Agoraphobia : Difficulty Reading
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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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