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Phobias: Fighting the Fear
Helen Saul


A fascinating, unbiased study of what phobias are, how they occur and how we can stop them.Two in five people struggle through life under the burden of a phobia of some kind. Yet little has been done to help these sufferers understand their affliction and hence minimise it. Recent researches in evolutionary theory, physiology, neuroscience and genetics have begun to analyse the causes and effects of human phobia and have come up with thought-provoking, but widely differing, interpretations and prescriptions.Why are phobias easier to cope with at night or when wearing sunglasses? How do phobias differ throughout the world and history? Are phobias biological or psychological? Is the fear of spiders, snakes and darkness an evolutionary throwback? Does aversion therapy work? Is phobia hereditary?The first book to balance all these issues, ‘Phobias: Fighting the Fear’ is a powerful, uniquely accessible work of popular science.









Phobias:

Fighting the Fear

Helen Saul












to Mark




Table of Contents


Cover Page (#ud5ddd36d-2358-5b88-9b40-735c28de0a0e)

Title Page (#u092dd527-0c88-5b14-af92-e522e0be1d74)

Preface (#uf6c07f19-11b6-5076-abc3-1038f3496264)

Introduction (#u442a1d93-c2ee-57cf-bd1d-e0ac0ee43951)

CHAPTER 1 History (#u151799d0-5410-5581-ab38-b67062f70406)

CHAPTER 2 Evolution (#ua4c64671-8aad-532e-9387-17a87fbd48d3)

CHAPTER 3 Genetics (#litres_trial_promo)

CHAPTER 4 Neurophysiology (#litres_trial_promo)

CHAPTER 5 Behaviour (#litres_trial_promo)

CHAPTER 6 Cognition (#litres_trial_promo)

CHAPTER 7 Personality and Temperament (#litres_trial_promo)

CHAPTER 8 Gender and Hormones (#litres_trial_promo)

CHAPTER 9 Light and Electromagnetism (#litres_trial_promo)

CHAPTER 10 A Physical Problem? (#litres_trial_promo)

Conclusion (#litres_trial_promo)

Further Reading (#litres_trial_promo)

Index (#litres_trial_promo)

Acknowledgements (#litres_trial_promo)

About the Author (#litres_trial_promo)

Copyright (#litres_trial_promo)

About the Publisher (#litres_trial_promo)




Preface (#ulink_94e1b49a-22a6-5470-b48b-00eea3146f5a)


While working on this book, I was often asked which phobias I was writing about. The question initially puzzled me – my intention was always to write about all phobias – though it does perhaps reflect the common but unhelpful assumption that each phobia is a distinct problem with a distinct cause and treatment. In fact, the root causes of fear could apply equally to triskaidekaphobia (fear of the number 13) or gephyrophobia (crossing bridges). This book is intended to be less a self-help book than an exploration of the ideas and thoughts driving progress in the laboratory and the clinic. Everyone with a phobia knows what it is to fight fear and I only hope this book properly acknowledges their courage. But it aims also to focus on the way doctors and scientists are improving our understanding and fighting fear on their behalf.

I am a freelance science and medical journalist and have worked variously in TV, radio, newspapers and magazines. I have no specialist training in phobias, other than a degree in medical sciences. I have never had a phobia or received treatment. My involvement with phobias began in the autumn of 1993 while I was working at New Scientist. The then features editor, Bill O’Neill, received a dossier on the subject from a remarkably well-informed former agoraphobic, Mary Dwarka (whose story is told fully in chapter 9). She had researched her own condition in huge depth and was suggesting that New Scientist run a feature on agoraphobia. Bill was somewhat perplexed by the range of science and arguments in Mary’s work and asked me to look through it to see whether I thought there was enough in the subject to make a feature.

There was more than enough. Enough for a book, I later discovered. At the time, I spoke to a couple of people with experience of phobias and a variety of scientists working on the subject, some suggested by Mary. The resulting feature was optimistic in tone, concentrating on the great advances in our understanding and how they are already translating into new treatments in the clinic.

It sometimes seems that the more one knows about phobias, the less clear everything becomes. Ask members of the public what a phobia is and they will tell you about extreme reactions to spiders or heights. Many will reel off an anecdote about someone they have known with a bizarre fear. And, of course, these are phobias. But as one delves further, boundaries seem to disappear. Where does normal protective fear turn into a phobia? What is the link between generalised anxiety and phobias? Or between panic disorder and panic attacks and phobias? When is agoraphobia a true phobia and when a consequence or the cause of depression? What about avoidance disorders, alcoholism, some personality disorders? Where does phobia end and psychiatry begin? Entire libraries could be devoted to the subject.

Equally, when you ask specialists, they very often produce good clear answers. But ask four professionals in different disciplines and you will be lucky to hear the same thing twice. The amorphous mass of phobia research needs to be simplified for us to get anywhere. Specialists emphasise different aspects, and while none is entirely wrong, none is entirely right either.

This book is an attempt to represent many different points of view. I have chosen to focus a chapter on each approach. Readers may find that some strike a chord while others seem less relevant. Where previous books on phobias have focused on a single approach, this attempts to be an unbiased account of all the advances in all the major schools of thought dealing with phobias.





Introduction (#ulink_641392f2-0b96-55b4-abc9-dc9bdb8a723a)

Fight the Fear


John gazed out of the window in private joy. Normally reticent, he grinned broadly at the beauty of the scene. A perfectly round orange sun sat above a plain of clouds but that was not the reason. After years of fear, John was sitting for the first time in an aeroplane.

Other passengers were more obviously excited – not exactly unruly but in exceptionally high spirits. They had come through against all the odds and were laughing with their fellow heroes. Triumph, infused with slight hysteria, prevailed. They slapped each other on the back, charged around kissing and shaking hands with near-total strangers, and one or two cried.

The crew encouraged the party atmosphere, urging passengers to take off their safety belts and walk around. Boisterous adults queued to see the flight deck. Cameras clicked. The aeroplane buzzed with laughter. There were cheers as the plane went through the clouds. Cheers for Mr Evans who had just celebrated his eighty-fifth birthday. Cheers for the pilot, cheers for passengers, cheers for any reason anyone could think of.

This extraordinary journey was solely for those afraid of flying. The forty-five minute round trip from Manchester Airport was the culmination of a day’s ‘Fly with Confidence’ course. This has been run by two British Airways pilots, Captains Douglas Ord and Peter Hughes, ever since 1986, when they realised that many on BA’s flights to view Halley’s Comet had no interest in astronomy. Nervous of flying, they simply wanted to try out a short flight. Since then, 10,000 have enrolled on the course and 98 per cent have boarded the aircraft at the day’s end. No detailed follow-up has been carried out, but Hughes claims nineteen out of twenty feel more comfortable flying as a result.

Single-session treatments symbolise recent progress in dealing with phobias. Immersed in the latest therapies, sufferers can find their years-old phobia conquered in one day. Within a morning, they have been taken through the technicalities of flight, had their views on its dangers challenged and been taught basic relaxation techniques. In the afternoon this brief training is put to the test when they get on an aeroplane. Similar courses exist for those afraid of spiders. Various therapies prepare them for entry into the spider house. The vast majority are then happy to allow huge spiders to run up their arms and even through their hair.

These commercial courses represent the new attitude towards treatment for phobias. Directed at a few specific phobias, they are not a real option for most phobia sufferers. But they do demonstrate the prevailing optimism. In mainstream medicine, doctors and therapists are now confident that they can offer a working solution. Hundreds of years of theories and ideas have finally begun to make an impact.

A simple but dramatic shift in thinking has cleared the way. Phobias were once thought just the tip of an iceberg. Psychiatrists and psychologists believed that therapy had to be undertaken extremely gently for fear of what might be unleashed. This meant that treatment could involve months looking at words or drawings before moving on to the next stage. Vast patience and stamina were essential to complete such a course and most phobias continued unchecked.

In fact, though successful treatment can have knock-on effects, they are usually positive. Some people’s self-esteem gets such a boost, for instance, when they overcome their fear of flying that it can improve all aspects of their life. One woman was completely distraught when she arrived. But fear of flying was only a fraction of her worries. She fretted about her journey home and what would happen if she was late to pick up her children. She was sure the ensuing chaos would make the family late to bed so they would all sleep in the next morning which would ruin the whole day. A catalogue of disaster stretched ahead. As it happened, she was so relaxed and delighted at her own success that she actually missed her motorway turn-off. Though late, the anticipated chain of events did not occur. Her new laid-back attitude persisted and she said later that the course had changed her life.

So phobias can be taken at face value and their symptoms addressed directly. This approach is standard in medicine. A girl with a bacterial infection normally improves quickly once on antibiotics. Her doctor does not have a philosophical debate about why she was the only child in the class to succumb. If she recovers quickly, the doctor has done a good job. Fear, like bacteria, can be confronted, and long-term inhibitions and preoccupations undermined almost immediately. This is tremendously encouraging for anyone with a phobia today. Treatments work and need not take for ever. The root cause may never be known but often has no bearing on the treatment.

Furthermore, phobias often disappear without trace. People suffering from depression may have to embark on a lifetime’s struggle to keep symptoms at bay. Many ex-smokers or drinkers know that they remain a single lapse away from addiction. Phobias, in contrast, can be wiped out for ever with a single course of treatment.

Some phobias are replaced by a fascination with the thing once so dreaded. People previously afraid of snakes or spiders may keep them as pets. A fear of heights might be replaced by the new hobby of rock-climbing. Diana, whose story is told in chapter 5, once had such severe agoraphobia that she was unable to answer the telephone or open a letter. She now gives presentations about her experience. She will never forget her years with agoraphobia or how much it disrupted her (and her family’s) lives, but she can no longer identify with the fear itself.

This new optimism should not, however, belittle the very real problems that remain unsolved. Phobias often go unheralded, unnoticed and, most importantly, untreated. The largest study ever, the Epidemiologic Catchment Area (ECA) Program in the US, aimed to discover how common various disorders are within the general population. More than 20,000 people in the community were interviewed about fifteen different disorders, among them phobias. Researchers found that fewer than one in four with a phobia had received treatment.

Treatments could be improved. Single-session treatments demand tremendous courage, too much for many. Thousands are helped but most phobics find the very idea of attending unthinkable. They often know about the courses, even acknowledge that they themselves could benefit, but their fear is far too great to allow them to sign up. People with phobias live with levels of unimaginable fear and this fear makes even a single day, which could eradicate their problem, too much to ask. Moreover, many who do attend are helped but not cured. Their terror is reduced but they remain exceptionally nervous. A rare few others are not helped at all.

Progress, though, is accelerating. Advances in psychology, psychiatry, genetics and molecular biology are all converging, improving our understanding of the causes of fear and providing new ways of addressing it. A range of much gentler approaches is now becoming available. Increasingly effective drugs can be used alongside behaviour and talking therapies. The talking therapies themselves are being streamlined to focus on practical improvements, rather than dwelling on childhood traumas. Improved understanding of how phobias develop may help us protect our children from ever developing them. Alternative, more speculative approaches suggest lifestyle changes which may make a difference. Whatever treatment is chosen, phobics can now expect relief from their fear in a limited number of sessions. This improvement has been one of the medical success stories of the decade.




The Hidden Epidemic


So, is that the problem solved? Well, no, not quite. For a start, the scale of the problem is immense. Community studies report that up to two in five of us have a severe dislike of something, and even full-blown phobias are common. Strictly speaking, there is no phobia epidemic, since an epidemic usually refers to an infectious disease that has struck an unusual number. There is no evidence suggesting that there are suddenly more people affected than ever before. But to get a rough idea of the scope, let us just compare the prevalence of phobias with a relatively common infectious disease like influenza.

In the winter of 1999/2000, almost 400 out of every 100,000 in the British population went to their doctor with influenza, which means that it was approaching epidemic levels. The impact on the National Health Service was extreme. Hospital beds were filled with flu patients, so planned operations for cancer and heart disease had to be cancelled, and the NHS was in crisis. And this, at a level of 0.4 per cent.

Official figures are probably an underestimate, as many sensibly managed their illness at home, but even if only one in five consulted their doctor, that would mean the real figure affected was 2 per cent. How does this compare with the numbers affected by phobias?

The ECA study mentioned above found that between 4 and 11 per cent of interviewees had suffered from at least one phobia in the past month. From this, researchers estimated that more than 6 per cent of the population has a phobia at any one time.

We all knew at least a handful of people who were ill with influenza in the winter of 1999/2000. This guestimate suggests that, whether aware of it or not, we probably know three times as many with phobias. These figures give some idea of just how widespread phobias are.




A Few Famous Phobics…


Phobias strike across the board, irrespective of intelligence, beauty or success. Kim Basinger and Sir Isaac Newton both suffered from agoraphobia. Sir Isaac was housebound for years up to 1684, after a period of severe stress. His mother died, a fire destroyed some important papers, he was exhausted after finishing his Principia and he was arguing with Cambridge University. All must have been distressing, but none restricted him as much as the agoraphobia that followed. Kim Basinger developed agoraphobia after the birth of her daughter. In some ways it is harder to imagine agoraphobia in an actress: academics can succeed with limited socialising, whereas actresses are subject to the most intense public scrutiny. But Basinger’s experience of agoraphobia is typical of many women’s. The hormonal and lifestyle changes surrounding childbirth are profound, and not even the most glamorous women are immune. This is explored further in chapter 8, on gender.

Arsenal striker Dennis Bergkamp has had a golden career. He has been voted FIFA’s third best player and the top European. But he is unlikely to get a game in Greece, Turkey or Eastern Europe. For Bergkamp has a clause written into his contract ensuring that his club cannot insist on his flying. While the rest of the team take short flights to matches in the north of England or Europe, Bergkamp sets off by car, coach or train. He has flown in the past, but the last time was to play for Holland in the 1994 World Cup in the US. Since then, he has refused to fly at all and if he cannot get to a match overland, he cannot play. Bergkamp’s fear is common knowledge in football circles but he will not talk about the reasons behind it. He has said that after he finishes playing football he may address his fear, but that for the time being at least, he is grounded.

