Do you ever imagine yourself in some extreme situation and wonder how you will react? Most of us will never find ourselves at the scene of a crime. Many people trained in CPR are never called on to actually use it. Being lost in the wilderness is, these days, quite rare. But a friend recently related an interesting story about an experience where he was in some danger of drowning, and it has a useful lesson about how people tend to react in a crisis, including health crises.
There are two important pieces of background information from my friend’s childhood: First, he never learned how to swim. Second, he had very bad asthma as a child. The two may have been related to one another: Children with asthma in the 1970s had fewer treatment options, and therefore much more often had the experience of not being able to breathe. They were also routinely advised not to do anything too strenuous (like swimming), for fear of provoking an uncontrolled asthma attack. When an attack did occur, a rescue inhaler could be used (daily “controller” medications were not yet in widespread use), but these inhalers were less immediately effective than today’s medications. Because of the limitations of medical science, children were often given more psychological advice about how to manage their asthma: Stay calm, tell yourself that it will be OK, and the attack will eventually pass so that you can breathe again. Without this type of self-talk, the experience of breathlessness could lead to panic and an increased need for air that would worsen the attack.
These childhood experiences became less important over time as asthma medications improved and my friend grew out of his early breathing difficulties. But they came to the fore when he and his girlfriend went on an offshore kayaking expedition in Mexico. They were in a two-person kayak, following along the coastline as part of a group, when the ocean grew rough. A large wave came up alongside the narrow kayak, and the two of them were tipped out into the Pacific. This would be a terrifying experience for anyone, but especially for someone who can’t swim. The kayak was completely upside down, down was up, and the ocean depths were in every direction.
My friend was wearing a life preserver, which did eventually pop his head back above the surface. But what’s most interesting is what went through his mind while he was underwater. The thoughts that came immediately to mind were “You’re not going to die. Just keep calm and you’ll be all right.” They were exactly the statements his doctors had ingrained in him as a child, to help him endure an asthma attack without panicking. It had been 35 years since he had last used these skills, at the age of 11, yet they immediately came to the fore to help him through. He writes: "What still astonishes me was how automatically my training kicked in and how calm and clear-headed I was at that moment. Literally the first thought that went through my mind was 'You’re not going to die.' I think my experiences with asthma trained me to defer my panic and think clearly in a moment of danger. It’s a good thing, too—if I had begun panicking instead of letting my life jacket do its work, I probably wouldn’t have floated as easily and likely would have inhaled a lot of water.
Afterwards, my friend was surprised at how perfectly calm he had remained under pressure — when he thought about it later, the situation seemed a lot more scary than it had in the moments when he was actually experiencing it. In his words: "I was absolutely shocked, after I surfaced, that I had unthinkingly prevented myself from breathing until I could float. It wasn’t a conscious effort. 'Decision' isn’t really the right word because I didn’t think about it at all. It is simultaneously reassuring and scary to consider how much of what we do is totally automatic."
According to Two Minds Theory, key characteristics of the Intuitive mind are that it is fast, automatic, and largely outside of conscious control. This set of characteristics is perfectly exemplified by my friend’s experience. There was no time to think through his predicament, so his Intuitive mind reacted in the way that it had been previously trained, calling on a set of coping skills that he hadn’t used in 35 years. There was no decision to do this, just the activation of a well-practiced behavioral routine in response to the once-familiar sensation of not being able to breathe. Later on, when there was time to think, the Narrative mind weighed in with its delayed assessment of risks, and produced a sensation of fear that wasn’t present at the time.
In some ways it is impossible to know how one will react in an extreme situation until it actually occurs. But with no time for conscious thought, it is most likely that we will react as we have been trained. To increase our resilience to unusual circumstances, we can practice appropriate responses in less-intense scenarios, instilling specific kinds of reactions into the Intuitive System. In the case of asthma, there is still a benefit in teaching children how to manage their breathing, even though better medications have made symptoms of breathlessness less common for today’s children with asthma. As my friend’s experience shows, you never know when that kind of training might come in handy.
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