Dear Exasperated in Minneapolis:
You’re right. I shouldn’t have gone in there. It was selfish. And I’m sorry. Airports bring out the worst in people—all the waiting in lines, the taking off your shoes, the obscene mark ups on cinnamon rolls—and I was yet another asshole you had to contend with. But if you’ll let me explain, maybe you won’t think I’m so terrible. Maybe you’ll keep me in your prayers. Maybe you’ll give me a hug. Maybe you’ll give me carte blanche to use any restroom I want. Or maybe you’ll just think I’m nuts. You see, to most people, using a public restroom is a standard practice; for me it is exposure therapy.
Before I explain, it’s important to me that you know prior to my bathroom infraction, I had been in airports for several hours and had used their packed, putrid public women’s restrooms several times. Each time, before entering the restroom, I would pause in the crowded hallway before getting into line, place my noise-canceling headphones over my ears, blast some of my favorite tunes, ambient, reassuring songs by artists like Elliott Smith and Simon and Garfunkel that surround me, hold me close, protect me, and then, after doing what I needed to do, exit as quickly as I could. And this system “worked” for me until I tried to enter a stall and a woman stopped me.
“You don’t want to use that one,” she said coming out of the stall next door. “Someone vomited in there.”
“People are so gross,” said the woman behind me in line.
I wanted to respond, but I couldn’t. What was before just an increased heartrate has now become the bass of my teenage neighbor’s car stereo pounding in my ears.
Now, let me stop you. Please don’t take this opportunity to tell me about the times you’ve vomited, been vomited on, or seen someone vomit in an airport or other public place because that funny story about your barista vomiting into a grande cup in the middle of your order will cost me a six month hiatus from Starbucks. And don’t tell me about that time you were sooooooooo sick, because chances are, after the conversation, I’m going to be convinced I’m coming down with it. Unless the story happened when you were pregnant, because I am just rational enough to, even in my most volatile moments, understand that I can’t catch pregnancy but still irrational enough to always be a little uncomfortable around pregnant women, fearing that their puking is spontaneous and inevitable.
“It might not be their fault,” a third woman remarked, holding her young son up to wash his hands at the sink. “There’s been something terrible going around. Everyone in Timmy’s class has had it.”
“Not me!” Timmy said proudly.
“Nope, not you,” she responded, kissing him on the cheek before putting him down. She even ruffled his hair like dads do to their sons in the movies. If I were even remotely emotionally stable at this moment, I would have thought the whole scene was fucking adorable.
The woman who made me aware of Vomit Stall tried to make eye contact with me and the woman behind me in line as if to say, is that precious? Meanwhile, all I could think was, what stall did Timmy use? Does Timmy look pale to you? That didn’t seem like 30 seconds—put those hands back under the sink, son. For God’s sake, there’s an epidemic out there!
From where I stood, next in line, I wordlessly pivoted, walked back to my gate, and planned to hold it until I arrived in Memphis. I began cataloguing anything and everything I may have touched and remind myself not to touch my face until I can sanitize my hands.
Over the years I’ve been diagnosed with hypothyroidism, Crohns’s Disease, obsessive-compulsive disorder, germophobia, endometriosis, eczema, social phobia, agoraphobia, irritable bowel syndrome, Celiac Disease, PTSD, and depression. These days, I’m not sure if I have any of them. What I do know is that I suffer from emetophobia.
The DSM-IV categorizes emetophobia as a “300.29 Specific Phobia: Other Type,” noting that the “other type” refers to “situations that might lead to illness, choking, vomiting” (213). The DSM-IV further explains that the “marked and persistent fear” felt by those with Specific Phobias is “excessive or unreasonable” (213) and that those with Specific Phobias will experience “immediate anxiety responses” when exposed to “phobic stimulus” and will thus practice behaviors of avoidance (214). And I’m a textbook case.
