Fears and Phobias

A phobia can be defined as an intense anxiety reaction, in which specific stimuli that arouse the reaction can be identified, and in which the feared object actually lacks the dangerous qualities expected by the individual concerned.

What this means, simply, is that the intensity of a phobic individual's reaction to the object of his phobia is out of all proportion to the actual danger. In this chapter, we shall explain how a person can come to fear an object, event or situation which is, in reality, quite harmless We shall also examine the problems which phobias can cause.

HOW PHOBIAS DEVELOP

1: CONDITIONING

If you experience anxiety in a particular situation, you may later feel anxiety in other similar situations. This conditioned anxiety - or 'fear' - is often strong and tends to recur many times in the future. The process is illustrated by a girl with claustrophobia. She remembered being shut into a coal-bunker by her parents.

She described the experience in this way: 'I was shut in ... pitch black everywhere and choking in coal dust, left there all day. I still shiver when I think about it. For years I could not be left alone and had nightmares galore'. Obviously this brutal punishment had terrified her, and the psychological pain and trauma which it had produced were evoked by any remotely similar situations later in life.

We can develop a phobia about literally anything. However, some phobias (for example, the fear of spiders, snakes and high places) are more common than others, an observation which has led Dr Seligman of Pennsylvania University to suggest that humans are predisposed to develop certain fears.

It is indeed true that the most common phobic objects such as snakes or insects might have represented one of the more dangerous environmental influences during the evolution of our ancestors. Although this idea is mostly speculation, it is supported to some extent by the observation that babies avoid the edges of surfaces above the ground - as though they are instinctively afraid of heights.

In contrast, we know for sure that a person's level of arousal during a traumatic event (or series of events) is a factor of great importance in determining whether or not he or she develops a phobia as a result of that event.

As you may recall, this is because conditioning is much more powerful when you're emotionally highly aroused. The extent to which one becomes aroused in any situation depends in part upon how one perceives that situation.

Consider, for example, a fear of the dark. As a child, you may have vividly imagined all sorts of dangers lurking in the dark. if your parents did not discourage these fears, you might have been frightened very easily by strange or unexpected noises at night.

The more anxious you became, the greater the likelihood that you would develop a fear of the dark.

Many phobias develop during childhood we may not have the mental and physical ability to cope with stressful experiences in a rational way. The next two cases illustrate this point. The first concerns a middle-aged woman who had a phobia about dogs which was so severe that she became physically ill if one so much as touched her.

Investigation revealed that when she was a very young child, a dog had jumped up at her, knocked her over, and dragged her along the road by pulling her coat. Although as an adult the woman knew that dogs are usually quite harmless, her subconscious mind had been conditioned by the experience and so she continued to feel fear whenever she saw a dog.

(Incidentally, this emphasizes the protective function of the conditioning process - that is, to keep us away from whatever has been a source of danger in the past.)

The second case concerns a woman with a phobic fear of cats. This lady clearly remembered the incident which had started the problem: at the age of four, her father had drowned a favorite kitten in front of her. When, at the age of 14, her parents placed a fur coat inside her bed, she became hysterical; and when she was 18, the sight of a cat produced another bout of hysteria.

After this, her phobia continued to develop, until, by the time she was 30, her fear of cats was so marked that she refused to walk out of doors on her own. Nor would she enter a room or house where she suspected there might be a cat. Even touching her daughter's furry teddy bear upset her! This woman did not feel anxious when she actually saw a cat - rather, she spent much of her time in a state of fear that she might see one.

This kind of irrational fear may be the 'final straw' which actually impels a phobic person to seek help. Secondly, the woman's fear had generalized from the original stimulus - a cat - to other vaguely similar objects, including the teddy bear.

This process of generalization is common with phobic anxiety. For example, Helen was a client ours who has had a fear of heights since she was 15. Her phobia developed when she was lying on a cliff-top with some school friends.

One of the boys grabbed her arm and pretended that he was going to push her over. Helen was extremely frightened and alarmed, even though the boy quickly released her. Ever since then, she has felt dizzy each time she's been near a cliff-edge, and she has avoided high places as much as possible.

Interestingly she is also scared of flying although she manages to travel on planes, albeit with mild discomfort and anxiety. It seems likely that this is a generalization of her fear of heights, rather than a genuine fear of flying.

It's important to realize that the way in which we view any potentially stressful event determines the effect which it will have on us.

Social phobias

As we mentioned earlier, it is possible to develop a phobia about any object, situation or event. Thus, for example, some people find that the idea of eating in public causes them intense anxiety. Other people find public speaking to be a major ordeal. Social phobias like these develop in much the same way as the more well-known phobias about insects, flying, high places, and such like.

We mentioned earlier that a common phobia centers on anxiety about eating in public. Quite often this phobia develops after an embarrassing or alarming experience such as having a fish-bone stick in your throat or coughing violently after you've swallowed a drink 'the wrong way'.

Although a person who experiences an unfortunate incident like this will probably feel better very quickly, he may be surprised to find that next time he sits down to eat a meal, he feels more and more anxious. As so often, this anxiety gradually increases - perhaps to the point where it is impossible to eat or drink in public.

Intense anxiety about situations which involve other people may arise in a slightly different way. Suppose, for example, that a person's quite normal anxiety in a particular situation results in a  stammer, a blush to the face, a slight shaking of the hands or a need to visit the toilet. Such reactions are, of course, quite normal (for example, even the most accomplished public speakers sometimes find that their hands are shaking, even if they do not feel nervous). Unfortunately, they can also be very embarrassing.

