Rx For Facing Fear

By MARC K. SIEGEL

FRIDAY morning, I asked my 8-year-old if he had heard about Thursday's terrorist attacks in London; he said yes.

"Are you afraid?"

"No. Because it's far away."

But the trouble with terror is that all too often it doesn't feel as if "it's far away."

The real tool of terrorists is fear, not bombs. Throughout history, fear has hurt more people than any attack.

Organized terrorists deliberately choose targets like mass transit because they know that we all travel and can easily relate to peril in subways, planes and buses. They also know that the more we personalize the risk, the more afraid we become.

In 1995, when Saran gas was used in a Tokyo subway, 12 people were killed — but hundreds were injured fleeing and thousands were afraid to take the subway for months afterward.

Here in New York City, people who were nowhere near the World Trade Center replayed the images in their minds for months. I and other physicians treated many patients with Valium and other anti-anxiety treatments. The terrorist event initiated a cycle of worry that was tough to break.

What should the normal citizen do to not overreact?

The first answer is that threats must be seen with the perspective of real risk. Fear's true purpose is to protect us, not to unnerve us. We inherit the fear instinct (fight or flight) from animals. It is supposed to be a life-saving reaction to an imminent threat.

Unfortunately, all too often we humans convince ourselves that an attack is in the offing when it really isn't. We rev up, scanning the environment for danger signals that just aren't there.

The result is that we wear down our bodies, because the "fear switch" is harder to turn off than to turn on. We make more stress hormones (adrenaline, noradrenaline and cortisone) than our body needs.

In so doing, we put ourselves at risk for stress-induced diseases like heart attacks, strokes, depression and cancer. And these are the things we really should be afraid of in the first place!

When it comes to terrorism, no matter how many safety nets are constructed, for many, logic and statistics do not prevail over the strong emotions of fear.

The London attacks have caused many around the world to feel unsafe, despite London's intensive security system, which works almost all the time. Ironically, many old-timers in London — who survived the World War II bombings — are having less trouble returning to "business as usual" than people thousands of miles away.

In New York, too many of us continue to worry about worst-case scenarios. For these folks, I recommend taking your mind off terrorism by concentrating on your work and your play. Continue the normal patterns of your life; eat, sleep and exercise regularly. (If you haven't been doing that last before, now is the time to start.)

For those afraid to use the subway or buses, I would say that continued use — less often at first but gradually increased over time — should lead to decreased fear as your body slowly realizes that there is no real danger. Strict avoidance of the subway, on the other hand, will continue to feed the fear of imagined dangers.

The question I am asked most frequently about terrorism is: How can we keep our children from being afraid? The answer I commonly give is to not be afraid ourselves.

But my son, a young philosopher, doesn't need me to keep him feeling safe by being a proper role model. He has sized up the situation himself: The danger is real, but it is too far away to hurt him.

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Copyright © 1990-2007 Marc K. Siegel, M.D.