The multifactoral causation of illness applies even in psychoneurotic conditions. In these disorders there is often a clear-cut causal relationship between some past event and the present disability. This is the cause. But whether or not the cause actually produces symptoms may depend on the individual’s general level of stress. Furthermore, understanding the psychological causation of the illness may not be enough in itself to relieve the symptoms without some reduction of the general level of stress.
Claustrophobia
«This all happened a few years back, but I remember the story vividly.
‘It’s damn silly. Get the jitters if I go to the toilet and shut the door. The jitters, and can’t do what I came for. All right if I leave the door open. Can’t always do that. Know all about it. Tail gunner with the Lancasters. Thirty missions over Germany. It was at the bad time. They said ten per cent chance of coming through a tour of duty. I know all about that. Get caught in the search lights. God! How did it feel! All the ack-ack in the world firing. Terrible crash. But the old bus kept going. It’s the blast that makes the crash. Fighters on our tail. Gave them what I could. I know all that. Bombs away. Then home at last. Our ‘drome bombed out. Craters miles deep in the runway. Flying around in the dark, trying to find somewhere to get down. I know all about that. Off again in a couple of nights. Up the steps into that little box on the tail of the plane. Chap on the ground slams the door. How did it feel! I know all about that, but I still get the jitters if I close the door of the toilet. »
The psychopathology is painfully obvious to everyone including the patient. This demonstrates a very important point. There is a widespread delusion among people in general, and not a few psychiatrists and psychologists that a knowledge of the cause of nervous symptoms will make them go away. This is simply not true. The relief of the symptoms requires some other factor as well. This may sometimes be provided by the relief of stress in the profound experience of intensive meditation.
«Can’t stand being shut in. Terrible panic. Sweat. Heart thumps. Feel I’m going to faint. If I go anywhere, have to sit by the door. Better if it’s open. Have to sit by the door in church, and on an aisle at the cinema. »
Unlike the tail gunner, she had no idea as to the cause of her claustrophobia. However, when under deep hypnosis, she became very disturbed, crying out, ‘Let me out of here. Let me out.’ It transpired that she had regressed to an incident in childhood when her mother had locked her in the broom cupboard for being naughty.
The interesting point is that this dramatic insight did not give immediate relief to her claustrophobia. Her relief came only slowly over a period of some weeks as the level of her stress was gradually reduced.
*58/98/5*
