‘Ending the Culture of Fear’: Fantasy or Possibility?
A Dialogue between Nonye & Michael
R. Michael Fisher & Nonye T. Aghanya
[Note: Michael (Canada) approached Nonye (USA) recently and conducted this email exchange over a few weeks focusing on their interests and questions about the phenomenon called “culture of fear”]
Recent decades have witnessed the emergence of competitive scaremongering, where different groups vie with one another about what we should and should not fear. So while one group of professionals advises parents to shield their children from the sun in order to protect them from skin cancer, another group points to the risk of children suffering from vitamin D deficiency because they have been shield from the sun. Competitive scaremongering surrounds the debate on whether vaccinating children carries more risk than letting nature run its course. People routinely accuse one another of promoting fear, playing the fear card, or allowing themselves to be manipulated by appeals to fear....Barry Glassner [sociologist] claims that “we are living in the most fear-mongering time in history.’ Perhaps he is right. -Frank Furedi [1]
RMF: I have recently been working on a paper tracking the history of the “culture of fear” concept across disciplines [2]. Although, this concept has been in my research, writing and teaching since 1997 or so, it remains a sturdy concept for critical analysis of our individual and collective lives. In 2004, I was contracted to do a baseline study of the uses and definitions of “culture of fear” across disciplines. I directed it for leaders, although that report was never published widely [3]. I observe, unfortunately, there is still a good deal of (mis-)interpretation going on amongst those that throw the term around today. So, that’s one issue I’d be curious to explore with you in this brief interview.
Oh, I’m curious Nonye if and when you had heard of the term “culture of fear” or “climate of fear”; and have you pursued researching more into those at all? Do you teach about these concepts as contexts within nursing education or in your online program per se, what is it called?
Nonye: Thanks Michael, this is truly an interesting topic and I’m excited to explore and gain some insights from a fearologist on “culture of fear,” especially as it pertains to healthcare. In the context of Nursing/Medical education and healthcare practices, many institutions for countless years have implemented and embraced various methodologies for more efficient general care delivery. An example is the use of Wong Baker pain scale for objective assessment and better pain management for patients.
However, in my review of various existing empirical studies, there seemed to be a lack of methodology to effectively address patients’ apprehensions due to anxieties and fears in healthcare settings. Such patients’ state of anxiety is quite comparable to the “climate of fear” brought on by the feeling of unknown amongst other factors. Some studies highlight various contributory factors, for e.g. decline of practitioners’ empathy and compassion in healthcare practices and further suggest educational interventions for enhancing empathy in healthcare practitioners as part of a solution to the problem of fear/anxiety management. I’m optimistic about introducing my findings on the use of soft skills of communication as a vital tool for curbing patients fears and anxieties and improving the chances of trust development with healthcare practitioners. Contents of my online courses and book can be used as educational resources in Nursing and medical institutions.
RMF: Okay. But before we get to the conception of what makes a culture of fear, and how to best ‘know’ what a culture of fear is and transform it, I’ll ask you to respond to the recent article in the British Medical Journal (2018) that caught my eye, with a provocative title: “End the Culture of Fear in Healthcare” (Ladher, 2018). This is a prestigious journal in this field. And as a 30 year experienced nurse-educator yourself, I’m sure you are aware of the phenomenon itself where fear, mistrust, intimidation is very real in organizational cultures in the health field. Could you comment on this excerpt from Ladher (2018): “A key finding of the independent report into deaths at Gosport War Memorial Hospital, where around 600 people received fatal and medically unjustified does of opioids, was a hospital culture of uncritical deference to doctors and a fear of raising concerns.” Ladher goes on to note that the report mentioned calls for “ending professional hierarchies in clinical practice”—you wrote a book or two on this have you not? What’s your take on this kind of finding from such a report, and I am sure there are many other examples of such reports we could find all over in various nations and sectors of society?
Nonye: First, from a practical perspective, I believe there needs to be further clarification of the latter part of Ladher’s article excerpt particularly on the “fear of raising concerns” within the hospital organization and how it may have contributed to the unfortunate fatal opioid overdosing of some 600 hospital residents.
I have written two books [4] in recent years on the issues of overcoming fears and anxiety in regard to the clinician-patient relationship—focusing on communication effectiveness as it relates to treatment effectiveness. This UK report creates more questions than answers. Did many patients’ hesitations and fears of expressing their opinions to their doctors and/or administration of the hospital contribute to strained dialogue and mistrust that made it difficult for the doctors to ascertain their pain levels accurately?
