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The Agoraphobia Cause and Treatment Webpage ©

The physical causes

This webpage has been reinstated from a prevous one and updated in April 2011

Poor posture, the over-reactive nervous system, and agoraphobia

When I was trying to determine the cause the symptom of chronic fatigue I was aware of the general idea that it can be caused by 'stress', where the word 'stress' in relation to physics referred to mechanical strain, but in humans it most commonly referred to 'anxiety' or 'fear'.

However I found a definition for Valsalva's maneuver which caught my interest because if referred to a method of causing 'stress' on the human body in the scientific laboratory, where 'stress' is any factor that stimulates the autonomic nervous system.

The method requires an individual to pinch their nose and close their mouth tightly and try to forcibly breath out. That causes a large increase in pressure in the air in the chest which impairs the flow of blood from the feet to the brain, and would cause faintness if sustained.

However, the nervous system has automatic reflexes in the brain which detect the reduced blood flow, so it reacts by stimulating the nerves in the blood vessels of the lower half of the body to increase blood pressure, and thereby force blood through the compressed section of the chest to the brain to prevent the faint.

I therefore drew the conclusion that poor posture could cause 'mechanical tress' by compressing the air in the chest and stimulating the nervous system. Of course , compressing the chest once was not the problem. However, if an individual had a stooped spine and leaned forward repeatedly, as occurs in activities such as reading or writing then the accumulated affects of several years of repeated compression could weaken the blood vessels and or over-stimulate the nervous system.

The general over-reactivity of the nervous system then over-stimulates the mind to cause excessive responses to normal situations. For example most people go to the shops, drive their car, or go on plane flights despite the fact that they can get embarrassed, or have a car accident, or be in a plane crash, but some people over-react to the daily occurrences, or the occasional plane crash by developing a fear of those activities. However, some become afraid of everything, and stay housebound for fear of open spaces, or public marketplaces, and they have a fear of driving or planes etc., in which case their condition is known as agoraphobia.

I therefore developed the idea that poor posture could repeatedly compress the air in the chest to produce Valsalva's maneuver, and stimulate the autonomic nervous system, to produce over-reactions of the nervous system, which results in over-reactions of the mind, which disposes to the fear of certain things, or the fear of everything.

i.e. that poor posture is one of the causes agoraphobia.
It could also be considered that a person with poor posture is much more likely to be nervous, and to develop agoraphobia than a person of good physique.

The physical cause, nature and treatment of Agoraphobia ©

Due to Carbon Dioxide sensitivity etc.

The word agoraphobia literally means the fear of the market place from the Greek word agora which means market place and phobos which means fear. However the word has also been used to refer to the fear of many differnet things such that the person becomes housebound because they are afraid to venture outside, and the condition is regarded as a fear of open spaces.

Such fears are usually attributed to psychological factors but a close consideration of the phobias reveals some common physical factors in the major types.

For example market places are crowded with people who breath in a lot of the oxygen from the air and breath out a lot of carbon dioxide, and some people, who have a sensitivity to high concentrations of carbon dioxide will experience palpitations, a sense of oppressive suffocation, or faintness, with an impending sense of losing consciousness or collapsing, and it is the distressing effects of these physical symptoms which is the real cause of their fears. Other examples of the fear of enclosed spaces are the fear of being confined to a small cupboard which is claustrophobia, and also the fear of the enclosed areas such as lifts, planes, trains, cars, buses, or crowded theatres.

However there are other common factors. For example some people experience distressing symptoms of palpitations or faintness when their body is exposed to centrifugal forces such as occur when the body is thrown outward in side show rides, or when it is subjected to the gravitational forces when a lift accelerates to rise or descend, or when a plane accelerates on take off or landing. This can occur if their internal anatomy is moving excessively due to a condition called visceroptosis. The moving anatomy compresses blood vessels and reduces blood flow to the heart and brain so that the person feel faint. They may also have weak circulation so that centrifugal forces disrupt blood flow more readily than is the case with healthy people.

