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Everyone has fears of one sort or another. Sometimes these fears seem so irrational or exaggerated, they are given a name, for example, mysophobia, (the fear of germs) or erythrophobia (the fear of blushing.) I saw someone recently who had a fear of statues. She wanted to know the name of her disorder. As far as I know there is no name for her condition; but tomorrow there might be. It seems that we feel more comfortable giving a name to whatever fear we have, as if naming it is a way of understanding it, or getting control of it in some way. Last time I looked there were about thirty Greek names for phobias of one sort or another, clowns, airplanes, insects, needles and so on. The two most familiar named phobias are claustrophobia and agoraphobia.
Claustrophobia (the fear of enclosed spaces, such as elevators) and agoraphobia (the fear of open spaces, such as shopping centers and theaters) seem at first glance to be opposites; but they stem from the same underlying fears, and extend commonly to other places, such as bridges, tunnels, restaurants, airplanes, shopping malls, and still other places, any one of which may predominate in a particular person. Claustrophobia can be considered a variant of agoraphobia. This phobia usually occurs in the context of a panic disorder. Someone suffering from a panic disorder experiences unpredictably sudden attacks of fear with the usual physical manifestations of fear: shortness of breath, a fast heartbeat, dry mouth, etc. along with a psychological fear of losing control and doing something that is either dangerous, like driving off a bridge, or embarrassing, like throwing up or falling to the ground. It seems to such an affected person that the feeling will become overwhelming if he/she doesn’t leave that situation immediately. Consequently, phobics begin to feel uncomfortable in places where they are physically prevented from leaving (a stuck elevator, for instance,) or, more commonly, socially constrained from leaving, for example, leaving a restaurant in the middle of a meal. When they do leave, they usually think, “If I hadn’t left just then, just in time, I would have lost control completely.” When they do have an attack in these places, they never stay long enough to realize the attack will go away by itself.
During the great blackout in New York City some years back, I had a number of my patients, elevator phobics, trapped in elevators overnight. They all had the same experience in the same sequence: At first, they realized, at last, that what they have always feared had in fact happened. Then they pushed the elevator buttons to no avail. Their anxiety level spiked, lessened, then spiked again. They talked to the other people in the elevator. After about 30 to 45 minutes, they all calmed down! The rest of the night was spent thinking the same thoughts that anyone would think: how do I contact my family, how do I go to the bathroom, and so on. The panic attacks disappeared.
The treatment of panic disorder requires simply that the patient stay in the phobic situation long enough for the attack to go away. After repeated such incidents, he/she will become unafraid of future attacks. At that point the attacks become less frequent and last for a shorter period of time. Before they disappear altogether, they become uninteresting to the phobic person. It is possible to become blasé about being panicky! It may take some time, months, or years sometimes, for the attacks to go away forever; but they do. I have run into some patients years after treatment for this condition. When I ask about their panic attacks, they get annoyed. “That was a long time ago,” they say. They don’t remember, or choose not to remember, how bad they used to feel. © Fredric Neuman
Fredric Neuman M.D Read Dr. Neuman’s blog at www.fredricneumanmd.com/blog
