Agoraphobia and its Portrayal in "The Woman in the Window"

Payal Somani

There are various types of anxiety disorders recognized by the DSM-5, agoraphobia being one of them. This disorder is characterized by “uneasiness and fearfulness in situations where the person perceives the environment to be unpredictable, dangerous or unsafe” (Aqeel, Aqeel, & Tohid, 2016). This can include being in spaces such as shopping malls, airports, and parking lots. Without a pre-existing panic disorder, the prevalence of agoraphobia in the general population is only about 0.8% (McCabe, 2018), which makes it somewhat absent from mainstream media and literature. However, the 2017 book “The Woman in the Window,” by AJ Finn, is a thriller where the protagonist suffers from a severe case of agoraphobia. This paper will look at the portrayal of this anxiety disorder in the novel and analyze whether this representation was accurate or not.

There are various biological and psychological causal factors of agoraphobia. The biological ones include genetics and biological agents, while the psychological causal factors may be stressful environmental triggers, substance abuse or a pre-existing generalized anxiety disorder, among other things (Kivi, Boskey, & Cherney, 2016). The loss of a close relative or friend may also cause agoraphobia (Aqeel, Aqeel, & Tohid, 2016). In Finn’s book, Anna Fox, the protagonist, became agoraphobic after a particularly catastrophic accident resulted in the death of her husband and daughter. The same accident had left her in the middle of nowhere in a snowstorm for hours before she received any help. Both of these causes led to her agoraphobia, so the novel dealt accurately with what might cause this disorder in a person who previously had no anxiety problems.

The novel managed to show the side-effects associated with agoraphobia very well. Anna had a serious problem of drinking, and according to Panic with Agoraphobia Linked to Alcohol Abuse (2007), people who have panic disorder with agoraphobia often develop an alcohol use disorder and vice versa. Anna also suffered from depression, which is comorbid with most anxiety disorders (Gorman, 1997). There are a few psychotic symptoms that are related to agoraphobia, such as hallucinations, delusions, etc. (Nowak, 2018). In the novel, Anna had recurring delusions of seeing her dead husband and daughter and even talked to them as if they were there. She was not able to distinguish between reality and delusion in these situations, which made these encounters come off as being very real to the reader.

Amongst the treatment methods used for agoraphobia are the uses of medication, behavioral therapy, and psychotherapy (Agoraphobia: Diagnosis and Treatment, 2017). In the novel, Anna Fox took daily medication to deal with her anxiety, and twice a week, her psychologist came home to make her do exposure therapy. A combination of drugs and exposure is more effective in agoraphobia than just either of the two (Telch, Agras, Taylor, Roth, & Gallen, 1985) For the exposure therapy, the therapist made Anna take a few steps into her backyard, with her holding an umbrella in front to act as a shield. This worked for her because slowly, she learned to take more steps outside at a time.

There are instances where the novel fell short of depicting agoraphobia accurately. Although Anna was highly fearful of leaving her house and would barely be able to take three steps down to her backyard, she ended up going to a café in a whim while following another character. Although she still used an umbrella as her ‘shield’, it is highly unconvincing that an agoraphobic patient was able to take the decision of venturing out to as anxiety-inducing a place as a café. This also happened in the climax of the novel, where she ended up in a fight with the villain on the terrace in a storm, with only a few signs of anxiety initially. These parts of the novel show that the author sometimes molded the disorder of agoraphobia according to the convenience of the plot, leading to some inaccurate depictions.

Despite a few inaccuracies, the novel did a good job overall in depicting agoraphobia. The fact that the novel is written in the first-person narrative gave an insight into the head of a patient with agoraphobia and thus provided first-hand information on the disorder. It showed how psychologically daunting it can be for a previously social person to not be able to step out of the house, and thus managed to capture the crux of agoraphobia.

References:

Agoraphobia: Diagnosis and Treatment. (2017, November 18). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/agoraphobia/diagnosis-treatment/drc-20355993

Aqeel, N., Aqeel, A., & Tohid, H. (2016, October 19). A Strange Case of Agoraphobia: A Case Study. Retrieved from Quality in Primary Care: http://primarycare.imedpub.com/a-strange-case-of-agoraphobia-a-case-study.php?aid=17362#corr

Gorman, J. (1997). Comorbid depression and anxiety spectrum disorders. Depression and Anxiety, 160-168.

Kivi, R., Boskey, E., & Cherney, K. (2016, January 29). Agoraphobia. Retrieved from healthline: https://www.healthline.com/health/agoraphobia

McCabe, R. (2018, May 10). Agoraphobia in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. Retrieved from UpTo Date: https://www.uptodate.com/contents/agoraphobia-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-and-diagnosis

Nowak, L. (2018, August 22). Can Anxiety Lead to Psychosis? Treating Psychotic Disorders vs Anxiety with Psychotic Features. Retrieved from BrightQuest: https://www.brightquest.com/blog/can-anxiety-lead-to-psychosis-treating-psychotic-disorders-vs-anxiety-with-psychotic-features/

Panic with agoraphobia linked to alcohol abuse. (2007, July 31). Retrieved from reuters: https://www.reuters.com/article/us-agoraphobia-abuse-idUSCOL15951420070731

Telch, M. J., Agras, S., Taylor, B., Roth, W., & Gallen, C. (1985). Combined pharmacological and behavioral treatment for agoraphobia. Behaviour Research and Therapy, 325-335.