| CLAUSTROPHOBIA: Fear of being in
Anil, a bright young man in his late twenties, had an extremely painful background. His mother was a dominating, harsh woman who would punish Nikhil for the most trivial things by locking him up in the bathroom. His older brother was also quite abusive towards him. Nikhil developed into an anxious, nervous, reclusive adult, given to panic attacks associated with buses, planes, lifts and crowds—any place where he felt trapped. He would feel like running away and screaming, as he became a victim of claustrophobia—a terrifying fear of being shut in.
Most of us have a fear of being confined to small, closed spaces or being crushed in a crowd, but the unpleasant feeling usually passes off. However, for a claustrophobic person, an initial fear of feeling trapped becomes more pronounced on every such subsequent situation. It slowly generalises to other similar situations as well, producing full-fledged symptoms of anxiety or panic attack. The fear-producing situation is different for different people. While some can tolerate a crowded room if the door is open, others cannot. To some the feeling of being shut in need not depend on an actual physical door but can be created by darkness or even on a boat in water. The fear is one of not finding the outlet to escape.
Claustrophobia may seriously interfere with one's life, especially while traveling, commuting, using a lift at office or shopping in crowded markets. Many go to great lengths to avoid such phobic situations by changing the mode of transport or their job, or requesting others to handle tricky situations for them. Yet fear nevertheless stalks them.
Most people with claustrophobia appear to have developed the phobia after some unpleasant negative childhood experience or having had experience of anesthesia as a child, with its accompanying feelings of suffocation under a mask. Some may even develop claustrophobia after a dream of being trapped in some place. Whatever the experience, it leaves its mark on the person’s psyche for life.
AGORAPHOBIA: Fear of being OUT
Closely linked with claustrophobia but somewhat its opposite is agoraphobia. It is described as the fear of leaving home or being out in open spaces such as streets, squares and markets. It leads to a strong avoidance of going out at all, ultimately forcing the sufferer to become housebound. What makes agoraphobia most distressing is that though the anxiety is vaguely present all the time, terror strikes without warning, at any place or anytime, in the form of a panic attack, making the person want to cling to the security of his or her home or be in the company of a close person. The fear is often elusive and anything may bring on an anxiety attack, seemingly with no reprieve from its clutches. The agoraphobic feels that the only relief from such terrorising feelings is to confine themselves to a carefully drawn safety zone, so they can avoid the world completely, disabling them in more ways than one. Even simple tasks like shopping, going to the bank, taking a walk in the park or answering the phone can become Herculean challenges, making agoraphobics retreat from family and friends, quit jobs and becoming virtual prisoners of fear.
Agoraphobia usually starts in a person in their twenties and often rather unexpectedly and may be associated with panic attacks. It may follow a severe shock such as the death of a parent, spouse or close friend, or may be associated with a serious operation or dramatic change in life situation. But none of these relate in a simple one to one way to the development of agoraphobia. Those with claustrophobia or agoraphobia may develop depression, secondary to their problem or disabilities related with the phobia.
SEEKING SOLUTIONS
Dealing with both claustrophobia and agoraphobia requires the same strategies as with other phobias in general. As a first step it is important to separate yourself from your panic and reorganise the imagined belief that disaster is lurking around every corner, and not let the negative 'what if' thinking dominate you. Seeking psychological/psychiatric consultation will hasten the process of overcoming the phobia. A course of anti-anxiety drugs may be required and serve to control the acute panic symptoms, while psychological behavior modification techniques will guide the phobic person to master fear situations in a systematic, scientific manner. Family members or friends can help in lessening the phobia through support and encouragement. Remember every effort to overcome fear brings you closer to that freedom over living life in the shadows of your phobia.
—Dr. Avdesh Sharma is a celebrated mental health expert and Heads 'Media and Public Education Committee' of 'Psychiatry in Developing Countries Section' of World Psychiatric Association
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