Scribe Publications
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*/ span.dg-Bold { font-weight: bold; } /* Normal used 38 times, e.g. DontPanic-0010-dedication.htmlIn Memory Of
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*/ span.Normal-dg-Italic { } /* Normal used 3 times, e.g. DontPanic-0010-dedication.htmlRichard McLaren National Library of Australia Contents Contents 1 FEAR I am grateful to many people for their help in my writing of this book. In particular, I thank the many hundreds of patients who have been prepared to share the most private and often the most painful aspects of their lives with me. This book was written for all of you, and I hope it reflects the love and compassion I hold in my heart towards you. Your huge efforts in recovery have been completely inspiring. I thank the Anxiety Disorders Association of Victoria (ADAVIC) for their support throughout the project. ADAVIC has been instrumental in providing help for people within the community who are anxious and distressed. The work is carried out by volunteers who are truly dedicated to their work. In particular, I want to thank Anna Kouloubos, Cathleen Geoghegan, Megan Sloley, Noel Brown, Catherine Madigan, Frank Duke, Michelle McMichael, Maria Villani, Danny Kelly, Merryn Snare, and Ruth Rosalion—a wonderful group of people. Introduction JULIAN’S ANXIETY AND DEPRESSION had started about one year before he came to me. His symptoms seemed to have come out of the blue. At the time, Julian was taken to a psychiatrist, who placed him on anti-depressant medication. Julian’s mother was told by the prescribing psychiatrist that Julian had a biochemical imbalance in his brain, that he might never recover, and that he would need to take medication for years, if not for the rest of his life, to counter the imbalance. This was devastating news for a 13-year-old, but he began his medication in the hope that it would improve his symptoms. • being passive and letting other people direct your life KEY IDEAS CHAPTER ONE ‘The world feels dangerous’ ‘The world feels dangerous’ My mother wanted an abortion when she found out she was pregnant with me, but she was talked out of it by a friend. For most of my life she’s never stopped saying how much she hated having me and how much I’ve wrecked her life. I’ve always felt I had to look after her and do things for her, to make up for just being here … this makes me feel hurt and scared … when I get scared my anxiety can just take over and I get terrified to drive or catch trams or go into supermarkets … sometimes I can get really afraid of people for no obvious reason. Shyness and lack of confidence Shyness and lack of confidence ELENI Eleni was 35 years old when she first came to see me. She came from a Spanish family of nine children. When Eleni was young, her mother had very little time to spend with the children beyond making sure their physical needs were attended to. Her father was fairly remote, working long hours at several menial jobs to gain enough money to support the family. Eleni spent large amounts of time with an aunt, whom she grew to love. Then her parents decided, in their forties, to migrate with the children to Australia, bringing the aunt with them. Eleni’s mother never got over the migration experience. She felt isolated, lonely, and bitter. Being always at home, she found the English language difficult to practise, and she never learned to speak more than a few words. Eleni’s parents bickered much of the time about leaving Spain, and the mother harboured a great deal of resentment about feeling ‘forced’ to migrate by her husband. Eleni thought that her parents had a ‘poor’ relationship, ‘always fighting’ and ‘always trying to control each other’. Indeed, she could not remember hearing them have a civil or sustained conversation with each other. She puts me down all the time in really cruel ways, telling me things like I’ll never amount to anything or that I’m useless … she laughed at me when I got married and we bought a house, saying ‘I wouldn’t have a hope of making it work’ … she can get really cruel. It took a long time but, eventually, Eleni started to improve. She had to learn how to relax her brain and stop the hypersensitivity reaction that had been happening. Meanwhile, Eleni had to slowly start to do the things she had been avoiding. She gradually learned to be able to eat, cook, and wash her own clothes. The next step was getting some part-time work, and then slowly forming a close relationship. Without a doubt, Eleni was one of my most difficult cases of sheer, unrelenting, and lateralised fear. Fear and the body’s response Important advances have occurred in our understanding of normal learning processes. We now know that learned fear is dependent upon genes being switched on so that protein synthesis can result in the building of more synaptic connections. In this way, the normal process of learning is materially observable in the brain through synaptic growth and density. However, learned fear does not appear to result from any abnormal gene. Instead, long-term memory storage of fear (so that it becomes learned) seems to be directly induced by exposure to environmental insult. For example, when animals are exposed to repeated electric shocks in the environment, specific protein kinase enzymes are imported into the cell nucleus and act upon the DNA, switching on a cascade of gene expression that results in learned fear that can be observed through measurable synaptic strengthening. It is the repeated environmental insult that initiates the normal gene to become activated.1 1 Kandel, Eric R. (2001). ‘The molecular biology of memory storage: a dialogue between genes and synapes.’ Science, 294, 1030–8. 2 Valenstein, E.S. (1998). Blaming the Brain: the truth about drugs and mental health. New York: The Free Press, pp. 100–1; 104–6. When you [ring me up and make critical comments about many aspects of my behaviour, such as when you say that I am too lazy, or too fat, or too greedy, or too selfish] What were the consequences of your behaviour for other people? What were the consequences for you? What harm was done? How much did that outcome lead to other poor decisions, whose outcomes then led to other even poorer decisions? (This is known as collateral damage or a chain reaction.)
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