Jeff Wise | Talks at Google - Agoraphobia

Jeff Wise | Talks at Google




>> Welcome, everyone.
This is another amazing Authors@Google event.
Today's talk is by Jeff Wise, who's a science
journalist and a
full-time adventure seeker.
He seems to find adventures wherever he goes.
He's a contributor to many popular magazines,
including the very
popular andquot;I'll Try Anythingandquot; column for Popular
Mechanics.
He's here to talk about his book called andquot;Extreme
Fearandquot;, get a copy.
Um, andquot;Extreme Fear: The Science of Your Mind
in Dangerandquot;.
In this book, he talks about fear.
And he writes a very gripping view of the
science behind it.
Let's give him a warm welcome.
JEFF WISE: Thank you very much.
I appreciate you're all coming out to learn
about my book.
So I just want to start by talking about fear
-- what is fear?
Why should we care about it?
Now, every organism on the planet has some
very basic motivations.
It needs to find food and it needs to reproduce.
And it needs to avoid being eaten or killed.
So fear is a response that, you know, even
in the most primitive form,
every creature has.
And it's -- it evolved in a very early state
in our development but as
we evolved, we generated layer after layer
of sophistication.
And it's something that we tend to have a
paradoxical relationship
with.
It's something that we on the one hand that
we try to avoid as much as
possible.
We avoid danger.
We avoid situations where we're going to become
fearful.
But at the same time, we're drawn to it.
We go on roller coaster rides.
We go to see scary movies.
We read books like andquot;Extreme Fear: The Science
of Your Mind in Dangerandquot;.
So for me it became a really interesting question
of why is it that we
can have such contradictory feelings towards
this one seemingly simple
emotion?
A little bit about myself, my own background.
I started off being interested in science.
I got my degree in biology at Harvard and
wasn't really interested in
test tubes or field work.
I was more interested in the storytelling
aspect of fear, learning
about how things evolved, why things are the
way they are.
And I became a journalist, ultimately, rather
than a scientist.
But I was drawn to the scientific stories
that were unfolding in the
world around me.
And the way my career took me was towards
a lot of adventure travel.
And I found myself doing things like bungee
jumping, white water
rafting, jumping out of airplanes, that sort
of thing.
And as I found myself in these situations,
where my heart was in my
throat, my palms were sweaty, my heart was
racing -- much like right
now, for instance.
[LAUGHTER]
Um, I thought, why is this happening?
What's going on?
Like most of us, I tend to think of myself
as someone who is in charge
of my brain.
I'm in charge of what I do.
I'm in charge of what I think and how I act.
But when you're on the edge of a cliff and
you know rationally that
there's nothing to be afraid of.
You know that there's these elastic cords
attached to your ankles.
You know, the chances of something going wrong
are pretty small.
Statistically.
But there's something inside your brain that
doesn't recognize
statistics, it doesn't understand elastic
bands.
And it comes up in a very powerful way.
And you suddenly find yourself thinking, what
am I doing here?
This is awful.
I'd rather be anywhere than here.
And so I found myself again and again in this
situation where a part of
my brain was taking over my conscious thought.
And I thought, what's happening?
I want to find out more about this.
And so I started this journey of looking into
the research and talking
to scientists and figuring out what's happening?
Where does it come from?
And how does it work?
Ultimately, the idea is being that if you
understand how it works,
hopefully, you'll be able to stay in control
a little bit better.
That's the hope.
Um, but since I'm at Google today, I thought
I would look at it from a
slightly different perspective from how I
tackle it in the book.
I guess there's probably a fairly high concentration
of computer
scientists here and people who work with code
and processors and
things.
So I think that you guys all have a unique
perspective on how the brain
works or how we think about how the brain
works.
Because as you know, the brain is a mysterious
thing that we only can
grasp indirectly.
I mean, we have our own direct intuition of
what's happening inside our
own skulls but it's a slippery fish that evades
our grasp.
I think I'm going to do this and I then I
wind up doing something else.
Or one day I think that buying a certain kind
of car tomorrow is going
to make me happy and then it turns out that
it makes me miserable.
We're very poor at predicting our own mental
behavior.
So, to make a long story short, we have --
tend to have metaphors for what
the brain is like.
And, um, when computers became a reality in
-- after World War II, the
model of the mind as a kind of computer became
increasingly
fashionable.
And one of the seminal moments in the modern
understanding of the brain
was a theorist named Alan Turing, who I'm
sure you all are familiar
with, who devised a kind of a thought experiment
called the Turing test.
And the idea was that if you could create
a machine who could answer simple
questions or not-so-simple questions in a
way that was indistinguishable
from a human being then you would have to
admit that that computer was
essentially equivalent in some fundamental
way to the human mind.
And it's a good story and so it became very
plausible.
And it became essentially the basis, I think,
for how artificial
researchers progressed from that point.
The idea was that if you could model a response
to a English language
question or whatever language you're posing
it in, if you could get
that right then you had essentially solved
the problem of human
consciousness.
So in Turing's sort of thought experiment,
he gave the example of a --
of a teletype.
So you're getting a message over this text
printout machine like a
printer.
And he was talking about scanning a line of
Shakespearian verse.
And if you can explain this line of Shakespearian
verse, then you're
essentially a human, you are essentially conscious.
You are equivalent to us as thinking beings.
And in the 70's, this became a leading school
of thought in
artificial intelligence.
It was the idea of language of thought.
The idea was that when we speak, what we're
essentially doing is giving
physical manifestation to what is happening
inside our brains.
And that was a prominent leading view for
a long time.
The problem with this is that it fails to
answer some pretty basic
questions.
And one of the problems that was pointed out
was something called the
frame problem.
Okay?
So say you're a robot and you're running this
software in your little
metal head and you're pushing a cart.
And on this cart is a bomb.
Now you're processing where the cart is located,
where your goal is,
how to get there on the corridor, and then
there's a flashing light on
the bomb that means that it's going to blowup.
So how -- amidst all the other processing
tasks that you're trying to
do, how do you deal with the fact that there's
also a flashing red
light and what that means and what you should
do in response?
And given the state of artificial intelligence
at the time it was an
unsolvable problem.
Well, what's happened since then it is not
a serial processor kind of
situation.
