FEARS and PHOBIAS
Not only is fear a very normal emotion, but it is also an essential emotion. To be totally without fear is to be in serious danger. Fear is an essential defence mechanism. Fear is rather a complex thing, being made up of an emotional feeling and a number of bodily changes. These changes have been described as the ‘fight or flight phenomenon’, since they are the body’s preparation for either of these actions in a life threating situation.
Anxiety is very much like fear and in a way is lesser version of fear. However, there are significant differences since fear is generated by a specific object or situation, while anxiety can occur for no apparent reason or be produced by situations that are not in themselves fear-provoking. Anxiety associated with specific objects, situations, is described as phobic anxiety.
Phobia is persistent avoidance behavior secondary to irrational fears of a specific objects, activity or situation. The fear is recognized by the individual as unreasonable and unwarranted by the actual dangerousness of the object, activity or situation. Phobic disorders seem to affect less than 1 percent of a given population. In many adults, phobias are circumscribed, casue little in the way of disability, and do not lead them to seek medical help.
Phobias can be divided into these main groups :—
- Fears of situation, such as being on the top of a high building, in a confined space, at school at work (Agoraphobia and Claustrophobia).
- Social Phobias, or fear of social situations.
- Fear of a specific illness, of dying or death.
- Fears of specific objects (Simple phobia), such as mice, cats, snakes, numbers etc.
Phobias are characterized by the arousal in the patient of severe anxiety, often mounting to panic, in circumstances specific to each person — circumstances that do not in reality warrant the emotional reactions evoked. The syndrome’s degree of severity and the incapacity resulting from it depend on the practical significance for the patient of the phobic circumstances.
Agoraphobic patient is generally thrown into a state of trepidation when he is forced into a situation in which he may be subjected to the sense of helplessness or humiliation that results from the eruption of the panic attacks to which he is subject. He is threatened not only by open, public places but by those situations — such as crowded stores, public transportation, elevators, and theaters — from which he can find no ready escape from public view. Although he may feel more comfortable when accompanied by a friend or a relative, he tends to avoid the dangerous situations by restricting his activities and excursions to an increasingly smaller area, and in extreme cases he may be totally confined to his spouse.
Most of us have a tendency to claustrophobia. Reading about, or hearing of people who are trapped tends to stir up a little anxiety and there are occassions when most of us feel a little closed in upon and become anxious because of this. Being crushed in a crowd is unpleasant, but becomes much more unpleasant if the crowd is confined within a restricted space such as an underground train, a lift, plane or a small room or bathroom. Some of us become extremely anxious and panic stricken when placed in a confined space and are the victims of claustrophobia.
To experience a mild degree of anxiety when exposed to the public gaze is a very normal human reaction. Most of us, if we have to appear in public and give a speech feel anxious much social phobic anxiety is related to sexual anxiety. A fear of meeting people may be a fear of meeting someone of the opposite sex, and anxieties about looking foolish, ugly, or doing something unpleasant in public.
Social phobias, like every other phobia, affect individuals to varying degrees. Some of us may be abnormally anxious if we meet strangers, or go to social ocassions where there are few people we know. this may not stop us meeting strangers, or going to social gatherings, but we may have to fortify ourselves with alcohol before this is possible. Others may manage to deal with these situations but at the expense of feeling extremely anxious, sick and worried. Others again may be so overpoweringly anxious that social contacts of this nature are impossible.
FEAR OF ILLNESS AND DEATH
We all fear illness, pain, madness and death at some time of our lives and some of us fear these things for most of our lives. This general anxeity about health and a fear of varying diseases can occur as a personality trait, or be closely related to some specific mental illness. Phobic anxiety about illness called Nosophobia is usually focussed on a specific illness.
Phobic disorders tend to be chronic, with a frequent recurrence of symptoms that are often resistant to therapeutic measures. Sometimes phobias may be part of other psychiatric illnesses like anxiety, depression, schizophrenia etc. which need to ruled out by a mental health professional.
Treatment for phobic disorders is through psychotherapeutic approaches with medical support whenever necessary.
Medication is the form of anti-anxiety drugs may help to control acute anxiety and avoidance behavior in phobic situations and help to calm down the person and be more receptive to psychotherapy. Medication is especially indicated in agoraphobia with panic attacks.
Psychotherapy is useful to uncover and analize unconscious conflicts and go back to their origins, so that the person learns to handle his or her fear related conflict in positive way.
Behavior therapy is recognized as the most effective approach in the treatment of phobias. This involves initial training in ‘relaxation techniques’ followed by a program of ‘systematic desensitization’ to the feared object or situation in a graded serial manner, repeatedly in imagination till he/she learns to overcome the fear. In another technique ‘flooding’ the patient is exposed forcefully into the phobic situation until he no longer fears it anymore. Through ‘modeling’ the phobic person observes another person being in the feared situation without fear, so that he or she learns to cope through the ‘model’.
In many phobic cases a combination of the above behaviorial techniques may be used for better results.
It is important that the family and significant others encourages the person for the efforts/success and not make fun. Phobias are best treated in the early stages and thus should be tackled as soon as it starts.