Dr. Eric Anderson, a charter diplomat of the American Board of Family Practice and a former president of the New Hampshire Academy of Family Physicians, is a regular contributor to Travel Tips 'n' Tales. He is widely traveled and published, having written a travel health column for Travel 50 & Beyond and a weekly online column, Ask The Doctor, for The New York Times Syndicate.

Dr. Anderson invites you to send your questions regarding travel health issues to ericmd@lorrypatton.com

Dr. Eric Anderson

Question: Phobias stop many people from the joys of travel, the most restrictive being fear of flying. Any simple answer why some people have them and others don't? The physical symptoms are real enough -- weak knees, rapid heartbeat, pins and needles ... What causes them?

We are all frightened of something. Sometimes with reason. A climbing instructor once told me, "People have irrational fears of heights, we try and remove that and leave them with rational fear." So it's fairly normal to be scared of heights. It's a common phobia and has its own name, acrophobia. However, hundreds of phobias have been identified ranging from understandable ones like antlophobia (fear of floods) and zoophobia (fear of animals) to odd-ball ones like apeirophobia (fear of infinity) and zelophobia (fear of jealousy).

Although encounters by phobic persons are very specific and reactions may happen only in those situations, in general phobias are found as part of the anxiety reaction, as a component of panic attacks. Those attacks are very real. When I was a medical student, one of our top professors collapsed once on to the dirty tiled floor of a department store, a floor soiled by winter snow and slush, and begged the assistant , "Please call an ambulance. I'm having a heart attack." He wasn't; it was a panic attack.

We are a bit more aware of panic attacks now that Hollywood uses them in its story lines. In the movie, "Shampoo," Goldie Hawn was shown breathing into a paper bag for relief as Warren Beattie charged up the stairs to help her, and in "Starting Over" Burt Reynolds collapsed on a sofa in a furniture store, bereft until bystanders offered Valium.

It's as if some persons are born one Valium below par. Clearly your genes play a part. But as always in those arguments we can't exclude environment and nurture. I often cared for three generations as a family doctor in NH for 21 years. I recall one family where the grandmother and mother both had panic attacks at times and, as the little one got older, I saw the grandchild develop the same problem. Genetics you say? No, both the mother and her child were adopted.

We don't really know why some people get panic attacks but we're on surer ground when we try to explain what is happening. It's all part of the biochemistry of the brain. One of the world authorities on panic attacks was an elderly GP in Australia. She wrote several paperbacks on the subject and finally confessed to a colleague of mine that she suffered those attacks herself. But she didn't give in. She would just stop whatever she was doing and tell herself that "On the other side of Panic lay Peace"; she would just stand there, she said, "until the chemicals in her brain rearranged themselves."

Most patients, however, can't do that and start to over-breathe (hyperventilate). In so doing they wash a lot of stale air out of their lungs. It sounds good, but it isn't. The stale air is CO2 dissolved in the water in the blood to form a weak, useful acid called carbonic acid (H2CO3). If we wash a lot of that acid out of our body, our blood becomes somewhat alkaline. And that's what causes the symptoms of hyperventilation syndrome: dizziness, faintness, vertigo or a sense of floating, sometimes chest pain and often tingling in the extremities.

Those symptoms can be demonstrated by any one foolish enough to swallow huge amounts of what we formerly used for acid indigestion, baking soda. Re-breathing from a paper bag puts stale air back into the body to correct the acid imbalance.

What can you do?

First, let me agree that when Valium* first came out doctors over-prescribed it, but, in time, the manufacturer tightened the protocols for its use. Doctors use less Valium now but it's still a great medication for occasional issues such as fear of flying or fear of other situations. Since it can cause drowsiness it clearly wouldn't be recommended for those in high places who get phobic when they look down.

No. If you are a fairly placid person yet an encounter with some situation causes a fear so strong you'll do almost anything to avoid it, you may have one of the simple phobias without any underlying anxiety state. Psychologists say in those situations you should try to use imagery: picture the situation and see yourself handling it successfully.

Develop insight.

Explore your beliefs. Why are YOU scared? Confront your fear with an unafraid person, your role model for "deconditioning." During this systematic desensitization learn to stay calm. Talk yourself down.

Some say such behavioral solutions are superficial but they often work even though antidepressants or anti-anxiety medications may be necessary at the same time.

Psychiatrists say the more patients avoid what they fear, the more they are liable to fear it and, thus, psychotherapy is sometimes necessary.

Take some comfort in knowing that you are not alone. Phobias are very common and, as you yourself say, life goes on.

* Drugs like Valium should not be taken habitually or for periods longer than six weeks

NOTE: Lorry Patton's Travel Tips 'n' Tales would like to remind you to always consult with your personal physician before following any medical advice and to please read the Travel Tips 'n' Tales "Terms of Use" found on the bottom of each page of this website. Dr. Anderson's opinions are not necessarily the opinions of Lorry Patton or Travel Tips 'n' Tales.