I agreed to participate in a functional MRI study of operational/working memory tasks in healthy controls and recovered depressed subjects (incidentally, it has yet to be determined if I will be placed in the former or latter group). Today was the second day of the study; I was debriefed on performing the memory task. It consisted of recalling letters (specifically, "a", "b", "c" and "d") that flashed for 2 seconds on a computer screen. I was compelled to recall "0-back" (a control task identifying "a" when it flashed upon the screen), "1 back" and "2 back" tasks. The "2-back" is suprisingly much more difficult than it seems, especially when the letters flash so briefly and in rapid succession.
Unfortunately, I received little debriefing about what the actual neuroimaging other than that it would require ~1-1.5 hours. I am aware of the frequency of MRI-induced claustrophobia, but, prototypically, believed that this peculiarity would not affect me in the present situation. Of course, this irrational event only affects affects the delirious or demeted elderly patient who is not nearly as knowledgeable about the specifics of the procedure. I emptied my pockets of all metallic items, including cell phone, wallet and keys. I was not allowed to wear my glasses into the room due to their metallic screws; I was provided with the front portion of this atrocious plastic frame that did not match my true prescription. Once I settled into the bed leading into the machine, a shield with a mirror was placed ~2 inches over my face such that I could read the computer screen placed behind me with its incessant flashing letters. I was also provided with a two-button clicker to select whether the presented item did or did not match the letter the prespecified number back. Earplugs and dampening headphones were also fit to limit the sound of the clanging magnet.
At this point, I was placed into the machine. Immediately upon elevation and insertion in the narrow tube, a pervasive feeling of discomfort seized me. I felt my shoulders internally rotate and trap against the sides of the cylinder. I became paralyzed with the thought that I must remain in this position for over an hour. The pervasive sensation was that I was too large for this specific machine, albeit all closed MRI machines are likely of an identifcal diameter. At the time, I felt no loss of control or symptoms of panic (lightheadedness, palpitations, a sense of impending doom, etc.), but I had dominant sensation that this protocol would never be completed when I politely asked the technician, "Can you please take me out for a minute?".
I felt immediately embarassed and even nonplussed when sitting up from the bed after the brief 10-second interval in the machine to discover an increase in my respiratory rate. I felt no other indication of sympathetic activation but this aberrant vital sign was clear. I quickly removed all of the conpounding apperati that restricted my sensorium and was told that I was "claustrophic" and had a "panic attack" (the former is likely true, yet I remain dubious of the latter contention). Nevertheless, in addition to my fear of heights, I discovered another specific phobia that my often-haughty rationality was unable to effectively combat while my emotions swirled and swelled out of control. Dostoevsky's Undergound Man is again proven correct that the intellect is no match for the emotions, the id; the Undergound Man argues for the irrational, or, better yet, the supra-rational man. This despicable man is proven correct time and again.
Time is presently short, but I will seek to turn to that most refined and haughty coping mechanism, the intellect, in an attempt to understand the neurobiological and psychological underpinnings of this specific phobia. Not surprisingly, a PubMed search of "MRI AND claustrophobia" reveals 187 hits dating back to 1984.
