Fear, stoats, and turbulence
One of the first lessons I learned recording the podcast ‘Sciencing the s**t out of MS’ is that to stave off anxiety we must do the thing that we find frightening. The theory goes that we can detach the level of actual danger, the realistic chance of a feared outcome, from the perceived risk. In short things can easily seem scarier than they are.
Humans do this all the time. Consider flying in a large passenger aircraft. The part of the trip that frightens us is the flight itself, being thousands of feet in the air appears to us as a risky thing to do. Yet we’ll drive to the airport without a second thought, though in reality the driving is far riskier than the flight.
Pilots have a far more realistic view of the risks of flying and the reason is simply experience, they do the scary thing so frequently and land unscathed that they teach their brains to more realistically appraise the risk.
This leads me to my present conundrum.
My immune system is suppressed by Ocrevus and so there’s a risk that’s genuinely hard to calculate that I will get an infection; they’re more likely, and when they arise they last longer and can be more severe and there’s an increased risk of serious infection, the kind that risks real trouble. So the recommendation from doctors is to avoid situations that elevate the risk of infection further, spending time in crowds unmasked, being around people you know to be unwell, effectively self-isolating where it is reasonable.
So now there’s a risk where the actual chance of trouble is hard to accurately calculate and the likely outcomes from trouble are also hard to predict. There are steps we can take to mitigate the risk but it’s hard to know which steps are reasonable because more considerable steps are reasonable if the risk is higher, and while we know the risk to be elevated we don’t know how elevated it really is.
Essentially we’re boarding the plane and the captain comes on the intercom to welcome us aboard and to let the passengers know that the engines are a little full of pidgeons and the occasional adventurous stoat. While that does indeed elevate the risk of turbulence, and if we do hit turbulence it will likely last longer and be more severe and that yes there’s an increased chance of an engine fire that could possibly lead to a crash, we’re not exactly sure how likely a crash would be.
Do you take the flight?
My answer would be ‘can I use the emergency exit or should I just leave a Cora shaped hole in the side of the plane?’
The problem is that getting off the plane means that you don’t crash but also means you don’t get to fly somewhere. Getting off the plane also gives rise to a difficult cognition ‘I didn’t crash because I didn’t fly’ and that cognition amplifies the risk associated with flying with local stoats even though it is entirely possible that the stoats simply cause a little turbulence, and maybe a little turbulence is worth the adventure of getting to fly somewhere.
My friends invited me out for lunch and I want to go, but I’ve got my infusion around the corner and I can’t tell if going out is totally reasonable because the risk is only a little elevated, or if going out is deeply reckless.
But the principle that I must remember is that of acceptance and activation. We accept the situation, we mitigate the risk, and we do the thing that brings us closer to other people, that connects us to our values, that makes us happy, even if, maybe particularly if, it makes us anxious.
So I’m going to go out with friends. I will get anxious about the risk and do my best to manage it, and if someone nearby is apparently unwell I will for sure have something of a panic attack, but I will do the thing that makes me anxious and hope that I can get the experience I need to better appraise the risk in the future.