25. April 2022

Learning to Live with Fear Learning to Live with Fear: Interview with Prof. Dr. Franziska Geiser

Interview with Dr. Franziska Geiser

Many people are living with a sense of fear right now. First came the COVID-19 pandemic, then the war in Ukraine. Yet where does this fear come from, and what can we do about it? To find answers, we spoke with Professor Franziska Geiser of the Faculty of Medicine. She works for the Inpatient and Outpatient Clinics for Psychosomatic Medicine and Psychotherapy at the University Hospital Bonn. As part of an interdisciplinary DFG research project, she is also collaborating with Bonn theologians and philosophers on a “Dynamic of Resilience in Life Crises: An Interdisciplinary Exploration of Terms and Operationalization.”

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Ms. Geiser, is fear sometimes an issue for you as well?
Of course. Especially as I get older, I’m finding that when I go hiking on a narrow path near a drop-off, I notice a fear of heights. My heart starts pounding when I have to engage in confrontation. And when I look at the global political situation and the climate crisis, I’m also afraid for our children.

What is fear?

Fear is a very old evolutionary system. It is a crucial part of our lives, and for the very survival of our species. When we perceive a threat, it signalizes to us that it is time for fight or flight, or alternatively to freeze up. It activates all the necessarily bodily systems: Our heart races. We breath quicker. Our pupils dilate. If, for example, a car is barreling toward us, we jump to the side without stopping to thinking about it first. It is a crucial fundamental propensity, since it can save our lives.

In modern (western) daily life, such physically perilous situations have become more of a rarity. So we tend to encounter fear more in the social space: Such as in the aforementioned situations of conflict, or in the fear of failure or examinations. An overly fast heart rate or sweaty hands don’t really help us much when it comes to an important discussion, however. You could say that fear helps motivate me to study more ahead of a test. But when the test itself arrivals, we often perceive fear as a handicap.

This reflects a special feature of our human brains: Our capacity to think in symbols, as well as to react with fear to remote or abstract concepts. On the one hand, this helps us anticipate potential problems, but it also expands the source of our fears. Not only are we capable of imagining all manners of threats, but also the scope of our fear unfortunately is often disproportionate to the actual probability of it happening. What matters more for our sense of well-being is how threatening we find a concept (such as being criticized by our boss), and how much space this fear leaves in our life. Fear tends to take up the space that we grant it: if I’m a fundamentally fearful person, then I have more internal room for fear. If I’m occupied with many other things, then a certain level of fear might well fade into the background. If a person’s fear reaction is so sensitive that it activates too frequently, or too strongly, and prevents that person from achieving a sense of peace, then we talk about a fear disorder.


How do you treat fear?

A person not suffering from a fear disorder can push away their fears. We are generally pretty good at switching to a parallel set of tracks in our heads: one of them shaped by fear, either from an acute event or from a reminder of some threat. At that point you can decide: I am going to be proactive and try to make changes. But we can also return to the other track and to daily life when we realize: Ok, this fear isn’t necessarily an immediate threat to me. Then we can allow ourselves to be distracted, or turn off.

The fact we can do this is important. We don’t have to be ashamed of the fact that we sometimes switch off. To use a current example, many of us look the situation in Ukraine and perhaps on the one hand make a donation or provide assistance, but also continue doing something nice for ourselves. That is how we are built at a biological level, because it allows us to keep living our lives. If you find you are unable to distract yourself from your fears, and the fear reaction is constantly being activated, even when there is no immediate threat, then this may well involve a fear disorder. And that’s where psychotherapy can help.

Should we be afraid when we look at other crises? 

When talking about the war of aggression in Ukraine, we generally first and foremost feel a sense of sympathy with those who are affected. We are shocked by the images of violence. Yet fear in the strictest sense generally arises with an eye toward ourselves: Could the war potentially come here? What consequences will that have for life in Europe? Fear is, as we noted, a sensible warning about a potential threat requiring assessment. If we confirm that the threat is real, then we actually need fear as a driver (alongside other feelings such as empathy and a sense of fairness) to set ourselves into motion. This applies not just for the war in Ukraine, but for the climate crisis as well. Greta Thunberg isn’t wrong when she says: “I want you to be afraid.”

How can we handle our fears?

We can start by acknowledging that crises are a normal thing. Life is full of fear. You can resist it and shape it. You can even confront it with humor and self-irony—it doesn’t always work, but sometimes that can help.

Then we can try to work around our fears. To ponder: what is in my control? You can’t influence a war, but you can become engaged in countering it. One of my co-workers works with an emergency services organization, for example. The fact that she’s there for refugees means that she’s primarily helping others, but she’s also instilling in herself a better feeling than by doing nothing. You can change profile images, click “Like” on social media posts, drive slow on the Autobahn, or turn down your heating.

Or you can deal with it: Stand your ground and seek out company. Talking about fears is essential. If you don’t talk about your fears, then you’ll end up going in circles. From that first moment when I express fears to someone else, I experience resonance. Other people listen to me, they answer me, I’m not alone. From a biological standpoint, we are herd animals; it’s important for our well-being to be able to share things with others, to provide solidarity and to draw on it as well.

