Panic, SSRI's, and Adulthood in the 21st Century: What are YOU on?

1. TO SPIN OUT OF CONTROL YOU FIRST HAVE TO BE IN CONTROL:  THE ORIGINS OF MY PROBLEM.  You know, I thought for a long time that I was handling adult life fairly well. 

When I first started being (technically) an adult, I didn't do so well at it; I was really behind the curve in working out how being grown up differed from being an adolescent.   I went on being a maturity-challenged child well into my thirties.   Fortunately (in retrospect, though I didn't see it that way at the time) I got involved in my early thirties with a much older man who had little tolerance for the liberties and excuses I was inclined to allow myself.  He and an older female colleague I didn't like at all were major forces in bringing me to maturity.  Painfully, though.

Among other things, I learned from them that one way to tell an adult from someone who looks like one but isn't is that an adult does what she says she's going to do.  Another is that an adult doesn't consider a good excuse to be a reasonable substitute for actual performance.  And though she would take responsibility for the consequences of a bad decision or poor judgment, she won't often have to do that because she'll make sure that her decisions and judgments are---to the extent humanly possible---at least reasonable ones. 

I didn't exactly learn any of these useful lessons overnight; I had a prolonged and difficult struggle with both these mentors, and my relationships with both ended unpleasantly.  Yet when the thought flits through my mind that I might call in sick when I'm not---or even when I am---it's their voices I hear in my mind 20 years later.  Whereas in my younger days I was thought unreliable, self-absorbed, arrogant, and self-serving (and also perhaps something of a liar when it came to excuses), I now am considered conscientious, all too inclined toward humility (this is what my boss said), helpful to others, kind, etc. etc.  Even when my husband died, I went straight back to work after the first week, partly because my mother said I had to but also because if I didn't, it would have put tremendous stress on my colleagues and my department. 

So from the standpoint of the rest of the world:  big improvement.   I am super-conscientious.  My "slacker if she can get away with it" reputation is a thing of the distant past.   

But of course we all know by instinct even when we're too young to have seen how it plays out that developing character and a sense of responsibility----so good for our family, friends, and associates---comes with a terribly high price, and that price is not paid by those who are benefited by the development but by the developer.

2.  FROM GRASSHOPPER TO ANT;  WHY?  Becoming a better person---an ant rather than a grasshopper---permanentaly alters your chemistry and the effect of those changes is to make life harder rather than easier. 

In my (prolonged) grasshopper youth, my goal in life was to spend as little time as I could manage doing things I didn't want to do and as much as possible pursuing what I thought of as "happiness."   I truly was a grasshopper.  In fact, I wasn't at all happy, but it was not for the want of trying.  I didn't start coming to terms with the fact that this isn't a legitimate or even an achievable life goal till I was in my thirties.

My second marriage, though there were plenty of bits that made it worthwhile, brought me into a situation that was in a constant state of turmoil.  My second husband had issues with his ex; the two of them battled constantly over...well, everything, really.  He was in an industry where jobs just don't last very long and he had some sort of fatal flaw that I didn't understand then and don't now that made his bosses unwilling to hand over the reins to him; as a result, he was chronically ridiculously underemployed, used by people less experienced than he to implement their plans but rarely rewarded or given the credit he doubtless deserved, and always underpaid. 

And those problems were the easy ones.  For the seven years before he died of a cerebral hemorrhage, we had constant strife---not with each other, but from one bruising event after another.

During that time, I had plenty of periods of feeling depressed and anxious, but except for a couple of particularly acute periods, I was mainly able to keep those feelings at bay (though of course they took their toll).  For one thing, the good things were really good.  We shared a hobby---photographing Northern Florida---that was really absorbing and spiritually fulfilling to us both; and that really helped. 

But the most important aspect of my coping during those days was this:  nothing that happened was my fault.  All the problems we had came from him, his family, his children, his job, his past, and his personal demons.  Though I carried on feeling that I had to be duty, fulfill all my obligations, and do the best I could to get through the periods (and there were many) of uncertainty and chaos, at a certain level I knew that none of it was my fault and---as my mom kept saying---I could only do so much and no more to keep things stable.  It was like living in the eye of a hurricane where you get credit just for surviving and carrying on. 

And while not being able to control your life definitely can lead to depression and anxiety, I've found out since that nothing creates anxiety like being totally in control of your life.  At least if you have or need an "external locus of control," you don't feel ultimately responsible for everything that happens to you. 