Of course in some cases, as in lifts and planes, both factors, enclosed space, and centrifugal forces are involved, which probably explains why these are among the most common phobias.

The third type of phobia occurs as a secondary effect of these physical problems. This is because the patient does not know the real cause of the problems. They only know that they get problems with palpitations, breathlessness, or faintness in many situations where the symptoms get out of control until they remove themselves from the lift, or the plane etc. They therefore become suspicious of everything and will tend to develop phobias to anything and everything which occurs when they are experiencing symptoms, but this is a problem of association. For example, if they are watching a harmless white rabbit in a pet shop window in the mall of a crowded shopping centre, they may develop symptoms because of the increased carbon dioxide concentration caused by the crowd, and start getting the symptoms whenever they see a white rabbit at any time in the future. White rabbits are harmless so the fear of white rabbits is diagnosed as being irrational, and is regarded as evidence that all the other fears are irrational. Without kwnowing the real cause of the problem it has sometimes been regarded as having a subconscious psychological basis which dates back to early childhood traumas of some sort.

There are of course other phobias such as the fear of public speaking which is probably better described as the fear of the palpitations which occur when a person is apprehensive about speaking in front of an audience, and of course a person who has carbon dioxide sensitivity etc. will have more pronounced palpitations and is therefore more likely to develop such a phobia.

However, in many cases psychological factors have little or nothing to do with the problem, and most methods of treating the condition are physically based and inappropriately referred to as psychotherapy. For example, taking a few deep breaths as a plane accelerates on take off may be enough to prevent symptoms, but psychiatrists advise their patients to use this technique and call it psychotherapy. It is a physical method for treating a physical symptom and is not psychotherapy.

In some cases advising the patient about the breathing technique and why it is effective is all that is necessary to solve the problem. In other cases, if necessary, the psychotherapy is simply treating the consequences of the physical problem, and not the cause of it. M.B.

 

A theory on the postural cause for the symptoms of agoraphobia (6-3-02)

When a person with a stooped spine and a flat chest slouches forward the base of the ribcage buckles backwards and compresses the heart, lungs, and diaphragm. If this occurs repeatedly for many years it is likely that the function of those anatomical structures would be altered resulting in defective aerobic metabolism. This may explain the observation that many people with the chronic fatigue syndrome have shallow breathing during exercise and a sensitivity to high concentrations of carbon dioxide (CO2). The fact that this aerobic problem is not found in all cases of chronic fatigue syndrome is an indication that there are several types of CFS, and that the obsolete term "Effort Syndrome" is appropriate for one specific category of the condition.

People who are sensitive to high concentrations of CO2 would be likely to develop a sense of breathlessness, suffocation, or palpitations if they were confined to a small poorly ventilated space where they breathed in much of the oxygen and the exhaled CO2 was sufficient to produce the distressing symptoms. This would occur if they were confined to a small cupboard where the symptoms have been described as claustrophobia. It could also occur in larger confined areas where many people are breathing out CO2 , such as in lifts, or in an aircraft cabin , where it has been called aerophobia, or in very crowded theatres or public gatherings where it has been called agoraphobia, or if several people are affected it has been called mass hysteria.

If this is so then these problems may not due to an irrational fear of particular situations, but are due to posturally induced impairment of lung function which results in a sensitivity to high concentrations of CO2.

These problems could occur without there being any fear of the particular situation, and, or, would also be much more likely to affect people with the Effort Syndrome than those in the general population.

It is noteworthy that the symptoms of the Effort Syndrome come first, and that patients tend to develop the so-called phobias at some future time. It is also noteworthy that patients will insist that they are not afraid of the particular situation but that the symptoms which occur in those circumstances are distressing. M.B.

