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Monday Jul 16, 2018

Xanax Is Not the Answer to Xenophobia

Fear -- the great motivator.

[man pushing against orange fear letters]

For years, I found the level of anxiety rising in my patient panel. There were those we thought were simply looking for Xanax, but I believe there was something underlying all that anxiety.

It really began around 9/11. The attack on our country prompted the most basic of instincts: the fight-or-flight response. That made sense. People felt threatened, and I saw a steady rise in patients with anxiety.

What causes anxiety? Fear. We live in a country where fear rules the day. We seem to be afraid of everything. Fear of another terrorist attack. Fear of death. Fear of injury. Fear of illness. Fear of fear.

Fear is a great motivator because it engages the most basic, primal parts of our brains. When the fight-or-flight response kicks in, your body gets ready for you to either run or defend yourself. Basically, your thalamus gets input from your senses and sends a signal to your amygdala. Your amygdala tells your hypothalamus to pump up the adrenals, which rush blood to your muscles so you can get yourself out of danger. In a slower response, the amygdala alerts the prefrontal sensory cortex, which compares the threat to previous memories of threats to gauge the severity of the situation. All of this happens in milliseconds.

When we have an overwhelming emotional response out of proportion to the stimulus presented that shuts down that sensory cortex, we call it an amygdala hijack. In other words, we don't apply reason to a situation. We just react.

Why is fear a motivator? We see what it does internally, but it goes one step further. If someone presents you with a solution -- a way out of a problematic situation -- you are likely to buy into that solution. That is why commercials that offer us solutions do so well. It doesn't matter if the marketing agents are selling cars, medicine or home security systems; the products are presented as the answers we need.

Fear is used to sell most anything. Potential solutions make us feel good -- safe -- for a moment. Then we move on to feeling fearful of something else and seek the solution for that next worry.

For centuries, fear has been used to take advantage of situations. It has repeatedly led to armed conflict. The fear of the other is certainly a motivator.

What makes us feel better in these situations?

One strategy is to demonize other people. We have done that many times in our past. We did it to Native Americans, the Irish and African-Americans, just to name a few.

As a result, many people in our country now fear immigrants of any kind. Why? Because we have been told to fear them. That indoctrinated fear is a great motivator.

In such instances, we find comfort in surrounding ourselves with others who believe as we do. Watching certain TV networks or listening to certain radio programs that support our point of view reinforces our fears. This simply paves the way for those neurons that that trigger the amygdala hijack.

This may not seem rational, and indeed, that amygdala hijack blocks out reasoning. We all are guilty of experiencing this reaction, but there is hope. Once we recognize this amygdala hijack and the feeling of fear and the need to lash out, we can force ourselves to realize what is happening and then retrain our brain to think before we speak.

The amygdala hijack causes us to do things that will make us say, "Wow, I really should not have done that," when we look back later.

For me, I know it is happening when I sense several things happening. My heart begins to race because the adrenals kick in. I feel my muscles start to tense up, getting ready for that fight or flight. I also feel like the focus is on me. After all, I am the one being threatened, right?

Fear may tell you another person is dangerous. The rational self would say, "OK, that person doesn't have a gun or a knife, so I am in no immediate danger." The other person may be perceived as scary, but thinking rationally, we would know that our fear comes from our own personal biases. Rationally, we can think our way through the situation.

The bottom line is that this frenzy of activity in our brain in response to frightening stimuli is not good for us or society. This is what is at the heart of post-traumatic stress disorder. This overstimulation leads to short circuits in the fear pathway that make that fight-or-flight amygdala hijack the predominant response. This leads to violent outbursts and violent acts.

We all need to recognize the motivation of fear. We need to retrain ourselves to not get hijacked.

We need to think rationally again.

Leonard Reeves, M.D., is a member of the AAFP Board of Directors.

Posted at 01:48PM Jul 16, 2018 by Leonard Reeves, M.D.

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