The G Spot: Fear and Loathing in Shasta County

“Only thing we have to fear is fear itself”
-Franklin D. Roosevelt

This phrase was spoken by president Franklin D. Roosevelt in his inaugural address in 1932 when our country was in the throes of the Great Depression and still recovering from the devastation of WWI that had ended less than a decade and a half prior. His words were prophetic as our society has now found itself more secure and healthier than ever before, yet anxiety is the next epidemic looming around the corner and is likely related to our current epidemic of drug abuse.

When you look back at history, the world was a scary place. I was recently reading about Genghis Khan and the 12th century was scary place beyond imagination. In Asia there were feudal villages and cities where being raided would result in rape, pillaging and mass murder. Genghis Khan and his soldiers would destroy entire cities, slaughtering men, women, children, even dogs and cats. In Europe, there were wars throughout Europe and one’s possessions and safety were never guaranteed. This occurred for millennia and the current security that humans enjoy is just a brief moment in our species’ time.

As we look back in our country just a couple of hundred years ago, life was no picnic. Mothers often died in childbirth. Death was always just an infection away as most people died from disease. The average life expectancy in the United States for whites born in 1850 was 39, and much of this was related to a high rate of childhood death. If you were Native American, your outlook was very bleak. Death was always potentially around the corner. You didn’t have time to think about it because all but a privileged few were working long days to meet their basic needs. Most of this was improved by modern sanitation practices.

Now let’s look at our modern society. The average citizen of the United States does not have to fear death from war or invasion. There are small threats such as terrorism. Of the 2.6 million deaths in the United States in 2014, 32 were secondary to terrorism. That is increasing recently, but we are still discussing less than 200 deaths in a year. You should be much more afraid of driving to work tomorrow than of a terrorist attack. At 44 years old, I’m probably not going to die from the flu or an abscess that takes over my body. My children don’t have to fear meningitis, polio, tetanus, etc. We live in a very secure world.

So why are we all so anxious? In Shasta County, of approximately 140,000 adults, 24,228 had a prescription for a benzodiazepine (Valium, Xanax, Ativan, Klonopin, etc.) last year. These medications have been associated with an increased risk of death by any cause. How could we be so incredibly anxious that one out of six adults in our county requires dangerous medications to cope? One in four in the United States suffers from a mood disorder. We live in a world with more security and safety than ever before, with decreasing risks of lethal disease, decreasing risk of death from violence. Why are we so anxious?

First, let’s look at why we have anxiety. In your brain is something called the amygdala which is responsible for your fight or flight response. If you were primitive man, you never knew when another Neanderthal would decide to kill you for your really cool bear skin loin cloth or a mountain lion might decide to see if you taste like chicken. If you lived in colonial America, you were surrounded by death, disease, and whomever we were fighting that day. In today’s society, you don’t have a lot of threats to be afraid of and your amygdala gets bored. Now instead of being afraid that you will be torn apart by wolves, you’re afraid of whether that guy will return your text, that you didn’t study enough for your test, if your boss is going to be mean to you today, or maybe a homeless guy will aggressively ask for change. Instead of safe spaces from arrows, you need a safe space because someone may say a word that triggers you. You may have a panic attack because someone cyber bullied you on Facebook.

We now fear words and ideas because concrete life threats have abated. In universities, the bastion of free speech and free thought, speakers are being turned away because adult students might get their feelings hurt. These are the same adults who were expected to run into the line of fire in WWII and were proud to do it. Our brains have not adapted to the security in which we live and inappropriately apply mortal fear to truly trivial things.

We live in a society where our basic needs are generally met. Food is available to everyone. You can argue about “food insecurity” but I’ve worked as a physician in three states and in inner city environments and I have never seen anyone starve from lack of food. Although homelessness is a problem, there are many programs to help and shelter is available to some extent to most people. We even give out free cell phones to those with low income. Medical care is accessible to all through insurance, the Affordable Care Act, or safety net clinics. Perhaps parents who decline vaccination for their children should be a little more worried about the consequences of their decisions but that’s for another column.

Now we know that our anxiety may be the result of a bored amygdala, now what? There are people who truly suffer from anxiety and require medications. If your anxiety is significantly interfering with your life, you should see a medical provider for help. For most of us, medication is not the answer. Many have found yoga and meditation to be very helpful to manage their stress. It is more accessible than ever as there are many apps that can guide you through yoga and meditation. Mindfulness has demonstrated positive physical and mental health outcomes and may be worth looking into if you are finding your stress and anxiety difficult to manage (e.g. mindful.org). Cognitive behavioral therapy with a trained therapist has been demonstrated to be as good as medications with much fewer side effects. If you have children or care for others, take time for yourself.

Depending upon your beliefs, our brains were either designed or evolved for constant mortal threats. That same mechanism unfortunately impedes our sense of security and happiness and causes stress and anxiety. Instead of being a victim to the modern world, you can choose empowerment and find ways to train your brain for the modern world that is safer than ever.

