I’ve mentioned this on the blog in passing, but I have this little gem of an anxiety disorder called Panic Disorder.
There’s a whhoooolleee lot of misconceptions and myths about anxiety disorders embedded in media and today’s social structure, and after spending this past Christmas explaining to each side of my family, and my boyfriend’s family, why the fact that I was having so much trouble eating did not actually mean I was afraid of food itself, and what a panic attack actually *is*, I wanted to take some time to dispel some of the big ones, and go over some of what anxiety disorders and Panic Disorder actually constitute, as far as my own, meager (non-medical, non-expert) understanding of them extends.
Besides which, conventional wisdom tells me I’m supposed to shut up in polite society about things like mental health issues and therapy, which of course just makes me want to talk about it all the time. It’s about time that we shook off the stigmas clinging to these things and starting fucking conversing about them.
First, the short/medium version of my own descent into Panic Disorder goes thusly: Two years back I had a heck of a stressful year for about 10,000 reasons. During this time, in addition to other stressors, I was given to understand by doctors that I had an allergy to tree nuts which could lead to anaphylaxis (this, by itself, not a huge problem.) I was equipped with an EpiPen, told to be HELLA CAREFUL about what I ate, and then sent on my way. The year was a busy one, and fool that I am, I put off seeing an actual allergist for a year and a half, instead growing more and more hyper vigilant about what I ate. This hyper vigilance combined with several other factors (including a predisposition to anxiety) snowballed until the panic attacks appeared. And, while the attacks are the result of many, many factors, they came to focus on the one thing in my life I thought I could control: my food.
Control, by the way, is a total illusion, and panic disorder is not a beast of reason, so before I knew it, the simple act of eating was a trigger. I would sit down to a meal of peppered mashed potatoes, feel a tingle in my throat (from the dang pepper of course) and POW, panic attack.
Last spring, when I finally caved and called my doctor to scream into the phone something along the lines of “HoLy SHIt I ThINK I MigHt NeEd a THErApiST” I was having, on average, four panic attacks a day (anywhere from 2 to 10). Which is like, a lot. And which was most certainly affecting my ability to live my life and do simple things like, go to work, see my friends, and most importantly eat my lunch.
I found a therapist, saw and allergist, underwent numerous tests of the pokey, staby, variety, and came to find out that I did not, actually, have a food allergy. The EpiPen I carry everywhere is vestigial to my own needs. But by then it was too late, damage done, the list of foods I could eat without melting into a gasping, shuddering mess was about twenty items long.
So Panic Disorder itself. Tl;dr, panic disorder is officially defined as when an individual experiences at least two panic attacks within a six month period. Anyone can experience a panic attack, they’re not exclusive to a spilled-spaghetti brain like mine, but the common recurrence of them is what makes it a disorder.
Which brings me to my first myth:
All a person having a panic attack needs to do to feel better is just calm down.
People say this all the time on TV, in real life, in magazines, on health blogs: “Just calm down. Just take it easy. Take a deep breath.”
People who say this don’t have a clear idea of what a panic attack actually is. For starters, it is just not that easy. Why not? Well, first:
What’s a panic attack? <– There’s a link, but my personal description of a panic attack is that it’s basically a physiological response that occurs in a situation that your lizard brain interprets as life threatening (or if you have social anxiety, world crumbling). Lizard brain kicks your body into fight or flight, full speed ahead: adrenaline whams into your system, sweat prickles out of your skin, your hands shake, your legs itch, your chest tightens to the point of actual pain, and your throat physically closes in panic. You feel like you can’t breathe, (which leads to hyperventilation) and you get dizzy, your lips and fingers tingle, and your heart does it’s level best to slam its way out of your chest like a TV FBI agent kicking down a door.