And as one's embarrassment begins to mount, with thoughts such as 'Oh no, what will all these people think of me?' one's anxiety also increases. This in itself makes the problem worse. But as if that wasn't bad enough, as soon as you focus your attention on a muscular tremble, a blush to your cheeks, a need to visit the toilet or a slight stammer, they all begin to seem more obvious and more urgent!

Now, some people can laugh off such experiences and never worry about them again. But other people are acutely sensitive to this kind of embarrassment and worry, and next time they are in a similar situation, they will have a lot of anxiety about the same thing happening again.

Worry like this is the first step in what could become a self-fulfilling prophecy: in other words, you worry about blushing, stammering, trembling, saying the wrong thing, or one of a hundred other problems, and before you know it, your anxiety is so intense that it has actually happened! You then feel an overwhelming urge to escape from the anxiety-producing situation - and never to return in the future!

Other common fears and worries look like 'social phobias'. For example, there are many anxious people who believe - quite wrongly - that 'everyone is looking at me'. Such worries centre on a fear of being the focus of attention.

Someone with this type of anxiety problem may become so self-conscious that he will not enter a room of strangers or walk past other men and women at, say, a bus-stop. Sometimes anxiety centers on worries that one's body is unusual, ridiculous or amusing. Again, this can develop into an extreme self-consciousness; this time, about revealing one's body in a swimming costume, and such like.

It's often not so easy to explain the origin of fears like these. They come from a mixture of a poor self-image, unpleasant past experiences in childhood and adolescence (a time at which one's developing sense of self-identity and self-esteem is very vulnerable to the ridicule of one's peers), conditioned anxiety from unpleasant experiences in adulthood; and other repressed fears and worries.

But perhaps the most common 'social phobia' of all is anxiety when meeting other people - or at the thought of meeting other people. Of course, nearly all of us have at least some initial anxiety in social situations.

Shy people, however, often experience such intense anxiety that they really can be said to have 'a fear of meeting people'. Sometimes it is hard to distinguish between 'normal' anxiety, self-consciousness and shyness, and this more extreme form.

II: REPRESSION

Earlier, we explained how thoughts, feelings and emotions which a person finds unacceptable may be repressed from the conscious to the subconscious mind. The process starts when an unacceptable fear or worry is repressed into the subconscious mind, which then appears to 'search' for something symbolic on to which the original feelings of fear and anxiety can be projected.

As a result, the apparent object of the phobia actually masks the real fear. Some examples will help to illustrate this idea.

In one case a young woman with an irrational fear of snakes and lizards had to check all the bedding on her bed before she went to sleep each night. Her fear also generalized on to insects, so that if she saw a centipede or worm on the ground, she would take refuge in her house in panic.

When she began to talk of moving house so as to avoid these animals, she was persuaded to obtain professional help. After some discussion with her doctor, the cause of the problem emerged: as a child, she had been sexually assaulted by her cousin. However, she had not told her parents because she thought they might blame her for the incident.

Rather, she repressed all her memories of the event, presumably with the feelings of guilt and anxiety which it had produced. After her marriage, her sexual activity reawakened memories of that childhood experience and the guilt and shame she had felt.

All the distressing emotions and feelings which she recalled became associated with sexual activity and were transferred in symbolic form on to these small animals. Interestingly, when she began to discuss the childhood experience, her shame and guilt vanished and her phobia went with it.

A person who fears success (or the responsibility attached to success) might find he develops a fear of heights. Other products of this repression and projection process could include a fear of ladders, looking over the tops of buildings and so on. Incidentally, people often experience strong thoughts or fears when they are on top of high cliffs or buildings.

These can take the form of an irrational worry that you might throw yourself over the edge. Similarly, some people have experienced an irrational urge to drive your car at a brick wall. Perhaps feelings and thoughts like these consciously represent a subconscious fear of 'not being in control of oneself'.

So a phobia sometimes acts as a defense mechanism which helps a person to avoid the real cause of his anxiety. For example:

  • If only I wasn't afraid of flying, I could take that job in America.
  • If only I didn't have a phobia about her dogs, I could move in and live with my girlfriend.
  • I feel so awful when I'm in an enclosed room. It stops me joining my friends and colleagues at parties and restaurants.

In each case, the person concerned might be using his phobia to avoid doing something which would cause him even more anxiety. Thus, if you have a phobia, try asking yourself what you would do if the phobia was suddenly removed. Your answer may reveal the real cause of your fear.

Is it possible to treat a phobia without a full knowledge and understanding of how and why it originally developed? Psychodynamic psychotherapists claim treatment of a phobia is only possible if the full psychological background is known.

Behavioral therapists, on the other hand, have claimed a 90 per cent success rate for the treatment of phobias - without even knowing the original cause of the problem. It seems one can safely treat a phobia without probing into its origins, so long as any associated anxiety, depression and personality problems are dealt with at the same time.

Worry and Phobias

Usually a phobic person only experiences anxiety when he or she comes into contact with the object of his or her phobia. But as we have already seen, phobic anxiety sometimes develops into a constant, more-or-less intense anxiety centered on the possibility of actually coming across the phobic object.

This is probably rather more common than you might think. It can take many different forms; in every case, though, the person concerned cannot perceive or accept that his fear is irrational (even if there is a fragment of reality at the bottom of the problem). Maybe newspapers and TV play a role in promoting needless fear and anxiety?

The intense and persistent but totally irrational nature of fears such as these strongly suggests that repression and projection have taken place. In other words, that a person has repressed some worry or other emotional problem into his or her subconscious, and that his subconscious has then projected the emotional problem on to the feared object or event.

If this is so, it might be important to identify and deal with the underlying problem when the obvious phobia is treated.

Next: Illness phobias and agoraphobia


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