By, Michel J. Gimeno

Publilius Syrus (c. 43 B.C.)

Agoraphobia stems from the Greek, and it means fear of the market place. However, Agoraphobia is much more than that. It is a conditioned response to severe anxiety. One could redefine Agoraphobia as being an all-consuming, irrational fear to what is no longer familiar. The fear of venturing beyond one's home, the fear of driving over bridges or driving on the open highway. It can also be the fear of flying, the fear of being caught in a place like a shopping mall, a supermarket, an elevator…

Most Agoraphobics will have a "safe territory" beyond which they seldom venture, or if they do it is with great discomfort and usually accompanied by someone. But why this strange irrational fear that borders on obsession?

There is no mind without a brain, and the brain, like the stomach or heart or any other organ, is subject to the same physical biological constraints. When something goes wrong with the brain's complex chemistry, symptoms will occur. These symptoms can be emotional or "mental" as well as physical.

Agoraphobia tends to self perpetuate just like any other conditioning process. The victim becomes conditioned by the fear they so vividly experience and develops, at first, a welcomed avoidance behaviour. Before you know it the victim starts avoiding malls, etc. Why? Why do we develop this incomprehensible fear?

We have in our brain, a group of cells that serve us as an alarm system. Imagine for a minute you just came out of the barbershop and on your way to your car you come face to face with a huge, ferocious looking tiger. What happens next? You run faster than you can say abracadabra. The reaction you experienced when you came face to face with the tiger is the "fight or flight" reaction. It was designed to insure our survival in ancient times.

Agoraphobia is a maladaptive conditioned response to the "fight or flight" reaction. When you walk to your car and you experience a feeling of tremendous dread and extreme anxiety together with dizziness and your heart's beating extremely fast in the "absence of a tiger", you have suffered a SPONTANEOUS PANIC ATTACK. These attacks tend to recur and soon you find yourself in a merry go round trying to avoid what you think caused the attack. You have developed Panic Attacks with Agoraphobia. Your life becomes a living nightmare best summarized by this little poem I wrote sometime ago:

Suddenly,

A feeling of impending doom,

A dizzy terror

Sends your heart into a frenzy,

And you think you are going

To die.

You have met the TIGER,

Ferocious but….

Invisible

That goes by the name AGORAPHOBIA.

Gradually,

The panic is overwhelming.

Shopping becomes

An excruciating chore.

Slowly,

Almost imperceptibly,

You are transformed into

A recluse

A prisoner of your own

Brain biochemistry gone awry.

But there is hope and there is help available. The tiger can be tamed and turned into a loving, purring little kitten.

"Pure" agoraphobia seldom exists by itself. There almost always exists a concomitant spontaneous panic anxiety. It is this unremitting panic anxiety that eventually leads to the phobic avoidance.

This spontaneous panic anxiety is a sudden excessive discharge of adrenaline into the bloodstream causing the blood pressure to rise, the heartbeat to race as well as the pulse. There is hyperventilation, which further increases air hunger, and the victim feels as if he or she may be losing their mind, losing control. This outpouring of adrenaline is in turn stimulated by the spontaneous firing of some neurons in the brainstem. As the neurons fire they release several brain chemicals.

The treatment: (1) the victim must eliminate all alcoholic beverages and drastically reduce the consumption of CAFFEINE as well as the complete avoidance of ASPARTAME. Also care must be taken with the use of over the counter cold medicines that contain pseudoephedrine. Many nasal sprays can also exacerbate Panic Attacks. Monosodium Glutamic (MSG) in some patients will aggravate their symptoms. (2) A program of desensitization with an experienced therapist is a must in most cases. The patient must face his/her fears by gradual exposure to the phobic stimuli. (3) Last but not least: Medications such as antidepressants and certain minor tranquilizers may be needed in order to facilitate the ongoing desensitization. Many physicians use Xanax (Alprazolan) but I strongly recommend against it.

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