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.