I’m a wormy hermit in a country of prize pigs so corn-happy they can't see the slaughterhouse at the end of the track. I'm Jeremiah vision-bitten in the land of Cockaigne. —Sylvia Plath, Johnny Panic

I was twenty-six the first time I visited a shrink, the practice tucked away on Manhattan’s Upper East Side, a brass plate on a black door. The therapists’ offices faced in toward the waiting room, each with an overstuffed couch or, in the smaller offices, a large wing chair. Huge desks barricaded the far walls, and the rooms were painted in muted primary colors.

I had gone from being a perfectly content flyer to the kind of person who would demand to be let off an airplane only minutes before it taxied onto the runway.

Even at the mechanic I want to be told more than how much and how long, because I like to believe that part of what I’m paying for is a better understanding of my car. And so when I visited the shrink I also thought that my treatment would entail me learning something new about myself, at the very least how, over the course of two years, I had gone from being a perfectly content flyer to the kind of person who would demand to be let off an airplane only minutes before it taxied onto the runway. And why. And what did it mean.

The first thing he did was explain how much and how long (a hundred bucks per visit on a sliding scale, a dozen or so visits). He then allowed me a few minutes to describe the history of my particular ailment. The history of my ailment was typical. Throughout my teens and early twenties I had taken a half-dozen trips on airplanes, each excursion an extended fantasy about my place in the world, each a potential adventure set in the shadows of steel-girded cities or on the beds of transient women. Though the adventures and women were few and far between, I loved flying. Then, at twenty-two, I dropped out of a graduate program and gave myself over to writing or, rather, to a naïve idea of what being a writer meant. I read a lot of Henry Miller and Paul Bowles, moved to El Paso and then Juárez, Mexico, where the cockroaches at night were as loud as cicadas, and dust storms and food poisoning, regular occurrences. I thought of Juárez as an end-of-the-millennium Paris or Tangiers, apocalyptic with its yellow lights stretched across the Chihuahuan Desert, a serial killer lurking in that same wasteland, murdering young women who worked in the maquiladoras, burying their bodies in the sand. Juárez was cheap and dirty and dangerous. How could a story not come of it?

Two years later nothing had come of it and I grew afraid that nothing ever would, that twenty years from now I might be living in the same shabby, cinder-block apartment, patching the same inflatable mattress. The restaurants in downtown El Paso might change, but I’d still be bicycling across the border every morning to wait their tables. At the first opportunity I hurried back east, but it was too late: something had begun to slip.

At first it happened only at night when I lay in bed, a sense that gravity itself might give up on me, throw its hands in the air and send me hurtling out into space. Why only at night? I don’t know, but I suspect there was not enough time during my days, not with a job and groceries to be bought, movies and bars and maybe an hour or two in front of my keyboard. At night the fog of activity dissipated and I had time at last to think about the night sky, my place in the world, the small rock we call Earth and how I was pinned to it by a force I could neither see nor really comprehend. Only recently so much seemed inevitable: love, success, money. Now nothing did.

***

Eventually this feeling of being cut loose—from the world, from my place in it, from the self-assurance of that first decade out of college—became related to flight. At the time I didn’t understand why. I told the shrink my history, but it did not seem to him especially interesting or pertinent. “People develop phobias for all sorts of reasons,” he said. “And sometimes for no reason at all. When it comes to treatment, the original trigger doesn’t much matter.” And that was the last we spoke of it.

I needed to realize that I was less afraid of flying than the sensation of panic it induced in me.

During my second visit he sat me in his office chair and had me spin. I spun until I was dizzy. He’d have me do other things that made me feel equally self-conscious, like forcing myself to hyperventilate or recording myself talking about my fear and then listening to the recording. He had two goals. First, I needed to realize that I was less afraid of flying than the sensation of panic it induced in me. I feared the sweaty palms, the vertigo, the tightness in my chest, the way my thoughts raced forward of their own volition, how the periphery became a monstrous fisheye through which I could see nothing but the blue seatbacks and white overhead storage containers.

