Tuesday, September 1, 2009

The Fall Within - More About My Anxiety Story Part III

As my generalized anxiety disorder became more severe, it also became more focused as social anxiety. It is very hard to explain this phenomenon to someone who has never suffered from it in the same way it is impossible for me to understand what an anorexic or a cutter thinks or does. It’s also like trying to “explain” the Grand Canyon to someone who has never seen it or even seen a picture of it. You can talk about it dimensionally, as in feet deep, miles across . . . but you just can’t explain it.

Social anxiety is, as Jamie said a long time ago, an irrational fear. You can not explicate it rationally. It is wired deeply within the brain and is very primal. In social anxiety it is the illogical and intense fear of being judged. But worse than that, it is an absurd fear that that judgment carries infinite weight. It is not just someone’s opinion that you are a bad person but their “opinion” actually declares you to be a bad person. I still may not be conveying the depth and the width of this fear. When social (or any) anxiety is at its prime, it is worse than a fear of death. This is why it is hard for someone who doesn’t suffer from it to understand. They would just think, “I don’t care what the hell they think about me.” In the same why I would ask an anorexic person, who is near death . . . but really wants to live . . . “Just eat, damn-it EAT!” I can’t grasp why they can’t.

I mentioned once before that four years ago I was sleeping in a pup-tent alone, beside the road in Northwest Pakistan. It was a tense time (as it always is there) where the anti-Islamic Dutch cartoons had just been published and George W. Bush was visiting Pakistan the following week. The day before a crowd had been circling our encampment shouting, in English btw, “Death to the Americans!”

After I had been sleeping for a while, one of the team’s Pakistani body guards awaken me and said, almost in a shout, “You’re going to die sleeping here! These Taliban are going to come in here while you’re asleep and cut your throat from ear to ear and there is nothing my men or I can do about it.”

I was sleeping alone because the rest of our team was sleeping in a shipping container under the watch of the guards. I could not sleep lying side by side, like sardines in a tin can, with a bunch of snoring doctors and medics.

But even after that warning, I was calm enough to go back to sleep . . . waiting until the next day to move my tent to a safer place.

However, the night before I have to do a public speaking event, I don’t sleep at all but lie in a pool of cold sweat. That is social anxiety and that is how the fear is worse than the fear of death itself. It is totally irrational.

After my acute anxiety experience twelve or so years ago, I started this pattern of having panic attacks in virtually every social situation (parties, seeing patients, Sunday school classes). I continued to do public speaking but it was extremely hard. I actually had a panic attack once when I was suddenly asked to read scripture in front of our church over several hundred people. My voice was shaking so hard that people couldn’t understand me.

I want to say something about panic attacks before I close this posting. I will also say in summary that while my horrible anxiety improved over the subsequent years, it has never returned to the mild level of 15 years ago. In my next posting (and last I hope) I will describe my experiences seeking help from two different Christian psychologists and one secular.

The Panic Attack:

A panic attack is very physical. For the specifics, go back to two posts ago and click on the title. It takes you to a very detailed description of what goes on in the brain, adrenals and heart during anxiety and panic.

But in simpler terms, it is initiated subconsciously. So you don’t have a panic attack on purpose or by “talking yourself into it,” as someone might say who has never had one. Once it starts (in my case) it takes off automatically. Eventually, a large dose of adrenalin is dumped into your bloodstream. Adrenalin (and the other complex processes) speed up the heart rate to about 150, start a hypoxia (starving of air) response, create generalized shaking and often causes the muscles to literally lock up.

These responses in themselves have a very healthy purpose, and originally were good and designed by God. To have a dose of adrenalin helps you to escape real danger. You can outrun a robber if you have this effect. Even the freezing up has a purpose, like that of an opossum (by avoiding attracting attention to yourself when you lie very still).

But in the social context of having anxiety and then a panic attack, this physiological response can seem devastating and unstoppable. The problem is that panic attacks associated with anxiety disorders are self-perpetuating. For example, if you have an irrational fear of being judged (as being bad, loopy or stupid) then you have a fear of a panic attack because if you do have one, then you will (at least in your mind) convince people that you really are nuts.

It goes like this. You are terrified if you speak in front of a group that they might think you are goofy. So you get up in front of the people, then you lock up or start shaking so badly you actually DO look goofy. Then the next time you will be more afraid.

I know beyond a shadow of a doubt that my biggest anxiety is anxiety itself and panic attacks. If I already have social phobias, then my greatest phobia is that I will have a panic attack and thus prove that I am stupid . . . or a nutcase, or unspiritual.

Panic attacks do not make me feel like I’m sick or dying (because I work in medicine and I know better), however, for many sufferers it does. Some people with anxiety disorders have a fear of being sick (heart attacks, MS, seizures, dementia, etc). So when they get the adrenalin rush, it convinces them they are having one of those diseases.

It takes a huge amount of energy to physical fight anxiety and to keep a panic attack from coming.

