After reading this article you will learn about:- 1. Meaning of Phobia 2. Types of Phobia 3. Symptoms 4. Theories 5. Treatment.
Meaning of Phobia:
A phobia is a morbid on pathological fear which the patient realizes to be absurd but nevertheless is unable to explain and overcome it. First recognised by Hippocrates and subsequently discussed by Locke, Phobias, according to Shanmugam (1981), may be defined as “a fear mediated avoidance out of proportion to danger posed by a particular object or situation”.
Individuals with phobias usually recognize consciously or rationally that the feared stimulus is safe, un-harmful. But in-spite of this realization, if the feared object is not avoided, intense anxiety occurs.
Coleman (1981) defines phobias as follows; “A phobic reaction is a persistent fear of some object or situation which presents no actual danger to the patient or in which the danger is magnified out of all proportion to its actual seriousness”.
Phobic fear differs from normal fear in several respects:
1. It is more intense and paralyzing.
2. The stimulus which arouses the fear is not an adequate stimulus to create normal fear.
3. The original fear experience is forgotten due to repression.
4. This fear appears to the person to be absurd and unjustified.
5. The individual has no control over his phobia whatsoever.
6. A sense of guilt is always involved in the original experience.
Obvious differences also exist between anxiety neurotics and neurotic phobic people.
While the anxiety neurotics may not know the source of their tension, people with phobias attach their fear to something that realistically is minimally harmful. Another major difference between anxiety neurotics and neurotic phobic people is that phobic people have a definite identifiable source for their fear.
The fear, in other words, is not free floating as it is commonly found in anxiety neurotics, but is rather attached to something. Duke and Nowicki (1979) opine that non-disabling phobias are common in the general population compared to other neuroses affecting approximately 77 out of every 1000 people.
However, disabling phobias are relatively rare affecting 02 out of 1000 people according to the reports of Agras, Syevester and Oliveau (1969). Out patient clinic data show that phobias make up only 5 per cent of the neurotic patients seen.When either the feared object or stimulus is constantly present in the environment or interferes with the normal performance of the individual, it becomes incapacitating or disabling phobia.
For instance, a fear of closed places (claustrophobia) may be disabling to a coal miner or an elevator operator, but probably not to a person working in a firm. Phobias are more commonly found in children and adolescents than in adults.
For instance, fear of ghosts and darkness are very commonly observed among children and adolescents. Moreover, the percentage of phobic reaction is slightly greater in females than in males.
Phobias have no reservation for age, sex, intellectual position, profession or social status. Even quite grown-up people have fear for air flight, for running water, for darkness, for blood and for any object. The mere sight of certain very common objects say a spider or a bunch of hair may produce screams as if the person’s life is in acute danger.
Types of Phobia:
Phobias can be classified into two types:
1. Neurotic phobia
2. Traumatic phobia
1. Neurotic Phobias:
Neurotic phobias represents a strong tendency and persistence for the fear to generalize similar objects or events. A fear for an Alsatian may become a fear of all types of dogs in course of time.
This fear may again spread to all four legged animals, then of places where animals live and so on and so forth. Thus, in neurotic phobia, the main tendency is to generalize the fear from the situation or object to similar objects and situations.
According to Page (1976) patients suffering from neurotic phobias are not aware of the real basis of their fears, their reactions to them are often violent and they are greatly inconvenienced by them. When coming in contact with the object of their fear, the neurotic phobias experience severe terror. Fear of moths, spiders, cockroaches, rats, fear for dark places are typical examples of phobic fear.
2. Traumatic Phobia:
In contrast to neurotic phobia where a strong tendency to generalize the fear is obvious in traumatic phobia, a single traumatic event is sufficient to establish a severe fear for a life time. In traumatic phobia, the fear often remains fairly well encapsulated. For example, fear for a particular boating in a lake may remain limited to that ride and not generalized to others.
Given below is the table representing a list of common phobias and their objects. This list can give some idea about the different types of situations and objects around which phobias can grow and spread.
