For years Manhattan Poet Joel Oppenheimer, now 47, took exactly the same route from his Greenwich Village apartment to his local bar, the Lion's Head. One day he tried a more circuitous route, walking along different streets. Midway to the bar he broke out in a cold sweat, suffering from heart palpitations, jelly legs and vertigo. "I had no control over my body," he said. "It was total panic."
Diagnosis: agoraphobia, the most common and disabling of all the phobias, one that may afflict as many as 2.5 million Americans—85% to 90% of them women. Classically known as "fear of open spaces," agoraphobia is actually a cluster of different fears, all amounting to intense anxiety about panicking in unfamiliar situations. Crowds are no protection; Oppenheimer suffered one attack while surrounded by 55,000 fellow Met fans at a playoff game. Severe agoraphobics stick to familiar routines and rarely venture out alone. When they do travel, they usually bring along a friend, child or dog as a prop. "For years," says Oppenheimer, "I was terrified of a new bed, chair, bar, room or restaurant."
Specialists disagree about the causes of agoraphobia. A few doctors think it may stem from hormonal imbalances or overuse of stimulants, even coffee, but most experts are sure the affliction is a psychic one. Freudians consider it a neurotic symptom. Many psychologists see it simply as learned behavior: a patient has an initial breakdown so traumatic that it leaves him in a constant state of anxiety over a possible recurrence, thus producing the phobia.
Therapists also differ widely about how the condition should be treated. The most common technique is behavior modification; its use is based on the assumption that agoraphobia is a habit to be broken. Treatment consists of gradually exposing the phobic patient to feared sit uations, first by having him imagine them, then by forcing him, for instance, to take longer and longer solo walks until the stress disappears. A more drastic technique, similar to throwing a baby into a pool to teach it how to swim, is known as "implosion"—a patient might be driven to a large empty field and left there for hours to cope with his fears. The theory is that terror drains away once it is faced directly.
One problem is that behavior modification works better with specific limited phobias—say, of dogs or birds—than with the generalized panic of agoraphobia. Says Dr. Claire Weekes of Sydney, Australia, a specialist in agoraphobia: "Agoraphobia is not a true phobia. It's one phase of an anxiety state." Weekes, author of Simple, Effective Treatment of Agoraphobia, has treated 1,200 agoraphobics in person and 4,000 more with records, tapes and letters. In her opinion, behaviorists are on the wrong track when they train agoraphobics to avoid panic. Says she: "Recovery lies in the attack itself and learning to cope with it. If you teach people to avoid panic, when it comes, they fall apart and relapse." Her advice: "float" with the anxiety attack, don't fight it.