Agoraphobia and Hypochondria as Disorders of Dwelling more

lnternationalStudies Philosophv in 36:2 AconaPHoBrA AND HvpocHoNDRrA AS DISORDERS DWELLING OF Kirsten ]acobson f nfluenced by the works of Merleau-Ponty and of Heidegger, I argue that our spatial experience is rooted in the way we are engaged I with and in our world. Space is not a predetermined and uniform geometrical grid, but the network of engagement and alienation that provides one's orientation in the inter-humanworld. Drawing on this phenomenological conception of space, I show that the neuroses of agoraphobia and, more unexpectedly, hypochondria must not be understood as mere "psychological" problems, but rather as problems of one's overall way of spatial being-in-the-world, that is, of "dwelling." With respect to both neuroses, I argue that subjects experience a sense of spatial contraction that mirrors a contraction in their abilities to engage with the people, the environment, and the situations that surround them. T P A R TI : T O W A R D A P H E N O M E N O L O C I C A L UNDEITSTANDINC F SPACE O We frequently approach the space of our surroundings as if it were a container in which objects-including our own selves-can be located and measured according to a rigid scale. For example, we may report that the distance to a caf6 is one mile; the space of a house is 3500 square-feet; or that we are some particular number of feet and inches tall. When we make such reports, we do not question the truth of our measurements; quite the contrar|, we think and act on the basis of the factuality of such statements. In these descriptions, we treat space as a fixed system in which measurements are exact and 1 3 2) K ] R S T E N] A C O B S O N unchanging. While there is no denying that these standardized descriptions capture an aspect of our spatial relationships with objects in our world, if we limit ourselves to this way of understanding space,we will fail to provide a comprehensive account of human spatiality and, ultimately, of the human experience as a whole. A comprehensive account of our spatiality can only be provided by recognizing spaceas wrapped up with our way of dwelling in the world-in other words, as something that we live. Supporting this point, Merleau-Ponty argues that if we attend to our experience of space,we will recognize'thatspaceunfolds before us ns the particular leaelof experience that arises for us as our body and its abilities align with the objects it encounters in a way that allows for our projects to be successfully carried out.r In other words, spaceis that lettelwherewe are able to take up the possibility we are aiming to fulfill. MerleauPonty observes that a person's spatial orientation toward her surroundings is, therefore, based not on her body's factual or objective situation, but rather on her body as a ". . . system of possible actions, a virtual body with its phenomenal'place'defined by its task and situation" (Merleau-Ponty, Ph.P,250).Our spatial engagement with our surroundings will, therefore, differ depending on tire way in wllich, 'setas Merleau-Ponty again observes, we "... cast anchor in some ting'which is offered to us" (Merleau-Ponty, Ph.P,253).For example, in some cases,our experience of spacemay be shaped by our concern for standard demarcations-say, if we are involved in building a house from a blueprint. Yet, at a later time, when we have finishecl building and the house has become a home for us, we may experience this "objectively identical" space as one of intimacy-that is, as a space that, as Bachelard might describe, caringly compresses itself around ns.2These contrasting encounters of the space of the house are specific to the particular projects in which we are engaged. Importing an interest in fall lines and beam width into the experience of the coziness of a home would be as disastrous to the project of finding intimacy therein as would guiding our building efforts by our desire for walls that feel like they are hugging inward. Even this one example begins to show that rather than thinking of ourselves and the objects around us as points variously situated in an predetermined spatial grid, we must recognize that we experience space as expanding and contracting around us in accordance with our activities and interests, as our way of making a "home" in the world. AGORAPHOBIA AND HYPOCHONDRIA (JJJ Consider, for example,my relationship to a coffeeshop I dislike. Sincethe coffeeshop standsoutside of my regular sphereof interest and attention, I generally experienceit as far from me. I can passdirectly in front of the coffee shop and feel farther from it than I do from something that is miles away from me, but which holds my attention. If I happen,however, to have reasonfor going to this