Abstract
Agoraphobia is commonly considered to be a fear of outside, open, or crowded spaces, and is treated with therapies that work on acclimating the agoraphobic to external places she would otherwise avoid. I argue, however, that existential phenomenology provides the resources for an alternative interpretation and treatment of agoraphobia that locates the problem of the disorder not in something lying beyond home, but rather in a flawed relationship with home itself. More specifically, I demonstrate that agoraphobia is the lived body expression of a person who has developed an inward-turning tendency with respect to being-at-home, and who finds herself, as a result, vulnerable and even incapacitated when attempting to emerge into the public arena as a fully participatory agent. I consider this thesis in light of the fact that since World War I agoraphobia has been diagnosed significantly more in women than in men; indeed, one study found women to be 89% more likely than men to suffer from agoraphobia. I conclude that agoraphobia is a disorder that stands as an emblematic expression of the ongoing pathology of being a woman in contemporary society–a disorder that reflects that even today women belong to a political world in which they are not able to feel properly at-home.
Similar content being viewed by others
Notes
Three of the most common treatment modalities—exposure therapy, cognitive behavioral therapy, and medication—work specifically on moderating the physiological and psychological reactions the agoraphobic has when she ventures beyond her home territory (Hallam 1978; Öst et al. 2004; Harman et al. 2002).
The prevalence alone of agoraphobia makes it an important psychological disorder to study. For instance, one study reports an incidence rate of 4.9% in Americans between the ages of 18 and 54, and a 1994 study found the prevalence of agoraphobia across the human lifespan to be 5.3% (U.S. Department of Health and Human Services 1999; Kessler et al. 1994). A 2005 study reports a lower population incidence rate of 1.4% (Kessler et al. 2005, but this rate is arguably affected by shifts in Diagnostic and Statistical Manual of Mental Disorders (DSM) codes that have led to many patients who exhibit agoraphobia receiving primary diagnoses other than agoraphobia (see, for example, Hedley and Hoffart 2001).
One report illustrates this point quite strikingly: A mere 18% of agoraphobic patients whose symptoms had diminished following treatment reported themselves to be “symptom-free” 4 years following treatment (McPherson et al. 1980: 152).
While in Western society, “private” may immediately suggest the notion of “private ownership” or at least of an enclosed space over which we have exclusive rights, I recognize that not all people have access to homes of this sort. I use “private” here to indicate a relationship of privileged belonging.
Cases in which people do feel imprisoned as alien residents within their “own” homes or feel themselves to have no place of “my own” are situations of crisis. A person living in such a situation may ultimately be more lacking in home than some people who are considered “homeless,” but who are in fact quite “at home” in being without a physical house-structure. See Young (2005: 152).
Gilman's is an interesting reaction insofar as many agoraphobics are further incapacitated when removed from their familiar places and companions. Regardless of the specific reaction, however, home and the home-body for the agoraphobic have become so static that a change in their status has debilitating consequences for the agoraphobic sufferer (Davidson 2003: 100–105).
Young (2005) makes a similar point, describing the lived body as a “body-in-situation” (18).
See Jacobson (2010).
Haley (1980: 30), a family systems therapist, confirms the operative claim here—namely, that the structure of the family home is what makes it possible or prohibits the child's successful emergence from the family into the larger world.
Arrindell et al. (2003) write: “A society that does not teach women to be instrumental, competent and assertive, rather than just house-oriented or nurturing and expressive, is one that breeds (agora) phobic women” (797, citing Fodor (1974) and Chambless and Mason (1986). See also Chambless and Goldstein (1982: 52) for a discussion of agoraphobics as conceiving of themselves as incapable of functioning independently. For discussions of agoraphobics' preoccupation with being abandoned, rejected or being alone, see Evans and Liggett (1971: 150), and also Byrne et al. (2004: 107).
See Russon (2003: 65–68).
For a helpful discussion of the normative structures and influences of both the state and the family with respect to gender differences, see Christman's (2002) chapter “Race, Gender, and the Politics of Identity,” especially the sections “Public and Private” and “Justice and Care”.
