Phobias: Fighting the Fear

It provided a simple way of thinking about phobias. A single event causes lasting fear. A child is frightened when a big dog snarls and attempts to bite and afterwards fears and avoids all dogs, even small and friendly ones. Behavioural therapy attempts to reverse the process. By gradually reintroducing the child to dogs, the link between the snarling dog and others is broken, the child gains confidence and the fear disappears.

However, behaviourism 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. Klein eventually realises he needs help, regains normal sensitivities – along with his allergy to strawberries – and the story is resolved. Anyone behaving like this in real life would be lucky to escape so lightly.

The anxiety system can go wrong, of course, and we would all like to banish the misery of panic attacks, obsessional behaviour or phobias. Successful treatment for these problems can revolutionise lives and nobody wants to get in the way of this. But evolutionists insist we would benefit from taking a step back and looking at why there is so much anxiety in society. They challenge the prevailing view of anxiety as a wholly negative experience. On the contrary, they say anxiety is a prime motivator, a positive drive, a force for good. It prompts us to achieve at work, to guard our reputation and to keep our families together.

We do not doubt that other animals need the ability to recognise and respond to threats. All living things face danger and must react appropriately if they are to survive. Creatures have a fascinating array of defence mechanisms, each specific to the threats they most commonly encounter. The chameleon changes colour to blend in with its surroundings and hide from potential attackers. A threatened squid squirts ink at its aggressors. Antelope simply run away from lions. Moths are preyed on by bats and have become experts in bat-frequency signals. They monitor the signals continuously and map the direction of their predators’ flight. Only if the bat is heading directly for it does the moth snap its wings shut and fall, as if dead, to the ground. Familiar reactions like these have been sufficient, not for every animal to survive, but to keep the species going.

The intensity of the reaction also has to be appropriate since animals use up precious resources when trying to defend themselves. An antelope that is too ready to give up grazing and run will soon become undernourished; squid do not have unlimited ink. Even the simplest creatures have remarkably sophisticated responses, as demonstrated by American biologist Herbert Jennings, working in Europe at the turn of the century.

Jennings was interested in the ordered and elegant lifestyle of a tiny pond animal called a stentor. A stentor is only one cell big, a trumpet-shaped creature, attached by a ‘foot’ to a rock on the water bed. It has a tube at its base which can provide shelter, and the trumpet is an open pouch at its free end for feeding. Hairs around the edge of the pouch waft in food particles.

Jennings used carmine, a natural red dye extracted from the cochineal beetle. It can be an irritant even for humans and is certainly toxic to tiny animals like stentor. He added carmine to the water tank in which the stentor was living, and simply watched to see what happened.

The stentor did not at first react to the carmine in the water, but then decisively bent away from the oncoming red specks. The gesture is normally enough to keep it out of trouble in the peaceful conditions at the bottom of a pond. It costs the animal little to try, and it can continue feeding even as it defends itself. In Jennings’s experiment, the stentor bent this way three or four times, and when the strategy did not work, demonstrated a second line of defence. It suddenly pushed its pouch out in the opposite direction in an attempt to dislodge any poisonous particles around the mouth. Again this failed, as Jennings continued to drop carmine into the water. Red particles settled on the pouch and a few more similar moves by the stentor proved futile.

Drastic measures were called for, so the stentor retreated. It contracted and moved down into the tube at its base. It waited there for a time but could not wait for ever because a single cell does not store much energy and it cannot feed in its bolthole. It moved tentatively upwards out of the tube, but found the water still full of carmine and had to force itself back down again. It advanced to test the water a couple more times but when conditions had not improved, the tiny creature risked its remaining precious energy, contracted violently, dragged its foot away from the rock and floated away in search of an uncontaminated spot.

Experiments like this have been given new significance by the latest thinking on the adaptive and positive role of fear. A one-celled creature like the stentor has a graded response to a threat, from simply swaying away from the toxin, to pulling up its foot and drifting into the unknown. Stentor allocates its resources meanly so that only the minimum is used to meet a threat. How much more complex, then, might our own reactions to danger be? And could they be built on similar principles?