That the human brain is running multiple modules
in parallel, all at
the same time.
Few of these ever reach consciousness.
And so this idea that it can all be explained
by the language of
thought, that everything that essentially
is playing out in this inner
dialogue in our heads is all we really need
to know about the situation
is fundamentally flawed.
And so something else that's happened recently
is this idea of
embodiment of cognition.
The idea that a brain only really makes sense
in the context of the
body that's it's in.
And so our moods, our hungers, our appetites.
These aren't just phenomena that occur on
the fringes of our consciousness
and sort of muddy our Spock-like thinking
of the world.
They're actually crucial to why we have cognition
in the first place.
Um, so, to kind of get back to the original
point, the idea that we are
living in our heads, essentially, generating
thought, solving chess
problems, this kind of intellectual endeavor
that occupied so much of
our day-to-day lives and feels like the essence
of who we are is
actually a very small part of what our brain
is doing.
And it's a crucial misunderstanding that a
lot of us walk around with
and it especially becomes important when we're
trying to understand the
fear response.
Well, a lot of time, we don't care about the
fear response.
Most of us go through our daily lives not
being afraid of much.
And we can just think our thoughts and plan
our day and go about our
lives without having to worry anything about
anything except for our
rational, Spock-like thoughts.
And so we have a hard time escaping from this
illusion that is really
ancient.
And it was best formulated by Rene Descartes
who said, andquot;I think,
therefore I am,andquot; among other things.
And he lent his name to the Descartesian dualistic
point of view or
illusion as it's commonly referred to.
So the idea that -- the Descartesian Dualism
is that there's a little
man in our heads with a bunch of levers.
Light comes in from the eyes, from the ears,
and he -- everything
that's processed in the brain goes to this
little man and he makes
everything happen.
And it feels like that's how it works until
you're in a situation where
you're, um, suddenly overwhelmed with fear
and you find yourself
running or you find yourself frozen or you
find yourself playing possum
willy-nilly and all of a sudden this Descartesian
Dualism gets thrown
out the window in rather stark terms.
So, um, it can be confusing if you haven't
encountered this before.
So in the book, I talk about a woman who was
very generous with her
time with me her name is Cindy Jacobs.
She wasn't really unusual in any regard.
She was one of millions of Americans who suffer
from anxiety disorder.
And so she was driving down the road one day
-- and I wouldn't be
surprised if a fair percentage of people in
this room have had a problem like
this, I have.
She was driving down the road and she started
-- she had her four
children in the back.
She'd been picking them up from daycare, she
had to deliver them home,
feed them, take them to somewhere else.
She had a very busy day.
She was a normal homemaker.
She started to have a heart attack as she
was driving down the road.
She pulled over, she took out her cell phone,
she called the nurse of
the HMO that she belonged to and she said,
andquot;I'm having a heart attack.
Can you please arrange for medical care?andquot;
And the nurse said, andquot;You're not having a heart
attack.
If you were having a heart attack, you wouldn't
be on the phone to me.andquot;
So she was a bit flummoxed by this because
she was -- had this pain in
her chest and she couldn't breathe and all
the things that you feel
like when you are dying.
And so ultimately she -- the nurse sort of
talked her down and she got
back on the road and drove home and didn't
really think about it.
But then a few weeks later, she was in church
and again she felt she
was having a heart attack.
And she -- why did she think this?
Her doctor told her that she was having an
anxiety attack, a panic
attack.
So she couldn't believe it.
She thought I'm not the sort of person who
is nervous or has mental
problems.
I am a person who gets things done.
And so this is not possible.
She didn't -- because she was so firmly in
the grips of the
Descartesian Illusion that she -- she had
no mental model for how it
would be possible to find yourself taken over,
essentially.
These, um, deep centers that lie within our
brain that handle the fear
response are so below our conscious level
that they feel almost
external or that they're happening within
some other part of our body
that's not connected directly to our brains.
The word andquot;panicandquot; derives from the name of
the Greek god Pan.
It was believed that when you were walking
in the forest and suddenly
became so overwhelmed with fear that you started
running pellmell, this
was a case of possession by the god Pan.
It feels like possession.
It feels like an external force taking over
your brain and making you
do whatever you do.
And so why does it matter that we dispense
with the Descartesian
Illusion?
Only it matters because we have fear in our
lives.
Fear can crop up unexpectedly, that's its
nature.
So forewarned is forearmed.
This is how our brains work.
They don't work the way we expect them to,
especially in dangerous
situations or in scary situations that aren't
dangerous.
One of the mantras in the book is that when
we're afraid, we have two
problems essentially.
We have the thing that's making us afraid
and we have the fear itself.
Our own fear response is often the most dangerous
thing about the
situation.
And sometimes there isn't something making
us afraid.
Sometimes there are things that should be
making us afraid and they're
not.
But if we just rely on our little man in our
heads to steer our way
through danger, we'll find ourselves becoming
a copper because what
happens is when the fear centers are activated,
the sympathetic nervous
system, fight or flight, pumps powerful brain
chemicals into your
system.
And one of the first things it does is to
shut down the frontal cortex,
the part of our brain that thinks complex
thoughts, that makes plans,
and arranges for the future.
And so, a very simple example.
If you're in a nightclub, for instance, if
you come in, and you don't
notice where the fire exits are and then a
fire happens -- and this has
happened several times -- your frontal cortex
is shut down.
All you can essentially do is follow everyone
else out through the door
that you came in.
Most people avoid the fire exits.
And that can have really tragic consequences.
So knowing how the brain works, we can, not
necessarily -- no let me
rephrase that.
Knowing how fear works does nothing to help
us control our fear.
Fear is a very powerful force that simply
understanding it does not
help you suppress it.
It's like being swept out to sea by a tidal
wave.
It's overwhelming.
You can't fight it with sheer will power.
However, if you understand how it works, you
can, (A) go a little bit
easier on yourself, like Cindy Jacobs.
When she gradually, after a year, came to
understand, that okay, my problem
is anxiety.
I will treat it using medication, using therapy.
And in that way, you can get a grip on it.
You can also avoid the mental unpleasantness
of beating up on yourself
for thinking, I'm a coward, I'm mentally ill,
I shouldn't be doing
this.
