Forty years ago in rural Tanzania, Harry Barry was walking home at 3am from the missionary hospital where he worked when a leopard crossed his path.
Three in the morning is not a good time to meet a leopard, if indeed such a time exists, but luckily for Dr Barry, he was well-armed. He had his amygdala.
It may sound like a cross between a lucky amulet and a medieval cutlass but the amygdala is a far less fanciful device.
It is two small bunches of neurons either side of the brain and its job is to spot leopards and other assorted hazards likely to lose a human a limb, or worse.
Once it has seen the danger, it reacts with lightning speed so, with it in charge of the situation that night in the Tanzanian bush, Dr Barry instantly froze. That was a critical reaction as movement would attract attention.
Dr Barry takes up the story.
“Then suddenly I was shaking, I was sweating, I was hyper-ventilating, my muscles were tense, my mouth was dry.
“My amygdala was getting me ready to run and it did that by sending messages that caused adrenaline to be poured into my bloodstream.
“I let the leopard go by about 10 yards and then I ran. I really ran. And then I got back to the house and after about 15 minutes, everything went back to normal — my breathing, my heart-rate — because the danger was gone.”
For years, the leopard encounter served Dr Barry simply as a colourful anecdote from a period in his life. However, later, in his work as a GP in Drogheda, Co Louth, the experience took on new significance.
He says: “Think about the physical response I had. The shaking, sweating, hyperventilating, the dry mouth, the tense muscles. They’re exactly the things that you get in a panic attack.”
Yet his reaction to the leopard made perfect sense and probably saved his life in the face of real danger.
Panic, on the other hand, is a disproportionate reaction to a perceived danger and serves no practical purpose.
So how come the physical responses are almost identical? What is going on in the mind and what does it suggest about the way panic and the related affliction of anxiety should be treated?
Questions like this came to intrigue Dr Barry over the years as he found himself veering towards specialising in mental health.
He was struck by the large number of patients he saw with mental health issues, and bothered by his own profession’s struggles to comprehensively and conclusively treat them.
ine years ago he wrote his first book on the subject, Flagging The Problem: A New Approach To Mental Health, in which he touched the main mental health problems found in a GP’s waiting room.
Since then he has returned to them to explore each in more depth and has become a regular contributor to RTÉ Radio’s Today with Sean O’Rourke.
His latest book, the sixth in the series, is Flagging Anxiety and Panic – How To Reshape Your Anxious Mind And Brain.
Published in the spring this year, it sold out before summer and a second print run is now arriving on bookshop shelves.
That’s the unscientific way of knowing there are a lot of people out there suffering from anxiety in all its forms — general, social, acute, phobias, post-traumatic stress — all the way to the dreaded and debilitating panic attacks.
Dr Barry would like to be more precise in enumerating them but as he says in the book itself, those living with the problem dwell in a “hidden shadowy world”.
“People suffer in silence. What commonly brings people to me for the first time is that while they may have a history of being generally anxious, eventually they get persistent, low-grade physical symptoms.
“They’re exhausted all the time or they can’t sleep or they have irritable bowel or they feel short of breath. They’ll ask for help with those things when what they really need help with is the anxiety that’s causing the symptoms.
“I have seen people in some cases who have had panic attacks for 20 or 30 years without getting help.
“The problem is that anxiety was the poor relation of depression for many years. If you weren’t depressed, if you were ‘only’ anxious, the attitude was: ‘sure that’s nothing’.
“The language we used to use for someone who was anxious didn’t help either. They were either neurotic or they were suffering with their nerves. It was quite disparaging.
“The funny thing is that, when we spoke of suffering from nerves, there was a certain amount of truth in it because we now know that anxiety is a neurological response,” he said.
And that brings us back to the amygdala. “The amygdala is this very ancient organ in our emotional brain and its job, its only job, is to look for danger,” says Dr Barry.
“I call him the gunslinger because he draws and fires without thinking. He’s very trigger happy,” he says.
That’s an important attribute when encountering wild beasts. You don’t want a lengthy internal debate going on about the probability of an attack when a limb or two could be lost before the discussion concludes.
However, a problem arises when the amygdala starts seeing leopards in everyday situations, when the normal anxiety that life’s problems and challenges create becomes a constant feature, regardless of how minor, or imaginary, the problems are.
Dr Barry calls it ‘catastrophising’. “Everybody gets anxious but most of the time there are fairly obvious reasons for it.
“If you have a job interview or an exam or a loved one is unwell, you’re going to feel anxious and probably get some of the natural physical reactions.
“But when that kind of anxiety becomes chronic, where we start to worry about everything, including things that are never going to happen, when we spend all our time visualising the worst case scenario and how awful it is going to be, when our amygdala is firing all the time, that’s catastrophising and that is absolutely not healthy,” he says.
Why this should happen to some people and not others is not terribly clear. It is believed genetics plays a part in that some people may be predisposed to anxiety.
