WHAT ARE WE PREPARING FOR?

Many of my patients tell me that they have to worry a lot so that they are "prepared." If I am quiet after they tell me that they feel they need to be prepared, often they will say that they don't know what they are preparing for. However, they still feel that they need to prepare in case something bad happens. So, why do we feel a need to be prepared? Is it so that we will know what to do if something bad happens? What does feeling stessed and anxious and worried prepare us to do? Doesn't it prepare us to continue to be stressed and anxious and worried? What good is that? Well, you will know what is going to happen [you will be stressed, anxiious and worried] and that can be reassuring as you don't have to face the unknown.

Many of the people who need to be prepared also fear the unknown and can't imagine just seeing what happens every day [every moment?]. They anticpate bad things happening frequently and if they worry about this they feel that they will not be surprised and will be more prepared. Are they more prepared? Research suggests that they are not preparing to manage stress but are actually creating stress by their preparation. In his book: Why Zebras Don't Get Ulcers, Robert Sapolsky indicates that when Zebras are stressed it is brief as they are either rapidly killed by a predator or they are not. Apparently, Zebras do not walk around worrying when the next predator attack might come, so their stress is over quickly. Humans however, have the ability to instruct their brains to be on guard in case we are threatened as we recall past threats as if they will reoccur. Thus, we are intermittantly stressed as we anticipate repeat of past stresses [constant stress would be something like a full body second degree burn with constant severe pain]. This activation of our brain's stress reponse mechanism is frequent enough that our brain's immune system can not recover before the next stress activation. This compromises our immune sytem's ability to respond to stress and is one of the reasons that autoimmune disorders are increasing as our compromised immune systems are more likely to attack our own body as if it were a foreign body. 

But if it clearly hurts us, why do we keep worrying? It gets back to the fact that our brains take instructions from us. How can it be that our brains are merely following orders [instructions if that sounds better than orders]. Why would we give our brains instructions that hurt us? Well it might be that at one time in the past those instructions to worry helped to temporarily reduce our fears and anxieties. These worries are not helpful now but we keep telling our brains that we need them as we continue to worry. In fairness, our brain's stress response happens in one nanosecond [a billionth of a second] so we are feeling stressed before we are actually aware that we are stressed. 

So, it is clearly better to not prepare ourselves to control stress by worrying but what alternatives do we have. There are specific cognitive behavioral treatments that can help us to not have to prepare by being stressed utilizing a technique called EMDR. This stands for Eye Movement, Desensitization and Reprocessing allows you to process past traumas while your brain is occupied by eye movements so that you can avoid or reduce stress being connected to the memory. There are also medications that can separate stress from past memories. These include: propranolol, low dose lithium, ketamine and a number of hallucinogens that have yet to receive FDA approval. There are also some supplements that might turn out to be helpful but it is to soon to tell.

LOVE YOUR NEIGHBOR

The title is a well known phrase and yet I believe that it contains an important message to all of us. The message has to do with the definition of neighbor. I am reminded of Fred Rogers [Mr. Rogers' Neighborhood] who clearly promoted the belief that we are all neighbors. If this is true then we are meant to love [be kind to] everyone so no one is left out. That doesn't seem reasonable, does it. Why does that matter? Does it matter? What are the consequences if we do not love all our neighbors?

One significant consequence is that people who you are not accepted and welcomed will feel left out and not included. This can lead to their feeling anger and have a desire to punish those who they feel are leaving them out. I believe that this is one reason we have wars, hatred, us against them thinking and acting. People who feel left out are easier for tyrants and dictators to control as the dictators feed into the feeling of being left out and reinforce people blaming others for leaving them out. This can start a chain reaction where there are different factions that don't trust each other, blame each other for problems, and don't take responsibility for themselves.

What do you think?

THE IMPORTANCE OF LISTENING WITHOUT REACTING

"I just listened." That is what a woman told me about her response when she was with someone who had just had a family member die suddenly. This woman was convinced that she had not been helpful and felt inadequate because of her listening and not talking. I asked what the person who had experienced the loss said and my patient said that she thanked her for listening. But my patient was convinced that her friend was just being nice and that her listening to her friend was useless.  A few months later I asked how her friend was doing and my patient told me that her friend was back to living her life and that her friend continued to say that my patient's listening was very helpful. As my patient and I talked about this I was listening to my patient and not reacting to what she was saying and mostly being silent, initially. My patient then said "you know when you listen to me I feel that you care and that you understand what I am experiencing"...so maybe that is what her friend had experienced when my patient listened to her after her family member died.

I am more and more convinced that listening to others without our personal reactions [virtually any reaction is likely to be our personal reaction] is an important way that we are with others and share their life experiences. It is a way of making a connection to another. Now, some people might get upset if you do this as they may be used to people reacting and then the reaction becomes the issue. So, if you don't react then it becomes an opportunity for that person to hear themselves and to take responsibiity for what they are thinking or doing. That is a wonderful gift for others that is not always immediately appreciated.