Fodor (1974) maintains that this discrepancy owes to the fact that, on the one hand, in their formative years, “young people are forging out in new areas,” but, on the other hand, girls have not been reinforced in this activity in the same way boys have (147). She specifically argues that girls are raised in ways that reinforce docile, submissive, and conservative roles, while boys are encouraged to be self-assertive, achievement oriented, and independent (138, 141–142).
One study conducted in the 1980s documented that within households in which both husband and wife worked full-time outside the home, women were still held responsible for a full 80 percent of the domestic work (Marcus 1995: 154). See also Rybczynski (1986: 75; the entire chapter “Domesticity,” and 159–162); Porteous and Smith (2001: 48–50); Mallett (2004: 74–77); Marcus (1995: 104); and, Waldman (2003: 662–671), and, most pertinent to the topic of agoraphobia, Davidson (2003: 119 and chap. 6).
See also Young (2005: 144–151).
While de Beauvoir (1972) is writing of women in the first half of the twentieth Century, the persisting differentiation in household roles between men and women suggests that there continues to be a significant distinction between men and women in this arena. In an interview more than two decades after publishing The Second Sex, de Beauvoir held firm to a similar point, arguing that “…being banished to the ghetto of domesticity and the division of labour along male/female, private/public lines is precisely what women should be rejecting if they want to realize their full value as human beings” (Schwarzer 1984: 75).
Prior to WWI, 80% of cases of agoraphobia were diagnosed in men (Reuter 2007: 8, 35–36, 38–39). While agoraphobia certainly existed in women prior to World War I, Reuter argues that it would not have been as visible, since prior to the war, it would have been considered “normal” for women in financially middle and upper class families to remain close to home, and, thus, the symptoms of agoraphobia would not become visible to others or possibly even to oneself (74–76).
Margolis (1984) notes that while the net number of women entering the workplace around WWI increased only by 5%, the workforce at this time was undergoing a significant change in terms of the types and wage-level of jobs open to women (203).
Even the Women's Bureau—an institution specifically focused on the rights of women workers—officially took the position that “wives that work… were a threat to the health and happiness of their families” (Margolis 1984: 206). Margolis concludes that at this point in time, “combining career, marriage, and motherhood was simply unthinkable” (207). See also Smith-Rosenberg (1985: 199–200).
During WWII, the number of women in the workforce increased significantly—rising from 14 to 19 million—and married women composed a notable 75% of this increase (Mintz and Kellogg 1998: 161).
A recent news article discusses the upcoming change to French law that will mandate that 40% of company boards be made up of women (“La Vie en Rose” 2008, May 8; see also “Skirting the Issue” 2010, March 13). The article reports that some companies are “getting around” the quota by planting token women on their boards—women chosen for their attractiveness or public appeal rather than for their expertise. Critics complain that attention is being aimed at the top of the job market without addressing imbalances lower down.
Recently, significant attention has been paid to gender biases in research studies as well as in treatment-protocols; see, for instance, the editorial and a trio of articles in a recent issue of Nature (2010, June 10): “Putting Gender on the Agenda”; “Sex bias in trials and treatment must end”; “Pregnant women deserve better”; and “Males still dominate animal studies”.
In the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV 1994), the language describing agoraphobia was itself changed in such a way that reflects a gender differentiation (396). A common symptom of agoraphobic behavior was at that time identified as the inability to carry out “homemaking responsibilities” such as grocery shopping, taking children to appropriate places and events, etc.
See also Evans and Liggett (1971: 152–153). They argue that an effective means of treatment must involve allowing the agoraphobic to actively experience—rather than superficially eliminate—her fears, and to develop a recognition in the agoraphobic that their source is rooted in interpersonal issues rather than in fixed features of her environment (153).
References
American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
APA. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.
Arrindell, W. A., Eisemann, M., Richter, J., Oei, T. P. S., Caballo, V. E., van der Ende, J., et al. (2003). Masculinity–femininity as a national characteristic and its relationship with national agoraphobic fear levels: Fodor’s sex role hypothesis revitalized. Behaviour Research and Therapy, 41, 795–807.
Bachelard, G. (1964). The poetics of space (M. Jolas, Trans.). Boston: Beacon Press (Original work published 1958).
Bartky, S. (1999). Foucault, femininity, and the modernization of patriarchal power. In M. Pearsall (Ed.), Women and values: Readings in recent feminist philosophy (3rd ed., pp. 160–173). Belmont, CA: Wadsworth.
