The Fear Factor - A Major Issue of Us

John McManamy Health Guide
  • Thank you, readers for your input. As a result of your comments, it looks like we are going to have a great conversation on two polar opposites - fear and happiness. The first can be called a primal emotion, the second a state of mind. This week, as a Question of the Week, I asked, “How Happy Are You Right Now?” The responses thus far are moving and insightful and will be the topic of a future piece.

    Last week, in a sharepost, I investigated the issue of why so many of us seemed “stuck” in our recovery. Here, your comments came in loud and clear: We are a highly fearful lot. For instance, Tabby remarks that many patients “have become ‘super observant’ to their illness and as such... are too afraid to do anything that may rock the boat so to speak.”

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    This includes their extreme reluctance to get off of disability for fear of losing their medical coverage. Since being on disability generally involves being condemned to a life of extreme poverty, we are talking the equivalent of being afraid to let go of the edge of the swimming pool. So when does playing it safe become an irrational decision?

    “U won’t like me when I’m angry” observes: “It is too easy to use bipolar as an excuse for doing or not doing something, and we can become so good at it that we even fool ourselves...By the same token, I can understand the fear of trying to stretch out and do something when this has led to bad experiences in the past.”

    "Fear is the path of the Dark Side. Fear leads to anger, anger leads to hate, hate leads to suffering." Is it really that simple? Is the secret to finding happiness nothing more than a remedial attempt to catch up to Master Yoda?

    Hagop Akiskal MD of the University of California, San Diego is on everyone’s list as one of the top authorities on bipolar. He is a leading proponent of the “spectrum” approach to bipolar, which posits, among other things, that some of us can have “a little bit” of bipolar, enough to make a major clinical difference. Dr Akiskal also includes temperament (inherited character traits) on his spectrum.

    In playing around with mood and temperament, Dr Akiskal (with Brazilian collaborator Diogo Lara) came up with the idea that fear and anger (anger is used in an expansive sense here here that can include both “sunny” and “dark” sides) underlie virtually all our behaviors. In two articles in The Journal of Affective Disorders from a few years back, Akiskal and Lara review the scientific evidence and connect their own dots:

    High fear states are associated with depression and anxiety and low drive and focus. Fear and anger in various combinations account for much of our bipolar mood states and personality disorders.

    The emotions of fear and anger are primitive and based in the ancient limbic regions, particularly the amygdala, while well-developed cortical regions have a modulatory role. A variation in the serotonin transporter gene has been linked to a heightened response in the amygdala and fear treats in healthy individuals. The same gene variation has also been implicated in stress-induced depression. In mice, higher serotonin predisposes to anxiety while in primates lower serotonin predicts lack of impulse control.


  • Also in the fear mix, according to Akiskal and Lara, a "robust body of evidence" supports GABA in the modulation of anxiety and fear. Other suspects include the BDNF receptor, the neuromodulator adenosine (caffeine blocks the A1 and A2 receptors), cortisol, and vasopressin.

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    Early life events and our environment also loom large, in essence nature interacting with nurture.

    In short, it may be helpful to think of ourselves as wired for fear, egged on by our environment. As well as contributing to our illness symptoms and various behaviors, this primal emotion also interferes in our recovery, and probably had a lot to do with why so many of us remain “stuck” in our present half-lives.

    But our human brains also come equipped with something other animals don’t have - self-awareness and the capacity to transcend what circumstances and nature handed us. Try tapping into this precious resource - don’t be afraid.

Published On: September 10, 2009