Agoraphobia: Fear of Open Spaces


The cast of medical mystery TV show House M.D. tackles the difficulty of living with agoraphobia in season five, episode seven of the series as the doctors try to diagnose the physical ailments of a man called Stewart with severe agoraphobia who refuses to leave his home for diagnosis and treatment.  In line with some severe cases of the mental health disorder, Stewart becomes violent and panicked at the beginning of the episode in an encounter with the paramedics who are attempting to take him away from the safe and trusted space of his home and into the foreign place of the hospital.  He breaks free of the gurney restraints and has a physical altercation with the medical personnel before running into his home and locking the door, keeping the strangers out while keeping himself in.  Stewart refuses to leave his home for potentially life-saving medical treatment due to his agoraphobia and the extent to which it affects his life.  This act of self-preservation takes place because Stewart is attempting to keep himself away from public and unknown spaces where his fears could manifest, and his actions make sense because his anxiety was triggered by the transportation of himself toward an ambulance.  His violence can be perceived as the agoraphobic symptom of unusual agitation. 

(Spoiler alert!) At the end of the episode, even though Dr. House’s team acknowledges that their patient’s agoraphobia is not resultant of any of his (now cured) physiological ailments, Stewart is shown miraculously to have “overcome” his agoraphobia, as the viewers watch him gradually convincing himself to part from his house.  Our final image of Stewart is him walking down the block, out into the environment he couldn’t bear to be in at the beginning of the episode due to crippling fear of being out in public spaces.  The episode’s ending seems to push the message that the man was able to conquer his agoraphobia and get rid of it, even though the doctors in the show acknowledge that Stewart’s agoraphobia could not have been caused by what brought him into their care in the first place.  Apparently House and his team are such skilled medical professionals that they succeed in convincing a person to spontaneously get rid of his mental health disorder without administering any real treatment for it. 

Agoraphobia, which is typically comorbid with panic disorder, is the fear of open or public places, where people with this anxiety disorder develop severe anxiety or panic symptoms (like an accelerated heart rate and sweaty palms) when they are away from home or in crowded spaces (Miller, 2011).  Possible symptoms include fearing the ensuing panic symptoms, fearing one’s loss of self-control in public, and perceiving that one’s own body does not exist (Miller, 2011).  Because they know how they will feel in such situations, people with agoraphobia actively avoid them, which, in the most severe cases, can result in never leaving home (Miller, 2011).  Developing this mental health disorder can, for example, result from suffering a panic attack in public, thus leading the afflicted person to avoid going out in public so as to prevent a similar incident from taking place (Miller, 2011). 

The viewers are given an accurate and unfortunate interpretation of living with agoraphobia as soon as  House starts in with his ignorant demands of Stewart to leave his home.  True to his arrogant personality, House treats his patient’s phobia as a simple, escapable fear, asking Stewart, “Whatever you’re scared of out there, aren’t you more scared of death?” To people with agoraphobia, being ‘out there’ equates to panic symptoms that can make them feel as though they are dying.  This mental health disorder necessitates treatment like exposure-based cognitive behavioral therapy with relaxation techniques and sometimes medication (Miller, 2011); the severe anxiety and fear entailed in agoraphobia is not easily conquered by sheer force of will.  This line of dialogue from the episode portrays one kind of real stigma against people with this mental health disorder, and it also portrays one misunderstanding about the disorder itself: agoraphobia isn’t about being ‘scared,’ it’s an intense and consuming fear that can be detrimental to a person’s mental and physiological well-being. 

Furthermore, House argues that his patient is “doing it to avoid sunlight and fresh air,” as if to say that Stewart claims to have agoraphobia because he simply does not want to go outside.  Here we see another misinterpretation of the phobia in this line of dialogue as well; agoraphobia is not about wants, it’s about needs.  People with this anxiety disorder feel more than compelled to stay away from public spaces because of their phobia, so they do feel that they need to abide by their severe anxieties and fears — it is a need.  House’s wrongful words about Stewart perpetuate the stigma and misunderstandings of agoraphobia because the show depicts House as a deified doctor who can do everything that everyone else cannot: because of House’s high status in the show, viewers may confuse his arrogant behavior as correct words of wisdom in terms of agoraphobia.  This means to say that people watching the show could be led to believe that, due to House’s high intelligence, it’s true that people with agoraphobia are just “scared” of being in public and that they simply do not wish to go outside — and those viewers who already believe such things might feel justified because House seems to agree.  

The realness and severity of the mental health disorder need to be conveyed accurately and adequately in order to teach people that this is something that can be debilitating and must be taken seriously.  While the show accurately portrayed the intense fear possessed by those with agoraphobia, as well as the stigma and misconceptions of some people without agoraphobia, it failed in the end by alluding to the idea that, prior to his visit with these doctors, this man had not been trying hard enough to trump his fears.  I personally love watching this show, but I felt let down upon re-watching this episode after learning a lot about anxiety disorders like agoraphobia.  Maybe the creators of the show decided that having the man with agoraphobia end up leaving his house at the end would be a great way to finish it off because it evokes an inspiring message for the viewers; I understand that television shows are meant to be entertaining, I just hope that this episode does not make its viewers mistakenly believe that agoraphobia is not a real mental health disorder, or that it doesn’t need to be taken seriously. 

References:

Miller, M. C. (2011). What is agoraphobia?. Harvard Mental Health Letter27(11), 8-8 1p. 


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