Mind, Body, and Meltdown or How D Fox Got His Groove Back
In 2013, I had a major panic attack blind side me out of nowhere while serving in the Peace Corps. It’s a moment I won’t forget for as long as I live. I was in a small hotel room in Tangier, Morocco when it hit: a sudden, powerful rush of pure physical distress and raw panic. Everything momentarily faded to black, my chest felt like it was going to burst, and my head going to explode. Following that, for the next 16 hours (yes 16) I cycled in and out of panic until, with the help of a dear friend, I was finally able to stabilize. It’s true that in the worst moments of a panic attack, the only accurate description of the experience is to say you think you’re dying — as you can guess, it’s utterly terrifying, indescribably claustrophobic, and positively dreadful. There were long moments where all I could do was lie face down on a bed, retreating to some far away corner of my mind in hopes of escaping whatever was physically happening to me. It’s an experience and kind of misery I would wish upon no one.
Prior to this, I’d had no apparent history of anxiety, panic attacks, or extraordinary stress. To the opposite, I had been thriving as a volunteer in Morocco, I’d recently knocked out a year of grad school while juggling three jobs, and gone, rather boldly, on several solo trips to places I’d have never dreamed of visiting. To underscore this, I had vision, determination, passion, and that youthful exuberance that nothing could stop whatever I wanted to accomplish. I was only 24. I experienced average levels of stress and anxiousness par the course that everyone tends to, but otherwise was healthy, happy, and excited for what was to come. That night in Tangier though, all this was turned upside down for me. Over the coming weeks I went from feeling like an energetic, unafraid, rising star, to a disoriented, frightened, mentally bed ridden burnout with no idea what was happening to him.
What made it so, was that in the past, if I ever got sick, my system recovered, if I ever got hurt, my body healed, and if I ever failed, I bounced back. Similarly, I imagined I would wake up in a day or two and have the whole experience behind me. Unfortunately, my hopes were dashed. Not that day, nor the next, nor the day after that did I wake up feeling any better… Instead, over the next few weeks I was host to a barrage of severe, new, and terrible symptoms over which I felt I had little control — dizziness, blurred vision, shakes, tingling skin, feelings of insanity, pressure in my chest, almost out of body like floating, etc… Worse than that, each experience made a little part of me feel like was back in that tiny little hotel room in Tangier, far, far, from home, surrounded by nothing but naked, raw, unchecked panic convinced it was the end.
It’s difficult to convey how helpless and incapacitating I could feel. Something as simple as going for a walk would be terrifying. Being in too bright of a room would be terrifying. Drinking a cup of coffee wasn’t even remotely an option. Everything I did felt like a precursor to a panic attack, and for a while I feared I was never going to recover. What’s more, I had to return home to the US on medical leave from my Peace Corps assignment, which, although necessary, left me devastated.
Thankfully though, with the help of friends, family, diet, exercise, and some helpful professionals, I soon started to find balance as well as ways to cope. My first visit with a psychiatrist began to provide for me some clarity, and sparked a fascination I’ve nursed ever since in learning about the brain. Since this all began, even during my initial attack, I’m often reassured that everything happening to me “is in my head.” While true, it’s a misleading phrase as it makes it sound as if during panic and anxiety you’re just imagining things which is a gross mischaracterization.
A panic attack may really be all in your head, but that doesn’t mean nothing is going on up there. In fact, during a panic attack, a lot is happening in your brain. Exactly why and to whom it’s happening isn’t fully understood, but it’s clear that during a panic attack some of our very primitive, survival oriented parts of the brain that regulate the fight/flight response start having a chemical meltdown. As if cornered by some unperceived threat, the limbic system starts beating its danger drums and begins to dominate the prefrontal cortex (our good ol’ source of consciousness) which, under normal circumstances, calms those primitive danger mechanisms down when we process that there’s no real threat to us. When the danger drums start beating during a panic attack though, it’s extremely difficult to get them to stop, causing a feedback loop which grows and grows culminating in a maelstrom of panic — your mammalian warning system goes completely ape shit, activating other functions of your body that this same system regulates, i.e… your clinched sphincter, those sweaty palms, your increased heart rate, your dilated pupils. All the while there’s not a lot the more rational part of your mind can do to stop it other than wait and watch with a palm on its face. A lot is happening, and although your mind is in a kind of pinched delirium, you’re in no more danger than if you were engaged in a light workout. However, you’d have a better chance at getting a 5 year old to explain quantum computing than convincing yourself in the midst of a panic attack that you’re in no danger.
