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Hi, again –

Here is the most important article from “Freedom From Agoraphobia.” It is the answer to the question: “Why do people get agoraphobia?” It came about this way: Back when we started treating agoraphobia, it was the practice to do a complete psychiatric evaluation of all new patients. Part of the evaluation was eliciting the full life story of each person. This meant spending as many hours as necessary going over what had happened to the individual, what her reactions had been and what she had done and why all the way through her life.

After learning the life stories of many agoraphobics, it began to appear what they had in common. And from this emerged a remarkable discovery - how agoraphobia comes about!

So, here’s the result of those many hours of studying agoraphobics’ lives. You may recognize yourself right away. If not, there is help in doing this in future articles.

After learning the life stories of many agoraphobics, it began to appear what they had in common. And from this emerged a remarkable discovery - how agoraphobia comes about!

I hope you will get as much from this article as so many people in my office have.

Good Luck!

Mark Eisenstadt, M.D.

Article Four: The Key to Agoraphobia Or: The Secret of What's Behind It All.

Here is the key that unlocks the door to life without Agoraphobia:

It is the word "traps."

We develop panic attacks when we're trapped in our lives. We stop having panic attacks when we escape from those traps. We go in and out of periods of having panic attacks as we go in and out of periods of being trapped in the our lives. It's that simple!

This is why people will have panic attacks for a number of years and then, apparently, get over them. To their great disappointment, the panic attacks come back after more years have elapsed, seemingly for no reason. But there is a reason. If we look at what has been going on in the individual's life we find that she was in a trap when the panic attacks began, later got out of the trap causing them to get better and somehow slid back into another trap resulting in their return. But what is a trap?

A trap is any situation we do not want to be in but from which we can see no acceptable escape. Straightforward enough, right? Read on. You will see that this simple definition - again: any situation we do not want to be in but from which we can see no acceptable escape -- contains all sorts of clues to the solution to Agoraphobia.

Traps can be big or little. They can last for minutes or years. They can have obvious exits or they can be nigh on impossible to find a way out of. They can be completely internal to the agoraphobic or they can involve all sorts of external circumstances and people.

Let's look at some:

Here's a common one that can last for decades if not a person's entire life:

Sylvia is growing up with a father who sexually molests her and a mother who drinks and refuses to admit what is going on. Sylvia has a friend who had the same problem with her own father and who told her teacher about it. Her father was sent to jail. Now, Sylvia's friend’s whole family blames her for the fact that they have to be on welfare. They do not have many of the things they could afford when Dad was there to bring home a paycheck. Sylvia certainly does not want to have everyone in her family angry with her. But on the other hand, the weekend is coming. And that's when Mom goes out drinking and Dad will be coming to Sylvia's bedroom. The result? Sylvia has a panic attack. (Not surprising, huh?)

At 17, Sylvia grabs the opportunity to get out of the trap at home by leaving high school to marry her steady boyfriend, Darrell. Sylvia's panic attacks go away and it looks like her problems are over. She becomes pregnant and has a beautiful daughter whose smile is the light of her life.

But Darrell's company goes broke and he loses his job. As months go by and Darrell is unable to find another job, he becomes increasingly short-tempered. He begins to stay out evenings and comes home smelling of alcohol. When Sylvia comments that their limited money might be better spent paying the bills, Darrell flies into a rage and hits her. Soon, the drinking, arguments and physical abuse have become commonplace in Sylvia's life. And she can see no way out.

Darrell has told her that if she leaves he will find her and kill her. (He demonstrated what he meant by a punch in the face.) In any case, Sylvia can see no way to support herself and her baby. She does not even have a high school diploma with which to find a job.

One evening, she sits in her bedroom waiting for Darrell to come home from the bar and knowing that an argument and a beating are coming with him. In her mind, she struggles to find a solution but keeps running into the same barriers as always. Darrell can't find a job. The economy is bad. He has no training for skilled work. He won't stop drinking. There is no way to avoid a fight when he comes home. Even if she does not say anything to him, he'll just get mad at that. If only she could run away. But where would she go? And she has no money. And Darrell said he'd kill her. And the baby needs things... and...and...

