Opinion Sur Joven

The following was a common scene among most Argentines last winter due to a swine flu outbreak:

“Buy me a mask”. “But haven’t you heard they’re useless and even counterproductive?” “It doesn’t matter, just buy me one. I’m scared of going out without it”. “OK”. “I also need alcohol hand sanitizer, but there’s a shortage. What do I do? Maybe I shouldn’t go out”. “Don’t worry, dad, you can wash your hands with soap”. “But I want alcohol hand sanitizer…”

Gloves, masks, people who stopped taking their kids to school (before the government suggested it as a generalized preventive measure), people who stopped going out from their homes and changed their habits… all because of the flu. By saying this we’re not trying to minimize the effects of this pandemic, let alone question the sanitary measures the government enforced all over the country. However, some people almost developed a phobia, a sensation that the swine flu could attack them any minute. That situation inspired this article. What are phobias, and how can we deal with them?

A phobia is defined as as an extreme or irrational fear of or aversion to something. That fear increases anxiety levels, generating different types of reactions in the person suffering from it: fear of fainting or even dying, heart rate increase, sweating, breathing disorders, agitation, tingling… At the same time, this makes the person avoid the object or situation that produces this unpleasant situation. And that’s how a vicious circle begins.

“Anxiety is a normal reaction of all living organisms, and it’s healthy in certain situations. When those levels are too high, they start having significant consequences in everyday life”, explains Lisandro Frutos, a psychologist specialized in anxiety disorders from Fundación Aiglé, a psychotherapy research institute with a cognitive-integrative perspective.

According to his explanation, human beings are always supposed to feel anxiety upon certain stimuli. That’s what lets us react in a proper manner upon dangerous or tense situations. The problem with phobics is that their fear and anxiety are excessive.

But if we all fear different things, how can we know whether it’s a phobia and requires treatment? “We can’t quantify it, but we can analyze it from a qualitative perspective. It’s the person who defines whether the level is high or not, depending on whether it affects their work, their social life or some other aspect of their everyday life. If the anxiety level causes dysfunctions, then it requires a treatment. We should explore the degree of discomfort this causes. We aim at dealing with these issues”, Frutos assures.

There are different types of phobias. The two main groups are social phobias and specific phobias. The latter are divided into “animals” (e.g. fear of dogs, cats), “natural situations” (storms, darkness, cliffs, heights), “situational” (subways, planes, tunnels) and “others” (fear of falling or vomiting, etc.).

On the other hand, social phobias are the most difficult ones to understand. Frutos explains it: “It’s the fear of being judged by others in a negative way. That fear triggers a routine of avoidance in different areas. Sometimes there’s no avoidance, but the person is exposed with great suffering”. It may occur in situations such as speaking in public, eating in social meetings, facing someone of the opposite sex, going to work, talking to the boss... This disorder appears in different ways depending on the person.

Whether social or specific, all cases are defined as phobias when they have a meaning for the person. “For instance, if fear of sharks doesn’t affect any area of your life, then said phobia isn’t worth a treatment”, Frutos points out.

One of the most famous cases of phobia was Little Hans’s, described by the father of psychoanalysis, Sigmund Freud. Hans, a Viennese boy, was afraid of horses. At the beginning of the 20th century, horses were the main means of transportation, and it was impossible to avoid them. Now, if a kid living in a city today has a fear of horses, is it worth treating him if that doesn’t generate significant difficulties? Most psychologists would say no.

In conclusion, phobias -just like any other mental disorder- have a strong contextual and social-historical component. Fear of horses was probably more common a century ago; today, fear of elevators or confined places are the most common issues.

These types of pathologies aren’t determined by a certain age or sex. However, they’re believed to be more common among young people who are passing from adolescence to adulthood.

In the case of children, it is important to make a distinction between phobias and the logical fears that occur at their age. That’s why experts say a six-month period of that fear must persist to diagnose it as a phobia. And the diagnosis must be made by a mental health professional.

How are phobias treated? The different therapeutic streams suggest different ways of approaching the problem. In Buenos Aires, most psychologists have psychoanalytical training. According to this theory, a phobia is a result of a psychic conflict based on the person’s history and his or her sexuality (in the broad sense of the term). Fears are deeply rooted within the patient’s psychic constellation, which may be treated with the psychoanalytical method, popularized through the divan icon. A phobia may not necessarily be the reason why the patient resorts to therapy.

Frutos, whose orientation is cognitive, essentially treats patients with serious phobias and makes them deal with their beliefs. He starts with some “psycho-education” sessions, trying to show the patients how their pathologies work, to let them know the possible reactions.

For instance, patients with social phobias have a mental representation of what others think about them: the patients believe the others have high expectations regarding them, and their representation of themselves isn’t up to the standard. “There’s a comparison between these two representations, and that distance is usually lived with great pain. This activates different psychological symptoms that worsen their condition”, Frutos explains, and adds: “The aim is that patients understand what happens to them, so they can develop resources to face the problem”. Therefore, if you know how “the enemy” works, you’ll probably have more weapons to fight it.

On the second stage, the aim is to “flexibilize the patient’s beliefs”. What does this mean? First, the purpose is to identify the things the patients fear. Let’s suppose a patient is afraid of dogs. Does he fear all dogs or just some dogs? In what circumstances? Is he also altered by a picture or a video? What does he believe would be the worse thing a dog could do to him? What does he believe would be the best?

Based on this diagnosis, the professional tries to find grey areas and to expose the patient to certain situations. “We don’t ask them to go to work every day, because that could generate the opposite effect. But we gradually measure the degree of discomfort they experience and try to bring them closer”, Frutos describes. “Besides, this strengthens the therapeutic relationship as the patient starts seeing positive results. And that paves the way for future changes”.

The results are noticeable, and many attitudes may be changed in a short term. The key is to face the fears and not to let them paralyze us. And if we can’t do it on our own, we might as well resort to a specialist to help us go through this process.

Illustration: Hernán Pitarqué

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