People with the panic disorder known as Agoraphobia basically suffer from the fear of losing control. This fear can become overwhelming.
The roots of the word come from agora-- greek for marketplace and phobia fear-- fear of the marketplace. In practical terms, agoraphobics are usually afraid of a range of situations-- the further from the place where they feel in-control, the worse. Some fear leaving their house, some going into big open spaces, some being in lines that they can't get out of. Some won't drive more than a few blocks. Some only drive by one route. If there's a detour, they turn around and go home. You won't find many agoraphobics in a line at Disneyworld. Many don't like any lines, even in the supermarket. Even ordering a meal at a restaurant, or sitting towards the front of a movie theater can be anxiety producing, since the agoraphobic worries about losing control while in front of other people.
In their minds, agoraphobics magnify the anticipation of a situation in which they panic, when their anxiety reaches a boiling point and they literally go crazy-- heart palpitating, screaming, passing out, having a heart attack, losing bowel or bladder control.
These moments of absolute loss of control rarely, if ever happen. The agoraphobics suffer more from anticipation than the actual experience. Yes, they feel anxiety. Yes their hearts race. But just thinking about going somewhere can set off those feelings and cause the victim to avoid, to stay at home.
I spent a few years, back in the 80's as a co-leader of agoraphobia groups, over that time, working with several hundred agoraphobics. It was gratifying work, especially compared to working with other psychological diagnoses. We helped heal a lot of people so they could lead more normal lives.
When I got an email from a reader recently, his response to the threat of terrorism reminded me of the folks I used to work with.
He wrote, in response to my article suggesting that Bush supporting men use their support of Bush and the war as a form of Viagra:
Who are you kidding? Do you realize in this situation, it is a cliche', "Kill or be Killed." If we don't protect ourselves, we will be under attack untill we are no longer the people of America, but the people of a fallen nation.
You talk as if you want us to look the other way while we are attacked. If Bill Clinton spent any of the money he wasted on trying to chase down Bill gates on defending our country, we woudl not need to protect our selves against an attack that started over a decade ago.
Ignoring the obvious evidence that this reader has digested and assimilated right wing anti-democrat talking points, it's clear that he is in a semi-panic state of mind. A lot of people talk about fear. But it just hit me, when I read his letter to the editor, that this is a LOT like the thinking of a panic disorder person.
People with panic disorder, a slightly broader term that includes agoraphobia, settle for less in life-- a lot less. They don't leave their house, or they avoid shopping malls, supermarkets, lines, movie theaters, long drives-- all because they are afraid of a reaction they don't even want to think about happening-- that they will have this massive panic attack, lose control, go crazy,soil their pants... So they don't do the things they fear. The live these narrow, avoidant, protected lives. I used to chide them that they might as well not walk out the door because an airplane could crash on their front step as they were walking out.
Any time they have a close call, when they feel their hearts pound, their thoughts race, their hands sweaty, their phobia is reinforced.
The treatment is remarkably simple, and effective. There are four primary components:
-group support: talk about the experience, learn and understand how anticipatory anxiety, how anticipation is the primary problem, how you are not alone, how other people learn to face the anxiety and persevere.
-self regulation/ relaxation training: building basic skills in learning to be relaxed, through biofeedback, meditation, yoga, guided imagery, different specific relaxation techniques that give the person more confidence in his or her ability to stay in control
-self talk skills: Cognitive training in how to talk oneself through anticipatory anxiety, rather than talking oneself into building anxiety. George Lakoff calls his approach to re-framing cognitive science.
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