Dr Alan Wade, a GP from Clydebank, became aware of the condition through his interest in phobias and panic attacks.
'Sufferers grossly underachieve/ he says. They often don't earn as much as the average person and favour solitary jobs where they can avoid scrutiny. They may even choose t& be unemployed because they can't face going out. They are prone to depression and other disorders such as agoraphobia, which has similar symptoms.
These phobias do not evoke much sympathy in those who have never experienced them. On the whole they seem trivial and sufferers do their best to hide them, feeling that they might be laughed at. Walking past a line of people standing at a bank counter, writing a cheque, speaking in front of a class - such simple actions for most of us, but agonising for many social phobia sufferers.
How can a visit to the bank be as traumatic as a visit to the dentist? It is the way that a phobic person's mind works ¬always jumping ahead, expecting the worst. One member of PAX explains his fear of his bank and the thoughts that run through his mind.
There are a lot of people waiting, I feel trapped already. I should have checked how much there is in my account. Supposing there isn't enough to cover this cheque? Why is the bank clerk looking at me in that funny way? What is the computer telling her? Why has she walked away? Everyone is looking at me.
By this time he can hardly take his money because his hand is shaking so much.
Another PAX member, this time a woman, wrote;
I cannot bear to be looked at. I am afraid I might do something silly, make a fool of myself, make a mistake or lose control in some way. More than anything I am afraid of anyone KNOWING I'm afraid.
Again, the problem is the need to escape before she commits the dreadful crime of drawing attention to herself. As we see, this is closely linked to the agoraphobic state. Avoiding social situations means that she may become housebound, but unlike the agoraphobic who can find sanctuary from her fears in her home, the social phobic finds that her problems follow her indoors.
To this person, the arrival of an unexpected caller can be a disaster. The sound of the doorbell, a knock on the door, sets off warning signals. Who is it? Why are they here? What do they want? These thoughts flash through her mind as she ducks into a corner where she cannot be seen. Her heart races, her mouth dries up as she feels the situation is getting out of hand and she won’t be able to cope. The only thing to do is to stay hidden until they go away. Unfortunately there are times when visitors must be faced,
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Tuesday 13 January 2009
Social Agoraphobia Sufferer - Escape to Safety
The agoraphobia sufferer has a need to escape to safety. She may be in a crowd of people, she may be alone in her phobic situation, but she feels trapped by her inability to detach herself quickly from the place where she is un¬comfortable and escape to her home or somewhere where she feels safe.
The person who suffers from social phobia does not have the same need to escape from a situation; it is other people he finds threatening, He cannot bear to be looked at, to have his body space invaded, to be touched, even inadvertently. Some sufferers find it physically impossible to touch or be touched by anyone other than members of their own immediate family.
Social phobics feel they are under scrutiny all the time; they imagine that all eyes are upon them and experience symptoms of acute anxiety, displaying outward signs of distress such as blushing, sweating and hyperventilating which they are sure everyone notices and despises them for. They are afraid of drawing attention to themselves, of being embarrassed by making a mistake or making fools of themselves. At the root of their shame is a fear of losing control in some way or not being able to continue what they are doing while they are being watched.
Social phobics often find themselves unable to relate to other people on any sort of personal level. They may have difficulty in expressing their emotions and feel that they cannot get close to others physically or emotionally; often, they are children who have had an over-protected upbringing, have not developed a sense of independence and are therefore unable to function adequately in an adult social world.
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The person who suffers from social phobia does not have the same need to escape from a situation; it is other people he finds threatening, He cannot bear to be looked at, to have his body space invaded, to be touched, even inadvertently. Some sufferers find it physically impossible to touch or be touched by anyone other than members of their own immediate family.
Social phobics feel they are under scrutiny all the time; they imagine that all eyes are upon them and experience symptoms of acute anxiety, displaying outward signs of distress such as blushing, sweating and hyperventilating which they are sure everyone notices and despises them for. They are afraid of drawing attention to themselves, of being embarrassed by making a mistake or making fools of themselves. At the root of their shame is a fear of losing control in some way or not being able to continue what they are doing while they are being watched.
Social phobics often find themselves unable to relate to other people on any sort of personal level. They may have difficulty in expressing their emotions and feel that they cannot get close to others physically or emotionally; often, they are children who have had an over-protected upbringing, have not developed a sense of independence and are therefore unable to function adequately in an adult social world.
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Social Phobia - Other people are quite dreadful The only possible society is oneself
A cure for shyness!' Newspaper headlines in the late 1990s were quickly taken up by the programme This Morning when Richard Madeley and Judy Finnegan told the nation that this new drug would transform the lives of people who suffered from devastating shyness. In fact, this drug - Seroxat (Paroxetine), an antidepressant - was not new. ?or several years it had been prescribed for depression, panic attacks and agoraphobia, and a large number of PAX members were finding it very helpful towards over¬coming their problems. Recently, though, Seroxat had been hailed as the new treatment for social phobias and acute shyness.
This Mornings presenters announced that they would hand out supplies of the drug to volunteers, who would be asked to try it out Tor a few days' and then report back to the programme, hopefully to tell viewers that their shyness had disappeared and that they were able to enjoy a full social life once more.