A Final Statement

Guilt is a big part of social anxiety (and depression and a host of other metal ailments). If your fear is being judged, and that judgment (like the judgment of God) carries eternal weight, then you feel perpetually guilty. This is where people with anxiety disorders can be manipulated by the Christians (pastors, Christian psychologists, etc) who have other mental health issues (narcissistic) or personality disorders. They will say things like, “Why weren’t you at the meeting? I was really counting on your.” The meeting was usually some waste of time to boost that Christian's ego, but he or she wraps it up in the “Jesus blanket” so they can use guilt manipulation to make you come.

It is also, in my opinion, why we need to hear about, meditate on and experience the Grace of God, the mercy of Christ, the total redemption and absolute justification that comes via the cross. It is counterproductive, in my opinion, to preach to us about discipline, being in the hands of an “angry God,” etc . . . because we have this constant feeling of being in the sweaty, trembling, angry hands of God almighty. That is one reason I think nut cases who practice Nouthic counseling will have to answer to God someday for the damage they have done (okay, they have the mercy too, but it is my emotions speaking).

I will end next time with my experiences, good and bad, of trying to get better.


Don Hendricks said...

Completely absorbed in your story.

Anonymous said...

Though I probably have a low-grade anxiety disorder (and am very prone to guilt manipulation), I have only had one full-honk panic attack in my life. (And the instantaneous onset and surrounding circumstances make me suspect that one may actually have had a paranormal/supernatural trigger.)

There's only one way to describe a sudden-onset panic attack, and that's in D&D terms:

It's like getting hit with a Fear spell.

Headless Unicorn Guy

Anonymous said...

I never had a panic anything in my life until I lived in an abusive marriage, and the stress of that environment slowly changed the way my body worked... The first panic attack hit about 6-7 years into the marriage and my body went downhill from there. I didn't know what was happening to me...they grew in intensity until I finally figured out what was going on.

I never told anyone at first...so freaked out by it...not sure what was happening...and in a climate where that kind of stuff would be frowned upon...just couldn't take the "trust in God" cliche stuff... I would just sit in bed and shake, totally and completely paralyzed with fear. I knew it didn't make any sense, and yet I couldn't stop it. My body was breaking down in so many different ways, the panic being just one of them...I think that I was just so strong and good at putting up a front (not all for the wrong reasons---I truly thought that it was God's will that I be cheerful and not think any negative thoughts about my "spiritual leader")....so when the panic started and stuff, I mostly just kept it all to myself (aside from multiple doctor visits to try and figure out what in the world was happening to me)... it was SO NICE to finally figure out what was going on. Talk about a relief! Even when being flooded with adrenalin, it's still nice to know that it's simply a physiological response gone wrong, etc...

The extreme panic stuff peaked about two and a half years ago and then, once I figured out what was going on, slowly started getting better, though my "panic response" is on a hair trigger, especially as the day progresses into night. It is really frustrating, but yet there has been so much improvement that I'm more encouraged than anything else. Often, I can feel one starting to come on and can head it off at the pass, though as you said, it certainly takes energy/concentration to do that.

I don't know if it will ever heal entirely...probably not...but there is so much power in knowing what it is, vs. not realizing what was going on and just being in the throes of utter terror.

MJ said...

I'll be back to comment on your comments . . . had just second to upload my last post.

Jaimie said...

Everything you are writing is so good to read. I am realizing things about my childhood... how I would shy away from social events. Even if I went on a youth activity, I would sit in the corner and read a book nearly the entire time. I was just more comfortable with fantasy. If I couldn't read, I had stories running through my head. It's made me creative with the writing, at least. Heh.

I hated and loathed the idea of taking a speech class in high school. However, I was decently talented at it. The theory of it, the organization, although my delivery of course sucked. I felt like I was giving the speech in auto-pilot. I could prepare and prepare but once I got up to give the speech in front of people, who knew what would happen.

In college, I majored in communication and took five speech classes, along with studying the art of speech writing and delivery. I also minored in theatre and took performance classes. I think this is because I was annoyed with the public anxiety "weakness." And so I trained it out of me.

Taking those classes helped me so much. No matter what I do now, I have been in a more nerve-wracking situation. I was delivering monologues and speeches in front of 3,000 people. And even if I delivered a speech in front of 10,000 people, I'm not being graded like I was in class. Ugh, GRADED for a speech is just the WORST. I learned in classes that most of your audience wants you to do well (statistically!), and if you start to screw up, they actually feel embarrassed for you... the audience is your friend, haha.

Anyway, I didn't realize until now that I did not major in communication because I liked it... I did it because I couldn't stand being afraid anymore. I'm still afraid, but not nearly what I was.

And now my anxiety is mostly... general, irrational, depression/angst about the future.

MJ said...

Fear spell . . . that makes sense.

Adven-n-mercy, maybe you would like to write a complete posting or two about your experiences, or if you've done it on your web page, give a link to it.

