The Fear Contagion: A Psycho-bio-medico-historical Perspective (symposium article)

What is fear? Why should we talk about fear at the time of fearless space travel, driverless cars, robotics, tissue regeneration, conquering many cancers, and other advances in human intelligence and creativity? Why did we become (“all of a sudden”) so fearful of each other, our communications, and our variety of opinions—something that we cherished in our democratic society for a good while?

The last question bothers me a lot, on many levels. First, it bothers me as a person who came to the U.S. 30 years ago from a communist regime (not from a beautiful but utopian idea of communism, but a regime!). Second, it bothers me as a grandma of an almost three-year-old beautiful boy who belongs to a “COVID baby” generation and does not recognize the value of peer interaction (I hope not yet, but that he will).

At this time of radical disagreements about everything, we all would agree that fear is an ancient part of the human condition; it is the emotional response to the immediate threat and protects us as a species, evolutionarily, from being eaten by other, stronger carnivores. Fear is universal and adaptive, allowing for the mobilization of one’s internal resources when his/her welfare is threatened. So, each of us reading this article has experienced fear in our lives by now and knows what fear feels like as soon as it happens, although our descriptions of these experiences differ. They differ because our body/mind reactions that we describe as “fear” are different: some people go into a fight-or-flight reaction, literally, and oth-

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ers freeze, physically or/and emotionally; feel dread like a knot in one’s stomach; feel “cold” inside; and still others feel like they are choking or as if something is crawling under their skin or on the walls of the room they are in. Some people feel that they are “dying” from fear. Others end up having chronic anxieties and even severe and lasting vascular spasms that could be experienced as a heart attack or a stroke during an extreme fear state, sometimes called terror.

Fear is so basic and so important that each of us has a fear circuit that operates in the “reptilian” part of our brains (as per the Triune Brain Theory of Paul MacLean), which engages only one small-paired pea-size limbic system’s organ, the amygdala, to process this emotion. The rest of the reptilian brain occupies the territory of the brainstem, a structure that connects our body with our brain, and which carries through all the pathways for movements and bodily sensations (like high-voltage power lines). Amygdalae, as the representatives of higher-level limbic system structures (of our reptilian brain), trigger our body’s physiology, increasing our body’s stress hormones, oxygen consumption, and heart rate.

In psychoanalysis, we acknowledge the unconscious mechanisms of defense that our Ego (a negotiator between our Id, our wants, and the real world) invents to protect us from conscious knowing; and we identify some sort of a hierarchy of those mechanisms in terms of human development level at which those defenses had originated. For example, repression and conversion/somatization defenses are used more by those with a neurotic level of psychic organization, while denial and splitting (more primitive defenses) are used by those with borderline organization, as well as for signifying early trauma. This helps us to reconstruct a person’s psychohistorical roots.

Similar to this, our feelings can be seen as having a hierarchy too, with fear and disgust, joy and sadness, anger and trust, and surprise and anticipation being “basic” emotions (see Plutchik’s Wheel of Emotions). They are called basic because they are global and automatic, although their expression intensity differs in different people. The automatic function comes from the early (in development) and basic (by location) processes that have motivational, social, and adaptive functions. Out of all basic emotions, fear plays a special role in protecting the individual from danger. It is interesting for psychohistorians to know that the amygdalae, a main biological substrate that processes fear, develops differently in males

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 and females—because of an abundance of androgen receptors, which bind testosterone (prevailing in males). This, in turn, regulates gene expression, as well as the ability to make (protective) decisions at the time of danger.

Although fear is a basic psycho-bio-physiological phenomenon, I perceive individual fears as differing from each other on a few levels. One difference is in the type of threat at play. The spectrum here is wide: from an existential immediate threat to one’s life to an existential threat to our loved ones that can cause their death to more “psychological” fears of failure, success, social isolation, in-group exclusion, and not being good enough (just to name a few).

Another difference between fears is the way our mind deals with their expression, as well as with their long-term health consequences, and how early and how often we were/are subjected to fears/threats. If one is subjected to existential threats in childhood, and if those threats are paired with aversive (negative) consequences, this creates adverse childhood experiences (ACEs) that predispose these people to be traumatized, even by not really grave situations—because of the wired (or fired) together brain/mind phenomenon. Wired together phenomena are utilized by the brain/mind dyad because of so-called neural economics: When some image or situation is paired with a specific emotion once, next time that image or situation is brought to light, our mind connects it/them to the emotion elicited earlier. For example, if a child was scolded by a big man once and felt fear or panic because of that, next time the sight of a big man, even a friendly one, may be accompanied by fear or anxiety in this person, even when he/she grows up. In the meantime, if children did not have fears paired with punishment or observation of their peers or siblings being punished (and even paired with some encouraging/positive messages), they do not tend to develop long-term consequences of fear and trauma.