What is the focus of the resilience project?

Our project promotes close cooperation between colleagues from the humanities and life sciences. Resilience is often equated with invulnerability: a crisis comes, is handled easily, and then everything returns to normal. Think of a rubber ball that I can throw against a wall. It deforms at the moment of impact, but once it bounces back it’s the same as ever. That’s not how people work, though. It’s not a flaw to be affected by a crisis, to suffer from it and to struggle with it. That struggle is perhaps even a necessity, if it allows for changes to be made. Crises are part of our lives, and also part of the way in which we recount our lives and the narratives we see in it. For this project, we’re looking at the process: What strengthens people in crisis? What resources and pressures are present, such as for those working in the health care system during Corona? That’s another factor that we explored as part of a large online survey. What kind of things, even small ones, can help at an individual level? And, most especially: What gives people in crisis a sense of purpose?

We learn nowadays to work in a highly goal-oriented manner and to think: “Things will only be good for me once I reach my goal.” In the process, we often forget the value of the journey of daily life. If you live a bit more strongly oriented toward the process, then you naturally also have objectives, but still appreciate things and feelings along the way. Such as gratitude, or a pleasant encounter. You still get to the same destination, perhaps a little bit slower. But along the way, you come into contact with many more experiences that can help quiet the fear reaction. These can be encounters, feelings, or perceptions. But it also includes the freedom to wait something out or extend trust. Those are elements that we find very important for resilience.

That sounds like mindfulness.

Yes. But mindfulness isn’t a strategy. It’s an attitude. Mindfulness comes from Buddhist practices, among other sources, and is accompanied by a fundamental principle: “Life is suffering.”  It isn’t there to hide fears. But rather to experience fear, to perceive it and say:  I am afraid on the one hand, but I can also feel myself blessed on the other. You don’t have to work first on eliminating fear before you do something else. Otherwise you’ll end up endlessly occupied with fear and see no longer see anything else. I like to say, a bit tongue in cheek: I’ve got a rabbit heart—I’m somebody who is fearful in certain situations. But a rabbit heart is also something tender, and if I can get a handle on it, then I’ll go far. And I wish that for others as well.

Like in 2015, when people came to us who had experienced war, exile, and hunger. Why does Ukraine affect us more than Syria?
In both cases, people came to us from war zones. We may sometimes be surprised with ourselves for being less moved by Syria than Ukraine, if only because it’s further away from us geographically. There’s certainly a biological explanation for that, since fears arise quicker when something is closer. Nevertheless, we are naturally more than just our biology, which means we can choose to engage just as much for Syria.

How does the experience of war change one’s life

Between 20 and 40 percent of persons who are subjected to war develop post-traumatic stress disorder. It is marked by hyper-vigilance, intrusion symptoms, and avoidance: One becomes fearful and easily disturbed. One experiences suddenly recurring memories. We’re not talking about: I become sad when I think about it. But rather: I smell the burning and hear the noises and feel that I’ve been transported back into the middle of the traumatic situation. As a result, one ends up trying to avoid those “triggers”: scary experiences in the hospital cause you to avoid going near a hospital. Post-traumatic stress disorder can, and must, be treated at a psychotherapeutic level.


Can it be cured?

We are all shaped by our life experiences. Our system for reacting to fear is capable of moving past minor fears. We saw that with the first wave of Corona, a time when we all faced strong uncertainty about what exactly was safe and what wasn’t. Then a new normality set it, where we became used to it, despite a threat that, objectively speaking, remained unchanged. This came because we had noticed: nothing has happened to me in my daily life. When we experience threats to our life at a massive level, however, the fear anchors itself very differently. Our system for reacting to fear knows: I must not forget this experience, ever. If it arises again, I need to save myself. The fear remains. The fundamental security that this “won’t happen again to me (or us)” disappears.

To rebuild that fundamental trust, an inner balance must be reestablished, and that’s a long road. I have to live with the knowledge that life can be two things: safe, but also without firm footing below, and both are true. To get to that point, I need the opportunity to analyze the things I’ve experienced and to give them some sense. It may well be that what I’ve experienced remains beyond the reach of reason, something that has befallen us. But the point is to reestablish contact with other people, to have a sense of connection with a hope, a belief, a system or values, or even nature.

Do we need to increase the available capacity for treatment?

Yes, we do. Here in NRW, we have a relatively strong network, built up by colleagues on their own initiative to provide trauma treatment for flood victims in NRW. But that network would be completely overwhelmed with the Ukraine refugees. Not all will need help, but certainly many will. Which is why we need more capacity for psychotherapy.


A discussion with Sebastian Eckert

Dr. Franziska Geiser
Dr. Franziska Geiser - Director of the Clinic for Psychosomatic Medicine and Psychotherapy at the University Hospital Bonn © University Hospital Bonn

The full version of the interview is available in podcast form at uni-bonn.de/forsch and other podcast services

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