The panic grew with every move I made: every time I gripped a small handhold with suddenly sweaty palms, placed my soft rubber-soled climbing shoes onto a small ledge or nub in the granite face. My chest seized up. The fear gripping my lungs and my brain made me dizzy. I breathed loud and fast through my mouth, and my brain screamed warnings at my body. Stop! Go back! Don’t do this! You will fall. You will get hurt! You! Are! Not! Safe!
I was only a few feet off the ground. It was an early summer evening at the Rock Gardens, a popular climbing crag in Whitehorse, soon after my miserable skydive. And as I’d expected, I was utterly failing to remain calm as I tried to climb.
It was my first attempt at a do-it-yourself regimen of exposure therapy, my new plan to cure my fear of heights. And it was an inauspicious start: in the end, I managed to force my way six or seven feet up a twenty-six-foot route before I begged my climbing partner, belaying me from below, to lower me down. As my feet touched the ground, I tried to control my panting and avoided looking anyone in the eye. I was facing my fear, but it was hard to imagine my resulting feelings, or my control over them, ever improving.
I have never been able to explain why I froze at the top of that airport escalator. All I remember is that I didn’t feel safe; in fact, I felt certain that I would fall. (And then, of course, I did.) But decades later, I realized that my jolt of fear in that moment, sudden and without explanation, was not an isolated incident. There was a pattern.
Throughout my childhood, I never climbed trees—I just didn’t want to, I figured—and I was uncomfortable when my friends and I clambered up to sit on top of the monkey bars in the playground at recess. But if I ever thought about it, I put my nerves and reluctance down to a general timidity: normal scaredy-cat stuff.
Then came my panic as I clung to the mast on that tall ship as a teen. But after I was back on dry land, I put the incident away in my memory; it wasn’t something I wanted to dwell on. I never tried to put a label on what had happened, never interrogated the event further.
Years passed. I finished high school, then undergrad, then grad school. After I wrapped up my master’s degree, I liquidated what was left of my student loan and went backpacking with two friends in Europe. I’d developed a fascination with the art and architecture of old churches, and we hit cathedral after cathedral across the southern half of the continent. We visited a few cathedral towers, and I gritted my teeth going up and down the narrow stone stairways to reach each one. But I didn’t truly lose it until Florence.
I’d made it to the top of the Duomo, as the city’s cathedral is known, and was breathing deeply, trying to stay calm and enjoy myself as I looked out over the city’s terra-cotta rooftops. The famous steep red dome of the cathedral curved away below me, and as I glanced down at it, suddenly all I could think about was how it would feel to tumble over the flimsy metal railing in front of me, to slide down over those red tiles towards the edge. I could picture it, could feel it in my mind and my body, my speed accelerating as I slid, my complete inability to stop what was coming.
I couldn’t breathe.
The viewing platform was crowded with tourists. I pushed through them to the wall and slid down with my back against it, put my head between my knees to block out the view, and hyperventilated through my tears. My friends found me there, eventually talked me to my feet, and held my hands while we inched back down the twisting staircase to solid ground and safety. We didn’t visit any more cathedral towers after that.
Still, somehow, “I am afraid of heights” didn’t become part of the story I told about myself. Today, the thread seems obvious, but when I was living these incidents, each one seemed unrelated. Never mind the fact that now, when I look back, my queasy visions as I clung to the mast on the tall ship, as I stared down over the cathedral dome in Florence, and as I refused to descend the icy creek seem almost identical—the specific circumstances varying in each incident, sure, but the feelings, the irrational visions of my doom, the same. At the time, I either couldn’t see their similarities or, on some level, refused to. Aside from my short flirtation with epilepsy, I had always been healthy, and happy more often than not. I didn’t want to label myself as phobic, or even fearful. That kind of thing leaned a little too close to the words “mental illness” for my comfort.
So instead, I quietly practised what I now know is referred to in clinical circles as avoidance. I quit sailing on tall ships. I stopped scaling the stairs of cathedral towers. I was long past the age of climbing trees or playing on monkey bars anyhow. After my money ran out on that Europe trip, I flew home to Ottawa. I worked a few different jobs before launching my new life as a freelance writer. I moved to the Yukon. And then, living in proximity to mountains for the first time in my life, I was forced to face the truth.
It was May, a weekend, about six months after I’d made the cross-country move to Whitehorse. Some friends and I were on our way to the village of Haines, just across the Yukon-Alaska border, for a craft beer festival. We stopped partway there, at a place called Paint Mountain, so my friends could do a bit of rock climbing. I had no intention of participating, but I figured I’d tag along for the hike and then enjoy the sunshine and the view of the landscape around us while everybody else climbed.
