Fear and loathing

I listened to a good programme on Radio 4 today which got me thinking. This programme, "I'm Suzy and I'm a Phobic" dealt with phobias: chronic fear of certain situations or things. Phobia is what we call it when the normal, natural, and helpful emotion of fear gets out of control in everyday situations, and needs to be treated as a medical condition. It is estimated that 10% of the UK population have some sort of phobia.

You can listen to the programme on iPlayer (for the next 7days). I was arrested by the opening lines:

Fear can save you life. If you are being chased by a tiger, or standing on the ledge of a tall building, or you simply want to avoid being hit by a car in the road, fear is you friend.

Of course, this got me thinking about the psychology of cycling on the road, fear of traffic, and how natural this is, and how it fits in with the wider spectrum of fear, rational and irrational, helpful and unhelpful, and how it should be dealt with socially.

Again, interestingly, the programme did deal largely with a phobia, that of the narrator, Suzy Klein, that was transport-related. She has claustrophobia, and, in particular, she has been terrified of being on trains in tunnels, and terrified of going into the London Underground, both into stations and onto trains. Part of the treatment, or therapy, featured in the programme, involved Suzy being taken on to the Underground with the therapist, and trying to overcome this fear. She did succeed in getting on a train.

Elsewhere in the programme there was discussion of to what extent phobia really is an illness. There was an attitude from the Daily Telegraph's medical man James LeFanu that the great increase in the number of people diagnosed with phobias in modern Britain is due to an increasing tendency to medicalise conditions which are in the normal range of human behaviour and emotion, which he thought might be driven by potential profits to be made by the drug companies. There can be no doubt, however, that phobias are a major problem for many people, seriously impairing their lives.

So how does all this connect with cycling? Well it's clear I think. We know that most people won't cycle on our roads full of motor traffic, because it makes them, rightly or wrongly, rationally or irrationally, scared. Cycle training programmes aim to get people to overcome that fear, a bit like the cognitive behaviour therapy (CBT), and exposure therapies, featured in the programme on phobias. CBT gets people to analyse and deconstruct the reasons for their fear and their reactions, and hence aims to help them to overcome the fear. But, as LeFanu told us, it is not all that clinically successful, with only a 30% success rate. It needs to be combined, he told us, in most cases, with exposure therapy: actually getting the phobic person to do or get in contact with the thing of which they are frightened. Which of course what cycle training aims to do as well. As the very well-written Cycling Embassy of Great Britain response to the London Assembly's current investigation into cycling puts it (page 4):

... cycle training [–] attempts to help people to scale the barrier to cycling, rather than to remove that barrier; to enable cycling it requires acquiring a confidence in traffic which many will never attain. 

(There is much more to what the Embassy has to say, and I recommend you to read it all.)

I have been caused to think about these relationships before in my cycle campaigning career. Sometimes I have been told that I am over-emphasising the dangers involved in cycling, and I was once told by a very well-known exponent of cycle training, and a very well-known figure on the London cycling scene, that he thought this was actually a personal, psychological problem that I had. He thought I actually had a phobia, or an insecurity that manifested itself in an emphasis on the dangers of cycling in motor traffic  – despite the fact that I was, at that time, cycling over 3,000 miles a year in London traffic.

So this is an interesting problem, this fear and behaviour thing. Because fear of a big mass of hard metal with a lot of kinetic energy coming into contact with your flesh is surely a very right and natural and helpful fear, as the radio programme suggested at the outset. And perhaps even fear of being in the same space as that mass of metal with high kinetic energy is also rather natural and helpful. But that covers all cycling on the road. Do we medicalise all the people who won't cycle under current conditions in the UK? Do we attempt to treat them for a phobia?

Paul Gannon wrote about this very well, in discussing the arguments for and againast "Shared Space" treartment of roads. I've quoted what he wrote before, and I'll do so again:

The facts of power and status on the roads – which people understand tacitly – is what lies behind people saying that cycling is dangerous. The effectiveness of the cavalry attack depended on the horse and rider, individually or in a mass, approaching at a high speed and with weight. If a square of soldiers could withstand the shock of the attack, they could survive; if they dithered and cowered, or as individuals, they never stood a chance. The psychological component of the weapon was intimidation, playing upon the natural human inclination to get the hell out of the way when a half a ton of fast-moving mass is coming straight at you. The modern equivalent of the charging horse is the motor vehicle (and not just the 4x4) because it uses the same effect as the charger to establish its priority by fear of ‘flesh to metal interaction’. 

