Is it reasonable to be afraid of trucks when traveling down a highway, or is that fear really a phobia?
Phobic patients come to treatment knowing full well that they are phobic. Usually, there are a number of places where they feel uncomfortable. These include bridges, tunnels, airplanes, elevators, theaters and restaurants, and so on. They understand that most sensible people are not afraid of being trapped in such places. These patients come to treatment wanting to be free of what they recognize are irrational fears.The psychotherapy of phobias centers on exposure therapy, that is, putting the phobic person into the feared situation repeatedly, over a long enough period, until that person becomes unafraid. This simple, but difficult, treatment works most of the time. Since the underlying fear is the fear of a panic attack, it is important that the patient not avoid any place just because he/she may get panicky. Patients, in order to be cured once and for all, have to be willing to endure any situation that is not inherently dangerous. But once those places, like the ones mentioned above, become comfortable, there are still other places or circumstances that elicit avoidance behavior. Often, I am inclined to think this behavior is still part of the phobia, but the patient may disagree.
“I think it is reasonable to avoid the front seats in an airplane,” the patient says. (I do not.)
“I think it is commonsense to check on the location of hospitals when I go on a long trip. (I disagree.)
“I think it is foolish to lean against a railing on a terrace.” (Not most railings.)
“New York City is dangerous. Any sensible person would avoid going there.” (I spent 30 years living in N.Y.C. The only time I ever got mugged was on the campus of Princeton University.)
“I think it is sensible before going to sleep to make sure the front door is locked and all the windows are locked, even on the second floor.” the patient says. (I don’t)
“I think it is a sensible precaution to use a paper towel when holding onto the doorknob of a public bathroom.” (It is surely not. There are germs everywhere, and probably less on a metallic surface than in other places.)
When there is this sort of disagreement, I cannot simply ask patients to trust my judgement. First of all, they won’t, and second of all, they shouldn’t. I’m not always right. The only way of deciding whether a particular place or set of circumstances is dangerous is to ask other people. Sometimes an expert can be consulted. A patient and I were able to track down a world expert on asbestos to determine whether it was dangerous to drive on highways. (Brake pads contain asbestos, and people brake on highways to slow down for the toll booths. This concern may strike the reader as absurd, but the patient who was very bright certainly didn’t think so.) The expert agreed with me that it was safe.
One patient, who was otherwise improved, told me she avoided going on highways because of trucks. When I expressed surprise, she frowned at me. “Everyone knows,” she said. “that trucks are dangerous and frighten everyone.”
“My friends, They all feel the same way.”
Since I had learned to suspect that this sort of report may not be entirely accurate, I asked her how exactly she had spoken to her friends about the trucks.
She told me: “I said, ‘Don’t you ever get startled when two trucks go ZOOM by on both sides of you?’ and they said, “Yes.’”
“That is not the same thing. Do they avoid the highways?”
If there is no expert readily at hand, there is no way of determining whether something –ie. gymnastics, driving a motorcycle, having sleep over dates, etc. is dangerous without getting the opinion of other sensible people. But this “truck phenomenon” illustrates a central problem: people present their fears in ways that make other people seem to confirm those fears. Similarly, someone afraid of walking in a particular neighborhood keeps track of every untoward event that happens in that neighborhood, perhaps by reading a local newspaper, but little realizes that these newsworthy events are reported precisely because they are unusual. Dangerous circumstances are exaggerated in the phobic’s mind because he/she is so closely attuned to bad things happening. In such a way, the prejudices of phobic people are confirmed by events that seem to everyone else to be insignificant. Still, I can think of no other way of deciding these matters. For the record, though, I think it is safe to drive on highways even though the trucks ZOOM by every once in a while. (c) 2012 Read Dr. Neuman's blog at www.fredricneumanmd.com/blog