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My Favorite Song

By Michael Sharp, MD

A 40-year-old professional mother of two came to me this week with an illness that had begun when she was a child—with belly aches. Over the years the illness had become complex with other symptoms appearing such as painful joints, odd rashes, and headaches. She had eventually gotten the diagnosis of ulcerative colitis but not until she was well into her thirties, despite having seen many physicians over the years. She describes herself as an anxious person.

Michael Sharp, MD

Anxiety is fear by another name. The part of our brain where fear lives resides deep within us and it has a kind of veto power over other parts of our awareness. The veto power is more of a gut and muscle-based power than a logical or thoughtful one. Because it has the responsibility of keeping us safe, it gets to take control when it says so.

This part of the brain lives in a continuum. If it is “set” on high alert by virtue of a sequence of events that are unsettling to its sense of safety, it tends to overreact. The opposite is also true but much harder to establish as a “set” because survival needs trump rest and recovery.

Imagine you live in a small, primitive community on a beautiful savannah. The community is in a state of harmony: hunting and gathering are good, the cultivated fields are abundant with harvest, and the community laughs, dances, and sings together in joy almost every evening.
One day a member of the community goes missing. The people wonder—are concerned but tell stories of visiting a distant cousin. A week later a child goes missing and the stories are not so easy. And then a third. The dancing stops.

As you imagine yourself a member of this tribe, imagine that you are given the task of harvesting the yams in one of the nearby fields. Imagine that you take your basket and your child with you. Imagine your heart rate and your ability to concentrate on your work. Imagine how often you look up to scan the world around you. Imagine now that you notice the tall grass over there beginning to move. Is it the wind or something else?

When this part of you that is there to protect you is convinced that the world is dangerous it takes over. It will now tend to not only be hypervigilant but also to over-react or misinterpret innocent signals as ones that are dangerous. It often becomes exquisitely sensitive to certain signals. These may puzzle the logical brain. Let me illustrate.

Let’s change the scene. Now you are living in modern suburbia. Not so much a community, not so much singing and dancing unfortunately. Lots of things to do—hard to keep up with all of them. You have picked your kids up from school, buckled them safely in expensive car seats and are a bit rushed to get to the next place on your list of to-dos. You’re listening to one of your favorite songs. You have the green light.

Someone who has had too much Christmas “cheer” and is texting his next appointment T-bones you from the right. Loud noise, car flips, you’re disoriented and stunned. What happened? It takes a while—people help, the police and ambulance come. Something very bad has happened.

Next summer you are better but not right. You are anxious. You are driving—the favorite song that was playing during the accident months ago comes on. Your conscious mind only remembers favorite song. But your heart rate skyrockets, and you can’t get your breath. A feeling of dread overtakes you. You have no idea why.

The danger monitoring and action center (DMAC) retains large amounts of information and associations; often in a detail that is surprising in its fineness and accuracy but also often out of the conscious brain’s reach. It communicates its monitoring activities to the body more readily than to our conscious brain and these communications often disrupt our sleep and digestive systems. Breakdowns in those systems happen over time. We get sick. Chronically sick.

Although there are genetic variations that make some people more likely to have their DMAC set on high alert, I don’t believe that anyone is really an anxious person. I believe there are conditions that create triggers and it is the nature of the conditions and the associated triggers that need to be understood to convince the DMAC that things are really OK. The triggers and associations can be dissolved with some techniques that are just beginning to be understood based on new understandings of our nervous systems. We’ll look at them together in my next column.

To Your Health!