As part of the human body’s acute stress system, the “fight-or-flight” response works by stimulating the heart rate, dilating air passages, and contracting blood vessels—all of which increase blood flow and oxygen to the muscles, so we can be ready to run away from something life-threatening: a wild mammal, a fast car, a dangerous person. As physiological responses go, it’s pretty important. Only, sometimes, we short-circuit a bit.
Charles Darwin, who for years was reported to have suffered from crippling panic disorder that often left him housebound, argued that, to a degree, it is highly evolved to be “on alert” most of the time. But the fight-or-flight response, “isn’t conscious—it’s controlled by one of the most ‘primeval’ parts of the brain, which means it’s often a bit simplistic in the way it interprets danger.
In fact, it makes no distinction between an external threat, such as a tiger, and an internal one, such as a troubling memory or a future worry. It treats both as threats that either need to be fought off or run away from.” As the Atlantic’s editor in chief, Scott Stossel, researched in his brilliant and harrowing memoir, My Age of Anxiety, “Species that ‘fear rightly’ increase their chances of survival. We anxious people are less likely to remove ourselves from the gene pool by, say, frolicking on the edge of cliffs or becoming fighter pilots.”
Sometimes, though, the “dangerous” person is you.
I’ve negotiated anxiety in the form of a panic disorder for the last 15 years. Twice, it’s tipped over into a severe depression—the kind that imprisons you in your flat, unable to do anything but watch The Simpsons on YouTube and eat Carr’s water biscuits.
Will this be the time it makes me psychotic? Should I call an ambulance? How many sleeping pills would I have to take to sleep for 24 hours but not die?
These are the kinds of questions I’ve asked myself in the past, stuck in a tornado of negative thought, my ability for rationality sweating out through my armpits while staring at pictures of myself as a child, saying out loud, “Where did she go?” As if there are two versions of me—Version 1.0: Pre-anxious and Version 2.0: Anxious.
Only, it’s not an entirely crackpot theory. Through ongoing CBT therapy I’ve managed to pinpoint the root of my anxiety—a spectacular near-death experience with a burst appendix that swallowed about six months of my life. Turns out that, if you’re a sensitive kid, your body going gangrenous and becoming so weak you have to recuperate in intensive care can have quite an impact on your future mental wellbeing. Particularly when the physical ramifications of said episode have basically ruined your insides forever.
My first taste of panic happened during my first week back at school after appendix-gate. Teachers stopped in the corridors. “Eleanor, are you alright?” they’d ask, in coffee breath whispers. I was chef’s special of the week. But after a few days, something happened.
One afternoon, I started to feel nauseous in biology class. My hands went numb and I felt as if my skull was about to crack like an egg. It was an alien feeling, one with no reference point whatsoever. I went to the toilet and there, for a few minutes, my brain and body weren’t my own. I thought I was going to vomit, but nothing came. Just wave after wave of nauseating pressure, from my temples to my toes. Then came a cold, black fear like I’d never known: my head swam, the walls felt like Silly Putty. Absolutely nothing in my body or surroundings made sense. This was possession, pure and simple.
What the fuck is happening to me? Am I dying?
It was my first panic attack, but I didn’t know that then. For the next few weeks, I thought about nothing else. It happened again a few times. At night I’d cry, but telling my parents was out of the question. They just wouldn’t get it—whatever “it” was. I thought it was a physical thing, something related to my damaged insides. But after three weeks of hell and one totally sleepless night, I went to the doctor, alone, who said, “I think you might be having panic attacks,” gave me some leaflets, and referred me to an elderly therapist in the community centre next to the Shell garage.
Every next second and its potential escape route had to be mapped out. Just in case. Anxiety is the “what if” disease
This lady’s approach was to give me some elastic bands to wear on my wrist, telling me to snap them against my skin every time I felt my internal pressure gauge starting to rise. I don’t remember it helping the anxiety itself, but it certainly made me aware that there was a flow of energy that needed to be caught. Somehow.
