Phobias: Fighting the Fear. Helen Saul

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СКАЧАТЬ failed to see off Freud. Its practical shortcomings were, ironically, demonstrated by Watson. Like Freud, he was unable to heal himself. Watson had a lifelong fear of the dark which his behaviourist methods could not banish. It is hard to imagine anyone with a phobia believing as fervently in their treatment or being as determined for it to succeed, but it did not work for Watson.

      His personal life may have dealt behaviourism an equally serious blow. He had a scandalous divorce following his affair with Rosalie Rayner. They subsequently married, but he was forced out of his job at the prestigious Johns Hopkins University and left academia for advertising. Behaviourism was robbed of its figurehead, research started to go in many different directions and it never regained its earlier theoretical coherence.

      Behavioural learning theory may have foundered but behaviour therapy, a logical extension of the theory, is still a core feature of most treatments for phobias. Just as Watson was only interested in studying behaviour, the task of the modern behaviour therapist is limited to changing behaviour. Watson did not argue that consciousness did not exist, only that it could not be measured. Similarly, therapists acknowledge that phobias mean fear, but they do not tackle the emotion directly. Instead, they work to change behaviour and prevent avoidance of the feared object. The therapy, discussed in chapter 5, may not have helped Watson, but it is routinely successful.

      Computers, Cognitivism and Progress

      Freud and Watson’s pre-eminent positions were eventually usurped in the 1950s by the silicon chip. Computers provided the inspiration for the next way of thinking about thinking. Centuries earlier, doctors trying to understand the heart were baffled until engineers invented the pump. The pump gave them a model for how the heart could work, and it was a good comparison. In the same way, computers introduced notions of information processing and storage which were new. Doctors hijacked these ideas to explain the workings of the human mind and memory. The analogy of programming a computer to carry out tasks was a more satisfactory explanation for how we learn complex skills than anything behaviourism had put forward.

      So computers’ first contribution to the progression of thought on phobias was as a model for thought processes and the mind. More recently, computers have driven research into the physical causes of fear in a way that has never been possible before. The power of modern computers allows geneticists to trawl through immense heaps of data in an attempt to pinpoint the genes responsible for panic disorder. Advances in imaging have given scientists new ways of looking at the brain and allowing them to piece together an ever-clearer picture of the physical changes when someone thinks, laughs or is afraid. Computers are being used to design molecules that will surely give us the next generation of fear-busting pills. The neurosciences are advancing in many different directions and none of it would be possible without the modern computer.

      But if history has taught us anything, it must be that no one school of thought has all the answers. Hippocrates and the ancient Greeks gave telling descriptions of phobias, but did little to help their patients. The philosophers had some brilliant insights which failed to make it into clinicians’ textbooks. Progress has been halting over the centuries, characterised by dead ends, false dawns and the odd piece of brilliance, quickly obscured.

      Freud must be credited with separating phobias from generalised anxiety and establishing them as a new and distinct subject for study. His classification of anxiety types was a big step forward because it drew attention to the special and specific features of phobias which today’s therapists are capitalising on and which are making new treatments so promising. However, his later psychoanalytical work, with its subjective interpretations of hidden feelings, is spectacularly unfashionable in the age of computers and hard data.

      Practical progress has been most marked where sciences have interacted. The theory of cognitivism may have overtaken behaviourism, but most phobia clinics now offer cognitive-behavioural therapy. The theories may be irreconcilable, but the two approaches taken together are more effective than either alone.

      This could also be true of the neurosciences, psychology and psychoanalysis, which continue to pay scant regard to each other’s findings. They have developed more or less independently, with little reference to each other. Neuroscience is a thriving field at the beginning of this new century and it is tempting to feel we can safely reject everything that has gone before. Undue attention to underlying problems, spearheaded by Freud, held back treatment of phobias for years and the demise of psychodynamics has been liberating and productive for scientists, clinicians and those with phobias. It is thrilling to be able to discard confusing psychoanalytical theory in favour of neuroscience and its promises of definite answers to clearly defined problems. But the dawn of the neurosciences could yet produce a need for a deeper understanding of the meanings of fear. Because, in the end, fear is more than a chemical reaction. No one with a phobia really cares about their hormone levels or brain activity. What they want is an end to their phobia and the sensation of fear.

       CHAPTER 2 Evolution

      Living Without Fear

      The man stood, arms outstretched, looking at the traffic below. He grinned, threw back his head and laughed. The wind ruffled his hair and tugged at his coat and he seemed euphoric. He started to turn clumsily round and round on the spot, like a small child having fun. A few yards away, his wife stared at him in disbelief. He was dancing on the corner of a parapet on the roof of a San Francisco skyscraper, one step from certain death.

      The fictional character Max Klein, played by Jeff Bridges in the film Fearless, had survived a plane crash and became convinced he was invulnerable. His high-rise jig came some time after he walked across a city highway without looking, cars and vans screeching to a halt all around. He ate a bowl of strawberries, knowing that his allergy to them could cause a fatal reaction. Finally, he drove at top speed into a brick wall.

      Klein survived a few months of this behaviour, but his life was disintegrating. His close encounter with death during the crash had eliminated his day-to-day anxieties and he felt he did not have to answer to anyone. He became so self-sufficient, not to say arrogant, that he felt little need for the closeness of those around him. He was remote and distant from his wife; he alienated friends with his lack of sensitivity. He spent more time with a young boy he had rescued from the crash than with his own son. He was not working, but spent his days looking at buildings. When introduced to a fellow survivor of the crash, he told his wife he had a feeling of overwhelming love for this woman. He had never felt anything like it before, he said. A few months of this and his wife was ready to leave him.

      His psychiatrist was struggling with an extreme case of post-traumatic stress disorder; Klein himself claimed the crash was the best thing that had ever happened to him. It had been extraordinary, and had shown him ‘the taste and touch and beauty of life’. He would not give up this state of mind.

      Subjectively, Klein felt more alive than ever; objectively, he stood to lose his wife, son and home, his friends and his livelihood. It is an interesting take on fear. We are so used to portrayals of neurotics crippled by a million anxieties that we seldom stop to think what would happen if we had none at all. Anxiety and stress have a bad image. They are the scourge of the modern age, blamed for everything from undermining happy marriages to destroying sleep and causing headaches. Anxiety exaggerates bodily pains, it ruins good performances at work or school and quenches joy and laughter. It leads to alcoholism, eating disorders, domestic violence. The lifestyle pages of newspapers and magazines are filled with articles about dealing with stress and, we are told, life without anxiety would be wonderful.

      Yet in this film, fear is portrayed as the glue that holds lives together, keeps marriages, friendships and careers intact and protects us from avoidable accidents. СКАЧАТЬ