Before you jump in and say, “Everyone has that phobia, no one likes throwing up,” let me explain how a phobia is different from an aversion. When possible, I avoid handrails, door-knobs, banisters, doctors’ offices, dentists’ offices, hospitals, public bathrooms, and sick people. I try not to share beverages or food and, like the classic Seinfeld episode, I am sensitive to double-dipping. When someone I work with mentions that she or someone in her family or someone she passed in the parking lot was sick, I will wash my hands until the skin beneath my fingernails peels and the pads of my fingers split open. I will exist, nervously, until the incubation period of the illness I assume they have has passed and sometimes even pray that I won’t be sick even though, in my saner moments, I consider myself on the atheist end of agnostic.
I circumvent alcohol and often leave places where alcohol is being consumed as soon as anyone starts slurring or hiccupping. I avoid extreme work-out classes, chicken served at restaurants, medications, shows like Tosh.0 and Jackass, untitled YouTube videos, and children. I do everything I can to not be left alone with children. Every time they put their hands in their mouths; I put mine under the faucet.
As the DSM-IV suggests, because of my fear of vomiting, I exhibit agoraphobic behaviors. I avoid fairs and amusement parks, public transportation, road trips, pharmacies, airplanes, cruises, and bars (300.29 G, 214).
I exhibit claustrophobic behaviors. I opt not to frequent crowded places and elevators. I call ahead and ask to stay on the lowest floor available at hotels, often blaming it on an imaginary companion. She’s afraid of heights. He’s too impatient for elevators.
However, what the DSM-IV definition doesn’t tell you is that because of my fear of vomiting, I often have symptoms aligned with irritable bowel syndrome, hypothyroidism, Crohns’s Disease, and Celiac Disease. My stomach hurts all of the time (at least I think it does). Certain foods make me feel sick (at least I think they do). If there’s an illness going around, I will most certainly catch it (or at least I fear I will).
This is the problem.
With Emetophobia, it becomes impossible to distinguish the real from the imagined. My reality thus becomes a composite of my worst nightmares.
For a long time, I truly believed that no one but me knew what this felt like.
Then, somewhere around 1999, I watched an Oprah episode in our college dorm with a few friends. The woman on the screen had ichtyophobia, a debilitating phobia of fish—cooked fish, raw fish, goldfish, ocean-fish—all fish. A psychologist attempted exposure therapy on-screen. Took her hand and led her into an aquarium. The woman screamed, cried, wriggled, writhed, fell to the floor, weeping, powerless.
My friends thought it was hilarious.
Luckily this was before Tivo and DVR, otherwise, I’m sure they would have played it over and over.
Look at the crazy person!
Look at the crazy person!
My friends thought she was weak, or maybe even faking it.
“There’s no way anyone is that crazy,” one of my friends said. That moment has stuck with me ever since because I am living proof to the contrary.
At the end of the episode, when she walked into the aquarium without crying I was overcome by her strength. In fact, I thought of her years later as I began exposure therapy and again and again, whenever I see someone accomplish something extraordinary. I thought about her when Captain Sully landed that plane in the Hudson, when I saw 127 Hours, and recently when I sat by my aunt’s side as she battled kidney cancer. I think of her because I know it’s not easy to live with a phobia and that it’s even harder to work through one.
If you’re not sure whether or not you have a phobia, let me help you out. You don’t. Thank you for coming. I accept all major insurances.
As I walk back to where my husband, Liam, is sitting with our stuff at the gate, I can’t stop thinking, someone here has vomited and she’s walking among us, breathing and touching things. My own stomach begins to bubble. I grab a piece of gum. The mint of the gum settles my stomach. I buy it in bulk from Sam’s Club: Orbit Wintermint. If I leave home without it, I will run back by the house or stop by a gas station.
As more and more people pass me, the halls seem to narrow like in Indiana Jones Movies. I have to work to elongate my breaths, which threaten to leave my mouth in short, shallow gasps. I think about breathing techniques I’ve learned from therapy, yoga, and years of experience with panic attacks.
I turn up my music.
Only look straight ahead.
I try to deflect.
I think about my lesson plans. I think about the next essay I plan to write.