Fortunately, some concerned doctors and some of us involved in the phobia organisations managed to stop this irresponsible experiment before it got under way. Can you imagine the hopes raised and then dashed to the ground? Of course, the drug has been of great help to thousands with anxiety problems, but it takes a good three weeks to act and it needs to be prescribed by a doctor or psychiatrist, preferably in conjunction with further therapy.
What a fuss to make about being shy, you might think. After all, thousands and thousands of people suffer from shyness and a lack of self-confidence. Surely it is a matter of facing up to life and tackling problems, something that would automatically improve with maturity.
Social phobia is a growing problem which affects equal numbers of men and women, unlike agoraphobia, which is a condition more often attributed to women, though there is a considerable overlap between social phobia and agoraphobia.
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This Mornings presenters announced that they would hand out supplies of the drug to volunteers, who would be asked to try it out Tor a few days' and then report back to the programme, hopefully to tell viewers that their shyness had disappeared and that they were able to enjoy a full social life once more.
Fortunately, some concerned doctors and some of us involved in the phobia organisations managed to stop this irresponsible experiment before it got under way. Can you imagine the hopes raised and then dashed to the ground? Of course, the drug has been of great help to thousands with anxiety problems, but it takes a good three weeks to act and it needs to be prescribed by a doctor or psychiatrist, preferably in conjunction with further therapy.
What a fuss to make about being shy, you might think. After all, thousands and thousands of people suffer from shyness and a lack of self-confidence. Surely it is a matter of facing up to life and tackling problems, something that would automatically improve with maturity.
Social phobia is a growing problem which affects equal numbers of men and women, unlike agoraphobia, which is a condition more often attributed to women, though there is a considerable overlap between social phobia and agoraphobia.
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PAX newsletters
PAX newsletters are full of enthusiastic reports from recovering members.
Penny (thirty): I was never completely housebound but was heading that way. My GP prescribed Seroxat, and although it took several weeks before I noticed any effect it has been extremely helpful. I was told by my GP that I also needed to see a cognitive behavioural therapist as I could not rely on drugs for ever and must learn how to manage panic attacks if they returned. I found this a rather depressing outlook. Eventually I did see a behaviourist, by which time my GP had weaned me off Seroxat, encouraging me to try and do without it.
Unfortunately the panic attacks returned. It had been so easy to live a normal, panic-free life and I rather resented finding myself back to square one. I had to learn to tolerate the panics - though it took several attempts to get through the first occasions when I had to stand outside the super¬market. I didn't know it at the time, but my husband was hovering about, out of my sight. He wasn't convinced that wasn't going to react badly, collapse or burst into tears. The therapist wasn't too pleased when he found out and Richard was told quite firmly that he was to keep right way and let me work towards recovery on my own, without im fussing around me.
I realised how much I had depended on Richard's support in the past, but it was pointed out to both of us that his attitude was holding me back.
After four months I can now shop in the supermarket on my own. I still dread the panic attacks but am learning to tolerate them. My next step is a train journey - alone. I would feel happier if the trains were more reliable, as they are inclined to stop sometimes for fifteen minutes between stations. If this happens I shall look on this as an oppor¬tunity to put into practice all I have been taught about going through panic.
Many people have written to me who are having professional help and making progress with their recovery, and remind me about the late Dr Claire Weekes. In the 1960s her books helped thousands, and her advice is as appropriate today as it was forty years ago when Self Help for Your Nerves was the most requested book in libraries all over the world.
William wrote to the PAX newsletter:
I am a man of thirty-one and a recovered agoraphobic (note 'recovered', not 'recovering'). I have had six months of treatment - behavioural therapy at my local hospital - and I am for ever grateful to those who have helped me tackle my fears and overcome them.
I also attribute much of my present happy state to Claire Weekes, the Australian doctor whose books helped me through the worst time in my life when suffering constant panic attacks. I had to be persuaded by my mother to look at these books - I thought they were just for neurotic women.
Dr Weekes teaches four concepts of fear:
Face fear - do not run away.
Accept fear - do not fight it.
Float through fear - do not run away.
Let time pass - do not be impatient.
I would urge fellow PAX members to read Self Help for Your Nerves.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
Penny (thirty): I was never completely housebound but was heading that way. My GP prescribed Seroxat, and although it took several weeks before I noticed any effect it has been extremely helpful. I was told by my GP that I also needed to see a cognitive behavioural therapist as I could not rely on drugs for ever and must learn how to manage panic attacks if they returned. I found this a rather depressing outlook. Eventually I did see a behaviourist, by which time my GP had weaned me off Seroxat, encouraging me to try and do without it.
Unfortunately the panic attacks returned. It had been so easy to live a normal, panic-free life and I rather resented finding myself back to square one. I had to learn to tolerate the panics - though it took several attempts to get through the first occasions when I had to stand outside the super¬market. I didn't know it at the time, but my husband was hovering about, out of my sight. He wasn't convinced that wasn't going to react badly, collapse or burst into tears. The therapist wasn't too pleased when he found out and Richard was told quite firmly that he was to keep right way and let me work towards recovery on my own, without im fussing around me.
I realised how much I had depended on Richard's support in the past, but it was pointed out to both of us that his attitude was holding me back.
