Problems

As with grief and rage, where intermediate states of depression or resentment present more problems than any temporary block of the expression once it is underway, so with fear the most persistent problem is low-grade anxiety. It is as if fear is ever present but not mobilized. The person, whether semi-frozen or constantly agitated, seems to exert a drain on other people. With anxiety the situation is made even worse by the characteristic perceptual blocking associated with fear: the person cannot see reason, cannot hear reassurance. You cannot get through.

An associated problem is that very basic fears are so threatening to the organism that even their perception is blocked, but the condition of contraction of the organism remains. Just as specific anger may be repressed and displaced into generalised resentment or petty irritation, a basic fear may become displaced into an anxiety about something seemingly nonthreatening or irrelevant. The case histories of psychoanalysis abound with examples of irrational phobias—a fear of spiders when perhaps the person is afraid of being touched (touching has been a threat since long ago); of water when the person is perhaps afraid of being overwhelmed by longing (longing would excite the person to breath more deeply, but this is suppressed with a suffocated sensation like drowning); of going out into crowds when the person is repressing a deep anger against other people, and so on. In such cases, there are no proper equivalents. One person's phobia of spiders may have a different associational meaning from someone else's.

Some forms of therapy attempt to tackle such phobias directly, as does behavioral therapy, which seeks to decondition the person from the phobia. But new phobias or distorted versions of the old tend to emerge. A therapy that attempts to take the energetic dynamics of the whole organism into account, such as Reichian therapy or psychoanalysis in the hands of some practitioners, would postulate that only when the underlying condition of fear is removed will the tendency to form phobias disappear. This usually means long term therapeutic work. But how can the ordinary person, or the EFA helper, react to such a phobia? If another person shows a constant fear of spiders, for example, and insists on turning the whole environment upside down in attempts to keep it spider-free, our instinctive reaction may well be annoyance rather than the wish to help, even when asked. It must be admitted that when a person who is apparently functional, in the sense that they are not under treatment for illness, displays a persistent phobia, this creates a net result of antagonism in others, as effectively as does the complaining masochist. Fear, like grieving pain, can have the result of provocation. If you react with honest anger at such provocation, you have fallen into the trap of becoming a persecutor or an enemy to someone who is genuinely frightened— but of something else, nothing you can reach. Apart from gently steering the person with a phobia toward professional help, the only course is patience. But beware of becoming the victim of the other person's phobias: do not let your life be influenced by the need to ensure total protection against spiders.

Sometimes a deep anxiety is not channeled into a specific phobia but is instead 'free floating,' available to attach itself to any event or object. Here again, other people may find themselves being drawn into unexpected reactions of anger. Remember the possibility that such anger in you may be partly a cover-up for your own fear, which occurs as you are 'infected' by the other person's. Free-floating anxiety seems particularly infectious, precisely because it lacks an identified object. If you pick it up you tend to attach it to your own fears. For example, a friend's anxiety that seems objectless, but which is perhaps connected with some life situation such as a bad marriage, may make you anxious about something more relevant to you, such as an upcoming journey.

In such situations, you may certainly either offer your help and reassurance or encourage the person to seek professional help. But at the same time, just as when you are required to care for extreme and longterm situations of grief, you do have the right to protect yourself. Self protection against the harmful effects of another person's emotional trouble is not inconsistent with EFA. On the contrary, any effective helper must take necessary steps to protect him or herself against infection that would decrease effectiveness. After all, we think nothing of it when a medical helper in an epidemic wears a mask for protection. And we are certainly grateful that our surgeons keep their instruments sterile. In Emotional First Aid, your perceptions are like the instruments of a surgeon. As Reich emphasized, they must be kept clean. This does not mean that you become detached, any more than the surgeon keeps his instruments clean by not touching the patient's wound. But you have the right to keep a balance between involvement and detachment, to retain your own freedom of emotional movement.

Chronic emergency patterns. The main problems in EFA of fear can be traced to the chronic emergency patterns mentioned earlier (Chapter 2). These patterns, varying according to the person's character structure, are activated in any situation of emotional distress, but never more dearly than in fear. It can be said that the fear of fear underlies all emotional distress inasmuch as blocked grief and blocked rage are ultimately due to the fear of letting go and perhaps being deeply frightened. Many people react to the least anxiety in a predictable way. Without exploring what I have called the ambivalent emergency reactions, which underlie the complexities of masochistic provocation, it is worth mentioning here the basic reactions of freezing, collapse, clinging, panic, and attack. This chapter has already discussed freezing and panic. The other three reactions present specific problems.

Collapse. This is similar to freezing, where the person's 'ice' can be either broken through movement or thawed through contact. The difference is that instead of a rigid frozen state, this is a soft, flaccid paralysis where the skin is cool and the muscles have no tension. As already mentioned, the same rules apply as with freezing: initiate contact and movement. But such measures, in collapse, may have to be more long term. It is as if the energy, rather than being frozen at the surface like ice on a pond, has retreated to some dark and cold spot in the depths of the organism. It takes much longer for warmth to reach it, and there are no torrents of panic on thawing out, but rather a gradual coming back to life. When infant-like needs to be cradled or rocked emerge, this is a good sign. Recovery is gentle.

