46. The curse of the mobile phone

I have written before about the way in which I think the use of mobile phones and other electronic equipment is having a negative effect upon human interactions.  I am reluctant to condemn all these new inventions because in many ways they are miracles of human invention, but it is hard for me to see their good in a world now increasingly peopled by automaton-like figures peering into their screens with never an eye raised to acknowledge the presence of those they are passing by.

If you become used to allowing the demands of the mobile phone to control your life in this way, I wonder how this will affect human interactions in the long term.  More and more people now appear to be compelled by their insistent ringing tones to give mobile phones priority over everything else to the extent that they allow them to interrupt whatever social interactions are taking place at the time.

I was reminded of this at a restaurant I went to last week, where the owner said that she was quite happy for us to sit on as long as we wanted after we had finished our meal, because she was so pleased to find people who had not spent the whole of their meal shouting into mobile phones, as her other guests often do. She is appalled at the way these telephone conversations are conducted at high volume without consideration for other diners, but said, “I can’t tell people they mustn’t use their phones because I would lose too many customers if I did”.  Recently I heard the story of an irate diner, who, plagued by the incessant loud mobile conversation at the table next to his, had simply got up, grabbed the phone and thrown it into a large bowl of flowers where it bobbed about helplessly. “You’ve spoilt my meal, “he said, “so now I’m spoiling yours”.  I certainly often have a strong inclination to follow suit, but I’m not sure I have this man’s courage.

There appear to be very few people left who would still consider it rude to interrupt a conversation with a friend to answer their phones. And if we increasingly ignore those that are physically close to us as we respond to the demands of those disembodied voices on our machines, what effect will that have on human relationships in the future?

Why the need, too, for so much hurry?  We have become slaves to these tiny machines.

  

 

 

 

45. The seven ages of man (and woman)

I have always liked to see the five elements as each embodying one of what are known as the Seven Ages of Man (though two of those ages are shared between the five elements).  If we think of human life as circling in stages from birth to death, each life forms a similar progression to that of the elements, as it passes from its beginnings in Water on to Wood, to Fire, to Earth, to Metal and finally back to Water again.  As Shakespeare puts it in Jacques‘ famous soliloquy in As you like it:

“All the world's a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages. At first the infant…..

And ending with:

………………Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.”

I see each phase of this circle of life as imparting its own quality to that life, each adding the quality of the element which it represents to those whose guardian element it is.  There will therefore always be something of the child in a person with Wood as their guardian element, as there will be something of the exuberant joyfulness of the young adult emerging into the wider world of the adult in all Fire people, whatever their age.  Each Earth person will show something of the mature adult throughout their life, as will a young Metal person show something of the wisdom of those approaching old age even in childhood.  Water, always the most mysterious of all elements, the beginning and end of all things, will show both the naivety of the child which Wood always shows and the age-old wisdom of those living at the end of their days, which Metal hints at.

If a five element practitioner is unsure which element dominates in one of their patients, and they are unable to get enough information from their five senses to point towards one element, an attempt to see their patients in terms of how they appear in relation to the kind of stage of life they represent is a further way of helping our diagnosis.  In my book Keepers of the Soul  I gave the example of my mother, definitely of the Wood element, who showed a childlike enjoyment of life at nearly 90 years of age, and I have a Metal son who I turn to to put me right about decisions in my life which my Fire element does not appear mature enough to make.

In this context, it is interesting to note the emotional ages of the friends we choose.  I seem mostly to have chosen those who are further along the cycle of the elements than me, predominantly the Metal element.  I notice, too, that other people’s choices of friends reflect something about the need for their own element to receive support often from an element not their own which stimulates them.

I have never made a statistical survey of people’s elements compared with the elements of their friends.  This would indeed prove an almost impossible task, given that we need to treat a person for some time before really being sure of their element.  But I suspect that many of us choose friends from amongst elements other than our own.  I have always certainly done so, because, I have decided, I do not wish to have to observe in my friends the weaknesses I see in myself.   

44. Always query your diagnosis

I always like to focus our seminar days on diagnosing the elements in patients our participants want help with, or diagnosing the participants themselves who want a clearer picture of their own element.  You will note that I say “a clearer picture” rather than a definite diagnosis.  This is something I insist upon, because I am so aware that a diagnosis can initially only be a tentative hypothesis and awaits confirmation from the way in which a patient responds to treatment.  In other words, we are never sure that we have the right guardian element until that element has shown us, through its positive reaction to treatment, that this treatment is directed in the right place along the circle of the elements.