It was an easy approach hike, on a marked trail that climbed gradually uphill from a dead-end road in a rural subdivision. But as we walked up a broad, gently sloping rock face, my foot slipped. Just a little—I didn’t fall—yet the slip, the sudden uncertainty, was like a trap door opening in my brain. I plummeted into a full-blown fear response: heart hammering, pupils wide, adrenalin flaring. Again came the wild visions of my own doom. I felt as though I might tumble down the entire mountain, never mind that the slope was too gentle and vegetated for me to get far, even if I tried to roll myself down. I was convinced that a catastrophic fall was imminent. So I did what seemed safest, the only thing I could think of that would minimize my exposure. I lay flat on the rock and then curled up, suddenly fetal.
I’d been hiking last in line. In a pattern that would repeat itself years later, on the Usual, I pretended that my reaction was reasonable and normal. I called out from my prone position, trying to sound calm, just letting them know that I wouldn’t be going any farther. I would just stay right here until they were done climbing. My friend Lindsay turned around, saw me lying there, and retraced her steps to crouch beside me. Obviously they were not going to leave me here, she said, concerned but calm. She talked me to my feet, and the whole group turned around and trooped back the way we’d come.
After that, I finally started thinking it, started saying it out loud: I am afraid of heights.
Specifically, I realized, as I sifted back through my memories of each major incident, I was afraid of falling from heights. Airplanes were fine, elevators were fine, sturdy bridges and balconies were okay too. My fear was triggered when I sensed exposure, when I felt like my own feet could betray me and send me tumbling.
Once I saw the pattern, I couldn’t understand why I’d missed it for all those years.
Acrophobia, or extreme fear of heights, is among the most common phobias in the world. One Dutch study found that it affects as many as one in twenty people. Even more people suffer from a non-phobic fear of heights; they don’t meet the bar to be technically diagnosed, but they share symptoms with true acrophobes. All told, as much as 28 percent of the general population may have some height-induced fear.
Plenty of people work around acrophobia by avoiding triggering situations. But in my new Yukon life, that was almost impossible. Avoiding exposure to heights, to places where I felt like I might fall, meant avoiding hiking, climbing, mountain biking—all the things I was trying to learn to do, all the things my friends liked to do, all the best ways to enjoy my wild new home.
Later that same summer, after the Paint Mountain incident, I went backpacking with a group of friends. We planned to hike the Chilkoot Trail, the classic Klondike Gold Rush route from coastal Alaska over the mountains to northernmost British Columbia and the Yukon. Most people spread the whole hike over three to five days, and the crux of it, which generally falls on day two, is the Golden Stairs, a steep climb up a jumble of fallen rock. If you’ve ever seen one of the classic photos of gold-seekers bound for the Klondike, silhouetted in a long line as they work their way up a mountain slope, hunched under the weight of their packs, that’s the one. It’s the last stretch before the summit of the pass.
It was only my second real backpacking trip, and I was easily the slowest of the group. By the time I reached the base of the stairs, my friend Florian was already at the top. Because we all knew the stairs were going to be hard for me—I had, after all, finally identified the pattern and admitted my problem—Florian left his pack at the summit and scampered back down the boulder field unencumbered. When he reached me, where I’d started picking my way upwards, fighting the sudden, panicked feeling that the wind was going to blow me backwards off the mountain, he took my pack from me. Then he paced me as I climbed, or rather crawled. The only way I could convince myself to keep going, with my mind screaming that the wind would hurl me to my death, was to climb Gollum-like, on all fours. Belly to the ground, I ascended.
The next summer, Lindsay took me out rock climbing for the first time. Even back then, I had the vague idea that facing my fear might help me to control it, and I didn’t want to accept that I would simply have to bow out of future excursions with my friends.
With Lindsay coaching me, my chest tight and my breath coming fast, I crept up a rock wall at White Mountain, a popular climbing area about an hour outside Whitehorse. I made it to the top, slapped the anchor in triumph, and was lowered back to the ground again. Suddenly, anything seemed possible. I could do this!
I was halfway up a second climb, stalled out and starting to fret, when a new carload full of climbers arrived below me. These were near-strangers, not the trusted friends I’d come with, and as soon as I heard their voices, I felt my anxiety spike. This, I realized, was another element of my acrophobic meltdowns over the years: they were always worse when crowds of people were gathered around me. It had been that way on the tall ship and in Florence. With strangers watching me, my fear of falling was compounded by my fear of embarrassment, of humiliation, and then it snowballed. (Phobia, meet your unwelcome cousin, social anxiety.)
I begged Lindsay to lower me to the ground before I could whine or cry or otherwise shame myself in front of the newcomers. I didn’t climb again that day, or that year.
