Treatment Tuesday - Claustrophobia

This week's assessment is from Lindy*. She wrote in a few scenario questions which happen to go really well with Maslow's Heirarchy of Needs that we've been looking at for Thursday Therapeutic Thoughts.

* Name has been changed to protect the not-so-fictional.

Lindy wants to know: If a character has a phobia of small places like closets and elevators, and is being held by a killer in a shed, how would she react? Would she be more concerned about the killer murdering her or will the phobia overpower her?

I'm going to answer this question strictly from Maslow's theory and we'll see how the character could be written out.

Linday has given her character claustrophobia--a fear of small places. This isn't a clinical term for an actual diagnosis, which may or may not be important for you to know. This character would likely fall under the diagnosis of agoraphobia, with or without panic disorder, or perhaps generalized anxiety disorder if they don't meet all the qualifications for agoraphobia.

People who suffer from claustrophobia are usually afraid of two things: 1) being restricted and 2) being suffocated. I'll break these down according to which of Maslow's Needs. What's at stake when a person is restricted, either by movement of arms or limbs or being unable to stand or move at will? It's the fear of not being safe, not being able to get your person--your body--out of danger. Being restricted plays out on Maslow's pyramid as a Safety Need. A person with this disorder would move mountains not to be put in such a dangerous situation to them as being shoved in a shed.

Being suffocated is a different story. What's at stake? Not being able to breath, i.e., not being able to stay alive. This is a Basic Need, arguably the most basic need of all. Everything else pales to not being able to breathe. This is why most people with agoraphobia are diagnosed hand-in-hand with panic disorder.

A character in this situation will likely have a panic disorder at the idea that they won't be able to breathe. It's a catch 22, of course, because as they have the panic attack, their airway does close off, making it more difficult to drag in a breath, consequently making them feel as if they are starving of oxygen. I can only imagine how truly awful it is to think you can't get a breath. Think of people with asthma. *sigh* Huge Basic Need problem. (FYI, Brandilyn Collins does a terrific job of describing full blown panic attacks in her book Exposure. Excellent read.)

Bottom line will be that you've got to think through how bad a phobia you want to give her. I don't care to be stuck in an elevator going up 50 flights. I can do it without sweating and I don't consider myself claustrophobic. But if I had a preference, I would have Scotty beam me up instead.

But you've also added the little tidbit of a killer about to murder her. While she's in that shed, the threat of the killer is really a Safety Need threat. He's not actively trying to kill her. If, say, he were trying to gag her, that's the need of oxygen, which is a Basic Need. If he's trying to chase at her with a knife, then it's the need to avoid pain/survive, a Basic Need.

So the character is in the shed with two Safety Needs not being met and likely one Basic Need not being met, that of lack of oxygen because she's probably hyperventilating in the confined space, thinking she's going to suffocate. In this scenario, with a true claustrophobic, I guarantee that her will to draw in a breath will outweigh some future threat of danger from the killer-slash-kidnapper.

Of course, Maslow's theory is a theory. But I happen to think it makes an awful lot of sense.

Hope this helps Lindy!

Q4U: Any claustrophobics in your novels? Do they have panic disorder to accompany their fear?