Did the doctors unwelcoming attitudes make it difficult for patients to be vulnerable and transparent about their pain levels? Did the nurses participate in assessing patients pain scales and response to opioid management?
If and when patients attempted to suggest alternate pain management plans, other than opioids (e.g., heating pads, NSAIDS, non-narcotics analgesics), was there a perception that doctors were not accommodating of their suggestions? Did the patients disclose these concerns to nurses and did the nurses fail to inform the prescribing doctors? Did such communication breakdown create a sense of patient dependency and the disastrous impact of opioid over-medication?
RMF: You mention “communication breakdown.” You seem to frame everything in your analysis of your work on communication effectiveness? Is this something you were personally interested in, perhaps even before your training as a nurse? Where did that focus come from? It seems to be a lens you bring to determining what’s really important in reality.
Nonye: Effective communication is achieved via a “two way venture” and this became apparent to me very early in life, as early as 5 years old. I was always an anxious child and grew up into an anxious adult, very eager to please others around me. The realization that I could dramatically reduce my state of anxiety by aiding someone else, by any possible means, to become less anxious while they interacted with me was my eureka moment! Noted in one of my study analyses was a disclosure from Dr Stephen Trzeciak, the chief of medicine at the Cooper University Healthcare in Camden, N.J. In his 2018 TEDx talk which explored the existence of a healthcare compassion crisis, I was fascinated by his mentioning of a stark difference between sympathy and compassion. Sympathy is characterized by feelings while compassion is characterized by actions. Thus the practice of strategic and compassionate engagement became an actionable effective tool which needed to be shared with other healthcare professionals and nursing/medical institutions.
By recognizing human characteristics and behaviors, and adjusting engagement approach strategically, healthcare practitioners can help reduce patients anxieties while promoting the chances of trust development complementary with compassion development.
RMF: Oh interesting about your core childhood strategy. I would call that a core base for a fear management system, based on the need for social acceptance and comfort, which then becomes a form of social conformity, which then functions “well” not only to lower your anxiety but it maybe adaptable in a career choice, maybe in a society as a whole, where the strategy gets rewarded via the culture’s need for cooperation, consensus, and being a good workers—or a good person, etc. All that conforming, I suppose is anxiety-reducing too; yet, it can also exacerbate anxiety further below the surface. I know you also are somewhat of a rebel too (smile).
That’s very reasonable as a core fear management system, and is seen as part of the evolutionary history of our species; so, don’t get me wrong, in that I am not complaining about it, I’m more curious how it fits and works at one level; but my thinking is always critical and reflective too. I have mapped out at least 10 different fear management systems in human cultural evolution [5]—some which individuals may choose to stick with and sometimes they also change and evolve to meet newer challenging conditions when an individual or a culture is faced with bigger challenges that the old fear management system adaptations may start to fail to be serviceable. I guess, I’m always teaching people to examine both what fails and what works, when it comes to their fear management systems—and/or habits. Learn from both. There is always a possibility that even what “works” may have limitations and prevent growth and development. But that’s a larger topic, perhaps for another time. So, back to your professional work...
Nonye: I learned long ago to ask a lot of questions when I see a problem like that described by the article above. If healthcare providers failed to consider patients’ contributions towards the treatment plan, did this lead to a situation where patients just continued to overly ingest opioids because “doctor knows best”? Did doctors uptight and unfriendly demeanor make it difficult for patients to inquire about the frequent dosing of their opioids because they were afraid to upset the doctors by “asking too many questions”?
These are some of the factors that could have contributed to this tragic and unfortunate event and I don’t particularly believe that Ladher’s singular suggestion for “ending professional hierarchy in clinical practice” is sufficient to adequately address this issue and prevent recurrence.
RMF: I agree. If all an institution does, be it a medical and health one or not, is tweak the surfaces of the problems, and focus on the issue of “hierarchy” without focusing on the nature and role of fear, not much will change. I mean Ladher’s summary does note fear is a factor. That is not uncommon in issues when “culture of fear” is raised to a head as an organizational problem. The issue for me is that the thinking of “fear is a factor” is just too tame or euphemistic, and reductionistic. It tends to psychologize, even individualize, fear. It is easy to say “fear is a factor,” more or less—although, in some uptight fear-based organizations they won’t even allow that discussion to come to the surface. It is because “fear management” is a topic way off-the-radar. “Pain management” is on the radar, but not fear management. And, I’m generalizing but this is what seems to happen in health care generally. “Fear” is still like a taboo topic itself, often, and that’s what I see as a professional education and training deficit problem in many organizations. Have you noticed this? Have you thought about this, and what might be some solutions?
