According to pop culture, agoraphobia is a general fear of going outside, and it strikes an unusual number of detectives, criminologists, and authors. It's one of the more inexplicable phobias out there. After all, we're all a little nervous about, say, spiders, clowns, or enclosed spaces -- phobic people are just a little more scared of them than normal. But it's impossible to imagine being afraid of, well, everything in the Universe outside your front door. Unless, of course, you've been there.
The truth is that it's not merely a phobia -- it's a physical illness that can be treated, though it's not as simple as taking a pill. To try to figure out this poorly understood condition, we talked to psychologist Dr. Paula Levine and two people with agoraphobia, Christie and Blaise. They said ...
If you know the word "agoraphobia," you probably think of it as that weird, superstitious fear of going out into public places. Drag a sufferer out to the mall, and they'll have a physical panic reaction bad enough that they can actually lose control of their bodily functions. The literal meaning is "fear of the marketplace," but that's more of a misnomer than calling Budweiser the King of Beers. As Dr. Levine points out, it is in fact the fear of having that panic attack -- specifically, having one in a public place and not being able to escape or get help. These are people who have had said attacks before, and their fear comes from hard experience. If that sounds like a ridiculous paradox ("So they're afraid of becoming afraid?"), well, welcome to the world of the agoraphobic. It's a cruel, self-sustaining cycle of anxiety over the prospect of getting anxious.
So it's not about a fear of the outdoors; it's about shame. It's a fear of having a meltdown in front of other people. That's what makes the hobbit lifestyle attractive to the agoraphobic. Many restructure their lives so they can justify staying in, whether that's by getting a job where they can work from home, cutting themselves off from society completely, or in Christie's case, moving back in with mom and dad. "My parents helped me -- initially by going to the shop for me, but [later] by accompanying me to places so that I felt like I had a little bit more support if I needed it."
Now imagine the life of a sufferer who doesn't have someone as understanding as Christie's parents to help them along. Those are the people who lock themselves away. Forever.
And it's not as if becoming a shut-in fixes the problem. As Dr. Levine explains, panic attacks are like Go-Gurt -- you can have one anywhere, and they always suck. "Staying home doesn't mean you're not going to have another panic attack. But that's what the mind does. The mind tries to make sense of a very surprising, out-of-the-blue [phenomenon]." Making a quick exit from the stressful situation provides relief. And so staying at home essentially means making camp in the second half of fight or flight mode. "What agoraphobics unfortunately do, which starts and maintains the phobia, is run. They flee the minute they feel panic beginning to mount. So they associate the flight and the feeling of relief with 'That's what I have to do to maintain my peace of mind.'"
And the more time you spend at home, the scarier the outdoors seem. So what is triggering these panic attacks in the first place?
A "panic attack" is a false alarm in the body's "fight or flight" response. This is the emergency system all of us have -- it floods the body with adrenaline, your heart starts pounding, you break out in a sweat. As Dr. Levine says, it's "a fight or flight response where there's nothing to fear -- no bigger animal chasing you, nobody really yelled 'Fire,' there's no reason for you to run, to have that feeling ... but the body is saying to you, 'I'm in such a state of upset that I have to get out of here.'"
As for what triggers this response in non-dangerous situations, your guess is as good as the experts'. Colorful theories abound, but nothing with the brain is ever simple. For example, run-of-the-mill workplace stress is a common precursor. That's what happened to Christie; she was working an unfulfilling bank job (as an employee; she wasn't casing the local Wells Fargo in preparation for a heist) when the attacks started. "It feels like a dream. Your eyesight is distorted and sometimes you get visual hallucinations. Nothing delusional, just unusual light patterns. On one occasion, I had a vertigo-type feeling where I actually fell and I had to go to hospital."
Her next job was equally stressful, and she realized that hustling business environments weren't for her. So she quit, but the anxiety lingered. "There was no stressor at home, but I still continued to have the same issues. Every day I would wake up with my heart pounding, I was sweating, feeling sick, but there was no reason for it anymore."
So what appears to happen is that in cases where your body should react with a moderate stress response ("Fuck this shit, I want to eat a solid pound of chocolate in the bathtub"), it instead overreacts, as if a miscommunication in the brain mistranslated "Financial report due Friday" as "OH SHIT WE'VE BEEN LOCKED IN A COFFIN AND THROWN INTO A VOLCANO." And once that happens, the cycle begins. The next attack can arrive at any moment, even if you're not under any stress at all. It's like a janky smoke alarm that goes off every other day, even though you put the fire out two weeks ago.
This is why it's so confusing for outsiders. They don't understand why sufferers can't simply shut their panic down the moment they realize there's no real danger. But it's a physical reaction; the body is doing this against their will. People having their first panic attack often think they're having a heart attack -- all they know is that their body is suddenly freaking out for no reason. From that point on, the "phobia" is of the freakout reoccurring. "[It] became worse and worse," Christie says, "until I found that I could not leave my house at all because there was nowhere I felt safe."
Another source, Blaise, experienced the same downward spiral from stress into isolation. He randomly had his panic attack while driving on his 21st birthday. It began to affect his college career, and six years later, he was living in his grandmother's house and unable to walk any further than the mailbox. Your career, your friends, your romantic relationships -- everything crashes to a halt.
Life gets pretty freaking weird when you find yourself at war with your own brain. As you can imagine, the everyday tricks and hacks intended to get around your malfunctioning stress response system aren't exactly logical themselves. Sometimes you have to fight superstition with superstition.
For example, some of you had a "security blanket" as a kid -- some object or toy you'd lug around with you, bursting into tears if you were forced to leave home without it. It's common for agoraphobics to wind up right back in that situation. Christie found she always had to take a bottle of water with her, feeling it might somehow save her if disaster struck. She also had to carry "something mint," because nothing helps lessen the stress of a panic attack like fresh breath.