coffee shop,I experienceit asimmediately closerto me than it is on average; it emerges from the distant background of my experienceand becan be comes an active figure for me. Yet, this feeling of cioseness challengedin an altogethernew way if Irealize that I am late in meetfar ing a friend there.The coffeeshop is now oppressiaely from me and my desired end. Worrying that my friend will be irritated by *y tardiness,I walk impatiently along streetsthat seemto multiply before me. But, then, in a flash, something brings the coffeeshop suddenly near to me: I have seenmy friend standing out front of it and shehas seenmei even though I am still a block or more away from my destination,I feel, all at once,that I have already arrived. I experience my body thrust out through spaceso tangibly that if someoneblocks my sight while my friend and I are waving to one another, I feel jarred and quickly move to regain our eye contact;I may even feel anIn noyed at the intruder for being inmy space. theseshifting experiencesof the distancebetweenme and the coffeeshop,we can seehow or a person's experience distancesvaries from standard giaenmeasof urements.This is so because person'sexperienceof spaceis neither a giaenin advancenor is it determined by external standards.On the contrary, spaceexpandsand contractsfrom us, reflecting our flexing engaBements with the world.l We have seenthrough just a few common examplesthat we must recognizespaceas an extensionof ourselves,not as a predetermined grid into which we are inserted.We have seenthat own body extends into the things with which we are engaged-as if we were elastic spheresstretching and contracting as our attention moves from one project and one objectto the next. In this way, we are neither isolated l-heres that orient ourselveswith respectto independent there-things nor are we at the center of a rigid set of distant objects;rather, we dwell inthe things for which we care,and this dwelling is constitutive of our existence.As Heidegger writes: "To say that mortals areis to say that in dwellingthey persist through spaces virtue of their stay by among things and locations."{ And, it is from this stretching of our- t , 3 4) KIRSTEN JACOBSON selves throughout the objects of our care that our senseof an extended world arises-a world that grows and contractsin unison with our projects and cares.Even the spacein which we are not currently engrossedis not a stiff, predetermined structure; it is rather a flexing horizon whose definition awaitsus and our possibilities. If we ignore the way in which spaceis a reflection of our manner of dwelling, and instead assumeit to be a foreign framework that we passthrough, we limit our ability to understandour own nature; for, we ascribeto something beyond us what in fact most essentiallyemanates from us and, thus, belongs to us. The failure to recognize ourselves the locusof spatialitycanleadto the misinterpretation as of our attitudes and behaviors,aswe shall now seeby turning our attenthat are commonlymisunderstood, argue,for tion to two neuroses I of this very reason.I will show that the neuroses agoraphobiaand, more unexpectedly, hypochondria should be understood in light of a phenomenological understanding lived space.s of Through suchan understanding,these neurosesare revealed to be not what some might call "mere psychological"issues,but rather problems with one's overall way of spatial being-in-the-world-i.e., problems of dwelling. P A R TI I : A G O R A P H O B IA N D H Y P O C H O N D R I A A AS DISORDERS DWELLINC OF A person suffering from agoraphobia feels confined to a contractedareaof the world. He hascertainplaces which he feelscomin fortable and able to function; theseare his home and placeshe might call homebases.n Outside of thesehome bases, agoraphobic the loses his ability to engageand communicateeffectivelywith othersanclhis surroundings. In the past, psychologistsand sociologistscommonly identified the sourceof the agoraphobic's neurotic contractionas a fear of open spaces alternatively, crowded spaces. or, of Oftentimes the underlying causeof agoraphobia was locatedin the very appearance or structure of the "space" of the city.7Such descriptions conceiveof spaceas possessing predeterminedqualitiesthat happento be unbearable the personwith agoraphobia. to Space thus takenas is fundamentally independent of the subject.Our recent phenomenologicalexplorationofhumanspatialityshould provokeus to question such an approach to understanding agoraphobiainsofar as it over- AGORAPHOBIA AND HYPOCHONDRIA t35l looks the role that the agoraphobic has in creatingthe contracted spacein which he dwells. Though many current theoriesof agoraphobia acknowledgethe psychological participationof the agoraphobic in shaping spaceasfearful