Agoraphobia Q&A

   These are some commonly asked questions about our disorder and some answers so that we can all be on common ground for terms.

1. What is agoraphobia?

Agoraphobia (Greek for “fear of the market place”) is an avoidant behavior brought on by repeated panic attacks in circumstances where getting to safety is not immediate or easy – a crowded market place, for example.  See question 4 for more on panic attacks.  Symptoms of agoraphobia include constant anxiety; panic attacks; fear of traveling beyond a safe area; restlessness and sleeplessness; inability to concentrate, and more.  Essentially, agoraphobia is the result and panic disorder is the cause.

2. What is panic disorder?

Panic disorder by my definition is the chronic state of anxiousness resulting from having had one too many panic attacks.  A person with panic disorder is someone who begins to be subconsciously alert to the threat of another attack and suffers constant unease that is essentially “fear of fear.”

3.  Does this mean the person is mentally ill?

   Agoraphobia is listed as a seriously disabling mental illness in the bible for mental health professionals – “DSM IV.” *   Therefore, if you go by the book,  the answer is yes, but panic disorder should be considered a temporary condition. Your  friend isn’t “crazy,” though; that word is best employed to describe those we can’t prove are mentally ill but obviously are.  I define the truly crazy people as those who allow themselves to be taken over by a system of capitalism and greed.  Unlike most of the other significant mental illnesses, agoraphobia can be completely cured. (Witness moi – auteur.)  Recovery is easier if treatment starts soon after symptoms appear.  Treatment can include self help (this book); professional therapy; and short term use of medication.  Agoraphobia should be considered a temporary condition, duration unknown.

4.  How does somebody become agoraphobic?

   A person with a history of random panic attacks can develop a heightened sense of alert we all call anxiety.  Someone constantly on high alert is almost certain to begin avoiding certain places or circumstances.  If avoidance extends to more than one thing or place, “agoraphobia” is the verdict.  Agoraphobia has several levels, from being housebound (Level 1) to being capable of everything but long-distant travel (Level 3).   Essentially it is avoidance of pretty much everything outside a safe circumference.  Agoraphobic folks bond with one another easily because they are so much alike; they are as alike as first cousins if not sisters and brothers.*

5.  What causes panic attacks?

   There is no clear answer to this, but theories abound.  When we are startled or alarmed by something that turns out not to be dangerous, our ancestor-tainted “fight or flight” response system can be misled into believing there is a full-scale emergency.  As a result, adrenaline floods through the victim’s system and blood flows to the muscles, making the body ready for action when there is no “action” to be had.  Pulse, breathing rate and blood pressure rise, for naught.  The overwhelming feeling of fear is real, but there is nothing real to fear.  This constitutes a “panic attack.”  It seems clear that some people have an elevated susceptibility to being startled, and therefore could be the type to throw gasoline on the tiny spark of something as harmless as a sudden noise.   I surmise that both learned and genetic brain “chemistry”  are involved in making one person likely to easily recover from being startled and another person more easily misled and unable to halt the “fight or flight” response to a mere startle

Think of an occasion when you were surprised or startled by something that caused you to jump up and quickly move out of the way.  The something could have been as harmless to most people as a honey bee or it could have been an ax-wielding maniac. If the bee wandered off in another direction and disappeared, a “normal” person would return to normal.  If the ax maniac persisted, a “normal” person would continue evading or fighting back with elevated strength and speed provided by the flood of adrenaline.  The person with panic disorder does not know how to turn off the alarm process once it gets going, and must endure a terrifying experience of unknown duration even though there is nothing apparent to fear. The bee left, but they still got stung.

Brain science tells us that two smallish parts of the brain – the “amygdala” and the “hippocampus” are essentially the guards at the gate, taking in all data as it arrives at us.*  I will now paraphrase what I have learned: Genetics are involved in determining how we act or react under a given circumstance, but some of the decisions on how to evaluate a given bit of information are made through a deliberate, conscious process.  You have many times in your life told your brain to go on alert when certain, specific, things are present because you regard them as dangerous. Our early ancestors had to be on high alert whenever they were away from camp because there were many dangerous critters roaming the Earth.  The fight or flight system allowed a Neanderthal adult to be in full sprint within milliseconds of having seen the fangs of a nearby people eater.  That was then and this is now so one would think time plus reality would have toned down our defense system a bit.

The reality is, unfortunately, some people have alarm systems that need to be reprogrammed.  We all take in squintillions of units of information daily; nearly every time you turn your head you see changes.  Our brains have to filter data so that we can conduct somewhat rational lives without being overwhelmed.  The filter is the aforementioned amygdala and hippocampus team, hereinafter known as “Amhip.”   Try to imagine how many mixed messages have been transmitted from one part of your brain to another and back when things once scary or misinterpreted changed status a few times – something as simple as a particular person at school for example.  Multiply that example by millions of experiences with change and we wonder how we ever learn to be afraid of the appropriate things and make the correct response to any given stimuli.

