The Capacity to Act in the Face of Fear

May 15, 2013

Dr. Lown

Dr. Bernard Lown is Professor Emeritus of Cardiology at the Harvard School of Public Health, senior physician at Brigham and Women s Hospital in Boston, inventor of the DC defibrillator and founder of SATELLIFE, ProCor and the Lown Cardiovascular Research Foundation.

OUT ON A LIMB

During the development of the defibrillator, my biggest dread was failure or self-discredit, especially if I lost faith in my capacity to be active in healthcare. Each thing I've done in my life has involved a certain chance of not being successful. The defibrillator was a wild guess, but the health issues involved were so profound that I was ready to stick to it.

It made no sense at the time, but now it's changed the way we practice cardiology. I had to go out on a limb. In life, you never know if what you do has a chance of succeeding, but if you don't take that chance, you won't fulfill your destiny. Chance means risk, and risk means failure.

Going on an uncertain adventure is what each one of us has to do, because the nature of living is uncertain. Nothing about knowing the past or studying the present gives you secure boundaries about what will transpire in the future. Look at Iraq and Vietnam all of their consequences are so overlooked. A year ago people said that this market crisis could never occur. Everybody talked about it going from one success to the next. Only a few economists predicted that it was going to be a failure.

PRESCRIPTION: ACTION

To combat fear, action is the greatest antidote to depression, fear and anxiety. Action. The reason I reject fear is because it undermines the capacity to act. The moment you re engaged in deliberate action well, thought-out action that is likely to be effective all fear goes away. But action cannot be chaotic; it has to be focused. For that, you need an education. You need to know what happened before. The facts.

I tell medical students that the fear of being wrong is their greatest impediment to mastering the art of medicine and being a good doctor. Medicine is so complex that science is an imperfect guide to action. Therefore it requires experience you don't have. Therefore you re afraid you ll make mistakes. When you do, you think it's a mortal sin and you hide it. Then you won't learn from it and you will repeat it.

I used to tell students that every day I came home, I asked myself, What terrible mistake did you make today, Lown? Whom have you screwed up? Whom have you hurt? What have you forgotten to do? What don't you know ? These aren't nice questions to ask anybody, including yourself.

I wanted above all to acknowledge our mistakes. Every morning at rounds, I asked, What mistakes did we make yesterday ? We d look at the log books and see that more than 10 times at least, the wrong medication was given, or the wrong dose, or the wrong order was written.

Human beings are fallible animals. As soon as you confront that fact, you re able only partially to overcome the predisposition for and the fear of erring, because action is the greatest dissipater of fear. Correct action in relation to fear is to acknowledge your own errors, and it's best to do it in public, because soliloquy is no substitute for dialogue.

A DOCTOR ON DYING

it's important to give people behavioral examples of how to cope with the fear of living, because the greatest fear is life itself. Living is a hold on uncertainty and brevity. Before you know it, you re an old man. We think we're running from fear, but we run away from real life itself frequently. That creates a host of bad emotions.

ON DYING

Unfortunately, we deal with it by prescribing a pill, a dye to prevent the whitening of your hair, an injection of Botox. But this is the wrong way to fight aging. It merely enhances fear, anxiety and, ultimately, depression, self-doubt and takes away the dignity of the person.

Being a doctor preoccupied with issues of cardiac death, I dealt with death as my constant companion. The moment you do that, you begin to see yourself in a new way. If you see yourself as a distinct identity, it is hard and frightening to conceive death. We are not here. We disappear as though we never lived.

But the moment you change it around and say, I am who I am by virtue of being a part of a community and humanity and a long history, of a striving for a more humane existence, you have a more eternal life. It motivates you and augments your energy, so life becomes more pleasurable, even though we live in a world that has as much tragedy and unfulfilled promises.

That doesn't mean that each of us doesn't occasionally experience a sort of terror around death. I'mnot happy about my dying or not being here, largely because I'mvery curious. I'd like to know what happens to the world after I'mgone. What will the world be like? Will we have solved the energy crisis? Will we live still with the threat of nuclear weapons? What will happen to my grandchildren? This question of curiosity is the strongest linkage I have to stay alive as long as possible.