Clinging. This may take the form of actual physical clinging or of a kind of smothering of the prospective helper with detail and complaint. Although the person means no harm, the net result is to infect the helper with the fear and to produce further reactions of anger as the helper tries to struggle free. Approach toward contact with the helper is of course much to be desired in EFA. This becomes clinging when the contact is not followed by a natural withdrawal in which the person returns to adult, independent state. The clinging person begins to almost feed off the helper. As the helper, your support becomes a drain on you, but if you withdraw it, the result is anxiety. This is, however, the only solution. If you have done your best, the person's chronic anxiety is too much for EFA to help, and you must urge them to seek help elsewhere with a professional who has experience in weaning a person from this sort of over-attachment.

Attack. Some people react to any emergency situation with anger and verbal attack. Watch, however, for the give-away expression of fear in the forehead and eyes. You may point it out. But this may be the excuse for further attack. In its most extreme form, this chronic emergency reaction can be paranoia. But a great many rather lively people show it. It is, after all, a vigorous and often functional reaction to emergency. The problem is that it is a denial of the softer emotions of grief and of vulnerability. The person suffers from this hardening. The only solution is for you to avoid any kind of hard reaction in yourself, since the opposition of two hard reactions becomes easily a battle: steel is met with steel. It may be a test of your pride in your own strength, but it is useful to give, and to remain soft. Remember, you see that fear in the eyes. Speak to it, reassure it. Do not threaten. The person may feel safe with you and become able to soften and let some of the fear in. (Of course, the situation is different when you see the concentrated frown of anger in forehead and eyes, in which case your softness may indeed be appeasement.)

If a person shows a consistent pattern of emergency behavior that forms a wall against all your efforts to reach through, you may have to accept that this is more than an EFA problem.

Emergency

Self-destructive behavior in agitation has already been discussed under grief. The main specific emergency for fear is hyperventilation.

Hyperventilation may be puzzling to those who have never seen it. A person will sometimes hyperventilate under the pressure of a severe emergency. The signs are:

—Quick, panting breathing that continues without stopping even if the person is urged to slow down. This is high breathing, i.e. the chest heaves up and down.

—Indications of what is medically called 'tetany': progressive rigidification of the upper body, tightening around the mouth, and contraction of the hands. This last is specifically recognizable as a rigidification of the fingers and a drawing of the thumbs across the palm. The hands thus become locked.

—At the same time the person is out of eye contact even if the eyes are open, and it is seemingly impossible to make contact.

The whole picture is of progressive freezing and locking of the body musculature, in the presence of continued fast breathing. This can be a dangerous condition, since the blood supply to the brain is affected by increasing alkalinization, and the person may eventually black out. Ways of treating it are as follows:

—A traditional first aid method is to take a paper bag and ask the person to breathe into it for a while, thus forcing a rebreathing of air, which eventually restores the chemical balance in the tissues.

—A more simple method (especially if there are no paper bags available), although it requires more contact, is to block the person's breathing by putting your hand over the mouth and nose and pressing firmly in such a way as to block all air intake. Count to twenty, unless the person squirms to push you away (in which case the hyperventilation is not severe since he or she is relatively mobile). Under the circumstances, you will not suffocate the person. (Pearl divers hyperventilate deliberately to a partial extent so as to be able to suspend breathing for long periods.) Withdraw your hand and encourage contact, telling the person to look at your eyes and to breathe slowly. If this does not work, block the breathing again.

—You may try to stop hyperventilation by verbal means alone, encouraging contact and slower breathing, but if these do not work, you have to take further steps, as above.

What the person is feeling is usually increasing paralysis, a sense of being spaced out and detached, and increasing sensations of sharp currents like pins and needles in face, arms, and legs. It is as if the fear situation is so overwhelming that the organism becomes stuck in the normal emergency reaction of a startled intake of breath. The intake keeps repeating itself. The person becomes 'pumped up,' as it were, and is unable to discharge through emotional expression.

Some people have a chronic problem of hyperventilation in even minor emergency states, or from generalized anxiety. They should be referred to professional help. But any person who tends to block the emotions of fear, or who is subjected to a sudden shock, may go into a state of hyperventilation. If measures are taken as above, it soon passes, and there is nothing to be alarmed about.

After you have helped a person deal with the hyperventilation, and the breathing has returned to normal, stay with them for a while, since either one of two things may happen: the person may suddenly enter into contact again with a memory of the emergency situation that has provoked the hyperventilation, and it may start again, or else after a pause of some minutes there may be a strong tendency toward an emotional discharge either of fear or grief. Watch for the signs of this impending discharge (preliminary signs of terror or crying) and encourage them gently, remembering that this is often an area of emotional expression which is in itself frightening to the person. Another possibility is that the person is frightened to express the emotion in front of you. Make it clear that you're there for support.