Second, I needed to acclimate myself to these physical sensations, inure myself to them the way a skin diver inures himself to the burning in his lungs. I would learn ways to counteract the physical panic, such as breathing and positive visualization exercises, but all that was secondary. More important was that I wallow in my fear and realize that it signified nothing. To that end he strapped me into his virtual reality machine and had me “fly” until the experience had no more meaning than a video game—less, in fact, since video games are highly emotional experiences and the goal of virtual reality therapy is to reach a sort of null where you feel nothing, or at least nothing that means anything.

In 1884 the philosopher William James argued that our concept of emotions means nothing outside the bodily sensations we associate with them. “We feel sorry because we cry, angry because we strike, afraid because we tremble,” and not vice versa. This is known as the James-Lange Theory, and though shrinks have bickered over the order of things ever since, most agree that whether fear or trembling comes first, getting rid of the one eradicates the other. Trembling just happens to be more easily treated. My doctor, a cognitive-behaviorist, believed that by eliminating certain habits and alleviating certain physical symptoms, I could eradicate the coexisting anxieties. For him, the symptoms were the disease. For me, my anxieties had become little more than problems, obstacles to be overcome. A fear of flying forces you to drive, which is inefficient at long distances. Aviophobics can’t take advantage of cheap flights to Cancun, the off-season fares to Europe. They spend two hundred dollars on a ticket home and then walk off the plane at the last minute.

***

What happens when our emotions become little more than common medical conditions? What do we ignore? What do we lose?  Have our lives improved? What does it mean that antidepressants are the most prescribed drug in the United States? How do we decide when to take the cure? Who decides?

With depression, phobias, and anxiety, the deciding factor is that this thing (the depression, phobia, anxiety) is somehow obstructing the rest of our lives. In addition, with phobias, and more or less with the others, treatment is only justified when the fear is disproportionate to the circumstance. But what is the correct proportion when you’re dealing with something as complex and unknowable as a 747? The airplane has six million parts, half of which are fasteners, and contains 171 miles of wiring and five miles of tubing. At its tallest point it reaches to a height of sixty-three feet, eight inches: six stories. It takes off at 180 miles per hour, cruises at 565 miles per hour, and lands at 160. Inside it contains 31,285 cubic feet, as much space as three average-size houses or enough room that the Kitty Hawk flight could have occurred in economy class. To describe it is to mimic a medieval bestiary, so how can you ignore the possibility, when you are thirty thousand feet up and utterly defenseless, that something might go wrong? Yes, you might get run over trying to cross the street, but you cross the street on your own two feet, and though you may not understand exactly how those feet work, at least you control them and at least you can hop back on the curb. But when you are in the belly of a beast, your fate is utterly outside your control. So why not panic?

***

When I tell people that I’m afraid to fly—recently I’ve started saying I don’t fly—it’s almost always followed by me explaining why I’m not afraid to fly. That is, I don’t expect the plane to crash. I don’t think the fuselage will crack open and I’ll be sucked out into the unforgiving sky. I don’t even worry about hijackers. I’m a little claustrophobic, yes, but I do fine in much smaller spaces, like the sleeping compartments of trains. Though to be honest, I sometimes have all of these fears and others besides, like that I’ll go berserk, be one of those guys you sometimes see on the news who had to be held down by his fellow passengers while the plane made an emergency stop in Bangor, Maine. But mostly, when the panic comes, I think almost nothing at all.

The “me” I had grown accustomed to over the course of twenty-six years receded, became a tiny audience, cowered in the corner while some other me shrieked, Everything is okay!

