Thursday, July 13, 2017

The Art of Fear

A friend of mine was telling me over a piece of Torah (This could be anything learned from the Jewish holy books, from the most complex argument, to a simple story.) He added that on the day he learned it, he also came across the same lesson from a different source. And then it happened again, the very next day, same lesson, while reading something secular. 

Cool, right? We both said it at the same time. But a part of me thought, Or random. What my friend is referring to is Torat Emet, a sign, repeated pointers, to the truth of the lesson. The emet. It is a spiritual thing that manifests in the real world.

Knowing this, while reading Kristen Ulmer's book, The Art of Fear I had a similar experience.

Otherwise it would be easy to dismiss this bio-self-help book, like my professional self insisted. Because Ms Ulmer isn't a mental health professional, and she cites no research or empirical validation of her methods. The Art of Fear is about the lessons she has learned from life as an extreme skier, as the first woman to break into extreme ski jumping, or simply, flying off mountains. On skis. She's learned much from her Zen master, and we could say that this teaching, her book, is her Torah.

So two things happened in that odd, spiritual way, that pointed to taking Kristen's work seriously, one anecdotal, the other clinical. We'll get to them. But something is bothering me. There's a huge problem, and it is laced within the pages of The Art of Fear. It isn't content, not the lack of empirical evidence back up her own claims of treatment efficacy, but an opinion, a slap in the face, a narcissistic injury. Our author dismisses the whole of psychotherapy, all of it, behavioral treatment, dialectical, cognitive therapy, everything, you name it, based upon a handful of visits to a psychiatrist and a therapist. She thinks that time spent with people like me, or maybe you, too, the clock ticking dollars and cents away, is time and money wasted.

What, Kristen, you didn't think we'd notice?

A short rant to the author is in order:
My life, and the lives of every other therapist in the world, the millions of patient hours that we spend with the people we see, matter. Our time with people helps. And although some might benefit from The Art of Fear, I'm sorry, many will not. 
 The online courses offered on your website may be fabulous, Kristen, but the bias, your accusation about the mental health professions are simply outrageous, and not nice. And those online courses that promise, well, everything? Smack of snake oil.
That just came out, the part about the snake oil, because meditation isn't snake oil, not at all, far from it, or quackery. We see good results with patients who have studied with zen masters, and many of us recommend meditation almost always for emotional management. Yes, management. It is like sending an alcoholic to an AA meeting, very helpful. When it works. If he works it, it is therapeutic to manage emotion, when we can pull it off, and more so, to make behavioral changes. Life should be about change, growth. Not navel gazing.

Still, this method does help. And Kristen's way of seeing, a nice way to conceptualize emotion, so we won't dismiss it. To sum up her therapy in two words, they would be body meditation. In this practice one learns to switch from nagging thoughts to the body, to feelings and where they are located. Body meditation practice can be very very helpful, especially for anxiety, thus no disrespect. But my patients come back to me a month or two later as if they have forgotten all of it. They lose the entire Torah.

"Are you still meditating?" I ask.

"Well of course, and it is very helpful. I'd be a mess without it."

"Keep that up," is my stock response. Then we proceed to discuss the entire gestalt, feelings, thoughts, behavior, the past, the future, all of it, everything that is bubbling over in that moment. And yes, we are speaking, feeling, in the here and now, yet talking about the past and the future. Because being here now, the patient is still a mess. And needs to talk about it now.

So here's the story.

The Good Reads book tour sends me intriguing paperbacks for review, and The Art of Fear landed in my mail box a few days before my vacation in early June.

Having buzzed through half the book before leaving, I get a call from a patient having a huge panic attack. His anticipatory anxiety is about an upcoming event, and his state of panic is his worst ever.

We had worked on the likelihood of ensuing panic before and during the event, and he had a few tools to work with. These usually worked: the breathing, the muscle contraction, finding rational reasons for and counters to his fear. He wanted to try a treatment strategy, virtual reality therapy, or VRT, that based upon my review of the research, might help, too. But the treatment center that advertised it still hadn't set up a program. So glad you called. Try us in December.

Kristen's words still fresh in my head, it was a no-brainer to try her intervention.
Listen, I said. You and your fear are one person. And you are a good person, Fear is a part of your self. It is you (one of you). You have fear for a very good reason, and you are showing respect by letting Fear out of the basement, not repressing her. She won't kill you, she loves you. All she's saying is, Pay attention to me, would you PLEASE? Because if you don't, I'm going to mess up this event, it will be a rocky affair and there is nothing you can do about it.
Fear can be a relentless, mean part of our psychology, And it is true, our emotions, ourselves, one in the same. Every therapist knows this. We don't suggest running from it, avoidance, or repression. Those are primitive defenses. We talk, and experience, feel and dialogue. It is what therapy is. We do a million other things, too, because there's no one size fits all in this business.

Fear, Kristen rightly tells us, is on our team, working for the good, just one voice, one of ten thousand employees at work in our community of selves. All for one, one for all, our feelings are hard at work, teaching us about ourselves, and they are starved for attention.

Her advice in The Art of Fear? Just listen, give Fear all of your attention, bow to her. Fear deserves respect. And pay no mind to all of that negativity in your head, those scary interpretations about fear, and her representative, anxiety. Negative thoughts build on one another (as if you didn't know) and grow more powerful as we obsess, even when there's no reason to believe any of it to be truly likely to happen. There's always a chance, however, so the thinking brain will go crazy, lawyering around, defending reasons to feel afraid.