After four months I can now shop in the supermarket on my own. I still dread the panic attacks but am learning to tolerate them. My next step is a train journey - alone. I would feel happier if the trains were more reliable, as they are inclined to stop sometimes for fifteen minutes between stations. If this happens I shall look on this as an oppor¬tunity to put into practice all I have been taught about going through panic.
Many people have written to me who are having professional help and making progress with their recovery, and remind me about the late Dr Claire Weekes. In the 1960s her books helped thousands, and her advice is as appropriate today as it was forty years ago when Self Help for Your Nerves was the most requested book in libraries all over the world.
William wrote to the PAX newsletter:
I am a man of thirty-one and a recovered agoraphobic (note 'recovered', not 'recovering'). I have had six months of treatment - behavioural therapy at my local hospital - and I am for ever grateful to those who have helped me tackle my fears and overcome them.
I also attribute much of my present happy state to Claire Weekes, the Australian doctor whose books helped me through the worst time in my life when suffering constant panic attacks. I had to be persuaded by my mother to look at these books - I thought they were just for neurotic women.
Dr Weekes teaches four concepts of fear:
Face fear - do not run away.
Accept fear - do not fight it.
Float through fear - do not run away.
Let time pass - do not be impatient.
I would urge fellow PAX members to read Self Help for Your Nerves.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
Only Way Tackle Agoraphobia
Those of us who have emerged from the shadow of agoraphobia know that there is only one way to tackle it, and that is by exposure to the situations which you feel you cannot face - exposure to the situation and exposure to the unpleasant symptoms. Agoraphobics are inclined to judge their progress on their ability not to feel panic. Two or three panic-free trips to the supermarket; they are doing really well. Then on the next occasion the old frightening feelings come flooding back and it's back to square one again.
Face the fear. Enter into the phobic situation. Sounds simple and easy to do, but it can seem an insurmountable task for the agoraphobic. The most traumatic approach is known as flooding, where the patient is exposed to her most dreaded situation and encouraged to remain within it, experiencing the worst sensations that her phobia can produce, facing the panic feelings and the distress that follows until the peak is past and the symptoms gradually evaporate. This might take a few minutes, or it might take an hour or two, but the important point is that the sufferer stands her ground until the anxiety starts to lessen, and has to be prepared to remain "until it does.
The patient's fear is that her system cannot tolerate the acute phase of a panic attack, that there must be some terrible climax which will prove fatal. This is not so; when the panic feelings reach a peak there is only one way they can go -down. They will gradually subside and the sufferer will find herself sick and shaky but still in one piece ... and a step nearer recovery.
There is no doubt that such an experience is more exhaust¬ing than exhilarating, but it cannot be denied that if she is well prepared by her therapist and has the motivation and the courage to co-operate, this can be the fastest way to overcome agoraphobia.
Systematic desensitisation was popular in the 1970s as this as a more acceptable form of therapy for the patients. It involved learning to relax completely before visualising the phobic situations that the agoraphobic most feared. Learning o curb her out-of-control imagination was difficult, but the therapist would then guide her to the next stage - actually going to these places and finding that she could tolerate them without experiencing a panic attack.
This approach was very time-consuming for the therapist and unrealistic for the patient who, happily acclimatising herself to the phobic situations, was unprepared when a panic attack did materialise, didn't know how to cope with it and became disillusioned with the treatment.
These days the patient is instructed to take a different view of her phobia, changing her negative attitude towards e problem ('I know I shall have a panic attach) and telling herself instead, 'I shall probably feel panicky but I am no longer frightened by the thought of this as I understand how to over¬come it!
Instead of the flooding approach, where the agoraphobic was plunged into her worst nightmare and forced to endure the panic until it peaked then subsided, she is now instructed by her therapist to take it a step at a time.
She is told to 'construct a hierarchy' - making a list of her phobic situations ranging from the very mild to the most alarming. Listing them from one to ten, she will then proceed up the scale, learning to tolerate each one before progressing to one she finds more difficult.
The object of the exercise is not to try and avoid a panic attack but to actively encourage it to do its worst. Knowing that it is not going to damage her in any way, the agoraphobic goes through the experience, emerging at the end unscathed. Unlike the flooding technique the process is gradual, and the patient does not have to tackle her worst fears until she is well prepared.
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Face the fear. Enter into the phobic situation. Sounds simple and easy to do, but it can seem an insurmountable task for the agoraphobic. The most traumatic approach is known as flooding, where the patient is exposed to her most dreaded situation and encouraged to remain within it, experiencing the worst sensations that her phobia can produce, facing the panic feelings and the distress that follows until the peak is past and the symptoms gradually evaporate. This might take a few minutes, or it might take an hour or two, but the important point is that the sufferer stands her ground until the anxiety starts to lessen, and has to be prepared to remain "until it does.
The patient's fear is that her system cannot tolerate the acute phase of a panic attack, that there must be some terrible climax which will prove fatal. This is not so; when the panic feelings reach a peak there is only one way they can go -down. They will gradually subside and the sufferer will find herself sick and shaky but still in one piece ... and a step nearer recovery.
There is no doubt that such an experience is more exhaust¬ing than exhilarating, but it cannot be denied that if she is well prepared by her therapist and has the motivation and the courage to co-operate, this can be the fastest way to overcome agoraphobia.
