Fear factor: Sorting the phobics from the phonies
Genuine phobias are irrational anxieties - not mere dislikes, ramped up to gain sympathy.
Thursday 25 November 2010
It was in similarly straitened times to our own that Franklin Delano Roosevelt gave the 20th century perhaps its greatest lesson in human fortitude. "The only thing we have to fear is fear itself: nameless, unreasoning unjustified terror which paralyses needed effort to convert retreat into advance," he intoned.
If only it were so easy.
Scroll forward 80 years to the steamy surroundings of the reality television show I'm a Celebrity ... Get Me Out of Here and FDR's point about the disabling impact of anxiety is being played out before British television audiences courtesy of Gillian McKeith. The self-styled "internationally acclaimed holistic nutritionist" whose Channel 4 programme You Are What You Eat climaxed each week with the examination of a real human poo sample is embroiled in a highly public wrestling bout with her demons. These are an unholy trinity of threats posed to her by insects, heights and water, though she has some pretty low thresholds when it comes to the way other people chew their food too. Even before entering the jungle she warned viewers her phobias "terrified" her to a "level you've never seen before". True to her word, when she was called forward to take part in her seventh bushtucker trial to earn food for her fellow celebrities marooned alongside her in the Australian jungle, she promptly collapsed.
Well, sort of. As the producers of the show cut to a commercial break and Bob the medic strapped an oxygen mask to her gurning face, many viewers were left wondering how she came to enrol in a programme notorious for playing on contestant's inner fears of creepy crawlies and all things slimy and wet.
McKeith's fellow jungle inmates were not impressed. "I think she's maybe a better actress than I am," said Britt Ekland, while former Happy Mondays front man Shaun Ryder suggested her collapse was about as real as his sparkling new dental work. Former I'm a Celebrity ... entrants went on air to pillory her and websites filled up with demands for her to be left where she dropped. More than 300,000 added their names to the inevitable Facebook page entitled Quick Get the Oxygen Out. In her native Scotland she has been decried as a national disgrace. With more than 10m viewers tuning in to watch her suffer, McKeith's travails – real or imagined – are becoming a national debating point.
But regardless of the authenticity or otherwise of her fainting fits, the TV nutritionist is far from alone. According to Anxiety UK, one in six adults in the UK will experience a neurotic health problem over their lives, with 13 per cent of us likely to suffer from a full-blown phobia. Catherine O'Neill, the charity's services manager, admits it was rare for someone to undergo a full collapse but that McKeith's reported symptoms were all-too recognisable to sufferers. Meanwhile, the ferocity of the public reaction displays not only a lurking sadistic streak within the national psyche but that we are still far from coming to terms with issues of anxiety.
"There is still a big stigma attached to having a mental health problem but double so with anxiety. People think 'just get on with it' or 'pull yourself together'. Depression is taken seriously, so is schizophrenia, but although anxiety can be just as debilitating it can be seen as a bit silly," she says.
A quick glance through the internet reveals there's no shortage of strange and fantastical-sounding phobias and something of a growth industry in potential cures.
The current NHS advice is to use "talking cures", such as counselling, psychotherapy and cognitive behavioural therapy – for which there are many, many private practitioners able to charge whatever they like.
Alongside traditional staples such as arachnophobia and fear of flying (aviophobia), can be found koumpounophobia, a button anxiety said to affect one in 75,000 people. Triskaidekaphobia leaves sufferers immobile when confronted with the number 13, while the improbable and possibly untrue hippopotomonstrosesquippedaliophobia renders a fear of long words.
And while hardly an obvious fashion accessory, celebrities have been surprisingly forthcoming about their own inner fears. Johnny Depp is a self-avowed coulrophobic (fearful of clowns); Madonna is reportedly terrified of thunder (brontophobia), and the master of suspense Alfred Hitchcock was himself horrified at the prospect of a cigarette being extinguished in a runny egg yolk – a condition for which no name has yet been invented. It seems Kylie Minogue's confession that she feared coat hangers is positively humdrum.
"It seems that there is surprisingly little that does not have the potential to make us fearful," explains Dr Allan Norris, a consultant clinical psychologist at the Edgbaston Hospital in Birmingham with more than 30 years' experience treating sufferers. "It is certainly a common problem. I think phobias engage something very primitive in us. Anxiety is nature's alarm system. You can have false alarms – and phobias are these false alarms when a person is acting as if there is a real threat."