or problematic in someway, thesetheories frequently persist in castingspaceas somethingthat is mostlyindependent thesubjecf, of and that has becomenegatively charged,so to speak,by the subject'sconcernsor fears.By maintaining this distance betweenthe subjectand space, theseapproaches alsofail to properly recognize the nature of lived space and, as a result, can neither comprehendthe existentialfoundationsof agoraphobianor recognize agoraphobia as-what I claim it to be-a disorderof dwelling. We canbeginto seethe problemswith overlookingthe existential lived experience spacein one of the of character the agoraphobic's of for prevailing treatmentapproaches agoraphobia-namely, exposure therapy. Exposure therapy involves subjectingthe agoraphobicpatient to a regimen of graduated exposuresto places identified as threatening the patientor sometimes the therapistwithout any by by on patient input.bThis approachfocuses building up a patient'stoleranceto threatening situations and on helping the patient developbehavioral skills that will enablehim to cope with the anxietieshe In experiences suchsituations. spiteof the factthat the copingtechin niquesgainedthrough this type of treatmentmay help the patient to function in an objectively larger sphere, they do not address the reasonswhy and how the patient has contracted spatialexperihis ence."Though the treated patient may, therefore, appear be proto ceedingthrough the world in a normal manner,he will continueto experiencethe world as contracted,as something with which he is not yet fully communicating. The failure of exposuretherapyto "cure" the agoraphobic his of is contractedworld experience documentedin studiesas well as in patient and professional testimonies.For instance,one study of the effectiveness behavioral treatmentreported that exposuretherapy of tended to "improve" agoraphobic patients,but to leave them with "significant residualproblems."r0 Another study found a forty-four percent "failure" rate for agoraphobics who were treatedby a behavioral approach (Gournay, ACP,130). More tangibly striking than these statistics are the observationsof a psychologist regarding the myopic results of a patient treatedby exposuretherapy: "The young man had a phobia about telephonesand travelling. About a year of t36l K I R S T E N] A C O B S O N desensitisation enabled him to travel and use the telephone. He commented on the utter pointlessness of such an achievement since he had no one to ring up and no one to travel to. He had formed no relationships with his fellows."11These reports allow for a general criticism of exposure-based treatment of agoraphobia-namely, that such an approach neglects to address the unhealthy structures of Iiving that underlie the patient's phobic feelings and behaviors, and, therefore, serves only to mask the problem. My argument here is that this as well as other common approaches to agoraphobia are vulnerable to this criticism due to their unspoken commitment to the conception of space as something existing outside of or independent from the agoraphobic. By rejecting this dualistic conception in favor of one that recognizes spatiality as rooted within the subject himself, the spatial restrictions of the agoraphobic can be interpreted as symptomatic of an overall problem with his way of dwelling or being-inthe-world. With this recognition, the agoraphobic can be acknowledged as the source of a problematic self-contraction, and, as a result, he,not merely his symptoms, can be addressed.r2 Let us turn to some of the experiences of the agoraphobic person to see how this shift in perspective may help us to better understand this neurosis. First, let us consider the agoraphobic's marking out of certain places as safe or as home basesand others as fearful and to be avoided. It is only when the agoraphobic is in his safe places or somewhere from which there is a reliable avenue to what he considers a home base that he feels comfortable and capable of carryin5; or"rthis daily activities and interests (Chambless and Goldstein, AMP,2). One agoraphobic describeshis inability to be actively present ln unsafe situations as follows: "It is difficult to concentrate whilst anxious. Thoughts such as 'How do I get away from here if I need to?' and 'What if somebody notices that I'm scared?' intrude, impeding the ability to focus attention on external events.Concentration difficulties result from the deployment of part of your attention on anxiety and its concomitants, instead of on the 'here and now"' (Clarke and Wardman, ACPA,36). In this quote, the agoraphobic describes an inability to be engaged in living when beyond his strictly defined sphereof safety; for, once he travels beyond this sphere, he becomes wrapped up in his anxieties about