But I did get a new pair of hiking boots that summer, replacing my worn-out, smooth-soled older pair. The new boots, in a stiff, traditional style and made of leather rather than a mix of modern fabrics, bought me a new confidence on narrow ledges and steep terrain. I trusted them—and, I guess, I trusted myself more when I wore them.
Later that same summer, with my writing career in disarray and my credit card bill mounting, I took a job as a labourer in the Yukon’s then-booming mineral exploration industry. Some big finds had kicked off what people were calling a second gold rush, as mining companies rushed to stake and sample territory in the hope of locating significant gold deposits. I wound up in a remote, seven-person soil-sampling camp, a forty-five-minute helicopter ride from the nearest dirt airstrip, and another forty-five-minute flight in a small plane from there back to the nearest village and the highway. My job was to follow a designated line on a map, using GPS to navigate, and to collect a sample at regular intervals. I’d dig down a foot or so, bag a fistful of soil for later testing in a lab, fill out some paperwork, mark the spot on my GPS, and move along.
Simple enough, but the terrain was…challenging. On flat ground, we would have had our work laid out on a grid. But since we were in the mountains, sampling dirt from the hillsides, we worked along contours instead. Each of us would be assigned an elevation for the day—4,000 feet, say—and then we would do our best to stick to it. Whatever we encountered, we were meant to cross, sticking to our line, whether that meant slogging through dense brush, side-hilling across steep scree slopes like mountain sheep, or clambering over, across, or around bare rock formations.
The work scared me—the places I had to go, alone, and the things I had to do—but I never froze, never melted down. I got through each challenge, and I got stronger and more confident every day. When I came home after a month, my friends joked that all I’d needed to cure my fear was the right incentive: a ten-thousand-dollar credit card bill on the one hand, and on the other a chance to earn two hundred dollars per day, plus room and board, to start paying it off. It was my own personal, but temporary, miracle cure.
From then on, it seemed like maybe I was getting better, a little. Better at controlling myself, at least, even if I remained nearly as afraid as ever. I was never again as fearless as I’d become during the soil-sampling job, but I kept hiking. I was cautious about which trails I tackled but never again felt obliged to lie down on the ground to save myself. I started ice climbing, casually, in the winters with Ryan and Carrie—the sport was both terrifying and satisfying. For several years, I felt like I was making progress on “my heights thing,” as I usually called it. And then came my meltdown on the Usual, and suddenly it felt like all my work had come undone.
I regrouped, determined to try again. The skydive had been my first step, an extreme attempt to force my way through fear. But after that effort failed so spectacularly, I decided to try something simpler, something quieter. So in the summer after the incident on the frozen creek, and a year after my mom’s death, I went to the bookstore and bought a copy of The Anxiety and Phobia Workbook. Back at home, I flipped to the chapter titled “Help for Phobias: Exposure” and read through the advice, exercises, and worksheets it contained. The book suggested that I could design my own program—that, with a little persistence, I could heal myself.
I decided to build myself a DIY cure, or at the very least a coping mechanism. I would learn to rock climb, putting in real effort and commitment for the first time, and I would use that learning process as a form of exposure therapy. I had climbed, badly and fearfully, a handful of times since that first outing with Lindsay. I hadn’t stuck with it, because I didn’t enjoy it even to the limited extent that I enjoyed ice climbing. It scared me at least as much, but didn’t fulfill me in the same ways. Still, I realized, it was accessible, and it was replicable. I could do the same climbs in the Whitehorse area as many times as I wanted. And it had one more clear benefit: it definitely terrified me. The workbook told me that I would have to be willing to take risks, learn to tolerate discomfort, and persist if my plan was going to work.
I was going to master my fear by exposing myself to it, over and over again.
After my mom died, my dad and I started talking a lot more. It wasn’t that we hadn’t been close before—growing up, I spent every other week at his house, eating dinner together, listening to CBC Radio, and talking about the news of the day. He taught me to listen closely and think critically, to construct an argument of my own and to find the holes in someone else’s. I remember him playing devil’s advocate across our dining room table, pushing me to think through my beliefs and positions, to articulate them and defend them. (It drove me crazy, but it did me good.) Later, after I’d moved across the country, we had a ritual whenever I came back home to visit: we’d go out to a pool hall, play a few games, watch some hockey, and talk politics.
But once my mom was gone, things changed, deepened. We’d never been prone to talking about feelings much, and now, with both of us painfully aware of the gaping hole that had been blown in my emotional support network, we made more of an effort. So it was only after my mom’s death that I learned that my dad, too, had once been afraid of heights.