Baylis, F. (2010). Pregnant women deserve better. Nature, 465(7299), 689–690.
Bordo, S. (2003). Unbearable weight: Feminism, western culture, and the body (10th anniversary ed.). Berkeley: University of California Press.
Byrne, M., Carr, A., & Clark, M. (2004). The efficacy of couples-based interventions for panic disorder with agoraphobia. Journal of Family Therapy, 26, 105–125.
Chambless, D. L., & Goldstein, A. J. (Eds.). (1982). Agoraphobia: Multiple perspectives on theory and treatment. New York: Wiley.
Chambless, D. L., & Mason, J. (1986). Sex, sex-role stereotyping and agoraphobia. Behaviour Research and Therapy, 24, 231–235.
Christman, J. (2002). Social and political philosophy: A contemporary introduction. London: Routledge.
Clum, G. A., & Knowles, S. L. (1991). Why do some people with panic disorder become avoidant?: A review. Clinical Psychology Review, 11, 295–313.
Daiuto, A. D., Baucom, D. H., Epstein, N., & Dutton, S. S. (1998). The application of behavioral couples therapy to the assessment and treatment of agoraphobia: Implications of empirical research. Clinical Psychology Review, 18(6), 663–687.
Dancy, R. B. (1996). Gender and parenting. Special Delivery, 19(3), 8–9.
Davidson, J. (2003). Phobic geographies: The phenomenology and spatiality of identity. Burlington, VT: Ashgate Pub. Co.
De Beauvoir, S. (1972). The second sex (H.M. Parshley, Trans.). New York: Penguin.
Derrida, J. (2000). Of hospitality: Anne Doufourmantelle invites Jacques Derrida to respond (R. Bowlby, Trans.). Stanford, CA: Stanford University Press.
Duckworth, J., & Anderson, W. (1986). MMPI interpretation manual for counselors and clinicians (3rd ed.). Muncie, IN: Accelerated Development Inc.
Emmelkamp, P. M. G., van der Hout, A., & de Vries, K. (1983). Assertive training for agoraphobics. Behaviour Research and Therapy, 21(1), 63–68.
Evans, P., & Liggett, J. (1971). Loss and bereavement in agoraphobia: Implications for therapy. British Journal of Medical Psychology, 44(2), 149–154.
Fodor, I. G. (1974). The phobic syndrome in women: Implications for treatment. In V. Franks & V. Burtle (Eds.), Women in therapy: New psychotherapies for a changing society (pp. 132–168). New York: Brunner/Mazel.
Frances, A., & Dunn, P. (1975). The attachment-autonomy conflict in agoraphobia. International Journal of Psycho-Analysis, 56(4), 435–439.
Frances, A., & Egger, H. (1999). Whither psychiatric diagnosis. Australian and New Zealand Journal of Psychiatry, 33, 161–165.
Fredrikson, M., Annas, P., Fischer, H., & Wik, G. (1996). Gender and age differences in the prevalence of specific fears and phobias. Behavior Research and Therapy, 34(1), 33–39.
Freund, P. E. S. (1990). The expressive body: A common ground for the sociology of emotions and health and illness. Sociology of Health & Illness, 12(4), 452–477.
Fullerton, H. N., Jr. (1999). Labor force participation: 75 years of change, 1950–1998 and 1998–2025. Monthly Labor Review, 122, 3–12.
Gassner, S. M. (2004). The role of traumatic experience in panic disorder and agoraphobia. Psychoanalytic Psychology, 23(2), 222–243.
Gilligan, C. (1993). In a different voice: Psychological theory and women’s development (Reissue ed.). Cambridge, MA: Harvard University Press.
Gilman, C. P. (1989). The yellow wallpaper and other writings. New York: Bantam Books.
Greenwald, M. W. (1980). Women, war, and work: The impact of world war I on women workers in the United States. Ithaca, NY: Cornell University Press.
Haimo, S., & Blitman, F. (1985). The effects of assertive training on sex role concept in female agoraphobics. Women & Therapy, 4(2), 53–61.
Haley, J. (1980). Leaving home: The therapy of disturbed young people. New York: McGraw-Hill Book Company.