Or maybe I think everything, all at once, the volume at ten. You’re going to be fine! my brain screams. Stop worrying so goddamn much! This is not the whisper of your normal internal dialogue but the loud cacophony of a fever dream. That’s how it was the time I walked off the plane at JFK. My arms felt fuzzy, my legs wobbly. I didn’t know for sure if I needed to pee, but I went to the bathroom four or five times just so I wouldn’t have to do so later on the plane. This is what a psychotic break must feel like. The “me” I had grown accustomed to over the course of twenty-six years receded, became a tiny audience, cowered in the corner while some other me shrieked, Everything is okay! It’s odd how nothing is quite as frightening as being told in a loud voice that everything is okay.

The plane could not load from the gate, so the other passengers and I climbed onto a minibus and got off a hundred yards farther down the tarmac. It was July and I could smell the jet fuel in the air. We got off the bus and climbed the steps into the airplane. I started thinking how long it would be before they closed the door, how long before we were in the sky, how long before we landed again. Two hours at least and I was already dividing it into minutes and half-minutes. I had a window seat. Beside me was a big man in khakis and a white button-up, a perfect extra in the drama of commercial flight, a little flustered things were taking so long, a little sweaty, looking forward to his magazine and his pretzels and his Coca-Cola. He had not yet acknowledged me when I said, “Excuse me,” and clambered over his lap. I could hear him cursing as I walked to the front of the plane and told the attendant that I felt really sick and needed off. “It’s a short flight,” she said. “You’ll be fine.” I insisted and she got on the phone and told somebody something I couldn’t hear. She told me to sit down on the steps to the plane (she’d reopened the door, to the dismay of the other passengers). Eventually the minibus returned. Eventually someone hunted down my luggage, since it couldn’t very well fly without me. And I returned to my apartment and called my family. Having nothing else to do for the next week, I spent a great deal of time wondering what the hell had become of me.

***

I chose my shrink because cognitive-behavior therapy is one of the most effective ways to treat a flying phobia and because, in his field, he was at the top. It was inexpensive and wouldn’t take long and, in more ways than one, I was ready to surrender. I could no longer deal with the fear, with the embarrassment that followed. Life was plenty difficult already. I wanted to be “fixed” and I wanted the cure to be no-nonsense.

A few months later I flew again, and then twice more after that. I was not entirely comfortable. I did not read a magazine. Still, the flights were bearable and seemed to be getting better. But the cure didn’t stick. Why? I don’t know. Partly because I became lazy with my homework. Partly, because of money and time, I took a long break from travel of any kind, which is not what you’re supposed to do. You have to keep at it. And then I began to reflect on my fear, on what it meant to me, what it signified, why it came at a time when it was so easy to lie to myself, when cockroaches and dust and food poisoning were still minor inconveniences, when being a writer was little more than an attitude, a lifestyle, unrelated to anything resembling work, when work itself seemed an inconvenience indefinitely delayed.

In an interview with NPR’s Terry Gross, the astronaut Jerry Linenger said that he was so frightened at finding himself dangling in space clipped to the end of a mechanical arm, that he had to explain to himself that it didn’t matter that he was falling at eighteen thousand miles per hour because he would never hit bottom. He was referring to the fact that objects (including the moon) remain in orbit not because they have escaped gravity’s pull but because they fall in such a way that they continuously skirt the planet’s rim. They never hit bottom.

“You think this perpetual falling doesn’t matter,” Vicente Huidobro wrote, “if you can manage to escape. Don’t you see you’re still falling?” We’re always falling—Linenger, me, you—into love, out of grace, asleep, into our graves. We fall for Ponzi schemes, our arches fall, as do empires, stocks, rain, entire rain forests. When I sit in the economy section of a 747, I feel the inevitability of the “slaughterhouse at the end of the tracks.” It’s an awful feeling, but it’s also honest and I’m glad that, as busy as life can be, there’s a place I can’t escape it.

Ed. note: A version of this essay first appeared in the Florida Review.

Josh McCall's work has appeared in the Surreal South '09 and '11 anthologies, Southern Humanities Review, Florida Review, New Plains Review, Southeast Review Online, and the Dallas Morning News. He lives in East Texas with his wife and son.

Art by Maki Naro.