What about fears that spread through families, societies, countries, and continents like a contagion? Is it a possibility or just a clever line on the poster of the 2011 movie Contagion: “Nothing Spreads Like Fear”? Notice that this movie was produced a decade before the COVID pandemic, but it depicted the state of international fear that swallowed the nations. So, what do people fear about our current situation? Death. Transmission of the virus to a loved one—which means Death. Having no treatment options—that also means Death. Sounds very existential. But in her

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book, A State of Fear: How the UK government weaponised fear during the Covid-19 pandemic, Laura Dodsworth (2021) writes: “I was more frightened of authoritarianism than death, and more disturbed by manipulation than sickness. Has my fear helped or hindered me?” (p. 2). Also, I would add another question here: Can fear actually be contagious? If the response is positive, then: Can media, people, groups, as well as politicians, use fear as a bioweapon of mass destruction where our interpersonal connections (that help us to survive as the human race) serve as a vector of the Fear Virus, using the individual’s own immune and clotting systems as the executioners? Unfortunately, all these questions can be answered positively. I will elaborate a bit more on this here.

Recently, Tashjian et al. (2022), investigators from the California Institute of Technology, published the results of a haunted house study of physiological responses to threat/fear, which showed that people feel more fear when experiencing it in a group of friends. They showed that the intensity of fear increased with the number of threat experiences that were stacked one after another (as people were going from one “haunted” room to another) and when the subjects of the study observed their friends experiencing fear too. This study was not designed to find out why this happens, but we can have an educated guess about the “mirror neuron system” (which allows us to co-experience something with the other, although we are not involved in that experience in reality) playing its role here, as well as the whole “empathic biological cascade” used by our brains when in the presence of others. As Freud (1914) stated in his paper “On Narcissism”: “We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure” (p. 78). This “one day” is here for a while, although many people in various professional intellectual worlds want to deny the fact that bio-physiology comes before psychology, thinking, and logic. Why? Let’s go back to Paul MacLean’s Triune Brain Theory for a minute.

Some like to play around with the reptilian brain metaphor, especially if this can be used against their political or intellectual opponents. But MacLean called his theory “triune” because only in the unity of all three levels of functioning—reptilian (with basic body responses and fear processing); mammalian (represented by the Limbic System and all feelings and emotions); and human (represented by the neocortex/logical, synthetic, integrating, verbal parts of the brain)—can we act as the higher-level creatures. So,

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every human has all three functional levels working—from the time we are in our mothers’ wombs to the day we die. But it is up to us to use all three levels in synchrony and concert or to produce the song of fear that “transmutes your entire being from ears to toes into a frozen sentence from an unknown dialect that no one understands” (Petit, n.d., para 13). We just need to be curious about our brain/mind works and the possibilities this creative dyad offers; and, of course, we should use these possibilities to our advantage.

How do people deal with fear? Marie Curie was quoted as saying that “Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” I agree with her wholeheartedly. That is why I resort to my knowledge as a physician-neurologist, psychoanalyst, neurodevelopmental educator, systems thinker, psychohistorian, and transdisciplinary researcher—to connect the dots and understand what is happening; how and why it is happening; and what can be done about the situation. How did I deal with my own fears and the fears of my family and friends, patients, and their families, in this COVID situation? Without denying these fears, I helped myself and many others to conquer them. I reached out, virtually and by phone, to the international community of physicians, nurses, and holistic practitioners, and I joined as many international groups that deal with COVID as I could. I’ve learned about protocols that were used and worked (or not), paying attention to every detail of something that did work and made sense. Why? Because if we concentrate on fear, on something bad that is inevitable, on negative consequences only—we lose the power that our minds have—in figuring things out, in using our Triune Brain as a whole, and not making the survival-based, fear-based (and often harmful) “solutions” the only road we know.

Some Regression: Fears in My Life

Although my longtime friends call me fearless, I do have fears, just like any other human being. While reflecting on this topic, I realize more and more that my parents had something to do with the fact that I never dwell on fears. My Dad made me feel as if I can accomplish anything I started or dreamed about; he was a “pragmatic” leader—we planted a garden together, fixed the roof, wove baskets, made preserves, carved wood, played chess, made sketches for my Dad’s work projects, and I drove our family’s first car when I was 14. My Mom was an intellectual and inspirational leader who taught me to be curious and ask (rather than avoid) the

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“Why? Why not? What would happen if…?” questions, which was everything I needed to succeed in life. So, my way to deal with fears would be to ask those questions and to make a plan to find out, to “understand,” as Marie Curie would say, even if it takes time to get into many rabbit holes—and then execute my plans, pragmatically. With time, and especially after I became a parent, I added another habit that helps deal with fear: I ask, “What is the benefit of dealing with this fear? What did it teach me about myself, others, and the world?” I look for a silver lining or consider any fear to be a sign of a possible “sentinel event.” (I’ve learned about sentinel [unexpected, deadly] events in medicine during my neurology residency training. One of the main hospitals where we worked then had a gunshot trauma center, a burn unit, and a state-level general trauma center, and anything was expected there; so any unexpected event was taken super-seriously. It was good practice for fighting our fear demons.)