Recently a student of mine wrote a paper about loving a boy that she worked with one summer at Old Navy. She admitted that despite the numerous calls to her girlfriends about his tan biceps or how their hands touched while folding girls’ tank tops, she barely knew him. She knew that he liked The Ramones and men’s hair-care products. She knew he drove a Mustang and hated sweeping. She did not know much about his upbringing, his ideals, his politics, or his aspirations. But she was in love.
“I knew I loved him because of how I felt when I was around him,” she wrote. She described the chills, the dizziness, and the shortness of breath.
What a sick joke to have love and panic exhibit the same physiological symptoms. At the risk of channeling Carrie Bradshaw, is this the reason that when someone who has panic attacks describes them to someone who does not, the trauma is lost in translation?
The go-to description is “I feel like I’m going to die.”
How do you know you’re having one? I’ve been asked.
You just do.
How do I know when to shift? I asked my husband one day as he tried to teach me to drive a manual car.
You just do, my husband replied.
I have trouble picking good melons and deciding on paint colors, but I know a panic attack when I encounter one.
Do you actually think you are going to die? My most recent therapist asked me.
Well no, I admitted. I just feel like I am going to.
My most recent therapist was not the first and is probably not the last to ask me this question. He is also probably not the first or the last to solicit my snotty follow up response, that’s precisely why I said ‘feel like.’
The aforementioned student concluded her essay by saying that her experience with Old Navy guy prepared her for anything she might experience and that nothing could ever trump the moment she saw his movie collection and realized he was all wrong for her.
How naïve, immature, and egocentric, I found myself thinking.
However, when someone mentions that they feel nauseous, or when I enter a crowded place, my rational side plays the woodblock while my irrational side incessantly clamors cymbals.
When commenting on the student’s paper, I urged her to dig a little deeper. Did this awkward encounter really prepare you to experience anything life throws at you? Did it prepare you to fix a flat tire on the interstate, to lose a loved one, to deal with world famine? Consider what you actually learned from this experience. Maybe you learned something about the fleeting nature of love based on attraction alone, maybe you realized that compared to the monotony of folding and refolding American Flag t-shirts, anything or anyone could seem appealing. Maybe you used to look for a guy but, now as you age, you are looking for the guy. Again, dig deeper.
In one of our last sessions before my husband and I moved from New York to Arkansas, my therapist asked me why I thought vomit bothers me so much.
Describe what it is about vomit that makes you so anxious.
I’ve had three therapists: two in Missouri and one, more recently, in New York. My initial visit to each of them was triggered by hoping/wanting/needing to get a handle on my emetophobia. Early on in our relationships, each of them has asked me some version of this question. What it is about vomit that makes you so anxious?
When my New York therapist asked me, I thought for a few moments, searching for a new way to explain what I’ve explained to Missouri 1 and 2.
It’s the heaving, I finally say. And I said what I always say. The way it seems so chaotic. So unpredictable. People seem so helpless.
Okay, he says, dig deeper.
They all ask me to do this and thus, I have become increasingly aware that I should stop asking my students to do this because it’s annoying.
What’s the earliest experience with vomit you remember?
And this is where I have to explain that I can’t remember which happened first: My mother coming home from one of her first round of Chemotherapy sessions, asking for a hug, and then, without warning, vomiting on me OR having my blouse ripped off by an unknown man who was waiting in the Hermann Park restroom while I was taking a quick break from playing at the playground with my brother and cousins and then vomiting in the grass as I ran back to them.
And this is the point where my phobia seems to make sense to everyone. The therapist typically starts to get a little excited. Eager even. They’ve got it figured out. At least one of them, I anticipated, was already accepting an award in his head for confirming the long speculated link between sexual abuse and emetophobia. Since I get excited about misplaced modifiers and a well-chosen word, I suppose I shouldn’t judge.
We also talk about how anxiety runs in my family. That my mother had a debilitating fear of bridges until she had to drive over one to see her father at the hospital twenty years ago. That she passes out at the sight of needles and from drinking too much. That my brother used to have nightmares about a stranger murdering our parents (though to be fair, he’s always been a Batman fan). That my aunt, may she rest in peace, was also emetophobic. That my father and I are the only two people in my family I can think of who aren’t on anti-anxiety and anti-depression medication, even though maybe we both probably should be.
