Fear of flying

Last week I had one of the most frightening journeys I’ve ever experienced in my life. I flew back into Orkney in the middle of the ‘weather bomb’ that hit Northern Scotland. Despite the forecast, it was surprising calm as the Loganair flight left Aberdeen, but after we had been served the customary tea and Tunnock’s caramel wafer I always look forward to, the wind began to buffet the plane violently, not only from side to side but also up and down. As we came out of the clouds towards the islands we turned on dipped wing into a curve that I soon recognised as the familiar holding pattern.

“Sorry about this,” came the calm voice of the female co-pilot, “there’s a snowstorm at the airport in Kirkwall so it’s going to be a little while before we can land.”

For the next fifteen minutes or so, it may have been longer I lost track of time, we jerked through troughs and peaks of stormy shades of grey, occasionally illuminated by a flash of lightning. My hands, cold and clammy by now, gripped the armrests. My stomach rose up into my throat as I shared false smiles with a woman seated across the aisle. Behind me, another passenger lost the contents of her stomach. As I caught occasional glimpses of the flinty sea just below I began to have those familiar thoughts: ‘is this where it will end, after all?’

A few days before I had been working with fear of a different kind as novice therapists I was teaching about suicide talked about the anxiety which comes with not knowing how to cope when you, as a mental health worker, are faced with someone who might want to end their life.

From my early days in psychiatry I had to try and learn how to cope with uncertainty. I often meet doctors, nurses and other health professionals who quiz me about what is the ‘right’ thing to say or do in a particular situation; as though we can always be prepared for whatever we have to face in a consultation, and handle it ‘properly’. As if, by some magic, we can always find out exactly what the chances are of a person seriously harming themselves by asking them the ‘right’ questions, and manage any situation by being ‘ready’ with the ‘correct’ words and interventions. So that they will be safe…and we will of course not be criticised.

The problem is that it simply isn’t possible for any of us, therapists, doctors, patients or service users, to be sufficiently primed to deal with everything in work (or life) beforehand. There are too many different permutations possible. You have to learn how to use the knowledge, skills and particular talents you have and the information you can glean at that particular moment, to do the best you can to help someone in the time available. In talking to a patient, a mental health worker has to work hard to gain a person’s trust so that the answers to his or her questions will be at the very least some reliable refection of how they are feeling. In order to achieve this the worker has to be able to contain their own anxieties; about their own performance, the safety of the patient, what might or might not happen, in order to help the patient contain theirs. If the worker is struggling to deal with their own fears, such as being simply overwhelmed by the enormity of the person’s problems, the person seeking help will not feel safe enough at that moment to share how they feel- and the worker probably will not obtain an emotionally accurate sense of what is happening for them.

Its not only novice mental health workers who find it hard to manage uncertainty. I meet some quite experienced professionals who are still very obviously struggling to cope with their own fears. For me, it indicates they need a time and place to share their worries about the job. Supervision is still sorely lacking for many workers. As a consultant psychiatrist I regularly shared my concerns with my closest colleagues but I had no formal arrangement for support and supervision. But I have seen how, if we don’t learn to cope successfully with the uncertainty and fear we face in our work, we manage it in other ways. By detaching ourselves from the pain and becoming less empathic; by trying to dissolve it in alcohol and other substances; or just trying to exert an even greater control over the world, searching for answers to those unanswerable questions I get asked at the end of lectures which always raise an uncomfortable laugh from the audience. Our fear is palpable to our colleagues as well as patients.

If we can acknowledge the limits of certainty we have a least a good chance of reaching out and helping a person to tolerate the fear they are experiencing when they begin to tell us about something awful- like their thoughts about dying or the abuse they faced in childhood. Then we can begin to give them some hope. The first step in this must be staying calm, and showing we can take it.

I used to be very afraid of flying. I suppose I’ve undergone a prolonged course of desensitization over the years, but my palms still sweat at every take off and landing. Last week they were wringing wet.

After one run at the airfield which was aborted because of a ‘build up of traffic waiting to get in’ we eventually landed at Kirkwall. I was emotionally drained and almost tearful. But I know that what helped me to contain my fear of dying in the storm was the reassuring commentary of the co-pilot. Her calm professionalism helped. There could have been panic in the cockpit. But it didn’t show.

“Ladies and gentlemen, I know it’s been a difficult flight but you’ll be pleased to know they have just checked the runway; it’s safe and we’ll have you on the ground in a few minutes now.”

I wanted to thank and hug her, but I didn’t…being British of course. So I just said ‘goodbye’ with a teary smile, and stepped onwards into the rain. Happy to still be alive.

2 thoughts on “Fear of flying”

  1. One-hundred million years ago, the most advanced creature had a brain consisting of an amygdala. The amygdala picked up what was going on, and if it went on repeatedly, memorized it. When a memorized thing happened, the amygdala ignored it. When a non-memorized thing happened, the amygdala produced stress hormones which caused the creature to run away.

    Then a more sophisticated creature developed. In addition to the amygdala, it had a cortex which could think. Now, when the amygdala sensed something non-routine, the cortex could inhibit the urge to run to give it time to assess the situation. If the assessment revealed that the non-routine happening to be irrelevant, and the cortex could be sure of safety, the cortex signaled the amygdala to stop releasing stress hormones.

    This was a huge advantage. It saved a lot of running for nothing, which means it saved of a lot of calories. Saving a lot of calories made life safer, because leaving a hiding place to look for something to eat required being exposed, and risk of being eaten. So, creatures with a cortex – in addition to an amygdala – thrived.

    Today, we humans have a huge cortex. We still have the tiny amygdala. The amygdala still does the same thing; when it senses anything non-routine, it zaps us with stress hormones. The stress hormones do the same thing; we feel an urge to run. But the stress hormones also activate the cortex. The cortex is supposed to inhibit the urge to run well enough for us to make an intelligent assessment of the situation. But, some of us, when we feel the urge to run, assume we are in danger. Perhaps trauma at some point in our lives (most likely very young) caused us to tightly link the feelings produced by stress hormones with danger. Whatever the reason, this puts the person in a primitive mode. The person’s behavior approaches that of a creature with no cortex.

    We all need to come to grips with the fact that, though the amygdala might be right and we need to run, the amygdala is not as smart as the cortex. The problem most people I work with have is, if their cortex cannot be ABSOLUTELY certain there is no danger, they are intimidated; they defer to the tiny amygdala and, if not in control of the situation, they seek escape.

    Unfortunately, some of us have been brainwashed to believe absolute certain is necessary before acting. There is no such thing as absolute certainty unless every item of evidence is know, and that is practically impossible. It is – for all practical purposes – impossible to disprove a negative. If taught that by parents, the parents have placed their children in a bind in which they, if they obey their parents, they cannot function.

    Thus, since the cortex is there to facilitate life, and life cannot be conducted based on certainty, the cortex is a probability computer. Our job (as a person who nature has designed to function in the world) is to determine, based on the available evidence, what is probable. It is our job to assert dominance of the cortex. It is our job to navigate through life based on probability. To carry out our job, we need to to tell the amygdala to shut up, and if it won’t, to simply ignore it.

    If interested in how we can train to amygdala to ignore situations that we (such as flying) want to participate in, see http://bit.ly/1G0baJa

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