shortbread, and a fireside armchair. Shes doing well, Mrs. Rhodes. I couldnt be more pleased.
Isnt there medication you could give her? I was reading that anxiety medication
In her case, anxiety medication would be a very grave mistake. Drugs arent always the answer, Mrs. Rhodes. Believe me, if they would help her, Id write the prescription in a minute.
But shes been like this for sixteen months.
He cocked his head and regarded her almost as if he suspected that she was teasing him. Have you really seen no change in her, especially over the last few months?
Oh, yes. Plenty. And it seems to me... Well, Im no doctor, no therapist, but lately Susan seems to be worse. A lot worse.
Youre right. Shes getting worse, but thats not a bad sign.
Baffled, Martie said, Its not?
Sensing the depth of Marties distress, perhaps intuitively aware that her anxiety arose not entirely from her concern about her friend, Dr. Ahriman guided her to a chair. He settled into the seat beside her.
Agoraphobia, he explained, is almost always a sudden-onset condition, rarely gradual. The intensity of the fear is as severe during the first panic attack as during the hundredth. So when theres a change in the intensity, it often indicates the patient is on the edge of a breakthrough.
Even if the fear gets worse?
Especially when it gets worse. Ahriman hesitated. Im sure you realize I cant violate Susans privacy by discussing the details of her specific case. But in general the agoraphobic often uses his or her fear as a refuge from the world, as a way to escape engagement with other people or to avoid dealing with particularly traumatic personal experiences. Theres a perverse comfort in the isolation
But Susan hates being so fearful, trapped in that apartment.
He nodded. Her despair is deep and genuine. However, her need for isolation is even greater than her anguish over the limitations imposed by her phobia.
Martie had noticed that sometimes Susan seemed to cling to her apartment because she was happy there more than because she was too frightened of the world beyond.
If the patient begins to understand why shes embracing her loneliness, Ahriman continued, if at last she starts to identify the real trauma shes trying not to face, then sometimes, in denial, she will cling to the agoraphobia more fiercely. An intensification of symptoms usually means shes making a last-ditch defense against the truth. When that defense fails, shell finally face the thing she really fearsnot open spaces, but something more personal and immediate.
The doctors explanation made sense to Martie, yet she couldnt easily accept the idea that an ever steeper decline would inevitably lead to a cure. Last year, her fathers battle with cancer progressed along a relentless downward spiral, and at the bottom there had been no joyful breakthrough, only death. Of course a psychological illness could not be compared to a physical disease. Nevertheless Did I set your mind at rest, Mrs. Rhodes? A twinkle of humor enlivened his eyes. Or do you think Im full of psychobabble?
His charm won her over. The impressive array of diplomas in his office, his reputation as the finest specialist in phobic therapy in California and perhaps in the nation, and his keen mind were no more important to building patient trust than was his bedside manner.
Martie smiled and shook her head. No. The only babble is coming from me. I guess... I feel like Ive failed her somehow.
No, no, no. He placed a hand reassuringly on her shoulder. Mrs. Rhodes, I cant stress strongly enough how important you are to Susans recovery. Your commitment to her means more than anything I can do. You must always feel comfortable about expressing your worries to me. Your concern for her is the rock on which she stands.
Marties voice thickened. Weve been friends since we