COPYRIGHT 2005 SCIENTIFIC AMERICAN, INC.

?
We naturally view any risk we witness as a personal threat —
even when it is on the opposite side of the globe
and we see it only on TV. Is popping a pill the answer?

By Marc Siegel

Can We Cure
FEAR
I
n early 2004 my daughter, Rebecca, was taking a bath.
She was almost three years old. When the tub’s Jacuzzi
device turned on, she became petrified. I raced to her side,
to find her standing straight up, bright red from crying.
For months afterward, she abhorred baths. As a phy-
sician who has studied the neurobiology of fear, I knew
that the prefrontal cortex of her young brain had just fin-
ished wiring its “safety center,” where analytical reasoning
can overcome primitive emotions. I tried to appeal to her
newly working brain center to suppress the worry that this

Excerpted with permission of John Wiley & Sons, Inc.

(www.wiley.com), from False Alarm: The Truth about the
Epidemic of Fear. Copyright © 2005 by Marc Siegel.

45
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 The Fear Response

C
ortical and subcortical pathways in the brain may nals from the thalamus and, with more sophistication
bring about a fearful response to a snake on a and more time, determines that there is a snake on the
hiker’s path. Visual stimuli are first processed by path (blue). This information is relayed to the amygdala,
the thalamus, which passes rough, almost archetypal, causing heart rate and blood pressure to increase and
information to the amygdala (red). This quick transmis- muscles to contract. If, however, the cortex had deter-
sion allows the brain to respond to the possible danger mined that the object was not a snake, the message to
(green). Meanwhile the visual cortex also receives sig- the amygdala would quell the fear response.

Visual thalamus

Visual cortex

Amygdala

Heart rate

Blood pressure Muscle

CORBIS (page 44) ; ROBERTO OSTI (this page)

tub would always bring the scary bubbles, but her sions, on Web sites and on newspapers’ front pag-
body’s innate response was too strong. By starting es — is such verbal support enough? Answering a
with showers and diverting the focus of her atten- perceived need, fear-blunting medications are
tion from the tub, I was gradually able to return her coming onto the scene. Could we — should we —
to baths. But to this day she is wary of bubbles. all simply pop pills to ease our anxieties?
Why is fear so intractable? And what can we Fear is more than a state of mind; it is chemi-
do about it? Therapy has provided succor for many cal. The feeling of alarm arises from the circuitry
people; others have relied on the strength they get of our brains, in the neurochemical exchanges be-
from their faith or other support networks. But in tween nerve cells. Fear is a physical reaction to a
a world where we regularly witness hair-raising hazard. As long as the danger is direct and real,
events— such as the aftermath of suicide bomber fear is normal and helps to protect us. Fear also
attacks in full color on our living-room televi- has a genetic component. A rat will recoil from

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 the odor of a fox, even if that rodent has spent its we have only read or heard about, so we may wor-
whole life in a laboratory. Likewise, we humans ry about disasters we may never experience. If we
are automatically apprehensive about situations are unable to respond for lack of an appropriate
that once threatened our ancestors. target, we become anxious.
When one feels threatened, the metabolism Adding to the problem— according to studies
revs up in anticipation of an imminent need to of how humans evaluate risks by University of Ha-
defend oneself or flee. “Fight or flight,” or the waii at Manoa psychologists Robert J. Blanchard
acute stress response, was first described in the and D. Caroline Blanchard— is that people often
1920s by Walter B. Cannon, a physiologist at fail to assess the level of threat accurately. We tend
Harvard University. Cannon observed that ani- to overpersonalize risk and to experience an un-
mals, including humans, react to dangers with a realistic sense of peril when we hear or read of a
hormonal discharge of the nervous system. The bad event occurring to someone else.
body unleashes an outpouring of vessel-constrict- For example, my mother-in-law has a severe
ing, heart-thumping hormones, including epi- case of multiple sclerosis and has been confined