Systematic desensitisation was popular in the 1970s as this as a more acceptable form of therapy for the patients. It involved learning to relax completely before visualising the phobic situations that the agoraphobic most feared. Learning o curb her out-of-control imagination was difficult, but the therapist would then guide her to the next stage - actually going to these places and finding that she could tolerate them without experiencing a panic attack.
This approach was very time-consuming for the therapist and unrealistic for the patient who, happily acclimatising herself to the phobic situations, was unprepared when a panic attack did materialise, didn't know how to cope with it and became disillusioned with the treatment.
These days the patient is instructed to take a different view of her phobia, changing her negative attitude towards e problem ('I know I shall have a panic attach) and telling herself instead, 'I shall probably feel panicky but I am no longer frightened by the thought of this as I understand how to over¬come it!
Instead of the flooding approach, where the agoraphobic was plunged into her worst nightmare and forced to endure the panic until it peaked then subsided, she is now instructed by her therapist to take it a step at a time.
She is told to 'construct a hierarchy' - making a list of her phobic situations ranging from the very mild to the most alarming. Listing them from one to ten, she will then proceed up the scale, learning to tolerate each one before progressing to one she finds more difficult.
The object of the exercise is not to try and avoid a panic attack but to actively encourage it to do its worst. Knowing that it is not going to damage her in any way, the agoraphobic goes through the experience, emerging at the end unscathed. Unlike the flooding technique the process is gradual, and the patient does not have to tackle her worst fears until she is well prepared.
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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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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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Common Contributing Factors that Cause Teen's Depression
Genes
Genes are materials in the cell that determine our physical and other characteristics such as eye color, height, and blood type and are passed on from one generation to the next. Probably several genes are involved in depression, and families with histories of alcohol or anxiety problems also carry a higher risk of depression. This does not mean that if a parent has depression (or bipolar disorder), that the child will have depression (or bipolar). In fact, when a first-degree relative of a child (parent or sibling) has depression, there is a 1.5 percent chance of the child being depressed and 16 percent chance they will have bipolar disorder. Likewise, if a first-degree relative has bipolar disorder, the child has a 4.5 percent chance of becoming bipolar and a 14 percent chance of experiencing depression. The bottom line is, most children of depressed parents do not become depressed, but they are at higher risk than the average child.
Brain Chemicals
A number of brain chemicals, or neurotransmitters, help brain cells communicate with one another. Serotonin and norepinephrine are two such chemicals, and people who are depressed tend to have lower than average levels of these chemicals in certain parts of the brain. Because medications that increase levels of either of these chemicals tend to be helpful in about 80 percent of depressed people, we conclude that many people have a biological basis for their depression. However, these brain chemicals are also influenced by environmental factors. Children who are abused, for example, can have altered brain chemistry associated with their abuse.
Kindling
Once the brain gets used to thinking in depressed ways, it becomes progressively easier to slip into these depressed thinking patterns in response to problems. This "kindling" (or tendency for commonly used thinking styles to become automatic) is one reason why early treatment of depression is so important!
Life stress
Most people respond to stress with a "fight or flight" response, to either deal with the stress or escape it. Depression occurs in reaction to stress only when the stress is either:
1)too great to deal with (for example, a major loss); or
2)repeated and perceived to be inescapable (termed "learned helplessness"). Stress often acts as a trigger for an episode of depression.
Learned Helplessness
Learned helplessness (the perception that stress is inescapable) is particularly problematic, because it interferes with the desire to help oneself. After all, what's the point in trying to change things if you can't reduce the stress anyway? Eventually, this attitude leads to hopelessness and despair. Some theorists link most or all depression to this state of mind.
In most cases, depression is due to a combination of several of these factors and not just one alone.
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Genes are materials in the cell that determine our physical and other characteristics such as eye color, height, and blood type and are passed on from one generation to the next. Probably several genes are involved in depression, and families with histories of alcohol or anxiety problems also carry a higher risk of depression. This does not mean that if a parent has depression (or bipolar disorder), that the child will have depression (or bipolar). In fact, when a first-degree relative of a child (parent or sibling) has depression, there is a 1.5 percent chance of the child being depressed and 16 percent chance they will have bipolar disorder. Likewise, if a first-degree relative has bipolar disorder, the child has a 4.5 percent chance of becoming bipolar and a 14 percent chance of experiencing depression. The bottom line is, most children of depressed parents do not become depressed, but they are at higher risk than the average child.
Brain Chemicals
A number of brain chemicals, or neurotransmitters, help brain cells communicate with one another. Serotonin and norepinephrine are two such chemicals, and people who are depressed tend to have lower than average levels of these chemicals in certain parts of the brain. Because medications that increase levels of either of these chemicals tend to be helpful in about 80 percent of depressed people, we conclude that many people have a biological basis for their depression. However, these brain chemicals are also influenced by environmental factors. Children who are abused, for example, can have altered brain chemistry associated with their abuse.
Kindling
Once the brain gets used to thinking in depressed ways, it becomes progressively easier to slip into these depressed thinking patterns in response to problems. This "kindling" (or tendency for commonly used thinking styles to become automatic) is one reason why early treatment of depression is so important!