This was news to me. I’d watched him climb ladders to do chores and maintenance work my whole life. For a couple of years when I was a kid, after the job that had moved us from Saskatoon to Ottawa had dried up, he’d earned a living as a handyman, and I’d seen him scrambling across rooftops on two- and three-storey buildings around our neighbourhood. But it was true, he told me. He’d been deeply afraid of heights. As a kid, he’d had a recurring dream about falling from the top of a mountain. Then, in the summer after high school, he’d gotten a job at a steel mill. The job required him to climb up ladders and walk across catwalks above the firebrick enclosures where the steel was melted, swaddled in an asbestos overcoat for protection from the heat. Sometimes he had to help repair the enclosures’ brick roofs, with the molten metal visible below him. Like me, when I worked in that mining camp, he had, out of sheer necessity, and without entirely realizing what he was doing, enrolled himself in a program of informal exposure therapy. And it had worked.
We both wondered if I had inherited my fear from him. Later, I learned that it was possible. We still don’t entirely understand the origins of phobias, the mechanisms for their acquisition. There are various theories, and my bet is that no single answer is the answer, that there’s no one theory to rule them all.
There’s the evolutionary explanation, in which phobias are the lingering result of the reasonable fears on which ancient humans acted to stay alive—once necessary responses but now vestigial, hanging around like our wisdom teeth. “The brain’s hardwiring determines how ready we are to become afraid of something,” Helen Saul writes in Phobias, an overview of the history and evolving science behind the phenomenon. “It provides a kind of mold for our fears.” Plenty of specific phobias fit neatly within this explanation: fear of heights, sharks, snakes, tightly confined spaces, the dark. These were all things that could have killed a hunter-gatherer. And the evolutionary view might help to explain why some modern objects that probably should scare us—cars, say, or guns—don’t tend to inspire phobias. But it doesn’t offer much when you consider social phobia, or agoraphobia. It’s hard to see what kind of ancient advantage those fears would have brought to someone trying to survive in a communal, outdoor world.
Then there’s the possibility that phobias are heritable, encoded in our genes and passed down through families. One broad study of families, phobias, and anxiety disorders, in New York City, found that the immediate relatives of people who had undergone treatment for a specific phobia were themselves three times more likely than usual to have a specific phobia. Family members tended to share similar, but not identical, phobias, the study found. “Where a parent feared dogs, the child hated cats; or if a girl disliked the dark, her brother feared heights,” Saul writes. The categories seemed distinct, too: specific phobias clustered together within families, but they did not appear to be risk factors for anxiety, depression, or social phobias.
The researcher behind this study, Abby Fyer, argued that specific phobias are passed down genetically in what Saul describes as a “discrete bundle,” separate from other, broader anxiety disorders. Other researchers disagree, arguing for an umbrella gene for the whole set of conditions. “Both camps agree that genetics and environment contribute to the development of phobias,” writes Saul. So far, neither camp has had its view definitively borne out by gene mapping.
Related to the gene theory is the idea that phobias are extensions of our personalities, our essential natures. In the 1950s, the American psychologist Jerome Kagan became interested in how, or whether, people’s personalities endured over the course of a lifetime. Following up on a long-term personality study, he checked in on a number of adults who’d been assessed decades earlier. He found that, broadly speaking, the adults had aged into people very different from their childhood selves. But one characteristic remained relatively stable. As Helen Saul writes, “Children who were fearful of the strange and new grew into adults with the same reservations.”
Kagan went on to set up his own long-term personality study, hoping to better understand what became known as inhibition, the character trait that sees children shrinking away from strangers rather than displaying curiosity—like when I used to hide in my mom’s long skirt as a shy toddler. Later he collaborated with another psychologist, Jerrold Rosenbaum, whose work focused on adults with anxiety disorders and agoraphobia.
Rosenbaum and Kagan gathered a group of children with a family history of anxiety disorders and analyzed them alongside Kagan’s longer-term research subjects, who were selected from a population without a history of these sorts of issues. They wanted to understand the links, if any, between inhibition and larger-scale anxiety and phobia issues, and their results were clear. “Where parents had panic disorder and agoraphobia,” Saul writes, “their children were more likely to be inhibited than children whose parents were healthy.” And inhibited children, regardless of their parents’ status, were at greater than average risk of anxiety disorders.
It’s always difficult to parse nature and nurture, and there are many more children with an “inhibited” temperament than there are people with social phobias. But Kagan and Rosenbaum’s research suggests that, at the least, inhibition in a child is a risk factor for larger issues, whether or not they have a parent modelling anxiety and avoidance for them.