You know, we have a really erroneous idea
fed to us through the media
of what the proper fear response is because
in movie after movie, as
obsessed as we are with what extreme danger
is like, we see movies like
Diehard, and you know, High Noon and movies
where people are in mortal
danger.
These movies are very erroneous.
You know, Clint Eastwood walks down the street,
there's the bad guys
ahead of him packing heat.
Somebody's going to shoot somebody else.
It's going to be bad.
Somebody should be afraid.
But, you know, Clint Eastwood just kind of
narrows his eyelids a little
bit and that's it.
Well, he's a very brave man obviously.
Well, not really.
That's not how brave people respond to danger.
You know, the famous case of Captain Sullenberger,
who landed the
airplane in the river last year, was a marvelous
feat.
He had practiced thousands of hours so that
when danger happened, he
could do what he needed to do without needing
to use his frontal cortex
too much.
He was very calm and collected given the situation.
But he was extremely nervous.
He was terrified.
And he later said it was the scariest day
of his life.
I tell a story in the book about another pilot
whose wings started to
come off as he was performing aerobatics,
and he -- he performed
masterfully.
But his legs were shaking, he was trembling.
He said he found it very difficult to think
straight as well.
So I think if we have a more realistic idea
of what the fear response
is like, we can prepare ourselves better to
deal with it.
We can not beat ourselves up when we behave
differently from how Clint
Eastwood has led us to expect we should behave.
And we can generally lead a life that is less
fearful of fear.
If we -- if we make a habit of just getting
a little bit closer to the
edge of what's makes us comfortable, we become
habituated to the
sensation of fear a little bit.
Not to be, you know, to just go out and start
jumping off of buildings
with your base jumping parachute tomorrow,
but if you just do something
a little bit different -- eat a different
food or take a different
route home from work or, you know, see a different
kind of movie, make
yourself a little bit uncomfortable.
Take a risk.
Let yourself enjoy the payoff of that risk
or if the risk doesn't pay
off, you know, don't beat yourself up about
it.
Your -- your field of possibilities becomes
gradually larger.
And I think that's really the ultimate goal
of the book is, you know,
not only to tell some hopefully gripping tales
and lend some insight
into how fear works, but also just to encourage
people to not feel
afraid of fear, to recognize it as an emotion
that's part of all of our
lives.
And to embrace it, even.
To accept that it's a fine line between fear
and excitement.
And to -- to lead a life that's more enriched
because of it.
How are we doing for time?
We have lots of time?
We have too much time?
Um, well -- is it too early to see if people
have questions?
It's okay?
Let's take a few questions.
Does anybody have any questions?
Do you want to come up to the microphone,
I guess that will --
[PAUSE]
>> Yeah, panic attacks seem decidedly inconvenient.
Is -- are there any theories on sort of like
the evolutionary rationale
for such things or is it just the body breaking
down as it gets older?
JEFF WISE: Well, thank you.
That's a great question.
There's a couple chapters in the book about
panic attacks.
And essentially, what happens is -- I haven't
really gotten into the
anatomy of the fear response too much here
today -- but the long and
short is that we have these subcortical structures
deep within our
brain, evolutionarily ancient structures that
become activated by
stimuli that we don't necessarily become aware
of consciously.
And these, um, stimuli can trigger the fight
or flight response.
And if we've been trying like Cindy Jacobs
to not think about what's making
us nervous or trying to just sort of endure
whatever hardship we're in
life.
We're stressed out but we don't want to admit
that we're stressed out.
So the stimuli reach a critical threshold,
subconsciously activates the
fear response so we get the racing heart,
the shortness of breath, the
sweaty palms, and then we consciously notice
that.
We notice the external symptoms of the sympathetic
nervous system
activation.
So we become consciously afraid.
So the conscious mind, which not only can
suppress fear but also
activate fear, notices these symptoms, thinks
something's happening.
What is happening?
That fear about the fear response is a feedback
loop.
And so it's not that the system is breaking,
it's like a microphone
that picks up its own signal and it just spirals
out of control.
Now what you can do -- it's fairly treatable.
What you can do -- this isn't appropriate
for everyone in all
situations -- but if you take a betablocker,
what it essentially does
is suppresses the outward manifestations of
the fear response, the
racing heart and so forth and it just cuts
that feedback loop.
I don't know if that answers your question?
>>Yes.
Jeff: Okay. Thank you.
>> Such a interesting topic.
I'm wondering if you can comment on fear and
the ability to learn or
cognitive ability.
I guess I'm thinking of maybe the example
of children or kids who are
in, you know, maybe a bad area of town and
there's violence or they're
in an abusive household, and what the impact
is on the ability to
learn.
JEFF WISE: Right.
That's a great question.
We're really talking about two separate situations,
I would think.
A lot of what I deal with in the book is acute
fear, meaning some
specific danger that is present but that will
go away.
And so if you're living in a bad neighborhood
and say someone starts to
chase after you with a knife or something,
that has one effect on our
brains and bodies.
One of the things I do -- it does, as I mentioned,
is it will shut down
our ability to think sophisticated, complex
thoughts.
But I think what you're referring to more
involves not acute stress but
stress that persists for a long amount of
time.
And what happens in that situation is that
a lot of the body's
resources that are mobilized to deal with
an acute stress, like in
evolutionary times, being chased by a bear,
for instance.
They linger.
Cortisol is one the main stress hormones and
if it's released and
reaches elevated levels for a long period
of time, it becomes
neurotoxic.
It essentially -- among its many negative
effects, I mean, all the
negative effects of stress can -- heart disease
for instance, can be
traced to cortisol as well.
But it can hinder long-term learning.
And yes, to live in a consistently stressful
environment, I think, can have
damaging effects on brain such as learning
and memory and cognition.
>> Quick followup.
Sorry.
Is there any linkage or relationship between
fear and addiction?
JEFF WISE: Well, that's a great question.
I've never considered it in that direct way.
But I think it's very interesting, um, that
fear -- as I mentioned at
the very beginning of the talk, it's something
that we have a very
complex relationship with.
We avoid it and we also seek it out.
And one of the reasons we seek it out is that
it has -- we were just
talking about negative effects that fear and
stress have in terms of
shutting down the brain, hurting memory, hurting
cognition.
But it also has lots of positive effects.
