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Sensitization: The Simple Cause of So Much Nervous IllnessIf nervous suffering has led you to this book, you may have picked it up with both hope and doubt. Possibly you have tried so hard to recover in the past and have—as you think—let yourself down so often that you may hesitate to trust yourself to try again. Perhaps you have been ill so long you suspect you are beyond help. Small wonder doubt is mixed with hope. And yet, I assure you, however often you may have failed in the past, however long you may have suffered, you can recover.
Perhaps, like so many of my nervously ill patients, you have no personality defect making or keeping you ill; indeed, you may have no particular problem except finding the way to recovery. Many of my patients were happy in their home life and at work until they became ill. They then became afraid of the state they were in, of the way they felt—not only of what was happening at the time but also of what they feared might yet be in store. Without realizing it, their nerves had tricked them, duped them.
TRICKS YOUR NERVES PLAY
Through the years I have seen every shade of every trick my patients’ nerves have played upon them; I saw how easily, how unwittingly, many were led into nervous illness, and because of this I want to open your eyes to the way your nerves could now be tricking you.
We should know there are three special pitfalls that can lead to nervous illness, and above all we should know how to cope with them. The three pitfalls are sensitization, bewilderment, and fear. Sensitization is a state in which nerves are conditioned to react to stress in an exaggerated way; that is, they bring unusually intense feelings when under stress, and at times with alarming swiftness.
There is no mystery about sensitization. Most of us have surely felt it in a mild way when we have been working under pressure and our nerves have become alerted to respond too quickly, too acutely, to situations that would, at other times, leave us unmoved. When mildly sensitized, we may be irritated by those near us, impatient with driving home in heavy traffic or waiting for the evening bus. We continue working, driving, traveling, however, and these feelings will gradually pass.
On the other hand, severe sensitization can be upsetting indeed. Besides feeling painfully edgy and agitated, a severely sensitized person may feel his heart constantly beating quickly, “missing” beats, or thumping; he may have recurring attacks of palpitations; he may feel his stomach churn—especially on waking in the morning or after an afternoon nap. His hands may tremble and sweat. He may have difficulty expanding his chest to take in a deep breath and may—in the words of one woman—gasp and gulp for air. He may complain of a lump in his throat which seems to interfere with swallowing solid food, or he may have weak turns. He may suffer from headaches—a feeling of weight pressing on top of his head, of an “iron band” around it; giddiness; or a sensation of lurching, swaying, or of being pulled to one side while walking.
Most alarming of all, panic may come so easily and swiftly that the slightest shock may bring it: perhaps no more than the unexpected sound of a slamming door. More bewildering still, panic may come for no apparent reason. Although these are no more than the usual symptoms of stress exaggerated by sensitization, the sufferer rarely recognizes them as stress symptoms. He thinks they are unique to him, that no one could have possibly suffered this way before.
SUDDEN SENSITIZATION
One need not be a special type to become sensitized. Quite severe sensitization can be suddenly and unexpectedly thrust upon any one of us at any time. It may follow the stress of a physical shock to our nerves, such as an exhausting surgical operation, a heavy hemorrhage, a difficult confinement, an accident, and so on.
For example, when severe sensitization follows a surgical operation, the simplest postoperative routine—such as a finger prick for a blood count or the dressing of a wound—can almost reduce its victim to tears. Any frustration, perhaps no more than waiting for the doctor to arrive, may bring intense agitation and make nerves feel so taut that a sudden noise jars painfully. Also, panic can follow the slightest anxious thought: hence the necessity to understand sensitization and know how to cope with it.
A retired nursing sister who had been in charge of a surgical ward for years said recently, “If I had known more about sensitization when I was nursing, how much more understanding I could have given my patients.” At that time she was sensitized herself.
GRADUAL SENSITIZATION
Of course, severe sensitization can come about more slowly. It may gradually accompany continuous domestic stress, too strenuous dieting, a debilitating illness—anything that puts nerves under stress for a prolonged time. The stress need not necessarily be unhappy. An actor constantly alert to give his best performance may become quite sensitized, especially if he neglects sleep and food.
THE PATTERN IS LIMITED
Since the symptoms of sensitization are the symptoms of stress, they conform to the usual pattern of stress symptoms. This pattern is set, limited, because nerves under stress always release the same chemicals, which act on the same organs and always produce the same results. It comforts a sufferer to learn that the pattern of his suffering is limited and that he has probably already experienced the severest symptoms his nerves can bring. I have seen this information alone cure some people. Because their body had brought them so many surprises in the past and had, as they thought, let them down so badly, they were constantly worried about what further surprises the future might yet hold.
