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December 2, 2009

Leaving the Wilderness Alive: How to Survive The Worst When All You've Got is You.

By Judith Acosta

Mental survival-regardless of where a person is, whether that's in the extremes of battle or a backpacking expedition-is often a matter of recalling or being made aware of the resources one already has--particularly words. What we think, we become. Literally.


Lt. Costello (Name and location changed. The story is true.)sat behind a large, conspicuously clean desk at the Tarrytown Police Station in N.Y. He was cool, composed, and seemed as uncluttered mentally as he was physically. The awards on his book cases and certificates on the wall attested to a long, successful career. "I paid my dues," he smiled as he scanned the room and the work it all represented. As he saw it, however, his career really started in Vietnam when he was only a teenager serving in the U.S. Army. It was there, assigned to an armored car division sent deep into the jungle, that he learned what it took to survive physically, mentally, and emotionally.

He was on a mission in the Delta, it was summer and the temperature outside had reached upwards of 115 degrees Fahrenheit before noon. Inside the tank it was at best unbearable under normal conditions. On one particular day he still remembers with stunning clarity, it was life-threatening.

 "It must have been 130 or more inside. It was hot in a way I had never experienced before. I couldn't stop sweating, couldn't drink enough, couldn't just get up and go to the bathroom. I was burning up. I don't mean that metaphorically. I was literally burning up and I had to lower my body temperature somehow or I was going to die.  Funny how it didn't scare me. It was just as clear to me as the coffee in front of me now. It was a fact. I had no air conditioning. I couldn't get out of the tank. There was nowhere to go except a POW camp, if I was lucky enough to get caught and not killed right away. I remember thinking that I should have been panicking. Instead, I was utterly, crystal clear. It was in the space of such a small moment that I realized it was completely up to me. Whether I survived or not was between me and my own mind." The lieutenant sat forward, his body compressed with the intensity of the experience, still vivid in him.

 "For some reason, I thought about something I'd heard about some monks in the Himalayas, how they went outside in sub-zero temperatures and howling winds to meditate and never suffered any ill effects. They raised their own thermostats. And I figured if they could do it that way, I could lower it. To this day I don't know exactly what I did or how I did it, but I imagined cool water inside me and around me, like I was dunking myself into a cooler filled with ice or skinny dipping in the lake back home. And hell if it didn't work. I'm here. I never forgot that," he sat back. "This," he pointed to his head, "was my greatest weapon of all. And it has served me ever since, no matter what or where the battle."

Surviving A Crisis

Since 9/11 the two ratings-building spin words are "survival" and "emergency." Today, Americans are fed a regular diet of security alerts, color-coded for those who need the visual aids, preparedness strategies, complete with thousands of products one can buy for only $49.95 plus shipping and handling, and countless medications courtesy of the pharmaceutical industry to help us all manage the resulting anxiety, depression, and despair.

This is not all that different from the build-a-bunker-mentality of the anti-communist frenzy during the cold war and the subsequent pill-popping that ensued. We had to protect ourselves then no matter what it took. And we feel the same urgency now.

But most of the people who are building bunkers today, anxiously watching the colors flip back and forth from orange to red alert status, packing enormous first aid kits when they go hiking on local trails, or getting into armored tanks that can put holes through mountains are "prepared" in almost every way except what scientists are now coming to believe is the most important way.

And that is the way of the mind. The images we hold in our minds seem to be held in our bodies as well. What we think is what we are. What we feel determines how we heal.

Images in The Mind Create Bodily Changes

Dr. Larry Dossey, best-selling author and one of the foremost proponents of mind/body medicine, has written, "Images create bodily changes-just as if the experience were really happening. For example, if you imagine yourself lying on a beach in the sun, you become relaxed, your peripheral blood vessels dilate, and your hands become warm, as in the real thing."

If this is even partially true, it is an astonishing statement.

The case to definitively establish the link between mind and body was opened almost 1,500 years ago when Hippocrates wrote that a person might yet recover from his or her belief in the goodness of the physician. Belief, image, thought-these were all clinical "givens" long before the advent of modern technology.

In 1912 one doctor reported that tuberculosis patients who had previously been on the mend, when given bad news (e.g., that a relative had passed away) took sudden turns for the worse and died. It was not called "stress medicine" or psychoneuroimmunology at that time, but the concepts were the same. And today the data supporting the connection between thoughts and health, indeed between mental images and survival, are mounting.