Growing up in an anxious household can also leave its mark, particularly for someone with a predisposition. Suffering a traumatic experience can also be a trigger.
n Dr Barry’s experience, gender can also be a factor as he believes women are twice as susceptible to anxiety than men. And then there are the times we live in.
“We live in a world of almost daily catastrophe. Every time we turn on the radio or TV there’s some other disaster.
“In the old days that might have taken a week to get to the papers. Now we know about it within 30 minutes because of social media.
“The trouble with that constant barrage of negative bad news is that it is inclined to hype us up so we almost wait for the catastrophe to happen,” he says.
When dealing with patients, however, he is less concerned with pinning down the reason they are anxious than finding a way to help them.
“We can often trace what happened to trigger the anxiety but that doesn’t help us move on. I use the line that if I had a puncture and I was stuck on the M50, is it better to have the skills to know how to change the tyre or walk back 10 miles to where we got the puncture?
“Now if I was getting a lot of punctures, it might be useful to go back and find out where I got them but, for most people, they just want to be able to change the tyre and move on,” he says.
Speaking of the M50, one of the many examples Dr Barry has to show just how intrusive chronic anxiety can be, is that patients drive from all over the country to see him, some without ever taking a motorway.
They are convinced they will have an accident on the fast road and get so anxious at the thought of it, that they’d rather go miles out of their way on rural and national routes when the reality is that far more people die on those roads than on our motorway network.
Back to that puncture. Is it possible to learn to change the tyre and move on? The clue is in the book’s subtitle: ‘How to reshape your anxious mind and brain’.
“The whole reason for writing this book is that, number one, I felt people didn’t understand the physical side to anxiety and secondly, that there are very simple techniques we can use that are absolutely transformative.”
So whatever about the leopard’s inability to change its spots, it seems those who feel him perpetually on the prowl can alter the way they see him.
“We call it ‘neuroplasticity’ — the ability of the brain to change. We know from brain scanning we can physically change the pathways in our brain and alter the messages it sends. You are not doomed to be anxious for the rest of your life.”
Dr Harry Barry will be speaking and signing books in Waterstones, Cork on September 22 at 7pm. He will also be speaking at the Dublin Book Festival in November.
‘Flagging Anxiety and Panic: How To Reshape Your Anxious Mind And Brain’ €14.99
When Dr Barry tells patients he’s going to help them rewire their brain, the response can be bafflement but his book shows how it’s done through examples and case studies featuring ordinary people with whom readers will readily identify.
His methods are based on cognitive behavioural therapy and require the patient to examine in depth the issues and incidents that distress them.
They are asked to break them down into bite-size pieces that they can analyse calmly to see what about each one is so alarming and whether, if looked at from another perspective, they could be dismissed as unlikely to have any consequences, or, at worst, consequences that would be perfectly manageable.
“You’re taking back control from the amygdala, enabling the logical part of the brain to over-rule its responses so that it learns to keep its guns in its holsters when they’re not needed. It will still fire in an emergency but it won’t fire inappropriately,” he said.
To start with, he often employs one of the most trusted cognitive behavioural therapy methods — the ABC technique devised by the late pioneering psychologist Albert Ellis.
A is for activating event — identifying the trigger causing the anxiety. B is for belief — what the person believes will happen as a result, what they believe they will have to do about it and the demands they put on themselves in response. C is for consequences — the person’s emotional, physical and behavioural reactions, voluntary and otherwise, to A and B.
“It helps to really clarify for the person what is happening to them because with anxiety, everything can be very overwhelming. We need to help the brain sort out the facts to begin the process of changing its reaction to events.”
For those suffering from panic attacks, the first task is to clarify the source of their terror.
“People will say it’s a particular situation or maybe going into a lift or an open space, but what they’re really scared of is the physical response to their anxiety.
“They feel like they’re going to have a heart attack or that they’ll suffocate because they can’t breathe so that’s what terrifies them and makes them want to flee — out of the lift, back indoors or to A&E.
“I get people to either physically or in their imagination go to those places and situations and imagine that they’re stuck to the floor so they can’t run — they have to experience the panic and let it flood over them.
"It’s hard but when you realise your heart kept beating, you didn’t stop breathing, that these reactions are very uncomfortable but not dangerous, you’re on the road to recovery.”
He says some of his patients have been cured after a few sessions and it frustrates him that cognitive behavioural therapy practitioners are not more widely available in the public health system.
He doesn’t entirely rule out medication where symptoms are very severe, but warns that while drugs can provide relief by dulling the amygdala’s responses, they also stop it learning to change its behaviour which is the ultimate goal.
Even a deft exercise in brain rewiring can benefit from a dose of common sense though and Dr Barry pleads with people not to neglect the obvious.
“We need to take care of ourselves. We need a good diet with plenty of omega 3 oils, we need exercise, relaxation, sufficient sleep. We don’t need the second glass of wine and, if I could suggest just one thing, it would be to put down the mobile phone.
If I had my way, no child under 14 would have any phone other than a basic one to make calls and send texts.”