Lets Get Better -- Fear of Losing Control? Lets Unpack That.
I have seen a lot of analysis about emetophobia that boils the fear down to a more base fear. It isn't about the fear of vomiting, it is said, but the fear of losing control. The more that I roll this idea around in my head -- that the fear of losing internal control is the base of emetophobia -- the less it makes sense to me. I mean, I guess I can see how one would arrive at that conclusion; vomiting is one of those sudden losses of internal control that we cannot help, that arrives spontaneously, and leaves as suddenly as it came. To a lot of emetophobes, this seems like the scary part. But I think that emetophobia goes far beyond the fear of losing internal control, at least for me. I think it is a deeper fear, a fear that has been with humanity since time immemorial, a fear that has plagued humanity since humanity came into its existence. I think understanding this fear may go a long way to figuring out the "why?" of emetophobia that seems to be so lost on emetophobes, including myself.
Okay, so fear of losing control. First, lets examine what could possibly be meant by that phrase. When we talk about control, we are really talking about two primary types (and I don't really feel like getting into psychological jargon because 1) that would require much more research than I am prepared to do, not to mention recalling stuff from my general psychology classes I took years ago, and 2) I am a sociologist by training so my psychology is a little rusty anyway, so forgive my layman lingo) internal and external control. The first question that comes to my mind is "what is the difference between these two types of control and how do they apply to emetophobia?" Well, lets examine that. First, there is external control. External control, to me, is defined by control over things outside of ourselves such as people, routines, objects, norms, situations, etc. I think that this loss of this type of control may be downplayed a little bit when trying to figure out what the root cause of emetophobia actually is, and may actually play a bigger role than it seems to the casual glance (and I'll get to that in a few seconds, first I want to deal with loss of internal control)
So that leaves us with internal control, meaning our thoughts, emotions, and physical actions. I would suspect it is this type of control that many are referring to when they say that emetophobia really boils down to loss of control, and again, at first blush it really seems plausible. But, as I thought of this more, something didn't seem right, like it seemed as if control maybe played a small role in my phobia, but it wasn't the entire reason my phobia came into existence. For example, if I am afraid of losing internal control, then why am I not afraid of, say, burping suddenly? I mean, its an action that I cannot control, that seems to arise spontaneously out of my body. Its something that may happen in front of strangers. In essence, burping is something I have absolutely no control over. An even better example is sneezing. That happens even more suddenly, and to me, mirrors the act of vomiting (sans the liquid and fear, of course) almost to a tee. I mean, every element is there. The sudden movement of the diaphragm, a big loud noise that comes out of the body, a complete temporary loss of control of bodily function, an action that seems almost like a gag...seems like if I did fear losing internal control of my body that sneezing would be a greater fear than vomiting, yes? It happens way more often than vomiting does, comes just as suddenly, and leaves as soon as it came...why no fear?
This is about when the idea that emetophobia is about internal loss of control started to break down for me. It simply didn't make any sense. So, over the course of a couple weeks (and yes, I do think about my phobia that much. My first reaction to any problem is to intellectualize it...thanks college) I began to unpack this idea of loss of internal control. What are its constituent components? What are the parts of this hypothesis that tends to make people believe it to be true? I came up with couple of factors. First, suddenness. I think that when people say "loss of internal control" part of what they are really saying is "how fast the feeling came" and "how there was no or very little warning when the act of vomiting began". To me, this doesn't signify a fear of loss of internal control, it signifies a fear of suddenness, a fear of something happening to them with little or no warning, and deeper than that (and I think more importantly), a fear of the unknown. It is the fear of time itself, but not a fear of what might happen in some distant, possible future, but fear of what might happen in the immediate future.
The next part of "fear of the loss of internal control" that I unpacked is fear of the destruction of everyday routine. I think this manifests itself in an interesting way. I have noticed a lot of emetophobes stick to their routines, their rituals, and their everyday norms as a way to ward off a perceived danger of vomiting. I am not sure if this is true for other phobias (again, not a psychologist), but at least for emetophobes, it seems to be a common theme. This is where fear of loss over external control begins to play a bigger role than many people think. These rituals become a part of us, they become a way for us to cope, and the ultimate breaking of these routines, norms and rituals is to vomit. So I think the fear is not of losing some sort of control over your own body, its fear of breaking your routines.
Up until this point I have been using routines and rituals interchangeably, but I do not think they are one in the same. Routines are the things that one does every day, without fail. To the emetophobe, the ultimate breaking of these routines is to vomit. The rituals, on the other hand, are deployed as a last ditch effort to save yourself from breaking your routine, from vomiting essentially. The rituals may not be something that you do every day, but they are something that an emetophobe has used, probably most of their lives, to stave off nausea. These rituals are used in service of your routine, to ensure that it is not broken, that something completely outside of your everyday life does not happen, and that ultimately, you do not lose external control over the situation.
So far, the two ideas we have distilled out of "fear of losing control" are 1) Fear of the unknown, of time and 2) Fear of the destruction of routine. I think the last "base" fear that emetophobia boils down to is simply the body's reaction to an unseen, but nevertheless existential, threat. I think that some time in most our pasts we some how associated vomiting and danger. Now, emetophobes, of course, understand rationally that vomiting is not dangerous and ultimately will not harm them, but at a base, instinctual level an association was made between vomiting and a threat to the integrity of the body. I am sure that most of us have a very individual stories of how that happened. For me, I don't even remember how this association was made but I have been told from my mother that from the time I was born until about age 2 I vomited non-stop. My digestive system was extremely screwed up, I had severe lactose intolerance, and I was highly allergic to many ingredients found in formula and baby food. Over time, my digestive system got better, my lactose intolerance and food allergies faded, and yet I was still scared of vomiting. Even though growing up as a child and young adult I very rarely, if ever, vomited, those formative experiences as a baby and toddler made an association in my brain that vomiting was a threat to my existence.
Combine these three elements (fear of the unknown, fear of destruction of everyday routine, and fear of danger) and you have a perfect storm of fear. Take heart, these fears are not abnormal, in fact, they have been around since before history began being recorded. These fear responses you are having may be for an irrational reason (vomiting will not harm you), but the bases of your fear are perfectly rational, and have been around for a very long time.
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Originally Posted by hairyfairy
