What Cancer Has Taught Me About Fear

During my cancer journey, Gubar was one of my regular reads and I still follow her columns. Her most recent column reflects as well my experience during these strange times and the increased vigilance, as well as finding ways to focus elsewhere (this blog and my various articles are one of the results of my “living with cancer”:

Sequestered during the pandemic, I find myself thinking that cancer patients’ expertise in fear can help others heed its warnings. We all need tactics not only to overcome the destructive capacity of fear but also to tap its protective potential.

An iconic portrait of one petrified creature, Edvard Munch’s painting “The Screamcaptures the fright gripping many people today — of an invisible threat that has caused an exponential explosion of infections, a shocking influx of patients into hospitals, mounting deaths and the ghastly appearance of refrigerated trucksparked next to hospitals as mobile morgues. Munch’s figure holds his helpless hands up, even though they cannot muffle his involuntary response to what his wide-open eyes cannot bear seeing. His silent shriek echoes outward only to further imprison him. In a public place, he is immobilized beneath a bloody sky.

Munch’s original title, “The Scream of Nature,” indicates how well he understood fear to be ontological, not psychological: a force of nature, not just human nature. Nature has turned our world into a sinister dystopia.

Cancer patients understand this phenomenon, for we deal daily with dread stirred by organisms produced by the body they attack. The masks worn by those touched by cancer and the coronavirus manifest identical, overwhelming and rational anxieties — about contagion, isolation, degeneration, impending death — that escalate when people with cancer struggle to subsist during a plague year.

Regardless of age, cancer patients and survivors need to be more fearful these days than healthy children, young adults and people in their prime. With immune systems compromised by various treatments, we are highly susceptible to the coronavirus. We must take every precaution — of repeated hand-washing, of social distancing and sometimes of self-quarantining — even though such measures will damage the support systems we badly need.

Worse, many of us depend upon periodic medical interventions that may be compromised by the stress put on institutions dealing with the virus. We get regular blood draws, scans, infusions, pills and surgical procedures in hospitals. But are they safe places to enter in a pandemic? Nurses have been concerned that cancer patients will get infected in some facilities. Yet despite the best of intentions, the virtual consultations set up for me at my hospital have been a travesty because of glitches in technology. Will oncology services collapse under the strain of massive viral care? Biopsies are being delayed, clinical trials are being shut down, and research is grinding to a halt. Will people hospitalized with the virus be denied ventilators, if they have cancer and if a scarcity of medical equipment means that doctors must choose?

And yet, having survived months or years of living intimately with the mortal threat of cancer, the members of my cancer support group — who now connect via email — manage to carry on while keeping as calm as possible during the current health crisis. Not fully resistant to bouts of contagious terror, we nevertheless find coping mechanisms.

We know that fear can be debilitating, but it can also be self-preserving. The chronic patients in my support group cultivate vigilant fear: They use their trepidation to do everything they can to extend their survival without being capsized into despair, hysteria or paralysis. One of us picks up her shopping wearing Nitrile gloves, just as she did when in chemotherapy. Upon returning home, she swabs what she has bought with a disinfecting wipe.

Beyond this sort of physical caution — which remains crucial for keeping the death toll as low as possible — how do we maintain mental health? For only when we are free from the vise of terror can we take protective measures, most of which these days involve staying at home without going stir-crazy.

Cancer patients who steer between the Scylla of alarmism and the Charybdis of defeatism have devised oblique stratagems to navigate the difficult passageway of fearful vigilance. Within its straits, we seek not to banish fear — an impossibility — but to filter, buffer, intercept, sidetrack or dilute it so it can serve as a safeguard without obliterating us.

Concentrating on something besides the fright — on breathing or stretching, on an intriguing task to accomplish — distracts us but also gives us a routine or objective over which we can exert some control. Just as happiness cannot be attained by making it a goal — John Stuart Mill believed one must aim at “something else” to stumble upon happiness as a sort of byproduct — fear cannot be defanged except through indirect methods.

Especially within the narrowed circumstances imposed by the coronavirus, it requires ingenuity to discover quotidian undertakings that can convert fear from a virulent to a vigilant emotion. While we strive to remain conscious of our interdependence — our vulnerability to people who may be contagious, our responsibility not to endanger others — we need to engage in small but innovative enterprises.

On a practical level, consider what activities you enjoy in normal times. Begin to bake bread, one member of my support group advises; go on nature walks, another says. Organize digital pictures into a photo album, practice the guitar, check out a remote learning class, put together a film festival or a playlist, take a virtual tour of a museum, cultivate a garden, set up regular FaceTime or Skype sessions with family, try woodworking, use apps to play games with distant friends, devise home schooling lessons, sing on your balcony as many Italians did or for Yo-Yo Ma’s #SongsofComfort project, contribute to a food bank, or do as I am doing: Learn how to knit socks.

Munch’s screamer clearly cannot heed instructions not to touch his face or to take shelter at home, but we are trying to do so and trying to use vigilant fear as a bulwark against incapacitating terror.

In the cruelest month of April, here’s what many of us hope: That we will be able to look back on this alarming period in years to come and say that the power of vigilant fear — for ourselves and for each other — has seen more of us through than we had ever thought possible.

A fear of others in Australia’s ethnically diverse neighbourhoods is affecting mental health

While not captured in the study, suspect that some of the anti-immigrant rhetoric among some Australian politicians may be a contributing factor to lack of trust:

We’re often told to ‘love thy neighbour’ in order to build a more harmonious society, but when it comes to multicultural communities, it seems concerns about ‘others’ are rife – and it’s impacting peoples’ mental health.