The person who is the "master of her fate" and "the captain of her soul" is a person who is going to feel obliged to go down with the ship if it founders.   And knowing that makes it extremely difficult to acknowledge to yourself that it is foundering.  You look for some other explanation, one that doesn't require you to go on  feeling responsible when it becomes clear that you are going down. 

3.  CHANGE OF LIFE, CHANGES IN THINKING. After Don died, I made a decision that I was going to get everything in my life under my control that I could manage to control and that I was going to find ways to conquer some of the habits and modes of thought that get in my way.  I won't bore you with the details, but I have to tell you that "taking control of your life" has a serious downside as well as an upside. 

I think I coped as well as I possibly could have with Don's death, possibly because during the critical months I was living hundreds of miles away from most of the people I was close to and was too numb and dazed to feel much except a desire to escape my life.  I didn't have anything to do, so I spent the time I had to fill in by settling some rather substantial issues he left behind.  The feeling of actually being in control was initially a heady one.  I began to feel a certain pride in the fact that I was "coping" and that I was managing on my own, not "so well" because it wasn't that well, but managing.  I won't deny that the Paxil that was prescribed for me helped me get through that. 

When I met and married Nick, things changed again and I finally obtained the peace and stability I longed for. So it was odd that I actually felt more vulnerable and much more inclined to feel anxious, even panicky, and to get emotional at the thought of having anything occur that would have to be "handled."  Why?  Initially, I assumed it must have something to do with some fairly bothersome "female trouble" (to use my mom's phrase) and that the hysterectomy I had to have would take care of it. 

But the ensuing years brought about a slow downward spiral.  First of all I didn't bounce back from the hysterectomy as I'd expected.  I was allergic to the estrogen patch the doctor prescribed.  I had to take oral estrogen, which made me chronically nauseated.  I began developing the symptoms of a low-grade chronic immune system disorder that no one (apparently) could do anything about.  I felt chronically sick to my stomach; and I had occasional reflux, but the nausea never went away.  I developed a similar burning in my bladder.  I became allergic to my own perspiration; if I broke out into a sweat, it left a red mark. A therapist friend suggested that it was post-traumatic stress syndrome resulting from Don's death and from the stresses that followed it.   

When I was on estrogen, I felt nauseated and clogged up, as if my tissues had soaked up excess fluid like a sponge.  My doctor put me on antidepressants which helped with the depression.  For awhile, things got better.  Somewhere around spring 2005 I started feeling so good that I decided I could finally get off the estrogen.  I was on the lowest possible dose in any case and it wasn't helping the hot flashes in any case.  And for awhile I felt fine.

So much so that I didn't connect getting off estrogen with what started to happen a couple of months later.  I was working on a major project I was really excited about involving a certain amount of (not at all difficult) research and a lot of writing.  I was working with people I really liked and respected.  Everything seemed to be on the upswing. 

3.  PANIC AND THE FEAR OF PANICKING.   And one weekend everything changed. I woke up one morning feeling terrified and confused.  I couldn't explain to Nick what was wrong.  I felt shaky and disoriented.  Because I had a history of epilepsy----though nothing in that way for a year or so previous----I assumed that I was having some sort of related neurological fall-out, because if you're epileptic, that's what you do assume.  I was upset about it because I'd been seizure free for so long, but I couldn't imagine any cause except the brain disorder for the buzzing in my ears, the illusory smells---my mother's favorite perfume from the eighties, "Poison" in particular---the sharpened color of things, the feeling that something dire was going to happen. I even wrote a note about epilepsy and posted it here. The tone is self-consciously bright and the writing nervously garrulous.  It's absolutely accurate about what my seizures were like when I had them. But at the time I wrote it, I hadn't had a seizure in years.  And I think I knew that what was happening to me was different.   

There were symptoms I didn't remember from past seizures:  the nausea and dizziness; the fact that though sometimes I'd get tunnel vision and things would go grey, I never actually did lose consciousness; and especially the extreme anxiety that went on and on and on.  My hot flashes turned into flop sweats.  My pulses and my heart would suddenly start to race and I'd be certain I was on the point of a heart attack.  And the thing is----despite all that was good in my life----I felt at a certain level that I wanted  to die, because for me, the anxiety that started out of the blue one weekend in June 2005 just never stopped.  Sometimes it was at a low enough level that I could avoid thinking about it and get on with my work, but there were other times when I was too overwhelmed to do anything except lie curled up in a fetal position.  I used to pray to lose consciousness, but the problem was that I was all too conscious.