Nonye: I totally agree with your assessment of the lax use of fear as a factor that impacts many events in healthcare practices and other organizations. More often than not, there seems to be a reluctance of organizations to delve deeper and discover the root causes of fears that affect the organizational culture and employee performance. This is an important aspect of quality performance process as it can ultimately provide clues for implementing changes that will positively impact an organization’s performance, in healthcare and otherwise.
As part of a quality performance assessment process, this could involve the act of organizational and individual self-reflection. It could sometimes be conducted via a self-assessment questionnaire. This process of reflection may quite frankly be a bit awkward for some but it’s a necessary step for unraveling and successfully addressing the causes of many fears in various institutions and making positive and lasting changes from the result of the revelation of such assessment processes.
RMF: So what if “culture” or at least institutional culture is itself a phenomenon that is a defensive reaction against fear—as existentialists and social psychologists [6] say? What if the entire matrix of the system is so pathological and toxic, which is what “culture of fear” means?
Nonye: Culture of fear in healthcare is a complex one influenced by many factors such as patients’ behaviors, perceptions, healthcare providers’ personal ethics and consulting styles with patients and their abilities to identify patient characteristics and apply appropriate communication styles that lead to more sincere and productive engagements with patients.
These factors must critically be addressed to help reduce the risks of such unfortunate events as reported at Gosport War Memorial hospital. When you speak of culture itself as virtually a fear-based reaction—a defense—and thus seemingly toxic inherently, I don’t know what to say but that’s not a familiar notion to me. Can you say more?
RMF: Sure, but let me first define what a culture of fear is generically, as a dynamics of a living system. And to quote Furedi, “The term culture of fear works as a rhetorical idiom rather than as a precise concept. Its meaning is often far from clear.” [7] I tend to agree with him, in part. At least, this is what I came up with as a first working definition (and, I did not find it in the dictionary or a sociology encyclopedia or in Frank Furedi’s or Barry Glassner’s books, as useful as those resources may be at one level). Rather, I came up with this after reading hundreds of documents across history and disciplines: culture of fear – is when a system tries to manage fear and ends up creating more fear. It’s a paradoxical fear management regime, you might say. That creates a dilemma because one has to really ask about ‘who’ or ‘what’ to trust in terms of furnishing us as citizens, workers, and leaders with good knowledge on fear management in the context of a culture of fear?
And, without going into further theorizing, the basic thing I discovered is that most people assess the culture of fear based on ‘scientific’ and measurable things, like fear factors, mistrust factors, intimidation factors in the organization, and of course self-assessed fear(s), and so on. The standard psychological fare of applying tools to understand what is going on. But there was in none of the literature (virtually none) any consciousness on the part of the theorists, the professionals, or those creating the assessment tools, that (arguably) 90% of fear (which motivates us; often as anxiety) is unconscious and one doesn’t know the root cause per se. Now, that is my existential, psychoanalytical and fearological lens being applied for that conclusion.
You can see that I go deeper than a rationale based on communications or cognitive behavioral psychological modes per se in the pursuit of understanding fear or what I also call ‘fear’ (culturally modified fear – analogous to culturally modified organisms). The world hasn’t yet caught up with the complex morphing and evolving of ‘fear’ in ‘culture’ (i.e., within culturalism as ideology; i.e., within a culture of fear context)—I mean culturalism as the process of dominating belief systems (and taboos)—mostly that are culturally-created meaning systems as defenses against existential terror—and thus social fictions are used to avoid dealing honestly with that deep unconscious terror).
That’s just one part of my thesis here, then there are all the psychoanalytical implications of say “staff” working under “authorities” and so on. Or patients trying to survive under “authorities” who have at times, literally, control of their life—that is, control of their death. I have written some about that in my latest Technical Paper No. 98. With all these conflicting dynamics as part of communications and basic existence, there is often as Furedi described above, a competition of scaremongering going on as part of people trying to control their world. I don’t mean a natural control within reason, I mean an irrational neurotic and obsessive control. At times, some critics have said, today people are addicted to fear and that glues the whole culture of fear system together. I often meet people who cannot stand the word fearlessness because they say they want to keep their fear. And, I wonder exactly what they mean? Do they want to keep their addiction? Anyways, most people are just not well-enough educated on the history of the culture of fear phenomenon at the base of social life and cultural formations and evolution. Anyways, maybe that’s deeper than you are interested or see as practical in the workplace (?). I’m a fearologist so I cannot restrict myself in researching deeper on the topic of fear (and ‘fear’) and society.
