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The patients who were diagnosed as cases of “phobic reaction” were those who were either in a “phobic stare,” generally fearful of everything with continuous shifting fears, or who presented “true” phobias. The latter, complaining of one or more specific phobia, came for help only because the dreaded object or situation could no longer be avoided.
Phobias and phobic states were numerous in both groups. The phobic state pertained more to a generalized fear of venturing into certain situations while the phobias singled out certain specific objects or situations as evocative of great fear. Phobic states rode on waves of anxiety attacks. One observed, however, that even after the acute phase of the illness has passed (with the patient declaring himself “well”) one or two phobias continued to persist. It turned out that these remaining phobias had been there long before the illness but had never been an object of concern to the patient. Other phobias were mentioned accidentally or casually during treatment, causing hardly any discomfort and, at most, only a bit of embarrassment or amusement.
In other instances, even though the patient’s behavior had clearly indicated a great fear of death, he had not been aware of it, as such. One patient postponed a gall bladder operation several times. He first prepared a will, visited relatives he has not seen for some time, wrote long overdue letters. Then he took a trip outside Manila. Agreeing finally to the operation, he asked that a particular room in a particular hospital be assigned to him, otherwise he would not submit to surgery. It was only in retrospect that he saw the meaning of his actions.
Patients associated death with separation from loved ones or would see it as a form of terrible punishment for past misdeeds. The first thought of a mother was that of concern over how the children would fare if she died. They generally felt that husbands would do rather well and most likely would remarry. Men worried about how their families would fare materially. Aside from this worry about how the, prospective survivors would fare, there was the sad thought of being completely alone and separated from loved ones. The idea of being alone, from the moment of death on, was enough to strike great fear in their minds.
The thought that death must be a punishment for past misdeeds did not occasion a deluge of guilt feelings. Rather, it seemed to be a logical possibility to entertain. Patients said there are only two reasons why God sends suffering to a person: to punish him or to test him. It was more difficult to empathize with the idea of being “tested,” hence, the tendency was to think that God is probably displeased about something.
The fear of being alone approximated near-panic reaction. Again, when the patient improved and felt well, it was often revealed that the phobia had always been there but caused no anxiety. The state of being alone had been unconsciously and successfully avoided by being with someone all the time. At the height of the illness, the presence of a companion did not always completely remove the apprehension. The fear of being alone was rationalized as fear of absence of help if something dreadful should happen. Thus, it was also related to fear of collapse, illness, and death. Sometimes, the fear was modified to pertain only to being alone in a specific situation such as fear of going out alone, fear of riding the bus or jeepney alone, fear of going downstairs or upstairs alone, or fear of sleeping alone. One housewife was afraid to be left alone awake at night so she would never allow her spouse to sleep ahead of her.
Six women came for sexual phobias (fear of sexual intercourse). Four of them were young women, married for about three to four months, in whom sexual penetration by the male organ could not be accomplished. They had all been seen and examined by gynecologists; two had undergone dilatation or hymenectomy, procedures which were met with great emotional resistance by the patients. Two of the patients, in their early forties, felt a great repulsion for any physical contact with the husband. The sexual approach of the husband in these six cases was met with great fright and panic-like reactions to the point of screaming and fighting.
Therapy revealed instances of displacement of the sexual phobia to something else during or prior to sexual intercourse. Two women could not perform the sex act unless they were sure the windows and doors were unbolted. Three had greatly exaggerated fear of noises, at the same time listening intently for such disturbances. Thus, one woman would turn off the air-conditioner in order to be able to detect any sound from the outside. A few were unable to go through the sex act unless certain inordinate rituals of cleanliness were carried out first. These ranged from insistence on bathing before the act, changing the sheets and pillow cases, and in one case stipulating that the husband should never wear his pajamas outside the bedroom. There were some women who were very upset when the husband wanted sex when the sheets and pillow cases were newly changed and she herself had just taken a bash. It was also not uncommon to have adverse reactions such as nausea, in- creased tenseness, etc., to certain forms of foreplay such as fellatio or breast play. One woman, from extreme tenseness, laughed and giggled throughout the sex act. Since these reactions and attitudes were particularly related to the performance of the sex act, they represented derivatives of the sexual phobia. While there was no fear or anxiety to merit calling each case as such, such attitudes do suggest existence of underlying fears.