Especially with the latter two therapists, we spent weeks talking it all out. We talked about my relief when an adult woman, another stranger, walked in just after my breasts were exposed in that cold stone restroom, yelled at the man, told me to run. About why I vomited running down the grassy hill toward my family and what I felt at that moment. We talked about how scary it must have been to watch my mother lose weight, her hair, and her breasts, to hear her heaving in the bathroom while I watched the Jetsons to stand out at the sink while she vomited in public restrooms. We talked about all of these things, often and at length, but eventually both therapists got to the same place: cognitive behavioral therapy isn’t enough. Just talking about these things isn’t enough. Charting my rational versus irrational responses isn’t enough. Both Missouri 2 and New York felt we needed to engage in exposure therapy.
With both New York and Missouri 2, especially New York, I made some notable progress. With both, we began getting more comfortable with the word “vomit” and read stories about vomit. With Missouri 2, we engaged in simulation exercises in which, after some meditation and hypnosis, I was guided to imagine my worst nightmare, being vomited on in an airplane.
I haven’t seen Missouri 2 since.
After I was in therapy with New York for about four months, a letter arrived in the mail letting me know that my insurance had approved me for routine visits. This is great news, New York therapist told me. Now we don’t have to worry about how many individual sessions we have left. We can just worry about you.
That evening I found myself staring at the letter. Turning it over and over in my hands. I joked to my husband that it was my official crazy notice. Even insurance, notorious for minimizing mental and physical ailments, felt that I was mentally ill enough to deserve an exception to their typical heartlessness.
Of course my husband told me the same thing New York did. Great news.
I worked with New York for almost three years. By the time I moved to Arkansas, I could speak about vomit, read about vomit, watch cartoon characters vomit, watch the pie-eating contest scene from Stand By Me, and had watched several YouTube videos of real people vomiting. We even had plans to hold a session on the bench outside the local hospital’s emergency room’s entrance, though luckily, I moved before that plan came into fruition.
Based on New York’s prodding, I even told some of my closest friends and loved ones about my phobia and about therapy. Since sharing the reality of my phobia, at concerts, my best friend Ashley works as a shield against potentially drunkenly sick groupies and under-age kids. Without provocation from me, when Bridesmaids was released, my friend Mimi wrote out a detailed description of the events leading up to the infamous extended vomit scene, being sure to include exact timestamps so I could still accompany her and a couple of our friends to see it at the theater without drawing attention to myself. When my family, including my frequently ill pregnant sister-in-law, met at a cabin in Hot Springs, AR, no one questioned that Liam and I should have the only room with a private bathroom.
Occasionally these friends and loved ones will contact me when a celebrity’s phobia has become public like Orlando Bloom’s fear of pigs, Madonna’s fear of thunder, and Jennifer Aniston’s fear of flying. One friend said, “No seriously, David Beckam has atxophobia. It’s a fear of untidiness. It’s so bad that he sometimes requests an individual locker room at away games.” Today I can’t help but wonder if his phobia would ever lead him to enter a family restroom on a busy day at the airport. Beckham and the others probably have people to help them with such things—a to keep pigs away from Orlando, to soundproof Madonna’s home. I have such a person. My husband, Liam.
The therapists I haven’t liked have called him an enabler. The therapists I have liked have called him amazing. I realize now that he’s both.
When I get to my seat, I take out my traveling kit, which consists of prescription anti-nausea medication, Tums, Pepto Bismal tablets, and an extra pack of gum, in case I run through the six sticks in my pocket.
Liam asks, “everything okay?”
He takes my hand as though to reassure me, before you know it, we’ll be home.
And like clockwork, I begin to simultaneously thank a god I’m not even sure exists for my understanding husband and fear that I’m too much hassle. Too crazy. That he will leave me, or worse, stay with me and begin to resent me. Or worse, that he will leave me.
And I will have to handle this alone.