   6.  How do you cure it?

   This book, “Un-agoraphobic,”  contains all the tools needed for full recovery, including information and advice on therapy and medication.  The agoraphobic person will recover by tricking her mind into not fearing panic attacks.  Once she stops fearing panic attacks she will never have another.  I have developed a process for “tricking the mind,” for making the necessary holistic changes in order to fully recover.

Briefly, an agoraphobic person needs to do serious work in the following areas: willingness to change; letting go; communication skills; confidence; self respect; self knowledge; self love; knowledge about agoraphobia, and courage.  The book demonstrates how to remember joy, how to become calm, how to learn, how to change.  Central to overcoming agoraphobia is the “Recovery Plan” as laid out in the book.  The plan evolves and develops day by day by as in specific activities and journal writing.  Recovery requires diligent work, creative actions and self-learned tactics.  I designed the recovery process so the reader finally “invents” a way to break out of prison.

A therapist who specializes in panic and anxiety disorder can greatly assist recovery, and there are some medications that can help if used prudently.  If your friend or partner cannot afford therapy, options are detailed in Chapter 4, Shrinking.

7.  How can I help?

    If you want to be of help, read this book so you will understand the process your buddy is undertaking.  Agoraphobic people recover more easily when they have friends or partners who understand the condition and are supportive.  Help beyond that depends on many variables.  An important thing to comprehend is that you cannot have expectations about time of recovery.  Too many variables.  If you are able to help with research as suggested in this book, your time will have been well spent.  Do not use any kind of pressure if your partner is working on a recovery plan.  Outside pressure is almost always counter productive.  Communication is important, so plan regular “conferences.”

As a mental health social worker I saw many families torn apart or at least negatively affected by mental illness.  I, therefore, advise you to take all steps necessary to preserve your well being.  Doing so could include dramatic changes or even separation from the relationship.  This is the hard part, but if you don’t take care of yourself you cannot be of help to anyone else.  Agoraphobic people are hyper sensitive, and if your participation is not clear and pure and from the heart, you will make matters worse.

Ask what things your friend needs help with, then be honest with yourself about how much you are willing and able to do.  You may be able to help find others inclined to give rides and provide some services.  You can also help by coordinating assistance from friends, family and neighbors, as well as public assistance agencies if necessary.  If your friend is going through a homebound phase you can get extra Saint points by helping to survive it.  “Help” in this case would include bringing in outside necessities, running errands and being available to assist with “baby step” trips outside the safe confines.  The dramatic increase in fear that forces an agoraphobe into a corner is demoralizing.  Moral support is important during this time.  Do what you can.

Here’s one bit of agoratrivia that may help you. The circumstances of the initial, panic-inducing event don’t really matter because when fear of and avoidance of any one circumstance starts, dominoes fall.  Panic attacks in a crowded mall lead one to avoid not just malls, but any crowded place.  Travel more than a short distance from a safe place can become difficult.  Having panic attacks keeps the agoraphobic person on high alert all the time, making it more likely a panic attack will occur. Yes, while guarding against the feared panic attack agoraphobics subconsciously create the perfect  circumstances for a panic attack.  It’s complicated.

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8 thoughts on “Agoraphobia Q&A

  1. Hi,
    I just started reading your book. It was really hard to find a book on agoraphobia and not so much panic attacks. I am 58 and have had anxiety in situations but only 3 actual full blown panic attacks. I don’t feel my agoraphobia is the fear of having a panic attack in public, its the fear of the unknown if I leave my house. I am fine as long as I am with someone but it is very difficult for me to go anywhere alone. Is this common and will your program help me? I do’t want to read another book about panic attacks.

    • Hello – Thanks for your note. Most people who become agoraphobic, do so because they fear having a panic attack. You describe your situation as “fear of the unknown.” My book sets out a daily program of studies and activities designed to increase confidence and reduce fear. If you work hard on your recovery program and do all the things I suggest, you will become free to leave your house or city or state completely on your own. Let me know how you are progressing. I have been totally free of irrational fears for over 20 years. Hope to hear more from you. Hal

    • Hello Ms. Grizzle – I am a little puzzled that you don’t fear having a panic attack – although you did say you don’t have the fear of “having a panic attack in public.” Does the thought of having a panic attack frighten you? If that’s not the case, I think you would benefit from at least a few sessions with a therapist. Therapy helped me understand my thoughts by expressing them and hearing another person interpret and question what I’d been thinking. Cognitive behavioral therapy helps one organize and prioritize thought processes.

      My book is designed to help a person start thinking differently about fear and learn how to gain confidence. The daily sessions are routines that address all the things that make an anxious person an anxious person. “Un-Agoraphobic” doesn’t try to tell someone how to overcome a panic attack – instead, it demonstrates a methodical way to become the sort of person who doesn’t have the kind of fear that leads to panic attacks. I know the book will help you. I had an agoraphobic friend several years ago who maddened me because she could travel nearly anywhere with her boyfriend, but had trouble getting across town when she was alone. I couldn’t travel beyond a few miles out of town even with my girl friend. I haven’t had a panic attack in over 20 years and am happy with my life. Please do as many of the activities as you can as regularly as you can. Keep me posted on your progress. Hal

