Eva Holland’s book Nerve: A Personal Journey Through the Science of Fear, publishing in Canada on April 7 and the U.S. on April 14, took shape in the aftermath of a series of devastating events. Her mother had died suddenly the previous summer, realizing what had been, for Holland, a lifelong source of dread. Holland’s seemingly irrational fear of heights had also grown more debilitating. A panic attack while hiking froze her in place, unable to descend the route without help. On top of all that, a planned book proposal had just fizzled out, leaving her searching for a different topic to try again. As she neared the end of a long road trip, musing about subjects on which she could offer a meaningful voice, it hit her. Or rather, she (and her car) hit something—a patch of hail on the highway that left Holland hanging from her seat belt, flipped in a ditch.
A lifetime of wrestling with being afraid—of losing her mother, of heights, and, most recently, of driving—came into focus. That night, in a hospital bed a long way from home, she decided it was time to tackle fear head-on with science.
In Nerve, Holland, a freelance journalist based in Canada’s Yukon Territory, takes readers along on her journey to reexamine her relationship with fear as she pushes herself to the edge, jumps out of a plane, explores how and why we get scared, and probes how to live with—or without—fear. She spoke with Jill Sakai about weaving together a deeply personal narrative with hard science, the rightful place of fear in our lives, and the meta-ness of how scary it is to write about fear—especially your own. (This interview has been edited for length and clarity.)
How did this book take shape?
I came up with the idea for this book on the day I had the car accident [described] in chapter 6. I had talked to my agent that day. We had been trying to sell a previous book proposal I had put together, and we had decided to set that proposal aside. I was thinking about what else I could write about, because I knew I wanted to do a book. And I was trying to think of subjects that I had some knowledge or insight into that would be broadly appealing to other people. This was in April 2016. I was sort of toying with these thoughts about my fear of heights and what I had gone through with my mom’s death and having feared that for so long. I [was] coming out the other side of the worst grief at that point, and I had had this panic attack on an ice climbing trip about two months earlier, so this stuff was on my mind. I was driving home from Arizona in my mom’s car and thinking about this book idea. Then I had the car accident, later that day. And that night in the hospital bed, I was like, yeah, okay, you’ve got to do this book now.
How did you balance the autobiographical and scientific threads of the story in your book proposal? What was it like to pitch something so emotionally charged?
I made sure that I was very upfront. I put the part about my worst fear having been my mom’s death right in the first paragraph, because it wasn’t going to be that visible in the rest of my proposal. My sample chapter was chapter 4, the skydiving chapter, which is sort of fun, and I wanted to be clear that there was this darker personal storyline that I wanted to include. Some of the editors the book was pitched to didn’t want that side of things, or had comments about whether they thought that the combination would work. When something’s really personal, it’s tough to hear that people don’t want to hear about it, or that they don’t think it fits. Nobody’s being unkind, but it’s sensitive—like, what do you mean you don’t want to hear about my mom’s funeral?
Most of your writing before Nerve was for magazines. How did you approach the transition into writing your first book?
I was pretty intimidated. When I conceived the proposal for the book, I made the chapters largely thematic so I could think of it as a series of magazine stories. Here’s the trauma chapter, it’s like a magazine article on trauma. Here’s the phobias chapter. And then I did a lot of thinking about the larger narrative of the book and trying to weave the chapters together after they were written. A lot of it involved fairly subtle changes, like some cross-referencing back to previous chapters that I might not have done when I was initially drafting them—referring back, for instance, to something my mom had said or done in the past. That helped me tackle the book in a way that wasn’t too scary.
Chapter 2 [which outlines how fear has been studied over time] was written less thematically and had some of the more sweeping changes to it over time, because it had such a critical role in laying the groundwork for the more specific science chapters that were to come. So whereas chapter 7 is very discrete—my experience in Amsterdam—I had to set that up in chapter 2 with some explanation of fear science and memory science in order for chapter 7 to make sense to people.
Much of Nerve follows a roughly chronological structure through your explorations of the experience and science of fear. But the prologue brings readers in partway through that journey, after you’ve already faced several tough ordeals. How did you decide where to start, and how did you grapple with giving readers enough context to jump in and understand where you were?
