Fear of heights in ancient China

Abstract

Fear of heights (acrophobia) is defined as a subtype of specific phobias by the DSM-IV TR [1] criteria based on the diagnostic features of panic attacks. It has a lifetime prevalence of 3.1–5.3 % [2]. There is, however, a continuum extending from acrophobia to stimulus-dependent visual height intolerance, which does not fulfill the diagnostic criteria of a specific phobia. The frequency of visual height intolerance (height vertigo) is much higher. A recent epidemiological study based on a representative survey revealed that visual height intolerance has a prevalence of 28 % [3]. Thus, height vertigo is a well-known condition that manifests either as a specific phobia or, if less severe, as visual height intolerance. In their historical review, Balaban and Jacob [4] convincingly describe the comorbidity of vertigo and anxiety as an integral component of the medical literature since antiquity. We found a vivid description of symptoms typical for fear of heights in the Greek Corpus Hippocraticum, 5th century BC [5]: ‘‘When Demokles was with him, he said that he felt his eyesight had worsened, and the muscles in his entire body had slackened. He was, he said, not able to walk along the edge of a precipice or cross over a bridge. He would not dare walk over a ditch, regardless how shallow, for he would be afraid to fall into it. However, he would dare to walk in the ditch itself’’. This raised the question as to whether comparable descriptions can be found in other cultures from nearly the same time period but with a completely different concept of bodily function and disorders, namely in the Chinese medical classics. The 80th chapter (‘Discourse on great confusion’) of the book Huangdi Neijing Lingshu, whose content dates back to between the 2nd century BC and the 2nd century AD [6– 8], provides a lively description of height vertigo. The book is part of the Huangdi Neijing (The internal classic of the Yellow Thearch), the theoretical foundation of Chinese medicine. The Yellow Thearch, Huang Di, is considered the cultural hero who bestowed the gift of medicine on the Chinese people. The chapters of the book are mostly written as interviews between Huang Di and his physicians. In the text, Huang Di asks Qi Bo: ‘‘Often when I climb onto a clear, cold observation platform, after I have gone up half of the steps, look around, and crawl further forward; there is a confusion’’. (Fig. 1) (Clarification: a later commentary refers to the height of the platform as an explanation for this description: ‘‘[its] Qi is cold, it is therefore called ‘a clear, cold platform’.)’’. He continues: ‘‘I feel unusual and inwardly strange, I close my eyes, and then I open them. I calm my mind and steady my breath. A longer time passes, but the confusion does not resolve. Everything spins around and I feel dizzy. I loosen my hair and kneel on the ground, I bow my head, and look down. This [strange feeling] doesn’t stop for a long time. What kind of Qi causes this?’’ Qi Bo replies: ‘‘The essence of the Qi of the five depot-organs and of the six palace-organs all flow upwards to the eyes and give them clarity.(...) The eyelids envelop the essence of the sinews, the bones, the blood and the Qi and together with the vessels they form a connection. At the top it connects to the brain, at the back it comes out in the middle of the neck. If the evil strikes M. Bauer Horst-Gortz-Institute for Theory, History, and Ethics of Chinese Life Sciences, Chariteplatz 1, 10117 Berlin, Germany