She sits there in despair, waiting for the sound of the car in the driveway.

The next day, Sylvia and her black eye are in the supermarket. She is stuck in a long line at the checkout counter. The baby is getting tired and irritable. It's hot and the fluorescent lights are bothering her. But she can't leave. She needs the diapers, formula and other items in the shopping cart. She desperately thinks: "Why don't they call for another cashier?" There is only the one checkout line and the cashier in that one is obviously a friend of the old lady she is waiting on. The two of them are chatting away, oblivious to the long line in which Sylvia is stuck. The cashier keeps talking and interrupting the old lady from writing a check for her purchases. The line isn't moving. There is no way out. The heat and light make Sylvia dizzy. She is sweating. Her heart begins to pound. Suddenly, Sylvia finds that she is having a full-blown panic attack. It's the first since she left home almost two years ago.

Naturally, Sylvia can now easily develop an avoidance pattern that includes going to the supermarket. The next time she thinks of going there, she will remember this panic attack and begin to feel anxious at the thought of going back. If she goes anyway, she may well have another panic attack. Especially if she gets caught in another long checkout line. She may believe that the panic attacks are the result of being stuck in the supermarket situation. In a small way, she would be right. But in a larger way, Sylvia will have panic attacks one place or another. She'll even have them at home until she gets out of the trap she is in with Darrell. If that trap goes on for years or even decades, her panic attacks will go on for years or even decades.

Often, the panic attacks serve to indirectly improve the trapped situation. For example, Sylvia might go to a doctor or counselor who might help her to find ways out of her abusive marriage. Or Darrell might actually feel a bit better about himself now that his wife needs him to help her go to such places as the supermarket. So the return of Sylvia's Agoraphobia might make the marriage somewhat less unpleasant for both of them. But even if this happens, as long as Sylvia is in the trap, she will have panic attacks. And when she gets free of the trap, she will be free of them. (We will see how Sylvia does this and her panic attacks stop in a future article.)

Let's look at some other traps:

The Little League Mom typifies another kind of situation I have often seen. She lived in a beautiful home in a beautiful town, had a caring husband and an athletic 14-year-old son. Her son was a star on the local Little League team and the team had been the national champions more than once. (This probably looks pretty good until you learn that for her, it meant not having a life.)

The entire family was centered on the celebrated son's Little League activities. And Mom was the one who had to make it all happen. The family traveled to all the Little League games - which were often held in other states or in Canada. Mom had to do all the packing for everyone including Dad because he couldn't be counted on to even bring matching socks. (Would it surprise you to hear that she often described Dad as: "just like having another kid?")

She would lay out everyone's clothes for the trip, pack all the food, get the maps, arrange for the mail and call the police to keep an eye on the house while they were away. All the Little League moms cooked for the team and for the dads. She also had to drive her son to and from practice every day, attend meetings of Little League parents and do fund-raising for team uniforms and supplies. The bottom line? Almost all of her time was devoted to Little League activities. She was ready to scream.

Why not quit? Well, was she going to stand up in front of her friends and be the only mom who did not care enough about her son to support his great effort and success in athletics? Certainly not!

The result was practically a foregone conclusion -- panic attacks. (We'll also see how she solved her problem later on, as well.)

Another person with an obvious trap was Audrey who had recently put her mother in a long-term rehab hospital because of a broken hip. She had done so with the greatest reluctance and only after exhausting all other possibilities. The reluctance was because Audrey had heard all sorts of horror stories about rehab hospitals: People were neglected there. They were given the wrong medications. No one came when they called. Sometimes patients were abused or left to lie in their own waste for hours or even days before anyone took notice. And Audrey knew that sometimes older people die after breaking a hip.

Nonetheless, her mother's physical needs were way beyond what Audrey could manage at home. And there was no one else to provide the care. Finally bowing to the inevitable, Audrey had her mother admitted. Her fear was so great, however, that Audrey spent all day every day at her mother's side -- making sure that none of the disasters occurred. Audrey's husband and children were left to fend for themselves. They did not accept this easily. The staff of the hospital also complained that Audrey was driving them crazy (which she was). They constantly pressed for her to go home. But Audrey could hardly compound the sin of having put her mother in such a place by leaving her to the harm that would surely befall if she were not there to prevent it.

