Conceptually, according to Bolles and Fanselow ⁽¹⁾, fear and pain may be thought of as distinct, competitive, motivational systems that modify perception and behavior, with fear being dominant.  What actually provokes the fear response is the expectancy of pain and not the pain itself. This pain expectancy or worry is known as Anticipatory Anxiety. Pain is suffering, and suffering is painful.  Pain is usually perceived as physical suffering whereas suffering, as emotional pain.  Nevertheless, all suffering and all pain are caused by loss, the loss of what is dear to us. “I further maintain that sorrow comes of loving what I cannot have,” said Meister Eckhart (AD 1260-1328). Physical suffering is usually caused by the loss of health while emotional suffering, by the loss of what we have come to love, cherish, dream of, struggle for, and care about.

  
Fear may be real or imaginary, rational or irrational.  Imaginary or irrational fear is often harder to allay than real or rational fear.  This is so because rational fear may yield to reason whereas irrational fear resists evidence and logic.  “The thing I fear most is fear,” said Michel De Montaigne (AD 1533-1592).

In medicine, imaginary or irrational fear is a common confounder that often interferes with evidence-based treatments that prevent disease, improve health, and save lives.  Most patients who resist taking medications for cholesterol, high blood pressure, diabetes, addiction, mental illness, etc. or those who refuse vaccines, blood tests, medical investigations, preventive examinations, surgical interventions etc. do so because of imaginary fears, and they utilize denial, delusion, and justification to reinforce their contentions.

On the other side of science lurk multibillion-dollar industries that promote supplements and herbal products lacking valid efficacy and safety data.  The popularity of these non-evidence-based supplemental products is proportional to the prevalent fears regarding the loss of health and youth among peoples.  Pervasive, delusional beliefs in the occult powers of such supplemental products approach mythological proportions and seem to be growing exponentially in irreversible, revolutionary patterns that defy the unyielding realities of modern science.  The words of Petronius (27-66 AD) “It was fear in the world that first made Gods,” are even more poignant today than they were in Roman times when mythology, instead of science, provided all the explanations of life’s tragedies and the natural phenomena.

And while rational fears may be tempered with debate, education, and reassurance, irrational fears require dedicated Cognitive Therapy before they may be allayed.  Cognitive Therapy aims to undermine personal biases and to reduce personal resistance to evidence by helping patients see the logical errors inherent in their faulty reasoning.  This is necessary because all frightened people, and that includes all of us, seem to “reason correctly but from the wrong precepts”. Unfortunately, Cognitive Therapy can only be taught to motivated, open-minded patients.  If the patient is incapable or unmotivated, the fear state, with all its distortions of reality, persists unabated and undermines health and the quality of life.

Fear is a mental fire; when it is not extinguished from the outset, it rages wild and becomes uncontrollable.  “Then fear drives out all wisdom from my heart,” said Quintus Ennius (BC 239-169).  A good doctor first treats his patient’s fear and then he treats the disease.

Medical News

During the past 50 years, 200,000 cases of ovarian cancer and 100,000 deaths from the disease have already been prevented world-wide through the use of oral contraceptives.  At the current level of contraceptive use, at lease 30,000 cases of ovarian cancer could eventually be prevented every year. 

(The Lancet, Volume 371, January 26, 2008)

⁽¹⁾  Bolles RC, Fanselow MS. A perceptual-defensive-recuperative model of fear and pain. The Behavioral And Brain Sciences. 1980; 3:291-323.  

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