Fear of Falling

Why the fall matters more than the height

The English Wikipedia article on the fear of falling separates it from acrophobia in one sentence: it covers the anxieties that accompany the sensation of falling and its possibly dangerous effects, rather than the height itself. The two are closely related, and a person can hold either without the other. Acrophobia needs a high place; the fear of falling only needs a body that can lose its footing.

Its absence has a name of its own, a head for heights, which is a hiring requirement rather than a diagnosis. Its presence has two names that are the same word. Wikipedia's page for basophobia is a disambiguation, and it lists both senses without choosing:

• basophobia, the fear associated with astasia-abasia, meaning a fear of walking or standing erect
• basophobia, the fear of falling

Wiktionary keeps both senses too, and its etymology explains why they sit together: the word is built on the Ancient Greek basis, a step. The word names the step, not the drop, which is how one term ended up covering both the fear of the fall and the inability to stand at all.

What the visual cliff showed about infants

The best-known experiment on the fear was built out of a sheet of heavy glass. Eleanor J. Gibson and Richard D. Walk laid a board across it, put patterned material flush against the underside of the glass on one side and on the floor beneath it on the other, so that half the apparatus looked solid and half looked like a drop.

Thirty-six infants between six and fourteen months were tested. Twenty-seven crawled to the shallow side when their mothers called them. Three ventured over the edge. Some infants cried because they could not reach a mother calling from the deep end, and some patted the glass, felt that it was solid, and still would not cross it. Gibson and Walk were careful that this does not prove the fear is innate, only that infants of that age have working depth perception and connect depth with danger.

The same apparatus was run with chicks, turtles, rats, kids, lambs, kittens and puppies. The chicks were tested less than a day after hatching and never once walked onto the deep side. Kids and lambs placed on the glass went into a posture of defence, front legs rigid and back legs limp, and relaxed only when they were pushed far enough forward for their heads to cross the solid edge.

Why an injurious fall predicted less fear

In May 1998 Behaviour Research and Therapy published a longitudinal survey by Richie Poulton, Simon Davies, Ross G. Menzies, John D. Langley and Phil A. Silva, drawn from the Dunedin Multidisciplinary Health and Development Study. It compared participants injured in a fall between the ages of five and nine against participants who had not been.

At eighteen, acrophobia was present in 2 per cent of those who had been hurt in a fall and 7 per cent of those who had not, and typical basophobia in the same sample was seven times less common among the participants with an injurious childhood fall. The experience the fear is supposed to be about predicted less of it, not more.

Isaac Marks, Randolph M. Nesse and George C. Williams approached the same evidence from the other end. People whose response to the adaptive fears is systematically deficient are more careless and more likely to be hurt in ways that can kill them, and the three proposed a name for that deficiency, hypophobia, on the grounds that a missing fear has consequences a genome notices.

How falling behaves after the first fall

For a long time the fear was treated as psychological damage from a fall, and given a name that says so: post-fall syndrome, described in 1982 by Murphy and Isaacs, who noticed that people who had been walking normally developed intense fear and disordered walking afterwards. The fear of falling was identified as one of its key symptoms.

The account did not survive contact with the wider population. The fear turned out to be common among older adults who had never fallen at all, and it is now treated as a health problem in its own right rather than as an aftermath. Its reported pattern is that it becomes more common with age and is higher in women, with dizziness, self-rated health, depression, and problems with gait and balance named as risk factors alongside it.

Postural control supplies a mechanism. People afraid of heights or of falling have poorer postural control, and lean more heavily on vision to keep it, which is why the trouble shows up when visual cues are weak. The vestibular system responds to the instability it senses by increasing postural sway, an attempt to reactivate the visual feedback that balance is being run from. When that fails the result is a sensation of greater instability, and that sensation is read as fear.

Where the falling dream fits

Falling is also the most reported dream there is. Freud placed it among the typical dreams, the ones almost everybody has and which are assumed to mean the same thing for everyone, and a 2003 study of Canadian university students put a figure on it with a Typical Dreams Questionnaire: falling at 73.8 per cent, flying at 48.3 per cent, swimming at 34.3 per cent.

What the dream means has never settled. Saul and Curtis, writing in 1967, listed the sensation of falling asleep, a real risk of falling out of bed, repeated experience of falls in childhood, birth, ambition, and the renouncement of responsibility. They quote Gutheil, from 1951, gathering the lot under loss of equilibrium: of temper, of self-control, of consciousness. A later study of 685 secondary school students in Milan found the emotional split that dream research keeps returning to, with fear attached to falling and happiness attached to flying.