Everything that crossed my mind frightened me.  Why?  I felt that whatever happened, I could not cope.  During working hours, I managed to keep it sufficiently under control that other people didn't notice this too much, and to the extent that they did notice that I seemed distracted, upset, and unusually anxious, I explained about the other symptoms:  the chronic nausea, the chronic rhinitis, the chronic bladder pain, and the weird allergies and sensitivities I was developing.  At least at work, there were things on which I could focus my attention.

But free time was disastrous for me.  As time went on, I began to feel terrified all the time.  And if I thought about anything, I immediately thought of all the ways it could go wrong, how its doing so could "destroy my life," and how if that occurred I would not be able to cope.  I started blogging in 2005 as a way of trying to come to terms with it.  The first thing I wrote was a semi-fictional account of an encounter with old friends who tried to help me do that. As I didn't share their faith, it didn't help much, but the blogging helped.  It helped a little.  It at least gave me a channel for my generalized anxiety and my resulting anger at everyone in the world.

I was angriest at my neurologist who refused to acknowledge that my problems were due to my epilepsy and at the medical people I felt were being disrespectful of me when they suggested that maybe, just maybe, the problem this time wasn't neurological.  I wasn't losing consciousness; the problem didn't seem connected in anyway to my usual seizure triggers; and I'd just gone off estrogen.  I was furious that they weren't taking me seriously (which is pretty much, to be fair to me, what they conveyed.)

And that was the weirdest part of all.  I had had years of volunteer work that included dealing with people suffering from panic attacks.  I had watched The Sopranos.  I knew from my own experience and from various other sources that panic when it comes out of nowhere and there's nowhere to run makes people believe they are dying; it makes everything go grey; it can even make them faint.   

I'd talked people down from panic attacks plenty of times.  How could I have not put two and two together?

At last the young neurologist more or less told me straight out that she didn't think my problem was neurological or that there was anything she could do for me.  The trileptal she'd prescribed wasn't making a difference; I was still in a state of chronic anxiety and disorientation.   My short term memory problems, the cold sweats, and all the rest of it could, she said, be caused by anxiety.  And my getting off of estrogen could have triggered it.  She gave me the number of a local psychiatrist and told me to call her.  I was even more furious; I was also humiliated.  Given my history, how dare the neurologist suggest that my problems weren't physical?  How dare she ascribe them to panic attacks?

4.  MEDICAL RAMIFICATIONS:  "NEUROTIC."  Given what appears to be an epidemic of them, at least among the people I know, you'd think people, including me, wouldn't view panic attacks as anything but an understandable development of the stress of living in a time when the worst demons are things you can't fight or flee from.  That's not the case.  My experience is that medical personnel who are dealing with what they believe to be a purely psychological issue display---whether they intend to or not----impatience, disgust, and contempt.  I'm not basing this on a single encounter but on a large number of them.  I get that it must be annoying to have to deal with someone who hasn't got anything physically wrong if you don't know how to deal with problems that aren't physical. 

But I think a lot of them need to work on their patient care skills.  Instead, they tend to convey the sort of  "grow up/pull yourself together/I've got people with REAL problems to treat" that I'd expect from people who are ignorant of the nexus between physiology and psychology and that seems to the suffering (but not at all ill) patient to be a bit much, coming from people whose services cost as much as theirs do.  It would be a lot easier to say, "Oh, perhaps it is a panic attack" if the person making the suggestion or the diagnosis didn't subtly or unsubtly convey along with it that a panic attack is just a panic attack.

There is no such thing as just a panic attack, my friends.  If it happens to you, it marks you permanently. 

6.  SALVATION IN CONVENIENT CAPSULE FORM. The problem from the patient's standpoint is that these attacks really can't be controlled.  The psychiatrist---or as I think of him, my savior----explained to me that chronic anxiety over time fundamentally alters the nervous system.  After awhile you get caught in a sort of loop where the fear of a panic attack---which is ongoing---will itself lead to such an attack.  The solution, and probably the only solution, is medication that will break the anxiety cycle so that the nervous system can return to normal.  It's not a problem that can really be solved by talk therapy (or by ONLY that).