The straightforward idea that phobias are derived from previous upsetting experiences is still on the table too. Think back to Little Hans and his fear of horses—only instead of the Freudian take, in which Hans subconsciously fears his father’s violent retribution for the boy’s lusting after his mother, something simpler happens. The boy sees the horse crash to the ground; the boy is terrified by the sight, the sounds, the animal’s fear and power; now the boy is scared of horses. Seems logical, right? And it does seem to explain some phobias. But a study in New Zealand, comparing data from children who’d experienced significant falls from heights when they were small, found no overall relationship between falls and later acrophobia. In fact, kids who experienced “significant injury” from a fall between five and nine years old were less likely to develop a fear or heights. The researchers’ suspicion was that it was the children’s experience with “safe exposure” to falls that might have protected them from phobia. Perhaps that initial exposure can be tracked back to temperament: children with a lack of fear, due to their more reckless, uninhibited natures, had the falls in the first place. Afterward, instead of the falls producing a phobia, their fearlessness remained intact.
I’ve wondered over the years if my fear of heights stems from that incident on the escalator at Pearson Airport. The problem with that theory, though, is that I remember my fear so clearly, and it hit me before I fell. Where did it come from? Evolution? My dad’s genes? My generally passive or inhibited nature as a child?
There may be no way to know for sure. But researchers have also studied acrophobia on its own rather than attempting a blanket explanation for all phobias, and one study offers a clue. If I’m anything like the subjects of this research, I probably have measurably sub-par control over my body’s movement through space, as well as an over-dependence on visual cues—which are distorted by heights—to manage my movement through the world. In other words, I am afraid of falling from heights because I am more likely than other people to fall from heights.
For a 2014 paper in the Journal of Vestibular Research, a team of German scientists studied the eye and head movements of people who are afraid of heights, plus a control group, as they looked over a balcony. They found that their fearful subjects tended to restrict their gazes, locking their heads in place and fixing their eyes on the horizon rather than looking down or around at their surroundings. That description will be familiar to anyone who’s ever felt afraid of heights or tried to counsel someone who is: Don’t look down. Whatever you do, don’t look down.
According to this study, here’s how my reaction plays out: I fix my gaze on the horizon as a defence mechanism against my fear, but because that fear is rooted in my overreliance on visual cues, restricting my range of vision only makes things worse. It’s a cycle. My brain knows that my body is bad at navigating heights, so it sends out fear signals as a warning. My body shuts down in response, which only increases the likelihood that I will actually harm my klutzy self. And thus a once rational response to a reasonable concern feeds on itself, growing and spreading to the point where I can hardly stand on a sturdy stepladder.
It’s only one paper, one theory among many. But when I think about how I behave when my fear of heights is active, it’s a theory that feels true to my experience.
Just as there is an array of theories about the causes of phobias, there have been various theories on how to treat them. Freud and Little Hans led the way into the twentieth century. The Freudian school of thought held that the act of bringing the subconscious associations and urges that were driving a person’s phobic behaviour out into the light would resolve the problem.
Then came John Watson, Rosalie Rayner, and Little Albert. Now it was clear that fears could be induced—that the memory of past events could be explicitly linked to later fear responses. Where Freud had emphasized subconscious desires, the new school emphasized the phobia sufferer’s actions, their conduct, above all. “Behaviourists saw fears as maladaptive conditioned responses,” writes Joanna Bourke in Fear: A Cultural History. And there was a solution for that.
Watson and Rayner had always intended to try to undo Little Albert’s newly conditioned fear of furry critters. But, so the story goes, Albert and his mother left the hospital before the researchers had the chance. (I wonder why.) So it was left to Mary Cover Jones, then a graduate student at Columbia University, to figure out how to reverse the fear conditioning process.
Soon after Watson and Rayner’s groundbreaking but ethically dubious study, Cover Jones and her colleagues studied a toddler named Peter. (Inevitably, like Hans and Albert before him, he became known as Little Peter.) Peter was deeply afraid of a white rat, and he also exhibited fear responses to a white rabbit, a fur coat, feathers, and so on—fluffy objects and creatures, basically. “This case made it possible for the experiment to continue where Dr. Watson had left off,” Cover Jones wrote in a 1924 article in Pedagogical Seminary. “The first problem was that of ‘unconditioning’ a fear response to an animal, and the second, that of determining whether unconditioning to one stimulus spreads without further training to other stimuli.”
Cover Jones and her colleagues approached the problem in two phases. First was the “unconditioning” phase, sessions in which a white rabbit (which seemed to scare him even more than the rat) was present while Peter was left to play with other children, none of whom showed any fear of the critter. “New situations requiring closer contact with the rabbit had been gradually introduced and the degree to which these situations were avoided, tolerated, or welcomed, at each experimental session, gave the measure of improvement,” Cover Jones wrote.
Peter responded fearfully at first if the rabbit was anywhere in the room. Then, gradually, he learned to remain calm if it was locked in a cage twelve feet away, and then four feet away, and so on.
The second, “direct conditioning,” phase was more explicitly Pavlovian. Peter was put in a high chair and given his favourite foods to eat, and the rabbit was placed nearby and then brought closer and closer over multiple sessions. Instead of pairing the rabbit’s presence with a negative stimulus, like a shock or a loud noise, it was paired with a positive one instead: the snacks.
