PHOBIAS FIGHTING FEAR EPU EB

Helen Saul

• Publisher: HarperCollins
• Year: 2011
• Print ISBN: 9780006384311
• eBook ISBN: 9780007394319
• Topic: Psychology
• Subtopic: Diseases & Allergies
• Index: Psychology

A fascinating, unbiased study of what phobias are, how they occur and how we can stop them.

Two in five people struggle through life under the burden of a phobia of some kind. Yet little has been done to help these sufferers understand their affliction and hence minimise it. Recent researches in evolutionary theory, physiology, neuroscience and genetics have begun to analyse the causes and effects of human phobia and have come up with thought-provoking, but widely differing, interpretations and prescriptions.

Why are phobias easier to cope with at night or when wearing sunglasses? How do phobias differ throughout the world and history? Are phobias biological or psychological? Is the fear of spiders, snakes and darkness an evolutionary throwback? Does aversion therapy work? Is phobia hereditary?

The first book to balance all these issues, 'Phobias: Fighting the Fear' is a powerful, uniquely accessible work of popular science.

CHAPTER 1
History

In the Beginning

The doctor was intrigued. His patient was in good physical health but he was so afraid of crowds and of the light that he hated leaving home. Whenever he went out, he chose if possible to go in the evening so that he could scuttle through deserted, dark streets to his destination. If he had to go out in the day-time, he would cover his head. He wanted to avoid seeing, and being seen by, anyone.

The man had done no wrong and had crossed nobody, but he was behaving like an escaped convict. He did not trust anyone outside his immediate circle. He was tremendously timid and the doctor became convinced that his fear of leaving home was due more to natural shyness than any real threat posed to him by the world at large.

The doctor was reminded of another patient who had yet another baffling fear. This man never went to parties, the theatre or any public gathering because he was convinced that he would disgrace himself. He thought he was bound to say something unacceptable, fall over or perhaps be sick in the middle of a crowd. Whatever it was, he believed that everyone would look at him, spit at him, jeer and mock him. He was so sure that everyone hated him that he avoided public events at all costs.

The doctor mused over the two cases and went home and wrote in his journal about the ‘men who feared that which need not be feared’, a fair definition of phobias. The men’s thoughts and behaviour will sound familiar today to anyone with experience of agoraphobia and social phobia even though the doctor was the Greek physician Hippocrates and he was writing 2,400 years ago.

Time has passed, language changed, but people’s experience of phobias remains much the same. The first patient, according to Hippocrates, ‘through bashfulness, suspicion and timorousness will not be seen abroad, loves darkness as life and cannot endure the light, or to sit in lightsome places, his hat over his eyes, he will neither see nor be seen by his good will.’ The second, he said, ‘dared not come in company for fear he should be misused, disgraced, overshoot himself in gesture or speech, or be sick; he thinks every man observes him, aims at him, derides him, owes him malice.’

Hippocrates saw people with many different phobias over the years, ranging from agoraphobia and social phobia to animal phobias and other fears still common today. Damocles, he said, was terrified of heights and ‘could not go near a precipice, or over a bridge, or beside even the shallowest ditch; and yet he could walk in the ditch itself’. He described other, quirkier phobias such as that of Nicanor, who was untroubled by the sound of someone playing a flute through the day but ‘beset with terror’ when he heard the same sound at an evening banquet.

Hippocrates’ writing may be more poetic than modern medical notes but it demonstrates that the nature of fear has not changed over two thousand years. The ancient Greeks had the same experience of strange and unreasonable fears as we do today. Phobias have been around as long as we have, they are deeply ingrained in us, an integral part of human existence. This may not be much comfort to anyone with a phobia now but it does mean we have more than two thousand years’ worth of thought and insight into fears and phobias.

Unfortunately, this does not mean two thousand years of steady advances in understanding. Periods of intense activity by scientists, philosophers and doctors have been separated by gaps of hundreds of years when little happened. Early insights were overtaken by other bogus or unhelpful ideas and progress has been as likely to move backwards as forwards. But sometimes an apparently new idea chimes with an ancient one. Many modern theories are updated versions of ancient thoughts and some of the questions that puzzled the ancient Greeks still go unanswered.