Every single doctor I’ve seen on the matter has told me, in the same credulous voice, as if they were revealing to me the secrets of the universe, that’s it’s not uncommon for people having a panic attack to go to the ER or call 911 thinking they’re having a heart attack. Because it feels like a heart attack, it feels like you’re actually dying. (The irony of doctors who have clearly never had a panic attack telling me this as if I won’t be able to believe it cracks me up every time. Of course people go to the ER, THEY THINK THEY’RE DYING, isn’t that why anyone goes to the ER?)
Imagine sitting in a chair, physically feeling like you’re having a heart attack, and these are actual physiological symptoms remember, it’s not just something you’re imagining in your head, and then they guy next to you says: “Just calm down.”
Not helpful. Also usually not helpful is the advice to “take a deep breath.” Someone having a panic attack is likely already hyperventilating, which is basically the issue of taking too many deep breaths. When you hyperventilate, you blow off too much carbon dioxide and take in more and more oxygen, which causes your blood to become more alkaline and as a result, you to become dizzy and nauseated. The kicker is that hyperventilation is often interpreted by the brain as the lungs not getting enough oxygen. So, you’re over breathing, but you feel like you’re not breathing at all, so you over breath even more. It’s a vicious cycle.
Just “calming down” isn’t good enough. There is no instantaneous, magic feel better solution. And actual solutions obviously differ for different people.
A few things I, myself, have found helpful:
Yoga breathing. Breath in slowly, through your nose, filling up your diaphragm so your stomach expands, and just when you think you can’t take in any more air, take in a little more. Then exhale, slowly, through your mouth, lips pursed, emptying your lungs completely of air, squeezing out that little extra at the very end. Repeat for a few minutes. This is something my therapist (who is a lovely woman) taught me. Basically, the body can’t be both relaxed and panicking at the same time, and breathing like this (and focusing on relaxing the shoulders and the muscles of the face) relaxes the body.
Relaxing into the panic attack. This sounds insane, like leaning into a punch. But think of it like jumping into a wave, if you dive headfirst into the wave all of a sudden your through it on the other side, if you stand still, rigid, freaking out, that wave is gonna knock you on your ass, drag you up the sand like an impotent jellyfish, and dump you, gasping and scraped up, on the shore with a nose full of seaweed. Remind yourself it’s only a panic attack, tell your Lizard Brain to shut up about whatever it’s freaking out about, and just let it happen when you feel it coming. Just sit and relax your shoulders and say to yourself, “okay, I’m having a panic attack, so what? It’ll pass.”
Regular Exercise. Exercise causes endorphins. Endorphins make you happy. Happy people don’t just kill their husbands. They just don’t. (Wait, no, that’s Legally Blonde.) But, exercise *does* cause endorphins, and endorphins *do* help in the management of anxiety. Believe me, the irony in the fact that the desire to feel like a normal person (rather than a rumbling, tumbling, weed of nerves and panic) may be the reason I finally get into a decent amount of shape is not lost on me.
A panic attack is when someone pulls a Chicken Little and assumes the sky is falling down without actual evidence of the sky falling down.
This misconception is a little harder to sum up in one sentence, but basically, people assume when I’m having a panic attack, that I am reacting to an irrational thought which I totally believe to be true. “This lentil soup might kill me!” They think that I have jumped to a ridiculous conclusion with the rational part of my brain, and that is what has spun me into a panic attack. Lentil soup doesn’t kill people. Spiders don’t kill people. I’m not going to catch Ebola and drop dead just because that guy two seats away on the bus sneezed.
A panic attack, like other symptoms of anxiety, and some symptoms of PTSD, can, and usually does, have triggers. Little day to day things that can set it off like a bad guy pushing a big red doomy button.
So, in my own example, my trigger is the act of eating (sometimes the act of smelling) combined with the little, insidious gremlin of “What if?” The trigger is two-fold.
This doesn’t answer the question of why some people having panic attacks about things which seem perfectly harmless and banal (such as individuals with phobias). Let’s turn to a probable example from your own life. Remember that thing you ate that one time years ago, and right after you ate that thing you threw up for hours, and as a result you can’t eat that thing anymore? You can barely look at that thing? The very smell of that thing wafting through the air makes you want to make like a one-woman stampede out of the room?