I know that hovering over all five element acupuncturists is the picture of JR Worsley interacting with a patient for a few minutes, and then turning to us with an immediate diagnosis of one element.  This picture can delude us into thinking that every diagnosis we make should be equally as fast.  But, as JR told us as students, it had taken him more than 40 years’ hard work to get to the stage he had reached.  We would all be able to do the same, he said, once we had the same number of years’ practice behind us.  So those of us with far fewer years’ experience will have to accept that tracking an element down to its source in a patient takes more than just a few minutes, and very often many more than just a few treatments.

What I tell students is that no patient minds how long this takes provided they feel our compassion for them.  A practitioner who has attended many of our seminars, has just sent me the following lovely quote:  “People don't care what you know, they want to know that you care.”  As long as we show we care, a patient will trust us to know what we are doing and allow us the time to work out gradually which element we should address with our treatment.  We must never allow ourselves to be hurried by our patients into feeling that things should be moving more quickly than they are.  One of the things we were told as students was that it takes about a month of treatment for every year of illness.  That does not mean continuous weekly treatments, but it is a helpful rule of thumb, and allows us to tailor our expectations to a more realistic level.

Once my patients have started treatment, I have noticed that very few of them, if any, seem to spend much time talking about their symptoms, but instead want to talk about their life in general.  In fact they often forget altogether why they originally came to see me, evidence that patients do indeed want “care”, and not necessarily a “cure”, although with care often comes cure, since usually the two are closely related.

43. The joy of being with other five element acupuncturists

I always return from my seminars in China invigorated by having taken part in another heart-warming seminar there.  I love the word “heart-warming”, a word close indeed to every Fire person’s heart, such as mine, because it does feel as if my heart is indeed warmer after time spent in the presence of a group of dedicated five element practitioners and students.

We look at patients together, observe their treatments, include some practical work helping participants feel more confident about their clinical skills, and, most importantly of all, mull over together the problems we confront as practitioners.  Mostly, though, we concentrate simply on making participants feel more confident in what they are doing, and helping them by making them aware that they are part of a family of five element acupuncturists.  The main thing which I like to emphasize and which I hope they all take away with them are my two mantras, “The simpler the better”, and “Points are messengers of the elements, not the message itself”.

I am constantly bewildered by the emphasis so many people now seem to put on points and point selection.  When I trained all those years ago, we never seemed to worry about which points to select because the whole emphasis of training was on trying to find a patient’s element. Once found, or at least once we had made our first decision about which element to address, we carried out the simplest of treatments:  first, of course, Agressive Energy drain, then source (yuan) points, tonification points, horary points, AEPs (back shu points), interspersed, obviously, by clearing any blocks, such as Possession, Husband/Wife or Entry/Exit blocks.  I don’t remember us ever worrying about point selection, unlike present generations of practitioners who seem to spend an inordinate amount of time mulling over the actions of different points and when to use them, and disproportionately less time learning to look carefully at the elements of which these points are just the servants.

Another mantra of mine could be “Find the element and the points look after themselves”.  And if they don’t yet look after themselves, because you are new to the world of five element acupuncture, then look at a copy of my Handbook of Five Element Practice, published by Singing Dragon Press, which lists in careful detail the points on each element to be used at different stages of treatment.

So time spent with my group of five element practitioners and students, all speaking the same language of the elements, is confirmation that the spirit of five element acupuncture in its purest form continues to flourish.  This confirmation has been given an additional boost by an email from one of the participants which I received at the end of the day, telling me how grateful he and other members of the group were to see “how you simplify five element  acupuncture in a way that helps us all get a real grasp of the elements”.   

 

 

42. Tips for novice five element practitioners

It takes time for new five element practitioners to become sufficiently comfortable and relaxed in the practice room to make their patients feel safe enough to remove their masks and tell us what their problems really are.  So those starting on their practice must not demand too much of themselves.  Many of the problems the novice practitioners have are learning about how to maintain control in the practice room.  I think their greatest worry is always at first directed at trying to diagnose the right element, rather than doing that most essential of all things, which is getting to know their patient and putting their patient at ease with them.  No patient stops coming for treatment if we don’t diagnose the right element, but they do stop if they feel uneasy in the relationship to us.  Rather than concentrating all our attention upon trying to track down the element, we should instead take as much time as is necessary to establish a sense of trust between our patients and us, and make sure that they feel we are really interested in learning about their lives.  This provides the necessary foundation for a good patient-practitioner relationship, without which no diagnosis, even of the right element, will ensure successful treatment.  If a patient is uneasy in our presence, I like to think that their elements cower away, and fail to respond to treatment, however focussed it is.

