I know this distress. Sometimes the ruminations get so bad that your mind starts skipping – like an old vinyl player getting stuck. You’re so mentally exhausted that you start repeating words, phrases and sayings in your mind. You can’t work your way out of the loop, and you feel hopeless. This, in turn, provokes fear, and then physical symptoms, and then back to obsessive thoughts. Do I sound overdramatic? I assure you, if anything, I’m downplaying it slightly for space reasons.
Panic disorder
This is characterised by panic attacks – an extreme distortion of the fight-or-flight response. What’s that? The fight-or-flight response is a basic human reaction triggered when we feel a negative emotion like fear. Obviously, it’s very normal to feel fear when you’re in danger. This response evolved to let us react quickly in a threatening situation: to fight, or to run away. The adrenaline released in such a situation allows us to move faster, gives us strength and makes our reactions sharper – some think it’s what allows amazing examples of strength in a crisis – e.g. a mother managing to lift a car off her trapped son. That phenomenon has a great name – ‘hysterical strength’.
But panic attacks can happen when there is no actual danger near. They seem to be triggered by false alarms, and the adrenaline and cortisol produced then work against us, making us hyperventilate, feel dizzy and shake after the fear has passed. But the danger seems so real, it’s hard to believe there’s nothing to be afraid of. Cue more attacks.
Before I explain the wide-ranging symptoms of such horrible attacks, it might first be helpful to describe what it feels like to actually have one. The worst panic attack I ever had took place in Finchley, North London. I suppose it was as good a place as any. I was eighteen, driving my car across a main road in a terrible storm. The cars were queuing up and slowing down, and the torrential rain meant driving through what looked like a lake in the middle of the road. My heart was beating fast, and my skin suddenly felt freezing cold, but I was pouring sweat. As I inched towards the ‘lake’, my ears roared with white noise and I started to lose my vision. Spots and flashes flew before my eyes and I couldn’t breathe. I mean it. I could not catch a breath. I was heaving and gasping but no air seemed to be getting into my lungs. Every part of my body was shaking and nothing felt real anymore. My legs and arms felt detached from my body, and I believed I would die, right there in that car, crossing that stormy road. I didn’t, of course. I got across. I pulled over. I shook uncontrollably for about twenty minutes, cried a lot and went home. You can bet I avoided that crossing for years.
Eleanor Morgan, the writer of Anxiety for Beginners, describes the first time she ever had a panic attack even more viscerally. Because it’s the first one which is the most terrifying. The one where you feel you’re dying for real. Later on you might know you’re not, even though your body insists you’re wrong. But that first one. Hoo boy. Morgan was at school, and ran to the loo, thinking she was going to vomit. But instead the cubicle started to move around her, and the walls felt ‘like putty’.
‘Nothing made sense to any one of my senses … what else, if not death, could be the end point of such physical and mental free fall?’[27]
Like Eleanor’s, Beth’s panic attacks started as a teenager. She told me that the symptoms terrified her, because they felt like a physical illness, as they do for so many initially. ‘For a long time people definitely didn’t believe what I was saying when I tried to explain how I felt. When it first started all the symptoms matched up with those of a stroke, my arms would become ridiculously heavy, I’d get numbness and tingles over my body, my eyesight would go, my body just felt like it was shutting down and it was terrifying. My legs turn to jelly, I shake, I get very cold, my stomach drops, I get dizzy. It can genuinely knock me out for a day after, which is great fun. I tense up so badly when it starts, [that] I just cause more issues for myself when it calms down. I hate not being in control, so trying to repress it is how I deal with it. It’s never worked.’
Catherine’s panic attacks also started at school – more particularly, at a stressful point in life – her GCSE exams. As is common, they were initially intensely physical. ‘When I was sixteen and didn’t understand that I had anxiety or that I was experiencing panic attacks, my symptoms were very physical – pounding chest, weak legs, blurry vision, knotted stomach, hyperventilating etc.,’ Catherine told me. ‘As I educated myself on the symptoms and the fight-or-flight response, my physical responses subsided and my symptoms became a lot more mental. My panic attacks now will manifest in a tense feeling and slight blurry vision and are now mostly uncontrollable, with fast thoughts racing around my head and feelings of detachment.’
Panic disorder means having several of these episodes a day – and they can last up to twenty minutes, and even longer attacks have been recorded. Imagine the fear just one panic attack can produce. Shaking, difficulty breathing, nausea, chest pain, fear of dying. The slump afterwards when the adrenaline leaves you. Then imagine how far you’d go out of your way to avoid another one. Just as I did in the car, people with panic disorder will often avoid a place where they’ve had an attack. This can limit your ‘safe’ places scarily fast. While it might feel like you’re doing the sensible thing in not ushering in an attack, you’re actually reinforcing the fear – giving it legitimacy. A person with panic disorder lives in fear of an attack, but will also have more general fears – meaning there is no real safe space for them at all.
Catherine has identified what brings on her attacks, and although everyone is different, I recognised a lot of my own triggers in what she said: ‘Feeling out of control or not feeling as if I know enough about something. For example: going into town without having a plan of how I will be getting home, being spontaneous about plans, or going into a university class/exam unprepared.
‘My second theme seems to be health related – I can get panic attacks related to doing things that could make my health worse, such as side effects of antibiotics or thinking I might be having allergic reactions to something. I also sometimes panic about the fear of passing out. If I’m very hungry, or I work out too hard, I can have a panic attack about the fear of passing out.’
While still having panic attacks, Catherine has done something I didn’t do at her age: seeking help early. She has signed up for CBT sessions and also uses coping strategies when she senses that she might be about to have an attack:
‘In the moment of panic my usual coping strategy is deep breathing, sipping water and mentally telling myself “there is no threat, everything is fine, and to be calm.” I may remove myself from the situation if my panic is incredibly bad but usually I make myself stay, ride it out and show myself that what I’m panicking about isn’t going to harm me. In terms of prevention I mostly use lifestyle – I get enough sleep, eat well, take vitamins, go for walks – generally just keep myself healthy and stress free. If I’m having an anxious time I can recognise when I’m pushing myself too far and when to take time to myself.’
Phobias
Almost everyone has a fear of something strange. The NHS estimates 10 million people in the UK have some kind of phobia.[28] My mum hates rats. For years, she wouldn’t even allow the word to be spoken in front of her. We had to