That’s an aversion. And it’s caused by that old, practically prehistoric part of your brain that, in times gone by, kept your ancient lineage alive. Prehistoric Peri ate some red berries one time and was violently ill afterwards, but, Prehistoric Peri, basically just a walking appetite, didn’t have the kind of cognition necessary to draw the logical conclusion that maybe those berries were BAD FREAKING NEWS. But, P. Peri did have instincts that linked those red berries to a health threatening situation and created an associated icky feeling, so that P. Peri wouldn’t eat those fucking berries anymore.
I call this part of my brain: Lizard Brain, whether or not that’s exactly scientifically accurate. You can call it something else if that’s what you’re comfortable with, but the point is that Lizard Brain is still around after all these years, trying to make sure you don’t eat little red berries.
The obvious problem, is that Lizard Brain is seriously guilty of the Post Hoc Ergo Propter Hoc fallacy. Lizard Brain thinks that because you threw up after you drank strawberry milk that one time, all strawberry milk is no good, very bad poison (when actually you just had the flu and it chose that moment to rear its virusy-gopher flu head.) Now, you may know that it wasn’t the fault of the strawberry milk, but you still can’t drink the stuff. (Or it takes you a long time to drink the stuff again with any enjoyment.)
People with anxiety sort of have a Lizard Brain that’s in over drive. Lizard Brain has made an erroneous connection, for one or more of several reasons. Trauma being a major one. So a person goes to war where things that make loud sounds = things that will kill you, then they come home and that connection still exists. A car backfires, fireworks go off, and their automatic physiological response will be one of someone in a life-threatening situation.
Lizard Brain thinks “x” is deadly or calamitous. And thus Lizard Brain behaves as if “x” is deadly or calamitous.
Then there is the mental component, often in the form of a what if, with some panic attacks. So, for instance, I’m not actually afraid of food. I don’t see a steaming pile of creamed corn and want to run for the hills. But, a little over a year ago, I spent a good deal of time being told by doctors not to eat certain things or I could DIE. I was told, over and over, that I had a food allergic and was at risk for anaphylaxis (when in fact I wasn’t) and that I had to check labels, eat only things I knew the ingredients of, and I became so used to that kind of hyper vigilance, that now my brain connects the act of eating food with the risk a potential attack of anaphylaxis.
Even though I *know* I don’t have a food allergy. Even though I know, rationally, that creamed corn won’t kill me, my lizard brain has been trained to fear that scenario, and has learned to continually ask “What if?”
Lizard Brain doesn’t care what I know. Lizard Brain isn’t taking any chances. I take a bite of a donut and lizard brain goes “What if there’s a tree nut in there and your throat closes and then you OMG DO YOU FEEL THAT? YOUR THROAT IS CLOSING, YOUR HANDS ARE NUMB, YOU’RE DYING, OHSHITOHSHITOHSHIT.”
Of course really I’m just having a panic attack. And then I have to sit there and talk myself back down, reminding Lizard Brain that we have the results of medical tests that clearly state we don’t have a food allergy.
And, for many, the worry about having another panic attack (since they are SO VERY UNGODLY UNCOMFORTABLE AND UNPLEASANT) is enough of a worry to induce another panic attack. “What if I have a panic attack right now where people can see me? That would suck. Oh jeeze, my chest hurts. Oh shit they’re gonna know and they’re gonna judge me and ohgod oh shit, I can’t breathe…” That’s a hell of a Catch 22.
“That corn isn’t going to kill you.” Yes. I know that. Logically, I have a firm grasp on reality. But my body has been trained, like Pavlov’s dogs, to respond to certain situations a certain way, and retraining my body and my lizard brain is one hell of an uphill, Sysiphus-like endeavor.
Panic attacks are goofy, minor things that are just quirky personality traits owned by adorable, pixie dream girls in movies, and they don’t really affect people’s lives.
