Agoraphobia

Introduction

Since the late 1970s, there has been a surge of interest in agoraphobia and panic among clinicians, and publications on the subject often begin by drawing attention to its contemporary prevalence. Agoraphobia is described by clinical researchers as one of the most common – as well as distressing – phobic disorders encountered. The significance of phobic anxieties for contemporary life has not gone unnoticed beyond clinical circles, and different disciplinary perspectives have helped shed light on the experience and meanings of agoraphobia. As this article shows, feminist geographers have made an important contribution to such studies, particularly through their insistence on rethinking boundaries and relations between gendered bodies and environments.

Definitions and Background

Contrary to popular opinion, the condition of agoraphobia actually relates to public and social, as opposed to open spaces. Although such widely held misconceptions are supported by dictionary definitions of the disorder, notes on the term’s origins explain its derivation from the Greek agora or marketplace, providing substantial clues as to the realities of the condition for its many sufferers. It is precisely such populous gathering places that agoraphobics avoid to this day.

Clinicians’ descriptions and diagnostic criteria have continued to evolve since the first usage of the term agoraphobia in 1871 by German psychiatrist Karl Otto Westphal. Current definitions tend to be drawn from the American Psychiatric Association’s Diagnostic and Stat istical Manual of Mental Disorders. Here, the clinical features emphasized involve persistent anxiety, repeated experience of panic attacks (discussed below), and avoidance of places associated with the onset of these attacks.

Prevalence

Exactly how many sufferers there are is a matter of some debate, and estimates range from between 6 per 1000 and 6 per 100. It is widely agreed, however, that the vast majority of agoraphobia sufferers – almost 90% – are women. For all those who develop agoraphobia, the onset tends to occur between the ages of 18 and 35, and the condition tends to be chronic. Many sufferers attest to the fact that one can never be entirely cured from agoraphobia, but must rather learn to cope with it on a continuing, daily basis.

Causes and Treatment

Clinical research on causes of agoraphobia has not been conclusive, but there is evidence that higher than usual levels of stress and events that undermine the person’s sense of safety tend to be experienced prior to its onset. In terms of treatment, reviews of recent literature suggest that a multifaceted approach capable of recognizing and tackling each problematic aspect of the disorder is most likely to be successful. For example, programs of cognitive therapy to unsettle harmful patterns of fearful thoughts can be combined with behavioral therapy, involving gradual exposure to avoided situations, and drug treatments that target physiological symptoms of anxiety. Approaches documented in clinical literature thus acknowledge much of the disorder’s complexity, but representations tend to be simplistic in certain important respects, and the model of the subject employed tends to be somewhat philosophically naive. Also, while recognizing that agoraphobia is socially and spatially mediated, understandings of what this might mean for sufferers and how social and spatial theory might be of benefit are, as one might expect, limited.

A small number of nonclinical studies have argued that some of these limitations might be at least partially rectified by the careful inclusion of sufferers’ own voices (conspicuously absent from clinical accounts) and resolved further with reference to a sympathetic theoretical perspective. Arguably, geographers – informed by feminist, philosophical and sociological theory – are particularly well placed to refine and improve existing definitions of agoraphobia. Employing a more spatialized and experientially influenced perspective, geographers can better account for and understand the mutually constitutive nature of person/place relations, and the implications of these relations for emotional health.

Embodying and Theorizing Agoraphobia

Managing Social Space

Gendered Boundaries