by Sam Kean
Perhaps the most transformative application of exposure therapy is using it not to combat specific phobias, or even broader anxiety-based disorders, but post-traumatic stress disorder. In 1980, PTSD was included for the first time in the Diagnostic and Statistical Manual of Mental Disorders. In the decades since, our understanding of the disorder has grown, and so has our grasp of its staggering reach. We now know that PTSD affects not just soldiers and civilians emerging from war but also drone operators who’ve never left their home base; first responders from beat cops to search-and-rescue volunteers operating out of luxurious mountain resorts; survivors of car wrecks, assaults, and less obvious forms of trauma.
But back in the early 1980s, “we didn’t have any studies on PTSD,” Foa said. “And I thought, well, this is an anxiety disorder, there is no reason why we cannot adapt the treatment, the exposure therapy treatment, to PTSD.” You can’t re-expose someone to a rape or a bomb, so Foa settled on a program of imaginal exposure for the traumatic memory itself but in vivo exposure to the secondary effects: the patient’s avoidance behaviors, which can perpetuate trauma’s power. In sessions with therapists, patients would confront the memory using imaginal exposure. Their “in vivo” exposure came as homework: going to places that reminded them of the trauma, or to safe places they perceived as dangerous. Sometimes that meant walking a downtown street at night after a violent assault or going to malls again after a mass shooting.
Throughout the 1990s, Foa’s team taught other groups of therapists how to administer what she called prolonged exposure therapy (or PE), and how to monitor the results. They found that PE was effective in almost 80 percent of patients: between 40 and 50 percent became essentially symptom-free, while 20 to 30 percent still had some recurring symptoms but were much improved. “We’re not 100 percent successful,” she said, “but no treatment is.” She launched PE into the wider world with a series of papers in the late 1990s, and within a few years the program had become the gold standard for treatment of anxiety disorders and PTSD. In 2010, Foa was named one of Time’s 100 most influential people. “No one is doing more” to end the suffering caused by PTSD, the magazine declared.
An estimated 8 million American adults experience PTSD every year. Nineteen million more deal with specific phobias, 6 million with panic disorders, 7 million with generalized anxiety disorder, and more than 2 million with OCD. The Anxiety and Depression Association of America estimates that only one-third of anxiety-disordered patients receive treatment. Now, researchers are exploring whether pharmaceuticals can enhance the effectiveness of exposure therapy, while others have applied variations of PE to grief, depression, eating disorders, and beyond.
Compared to living with PTSD or broader anxiety disorders, my fear of heights is trivial. It doesn’t keep me awake at night, or ruin my relationships, or bleed into every area of my life. If I moved back to the flatlands and avoided high-rise balconies, dodging my symptoms by practicing avoidance, I would hardly notice it.
Still, it can limit me. I would have liked to climb that mast high into the rigging, to enjoy the view over Florence. Sometimes I get scared on bridges or balconies, and I have still never climbed a tree. Taken individually those are all tiny things, but they add up to a feeling of helplessness: my choices are not entirely my own.
The rock was cold enough to numb my fingers. It was October 2, and I was on my eighth and final climbing excursion of the season, before winter set in. All summer, I had gone climbing every time someone with the necessary expertise and gear was willing to take me along. I had tried to systematize my outings, repeating the same routes to see if I could get farther, and stay calmer, each time.
In previous years, I would have pushed myself until my panic was unbearable, hoping that I could pop it like a soap bubble if only I tried hard enough. But now my strategy was to go only as far up as I could without paralysis setting in. The goal was to build up the alternate structure in my brain that said, “This is okay. You are safe,” then come down before the old structure could assert itself, and hope to get a foot or two farther next time around.
For this last outing, three friends and I were at Copper Cliffs, a crag in Whitehorse’s semi-industrial backyard: once a booming copper-mining area, now a maze of quarries and mountain biking trails and small, shallow lakes. I was climbing Anna Banana, a short, beginner-friendly, 16-foot route up one side of an arête, a sharp wedge of rock protruding from the main cliff face. My first steps had been on easy footholds, gaps cutting into the leading point of the wedge, and I had no trouble until my feet were seven and a half, eight feet off the ground. I stalled out there, my right foot resting on a good ledge just around the corner of the arête while my left toe was tucked into a little cubbyhole a foot below. To continue, I had to pull my left leg up several feet, to the next good hold.
