Basil, a 33-year-old in Colorado, finds herself leaving the house more than usual during her coronavirus quarantine. As someone who suffers from agoraphobia, she says, “anything greater than zero counts as more.”
Basil doesn’t work outside of her home or even go out in her yard often. She doesn’t drive, she doesn’t visit people and she doesn’t run her own errands. “So home life for me hasn’t changed much at all,” she explains. “I have many hobbies and know how to fill my time extremely well, but having older, at-risk parents has given me the push I needed to venture out much more than I normally would.”
For Basil, even the thought of running errands for her parents would be the source of great anxiety in normal times. But we’re not living in normal times, and “having a purpose like that has been an excellent motivator to put myself into situations I would otherwise avoid,” she says.
Agoraphobia is often misunderstood. According to Mark Rego, assistant clinical professor of psychiatry at Yale University, agoraphobia is typically derived from a belief that such a situation is dangerous or risky. This is why agoraphobia can manifest in varied ways: It can be a fear of closed spaces, fear of wide-open spaces, fear of grocery stores because of the space and the amount of people, or fear of being too far from a hospital.
“It was long thought that the exact nature derived from where the person was when they had their first panic attack, but research has shown that this isn’t always so,” he adds. However, fear often leads to panic, and having a panic attack on the subway will only reinforce one’s fear of the subway.
Basil echoes the sentiment. Agoraphobia “doesn’t resemble how it’s portrayed in the media,” she says. “Everyone has individual reasons for why they struggle with it, and [there are] individual levels of severity, just like any other condition.”
Regardless of the source of their anxiety, it takes a lot of slow, arduous work to treat and overcome the condition — which is why being forced to stay home presents a unique situation for people with agoraphobia.
Basil worries about her personal space being invaded, unwanted physical or verbal contact with others and crowded spaces like grocery stores. “It’s interesting to be traveling in a world that suddenly seems more accessible to people with anxiety disorders in general,” she says. With all the social-distancing precautions stores in her area have been taking — limiting the number of people allowed inside, putting up plastic dividers between customer and checker, and curbside pickup at restaurants — “it’s honestly paradise,” Basil says.
For other agoraphobics, however, quarantine has only made things worse.
Airlee, a 42-year-old in Australia, says her exposure therapy has come to a complete halt. The mother of two teenage boys has a phobia of standstill traffic, public transport and basically anywhere she feels she doesn’t have an escape. “After therapy and medicine I recovered to a functional state where I can leave the house to go work and take kids to school, go to the shops, go to church,” she explains. But since being in lockdown, all her typical sources of exposure therapy are off the table. “Going on public transit, being on [elevators], etc., are all temporarily on hold right now.”
Because we’ve never been confronted with a nationwide quarantine before, Rego says, there isn’t any precedent for how agoraphobics will fare amid the COVID-19 outbreak. But there’s no doubt it’s going to be tough. “Practicing exposure and doing what they fear in a graded fashion is how agoraphobics would normally get through things, but right now the usual ways are closed off,” he says. “If left untreated, the fear generalizes.”
The more they’re able to incrementally expose themselves to the things they’re afraid of, the better at overcoming the crippling anxiety they become. So when they’re unable to, say, walk to the grocery store every day, their anxiety could potentially get worse — e.g., fear of grocery stores becomes fear of going inside any building. “The underlying theme and central fear is being away from safety, [so] before long, a person may become housebound,” Rego tells me. “People avoid the phobic situation and become anxious when even thinking about going into it.”
“You’d think being alone or with your family was a death sentence,” Basil says. “[People without agoraphobia] say they’re so bored they want to die or talk about how depressed they are simply because they can’t go out to eat, or break guidelines to do frivolous things like that because they literally don’t know how to entertain themselves. Then I do feel a little bit like just screaming, ‘Have you people never heard of hobbies before? Books, cooking, plants, movies, TV, music, foreign languages, crafts, ANYTHING?’
“I start to wonder, in this specific situation, who the crazy ones really are,” she adds.
On the other hand, Basil knows all too well that blanket fear of leaving the house isn’t exactly fun to live under, and she wouldn’t wish it on anyone else, let alone an entire country. “Even when the wildly social people I know unknowingly criticize the life I lead every day, I’m aware of the fact that their lives have changed dramatically,” she explains. “I know I’m struggling with an issue that’s made my life very small, that I’m the odd one, not them.”
And while Rego says neurotypical people aren’t necessarily at risk of becoming agoraphobic during this public-health crisis (though people with underlying general anxiety or depression certainly are), there are some things everyone — both agoraphobic and not — can do to retain a healthy state of mind. First and foremost, if you need to, “keep in touch with your doctor or therapist to discuss how you’re doing and come up with the best strategy for you,” he says.
From there, Rego advises trying to “cultivate calmness.” That means “meditation, yoga, and breathing exercises, along with general good mental-health practice such as sleep, exercise, talking to friends and family, etc.,” he says. “The other is to practice mental exposure. Try to imagine yourself as best as you can in the situation that gives you anxiety.” It takes some practice and coaching to learn to pay attention to details and move deeper into the imagery, he says, “and while it’s not as helpful as the real thing, it’s better than nothing.”
Take Basil’s neurotypical husband, for example, who had to learn a thing or two from his agoraphobic wife. “He had to disconnect from the news because it was driving him crazy, but I’ve been doing fine because I educated myself and I know how to be safe,” she says. “Control is always an illusion, but we have to find some sort of happy medium with our brain so we don’t drive ourselves crazy.”
This Is Life Under Quarantine
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