Most of such fears, if they do not show serious symptoms are learned from the childhood experiences. But how far the fear is normal or neurotic depends upon the degree and absurdity of fear. If the person does not understand the origin, meaning and significance of such fear, it is surely neurotic fear and hence named as phobia.
A lady who is otherwise very courageous and is not usually fearful is used to show fear towards rats. When asked why she is afraid of rats, she described a childhood experience related to this fear. When she was about 7 years old while sleeping in the night her finger was beaten by a big rat leading to severe injury and pain.
This very experience was so traumatic for her that later on, she could not even tolerate the sight of a rat. This fear for a rat cannot be called traumatic as the person involved understands the origin, meaning and root of such fear.
Normal fear for water, harmless animals, closed places, dark, rooms are established due to childhood conditions. A child while swimming was rescued when he was about to be drowned in a river. From that day he developed fear for running water.
The mother of a boy of 2 years used to scream in fear when the light was off all on a sudden in the night. She could not tolerate a bit of darkness. In the beginning the child did not show any such fear but he also started screaming at the age of 5-6 years when there was darkness.
Similarly, fear for thunder and lightning may develop out of childhood conditioning. Watson and Raynor’s experiment on development of fear of Albert towards his pet white rat is a classic example how such fear develops out of conditioning. Thus, plenty of day to day experience do explain the development of fear due to learning and childhood experiences.
A young woman of 20, suffered from a severe phobia of running waters, since she was seven years old. She was afraid of any place or anything connected with water. Cause — when she was a child, she accompanied a picnic party.
Alone she went to a stream and was about to be drowned when she was rescued by an onlooker. Once she was reminded about this incident her fear for running water disappeared by and large, though she subsequently became quite cautious while crossing a river.
Sometimes, a phobia becomes symbolic. Though the individual is afraid to the object itself, the original fear is something else. In fact, the object of fear only stands as a definite symbol for the original fear.
A young lady, very fond of her father, developed a morbid fear for a kitchen knife. Whenever she used to see this knife, the apprehension that her mother would struck her in the knife developed. Her feeling towards her mother appeared to be a combination of fear, jealousy and sympathy because of Electra complex.
Similarly a woman who has repressed her abnormal sexual interest for men may develop an anthrophobia (fear for men).
Symptoms of Phobia:
Most people experience some sort of minor fear in their day to day life and they do not disturb our every day routine activities. But the reaction to phobic fear is unexpectedly intense and it interferes with the every-day activities of the patient. A sales representative or an insurance agent who has to travel a number of places daily, if has mysophobia (fear for contamination or germs), it affects his normal profession.
Similarly, a doctor having hematophobia cannot be a successful physician. An old lady developed so much of mysophobia that she used to carry her utensils when she travelled outside. This problem posed such a handicap for her that she ultimately gave up going out or joining social functions or get together.
Patients suffering from phobias often confess that it is no use of being afraid of such harmless stimuli as they have no justification to be afraid of. But the most unfortunate aspect of this is that they cannot help themselves.
If at all, they do not avoid the phobic stimulus, by withdrawing from it, they experience anxiety which in some cases may lead to very mild feelings of uneasiness and depression and in other cases to a severe anxiety attack.
Along with morbid fear phobic patients by and large, demonstrate physical symptoms such as headaches, back pains, stomach upsets, dizziness etc. Among the psychological symptoms and aftereffects, feelings of inferiority, fear of having serious organic diseases and general worry are note worthy.
Persistent obsessive fears are also visible in many phobic. A study by Kerry (1960) on a few patients having outer space phobia led Terhune (1961) to point out of current culture in the development of a particular phobia.
Aetiology:
Coleman (1981) has reported that “phobic reactions may occur in a wide range of personality patterns and clinical syndromes”. Phobias are taken for granted as “simple defensive reactions” in view of the fact that the phobic try to adjust themselves with the overt or covert dangers by preventing their occurrence or carefully avoiding them.