being away from home and in his plans for how to return there. As long as the agoraphobic is unable to respond with easeand spontaneity to the inviting calls of the people, AGORAPHOBIA AND HYPOCHONDRIA (37) places, and events that surround him, he has not yet succeededin dwellingbeyondhis zone of safetyeventhough he may have ventured into new geographical territory. Let us also consider the fact that many agoraphobicpersons report being able to travel beyond their "safety zones"with a good degreeof comfort fthey are accompanied by a close friend or family member or even a pet or cherishedinanimate object (Chamblessand Goldstein,AMP,2). At first glance,this may seemto be an expansionof the agoraphobic'ssaferange; yet, if he relies on his companion throughout their "outing," he effectively remains wrapped up in the familiarity of his companion and, therefore, has nof succeed extending himself into his new surroundings. in He persists in living within his narrow definition of what counts as safe, as home. Even when securely within the confines of a home base,his experienceof beingat homecontrastsin at least two significant ways with that of a healthy person's.To begin, home is a place of refuge and retreat for the agoraphobic,not, as it would be for the healthy person, a supportive base from which projects can be launched. Moreover, even though the healthy person may identify some particular place as "home," shepossesses fluid ability to beat a homeor to make herself home a diversity of situations.By contrast, at in the agoraphobic'sexperienceof being at home is one of rigidity and stasis; his possibilities for being at home are rigidly defined and constricted to his particular set of safeplaces. I maintain that we should recognizethe constrictionof the agoraphobic to be a spatially manifested avoidance of encounters with other persons,events,and even objects-that is, as an expressionof a problem with one's way of being-in-the-world. Merleau-Ponty expressesthis well inhis Phenomenology Perception: "The perception of of spaceis not a particular classof 'statesof consciousness' acts.Its or modalities are always an expressionof thetotal life of the subject,the energy with which he tends towards a future through his body and his world" (Merleau-Ponty,Ph.P,283, emphasis). my Following Merleau-Ponty, we must recognize the spatial limitations of the agoraphobic as a reflection of a total lived stance. If we turn again to researchon agoraphobia,we can find support for identifying the stanceof the agoraphobic as one of generally leaning away from certain sorts of contact and communion with other persons and places-namely, those sorts which are or may prove challenging or overLy exciting to the agoraphobic. One patient-psy- t38l KIRSTEN JACOBSON chologist team reports that "agoraphobicpeopleshow strong tendencies to avoid things, not only physically but also socially, veering away from any kind of interpersonal confrontation or unpleasantness. Most go to great lengths to avoid such feelings as anger and frustration, and even feelingsusually valued aspositive such ashappiness,excitement,and sexuality" (Chambless and Goldstein, AMP, 185). Another researcher more directly links the agoraphobic's experience spatial constrictionto his hamperedability to experiof ence and addressemotions;he writes: "... the agoraphobichas a of poorly elaboratedsubsystem constructsconcerningemotions,particularly thoserelating to interpersonal conflict,... which leadsthe response to, client to experienceanxiety in, and to adopt a constrictiae such situations."r3 This author further substantiates notion that the agoraphobia points to a problem with one's way of being-in-theworld when he writes: "Agoraphobia might ... be consideredto in reflect an expressionat the behavioral level of ... constriction, which a person draws in the outer boundaries of their perceptual field to exclude from awarenessmaterial which their constructsare ill-equipped to predict and which therefore generatesanxiety and confusion."r4It is by attending to the significance the liaed spatial of nature of agoraphobiathat we canbegin to recognizethat at the heart of this neurosis is the tendency to withdraw from one's engagement with the world and other persons,and, thus, to rejectcooperativeand responsivecontactwith the world and with others.If the lived significanceof the agoraphobic's contractionis ignored-as is typical-the agoraphobic will be treated as if his problems with spacewere distinct from the overall way in which he dwells in the world, and he will, as a result,fail to be treatedas a whole. Extending what we have seen here regarding agoraphobia can help us to better understand another neurosis-one that is rarely, if ever, considered on the basis of its