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‘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.

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:

1. Furedi, F. (2018). How fear works: Culture of fear in the twenty-first century. Bloomsbury Continuum, p. 5.  

2. Fisher, R. M. (2020). Culture of fear: A critical history of two streams. Technical Paper No. 98. In Search of Fearlessness Research Institute.  

3. Fisher, R. M. (2004). Capitalizing on fear: A baseline study on the culture of fear for leaders. Intellectual Architects, Ltd.  

4. 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.  

5. 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 21^st century. University Press of America/Rowman & Littlefield.  

6. 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.).  

7. Furedi, pp. 4-5.  

8. 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.

Is the WHO organization spreading more fear dis-ease than it is preventing, while playing out their worst fears re: Epidemics?

This blog is all about the intersection of Health & Wellness and Fear. I see many research and career opportunities for people studying fear(ism). Here are 4 examples from one small local Alberta newspaper (March 16, 2018) [1] that show this intersection. I also know, in the West at least, there is a lot more available dollars and funding in the Health and Medical Field than any other field and they are likely to be more interested in fear and its impacts. There is a readiness for fearism studies awaiting. Now, to the four examples, and my brief critiques: 

Example 1: WHO is seemingly in its policies so overly exuberant to prevent disasters regarding "new" or "old" viruses and bacterial epidemices it has, according to this newspaper article (above) named "Disease X" as its priority. You have likely heard of Zika, SARS, Ebola, etc. but WHO has decided to name the worst epidemic disease before it is known. There is something really weird about that, even though they will tell us, as in this article, their rationale is to pre-prevent as much as possible the "next" outbreak that could threaten us. WHO is becoming like this major "security" company, organization, dominant voice and player in the role of fear and disease. Yes, as I read this article they want us to be afraid of the next unknown big killer disease before we know what it is. That's weird, and seems on the point of extreme dis-ease (fear-based) way of operating and making policies about world health. Even if their intention is good, which I trust it is, their means of getting there is dubious and I think adds more fear on the planet, and more fear adds more distress to people awaiting and trying to avoid getting sick from anything. More fear, more distress and worry, and guess what, one's immune system goes down in functioning because it is on chronic altert (worry mode) and that creates more susceptibility to infections. WHO is not paying attention to their own dysfunctional logic to create this "Disease X" as the unknown big killing epidemic disease. By calling it the unknown disease, listen to what the reporter of this article writes, and others will too as they spread the news of WHO and its listed "Disease X": "The WHO said Disease X could come from anywhere and strike at any time" and goes on to say (citing a scientific adviser to WHO) "it is likely the next big outbreak will be something we have not seen before" and don't know how to treat and people will not be immune. On and on this newspaper article goes creating the fear of the unknown in all of us over something we don't know will happen but probably will, according to experts, and they are sure good at creating the worst case scenarios and then try to convince us we should trust WHO because they are so on top of protecting us or will try to do so... etc. As I say, this is a type of totalitarian thinking and authoritarian politics to health and wellness, that the world doesn't need, it only breeds more fear. This is a primary case, on a global scale, of fear appeal advertising at its worst. It creates dependency and fear of the unknown everywhere and anytime; it creates ghosts in our minds and lives, and this chronic fear distress is a fear-disease itself being spread by a global organization (WHO) that is supposed to be improving our health, not compromising it(?). 

 Example 2: ADDING HOPE TO FEAR(S) is about how to best boost people's motivation to be well, healthy, happy, while at the same time warning them of health risks. Adversting in the field of what is called "Health Education" or "Health Communications" is a topic of research and debate. The question and concern is how much "fear" should be induced to motivate people, and when is it too much or better to add "hope" (for e.g.) to create empowerment in the consumers of these advertisements and educational programs to promote well-being? This next article gives some research, and sides in favor that "Fear will get attention, but it is better to provide them with possible solutions." I won't give more details, but this article is pointing to research that is the exact opposite of the WHO strategy (above), thus, a contradiction in the health field as our health experts themselves may not be following their own research and best practices and advice(?)

