Fear and Courage: A Psychological Perspective

Stanley J. Rachman Fear and Courage: A Psychological Perspective Socrates: Then, Laches, suppose we set about determining the nature ofcourage and in the secondplace, proceed to enquire howtheyoung menmay attain this quality by thehelp ofstudy andpursuits. Tell me, ifyou can, what is courage?—plato (1953) MOST PEOPLE ACQUIRE REMARKABLY FEW FEARS. BEFORE WORLD WAR II the population and the authorities greatly over-predicted how much fear would be provoked, especially during air raids on civilian popula­ tions. For example, in 1934 Winston Churchill warned the House of Commons to anticipate massive damage and casualties from repeated air attacks. He said the dangers were material but “no less formidable than these material effects are the reaction which will be produced upon the mind of the civilian population. We must expect. . . that at least 3 million or 4 million people will be driven out into the open country around the Metropolis” (Jenkins, 2002: 476). Contrary to the virtually universal expectation that repeated air attacks would produce mass panic and very large numbers of psychiatric casualties, people endured astonishingly well (Janis, 1951). The expected panic and uncon­ trollable fear did not occur. As a clinician working with people who are distressed and disabled by intense fear, I was puzzled by the apparent contrast between the intense and intrusive fears of the patients, and the fear­ social research Vol 71 : No 1 : Spring 2004 149 lessness of people who were the victims of repeated air attacks. My curiosity about this fearlessness was enhanced by a paradox that emerged out of the introduction of behavioral methods for the treat­ ment of abnormal fears. THE COURAGEOUS ACTS OF FRIGHTENED PEOPLE The paradox is that in therapy we urge patients to carry out acts of considerable courage; we ask them to approach and engage the places or cues that frighten them, and to do so frequently and for protracted periods. We expect them to perform courageously—and they gener­ ally do. Examples of fearful people displaying courageous behavior are everyday clinical experiences made more prominent by the common use of methods in which the person is exposed to the very situations that provoke the fear. A middle-aged woman who was deeply troubled by intense, irrational fears of disease, germs, and dirt was given a course of such treatment. These deep, chronic fears had distorted and damaged all aspects of her life. She was extremely frightened of touch­ ing “unsafe” objects, eating foods that she believed were dangerous, or even touching people whom she felt were diseased. She avoided any physical contact with other people, including members of her own family, and spent m ost o f the day sitting in the only chair that remained safe. Even her safe chair had to be scrubbed down with power­ ful antiseptics each day. The treatment was described to her, and it was explained that she would have to come into direct, graded contact with the objects and people whom she felt were diseased and danger­ ous. After a period of hesitation, during which her fear was extremely high, she bravely chose to carry out the treatment. She made good progress during the 15 sessions, even though the first 3 were exceed­ ingly difficult for her. She felt extremely frightened at times, and endured unpleasant physical reactions that included profuse sweating and palpitations. After completing each of these early sessions, she felt exhausted for a couple of hours. Even so, she persevered, displaying commendable courage. After two months of treatment she was greatly improved, her fears had subsided, and she was once again able to touch 150 social research her children and other people. Her extensive avoidance behavior was reduced. Unfortunately, her courage eroded when she returned home and she refused further help. A severely anxious and totally housebound agoraphobic woman provides a second clinical example of courageous perseverance. When her elderly mother fell ill and was confined to bed for six weeks, the patient forced herself to go out repeatedly to obtain food and medicine for her parent. She dreaded each excursion and experienced intense fear, but she persisted nevertheless. Patients with panic disorder who fear that the palpitations they experience during excursions are a sign of an...