The good news is that you can train your brain, and with the right mindset your life will be better and you won’t be “triggered” by the next Trump rally.

Greg Greenberg
Greg Greenberg grew up in Santa Monica, California. After undergraduate training at UCLA he attended medical school at Ohio State University and completed a residency in family medicine in Columbus, Ohio. He moved to Redding after residency in 2004 and has served the Redding community as a family physician, hospitalist, emergency physician, and, most recently, in addiction medicine. When he’s not enjoying the calm atmosphere of the emergency department he enjoys the chaos of being a full-time parent as well.
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20 Responses

  1. Tim says:

    Excellent essay

    • Greg Greenberg Greg Greenberg says:

      Thank you. I hope this speaks to a lot of readers as anxiety is probably the number one reason I see people in the emergency department (often as chest pain, shortness of breath, abdominal pain). When I went through a very difficult and chaotic divorce I learned first hand how it can be.

      • K. Beck says:

        While I like FDR’s quote I have to add: what is “nameless, unreasoning, unjustified terror” to one person is, in fact, totally justified to another person. We only walk in our own shoes, we do not know what other people’s lives have been, or currently are.

        “Now let’s look at our modern society. The average citizen of the United States does not have to fear death from war or invasion.” Tell that to people in the US military, and their families, or the people who have been blown apart by terrorist bombs, including the 9-11 attack, in the US, or the people who just lost their families due to a deranged person with guns. Most of this has to do with fear of the unknown, of what “might happen” that is why it is called “terrorism”…it doesn’t matter if it “might not” happen. That aspect doesn’t make the 24 hour news cycle. Never mind many people are terrorized in their own homes, and now we find many being terrorized in their places of employment.

        “We live in a society where our basic needs are generally met. Food is available to everyone. You can argue about “food insecurity” but I’ve worked as a physician in three states and in inner city environments and I have never seen anyone starve from lack of food. Although homelessness is a problem, there are many programs to help and shelter is available to some extent to most people. We even give out free cell phones to those with low income. Medical care is accessible to all through insurance, the Affordable Care Act, or safety net clinics.” Right, poor people in the US live the “Life of Riley/Reilly,” they have nothing to worry about. It is a strange bubble you live in Dr. Greenberg.

        I much prefer living by Mary T. Lathrap’s 1895 poem “Walk a Mile in His [Their] Moccasins.”

  2. cheyenne says:

    Greg, you mention Yoga and meditation as self help. Here in Cheyenne, with a lot of returned combat veterans, a few groups have formed, including women veterans only, that use fly fishing and hunting small game for mental healing processes. Shasta County has several fly fishing spots that place high on state as well as national charts. It also puts food on the table.

    • Greg Greenberg Greg Greenberg says:

      Cheyenne, I agree, it’s all about whatever distracts you from your fear and anxiety. I went fly fishing for the first tome this summer with an awesome guide who is a vet and will take other vets fly fishing to help with their PTSD. I found it very relaxing. Or maybe that was the beer.

  3. conservative says:

    Humans evolved in a stressful and dirty environment. Popular culture teaches that stress is bad.

    Popular culture also teaches that children should be raised in a very clean environment, as if the human immune system were incapable of reacting to the hundreds of thousands of antigens it normally does in the first years of life. Many people who consume media think that vaccines are harmful because they expose the immune system to too many antigens. The opposite is true. Children raised in a very clean environment have a higher incidence of asthma. If the immune system is not occupied as it evolved to do, it reacts with harmless antigens in the environment.

  4. Steve Towers Steve Towers says:

    The subject of how bad we are at assessing relative risk is fascinating. We are terrified of mass shootings and foreign terrorists because of how horrific those events are. I said elsewhere on ANC today, the school across the street from me recently voted to allow teachers to pack heat in their classrooms. That apparently seemed reasonable to the school board: If anyone attempts a mass murder at North Cow Creek School, there will be return fire. In reality, in every classroom where there is a gun, the kids are now at higher risk of being killed or maimed by a gun than they were previously, just by virtue of being proximate to a gun. (That’s assuming any of the teachers are on board with the new policy.)

    Yep, we are predisposed by evolution to assume that risk is everywhere. Coping mechanisms such as meditation and fly fishing are great, but there are also methods of co-opting our preparedness for strife. I play tennis about four days per week. We keep score. It’s ritualized physical competition, and there’s a lot on the line. There are younger players to hold back for as many years as you can, using skill and experience. There are attractive members of the opposite sex paying attention. We’re not exactly using the same methods as the Vikings to achieve those ends, are we?

    • cheyenne says:

      I would prefer fly fishing on a cool mountain stream with a beer in my hand to running up and down a tennis court. But, that’s just me.

      • Steve Towers Steve Towers says:

        There’s room for both. One fills the meditative function, the other fills the “blow off steam” function. I definitely need more balance, though, both mentally and physically. My body could do with a lot less pounding from chasing around on that cement battlefield. My mind could use a lot more quiet time.