The phobic has to succumb to such fear evoking situations (by withdrawing from it or trying to prevent it) or else there will be a serious threat to the ego resulting in anxiety. Thus, to be free from the trauma of anxiety the phobic patient in-spite of knowing the fact that his fear is irrational tries to give in.
Theories of Phobia:
Five important theories of phobia have been developed:
1. Psychoanalytic Theory:
On the basis of the case history of little Hans (1909) and further clinical experience Freud held that phobias represent displaced anxiety associated with Oedipus complex. Thus, getting the root from Freud, psychoanalysts have theorized that displacement of anxiety from the stress situation which produced it to some other object or situation is represented in a phobia.
In case of Hans, the 5 year old boy, for instance, they argued his desire to possess his mother sexually and his jealousy and hostility towards his father leads to fear for father, specially the apprehension of being castrated by the father if he loves his mother. This very fear of the father was displaced to horses which stand for fear of castration by the father.
Freud summed up his view by saying that phobias in adults develop only in people with disturbed sexual relationships i.e. those who have for instance failed to resolve their Oedipus problems in the phallic stage of psychosexual development.
Subsequently, experts in the area of psychoanalysis have emphasized that not only disturbed sexual relationships, but also different kinds of stresses and strains of life, frustrations may lead through displacement to various phobic reactions also.
A student who apprehends that he would fail in the examination may develop a fear for the class teacher which forces him not to attend his classes. In order to save himself from the embarrassment of failure and probable anxiety therein, he takes recourse to this action unconsciously. Such a person may be completely unaware of the actual source of his anxiety and fear.
Wolpe and Rachman (1960) have also criticised the psychoanalytic theory. They hold that Freud has over generalized the little Hans’s phobia. They view that Hans became afraid of horses after meeting an accident involving a horse. According to them, Hans’s phobia could be explained effectively by the conditioning model of Pavlev.
2. Defence Against Dangerous Impulses:
Sometimes defensive reactions of the individual help him to protect himself from dangerous repressed aggressive and sexual urges. In fact, the theory for which phobia is developed consciously is not the real cause of anxiety. The real cause of anxiety is displaced.
Thus, a son may develop a phobia for knives because of repressed impulses to kill his father. A lover may develop fear for high places because on several previous occasions, he has repressed his persistent thought of throwing out his beloved.
Coleman (1981) describes the case of a 24 year old young man who developed the morbid fear Syphilis which made it impossible to have sexual relationship with the opposite sex. During psychotherapy it clearly revealed that the patient’s fear for Syphilis represented a displacement of a fear of engaging in homosexual relations.
In other words, to save himself from homosexual behaviour, which he thought was immoral, he developed sypilophobia. At the same time, he failed to have heterosexual relations (though it was moral according to him) because during intercourse his mind was completely dominated by homosexual fantasies. These fantasies aroused severe anxiety and led impotency in certain occasions.
To avoid the anxiety arising out of this highly embarrassing impotency, he displaced his anxiety to control his threatening inner impulses to fear for Syphilis.
3. Conditioning Theory:
The learning or the behaviour theorists like Watson, Raynor have comphasized the conditioning theory in explaining the aetiology of phobia. Such phobias are common in every one’s life. Being associated with a fear provoking situation when a neutral stimulus is able to provoke similar fear in the individual, it is popularly called conditioned fear reaction.
Example of Albert in Watson and Raynor’s experiment of fear conditioning proves the point. If the initial fear is intense or traumatic, or if the fear experience is repeated several times, it may lead to neurotic fear. There also may be generalisation of fear stimulus.
A mother who trembles at the sight of a parrot may displace or communicate this fear to her children. Thus such fears of thunder, lightening, spider, rat, bunch of hair, or cockroaches which develop out of learning and conditioning are simple cases of maladaptive responses that have been learned in course of development. They are not the fears having a neurotic nucleus.
Evaluation:
To a behaviourist a particular object of phobia does not have any significance. To them, a phobia for closed space or a phobia for animals are equal. Their approach is totally functional.