 Example 3: Love and Fear debate is ongoing, and Desh and I have written about it in our book (Fisher and Subba, 2016), and I have done research on this debate for 28 years.  In this popular article the author opens with the lines: "Reject fear, choose love" --although, it is easier said than done. If we all did it the world would be a fantasy utopia and health and wellness and good relationships would abound. What the article does not analyze, other than an individual making a committed choice to follow love even when fear pulls them in the opposite direction, is the full nature of the Fear Problem in the first place. Because, it raises the issue about why love, if it is so great, hasn't kept us as a species out of the spiraling down the drain into major crises where clearly fear is ruling not love. My point, "fear" no matter how you look at it, isn't just a "choice" and that begins a whole other philosophical, psychological, historical, theological, sociological inquiry. Fearism is one more additional mode of inquiry into this debate, and of course, the author of this article doesn't mention fearism as a new perspective in the study of fear. Unfortunately, this binary simplification "love vs. fear" (as a choice) is really kindergarten education, better than nothing, but it leaves out more than one can imagine--or, more than I'd like to see be left out of our basic fear management/education on this planet. I can say, there is an huge amount of popular interest, writing, workshops, and teachings about love in relationships, and I am glad (somewhat) that fear is recognized as a most powerful, if not the most powerful, "emotion" in relationships that can be useful or be destructive. Trying to just replace by choice fear with love, however, is fallacious and reductionistic--it will work perhaps "a little" but not a lot. And, we need a lot more understanding about the nature of fear. Although, as I say that, I know there is a great swarm of advocates who will disagree and say "no you are wrong, we need mor understanding about the nature of love." Who is right? I say, and Desh and I have said, we need a dialectical methodology of fearism to study the love vs. fear problem. [see Fisher, R. M., & Subba, D. (2016). Philosophy of fearism: A first East-West dialogue. Australia: Xlibris.)

  Example 4: Pain Reduction: Fear Reduction is an article about the new research in medicine showing that use of opioids (e.g., methadone, heroine, etc.) cause worse symptoms regarding pain and anxiety problems than are helpful. The opioids are addictive and actually damage the biological systems own resilience to pain and fear. I suggest this is a great teaching to us all, and a critique of the field of Medicine overall, and a metaphor. Too much trying to take pain and fear away (as they are like twins), is not going to help in the long run. Of course, my complaint about the "pain" and opoid studies and the way the media covers this research, is that there is not enough talk about the fact that "fear" with "pain" is what the real problem is, and instead of just getting chronic pain (addicts) "off opoids" is not a solution but a moving the furniture around in the room. What these fear-patients need (a term Desh prefers, as does Feariatry, which we are working on), is attention on "fear" as the core of their problems, along with pain that goes with it. That's the larger discussion needed, is to look more closely at pain management within the context of fear management--then, we can really move forward as a society, and doctors who prescribe pharmaceuticals can readjust their paradigm of treatment, and truly follow the Hippocratic Oath they took in med schools, that is, to "cause no harm" in trying to help. Again, I believe there is a larger metaphor and teaching that goes to apply here to all of society, not just the field of medicine. Parenting and schooling and socialization in a culture of fear, a risk-avoidance society, etc. is the real problem. We end up teaching children, against their nature, to "fear pain" rather than truly come to understand it, themselves, and manage pain better: and, I could say the exact same thing with fear. Let's move this agenda of fearism forward because there are openings in the culture now, more than ever, to really find this new paradigm, perhaps it is a Fearlessness Paradigm, that can liberate.   

Notes

1. All articles are excerpted from www.TheEpochTimes.com ; (March 16-23, 2018), for educational purposes only. 

This is a preliminary essay intended to invoke further interest in what Fisher & Subba (2016) have called feariatry; we defined it (a term first named by Subba (2014)): feariatry (feariatric) - refers to the study and application of fear-disease relations in the mental health and wellness fields; analogous to psychiatry and psychiatric [1]

"Feariatry" is one of the sub-branches of a triad under FEAROLOGY, the latter which is one of the triad ("three pillars") identified in Fisher & Subba (2016) as an Integral Model of Relationships that are important to health and wellness, liberation and a better way to understand fear and create new knowledge about fear (p. 141).  Feariatry has the least development conceptually (theoretically) and practically relative to the other triads. For previous writing on feariatry search this blog [2].  

What is Feariatry? 

This is an open question that has not near been answered in the short-life span (a couple of years) of its growth as a concept. I won't summarize here everything Subba has published on it nor myself. I merely want to share some of my latest thinking. Feariatry is a re-calibration of the nature and role of fear (utilizing a philosophy of fearism) within its applications to health and wellness, medicine, psychiatry, therapy and psychology. The impetus behind this concept (and field of inquiry and care service) has been that fear requires a 'new' revision from its place in these areas, especially the field of psychiatry. Subba and myself argue that most all mental health problems and/or disorders (e.g., phobias, and other disorders in the DSM-V Manual that psychiatrists and psychologists use) are basically at their roots different forms of "fear-disease" relations.