Eventually, with some relapses along the way, Peter was able to touch and play with the rabbit.
Mary Cover Jones concluded that Peter “showed in the last interview, as on the later portions of the chart, a genuine fondness for the rabbit. What has happened to the fear of the other objects? The fear of the cotton, the fur coat, feathers, was entirely absent at our last interview.”
Cover Jones’s work was not initially widely noticed, but in the 1950s, the psychologist Joseph Wolpe leaned on her findings to develop a treatment that he called “systematic desensitization.” It involved a combination of relaxation techniques and imaginative work. Patients were taught to enter a relaxed state, loosening their muscles and letting go of their tension, and then, gradually, to imagine themselves being exposed to the object of their fears. The idea, Joanna Bourke writes, was that “relaxation was incompatible with fear, and countered the fear response.” The hope was that, with time, the mental habit of relaxation would become dominant, a gentler form of unconditioning than what Little Peter had undergone.
Meanwhile, psychologists weren’t the only ones working on potential remedies. The field of neurology was still young, but it was growing, and it included several proponents of procedures that later became known as psychosurgery. The most famous of these procedures is the lobotomy.
We all know the term, but perhaps not the grim details. First attempted in the late nineteenth century, and then adopted more widely beginning in the 1930s, the lobotomy involved the targeted (well, loosely targeted) removal of otherwise healthy brain tissue with the end goal of altering the patient’s behaviour. Lobotomizing someone wasn’t about cutting out a brain tumour, or even the kinds of malfunctioning brain cells that caused my epileptic seizures when I was a kid. It was something else entirely, something that now strikes most of us as invasive, violating, and deeply wrong: an effort to permanently pacify people whose mental or emotional state meant they didn’t quite fit in.
“The best method,” wrote Walter Freeman, a pioneering and prolific lobotomist, “is just to cut until the patient becomes confused.” The neurosurgeons who adopted the practice knew that their patients would be left with an array of impairments, physical and mental. Nonetheless the treatment was applied to thousands of people between the mid-1930s and the mid-1950s. (It also saw a brief resurgence of popularity in the 1970s.) People were lobotomized for all sorts of reasons and ailments, including anxiety, depression, and other “neuroses.” Phobias were on the list.
In Joanna Bourke’s telling, the lobotomists were under enormous pressure to find a cure for a gamut of mental disorders. In the 1930s, first-time admissions to American psychiatric hospitals were increasing by 80 percent each year. And soon the Second World War would create a whole new wave of distressed, fearful, and traumatized people.
Surgery wasn’t the only physical, hands-on option. Doctors also treated phobics and others with a “metrazol storm”—injecting a drug that would induce violent seizures—as well as with insulin shock and electroshock therapy (ECT). While the metrazol treatment didn’t achieve a cure for phobias, it did cause spinal fractures in 42 percent of patients. And the ECT could indeed, it seemed, dull a patient’s fears, but most often that improvement came as part of a new, more general numbness. Here’s the recollection of Stanley Law, a patient who underwent ECT in the middle of the century in an effort to cure his phobia:
I lay fully conscious on the table, full of trepidation, surrounded by male nurses, insulation was pasted to my temples, a rubber pad was stuck between my jaws, and the electrodes were placed in position; in much the same way pigs were prepared in the slaughterhouse. The low voltage electricity was switched on, I felt the early vibrations, and then I knew no more. Upon regaining consciousness, I found myself much as I was before. I was on a kind of table. I didn’t for a time know where I was or who I was. Gradually, I saw the mass of equipment around me, vagueness was replaced by a slight awareness. I had some sort of idea that I knew the lady by my side, although I didn’t for some time realize that she was my wife. My memory was affected. Part of me wanted to panic now, but I couldn’t. All I felt was a benumbing, vegetative, timeless, motionless dimness, a lack of sensory perception, and a startling diminution of the life force.
Law’s experience was fairly typical, according to Bourke, who quoted his account in Fear: A Cultural History. He underwent ECT seven times before his phobia was declared sufficiently “dulled.” (I don’t know about you, but, all in all, I think I might have preferred Hippocrates’s method, the inducement of vomiting and diarrhea to purge my body of its black bile.)
From mid-century on, these sorts of treatments fell out of fashion. The turn away from lobotomies and electroshock therapy is sometimes attributed to a broad cultural backlash—with help from grim depictions of the treatments like the one in One Flew Over the Cuckoo’s Nest—but the change was also driven by the new availability of less dramatic treatments. In the early 1950s, chlorpromazine became the first drug to be marketed as an antipsychotic. It was followed by the creation of many more drugs aimed at treating the whole gauntlet of mental disorders: antidepressants, anti-anxiety medications, antipsychotics.