People do not function in the same way as protozoans, but some of nature’s rules are universally true. A great deal of our knowledge of human genetics, for example, is derived from study of the fruit fly, Drosophila melanogaster. Our genetic material is the very template from which we grow, and yet most of it can be found in a fly. As Oxford Professor of Physiology Colin Blakemore once rather flippantly pointed out we probably share 70 per cent of our genes with a garden lettuce.

Biologists discovered in 1972 that human cells can apparently commit suicide for the greater good of the whole body. Cells normally receive signals from neighbouring cells telling them to keep going, and should these stop, they die. Cell death is part of the normal development of a foetus in the womb. Babies develop with webbed hands and feet but the skin between the digits normally retreats before they are born. The cells in this skin die, they ‘commit suicide’ and allow babies to be born with perfectly separated fingers and toes. When cell suicide was first described, it was assumed to be relevant only to the highest creatures since a single-celled organism cannot benefit from its own death. Twenty years after the initial discovery, though, researchers found that single-celled creatures do indeed die in this way. They apparently ‘lay down their lives’ for the good of their community.

This is just one of many biological similarities between creatures of very different appearance and classification. There is obviously a big difference between the death of a few cells and an all-pervading feeling of fear, but both could be essential for healthy development. Careful observation of animals might help scientists ask more relevant questions about humans. For example, an obvious feature of animals’ fear is that it is necessary. If stentor does not react to a toxin, it dies. If the antelope does not run from the lion, it gets eaten. Max Klein lacked normal fear and stood to damage himself socially, financially and physically. All animals need to be able to respond to danger. But how does that help us understand the common phobias?

Age-Old Anxieties

A mixed bunch of academic publishers, scientific editors and advertising sales staff ate dinner together at the end of a conference. One editor was regaling the table with tales of her previous career as an Avon lady. She lost one of her clients, she said, when she took a swipe at the woman’s budgie with her cosmetics bag. Everyone looked up, amazed. ‘It was coming straight at me,’ she said, by way of explanation. This confident, bright young woman had ornithophobia and was not going to stay in the same room as a free bird.

One of the sales staff was listening with particular interest. ‘I know exactly how you feel,’ he said with feeling. He was afraid of butterflies and moths, and they started discussing the intricacies of the unpleasantness of wing flapping. Suddenly other diners were vying to compare the strength of their fears. His boss chipped in with a fear of heights and a publisher managed both a fear of spiders and of flying.

The conversation unearthed five phobias in four people among the twelve at the table. Doubtless a psychologist could have found more by interviewing us individually – those mentioned were specific and without much stigma attached – but even this tiny straw poll was telling. The phobias discussed so freely in the restaurant were all directed at threats in the natural world.

No scientist would be impressed by the dubious methods of this survey, but the results are surprisingly reproducible. Whenever a group starts talking about phobias, notice the fears people describe. Occasionally someone has a weird phobia of buttons, cotton wool or wallpaper, and if they do this may dominate the conversation. But most people fear a limited range of creatures or situations. They fear spiders, snakes, the dark, open or closed spaces; creatures and situations that pose few real problems in the West today but which could be dangerous if we lived less cosseted lives.

Evolutionists believe that this observation is important in our understanding of phobias. They say the things we fear today could have been fatal to our prehistoric ancestors. A bite from a spider or snake could have killed; it would have been dangerous to be out after dark; being cornered in a cave by an animal was definitely best avoided. By contrast, the things that really do kill us today – cars, guns or cigarettes – rarely inspire the same level of fear.

They believe that we are, at heart, barely adapted Stone-Agers, now working in offices and driving cars. We are strangely mismatched with our circumstances. We have modern and sophisticated lives but the deep recesses of our mind have developed to react to long-gone situations. The primeval drive of fear is more easily provoked by ancient threats, evolutionists say, because it is still best attuned to days spent roaming the African plains. Then, it would have made sense to have a proper respect for spiders, the dark or enclosed spaces. Stone-Agers lived in dangerous times and required a certain level of caution to survive and have children. Those who did survive passed their safety-consciousness on to their offspring and it became programmed into the human psyche.

The conversation at the dinner table might have ostensibly been about crazy, overblown fears of harmless objects, but an evolutionist would contend that it was in fact about proper caution for dangerous situations – albeit a few tens of thousands of years late.