HOW NERVES NORMALLY FUNCTION
When we say someone is suffering from nerves, we do not only mean nerves are stimulated to bring certain symptoms, but we also imply that nerves have “gone wrong” and are somehow at fault. Actually they are responding faithfully and physiologically to the messages sent to them. To be cured one should understand this, and to do so it is essential to know how nerves normally function. Although I described this in detail in my earlier book, Hope and Help for Your Nerves, it is necessary to repeat the description at least briefly here.
Our nervous system consists of two parts: voluntary and involuntary. By means of our voluntary nerves we move our muscles (hence our body) more or less as we wish. These nerves obey our direct command, so we call them voluntary. The involuntary nerves help our glands control the functioning of our organs—heart, lungs, bowels, and so on. Unlike the voluntary nerves, we have (with a few exceptions) no direct control over them—hence the term “involuntary.”
The involuntary nerves themselves consist of two divisions, sympathetic and parasympathetic. In a peaceful body these two hold each other in check. If we are emotional, however—afraid, angry, excited, agitated—the sympathetic usually dominates the parasympathetic, and we are aware of certain organs functioning: We may feel our heart race and pound, we may breathe quickly, our hands may sweat, and so on. Sympathetic nerves produce these reactions mainly by means of a chemical called adrenaline, which is released at the nerve endings in the organs concerned.
Normally when afraid, we accept our racing heart, rapid breathing, even the spasm of fear in our “middle,” because we know that when the cause of the fear goes, these reactions will also pass. Our feelings calm because we no longer think fearfully. Changing mood (attitude) is the only conscious control other than medication we have over our symptoms of stress. I emphasize this because understanding it is of paramount importance in understanding recovery from so much nervous illness.
BEWILDERMENT AND FEAR
Now I come to a point I wish to highlight: The symptoms of much nervous illness are no more than the symptoms of stress exaggerated by severe sensitization. One might well ask, What is the difference between severe sensitization and nervous illness? When do we say someone is merely sensitized and when nervously ill? And how does he pass from sensitization to nervous illness?
We say a person is nervously ill when sensitization upsets him so much that it interferes with his way of life. Someone who has never been sensitized might well then ask, What keeps a person sensitized long enough for this to happen? And this is a good question, because it brings us face to face with those other two culprits previously mentioned, bewilderment and fear.
Bewilderment and fear keep sensitization alive. Bewilderment acts by placing a sensitized person constantly under the strain of asking himself, What is wrong with me? Why am I like this? The more he struggles to be the person he was, the more exasperation, the more tension, and consequently the more stress he adds. His failure to find a way out of this maze makes him feel incapable of coping with any future course his illness might take, and he vaguely sees himself being “taken away somewhere.”
While he feels in his bewilderment that he cannot direct his thoughts and actions adequately, he stands especially vulnerable to, and defenseless before, fear, which can overwhelm him before he has time to reason with it. It is the stress of bewilderment and fear continually being added to the stress of the original sensitization that keeps this sensitization alive and keeps its symptoms so severe. The sensitized person puts himself in a cycle of fear-adrenaline-fear. In other words, his fear of the state he is in produces the adrenaline and other stress hormones, which continue to excite his nerves to produce the very symptoms he fears. The fear-adrenaline-fear cycle is also called an anxiety state.
So many of the people who have come to me for help have had no particular problem or no cause in their subconscious either creating their illnesses or keeping them ill. Their main difficulties were finding the way to recovery and trying to meet responsibilities that because of illness seemed beyond them. They had been tricked into illness by those three bogeys, sensitization, bewilderment, and fear.
THE HABIT OF FEAR
In my opinion, too much time is spent and too much suffering is caused today by unnecessary searching for deep-seated causes of nervous illness when so often none exist. It is not enough to be told that such and such happened when one was young and that this is why one is nervous now. Whatever may have originally caused the illness—and in my experience it is by no means as often a childhood cause as is commonly believed—present sensitization remains. The habit of fear is the important thing now. This must be cured.
A woman from America wrote:
I saw a doctor four years ago, but out of sheer frustration, I quit. He did nothing but continually rehash the past. All I seemed to hear was that my mother left me to the maids and my father didn’t love me either. I have been told over and over again that lack of love caused my acute phobias, but never how to handle the fears themselves, especially fear of leaving home alone. I have repeatedly asked for help to deal with today, with the acute and constant fears and awful physical feelings I have. It seems all I’ve been given to live with is “but if” and “if only.”