Hans Christian Andersen was middle-aged by the time he developed his fear of fire, following the death of his old friend Jette Wulff in a blaze aboard the Atlantic steamer Austria. After that, Andersen always carried a rope with him, so that he could escape through a window in case of fire. He never used the rope, but it can still be seen at the Hans Christian Andersen Museum in Denmark. His behaviour was exceptional even at a time when fires were relatively common because contemporary buildings were often wooden. But his fear did not prevent him travelling, it simply added to his luggage. He wrote about fire in at least three stories, ‘The Pixie and the Grocers’, ‘The Tin Soldier’ and ‘The Lovers’, but he never tackled his fear.

He had other, stranger fears. He was afraid of dying, of seeming dead while still alive and of being buried alive. He was also afraid of seeing the dead. These fears were not unusual for the time. The mid nineteenth century was a morbid era and many were fixated with death. At a New Year’s Eve party in 1845, he declared that dead people should mark their presence with tones. But then, both he and his hostess, Jenny Lind, the famous Swedish opera singer, were shocked and frightened when they heard a loud C ring out from an apparently untouched piano. However, he managed to capitalise on his fears. Twelve years later, in To Be Or Not To Be the hero hears a reverberating E and thinks it may be a sign from his dead beloved, Esther. So his fear was not entirely in vain.




…And Some Fictional Ones


Spiders, snakes and rats are convenient symbols for fear or disgust and our screens are littered with them. Film directors rely on our near-universal unease to set a scene within a couple of frames. These are obviously difficult viewing if they are the object of your phobia and chapter 2 explores how far the media might even contribute to some of our fears.

Direct portrayals of phobias are less common but in the film Arachnophobia, Dr Ross Jennings (played by Jeff Daniels) has been intensely afraid of spiders all his life. His first memory is of himself lying near-naked in his cot when a spider crawled through the bars and on to his leg. His limbs froze and he was utterly helpless, unable to stop it moving over his bare skin.

The film climaxes with a replica of this incident. Now adult, Jennings is lying motionless, trapped by fallen rubble: the cellar is starting to catch fire. He watches horrified as a huge Venezuelan spider approaches his foot. This time the spider’s bite would be fatal. It moves up his leg and onto his shirt. Is Jennings paralysed with fear again? Or does he have a plan? With impeccable timing, he waits until the spider climbs over a piece of wood lying across his chest, and then thumps the far end of the plank, catapulting the spider across the room into the fire. He and his country are spared.

George Orwell’s 1984 tackles the subject of specific fears more directly. Winston Smith pales and endures ‘a black instant of panic’ when a rat appears in the secret room he shares with his girlfriend, Julia. Later, when his opposition to the all-pervading Party is discovered, he is sent to the Ministry of Love. He is beaten with fists, truncheons, steel rods and boots. He endures high-voltage electric shocks, is deprived of food and sleep, undergoes hours of questioning and makes numerous confessions, but still he loves Julia. Then he is transported to the notorious Room 101.

Room 101 contains ‘the worst thing in the world’. His captor, O’Brien, tells him: ‘The worst thing in the world varies from individual to individual. It may be burial alive, or death by fire, or by drowning, or by impalement, or fifty other deaths. There are cases where it is some quite trivial thing, not even fatal.’

This sounds rather like phobias. Winston’s Room 101 contains two enormous hungry rats in a cage held close to his face. O’Brien continues:

There are occasions when a human being will stand out against pain, even to the point of death. But for everyone there is something unendurable – something that cannot be contemplated. Courage and cowardice are not involved. If you are falling from a height it is not cowardly to clutch at a rope. If you have come up from deep water it is not cowardly to fill your lungs with air. It is merely an instinct which cannot be destroyed. It is the same with the rats. For you they are unendurable. They are a form of pressure that you cannot withstand, even if you wished to.

O’Brien is right. As the cage is brought so close that ‘the foul musty odour of the brutes struck his nostrils’ and the wire touches Winston’s cheek, he starts shouting frantically: ‘Do it to Julia! Do it to Julia! Not me! Julia! I don’t care what you do to her. Tear her face off, strip her to the bones. Not me! Julia! Not me!’

With this betrayal, Winston’s punishment comes to an abrupt halt, he is released but he is broken. He lives a humdrum existence until the ‘long-hoped-for bullet’ enters his brain.

The torturer’s insights into extreme fear may be more telling than the routine assurances of health professionals. The idea of ‘an instinct which cannot be destroyed’ is untrue, as I will show, but describes how many feel when confronted with the object of their phobia. O’Brien also notes, correctly, that the cause of fear can be trivial and yet unendurable for that individual. He recognises that the fear is so intense that courage and cowardice become irrelevant and says that even people who could endure pain to the point of death will be unable to withstand it. Unlike health professionals, of course, he then goes on to exert just this level of pressure.

Alfred Hitchcock’s Vertigo is another extreme phobic portrayal. Detective Johnny Ferguson (James Stewart) is chasing a criminal across wet rooftops. He slips and is dangling over an edge, clinging on by his fingertips. A colleague above leans down to him and offers a hand, but Ferguson is dizzy and unable to take it. The colleague loses his balance and falls to his death below.

This is Ferguson’s first inkling of his vertigo and he quits his job with the police force. ‘There’s no losing it,’ Ferguson is assured by his friend, Midge, who says that only another emotional shock will cure him. Rejecting this, he tries out some homespun behaviour therapy of his own, standing first on a stool and looking up and down. All is going well so he tries some higher steps. Unfortunately, he glimpses the street below out of the window and promptly faints. Thus his treatment ends. His vertigo is then assumed so permanent that others can base a murder plot on the certainty that he will not make it to the top of a tower at a crucial moment.

The three very different stories all successfully convey the extent of phobic fear and the individual cost. Ross Jennings, a highly respected doctor, has spent his life dreading spiders and relying on others to kill or remove them. Winston Smith betrays his girlfriend and, in the end, himself, through his fear of rats. Johnny Ferguson gives up a long-held ambition to become Chief of Police when he quits his job and, worse, is unable to save the life of the woman he loves because of his vertigo.

All three carry the fatalistic and depressing message that phobias are as much a part of us as our height or eye colour. It chimes with and may even have shaped the widespread perception that phobias are for life. Sadly, this is often true as we accept limitations on our lives far too readily and only a small proportion of phobias ever receive treatment. But, as this book sets out to show, phobias can be and are being cracked.




From Antophobia to Zoophobia


So what do we develop phobias of? In short: anything. The National Phobics Society has a list of over 250 phobias, and it is not exhaustive. Some, like arachnophobia (fear of spiders) and claustrophobia (fear of enclosed spaces) are familiar; others less so. We may not know anyone with taphophobia (fear of being buried alive), antophobia (flowers), genuphobia (knees), metrophobia (poetry) or zoophobia (animals), but all these do exist.

Phobias are truly international, crossing the boundaries of language and culture. A study within the mainly Hispanic population of Puerto Rico relied on translated questions asked in the ECA. It found 12 per cent of people had phobias at some stage in their lives, a figure on the same range as mainland North America.

Studying phobias across cultures is more difficult: they were, for instance, once thought almost non-existent in sub-Saharan Africa. More recent work suggests that phobias are as common, just less obvious than in the West. Africans are likely to develop physical complaints as a result of fear and this can mask the underlying phobia. They also fear different things. Witchcraft, sorcery and supernatural phenomena are still important among peoples such as the Yoruba in Nigeria. Within Yoruba communities, people with no psychological problems routinely believe that others (who appear harmless) may be plotting against them. They cannot talk about specific concerns for fear of the sorcerer’s retaliation. Nigerian research had to rely on drug-assisted interviews to break down some of this reluctance and found that at least 20 per cent of outpatients at psychiatric units were definitely phobic.

In the US, the ECA study estimated that between 1.5 and 12.5 per cent of the population has agoraphobia at some stage of their lives. Agoraphobia – literally, fear of the market place – usually translates to a fear of being away from home or a safe place. Using public transport, going to shopping centres or any crowded area is often out of the question. People with agoraphobia may become housebound, unable to work or have any sort of social life. Some are so anxious that they need someone with them constantly, even at home, which places a huge burden of responsibility on family and friends. The entire family set-up frequently revolves around the agoraphobia.

Agoraphobia is defined as a complex phobia because it is often interlinked with generalised anxiety and fear. Most sufferers are women. It typically starts after the late teenage years and before the mid thirties, but can linger for years, even decades. Arguably the most debilitating of all phobias, it can touch every aspect of life.

Social phobia, another complex, all-pervading fear, was found by Swedish researchers to affect between 2 and 20 per cent at any one time, depending on the precise definition. It is a fear of being scrutinised by other people and embarrassed. Social situations, any sort of public performance, even eating or drinking out, may be impossible. For some, anxiety is limited to a single situation such as being unable to write in front of others – tricky when most of us rely on credit cards – being unable to speak in public or urinate in public toilets. Well-defined social phobias like these may have an important but relatively limited impact on someone’s life. However, like agoraphobia, social phobia can often have far-reaching effects.

Social phobia is more evenly distributed between the sexes and, if anything, more men than women are affected. It often develops from childhood shyness, becoming full-blown in adolescence, just as young people are starting to establish their own social lives. Parties, eating out and shared activities are a misery for those with social phobia. Dating can be a nightmare. Solitary leisure pursuits and a career that avoids any sort of public speaking are possible, but most families and jobs demand some level of socialising. Some manage to endure situations they dread, but their social anxiety effectively quashes all enjoyment.

This phobia takes varying forms in different cultures. In Japan and Korea, people with social phobia do not worry about being embarrassed, but are more likely to be excessively afraid that they will offend others, either through body odour, blushing or eye contact.

Specific phobias, considered the least serious group of phobias, are more easily pinpointed and sufferers can say exactly what they are afraid of. Specific phobias often start in childhood and last a lifetime. They include fears of animals or insects, or of something in the natural environment such as storms, heights or water. Fear of blood, injections and injury come into this group, as do fears of specific situations such as tunnels, bridges or lifts. The same New York researchers estimated that one in ten of us has a specific phobia at some stage.

Specific phobias give flashes of extreme anxiety in set circumstances. They tend not to dominate lives as phobics may only need to avoid well-defined situations, such as lifts carrying more than six people beyond the tenth floor. But while phobias of buttons, wallpaper or cotton wool can sound trivial, bizarre or even funny, such fears can still affect career decisions or cast shadows over family life. A driver with arachnophobia could swerve dangerously if a spider appeared on his dashboard. Women with blood and injury phobias may decide not to have children because they cannot bear the thought of giving birth. Less dramatically, a fear of dogs can put a stop to picnics, and a fear of tunnels or bridges can make travelling extremely complicated.

Phobias fit into neat categories on paper, but in practice overlap and are difficult to distinguish. Someone who never goes out is probably agoraphobic, but may have social phobia if they avoid only social situations and fear being embarrassed in front of others. Someone terrified of buses or trains might have agoraphobia, but if they fear public transport and nothing else, it would be considered a specific phobia. Specific phobias exist of, say, dirty cutlery in restaurants, but someone who obsesses about dirt and has developed time-consuming cleaning rituals has an obsessive-compulsive disorder.

A single phobia such as fear of flying can have many roots and people on ‘Fly with Confidence’ courses tend to have mixed problems. Some are claustrophobic, some scared of heights; others are afraid of dying and convinced that flying is unsafe. The organisers estimate that a third of the attendees have never flown before but are terrified of the very idea. They are the easiest to treat, and some, like John, hardly need to get both feet inside the plane to feel better. Part of his fear was based on the assumption that planes are very cramped: one look was enough to disprove it. Another third have flown happily for years before having a bad experience which precipitated their phobia, either a physical event such as extreme turbulence, or a personal crisis which happened to coincide with a flight. The final third might still be flying regularly but feeling progressively worse about it. Their fear is likely to be part of a complex phobia – agoraphobia or social phobia – and they are the hardest to treat. They have seen inside planes, they know the statistics of aeroplane crashes, but no amount of information will help. Their fear is inside – they fear their own reactions, afraid of having a panic attack, terrified by the total lack of an escape route. They are sure that they will be the one running up and down the aisle, hammering at the door, screaming, ‘Don’t panic! Don’t panic!’ For these people, a quick-fix solution is unlikely to be all that is needed.

Clinical classification of phobias is important because of the seriousness of the complex phobias. Agoraphobia and social phobia routinely lead to missed opportunities in life but are also likely to be associated with other disorders. People with social phobia are more than twice as likely to have problems with alcohol as non-phobics. Agoraphobics too are at an increased risk of alcoholism. Agoraphobia is also linked with some unfortunate personality measures such as dependency, unassertiveness and a lack of self-confidence as well as anxiety and avoidant behaviour. American research suggests that one in five with panic disorder, which is often associated with agoraphobia, attempt suicide. This is more even than people with major depression and twenty times the normal rate.

The tragedy is that phobias can be helped today but usually are not. Many different effective treatments exist but people continue to suffer. Phobias do have a stigma and it can be difficult to admit to a fear which you know, rationally, is out of proportion with reality. Why someone with a fear of heights should be more afraid of ridicule than someone with a broken arm or with high blood pressure is hard to say, though mental disorders traditionally have attracted less sympathy than physical ones.

Commercial one-day courses addressing fear of flying or spiders have the advantage of being based, respectively, at an airport or a zoo. Many find it easier to turn up there rather than at the local psychiatric unit and these courses have proved acceptable to those who might never seek help elsewhere. It seems likely, though, that their greatest appeal is among those whose phobias are least severe. In fact, drawing a line between normal fear and phobia is far from straightforward. Many, if pushed, would admit to disliking and fearing heights or spiders but do not have a phobia as this feeling causes no distress or infringement on their lives. A speaker at a recent meeting of the American Psychiatric Association pointed out that if she was not nervous about speaking to a room full of her most discerning peers, they might reasonably assume she was pathologically narcissistic. Some anxiety is not only inevitable in such a situation, it is probably good, prompting her to prepare her talk properly and deliver it well. If, however, she was so anxious about speaking that she refused to give lectures, or changed her job to avoid it, a diagnosis of social phobia would be appropriate.