Hippocrates’ careful observation of fear and phobias was exceptional at a time when most of his contemporaries thought that fear was sent down from the heavens. In Greek mythology, Phobos was the god of fright, son of Ares, the god of war. His brother was the god of fear, Deimos. Their companions included Eris, who represented strife and was insatiable in her fury; Enyo, who destroyed cities; and the Keres, who liked to drink the black blood of the dying. Myths related that this cheerful crew would stride on to the battlefield together, sowing disease and striking terror into the hearts of anyone they came across.

The god of nature, Pan, was responsible for contagious fear sweeping through crowds of people. Frightening sounds heard on mountains or in valleys at night-time were attributed to Pan, and he was thought to be the cause of sudden, groundless fear.

With the notable exception of the Stoics, the Greek people went along with mythology so far as to call on their gods for help and to blame them if they themselves were suffering. They would plead with Phobos to terrify their enemies, and at the same time assume that he was causing their own fear. They thought that Pan could determine the outcome of wars by generating mass hysteria throughout the ranks of one or other side and causing whole armies to disintegrate.

The Greeks were clearly comfortable with the concept of different types of fear. Phobos represented a sudden and acute fright, different from Deimos’ ongoing, rumbling fear. Pan symbolised the sort of fear which can spread through groups of people. This classification has been modified over thousands of years but still exists, another clue that our experience of fear has not changed much.

The words we use to describe these emotions reflect the ancient beliefs. Today’s Greek word phobos means intense fear or terror and translates directly into our word, phobia. The word panic is derived from Pan and has shifted its meaning more recently. It was once used to refer to the group process of mass panic, but now refers to an individual’s experience, including panic attack or panic disorder.

Our word anxiety comes from the Latin anxietas, which means troubled in mind. Again, the meaning has held steady despite translation into numerous other languages. French, Italian and Spanish all contain words derived from the Latin. Anxo in Greek means to squeeze, embrace or throttle, which came to mean weighted down with grief, burdens and trouble and has passed into German as angst. The sensation of constriction or tightening across the chest, of being unable to breathe freely, is a classic feature of panic.

Agoraphobia may have been described by Hippocrates, but it was not given the name until much later. The German psychiatrist C. Westphal coined the term ‘die agorophobie’, in a paper published in 1871. He described three men who either could not walk alone through certain streets or squares, or could do so only with great anxiety or a couple of stiff drinks inside them. Thinking about the feared situation could be every bit as alarming as actually walking into it. Westphal wrote:

The patients derived great comfort from the companionship of men or even an inanimate object such as a vehicle or cane. The use of beer or wine also allowed the patient to pass through the feared locality with comparative comfort. One man even sought, without immoral motives, the companionship of a prostitute as far as his own door.

Westphal’s choice of name harks back to Hippocrates’ time when the agora was a public meeting place, used for discussions of public affairs, games or contests. In ancient Greece a contest could be athletic, poetic or a mental challenge between dramatists, and was known as an agonia. An agonia demanded that individuals tested their skills and later the word came to mean mental anguish. After Westphal, confusion arose and agoraphobia came to mean not only a fear of open spaces or public places, the agora, but also the fear of deficiency in one’s performance, or agonia. It was not until the 1970s that the term ‘social phobia’ was brought into use to refer distinctly to the second of these, the fear of public scrutiny. It took a long time to get back to the starting point. Hippocrates may not have named these fears, but he certainly described the difference between agoraphobia and social phobia.

Hippocrates also explored possible causes. Unlike most Greeks, he thought it ridiculous to blame the gods for fear. He insisted that there was a physical cause within the individual. Neurotic symptoms fell into the class of melancholia, a type of insanity. It was caused by a build-up of black bile which made the brain overheat and caused passing terrors. Treatment was a regimen of diet, activity and exercise, designed to rid the body of the excess black bile. If this was not successful, drugs such as the poisonous hellebore were often given. The resulting vomiting and diarrhoea were taken as signs that the bile was being eliminated.

