Phobias: Fighting the Fear. Helen Saul

normal fear and phobia is far from straightforward. Many, if pushed, would admit to disliking and fearing heights or spiders but do not have a phobia as this feeling causes no distress or infringement on their lives. A speaker at a recent meeting of the American Psychiatric Association pointed out that if she was not nervous about speaking to a room full of her most discerning peers, they might reasonably assume she was pathologically narcissistic. Some anxiety is not only inevitable in such a situation, it is probably good, prompting her to prepare her talk properly and deliver it well. If, however, she was so anxious about speaking that she refused to give lectures, or changed her job to avoid it, a diagnosis of social phobia would be appropriate.

      Up in the Clouds

      On the ‘Fly with Confidence’ course, comradeship built up through the morning as people derived comfort from each other’s questions and shared fear. The group started to bond. But as the day wore on they became more subdued, less friendly, some even angry at how ill-prepared they felt to climb aboard. People kept looking at their watches in alarm at how quickly the flight was approaching. During a desensitisation exercise, they were asked to imagine various scenes, such as checking in, waiting to board, climbing the steps to the plane. After each scene they were to return to deep relaxation. ‘Impossible,’ muttered the man on my right.

      Despite such misgivings, all but one or two got on the plane and their relief was unmistakable. However, this was not universal. Across the aisle, a pale young man sat with his eyes closed, his head against the headrest. He was probably trying out newly learned relaxation exercises but he could have been praying. Helpful stewards provided numerous glasses of water, eliciting wan smiles, but did not make him much more comfortable. Occasionally he would open his eyes, look round, run his fingers through his hair and exchange a word with his neighbour. Then it was back to his private hell.

      The man beside me seemed coolly confident, but confided that it was only OK because we were flying British Airways. The woman on the other side looked close to tears but chatted incessantly. ‘I must be all right because I’m talking,’ she said. ‘If I was really bad I would be in a corner taking no notice of anyone.’

      People are recovering in their thousands through courses like this, but the process is demanding. The pale young man only slowly regained his colour and back in the terminal he was still, inexplicably, clutching his untouched airline meal.

       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