I always felt like I wanted to start the reader at some point that wasn’t the beginning. I thought it would be too slow to start with childhood memories, which is really where the story starts. The prologue allowed me to set the scene a little better—to be explicit about the larger issues that were going to come up in the book. I picked [my ice climbing trip and panic attack] because I felt like it encapsulated the problem I was trying to solve. It was the most extreme fear reaction I ever had in my life, and it also was close enough to my mom’s death that I was still really grieving pretty actively. Starting there allowed me to introduce [the] two sides of the book: my mom’s death and [its] aftermath, and this fear mission of trying to figure out how to stop having these reactions. And it was an active scene that I hoped would draw people in.
I did make some significant changes to the prologue pretty late in the game. Originally, the prologue was more of a pure narrative that just ended with my realization at the hotel [that I wanted to gain control over my fear]. The more expository parts at the end, where I explained the book more explicitly, those went in later.
As you wrote the book, how did you approach the process of weaving together your own narrative and the science?
It was hard, and I wasn’t sure it was going to work. I always wanted them to be equal halves of the book. I had come up with three personal threads: the fear of death and loss, my car-accident situation, and the fear of heights. They were the three most dominant fears in my life. As I learned more about the science [of phobias, trauma, and anxiety], they mapped onto each other fairly nicely.
I had sewing and weaving analogies running through my head the whole time. I tried to sew little reminders, in the science-y parts, of the personal story. I think the clearest examples of that are in chapter 2. I had initially conceived it as being a straight science chapter, and it wasn’t working, writing it that way. It was too much. So I very explicitly tried to bring back things like my memory of learning about Pavlovian conditioning, where I’m in my living room listening to this tape that my mom has given me and trying to understand the lyrics to that Barenaked Ladies song [“Brian Wilson,” which mentions Pavlov’s dogs]. Just little touches; sometimes it’s not a full-blown scene, but just a few sentences. I very much did think of it as stitching the two halves together with these little cross-references.
I wrote most of the personal parts first, rather than writing the book in order. I wrote all the car-accident sections and the therapy section in chapter 6 while I was still researching the broader science of trauma, for instance, just because I needed to be getting words down on paper. I wrote and reported the book simultaneously because I only had a year. So often I was stitching the science onto personal scenes that I had already written, sometimes weeks or months earlier.
You describe your experiences trying some of the treatments that you researched: eye movement desensitization and reprocessing (EMDR) to tackle traumatic memories and Merel Kindt’s single dose of the beta-blocker propranolol to treat phobias. How did those come about?
I had always intended to do some kind of therapy for chapter 6, but I hadn’t settled on what. I came to EMDR partway through the process. In terms of Merel Kindt’s work, in her papers she was using the treatment on specific sets of people with phobias that fit the criteria for a given controlled study, [so] I didn’t think I’d be allowed to try it. I was just planning to write about the research from a more quasi-objective point of view.
Then when we first spoke, she was listing off the different phobias she had treated, and she mentioned heights. And I said, “Oh, that’s what I have.” And she said, “Well, do you want to try it?”—kind of seeming like she was kidding. And I was like, “Haha, yes!” It turned out that just three or so months before we spoke, she had opened up the clinic to the general public, which meant that I could, if I qualified, just pay them and do the treatment. And I thought, You’ve got to do this—first of all, because it might change your life, and second of all, because it would be a great scene in the book.
I didn’t know if she would want a writer documenting it, but she was totally game. I went through the qualification process to be accepted into the clinic, booked a flight to Amsterdam, and got the treatment two weeks before my book deadline. And I basically wrote those scenes up on the flight home.
Much of the science of fear still seems to consist of open questions. Did you feel the need to wrap things up in a neat conclusion for the reader?
My original vision for the book was that it was going to end more with me having come to terms with living with my fears than with any real curing. I explicitly didn’t want to have a book that was like, “I conquered my fears and you can do it too!” [And] I always wanted to grapple with the fact that fear is essential, even though it can be a pain. I like a line of jacket copy that my editors came up with: Is there a better way to feel afraid? I think [that] is more in line with what I learned from the process—fear having its proper place in our lives, rather than conquering [it]. But then, you know, a couple of the treatments that I did for the book worked really, really fantastically, so that was an unexpectedly neat and tidy ending.
Fear and stress have a way of messing with our minds and our memories. Did you ever worry about relying on your memory for your individual anecdotes?
Oh, yeah. Hugely.
How did you go back and check the details?
I didn’t really, because I sort of wanted that ambiguity to some extent. One thing that was interesting is how connected the science of fear is to the science of memory. So rather than saying “X happened,” I say, “I remember X happened.” I didn’t even try to fact-check the memoir side, with a couple of exceptions. I just went with my memory, and I hope that people see that to some extent that’s part of what’s interesting—when you look at trauma, for instance, so much of it is related to what we remember and how we remember it.