It is good if we take some time for what I call setting the scene for treatment for our patients, so that they understand better what treatment involves.  It is useful to have in our minds a checklist of the topics we should discuss with them before they start treatment. They need to be given some facts, such as how many treatments they should be prepared for, how spaced-out these treatments will be and how treatment might affect them.  We also need to give them time to ask their own questions, for most of them will arrive for their first treatment with very little idea about what treatment will involve and what they should expect from it.

This blog is also in answer to more of the questions the practitioners at our latest seminar in Beijing asked.  Thinking how best to answer them, I realised that it would be useful for me to work out a kind of protocol to act as a checklist for each of us to go through with any new patient.  In our eagerness to get started, we often forget that patients come to us usually unfamiliar with acupuncture, and very uncertain about what to expect; they are therefore often uneasy.  It helps both them and us if we prepare the ground before they come for their first treatment so that they are already to some extent prepared for what is going to happen. 

In working through this preparatory checklist now, I had to think about how much to include in it, and how to condense the essential components of five element treatment into a simple format.  The list below is my first attempt at doing this.   

1. First of all, you must show that you are really interested in your patient, and are curious to learn as much about their lives as they wish to share with you.  Often the time with us is the first time anybody has shown them any real interest in their life, apart from perhaps their physical symptoms.  You have to develop a good memory for all the things they tell you, noting particularly those things which send up little warning signals in your mind.  We were told to call them “red flags”, meaning that here is something significant which we need to explore in greater detail with our patient later on.
2. .We must help our patients understand that five element acupuncture treats the whole person, body, mind and spirit, and that, unlike Western medicine, we are not interested only in their physical symptoms, but in their emotional well-being as well.  This is often a surprise to them, and usually a very welcome surprise.
3. We must not be judgemental or bring our own agenda into the treatment room.  We do, however, bring our own life experiences with us so that we can offer our patients help based upon what we ourselves have learnt.  Even if we have a patient who we find difficult to deal with because they have such a different approach to life or different values from us, we must be careful not to show that we find their opinions difficult or find them in any way unpleasant as human beings.  We have no right to impress our own values and prejudices on our patients.
4. We must remain in control of treatment at all times, which means that we don’t allow a patient to direct whatever he/she wants from treatment.  It is up to us to decide what treatment the patient needs and which element to treat, and we should not involve them in discussing our clinical decisions.  The frequency and spacing of treatments is also a clinical matter, and we are the only ones competent to decide on this.  If they are not happy with this, we are quite in our right to suggest that they go to another practitioner.
5. One of the lessons we all have to learn is to not to allow ourselves to be overwhelmed by events in our patients’ lives, but to develop sufficient emotional strength in ourselves to cope appropriately with whatever problems our patients present us with.
6. If you feel that there is something not right with your relationship to your patient, then do what we are often too nervous to do, which is learn to talk things through with your patient.  Always start by saying, “I feel that….(for example) you are not happy with your treatment..”  Often this will resolve problems because you may be surprised that your patient is quite happy with what is going on and it is your uncertainty which is making you doubt that your treatment is helping.
7. Don’t discuss a patient’s treatment with them outside the treatment room. If the patient has a problem they want to discuss with you, tell them that you will discuss this at the next treatment, and make an appointment for them to come.  Don’t discuss their treatment on email or social media.  All discussion needs to be kept private in the practice room.  If the patient wants to go on talking at the end of treatment and your next patient is waiting, you have to tell them that you will discuss this further at their next treatment.  Always keep to your treatment schedule, because some patients love to go on talking!
8. I don’t think it is helpful for patients to be having different kinds of therapy at the same time, for example herbs and acupuncture, because you never know which of the therapies is helping or whether the patient is not responding to your treatment because of the effect of the other therapy.  If a patient wants to try out all sorts of different therapies, I always tell them that it would be better if I don’t treat them.
9. There is always a problem with how to deal with a patient taking medicines prescribed by Western-based medical practitioners and five element acupuncture.  Some drugs are life-saving and must never be discontinued.  Others can gradually be reduced if the acupuncture treatment is helping the patient’s condition, but this must always be done with the consent of the patient’s prescribing practitioner.  We must not interfere with Western medical treatment, even if we feel that it is not helping our acupuncture treatment.  We always hope, though, that our patients will persuade their doctors to reduce the drug doses when the drugs are no longer necessary.
10. I believe that we are given our guardian element at the moment of our conception, and that it stays the same throughout our life, shaping that life in a special way according to the qualities of the element that has been handed to us as our elemental destiny.  I do not believe that it changes, although different elements may colour the dominant element at different stages of our life, depending on the life experiences we are subjected to.  For example the Metal element may appear to overshadow our guardian element for a while if we suffer some great bereavement, or Fire if we are very happy in our relationship.  But below this superficial colouring of another element there always remains the presence of our dominant element.