Jaimie, it must have taken a lot of courage to take those classes. I did one play in HS and I was the lead (I was Daniel Boone and the play was "The Daniel Boone Story). I made it through that okay. But today, the theater would scare the heck out of me.

Anonymous said...

I don't think I've ever really talked about it much... In many ways, I've just processed it over this last year, in that I've been realizing the full extent of what happened to me... I am careful/cautious about what I share on my blog, regarding my marriage, just because I don't exactly know who is reading, but I feel a bit more free in, say, comment boxes elsewhere and other more private-feeling venues.

For me, it was just a lot of fear, fear that something horrible was going to happen. I would know that it was completely illogical, yet it was like I couldn't help it, just in absolute fear for my children or something similar, late into the night so that I couldn't sleep. It was so horrible when it first happened, hard to breath, etc. I felt so guilty and ashamed, too, like, what in the world was wrong with me?

When I finally found a doctor (well, PA actually) who listened to me describe all my crazy symptoms and help me, it all made SO much sense... My body was just breaking down under the strain of living in such stressful conditions, made especially so by having no "allowed/approved" outlet for all the feelings that accompany living with someone who is mentally ill and abusive. I've since learned that it is very common for a woman in an abusive environment to have her body start going haywire after a certain amount of time...

My body just stopped working properly...along with the strange panic attacks at night, my muscles twitched, my skin broke out, I felt weak, lost way too much weight, my skin felt creepy and strange, my scalp and face had these super painful spots on them (I actually still have that... Very painful spots on my head, no bruises or anything, just very tender points all over)...it was just WEIRD...up to that point, I'd considered myself really healthy...my body falling apart just took me by total suprise and was really freaky...which was, in a sense, a blessed wake-up call for me. I was so good at burying the way that I felt that without my body breaking down, I am not sure I ever would have known.

Now, when the panic-ish feelings come on, which is not very often, I can feel the adrenalin starting to rush in and often times can head it off before it progresses any further. It's almost always late at night, and I've found that deep breathing helps, as is giving my mind something to concentrate on---mostly that. I put on my ipod and turn on a podcast---anything of interest, from Steve Brown Etc, to the godjourney podcasts, to This American Life or 60 minutes or Bill Moyers, etc... There is something about having an intellectual focus that seems to calm the adrenalin down right away. I usually drift straight to sleep. 99.9 out of 100 times, this works within minutes, if not sooner than that. I don't have a social anxiety or anything of that sort...it's just a general sense of fear/panic...so this works perfectly for me. Exercise also makes a big difference...working out and weight lifting, wow. What a good thing that has been on the stress levels and whatnot.

I think I spent unneccessary time HELPING my anxiety grow by stressing out about the fact that I was having these weird panic attacks in the first place. I felt like such a failure, or that something was so horribly wrong with me (all things that I was already predisposed to think, given my marital situation and the words that were so often said my way)... Anyways, I didn't mean to ramble...even though I know my anxiety thing is it's own weird deal and not like yours, there was much I could relate with.

Okay, on to read your latest post...

Anonymous said...

Fear spell . . . that makes sense.

Especially when you know the weird circumstances surrounding it.

Fullerton, California, 1980. I was visiting a gamer bud after a D&D game, and had an odd feeling like I was being watched; what American country folklore calls a "Behinder" -- you KNOW that something's always behind you, always hiding out of your sight. (I found out later that apartment had a reputation for "strange goings-on".)

After a while, I thought I could sense a location and direction to whatever was going on -- a little East of North, on a line to Brea Canyon, Cal Poly Pomona, and Death Valley. At this point, I said a prayer of protection. And that's when it hit. Total, sudden, full-honk Panic Attack.

A Fear spell, and I blew my saving throw rolling a one -- a sudden, instantaneous, all-consuming fear coming straight out of nowhere. Total freakout like I've never had before or since.

Somehow I got home that night, still terrified to the point of paralysis. Over the next two days (a weekend, fortunately) the all-consuming fear gradually subsided; by Monday I was functional enough to call a couple of the Cal Poly Gang and get a prayer-chain going.

Upon my next contact with the guy in whose apartment this all went down (some 2-3 weeks later), I found out that another who was in that apartment had narrowly survived a staphlycoccal septicemia that hit him just as the prayer-chain went underway. My informant told me cryptically "You don't know half the weird shit that goes on here", and his roomie told me that such "weird shit" (presumably "psychic") shut down abruptly around the same time.

I chalk this up as one of two possible paranormal experiences I've had in my life. And a demo on what it's like to "get hit by a Fear spell."

Headless Unicorn Guy

P.S. Some years later, I expanded the experience into a scenario for a contemporary-supernatural role-playing game, but the scenario-pack project fell through.

MJ said...


Just an add-on to what you were saying, I have a huge number of (mostly) women who have somatizaion disorders. Multiple medical problems without any physical evidence for them. They suffer greatly. The typical story for most is that they were severely abused, often as children. I think emotional pain can get so bad, that it eventual becomes physical pain.