(
Once a person has learned to feel apprehensive about
something, he or she may always dread it. )
nephrine, norepinephrine and the steroid cortisol. to a wheelchair for almost 20 years. Six years ago
The heart speeds up and pumps harder, the nerves my brother-in-law developed a mild case of MS,
fire more quickly, the skin cools and gets goose and my wife, a neurologist, then confided in me
bumps, the eyes dilate to see better, and the areas her fear, practically a conviction, that she would
of the brain involved in decision making receive a be next. Every time she brings up her perception
message that it is time to act. that MS is her destiny, I try to counter it with the
At the center of these processes is the amyg- bald statistic that only 4 percent of close relatives
dala, an almond-shaped region of the brain. Neu- are at risk for the disease. “There is a 96 percent
roscientist Joseph E. LeDoux of New York Uni- chance that you won’t get it,” I say. But for my
versity, a pioneer in the study of the fear cycle, wife, as for many others, the perception rests
describes the amygdala as “the hub in the brain’s with the 4 percent. Empathy for her mother and
wheel of fear.” The amygdala processes the prim- a natural tendency to personalize her experience
itive emotions of fear, hate, love and anger— all create the fear and the conviction, despite her
neighbors in the deep limbic brain we inherited neurologist’s knowledge of the disease.
from animals that evolved earlier. The amygdala Recurrent or unremitting fear has the same
works together with other brain centers that feed deleterious effects on the human body that run-
it or respond to it. This fear hub senses through ning persistently at 80 to 100 miles per hour has
the thalamus (the brain’s receiver), analyzes with on a car. Many illnesses are more likely to occur
the cortex (the seat of reasoning) and remembers as a result, including heart disease, stroke and de-
via the hippocampus (the memory-input device). pression. Thus, we should focus our efforts on
It takes only 12 milliseconds, according to avoiding the ordinary killers such as heart attacks
LeDoux, for the thalamus to process sensory in- that develop as a result of our unremitting worries
put and to signal the amygdala. He calls this emo- rather than extraordinary occurrences or exotic
tional brain the “low road.” The “high road,” or diseases. Consider: in 2001 terrorists killed 2,978
thinking brain, takes 30 to 40 milliseconds to pro- people in the U.S., including five from anthrax at-
cess what is happening. “People have fear they tacks. That same year, according to the Centers
don’t understand or can’t control because it is
processed by the low road,” LeDoux says.
(The Author)
Fear Factor MARC SIEGEL is an internist, an associate professor of medicine and a
Once a person has learned to feel apprehen- fellow in the Master Scholars Society at the New York University School
sive about something, he or she may always feel of Medicine. He is also a weekly columnist for the New York Daily News,
dread associated with that experience. And un- frequently writes for the Los Angeles Times, the Washington Post and
like mice, we humans can be alarmed by events Family Circle and appears on CNN and NBC’s Today Show.

w w w. s c i a m m i n d .c o m 47
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 Fear Not

I
learned how to defeat fear from one patient, whom even keel mentally also make good common sense:
I’ll call Joel Enrand. Enrand had an overriding terror of
losing everything— his health, his job, his family— ■ Avoid overhyped TV news programs or Web sites,
leading to depression, weight gain, high cholesterol which leave you susceptible to personalizing the dan-
and elevated blood pressure. Most of all, because of gers depicted.
his paralyzing middle-of-the-night bouts of sleepless ■ Like Enrand, identify what matters to you — and use
panic, he was concerned about losing his mind. “You’re that knowledge to bolster your courage.
not crazy,” I reassured him. The tiny muscles around ■ Practice the “five R’s”: regular sleep, regular meals,
his eyes then relaxed. Enrand soon embarked on a pro- regular entertainment, regular exercise and regular
gram of his own design, willing himself to jog three work schedule. Establishing order and control over
miles a day before work, eat regularly and limit himself many aspects of your daily life eases stressful fears.
to two cigars per week as his “one vice.” After six — M.S.
months he sat, at ease, in my office.
“My courage is back, Doc,” he said.
“Things were happening to me. I latched
onto the worry. I could feel it, like it was
real. It gripped me, and it grew.”
“But you fought it?”
“Just by sticking to routines, rituals;
they replaced the doubts little by little.
When I saw I was getting my life back, I
started to enjoy the routines.” Enrand
hesitated. “Most important,” he said,
“I’d always wanted to be a dad, and I
loved my son more than anything, and I
Regular routines,
knew I was responsible for him. He
such as exercising,
needed me, and I grew stronger by re- create a fear-quelling
fusing to let go of him.” feeling of control.
Many of the ways we can keep an

for Disease Control and Prevention, heart disease tem develops protective capabilities in response
killed 700,142; cancer, 553,768; accidents, to the presence of an injected (inert) disease
101,537; and suicide, 30,622. Murders (not in- agent. Rather the immune system might be chem-
cluding 9/11) accounted for only 17,330 deaths. ically primed with a shot so that it is as healthy
as possible — making the body less susceptible to
Liquid Courage hyperreacting to threats.
So what can be done about irrational fear? One of the first clues that an avenue to treat-
There is no one standard treatment in part be- ing fear could be to stop certain signals from
cause symptoms vary from one individual to the being received or transmitted by neurons came
next. A person may feel destined to a given bad from work by neuroscientist Larry Cahill of the
outcome and have a greater sense of foreboding University of California, Irvine. In 1994 Cahill
because of a certain family tendency. Some peo- tested on humans the effects of the drug pro-
ple’s bodies more easily release the fight-or-flight pranolol, a beta blocker that stops the reception
hormones than others. Time-consuming therapy of stress hormones called catecholamines. He
and the resulting reeducation, to avoid triggering found that the drug prevented people from re-
our fears, have been the chief solution to date. calling a gory story better than a bland one. Or-
Now research also suggests therapy could be dinarily, the mild stressfulness of hearing an ex-
supplemented by a simple pill that blocks the re- citing story makes it more memorable than an
ception or production of fear signals or even by uneventful tale. Propranolol is routinely pre-
CORBIS

a fear “vaccine.” The fear research does not seek scribed for anxiety relief and to treat high blood
a traditional vaccine — in which the immune sys- pressure and related ailments, but Cahill’s re-