lived spatiality-namely, hypochondria. Like agoraphobia,hypochondria reflects a problem with one's way of dwelling. My contention is that, in the caseof the hypochondriac, the retraction of the self is not, however, into a set of safe places,but rather into a body part. To understand what is at the root of this retraction, we must pay attention onceagain to the existential significance of the patients' experienceof space.But before turning our attention to the hypochondriac's experience of being-in-the- AGORAPHOBIA AND HYPOCHONDRIA t39l world, let us consider a common method for the treatment of hypochondria. The main goal of many current approachesto treating hypochondria is to educatethe hypochondriac regarding the "nature, perception, and reporting of physical symptoms, and . . . the psychological factors that amplify somaticdistress."lsAlong with this education, these treatments focus on improving the hypochondriac's ability to manage her obsessivethoughts about bodily ailments. There are however. To ample criticisms of suchbehaviorally basedapproaches, begin, there are some specialistson hypochondria who would dismiss these approaches altogether insofar as they believe that ". . . health concernsarenot centralto the prcblem."r6Many unwilling for to go this far have faulted behavioral treatment approaches being shortsighted by focusing on modifying reactions to one's body This criticism without offering insight into the underlying problem.lT who insists that a proper is taken up by one professor of psychiatry description of hypochondria must not get bogged down in the patient's relationship with her complaints and symptoms, but must 18 insteadattend to the hypochondriac's " entiremode being." Keeping of with these assessments, contend that that any treatment approach I for hypochondria whose focus is that of controlling the subject's reactionsto her body will fail to help the hypochondriac to develop healthy means of dealing with the worldly conflicts that originally thrust her into her concernsabout her body. For the hypochondriac's experience to be understood and addressed properly, one must recognizethe existentialsignificanceof the spatialcontractioncentral to her neurosis. To seethat this is so, let us explore both the experience of contraction that the hypochondriac undergoes as well as the functional role that such a withdrawal may fill for her. A person immersed in hypochondriacal thought sinks into her fears regarding a particular ailment or set of ailments that she takes herself to be experiencing. In doing so, her approach to the world around her shifts dramatically.leAll eventsin her experience begin to be filtered through the areaof her body that is concerningher (Ladee, H5,69). One psychiatrist describesthe hypochondriac as ". . . being occupied by this [i.e.,by her bodily concerns]above all other things, paying it continual and (in the absenceof strong distracting stimuli) practically exclusive attention"; he adds that "correlated with this is a loss of interest in one's total situationinlife" (Ladee,HS, 50). De- t40i K I R S T E N] A C O B S O N pending on the severity of her hypochondriacal immersion, she will feel either metaphorically or literally as if she is staring out at the world througlt this body part. If she is concerned about an ache in her stomach, for instance, she will find herself continually drawn back to her stomach pains and her thoughts about what these may imply. She will make or feel forced into decisions about what to do and what not to do based on these thoughts. An activity that involves sustained concentration may never be completed; or, it will be accomplished only in a rare stolen moment of respite when she has pacified herself with intricately woven reassurancesthat her fears about her stomach must be-or, at least, could be-mistaken. Even an activity such as talking with a friend may prove too demanding to balance with her stomach's demands: She will waver between being present in their conversation and sinking back into her pain; as a result, she will fail to be an attentive and committed participant in their presumably shareddialogue. Unable to pull herself away from her focus on her stomach, the hypochondriac experiences a world shrunken to the space of her ailment. My argument is that the habitual pattern of sinking oneself into an ailment in this way is a sign in the hypochondriac of a systemic problem with how she engages with her activities, her relationships, The hypochondriac demonstrates and-ultimately-with the world.2t' a tendency to shrink when challenges or even excitements arise.2l This shrinking is not figurative: The hypochondriac literally diminishes the size of herself by withdrawing from her engagements with the world and rooting