to suggest that unchecked fear may lie at the root of many diseases. I’m not suggesting that these diseases don’t also have biochemical roots, but I am suggesting that fear predisposes you to those harmful biochemical influences. Even more importantly, I’m suggesting that you can do something about this. You are not at fear’s mercy. There’s no need to feel helpless in the face of fear. Remember, fear has the potential to free you from suffering, and when you let it, your body will thank you.