What were the exceptions?
I checked some stuff with my dad and my aunt as far as what I remembered about my dad’s fear of heights, and I checked some details with my aunts about their parents’ deaths. That was more informal, just sort of filling in gaps in my knowledge. The formal check that I did was, I wasn’t confident in my description of my mom’s condition in the ICU because I was kind of a mess at that point. So I had Jane, my fact-checker, just check not specifically what was done in my mom’s case, but what might be typical for treating a stroke victim in a vegetative state.
If it felt like something where the fact of it mattered more than my perception, then I would check it. In some cases, what was influencing me was my perception. So it sort of doesn’t matter if it’s exact or not—as long as it’s what childhood Eva remembers, that’s what childhood Eva is acting on, right?
What was the hardest aspect of reporting and writing this book?
The hardest technical challenge was trying to get my head around the science. I was nervous about the neuroscience and trying to grasp how brains function. I don’t have a science background and I have plenty of imposter syndrome about that fact. And so I was really nervous about trying to grapple with some pretty heavy-duty science.
On the emotional side, it was hard to write. It was hard to make editorial decisions about writing about my mom’s death and my grief afterwards. And it was hard to think about the stuff I had to think about, particularly for chapter 9 [about why fear matters]. I have a memory of sitting on my couch in the depths of January, thinking about every bad thing that ever happened to me and trying to figure out which ones to put in the chapter. It was a pretty grim way to spend time. I actually originally envisioned this being kind of a funny book—like Mary Roach, the wacky science of fear! And I think there are elements of humor in it, but the whole project ended up being way darker than I anticipated.
How did you approach the challenge of exploring the neuroscience and figuring out what to include?
I started by just reading kind of broadly about the science of emotion. And helpfully for me, when people write about the science of emotion, they often use fear as the example. I did try to read broadly to make sure I wasn’t missing anything major, but I knew that it wasn’t going to be comprehensive and I sort of picked my moments to try to illuminate some larger issues. I started with some kind of semi-popular scientific books. From the broader reading, I went to more specific reading, and then to journal articles. Because living in the Yukon I don’t have great access to scholarly journal articles, I spent a week at the Killam Library at Dalhousie University in Halifax [where I have alumni privileges], just going through databases and downloading journal articles onto a thumb drive on broad themes: skydiving research, all of Merel Kindt’s work, stuff on EMDR. I downloaded 150 or 200 journal articles in a week.
I tried to read as much as I could and talk to some smart people—do enough to let readers in on some of how this works, but not go in over my head into science that I didn’t really understand. I don’t get into the molecules passing between axons and the [ions]. I read all about that stuff and I was like, this is a lot for me and probably a lot for my intended readership, too. So I scaled back up to the brain-structure level rather than the intercellular level. The fact-checker didn’t find much that was wrong. That was really validating and helped me feel more confident in putting the book out in the world.
How did you tackle hard editorial decisions about your own experiences?
I just had to get through it. It wasn’t pleasant. The hardest part was going back and forth with my editors on the stuff around my mom and what belonged in the book and what didn’t. My motto for the whole thing was, “The only way out is through.” I told myself that [the book would] be the best that I could make it given my abilities and experience and resources of time and money.
Is there anything you would do differently if you write another book?
I hope I don’t get in trouble with my editors for saying this, [but] I would have done more research first. I was so disappointed that my first book proposal didn’t work out that I did the second one on as little effort upfront as I could. When I then got the book deal, I was faced with, I hope I’m not way out on a limb here! That was something I would avoid in the future. I would do more legwork upfront. I spent a lot of time worrying that I had missed something important.
You’re putting a deeply personal story out into the world. Do you have any plans for yourself when the book is released?
I’ve written about myself before, but this is pretty vulnerable stuff, and I’m going to have to go out in public and let people react to it. I have a bunch of stuff I’ll have to do around book promotion; otherwise I would go hide on a beach somewhere! But I made a folder on my desktop, and I’m putting in screengrabs with people saying nice things about the book. So if I feel really bad someday I can go into my Folder of Good Feelings and look at people saying nice things to me. That’s one of my self-care plans.
Jill Sakai is a science writer and editor based in Madison, Wisconsin, and a longtime volunteer with the National Association of Science Writers. Follow her on Twitter @jill_sakai.