herself in her ailment. Her experience of space-the space of her person, the space of her surroundings, space as a whole-is limited by her concerns. She is, thereby, closed off or cut short where others are not. By withdrawing into the smaller space of one's body, the hypochondriac is, I am claiming, mimicking or avoiding a difficult situation that she is not able to cope with or solve effectively.22 This view is supported by one psychiatrist who notes that the symptoms of illness in a hypochondriac ".. . tend to wax and wane, shifting with Iife circumstances, with physical and emotional changes, and with tensions within [relationships]" (Cantor, P1,206);and by another who identifies "the hallmark of a hypochondriac" as the tendency and desire " . . . to deal with his emotional or psychosocial problems as if they were purely physical problems over which he has no control and AGORAPHOBIA AND HYPOCHONDRIA t 4 1l for which he can take no blame" (Baur, HWI,187).In this light, the woman who is obsessivelyabsorbedin concernsabout her stomach could be avoiding a challengeor an excitement-an open-endedsituation that takes her beyond her realm of security and control-that is arising with a friend. In the contracted space of her stomach, the hypochondriac may feel that she is able to manage or to secure a solution or, if not this, that shecan "reasonably" claim that the situation is beyond her control; both of these routes may have seemed unopen to her in her more complex dealings with her friend. By means of her concentration on her stomach,she has effectively reduced the range of her responsibilities and possibilities; she has shrunk the spacein which shecan dwell. Though this reduction may seemhelpful to her immediately, such a technique is obviously poisonousto healthy dealingsboth with her friend and in a wider world of relations with people and experiences. This pattern of responseto the world and its challengesis the tendency that she sharesin common with the agoraphobic-namely, the tendency to contract the spacein which she functions, in which she dwells and is at home. As such,hypochondria can be understood as a species agoraphobiaof more exactly, as an extreme form of this neurosis wherein what counts as home is reduced to the limits of one's body.23 CONCLUSION The above descriptions draw out how both the agoraphobicand the hypochondriac restrict their experiences space-the former by of setting up barriers beyond which he must not stray, the latter by harnessingher attention in a body part. By paying attention to the lived spatial experiences the agoraphobicand the hypochondriac, of we are able to recognizethat a problem with one'sway of dwelling is at the heart of theseneuroses.In both neuroses, subjectsare conthe fined to a massively restricted home base-one that does not allow them to engagewith and in the world ashealthy personstypically do. The failure to recognizethe existentialsignificanceof this contracted experienceof thehomespace leads, as we have seen,to a myopic understanding and treatment of the affectedpatients-one that necessarily remains trapped within the contracted spaceof the patients' neuroses.We must, therefore,recognizein theseneuroses/ well as as in the human experiencein general,that spaceexpandsand contracts t42) KIRSTEN JACOBSON around us in accordance with our projects and intentions, and, therefore,people must be understood not as objectsin a fixed world, but rather as subjectsin an inhabited,lived world-that is, assubjects a who dwell and, as such, make home. NOTES 1 Maurice Merleau-Ponty, Phenomenology Perception, of [Ph.P] trans. For of Colin Smith (London:Routledge,1962),p.250. a discussion "level," (Athens, OH: Ohio of seeG. B. Madison, ThePhenomenology Merleau-Ponty I University Press,1.981). have also benefitedfrom Maria Talero, "Spatial Level and ExistentialSpace" (unpublished). 2 GastonBachelard, Beacon Poetics Sp of ace, ans.Maria Jolas(Boston: tr Press,1964),p. 48. Martin Heidegger, Being and Time, 3 Merleau-P onty, Ph.P,1,39-40,258; 1996), trans.JoanStambaugh(Albany: StateUniversity of New York Press, H.pp. 102-05;Heidegger, "Building Dwelling Thinking" in Poetry,Language, Thought,trans. Albert Hofstadter(New York: Harper & Row, L978), p. 56. For a detailed study of the phenomenological conceptionof space, (Albany: StateUniversity of New York seeDavid Morris, TheSense Space of Press,forthcoming).For a discussionof the phenomenological conception of spacein relation to the history of philosophy,seeEdward S. Casey,The Fateof Place: Philosophical A History (Berkeley:University of California Press,1997),chapters10-11. 4 Heidegger, "Building Dwelling Thinking" in Poetry Language Thought,p. 157. 