Up in the Clouds


On the ‘Fly with Confidence’ course, comradeship built up through the morning as people derived comfort from each other’s questions and shared fear. The group started to bond. But as the day wore on they became more subdued, less friendly, some even angry at how ill-prepared they felt to climb aboard. People kept looking at their watches in alarm at how quickly the flight was approaching. During a desensitisation exercise, they were asked to imagine various scenes, such as checking in, waiting to board, climbing the steps to the plane. After each scene they were to return to deep relaxation. ‘Impossible,’ muttered the man on my right.

Despite such misgivings, all but one or two got on the plane and their relief was unmistakable. However, this was not universal. Across the aisle, a pale young man sat with his eyes closed, his head against the headrest. He was probably trying out newly learned relaxation exercises but he could have been praying. Helpful stewards provided numerous glasses of water, eliciting wan smiles, but did not make him much more comfortable. Occasionally he would open his eyes, look round, run his fingers through his hair and exchange a word with his neighbour. Then it was back to his private hell.

The man beside me seemed coolly confident, but confided that it was only OK because we were flying British Airways. The woman on the other side looked close to tears but chatted incessantly. ‘I must be all right because I’m talking,’ she said. ‘If I was really bad I would be in a corner taking no notice of anyone.’

People are recovering in their thousands through courses like this, but the process is demanding. The pale young man only slowly regained his colour and back in the terminal he was still, inexplicably, clutching his untouched airline meal.





CHAPTER 1 History (#ulink_00f20e0b-99a3-596b-9e0b-18028492d6dc)

In the Beginning


The doctor was intrigued. His patient was in good physical health but he was so afraid of crowds and of the light that he hated leaving home. Whenever he went out, he chose if possible to go in the evening so that he could scuttle through deserted, dark streets to his destination. If he had to go out in the day-time, he would cover his head. He wanted to avoid seeing, and being seen by, anyone.

The man had done no wrong and had crossed nobody, but he was behaving like an escaped convict. He did not trust anyone outside his immediate circle. He was tremendously timid and the doctor became convinced that his fear of leaving home was due more to natural shyness than any real threat posed to him by the world at large.

The doctor was reminded of another patient who had yet another baffling fear. This man never went to parties, the theatre or any public gathering because he was convinced that he would disgrace himself. He thought he was bound to say something unacceptable, fall over or perhaps be sick in the middle of a crowd. Whatever it was, he believed that everyone would look at him, spit at him, jeer and mock him. He was so sure that everyone hated him that he avoided public events at all costs.

The doctor mused over the two cases and went home and wrote in his journal about the ‘men who feared that which need not be feared’, a fair definition of phobias. The men’s thoughts and behaviour will sound familiar today to anyone with experience of agoraphobia and social phobia even though the doctor was the Greek physician Hippocrates and he was writing 2,400 years ago.

Time has passed, language changed, but people’s experience of phobias remains much the same. The first patient, according to Hippocrates, ‘through bashfulness, suspicion and timorousness will not be seen abroad, loves darkness as life and cannot endure the light, or to sit in lightsome places, his hat over his eyes, he will neither see nor be seen by his good will.’ The second, he said, ‘dared not come in company for fear he should be misused, disgraced, overshoot himself in gesture or speech, or be sick; he thinks every man observes him, aims at him, derides him, owes him malice.’

Hippocrates saw people with many different phobias over the years, ranging from agoraphobia and social phobia to animal phobias and other fears still common today. Damocles, he said, was terrified of heights and ‘could not go near a precipice, or over a bridge, or beside even the shallowest ditch; and yet he could walk in the ditch itself’. He described other, quirkier phobias such as that of Nicanor, who was untroubled by the sound of someone playing a flute through the day but ‘beset with terror’ when he heard the same sound at an evening banquet.

Hippocrates’ writing may be more poetic than modern medical notes but it demonstrates that the nature of fear has not changed over two thousand years. The ancient Greeks had the same experience of strange and unreasonable fears as we do today. Phobias have been around as long as we have, they are deeply ingrained in us, an integral part of human existence. This may not be much comfort to anyone with a phobia now but it does mean we have more than two thousand years’ worth of thought and insight into fears and phobias.

Unfortunately, this does not mean two thousand years of steady advances in understanding. Periods of intense activity by scientists, philosophers and doctors have been separated by gaps of hundreds of years when little happened. Early insights were overtaken by other bogus or unhelpful ideas and progress has been as likely to move backwards as forwards. But sometimes an apparently new idea chimes with an ancient one. Many modern theories are updated versions of ancient thoughts and some of the questions that puzzled the ancient Greeks still go unanswered.

Hippocrates’ careful observation of fear and phobias was exceptional at a time when most of his contemporaries thought that fear was sent down from the heavens. In Greek mythology, Phobos was the god of fright, son of Ares, the god of war. His brother was the god of fear, Deimos. Their companions included Eris, who represented strife and was insatiable in her fury; Enyo, who destroyed cities; and the Keres, who liked to drink the black blood of the dying. Myths related that this cheerful crew would stride on to the battlefield together, sowing disease and striking terror into the hearts of anyone they came across.

The god of nature, Pan, was responsible for contagious fear sweeping through crowds of people. Frightening sounds heard on mountains or in valleys at night-time were attributed to Pan, and he was thought to be the cause of sudden, groundless fear.

With the notable exception of the Stoics, the Greek people went along with mythology so far as to call on their gods for help and to blame them if they themselves were suffering. They would plead with Phobos to terrify their enemies, and at the same time assume that he was causing their own fear. They thought that Pan could determine the outcome of wars by generating mass hysteria throughout the ranks of one or other side and causing whole armies to disintegrate.

The Greeks were clearly comfortable with the concept of different types of fear. Phobos represented a sudden and acute fright, different from Deimos’ ongoing, rumbling fear. Pan symbolised the sort of fear which can spread through groups of people. This classification has been modified over thousands of years but still exists, another clue that our experience of fear has not changed much.

The words we use to describe these emotions reflect the ancient beliefs. Today’s Greek word phobos means intense fear or terror and translates directly into our word, phobia. The word panic is derived from Pan and has shifted its meaning more recently. It was once used to refer to the group process of mass panic, but now refers to an individual’s experience, including panic attack or panic disorder.

Our word anxiety comes from the Latin anxietas, which means troubled in mind. Again, the meaning has held steady despite translation into numerous other languages. French, Italian and Spanish all contain words derived from the Latin. Anxo in Greek means to squeeze, embrace or throttle, which came to mean weighted down with grief, burdens and trouble and has passed into German as angst. The sensation of constriction or tightening across the chest, of being unable to breathe freely, is a classic feature of panic.

Agoraphobia may have been described by Hippocrates, but it was not given the name until much later. The German psychiatrist C. Westphal coined the term ‘die agorophobie’, in a paper published in 1871. He described three men who either could not walk alone through certain streets or squares, or could do so only with great anxiety or a couple of stiff drinks inside them. Thinking about the feared situation could be every bit as alarming as actually walking into it. Westphal wrote:

The patients derived great comfort from the companionship of men or even an inanimate object such as a vehicle or cane. The use of beer or wine also allowed the patient to pass through the feared locality with comparative comfort. One man even sought, without immoral motives, the companionship of a prostitute as far as his own door.

Westphal’s choice of name harks back to Hippocrates’ time when the agora was a public meeting place, used for discussions of public affairs, games or contests. In ancient Greece a contest could be athletic, poetic or a mental challenge between dramatists, and was known as an agonia. An agonia demanded that individuals tested their skills and later the word came to mean mental anguish. After Westphal, confusion arose and agoraphobia came to mean not only a fear of open spaces or public places, the agora, but also the fear of deficiency in one’s performance, or agonia. It was not until the 1970s that the term ‘social phobia’ was brought into use to refer distinctly to the second of these, the fear of public scrutiny. It took a long time to get back to the starting point. Hippocrates may not have named these fears, but he certainly described the difference between agoraphobia and social phobia.

Hippocrates also explored possible causes. Unlike most Greeks, he thought it ridiculous to blame the gods for fear. He insisted that there was a physical cause within the individual. Neurotic symptoms fell into the class of melancholia, a type of insanity. It was caused by a build-up of black bile which made the brain overheat and caused passing terrors. Treatment was a regimen of diet, activity and exercise, designed to rid the body of the excess black bile. If this was not successful, drugs such as the poisonous hellebore were often given. The resulting vomiting and diarrhoea were taken as signs that the bile was being eliminated.

Hippocrates’ confidence in this particular scheme was somewhat misplaced but his belief in a physical cause for mental disorders has been shared by scientists ever since. One of his younger contemporaries, the philosopher Aristotle, also searched for a physical cause for nervousness. Aristotle decided that the heart was the seat of all sensations and the brain a cold, bloodless part of the body which absorbed hot vapours arising from the heart. This led much later to the old English idea of ‘the vapours’, meaning a nervous disorder, low spirits or boredom.

Great Greek thinkers and twentieth-century neuroscientists may be united in their belief in a physical, biological cause of fear but there have always been other ideas. The Stoic school of philosophy grew up shortly after the time of Hippocrates and survived for five hundred years, well into the Roman empire. The Stoics included emperors (Marcus Aurelius), slaves (Epictetus) and even Nero’s tutor, Seneca. Stoicism stressed the importance of human reason in finding an accord with nature. Emotions had to be conquered and passions shed in order to achieve imperturbability. People can be happy in the midst of the severest pain if they can master themselves and let nothing overwhelm them. We are not at the mercy of external events. (Cognitive therapy (chapter 6) still relies on some of these ideas.) More specifically, the Roman Caelius Aurelianus wrote that phobias were a type of mania and arose from problems in the mind, not from the body or physical brain:

Mania fills the mind now with anger, now with gaiety, now sadness, now with nullity, now with the dread of petty things. As some people have told; so that they are afraid of caves at one time, and chasms at another, lest they fall into them; or there may be other things which frighten them.

More than two thousand years ago, then, philosophers and medics could give a good description of phobias. Ideas about the causes may have been primitive but they were forerunners of some of the main schools of thought still in existence. Sadly, the brilliance of these great thinkers probably had little impact on most people of the day. The prevailing view was that fear was sent down from the heavens and that phobias were best treated by trying to appease some god.

The Roman empire, which had assimilated Greek civilization, itself collapsed in about AD 400. The Church then dominated society and effectively put a halt to studies into individuals’ emotional experience. Phobias obviously still existed, and fears of plague or syphilis were especially common. However, in a backward step for science, excessive or strange fears were assumed to be caused by an interaction between forces of good and evil, and people with phobias thought to have been overtaken by demons or evil spirits.

Throughout the Middle Ages, the Church dominated scholastic thought and pre-eminent thinkers were occupied with big theological questions. Not until the fourteenth century did attention turn gradually back to the individual. This paved the way for the golden age of philosophy, out of which grew psychology as we know it today. And it started with Descartes, once described as the first modern man.




Cartesian Logic


Born into a rich and noble family at the end of the sixteenth century, Descartes studied languages, literature and philosophy at one of the top French schools of the period. But even as a young man he became disillusioned with the limited nature of the teaching and quit his studies to lead a life of pleasure in Paris.

Boredom eventually set in and he joined the army in Holland, where he learned about mathematics and the natural sciences. Then later on, he joined the Bavarian imperial army in the Thirty Years War, which allowed him to travel through Germany, Austria, Hungary, Switzerland and Italy. He was constantly observing, contemplating reality, and working on his own philosophical method.

He moved back to Paris for a few years, eventually leaving again for a life of near-seclusion in Holland. His interests included mathematics, optics, astronomy, chemistry and botany and out of this unlikely mix came key ideas in the history of psychology.

His views on early learning, for example, are still vividly contemporary. In 1649, shortly before his death, he wrote that learning can start before birth.

It is easy to conceive that the strange aversion of some, who cannot endure the smell of roses, the sight of a cat, or the like, come only from hence, that when they were but newly alive they were displeased with some such objects, or else had a fellow-feeling of their mother’s resentment who was so distasted when she was with child; for it is certain there is an affinity between the motions of the mother and the child in her womb, so that whatsoever is displeasing to one offends the other; and the smell of roses may have caused some great headache in the child when it was in the cradle; or a cat may have affrighted it and none took notice of it, nor the child so much as remembered it; though the idea of that aversion he then had to roses or a cat remain imprinted in his brain to his life’s end.

Descartes’ major contribution applies to the whole of psychiatry, not just to phobias and anxiety. However, the respect in which he was held rather unfortunately cast in stone the mind-body split still so relevant to the treatment of phobias.

Descartes set out to question all accepted wisdom and build up his own philosophy from scratch. He was a firm believer in reason and thought all experience was fallible for he could never be completely sure that he had not been dreaming, or even tricked by a malicious demon. Bodily experiences were unreliable, he said, and the only thing he could be absolutely sure of was that he was thinking. His first principle of philosophy was, famously, ‘Cogito, ergo sum’, ‘I think, therefore I am’, and he came to regard the mind or soul as totally separate from the body. They are simply two different entities, he said: the mind is not a physical thing and therefore it can never truly merge with the body.

Descartes was searching for absolute truths and was not attempting to pit future psychiatrist against future psychiatrist. However, his reasoning led to Cartesian dualism, which has translated into medical circles as the great divide between mind and body. Does the cause of a psychological problem such as a phobia lie in the thinking mind or in the physical brain? The question has never been answered and professionals line up on opposite sides of this divide. Geneticists, molecular biologists and neurophysiologists, looking ever more closely into the physical and mechanistic workings of the brain, represent the ‘body’ side of the argument. Their remit is to explore the parts of the brain that can make us susceptible to phobias, anxiety and panic, somehow change its delicate chemistry and reduce our fear. On the ‘mind’ side, psychologists and psychotherapists examine past experiences or current beliefs and aim to challenge and change our thinking patterns to dispel our phobias.

