Embracing Anxiety: "The Ring of Fire"

Learning to live with anxiety is very different than fighting or avoiding it. These strategies only reinforce it, as your brain will develop wherever you place your attention. This was clearly shown in the “White Bears” study out of Harvard that demonstrated suppressing thoughts causes them to become stronger–dramatically so. (1)

Compassion-Focused Therapy

Many years ago, I was attending a conference on compassion in Louisville, Kentucky. I was introduced to the concept of Compassion Focused Therapy (CFT) popularized by Paul Gilbert. The speaker was Chris Irons, a London psychologist. He pointed out that there are three core categories of emotions that allow us to function as humans:

• Threat and self-protection
• Doing and achieving
• Contentment and feeling safe

He presented a slide that showed how people go back and forth between these three states. It made a lot of sense. I was excited about the conceptual model and showed it to my daughter who was about 21 at the time. She has always been wise beyond her years. She looked at it for a while and said, “These should be in circles.” After some thought, I saw her point. Here is what it looks like:

Here are some of the reasons that I agree with her: We spend most of our time going back and forth between “doing and achieving” (blue) and “self-protection” (red) trying to avoid feeling anxious and vulnerable. Eventually, you’ll wear out and descend into the ring. You then spend your life developing and maintaining a façade (identity) to present to the world while trying to cope with progressive anxiety. If you are reading this piece and don’t think you have anxiety, think again. There are an infinite number of ways to disguise and disconnect from it. You can’t survive without anxiety. Disconnecting from this innate emotion has significant mental and physical health implications.

I was raised in a difficult family situation filled with a lot of anger and dysfunctional behaviors. As I was the oldest of four children, I spent an inordinate amount of my childhood trying to create some calm, but to no avail. Finally, at age 15, I quietly shut the door on that part of my life and “moved on” – except I didn’t. What I now know what happened is that I disassociated. I completely suppressed the craziness of my childhood and created a life and persona that I wanted and pursued my dreams. Sounds pretty reasonable, right?

My New Life

I became athletic, social, smart, and developed leadership skills. I took extra college credits in addition to working 10 to 20 hours a week. I was having a great time experiencing this new life. I also internally developed an identity of being stable as a rock and “cool.” Nothing phased me or stopped me. I never got angry and thought it was a waste of time. I was somewhat legendary with regards to how much stress I could take for how long. When I entered medical school, I developed another identity of “being compassionate, wise, and a good listener.”

It worked great until it didn’t. It unraveled in 1990 when I began experiencing panic attacks out of the blue and I didn’t even know what anxiety was. It marked the beginning of a 13-year burnout and descent into hell. By 1997, I had a full-blown Obsessive-Compulsive Disorder (OCD), which is characterized by intense and unrelenting intrusive thoughts. I had the internal version of OCD with no outward behaviors. I had an endless string of intense negative intrusive thoughts that I would counter with positive thoughts. OCD is one of the more severe anxiety disorders.

I didn’t become a major spine surgeon by having anxiety. I achieved it by suppressing it. My modes of suppression included positive thinking, determination, not complaining, and moving through any obstacle that might be holding me back.

Avoiding the Ring of Fire

None of us enjoy the feeling of being anxious and vulnerable so we avoid it. We suppress it, avoid stressful situations, control ourselves and others around us, and mask it with anger. The ring of fire is not the place that we want to live.

I did what most of us do, in that I worked hard to stay in the blue by creating a life that was enjoyable, busy, interesting, and stimulating. Additionally, I became so enmeshed in this process that my identity became the blue zone. For many years I was successful or at least it felt like I was. The energy of my youth kept me hovering above the red to the point that I didn’t even know what the word anxiety meant.

“Bring It On”

I admitted a patient with an anxiety disorder during my first year of orthopedic residency. I was perplexed and I had to look up anxiety in my textbook of medicine. I was moving so fast that I was fearless – except I didn’t have a clue that my speed was because I was running so scared.

I remember sitting in my office late one evening in 1990 thinking about my day. I had a patient who I had just surgically drained for a huge deep wound infection, another one of my patients, who weighed over 300 pounds, had just gotten in an altercation with the hospital security guards, I didn’t get a paycheck that month because of high office overhead, and I had a malpractice lawsuit notice sitting on my desk. My thought was, “This is a bad day but bring it on.” I thought I could deal with almost anything. Two weeks later, I had my first panic attack driving across a bridge over Lake Washington at 10 o’clock at night.