Hallam, R. S. (1978). Agoraphobia: A critical review of the concept. British Journal of Psychiatry, 133, 314–319.
Harman, J. S., Rollman, B. L., Hanusa, B. H., Lenze, E. J., & Shear, M. K. (2002). Physician office visits of adults for anxiety disorders in the United States, 1985–1998. Journal of General Internal Medicine, 17, 165–172.
Hedley, L. M., & Hoffart, A. (2001). Agoraphobia without history of panic disorder. Clinical Psychology & Psychotherapy, 8(6), 436–443.
Heidegger, M. (1996). Hölderlin’s hymn “the Ister” (W. McNeill & J. Davis, Trans.). Bloomington and Indianapolis, IN: Indiana University Press.
Hofstede, G. (1980). Culture’s consequences: International differences in work-related values. Beverly Hills, CA: Sage.
Hofstede, G. (1986). Cultural differences in teaching and learning. International Journal of Intercultural Relations, 10, 301–320.
Hölderlin, F. (2004). Poems and fragments (4th ed.) (M. Hamburger, Trans.). London: Anvil Press Poetry.
Homer. (1967). Odyssey (R. Lattimore, Trans.). New York: Perennial Classics.
Hudson, B. (1974). The families of agoraphobics treated by behavior therapy. British Journal of Social Work, 4(1), 51–59.
Jacobson, K. (2004). Agoraphobia and hypochondria as disorders of dwelling. International Studies in Philosophy, 36(2), 31–44.
Jacobson, K. (2009). A developed nature: A phenomenological account of the experience of home. Continental Philosophy Review, 42, 355–373.
Jacobson, K. (2010). The experience of home and the space of citizenship. The Southern Journal of Philosophy, 48(3), 219–245.
Joyce, P. R., Bushnell, J. A., Oakley-Browne, M. A., Wells, J., Elisabeth, H., & Andrew, R. (1989). The epidemiology of panic symptomatology and agoraphobic avoidance. Comprehensive Psychiatry, 30(4), 303–312.
Kane, F. (1999). Boys will be boys: Let’s help them. Everyman, 36, 14–18.
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 617–627.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51(1), 8–19.
Kim, A. M., Tingen, C. M., & Woodruff, T. K. (2010). Sex bias in trials and treatment must end. Nature, 465(7299), 688–689.
Kleiner, L., & Marshall, W. L. (1987). The role of interpersonal problems in the development of agoraphobia with panic attacks. Journal of Anxiety Disorders, 1, 313–323.
La Vie en Rose [Editorial] (2008). The Economist, 395(8681), 66–67.
Leder, D. (1990). The absent body. Chicago: University of Chicago Press.
MacNeil, G. (2001). Time-limited psychological treatment for specific panic disorders and agoraphobia. Brief Treatment and Crisis Intervention, 1(1), 29–41.
Mallett, S. (2004). Understanding home: A critical review of the literature. Sociological Review, 52(1), 62–89.
Marcus, C. C. (1995). House as a mirror of self: Exploring the deeper meaning of home. Berkeley, CA: Conari Press.
Margolis, M. L. (1984). Mothers and such: Views of American women and why they changed. Berkeley, CA: University of California Press.
McPherson, F. M., Brougham, L., & McLaren, S. (1980). Maintenance of improvement in agoraphobia patients treated by behavioral methods: A four-year follow-up. Behavior Research and Therapy, 18, 150–152.
Merleau-Ponty, M. (1962). Phenomenology of perception (C. Smith, Trans.). New York: Routledge & Kegan Paul Ltd. (Original work published 1945).
Mintz, S., & Kellogg, S. (1998). Domestic revolutions: A social history of American family life. New York: The Free Press.
Öst, L.-G., Thulin, U., & Ramnerö, J. (2004). Cognitive behavior therapy vs exposure in vivo in the treatment of agoraphobia. Behaviour Research and Therapy, 42, 1105–1127.
Parker, G. (1979). Reported parental characteristics of agoraphobics and social phobics. British Journal of Psychiatry, 135, 555–560.
Poovey, M. (1987). Scenes of an indelicate character: The medical “treatment” of victorian women. In C. Gallagher & T. W. Laquer (Eds.), The making of the modern body: Sexuality and society in the nineteenth century. University of California Press: Berkeley.