    • Greg greenberg Greg greenberg says:

      It is truly fascinating how the brain works. I think there are an a average of 12 deaths per year from shark yet so many people are afraid of sharks. Most of the traumatic deaths I’ve seen from trauma are from car accidents yetnthe same people who fear sharks think little of having a couple of drinks or taking a Norco and driving. Terrorism plays on our fears yet is only a minimal risk to the average American.

      As much as we try to be rational, fear sometimes eluded reason. We need to distract our brains.

    • Tim says:

      I think a lot of society’s anxiety has to do with the increasing speed and decreasing quality of the information/news cycle. It used to be that today’s disaster made tomorrow’s news, at which point more information and context was available. Now it isn’t uncommon for national outlets to pick up a major story 15 minutes after it happened — before anyone really knows anything but while there is plenty of drama & angst.

      The news also used to be limited to once or twice a day — you maybe had the morning paper and the evening news. Today you can just swipe down to refresh your favorite feed, well under the addictive 400ms Doherty Threshold so you want to do it again and again — sneaking that next refresh at work like an old cigarette break…

      With news coming so fast and often, we’ve become a junky in need of a bigger, more potent fix. When young Sally breaks the local girl scout fundraising record, we yawn. When a suspect wrecks a stolen car fleeing the police, we perk up. When a tourist develops flesh eating bacteria, we want to know how… A surrogate mother accidentally getting pregnant with her own child? Do tell! A rampage shooting? Let me see!

      This emphasis on sensational stories skews our sense of representativeness – of what is normal. The extreme event seems so common because we just saw footage of it happening to a friend of a facebook friend. We talk about “assault rifles” as if they were a national epidemic (3,000 deaths/year from drowning). We worry about West Nile (<300 deaths/year) instead of the Flu (30,000 deaths/year). We don't realize we should worry more about hitting deer with our car (200 deaths/year) than being killed by terrorists (160 deaths/year).

      Meanwhile, we ignore the fact US Special Forces had combat missions in 138 countries last year, 70% of the planet. We don't care that over the past 15 years, RPD's budget grew 25% despite a 25% reduction in staff. We complain about the US debt, but don't dare consider cuts to Social Security. Put it off for another day, while we refresh refresh refresh…

  5. Dan says:

    Great reminder, thank you. 🙂

  6. Jamie Watts says:

    Great insight Dr Greenberg. I also find that reading my Bible and prayer work wonders. God gives peace that passes all understanding. I look forward to your next dossier. I enjoyed working with you in the ER. I miss those wonderful years.

  7. Steve Towers Steve Towers says:

    Just curious: The quote at the top attributes the saying to Theodore Roosevelt, but the first paragraph attributes it to Franklin D. Roosevelt. Was FDR quoting Teddy? 😉

    Here’s the full quote: ““So first of all let me assert my firm belief that the only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes the needed effort to needed efforts to convert retreat into advance.”

    • Greg greenberg Greg greenberg says:

      I screwed That one up, I meant FDR!

      • Steve Towers Steve Towers says:

        Well, I screwed up the full quote as well. I tried to copy the phrase he said in the actual speech over what he wrote in his draft, and ended up with an awkward redundancy:

        “…which paralyzes the needed effort to needed efforts to…”

        Doh!

  8. Joanne Lobeski Snyder says:

    When I finally went to a psychologist because I HAD to drive down to So Cal again and the anxiety was overwhelming. I started experiencing panic attacks in my early 20s and had just learned to deal with them. The psychologist and I had a great visit and he told me to see a medical doctor. This was after I told him that he could build a new home with the money I could pay him to hear the details of past trauma. The doctor I saw was qualified in in Psychopharmacology. I was reluctant to take drugs. I’d turned down the offers of prescriptions in my life for Valium and Xanax. I still have some Ativan I’ve never taken that one physician suggested I carry on a trip in case things got overwhelming. The SSRIS drug this doctor prescribed changed my world. I was sure the drug therapy wasn’t working until I got in my car to drive to L.A. and only experienced the normal stress one would feel driving through Sacramento and Los Angeles traffic. On a spectrum of rabbit to lion, I moved from rabbit to …coyote? Vigilant but feeling fairly secure in the world. Thank you for a great article. We don’t talk about or ever hear about “panic attacks” or stress related illnesses, so it’s not surprising that people end up in the ER because of the horrifying symptoms.

  9. K. Beck says:

    Backing up my 12 NOV post:

    https://news.stanford.edu/2016/02/02/poverty-report-grusky-020216/

    FEBRUARY 2, 2016

    Stanford report shows that U.S. performs poorly on poverty and inequality measures

    A new Stanford report shows that, compared with other well-off countries, the United States has the worst overall ranking on key poverty and inequality indicators.

    And the introduction to America’s Poverty Course:

  10. K. Beck says:

    I was able to find ALL the videos for America’s Poverty Course:

    Introduction: https://www.youtube.com/watch?v=qaHjl1KUjyI

    ALL the Course videos are here: http://inequality.stanford.edu/publications/americas-poverty-course

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