STAND UP AND SAY NO TO VIOLENCE

I am writing this a day after an 18 year old killed 19 fourth grade children and 2 teachers. He had recently [after turning 18] purchased two AR-15 [assault] rifles and carried one into the elementary school. These rifles that the NRA calls "America's rifle"can rapidly fire 40 bullets and are easy to reload. They were banned in 1994 after they were used in mass schootings and they were labeled "assault rifles." However people who already had these weapons could keep them and keep their large capacity magazines [allows someone to shoot a lot of bullets rapidly and reload rapidly]. In 2004 the law ended because of congressional inaction and the number of mass shootings in the US dramatically increased. This increase was likely in part because of the availability of large capacity magazines that have contributed to the number of people killed in mass shootings. Data on mass shootings from the National Institute of Justice's Public Mass Shootings Database shows that assault rifles were used in 25.1% of mass shootings, while handguns were used 77.2% of the time. 77% of the shooters purchased at least some of their weapons legally. In K-12 school shootings over 80% of the time the weapons were stolen from family members. Mental health issues are common in mass shootings with psychosis being noted to have a minor role in nearly 1/3 of the shootings and a primary role in 10% of the shootings. 31% of shooters had experienced severe childhood trauma and 80% were in crisis. In addition, 30% of the shooters were suicidal before the schooting and 39% were suicidal during the shooting. 92% of college age and younger shooters were suicidal. 64.5% of the shooters had a prior criminal record and 62.8% had a history of violence. Frequently the response by people who are against any restriction on what weapons can be owned is that it is really a mental health issue. It is like the notion that guns don't kill people, it is people with guns that do. It is true that mental health issues are common and yet access to weapons plays a very significant role. This is seen clearly in suicides using guns as access to guns matters since the time between a decision to kill oneself and acting on this happened in less than 3 hours 73% of the time in a paper by Laura Paashaus et al. Clin Psychol Psychother. 2021 Nov. entitled: "From decision to action: Suicidal history and time between decision to die and actual suicide attempt." This is even more significant considering that more than 50% of deaths from guns are suicides. In 2020 45,000 Americans died from guns so over 22,500 were suicides. If a wait of more than 3 hours could prevent suicides then a wait for a background check is long enough to prevent a suicide. It seems very clear that restricting access to guns would save a lot of lives including a lot of children's lives, especially as suicides are increasing in children and adolescents.

So, background checks, limits or a ban on assault type weapons, limits or bans on large capacity magazines and so called "red flag" laws taking guns away from people who are a danger to themselves or others would save a lot of lives. So, why isn't this happening? Do gun advocates not care about all these deaths, including children killed in mass shootings. I don't believe that. Something else must be keeping gun advocates from supporting laws that would save many lives. I think that it must be related to fear. This fear may be connected to messages that many of us give our brains. The focus on rights to own guns and even to conceal them, gives our brains the message that it is ok to have and to use guns, otherwise we wouldn't have so many and they wouldn't be so easy to get hold of and it wouldn't be ok to conceal that we have them. Significantly, lies are being spread that people will try to take your right to own a gun away from you and take away other rights so that you will end up being like a slave. This fear is translated into messages to our brains that we must have the right to have and to use our guns to protect ourselves, our families and even our country. This message puts our brains on high alert and the amygdala part of our brains will constantly scan our surroundings for danger and we will respond to a percieved threat in a nanosecond when we feel threatened. That nanosecond [one billionth of a second] is the speed that the amygdala in our brain responds to a perceived threat to us. When this reponse is activated we are responding before we are even aware that we are. When we are responding out of fear that fear is the number one priority for us [and for our brains] and nothing else matters. This is one reason that intelligent and compassionate people can respond to mass shootings by denying that it is related to access to guns and denying that assault style weapons are not needed to protect ourselves because their fear tells them that they must have guns to protect themselves. For people with this type of fear it feels like a matter of life and death.

So how do we help each other not to be afraid? Listening to one another's fears can help reduce them as people then don't feel as alone and are less likely to believe that other people are out to get them. Also, it can help to openly talk about fears that people of color want to make whites become slaves. These fears are ungrounded and actually the more racism and income disparity can end, the better the world will be for everyone. Even the ultra rich will be better off as they will realize that they don't need to be afraid that they don't have enough money. We feel divided by fears and to let go of the fears will allow us to let go of the "us against them" way of coping.

What do you think?

RECIPROCITY: RENEWAL OF THE WORLD FOR THE PRIVILEGE OF BREATHING

The above title is a quote from Robin Wall Kimmerer in her book Braiding Sweetgrass. She feels that we are meant to have a reciprocal relationship with other living beings [all living creatures]. A sharing, mutual enhancement, caring and being with each other that fills up our daily lives. This she calls reciprocity and will lead to a renewal of the world as we learn to share this wonderful world with all living beings. We are indebted to many kinds of living things, especially trees in forests, for providing us humans with the oxygen that allows us to breathe and thus to live. So, what do we give back to other living things? One way is to carefully leave trees that will allow the forest to be healthy when we thin out the forest. This is in stark contrast with clear cutting that always kills forests as the seedlings they plant won't grow as what they need to grow has been stripped away with the clear cutting. 

There are many ways we can give back to our planet and establish a reciprocal relationship with living things as we share with and help to take care of our wonderful earth. Isn't this whart we are all supposed to do?