This can be seen by referring to the recent discussion about pedestrian priority at junctions, as per Highway Code, and vehicle priority, as per reality. Pedestrians did not give up that priority willingly, saying to car drivers, ‘no, no, you go ahead, please’, but in stepping back from potential bodily damage from an approaching mass, eventually established the ‘standard’, with only a fossil memory somehow still preserved in the Highway Code. 

The simple fact of the matter is that people do not want to have to be put in the position of constantly having to face the life and death decision of "Do I carry on or give way?". When the odds are so heavily against you in the event of an error (in terms of asymmetric physical consequences for cyclist/pedestrian and vehicle driver), factors of power are unavoidable.

It seems to me that James LeFanu, though, is on to something with his discussion of the significance of numbers and population proportions who are diagnosed with a problem. You can't medicalise an entire population. Diagnosis of a disorder depends on it being a small minority suffering from the disorder. 

There was some discussion I recall, also from Radio 4, I think it was in their programme All in the mind a year or two ago, about the actual proportion of the UK population with, or who had suffered at some stage in their lives from, any kind of mental illness. An advertising campaign for a charity (that had put adverts, incidentally, on the London Underground) had spread about the claimed statistic that "One in four people in the UK had suffered from a mental illness". But the discussion raised a large amount of disagreement amongst experts as to whether this was a justifiable statistic. There are many was of defining mental illness, and, under the broadest, it turns out from studies, the proportion of the population that ever suffers from mental illness is higher than this, more like one in two to one in three. But the idea was put forward that the one in four figure had been promoted because it was more politically acceptable, though it doesn't seem to correspond with the results of any authoritative study. It "sounds about right", and the higher figure will seem, to most people, as an exaggeration of the problem, or an over-broad defining of illness, or medicalising almost the entire population, which most people find unacceptable.

So with Suzy Klein's fear of going into the Underground, and its practical implications. Let's imagine for a moment a world in which everybody suffered from her form of claustrophobia. Or, let's say, 90% of the population, a proportion which I guess to be similar to the proportion of people who now find traffic on the streets too scary to cycle in. Would we build an underground railway system as we have it, and then try to treat with psychotherapies all the people who are too scared to use it? I don't think we would. We would not build it. It wouldn't be worth it. Treating people is too expensive, difficult, intrusive and uncertain. We would instead demolish some buildings and put all the railways at street level, or have a tram system, like many other cities. The reason the lady who is afraid of being in tunnels was given psychotherapy was that she was in a small minority of the population with her particular phobia. In that situation, it is easier and cheaper for our society to put railways underground in an urban area like central London, and treat a few people for a phobia.

You can draw your own conclusions from all this. You can claim, based on whatever statistics you want to give, that cycling is "dangerous" or "not dangerous". I've discussed that recently, and in earlier blog posts. My point here is more about what it is actually practical for society to do, to solve a structural problem connected with transport, that is also bound up with human feelings and fears. An approach to attempting to increase cycling that relies largely on training, as I think our government's does, it seems to me is trying to do an extraordinary thing, trying to treat the mass of the population rather as doctors and therapists normally treat people with rare and unusual conditions. It's an approach which would not be used in any other comparable context.

As Joe Dunckley of At War With the Motorist put it in an excellent post The definition of madness, going into this subject from a slightly different angle (and by madness he does not mean mental illness):

The idea that somehow physical engineering is difficult and expensive and unpopular, while changing human behaviour is quick, easy, cheap and effective, is one that the British are remarkably strongly attached to.

But it's one the British are attached to only in certain contexts. For we have promoted car travel by making it fast and safe through good engineering. We have made it much faster to travel between towns by car than it was when I was born, and that was achieved through government policies. My father spent a lot of time travelling around in a car for business. When I was very young it took him 4–5 hours to do the 100 miles exactly from Christchurch to London. Now it takes 2 hours. The increase in speed was achieved by building motorways, bypasses round towns, and trunk roads. In other words, it was achieved using engineering, not psychology. It was not achieved by trying to educate drivers to overcome their fear of driving at 70 mph on twisting narrow country roads, trying to get them to treat their journey as a slalom race, and training up their skills of vehicle control to the level of a racing driver's. On the contrary, such antisocial use of the roads was discouraged using law-enforcement methods. The increase in speed was facilitated by infrastructure. To say this is so obvious, it sounds stupid.

My point in the end is about the contrast in approach between mass activities and issues and minority activities and issues. Driving is a mass activity. Mass activities and issues we address with infrastructure, minority activities and issues we address with education, training and therapy. The approach we take with cycling is both bound up with, and key to, its continued minority status.