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 search suggests it has a greater potential for Blunting fearful memories with pills or vac-
treating fear. cines is, however, not the same as retraining the
Along these lines, Roger K. Pitman, a profes- brain so that it is better equipped to handle fu-
sor of psychiatry at Harvard University, theo- ture situations. Regardless of the development of
rized that administering propranolol can both such medicines, therapy will continue to play an
prevent the laying down of fear memories and important role in treatment for fear. As the Pres-
blunt the fight-or-flight response. In 2002 Pit- ident’s Council on Bioethics put it in the 2003
man and his group looked at the effects of giving book Beyond Therapy, “Use of memory-blunters
propranolol to 41 people in the emergency room, at the time of traumatic events could interfere
starting within six hours of a traumatic event with the normal psychic work.... There is a dan-
(mostly car accidents). The study participants ger that our new pharmacological remedies will
received the drug for 10 days. Three months after keep us ‘bright’ or impassive in the face of things
the trauma, Pitman found a significantly lower that ought to trouble, sadden, outrage, or inspire

(
Could medical remedies keep us impassive in the face
of things that ought to sadden, outrage or inspire us? )
incidence of post-traumatic stress disorder in us — that our medicated souls will stay flat no
those who received the drug than in the control matter what happens to us or around us.”
group, which had not received the drug. For years, I have tried to help my patients
Another way to hinder the fear response is by handle their disease fears without knowing if I
disrupting signal production. LeDoux and Karim am succeeding or not. In studying the fear cir-
Nader of McGill University reported in the Au- cuitry of the brain, I have come to appreciate that
gust 17, 2000, issue of Nature that when rats teaching might not automatically lead to learn-
received a shot of anisomycin, an antibiotic that ing. Fear is a deep-rooted emotion, difficult for
inhibits protein synthesis, their fear memory was the brain to control. Sometimes it cannot be
blocked. They could not recall a previous fright avoided. My daughter’s experience with the bub-
and could not trigger a new fight-or-flight re- bles taught me that if fear is unlearned, it is be-
sponse, because the amygdala could not make cause a new emotion replaces it. (She developed
the signaling molecules. courage about returning to the bath.) This heal-
Reducing neural overreaction is another ap- ing occurs at its own speed, and a parent, or a
proach. In a study by neurobiologist Jonathan doctor, often has little control over it.
Kipnis, now at the University of Nebraska Medi- To conquer fear we must return it to its prim-
cal Center, and his colleagues published in the itive place as an instinct reserved for protecting us
May 25, 2004, issue of Proceedings of the Na- from true physical dangers. We must stop over-
tional Academy of Sciences USA, the authors personalizing it. We must resist those in the media
found evidence that immunological “vaccines” and elsewhere who highlight the wrong dangers
could prevent excess fear. They injected normal and hype the need to respond— making the threat
mice with amphetaminelike drugs that caused seem even more real. We must regain our footing
psychotic symptoms. Some of the mice received by exerting order over controllable aspects of our
the protective vaccine, a chemical cocktail known lives [see box on opposite page]. We must replace
as glatiramer acetate, or copolymer-1 (Cop-1); a our unreal fears with real courage. M
control group got no vaccine. Cop-1 stimulates
production of immune system T cells, which pro- (Further Reading)
tect nerve cells from “irritability,” or hair-trigger
◆ The Emotional Brain: The Mysterious Underpinnings of Emotional Life.
firing. The mice that received Cop-1 were able to
Reprint edition. Joseph LeDoux. Simon & Schuster, 1998.
learn to swim through a maze in recognizable ◆ The Culture of Fear: Why Americans Are Afraid of the Wrong Things.
patterns, whereas the control mice could not do so. Barry Glassner. Basic Books, 2000.
The Cop-1 mice exhibited normal calm behavior, ◆ Emotions Revealed: Recognizing Faces and Feelings to Improve
Communication and Emotional Life. Paul Ekman. Owl Books, 2004.
showing that they avoided a state of panic. This
◆ Does Stress Damage the Brain? Understanding Trauma-Related
kind of immune modulation has yet to be studied Disorders from a Mind-Body Perspective. New edition. J. Douglas
in humans, but such experiments are anticipated. Bremner. W. W. Norton and Company, 2005.

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