This is not an isolated cry. It comes from many. Until the importance of straightforward sensitization is recognized as a possible cause of nervous illness, our present rate of cure will not improve as much as it otherwise would. I stress again that so much nervous illness has no deep-seated cause and is no more than severe sensitization—perhaps accidentally acquired—kept alive by bewilderment and fear.
The nervously ill person is forever questioning not only himself but also others. Too often the answers are so unsatisfactory that he loses hope of ever finding the explanation he craves, especially if he has been ill for long. Should you be suffering like this, you need a full explanation of what is happening to you. You also need a program for recovery, and that is what I offer in this book.
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Fear of Leaving the Safety of Home (Agoraphobia)
“Agoraphobia” literally means “fear of the marketplace,” an abnormal fear of being in open or public places. In medical practice it refers to fear of leaving the safety of home either alone or in company. It is a much more crippling fear than claustrophobia—fear of enclosed places.
Until recently few people had heard of agoraphobia; even some doctors did not know the term. Four years ago, I accompanied a patient to see an ophthalmic surgeon of many years’ experience. I explained to him that the patient suffered with agoraphobia and mentioned the possible temporary effect of the tension on her vision. He listened politely, but when we were leaving, said, “I don’t believe in this illness you call agoraphobia. It doesn’t exist!” Since then there has been much publicity in England about the housebound housewife (suffering from agoraphobia) in newspapers and magazines and on radio and television; I doubt if that surgeon would say the same today.
It is possible this particular phase of nervous illness received so little attention in the past because an agoraphobic person often feels too self-conscious about his fears to discuss them even with a doctor. It is not easy for a woman to confess, especially to a man who she thinks may be unbelieving (as was that surgeon), that she is afraid to go to the supermarket alone and must either take a child with her for protection or send the child to do the shopping. It is just as difficult for a man to explain that he prefers to stay in a subordinate position at work because he cannot face taking a higher position that would mean traveling from city to city when he finds it so difficult to leave his own town.
This fear is not only difficult to explain to others but also difficult for the sufferers to understand themselves. Most of them used not to be like this, and they look back now in amazement at how freely they could once travel. This is why they think their illness is peculiar, something to be ashamed of, and why they are so surprised when they learn that many sensible, even notable, people suffer just as they do. After I have spoken about agoraphobia on radio or television, the studio switchboard is frequently jammed with incoming calls from people who have heard themselves and their fears described for the first time. Acknowledgment that the origin of their illness could be simple, the detailed description of how they feel, and especially recognition of the importance of their fear of fear are the reassurance they had been wanting for so long and had despaired of finding.
THE SAFETY ZONE
The sufferer from agoraphobia does not really think some particular place holds a special danger for him and that something there will harm him. He is afraid of how he will react when in a certain situation. He has become so sensitively aware of what happens within himself at the slightest stress—of how he panics, feels weak and giddy, and so on—that he lives in fear that these feelings will arise in places where he thinks he will be unable to cope with them and where he may consequently make a fool of himself in front of others. So the housewife clings to her home and the executive to his own hometown. They cling to their safety zone. This is why the nervous person sits at the back of the school meeting, on the aisle at the cinema, near the door in the restaurant—so that he can slip out quickly and unnoticed if he feels one of his turns coming. He specially dreads being in an airplane, a train, any vehicle he cannot stop and leave at will.
The interest aroused in agoraphobia today has led to surveys being made—principally in the British Isles—of groups of agoraphobic sufferers with special regard to cause and results of treatment. In my experience the cause in most people has been easy to find. Often agoraphobia begins with an unexpected attack of palpitations, giddiness, or perhaps weakness—a feeling of collapse—while the person is out. Frequently it has followed a sudden, unaccountable attack of severe panic. The basic cause of these attacks has usually been fatigue or some other form of stress, following a variety of experiences—difficult confinement, debilitating illness, and so on. Occasionally there is no obvious reason, and happily I have rarely found disclosing an original cause of agoraphobia essential for cure.
It will surely be appreciated how easily a housewife can be frightened by an attack of palpitations and then become afraid to venture far from home for fear of having a “heart attack” while out. Anything unusual to do with the heart is upsetting, and a sudden attack of palpitations can be alarming, especially if it comes when a person is alone and away from home. If the sufferer has more than one attack, she may be convinced there is something radically wrong with her heart. If she goes immediately to a doctor who reassures her that the trouble is “only nerves” and helps her to become reconciled to having an occasional attack until her health improves, all may be well. If she does not accept his reassurance, however, she may be constantly worried about her heart, especially if she has further attacks, and may be especially afraid the palpitations will come when she is where she cannot get help readily. Hence she develops a growing reluctance to move far from the house.
