Scared of Heights

Psychiatric TimesPsychiatric Times Vol 26 No 2
Volume 26
Issue 2

I am scared of heights. As a psychiatrist, it’s faintly embarrassing to have such a phobia-but given that I live in a Boston suburb, not the Rockies, it’s a problem that hardly ever comes up. Ski lifts and I don’t get along all that well, but other than that, I barely ever think of this as an issue in my life.

I am scared of heights. As a psychiatrist, it’s faintly embarrassing to have such a phobia-but given that I live in a Boston suburb, not the Rockies, it’s a problem that hardly ever comes up. Ski lifts and I don’t get along all that well, but other than that, I barely ever think of this as an issue in my life.

This fear is sort of the last vestige of what in my younger days (I’m almost 60 now) was a pretty crippling array of fears and anxieties that could probably best be described under the rubric of “social phobia”-although that pallid term hardly does justice to the misery and torment that these problems caused me. My problems surfaced in medical school and continued through my psychiatric residency and beyond. But, lucky for me, these problems improved tremendously with psychotherapy (psychoanalysis, actually) and Prozac-which in my family we affectionately call “vitamin P,” in acknowledgment of its helpfulness and, how, like a vitamin, it seems to let me be healthy and the person I want to be.

I’m so far away now from the days of my worst suffering that I often cheerfully (oh, God, could it be smugly?) refer to myself with colleagues and patients as “in recovery” with respect to these difficulties, and I often refer to myself with new patients whom I am evaluating (and who are evaluating me, of course) as “both the Hair Club president and also a client” (ie, someone who has benefited a great deal from psychiatric treatment, and who hopes to share that benefit with others).

But then there is that fear of heights.

Recently, my wife Julie and I were on vacation in Argentina. We were staying at a beautiful little 5-room hotel in a relatively remote part of Salta, and our innkeeper suggested a day-trip to see some pre-Incan ruins. We accepted, and the next morning, Julie and I and our guide and 2 other guests at the hotel crammed into our rented SUV, with me at the helm. We soon found ourselves on a gravel road, about a lane and a half wide, that snaked up the side of a mountain. There were no guard rails, of course, and the precipice loomed right out my window-with the sheerness and height gathering by the minute. Finally, our guide suggested we stop to admire the view.

Outside the car, Julie could clearly see that I was in distress, and it must have been pretty obvious to others as well, because one of the other guests (Herman, who’d been riding in back), gently and kindly asked me if I’d like him to drive. He’d enjoy it, he said.

I felt humiliated and embarrassed, but more than that, relieved, because I truly did not think I’d be able to continue to drive. I made a couple of jokes about being a “loco psychiatrist” and switched places with Herman. As we continued up the mountain, the road, if anything, got narrower, the turns tighter, and the sheer precipice more looming. It was terrifying to me even to ride in the car, much less drive it.

When we finally arrived at our destination, close to the summit, the plan was to walk down a path, also cut into the side of the mountain, to see a gorge called “The Devil’s Throat.” I started down this path, but then turned back, and said I’d wait at the car, while the others made the walk.

Even standing by the car, I felt waves of vertigo, anxiety, and deep, deep embarrassment. While I stood there, other cars of tourists arrived, and people piled out of the vehicles, cheerfully heading down this path . . . even little kids! Yet there I was, paralyzed. It was so utterly weird that these people and I were seeing the same world, the same situation, and yet for me, it was paralyzingly horrible, while for others it held interest, beauty, and wonder.

I met a number of people there as I waited, and I covered my fear with banter and humor, even joking about the fact that I, a psychiatrist, was too freaked out to go down the trail. All of this reminded me so very clearly of what it had been like for me as a younger person, dogged by symptoms, and trying to live around these problems, or to pretend that they were not there.

I also realized, with humbling clarity, what many of my current patients experience every single day. I had a renewed respect for what it must be like to be in a world that other people experience as ordinary and unthreatening but that feels-and for the person, truly is-full of threat.

When we finally drove down the mountain (again with my new best friend Herman at the wheel), it was worse because I could see the whole mountain below us and the sheerness of the precipice. My hands were sweating and I actually had to close my eyes. It’s a good thing I wasn’t trying to drive!

Now, back on the low, supportive earth, I’ve had a chance to reflect more on this experience and to share it with friends. As a psychiatrist, I always try to look at human problems from 4 points of view: a social perspective, which accounts for anything that might be stressing the person unduly in current time (eg, an abusive relationship, poverty); a biological perspective, which acknowledges that some psychiatric ailments can be thought of as illnesses with a biological basis or at least a biological contribution to the problem; a psychological perspective, which appreciates that many problems in current time reflect issues from the past; and finally, a spiritual perspective, which acknowledges that human suffering sometimes comes from our search for meaning in our lives.

Applying these models to this sudden, nightmarish experience in the middle of a lovely holiday, the biological model seems to me to make the most sense. After all, it felt like there was some wire in me that was crossed in a way that just wasn’t the case for the other people. It seemed like it had little or nothing to do with any choice on my part, although I felt intense shame at being so weak compared with the others. As I look back, I guess I do not really think that this peculiar, distinct phobia neces­sarily reflects on my character, my courage in general, or my worth as a human being. But in the moment, it felt like I was so inferior to others-so fundamentally screwed up, so damaged.

In addition to the renewed respect for my patients’ experience, other lessons emerge as well. First, my harsh self-judgment was at least as painful as the terror of acrophobia. Moreover, it is so striking that even for me, an experienced psychiatrist who in many ways really knows better, the stigma of mental illness is so deeply in­-grained that I felt stinging humiliation at this condition. As one of my psychiatrist pals pointed out, if a cardiac condition had prevented me from walking down the gorge, there’d have been next to no shame in it.

Lastly, I reflect on the kindness and warmth and good humor of the people around me who comforted me, and who literally drove me back to safety and wholeness. We have a lot to offer each other. Human love, in its many forms, including kindness and community, is a soothing balm. We must be here for each other.

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