"We now can measure changes in immune cells and the brain in ways that give us objective scientific proof of the connection between them," says Mary Jo Kreitzer, director of the Center for Spirituality & Healing at the University of Minnesota.

Hypnotic Suggestion: Talking to The Hand, Literally.

In psychotherapy circles, it is now considered common knowledge that people under hypnosis can be given suggestions and make them manifest in their bodies immediately. For example, a person who is given the suggestion that he is being touched by a burning cigarette will produce a burn blister even though the object that was actually touching him was neither hot nor cold. People known to suffer from multiple personality disorders have even been documented with allergic responses when presenting in one personality but not in the others.

Muscle movement is no different and, according to researchers, anyone who's ever watched a movie has personally experienced the physiologic power of thought or imagery. In one study, movie-goers were monitored (via machines which record galvanic skin responses) and found to unconsciously mimic what was occurring on screen with micro-muscle movements. When someone in the movie jumped, the muscles ordinarily responsible for jumping in the person watching the movie made similar movements.

Brain scans have similarly shown that when we imagine an event, our thoughts "light up" the areas of the brain that are triggered during the actual event. Sports psychologists have been responsible for extensive work in this area. In one study, skiers were wired to EMG machines and monitored in a manner similar to the movie-goers except that they were being monitored for electrical impulses sent to the muscles as they mentally rehearsed their downhill runs. The skiers' brains sent the same instructions to their bodies whether they were doing a jump or just thinking about it. 

Outdoor Survival With Words?
What does this mean for a person out in the mountains who suddenly finds himself stuck in a downpour and unable to get out before dark when the temperature is expected to fall nearly 40 degrees? How does this help someone with an asthma attack in the middle of a lake or a person with a broken leg one hour from the nearest ranger station? How does this help a rock scrambler or skier have the performance of a lifetime and keep themselves calm and healthy?

What some people claim is that it can mean the difference between life and death.  Verbal First Aid, a technique used by first responders around the world, for example, is based on the simple notion that the words we say (to ourselves and to one another) do matter, that they affect us both physically and mentally, there are ways to speak that make those words healing, no matter what the situation. "By saying the right words in the right way we are able to speak directly to the body, reduce an inflammatory response, help to slow down or stop bleeding, change the way an event is interpreted so that it is experienced differently IN the body," co-author Judith Prager states.

Others agree. 'There is ample evidence that negative thoughts and feelings can be harmful to the body," says Lorenzo Cohen, director of the Integrative Medicine Program at the M.D.AndersonCancerCenter in Houston. Stress is known to be a factor in heart disease, headaches, asthma and many other illnesses. Studies by Janice Kiecolt-Glaser and Ronald Glaser at Ohio State University show once again how even relatively minor stressors-a job interview or a speaking engagement, for example-can sufficiently compromise the immune system so as to predispose one to illness. The researchers found that a marital spat delays wound-healing and that the stress of caring for an Alzheimer's patient leaves the caregiver more vulnerable to illness even years later.

Chemistry Can Heal or Harm

As reported by the Glasers a healthy person releases cytokines (or "moving cells") which are chemicals that signal the need for immune agents. When a person is under stress (lack of nutrition, emotional duress such as fear or anger) the cytokines are distracted and, instead of calling in the immunity army (white blood cells, for example), they race around wildly through the bloodstream. In fact, according to Kiecolt-Glaser, "When cytokins are misdirected, they produce something you don't want-a prolonged inflammatory response that far exceeds what is needed with infection."

Happily, though, the situation is reversible for what can go down can go up, and what can be lost can be found. At MichiganStateUniversity researchers found that students could use guided imagery to improve the function of certain white blood cells called neutrophils to help themselves defend against bacterial and fungal infections.

Mind and Body: One Organism

Over the last fifty years the evidence supporting the claims of mindbody researchers has been steadily growing. Stress apparently makes us more than just tired. It inhibits the immune system, increases the production of epinephrine, norepinephrine and cortisol. It is linked with heart disease and other chronic diseases, as well as infertility. 

Not too long ago, one study found that the stress levels of a woman struggling with infertility are similar to those of someone who's just been told they have HIV. In another study, Alice Domar, Ph.D.,H (HarvardMedicalSchool) showed the positive effects of stress-reduction on women who were trying to get pregnant.