Descartes believed that mind and body were closely linked and he would not have supported this interpretation of his work. In The Passions of the Soul he wrote: ‘There is such a tie between our soul and body that when we once have joined any corporal action with any thought, one of them never presents itself without the other.’ It is ironic that a philosopher who gave himself the widest possible brief is best remembered for naming the rift between some of the most polarised views in medicine and psychiatry.

He even named the meeting place between mind and body as the pineal gland. We now know that the pineal is sensitive to light and one of the hormones produced there, melatonin, regulates our sleep-wake cycle. Scientists researching jet lag and shift-work patterns have long been interested in the pineal but their work apparently had little relevance to phobias. However, some researchers now believe that certain light frequencies, acting via the pineal, may influence our susceptibility to both anxiety and phobias (discussed further in chapter 9).

Descartes’ belief in the central nature of thinking and reason makes him, like the Stoics before him, a rationalist. Cognitive therapists say that our beliefs fuel our fear, almost ‘I think, therefore I am frightened.’ Chapter 6, on cognition, examines at this in depth and it is quite possible that Descartes would have agreed with some of the main ideas.

Immanuel Kant, more than a hundred years after Descartes, was another rationalist, and his ideas fit equally well with cognitive therapy. Again, he stressed the importance of reason. He said, ‘The understanding cannot see. The senses cannot think. Only by their union can knowledge be produced.’

Kant believed that our ideas shape our view of the world. It is as if our ideas are spectacles that distort what we see. They determine what we focus on and how appealing it looks. We do not see an event itself, but only its appearance through these unreliable glasses. Put simply, there are alternative ways of looking at any event. Cognitive therapists today would agree. They aim to change people’s interpretation of events, just like adjusting their spectacles to change the focus or the tint.




Locke and Empiricism


An alternative view is that reason does not come into it at all. The human mind is, in fact, like a blank sheet of paper. Ideas are generated through our physical senses and our experiences, and projected on to this blank sheet. We work on the information derived from our senses, make associations and generalisations and build up our psychological picture of the world. No matter how abstract or complex the idea, it begins with physical sensations. Even belief in the existence of God can be built up in this way.

These are the thoughts of John Locke, who was working soon after Descartes. He belonged to the opposite tradition in philosophy, empiricism, which rated experience above all else.

Learning and memory are built on experience alone, Locke said. Phobias are therefore learnt as the result of a bad experience. And like behavioural therapists today, he said that fear can also be unlearnt through experience. Locke’s most important work was the Essay Concerning Human Understanding, published in 1690. His advice on dealing with irrational fears could have come straight out of a modern behaviour therapy textbook:

If your child shrieks and runs away at the sight of a frog, let another catch it and lay it down at a good distance from him; at first accustom him to look upon it; when he can do that, to come nearer to it and see it leap without emotion; then to touch it lightly, when it is held fast in another’s hand; and so on, until he can come to handle it as confidently as a butterfly or sparrow.

Empiricists like Locke would be at home talking to behaviour therapists in the twenty-first century.

Behaviourism aligns itself with empiricism in the same way that cognitivism is linked with rationalism. These two schools of thought have continued through history like parallel lines, never getting any closer to each other. They ask different questions and look for different answers. Empiricists and behaviourists want to know what a boy does if you send a dog into the room where he is sitting. Rationalists and cognitivists ask why the boy starts screaming and climbs out of the window.

Unfortunately, accurate observation and brilliant insights did not necessarily translate into practical and humane treatments. The seventeenth and early eighteenth centuries may have been a time of rapid progress in theories of learning and thinking, but people with anxiety disorders probably shrank from some of the proffered cures. The physician Thomas Sydenham suggested that hysterical disorders or today’s anxiety disorders could be helped with ‘bleeding, purging, opiates, foetid medicines, chalybeate medicines, filings of steel and rhenish wines, plaister at the navel, hysteric julap, opening pills or electuary’. Another writer regarded anxiety as a symptom of cardiac disease and recommended ‘narcotics and anodynes, mucilages, things fat and emplastik, emulsions and roborants’. Royalty escaped lightly in comparison, and Queen Anne’s physician Sir Richard Blackmore used opium because, he wrote in 1725, ‘It calms and soothes the disorders and perturbations of the animal spirits.’

Treatment provided by the clergy was, perhaps predictably, more orientated towards ‘mind’ than ‘body’. One minister thought that the key to treating anxiety was to ‘put them in a Pleased condition’. Another clergyman who specialised in ‘Spiritual physicke to cure the diseases of the soule’ was effectively an early psychotherapist and recommended the use of silence.




Darwin and the Dawn of

Modern Science


Charles Darwin had no desire for a head-on collision with the Church. By nature he was diplomatic and unassuming, certainly not confrontational. On top of this, his beloved wife Emma Wedgewood was deeply religious. But he was exasperated by the Church’s stranglehold on biology. The doctrine that we are made in the image of God, implying our perfection, was a particular problem. It elevated any study of humans into a direct challenge to God’s greatness and effectively stifled scientific thought.

Scientists in other disciplines in the early nineteenth century had much more freedom than biologists. Darwin viewed them jealously as he wrote: ‘What would the Astronomer say to the doctrine that the planets moved [not] according to the laws of gravitation, but from the Creator having willed each separate planet to move in its particular orbit?’

Another problem facing biology was the legacy of rationalist philosophy. It had produced great insights and set up trains of thought still followed today, but in practical terms it had come to a dead end. The philosophical view of the brain did not lend itself to systematic study. Kant even said that the mind was unquantifiable and beyond direct investigation so that a science of the mind was a logical impossibility.

Darwin eventually overcame these obstacles and his work paved the way for an explosion of activity in mind and brain research. The parts relevant to phobias are explored in detail in the next chapter, but his greatest contribution was, in the mildest possible manner, to wrest control of biology from the Church.

The Origin of Species, published in 1859, simply observed that living things adapt themselves to their surroundings. Species change over generations, he said. And if living things are not God-given, created once for all time, this implies that they are a legitimate target for scientific study. Darwin carefully excluded humans so as not to court more problems with the Church than was absolutely necessary, but his argument plainly implied that we are not distinct from animals. And if we have not been selected by God for special treatment, there is no reason why we cannot be studied scientifically.

The work caused a social and moral storm on publication but it was assimilated by scientists and the public alike within a decade. From there, developments in the many fields of science relevant to anxiety, fear and phobias started to snowball. Psychologists started collecting data. They devised experiments and studied the behaviour of animals and humans. Wilhelm Wundt, who set up the first psychology laboratory in Leipzig, epitomised this new approach. His followers were trained to look for traits that could be measured, and then collect data before they started building their theories.

The foundations were laid for the modern neurosciences. Spanish physiologist Santiago Ramón y Cagal was awarded the Nobel prize for his discovery that the brain is made up of neurones, or nerve cells. Afterwards, scientists went on to establish that the brain consists of a vast interconnected network of these cells. Scientists today are still trying to determine how far communication between these cells determines emotions like fear or anxiety.

Medicine progressed. Psychiatrists like C. Westphal started closely observing and defining phobias. The American Civil War brought tragic opportunities for clinicians to study fear at close quarters. Doctors who might once have moralised about courage or faith started taking measurements and looking more dispassionately at the effect of fear on the heart, lungs and other body systems. They wrote up their observations and developed theories, some of which are explored in chapter 4, on neurophysiology.

All of this work set the scene for probably the single most influential figure in the history of thought on phobias.




Freud on Fear


Five-year-old Hans was walking along the street with his mother. It was in the early years of the twentieth century and there were horses trotting by, pulling carriages, vans and buses. Wheels and hooves clattered on the cobbled road, people walked across and between them and it was an ordinary, busy day.

Hans’ mother stopped to greet an acquaintance and he looked idly down the street. A bus came towards them, pulled by two black horses. Just as it reached them, one of the horses stumbled and fell heavily on to its belly, jolting the bus. The other horse swished its tail in distress, shook its head and stamped its feet. The driver jumped down to help, and people peered out of the bus to see what was going on.

The horse looked enormous as it lay on the ground, covered in dust, in front of Hans. It snorted and tried unsuccessfully to get up. Its harness was twisted, making it difficult for the horse to move. A crowd started to gather and the noise grew. Hans stared in fright and his mother led him away from the scene.

Hans was agitated and could think and speak of nothing else for the rest of the day. Soon afterwards, he developed a phobia of horses. He started crying on his normal walk to the park with his nursemaid, and wanted to be taken home. He was afraid a horse would bite him and later, at home, afraid that a horse would come into the room. He became reluctant to go out at all and was quiet and withdrawn in the evenings.

Hans led an unexceptional, if somewhat closeted, middle-class life. He had a younger sister but few friends of his own age. His parents had, for the previous two years, noticed what they considered to be a precocious interest in sex. He asked questions about his parents’ and his younger sister’s genitalia. Both parents told him that he had the phobia because he often touched his ‘widdler’.

His parents were devotees of Sigmund Freud and Hans’s father wrote to Freud about the horse phobia. The case of Little Hans, as it became known, was the first published account of child analysis, and became celebrated as a key success in psychoanalysis. Freud believed it was proof that sexual urges are an essential part of the development of phobias.

Freud said Hans had an Oedipus complex. He loved his mother and wanted to be taken into her bed. He wanted his father, his rival, dead, and was therefore afraid of him. Hans transferred his fear of his father on to horses and the phobia erupted after some months of longing for sexual contact with his mother. According to Freud, ‘His sexual excitement suddenly changed into anxiety.’ The affection for his mother ‘triumphantly achieved its aim’, by making Hans afraid of going out into the street and allowing him to stay at home with his mother.

These were tendencies in Hans which had already been suppressed [wrote Freud] and which, so far as we can tell, had never been able to find uninhibited expression: hostile and jealous feelings against his father, and sadistic impulses (premonitions, as it were, of copulation) towards his mother. These early suppressions may perhaps have gone to form the predisposition for his subsequent illness. These aggressive propensities of Hans found no outlet, and as soon as there came a time of privation and of intensified sexual excitement, they tried to break their way out with reinforced strength. It was then that the battle which we call his phobia burst out.

Hans’s father received Freud’s letters over a period of months and Hans recovered gradually.

The case of Little Hans, which has been argued about ever since, was a fascinating example of Freud’s theory of mind. Freud said the ‘id’ stands for untamed passion, and the ‘ego’ for reason and good sense. The id generates inappropriate sexual or aggressive impulses, which the ego tries to make socially acceptable. The ego receives the id’s dangerous urges, and represses them if at all possible. Failing that, the ego has to find another outlet and may alter excessive excitement so far that it ceases to be pleasurable and becomes a psychosomatic symptom such as palpitations or fainting.

So, according to Freud, Hans’s sexual desire for his mother and his longing for his father to be dead were unacceptable urges created by the id. They created more excitement than the ego could deal with and were converted into anxiety and a fear of horses.

A single anxiety attack, with palpitations or breathlessness, can be enough to trigger a phobia, said Freud, and many today would agree with this part of the theory, if not with the underlying explanation. The ego feels helpless during the attack, Freud says, and deals with this by projecting the anxiety on to the external situation. The anxiety attack then becomes associated with a bus or train journey, for example, rather than with forbidden excitement. It is easier to control external situations than internal thoughts and the phobia becomes a convenient way of explaining away a terrifying reaction. This process is carried out at a subconscious level; at the conscious level, all we know is that we are afraid of the situation. The ego then prompts us to avoid the situation in future as a defence against the impulse and the feeling of helplessness. So an external, tangible fear replaces an internal, instinctual danger and a phobia develops.

Freud’s theory was at once brilliant – and mistaken. On the positive side, he founded psychoanalysis and highlighted, long before mainstream science, the importance of relationships and childhood experience in shaping adult personalities. Furthermore, his emphasis on the subconscious opened up a whole new way of thinking about mental pain and inner conflicts. But his emphasis on sex was questionable. Other scientists have combed the 140 pages’ worth of his analysis of Little Hans and found no evidence that the boy sexually desired his mother. Nor are there any signs that he feared his father. But the link between sex and phobias, started by Freud, has hampered phobia treatment for decades.

Specialists and theorists today have largely given up the idea but it still lingers and can cause problems. Referral for a phobia from GP to psychiatrist can still lead to a discussion about relationships with parents and possible abuse. It is impossible to completely rule out a link between sex and a phobia; complex phobias can develop from a background of troubled emotions and difficult experiences and there are, of course, phobias of sex itself. But most phobias do not stem from sex or have anything to do with it.

Psychoanalysis itself is largely out of fashion in scientific circles, partly because it has failed to keep up to date and incorporate new findings from cognitive science or physiology. But its legacy in phobia treatment is the enduring idea that phobias are the visible signs of terrible inner conflict. For many years psychiatrists have approached phobias with extreme caution for fear of what might be uncovered.

The whole basis of recent progress (and this book’s premise), is that delving in someone’s unconscious, looking for the cause of a phobia, does not get results. Good treatments work regardless of the cause.

Other, less celebrated parts of Freud’s work provided a solid framework within psychiatry which still largely exists. He had a genius for making sense of the experiences described by his clients and categorising the different aspects of anxiety. The remnants of his classification are still apparent today in the mighty DSM, the Diagnostic and Statistical Manual of Mental Disorders, the bible of the American Psychiatric Association.

Until Freud’s paper in 1894, anxiety disorders were collectively known as neurasthenia. Freud’s achievement was to distinguish ‘anxiety neurosis’, or what we now call panic disorder, from general anxiety and to describe its three aspects. The first is the anxiety or panic attack; the second is anxious expectation, or anticipatory anxiety; and the third is phobic avoidance. Further, Freud recognised that people could have more than one anxiety syndrome, and that people could have mild forms of anxiety.

