Life Unlocked: 7 Revolutionary Lessons to Overcome Fear by Pillay M.D Srinivasan S

Author:Pillay M.D, Srinivasan S. [Pillay M.D, Srinivasan S.]
Format: epub
Publisher: Rodale
Published: 2010-08-16T16:00:00+00:00

For example, Andrew was a patient whom I had seen in therapy. He was a sharp, good-looking, HIV-positive, gay executive who was single and very frustrated with his romantic relationships. One relationship in particular left him feeling isolated, alone, and unable to get what he wanted. On a particular day, Andrew revealed to me that he had been frequenting bathhouses and having sex with strangers. Perhaps dangerous, but I wasn’t yet concerned. Then Andrew went on to explain that these strangers were teenage boys and that he hadn’t used condoms. He said that he was angry that he had to suffer with HIV infection alone, so he had lured in these young boys with his good looks and attempted to infect them. I immediately felt myself thrown into a dilemma over whether this man was homicidal. He firmly denied wanting to do this again and told me that he was talking about it because he felt guilty, but during the next session, he admitted to having repeated this behavior. I sought consultation and terminated the relationship, in part because it was a gray area in terms of reporting it (I am obligated to warn potential victims of homicide, but because Andrew traveled and I had no idea which bathhouses he frequented and he would not tell me, I had nobody specific to warn) and in part because I was not comfortable with participating in the dialogue because I felt immensely angry and afraid for both Andrew and his victims. I knew that I could not help Andrew anymore, but I also realized that although he was initially guilty and afraid, he was now on a rampage because he had lost all sense of control over his own life. His fear conditioning circuits were no longer functional. Apart from probably having prefrontal deficits, his amygdala was underfiring and his hippocampus was not remembering the context or actual fears that he initially felt in relation to his behavior. Here we see a classic but disturbing case of when a little more fear conditioning would be helpful.

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