Comments from other sources

Phobias" sometimes occur in neurasthenia, especially when it has lasted for some time.
Reference: The Illustrated Family Doctor (1935) p. 499
(neurasthenia means 'nerve weakness' and was the equivalent nineteenth century diagnosis for the chronic fatigue syndrome)


Claustrophobia sometimes occurs in patients who suffer from neurasthenia. "Such people may find it almost impossible to bring themselves to go into the carriage of a railway train or into a theatre or cinema."
Reference: The Universal Home Doctor (no date) p.183.

 

Since World War I it has been known that high concentrations of C02 can trigger a so-called 'anxiety attack' in patients with neurasthenia.
Reference: Neurocirorlatory Asthenia: 1972 Concept, Journal of Military Medicine (April 1972) p. 142-144

 

The nature of phobias - cause or effect

Phobias have been described as a fear of such things as lifts, plane flights, cars, buses, trains, crowds, theaters, and a variety of other factors. However many patients report that they experience a very distressing form of palpitations, faintness, or a sense of impending collapse which occurs in relation to those factors, and that they are simply anxious about the prospect of those physical symptoms, so they avoid situations in which they occur, and this is probably the true nature of those problems. i.e. the physical symptoms come first, and the anxiety, if it occurs at all, comes second, and if the physical symptom can be avoided or controlled, then the variety of multiple phobias would not eventuate or cause concern. Some people with these physical problems can prevent or control them and therefore they are not anxious about them and do not develop phobias, although they may avoid some situations because it is sensible to do so.

Cardiac Phobia and Cardiac Neuroses

The symptoms of Da Costa's syndrome (DCS), include chest pains, palpitations, breathlessness, and fatigue, so some patients think they have heart disease.

Britain's top researcher in the 1950's was Paul Wood who suggested that the symptoms make the patient worry about their hearts, so the heart beats faster, which causes a vicious cycle of palpitations and fear that leads to cardiophobia (the fear of heart disease) and cardiac neurosis.

The top researcher in the U.S. was Paul Dudley White who suggested not sending such patients to heart specialists because it might make them think that they had heart disease when they didn't.

As a patient who has had Da Costa's syndrome for more than 30 years I can say that I don't worry about the symptoms because I can control all of them, and I have actually had a type of coronary heart disease called Angina in 1997 which I cured with a vegetarian diet here, so I don't worry about that either, and like many adults, I have come to terms with my own mortality, and have no fear of death.

However, I occasionally meet people who tell me about their health problems, and some of them do appear to be anxious about them, so I generally respond in a matter of fact and positive tone about any disease.

I am also aware of up to a hundred different theories about Da Costa's syndrome, including the anxiety theories, and the ones which relate it to some aspect of the heart, such as prolapse of the mitral valve (MVP).

Consequently when I was writing about it for Wikipedia I didn't think it was necessary to make any comments about it, but I did mention it briefly, mainly because I would be accused of being ignorant if I didn't. Moreover, there is another page on that topic in Wikipedia, so, if necessary, all I had to do was add a link to it.

However, I had a critic in Wikipedia who was always losing arguments against me, and wanted to get me out of the discussions, so she was trying to invent ways of convincing other editors to ban me. One of her many lies was that I had been deliberately using older references, and avoiding that subject, because of bias.

 

6th October 2008 - This is the what she told another editor about me . . .

"he's chosen the 1950s with care, because mitral valve prolapse was finally figured out in the 1960s. MVP has a distinctive and easily identified heart "click". That click is clearly and recognizably described in a statistically significant subset of the early "DCS" patients, and it's one of the reasons that early researchers thought they had a truly physical cardiac problem in DCS patients. MVP runs in families -- note that I'm telling you have the current knowledge, not the half-a-century ago views -- is associated with deformities of the chest and spine, appears more in women than in men, is often diagnosed in young adults, is associated with a thin, lean body weight, makes the person susceptible to some particularly deadly infections, patients do better with less stress (less demand on the heart), have poor tolerance for exercise, are usually treated with "you'll be fine, just take it easy and call if you get sick" (only severe cases get surgery) -- does any of this sound familiar yet?
When you look at the old work, and you see that a paper reports that, say, a sixth of his patients have that distinctive click, then you really have to toss everything he's said about the "typical" patient, because he's talking about two different and unrelated diseases. It's literally like saying that you've studied the behavior of girls in school, but didn't realize until decades later that every sixth "girl" in your study was a boy. And in fact, that's what the modern sources have done. PW just didn't choose to tell you that." WhatamIdoing 17:27, 6 October 2008 .(end of quote) See here