There's actually an ideal middle ground that
we perform optimally at.
And one of the -- and so when you're very
afraid, fear focuses your
thoughts, makes you stronger, makes you faster,
makes you resistant to
pain.
It makes you a kind of a super human person
for a short while.
Why that is, is in part due to endogenous
chemicals that are released
within the brain that mimic the effects of
marijuana and amphetamines,
among other things.
So around about way to say that I haven't
thought about your specific
question in that specific way but it's very
interesting that in essence
when we become dependent on certain drugs,
what we're doing is
artificially elevating, or artificially recreating
elements of our fear
response.
And people become addicted to fear.
I mean, is there a relation between becoming
an adrenaline junkie who
has to jump out of an airplane every Saturday
and somebody who has to
smoke crystal meth or something?
I mean, it's very similar brain compounds
are involved.
I don't -- I'm no expert.
But -- and I don't think that anybody really
knows.
Frankly, addiction is an incredibly complex
and politically sensitive
topic.
But it's a really, real interesting question.
So thanks.
>> So this first question about children got
me thinking, right.
So in kids, you sometimes see this sort of
weird dichotomy, where kids
can be like just incredibly afraid of like
what's under the bed or in the
closet, but then they can go and they do something
sort of like ridiculously
foolish or courageous. They'll go around like
jumping over train tracks and
stuff like that.
There are any good explanations for that kind
of dichotomous behavior?
Or is it --
JEFF WISE: That's a really interesting question.
I have a 15-month old at home and he's just
gotten -- he just started
walking last week.
And so the dangers are infinite.
Although I have to say, I've been somewhat
surprised as a first-time
parent at how I sort of thought that every
potential lethal object he
could get his hands on, he would immediately
take and impale himself
on.
There does seem to be a certain amount of
self-preservation even at
that age.
But, you know, I'm definitely trying to keep
the bleach out of his
grasp.
Um, that's a fascinating question.
One of the things I've noticed about my young
son is that, you know,
the most highly evolved parts of our brain,
the planning, the thinking,
the reasoning, abstract concepts, and self-control
-- I mean it does
not exist.
He has no self-control.
He wants it, he wants it.
And there's no mitigation of whatever emotion
he happens to be feeling.
So, you know, if we look at, you know, the
issue of courage, of
self-control in the face of danger as being
a sort of tug of war
between our higher complex reasoning, the
frontal cortex, and our
primitive subcortical limbic system regions
like the amygdala.
He's missing the whole first part.
He's got none of that.
So if it triggers his fear, he's wildly afraid.
If doesn't trigger his fear, he's not afraid
at all.
So maybe the answer to your question has something
with the fact that
the amygdala doesn't understand trains.
It understands height, you know, understands
fire.
It's like Frankenstein, it's like a zombie.
It gets the really simple stuff but it gets
the simple stuff really,
really well.
So a dog, a barking dog or even a cat, you
know -- who knows?
It's scary to him it's not scary to us.
But because it's triggering the amygdala
-- and this also gets back to
the question of, you know, the -- I mentioned
very early on that we
have these multiple layers in the alarm system
that basically our fear
system is, and some of them act very quickly
but have a very, um, crude
handle on what's going on.
So if you're walking in the woods and you
hear a stick break or there's
a loud noise, you get very scared.
You jump, your heart races and everything.
And then a second later, it takes your, your
slower but more detailed,
more nuanced parts of your brain to sort of
sift through this incoming
data, and say, okay, look it's not a -- it
was my dog that stepped on the stick.
It wasn't a bear.
And so then you calm down.
But these very quick ones are very blunt,
very crude, very effective.
You know if someone shouts in your ear and
you're not expecting it, you
jump a foot up in the air.
It's neurologically impossible for you to
consciously suppress the
startle response.
like, it's a very small number of neurons
that are involved in it but it
doesn't discriminate between, you know, trains
and, you know, whatever
complex fear.
But I think that might be part of the answer
that kids who are young
who haven't finished their cognitive development,
they can't be afraid
of things that they don't understand.
It's not that the system is broken it's just
that it hasn't finished
building itself yet.
Essentially parents are functioning as a remote
frontal cortex.
You know, where it's sort of like an accessory
that hasn't been
integrated into the frame of the computer.
So --
>> Hi.
Um, I think you began to answer my question.
But can you elaborate how fear relates to
stress?
Is like one -- is the stress a low-grade version
of fear or is fear an
acute version of stress or are they related?
JEFF WISE: They're very closely related and
in fact, Lillian [INAUDIBLE]
, the scientist who I took part in her research
by jumping
out of an airplane wearing sensors and so
forth.
She made the really excellent point that when
we evolved we
basically were faced with threats that were
acute in nature.
A bear would chase after us, we'd escape.
It would be over, we'd feel good we'd go back
to base line.
Today, our threats don't go away.
Your taxes never go away.
You know?
Your deadline is looming.
Eventually it comes but then you get another
one.
And so we tend to be in these situations where
there's no resolution.
So the cortisol levels build, but they --
we never have that satisfying
sensation of the sympathetic nervous system
turning off, the
parasympathetic nervous system which handles
relaxation, digestion and
so forth, that never comes, that never gets
kicked in.
So then, the damaging effects of this stress
response kick in and so they're
related.
But, you know, in a way we -- we didn't really
evolve to live in the
modern world.
So it's not a great fit sometimes.
>> So as a followup, your kind of conclusion
of the book is that we
can't control the fear as much but maybe understanding
it helps us in a
certain way?
JEFF WISE: Yes.
>> Now with stress, is that -- also holds
true or is it a different --
JEFF WISE: Yes, yes.
That's an excellent point.
It does hold true.
And if you can, one of the most powerful things
you can do to counter
stress, for instance, is to exercise.
Now, say you go for a run.
I'm a jogger myself.
Jogging is something that a lot of psychologists
would consider what they
call EU-stress.
E-U stress, meaning stress that is positive
in its benefits.
So your body it reacts to this load that's
put on it by becoming
stronger.
When you put weight on your bones, they'll
grow thicker.
If you lift weights, they'll become -- your
muscles will become bigger.
Similarly, your stress response will become
more robust if you put
EU-stress on it.
So, you know, and this also helps us deal
with acute fear.