He described heart ‘spasms’ and the difficulty in breathing that can accompany anxiety attacks. In fact, ten of the thirteen symptoms included in the DSM as late as 1987 had been previously noted by Freud. Freud also recognised that specific phobias – not the term he used – were quite different from agoraphobia, and described them as an exaggerated reaction to dangers instinctively feared by everyone. The idea that most specific phobias are an overblown but essentially normal reaction surfaced again recently and is explored in the following chapter.

Freud, who was a neurologist, drew together much of the work that preceded him and his early work reflects his interest in neurophysiology. He cut across the nature-nurture debate and claimed, in a truly modern fashion, that inborn and biological factors interact with experience in causing anxiety disorders. Interestingly enough, he was himself phobic about travel.




Little Albert


J. B. Watson was an impatient young American. He was irritated by the state of psychology in the early twentieth century, by its lingering obsession with philosophical questions and its fascination with the subconscious. He set out to drag it into the realms of science.

Watson did not claim that mental phenomena do not exist, but rather that they cannot be measured and therefore might as well be ignored. In an unlikely agreement with Kant, he said that the mind, or consciousness, could not be investigated scientifically. Following on from Wundt, mentioned earlier, Watson stressed the importance of collecting data and measuring overt, visible behaviour. Little Albert, an 11-month-old baby, was the unfortunate guinea pig chosen.

Watson’s masterstroke was a direct challenge to Freud. He and his colleague, Rosalie Rayner, allowed Albert to play happily for a while and then showed him a furry white rat, at the same time banging an iron bar on metal just behind his head. The little boy got a terrible fright. A few days later, they showed Albert the rat again, this time without the noise. He was still obviously frightened. In fact, weeks after the experiment, he remained afraid of rats, dogs and anything furry, even fur coats.

A single, frightening event was enough to create a lasting fear in Little Albert. By extension, it suggests that the horse’s fall in front of Little Hans may have been sufficient in itself to cause his subsequent phobia. Analysis of his subconscious was therefore unnecessary.

Russian neurophysiologist Ivan Pavlov, working at the same time, would have agreed. He famously rang a bell every time he fed a group of dogs. Eventually, the dogs started to salivate at the sound of the bell whether or not there was any food. Pavlov said they had come to associate the bell with the food so strongly that either would make them salivate. The dogs were conditioned, to use Pavlov’s term, to salivate when the bell rang.

White rats were a convenient vehicle for studying behaviour because, like dogs, they can be conditioned. Simple experiments with rats produced simple results and fuelled enthusiasm for behaviourism. In variants of Pavlov’s experiments, rats were shown something innocuous, like a coloured light, at the same as they received a mild electric shock. With repetition, the rats came to fear the light alone.

It provided a simple way of thinking about phobias. A single event causes lasting fear. A child is frightened when a big dog snarls and attempts to bite and afterwards fears and avoids all dogs, even small and friendly ones. Behavioural therapy attempts to reverse the process. By gradually reintroducing the child to dogs, the link between the snarling dog and others is broken, the child gains confidence and the fear disappears.

However, behaviourism failed to see off Freud. Its practical shortcomings were, ironically, demonstrated by Watson. Like Freud, he was unable to heal himself. Watson had a lifelong fear of the dark which his behaviourist methods could not banish. It is hard to imagine anyone with a phobia believing as fervently in their treatment or being as determined for it to succeed, but it did not work for Watson.

His personal life may have dealt behaviourism an equally serious blow. He had a scandalous divorce following his affair with Rosalie Rayner. They subsequently married, but he was forced out of his job at the prestigious Johns Hopkins University and left academia for advertising. Behaviourism was robbed of its figurehead, research started to go in many different directions and it never regained its earlier theoretical coherence.

Behavioural learning theory may have foundered but behaviour therapy, a logical extension of the theory, is still a core feature of most treatments for phobias. Just as Watson was only interested in studying behaviour, the task of the modern behaviour therapist is limited to changing behaviour. Watson did not argue that consciousness did not exist, only that it could not be measured. Similarly, therapists acknowledge that phobias mean fear, but they do not tackle the emotion directly. Instead, they work to change behaviour and prevent avoidance of the feared object. The therapy, discussed in chapter 5, may not have helped Watson, but it is routinely successful.




Computers, Cognitivism and Progress


Freud and Watson’s pre-eminent positions were eventually usurped in the 1950s by the silicon chip. Computers provided the inspiration for the next way of thinking about thinking. Centuries earlier, doctors trying to understand the heart were baffled until engineers invented the pump. The pump gave them a model for how the heart could work, and it was a good comparison. In the same way, computers introduced notions of information processing and storage which were new. Doctors hijacked these ideas to explain the workings of the human mind and memory. The analogy of programming a computer to carry out tasks was a more satisfactory explanation for how we learn complex skills than anything behaviourism had put forward.

So computers’ first contribution to the progression of thought on phobias was as a model for thought processes and the mind. More recently, computers have driven research into the physical causes of fear in a way that has never been possible before. The power of modern computers allows geneticists to trawl through immense heaps of data in an attempt to pinpoint the genes responsible for panic disorder. Advances in imaging have given scientists new ways of looking at the brain and allowing them to piece together an ever-clearer picture of the physical changes when someone thinks, laughs or is afraid. Computers are being used to design molecules that will surely give us the next generation of fear-busting pills. The neurosciences are advancing in many different directions and none of it would be possible without the modern computer.

But if history has taught us anything, it must be that no one school of thought has all the answers. Hippocrates and the ancient Greeks gave telling descriptions of phobias, but did little to help their patients. The philosophers had some brilliant insights which failed to make it into clinicians’ textbooks. Progress has been halting over the centuries, characterised by dead ends, false dawns and the odd piece of brilliance, quickly obscured.

Freud must be credited with separating phobias from generalised anxiety and establishing them as a new and distinct subject for study. His classification of anxiety types was a big step forward because it drew attention to the special and specific features of phobias which today’s therapists are capitalising on and which are making new treatments so promising. However, his later psychoanalytical work, with its subjective interpretations of hidden feelings, is spectacularly unfashionable in the age of computers and hard data.

Practical progress has been most marked where sciences have interacted. The theory of cognitivism may have overtaken behaviourism, but most phobia clinics now offer cognitive-behavioural therapy. The theories may be irreconcilable, but the two approaches taken together are more effective than either alone.

This could also be true of the neurosciences, psychology and psychoanalysis, which continue to pay scant regard to each other’s findings. They have developed more or less independently, with little reference to each other. Neuroscience is a thriving field at the beginning of this new century and it is tempting to feel we can safely reject everything that has gone before. Undue attention to underlying problems, spearheaded by Freud, held back treatment of phobias for years and the demise of psychodynamics has been liberating and productive for scientists, clinicians and those with phobias. It is thrilling to be able to discard confusing psychoanalytical theory in favour of neuroscience and its promises of definite answers to clearly defined problems. But the dawn of the neurosciences could yet produce a need for a deeper understanding of the meanings of fear. Because, in the end, fear is more than a chemical reaction. No one with a phobia really cares about their hormone levels or brain activity. What they want is an end to their phobia and the sensation of fear.





CHAPTER 2 Evolution (#ulink_1877df62-261d-58d1-a4eb-4b9ec1a1e684)

Living Without Fear


The man stood, arms outstretched, looking at the traffic below. He grinned, threw back his head and laughed. The wind ruffled his hair and tugged at his coat and he seemed euphoric. He started to turn clumsily round and round on the spot, like a small child having fun. A few yards away, his wife stared at him in disbelief. He was dancing on the corner of a parapet on the roof of a San Francisco skyscraper, one step from certain death.

The fictional character Max Klein, played by Jeff Bridges in the film Fearless, had survived a plane crash and became convinced he was invulnerable. His high-rise jig came some time after he walked across a city highway without looking, cars and vans screeching to a halt all around. He ate a bowl of strawberries, knowing that his allergy to them could cause a fatal reaction. Finally, he drove at top speed into a brick wall.

Klein survived a few months of this behaviour, but his life was disintegrating. His close encounter with death during the crash had eliminated his day-to-day anxieties and he felt he did not have to answer to anyone. He became so self-sufficient, not to say arrogant, that he felt little need for the closeness of those around him. He was remote and distant from his wife; he alienated friends with his lack of sensitivity. He spent more time with a young boy he had rescued from the crash than with his own son. He was not working, but spent his days looking at buildings. When introduced to a fellow survivor of the crash, he told his wife he had a feeling of overwhelming love for this woman. He had never felt anything like it before, he said. A few months of this and his wife was ready to leave him.

His psychiatrist was struggling with an extreme case of post-traumatic stress disorder; Klein himself claimed the crash was the best thing that had ever happened to him. It had been extraordinary, and had shown him ‘the taste and touch and beauty of life’. He would not give up this state of mind.

Subjectively, Klein felt more alive than ever; objectively, he stood to lose his wife, son and home, his friends and his livelihood. It is an interesting take on fear. We are so used to portrayals of neurotics crippled by a million anxieties that we seldom stop to think what would happen if we had none at all. Anxiety and stress have a bad image. They are the scourge of the modern age, blamed for everything from undermining happy marriages to destroying sleep and causing headaches. Anxiety exaggerates bodily pains, it ruins good performances at work or school and quenches joy and laughter. It leads to alcoholism, eating disorders, domestic violence. The lifestyle pages of newspapers and magazines are filled with articles about dealing with stress and, we are told, life without anxiety would be wonderful.

Yet in this film, fear is portrayed as the glue that holds lives together, keeps marriages, friendships and careers intact and protects us from avoidable accidents. Klein eventually realises he needs help, regains normal sensitivities – along with his allergy to strawberries – and the story is resolved. Anyone behaving like this in real life would be lucky to escape so lightly.

The anxiety system can go wrong, of course, and we would all like to banish the misery of panic attacks, obsessional behaviour or phobias. Successful treatment for these problems can revolutionise lives and nobody wants to get in the way of this. But evolutionists insist we would benefit from taking a step back and looking at why there is so much anxiety in society. They challenge the prevailing view of anxiety as a wholly negative experience. On the contrary, they say anxiety is a prime motivator, a positive drive, a force for good. It prompts us to achieve at work, to guard our reputation and to keep our families together.

We do not doubt that other animals need the ability to recognise and respond to threats. All living things face danger and must react appropriately if they are to survive. Creatures have a fascinating array of defence mechanisms, each specific to the threats they most commonly encounter. The chameleon changes colour to blend in with its surroundings and hide from potential attackers. A threatened squid squirts ink at its aggressors. Antelope simply run away from lions. Moths are preyed on by bats and have become experts in bat-frequency signals. They monitor the signals continuously and map the direction of their predators’ flight. Only if the bat is heading directly for it does the moth snap its wings shut and fall, as if dead, to the ground. Familiar reactions like these have been sufficient, not for every animal to survive, but to keep the species going.

The intensity of the reaction also has to be appropriate since animals use up precious resources when trying to defend themselves. An antelope that is too ready to give up grazing and run will soon become undernourished; squid do not have unlimited ink. Even the simplest creatures have remarkably sophisticated responses, as demonstrated by American biologist Herbert Jennings, working in Europe at the turn of the century.

Jennings was interested in the ordered and elegant lifestyle of a tiny pond animal called a stentor. A stentor is only one cell big, a trumpet-shaped creature, attached by a ‘foot’ to a rock on the water bed. It has a tube at its base which can provide shelter, and the trumpet is an open pouch at its free end for feeding. Hairs around the edge of the pouch waft in food particles.

Jennings used carmine, a natural red dye extracted from the cochineal beetle. It can be an irritant even for humans and is certainly toxic to tiny animals like stentor. He added carmine to the water tank in which the stentor was living, and simply watched to see what happened.

The stentor did not at first react to the carmine in the water, but then decisively bent away from the oncoming red specks. The gesture is normally enough to keep it out of trouble in the peaceful conditions at the bottom of a pond. It costs the animal little to try, and it can continue feeding even as it defends itself. In Jennings’s experiment, the stentor bent this way three or four times, and when the strategy did not work, demonstrated a second line of defence. It suddenly pushed its pouch out in the opposite direction in an attempt to dislodge any poisonous particles around the mouth. Again this failed, as Jennings continued to drop carmine into the water. Red particles settled on the pouch and a few more similar moves by the stentor proved futile.

Drastic measures were called for, so the stentor retreated. It contracted and moved down into the tube at its base. It waited there for a time but could not wait for ever because a single cell does not store much energy and it cannot feed in its bolthole. It moved tentatively upwards out of the tube, but found the water still full of carmine and had to force itself back down again. It advanced to test the water a couple more times but when conditions had not improved, the tiny creature risked its remaining precious energy, contracted violently, dragged its foot away from the rock and floated away in search of an uncontaminated spot.

Experiments like this have been given new significance by the latest thinking on the adaptive and positive role of fear. A one-celled creature like the stentor has a graded response to a threat, from simply swaying away from the toxin, to pulling up its foot and drifting into the unknown. Stentor allocates its resources meanly so that only the minimum is used to meet a threat. How much more complex, then, might our own reactions to danger be? And could they be built on similar principles?

People do not function in the same way as protozoans, but some of nature’s rules are universally true. A great deal of our knowledge of human genetics, for example, is derived from study of the fruit fly, Drosophila melanogaster. Our genetic material is the very template from which we grow, and yet most of it can be found in a fly. As Oxford Professor of Physiology Colin Blakemore once rather flippantly pointed out we probably share 70 per cent of our genes with a garden lettuce.

