When The Heart Stops
When the heart stops,
the brain does not.
For several minutes
it goes on,
sending tiny flares
into the implacable dark,
as if guiding you,
in the gentlest way,
from where you are
to who you were.
What Are You Afraid Of?
Maybe you’re like me, anxious more often than not. Maybe you’ve read about that pair of panic buttons in the brain called the amygdalae. Troublesome though they may be, we’d be lost without them, unable to perceive and react to danger. The amygdalae are the gatekeepers of the limbic system, the brain’s most primitive region. Ever on guard, they make continual connections with other parts of the brain, and when sufficiently aroused, they alert the hypothalamus to initiate the “flight or fight” response; within seconds our hearts pound, our mouths go dry and our bodies are flooded with stress hormones.
It’s an impressive chain of command. All information taken in by the senses is first sent to the thalamus, which then relays this information to the appropriate sensory cortex. The cortex involved then evaluates the stimuli and assigns a meaning. If the meaning is perceived as a threat, the amygdala is engaged and produces the corresponding emotional reactions.
But a new feature of the process has recently been discovered. The cortex does not receive the entire message from the thalamus; a portion is sent directly to the amygdala, a shorter route that results in instantaneous alarm. This is the reason we see a coiled rope and think snake! An inability to react quickly could have dire consequences, so this shortcut confers a biological advantage. It is also the reason we have such difficulty overcoming phobias and anxiety attacks. The quiet messages sent by the rational cortex cannot be heard above the roar of our emotions.
There’s more. Scientists have also learned that the amygdalae can actually grow. Enlarged amygdalae have been found in children repeatedly exposed to trauma. Not only do these structures increase in size, they become more efficient at transmitting fear responses, the neurons involved developing more synapses to accommodate the volume of messages received. By the time we are adults, we are hardwired for the anxiety we were destined for.
Who can say where it starts, though it seems probable that anxious parents, particularly mothers, give birth to anxious offspring. A mother consumed with fear will pass these feelings onto her baby, right along with the effects of her diet and sleeping habits. How many babies are born to mothers who are serene, capable and financially secure?
Like many people—most people?—I did not have an easy childhood; in fact, I was routinely abused, a prisoner in my own home. That is the curse of childhood: adults can hold you hostage and get away with it. The only place I felt safe was outside, where I made forts out of pine boughs and lost myself in the marvels and mysteries of nature.
I grew up anyway, like we all do, not knowing how ill-equipped I was. When the panic attacks started, in my early twenties, I managed them with the only means I had—Jack Daniel’s-laced coffee and the Valium I received from a friend who dated doctors, just enough to get me on the subway so I could keep my job. Who else was going to pay my bills? Walking from the subway stop to my workplace, I would stop several times and study my image in plate glass windows, making sure I was there.
Eventually this free-floating anxiety crystallized into a fear of doctors and clinical settings—I must have felt a loss of control in these situations. This led to a skyrocketing of my blood pressure, which led to a fear of having it taken. I have yet to overcome this phobia. Fortunately, I have an understanding doctor who accepts the readings I take at home. I’ve actually come a long way—there was a time I couldn’t even look at a hospital, or a blood pressure cuff. Beyond this phobia, I am also prone to obsessive thoughts, a hallmark of anyone intimate with anxiety.
Therapists? I’ve tried a couple. Can’t say they helped me. I’d look at them and wonder what to divulge, and when, and how any of it mattered now. I wanted to believe in their power to cure me, but I couldn’t. I feel the same way about religion.
Exposure therapy, flooding, CBT, EFT, ACT—I’ve ventured most everything. I’ve also read every how-to manual I could find on the subject of anxiety and dutifully filled out the accompanying worksheets. I can’t say that any one avenue or book has been particularly useful, though cumulatively I suppose I’ve benefited from the effort.
Three years ago my doctor suggested Paxil. I gave it a go, not expecting much, but that little white caplet has made all the difference. Paxil offers a measure of objectivity by making me feel as if I am observing my fear instead of being pummeled by it. There are several SSRIs on the market and some are more effective than others depending on the user—we are all different.
We work with what we have. If genetics and trauma have given us a larger than normal pair of amygdalae, there are ways to mitigate the effects. I’d like to think that a drug is not the answer, but in fact it is. For me. As a good friend says, “Whatever it takes, Jean. Whatever it takes.”
Wow. I have just told the world, or at least anyone reading this, about my phobia (there are close friends of mine who don’t know I have one). I feel a little less burdened, a little more connected. We will ask people what they like or dislike, but rarely do we ask them what they’re afraid of. We need to talk about these things so that we can find each other in the dark and let compassion bring us together. The most frightening secrets of all are the ones we keep to ourselves.
First, Do No Harm
Memory. It’s a tricky thing. I’m not talking so much about our short-term memories: where are my keys? what did I come in this room for? I’m referring to long-term recollections, those shape-shifting phantoms that cannot be validated. When I get together with my sisters, we will inevitably discuss an event from our past, each of us spackling in what we remember until a revised sketch emerges. Our memories of these episodes are often incompatible, which should no longer surprise us, but does. At last, reluctantly, we allow these collaborative versions, figuring the truth is in there somewhere.
In the beginning of her book CAT’S EYE, Margaret Atwood compares time to “…a series of liquid transparencies, one laid on top of the other. You don’t look back along time but down through it, like water. Sometimes this comes to the surface, sometimes that…” What a perfect description of memory: a still, fecund pond with murky green water. In near constant succession, images float into view, displacing those around them before sinking back down. Because none of us sees the world the same way, my pictures do not look like your pictures, and what is real for me is not real for you. Each one of us is walking around with a cache of fluid memories from which we derive our identity. Who we are is what we remember.
It’s a flimsy arrangement for sure, and little wonder so many of us flock to therapy, desperate for clues to ourselves. The blurred, random images that represent our lives are not sufficient; we want verification, confirmation, something more solid to stand on than the squishy bottom of a pond. Surely a trained professional knows more about us than we know, can tell us what is wrong with our pictures and lead us out of the mire.
I recently watched a video about the fragility of our minds and how easily our memories can be corrupted, either by natural causes, like stress and aging, or by the intervention of others, specifically therapists. In some cases, I can see the value of dislodging troubling memories; indeed we probably all have painful memories we wish we could break free of. Good therapists are born healers, and I have talked to several people who are endlessly grateful for the treatment they received. Other folks have told me that therapy did not help them at all, and some even regret their sessions, claiming that therapy only made them feel worse. One woman told me she felt lost afterward, unrecognizable to others and a stranger to herself.
Our ability to remember is what enables us to learn: we need our memories to keep us alive and comforted, and to remind us where we are in this world. There are many therapists out there. The best ones, aware of their extraordinary responsibility, proceed with caution and compassion.
Jean Ryan 