I should -- you know, it's really an important
point about the science
of fear is that -- the military is putting
a lot of money into
researching this phenomenon.
And one of the main conclusions they've reached
is that what's
important when you're handling, say, what
they're interested in is
something like a fire fight.
You're going into a situation where for a
short period of time someone
is going to be trying to kill you with all
their might.
And it really matters how cleverly you can
think, how quickly you can
react.
And so, they -- what they have found is what
is crucial is not how
elevated your fear response is, how strongly
the sympathetic nervous
system kicks in, but rather how quickly do
you return to baseline
afterwords.
People who are physically fit tend to return
to baseline quickly.
So the cortisol dissipates.
If you don't exercise, if you aren't naturally
someone who handles
stress well, what tends to happen is that
-- that as I've said several
times before -- that bad stuff accumulates.
But it is -- I would say that as with fear,
the more you understand how
your stress response works, the more effectively
you can take steps to
deal with it.
Because you can't just will yourself to be
in control of your mind.
Your mind is a tricky, tricky thing to get
a grip on.
>> Thank you.
JEFF WISE: Sure.
>> Can you tell me about situations in which
we should be scared
spitless but we aren't?
I got hit by a car turning into me.
I consciously remember time slowing down and
thinking, oh, I'm going to
have a hood ornament on my hip.
And I was never afraid and I don't understand
why I shouldn't have been
scared.
JEFF WISE: That's a really interesting point.
Now, what's very common, very, very common
in situations like yours
where someone is in a car accident or, you
know, there's a story in my
book of a guy who was driving on the road
in Colorado, an avalanche
came and swept him and his wife and their
car off the cliff -- boom,
boom, boom.
Down they go, it was turning head over heels.
And he didn't feel afraid, he didn't feel
any pain even though a tree
trunk went through the windshield -- and he
had a severe bruise.
In fact, he had a dislocated rib.
He was in bad shape but he didn't feel any
pain.
And this gets back to what I was talking about
earlier, the beneficial
effects of fear.
It helps us, when it's working correctly,
it's an incredibly robust,
well-designed system for putting us where
we need to be mentally in
that acute danger.
And oftentimes I've heard people say, I didn't
feel any fear, I did
what I needed to do.
And only afterwards -- now this fellow said,
it wasn't until the next
day, he went to the lot where the wrecker
had put his car and he
saw how crushed it was that his knees went
weak and he felt fear for
the first time only the day after.
And it sounds you never felt fear at all.
But, um, it may be that, you know, you were
consciously thinking, oh
this is a bad situation, but your amygdala,
the part of your brain that
subconsciously processes fear, just didn't
register it as a threat.
And so when, you know, there's lots of examples
we can think of of
behavior that's dangerous but that doesn't
register to our subcortical
minds as dangerous because it's too abstract,
it's too complex, you
know.
Smoking a cigarette.
We don't have an innate fear of cigarettes
like we have an innate fear
of spiders.
Which is more dangerous a cigarette or a spider?
You know, your amygdala has a different answer
to that than your
frontal cortex does.
And, you know, you and -- you can never --
your cortex can never
convince your amygdala that it's the other
way around.
You just have to rationally take those steps
and try to keep
the amygdala out of it.
>> You said a difference between one moment
of intense stress versus
sustained low amounts of stress over time?
JEFF WISE: Yeah, that's something we were
touching on earlier.
Intense fear is -- is related, but it plays
-- the dynamic is very
different.
One of the things I should point out is there's
different kinds of fear and
just because you handle yourself well in one
situation doesn't
necessarily mean you'll handle yourself well
in another situation.
I tell the story in the book about Audie Murphy,
who was very famous
after World War II.
He was the most decorated U.S. solider and
he had this incredible
situation where he fought off an entire oncoming
armored German
battalion and he became famous for that.
And he was in movies and Life magazine and
everything.
So he didn't -- he was afraid -- it's not
correct to say he wasn't
afraid of German tanks, but he was able to
keep himself possessed and
to do what needed to be done.
Now when it came to girls, he was terrified
of girls.
And he didn't -- he hated standing in front
of a crowd.
He once said he was in front of a group like
this and he said I'd
rather be facing German tanks.
So, you know, we all have our quirks and oddities
of our personality.
We all are more afraid of some things than
of others.
But it's important to remember that the fear
is in here.
A tank is not scary, a crowd of people isn't
scary, a girl is not
scary, a tiger is not scary.
They're just what they are but we generate
the fear response
internally.
We generate it so automatically that we feel
like it's inherit in the
world around us.
And you know if we just take the step to recognize
okay, the spider
isn't scary, what I'm experiencing is my own
internal mechanism that
while it's very difficult to control, it is
a finite physical process
that I can have some effect on.
I love the story of a woman -- I heard this
story a long time ago, I
don't know if it's true or who it happened
to -- but she was terrified
of bugs.
And so she decided that she was going to handle
this head on and so she
started looking at pictures of bugs in books
until it no longer
bothered her to look at pictures of bugs in
books.
And then she started looking at bugs in real
life, like, far away but
-- and then she would get closer and closer
and closer eventually she
got to point where she could pick them up
with her bare hands.
And as this process happened, it turned out
that of course, the flip
side of fear is excitement.
And so this rush of adrenaline she would get
when she would first, look
at the book and later when she would look
at -- she became addicted to
that excitement.
And she became fascinated by the object of
that anxiety and she winded
up becoming an entomologist.
Like I said, I don't know if that story is
true but it kind of sounds
true and it sounds plausible to me.
So you know, here is this situation where
a woman was in -- you know,
you're talking about protracted fear, and
she was in control of that
fear.
One of the most stressful things in human
life is to be out of control.
It's something we instinctively seek.
Fear is less horrible when we have some modicum
of control or even if
we believe we have a modicum of control.
I think one of the reasons people pray when
a situation get really
bad -- look, if fear was really effective,
it would be the first thing that
you would do not the last thing that you would
do.
So I think that maybe prayer in itself is
not that effective but what
it does is when all else fails, you take a
course of action that is
available to you.
And that in itself can help you keep it together
when things are scary.
>> Hello.
Do you talk at all about shock?
And I ask that because the accident in question
triggered it.