You don't make a conscious judgment, and say one day, Oh, I've hit nirvana. I've had that ultimately epiphany, I feel liberated. it's more of a gradual maturation. We become more understanding and therefore more tolerant of the reality of life. That tolerance is a practical conclusion because we can do very little about anything else.

TIME, THE MOST PRECIOUS COMMODITY

Fear is a paralyzing emotion that has an element of irrationality about it. it's because you re confronted with challenges or tasks that you don't know how to cope with because time is finite. Or you think others have a bloated anticipation of what you are to produce, therefore you tax yourself to meet their expectations of you that you have planted in the first place.

In my life, I've lost jobs three or four times. I was kicked out of Hopkins, Yale, Harvard, all of them. And I'mbetter for it. Life is full of gray. it's not black or white; it's the fact that you accept it. You just have to realize that you re going to fail. One of the earliest problems I've faced is time: time allocated to family, to medicine, to the legal activities, to extracurricular activities, to friends, to all these demands made on you. it's impossible to proportion these tasks that are greedy for your time, because time is love. Giving time, the most precious commodity we all have, means that you express deep affection.

GREAT EXPECTATIONS

I've had fearful times when somebody in my family is sick and I'mstressed, and people are not living up to my expectations. My biggest source of anxiety is that I have very high expectations of people. it's only because I have a high expectation of myself. I make the projection saying, If I can do it, they can do it, so if they're not doing it, they're failing, and I feel frustrated and angry. But it's unrealistic. it's not fair to impose your standards on people with different methods and mindsets and expect them to live up to what you want.

Modern life, with its speed and enormous information overload, severs the connection of what living should be: an interaction with other people with a depth that is fulfilling for them and you. Personally, the most important aspects are my family and my wife, Louise, and books. Books give you a vicarious sense of participating in a broader family than just your own. Life is not lived as isolated individuals fulfilling themselves. That s a myth, in my mind. The individual is always fulfilled through interaction with others. Human beings acting together can develop enormous strength, wealth and creativity.

AFRAID OF THE LIGHT

When people fear wasting their potential, they have to examine what their potential is in the first place. Are they realistic about it? Frequently, people are forced by economic pressures to do things they don't like, and they don't recognize it. The job may be well-paid, so they become enslaved by their occupation, and we're unhappy because the person may be a great designer, painter, musician, philosopher, etc., but he s on Wall Street brokering derivatives.

afraid of light

Ultimately, we come back to the most pervasive question in literature, which is the preoccupation with death. Shakespeare said, In death, one is dead. There is no more dying then. That is, if you are able to visualize that and not be afraid, you overcome fear. Children are afraid of the dark, but men are afraid of the light, afraid of illumination, afraid of knowledge.

They're ill-prepared for life. That is part due to our education and part due to inadequate family that is wrought with conflict. it's due to the poor process of community so prevalent in America, especially because we live in a mobile society. A nomadic society can't sink deep roots in community to develop lasting friendships, cannot develop into significant conversation and communal activities, cannot give the best of itself.

WHAT IS HAPPINESS?

Those who want to apply their potential in a different direction have to make a deep evaluation and have the courage to live up to what they discover. it's easy to keep talking about our unhappiness, but we have to take control of reality. The most important question is; Do I enjoy what I'mdoing ?

Many years ago, I asked a famous physicist, jokingly, What is happiness ? He looked at me and said, Very simple. I wake up in the morning, and I love to go to work. Come five o clock in the afternoon, I love to go home. That s it. The more I thought of it, the more I realized it really embodied both aspects of our lives our family life and our professional life. If we love our work and we love our family, we're happy people. Then you can take all the strains in life.


About:
In 1985, Dr. Lown co-founded International Physicians for the Prevention of Nuclear War, an organization for which he won the Nobel Peace Prize. Dr. Lown is author of the best-selling book “The Lost Art of Healing: Practicing Compassion in Medicine” and “Prescription for Survival: A Doctor s Journey to End Nuclear Madness.”

Visit Dr. Lown’s website here.

Image by PhillipC and Neal.

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