41. Is a state of balance ever achievable or even desirable?

It was whilst I was thinking about how the different elements manifest their states of balance or imbalance that I realised that it would be useful to look at this from a much wider perspective, rather than from the point of view of each element.  I think we need to ask ourselves whether any of us can ever be said to live our lives in a state of anything more than temporary balance.  The pressures upon us exerted by those close to us, our families and friends, as well as the many thousands of others amongst whom we live in our communities, let alone the many millions more around this small globe of ours, all these pressures make it unlikely that any of us can avoid our elements being subject to all kinds of stresses which must lead them at intervals to struggle to maintain whatever balance they may have achieved.  Or at least to weaken their ability to withstand pressures upon their balance.

Before I look more closely at this, I need to define for myself what I regard as a balanced human being, and how far that is something achievable at more than rare times.  I must also ask myself how far we should regard this as something desirable.  Is there, as I think there may be, a positive side to the constant struggle of the elements to maintain their balance?  Is this, perhaps, something which offers human beings the potential for leading stimulating, creative lives?  In my Keepers of the Soul I wrote that we are, as I put it, “necessarily incomplete”.  I say this because each element is only able to hold its dominating role for one-fifth of the complete cycle.  We can see this in nature where each season only holds sway for a short time before having to hand over to the next season, Wood in spring having to hand over to Fire in summer, and so on.  This finds its echo within us, as each element passes on its function to the next, as they work together to bring us life. This means that since each element represents only one stage in the complete cycle, each has to accept that it is as I put necessarily incomplete.  And therefore each in a different way always remains at heart dissatisfied because the tasks it sets itself are never done.  If I think of my own element, Fire, everything I do is in some way connected with Fire’s need to enter into relationships with everybody it meets, and its deep need is to ensure that these relationships are good ones, bringing the happiness and joy its Heart strives for in all whom it encounters.  But then it must hand over its duties to its child element, Earth, as the cycle rolls on from summer to late summer.  And Earth, not pre-occupied as Fire is with the need to enter into relationships with everybody, has instead been given its own quite different task, that of producing the fruit of the two preceding elements, Wood and Fire.

The actions for which each element is responsible can therefore be seen as finding their completion not within the element itself but in the succeeding element, Wood in the Fire element, Fire in the Earth element and so on.  Each element concentrates with almost fanatical dedication upon achieving that one aspect of the complete cycle which it is its task to perform.  Fire can only do what Fire is there to do, just as summer can only be summer, and Water can only do what Water is there to do, as winter is always winter.  There is something almost tragic in each element’s recognition that it will not by itself be able to complete the tasks it sets itself, but has to hand them over incomplete to the elements which succeed it.  Wood will forever seek to carry out all the activities it is there to initiate, but will never complete all the activities it wants to before the cycle moves on and it has to hand over to Fire.  And so on, from element to element.

I like to think of the play of the element within us as what I call representing our elemental DNA, and like our body’s physical DNA this gives us a unique imprint which distinguishes us from anybody else.  The elements’ interactions within us are unique to us so that no Earth element manifests itself the same in any two people.  This is all the truer of those more complex inter-elemental relationships which we call those of the elements within our guardian element.  If a person’s Wood element is diagnosed as also having much of the quality of the Earth element within it, colouring its dominant green with a little yellow, and even deeper within it has a pink tinge which the Fire element adds to the Earth within it, this combination of elemental colours stamps us with a unique mark, as unique as any DNA sequence discovered by modern science.