A lecturer, afraid of having an attack of palpitations while speaking before an audience, gradually lost so much confidence he would not speak unless his wife was present. This is not as childish as it sounds because he was most likely to have an attack when apprehensive, and he was most apprehensive while lecturing. His wife’s presence gave him a feeling of support which allayed his fear.
If a housewife, afraid of heart attack (as she wrongly diagnoses palpitations) or of a weak turn or of panic, manages to walk as far as the supermarket, how natural, when faced with waiting in the check-out line, for her to be suddenly smitten with the thought, “What if I had a turn now?” Fear and tension can quickly agitate a sensitized person, and the feeling of vulnerability that comes with agitation will soon convince her that her symptoms could build up into one of her spells. This results in her eventual decision to avoid the supermarket or to find someone to shop with her.
NO RESPECTER OF SEX
More women than men suffer from agoraphobia. A woman’s life at home lends itself to the development of agoraphobia. There are agoraphobic men, however, and they, as mentioned earlier, whereas accustomed to leaving the house daily, usually show their illness by refusing to leave their own town. Many a deputy chief would be chief today were he not afraid of the traveling involved in seniority. I call this the citybound-executive syndrome.
Symptoms are no respecter of sex. A nervously ill man complains of the same symptoms as a nervous woman: palpitations, weak turns, giddiness, trembling, panic. These symptoms are not as “feminine” as one has been conditioned to think. They are the symptoms of stress and therefore experienced by men and women alike.
Weak spells are just as upsetting as palpitations. If the sufferer panics while out because of having a weak spell, she may feel so exhausted that she is sure she can go no further and must return home. How quickly those weak legs move when once headed toward the house, though. If instead of returning home, she tries to fight her way forward or by grim determination she stays in the supermarket (or any other place), mounting tension may so stiffen her muscles that she may feel locked in tension and stand “paralyzed,” holding on to the nearest support, unable—so she thinks—to move. She especially dreads a big emporium, where the crowd, heat, noise, and the absence of a place to sit seem to invite that faint feeling.
THE PAVEMENT SEEMS TO HEAVE
Giddiness is especially dreaded, and the sufferer is not so easily convinced that such a disturbing physical sensation can be caused by nerves. One woman said, “When I am overtired, I get giddy, and I’ve still got to convince myself the giddiness is only fatigue because when I am tired, it’s hard to convince myself of anything.” The thought of a brain tumor may haunt a woman who suffers from giddiness. Even if finally persuaded that nerves are the culprit, she finds walking down the street difficult, for the pavement seems to heave, the shops to topple. Nor is it easy to stay in the supermarket while the goods on the shelves seem to sway. In addition, tension may affect her sight, so that from time to time objects appear blurred and the distant view is covered with a shimmering haze.
Surely it is not difficult to understand how this woman, having these experiences, gradually comes to prefer to stay at home or take someone—even a child—to shop with her. If she takes a child, it may not be long before she becomes afraid the child will notice her peculiarities and see her “like this,” so she may postpone shopping until her husband can accompany her.
EXPOSING A CHILDHOOD CAUSE IS RARELY HELPFUL
An important part of treatment lies in showing a sensitized woman or man how to cope with the exaggerated symptoms of stress, particularly panic, so that they gradually desensitize themselves and, if agoraphobic, are no longer afraid to be alone, travel alone, be surrounded by people, or take the strain of waiting in line. As I said earlier, finding a childhood cause for present illness may be interesting, but it rarely helps cope with the present condition, especially if the sufferer has been ill a long time.
A happily married woman who had suffered for years from agoraphobia was told by an analyst that her reluctance to go out alone was based on a subconscious fear of becoming a prostitute: however, this woman had begun to have faint spells while driving a munitions wagon during World War II and naturally lost confidence in driving alone. The cause of her spells was probably fatigue. She had certainly not had enough rest or food. It was obvious from her history that the attacks she had later, during the years that followed, were induced by memory and fear of having a turn where she could not get help or where one would be humiliating or dangerous—in a crowd, driving a car, and so on. The orbit within which she could move gradually became so restricted that she could finally drive only a few miles from home, could not enter a big store alone, and could go on holiday only if accompanied there and back by a doctor. Naturally, she and the family took few holidays. She was finally taught by an explanation and encouragement how to cope with her fears. Part of her story, written by her, is in Journal 8.