By changing the negative thoughts ("I'll never have a baby") to positive thoughts ("I'm doing everything I can to get pregnant")-just words repeated internally-they were able to change the body's response.  The data spoke for themselves: Fifty-five percent of the women in the experimental group (those who used relaxation, yoga, imagery, and cognitive restructuring) got pregnant, in contrast with only twenty percent of the women in the control group.

This is especially noticeable with people who suffer from chronic pain. One occupational therapist in private practice in a NY suburb commented, "People in pain get into a 'set' and they don't hear what they need to or open up to healing well. Half of my work with them is changing their thinking and helping them to relax and detach from their disease."

Stress is a short-term and long-term killer. It has also been shown to affect the aging process and our susceptibility to disease in general. The average life expectancy of a man living in the United States is 73. The average life expectancy of a male police officer is 59. 

While adrenaline helps us to prepare for emergency action, the chemical cascade it initiates inhibits our ability to repair ourselves, to digest food properly, or even to reproduce. Epinephrine (a secretion of the adrenal glands) has been shown to constrict blood vessels. When this occurs in the uterus, it interferes with conception. Epinephrine also increases heart rate. A normal heart rate is 80 beats per minute (bpm), a dangerous stress level is 180 bpm, and police officers have been found with 300 bpm after a shooting. One study showed that traumatic stress can affect a person's neuroendocrine and immune systems for twenty years.

Short and Long-term Consequences of The Chemistry of Thoughts

Clearly, what we do with stress not only has immediate consequences, but long-term and sometimes invisible implications. Experts have agreed that how we "hold" stress, the language we use to one another as well as to ourselves in our private thoughts, and our attitudes have a great deal to do with the impact stress has on our bodies. Dr. Hans Selye, the father of modern Stress Medicine, even broke stress into two separate entities: Simple Stress, or the stress which depletes us and Eustress, or stress we experience as challenging and exciting, which enhances our immunity.

The question then becomes: How do we use this in the field? How can we utilize these ideas to get ourselves out of a bad situation alive?

What Can We Do, What Can We Say: Verbal First Aid in Real Life

Deepak Chopra begins to answer that last question when he uses the metaphor of two people in a roller coaster. The following example is an adaptation and elaboration of his story:

Two people are getting into a roller coaster. One is a young cowboy-hardly moving off the platform yet, but his arms are already in the air and he's hootin' and hollerin' with anticipation. His heart is pounding. But he's smiling. The woman next to him has her hands clamped down onto the metal rod in front of her, her heart pounding. She is not smiling. Both are in the same seat, on the same ride, but they are clearly not experiencing the same thing. The difference? Their thoughts.

The young cowboy in the roller coaster sees that the woman next to him is nervous. He turns to her. She looks to him, her eyes wide. She says, "How can you be so relaxed?" He smiles, points to his hat, "It's my magic hat." He takes it off his head and hands it to her. "You hold on to it while we ride, okay? It's easier to enjoy the ride when you know you've got magic with you." Her hands loosen their grip. She takes the hat. Tentatively, she smiles.

According to medical experts, anxiety (or fear) and pain are inextricably woven together for the vast majority of people. A great deal of human discomfort comes from our anticipation of it and our perception of it. Unfortunately, there is nothing marketed as vigorously in this country as is fear. If we're not scared to death by a headline, it's a radio report, a movie, a video game, or a television show. We're literally bombarded by images and ideas that promote fear. We are propelled by it and sold by it.

If the science is correct, the good news is that we can change it on every level-from the conscious to the autonomic. When we alter our thoughts, are soothed by a kind authority, or are assured that we are in good hands, we can begin to feel the changes in our bodies-the softening of muscle fiber, the opening of bronchial tubes, the quieting of pain, the start of healing. This is why so much of Verbal First Aid in the field is directed to the alleviation of anxiety through the development and utilization of rapport. In rapport, a person will feel, "She understands me." "He is going to help me." "I'm safe, now." When we feel understood, our anxiety is reduced. And when anxiety is reduced, pain is relieved. Even if we are entirely alone, clinicians and scientists agree that what we say to ourselves matters and we can direct our thoughts so that our chances for survival are enhanced.