And I also like to think that there may be a purpose to this, some reason why human beings have been endowed with this unique potential, offering each of us the possibility of being ourselves and like no other. None of us can truly know why human beings have been chosen amongst all the sentient beings on this planet to have been given individual destinies associated with one of the five elements.  No other species has to cope with the difficult task of shaping its own destiny as we have.  All others seem to be satisfied with living a herd-like existence, one among many, being almost clones of each other.  Each of us, on the other hand, has been given what seems to be an individual fate, related to the challenges the interactions of the elements within us offer us.  This seems to be for some deep purpose, related to our ability each to think our own thoughts and do our own thing, and therefore closely linked to the demands of our guardian element.   

 It would appear that we sit at the pinnacle of advanced life, our brains by far the most complex of any other living creature’s, with unparalleled ability to shape our environment both physically and spiritually through our artistic and intellectual achievements.  No other creature has managed not only to stand on its two feet and reach up to the heavens above, but to devise the means to escape the pull of gravity to penetrate far out into the secrets of deepest space.  And no other living creature, as far as we know, even wants to do this.  This curiosity of ours pushes us inexorably to try to decipher the secrets of the universe.  And somehow I feel that the great diversity which the characteristics of the different elements endows each of us with must play its part in all this.

I have written in The Keepers of the Soul of my own understanding of why this should be so.  Others may obviously have quite different views on this. I wrote: “I like to think that the impetus within us to evolve towards ever higher levels of diversification became so overriding at some point in our evolution that we were no longer able to contain within each of us the totality of characteristics which make up humankind.  Our very complexity appears to have placed so great a burden upon our individual capacity to absorb the awesome range of powers the human being has developed that we might be said to have burst the bounds of what each of us can encompass within ourselves of the human condition, becoming dispersed into so many fragments of the whole.”

If this is in some respects true, then the unique destiny conferred upon each of us through the imprint of our elemental DNA places not only a burden upon us, but is potentially a gift which we can make use of if we choose to do so.  But it leads us often to live precarious lives, subject to the unique demands placed upon us by the interactions of the elements within us and their interaction, in turn, with the elements of all those we encounter.  It is little wonder that human life is experienced as being so complex that it often threatens our ability to maintain our balance.

 

40. The positive and negative aspects of each element

I have been told that some of my Chinese students think that the Wood element has what we call a “bad press”.  They feel that we often make the kind of negative remarks about it which we apparently do not make about the other elements.  I am always surprised to hear this, because I like to think that I always emphasize that each element has both a positive and a negative side, one side which it shows when it is in balance, as opposed to the other when it is out of balance.  To me, lack of joy or excess joy, both evidence of the Fire element out of balance, for example, is just as disturbing to witness as an unbalanced expression of Wood’s emotion can be.  I have always felt that the reason why people think Wood’s imbalances are emphasized may very well lie in the word anger which is used to describe its emotion.  This has negative overtones which attach themselves to the Wood element, which the names of the emotions of the other four elements, joy, sympathy, grief and fear, do not immediately have.  This is why I always like to add a further definition of Wood’s emotion to that of anger, which is the word forcefulness.  Being forceful sounds much nicer in English than being angry, and yet anger, when expressed appropriately, is as positive an emotion as any of the other four.

It is good to look at the whole question of how each element reveals itself both in its balanced and in its unbalanced state.  First we need to define what we regard as a balanced element, and look at the way this may start to lose its balance when it is subject to too much pressure upon it.  Each element has balanced expressions of those four sensory attributes, its colour, its sound of voice, its smell and its emotion, by which it signals its control over those handed over to its protection.  (This is why I like to call this dominant element a person’s guardian element, because, like the more common expression, guardian angel, it hovers protectively over each of our lives.)  If we concentrate here on one of these qualities, an element’s emotion, then we should start by thinking about what we would describe as a balanced expression of these five emotions.  For each of us this will reflect something quite personal to us, perhaps based on our life experiences when engaging with people of different elements, but I imagine that there may well be a common quality about each emotion which we all recognise as being an expression of it when it is in balance.    