I raised my arms and patted the rock above my head, blindly seeking out handholds that I could use to pull myself up higher, to give my left foot a fighting chance. I tend to trust my hands and arms first, even though my legs are exponentially stronger: we’re less accustomed to trusting a narrow toehold than a fist clamped around something solid. But I didn’t find what I was looking for, so instead I spread my arms out wide and locked my fingers around the best stabilizing holds I could reach. Then I pushed off with all my weight on my right foot, pulled my arms tight to keep me close to the rock face, and scraped my left foot up the wall until I found the next hold, just as my right toe lost contact with the rock. I balanced there for a moment, then raised my hands to holds suddenly within my reach and pulled up my dangling right foot.
I had done it. More importantly, I had done it calmly and coolly, without needing extra minutes to fight off panic, without groaning and moaning before I gave it a try. My belayer lowered me down so I could climb up and do it again—more confidently, with even less hesitation. This time I kept going, through a series of easy moves to the top of the route, where I reached up and smacked the anchor bolts in triumph: a touchdown spike. I did a quick mental survey of my body: my breathing was steady, my head clear. For today, at least, I had successfully redirected my brain to reject fear.
Months later, I’m still working on training my brain. I’ve kept climbing through the winter, at big indoor gyms in San Francisco and Vancouver and on small, homemade climbing walls here at home; in local schools and in a friend’s basement. By my standards, I’ve made substantial progress. These days my chest doesn’t constrict and my pulse doesn’t start to pound in my ears until I’m much higher off the ground: 6, 8, 10 feet. Sometimes I can complete an entire short route without feeling afraid at all.
I’ve started applying the basic ideas behind exposure therapy in other areas of my life too. So often, whether in our careers or our athletic endeavors or even our love lives, we’re encouraged to “take the plunge,” to “push our limits,” to “go big or go home.” But my DIY climbing therapy has taught me the value of care, of caution, of building up your abilities and endurance slowly to reach a larger goal. Taking the plunge has its place, but sometimes it’s enough to immerse yourself toe by toe.
KATHRYN SCHULZ
Fantastic Beasts and How to Rank Them
from The New Yorker
Consider the yeti. Reputed to live in the mountainous regions of Tibet, Bhutan, and Nepal. Also known by the alias Abominable Snowman. Overgrown, in both senses: 8 or 10 or 12 feet tall; shaggy. Shy. Possibly a remnant of an otherwise extinct species. More possibly an elaborate hoax, or an inextinguishable hope. Closely related to the Australian Yowie, the Canadian Nuk-luk, the Missouri Momo, the Louisiana Swamp Ape, and Bigfoot. Okay, then: on a scale not of zero to ten but of, say, leprechaun to zombie, how likely do you think it is that the yeti exists?
One of the strangest things about the human mind is that it can reason about unreasonable things. It is possible, for example, to calculate the speed at which the sleigh would have to travel for Santa Claus to deliver all those gifts on Christmas Eve. It is possible to assess the rat
io of a dragon’s wings to its body to determine if it could fly. And it is possible to decide that a yeti is more likely to exist than a leprechaun, even if you think that the likelihood of either of them existing is precisely zero.
In fact, it is not only possible; it is fun. Take the following list of supernatural beings:
_ Angels
_ Giants
_ Demons
_ Pegasus
_ Dragons
_ Centaurs
_ Pixies
_ Unicorns
_ Ghosts
_ Tooth fairy
_ Harpies
_ Phoenix
_ Elves
_ Werewolves
_ Mermaids
_ Vampires
_ Loch Ness monster
_ Genies
_ Leviathan
_ Zombies
Never mind, for now, whether or not you actually believe in any of these creatures. We are interested here not in whether they are real but in to what extent they seem as if they could be. Your job, accordingly, is to rank them in order of plausibility, from most likely (No. 1) to least likely (No. 20). Better still, if you are in the mood for a party game this Halloween season, try having a lot of people rank them collectively. I guarantee that this will produce a surprising amount of concord—who among us could rank the tooth fairy above the Leviathan?—as well as a huge amount of impassioned disagreement. The Loch Ness monster will turn out to have a Johnnie Cochran–level defense attorney. Good friends of yours will say withering things about mermaids.
