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Q: Agoraphobia : Difficulty Reading
One of my symptoms is agoraphobia. IF I get myself somewhere I'm ok & I'm quite cognizant of that fact. But going is tough. For example, the last 3
Sundays I've wanted to attend a new church [altho I've not been a regular church
goer]. Anyway instead of going I have this ping-pong game of Go-Can't Go in my
brain that at some point gets torturous. How can I stop the torture? Note that I
don't ask how can I actually Go, although if there's any insight, please advise.
Also my absolutely worst symptom, esp. since I'm a professor & also simply love
books & reading is I can hardly read. Sometimes I can read ebooks but not print
books. [audio books are out] Any way to address this problem so I can read
again--my greatest & most satisfactory pleasure? Thanks for any help, info,
insights,&website.
Dear Ms. L' --
You describe two different and perhaps separate phenomena. Let's start with the
second, the difficulty reading. You note that sometimes you can read ebooks,
meaning that sometimes not even this is possible, I presume. If so, then it
seems you're describing some waxing and waning of this symptom -- and that is a
phenomenon I've heard from many of my patients. Very much like you indeed: "I
love to read, but sometimes I can't -- I can see the words but I can't get my
brain to take them in. I just read the same paragraph, or page, over and over,
and it won't stick." That sound like what happens? Usually this happens to
people who are having other symptoms of agitation and acceleration, particularly
"racing thoughts" -- they are having many thoughts at once and can't make their
mind stick with one and go somewhere with it. So they feel scattered, very
distractible (understatement). And usually they have difficulty falling asleep
because of this racing thinking.
You recognize that this kind of scattered acceleration
is "manic"-side symptoms, not a characteristic of depression, though often
people have depression symptoms at the same time, so called "mixed states".
Indeed, one of the more common version of bipolar disorder is a combination of
waxing and waning manic-side symptoms as above (including irritability), as well
as waxing and waning depression symptoms. Recently a graph of this kind of
pattern was published as an attempt to explain this kind of bipolar experience,
showing these alternating wave forms and the resulting complex mix of symptoms.
Here's that graph of
Mixed States as
Waves, with an explanation and a link to the original article).
Such mixed states are thought by many mood experts,
including the authors of that article, as an unfortunate result of having an
antidepressant among your medications; in which case, if you're taking one, the
good news is that slowly tapering off that antidepressant (with the full
knowledge and participation-in-planning of your psychiatrist; DO NOT DO THIS ON
YOUR OWN, right?) might make such symptoms less severe, or even make them
disappear.
Now for the second phenomenon you described,
"agoraphobia". You say that "if I get myself somewhere I'm okay". So there's a
good chance this is not agoraphobia (if it was, that's one of the most easily
treated psychiatric conditions, under the right circumstances anyway, so no need
to fear there). Instead you emphasize the "ping pong" discussion that takes
place in your head, about whether to go or not to go. I could easily be
over-extrapolating from the reading difficulty you described, but this ping-pong
too could be part of a manic-side symptom set; indeed, I've seen versions of
this ambivalence in bipolar disorder to the point where I've described
this phenomenon to colleagues, this acting out of two opposing thoughts as part
of mania (or hypomania). One of the most obvious versions I've seen is a patient
standing at the nursing station window on a psychiatric inpatient unit, trying
to decide to take the medication being offered -- or not. Sometimes patients
stand there for five minutes, even with other people lined up behind them,
picking up the pills, picking up the glass of water, holding them, looking at
them, putting them back down, looking at them, looking at the nurse, picking the
pills up again, putting them down, drinking the water without the pills, asking
for more water, and so on in a loop -- and then some wise nurse just gives 'em a
jolt, makes a joke, hands them the water with some momentum behind the glass
going toward the patient's mouth (ever so subtle, no forced action here, not by
a long shot) with a gentle reassurance, and the patient just pops the pills in
and swallows them.
So while you're figuring out how to approach this
"agoraphobia", put "ambivalence" on the list of possible explanations as well
-- especially if the story about the reading as a manic-side symptom (perhaps
rapid cycling, as shown in that Mixed States article) sounds like you, to you.
Good luck getting this figured out -- and treated!
Dr. Phelps
Published October, 2006
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