Result? You got it - panic attacks. (More about Audrey later.)

Lastly, did you know that a bad drug trip is actually a panic attack? And it is caused by the usual problem – a trap. Here's how it goes:

Cody and his friends decide to "drop some acid" (take LSD). Half an hour after taking it, Cody is happily enjoying the various bizarre colors, shapes and other hallucinations he is having. At one point, the thought comes: "Wouldn't it be great if this went on forever?" This is followed by the worry: "How do you know it won't?" Cody has heard stories of people whose LSD use resulted in permanent hallucinations. To reassure himself, Cody concentrates on a picture across the room, trying to get it to appear normal. But it still seems to be glowing and pulsing - alternately getting larger and smaller. Then, it assumes some strange shapes - no longer being a rectangle.

This increases Cody's worries that his hallucinations will never go away. He tries harder to get rid of them but they remain despite all his effort. He feels he must stop being on his "acid trip" but there is no way to stop. He becomes frightened. His fear then appears as dancing lights and animal shapes coming towards him. Cody panics. His heart is racing and feels as though it will burst out of his chest. He seems to not be able to get enough air - the room is too small and all the air is almost used up. He must run outside before he suffocates. But his knees feel weak and unable to support him. He must get out but he can't...

Indeed, most "bad trips" due to hallucinogens are actually panic attacks. These panic attacks are all the result of the same trap - each time, people become convinced that they need to stop experiencing the effects of the drug, but they have no choice other than going on experiencing those effects for the next several hours until the drug wears off. Usually, this is triggered by some unwanted experience such as unpleasant hallucinations, feeling out of control or fearing "going crazy." As a result, the drug-intoxicated state that had originally seemed desirable becomes intensely undesirable.

And this brings us back around to our original definition of a trap: an unwanted situation from which we can see no acceptable way out. If the situation had not become unwanted, Cody would have happily experienced the drug effects and no panic attack would have occurred. Indeed, "talking people down" from bad drug trips (so common in the 70's and 80's) consisted of persuading them to not resist the drug effects. They were instead encouraged to simply allow the experience to run its course. Thus, the trap would cease to be one because they had changed the first half of the equation -- the desire to get out.

One of my early patients went through several steps in learning about traps in therapy. At first, she learned what her major trap was. (Let's call it her "Life Trap" since it is the trap her life was in overall.) With much difficulty, she worked her way out of it. After that she would come in having sometimes had a good week and sometimes a bad one. Since we knew that there was no longer a major Life Trap going on, the recurrence of panic attacks had to mean that she had gotten into some small "Day-to-Day Trap."

"How have you gotten trapped this week?" I would ask. "I haven't," she used to say at first. "The panic attacks just came out of the blue."

This would leave no choice but the process of going over the whole week day by day. What had she done Monday? Had she wanted to do what she did? Had she made plans that she was really not comfortable with? Had she allowed herself to be pushed into a commitment to do something or go somewhere that she really wished she could get out of? Had she had strong feelings about something? Feelings that she felt she could not or should not feel and express? What about Tuesday? No? No traps? What about Wednesday?...

Sooner or later, we would discover what it was. Then, we would find a way out of the trap and the panic attacks would stop. And the next time she came in having had a bad week, we would go through the process all over again. But each time, she learned more about what traps were and how she got stuck in them. And she learned what being true to herself really was.

It did not take very long before she would come in having had a bad week and I could simply ask: "So how did you get trapped?" She now knew enough to be able to look over her week by herself and figure out what the trap had been and how to better handle the situation. This was close to the endpoint of our treatment. After that, when she had panic attacks, she asked it herself: "How have I gotten myself trapped?" And she could figure it out for herself. She took the final step when she developed the ability to "see a trap coming" - she would not allow herself to be put in a situation that she knew would be a trap for her.

Then what? Success!! No more panic attacks! How about that!!?

More to come about identifying and getting out of traps in future articles.

Until next month, I wish you peace and progress,

Mark Eisenstadt, M.D.

You can find Article five Here

Article: 1 2 3 4 5 6 7 8 9 10 11 - 12 - 13

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