It takes a lot of energy staying out of the ring of fire and my hovercraft ran out of fuel. I went into a 13-year tailspin that I survived out of luck or fate, depending on how you want to view it. By 2002, I didn’t have a shred of hope after trying every possible means to pull myself out of it. I did not realize that by spending so much effort trying to both treat and avoid anxiety that I was actually fueling it. I think most of us spend a lot of our time between the blue and the red trying to stay out of the red. It eventually wears you out and it can’t work. We spend much of our lives developing a façade to present to the world and ourselves that does not include having anxiety. “You have anxiety?” The problem is that anxiety is the essence of survival and is the core neurological response to the environment in every living creature – especially humans.

The Center

One issue is that you can’t be connected to the core of who you are (center green circle) when you are moving at a thousand miles per hour.

An obstacle stopping you from getting to the center is that you have to pass through the “ring of fire.” It’s critical that you learn to live with anxiety and it is intended to be unpleasant. It isn’t going to disappear, otherwise, you’d die. The paradox is that the more you fight it or try to fix it, the more powerful it will become. Also, as you age, anxiety will increase with repetition. For my generation (baby boomers), the age that I think it seems to become troublesome is in the mid- to late 30s. My problems began at age 37. These younger generations are in trouble in that the incidence of chronic pain has risen dramatically in adolescents. I witnessed this trend in my office and saw many patients in their 20s with widespread chronic pain and crippling anxiety.

I now live much of my life in the center and quickly am aware when I am in the red. I’m not happy about the way I found my way to the center. I don’t think that it’s necessary to endure the extreme suffering I experienced to find it. I was in chronic pain for 15 years with the last seven being intolerable. I ended up in the center by completely being stripped clean. Every link to the identity that I had created for me was broken and there was nothing left. Living in the red for many years was intolerable. I lost the capacity to enter the blue zone. During the worst part of my ordeal, I was working on trying to survive the next 10 minutes.

You do have to go through the ring of fire to get to the center and also from the center to the blue. It is a learned skill and anxiety becomes assimilated into your life and becomes somewhat of a non-issue. You don’t have to go down in flames to enter the green zone.

Getting Into the Center

Although it is a commonly held belief that you have to endure severe suffering to truly connect to your true self, I don’t buy it. I feel the key is whether you are open to new ideas and change. Extreme suffering often breaks through the barriers, but simply taking on the mindset of a seeker is much easier. Here are some suggestions for entering the center of the circle.

Separating from your anxiety:

• Expressive writing.
• Meditation.
• Awareness.
• Be open to outside help.
• Understand that anxiety is a neurophysiological reaction that is not subject to rational interventions.

Decreasing your stress chemicals:

• Mindfulness.
• Exercise/ Martial arts.
• Forgiveness.
• Engaging with your passion – regardless of your pain levels. Who and what is going to run your life?
• Not discussing your problems with everyone who will listen.
• Be nice – especially your family without exception.
• “No action in a reaction.”
• Adequate sleep.
• Training yourself to be OK with unpleasant emotions.

It is always a combination of approaches that will calm and re-route your nervous system.

Living in Center

You also have to pass from the center through the ring to take on new projects, challenges, and relationships. It is bi-directional. I live much of my life in the center and am aware every time I pass through the ring of fire in either direction. It is a learned skill that steadily becomes less difficult.

It doesn’t require effort to be in the green center and stay there. I’m not in a constant mental frenzy. I’m aware when I’m not there and quickly use the tools that I learned to return to the center. I have almost an endless amount of emotional energy and am limited just by the hours of the day and getting physically tired.

One metaphor that has stuck with me came from reading a small book, 365 Tao. I often become overwhelmed with everything that needs to be done and I do take on too much. One thought for the day described a stork who patiently stands in one spot waiting for a fish to swim by. It simply reaches down and grabs its next meal. You can only accomplish what is in your “sphere of influence” and that is enough.

I’m also sobered when I get stuck in the red ring. One day of being in this spot sucks out the equivalent of a week’s energy. What’s sobering is that I lived so much of my life in this state without any awareness of its existence.

By the way, Johnny Cash’s depiction of the ring of fire is remarkably accurate. The antidote to anxiety is control. Falling in love creates a loss of control – and also liberates you. It is a great experience until we try to reel ourselves and the other person back in. What if you could live your whole life with that degree of freedom?

Johnny Cash – “The Ring of Fire”