In other words, the ecology of fear has been messed up, made errors as a "defense system" or "motivation system" and the result of those errors (intrinsic and extrinsic) are psychopathologies of fear (often with physical pathologies). Fear is at their root cause, and therefore, fear management/education is their primary or at least important treatment. Psychiatry as it has developed in modern times, and its following under the Biomedical Paradigm (Model), has left us with a psychiatry that is not that attuned or well-informed to the way fear operates in psychopathologies in general and in particular psychopatholgies like phobias, etc. Obviously, psychiatry sees the powerful nature and role of fear in psychopathologies like neurosis, psychosis, phobias, panic, anxiety disorder, but in actual theory and operations of treatment psychiatry doesn't pay that much attention to how to best work with the ecology of fear as a whole system of dynamic interactions, both intrinsic and extrinsic, both individually and collectively, and objectively and subjectively--all operating as impacting on the way fear is shaping and controlling life process (including nearly all psychopathologies). 

Feariatry ought to include the best of what psychiatry has to offer, but it also ought not be caught following only, or being dominated by, psychiatry and the Biomedical Paradigm. Feariatry, like the philosophy of fearism, is something new in perspective--one that uses a "fearist perspective" or lens. There is to be an open-mindedness, creativity and imagination for fear like never before in history. In that sense, feariatry ought to be transdisciplinary in approach to gathering data, knowledge, and assessing outcomes of feariatric treatments on patients. Psychiatry and its domination of the definition of fear and ways of managing fear are seen now as too restrictive and dismissive of the findings of the philosophy of fearism. We want this relationship to change, and we want more dialogue between theorists and practitioners from psychiatry and feariatry. Well, fact is, we don't have any one practitioner at the moment who claims to be a feariatrist. There isn't yet training for them. Meaning, we don't have a curriculum and pedagogy already prepared and planned for such training of feariatrists. But it is slowly developing and I am personally very interested to help lead this work and teaching. 

What is the Biomedical Paradigm?

This is a long and complex topic. When I suggest (as have several other critics) that the field of Medicine (and Psychiatry) are deeply embedded in the assumptions, premises and culture of a paradigm of Science as supreme over other forms of knowing, knowledge, and paradigms--then, that's where there is a conflict that needs to be understood, with a history going way back. Anthropologists tell us that around the world there have been "medicines" and "medicine peoples" in all tribal cultures for most of human history. Indigenous medicine (as therapy) is ancient and has its own Indigenous science basis, which many Indigenous scholars are now reclaiming and documenting in writing. Most of that wisdom is oral tradition, passed on from masters to initiates. There has also in the last several decades been a challenge to Western Medicine by the Eastern approach to Medicine (or wellness and health). Again, this is a large topic, but the point is to say that the worldviews behind these different approaches have different value systems, beliefs, assumptions about reality, and about the way disease and cures are related. These different worldviews and their paradigms of operations are also different in how they view the nature of fear and how best to manage fear. They have different ways of theorizing the fear-diseases (i.e., what diseases or dis-eases are caused mainly by fear and which are not). 

The biomedical paradigm, at least in the Western world began in the early first millenium and especially in the 16th century, as "Science" was becoming thought by many (not all) to be the best method to find out the truth, to diagnose the true illness and find the true cure. Experimentation was systematized using new means of statistics, data analysis, validating procedures, etc. The history of diseases and cures is fascinating and gives one a larger perspective when practicing any kind of curing --therapy--etc. So, I encourage all psychiatrists and feariatrists to be philosophers and historians as well as practitioners. Keep an open mind, and especially with regard to the nature and role of fear in disease(s) and in health and cures. 

So, may feariatry move along and develop, and do so in part because of its open-dialogue with psychiatry. As for how hard that is going to be, I predict it will be very hard because psychiatry isn't very open in my experience to other paradigms for understanding medicine, wellness, health, therapy. Of course, I could be just as critical about Psychology today, especially in the Western world. 

I look forward to further dialogue. 

Notes: 

1. Fisher, R. M., & Subba, D. (2016). Philosophy of fearism: A first East-West dialogue. Australia: Xlibris, p. 157. See also Subba, D. (2014). Philosophy of fearism: Life is conducted, directed and controlled by the fear. Australia: Xlibris.

2. For e.g., I have written: "Advances in the Psychopathology of Fear" (FM blog Apr. 19/17); "Feariatry: A First Conceptual Map" (FM blog Aug. 26/16).