The Panic of Open Spaces

For years Manhattan Poet Joel Oppenheimer, now 47, took exactly the same route from his Greenwich Village apartment to his local bar, the Lion's Head. One day he tried a more circuitous route, walking along different streets. Midway to the bar he broke out in a cold sweat, suffering from heart palpitations, jelly legs and vertigo. "I had no control over my body," he said. "It was total panic."

Diagnosis: agoraphobia, the most common and disabling of all the phobias, one that may afflict as many as 2.5 million Americans--85% to 90% of them women. Classically known as "fear of open spaces," agoraphobia is actually a cluster of different fears, all amounting to intense anxiety about panicking in unfamiliar situations. Crowds are no protection; Oppenheimer suffered one attack while surrounded by 55,000 fellow Met fans at a playoff game. Severe agoraphobics stick to familiar routines and rarely venture out alone. When they do travel, they usually bring along a friend, child or dog as a prop. "For years," says Oppenheimer, "I was terrified of a new bed, chair, bar, room or restaurant."

Specialists disagree about the causes of agoraphobia. A few doctors think it may stem from hormonal imbalances or overuse of stimulants, even coffee, but most experts are sure the affliction is a psychic one. Freudians consider it a neurotic symptom. Many psychologists see it simply as learned behavior: a patient has an initial breakdown so traumatic that it leaves him in a constant state of anxiety over a possible recurrence, thus producing the phobia.

Therapists also differ widely about how the condition should be treated. The most common technique is behavior modification; its use is based on the assumption that agoraphobia is a habit to be broken. Treatment consists of gradually exposing the phobic patient to feared sit uations, first by having him imagine them, then by forcing him, for instance, to take longer and longer solo walks until the stress disappears. A more drastic technique, similar to throwing a baby into a pool to teach it how to swim, is known as "implosion"--a patient might be driven to a large empty field and left there for hours to cope with his fears. The theory is that terror drains away once it is faced directly.

One problem is that behavior modification works better with specific limited phobias--say, of dogs or birds--than with the generalized panic of agoraphobia. Says Dr. Claire Weekes of Sydney, Australia, a specialist in agoraphobia: "Agoraphobia is not a true phobia. It's one phase of an anxiety state." Weekes, author of Simple, Effective Treatment of Agoraphobia, has treated 1,200 agoraphobics in person and 4,000 more with records, tapes and letters. In her opinion, behaviorists are on the wrong track when they train agoraphobics to avoid panic. Says she: "Recovery lies in the attack itself and learning to cope with it. If you teach people to avoid panic, when it comes, they fall apart and relapse." Her advice: "float" with the anxiety attack, don't fight it.

Weekes believes that in most cases psychoanalysis is the wrong approach. She has found that prolonged stress or shock--a death, divorce or birth --can turn ordinary anxiety into a flash of panic. Then, she says, "the fear that it will recur keeps a person within a restricted orbit. What's the use of looking into that person's childhood for an explanation?"

Freudians, of course, do just that. In their view, agoraphobia, like all phobias, is a symbolic expression of deeply threatening sexual and/or aggressive urges. One difference, says Manhattan Psychoanalyst Walter Stewart, is that agoraphobics are "generally angrier and sicker" than other phobics. Why are most agoraphobics female? Los Angeles Psychoanalyst Ralph Greenson believes that men generally deal with anxiety by compulsively facing it. "If they are afraid of violence, they may become addicted to football, play it, see it again and again. Women are basically phobic; men are basically counterphobic."

Other Freudians say that because women traditionally associate the open streets with prostitutes and the danger of rape, agoraphobia can be a coded fantasy for illicit sex, a replay of the child's sexual attraction to her father during the Oedipal stage (starting around age 3).

Feminists and most non-Freudian therapists disagree. They believe women are more susceptible to agoraphobia because they are taught as girls that the outside world is dangerous and then grow up to be stay-at-home housewives who can afford to nurse their fears of the unknown. Give women confidence and jobs outside the home, they say, and female agoraphobia will drop to the male level.

Robert Seidenberg of Syracuse is one analyst who has bought the feminist argument. Says he: "We are confronted with the paradox that women are declared phobic when they exhibit anxiety in public places where custom, until yesterday, had prohibited them from entering. If one replaces the idea that the woman had the desire to sleep with father with the thought that she wanted to work with him in his downtown office, more salutary results might be obtained."

All schools of agoraphobia experts agree that experience in facing new situations can moderate some of the symptoms. That seems to be the case with Joel Oppenheimer, whose attacks are now milder and far rarer. Says he: "I think it has something to do with aging and also with my divorce. When I became a single parent, I just had to get out more. Besides, agoraphobia is on its way out as a cocktail-party topic. Everyone I know is now into low blood sugar.'' -

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