Society’s slings and arrows

Dear Doc
I have extreme claustrophobia which reaches a point when I can't even get into an elevator with more than four people in it. And using public transports like a bus is out of the question. Can you please tell why I feel the way I do and what can be done about it?
- Syed Mohammed

CLAUSTROPHOBIA is a kind of phobia (fear) which is a manifestation of Anxiety Disorder. Anxiety is actually a mixed emotion although a specific kind of fear is a major contributor in this case.

From a physical perspective, persistent problematic anxiety feeling (anxiety disorder) is the outcome of chemical imbalance in the brain. Nervous System has acquired heightened sensitivity and neurons start firing indiscriminately once it is triggered by some cue in the environment. It has lost its capacity to self-regulate the intensity and frequency of electrical and chemical impulses in the brain. Anxiolytic medication (different varieties are out there in the market) can help to correct the imbalance and give you relief.

From psychological perspective, any emotion (e-motion) is energy in motion. Anxiety is a manifestation of excessive suppressed emotional energy in unconscious mind. Fear is a normal emotion that tells us to run from danger or take necessary precautions, etc. In your case, an apparently benign situation (elevator, bus etc.), probably any closed space evokes a danger signal (false alarm!). A consequent physiological response ensues to the false alarm.

Claustrophobia (an unhealthy coping mechanism) can be a brain conditioning (stimuli-response relationship) that has resulted from an early life experience of feeling trapped (could be symbolic though) in a closed space. Memory, stored at an unconscious level, once triggered can lead to an automatic response which is out of proportion to present context.

Psychotherapy may help to bring that unconscious memory to the surface and then help to unlearn the faulty response and replace it with healthier conscious coping strategies. It is important that you seek help as quickly as possible. Otherwise the older the symptom gets, the harder it becomes to erase the pattern.  It is not unlikely that untreated claustrophobia gets further complicated with panic attacks on top of it.

Unfortunately, these potentially disabling mental health symptoms often get minimised by other health professionals and family members. As a result, people have to live a compromised lifestyle for a prolonged period of time and eventually start getting depressed. This is how anxiety and depression tend to feed each other and form a vicious cycle. Be proactive and look for professional help and be ready to cooperate in getting to the root cause of this issue.