Agoraphobia in an Uncertain World

If there is anything to place our bets upon in this life, it is that life is an uncertain thing. This uncertainty is prime territory for many disengaged feelings. For all the scrambled puzzle pieces of shattered lives, there is nothing close to agoraphobia. A mixture of genetic factors and environmental causes (1), agoraphobia is a premier disabling condition seen in less than 0.5% of the population. Much like walking about the world as a pariah, only the world never cast you out to begin with, as it is a personal decision that lacks much choice in the matter.

What Is Agoraphobia and What Can We Do?

Agoraphobia is a paradox, related to panic disorders (2) yet distinct in its presentation among those affected. One might call it an answer to a world full of questions. I have seen the effects of this debilitating disorder firsthand, and it saddens me to say there is no escape. In the most literal sense. A person with agoraphobia cannot cope with multiple situations, the most prominent of which is fear of society at large. The affected cannot imagine being confronted with a crowd of people for example, because there is no safety involved. There is always an element of risk to social interaction or the act of stepping outside. While we cannot classify agoraphobia as a full-blown psychosis, it is still as disabling a condition, because of the risk of overload turning into a severe panic attack response to external stimuli.

A person with agoraphobia may feel that she must leave a home only with the support of another person, and never leave the house alone. Leaving alone is anathema to those affected. One might think of it in relation to how a shy person on stage must feel in front of a crowd of people, only these people are judging you at every single movement you make. The possibility of embarrassing yourself is center stage, manifesting in avoiding social situations altogether, leading to a loss of friends, and usually by choice.

The best way to help an agoraphobic is to come at it from an angle of empathy and understanding. If the affected must leave the house, then it follows one must go with them for them to feel comfortable. The fear aspect is the most disconcerting symptom of the disorder, with replaying bouts of situations that may or may not happen at the forefront of their thoughts. We must stress that these situations being processed are only hypothetical, and with guidance and aid the likelihood of imagined situations is slim to none. Empathy is king. Even if a belief is not likely to happen, alleviating the fear is of the utmost importance.

The Spiritual Aspect of Agoraphobia

Self-treatment is not an option on the table for most patients (3) yet limited exposure to the outside world can have a therapeutic effect on the individual as time passes. Feeling trapped with no way out is a common theme among those affected, and the only way to break through is by confronting fears head on. It may be dangerous for more severe cases but looking at the issue from a spiritual perspective can enlighten to the individual and loved ones. We must ask the question. How can I allow God to help me through this tragic situation? Studies have shown spiritual acuity to be effective at a positive prognosis for many individuals (4).

A dichotomy between being primed for faith-filled solutions and crippling anxiety exists. After all, if one is afraid of everyday humanity, it becomes a greater fear accepting the power of the divine in one’s life. God is mysterious, and with that mystery comes a fear of the unknown which cycles back to the outlook of the affected. Still, the overall reception of those with agoraphobia to religious solutions is positive. A fulfilled prayer life is key, as they can do this in the convenience of their own home instead of a public place. When a loved one desires to pray along with the affected individual, the chance of utilizing faith for helping to calm anxiety doubles in efficacy. Yet, to be transparent in such a way requires a level of courage only God can provide.

Healing Disorders in the Scriptures

The gospels are full of instances where faith in God heals the afflicted, whether the disabling condition was mental or physical. God is the Great Physician, and with that title He shows Himself faithful to those under the sway of the fallen creation. Mark 1:34 states “And He healed many who were sick with various diseases ….” Agoraphobics are not without hope, especially when the grace of God is called upon. While it may be difficult to even attend a church service, private prayer and the wishes of those closest to the affected can be just as effective as in person attendance at a spiritual institution. Agoraphobia makes the world smaller, but it is in this intimate process of self-separation that God does His best work.

A Positive Outlook Through Technology

While the risk factors for agoraphobia also involve having a family member who also has the disorder, making it a genetically inherited disease, there is hope and a future in the situation’s face. An agoraphobic man who has spent his years housebound can learn to take small steps to exit his safety bubble. He is not at the whims of genetics. With rehabilitative therapy and the advancements of technology, a person with this disorder can receive virtual visits with a trained therapist from the comfort and safety of home (5). While not a literal disease in the physical sense, agoraphobia roots itself within the human psyche, intangible and just out of reach. Why not use the intangible as a method to deal with the intangible? A quick one-hour session through the computer or even a less personal approach like a phone call can turn the situation around for the better with some effort from the patient.

Technology is skyrocketing, and this means an affected individual can use it to their benefit. On the other side of virtual visits and phoned in appointments lies the world of virtual reality. While not 100% studied, using the virtual reality space offered through advancements in video games and augmented reality can be beneficial to an agoraphobic (6). It is an opportune situation when one can simulate the outside world within the comfort of their own home. Such studies are in their infancy, but they have supplied favorable results.

The world at large is becoming more agoraphobic on the heels of the pandemic, with more people choosing to work from home and telecommute to work. The post-pandemic world offers a chance for agoraphobics to test the boundaries of what they feel is possible, because in a way the world is becoming sympathetic to their plight without realizing it. The pandemic primed the world as the perfect testing ground for those in plight to dip their toes in what living with less fear might look like. While the virtualization of the world will never end fear and comes with its own set of problems, there has never been a time where an agoraphobic could interact with the world from the comfort of their place of safety on the level offered in the current post Covid-19 era.

Final Overview

Agoraphobia may be a debilitating condition, but it is not a condition without hope of recovery. Using a faith filled life combined with the many technological aspects of the modern age show forth a positive prognosis for those affected. Someone may never cure completely from agoraphobia, but there is still a ray of light. With a world becoming smaller and more contained, the agoraphobic will find it easier to thrive in society to the level they are comfortable with. The power of the gospel offers hope, and the technology man has discovered by the gift of God offers a positive future.

References

Bouchard, S., Paquin, B., Payeur, R., Allard, M., Rivard, V., Fournier, T., ... & Lapierre, J. (2004). Delivering cognitive-behavior therapy for panic disorder with agoraphobia in videoconference. Telemedicine Journal and E-health, 10(1), 13-25.

Bowen, R., Baetz, M., & D'Arcy, C. (2006). Self‐rated importance of religion predicts one‐year outcome of patients with panic disorder. Depression and Anxiety, 23(5), 266-273.

Ghosh, A., & Marks, I. M. (1987). Self-treatment of agoraphobia by exposure. Behavior therapy, 18(1), 3-16.

Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C., & Eaves, L. J. (1992). The genetic epidemiology of phobias in women: The interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia. Archives of general psychiatry, 49(4), 273-281.

Roth, M. (1984). Agoraphobia, panic disorder and generalized anxiety disorder: some implications of recent advances. Psychiatric Developments, 2(1), 31-52.