 

My comment: For most of the time I did not know that particular discussion was happening, and after several months, she managed to turn that neutral editor, and several others against me, and I was banned.

Summary: I was being sensible about the aspect of MVP because the world authorities on the topic recommended not mentioning possibilities that might cause unnecessary anxiety in patients, and my main critic said that I was deliberately avoiding it because of bias. I also gave them the opportunity to write something if they wished.

See also here and here and here . . . and . . . References: here

 

A comment from more than a month earlier which proves that my main is a liar

30th July 2008 . . . I made this comment about that issue . . . "I am familiar with Charles Wooley's 1976 essay Diseases of Yesteryear, which discusses the Mitral Valve Prolapse aspect, and have my own copy of it, and it has a University of Adelaide date stamp for July 1976, only two months after it was published in the U.S. (thirty years ago), and it has also been on Gordonofcartoon's talk page here [30] at the end of his to do list for 6 months, and I have previously asked him to comment on it, but he hasn't. 04:24, 30 July 2008 posturewriter. here

 

A discussion from more than three months later which proves that my main critic is a liar

09:04, 27 January 2009 . . . I made this comment which started a series of replies . . . "WhatamIdoing; regarding your continuing suggestion that I am ignoring MVP, I have added a paragraph and 6 references on it, four from Charles Wooley up until 2004 here[41], whose 1976 paper here[42] has been on User:Gordonofcartoon's User page for 12 months, since 20-12-07 here[43] without being discussed by him despite me asking him and you to review it . Note that it has Mitral Valve Prolapse Syndrome as a synonym in the title Posturewriter 09:04, 27 January 2009 posturwriter


09:28, 27 January 2009 . . .
Gordonofcartoon gave this insolent and ridiculous excuse . . . "Wikipedia:Assume good faith. I noted it there to read, and haven't yet got around to it. I can't read everything and can't attend to everything, especially amid the general excess of verbiage. Unlike you, I am not interested in this sole topic, and can't be expected to notice every single detail of it (particularly given your failure to follow the Wikipedia:Talk page guidelines to be concise and keep discussion focused).
You have also been told before: that Avnjay quote is out of context. It was made in good faith, but he/she is not a medical editor, and was unaware of the many problems pointed out by WhatamIdoing, who is." Gordonofcartoon 09:28, 27 January 2009


10:08, 27 January 2009 . . . I wrote these words in response . . . "Gordonofcartoon if you haven't been able to read something about Da Costa's syndrome that has been on your "to do" list for more than 12 months then you shouldn't be editing the page, and you definitely should not be criticising my 60 references. Also note that WhatamIdoings qualifications are self-described here[44] in particular WhatamIdoing is not a healthcare professional and have no plans to become one" . . . and is "typically useless in cardiology" and "can contribute at a very basic level, such as copy editing or reviewing sources" . . . and . . . If it's important . . . WhatamIdoing "can become an "instant expert" on more or less any narrow subject". I highlight the fact that you are too busy to learn about the things you profess to know, and WhatamIdoing is only an "instant expert" and is "useless at cardiology" so should not be commenting on the complex 140 years of Da Costa's syndrome research, or on MVP." Posturewriter 10:08, 27 January 2009 See here

 

They were telling lies, and talking nonsense, and making excuses, and yet an admin left the following message the next day . . 15:45, 28 January 2009 . . . "Posturewriter is banned. Apologies for not getting round to this sooner." Moreschi 15:45, 28 January 2009. (Several months later WhatamIdoing gave him a barnstar for banning me by using Wikipedia's "ignore all the rules" policy here).

