Fear is a response to a physical threat. While Anxiety is a response to a mental threat. Acute anxiety and fear has similar bodily and physiological responses. The body is ready for either fight or flight.
As a psychiatrist, I have dealt with anxiety all the times, but rarely you get opportunity to deal with fear, unless it is hidden under phobia.
When I was working in east London, at St. Clements hospital, one morning, as I arrived at 9am. A senior house officer stopped me and said he needed my help. Apparently, a man became aggressive and was out of control at his work place. Police were called to tackle him. While resisting arrest he fell in a blue dye drum. He was completely covered in a blue dye. It took eight policemen to arrest him and bring him to St. Clements as he was aggressively fighting with them. S. H. O. told me that he could not take any history and his attempt to give him tranquiliser met aggressive response. He only knew that he was agitated in workplace and every attempt to pacify him met with more agitation. Workplace had to called police. While trying to run away from police he fell in a tub of dye.
I went to see the patient. He was on floor. He was held by seven police officers. Two officers were holding right leg, one right arm. One was holding his head. Another officer was holding left arm and remaining two left leg. Eighth officer was ready for any assistance. I tried to make contact with patient. I said “Hello”.
He responded “You pakki go home” he continued “you pakki chapati.” I was unperturbed from his racial attack. I responded, “Have you ever tasted chapati?” He seemed unsure of my response to him. He replied “No.” I further responded, “then you do not know what you are missing in your life.” Without being threatened by him symbolically I communicated that I have something to offer him. He had no further response. Few seconds passed in silence. He further asked, “Doc do you have a cigarette?”
“I don’t.” but I turned to police officers if anyone has a cigarette which can be spared. One officer gave me a cigarette. I was about to give him, but his both hands were held by the officers. I asked a police officer who was holding his right hand to let it go. He was hesitated, but I encouraged him with my eyes. I gave the patient a cigarette in his released right hand. Another officer helped to light up his cigarette He started taking puffs. He was no longer agitated. I said “look at yourself. What is your condition. I like to admit you in the ward, where you can clean up yourself. We will give you some tranquiliser so sleep for a while. Later we will talk about your situation”. He agreed. We got a couple of nurses from the ward to accompany him. All police officers released him. His agitation had disappeared. I did not have to section him under mental health act or arrange a compulsory admission or had to give him medication against his wish.
I was able to move situation with minimal intervention. Both patient and police officers were tired of their situation. Patient needed grace exit, without losing his face from situation. If I would have reacted to his aggressive and racist behaviour, or I would have responded with institutionalised aggressive behaviour like “I am a doctor, you do what I say or threaten him with compulsory admission under mental health act, would have been locking into his aggression. By taking about chapati and granting him a cigarette, I was offering him an unthreatened human response. He was able to give in gracefully.
Fear breads fear, aggression breads aggression. Lots of time fear is expressed as aggression. Hence it is very important that health care staffs, police officers, prison officers etc should have good training so they learn to cope with aggression from their clients without reacting.
