Perhaps the greatest thrill in attending a summer meeting of the Wilderness Medical Society (WMS) is listening to new, enthusiastic and exciting speakers. They bring new insights and opinions to numerous topics and discussions, which is an essential part of the educational process. This past summer, at the 2010 Annual Meeting of the WMS held in Snowmass, Colorado, Dr. Drew Watters from the Indiana University School of Medicine approached the audience with his observations about neurobiology and survival. It was an innovative approach to a very common topic within wilderness medicine. How does one account for and handle emotions in a time of stress, including the most stressful situation of all—namely, a survival situation? When is it better to think, rather than to react? The objectives of his presentation were to understand to a certain extent survival, the anatomy of thought and perception, the neurobiology of emotions, behavior, emotive and cognitive decisions, and implementation of interventions in situations dominated by emotion.
Anyone who has practiced wilderness medicine knows that bad things happen, sometimes despite the best preparations and intentions. People make bad decisions that can too often be characterized as dumb. If they follow with more bad decisions, the situation can grow worse in a hurry. Conversely, there are individuals and groups that shine in difficult situations. They are probably more often survivors.
Strong emotions can prevail. Fear is a major emotion in dangerous or stressful situations. When it is appropriate, it is inherited, imparted, or learned. When fear becomes inappropriate, it is excessive, disabling, and may even be part of an incapacitating phobia.
What was my last personal physical emergency? I slipped on the ice and had a fracture-dislocation of my ankle. First, I was (very briefly) in denial. I can’t believe this just happened. Maybe it didn’t happen. When I tried to stand up and watched my foot fold in under my leg, and felt the lightning bolt of pain, there was no denying it. Then, I deliberated. What do I do next? Do I stay here or crawl out of a ditch in the middle of the night to position myself in the center of a dark road and hope to achieve assistance prior to being run over? I quickly decided—better to take a chance on an inattentive driver (not likely in the snowstorm) than on becoming hypothermic before getting myself rescued and transported to a safe environment.
Bad things happen because there is ample opportunity. Think about it. A good day is not just a day in which one has derived great pleasure or accomplished something important—it is also one during which nothing bad has happened. If you are an outdoor enthusiast, you are exposing yourself, so you need to know what that means for you personally and how to deal with it.
One thing is for certain: risky behavior increases risk. If you find this comment to be way too obvious, I apologize. However, when someone analyzes a bad outcome, they usually find that there has been some degree of risk unappreciated or ignored. Knowing how to manage risk is a lot of what we are about. That involves conditioning to a sense of safety, becoming more comfortable at a higher level of risk (either acclimating to it without lowering the risk or feeling like one is better able to manage a difficult situation), or diminishing the perception of risk (which is sometimes necessary to get through a tough circumstance).
There are many reasons why bad things happen. Some of the major causes are unfamiliarity or ignorance of the environment or situation, missing signals of impending demise or safer alternatives, or not knowing the options available at each phase of the activity, including during a crisis. Emotion is rarely a facilitator for improvement, unless it enforces good decision-making and the will to survive. When it induces anger, hate, or sorrow, it can create a big downdraft and suppress the beneficial effects of “good” emotions. Fear is an emotion. It can help or hurt, depending on how it is interpreted by the victim and translates into behavior.
When fear causes me to be vigilant, energized, and focused on what I need to do to succeed and survive, it helps me; when it makes me physically weak, nauseated, timid, or even paralyzed, it is counterproductive. In a medical setting, I am scared of certain situations wherein a bad decision or failure to perform means a bad or even horrific outcome for a patient. It is fear of failure, including the embarrassment that comes with it. When things go wrong, it can make me more methodical and motivated, or it can force me into a pattern of playing catch-up, which is fraught with increased risk and the potential for poor decision-making.
In an emergency situation, it is so important to do the first thing correctly—to establish a pattern of purpose of success. The best emotion I have found in such a situation is compassion. For me, all of the other emotions—denial, immobilization, panic, and arrogance—are not helpful. As stated by Dr. Watters, one seeks a state of productive preservation. Doing the first thing correctly means recognizing the situation, determining the best next move, being able to implement, and then reassessing in real time so that the interventions are appropriate to the situation and anticipated outcomes.