Life stress
Most people respond to stress with a "fight or flight" response, to either deal with the stress or escape it. Depression occurs in reaction to stress only when the stress is either:
1)too great to deal with (for example, a major loss); or
2)repeated and perceived to be inescapable (termed "learned helplessness"). Stress often acts as a trigger for an episode of depression.
Learned Helplessness
Learned helplessness (the perception that stress is inescapable) is particularly problematic, because it interferes with the desire to help oneself. After all, what's the point in trying to change things if you can't reduce the stress anyway? Eventually, this attitude leads to hopelessness and despair. Some theorists link most or all depression to this state of mind.
In most cases, depression is due to a combination of several of these factors and not just one alone.
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Sunday 11 January 2009
Agoraphobia And Driving Phobia
Unfortunately, agoraphobia/driving phobia seems to be on the increase, among both men and women. On motorways in particular, nervous feelings begin to build up when surrounded by heavy trucks belting along, spraying smaller cars with water, mud and dust. It might be ten miles to the next turn-off, time to let anxiety build up until the driver finds the tension unbearable. He cannot stop, and feels as though he is whirling into space and there is no escape.
Ken: Driving along the motorway at around sixty miles an hour, I thought I must have been in an accident and died, the sensation was so weird and 'out of this world'. After the first flash of fear I managed to drive on to the hard shoulder and pull up. By that time I was shaking violently, sweat was pouring from me and I felt as though a great weight was pressing on me, stopping me from breathing. It was no accident, I realised, but by then I was convinced I was having a heart attack. There was no way I could get out of the car to get help; I just sat there trying to make sense out of the totally unreal feelings. After some five minutes things began to get back to normal and I nervously started the car, creeping along cautiously, hoping I would reach the next exit safely. Once off the motorway I felt slightly better and eventually got home.
Unfortunately this has happened a couple of times since. I am a professional man in my forties and consider myself pretty well-balanced. These episodes have shaken me badly; I now wait for the next attack to hit me and am beginning to feel that somehow I am going to have to avoid motorways altogether.
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Ken: Driving along the motorway at around sixty miles an hour, I thought I must have been in an accident and died, the sensation was so weird and 'out of this world'. After the first flash of fear I managed to drive on to the hard shoulder and pull up. By that time I was shaking violently, sweat was pouring from me and I felt as though a great weight was pressing on me, stopping me from breathing. It was no accident, I realised, but by then I was convinced I was having a heart attack. There was no way I could get out of the car to get help; I just sat there trying to make sense out of the totally unreal feelings. After some five minutes things began to get back to normal and I nervously started the car, creeping along cautiously, hoping I would reach the next exit safely. Once off the motorway I felt slightly better and eventually got home.
Unfortunately this has happened a couple of times since. I am a professional man in my forties and consider myself pretty well-balanced. These episodes have shaken me badly; I now wait for the next attack to hit me and am beginning to feel that somehow I am going to have to avoid motorways altogether.
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Women's Phobia
Women, of course, always accepted in earlier times to have a more delicate constitution, were not so reticent about admit¬ting to nervous problems. There are many examples during the last hundred years or so of women who were quite possibly suffering from what we would now recognise as agoraphobia. Shock, anxiety, frustration and physical ill health often lie behind the development of agoraphobic symptoms. How many swooning Victorian matrons languished on their day¬beds? How many wilting maidens suffered fits of Vapours' or slipped into a decline that might today be recognised as agoraphobia?
In later life, Florence Nightingale, with no physical outlet for her tremendous nervous energy, became housebound and was a semi-invalid for many years. After the shock of Prince Albert's death, Queen Victoria retreated from public life, unable to face her subjects en masse. Elizabeth Barrett was confined to her couch with physical symptoms which miracu¬lously improved after Robert Browning whisked her off to Italy and married her. Retrospectively we can only guess, but each of these ladies displayed classic agoraphobic tendencies. Even in fiction there is Charles Dickens' Miss Havisham in Great Expectations, housebound since being jilted on her wedding day.
Not all agoraphobia sufferers experience constant panic attacks. Some people, women in particular, may become housebound for a variety of reasons, resulting in a loss of confidence and unwillingness to leave the house. The longer this lasts, the more nervous the subject becomes as the outside world appears hostile and threatening. If she is persuaded to go further than her base she may well experience rising anxiety, leading to a full-blown panic attack.
Many agoraphobics are free from their fear when driving because the family car can feel like an extension of the home; like a snail or a tortoise, these sufferers would like to carry with them a permanent shell into which they can retreat at any time.
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In later life, Florence Nightingale, with no physical outlet for her tremendous nervous energy, became housebound and was a semi-invalid for many years. After the shock of Prince Albert's death, Queen Victoria retreated from public life, unable to face her subjects en masse. Elizabeth Barrett was confined to her couch with physical symptoms which miracu¬lously improved after Robert Browning whisked her off to Italy and married her. Retrospectively we can only guess, but each of these ladies displayed classic agoraphobic tendencies. Even in fiction there is Charles Dickens' Miss Havisham in Great Expectations, housebound since being jilted on her wedding day.