Biologists discovered in 1972 that human cells can apparently commit suicide for the greater good of the whole body. Cells normally receive signals from neighbouring cells telling them to keep going, and should these stop, they die. Cell death is part of the normal development of a foetus in the womb. Babies develop with webbed hands and feet but the skin between the digits normally retreats before they are born. The cells in this skin die, they ‘commit suicide’ and allow babies to be born with perfectly separated fingers and toes. When cell suicide was first described, it was assumed to be relevant only to the highest creatures since a single-celled organism cannot benefit from its own death. Twenty years after the initial discovery, though, researchers found that single-celled creatures do indeed die in this way. They apparently ‘lay down their lives’ for the good of their community.

This is just one of many biological similarities between creatures of very different appearance and classification. There is obviously a big difference between the death of a few cells and an all-pervading feeling of fear, but both could be essential for healthy development. Careful observation of animals might help scientists ask more relevant questions about humans. For example, an obvious feature of animals’ fear is that it is necessary. If stentor does not react to a toxin, it dies. If the antelope does not run from the lion, it gets eaten. Max Klein lacked normal fear and stood to damage himself socially, financially and physically. All animals need to be able to respond to danger. But how does that help us understand the common phobias?




Age-Old Anxieties


A mixed bunch of academic publishers, scientific editors and advertising sales staff ate dinner together at the end of a conference. One editor was regaling the table with tales of her previous career as an Avon lady. She lost one of her clients, she said, when she took a swipe at the woman’s budgie with her cosmetics bag. Everyone looked up, amazed. ‘It was coming straight at me,’ she said, by way of explanation. This confident, bright young woman had ornithophobia and was not going to stay in the same room as a free bird.

One of the sales staff was listening with particular interest. ‘I know exactly how you feel,’ he said with feeling. He was afraid of butterflies and moths, and they started discussing the intricacies of the unpleasantness of wing flapping. Suddenly other diners were vying to compare the strength of their fears. His boss chipped in with a fear of heights and a publisher managed both a fear of spiders and of flying.

The conversation unearthed five phobias in four people among the twelve at the table. Doubtless a psychologist could have found more by interviewing us individually – those mentioned were specific and without much stigma attached – but even this tiny straw poll was telling. The phobias discussed so freely in the restaurant were all directed at threats in the natural world.

No scientist would be impressed by the dubious methods of this survey, but the results are surprisingly reproducible. Whenever a group starts talking about phobias, notice the fears people describe. Occasionally someone has a weird phobia of buttons, cotton wool or wallpaper, and if they do this may dominate the conversation. But most people fear a limited range of creatures or situations. They fear spiders, snakes, the dark, open or closed spaces; creatures and situations that pose few real problems in the West today but which could be dangerous if we lived less cosseted lives.

Evolutionists believe that this observation is important in our understanding of phobias. They say the things we fear today could have been fatal to our prehistoric ancestors. A bite from a spider or snake could have killed; it would have been dangerous to be out after dark; being cornered in a cave by an animal was definitely best avoided. By contrast, the things that really do kill us today – cars, guns or cigarettes – rarely inspire the same level of fear.

They believe that we are, at heart, barely adapted Stone-Agers, now working in offices and driving cars. We are strangely mismatched with our circumstances. We have modern and sophisticated lives but the deep recesses of our mind have developed to react to long-gone situations. The primeval drive of fear is more easily provoked by ancient threats, evolutionists say, because it is still best attuned to days spent roaming the African plains. Then, it would have made sense to have a proper respect for spiders, the dark or enclosed spaces. Stone-Agers lived in dangerous times and required a certain level of caution to survive and have children. Those who did survive passed their safety-consciousness on to their offspring and it became programmed into the human psyche.

The conversation at the dinner table might have ostensibly been about crazy, overblown fears of harmless objects, but an evolutionist would contend that it was in fact about proper caution for dangerous situations – albeit a few tens of thousands of years late.

The theory of evolution has been widely known since Charles Darwin shocked contemporary society with The Origin of Species, in 1859. The book had ramifications throughout science, religion and society, as discussed in the previous chapter. It hinted that humankind evolved from a primitive creature over millions of years and is related to the apes. Darwin was initially ridiculed and pilloried for his ideas, but acceptance of them grew and they are now largely taken for granted. In the past decade or so, scientists from many disciplines have revisited evolution theory and attempted to apply it to such diverse questions as why nations go to war and what features of the face or body determine sexual attractiveness. It has been used to argue for a new approach to pest control in agriculture; computers have been programmed to use a kind of technological natural selection to continually improve performance.

But what of our reactions to danger? Can evolution theory tell us anything about the nature of fear and anxiety? Evolutionists claim that part of the reason we develop phobias may lie in the mismatch between life in the twenty-first century and the Stone Age. As a species we are still primed to react to the threats and opportunities that our ancient ancestors faced. Evolutionarily speaking, we have hardly budged in the past ten thousand years but our lifestyle has changed beyond all recognition.

Primates are believed to have appeared sixty-five million years ago, followed thirty million years later by the first apelike creatures. They began walking on two legs about four million years ago, and using early stone tools two and a half million years ago. After a phase of rapid brain expansion two million years ago, they started to use shaped hand-axes and moved from Africa into Europe and Asia. This was the beginning of the Stone Age and its people developed a stable lifestyle roaming African plains for food until about ten thousand years ago.

Anatomically modern humans developed from their ancestors a hundred thousand years ago and discovered fire. Farming was introduced ten thousand years ago, the wheel about eight thousand years ago, and people started to write about 4000 BC. The pace of change accelerated and it took less than two hundred years to get from the first machines of mass production in the industrial revolution to the technology that put men on the moon.

It is rather like an old man who has lived for seventy years in an isolated spot in an unchanging world. One summer, somebody strikes oil nearby. Big business moves in, a town is developed, new roads are built, the population soars and he finds himself ill-equipped to cope. Humans have spent 99.5 per cent of their existence as hunter-gatherers and are barely out of the Stone Age in evolutionary terms. But life today bears little resemblance to that of our ancestors.

Evolutionists have attempted to explain many modern health problems in terms of the poor fit between our biological make-up and modern lifestyle. Soaring rates of obesity are a good example. Our ancestors had to move around constantly in search of food, which was often in short supply. The ability to store fat around their bodies so that they could survive times of potential starvation would have been a great advantage. Today in most parts of the Western world, food is plentiful. Supermarkets carry a dazzling and expanding range of foods and food shortages are almost unheard of. Add to that a sedentary lifestyle, in which we are entertained at home by the TV, transported around in cars and have our manual work done by machines. The result, according to the World Health Organisation, is that almost half of Britain’s adults are overweight and the entire population of America will be obese by 2230 if the increase seen since 1980 continues. Obesity is serious, known to contribute to heart disease, diabetes and premature death. Fat storage, the very mechanism which kept our starving ancestors alive, may be killing people off in the modern world.

The Pima Indians in Arizona, US, are a particularly dramatic example. They maintained a traditional way of life, relying on farming, hunting and fishing for food, until the late nineteenth century. Then, diversion of their water supply by American farmers upstream drove them to poverty and malnutrition, even starvation. The Second World War brought both prosperity and contact with Caucasian Americans, which westernised their dietary and lifestyle habits. Since then, the Pima Indians as a group have put on an unhealthy amount of weight. Half of the adults have diabetes and 95 per cent of those are overweight. Scientists from the US Government’s National Institute of Health have studied the Pima Indians for more than thirty years, looking for genetic causes of diabetes and obesity.

Just as the Pima Indians are physically adapted for a traditional lifestyle, our minds may be geared to deal with traditional dangers. We still eat as if food shortages were imminent; perhaps we are also still on the look-out for predators and natural threats. Certainly, evolutionary psychiatrists Randolph Nesse at the University of Michigan, and Isaac Marks, from London University, believe that we are all programmed to react to threats. Anxiety and fear are necessary, they say, and have been essential for our survival throughout evolution.

At the simplest level, mild anxiety boosts performance. It prompts the student to revise for exams, the musician to practise, the sales rep to rehearse a presentation. But evolutionists say it is far more sophisticated than that.

We could improve our understanding of anxiety at a stroke if we stopped thinking of it as a disorder, and considered it a defence that regulates and orchestrates our reactions to every threat and opportunity, say Nesse and Marks. The anxiety system is as important to our survival as is our immune system. It protects against threats to our whole body, and life, in the way that the immune system fights off specific physical threats. Both defence systems have developed within our species as we evolved. The individuals with appropriate reactions to danger or to micro-organisms are most likely to survive, produce offspring and pass on these traits to future generations.

Both have a range of reactions to meet specific threats. The immune system creates a scab to heal a cut finger and produces antibodies to deal with viruses. Similarly, at least some of our reactions to danger are clearly adaptive and matched exactly to the threat, say Marks and Nesse. For example, people who are afraid of heights may ‘freeze’ if they have to walk along a ledge or cross a narrow bridge. They cling to the side, unable to move. They may need a companion’s reassurance and physical assistance to get going again. This sort of reaction is not helpful if it stops you climbing stairs but in natural surroundings someone who became immobile by the side of a sheer drop might avoid a bad fall.

Blushing often seems to make a difficult situation worse. People who lack confidence in social gatherings dread being the centre of attention and burning cheeks do not help anyone blend into the background. But if, as has been argued, blushing signals social submission, a red face could be a plea for continued membership of the group. In ancient times, membership of a group would have been near-essential for survival. Anyone expelled and left alone would become vulnerable to cold, starvation and attack. They would also be unlikely to pass their influence on to the next generation if they could not reproduce.

Blood and injury phobias provide an intriguing physiological example of the possible benefits of an anxiety response. People with these phobias may faint at the scene of an accident or even at the sight of a syringe or needle. These are the only phobias associated with fainting. Someone with agoraphobia may feel extremely dizzy or uncomfortable in a crowded street and believe they are going to pass out, but they almost never do. As the agoraphobic prepares to flee the difficult situation, rising blood pressure effectively prevents a faint. By contrast, the blood and injury phobics’ blood pressure drops at the sight of blood, and they often do pass out. Nesse and Marks argue that this, again, could be adaptive. If a hunter saw blood, it was more likely to be his own than anyone else’s. An injured man loses less blood if his blood pressure drops. Even if he fainted, this could conceivably be useful. Some animals only attack moving creatures and lying still might just discourage further attack by predators.

Many animals are known to play dead while remaining conscious. Charles Darwin himself once caught a robin in a room and said it ‘fainted so completely, that for a time I thought it was dead’. David Barlow, an eminent psychologist in Albany, New York, says there may be a human parallel. Women who have been raped frequently describe being paralysed, rigid and cold during the attack. They are not unconscious because they can later remember details of what happened. In the past, this freezing has been wrongly taken by courts to mean that the women somehow consented to sex. Barlow says their immobility may in fact be an ancient defence mechanism. Remaining still may reduce further violence by a more powerful assailant and could conceivably reduce his sexual arousal.

In this way, the nature of a reaction is matched to the threat. Blushing is not likely to scare off a snake and freezing would not help in a difficult social situation. Normal phases of development also fit the evolutionists’ model. Babies may suddenly become afraid of strangers between six and twelve months old, just when they are starting to crawl and coming into more contact with unknown people. Animal fears peak at about four years old, the age when they may start meeting and playing with animals unattended. Social phobia typically starts in the late teens, just when young people are establishing their identities and facing all sorts of social pitfalls. While it would be unwise to take the argument too far – even Marks and Nesse have admitted that imaginative thinkers could come up with an adaptive use for virtually any human reaction – there are many compelling examples.

The strength of a reaction to a threat is every bit as important as its nature. Both the anxiety and immune systems are tightly regulated and over- or under-reaction causes problems. The human immunodeficiency virus, HIV, does not itself kill, but its destruction of immune defences means normally harmless bacterial and viral infections can become fatal. At the other end of the scale, allergies and hay fever develop when the immune system is overreacting to irrelevant stimuli like dust or pollen.

Anxiety is similar, argue Marks and Nesse. An underactive anxiety system may create real problems, as demonstrated by Max Klein in Fearless. A lack of concern about the future sounds wonderful, but not if this destroys all ability to plan for it. Never worrying about the consequences of your actions may mean you speak out when it would be diplomatic to say nothing. Telling your boss exactly what you think of him or her is a fantasy for many of us, but we never do it. A moment of extreme satisfaction could cost you your job. Similarly, you might feel like objecting loudly when someone pushes past you at a bar, but if they are big, drunk and bad-tempered, you probably keep your feelings to yourself. Those without normal levels of anxiety may lack basic caution and end up losing jobs and getting into fights where others simply sidestep trouble. Without the push of anxiety, it may be difficult to revise for exams or apply yourself to any long-term project. Marks has termed this hypophobia. It is interesting but speculative. It has not been studied much because those who lack anxiety often don’t imagine they have a problem and tend not to come forward for help. However, New Zealand researchers have some evidence to back the idea and at the same time, challenge the widespread assumption that a traumatic experience can trigger a phobia. They looked for height phobias among children who had serious falls between the ages of five and nine. They found that, at eighteen, these children were much less – not much more – likely than others to have height phobias. This study implies that temperament (discussed in chapter 7) may be all-important and suggests that children without fear, those who have never worried about heights may be hypophobic, and most likely to injure themselves in a fall.

The over-reactive end of anxiety is far more familiar. A wealth of anxiety disorders, including phobias, result directly from a tremendously sensitive anxiety system. People with these disorders can become upset by things others would never notice. Hoarders, obsessives and agoraphobics fear things but they all have hair-trigger anxiety systems. The hoarder is so afraid of losing something important that he cannot throw away anything. His house gradually silts up with layers of junk and old newspapers. The obsessive washes and cleans for three hours every morning and is quite unable to go to work unless she, and the house, are immaculate. The agoraphobic may hear about a road accident fifty miles away and be housebound for days afterwards.

Nesse carried out an interesting exercise in which he listed the physical and social dangers that would have threatened early humans. Physical dangers included accidents, disease, starvation, predators, hostile humans; social dangers included rejection, attacks on status or disruption of relationships. Modern anxiety disorders correspond well with these ancient threats. The hunter-gatherer’s proper fear of predators could have become today’s animal phobia; storage of food in times of plenty to ward off starvation could have become hoarding; cleaning rituals and taboos to ward off disease or contamination could have become obsessive-compulsive disorder. The hunter who sensibly stayed at the home base while a hungry lion roamed may have become today’s agoraphobic, highly reluctant to go out.