4. Modelling Theory:
Bandura and Rosenthal (1966) have advanced the modelling theory of phobia. In an experiment they arranged for subjects to watch another person (a model here) in an aversive conditioning situation. The model was connected to different electrical apparatus. Hearing the buzzers the model withdrew his hands rapidly from the arm of the chair and thus avoided the shock.
The physiological reactions of the subjects witnessing this behaviour of the model were recorded. After a number of such observations the subjects started reaching emotionally to harmless stimulus situations.
The investigators view that such kinds of vicarious conditioning procedures may also be applied to verbal instruction of phobic behaviour. Thus, a child may learn to show phobic reactions by observing his mother’s phobias or by obeying her repeated warning say to remain inside when there is thunder and lightning.
Criticism:
But all phobias can also not be explained by vicarious conditioning procedure. It is criticised that vicarious fear extinguishes quickly. In the second place, phobic do not report that they too become frightened after witnessing the model in distress or danger. Thirdly, observations show that many people witnessing the model going through the traumatic experience do not develop phobias.
5. Physiological Theory:
Under similar environmental conditions why some people show proneness to phobia while others not? This question has haunted many experts in the area. The autonomic nervous system is held responsible for this by some.
It is argued by the physiologists that depending upon the degree to which their autonomic nervous system is aroused by the wide range of stimuli, people may react differently to the same environmental situation. If this is accepted, one has to agree that heredity of the individual may play an important role in the development of phobias.
Shanmugam (1981) has referred to Eysenck’s account of conditionality in different types of personality as a solution to this problem. But further research and investigation in this area is necessary to establish the physiological dynamics of phobia.
Mark’s (1969) important study of different phobias showed that variables like frequency of occurrence, sex, incidence, age of onset, the course of the problem, associated symptoms and the psychophysiological responses are to be taken into consideration in the understanding and treatment of phobias.
On the basis of the findings and available current information’s one may conclude that it is not reasonable to explain all phobias by the help of a single theory or dynamics. While some phobias may be learned, and can be explained by the behaviouristic model, other phobias may be explained by the psychoanalytic model and so on.
Secondary gains:
Increased attention, assistance, cooperation, sympathy and some control over the behaviour of others are some of the secondary gains as a result of phobic behaviour. A person who does not want to attend a conference, all on a sudden for other reasons, may rationalise that he has flying phobia and nobody, not his ego even will blame him for this.
Disadvantages:
But the disadvantages are many. The phobic is constantly ridiculed by his friends, relatives and social group. Thus, he is unable to attend various social functions and get together. This leads to several interpersonal difficulties and social disapproval. All these in combination make his already maladaptive personality multi-maladaptive.
Treatment of Phobia:
Treatment depends upon the particular cause behind the typical phobic reaction. When the phobic reaction arises out of severe traumatic experiences, desensitization and extinction have been reported to be effective.
This programme involves encouraging the patient to face the phobic situation with someone in whom he has got enough confidence. For example, in case of a child, who is afraid of black cats, the mother may fondly show the child holding cat on her lap, that the cat is not at all harmful. This should be done gradually but steadily, until the phobia is completely extinguished.
Active deconditioning procedure may also be tried to reduce phobic reaction. In this method the feared object may be associated with some stimulus which is pleasant to the person. For instance, a child who is afraid of doctors, if is given a candy, each time he sees a doctor approaching, he may leant to decondition or un-condition his fear.
Lazarus (1960) conducted an investigation in which an 8 years old boy after meeting an accident developed a fear of moving vehicles which could be eradicated by the active deconditioning procedure. Coleman views that “the proper handling of fears immediately after the traumatic experience can of course do much to prevent the development of phobias of this type.”
Though deconditioning techniques may help in reducing immediate adverse and disturbing symptoms, more extensive psychotherapy is necessary to go deep into the root of phobia.
Bandura, Blanchard and Ritter (1969) on the basis of their study have suggested that overcoming a particular phobia gave the patients confidence to overcome any other problem that may arise. However, the effectiveness of a particular therapeutic method depends obviously on the particular pattern of aetiological factors.