Not all agoraphobia sufferers experience constant panic attacks. Some people, women in particular, may become housebound for a variety of reasons, resulting in a loss of confidence and unwillingness to leave the house. The longer this lasts, the more nervous the subject becomes as the outside world appears hostile and threatening. If she is persuaded to go further than her base she may well experience rising anxiety, leading to a full-blown panic attack.
Many agoraphobics are free from their fear when driving because the family car can feel like an extension of the home; like a snail or a tortoise, these sufferers would like to carry with them a permanent shell into which they can retreat at any time.
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Phobiaas History: fact and fiction
Phobias are not a phenomenon of contemporary life; through the ages people have suffered from a variety of phobias, but it is interesting to find that there are few historical references to omen being affected. This does not mean that women did suffer from them, but probably reflects the sexist bias that only events happening to men were worth recording!
Apparently there was no shame attached to a man admitting to a specific phobia, but when agoraphobia, with its background of sudden panic attacks, became recognised, it quickly came to be considered a woman's problem. Described the housebound housewife's complaint or the 'empty nest syndrome', it was linked with menopausal women whose children had left home. Even more alarming, until recent years agoraphobia was known as the 'Latent Prostitute Syndrome' and still is in some Scandinavian countries. This assumes that these women are afraid that unmanageable sexual urges might cause them to attack a man in the street. Therefore it is safer for them to stay indoors away from temptation!
It is hardly surprising that agoraphobic men disliked being identified as suffering from the condition as they battled on, determined to lead as normal a life as possible. Many men have a horror of anyone knowing they are agoraphobic, as there is often a definite possibility of jobs being at risk and careers ruined if their 'weakness' is exposed. At one time there were a number of well-known men in The Open Door -television and other media personalities, an eminent lawyer, several doctors and even a Member of Parliament. The late Roy Plomley, famous for his programme Desert Island Discs, admitted (privately) that he could imagine nothing more traumatic than being stranded on an island with no possibility of escape. Roy's agoraphobia was so bad that his wife had to drive him to and from the BBC; he couldn't travel on his own by public transport, nor could he drive his car alone.
There are, of course, a few recorded incidences of male agoraphobics, including - of all people - Sigmund Freud, who for several years had a fear of travelling and became so anxious that he would arrive at a station an hour before his train was due to leave.
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Apparently there was no shame attached to a man admitting to a specific phobia, but when agoraphobia, with its background of sudden panic attacks, became recognised, it quickly came to be considered a woman's problem. Described the housebound housewife's complaint or the 'empty nest syndrome', it was linked with menopausal women whose children had left home. Even more alarming, until recent years agoraphobia was known as the 'Latent Prostitute Syndrome' and still is in some Scandinavian countries. This assumes that these women are afraid that unmanageable sexual urges might cause them to attack a man in the street. Therefore it is safer for them to stay indoors away from temptation!
It is hardly surprising that agoraphobic men disliked being identified as suffering from the condition as they battled on, determined to lead as normal a life as possible. Many men have a horror of anyone knowing they are agoraphobic, as there is often a definite possibility of jobs being at risk and careers ruined if their 'weakness' is exposed. At one time there were a number of well-known men in The Open Door -television and other media personalities, an eminent lawyer, several doctors and even a Member of Parliament. The late Roy Plomley, famous for his programme Desert Island Discs, admitted (privately) that he could imagine nothing more traumatic than being stranded on an island with no possibility of escape. Roy's agoraphobia was so bad that his wife had to drive him to and from the BBC; he couldn't travel on his own by public transport, nor could he drive his car alone.
There are, of course, a few recorded incidences of male agoraphobics, including - of all people - Sigmund Freud, who for several years had a fear of travelling and became so anxious that he would arrive at a station an hour before his train was due to leave.
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Men Suffer Agoraphobia Too
In the early days of The Open Door (TOD) it was thought that as many as 90 per cent of agoraphobics were women. Now it is recognised as being around 75 per cent.
In the 1960s when I started TOD all our publicity was through women's magazines, with articles such as 'A prisoner in her own home', accompanied by photographs of a middle-aged woman peering anxiously through her net curtains. Programmes such as Woman's Hour featured such women, and all the agony aunts in the women's magazines reassured sufferers from panic attacks and agoraphobia, referring them to TOD and the other phobia organisations then springing up. No one seemed concerned about any men who might be experiencing the same problems until the 1970s, when the media began to acknowledge this.
At last, newspapers, radio and TV featured male agoraphobics and how their lives were affected by the condition. At once the phobia organisations began to hear from more and more men, many of them in their early twenties, which was a surprise to some of us. Until then, agoraphobia been assumed to be a female disorder.
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In the 1960s when I started TOD all our publicity was through women's magazines, with articles such as 'A prisoner in her own home', accompanied by photographs of a middle-aged woman peering anxiously through her net curtains. Programmes such as Woman's Hour featured such women, and all the agony aunts in the women's magazines reassured sufferers from panic attacks and agoraphobia, referring them to TOD and the other phobia organisations then springing up. No one seemed concerned about any men who might be experiencing the same problems until the 1970s, when the media began to acknowledge this.
At last, newspapers, radio and TV featured male agoraphobics and how their lives were affected by the condition. At once the phobia organisations began to hear from more and more men, many of them in their early twenties, which was a surprise to some of us. Until then, agoraphobia been assumed to be a female disorder.
