The Shape, Form, and Substance of Fear
We have established that fear is real, but what is reality? Real things
have properties. They take up space and have weight. Psychological enti-
ties have properties as well. They exist in space and time, with measur-
able intensity and duration. What makes them real is words. The larger
the vocabulary we have to describe our internal experiences, the more pos-
sibilities we have for controlling them. This is why simply talking about
psychological problems can improve them.
Freud used to describe the overall goal of psychoanalysis by saying,
“Where Idwas, shall Egobe.” To him, Id was the seething, inchoate mass
of unconscious, primitive urges that, though repressed, form the basis for
emotion. Ego is the part of the personality that reasons, organizes, and
sets priorities. Freud’s metaphor still fits with some of what we know about
how the brain operates. The structures deep inside mediate instinct and
emotion, and the outer parts think and use language. I’m sure that both
Freudian and neurological fundamentalists would cringe at the comparison,
but for our purposes, it holds.
Think about what we know about PTSD—that fearful images must
be translated into words before they can be stored as normal memories.
Perhaps this is the neurological basis of the talking cure.
Philosophical speculations aside, an important goal of psychotherapy—
for fear disorders and just about everything else—is to redefine reality as
what the mind knows rather than what the emotions feel.This is done with
words and explanations, which are a psychologist’s stock in trade.
Trish picks up the pillows on my sofa and piles them on her lap,
a soft fortress to protect her. “Since the accident,” she says, “I
can’t get the picture of that truck out of my mind. I even dream
about it.” A tear runs down her cheek. She says hesitantly, “I
think I’m going crazy.”
“You aren’t,” I say.
“I’m not?” she asks. A glimmer of hope flickers among the
tears.
“No,” I say, and spend the next half hour explaining what
PTSD is and how it works. I can see Trish beginning to relax,
basking in the brilliance of my exposition.112 ❧Explosions into Fear