Travelling is the agoraphobic's worst nightmare

Travelling is the agoraphobic's worst nightmare, particularly if he has to use public transport. Mingling with fellow travellers, waiting interminably for a bus or train while the anxiety grows, having to stand because there are no available seats - these are all situations which the sufferer dreads, believing that he is not going to survive without making an exhibition of himself.

Jo (sixteen): I have to take two buses and walk half a mile to school each day. Several of us travel together but I couldn't manage on my own. I live in dread that my friends might be ill or not coming to school that day for some reason. It is the walk that I feel I can't face. I dream about it most nights and see myself losing control, fainting or screaming. I never have fainted but the thought hangs over me like a dark cloud.

My doctor says I have agoraphobia and has put me on a waiting list for treatment at the hospital. He was a bit vague about what sort of therapy I will need and I am now very worried because I don't know what to expect. I've read about electro-convulsive therapy: I don't think I could face that. My imagination is working overtime filling me with fear and dread.

Although Jo's agoraphobia is fairly mild it could get worse if she doesn't have some help now. She could probably get help from one of the phobia organisations but as she is on a hospital waiting list it is important for her to know what to expect. Not ECT, for a start. One of the reasons so many agoraphobics refused to seek treatment in the past was that they knew the condition was often treated by electro-convul­sive therapy. Forty years ago, when it was assumed that agoraphobia was automatically linked with depression, many people underwent shock treatment for something they did not suffer from - it did nothing for their phobia. Depressed? Of course they were depressed: they were faced with the possibility of becoming permanently housebound and no one could explain to them exactly what was the matter. In the majority of cases the depression was caused by the agoraphobia, not vice versa.

There is a school of thought which feels that the cause of agoraphobia must be identified before the patient can be helped through analysis and psychotherapy, and it is obvious that if someone is seriously disturbed, psychotherapy will be a vital part of their treatment. However, most agoraphobics can pinpoint the onset of their condition to a time following a major upset in their lives.



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