Months later, I left for university in London with more of an understanding about panic attacks and the claustrophobic loops of anxiety they cause. My parents knew because I had to explain the abundance of fawn-colored elastic in both their houses, and were kind and understanding, but I still lived in constant fear of having one (something I’d later learn was a defining characteristic of panic disorder) when I was out and around other people. Whether I was in lectures, pubs or nightclubs, it never left me. Not for a minute.
Consequently, like many others with the disorder, I developed a pattern of avoidance behaviors relating to where and when I’d felt anxious in the past: “No, dick, you can’t walk through Green Park to get to that lecture because you had a really bad attack there last week,” or, “I know that pub only has one toilet, best give it a miss in case I freak out and there’s a queue, eh?” I’d say to myself in a never-ending internal dialogue—something my current therapist now refers to as “The Chatterbox.”
Knowing where the toilets were in every place I was going was an imperative—I had to have somewhere to “escape” to if I started to panic, especially considering that, at the sharp end, my panic mostly manifested with gut issues. If I couldn’t see a toilet, or at least a fire exit sign, I was fucked.
Open spaces were a navigable but daunting prospect and, if I did have to walk through Green Park, say, because my friends did, I’d mentally keep track of all the dense bushes I could hide behind—just in case. I had to sit at the end of the row in every lecture or cinema trip—just in case. If I ever got the tube (an increasing rarity), I’d stand by the door, facing the door—just in case.
Every next second and its potential escape route had to be mapped out. Just in case. Anxiety is a “what if” disease.
Fast forward to the present day and, while I could now write a fucking thesis on living with a panic disorder, I can also tell you that I didn’t make proper, significant progress until a few years ago and that I still find the idea of having a panic attack frightening because, well, how could it not be?
Only, that fear is lessened now because I have the techniques to manage the anxiety as it starts to swell, rather than when the wave crashes. I know that if I do have a panic attack I’ll be alright again afterwards, that I’ll deal with it the best I can.
“Few people today would dispute that chronic stress is a hallmark of our times or that anxiety has become a kind of cultural condition of modernity,” says Stossel. “We live, as has been said many times since the dawn of the atomic era, in an age of anxiety.” But not everyone has a “normal” response to anxiety.
Panic disorder is an anxiety disorder characterized by recurring panic attacks and an ongoing fear of a panic attack happening. Stats surrounding the prevalence of anxiety disorders in the UK, which were last compiled in 2007, suggested that 1.1 percent of adults (1.3 percent of women, 1 percent of men) met criteria for panic disorder in an adult psychiatric morbidity study.
In the US, the number of adults thought to have panic disorder is higher, at 2.7 percent. These, of course, are just the “officially” mentally unwell—my doctor told me recently that anxiety is one of the most frequent complaints she hears from patients. More frequent, sometimes, than coughs and colds.
Panic comes in lots of flavors. It can run the gamut from a gnawing unease in the belly to a fear that feels like being hit by a bullet train. My usual cocktail is a wormy prickling from head to toe, a blanched face, constricted lungs, numb hands and a lurching gut. I feel like I’m going to vomit or shit myself at any second. I have done the former but not, as yet, the latter—despite coming pretty close. It’s a lovely old dance, really.
There have been times where I’ve knelt in alleyways trying to steady my breathing and “hold on” to the ground, to root myself to the physical earth while my body enters what feels like another plane of existence. Anxiety physically manifests in every person differently, though. Some people call ambulances for themselves because it feels like they’re having a heart attack. Others hyperventilate. Others puke. Others shake like they’re standing naked in an Antarctic wind.
There’s the cognitive stuff, too. That got worse as I got older—before, the physical symptoms eclipsed the mental ones. Later, it became a waltzer-car spin of, I am going to explode, I am never going to be safe or normal ever again, my body is failing, everyone is going to see me losing it, I am losing it, I’m losing my mind. This is it. The next step is hard restraints on a psychiatric ward.
I am going to die. This is killing me.
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