A brief phobic reaction to a street following a specifically traumatic incident related to that street was recounted by four women. In one, the particular street was associated with the husband’s infidelity. In the second case, the woman while riding through that street had been falsely accused by another woman of adulterous relations with her husband and had threatened her with a knife. In the third, the street avoided was the residence of a hated mother-in- law who had condoned the husband’s affair with another woman. In the fourth, the woman had been held up and robbed in the street. For many months, the patient avoided it at all costs. The mere thought of being near it caused feelings of panic. The woman who avoided her mother-in law’s street always carried tranquilizers in her bag just in case the jeep or bus she was in would inadvertently pass that way. One woman who had many phobias and compulsions avoided one particular street because it was the scene of a sensational murder.
Although fear of losing control over one’s anger was common, related fears which may pertain to violence were not many. Fear of fire, of accidents happening to loved ones were found in about five men. Women who were frequently worried about the safety of children at night while they were sleeping checked at regular intervals on their breathing. Two women, at the height of their illness, were afraid of sharp objects.
There were eleven patients (seven women and four men) with “true” phobias who came only because circumstances were forcing them to overcome their phobia. Two patients had a phobia of leaving the house. In these instances, a relative would come to the clinic to ask in what way the patient could be helped. Both were chronic cases where the patients never left the home. Based on the history, there were no other signs of abnormal behavior. Each was supported either by the family business of his parents or by the wife. Although suggestions were made to the family on how to initiate treatment, the patients never came to see me.
The following were the listed phobias:
1. Fear of going out alone 2
2. Fear of injections 2
3. Fear of airplanes 2
4. Fear of elevator 1
1. Fear of airplanes 2
2. Fear of riding any vehicle 1
3. Fear of walking downtown alone 1
All of these patients were confronted with their fears in the course of their work. The fears all seemed to have something to do with locomotion or travel. The fear of injections came up when the patient had to take a trip for which inoculations were strictly required. When the injections were finally given, the patient expressed a fear of riding in an airplane and traveling alone which, however, was not difficult to overcome.
There were some fears which had, at that time, some realistic basis in the Manila scene. These were: fear of water shortage, fear of getting trapped in a traffic jam, fear of being raped, or fear of being held up or assaulted. From time to time, certain sections of Manila suffered from water shortage. Going through Manila traffic at certain hours was regarded by many as a most frustrating, and even frightening, experience. Rapes and holdups were common newspaper and radio fare. Patients capitalized on these situations to justify their fears but greatly exaggerated their own vulnerability, as well as -the consequences, should these dreaded events happen to them.
Phobias mentioned by patients are as follows:
1. Fear of death
2. Fear of being alone
3. Fear of looking at dead people
4. Fear of ghosts, Dracula, monsters
5. Fear of heart attack
6. Fear of falling asleep
7. Fear of harm coming to children
8. Fear of cancer
9. Fear of illness
10. Fear of collapse
11. Fear of attending funerals, going near funeral parlors
12. Fear of darkness
13. Fear of hospitals
14. Fear of injections
15. Fear of medicines (all kinds)
16. Fear of chemicals (like DDT)
17. Fear of allergy to certain foods
18. Fear of germs
19. Fear of travelling outside Manila
20. Fear of riding buses alone
21. Fear of walking alone
22. Fear of going downstairs and upstairs alone
23. Fear of falling while walking
24. Fear of heights
25. Fear of crowds
26. Fear of elevators, closed spaces
27. Fear of crossing the street
28. Fear of airplanes
29. Fear of being robbed, attacked, raped
30. Fear of being trapped in a traffic jam
31. Fear of water shortage
32. Fear of going hungry
33. Fear of swimming
34. Fear of rain, thunder, and lightning
35. Fear of fire (including pilot flame of gas ranges)
36. Fear of animals (lizards, snakes, dogs, cats)
37. Fear of public speaking
38. Fear of recitation in class
The first ten occurred in over 50% of these patients; the rest were encountered in sporadic cases. The last two—fear of public speaking and fear of reciting in class—were also quite frequent, being found in almost all the adolescents and in many adults, as well.