Responses that may once have been life-saving reactions have become inappropriate. Fear of heights, once a proper respect for the danger of a high cliff, is now a nuisance if it translates into fear of bridges or high-rise apartments. Reluctance to approach spiders may have been wise, and still is in some parts of the world. But fear of spiders in countries like Britain, where none is harmful, is widespread, and serves no useful purpose.

Nesse’s point is that today’s anxiety reactions would often have been essential in the Stone Age. There is nothing essentially wrong with the reactions, they are just too easily triggered for life today. It is a helpful idea. Fear of danger is a natural response and one which in other circumstances, thousands of years ago, might have protected us rather than blighted our lives.




The Evolution of Fear


The idea that we are attuned to life on the African plains makes a wonderful story, but most of us do not feel much like Stone-Agers. We have adapted to many changes even in the last few decades; we are more or less at ease with cars and aeroplanes, computers, dishwashers and foreign holidays. How come our fears lag so far behind?

Can we really blame our prehistoric ancestors for our fear of snakes and spiders? Fear may be contagious but evolution demands that it is passed down for tens of thousands of years. It is asking rather a lot for fear to survive intact so long. Diseases have died out in that time, whole species have become extinct. Yet evolutionists say that our fears of heights and the dark have remained unchanged since our predecessors in the Stone Age were trying to get back to their caves at night.

Charles Darwin first introduced evolution to the public in the mid nineteenth century. Some of his basic ideas were old, even then; Charles’s grandfather, Erasmus Darwin, had been one of several advocates of the theory in the eighteenth century. Charles Darwin himself became convinced during a five-year voyage through the southern hemisphere on HMS Beagle. He watched species of animals change gradually from island to island as the boat moved south. But it was his observations in the Galapagos Islands that were critical to forming his theories. Finches and giant tortoises varied slightly but predictably from island to island and the local people could always tell where a particular bird or tortoise belonged. It seemed that all the variations of these creatures must have had a common ancestor.

It took Darwin twenty years to publish The Origin of Species, possibly in part because he anticipated and dreaded the uproar it would cause. The book is packed with examples of evolving creatures: ants and bees, horses and zebras, birds, fish and plants. Darwin defined the process of natural selection as ‘the slow and gradual accumulation of numerous, slight, yet profitable variations’. If a tiny random change in an individual gives it an advantage over other members of the species it is more likely to survive, reproduce and pass the adaptation on to its offspring. The offspring in turn are more successful than those without the adaptation and over many generations more and more of the population are born with this small advantage. In the same way, variations which give their carriers a disadvantage are eliminated.

Natural selection works to produce gradations in animals’ instincts as well as in their physical features, Darwin said. Nesting birds, for instance, have an instinctive fear of most of their enemies, strengthened by their own experience and by the sight of fear in other birds. But they are slow to develop a fear of humans. According to Darwin, large birds in highly populated countries like England are wilder than small birds because they have been persecuted by humans. In uninhabited islands, large birds have no more fear than small birds. Magpies and hooded crows are wary in England but, in Darwin’s time at least, magpies were tame in Norway as were hooded crows in Egypt.

Darwin omitted humans from his arguments in The Origin of Species, but discussed them at length in later books, The Descent of Man, 1871, and The Expression of the Emotions in Man and Animals, 1872. Expression of the Emotions set out to demonstrate that different races, and even different species, show their emotions in a remarkably similar way, implying that emotions such as fear have been conserved throughout evolution:

That the chief expressive actions, exhibited by man and by the lower animals, are now innate or inherited – that is, have not been learnt by the individual – is admitted by every one. So little has learning or imitation to do with several of them that they are from the earliest days and throughout life quite beyond our control: for instance, the relaxation of the arteries of the skin in blushing, and the increased action of the heart in anger.

Fear is one of these chief emotions:

Fear was expressed from an extremely remote period, in almost the same manner as it now is by man; namely, by trembling, the erection of the hair, cold perspiration, pallor, widely opened eyes, the relaxation of most of the muscles, and by the whole body cowering downwards or held motionless.

Or, as he says elsewhere, quoting from Papinus Statius’ Thebaid: ‘Obstupui, steteruntque comae, et vox haesit’ (‘I was astounded, my hair stood on end, and my voice choked in my throat’).

Erection of the hair is singled out for special comment because it serves no purpose in humans and may simply be a leftover from evolution.

With respect to the involuntary bristling of the hair, we have good reason to believe that in the case of animals this action, however it may have originated, serves, together with certain voluntary movements, to make them appear terrible to their enemies; and as the same involuntary and voluntary actions are performed by animals nearly related to man, we are led to believe that man has retained through inheritance a relic of them, now become useless. It is certainly a remarkable fact, that the minute unstriped muscles, by which the hairs thinly scattered over man’s almost naked body are erected, should have been preserved to the present day; and that they should still contract under the same emotions, namely, terror and rage, which cause the hairs to stand on end in the lower members of the Order to which man belongs.

Darwin therefore argued that the similarity of our and animals’ response to danger is further proof of our common ancestry. But not all emotions are so ancient. Other emotions, such as blushing through shame, shyness or excessive attention, have developed more recently, he said. Different races of people across the world all blush, but animals never do.

It does not seem possible that any animal, until its mental powers had been developed to an equal or nearly equal degree with those of man, would have closely considered and been sensitive about its own personal appearance. Therefore we may conclude that blushing originated at a very late period in the long line of our descent.

Or as Mark Twain wrote, ‘Man is the only animal that blushes. Or needs to.’

Darwin referred to innate and inherited fears, but a key problem with his argument at the time was that he could not explain how physical or emotional traits were passed down. In fact, the Moravian monk Gregor Mendel was coming up with answers even then. Mendel was working with peas and developing the idea of genetic traits conserved through generations. This is now generally accepted as the mechanism by which evolution works and the idea of genes being passed from parents to children, determining family traits and peculiarities, is a familiar one.

Genes are the template from which we develop. They influence all aspects of our physical and mental well-being, including our appearance and vulnerability to diseases, our intelligence and personality. They are not the whole story and our environment also plays its part. But genes certainly influence the development of the brain’s structure and the activity of chemical messengers involved in our experience of fear. As explored in more depth in the next chapter, our genes could programme our brains to react to danger.

Although it may have taken millions of years for the lumbering progress of natural selection to give the world its incredible diversity of species, Nesse points out that individual traits can change much more quickly. Selective breeding of dogs for their temperament, for example, takes just a handful of generations to produce puppies which are either exceptionally easygoing or frantically neurotic.

But genes may not be our only link to the Stone Age. A chain of people also exists. If we are lucky, we know our parents and their parents and we may be familiar with the two or three, possibly even four generations which preceded us. These generations in turn knew their parents and grandparents and so on back through history. The human links are continuous and it could be that we learn our behaviour from those around us, just as they learnt it from another generation. A kind of cultural rather than genetic transmission of fear could take place.

Humans have passed on information since we could paint on cave walls and tell stories. Today’s films, books and TV programmes may be efficient ways of relaying a fear of ancient threats. When a writer wants to create a threatening atmosphere, a dark night, a few large spiders and a pair of animal’s eyes usually do the trick. Many ancient threats are symbols or shortcuts to fear and the storyteller only has to mention them to create the desired mood. Cultural learning is powerful and flexible and can quickly shape attitudes in an enduring way.

The idea was proposed by psychologist Graham Davey from the University of Sussex, and he set out to test it in relation to fear of spiders. Spiders have been embroiled in European culture since the Middle Ages, when they were thought to absorb poisons and to infect any food they touched. They were seen as the forerunners of disease and death during the Great Plague (the discovery that rats’ fleas carried the disease was not made until the nineteenth century). A form of hysteria called tarantulism was even blamed on the spider and only later found to be caused by too much sun. It was not all bad for the spider – tiny ‘money spiders’ were thought to bring financial good luck and cobwebs were used in traditional medicine to bind wounds – but for hundreds of years, in the main, spiders were thought to be highly dangerous and widely feared.

This thinking was confined to Europe, so if cultural learning is responsible for fear of spiders, Davey reasoned that it should only be widespread in Europeans and their descendants. Observations back him up. In parts of Africa the spider is thought to be wise and local people clean and protect its habitat. Spiders are eaten as a delicacy in areas as diverse as Indo-China, the Caribbean, among the native North Americans and Australian aborigines. Children in Brazil often keep spiders as pets. Hindus in eastern Bengal collect spiders to release at weddings to wish the couple good luck, and in Egypt it is common to put a spider in the bed of a newly married couple.

Researchers found that the incidence of spider fear in Britain is similar to that in Holland and in the US. So far, so good. Many North Americans are descended from Europeans, so this is not unexpected. The incidence in these countries was higher than in India, as predicted. But, strangely, the incidence in Japan, where there is no particular history of spider fear, is even higher, which tends to weaken the argument.

Davey’s central point is that it takes countless generations for the biology of a population to change even slightly. Threats would have had to be extremely dangerous and common, killing people in large numbers, for fear reactions to have become biologically programmed. He says we must not ignore the costs of our reactions. Our ancestors might have been well-advised to keep away from poisonous spiders or snakes, but they had to grub through plants to get food. Too much fear of insects would have led to malnutrition if it made people reluctant to look for food. An infant starting to explore its surroundings might be at risk from strangers and suspicion might be appropriate. But strangers are also likely to help a child in trouble and over-reluctance to approach a stranger could be fatal.

Spiders and snakes may simply have had longer to become embroiled in our culture and inherited learning than modern threats. Guns and electricity outlets have not been around long enough to acquire the symbolic significance that would mark them out as objects to fear. Children may develop fears by absorbing information from the people around them, who are themselves more likely to fear snakes than guns.

Cultural transmission of fear was a bold challenge to the prevailing view that our thought processes are shaped by strong biological links with our ancient predecessors. It suggested that our fears may have nothing to do with our biology and that perhaps our primitive brain was not, after all, programmed over millions of years. It is possible that we have learned them solely through careful observation of those around us.

However, this idea has not caught on. Nobody denies the importance of learning, but some of the most exciting research work is attempting to examine the structure and activity in our brains. It seems most likely that genetic and cultural transmission of information work in tandem. We have evolved with a certain biological background which comes to life only in the context of cultural learning. The tendency to fear may be instinctive or hardwired, irrevocably programmed into us as a species. But personal experience and observation of others may be essential before we develop specific fears.

The idea of flexible learning overlying hardwired fear has been re-explored by evolutionists in recent years. They are delving into aspects of the theory and attempting to test them out in practical, modern ways.




Animal Instincts


One of the good things about being an evolutionist is that you can never be definitively contradicted. Most scientists have their best work overturned within their own working life. They spend time trying to disprove other scientists’ ideas but they in turn are usually overtaken by someone else who contradicts or at least refines their work.

Believing in evolution gives a scientist some respite. Evolution took place over such a phenomenally long time scale that we can never recreate the same conditions and, ultimately, never know anything for certain. It provides a rather luxurious and permanent platform for scientists to stand on.

This does not mean that we have to accept the evolutionary perspective without question. With some lateral thinking, many ideas stemming from evolution theory can be studied scientifically. For example, evolutionists say that we are more likely to fear ancient rather than modern threats. If this is so, it should hold true for people of different races and cultures since we share the same ancestry and should therefore share the same fear programming.

A few small studies have produced some evidence for this. Researchers at a mental health clinic in Bangalore, India, found an incidence of phobias only a tenth of that in the West, a rate similar to that in other Indian communities. However, the vast majority of the phobias fitted the evolutionists’ model. Agoraphobia was the most common, closely followed by illness and social phobias. Animal phobias were rare, which is usually the case in clinics catering for people with the most seriously disabling problems. Scottish work found that more than two-thirds of a group’s phobias were relevant to ancient times. A Sri Lankan study used the same method and came up with virtually identical figures. This provides some backing for the idea that people in different parts of the world are similarly attuned to fear threats in the natural world.

More fundamentally, we cannot apply evolution theory to phobias at all unless we think cautious Stone-Agers were more likely to survive and produce offspring than their fearless friends. Fearfulness should have increased the chances of people passing on their genes to the next generation.

Coupled with this is the demand that ancient threats which still provoke fear today were capable of killing off people in large numbers, or at least reducing their chances of having children.

We cannot easily test this out in humans, but we can look for evidence in animals. Darwin noticed that birds are more ready to fear cats than people, presumably because they are at more risk from cats. More than one hundred years after Darwin, a psychologist at the University of Pennsylvania, Martin Seligman, became interested in how that should be. After all, both cats and people kill birds and it might be as well for the average bird to have a healthy respect for both.

Seligman said that birds are programmed to fear cats but not people. Somewhere in the depths of the bird’s tiny brain lies the knowledge or the instinct that makes them ready to fear cats. By contrast, they are essentially neutral towards humans. Birds may become afraid of humans, but are not likely to fear people unless they have been harmed or hounded in some way. Cats are natural enemies of birds and have killed off swathes of them down the ages.

Seligman said that birds are ‘prepared’ to fear cats but ‘unprepared’ to fear people. He said further that some animals are ‘contra-prepared’ to develop certain fears and never become afraid even if they have repeated bad experiences. For example, pigeons instinctively peck for food and in the laboratory they learn quickly to peck a lighted key if it delivers grain. But if the experiment is set up so that pecking the key prevents them getting grain, they do not learn, and continue pecking at the key even though they never get anything to eat. Pigeons normally have to peck to feed and they are contra-prepared to make an association between pecking and starvation. The hungrier they are, the harder they peck, and it never occurs to them that taking a rest might be the answer.