I had read somewhere that you can experience
pain up to a certain point
and then your body just sort of shuts down.
It can't bear that much pain.
And I wondered when you're in shock if that
overrides sort of fear, and
I'm not even sure if pain comes from the amygdala,
but you talk about
that at all?
JEFF WISE: I don't deal with shock per se.
I'm not very well versed in that topic.
But it's -- you know, it's very plausible
when the brain finds itself
in a situation where it can't effectively
cope with a situation, it
tends to shut down that option.
There's -- one of the chapters in my book
is about the different kinds
of panic.
There's actually four different kinds of panic
and which one becomes
implemented depends on the situation.
So, you know, I've sort of slandered the amygdala
for being crude and
blunt in its decision making, but there's
actually a surprising amount
of subtlety.
I tell the story in the book of a woman named
Sue Yellowtail, who was a
hydrologist studying a river in a remote canyon
in southwestern
Colorado and she noticed that a mountain lion
was looking at her from
the bank.
And her fear system kicked in, not surprisingly,
and she, first thing
she did was she froze.
And we're all familiar with the fight or flight
idea of fear, but
there's actually four Fs.
And I usually can't get them all in one go.
Fight, flight, freezing, and fainting.
And which one swings into action depends on
this context in which it
occurs.
So here she was on the riverbank, the mountain
lion was kind of far
away.
So she froze and when you freeze in response
to danger, your attention
turns to the threat, you become focused, very
still, it's an attitude of
waiting to see what happens next.
The mountain lion started to move towards
her and then that triggered
the next F which is fleeing.
She started to move away.
Now she had studied biology in school.
She knew about predator behavior and that
if you run, that can trigger
its own instinctual response, it will chase
after you and try to eat
you, in which it may have been on it's mind
already.
She wasn't sure.
So she used her frontal cortex, her complicated
knowledge of
theoretical matters to suppress this fear
response.
So she just moved fairly slowly away.
But the closer this thing got, the more quickly
she walked, the less
effective her attempts to suppress her flight
response became.
Ultimately, it was within leaping distance
of her and she completely
give into panic and started to run.
She ran into the river, she slipped, she fell.
The lion jumped on her and at that moment,
running was no longer an
effective option because the mountain lion
was now on her head with its
teeth on her scalp.
And she remembers having a kind of a dreamlike
sense of looking up at
the water shimmering above her, she could
feel this thing's mouth on
her head.
And she thought well, you know, we all have
our day when we have to go.
And it's fascinating because she went from
being very, you know, in
gear thinking very clearly about what she
needed to do and then doing
it, to being in a state where she essentially,
had dissociated and dissociation is
when you essentially remove yourself from
your mental environment.
And it, you know, people often report that
it was like they were watching a
movie.
But fortunately, that didn't last very long.
Next thing she knew she had sort of -- wait,
let me before I move on to
next phase --
So when you faint with the -- so she had moved
to this situation called
tonic immobility, immobility.
She was playing possum.
She had gone limp.
And it's a very reasonable thing to do when
you're trapped, you're
helpless.
There's nothing you can do and a lot of predators
won't eat dead prey.
So that's all you've got going for you, a
statistical predilection of
certain predators to not eat dead prey.
That's all you've got.
And so you know, it's very interesting.
You hear cases like when the Virginia Tech
shooting happened, some of
the students said, andquot;Well, he came in and I
decided to play dead.andquot;
It's very interesting because I'm sure in
their minds they were -- it
felt like they were deciding to play dead.
But what I would argue that what was happening
was that a region of
their midbrain was triggering this very stereotype
behavioral suite and
that they didn't really have a choice in the
matter.
You know it's -- when we do -- when we behave
rationally --
Let me put it this way: When we behave in
a way that seems reasonable
to us, we have a tendency to ascribe to ourselves
agency.
To say, I chose to do this.
Our brains are very good.
It's called confabulation.
We paint a picture for ourselves that's pleasing
to us.
That's why introspection is a very poor tool
for understanding how the
human brain works.
And it's why psychology really didn't make
very much progress until
quite recently because we're constantly deceiving
ourselves.
So anyway, she played possum, against her
will I would argue, and then
she, for whatever reason, that strategy wasn't
really working.
And so her brain went to option number four
which was to fight.
So she jumped up, she started to run.
And here's the interesting parenthetical observation,
for 15 seconds,
she had no recollection of what happened.
She doesn't know what happened between getting
up off the riverbed and
winding up on the bank of the river with her
arm down the lion's mouth.
So she came to, next thing she knows, she's
lying on the riverbank, her
arm is in the lion's mouth, she's leaning
on it with all her weight to
try to keep to down.
And she's trying to figure out what do to.
So now she's fighting.
This is the fourth of the four Fs, in this
telling anyway.
And so, this is -- this is where the strength
comes into it.
She -- when your sympathetic nervous system
is activated, you're in the
grips of full-on fight response, you're a
very formidable opponent.
And we all know about mother bears.
You don't want to get between a mother bear
and her cub because her
fight instinct is very strong and bears are
bad enough.
But when they've got this other thing happening,
now they're super
bears and they're pissed and they're mad at
you specifically.
So here she was wrestling with this predator
but she -- it was
interesting that while all this was going
on, and this gets, I think,
back to your idea of clear thinking in the
midst of a crisis, she was
able to reason through what she should do
next.
She thought she had a kind of a string that
was holding a set of pliers
essentially on her vest.
And she thought, well, if I can wrap it round
the neck and then I'll
strangle it, but she tried to do that and
it's teeth kind of got too
close and she thought that's not going to
work.
So wound up taking the pliers and the stabbing
the thing in its eye
until it just was done.
And it let go and she stood up and she managed
to back away.
And eventually, you know, she got to civilization,
she got treatment.
And again, as with the avalanche guy, it wasn't
until she was in the
ambulance that she started to feel pain.
You know, she had gotten some pretty serious
injuries scraps and so
forth in fighting this mountain lion, as one
does.
But only when she as coming down from that
plateau after all those
chemicals that we can become addicted to were
starting to leech out of
her system did she feel the pain.
So then some trackers went back and found
the mountain lion and shot it
as a threat to public health.
And it turned out that it was a female mountain
lion, it was quite old
in mountain lion terms.
It was emaciated.
