One of the elements of agoraphobia is the fear of becoming panicky while in a situation from which it is impossible to escape. It is the fear of being trapped; but when someone speaks of being trapped, it is not always clear exactly what is meant. Sometimes the reference is to physical circumstances. A person is trapped in a stuck elevator or in a train that has jumped the rails and turned over. A prisoner in solitary confinement is trapped. Some people think they are trapped if they are a passenger on an airplane and, consequently, unable to get off on a moment’s notice. Some are certain they would feel trapped in a submarine traveling deep underwater; but, of course, there are those who go about their work calmly while serving on a submarine. If phobic individuals were not worried about losing control of themselves, they would not worry about being trapped.
There are some such physical situations which make phobic patients especially uncomfortable, although not everyone is troubled to the same extent in the same particular circumstances. Some are fearful exclusively on airplanes, in which case they may not think of themselves as phobic in general. Some worry all the time about being stuck in traffic. If they are afraid of being trapped in an elevator or some other such closed-in space, they may be said to be claustrophobic, although this is only a variety of the more general condition known as agoraphobia. However, when phobic persons speak in general of feeling trapped, they are often referring to situations in which they are not constrained by physical circumstances; they feel trapped in certain very characteristic social situations:
Restaurants. They feel that they cannot just get up and leave if they feel panicky, or bad in any other way. They feel embarrassed, sometimes, just by getting up to go to the bathroom or to make a telephone call.
Movie theaters, church, parties. For similar reasons, they feel that others would see them getting up to leave and judge them critically in some way. Simply being noticed is upsetting.
Riding in an automobile. Wouldn’t it be awful, they think, if they had to stop their car on the middle of a bridge or tunnel? What would people think?
Waiting in a car at a red light, or standing on line in a bank. The few moments they are in these situations seem to last forever.
There are some who feel trapped by entering into an ordinary conversation. “I don’t want to talk to him because suppose I have a panic attack, and I have to leave?”
In all these situations, it is the exaggerated and certainly unwarranted fear of having to leave a social situation that contributes to the sense of being trapped. Simply standing up and being looked at is uncomfortable for certain phobic patients. Part of this reaction is their misreading of what others think. The tendency to worry about what strangers think can underlie a number of emotional disorders, such as a social anxiety, but is particularly obvious in agoraphobia. This fear is really part of the disorder.
Consequently, every treatment program has to emphasize engaging in those behaviors which phobics are afraid of. If someone is embarrassed by going to the bathroom, that person has to make a point of going to the bathroom in social situations. Inevitably, such a person will come to understand that going to the bathroom does not mark him/her as inferior in anyone else’s opinion. Also, phobics should be open about having a panic disorder. It is not necessary to sit friends down and make an elaborate exposition, “I have an agoraphobia.” It is enough to say, “I always feel nervous waiting on line in a bank.” Or “I feel uneasy crossing bridges.” The response that others will have is reassuring. Not worrying about what they might think is part of getting better. © Fredric Neuman