The Only Thing We Have to Fear…

Notes on Fear Itself

In youth ski racing, Super-G is the fastest and scariest event.

In Slalom, the most technical event, you make quick, little turns around the gates; in Giant Slalom, the turns are spaced out, but there are still enough of them to slow you down; in Super-G, your speed is limited more by your guts than by the gates: you click into the longest pair of skis you can handle and point your nose down the hill, sometimes hitting speeds of more than 50 miles an hour.

(Downhill – which we all know from the Olympics – is even straighter and faster, but considered too dangerous for youth sports – though it’s often hard to tell the difference just by looking at the course.)

One way to think about fear is as a balance between the primal brain – ruled by primordial instincts and primitive drives – and the Neocortex – where threats are mitigated by context, and emotion tempered by reason. If you see a tiger in the wild, for example, you might be terrified; the same tiger in a zoo might strike you as cute.

Sometimes both dynamics are at play – or interplay – as with a horror movie. On a basic level it’s scary; on a higher level you know it’s not real; on a higher level still, you intentionally suspend disbelief to resurrect fear’s primordial thrill.

Physiologically, fear activates the sympathetic nervous system and activates an acute stress reaction, the infamous “fight or flight” response. All activities that are nonessential to immediate survival – digestion, reproduction, growth, and tissue repair – are temporarily halted in service of the perceived threat at hand.

The amygdala signals the pituitary and adrenal glands pump out stress hormones like adrenaline, noradrenaline, and cortisol which course through the system. Pupils dilate, heart rate, blood pressure, and respiratory rate all rise. Blood sugar levels surge to prime the body for action with a burst of energy.

In maladaptive fear responses like performance anxiety, beta-blockers can offer relief. Twenty milligrams of propranolol before a concert will block the action of adrenaline on the cardiovascular system and allow you to perform without shaky hands or tremors in your voice.

Calm the body and the mind will follow.

Studies looking at the use of beta-blockers in PTSD suggest that this mind-body connection runs deep. Propranolol has been shown to be clinically effective in attenuating PTSD symptoms when administered both shortly after an initial traumatic experience, as well as in the setting of controlled memory reactivation.

In activities like Super-G, something additional goes on: the taming of fear with mastery.

Most of these kids are pretty good skiers. Some, like my own kids, have been skiing since they could walk – and some do a better job of it! They are so comfortable and graceful on skis that you have to remind yourself how hard what they are doing really is: what’s the difference between recreational skiers and ski racers? Regular skiers look like they are going fast when they are going slow, while racers look like they are going slow when they are going fast.

Furthermore, you are not allowed to compete in these events unless you attend a special training camp – speed camp, it’s called. So while there is always an element of risk involved with traveling at such high speed while balancing on two narrow boards wearing nothing but a speed suit and a helmet, skill mitigates the risk more than you might think.

Or does it?

Ski racing season is over now, but a few weeks ago I was at a ski race with my son, Kobi. The race took place at Gore Mountain, a gem of a ski resort in the Adirondacks, probably my favorite hill in New York State. The Super-G course was on a trail called Echo, which had a very steep pitch near the top followed by a long, narrow curve with woods on either side.

The girls were still racing – for some reason, the girls always race before the boys, chivalry’s last stand, perhaps? – and I was hiking up the side of the hill, safely on the other side of the red B-netting that is meant to prevent the racers from flying into the trees.

I like to watch the race from the middle of the course. For one thing, that’s where the most technically difficult parts are; for another, watching your child race is nerve-racking, and I prefer to be alone at that moment than in a scrum of parents.

I was near the top of the course, at the bottom of the pitch, where the trail bent around to the left. A couple of things conspired to make this a particularly tricky section – the place where the race would be won or lost, as they say.

First, you had to take the pitch straight and fast, which meant you were heading at top speed straight for the trees. Then you had to make a more than ninety-degree turn without losing too much speed, which means major G-force.

The surface would be particularly icy at that section, thanks to all the other racers scraping away the snow with their turns, so you had to be way up on your edges – high enough to hold the turn but not so high that you would lose your grip on the snow, slide out and crash.

I stopped to catch my breath and looked up the hill. A girl in a Stars and Stripes speed suit and a red helmet was coming down the pitch. She had a perfect tuck and was flying. Just when I thought it would be too late, she came out of her tuck, spread her arms just the right amount, and set her edges for the turn.

I instinctively stepped back, even though I was in no danger of being hit. She came around the turn hardly losing any speed at all, knees bent to absorb the pressure, minimal chatter of her skis on the ice. Killing it. At the apex of her turn, I was close enough and she was high up enough on her edges that I could see the black bottoms of her skis.

That’s when I heard her voice cutting through the cold, crisp air of the woods: “Don’t be afraid!”

And then she was gone. Out of the turn and down the hill into the next section of the course.

For some reason, thinking of that moment still sends chills down my spine. Maybe because it’s inspiring: a great example of how no matter how skilled you are, it’s always possible to push yourself to where you feel like a beginner.

Maybe because it’s poignant: to be so young and vulnerable and brave.

Maybe because of foreboding: the more great turns she makes, the closer she comes to the one that gets away – it’s really just a matter of time – and the prospect of a high-speed crash on skis always leaves you with your heart in your throat.

And then there’s the power of words spoken out loud.

The cliche about sticks and stones has it exactly backward. True, the physical world lords over us in so many ways, from the quotidian – hunger, cold, fatigue, illness – to the extraordinary – war, earthquakes, disasters, plague… not to mention death. Fear is both a sign and a symptom of our physicality, a byproduct of being mortal.

Words seem puny by comparison. Until, like a slap in the face, they remind you who has the upper hand.

“Don’t be afraid!”

I love how just saying it can make it so.

Dr. Bertie Bregman
Dr. Bertie Bregman
Full Stack Family Medicine is a newsletter about what it’s really like to practice medicine and run a medical practice in New York City.
This blog will be a mix of stories, advice and discussion – topics will diverge widely, but they will all share a point of view!