Its teeth had started to fall out so it wasn't
able to catch prey, so
it only in desperation that it had seen this
human being and thought,
well, I've got nothing to lose.
And so if it had been a full grown male in
its prime, she probably
wouldn't have had a chance.
But you know we are -- we like to think of
ourselves as individuals but
we are actually creatures of statistical outcome
of genes, you know.
And so everything that we -- all of the useful
things that our bodies
can do for us are there not because they're
going to guarantee our
survival but all they need to kind of increase
our probability of
passing the relevant genes along.
And she was lucky.
I mean, somebody accused me of succumbing
to survivor bias in this
book.
Namely, you know, I only tell the stories
of people who survived and
she might have -- all these wonderful systems
that I describe, happened
to work in all these cases.
And not in a few, a few cases.
But it's -- oh, we're out of time.
Sorry.
Anyway.
Okay, here's my book.
andquot;Extreme Fear: The Science of Your Mind in
Danger,andquot; available at fine
bookstores near you.
Thanks very much.
Appreciate it.
[APPLAUSE]

https://www.youtube.com/watch?v=t6W32jfKZeY


Agoraphobia




Agoraphobia is an anxiety disorder characterized
by anxiety in situations where the sufferer
perceives certain environments as dangerous
or uncomfortable, often due to the environment's
vast openness or crowdedness. These situations
include wide-open spaces, as well as uncontrollable
social situations such as the possibility
of being met in shopping malls, airports,
and on bridges. Agoraphobia is defined within
the DSM-IV TR as a subset of panic disorder,
involving the fear of incurring a panic attack
in those environments. In the DSM-5, however,
agoraphobia is classified as being separate
from panic disorder. The sufferer may go to
great lengths to avoid those situations, in
severe cases becoming unable to leave their
home or safe haven.
Although mostly thought to be a fear of public
places, it is now believed that agoraphobia
develops as a complication of panic attacks.
However, there is evidence that the implied
one-way causal relationship between spontaneous
panic attacks and agoraphobia in DSM-IV may
be incorrect. Onset is usually between ages
20 and 40 years and more common in women.
Approximately 3.2 million, or about 2.2%,
of adults in the US between the ages of 18
and 54, suffer from agoraphobia. Agoraphobia
can account for approximately 60% of phobias.
Studies have shown two different age groups
at first onset: early to mid twenties, and
early thirties.
In response to a traumatic event, anxiety
may interrupt the formation of memories and
disrupt the learning processes, resulting
in dissociation. Depersonalization and derealisation
are other dissociative methods of withdrawing
from anxiety.
Standardized tools, such as Panic and Agoraphobia
Scale, can be used to measure the severity
of agoraphobia and panic attacks and monitor
treatment.
Signs and symptoms
Agoraphobia is a condition where the sufferer
becomes anxious in environments that are unfamiliar
or where he or she perceives that they have
little control. Triggers for this anxiety
may include wide open spaces, crowds, or traveling.
Agoraphobia is often, but not always, compounded
by a fear of social embarrassment, as the
agoraphobic fears the onset of a panic attack
and appearing distraught in public. This is
also sometimes called 'social agoraphobia'
which may be a type of social anxiety disorder
also sometimes called andquot;social phobiaandquot;.
Not all agoraphobia is social in nature, however.
Some agoraphobics have a fear of open spaces.
Agoraphobia is also defined as andquot;a fear, sometimes
terrifying, by those who have experienced
one or more panic attacksandquot;. In these cases,
the sufferer is fearful of a particular place
because they have experienced a panic attack
at the same location in a previous time. Fearing
the onset of another panic attack, the sufferer
is fearful or even avoids the location. Some
refuse to leave their home even in medical
emergencies because the fear of being outside
of their comfort area is too great.
The sufferer can sometimes go to great lengths
to avoid the locations where they have experienced
the onset of a panic attack. Agoraphobia,
as described in this manner, is actually a
symptom professionals check for when making
a diagnosis of panic disorder. Other syndromes
like obsessive compulsive disorder or post
traumatic stress disorder can also cause agoraphobia.
Essentially, any irrational fear that keeps
one from going outside can cause the syndrome.
It is not uncommon for agoraphobics to also
suffer from temporary separation anxiety disorder
when certain other individuals of the household
depart from the residence temporarily, such
as a parent or spouse, or when the agoraphobic
is left home alone. Such temporary conditions
can result in an increase in anxiety or a
panic attack or feel the need to separate
themselves from family or maybe friends.
Another common associative disorder of agoraphobia
is necrophobia, the fear of death. The anxiety
level of agoraphobics often increases when
dwelling upon the idea of eventually dying,
which they may consciously or unconsciously
associate with being the ultimate separation
from their mortal emotional comfort and safety
zones and loved ones, even for those who may
otherwise spiritually believe in some form
of divine afterlife existence.
Panic attacks
Agoraphobia patients can experience sudden
panic attacks when traveling to places where
they fear they are out of control, help would
be difficult to obtain, or they could be embarrassed.
During a panic attack, epinephrine is released
in large amounts, triggering the body's natural
fight-or-flight response. A panic attack typically
has an abrupt onset, building to maximum intensity
within 10 to 15 minutes, and rarely lasts
longer than 30 minutes. Symptoms of a panic
attack include palpitations, a rapid heartbeat,
sweating, trembling, nausea, vomiting, dizziness,
tightness in the throat and shortness of breath.
Many patients report a fear of dying or of
losing control of emotions and/or behavior.
Causes
Although the exact causes of agoraphobia are
currently unknown, some clinicians who have
treated or attempted to treat agoraphobia
offer plausible hypotheses. The condition
has been linked to the presence of other anxiety
disorders, a stressful environment or substance
abuse.
Research has uncovered a linkage between agoraphobia
and difficulties with spatial orientation.
Individuals without agoraphobia are able to
maintain balance by combining information
from their vestibular system, their visual
system and their proprioceptive sense. A disproportionate
number of agoraphobics have weak vestibular
function and consequently rely more on visual
or tactile signals. They may become disoriented
when visual cues are sparse or overwhelming.
Likewise, they may be confused by sloping
or irregular surfaces. In a virtual reality
study, agoraphobics showed impaired processing
of changing audiovisual data in comparison
with non-suffering subjects.