SO CONFIDENT ON MONDAY, SO DEFEATED ON TUESDAY
So much depends on a doctor’s ability to explain why, when the patient is feeling better, a setback can come for no special reason—at least none that the patient can see—and be so immediately devastating, as if no progress had been made; why symptoms thought forgotten can return so acutely after months of absence; why all the symptoms can appear, one after the other; why panic can come “out of the blue”; why such demoralizing exhaustion can so rapidly follow stress; why, despite the right attitude, sensitization may linger on for such an unexpectedly long time; why, when the patient returns home after being especially successful, it may seem as if no success had been achieved and why going out the next day can be as difficult as ever. The “whys” seem countless. Unless a doctor has the necessary understanding, his advice may only induce pessimism. An agoraphobic woman wrote about herself and her fellow sufferers, “If unmarried, we may be patted on the back and told we will be better when married; if married, that having a child will fix us; if middle-aged, that it’s ‘the change’!”
TO BE AFRAID IS SO HUMAN
During interviews on radio and television I have been surprised at the intensity with which some of my colleagues have defended their belief that the anxiety state, including agoraphobia, is due either to some deep-seated cause, often thought to be subconscious, or to some character inadequacy, and that the illness can be cured only if these causes are found and treated. Severe sensitization, however, as already pointed out, can come to any one of us, at any time. To be bewildered by, and afraid of, its acute and baffling symptoms is so human, so natural, that it is difficult to understand why the many people who respond this way should be thought inadequate and different or why finding some deep-seated cause should be thought essential. Sudden severe sensitization can be so shocking that confidence can be quickly shattered, and one does not have to be a dependent type—as I have sometimes heard these sufferers described—to be so affected. If some nervously ill doctors can, with their medical training, fail to understand sensitization or know how to cope with its effects on themselves (and I have seen this), why should a layman be expected as a matter of course to be wise enough to do so and to be philosophical about it in the bargain?
Fear is one of the strongest, most disagreeable emotions we know; is it so inconceivable one could be afraid of it for its own sake? Must there always be a cause for fear other than fear of fear? Why cannot fear of fear, when it flashes almost electrically—as it does in a sensitized person—be a cause in itself? It is, you know.
Far from being dependent types, many nervously ill people, although unable to understand what is happening, show great courage with independence fighting their fears, often with little help or sympathy from their family. One woman telephoned recently and said, “Could I possibly have a copy of the journals by the weekend? My husband has said at last that he will read them!” Another woman said, “My husband is much kinder now he knows men suffer this way as well as women!”
A teacher, an intelligent woman, would not remain in a shop unless she clasped in her hand a toy car to remind her of her own car parked nearby, should she feel forced to leave in a hurry. When I mention this woman, listeners are often amused. It is because of such anticipated ridicule that sufferers from agoraphobia are frequently reluctant to confess it, even to their family and friends. Also, whereas a husband may begin by sympathizing with his wife, he may eventually become irritated, critical, and finally desperate at the inconveniences the illness brings. And yet the wife will struggle on heroically, understanding these difficulties only too well and feeling desperately guilty because of them.
PLANS ARE MADE, BROKEN, REMADE, REBROKEN
Contemplating taking an agoraphobic wife on vacation is especially frustrating and exhausting. One minute she says she will go, the next that she cannot make it; so plans are made, broken, remade, rebroken. Reservations are made and canceled several times, with many a deposit forfeited in the meantime. No small part of a husband’s frustration lies in his swinging from optimism at some apparent improvement in his wife’s condition to disappointment when she slips into a setback, usually for no reason that makes sense to him.
INABILITY TO FEEL LOVE
The wife also has her share of frustration, especially if, because of weariness or lack of interest, her husband fails to give the cooperation she craves. She feels this acutely because frustration, like so many of here motions, is exaggerated by sensitization. She may think he is wittingly uncooperative, and in a moment of despair, thinks she hates him. Indeed, she is sometimes bewildered by the depth of her antipathy and resentment. Although she knows the old love must be there, she cannot feel it. She thinks in confusion, “What is reality, my present dislike or my old love?” She is especially frightened because she feels the dislike so convincingly. One wife wrote, “It is as if I am just about to see through a mist of unreality but never quite make it. I don’t know if I really love my husband, because I see him now as another person, not the man I married.”
Another woman said, “D., who used to be such a marvelous help, has reached the stage of ‘do it yourself,’ and I don’t get much help from him now. If I have a spell during the night, his pat solution to the whole thing is, ‘Roll over and go to sleep!’ Doesn’t he know by now that if I could roll over and sleep, I would?”
