Fear and Realism

Alan Madison: I'm scared as hell at different periods. I wake up at night and cry a little.

People fear what they do not understand and cannot control. People who are feeling good on the new combinations of drugs fear that the drugs may stop working and worry about the results of each blood test. They worry about their finances: the drug regimens are expensive and they worry about whether they'll be able to continue to afford the drugs. People worry about symptoms that may or may not be serious. They fear being a patient in a hospital, or undergoing painful medical tests and procedures. They fear rejection: Alan was afraid that people would treat him as though he had leprosy; Helen said she was fearful of telling her sons. Rebecca said she'd gotten past her initial fears of being damaged goods, but still "I get little echoes of it when I disclose my HIV status. I hate that conversation." People with HIV infection are afraid they will give someone else the virus.

All these fears are realistic. The point is not to live without fear, only to live without being unduly troubled or hindered by fear.

Sometimes what people feel is not fear but anxiety. That is, they have feelings of fear that are unrealistic. People who are anxious say they feel as if something terrible were about to happen. They cannot say what exactly they fear, only that they have a sense of underlying uneasiness. They feel restless and uncomfortable wherever they are. They are irritable, tense, and preoccupied with their bodies. They have trouble breathing, are nauseated, break out into cold sweats, have racing pulses. Some have periods of feeling panicky.

People whose feelings of anxiety persist too long or are too severe should see a mental health professional or a doctor who might in turn recommend a visit to a psychiatrist. Persistent anxiety takes a tremendous amount of energy, and it is often curable. Psychiatrists can prescribe medication to relieve anxiety. Mental health professionals can teach techniques that help you relax. Physical relaxation usually makes people feel calmer and more themselves again.

Dissipating Fear With Information

Many fears do not hold up in the cold light of reality:

If you fear sickness, find out which symptoms you should see your doctor about and which you should ignore (see chapter 6). "I found out what's what," said Alan, "and now I don't worry about every little cough."

If you fear medications, tests, and procedures, educate yourself about them. Read what you can find, ask your doctor, ask people who have had the experience. Learn about drugs and their side effects. Talk to someone who's had a bronchoscopy, who's gone through a scanner, who's had a lumbar puncture. The fear of such things is often much worse than the things themselves.

Put the fear into perspective. Alan said, "I went to a therapist for a while. Then I had a big gigantic turning point. I was taking a shower and realized that all my problems were coming from the fear itself. Fear was creating all the problems, even the fear. Realizing that made the fear dissipate in a gush. Of course, it came back again, but it kept going away again too."

This book excerpt has been provided with the permission of The Johns Hopkins University Press.
Copyright © 2006 The Johns Hopkins University Press.