Similarly, they learn quickly to fly away to avoid a shock but only with great difficulty to peck a key to stop the shock. Again, it makes sense. Hopping or flying away from an unpleasant stimulus is a good idea. Pecking, as a rule, would not help.

Humans may also have degrees of preparedness to develop fears. Watson and Rayner’s experiment with Little Albert (described in the last chapter), showed that he learnt instantly to fear the furry rat, and many other similar objects, after the experimenters startled him with a loud noise while he was playing. He did not take against the scientists conducting the work, who quite clearly deserved it, which suggests he was more ready to fear animals than people. Another researcher gave children common household objects like curtains and blocks to play with, delivered a sudden loud noise, and found they developed no fear at all. In yet another similar experiment, children remained robustly unafraid of a wooden duck.

This may be an important hint as to how phobias develop. The brain’s hardwiring determines how ready we are to become afraid of something. It provides a kind of mould for our fears. Some animals and situations fit it well. Fears of them are instinctive and develop with the least provocation. Seligman initially said that objects or situations which threatened the survival of the species, such as insects, animals, heights or the dark, best fit the mould. Phobias develop without conscious thought, sometimes after a one-off event, and they are not easily extinguished. In addition, the more flexible process of experience, learning and observing others, means that we can become afraid of anything. Modern objects tend not to fit the mould and it takes very adverse circumstances to make us fear them. Phobias of objects can and do develop, but not easily. Seligman rather harshly suggested that people with these fears may have ‘talked’ themselves into it. Fear of cars or guns is unprepared, he says, our brains have no template for it, and it takes effort or severe experience to lodge the fear in our minds. We will return to this point later in the chapter.

For many years there was a fierce debate over whether people and animals were born with fears or developed them later, but in the 1960s researchers demonstrated that laboratory-reared monkeys are not at all afraid of snakes. Monkeys who have spent even a short period in the wild are extremely afraid. It is highly unlikely that all of the once-wild monkeys had had a traumatic experience with a snake, so this was puzzling and it seemed that at least some of the monkeys must have acquired their fear vicariously, through seeing another monkey acting scared – a kind of fear by proxy.

Susan Mineka and colleagues at the University of Wisconsin put a monkey’s favourite treat, such as a marshmallow or raisin, on a ledge behind a transparent box. There was a real or toy snake in the box and the monkey had to reach over the snake to get the sweet. The more afraid the monkey was, the more reluctant it was to stretch over the box, and Mineka found that the fearless laboratory-reared animals grabbed the treat where the once-wild monkeys refused it.

Some laboratory-reared monkeys had lived with their previously wild parents all their lives. This was obviously not sufficient for them to acquire the fear of snakes – they seemed to need some experience for the fear to develop. When the laboratory-reared monkeys were allowed to watch older, wild-reared monkeys cowering from the snake, the vast majority developed the same reaction themselves, within minutes. They mimicked the screen monkey’s behaviour, clutching or shaking the cage, grimacing or threatening.

Mineka then attempted to make monkeys fear flowers or rabbits, objects that could never pose a threat. One video showed a monkey afraid of a snake and another was edited so that the same monkey was apparently afraid of a flower. Fearless young monkeys watched the tapes and afterwards, those who had seen the snake tape avoided snakes, but those who had seen the flower tape remained unconcerned by flowers. It was clearly easier to induce a fear of snakes than flowers. A similar experiment demonstrated that the monkeys were more ready to fear toy crocodiles than toy rabbits.

This is powerful evidence that creatures really are programmed to fear certain things. These monkeys were born in laboratories and had never previously encountered snakes, flowers, crocodiles or rabbits. Mineka and Cook concluded that it was highly likely that the difference in the monkeys’ reactions was somehow in-built, or ‘phylogenetic’. In other words, snakes and toy crocodiles are a better fit for the mould in the monkey’s brain.

Monkeys may not be born afraid of snakes but any sort of demonstration is enough to provoke their fear. It makes sense from the evolutionists’ point of view. Animals may not get a second chance in the wild and mistakes can be fatal. It could be that monkeys that quickly learn to be afraid of snakes or crocodiles have a survival advantage over their bolder companions. They are more likely to avoid these animals and therefore to survive and produce offspring. They will pass on the tendency to fear and, over generations, natural selection would increase the proportion of all monkeys inclined to fear snakes or crocodiles.

Work like this could not be done on people because we would all have experience of any object the researchers chose. But it might still be possible to draw human parallels from the work. Monkeys are not people, but our learning processes are surprisingly similar.

Take a country like Britain, where we have only one poisonous snake, the adder, and virtually none of us has ever seen it. Yet many of us are afraid of snakes. Why? Mineka’s work suggests, if humans are anything like primates, it will not take much exposure to snakes for a strong fear to develop. Monkeys developed permanent fears from watching videos and people probably do, too. We could be watching from a distance as someone else reacts to a snake or, much more likely, see someone shuddering at them in a film or on TV. From a very young age, we learn of Little Miss Muffett being frightened away by the spider, or the farmer’s wife shrieking in terror at three blind mice.

Role models are powerful, especially – according to Mineka – if they are older and more dominant. Her models did not have to be related to the young monkeys but it helped if they knew each other. This suggests that parents or other influential adults – even television and film role models – could pass on their fear to children. Mineka believes that if adults have phobias, they should not confront snakes, spiders or whatever it is they fear in front of children. We might expect it to be a bad thing for parents to blatantly avoid objects or situations, but this study suggests that it is worse for children to see their parents visibly disturbed.

There is a plus side to this work. Mineka found that monkeys can be immunised against developing a fear and learn not to be afraid. A model monkey who was unafraid of a snake made a lasting impression on the naive monkeys. They apparently got the message that snakes are not to be feared and it prevented the later development of fear. If, afterwards, they saw another monkey afraid of the snake, three-quarters of the young monkeys remained fearless. This suggests that adults who show no signs of fear when dealing with spiders or snakes exert a powerful influence on children and may prevent them developing these fears.

Mineka’s work tells a neat story, based around the assumption that snakes and crocodiles were real threats to monkeys and killed them off in huge numbers. Monkeys who were afraid of these animals therefore had a survival advantage. Unfortunately, the evidence does not fully back up the theory. The rhesus monkeys used by Mineka evolved in India, where cobras and other poisonous snakes could have been dangerous. However, there is less evidence that crocodiles would have been a danger. Crocodiles might be feared because of their reptilian similarity to snakes, but this seems rather to weaken the argument.

It partly hangs on how the brain recognises threatening animals or situations. The brain could have a full picture of snake or crocodile irrevocably programmed into its hardwiring. Alternatively, features like smell, sliminess or sudden movements may be what we are on our guard for.

People with phobias often give vivid descriptions of what they fear; the appearance, feel or thought of the animal. Abrupt, jerky, unpredictable movements are frightening. Sliminess disgusts us. Even babies dislike strange, inhuman appearances. Jamie Bennet-Levy and Theresa Marteau in London asked a group of people about rats, cockroaches, butterflies, frogs, rabbits, spiders, blackbirds and other small animals. The volunteers rated each creature for ugliness, sliminess, speed and how suddenly they appear to move. Another group said how afraid they were of the various characteristics and how near they would go to each animal. Not surprisingly, the more harmful the animal was, the more afraid people were and the less prepared to get close. Physical characteristics, especially ugliness, also deterred them. The volunteers in the study said that ugliness was a composition of sliminess, hairiness, colour, dirtiness, number of limbs or antennae, compactness of body and the relation of the eyes to the head. In other words, how different the animals’ appearances were from humans. Touch and sound came into it as well and people hated the thought of a spider running up their leg or in their hair.

Similar work in the Netherlands also concluded that the more animals differ from humans, the more we fear and avoid them. Lack of predictability or control of the animals makes things worse. People are inclined to be suspicious of all things strange and seem ready to fear features of alien species. This suggests that the human brain is set up to notice unpleasant characteristics and probably does not contain a full picture of certain dangerous animals.

It is puzzling, then, that Mineka found monkeys quick to fear toy snakes and crocodiles, which do not have strange smells or movements. Suffice it to say that not even evolutionists can claim that all evidence points the same way.

The inner workings of the brain remain mysterious, despite increasingly sophisticated work such as that described in chapter 4, on neurophysiology. Tracking down the unconscious requires ingenuity and a Swedish group led by Arne Öhman and Joaquim Soares hit upon the idea of using subliminal images. The approach has a certain history. A classic but flawed experiment in the 1950s flashed up a message urging cinema viewers to drink Coca-Cola. The message disappeared so quickly that viewers had no idea their film had been interrupted, but this brief exposure was enough to make them inclined to buy more of the drink. However, the film itself was about food and drink and the results were inconclusive. In any case, sadly for the advertising industry, such tactics remain illegal.

In the laboratory, Öhman and Soares had more freedom and flashed pictures of spiders, snakes, flowers and mushrooms on screen. They recorded skin conductance on volunteers’ hands. It is a measure of arousal in the autonomic system and changes when people have any sort of anxiety reaction. Volunteers responded to the sublimal pictures. For example, people with spider phobias reacted more strongly to pictures of spiders than anyone else. They did not know what they had seen but nevertheless had a physical reaction. Like the cinemagoers who suddenly had an urge to drink cola, the volunteers unconsciously registered the picture they had seen.

The researchers then tried to make the volunteers artificially phobic and gave their finger an unpleasant electric shock as the flashed pictures appeared. Some received the shock when they saw the snake picture, others when they saw the spider, flower or mushroom pictures. They all reacted to the picture paired with the shock.

Volunteers then saw the flashed pictures again but without the shock. Responses to flowers and mushrooms were eliminated but responses to snakes and spiders endured. None of the students had any conscious idea what they were reacting to, but responses to snakes and spiders were consistently more resilient than those to flowers and mushrooms. It implies that the unconscious can somehow pick out fearful stimuli.

By the time we recognise a spider or snake, our unconscious is already generating a rising tide of arousal which puts us on red alert, said Öhman and Soares. This heightened awareness makes us more likely to feel defensive and afraid. Phobics cannot control their fear voluntarily because the initial reaction is unconscious and under the control of deeper, ancient parts of the brain.

These exciting results encouraged the researchers to look at another type of danger: threatening human faces. Threats from predators such as snakes are important to the most primitive creatures and defences would have evolved early. Social threats affect more sophisticated creatures and would have evolved much later. Therefore the relevant information may be processed in the higher brain, the cortex, which carries out more complex functions and developed late in evolution. This ties in neatly with Darwin’s earlier assertion that blushing developed comparatively recently.

The cortex has left and right halves with different functions. If social submissiveness is processed in the cortex, our reaction may depend on where the human face is when we see it. Negative emotion and perception of faces are believed to be processed in the right hemisphere in right-handed people. Information from the left side of someone’s visual field is also processed in the right hemisphere. If someone sees an angry face in their left visual field and the information goes straight to the hemisphere adapted to process it, they may react more vigorously than if the information is sent to the other side of the brain. There are lots of ifs here, but volunteers did react more strongly to a flash picture of an angry face when it was shown to their left rather than right visual field.

If fear of small animals is processed by the oldest parts of the brain, deep down where there is little difference between right and left sides, there ought to be little difference whether the slides are shown to the right or left visual field. This turned out to be true. People’s reactions were similar, regardless of where the slides were flashed up, which supports the idea that this reaction developed early in evolution.

Information on ancient threats is processed first by ancient parts of the brain, according to Öhman. Colour, texture, smell or type of movement may be sufficient to trigger this automatic response and we react immediately and instinctively. We may even have special pathways in the brain for transmitting information about ancient threats, pathways which existed before sophisticated reason and logic and which are physically distinct from those carrying conscious thought. This ancient reaction can produce a groundswell of emotion which colours our thoughts even before the higher brain has engaged and started to make us aware of a potential threat.

Like Seligman, Öhman suggests that responses to ancient threats are easier to establish and harder to extinguish than responses to unnatural or modern cues. It certainly provides a neat explanation for the reactions that may underpin many phobias. The reality is, unfortunately, less straightforward and Öhman’s results have proved fragile. There are many detractors, and even some supporters of the theory have been unable to come up with the same answers.

An American group led by Edwin Cook, himself an advocate of evolution theory, set out to repeat some of Öhman’s work. They used a similar set-up and were surprised to find that reactions to spiders and snakes were as easy to induce as modern fears of guns. It was also equally easy to eliminate them. In direct contrast to Öhman’s predictions, reactions to spiders disappeared as quickly as reactions to guns.

Cook used an unpleasant noise rather than an electric shock, so his volunteers received no tactile stimulus. When he added a vibratory stimulus to the hand, his experiments started to distinguish between modern and ancient threats, but the results were unconvincing. There was still no difference in acquisition or extinction of fears, though Cook found an increased heart rate associated with spiders or snakes and not guns.

When Cook followed Öhman’s protocol to the letter, he confirmed that fear of ancient objects was more resilient than that of modern threats. But the difference was slight. Overall, Cook’s work provided only flimsy support for Öhman and also raised questions about the relevance of some features of the experiment.

Cook was not the only one to have trouble replicating Öhman’s work. An American duo, Richard McNally from Chicago medical school and Edna Foa from Pennsylvania, changed mushrooms for strawberries in Öhman’s experiments. This was enough to eliminate differences in reactions to threatening and non-threatening objects. Even people who were phobic of snakes or spiders before the experiment reacted to strawberries just as strongly.

Perhaps the greatest disappointment to advocates of the theory is that it has little impact in the phobia clinic. Despite the predictions of Seligman and Öhman that fears of ancient threats are more easily acquired, more deeply ingrained and harder to reverse, this seems not to be the case. The Scottish and Sri Lankan studies mentioned earlier both found that the vast majority of phobias in these two quite different countries are related to ancient threats. However, neither study linked phobias of ancient threats to more severe impairment. Zafiropoulou, who led the Scottish study, said that success of treatment was unrelated to the type of phobia and suggested that the concept of phobias as vestiges of our ancient past is little practical use.




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