Substance induced
Chronic use of tranquilizers and sleeping
pills such as benzodiazepines has been linked
to onset of agoraphobia. In 10 patients who
had developed agoraphobia during benzodiazepine
dependence, symptoms abated within the first
year of assisted withdrawal. Similarly, alcohol
use disorders are associated with panic with
or without agoraphobia; this association may
be due to the long-term effects of alcohol
misuse causing a distortion in brain chemistry.
Tobacco smoking has also been associated with
the development and emergence of agoraphobia,
often with panic disorder; it is uncertain
how tobacco smoking results in anxiety-panic
with or without agoraphobia symptoms, but
the direct effects of nicotine dependence
or the effects of tobacco smoke on breathing
have been suggested as possible causes. Self-medication
or a combination of factors may also explain
the association between tobacco smoking and
agoraphobia and panic.
Attachment theory
Some scholars have explained agoraphobia as
an attachment deficit, i.e., the temporary
loss of the ability to tolerate spatial separations
from a secure base. Recent empirical research
has also linked attachment and spatial theories
of agoraphobia.
Spatial theory
In the social sciences there is a perceived
clinical bias in agoraphobia research. Branches
of the social sciences, especially geography,
have increasingly become interested in what
may be thought of as a spatial phenomenon.
One such approach links the development of
agoraphobia with modernity. Factors considered
contributing to agoraphobia within modernity
are the ubiquity of cars, and urbanization.
These have helped develop the expansion of
public space, on the one hand, and the contraction
of private space on the other, thus creating
in the minds of agoraphobic-prone people a
tense, unbridgeable gulf between the two.
Evolutionary psychology
An evolutionary psychology view is that the
more unusual primary agoraphobia without panic
attacks may be due to a different mechanism
from agoraphobia with panic attacks. Primary
agoraphobia without panic attacks may be a
specific phobia explained by it once having
been evolutionarily advantageous to avoid
exposed, large open spaces without cover or
concealment. On the other hand, agoraphobia
with panic attack may be an avoidance response
secondary to the panic attacks due to fear
of the situations in which the panic attacks
occurred.
Diagnosis
Most people who present to mental health specialists
develop agoraphobia after the onset of panic
disorder. Agoraphobia is best understood as
an adverse behavioral outcome of repeated
panic attacks and subsequent anxiety and preoccupation
with these attacks that leads to an avoidance
of situations where a panic attack could occur.
In rare cases where agoraphobics do not meet
the criteria used to diagnose panic disorder,
the formal diagnosis of agoraphobia without
history of panic disorder is used.
Treatments
Cognitive behavioral treatments
Exposure treatment can provide lasting relief
to the majority of patients with panic disorder
and agoraphobia. Disappearance of residual
and subclinical agoraphobic avoidance, and
not simply of panic attacks, should be the
aim of exposure therapy. Similarly, systematic
desensitization may also be used. Many patients
can deal with exposure easier if they are
in the company of a friend they can rely on.
It is vital that patients remain in the situation
until anxiety has abated because if they leave
the situation the phobic response will not
decrease and it may even rise.
Cognitive restructuring has also proved useful
in treating agoraphobia. This treatment involves
coaching a participant through a dianoetic
discussion, with the intent of replacing irrational,
counterproductive beliefs with more factual
and beneficial ones.
Relaxation techniques are often useful skills
for the agoraphobic to develop, as they can
be used to stop or prevent symptoms of anxiety
and panic.
Medications
Anti-depressant medications most commonly
used to treat anxiety disorders are mainly
in the selective serotonin reuptake inhibitor.
Benzodiazepines, MAO inhibitors and tricyclic
antidepressants are also sometimes prescribed
for treatment of agoraphobia. Antidepressants
are important because some have antipanic
effects. Antidepressants should be used in
conjunction with exposure as a form of self-help
or with cognitive behaviour therapy. Some
evidence shows that a combination of medication
and cognitive behaviour therapy is the most
effective treatment for agoraphobia.
Benzodiazepines - anti-anxiety medications
Examples are alprazolam and clonazepam. They
are used to treat anxiety and can also help
control the symptoms of a panic attack. If
taken in doses larger than those prescribed,
or for too long, they can cause dependence.
Side effects may include:
Confusion
Drowsiness
Light-headedness
Loss of balance
Memory loss
Alternative treatments
Eye movement desensitization and reprogramming
has been studied as a possible treatment for
agoraphobia, with poor results. As such, EMDR
is only recommended in cases where cognitive-behavioral
approaches have proven ineffective or in cases
where agoraphobia has developed following
trauma.
Many people with anxiety disorders benefit
from joining a self-help or support group.
Sharing problems and achievements with others
as well as sharing various self-help tools
are common activities in these groups. In
particular stress management techniques and
various kinds of meditation practices as well
as visualization techniques can help people
with anxiety disorders calm themselves and
may enhance the effects of therapy. So can
service to others which can distract from
the self-absorption that tends to go with
anxiety problems. There is also preliminary
evidence that aerobic exercise may have a
calming effect. Since caffeine, certain illicit
drugs, and even some over-the-counter cold
medications can aggravate the symptoms of
anxiety disorders, they should be avoided.
Epidemiology
Agoraphobia occurs about twice as commonly
among women as it does in men. The gender
difference may be attributable to several
factors: social-cultural traditions that encourage,
or permit, the greater expression of avoidant
coping strategies by women; women perhaps
being more likely to seek help and therefore
be diagnosed; men being more likely to abuse
alcohol in reaction to anxiety and be diagnosed
as an alcoholic. Research has not yet produced
a single clear explanation for the gender
difference in agoraphobia.
Notable cases
See also
List of films featuring mental illness: Agoraphobia
Agyrophobia, fear of crossing roads
Generalized anxiety disorder
Hikikomori
Obsessive compulsive disorder, which can feature
specific fears that cause one to become homebound
Post traumatic stress disorder
Social anxiety
Specific social phobia
Xenophobia, fear of strangers
References
External links
Support Group Providers for Agoraphobia at
DMOZ
Agoraphobia
 This article incorporates public domain
material from websites or documents of the
National Institute of Mental Health.

https://www.youtube.com/watch?v=Yw8eBneMqyg