Porteous, D. J., & Smith, S. E. (2001). Domicide: The global destruction of home. Montreal: McGill-Queen’s University Press.
Powell, K. A., & Abels, L. (2002). Sex-role stereotypes in TV programs aimed at the preschool audience. Women and Language, 25(2), 14–22.
Putting Gender on the Agenda [Editorial] (2010). Nature, 465(7299): 665.
Reuter, S. (2007). Narrating social order: Agoraphobia and the politics of lassification. Toronto: University of Toronto Press.
Rousseau, J. (1911). Emile (B. Foxley, Trans.). London: Everyman’s Library.
Russon, J. (2003). Human experience: Philosophy, neurosis, and the elements of everyday life. Albany, NY: SUNY Press.
Russon, J. (2009). Bearing witness to epiphany: Persons, things, and the nature of erotic life. Albany, NY: State University of New York Press.
Rybczynski, W. (1986). Home: A short history of an idea. New York: Viking Penguin.
Sartre, J.-P. (1956). Being and nothingness (H.E. Barnes, Trans.). New York: Pocket Books. (Original work published 1943).
Schneider, S. W. (2002). The presents we give to girls and women. Lilith, 27(2), 2–3.
Schwarzer, A. (1984). After The second sex: Conversations with Simone de Beauvoir (M. Howarth, Trans.). New York: Pantheon Books, 1984.
Seidenberg, R., & DeCrow, K. (1983). Women who marry houses: Panic and protest in agoraphobia. New York: McGraw-Hill.
Sheikh, J. I., Leskin, G. A., & Klein, D. F. (2002). Gender differences in panic disorder: Findings from the National Comorbidity Survey. The American Journal of Psychiatry, 159(1), 55–58.
Skirting the Issue [Editorial] (2010). The Economist, 394(8673), 71.
Smith-Rosenberg, C. (1985). Disorderly conduct: Visions of gender in Victorian America. New York: Alfred A. Knopf.
Steinbock, A. J. (1995). Home and beyond: Generative phenomenology after Husserl. Evanston, IL: Northwestern University Press.
Tannen, D. (1996). Gender and discourse (New ed.). Cambridge: Oxford University Press.
The Conundrum of the Glass Ceiling [Editorial] (2005). The economist, 376 (8436), 63–65.
Thorpe, G. L., Freedman, E. G., & Lazar, J. D. (1985). Assertiveness training and exposure in vivo for agoraphobics. Behavioural Psychotherapy, 13, 132–141.
Troutman, A. (1997). Inside fear: Secret place and hidden spaces in dwellings. In N. Ellin (Ed.), Architecture of fear (pp. 143–157). New York: Princeton Architectural Press.
Turgeon, L., Marchand, A., & Depuis, G. (1998). Clinical features in panic disorder with agoraphobia: A comparison of men and women. Journal of Anxiety Disorders, 12(6), 539–553.
U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general—executive summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
Vidler, A. (2000). Warped space: Art architecture, and anxiety in modern culture. Cambridge, MA: MIT Press.
Waldman, L. (2003). Houses and the ritual construction of gendered homes in South Africa. Journal of the Royal Anthropological Institute, 9, 657–679.
We Did It! [Editorial] (2010). The Economist, 394(8663), 7.
Weiss, G. (1999). Body image intercourse: A corporeal dialogue between Merleau-Ponty and Schilder. In D. Olkowski & J. Morley (Eds.), Merleau-Ponty: Interiority and exteriority, psychic life and the world (pp. 121–143). Albany, NY: SUNY Press.
Wilson, M. (1993). DSM-III and the transformation of American psychiatry: A history. The American Journal of Psychiatry, 150(3), 399–410.
Woolf, V. (1929). A room of one’s own. Orlando, FL: Harcourt Books.
Young, I. M. (2005). On female body experience. Oxford: Oxford University Press.
Zucker, I., & Beery, A. K. (2010). Males still dominate animal studies. Nature, 465(7299), 690.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jacobson, K. Embodied Domestics, Embodied Politics: Women, Home, and Agoraphobia. Hum Stud 34, 1–21 (2011). https://doi.org/10.1007/s10746-011-9172-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10746-011-9172-2