Self-Healing on The Trail

Whether you're speaking to yourself or to someone else on the trail, how you approach someone mentally and emotionally is at least as important as the medical expertise you have, according to Winnie Maggiore, former Asst. Chief of Placitas Volunteer Fire Brigade, paramedic, former Asst. D.A., and now a malpractice defense attorney. "We saw the same things in the wilderness that we saw locally-snake bites, mountain bike wrecks, breaks, falls, cardiac conditions-but the injuries in the wilderness feel worse to the patient in that he's away from familiar surroundings. Most of what we had to do in rescues was anxiety management. The first step is to let the person know you have the expertise to help. This conviction allowed us to say 'do this' in a way that motivated compliance."

The other major ingredient in dealing with crises on the trail, according to Maggiore, is giving people some sort of control over what is happening to them. "When we were just learning emergency medicine, we were given a course in hypnosis so it could be used in pain control, because it could be all we'd have to work with out there. The worst part for patients was being out of control so put them back in control as much as we could, gave them something positive to focus on. Panic is a patient's worst enemy."

People normally want to reassure with blanket statements, e.g., "you're fine." When this is obviously untrue, it's the sort of statement that breaks rapport. It's better to say, according to the experts, that the worst is over and you're there to help. Your caring presence is the cornerstone of the healing process. If you don't know what to say, say nothing and listen as you wait for help or do standard first aid. Your care can do more than you might imagine.                

The following are just two examples of ways we can talk to someone in distress so that they are calmed, their pain is reduced, and they are moved steadily towards healing

Asthma in the Sandias.

Sam and his son, Jared, went for a hike up the Tunnel Springs trail. Sam was sure Jared had packed his inhaler. Jared was sure his dad had packed it. When they got up to the first crest, Jared was straining for breath. When they realized they'd forgotten it, Sam was smart enough to take a deep breath himself so that when he turned to his son he was calm, focused, and sure-footed.

Sam:     Jared, I can see you're breathing but that it's a little tight?

Jared:    (Nods, but can't speak.)

Sam:      Sit with me here and lean forward like this. Put your head                   forward like this so your bronchial tubes can open and smooth out. [At this point, Sam's voice drops in pitch and slows down so that it's soothing and controlled. He "paces" his son's breath with his own, carefully so as not to hyperventilate, just enough so that there is a joint rhythm. As he speaks to his son, his breathing slows down just a little bit at a time, "leading" his son back to normal breathing.) And as you do, you can remember very clearly how your inhaler feels when you take a puff on it, a little cool, a little tingly and how it opens you up pretty quickly, you can remember how it feels when it's working...a little more open now...a little more open, a little cooler, until you can get a really good deep, slow, even breath...

A Tumble Along La Luz           

The La Luz trail in Albuquerque, New Mexico, is full of crumbled granite that feels like a trot on a field of ball bearings and has brought more than one person to his or her knees. Cuts, abrasions, bites are exceedingly common crises. For that reason, while it's always smart to pack along a first aid kit, it's even smarter to know what to say to stop the bleeding and initiate a healthy immune response.

Sandra skids down the trail and slides into a sharp rock. When she gathers herself up, blood is pouring down her leg from a 3-inch laceration along the side of her calf. Her friend Kim, well-prepared for a full day hike, pulls out some Betadine, cleans the wound, applies sterile gauze on top of it and wraps it with a clean, cotton bandana. As she does, she speaks to her friend so that the bleeding stops and healing begins.

Sandra:             Damn it! It's really bleeding.

 Kim:                 It is and that's actually a really good thing so that it cleans out the wound. As soon as you've washed it through enough, you can stop [Kim emphasizes "stop"] the bleeding.

Sandra:             Damn it. That was so stupid.

Kim:                 It happens to everyone. I know you've gotten cut before and you've stopped the bleeding before just like you're stopping it  right now. You can hold it tight like this. Y'know even as we're sitting here, it's already starting to heal and the bleeding has slowed to a stop so we can walk down the rest of the trail. 

Mental survival-regardless of where a person is, whether that's in the extremes of battle or a backpacking expedition-is often a matter of recalling  or being made aware of the resources one already has. As Lt. Costello learned the hard way, the mind is the greatest weapon of all.

Authors Bio:
Judith Acosta, LISW, CHT is a licensed psychotherapist and clinical homeopath in private practice in Placitas and Albuquerque. Her areas of specialization include the treatment of anxiety, depression, and trauma. She has appeared on both television and radio and is a regular lecturer throughout the U.S. She is the author of The Next Osama and co-author of the books, Verbal First Aid and The Worst Is Over, which has been dubbed the "bible of crisis communication."