One of the unusual fears that I’d like to share was transgenerational fear related to a story of us leaving the USSR a little over three decades ago when I was 30. Our family of four was uprooted from a pretty comfortable (in a Soviet person’s understanding of comfort) and happy life after an incident at the hospital where I worked as a newly minted neurologist—an incident that turned our lives’ trajectories from the very sure top to the bottomless, stateless unknown. The incident was not that dramatic for many people who heard the story, but I experienced real, gut-wrenching fear when the nurse aid (M.N.) who I asked nicely to shave the patient’s head for a burr hole procedure did not respond and chose not to talk to me: I spoke Russian (which was a common language in all Soviet republics, like English is in the U.S.), but on that bright spring early morning in 1989, some Moldavians who were nice coworkers, colleagues, or neighbors until then, decided that Russian is not okay to speak. I did not understand why. The nurse (N.N., an ethnic Ukrainian woman whose family has lived in Moldavia since before WWII), who worked with me on that shift and helped with drilling the burr holes in the patient’s skull, said, “It’s a revolution out there…” After I insisted, she translated for me one of the slogans pasted on the walls of the hospital: “Russians will be drowned in the blood of dirty Jews!” At that moment, I “knew” that we needed to leave the country. I could not explain how I knew.

Nothing like what was happening in Moldavia was occurring in Ukraine at the time. But I felt like there was no future for

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our kids in the former Soviet Union if something like this could happen overnight; they were three and four at that time. I call this transgenerational fear because I was afraid of something horrible being repeated without consciously knowing my family’s tragedies then: my Mom’s three uncles quartered by horses in Petlyura pogroms; my Grandma being sent to Siberian Gulags; and my Dad’s parents perishing when running from Hitler’s troops that occupied Romania—all because they were Jewish. Decades after all these tragedies, when my generation of Jews could be teachers, scientists, doctors, engineers, or ballet dancers—I couldn’t even speak Russian at work!

I was the same person, but overnight, I became a hated “other.” Yet now, it is not because I was (by blood, not religion) Jewish, but because I spoke my mother’s tongue, Russian. I could not really think much, but barely got to the kindergarten, took the kids home, waited for my husband to come back from work, and delivered the news to him. A couple of days later, we started to receive hateful letters (from “nice” neighbors?) about being dirty Jews that have no place there. We did not feel safe anymore. The kids went to live with my parents in Ukraine, and six months later, we left in unmarked railroad cars to Vienna. This was where we were met by representatives of the Jewish community and Austrian soldiers speaking a guttural-sounding language (that we recognized only from WWII movies), with German Shepherds that were bigger than our kids. I did not feel much fear then—if anything, I felt safer, even being stateless and penniless (we were allowed to exchange only $90 per person or $360 for a family of four).

So, what is the “benefit” of my retrospective appreciation of this “transgenerational” fear? It is in the understanding of “why” we left our Motherland, our family, friends, culture, language, and stability. It is also in understanding that we can overcome anything, embrace the journey, and appreciate our families, despite any arguments and hurdles.

Even in the safety of America, one of my greatest fears was losing my son to leukemia. He was 20, finishing college, and having a bright future when we got hit with this diagnosis. After two years of not knowing if he will survive and if the medication will work, he finally went into remission! There were ups and downs along the way, but he can live, work, create, and now has a family of his own. One would say that there is no benefit to this type of fear. But there was a silver lining here too: This fear mobilized me

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to create a new life (of working for myself and still doing what I love) that I never would have explored otherwise.

Another fear of mine is not being able to restore the health of a patient, who then dies, and to a lesser extent, maintaining my practice. This fear is mostly about failing in my battles with the hospital’s administration, which sees patients as “accounts” rather than people in need of medical care. In the neurorehabilitation team’s view, patients are moms, dads, sons, and daughters first and foremost. As a medical professional, I am invested in this “medical family” culture. The benefit of this fear is understanding that I have a pretty good gauge of the potential dangers to patients’ recovery. It also bolstered my skills of advocacy for people who might not even know the dangers that they are facing.

What is the benefit of talking about our fears in general? I think it is a significant one: We have a choice of either giving in to the Fear Contagion or becoming part of the remedy that lessens or destroys it.

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