Sunday, September 21, 2014

This week's blog is on the debilitating effects of fear.

“It is a poor life that achieves freedom from fear.”
Aldo Leopold

“Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure or nothing at all.”
Helen Keller

Just like pain is inevitable but suffering is optional, fear is inevitable but what we decide to do with the emotion is up to us. 
Stress can either be just stress or eustress – “good” stress. For some, stress or challenge is something they thrive on and enjoy. 
For the rest of us Fear can be something that can lead to an adventure or a hero/ine’s journey. It depends on how we look at it. Our memory for past events and our experience with fear and stress will frame the way we deal with challenges. A strong spiritual practice can increase the threshold we have for a fear response and make life more enjoyable and challenges more manageable. Having gone through a right of passage successfully makes it easier to prevail over another one. 
Disease creates Fear with associated anxiety, alienation, and isolation. Fear and stress elicit the fight or flight reaction from the autonomic nervous system that results from a cognitive appraisal of a threat. In the case of disease Fear may arise out of a threat to life, limb, organ or function, religious or superstitious beliefs and threats to the ego self that can create shame or remorse. There are two other responses to fear; freezing and feigning death which can manifest as paralysis, resignation, incompetence or ineffectiveness, all enemies of the Inner Healer. The possibility that life may be short-lived or never be the same again leads to a range of harmful emotions related to Fear. This elicits a response from the adrenal glands which pours out the hormones necessary for a fight or flight reaction. This is entirely appropriate if one is being chased by a bear but unhealthy on a chronic basis. The reaction was designed to get us out of a short-term emergency predicament. If the reaction persists, too much adrenaline overloads the cardiovascular system causing hypertension and atheroschlerosis, and excess cortisone taxes and exhausts the immune system and may even promote diabetes. Morbid Fear can totally overwhelm the Inner Healer.

Fear and Truth – The Prognosis: Physicians, with their scientific training, feel obligated to tell patients the "Truth." They may quote statistics, such as, "You only have six months to live because you have stage X and grade Y of disease Z." This can be a powerful negative affirmation, and even a type of voodoo curse or hex. Bad news should always be dispensed with a liberal amount of Hope. Whereas the prognosis given by the oncologist may be administered without intent to do harm, it can be an evil spell with a prophecy of doom that may become self-fulfilling.  Only exceptional patients can rise above this nocebo prediction and medical hexing and determine their own destiny with the disease. Patients should never quibble with the Truth of the diagnosis but 
the prognosis on the other hand is always an arguable matter that depends on many variables.
         For a few patients it may even be preferable to withhold the diagnosis because of their unique conditioning, culture or education. Knowledge of such a calamity might completely immobilize them with horror and trepidation. For this reason, withholding diagnoses is a common practice in some countries outside of the United States. I remember being told during my training in Johannesburg by one of my professors in South Africa that we should never tell a patient that he had cancer unless there were critical financial or other decisions to be made. Unfortunately this physician was biased by the fact he had the unfortunate experience of a patient committing  suicide when he was told his diagnosis.
The internet, if misused, can also become a type of self-hexing. Just because one is intelligent does not mean one can master a medical conundrum which may even challenge the best physician. This is just as true as believing that reading a flight manual enables one to be able to fly a plane.
         I try not to give my patient’s statistics about their possible outcome. In the end it is arrogant to believe that in our limited capacity as healers we know the Truth about the patient, the Inner Healer, the Field and God as well as the countless other factors that cannot be measured.

Physician Fear and Truth: American physicians are frequently motivated to tell the whole Truth, and nothing but the Truth because of their own Fear. This is a result of the litigious nature of the society. There always seems to be a phantom attorney sitting on the patient’s lap dictating the doctor’s decisions. No medic wants to be sued for lack of full disclosure. “Informed consent” before invasive procedures requires listing all conceivable complications related to diagnosis and therapy. This custom creates unnecessary Fear and anxiety. The Truth or informed consent prior to medical procedures can be delivered in an informative, supportive, nurturing manner with due regard for the patient’s sensitivities. There are different ways of telling the Truth and delivery of the message does not have to be detached, rough handed or cruel. Giving enough facts to inform but not terrify the patient is a vital clinical skill. Also the patient can be advised that suitable precautions have been set in place to prevent these and that they can participate, e.g. early ambulation to prevent blood clots forming in the legs. The physician’s Fear of the legal system should not be transmuted into patient terror.
The raw Truth may elicit Fear that may be a negative factor in healing but a compassionate, balanced and hopeful look at the Truth can be a  transformational tool that induces the changes required for better health and healing. A patient who is knowledgeable about his or her condition without being debilitated by the Fear of its consequences can rise to the challenge and gain a sense of command. Knowledge of one’s predicament can give a sense of control and lessen Fear. Ignorance is not necessarily bliss. Being well-versed and taking charge gives us a feeling of confidence that counteracts Fear and all its adverse ramifications. 
"Tell all the truth but tell it slant -
Success in Circuit lies
Too bright for our infirm Delight
The Truth's superb surprise
As Lightning to the children eased
With explanation kind
The Truth must dazzle gradually
Or every man be blind" 
Emily Dickenson 
Fear can be manipulated with time, risk, complexity and withholding information. 
This principle is used by the armed forces to train recruits and strengthen them against fear. These polarities are relevant to healing as well. 
If a patient is told he has a very slow growing tumor like prostate cancer and has plenty of time to make a decision about treatment, fear will be lessened. The opposite is true if he is told he has an aggressive and rapidly growing testicular cancer and treatment must be instituted immediately.
The fear factor will increase for the patient with adverse risk factors such as has heart failure, diabetes and obesity.
If the complexity is greater there will also be more fear, for instance the difference between having an appendectomy or a complicated open-heart operation.
If information is withheld about the procedure fear may be aggravated. This is the benefit of informed consent but the information must be given with compassion and skill.
Even in the face of formidable and justifiable fear the healer or physician  should never dispel hope.
When we are ill we need to see the wood for the trees. Our energy reservoir may be limited and we do not want to squander our life force on trivial fears and stresses. We need to focus on the life-threatening issues and not the inconsequential ones. This means concentrating on the disease and not the incompetence of the parking attendant who seems to be intentionally preventing you from getting to your doctor’s appointment. Equanimity is a friend of the Inner Healer, "dis"-ease is not.
 "Be master of your petty annoyances and conserve your energies for the big worthwhile things. It isn't the mountain ahead that wears you out - it's the grain of sand in your shoe"

Robert Service

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