What’s odd about this exercise is that everyone knows that “impossible” is an absolute condition. “Possible versus impossible” is not like “tall versus short.” Tall and short exist on a gradient, and when we adjudge the Empire State Building taller than LeBron James and LeBron James taller than Meryl Streep, we are reflecting facts about the world we live in. But possibility and impossibility are binary, and when we adjudge the yeti more probable than the leprechaun we aren’t reflecting facts about the world we live in; we aren’t reflecting the world we live in at all. So how, exactly, are we drawing these distinctions? And what does it say about our own wildly implausible, unmistakably real selves that we are able to do so?
In the fourth century B.C., several hundred years after the advent of harpies and some two millennia before the emergence of dementors, Aristotle sat down to do some thinking about supernatural occurrences in literature. On the whole, he was not a fan; in his Poetics, he mostly discouraged would-be fabulists from messing around with them. But he did allow that, if forced to choose, writers “should prefer a probable impossibility to an unconvincing possibility.” Better for Odysseus to return safely to Ithaca with the aid of ghosts, gods, sea nymphs, and a leather bag containing the wind than for his wife, Penelope, to get bored with waiting for him, grow interested in metalworking, and abandon domestic life for a career as a blacksmith.
As that suggests, for a possible thing to seem plausible it must be reasonably consistent with our prior experience. But what makes an impossible thing seem plausible? In a convoluted passage in the Poetics, Aristotle tells us that if an impossible thing would “necessarily” require something else to occur along with it, you should put that second thing in your story too, because then your readers will be more likely to believe the first one. In other words, even something that is factually impossible can be logically possible, and how closely that logic is followed will affect how plausible a supernatural being seems.
There’s a reason Aristotle addressed this advice to writers and artists. Unlike most of us, they have practical motives for wondering how best to make imaginary things seem convincing, a problem that must be solved as much for Vanity Fair as for A Wrinkle in Time. Accordingly, creative types have done an unusual amount of thinking about plausible impossibility. In the 1790s, for instance, Samuel Taylor Coleridge set out to write a series of poems about “persons and characters supernatural.” To do so, he knew, he had to make the fantastical seem credible—“to procure for these shadows of imagination,” he wrote, in a soon to be famous phrase, a “willing suspension of disbelief.”
Coleridge was excellent at inducing a suspension of disbelief. That’s why we are as gripped by “The Rime of the Ancient Mariner” as the wedding guest within the poem who can’t tear himself away from the sailor’s tale—even though the tale itself is an outrageous one involving a magical albatross, a terrible curse, and a ship crewed by ghosts. Yet Coleridge was vague about explaining how exactly he did it. His only advice for making impossible things seem believable was to give them “a semblance of truth.”
A little more than a hundred years later, a very different kind of artist got somewhat more specific. Although Walt Disney is best remembered today for his Magic Kingdom, his chief contribution to the art of animation was not his extraordinary imagination but his extraordinary realism. “We cannot do the fantastic things, based on the real, unless we first know the real,” he once wrote, by way of explaining why, in 1929, he began driving his animators to a studio in downtown Los Angeles for night classes in life drawing. In short order, the cartoons emerging from his workshop started exhibiting a quality that we have since come to take for granted but was revolutionary at the time: all those talking mice, singing lions, dancing puppets, and marching brooms began obeying the laws of physics.