The theory of evolution has been widely known since Charles Darwin shocked contemporary society with The Origin of Species, in 1859. The book had ramifications throughout science, religion and society, as discussed in the previous chapter. It hinted that humankind evolved from a primitive creature over millions of years and is related to the apes. Darwin was initially ridiculed and pilloried for his ideas, but acceptance of them grew and they are now largely taken for granted. In the past decade or so, scientists from many disciplines have revisited evolution theory and attempted to apply it to such diverse questions as why nations go to war and what features of the face or body determine sexual attractiveness. It has been used to argue for a new approach to pest control in agriculture; computers have been programmed to use a kind of technological natural selection to continually improve performance.

But what of our reactions to danger? Can evolution theory tell us anything about the nature of fear and anxiety? Evolutionists claim that part of the reason we develop phobias may lie in the mismatch between life in the twenty-first century and the Stone Age. As a species we are still primed to react to the threats and opportunities that our ancient ancestors faced. Evolutionarily speaking, we have hardly budged in the past ten thousand years but our lifestyle has changed beyond all recognition.

Primates are believed to have appeared sixty-five million years ago, followed thirty million years later by the first apelike creatures. They began walking on two legs about four million years ago, and using early stone tools two and a half million years ago. After a phase of rapid brain expansion two million years ago, they started to use shaped hand-axes and moved from Africa into Europe and Asia. This was the beginning of the Stone Age and its people developed a stable lifestyle roaming African plains for food until about ten thousand years ago.

Anatomically modern humans developed from their ancestors a hundred thousand years ago and discovered fire. Farming was introduced ten thousand years ago, the wheel about eight thousand years ago, and people started to write about 4000 BC. The pace of change accelerated and it took less than two hundred years to get from the first machines of mass production in the industrial revolution to the technology that put men on the moon.

It is rather like an old man who has lived for seventy years in an isolated spot in an unchanging world. One summer, somebody strikes oil nearby. Big business moves in, a town is developed, new roads are built, the population soars and he finds himself ill-equipped to cope. Humans have spent 99.5 per cent of their existence as hunter-gatherers and are barely out of the Stone Age in evolutionary terms. But life today bears little resemblance to that of our ancestors.

Evolutionists have attempted to explain many modern health problems in terms of the poor fit between our biological make-up and modern lifestyle. Soaring rates of obesity are a good example. Our ancestors had to move around constantly in search of food, which was often in short supply. The ability to store fat around their bodies so that they could survive times of potential starvation would have been a great advantage. Today in most parts of the Western world, food is plentiful. Supermarkets carry a dazzling and expanding range of foods and food shortages are almost unheard of. Add to that a sedentary lifestyle, in which we are entertained at home by the TV, transported around in cars and have our manual work done by machines. The result, according to the World Health Organisation, is that almost half of Britain’s adults are overweight and the entire population of America will be obese by 2230 if the increase seen since 1980 continues. Obesity is serious, known to contribute to heart disease, diabetes and premature death. Fat storage, the very mechanism which kept our starving ancestors alive, may be killing people off in the modern world.

The Pima Indians in Arizona, US, are a particularly dramatic example. They maintained a traditional way of life, relying on farming, hunting and fishing for food, until the late nineteenth century. Then, diversion of their water supply by American farmers upstream drove them to poverty and malnutrition, even starvation. The Second World War brought both prosperity and contact with Caucasian Americans, which westernised their dietary and lifestyle habits. Since then, the Pima Indians as a group have put on an unhealthy amount of weight. Half of the adults have diabetes and 95 per cent of those are overweight. Scientists from the US Government’s National Institute of Health have studied the Pima Indians for more than thirty years, looking for genetic causes of diabetes and obesity.

Just as the Pima Indians are physically adapted for a traditional lifestyle, our minds may be geared to deal with traditional dangers. We still eat as if food shortages were imminent; perhaps we are also still on the look-out for predators and natural threats. Certainly, evolutionary psychiatrists Randolph Nesse at the University of Michigan, and Isaac Marks, from London University, believe that we are all programmed to react to threats. Anxiety and fear are necessary, they say, and have been essential for our survival throughout evolution.