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Who suffers from agoraphobia?
It is difficult to estimate the number of agoraphobics in the world. We really have no idea how many there are as the number of people receiving treatment is a very small proportion of the whole, put best estimates are that it varies between three and five million.
At one end of the scale are those whose phobia affects their lifestyle totally, even to the extent of them becoming house¬bound, while at the other end there is an army of women and men whose symptoms are mildly disturbing but manageable, who would never dream of admitting to such problems and would certainly not seek treatment for what they would probably describe as a 'nuisance'.
As the official number of agoraphobics is based on the number receiving treatment it is obvious that this is quite irrelevant.
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At one end of the scale are those whose phobia affects their lifestyle totally, even to the extent of them becoming house¬bound, while at the other end there is an army of women and men whose symptoms are mildly disturbing but manageable, who would never dream of admitting to such problems and would certainly not seek treatment for what they would probably describe as a 'nuisance'.
As the official number of agoraphobics is based on the number receiving treatment it is obvious that this is quite irrelevant.
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Judith's Case of Agoraphobic's Dilemma
Judith: Each day on my way to work I have to pass a high fence about a hundred yards long. On the other side of the road is a church with a very tall steeple, which soars into the sky. I try to avoid looking up at it as I begin to feel dizzy and slightly sick, and I walk along beside the fence which appears to go on for ever. I feel more and more disorientated. If I break into a run my heart starts to race and I begin to sweat.
How crazy to be afraid of a stretch of road! I cannot avoid it as it is the only approach to the local train station and I must get to the city centre to my office. I have seriously thought of giving up my job because I cannot face this daily ordeal for much longer.
The agoraphobic's dilemma is that if she experiences these feelings in certain places, she will avoid these places in order to avert the panic; but with sensations of anxiety always resent she then begins to worry about other situations. She expects the panic to occur - so it does, almost as though her mind has an 'on' switch which operates whenever she thinks about the dreaded spot. The trouble is that she does not know to operate the 'off switch, so she retreats to safety - only soon nowhere is safe. If she is really unlucky she will feel that the only place to avoid panic is behind her own front door; but even then, if the habit of switching on fear has become established, the security of her home may not protect her from the dreaded attacks.
Some long-term agoraphobics may not be able to recall the last time they experienced a full-blown panic attack but, trapped by the fear of fear, they are not prepared to risk facing a dreaded situation - just in case.
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How crazy to be afraid of a stretch of road! I cannot avoid it as it is the only approach to the local train station and I must get to the city centre to my office. I have seriously thought of giving up my job because I cannot face this daily ordeal for much longer.
The agoraphobic's dilemma is that if she experiences these feelings in certain places, she will avoid these places in order to avert the panic; but with sensations of anxiety always resent she then begins to worry about other situations. She expects the panic to occur - so it does, almost as though her mind has an 'on' switch which operates whenever she thinks about the dreaded spot. The trouble is that she does not know to operate the 'off switch, so she retreats to safety - only soon nowhere is safe. If she is really unlucky she will feel that the only place to avoid panic is behind her own front door; but even then, if the habit of switching on fear has become established, the security of her home may not protect her from the dreaded attacks.
Some long-term agoraphobics may not be able to recall the last time they experienced a full-blown panic attack but, trapped by the fear of fear, they are not prepared to risk facing a dreaded situation - just in case.
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Agoraphobia - Nothing Is Terrible Except Fear Itself
Constant panic attacks become 'panic disorder' and, as the sufferer knows, they can strike at any time and in any situation. Because they usually happen away from the safety of the home, the term agoraphobia' was used in the past to signify fear of open spaces
The Greeks had the correct definition - agora the market lace or place of assembly, and phobos, terror or flight. They understood the panic-stricken need to escape from a situation - wherever it was, indoors or outside - when the feelings of ear became overwhelming.
Those who have not experienced this problem naturally find it difficult to comprehend the extent of the Offering it causes. It is a condition that defies easy description, for these days the word 'agoraphobia' is used as a collective term for a number of unpleasant sensations which can, if allowed, wreck the life of the sufferer, but which appear to bear little relation to the original definition: fear of open spaces. Fear is there, certainly, but fear of what? Not of the great outdoors, the shopping centre, the motorway - but fear of the terrifying irrational feeling of anxiety escalating to panic which for no apparent reason can overwhelm the victim. One person may well experience these feelings in a shopping centre, another in an open field, another on a bus or in church. Yet another sufferer may be affected in each one of these situations, but what we have to understand is that it is not the 'place of assembly' - the theatre or the supermarket - that is the object of the phobia; these become places to be avoided because they are the settings associated with the fear.
When panic strikes, the overwhelming need is to escape. If you are out in the open you must get under cover; if you are in a confined space you look round for an exit. You must get away from the people milling about you, must escape from the noise, the silence, the bright lights, the darkness. There are so many things to dread and all of them contradict each other. No wonder the sufferer is confused when told that agoraphobia is the problem when she feels just as panic-stricken in a lift or hemmed in by a crowd. Isn't this claustrophobia?
The definitions of the two states may appear to be con¬tradictory, but agoraphobia and claustrophobia both apply to a state of anxiety which manifests itself in certain situations, causing feelings of terror and a need to escape from and avoid these situations.