Early in his career, Bessel van der Kolk worked on the psychiatric ward that produced one of the first major studies legitimizing pharmaceuticals as a superior alternative to traditional talk therapy. In 2014, in The Body Keeps the Score, he looked back with some skepticism at the drug revolution that changed psychiatry:
Now a new paradigm was emerging: Anger, lust, pride, greed, avarice, and sloth—as well as all the other problems we humans have always struggled to manage—were recast as “disorders” that could be fixed by the administration of appropriate chemicals. Many psychiatrists were relieved and delighted to become “real scientists,” just like their med school classmates who had laboratories, animal experiments, expensive equipment, and complicated diagnostic tests, and set aside the wooly-headed theories of philosophers like Freud and Jung. A major textbook of psychiatry went so far as to state: “The cause of mental illness is now considered an aberration of the brain, a chemical imbalance.”
A cynical view of his colleagues’ motives? Maybe. But the shift was real.
These days, the pendulum has swung partway back again. People coping with phobias and other disorders have a menu of treatment options available to them, and often various components—drugs, talk therapy, other methods—are used in combination. Even ECT has made a partial comeback, in an altered, more humane form.
A few weeks after that first outing, I was back at the Rock Gardens. The route I was attempting was a beginner’s climb, laughably easy for most people with any experience. And it came with a cheat option: taking a detour of a few feet to the right, into a wide crack between two rock faces, made it even simpler. But to get to the crack and the easiest way up, I had to make one slightly tricky move. I would have to step forward with my left foot, balance the toe of my shoe on a small nub, shift all my weight briefly to that left toe, then swing my right foot over and across to the next proper ledge—all without any real handholds for balance.
My climbing partner, Maura, stood below me, holding the other end of the rope that secured me to the bolted metal anchors at the top of the climb. If I fell, she would pull down on the rope, using her belay device to stop me before I’d plummeted more than a foot or two. Climbing on top rope, as it’s known, involves very little real risk. But my lungs constricted anyway, and I fought to squelch my dizziness and panic. From the ground, my friends encouraged me: “Trust your shoes!” “Trust your feet!” “This will be fine!” “You can do this!”
Finally, I took a deep breath, stepped forward, shifted my weight from one foot to the other, and made it across. I fumbled above my head for handholds to steady myself, then grinned and tried to breathe. For a moment, while I was in motion, I had felt weightless, in control. Unafraid. Now the fear came seeping back as I continued climbing, scrambling through the loose dirt that had collected on the ledges and lumps of rock in the crack. I finished the climb, but raggedly, fending off panic the whole way. It was a good start, but as Maura lowered me back to the ground, I knew I had a long way to go.
I didn’t know any of the history when I decided to build myself a DIY exposure therapy program. Systematic, gradual exposure just seemed logical to me; I suppose maybe I’m a behaviourist at heart. But knowingly or not, I had opted for a program built on the work of Watson, Cover Jones, and Wolpe—and especially on one of Wolpe’s proteges, the Israeli psychologist Edna Foa. Foa is now the director of the University of Pennsylvania’s Center for the Treatment and Study of Anxiety. But as a post-doctoral fellow at Temple University in the early 1970s, Foa trained under Wolpe. Wolpe’s work emphasized “imaginal” exposure; for instance, having an arachnophobic patient imagine a spider at a distance, and then imagine it slightly closer, and so on.
Foa’s innovation was investigating whether a greater degree of “in vivo” exposure—exposure to the real fear stimulus, not just an imagined one—could improve on Wolpe’s promising results. Earlier researchers had assumed such direct exposure could be dangerous for patients with phobias and anxiety disorders, but the science on that front was changing. Foa didn’t go as far as some other clinicians had (in particular, a technique called “flooding” involved intense, even brutal, immersion), but she started to push harder within the system that Wolpe had developed. “I started to do studies of exposure in vivo, starting not with the highest level of fear but with moderate levels, and going faster, proceeding to higher and higher situations that evoke higher and higher anxiety,” Foa told me. The results, she said, were “excellent.”
As Mary Cover Jones’s work with Little Peter suggested, exposure therapy is basically an inversion of classical conditioning. If you can teach an animal to expect pain from a blinking red light by repeatedly combining the light’s appearance with an electrical shock until the animal reacts fearfully to the light alone, it makes sense that the twinning of stimulus and fear can be unravelled too. Show the animal the red light enough times without an accompanying shock, and eventually it will no longer fear the light—a process known as extinction. Though it’s worth noting that because our fear memories are designed, for survival reasons, to be sturdy and long-lasting, extinction can be a slower and weaker process than the initial conditioning. That’s part of what makes the curing of fears so hard.