The word phobia is used far outside the medically recognised condition – indeed, in some instances it is a byword for something a person hates, rather than has an extreme fear of. The words neurosis, fear, anxiety and phobia have become interchangeable in conversation and, it could be argued, in the minds of sufferers. As fellow I'm a Celebrity ... participant Stacey Solomon pointed out on Tuesday to Gillian McKeith: "If you have such terrible phobias you shouldn't be here. You should go home." McKeith's reply: "I can't break my contract, I'll never work again."
Although we may use the word in everyday language, to psychologists phobia has a very precise meaning.
"It is an anxiety disorder. Some are very specific and others are quite general and the person can be fearful of a situation or thing or even the possibility of encountering that thing," he says. The feared object creates the "fight or flight response", which sees our bodies flooded with adrenaline – a useful evolutionary trick when running away from a ravenous sabre-toothed tiger but less so when confronted with a spider in the bath.
Many of us are able to keep our phobic tendencies in check simply by avoiding certain things – such as reality TV programmes set in the jungle. If we don't like snakes for example, we can easily keep out of their way by not visiting the reptile house at the zoo.
But the more worrying disorders and those that can have potentially devastating impacts are the complex social phobias. For an insight into the reality of living with a phobia, look no further than Joanna, a Mancunian in her 50s, who has suffered for 30 years. "The symptoms are physical – blushing, palpitations, churning stomach, jelly legs, a lump in the throat, hands shaking. It has blighted my life since I was a teenager," she admits.
As the problem got worse she gradually withdrew from social life, shunning contact with others and refusing to speak up. "I thought people could see my heart pounding in my chest and they would think I was weak, odd or different," she says.
To clinicians a dislike of a thing or situation becomes a phobia when it begins to impact on a person's life and they start to organise their routines to avoid it. But thinking about phobias as an illness is quite wrong, says Dr Norris. Instead it is better to see the problem on a continuum. Some anxiety is healthy and central to our survival and those without any social fear can face equal problems as those that are cripplingly shy. Different types of phobia are also quite separate – hence the reason why someone can be quite happy to expose themselves to public ridicule on a television show yet collapse at the prospect of touching a cockroach.
The causes of specific or simple phobias can usually be traced back to an event in childhood or adolescence – common ones are an extreme or irrational fear of dogs, spiders, flying and dentists. (I suffer a lifelong fear of mice and rats after witnessing my father killing them with a hammer in his greengrocery shop, but I wouldn't call it a phobia – I've held one for a photograph, although I do look rather anxious in it.) They can also be triggered in later life by a traumatic event such as a car crash. Complex and social phobias – agoraphobia is a classic example – tend to emerge in young adulthood, although there is some evidence to suggest there may be a genetic element to these conditions, explains Dr Norris.
"People often say they went into a new social situation and someone made a disparaging remark that made everyone laugh at them," he adds. "They will have had vulnerability already while another person might have made a robust riposte or merely shrugged it off."
Clinicians say they treat twice as many women as men for simple phobias, and there is anecdotal evidence that women's fears can develop into phobias after they have children. The gender difference narrows among those suffering social phobias or agoraphobia, and although no one knows whether men really do suffer less it is thought that they are more reluctannt to ask for help.
The good news for anyone other than publicity-seeking minor celebrities is that phobias are understood and nearly always treatable – a major advance from the early days of psychology when they were seen as evidence of a past-life horror, reincarnation or ESP.
Sigmund Freud, whose theories of psychosexual development may have had more to tell us about Gillian McKeith's interest in the human stool than her panic attacks, famously believed phobias to be the product of an unresolved inner conflict. In the famous case of five-year-old Hans who was afraid of horses, Freud concluded the youngster was actually fearful that his father (who bore an equine-like moustache) would castrate him for sexually desiring his mother. One wonders what he would have made of today's ever-rising number of people claiming phobias. Freud is said to have been a sufferer too, variously described as being phobic of train travel, ferns and the number 62 – the age he feared he would die. (It should be noted that he died aged 83.)
Today nearly everyone with a phobia can expect a more sympathetic hearing and treatments are increasingly available on the NHS. Some 75-95 per cent of sufferers can expect a significant improvement, sometimes after a handful of sessions. Combination therapies gradually expose phobics to the thing they fear and cognitive behavioural therapy teaches them to retrain thought patterns. But people can be very good at creating coping techniques, weaving avoidance tactics into the fabric of their lives, explains Dr Norris: "I have known people who fear certain weather conditions who are better at reading a meteorological chart than Michael Fish."
How do you know you have a problem? "Ask does it inhibit your life in any way? Does it stop you doing anything you would otherwise do? If the answer is yes then it would be worth asking your GP for help," he says.
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