Hippocrates’ confidence in this particular scheme was somewhat misplaced but his belief in a physical cause for mental disorders has been shared by scientists ever since. One of his younger contemporaries, the philosopher Aristotle, also searched for a physical cause for nervousness. Aristotle decided that the heart was the seat of all sensations and the brain a cold, bloodless part of the body which absorbed hot vapours arising from the heart. This led much later to the old English idea of ‘the vapours’, meaning a nervous disorder, low spirits or boredom.

Great Greek thinkers and twentieth-century neuroscientists may be united in their belief in a physical, biological cause of fear but there have always been other ideas. The Stoic school of philosophy grew up shortly after the time of Hippocrates and survived for five hundred years, well into the Roman empire. The Stoics included emperors (Marcus Aurelius), slaves (Epictetus) and even Nero’s tutor, Seneca. Stoicism stressed the importance of human reason in finding an accord with nature. Emotions had to be conquered and passions shed in order to achieve imperturbability. People can be happy in the midst of the severest pain if they can master themselves and let nothing overwhelm them. We are not at the mercy of external events. (Cognitive therapy (chapter 6) still relies on some of these ideas.) More specifically, the Roman Caelius Aurelianus wrote that phobias were a type of mania and arose from problems in the mind, not from the body or physical brain:

Mania fills the mind now with anger, now with gaiety, now sadness, now with nullity, now with the dread of petty things. As some people have told; so that they are afraid of caves at one time, and chasms at another, lest they fall into them; or there may be other things which frighten them.

More than two thousand years ago, then, philosophers and medics could give a good description of phobias. Ideas about the causes may have been primitive but they were forerunners of some of the main schools of thought still in existence. Sadly, the brilliance of these great thinkers probably had little impact on most people of the day. The prevailing view was that fear was sent down from the heavens and that phobias were best treated by trying to appease some god.

The Roman empire, which had assimilated Greek civilization, itself collapsed in about AD 400. The Church then dominated society and effectively put a halt to studies into individuals’ emotional experience. Phobias obviously still existed, and fears of plague or syphilis were especially common. However, in a backward step for science, excessive or strange fears were assumed to be caused by an interaction between forces of good and evil, and people with phobias thought to have been overtaken by demons or evil spirits.

Throughout the Middle Ages, the Church dominated scholastic thought and pre-eminent thinkers were occupied with big theological questions. Not until the fourteenth century did attention turn gradually back to the individual. This paved the way for the golden age of philosophy, out of which grew psychology as we know it today. And it started with Descartes, once described as the first modern man.

Cartesian Logic

Born into a rich and noble family at the end of the sixteenth century, Descartes studied languages, literature and philosophy at one of the top French schools of the period. But even as a young man he became disillusioned with the limited nature of the teaching and quit his studies to lead a life of pleasure in Paris.

Boredom eventually set in and he joined the army in Holland, where he learned about mathematics and the natural sciences. Then later on, he joined the Bavarian imperial army in the Thirty Years War, which allowed him to travel through Germany, Austria, Hungary, Switzerland and Italy. He was constantly observing, contemplating reality, and working on his own philosophical method.

He moved back to Paris for a few years, eventually leaving again for a life of near-seclusion in Holland. His interests included mathematics, optics, astronomy, chemistry and botany and out of this unlikely mix came key ideas in the history of psychology.

His views on early learning, for example, are still vividly contemporary. In 1649, shortly before his death, he wrote that learning can start before birth.

It is easy to conceive that the strange aversion of some, who cannot endure the smell of roses, the sight of a cat, or the like, come only from hence, that when they were but newly alive they were displeased with some such objects, or else had a fellow-feeling of their mother’s resentment who was so distasted when she was with child; for it is certain there is an affinity between the motions of the mother and the child in her womb, so that whatsoever is displeasing to one offends the other; and the smell of roses may have caused some great headache in the child when it was in the cradle; or a cat may have affrighted it and none took notice of it, nor the child so much as remembered it; though the idea of that aversion he then had to roses or a cat remain imprinted in his brain to his life’s end.

Descartes’ major contribution applies to the whole of psychiatry, not just to phobias and anxiety. However, the respect in which he was held rather unfortunately cast in stone the mind-body split still so relevant to the treatment of phobias.