I like to tell patients,
When you hear a rustle in the park, it could be a bear, but it could be a bird. 
Giving negative thoughts all that power is irrational, so goes traditional cognitive behavioral therapy. Kristen would say, and she's not wrong, that the thoughts are our off-course way of controlling Fear, and Fear doesn't need to be controlled. She just wants some respect, time. We try to come up with a plan to keep her in the basement, but she will not be denied! Give her a few crumbs, heck, the whole loaf, junk the thoughts driving her.

(Because that's easy).

The treatment: To stop the madness (the thinking), shift to the body, become aware of how it feels, find the emotions, especially fear. Give her equal time, no, much more time than you spend justifying why you have cause to worry. need to be afraid.

Brilliant! It is. And if you like metaphors and little stories, the book is full of them.

The therapy is called Shift Therapy, and I like it very much, because it is so familiar, a warmed over version of Psychotherapy 101, first year graduate school education. Social workers (most therapists, believe it or not, are social workers) since the early 1900's, are trained to tell patients to give emotions their due, to validate them. The patient should get in touch with her feelings. Just feel. Stop working on not feeling, because feelings might escape in one way or another, disguised as anger or resentment, jealousy, blame, shame. Let the tears come, we say, and it is okay for the heart to quicken. It is telling us we're alive.

Old school, still delicious.

And what goes up, you know by now, must come down.

The art of feeling is nothing new, still remains the essence of a good psychotherapy, despite the dozens of manuals prescribing treatment protocols. Kristen's is now one of them, or could be, if she didn't have to diss the mental health professions to go it alone. That, darling, should say something, not to play therapist here.

My patient, the one with the panic attacks, reported that the event went spectacularly, by the way. He had a great day. It could not have gone better. I took that as evidence, validation of some of the truth of Kristen's book, grateful to have found it by chance. Or was it chance?

Then, last night, a few of my friends and I had movie night. We don't go out. One of us goes to the library and takes out five or six DVDs. We bring our own dinner, chow down and talk, then go through the selections to find one we haven't seen. We chose Eddie the Eagle.

Sounds like a dumb kids movie, but this is about a little boy who becomes a big boy, then a young man, who remains a little boy, forever. Eddie has always had just one ambition, to be an Olympic contender. He wants medals. He has a cute metal box awaiting them.

He fails miserably at all sports, is told that he is not an athlete, that he never, ever, will be in the Olympics, but he doesn't care. He keeps looking for yet another sport. He will practice, hard, because he is determined to be an Olympian, to compete with the gods of athletics. He is positive, he is sure, and he is, in a word, almost fearless.

I don't want to ruin this one for you, so we stop right there. This is a feel good movie, and a true story.

A seemingly random choice of a film, still, a sign pointing in the direction of Kristen Ulmer's book. Why? And why was I a day late blogging for the book tour? Because apparently, it had to wait until three women poured over some DVDs, only to decide to watch one about an Olympic ski jumper.
Kristen Ulmer's new book

Kristen Ulmer is a ski jumper, the first female extreme sport hero with accolades to prove it. Most of her life, she tells us, she kept Fear in the basement and fearlessly pursued all things dangerous, like flying on skis off cliffs.

Simply mind-boggling to anyone with a Jewish mother.

So that's it, the story, the whole truth.
A final word to our author:
I love the technique. It will work for some, not all, and I will continue to refer out to zen masters. My advice to you, however: Refer out, as well. Punt when you're in over your head, tackling the hundreds of other diagnoses in the DSM 5. Stick with athletes. You get them. For this work is not all about fear, believe it or not, and there's no one size fits all to calm that monkey brain.
Avoid all shades of autism and be very, very careful with patients with severe personality disorders and psychoses, even OCD, and certainly suicidal patients.
This is painful work, you will absorb more of it than you care to admit, and you'll cry, too, and laugh often if you love it.
But obviously you won't be keeping your emotions, and hopefully not your laughter, in the basement.



Heather J @ TLC Book Tours said...

Thanks for sharing your thoughts on this book for the tour.

Unknown said...

Read your post twice....
as someone with PTSD from childhood, the fear is hard wired and cannot be removed.
NOW after very many years, I know what is meant and how to 'go into my body and feel it", and to 'accept that the fear is part of me" BUT
a person already has to have an ability to 'go into the body and feel " anything.....which trauma survivors often never had, or have lost.

that advice only felt like I was doomed to be ruled by my anxiety/fear.

learning the difference between fear - appropriate useful response to identified, significant, and possible/likely to occur AND
anxiety - my body's burglar alarms going off inappropriately before gathering all necessary information

was the cognitive restructuring that helped me learn to SLOW DOWN, take deep breathes, and narrate (out loud to my therapist , at first) and now with a friend, or in my journal....all the thoughts and the body sensations so I could choose a reaction instead of automatically responding with the adrenaline overload...

not sure which 'theory(ies) that fits, but it's my way of understanding...built on 30 years of recovery/rebuilding/living.

thanks for sharing your soapbox!

therapydoc said...

Dear Unknown,
Sounds to me like you had good, eclectic treatment, maybe mostly CBT, and it helped! Thanks so much for stopping by and taking the time to comment.

Better Things-- Seeing Ghosts