I begin to sweat and my mind always travels to the same place from here: What if he gets sick on the flight? What if he gets sick someday? What if he gets norovirus or food poisoning or cancer? What will I do? And then I get so angry at myself for knowing that if he had cancer, I would be as afraid of him vomiting as I would of him dying.
I share with him that I’m having these thoughts and, he tells me that we’d make it through. That I’d stay in the guest room until he’s better, far enough that I couldn’t hear him if he got sick. That I could stay in a hotel. That someone else would transport him to and from Chemo. That he would sooner defy the “fasten seatbelts” sign, push aside a flight attendant, and make a beeline toward the other end of the plane before he’d vomit next to me. He reminds me again of the realities of illness transmission and that time he ate a salad covered in dressing that had been expired a year without any notable consequence.
Once after an intense therapy session in which I watched several un-pre-screened vomit videos with my therapist, I called my husband from the parking lot and told him, the deeper I dig, the more I feel like I am failing. The more I feel like I’m falling. The more this thing I can’t control is winning.
So there I was, sitting with my supportive husband, waiting for a plane that was two hours late with a full bladder and full of anxiety, and I saw the private family restroom, the door open, free of lines and stalls and vomit. And it felt like a win—a small victory in a day shadowed by losses. When I went in, no one was around and as soon as I heard you and your son waiting outside, especially when I realized he was crying, I immediately wished I could sneak out the back window, like they do in the movies. And when you exasperatedly said, “REALLY?!” as I exited the restroom and walked past you, I understood. I watched you maneuver your upset son and all of your bags into the room I’d just occupied and I felt terrible. I imagine you’ve already updated your Facebook status to tout my awfulness and I don’t blame you. You were obviously overwhelmed, frustrated, and in a hurry. And I guess this is my point, you and I intersected when I was falling and I am so sorry that, even for a moment, I took you down with me.
Anxious and Apologetic Everywhere
Dr. Kristi Murray Costello, a native of St. Louis, MO, is an Assistant Professor of Writing Studies and the Director of the Writing Program and Writing Center at Arkansas State University. She is the recipient of State University of New York Binghamton’s Newhouse Award for Poetry, two AWP Intro Awards, and an Academy of American Poets Prize. Her poetry and essays can be found in Paddlefish, The Paterson Literary Review, Caduceus, Pennsylvania English, The Connecticut River Review, College English Notes, The Subterranean Quarterly, The Chariton Review, and Big Muddy, among others. In her spare time, she enjoys attending concerts and taking walks with her rescue dogs.
Juhani Nuorvala (b. 1961) studied composition at the Sibelius Academy under Eero Hämeeniemi. He also studied in Paris under Tristan Murail and in New York under David Del Tredici.
A notable variety of influences – microtonality, American minimalism, New Romanticism, popular music, techno – has been regarded as a special feature of Nuorvala’s idiom. Despite this, he is not a collage artist; instead he has blended various ingredients to create a mode of expression entirely his own.
Nuorvala’s works are often marked with frenzied rhythmic drive. He makes music using elements and materials that both the mind and the body respond to. He finds these elements not only in old or new classical music but in various forms of urban popular music, such as the electronic music of modern dance clubs.
Nuorvala has composed chamber, orchestral and electronic works. The orchestral Pinta ja säe (Surface and Phrase) received a special commendation in the Vienna Modern Masters Competition in 1991. The Notturno urbano for chamber orchestra (1996) resounds with urban night life and is one of his most popular works. The Clarinet Concerto (1998) contains references to jazz, film music, Minimalism and techno. The strong rhythmic element is also present in the string quartet Dancescapes from 1992. The Second String Quartet (1997) includes some of Nuorvala’s most romantically soaring pages and has been adapted for string orchestra under the title Sinfonietta. During recent years Nuorvala has created the music and sound for several plays at the Finnish National Theatre, in addition to writing an opera (Flash Flash, 2005) based on the life of Andy Warhol.
His other chamber works include Prelude and Toccata for accordion as well as Boost for cello and synthesizer. His most recent large-scale work is Septimalia (2014), commissioned and premiered by the Finnish Radio Symphony Orchestra.