We don’t know exactly what happens in the brain during the extinction process. As Foa put it to me, “Is it that you erase the connections” between stimulus and fear “or that you replace them with a new structure?” Her hypothesis is that exposure therapy trains the brain to create a second, competing structure alongside the fearful one. The new structure, she explained, “does not have the fear, and does not have the perception that the world is entirely dangerous and that oneself is entirely incompetent.” When exposure therapy works, then, it’s because the new structure has managed to override the old one.
That was why my panicked success in the Rock Gardens that day was really no success at all. I had climbed the wall, sure, but I had failed to convince my brain to begin building a new structure. Repeatedly terrorizing myself wouldn’t solve anything; it wasn’t enough to scramble through with wild eyes and a pounding heart. I had to learn to stay calm.
The rock was cold enough to numb my fingers. It was October 2, winter was reaching out for us, and I was on my eighth and final climbing excursion of the season. All summer, I had gone climbing every time someone with the necessary expertise and gear was willing to take me along. I had tried to systematize my outings, repeating the same routes to see if I could get farther, and stay calmer, each time.
In previous years, I would have pushed myself until my panic was unbearable, hoping that I could pop it like a soap bubble if only I tried hard enough. But now my strategy was to go only as far as I could without paralysis setting in. The goal was to build up the alternate structure in my brain that said, This is okay. You are safe. Then I’d come down before the old structure could reassert itself and hope to get a foot or two farther the next time around.
For this last outing, Ryan, Carrie, Maura, and I were at Copper Cliffs, a crag in Whitehorse’s semi-industrial backyard, once a booming copper mining area, now a maze of quarries and mountain bike trails and small, shallow lakes. I was climbing Anna Banana, a short, beginner-friendly, sixteen-foot route up one side of an arête, a sharp wedge of rock protruding from the main cliff face. My first steps had been on easy footholds, gaps cutting into the leading point of the wedge, and I had no trouble until my feet were seven and a half, eight feet off the ground. I stalled out there, my right foot resting on a good ledge just around the corner of the arête while my left toe was tucked into a little cubbyhole a foot below. To continue, I had to pull my left leg up several feet to the next good hold.
I raised my arms and patted the rock above my head, blindly seeking out handholds I could use to pull myself up higher and give my left foot a fighting chance. I tend to rely on my hands and arms first, even though my legs are exponentially stronger; we’re less accustomed to trusting a narrow toehold than a fist clamped around something solid. But I didn’t find what I was looking for, so instead I spread my arms out wide and locked my fingers around the best stabilizing holds I could reach. Then I pushed off with all my weight on my right foot, pulled my arms tight to keep me close to the rock face, and scraped my left foot up the wall until it found the next hold, just as my right toe lost contact with the rock. I balanced there for a moment, raised my hands to solid holds now within my reach, and pulled up my dangling right foot.
I had done it. More importantly, I had done it calmly and coolly, without needing extra minutes to fight off panic, without groaning and moaning before I gave it a try. Maura lowered me down so I could climb up and do it again—more confidently, with even less hesitation. This time, I kept going, through a series of easy moves to the top of the route, where I reached up and smacked the anchor bolts in triumph: a touchdown spike. I did a quick mental survey of my body. My breathing was steady, my head clear. For one day at least, I had successfully redirected my brain to reject fear.
Compared to living with PTSD or broader anxiety disorders, or some harder-to-navigate phobias, my fear of heights is trivial. It doesn’t keep me awake at night, or ruin my relationships, or bleed into every area of my life. If I moved back to the flatlands and avoided high-rise balconies, dodging my symptoms by practising avoidance, I would hardly notice it.
Still, it can limit me. I would have liked to climb that mast high into the rigging during my too-brief sailing career, or enjoy the view over Florence. Sometimes I get scared on steep stairways or balconies with flimsy-seeming railings, and I have still never climbed a tree. Taken individually those are all tiny things, but they add up to a feeling of helplessness: my choices are not entirely my own.
During the winter that followed my exposure therapy experiment, I kept climbing: at big indoor gyms in San Francisco and Vancouver and on small, homemade climbing walls at home in Whitehorse, in local schools and a friend’s basement. By my standards, I made substantial progress. Gradually, I found I could climb higher—six, eight, ten, twelve feet—before my chest started to constrict and my pulse started to pound in my ears. Sometimes I could complete an entire short route without feeling afraid at all.
But even as I improved, I felt my priorities changing. I still didn’t actually enjoy climbing, really. It was like medicine, something slightly unpleasant I consumed because I thought that in the long run, it would do me good. I started to wonder if this particular self-prescribed treatment had given me all the benefit I was going to get from it, if it might make more sense to spend my time doing things that made me happy. Was I still practising avoidance if I chose joy over stress and struggle? I wasn’t sure.