 

Summary of the discussions: As you can see I was aware of the issue of MVP, and one of my critics had a research paper about it on his "To do" list on his own Wikipedia Userpage. I told him to read it, and use it if he thought it necessary, and he refused. My main critic was involved in those discussions and yet had the cheek to tell other editors that I was ignoring the subject, and that I needed to be banned for being unco-operative and disruptive. They were truly astonishing bald-faced liars.

 

The invisible reality as compared to the concept of 'all in the mind'

When the cause of a symptom is unknown or invisible there is a general tendency to attribute the problem to the mind, based on the idea that the mind is powerful and mysterious and can cause any and every unexplainable symptom and disease known to man.

The air inside passenger jets is invisible, however some modern jets have 600 passengers crowded into a small cabin. The air inside has significantly less oxygen than exists at sea level and is recycled from the air exhaled by the passengers, and is mixed with outside air which passes over the jet engines to heat it. The engines have seals which sometimes leak so that toxic fuel fumes get into the cabin.

The toxic fumes can cause nausea, vomiting, hyperventilation, tiredness, and paralysis, and can make the passengers feel drunk.

When flight attendants or pilots claim workers compensation for these problems they are told that their symptoms are "all in the mind" and are diagnosed with hysteria.

Other invisible aspects are the changes in air pressure as the plane rises in altitude, and even if the air inside the cabin is pressurised it is still different to that at sea level. The pressure of the air effects the saturation of oxygen in the blood in arteries, and also effects the air pressure in body cavities such as the lungs, colon, middle ear, and sinuses.

Also gravitational and centrifugal forces are invisible, but when a plane accelerates and rises on take-off the blood and internal anatomy is thrown backwards and downwards away from the brain. and when the plane descends and decelerates to land the blood and internal organs are thrown backwards and upwards, and if a plane passes through a pocket of air turbulence during flight the anatomy and blood can be thrown in all directions.

People who have long, narrow, flat, or weak chests, or weak, or diseased lungs, or carbon dioxide sensitivity, or weak circulation (neurocirculatory asthenia - the effort syndrome), or visceroptosis (loose internal anatomy) would be much more likely to develop unexplainable distressing symptoms during a plane flight than other passengers, and symptoms such as nausea, vomiting, and especially hyperventilation, faintness, or palpitations, would be misdiagnosed as an indication of fear due to aerophobia, because the real causes are invisible.

Sometimes there are political, social, expedient, or economic reasons why the cause of symptoms is deliberately misdiagnosed.

The cure for stage fright

I became aware that I, like 98% of normal humans, had stage fright, when I started performing as a comedian in the 1980's.

I had been reading medical books for more than seven years, so I has some information about it, but I didn't agree with the methods of treating it because they were not relevant or effective in my experience.

However, it did not take me very long to invent a method which was successful, and I haven't had any such problems since.

Unfortunately, like many of my methods, they are easily copied by people who take the credit for the ideas without telling anyone where they got their ideas from.

However, they have not copied them with any precision because I doubt that I have ever described the full details.

The only way that I know how to protect myself from copyright thieves is to never put the ideas in writing.

Consequently, it is one of the many methods that I developed which is only useful to me.

I don't need to scientifically prove the success of my method, because all I have to do is stand on stage and talk to an audience. I can and have done that many times since.

 

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Agoraphobia and Show rides

When a healthy person is subjected to the centrifugal forces of a swirling ride at a side show they experience a sensation of excitement in their chest which is scary but also thrilling and entertaining. However with the effort syndrome there is a sensation of the heart swaying and being about to stop and then being unable to start again. This sensation is alarming and distressing and can be terrifying. The symptom is not caused by fear and is not simply an exaggeration of the normal sensation, but is distinctly different. M.B.