Trapped! Inside or out, the feelings are the same. Agora¬phobia may begin when a panic attack strikes in a specific situation. The situation itself becomes the focus of the fear as the subject expects a repetition of the original panic attack and, anticipating it, involuntarily triggers it off.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
The Greeks had the correct definition - agora the market lace or place of assembly, and phobos, terror or flight. They understood the panic-stricken need to escape from a situation - wherever it was, indoors or outside - when the feelings of ear became overwhelming.
Those who have not experienced this problem naturally find it difficult to comprehend the extent of the Offering it causes. It is a condition that defies easy description, for these days the word 'agoraphobia' is used as a collective term for a number of unpleasant sensations which can, if allowed, wreck the life of the sufferer, but which appear to bear little relation to the original definition: fear of open spaces. Fear is there, certainly, but fear of what? Not of the great outdoors, the shopping centre, the motorway - but fear of the terrifying irrational feeling of anxiety escalating to panic which for no apparent reason can overwhelm the victim. One person may well experience these feelings in a shopping centre, another in an open field, another on a bus or in church. Yet another sufferer may be affected in each one of these situations, but what we have to understand is that it is not the 'place of assembly' - the theatre or the supermarket - that is the object of the phobia; these become places to be avoided because they are the settings associated with the fear.
When panic strikes, the overwhelming need is to escape. If you are out in the open you must get under cover; if you are in a confined space you look round for an exit. You must get away from the people milling about you, must escape from the noise, the silence, the bright lights, the darkness. There are so many things to dread and all of them contradict each other. No wonder the sufferer is confused when told that agoraphobia is the problem when she feels just as panic-stricken in a lift or hemmed in by a crowd. Isn't this claustrophobia?
The definitions of the two states may appear to be con¬tradictory, but agoraphobia and claustrophobia both apply to a state of anxiety which manifests itself in certain situations, causing feelings of terror and a need to escape from and avoid these situations.
Trapped! Inside or out, the feelings are the same. Agora¬phobia may begin when a panic attack strikes in a specific situation. The situation itself becomes the focus of the fear as the subject expects a repetition of the original panic attack and, anticipating it, involuntarily triggers it off.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
What If Your Depressed Teen Won't See a Psychologist or Psychiatrist?
Parents are often the first to recognize the presence of emotional or behavioral problems in their child's life. If you have identified symptoms of depression through this article or through others who know and have voiced concern about your teen, we strongly advise that you seek professional stigma. That is not to say that the decision to seek help is an easy one. With the negative stigma of depression, it can often be difficult and painful for parents and embarrassing for adolescents. But, we believe it is worth it.
The first step is to gentiy try to talk to your teen. An honest, open talk about your concern might help your teen to share his thoughts and feelings with you. He needs to know that you are concerned and would like to check things out for him with a professional.
Many teens are leery of seeing a "shrink." When they reject psychiatric help, it is often because they are familiar with media stereotypes of mental health professionals and the people who consult them, or because they fear appearing weak in front of peers.
See if your son would consider seeing a family doctor, nurse practitioner, or school nurse first. Some teens are willing to agree to a "check-up" of physical health (for example, to look at causes for the fatigue often associated with depression) but not to an appointment focused on mental health. A sensitive nurse or physician may be able to gradually explore mental health issues either as part of the check-up or during a follow-up visit. If your teen is hesitant about seeing his usual nurse or doctor, perhaps because of confidentiality concerns, provide some alternative names. In some communities, specialized "teen clinics" are available for adolescent health concerns as well. You could also ask the school counselor to chat with your teen about what is bothering him and, perhaps, about pursuing an appointment with a psychologist or psychiatrist.
If you cannot get your teen to see anybody, ask the professional you wanted your teen to consult whether he or she would be willing to speak to you, the parent, as a first step. Just getting an outside perspective on your child's difficulties may be helpful, and may give you additional ideas on how to get him to access help.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
The first step is to gentiy try to talk to your teen. An honest, open talk about your concern might help your teen to share his thoughts and feelings with you. He needs to know that you are concerned and would like to check things out for him with a professional.
Many teens are leery of seeing a "shrink." When they reject psychiatric help, it is often because they are familiar with media stereotypes of mental health professionals and the people who consult them, or because they fear appearing weak in front of peers.
See if your son would consider seeing a family doctor, nurse practitioner, or school nurse first. Some teens are willing to agree to a "check-up" of physical health (for example, to look at causes for the fatigue often associated with depression) but not to an appointment focused on mental health. A sensitive nurse or physician may be able to gradually explore mental health issues either as part of the check-up or during a follow-up visit. If your teen is hesitant about seeing his usual nurse or doctor, perhaps because of confidentiality concerns, provide some alternative names. In some communities, specialized "teen clinics" are available for adolescent health concerns as well. You could also ask the school counselor to chat with your teen about what is bothering him and, perhaps, about pursuing an appointment with a psychologist or psychiatrist.
If you cannot get your teen to see anybody, ask the professional you wanted your teen to consult whether he or she would be willing to speak to you, the parent, as a first step. Just getting an outside perspective on your child's difficulties may be helpful, and may give you additional ideas on how to get him to access help.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
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