It is easiest here to use Wood as an example, because its emotion, anger, is the most visible and in-your-face of all the emotions, and therefore one that we can relate easily to, unlike the more hidden emotions of grief or fear.  I think we can all agree that it would be entirely appropriate for anybody to show their anger if, as happened to me, somebody tried to snatch the cash as I was withdrawing it from a cash machine in the street. I remember shouting at the man as he did  so, my shout alerting those around me in the queue so that he let the money drop and sprinted away.  I like to think that my anger, which had the accompanying effect of changing my voice to a shout, can be seen as being an appropriate and balanced response to the situation.

But what if, instead of this, I had cowered back and refused to engage with the incident?  Could this not have been considered an inappropriate reaction from my Wood element, as it failed to do what balanced Wood would have done?  In that case, I would have been showing a lack of anger, an inability to show anger where anger would have been appropriate.  Equally, if Wood people explode with anger inappropriately, perhaps because they are the kind of people who blow their car horns repeatedly when in a traffic jam for no obvious purpose except to let off steam, this could be described as being an expression of excess anger.  Here both lack of anger and excess anger are the two sides of the same coin, both showing the Wood element out of balance.

It is good to look now at how each of the other four emotions changes from positive to negative as it becomes unbalanced, and how we need to learn to recognize this as a way of diagnosing imbalance in our patients.  If we look at the element at the centre, Earth, it will show, in balance, the comforting qualities associated with this loving mother element, nurturing us, supporting us, ensuring that we feel grounded in all that we do.  All these attributes, however, can become liabilities if it itself starts to feel deprived of good nourishment and is unable to feed itself sufficiently, both physically and emotionally, to replenish the reserves it needs with which to feed others.  It can then react in one of two ways, either by exaggerating its particular qualities, so that we see them as expressing an unnecessary level of sympathy, of the “poor you” kind, where this would be inappropriate.  The reverse of this is when it feels it has to suppress its natural tendencies, and instead turns itself into a surprisingly hard and unforgiving element, its emotion becoming an unyielding lack of sympathy for the problems of others.   

Very different, indeed, from this example of an unbalanced element is that of Earth’s own mother element, Fire.  Unlike Wood, Fire is always likely to be viewed positively, for does not the word joy, which describes its emotion, immediately make us feel happier?  But, as we know, there can always be too much of a good thing, and exaggerated expressions of joy can overwhelm those who approach a Fire element which is out of balance, much as we might scorch ourselves if we move too near an open flame.  Other elements, particularly I expect that coolest of all elements, Metal, can feel threatened by what can seem to them to be the somewhat overpowering warmth which the Fire element in excess can spread around itself.  The opposite manifestation of unbalanced Fire, that of depleted Fire, will express itself as a lack of joy.  I have found that this form of low Fire energy can have an extremely draining effect upon those in its presence, making us feel as though all the warmth of our own heart is being drawn from us.

My response to the emptiness of Fire, which we call a lack of joy, is here very different from what I experience in the presence of Metal, where the unbalanced expression of grief, lack of grief, is where this element is unable to show grief in situations in which grief would be appropriate.  Here Metal seems to distance itself from us even more than it normally does, an extreme expression of suppressed grief making it seem totally unapproachable.  Lack of grief is the kind of emotion Metal people show who we would describe as emotionally numb or stony-faced when others around them are weeping.  It is not that such people are not experiencing grief.  It is that they are so overwhelmed by their feelings, that they are unable to express them and have learnt to suppress them.  Unbalanced Metal can also express itself as excess grief, which is when a person is unable to recover from the death of a beloved person, and may continue to mourn for many years.

The unbalanced expression of Water, our final element, is very different from that of its parent element, Metal.  Its fear, appropriate when it faces any frightening situation, becomes exaggerated when it loses its sense of proportion, and sees danger where a greater sense of balance would reassure it that all is well.  Excess fear is easier to diagnose than lack of fear, as we may not be sufficiently sensitive to detect the anxieties hidden behind a Water person’s show of apparent indifference to danger.  I remember a Water patient of mine who enjoyed putting herself into extremely risky situations (a solo parachute jump with very little prior training, for example), and seemed to enjoy the challenges she voluntarily faced, despite fearing them.  I would call this a lack of appropriate fear.

All elements can therefore exhibit a range of responses which veer from the most appropriate, and therefore the most balanced, to the unbalanced, on a scale of from a mild to an extreme expression of their emotion.  By listening carefully to how our patients describe their responses to stressful situations we can learn a great deal about the balance of the elements within them.