Part 2- The Three Worlds: Survival, Emotional, And Practical
THE SURVIVAL WORLD
(SW)
At the conclusion of the previous blog post, I listed the Axioms that apply to all three of these Worlds in general. Here are the Axioms that apply to the SW:
This is a life or death World.
It is satisfied when there is an outcome, whether it is good or bad.
Denial in this world can be and is often deadly.
In medicine, there is a simple and true saying, if slightly grim, “One way or another, all patients stop bleeding.” Think about it. That is the essence of the SW. It is a world with an outcome, hopefully a good one. It can appear at any moment and without warning. The phone rings and the next thing we know, we are leaving the party that we were enjoying and rushing to the hospital, no questions asked. There are no longer any thoughts of the party. As Winston Churchill said, “Nothing focuses the attention like being shot at.” That is the SW.
When the SW appears and is recognized as being present, all other concerns remove themselves into the background. It is automatic, appropriate, and often helpful to adrenalize at a very high level. There are lots of true stories of people being able to perform seemingly superhuman feats while adrenalized. “You picked up the bumper of that car yesterday to save your grandson?” “Yep.” “Let me see you do it again.” “Sorry, I can’t get out of my rocking chair due to my arthritis.” That is the “gift” of adrenaline in the SW.
The greatest danger when the SW appears, other than the life or injury-threatening event itself, is DENIAL. If the SW is not perceived, then no action appropriate to the situation will be taken. I have a host of examples of men and women going through the symptoms of heart attacks where the person took no action until almost too late. In particular, it is easy for women to deny if a heart attack is taking place because their symptoms are very different from a man’s and much less dramatic.
There was a member of the Meyer Friedman Institute (MFI) Board of Trustees who was scheduled to go on an AIDS awareness hike with some friends. In addition to being on the board, he was a physician and medical director of a large multinational corporation. When his friends arrived to go with him to the walk, he looked pale and complained of not feeling well. One person suggested they call 911. “No, I think its just a bug that is coming on. You fellows go on the walk and come back here afterward. If I still feel bad, you can take me to the hospital.” He was the doctor after all. They agreed and returned in a few hours to find him dead.
When the SW does appear and is recognized, it is first and foremost a world that is only satisfied by taking action. It is intense and driven by specific data. Adrenaline is abundant and needs to be harnessed. Emotions are of no importance, except as a possible diagnostic indicator. Someone has to take charge and take control.
When an aircraft is in an urgent situation, the person sitting in the left hand seat makes the decisions and everyone else follows. There is only one head surgeon in an emergency operation. The goal is to preserve life or to limit crippling injury. Time is of the essence. Action cannot be postponed, but neither should time urgency overrun expertise.
Years ago one of my colleagues was talking to a cardiovascular surgeon. She asked him, “If a patient is in the hospital and suffers the bursting of an aortic aneurism, how long do you have to correct the situation without permanent damage?” “About four minutes.” “That is not very long.” “It’s plenty of time (to open the chest cavity and clamp off the bleeding) as long as you don’t get in a hurry.”
When the SW appears, many PW concerns go out the window. “I don’t care what it costs, just save him.” Without hesitation, Winston Churchill understood the threat (SW) to the civilized world that was posed by the Nazis. In the first year of the war, he oversaw the spending of the accumulated wealth of the British Empire from the previous two hundred years. After that, they borrowed. It is an action world that requires urgency… focused and informed urgency.
For over a decade, I was part of a study conducted by the MFI that involved 3,000 participants. Half of these individuals were a control group and half were given TAB modification training for five years. It sought to find out if heart attacks can be prevented in healthy people by training them about TAB. The results were inconclusive, but there were many fascinating vignettes.
At one point, there were twenty-three heart attacks among those who had received the training. Of that number, three of them had succumbed. Now, this is a pretty astonishing statistic. In the general population, one would expect seventeen deaths to occur from a similar number of heart attacks. The difference: the participants had been trained to recognize all the signs of a heart attack and acted very quickly when they perceived one taking place and thereby received the treatment that saved their lives. They recognized immediately that the SW was in the room and acted.
The key issue with all three of the Worlds, SW, EW, and PW is recognition. If I cannot accurately identify the World that is “in the room,” I may pull out the wrong set of tools. The three Worlds are entirely different, each requiring a unique response.
In talking about the SW, it is obvious that its presence must be perceived, identified, and acted upon. What is not as obvious, is the need to identify when the SW is NOT in the room; thereby obviating the need for all the action, adrenaline and urgency. If someone points a gun at us with malice, there will be a lot of adrenaline secreted and rightly so. In that situation, there is no doubt about the presence of the SW.
Unfortunately, our brains can vividly imagine someone pointing a gun at us and our “crocodile brain” doesn’t know the difference and will serve up the same amount of adrenaline. It’s like the old saying, “All dressed up and no place to go.” The presence of the adrenaline seems to suggest that the SW is present, when it is not.
These adrenaline surges can also take place in times of interpersonal conflict or situational frustration. It is certainly not pleasant to be read the “riot act” by someone, especially a loved one, but no one is in danger. The senses of outrage or injustice are unpleasant, not fatal. It is hard to be cut off by a slow moving freight train as we are rushing to an important meeting, but no one’s life hangs in the balance.
It is important to know the “Guidelines” that are needed when each of the Worlds is present. Here are the guidelines needed for the SW.
FOR THE ACUTE PHASE OF THE SW:
To act immediately in spite of doubt, denial or fear of embarrassment.
To think in spite of being adrenalized (panicked).
To seek expert assistance as quickly as possible.
FOR THE CHRONIC PHASE OF THE SW:
To remember what is at stake (to yourself and loved ones).
To be obedient and follow directions (Doctor’s orders).
To become a maven of your illness and pursue its treatment.
(Someone once said that the secret to living a long life is to contract a treatable disease and follow doctors’ orders.)
To be effective in any of the three Worlds, there is a common necessity: an available and functioning pre-frontal cortex. Usually, the most effective thing we can do when the SW is suddenly present is to get to someone with a “trained pre-fontal cortex.” That would be the EMT’s and the ER folk.
I often say to warring couples, those who are able to escalate on the turn of a dime, “I am a hired pre-frontal cortex.” That means, I am trained to handle the non-life threatening conflict in the room without getting what John Gottman calls “flooded.” When one is flooded with adrenaline, it singles out a portion of the brain that has only one function: survival.
Of course, the World that is often in the room that is causing all the panic and discomfort is the EW. Most of us lack adequate training in this World and feel a great temptation to use copiously the tools of either the SW or the PW; all to no avail or satisfaction.
We must be able to identify when the EW is present and we need to understand the tools of that world and what satisfies it. The EW will be the focus of my next post.