Nonye: Sure, I absolutely respect your deeper exploratory views on fear as a fearologist. I’m truly honored to have gained more insights from your work about these other aspects of fear management that I otherwise may not have been privileged to learn about. Thanks so much Michael for this interesting dialogue and I wish you much success in your upcoming book project on the past Democratic candidate Marianne Williamson [8].
RMF: Not that there is any one clear all-decided definition of a fearologist and what they are supposed to do, but over 20 years ago, I made a commitment to be able to be informed enough, and maybe even bring some wisdom, to conversations about fear with virtually anyone, and especially to be able to do so across the disciplines and professions. So, it’s been great to have this conversation with someone in the field of Medicine and Health Care. That really means a lot to me. Thanks.
And as for Ladher’s comment, from a medical perspective in that article, my response is: Let’s not overly jump ahead too far when we call out the problems of a culture of fear dynamic, and especially let’s not think that the culture of fear is only in some workplace, the home, the school or on the streets of some ghetto; my point in this dialogue has been to show, there is no “end of the culture of fear” per se, in the concrete sense—more so, there is an educational project that is required from K to 12 and beyond, across societies—whereby we actually teach about how best to educate ourselves on what fear is and what a culture of fear is that constitutes the way fear takes forms. All relationships are inducted into this matrix. Once we understand better, then we can start thinking about the “end of the culture of fear”—but, from my view, that means we have to end this Dominant culture that pervades, that oppresses, and transform its worldview to a new and better one—not based on fear itself. I posit a culture of fearlessness is the replacement. For some, they might say, a culture of love is the replacement. And, from that point of contention—is a whole other interesting dialogue to be had.
End Notes:
- Furedi, F. (2018). How fear works: Culture of fear in the twenty-first century. Bloomsbury Continuum, p. 5.
- Fisher, R. M. (2020). Culture of fear: A critical history of two streams. Technical Paper No. 98. In Search of Fearlessness Research Institute.
- Fisher, R. M. (2004). Capitalizing on fear: A baseline study on the culture of fear for leaders. Intellectual Architects, Ltd.
- Aghanya, N. T. (2016). Simple tips to developing a productive clinician-patient relationship. iUniverse; Aghanya, N. T. (2019). Principles for overcoming communication anxiety and improving trust. Folioavenue Publishing.
- To study the 10 fear management systems, I argue is a way to expand one’s knowledge of a full spectrum of consciousness and cultural systems, moving from more simple and immature to more complex and mature (i.e., ultimately, towards an emancipatory pull to ‘freedom’ and/or ‘enlightenment’ whatever one wants to call it); see the 10 fear management systems documented in Fisher, R. M. (2010). The world’s fearlessness teachings: A critical integral approach to fear management/education for the 21st century. University Press of America/Rowman & Littlefield.
- E.g., see the work of cultural anthropologist Ernest Becker (The Denial of Death); and, the social psychologists who have ‘proven’ Becker’s theories and created “Terror Management Theory” (e.g., Sheldon Solomon et al.).
- Furedi, pp. 4-5.
- She is referring to Michael’s book soon to be released by Peter Lang, Inc. entitled: “The Marianne Williamson Presidential Phenomenon: Cultural (R)Evolution in a Dangerous Time.” Nonye wrote an endorsement review about the book, “The gradual advances of a change agent may encounter numerous hiccups on its pathway to implementing change; but with honesty, grace and compassion the committed will forge ahead towards success. The book reflects such a journey of both the author and his subject. R. Michael Fisher, in both an exploratory and objective fashion, provides riveting detailed accounts of many observers who have encountered the remarkable social phenomenon, which has grown in and around a once American presidential candidate—Marianne Deborah Williamson, a true change agent. One must applaud her clear moral stance as a driver of a movement gaining momentum because of this quality of leadership, with a mission for pursuit of greatness in service of others....It is a democratic mission not driven by personal gain but rather driven by eternal fulfilment and the awareness that the benefits of righteousness far exceed those of condemnation. We really need this ‘message’ today.”
Nonye T. Aghanya, MSc., RN, FNP-C, nurse, nurse educator, author, mother and so much more. Originally from Nigeria, she moved as a young person to the USA, now living in Alexandria, VA. [for a recent 30 min. talk on her work go to: https://bit.ly/3k6HB1X ]
Michael Fisher, Ph.D., artist, educational theorist, author and teacher, has dedicated his life-purpose to the study of fear and fearlessness. He was born and raised in Calgary, AB and after traveling and working internationally, he has returned to Calgary to live and spread the word.