She also developed odd habits she could never really account for, like compulsively checking mirrors. She couldn't drive with anyone else in her car, because she was disturbed by the idea that there was a passenger relying on her. The agoraphobic will wind up with all of these little rituals to feel like they have some kind of control over their body's random freakouts.
If you've ever met someone with a really specific list of won'ts ("I won't stay out past 9:00," "I won't take the elevator even if it means 20 flights of stairs," etc.), that's a sign that they may have agoraphobia. Dr. Levine's worked with people who have had aversions to bright lights, or an insistence on having an aisle seat in a theater. "You realize it's not that they fear the theater or the supermarket or elevators; it's that they fear what might happen to them in those places."
Blaise, who's now a mental health counselor himself, said it's not unusual for people struggling with anxiety attacks to carry Xanax with them. Not so they can pop it in an emergency (it doesn't work that fast, if it works at all), but for the symbolic power. See? I don't need to panic, because I have my magical cure right here with me.
There have always been anxious people, so you think we'd be able to recognize and treat agoraphobia rather well by now. Well, you'd think wrong, hypothetical reader whom we set up to fail for rhetorical purposes. Christie and Blaise both had trouble getting accurate diagnoses, and Dr. Levine continues to receive patients from other therapists who have no idea what a panic attack is.
In the '70s, when agoraphobia was still largely unknown, Blaise's therapist made his panic issues worse. But while he was getting screwed, proper treatment techniques were being developed. And so now, decades later, we know that the best way to fight anxiety is with some good old-fashioned love, care, and brutally cold confrontations of your darkest fears. Sort of like becoming Batman.
Dr. Levine's first step with any patient is smothering misconceptions, especially the idea that panic attacks will debilitate you forever. "My favorite treatment technique is, 'And so?' So what if you get [a panic attack]?" This sounds to us like a useful tool for getting over any terrible situation; you keep forcing yourself to confront the worst-case scenario until you realize that none of them end with you dying a horrible death. So what if your co-workers see you freak out? So what if you're not able to get back home in time? It doesn't take long to run through all of the "And so" scenarios before realizing there's no scary monster at the end.
That line of thinking was invaluable to Christie ("It's not the anxiety that's the problem. It's the rejection of discomfort"). It's also the approach that got Blaise back out into the world, one mailbox at a time. "I eventually got to where I could walk around the block, then could run a little bit, then running full miles. It was a very gradual process."
Great, therapy works! But it's not pleasant. Remember, your mind is rebelling against your own body's instinctive reactions. Here's Christie describing the side effects of a trip to buy milk: "Sweating, shaking, feeling sick, bowel problems, palpitations, and absolute terror that I can't describe. All of these things need to be experienced in order to get better. There is absolutely no way to improve without it."
Dr. Levine agrees with that assessment: "You aren't going to get better by [doing nothing], but by going right back [into anxiety-inducing situations] gently, with this hierarchy we're going to create. We're going to sit in the shallow end and take some consistent steps."
Blaise has found interoceptive exercises effective with his clients. That's essentially recreating the symptoms of a panic attack (shortness of breath, spiked heartbeat, etc.) in a controlled environment, riding the symptoms out, and then evaluating how they made you feel. If you can control scary symptoms, they stop being scary. "While most anxiety sufferers are frightened to try them, they desensitize and become confident that these 'weird' sensations aren't really that scary. A sense of mastery over them reintroduces a sense of confidence they'd all but given up on ever regaining."
Blaise turned his own struggles with agoraphobia into a career in mental health, and he's not the only one to see it as a turning point. Apparently, having crippling psychological issues can really help you focus on what you want out of life. Christie wants to get on the brain study train too: "I lacked direction, so owing to my own personal experience, I am now in the third year of a university degree, and I hope to go on to work in the field of neuroscience."
It turns out that once you've gone through Vietnam-flashback-style horrors to get your groceries, a few doctoral papers don't look so tough. But don't take our word for it. Let's run through a bunch of celebrities who launched careers while dealing with agoraphobia:
Paula Dean suffered from agoraphobia, and figured that cooking for her family was something productive she could do from the comfort of her African-American-free home. Eventually, she worked up the courage to start a restaurant and sell butter, fat, and salt-themed cookbooks with the skills she acquired from a lot of time spent in the great indoors. Writer Chuck Palahniuk is agoraphobic, and when you don't like going anywhere and find yourself facing limited career options, you put a lot more effort into writing about fight clubs.
Go back further, and Emily Dickinson (who rarely left her home and often talked to guests through doors) and Marcel Proust (who almost never left his bedroom for his final three years) may have both had it. So if you're an agoraphobe who wants to become one of history's greatest poets or novelists, you may have a head start. Kim Basinger, Carly Simon, Sally Field, and Barbra Streisand may not have shaped their careers around their agoraphobia, but they certainly used modern therapy to fight through it and make sure they stayed stars.
But as with any disease or disorder involving the brain, the big problem is how few people seek out help. It's hard enough to get people to leave the house for therapy even when a fear of leaving the house isn't the very thing they're being treated for. But it can be beaten.
"I can say I came out better," says Blaise. "Agoraphobia forced me to confront myself and my fears." Yeah, having a disorder where your brain freaks out over bullshit winds up providing a stark object lesson about how much of all fear is bullshit. That seems like a lesson everyone could stand to learn.
Christie has a Twitter.
For more insider perspectives, check out 5 Ridiculous Myths You Probably Believe About Schizophrenia and 5 Awful Lessons I Learned Living With A Mystery Illness.
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