5 For another attempt to use Merleau-Ponty's philosophy to interpret agoraphobia,seejoyce Davidson, "A Phenomenology Fear:Merleauof Ponty and Agoraphobic Life-Worlds." Sociology Healthand lllness,22.5 of (2000):640-60. 6 Dianne L. Chambless and Alan J. Goldstein, eds., Agoraphobia: MultiplePerspectiaes onTheory andTreatment IAMP] (New York: John Wiley and Sons,1982),p.2. 7 Anthony Vidler, Warped Art, Space: Architecture, Anxiety in Modern and Culture(Cambridge,MA: MIT Press,2000),pp.26-32. AGORAPHOBIA AND HYPOCHONDRIA t43l 8 Christopher J. Clarke and Wayne Wardman, Agoraphobia: Clinical A and Personal Account(Sydney:PergamonPress,1985),pp. 58-59. 9 For a discussionof therapy comparable my own, seeJohnRusson, to Human Experience: Philosophy,Neurosis, and the Elements EaerydayLife of (Albany: StateUniversity of New York Press,2003),chapter6, especially pp.132-34. 10 Kevin Gournay, ed., Agoraphobia: CuruentPerspectiaes Theory on and TreatmentlACPl, (New York: Routledge, 1989),p. 1,21. 11 David A. Winter, "An Alternative Constructionof Agoraphobia" in Agoraphobia: on Current Perspectiues Theoryand TreatmentIACPAI, ed. KevinGournay, .115. p 12"He" is, of course,understoodhere not to refer to a Cartesiansubject, but to being-in-the-world.This conceptionis helpfully explained in R. D. Laing, TheDiaidedSef (London: Penguin Books,1959),chapter 1. 13 David A. Winter, "An Alternative Constructionof Agoraphobia" in Agoraphobia: CurrentPerspectiaes, Kevin Gournay, p. 96. ed. 14 David A. Winter, "An Alternative Constructionof Agoraphobia," in Agoraphobia: CurrentPerspectiaes, Kevin Gournay, p. 95. ed. 15 Vladan Starcevicand Don R. Lipsitt, eds.Hypochondriasis: Modern Perspectiues an AncientMalady(Oxford: Oxford University Press,2001), on p.296. 16 Warwick and Salkovskis, "Cognitive-BehavioralTreatment of Hypochondriasis" in Hypochondriasis, Starcevicand Lipsitt, p.316. eds. L7 Susan Baur, Hypochondria:WoefuI Imaginings [HWI] (Berkeley: U n i v e r s i t yo f C a l i f o r n i aP r e s s )p . 1 , 9 4 . , 18 G, A, Ladee Hypochondriacal Syndromes [HS] (Amsterdam: Elsevier Publishing Company, 1.966), p.43. 19 For a discussion of the relationship between increased bodily awarenessand alienation from one's environment, see SeanGallagher, "Lived Body and Environment." Research Phenomenology (1986),pp. in 16 1.39-70. This discussionalso applies to my analysisof agoraphobiaif we follow both Gallagher and Merleau-Pontyin recognizingthe lived body as extending into and through one's environment. t 44) KIRSTEN JACOBSON 20 Sean Gallagher makes a related claim when he writes: "A problem with the body is a problem with the environment because the environment is lived as the body is lived" ("Lived Body and Environment," p.164). Gallagher stresses that the environment is not separate from the iived body, but rather incorporated into or appropriated by the lived body. This incorporation is disturbed when the body-and, correspondingly, the environment-cease to belioed, and instead become objects for attention. For a relevant discussion of the codetermination the animal and the environof ment, see Francisco Varela, Evan Thompson, and Eleanor Rosch, The Em(Cambridge, MA: MIT bodiedMind: Cognitiae Science and Human Experience P r e s s , 1 9 9 1 ) ,c h a p t e r 8 . 21 For a discussion of the correlation of the hypochondriac's symptoms with emotional challenges and excitements, see Carla Cantor, Phantom IIIness: Shattering the Myths of Hypochondria [PI] (Boston: Houghton Mifflin, 1996). 22lt is important to recognize that neither the hypochondriac nor the agoraphobic is explicitly intending or willing these neurotic responses. Their behaviors and attitudes reflect a constricted manner of being-in-theworld-a habitual manner or style of being-that has developed over time as a means of engaging with and in a world that has been and continues to be overly troubling, challenging, and/or exciting. 23 I consider anorexia to be a similar and still more extreme form of this neurosis-one in which the space of dwelling is forever being contracted. (I have developed my spatial interpretation of anorexia in "Without Speech or Space: A Phenomenological Interpretation of Anorexia Nervosa" (Chiasmi,forthcoming).) The etymology of anorexiaunderscores this interpretation: Etymologically, anorexia is the Greek an, the alphaprivative indicating negation, and the Creekorexis, which means "desire." Orexis is in turn derived f rom orego,which among other things means "to stretch out" or "to thrust forward into." Thus, anorexia describes a systemic lack of desire, or a rejection of stretching or thrusting into what surrounds oneself. For an attempt to use Merleau-Ponty's philosophy to interpret anorexia, see Sarah Clift, "Anorexic Theory or, An Allegory of Dis-ease." International Studiesin Philosophy31.1 (1,999),pp.23-6.