It was Disney, for instance, who introduced to the cartoon universe one of the fundamental elements of the real one: gravity. Even those of his characters who could fly could fall, and, when they did, their knees, jowls, hair, and clothes responded as our human ones do when we thump to the ground. Other laws of nature applied too. Witches on broomsticks got buffeted by the wind. Goofy, attached by his feet to the top of a roller-coaster track and by his neck to the cars, didn’t just get longer as the ride started plunging downhill; he also got skinnier, which is to say that his volume remained constant. To Disney, these concessions to reality were crucial to achieving what he called, in an echo of Aristotle, the “plausible impossible.” Any story based on “the fantastic, the unreal, the imaginative,” he understood, needed “a foundation of fact.”
Taken together, Disney’s foundation of fact and Coleridge’s semblance of truth suggest a good starting place for any Unified Theory of the Plausibility of Supernatural Beings: the more closely such creatures hew to the real world, the more likely we are to deem them believable. But the real world is enormous, wildly heterogeneous, extraordinarily complicated, and, itself, often surpassingly strange. So if, indeed, the most plausible supernatural creatures are those which most resemble reality, the question becomes: which part?
The obvious candidate, at first glance, is the animal kingdom. Supernatural creatures are, after all, creatures, and we infer from them, or impose upon them, all kinds of biological characteristics. Like their natural counterparts, they can be organized by taxon (cervid, like the white stag; caprid, like the faun; bovine, like the Minotaur; feline, like the sphinx), or by habitat (alpine, like yetis; woodland, like satyrs; cave-dwelling, like dragons; aquatic, like mermaids). Given this tendency to situate unnatural beings in the natural world, it seems conceivable that our judgments about their plausibility might reflect how well they conform to the constraints of modern biology.
If that’s the case, our friend the yeti should rank very high on the believability scale. So, too, should giants, elves, unicorns, ogres, imps, sea monsters, and pixies. By the same token, this biological theory would deal a credibility blow to angels, demons, fairies, vampires, and werewolves, plus all those creatures assembled, as by an insane taxidermist, from the separate parts of real species: mermaids, griffins, centaurs, chimeras, sphinxes. It would also undermine the plausibility of fire-breathing dragons, there being no analogue in nature to a Zippo. In fact, biological limitations cast doubt on dragons in another way as well, since four legs plus two wings is not a naturally occurring configuration—a bummer also for harpies, griffins, gargoyles, and Pegasus.
If you couldn�
��t make it through that paragraph without starting to formulate an objection, you already know the first problem with this theory: it invites a lot of quibbling over what is and isn’t biologically feasible. As defenders of the supernatural will be quick to point out, many arthropods have six limbs; squids, skunks, bombardier beetles, and plenty of other real creatures spew strange things; nature sometimes contrives to recombine old animals in new ways (see the half-striped zedonk—part zebra, part donkey—or the recent emergence of the coywolf: part coyote, part wolf); and, considering the many kinds of metamorphoses exhibited by animals—tadpole to frog, caterpillar to butterfly, baby-faced to bearded—how far-fetched is it, really, for a bat to turn into a man?
Indeed, some fantastical creatures seem positively ordinary compared with the more byzantine products of 4 billion years of evolution. Consider the giant oarfish, a 36-foot-long behemoth with a silver body, a bright-red mane, and a tendency to hang out in the ocean vertically, like a shiny piscine telephone pole. Or consider the blue glaucus, an inch-long hermaphroditic sea slug capable of killing a Portuguese man-of-war—a beast 300 times its size—and then storing its poison for later use, including on humans.
Given so much natural extravagance, it’s not surprising that the real and the unreal are sometimes mistaken for each other. In 1735, when Carl Linnaeus organized all the species in the world into one vast taxonomy, he included a section on “Animalia Paradoxa”: creatures, common in folklore and myth or attested to by far-flung explorers, that he felt compelled to itemize yet deemed unlikely to exist. Among these were the manticore (head of a man, body of a lion, spiky tail), the lamia (head of a man, breasts of a woman, body of a scaly cow), and the Scythian lamb (like a regular lamb, except it grows out of a stalk in the ground)—but also, arrestingly, the antelope and the pelican. Conversely, a contributor to This American Life once recounted the experience of asking a group of strangers at a party, in all sincerity, whether unicorns were endangered or extinct. One sympathizes. Consider the giraffe. Consider the kangaroo.