Descartes set out to question all accepted wisdom and build up his own philosophy from scratch. He was a firm believer in reason and thought all experience was fallible for he could never be completely sure that he had not been dreaming, or even tricked by a malicious demon. Bodily experiences were unreliable, he said, and the only thing he could be absolutely sure of was that he was thinking. His first principle of philosophy was, famously, ‘Cogito, ergo sum’, ‘I think, therefore I am’, and he came to regard the mind or soul as totally separate from the body. They are simply two different entities, he said: the mind is not a physical thing and therefore it can never truly merge with the body.

Descartes was searching for absolute truths and was not attempting to pit future psychiatrist against future psychiatrist. However, his reasoning led to Cartesian dualism, which has translated into medical circles as the great divide between mind and body. Does the cause of a psychological problem such as a phobia lie in the thinking mind or in the physical brain? The question has never been answered and professionals line up on opposite sides of this divide. Geneticists, molecular biologists and neurophysiologists, looking ever more closely into the physical and mechanistic workings of the brain, represent the ‘body’ side of the argument. Their remit is to explore the parts of the brain that can make us susceptible to phobias, anxiety and panic, somehow change its delicate chemistry and reduce our fear. On the ‘mind’ side, psychologists and psychotherapists examine past experiences or current beliefs and aim to challenge and change our thinking patterns to dispel our phobias.

Descartes believed that mind and body were closely linked and he would not have supported this interpretation of his work. In The Passions of the Soul he wrote: ‘There is such a tie between our soul and body that when we once have joined any corporal action with any thought, one of them never presents itself without the other.’ It is ironic that a philosopher who gave himself the widest possible brief is best remembered for naming the rift between some of the most polarised views in medicine and psychiatry.

He even named the meeting place between mind and body as the pineal gland. We now know that the pineal is sensitive to light and one of the hormones produced there, melatonin, regulates our sleep-wake cycle. Scientists researching jet lag and shift-work patterns have long been interested in the pineal but their work apparently had little relevance to phobias. However, some researchers now believe that certain light frequencies, acting via the pineal, may influence our susceptibility to both anxiety and phobias (discussed further in chapter 9).

Descartes’ belief in the central nature of thinking and reason makes him, like the Stoics before him, a rationalist. Cognitive therapists say that our beliefs fuel our fear, almost ‘I think, therefore I am frightened.’ Chapter 6, on cognition, examines at this in depth and it is quite possible that Descartes would have agreed with some of the main ideas.

Immanuel Kant, more than a hundred years after Descartes, was another rationalist, and his ideas fit equally well with cognitive therapy. Again, he stressed the importance of reason. He said, ‘The understanding cannot see. The senses cannot think. Only by their union can knowledge be produced.’

Kant believed that our ideas shape our view of the world. It is as if our ideas are spectacles that distort what we see. They determine what we focus on and how appealing it looks. We do not see an event itself, but only its appearance through these unreliable glasses. Put simply, there are alternative ways of looking at any event. Cognitive therapists today would agree. They aim to change people’s interpretation of events, just like adjusting their spectacles to change the focus or the tint.

Locke and Empiricism

An alternative view is that reason does not come into it at all. The human mind is, in fact, like a blank sheet of paper. Ideas are generated through our physical senses and our experiences, and projected on to this blank sheet. We work on the information derived from our senses, make associations and generalisations and build up our psychological picture of the world. No matter how abstract or complex the idea, it begins with physical sensations. Even belief in the existence of God can be built up in this way.

These are the thoughts of John Locke, who was working soon after Descartes. He belonged to the opposite tradition in philosophy, empiricism, which rated experience above all else.

Learning and memory are built on experie...

Table of contents

• Phobias: Fighting the Fear
• Table of Contents
• Preface
• Introduction
• CHAPTER 1 History
• CHAPTER 2 Evolution
• CHAPTER 3 Genetics
• CHAPTER 4 Neurophysiology
• CHAPTER 5 Behaviour
• CHAPTER 6 Cognition
• CHAPTER 7 Personality and Temperament
• CHAPTER 8 Gender and Hormones
• CHAPTER 9 Light and Electromagnetism
• CHAPTER 10 A Physical Problem?
• Conclusion
• Further Reading
• Index
• Acknowledgements
• About the Author
• Copyright
• About the Publisher