ILLNESS PHOBIAS

Many people have a morbid fear of illness or death. These phobias may be a straightforward anxiety problem like the fears of spiders, enclosed spaces and cats described at the start of this chapter. On the other hand, they may become associated with intense irrational worry.

Perhaps not surprisingly, many illness phobias centre on the most well-known (and feared) diseases in our society: in particular, heart disease and cancer. One client, Jill, was tormented by her fear of cancer for several years.

This phobia apparently started after a period of personal stress which left her feeling anxious and depressed. She then came across an account of a cancer victim in a magazine and immediately grasped the idea that her own discomfort was caused by the same illness.

She began to imagine that any bruise on her skin would develop into a cancerous growth; she had also read that body moles and freckles could enlarge and become cancerous, so she kept going to her doctor for check-ups. Eventually, much of her time was spent looking for any abnormal signs of the illness, and even imagining that other people were discussing it.

Any reference to cancer caused her acute anxiety, for in some vague way she believed she was likely to develop it. A thorough medical examination which revealed no signs of the disease convinced her she was not physically ill and she experienced a great sense of relief.

Unfortunately, however, this relief was short-lived and the problem soon returned. The intensity of her anxiety varied according to the stress she experienced in her personal life, and it seemed clear that the cancer phobia masked some deeper worry, although it was not clear what this was. Eventually the problem cleared up of its own accord, presumably as Jill came to terms with her underlying problems.

Of course not all worries about health or physical appearance are neurotic forms of anxiety; far from it. In fact, many people suffer great agonies of mind because they genuinely believe that some aspect of their health, appearance or behaviour is 'abnormal'.

Often they are quite normal in every way - but over the years we have received literally hundreds of anxious questions from young men who have suffered huge turmoil because they have discovered what are actually completely normal white spots on the skin of their penis and scrotum....and they have concluded that they must have some dreadful STD, even when they have never had sex: the truth is these spots are completely normal in every way. (They are called Fordyce spots.)

So inevitably, perhaps, many such worries are sexual. In a society where we are constantly bombarded with so much propaganda about our behaviour and our bodies, is it any wonder that people may begin to worry about whether or not they match up to a 'desirable standard'? What may be cause for greater concern is the fact that so many adolescents (and adults) suffer needless anxiety about sex, when simple information would reassure them.

However, to return to the main theme of this section: why should someone develop a phobia about illness? (As in phobia meaning 'irrational fear'.) There are probably many, many reasons. For one, the emotional trauma of watching a friend or relative with a serious illness may produce considerable emotional stress. Not surprisingly, perhaps, this can take the form of intense worry that one has the same illness. Secondly, a person may repress some other fear or worry and subsequently develop an illness phobia.

For example, a phobia about infection with sexual disease could be caused by worries about sexual activity of a sort which made you feel guilty. Thirdly, the shock of one's own illness might produce anxiety and thereby predispose one to develop a phobia. Fourthly, we may suppose that a child brought up by parents who were excessively concerned with health (or illness) is likely to associate his emotional problems with his health.

Quite frequently, there is a background of general personality problems such as a lack of confidence or a low self-esteem: and it is not difficult to see how an illness phobia or intense worry might really represent a subconscious call for help, attention or sympathy on the part of an anxious or depressed or otherwise emotionally distressed individual.

Many people with illness phobias constantly ask for reassurance from the people around them. Even if this is forthcoming, it usually has only a transient effect, and the sufferer soon begins asking for reassurance again. But because reassurance does temporarily reduce anxiety, it is difficult to stop asking 'I'm not ill, am I?"

AGORAPHOBIA

Agoraphobia has been called a 'social disease' of our highly stressed, present-day world. It accounts for about 75 per cent of all the phobias, and 90 per cent of the sufferers are women, yet it is little understood among the general public.

Agoraphobia is usually thought of as 'a fear of open spaces'. Yet this is not exactly true; a sufferer seems to fear shops, crowded places, confined places, travelling away from home, situations where other people are in close proximity, and so on. In fact what really underlies this problem is that all agoraphobics fear an attack of anxiety if they move away from home.

A person with agoraphobia prefers to stay at home rather than risk an anxiety attack in a public place because the anxiety attacks associated with agoraphobia can be extremely alarming. Indeed, the sufferer may even think she is dying. This is especially true if she feels palpitations, a raised heart beat, and has difficulty in breathing or swallowing.

So how does this unusual and distressing condition develop? Most often, agoraphobia is nothing more than another form of conditioned emotional response. A typical sequence of events in its development might be something like this: suppose you were under some stress and had a mild attack of palpitations, a fainting episode, feelings of dizziness, or some similar experience one day when you were out of the house. Suppose you became embarrassed or anxious.

You might, for example, dread 'losing control' or making a scene in front of other people. If that happens, you'd want to leave the area quickly, so you might become more worried and tense, both mentally and physically. As this tension begins to increase, a vicious circle develops: greater anxiety produces more tension which then produces more anxiety. The palpitations, dizziness and so on then become even worse.

Eventually you'd get home. You'd feel 'safe' and your anxiety would die away. However, the damage has been done - you fear the same thing happening again. This fear begins to dominate your life and in the end you might prefer to stay at home rather than risk another anxiety attack. If you did venture outside, an attack of anxiety might be generated merely by memory of your previous experience. This would keep you away from anywhere likely to produce a similar reaction. Hence: home is 'safe', outside is 'dangerous'.

Sometimes an agoraphobic screws up all her courage and ventures outside. This use of will-power produces an increase in tension - so much so that the muscles of her body may become 'locked' tight and literally root her to the spot. Relief is only obtained by turning and fleeing homewards - and then, of course, her desire to remain indoors is heightened.

Many agoraphobic people are generally highly aroused and anxious. This means that even trivial and insignificant events can be very alarming and have a major effect in setting off an outbreak of panic. Each person or object becomes a major obstacle to movement. Is it surprising that under such emotional strain, an agoraphobic finds it easier to stay at home?

Frequently, this particular aspect of the problem is compounded by the so-called 'concerned husband syndrome'. He takes over the shopping, delivering the children to school, and other duties, thereby leaving his wife trapped with no motivation to go out, and her self-confidence and self-respect gradually disappear altogether.

As another example of how these things work: an agoraphobic may begin to avoid fast trains because she can't get off quickly if she experiences an anxiety attack. Unfortunately, slow trains soon become a site of panic attacks, and so she turns to buses. When panic attacks develop on buses, she restricts herself to walking. This clearly limits her range, but even so, she may still feel anxious. Before long, she walks no further than the end of the road, and eventually she 'cannot' leave the house at all.

Presumably agoraphobia can also represent a psychological defence mechanism against something one finds unacceptable. In one case, a university student became progressively more anxious as he tried to travel from his home to college. Investigation revealed that his parents had pressured him into university against his wishes. He also found the academic standards rather high. Perhaps rather than directly counter his parents' wishes, he developed the oblique resistance of agoraphobia as an expression of his desire to start a career directly after leaving school.

Whatever the cause of agoraphobia, if the individual concerned lives in an area where people 'keep themselves to themselves', his or her isolation may rapidly increase. Yet another cause of agoraphobia is a form of depressive illness.

And yet the good news is you can do a lot to cure yourself...... by means of relaxation and other behavioural treatment.

Next: SELF-HELP TREATMENT FOR PHOBIAS


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