A new report by RMIT University has found higher levels of neighbourhood ethnic diversity are associated with poorer mental health outcomes for people living there.

And it appears it’s because they don’t trust each other.

The study, Neighbourhood Ethnic Diversity and Mental Health in Australia, is the first of its kind to empirically examine the effects of ethnic diversity in an area on mental health. It was published this month in the journal Health Economics.

Based on 16 years of data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, up to 2016, it found a lack of trust in ‘others’ is having a negative impact.

Respondents to the HILDA surveys were asked how often they felt “nervous”, “down”, and “so down in the dumps that nothing could cheer them up”.

Dr Sefa Churchill, a senior research fellow at RMIT who led the study, said coping with difference tends to brings a greater mental load, which “not everyone finds easy or wants to make work”.

“In communities that are quite diverse we tend to see people that are a bit different in different ways, because we do not know them,” he told SBS News.

“It raises some sort of natural anxiety and suspicion about what they are doing because they are ‘different’.

“And that level of anxiety and unsettledness that is associated with this lower levels of trust, tends to hinder mental health.”

That lack of trust was the key factor behind poorer mental health outcomes in diverse communities, he said.

Dr Churchill said it is a natural compulsion to be wary of strangers, and the research shows it is not diversity itself that is the problem, but more likely the lack of trust that often accompanies it.

“If you do not know someone, if someone is different from you, you will not go be willing to go all in, in terms of trust, so from a fundamental perspective as part of nature, trust comes the more you get familiar with someone.”

“Trust is the glue that binds social networks, and social networks and feelings of inclusion are important predictors for mental health and wellbeing.”

But it’s not all bad news for those living in Australia’s ethnic melting pots.

When comparing diverse and homogeneous neighbourhoods which both had similar levels of trust, people living in diverse communities had better mental health outcomes.

“Our analysis considered potential scenarios where we have diverse communities and homogeneous communities both with high levels of trust, and the results actually did suggest if you are in a diverse community with higher levels of trust you tend to have better mental health than insular, homogeneous communities,” Dr Churchill said.

Australia is often touted as one of the most diverse countries in the world, with more than a quarter of residents born overseas.

Mohammad Al-Khafaji, CEO of the Federation of Ethnic Communities Councils of Australia (FECCA) told SBS News: “As in all parts of our society, mental health is a major issue in ethnically diverse communities that desperately needs greater attention”.

“What this study also demonstrates is that programs that promote cultural awareness and understanding make our communities happier and safer.

FECCA has partnered with Mental Health Australia and the National Ethnic Disability Alliance to deliver The Embrace Project – a platform raising awareness of mental health and suicide prevention and providing resources and services for those from culturally and linguistic diverse (CALD) backgrounds.

Mental Health Australia CEO Frank Quinlan told SBS News the project “recognises social isolation and stigma surrounding mental health in culturally and linguistically diverse communities can negatively impact mental health.

It “aims to engage people in CALD communities in a conversation and provide information about what comprises good mental health and where to seek support if needed,” he said.

Dr Churchill says the results of the study show the need for more policies that foster social inclusion and promote awareness of the benefits of diversity. That should help to build trust and reduce the negative effect of diversity on mental health, he said.

“We need to, at the local level, organise programs and events that bring us together, allow us to communicate, allow us to talk, allow us to know each other and go beyond the differences.”

“The fact that you do not know someone and all that, this will build that level of trust.”

Source: A fear of others in Australia’s ethnically diverse neighbourhoods is affecting mental health

How fear became the politician’s weapon of choice

Ian Buruma on the politics of fear:

As long as France’s state of emergency lasts, police may arrest people without warrants, break down the doors of private residences in the middle of the night, take over restaurants and other public places with armed force, and generally behave like agents in a police state. Most French citizens are now so frightened of Islamist attacks that such measures are widely supported. But they are almost certainly counterproductive.

A national leader can declare war on a state, not on a network of revolutionaries. Islamic State, despite its claims, is not a state, and Mr. Hollande should not treat it as one. Besides, even if bombing IS strongholds in Iraq or Syria makes military sense, it won’t break the spell of Islamist revolution for frustrated, bored and marginalized young people in French slums.

On the contrary: The canny leaders of IS also rely on an apocalyptic “us or them” view of the world. Most Muslims are not violent revolutionaries who condone, let alone admire, mass violence. IS seeks to broaden its support, especially among young Muslims, by convincing them that true Muslims are in an existential war with the West – that the infidels are their mortal enemies. For them no less than for Mr. Trump, fear is the most powerful weapon.

So the more a Western government allows its policemen to humiliate and bully Muslims in the name of security, the more IS is likely to win European recruits. The only way to combat revolutionary Islamist violence is to gain the trust of law-abiding Muslims in the West. This will not be easy, but arbitrary arrests are surely the wrong way to go about it.

Likewise, when it comes to civil wars in the Middle East, Western restraint is usually a better strategy than hasty military intervention driven by domestic fear. Republican candidates in the United States are already using the recent murder spree in Paris to blame President Barack Obama, and by extension any future Democratic candidate, for being weak. Mr. Trump has promised to “bomb the shit out of ISIS.”

This bellicosity has had the effect of pushing Hillary Clinton, the front-runner for the Democratic presidential nomination, into distancing herself from Mr. Obama. As with Mr. Hollande, she has to assuage public fear by talking tough and promising more military action.

Mr. Obama has consistently resisted the temptation to unleash more wars. His policies have sometimes been inconsistent and irresolute. But in his refusal to give in to panic and act rashly, he has been far braver than all the big talkers who accuse him of being a wimp.

Source: How fear became the politician’s weapon of choice – The Globe and Mail