Most of the time in media, panic attacks (and anxiety disorders in general) are treated like a personality quirk. Pixie Dream Girl is freaking out about that test she took. Nerdy Comic Relief Guy found a snake in his locker and he’s petrified of them.
Obviously, given all the descriptions above, I feel like I don’t need to beat this myth to death with a stick anymore, but I still think it’s worth saying that Panic Attacks can suck major ass. They can be debilitating. They can prevent people from living their lives, from leaving their homes, from calling their friends.
And this is true of many mental health disorders. They appear as the defining characteristic of a supporting character in a capacity that’s utterly misrepresented, or is treated as comic relief, when the reality of the disorder is much darker, and much more of a royal pain in the ass.
I am stuck, helpless as a screaming damsel tied to the railroad tracks, in the chugging, roaring path of my Anxiety.
This is probably less of a societal misconception as it is the misconception of a person actually suffering from anxiety, but that just makes it all the more important. Part and parcel with this misconception comes the secondary fear that you are the only poor S.O.B tied to these tracks. There are more than enough catalysts in the world to cause feelings of isolation, and I won’t pretend to have the wisdom to put them in a hierarchy, but feeling like you’re crazy and everyone else is fine is definitely one of them. You’re standing in line at Starbucks, internal alarms and whistles and earthquakes cracking apart your focus, and when you look around all you see is people looking relaxed and normal, people looking calm, people who don’t appear as though their worlds are coming down around them, and you think:
I’m the only one.
But you’re not. You’re totally not. Anxiety affects about 18% of adults in the US. And that percentage adds up to millions of people.
Even if you know, intellectually, that you’re not the only one, the more tangible feeling of being the lone crazy person having a wig-out in a room full of average, happy Joes, can be enough to stop a person from asking for help, or breaching the subject with a doctor. Not least because the media, that psychological slushie of stereotypes and “conventional wisdoms” which we are constantly slurping through our parched eyeballs, treats anxiety like a joke.
But there are things that can help. There’s medication. There’s therapy. There are support groups. Self-Help books on the subject. Blogs. Videos. Documentaries. I recommend whatever of these things work best on an individual basis, and I recommend taking the chance to find out. (“Recommend” I say, in that some of these things are helping me. No one can really recommend anything with certainty, although a doctor is a good place to start. Also I’m not an authority on the subject. I’m just a fellow wiggin.)
On top of that, there are actions that can help reduce anxiety. They vary, from person to person, and different types of anxiety. But there’s exercise (CURSE IT ALL, I know. This uncomfortable shit is going to turn out to be the freaking cure for death itself, it comes up everywhere). There’s a change in diet. Staying hydrated is a small but significant help for some people, since anxiety can be a symptom of dehydration (same thing with being hungry.) There’s exposure therapy, which is one of several methods I’m currently slogging through.
I will say that none of these things are necessarily easy. And changing your routine/way of living, especially when you already have anxiety, can be holy-shit levels of hard. As a general rule, people don’t like change. We like routine and comfort, dinner at the same time, watching our regular TV shows, seeing our regular friends… and stepping outside of our sphere of cozy, known-experiences, is not fun.
But, at the same time, change isn’t as hard as it seems in the beginning. Because your anxiety thinks that change is impossible. Anxiety believes that change is Not Even An Option. So once you disprove that, once you’re over that initial uncertainty and doubt, the new habits, over time, seem less and less monstrous. And so, it miraculously turns out, does your anxiety. That towering, neon green, saber-toothed, cranky fucker who keeps screwing up your day, starts to shrink, one millimeter at a time.
*Whew* Well, that’s all for now. I’m gonna just end this post abruptly, rather than making you all suffer through an essay-style recap. I hope all that blathering was at least mildly informative. Time for me to sneak off and have a nice quiet cup of Jane Austen to sooth the ragged nerves. (Coping Mechanisms come in all shapes and forms, my friends.)
(postscript: a West Wing clip, just for funzies)