Phobias: Fighting the Fear. Helen Saul

no interest in astronomy. Nervous of flying, they simply wanted to try out a short flight. Since then, 10,000 have enrolled on the course and 98 per cent have boarded the aircraft at the day’s end. No detailed follow-up has been carried out, but Hughes claims nineteen out of twenty feel more comfortable flying as a result.

      Single-session treatments symbolise recent progress in dealing with phobias. Immersed in the latest therapies, sufferers can find their years-old phobia conquered in one day. Within a morning, they have been taken through the technicalities of flight, had their views on its dangers challenged and been taught basic relaxation techniques. In the afternoon this brief training is put to the test when they get on an aeroplane. Similar courses exist for those afraid of spiders. Various therapies prepare them for entry into the spider house. The vast majority are then happy to allow huge spiders to run up their arms and even through their hair.

      These commercial courses represent the new attitude towards treatment for phobias. Directed at a few specific phobias, they are not a real option for most phobia sufferers. But they do demonstrate the prevailing optimism. In mainstream medicine, doctors and therapists are now confident that they can offer a working solution. Hundreds of years of theories and ideas have finally begun to make an impact.

      A simple but dramatic shift in thinking has cleared the way. Phobias were once thought just the tip of an iceberg. Psychiatrists and psychologists believed that therapy had to be undertaken extremely gently for fear of what might be unleashed. This meant that treatment could involve months looking at words or drawings before moving on to the next stage. Vast patience and stamina were essential to complete such a course and most phobias continued unchecked.

      In fact, though successful treatment can have knock-on effects, they are usually positive. Some people’s self-esteem gets such a boost, for instance, when they overcome their fear of flying that it can improve all aspects of their life. One woman was completely distraught when she arrived. But fear of flying was only a fraction of her worries. She fretted about her journey home and what would happen if she was late to pick up her children. She was sure the ensuing chaos would make the family late to bed so they would all sleep in the next morning which would ruin the whole day. A catalogue of disaster stretched ahead. As it happened, she was so relaxed and delighted at her own success that she actually missed her motorway turn-off. Though late, the anticipated chain of events did not occur. Her new laid-back attitude persisted and she said later that the course had changed her life.

      So phobias can be taken at face value and their symptoms addressed directly. This approach is standard in medicine. A girl with a bacterial infection normally improves quickly once on antibiotics. Her doctor does not have a philosophical debate about why she was the only child in the class to succumb. If she recovers quickly, the doctor has done a good job. Fear, like bacteria, can be confronted, and long-term inhibitions and preoccupations undermined almost immediately. This is tremendously encouraging for anyone with a phobia today. Treatments work and need not take for ever. The root cause may never be known but often has no bearing on the treatment.

      Furthermore, phobias often disappear without trace. People suffering from depression may have to embark on a lifetime’s struggle to keep symptoms at bay. Many ex-smokers or drinkers know that they remain a single lapse away from addiction. Phobias, in contrast, can be wiped out for ever with a single course of treatment.

      Some phobias are replaced by a fascination with the thing once so dreaded. People previously afraid of snakes or spiders may keep them as pets. A fear of heights might be replaced by the new hobby of rock-climbing. Diana, whose story is told in chapter 5, once had such severe agoraphobia that she was unable to answer the telephone or open a letter. She now gives presentations about her experience. She will never forget her years with agoraphobia or how much it disrupted her (and her family’s) lives, but she can no longer identify with the fear itself.

      This new optimism should not, however, belittle the very real problems that remain unsolved. Phobias often go unheralded, unnoticed and, most importantly, untreated. The largest study ever, the Epidemiologic Catchment Area (ECA) Program in the US, aimed to discover how common various disorders are within the general population. More than 20,000 people in the community were interviewed about fifteen different disorders, among them phobias. Researchers found that fewer than one in four with a phobia had received treatment.

      Treatments could be improved. Single-session treatments demand tremendous courage, too much for many. Thousands are helped but most phobics find the very idea of attending unthinkable. They often know about the courses, even acknowledge that they themselves could benefit, but their fear is far too great to allow them to sign up. People with phobias live with levels of unimaginable fear and this fear makes even a single day, which could eradicate their problem, too much to ask. Moreover, many who do attend are helped but not cured. Their terror is reduced but they remain exceptionally nervous. A rare few others are not helped at all.

      Progress, though, is accelerating. Advances in psychology, psychiatry, genetics and molecular biology are all converging, improving our understanding of the causes of fear and providing new ways of addressing it. A range of much gentler approaches is now becoming available. Increasingly effective drugs can be used alongside behaviour and talking therapies. The talking therapies themselves are being streamlined to focus on practical improvements, rather than dwelling on childhood traumas. Improved understanding of how phobias develop may help us protect our children from ever developing them. Alternative, more speculative approaches suggest lifestyle changes which may make a difference. Whatever treatment is chosen, phobics can now expect relief from their fear in a limited number of sessions. This improvement has been one of the medical success stories of the decade.

      The Hidden Epidemic

      So, is that the problem solved? Well, no, not quite. For a start, the scale of the problem is immense. Community studies report that up to two in five of us have a severe dislike of something, and even full-blown phobias are common. Strictly speaking, there is no phobia epidemic, since an epidemic usually refers to an infectious disease that has struck an unusual number. There is no evidence suggesting that there are suddenly more people affected than ever before. But to get a rough idea of the scope, let us just compare the prevalence of phobias with a relatively common infectious disease like influenza.

      In the winter of 1999/2000, almost 400 out of every 100,000 in the British population went to their doctor with influenza, which means that it was approaching epidemic levels. The impact on the National Health Service was extreme. Hospital beds were filled with flu patients, so planned operations for cancer and heart disease had to be cancelled, and the NHS was in crisis. And this, at a level of 0.4 per cent.

      Official figures are probably an underestimate, as many sensibly managed their illness at home, but even if only one in five consulted their doctor, that would mean the real figure affected was 2 per cent. How does this compare with the numbers affected by phobias?

      The ECA study mentioned above found that between 4 and 11 per cent of interviewees had suffered from at least one phobia in the past month. From this, researchers estimated that more than 6 per cent of the population has a phobia at any one time.

      We all knew at least a handful of people who were ill with influenza in the winter of 1999/2000. This guestimate suggests that, whether aware of it or not, we probably know three times as many with phobias. These figures give some idea of just how widespread phobias are.

       A Few Famous Phobics…

      Phobias strike across the board, irrespective of intelligence, beauty or success. Kim Basinger and Sir Isaac Newton both suffered from agoraphobia. Sir Isaac was housebound for years up to 1684, after a period of severe stress. His mother died, a fire destroyed some important papers, he was exhausted after finishing his Principia and he was arguing with Cambridge University. All must have been distressing, but none restricted him as much as the agoraphobia that followed. Kim Basinger developed agoraphobia after the birth of her daughter. In some ways it is harder to imagine agoraphobia in an actress: academics can succeed with limited socialising, whereas actresses are subject to the most intense public scrutiny. But Basinger’s experience of agoraphobia is typical of