The Thing You Think You Cannot Do: Fear and Anxiety

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As a psychiatrist, I spend my professional life in the presence of fearful people. An entire category of mental disorders is characterized by “anxiety,” a distress of the mind typified by worry and dread. This disorder is usually distinguished from fear by the fact that anxiety may have no specific object, except when it takes the form of so-called phobias: of crowds, of flying, or of driving, for example. When anxiety is acute, its physiological symptoms take the same form as those of fear: sweating, rapid heartbeat, muscular tension. We are, in short, manifesting the onceadaptive “fight-or-flight” phenomenon except that neither of these responses may now be called for. More common triggers in the present day are things such as public speaking, taking a test, or rejection in love. Fears of failure and humiliation have replaced the threat of imminent death as our most common sources of apprehension. Collectively, our fears take the form of a pervasive worry that supports huge therapeutic and pharmaceutical industries devoted to the alleviation of emotional distress. Because I work in one of these industries, I routinely employ medications, but I have found myself in recent years invoking virtues such as courage and resilience as alternatives to the sense of victimization and helplessness that medical diagnoses often engender. On the wall of my office hangs a 1915 picture of the British explorer Ernest Shackleton’s ship “Endurance” trapped in the ice of the Weddell Sea, near Antarctica. His ultimately successful battle for his crew’s survival has much to teach us about the courage required to confront adversity of all sorts.

Continued on page 3: What are we afraid of and what can we do about it... »