DANGER IN IMAGINATION
Words are the medicines to heal the wound of words. It is the formulation and composition of words that can make a difference whether it would cause injury to the psyche or it would act as soothing balm on the existing wounds. The words become associated with the emotions. The words become objects of emotions, that is, a word or set of words can elicit emotional response in a person. ‘Nash’ word is symbolically associated with devastation and it elicited an abnormally elevated fear response in Mr. Chand. ‘Nash’ was the key word in his problems which he survived for over 15 years.
The word ‘nash’ stirred a network of mental images symbolizing the devastation and its consequences. It represented actual danger for him. Excessive fear is the appropriate emotion to be experienced at the face of danger. Had there been an actual danger then his response of excessive fear could have been appropriate. The expression of fear from mild to severe level can be appropriate when it occurs proportionately to real life situations. But his fear reaction was associated with creations of his own imaginations. There were no actual signs of danger in his milieu. This is the difference between fear and phobia. Fear is a response to the perception of an actual or objective danger. For example, if a snake appears in your bedroom, you will feel terrified because there is a possibility of actual threat to life. Such scary reactions are called fear. Phobia on the other hand is an irrational fear. In phobia the object of fear does not pause a real threat to life or there is minimal risk; but the person perceives it equivalent to real danger and responds with excessive fear. This equivalence or real like life threat is created in the imagination of the person which makes his being to respond excessively with fear. Since, imagination is in action in phobia/OCD; the imagination magnifies the perception of danger; it becomes imperative to correct the imagined magnification of the danger perception in the patient. Once, there is correction in threatening imagination of the patient, then the perception of objects of fear gets normalized and the hitherto abnormal emotional reactions also becomes normalized proportionate to the value of actual threat contained in the objects of fear.
In phobia/OCD, the patient remains aware of irrationality of his excessive emotional reaction to minor or neutral objects of fear. Even then, he feels compelled to avoid or involve in safety behaviors. Mr. Chand was seeking safety from distorted danger perception by avoiding the people, situations and objects that could remind him of ‘nash’. He was aware of the irrationality of his reactions, still he was struggling to push away ‘nash’ word from the content of awareness.
A person with phobia/OCD engages in avoidance and safety behaviors because encounters with objects of fear alter the functioning of the body and mind which is painful and distressing to the individual. The body and mind of affected person react in following manner during the exposure or possibilities of exposure of the objects of phobia/OCD:
1. sweating
2. trembling
3. hot flushes or chills
4. shortness of breath or difficulty breathing
5. a choking sensation
6. pounding or racing heart
7. pain or tightness in the chest
8. rapid speech or inability to speak
9. a sensation of butterflies in the stomach
10. nausea
11. headaches and dizziness
12. feeling faint
13. dry mouth
14. a need to go to the toilet
15. ringing in ears
16. elevated blood pressure
1. Perception of some danger or a threat to life
2. Feelings of uneasiness
3. Feelings of confusion
4. Disgust
5. Fearfulness
6. Difficulty in decision making
7. Mind going blank
8. Restlessness
9. Feeling entrapped
10. Thoughts of avoiding/escaping the objects of phobia
When a person is successful in avoiding the objects of phobia/OCD then he/she feels relieved from these emotional reactions. The aborting of stirred emotional reactions on actual or anticipated exposure by avoidance or engaging in safety behavior creates a myth in the mind of the affected person. He comes to believe that avoidance or engaging in safety behaviors are the only solutions to his/her problems of phobia/OCD. This myth gets reinforced upon each repeated instance of avoidance/safety behaviors because in reality the stirred body and mind reactions subside. This is what happened with Mr. Chand. At times, he was successful in pushing away ‘nash’ word from his awareness; also he was successful in keeping himself aloof from the potential exposure to ‘nash’ word. But unfortunately, pushing away and avoidance are temporary mechanism because the sooner or later, the affected person is likely to have encounters with his/her objects of phobia/OCD. This struggle of removal of the content from mind and avoidance become so pervasive that the affected persons at times become housebound and dysfunctional due to the fear of possible exposure to the objects. Mr. Chand struggled more and more to remove ‘nash’ word and keep himself away from situations and objects that could remind him of ‘nash’. The end result of this trap was a dysfunctional person who lost his occupation, his social relations, freedom and joy in life. He remained preoccupied with ‘nash’ and his life was revolving around the ‘nash’ and safety mechanisms.
My task was to correct his distorted perception of life threat and devastation; to correct creations of his imaginations. He was scared of his own imaginations. He imagined real life threat. A simple act of impressing him with arguments and reasoning that the word ‘nash’ itself does not represent real danger was not going to help him. I disputed his magical thinking and impressed him that the thoughts of ‘nash’ in his mind are meaningless and they are unlikely to cause real ‘nash’. This disputation was not healing his wounds.
He was carrying products of his own imaginations in his mind. There was an obvious mismatch between his imagined threat of ‘nash’ and the actual threat of ‘nash’. Exposure is one of the best methods to correct this mismatch between imagination and reality. I am taught exposure to fear provoking objects/situations either in imagination or with real objects. I am not aware of any practice or teaching of exposure at verbal level. The verbal exposure is almost an ignored area in the practice of psychology. Long back I had read that words represent higher order conditioned stimuli. In exposure, we expose the persons with phobia/OCD to corresponding real objects or their mental representations. For example, a person scared of dogs; will either be exposed to real dogs or mental images of the dogs. Both the actual dogs and their mental representations are neutral objects which have become associated with phobic reactions.
It is seen that actual objects activate phobic reaction in affected individual; also the mental representations of the actual objects also activate the phobic reaction. A person phobic to dogs will also display body and mind reaction to the mental images of the dogs. In exposure in imagination, it is believed that when phobic reaction subsides to the mental images of the feared objects, then there is corresponding decline in the phobic reaction to actual objects also.
While working with Mr. Chand, I prominently realized that it is not only the actual objects or their imagination but also speaking of the words related to the objects of phobia/OCD also elicit the phobic reactions in affected individuals. Precisely, this was the reason that he was not able to verbalize ‘nash’ word because verbalizations did elicit severe phobic reactions in him. It was quite obvious that ‘words’ belong to the class of conditioned stimuli.
According to the principles of psychology, when a person is exposed for sufficient frequency and duration to the conditioned stimuli (feared object) then the body and mind will cease to respond fearfully to such objects. It is technically termed as Extinction. Since, the exposure to real objects or objects in imagination produce extinction, I reasoned that exposure to feared words should also result in extinction in similar manner. That is what exactly happened with Mr. Chand. I repeatedly exposed him to the feared words and asked him to keep on verbalizing the same; and the magic happened. This verbal exposure in a manner of drill, lead to faster extinction with minimal arousal of body and mind reactions. The real exposure takes longer time for reactions to subside; but in this case the resolutions of activated reactions were taking place very fast. It was a pleasant surprise to note that smooth and spontaneous generalization was taking place only with verbal exposure. He tested the generalization to natural settings by moving nearer to the persons who were using ‘nash’ word.
I could see many advantages of verbal exposure in this person. This kept on stirring my own imagination to formalize more and more this form of verbal exposure in the service of persons affected with phobia and OCD. I continued my quest and applications of this form of treatment to other patients as well.
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