  2. Dear Hal. I have read your website. It is very encouraging. I have been agoraphobic for a few years. I do leave my home alone or with friends. And I do drive, which people find surprising. I have fear of open spaces when walking. I do get anxious. I would like to obtain your book. I would appreciate assistance you can give me.
    Sheila
    sadlereaglescout@aol.com

    • Thanks for writing, Sheila. Apologies for the delay; I’m a potter and had art fairs and gallery requests on my mind. My book, Un-Agoraphobic, is based on a wild variety of experiences. The recovery program is a result of all the things that worked for me when I was sick, as well as things that didn’t help. After I recovered from agoraphobia and was able to travel freely again I got work as a mental health social worker. During those 17 years I learned much from psychiatrists, therapists and other social workers and the clients themselves about ideal treatments for mental illness, including panic disorder and agoraphobia. All of that went into the book. My program establishes a daily routine of activities and practices designed to help the sufferer gain confidence and knowledge that will lead to eliminating irrational fears from your operating system. Once you understand how and why you need not fear panic attacks, you’ll never have another.

      Open space was a huge problem for me, and in fact the sudden and dramatic fear I felt while traveling with college friends to a Montana city in the plains was what began my 30 years of agoraphobia prison. We had been driving through hilly timbered land and then suddenly came upon flat, empty country which triggered an instantaneous panic attack. I was 19. After that I had trouble getting across town, much less out of the city. Basically agoraphobes are victims of a hyper alert amygdala. You triggered your first panic attack by wrongly perceiving something. What ever it was that triggered your first was not what you perceived it to be, but the amygdala doesn’t know that. It just knows that you react to a particular phenomena with fear and so it tries to protect you by flooding you with the adrenaline required to fight or outrun a vicious foe. It’s as simple as that…. don’t make your temporary disorder into a terribly complicated something or other. The fight or flight response is purely survival instinct based on data you transmit.

      I have a theory about the open space problem. Since it’s our primitive early brain that creates a “panic attack” there must be some genetic remembrance of when humanoids lived in great peril, surrounded by vicious hungry beasts. The worst possible place to be when a sabre toothed tiger ambled by was out in the open…….. what do you think?

      I know I’m free of that because 2 years after recovering I drove across Nevada alone enroute to San Fran. The amygdala is constantly using your senses to avoid trouble. When you spy, hear or feel or smell something that could be dangerous you are, now, allowing the hyper alert amygdala to make decisions for you. A normal person would investigate the circumstances enough to know for sure whether something was dangerous before fully reacting. You want to get back to being that rational, calm and curious person.

      It’s been over 20 years for me. Work hard at this every day and you will become free again. Read everything you can about brain science and anxiety. It’s fascinating and will help you understand what changes you need to make. Stay in touch. Hal

  3. I am interested in your book. I know it’s going to be different for everyone, but how long did it take you personally to overcome your agoraphobia once you started on your recovery?

  4. I’ve been suffering from anxiety and panic attacks since I was 14 years old I am 24 now . I have had many set backs and many acomplisments aswell. My main thing is now I am suffering from agoraphobia and compulsive negative thoughts. my fear is going out somewhere in public or out of my comfort zone and having a bad panic attack to the point where is lose my mind. I know all the negative thoughts I have are just thoughts that I know won’t come true ,but I still struggle day to day with this fears. I am hoping your book will help me get to where i use to be as in being able to do daily activities such as driving on my own or small things of that ature without having the fear of fear. Is there anything you suggest I focus on the most ? thank you in advance

    • Hello Geno – My life also was filled with accomplishments and setbacks, so I can feel what you’re going through. The important thing for you to understand is that you are dealing with a badly-programmed “flight or fight” system that can be re-programmed. I completely overcame 30 years of agoraphobia by re-programming my system; my book is based on what worked for me. Your condition is not freakish or highly unusual. You’d be surprised how many people live on edge and with crippling anxiety because they have in one way or another set their alarm system at high alert. Being in that state makes panic attacks more likely. Start doing online research on “anxiety and the amygdala” so you know exactly what’s going on when the adrenaline button is pushed. I’m glad you understand the concept that you are experiencing “fear of fear” because that knowledge will help you overcome your crippling condition.

      My recovery system is based on working every day on activities and projects that will help you turn down your alert level and regain self confidence. When you’re first starting to venture out, make each outing a discovery adventure. I found reading and thinking about each sign I saw along the way was enough diversion to get me out of my head. Closely observing people by noting clothing color and design, types of strides, would be useful in the right settings. Count all the red cars, and so forth. Whatever you create as your search adventure, do it purposefully and mindfully and record it in your journal. You are in a good place. Let the book show you how to get a few things started that will begin to slow down your engine. Use your “Thought Police” to arrest and question your negative thoughts.

      It’s a process… and there are dramatic breakthroughs along the way to look forward to. As examples, one day you’ll walk down to the corner and just, what the hell, keep going on around the block and the next. Another day down the line you’ll forget you’re even driving over a bridge. Once you stop fearing panic attacks you’ll never have another. Been 23 years for me. Getting started is the best thing you’ve ever done for yourself. Keep me posted. I just want everyone to be free. Best wishes, Hal

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