On fear: Figuring it out, and facing it

"The cardinal rule of anxiety is that when we confront the things that make us anxious, they gradually decrease," Dr. Livingston says.
“The cardinal rule of anxiety is that when we confront the things that make us anxious, they gradually decrease,” Dr. Livingston says.

Psychiatrist Dr. Gordon Livingston is prescribing a heavy dose of courage, not pills, to combat a debilitating syndrome: fear.

In his book “The Thing You Think You Cannot Do,” now available in paperback, Dr. Livingston explains to us why we must depend on courage to survive.

You aim to invoke virtues rather than prescribe medicine. How do you implement that?

Although I do use medication for anxiety and depression, I think that we need to think about courage. The key — and that’s why the book is titled “The Thing You Think You Cannot Do” — is to confront our fears. The cardinal rule of anxiety is that when we confront the things that make us anxious, they gradually decrease. Many people, for example, have so-called phobias: things that they can’t do. They can’t fly, they can’t get on elevators; there are various things that people can be afraid of. But once those fears are confronted, systematically, they diminish. But if we react by avoidance, then our fears get worse. If we refuse to get on an airplane, then our lives are constricted.

So are we supposed to just dive right in? Or are there baby steps to decreasing fear?

Systematic desensitization is the way that we overcome those kinds of fears. If it’s getting on an airplane, then one day we’ll go the airport, and the next day we’ll go to the boarding area. There are ways in which you can do this that will overcome anxiety in a way that you can tolerate. We have to get away from avoidance, because that causes the fears and the anxiety to increase.

How did your war experience in Vietnam influence your view of fear and the advice you give?

That’s an example of a hazardous environment in which practically all normal people are apprehensive. You ask yourself, “What constitutes courage in that environment? What allows people to behave in courageous ways?” Part of it is training — that’s one of the things that the military emphasizes — but it’s hard to train a person to be willing to die for an idea. I think that what happens in the combat situation is people develop a kind of unit cohesion in which a sort of love develops among the participants, and it’s important not to let down these people who are dependent on you. Sometimes people are willing to take tremendous risks on behalf of the people that they’re with.

Speaking of love that develops among people, you talk about how intimacy is a great source of fear.

Anything that makes us vulnerable can be a source of fear or anxiety. And nothing makes us more vulnerable than being in love with or intimate with another human being, because we can get hurt. People are reluctant to take that chance, particularly if their previous attempts at intimacy resulted in their being hurt. Sometimes it’s a wonder that any of us are willing to take the risk of that kind of vulnerability. But what is life without it?

You’re saying risk-taking is especially important.

No one can live a risk-free life; we’re all subject to loss, and we’re all subject to loss of control, to the deaths of those we love. We’re all faced with our own demise. Just to get up each morning and try to live as fully as we can requires courage. Courage can only be taught by example. You can’t lecture somebody into being courageous. You can’t read a book and be courageous. Fear is a feeling, but courage is expressed only in action. I think we need to cultivate examples of people among us who are living full and courageous lives.

Who would be an example of a courageous person?

It happened recently in the subway system in New York — somebody fell onto the tracks, and another bystander jumped on top of them and held them down while the train went over them. That certainly is an example of courage. Courage requires, first of all, that one is willing to take a risk. Second of all, that you have a choice about that. And third, the risk has to be on behalf of someone else. Conversely, that pilot who landed the airplane on the Hudson was demonstrating good piloting skills, but I didn’t see any courage involved, because he was on the airplane! Fortunately for those 85 people on the airplane, he made a good landing.

What’s an easy, everyday tip for facing your fears?

Have a sense of humor. The ability to laugh in the face of fear is another form of courage that needs to be cultivated. People who react out of fear don’t make good decisions.



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