He prescribed a fairly powerful and relatively new SSRI that works directly on the nervous system.  Like everyone who is suffering from panic attacks, I was completely resistant to the notion that that's what was going on and absolutely dead set against taking medication since by taking medication I was admitting that maybe it was.  But he is really good at being a psychiatrist and---without making me feel like a fool, a hypochondriac, a pathetic neurotic, or a whiner---persuaded me to give it a try. 

The change happened within a couple of days.  It was like, I don't know, where someone trapped in a dungeon in a particularly grim fairy tale drinks a magic potion and wakes up to find she's been transported to some other place, where the birds sing and the sun shines and there are more pleasures than perils.  In other words, it was like waking up to normal life as it had appeared to me years before, back in my grasshopper days.  All the potential problems were still potential, but now it was the fact that they were merely potential and not yet actual that seemed significant.  I no longer saw them as things I needed to think about or deal with now.

And even real problems seemed manageable.  If, after putting forth my best efforts, I still had made mistakes in my project, I could deal with them!  If other things went wrong, I could cope!  I didn't need to look way down the road to anticipate every possible outcome; it would be enough if I was careful and mindful about what I was doing now!

In other words, as soon as I went on medication, everything changed.  Despite my continuing physical problems (digestive and so forth), I felt better than I had for years.  I could concentrate on my work because I didn't have that continual anxious chatter going on in the back of my mind.  Though prone to be preoccupied with something or other all the time, I was able to develop once more the flexibility to deal with problems one at a time.  Apprehensiveness about problems could be confined to the time I actually set aside to deal with them; everything didn't color everything else, turning my vision a uniform muddy semi-opaque tint of grey.  The bad things still looked bad, but they didn't prevent the bright things for looking bright.

A dear friend of mine recently confided to me that she was having similar symptoms (and on more substantial grounds than mine).  I was grateful at the time that I'd had my spate of panic attacks and panic attack-denial, because I was able to tell her about my own experiences and encourage her to seek help as soon as possible. 

Freud once said that psycholanalysis turns neurotic misery into ordinary unhappiness.  With respect to panic attacks, medication changes the chronic fear of losing control and of not being able to cope into normal boredom, exasperation, and a normal amount of worry about the problems life hands you.  Once I got used to not panicking, the bluebirds flew back into the trees, the sun went back to doing what the sun normally does, alternately shining and not shining, and the world went back to looking and seeming like the perilous and uncertain place it is. But it was okay!  Once again, I could tolerate it.

8.  MANAGEABLE PERILOUSNESS.  The thing is---now that I've got the buffer provided by the medication installed--- I'm able to accept now that life is perilous in ways I can't control.  I stopped falling apart every time I couldn't reach Nick by phone (because I always remember coming home and finding Don in the process of dying). I no longer hate life for its unpredictability; I am learning, once again, to see the lack of certainty exciting and stimulating.  I no longer worry, or not so much, that I might make a mistake.  And--most important---when things happen that I can't control, I am able to remember that the worst case scenario is exactly that:  the worst case.  Among the range of possible outcomes, it's the one that depends on everything going wrong.

So I'm not saying that people suffering from panic attacks that getting them controlled will lead to happiness.  That comes from other places.  But taking medication will lead to an alleviation of anxiety about your ability to cope.  First, you'll stop worrying that you might have a panic attack.  Then---once your anxiety level drops--- you'll stop having them.   

What I am saying is that if you suffer from panic attacks, you should most definitely consult a doctor. If the doctor recommends medication, you should definitely take it.  Don't assume you should be able to handle it all on your own.  If you're really having panic attacks, you probably can't.

I know half a dozen people---people I'd viewed as unshakably stoic, real pillars of stability---who have, out of the blue, suddenly found themselves spiralling out of control.  All of them tried for awhile to fight it on their own; none succeeded.  For all of them, it took medication to make the problem go away.  But once they started on medication, the problem did go away.

Don't be deterred by your sense (or the sense of your health care provider) that such problems are "imaginary" or under your control and that your suffering is a sign of your weakness.  In the first place, if so, so what?  That's still not a good reason to suffer pointlessly. In the second place, it's no one else's business--including or perhaps especially your doctor's-- to judge you.  Realize that a lot of things can trigger these attacks, including all the usual life stressors (death of a spouse, divorce, death of a family member, any bereavement, any illness, losing a job, getting a job, moving, and anything else that pushes you out of your comfort zone.