For a wound I couldn’t see, starting to learn and understand the neurological function of an attack gave me hope which I desperately needed at the time. For weeks, I continued to go through severe PTSD like symptoms where any deviation from my equilibrium felt like an oncoming panic attack. At the time, all I could do was operate on blind, hopeless faith that I would someday feel normal again. Knowing the neurology however, gave me some sort of picture of what was happening. It gave my rational mind something to latch onto and better recognize when its mammalian counterparts were wigging out irrationally — sensing it, naming it, identifying it, letting it pass, and carrying on — often easier said than done (this, in a nutshell, is my version of mindfulness).
One of the biggest impressions my night in Tangier had on me was the significance, reality, and power of the mind-body connection. It floored, and still floors me, knowing that seemingly abstract thoughts and impressions from nonetheless real experiences could manifest into such a severe physical breakdown. Life, though, doesn’t pass through us ethereally — our experiences literally etch themselves in and change the way our minds and bodies work. This has been found, for instance, in some early life trauma victims, whose brain scans indicate lower activity in parts of the brain that regulate imagination and even sense of time — consequently a lot of these victims have extreme difficulty developing a sense of self, purpose, and possibility going forward in life. Think about that — victims of trauma brains’ function differently following their traumatic event. When a victim of assault tells their assailant “you took something from me,” it’s hardly an abstract statement. Depending on the victim’s response, the assailant may have taken their victim’s mind’s previous ability to imagine, to process real vs. false threats, or to process any emotion at all. These things must now be relearned over a long, painful process of recovery.
For me, I’ll never know the exact combination of circumstances that seemingly transformed me from one person to another over the course of one evening. In time, I’ve come to identify both general and specific causes that probably sparked such an intense panic attack (most, if any, don’t last 16 hours), but that’s not really what this is about. What’s mattered over the last four years has been living in its wake, with a new, unwelcome passenger called anxiety in my life.
It took me about a year and a half to get back to “normal.” That is, a normal that, although wouldn’t ever be the same me that thrived pre-attack, would nonetheless be a me unimpaired by the fear of panic — of losing my mind — of being trapped in the twisted architecture of an unhealthy brain. For me, that new normal involved getting to know and cope with primarily physical symptoms that come and go, vary in intensity, and cause varying degrees of discomfort. It involved dissociating these symptoms from the fear of a panic attack. It involved finding coping mechanisms, routine, and learning what was good for me and what was bad. To that extent, to anyone like my former self that used to ask, “what’s the point of decaf coffee?” In all irony, I have become that point. Overall, it involved slowly trusting that I could live again with my own agency, will, and determination.
While I finally came to positive terms after that year and a half following the attack, I still found that old habits die hard. Old symptoms are often replaced, or rather just joined, by new ones that must then be integrated into new or existing coping mechanisms. This often takes time, energy, and can be extremely frustrating. Perhaps the most difficult part is trying to identify the cause. A recent comic I came across displayed this perfectly:
So it goes.
As alluded to, four years out and I’m aware by now that physical sensations more than thoughts are some of my worst triggers. The original panic attack left such an impression on me, that bad hangovers and working out too hard are almost guaranteed to trigger my panic system as they’re accompanied by sensations that mimic what I felt in the attack (dizziness, high heart rate, etc…). In fact, one motivation for writing this piece is because yesterday, hungover from a night of drinking with little to no food or water, I wound up in as deep a panic attack as I’ve been in years. Hyperventilation? Check. Loss of vision? Check. Uncontrollable shaking? Check. Sense of impending death? Check. It’s hard to convey, even to myself, that less than 24 hours ago I was convinced I needed to be rushed to the ER. But that’s how it works. Your logical brain is being dominated into submission by your very primal urge to survive. This time though, I got through it. And that’s primarily why I’m writing this, New Year’s day of all days, following a stark reminder of the unwelcome passenger my life has had to accommodate for the last four years.
Another reason for writing this is to encourage anyone who lives with something in the family of chronic anxiety and panic disorder. You can and you do get better. I don’t know nor necessarily even care about the statistics, but a startling amount of people, many who I never would have suspected, have shared with me their experiences going through clinical anxiety, panic attacks, and depression. It’s awfully prevalent, yet, for understandable reasons rarely discussed. Worse, even in the medical community much about such disorders remains unexplored including fundamentals like their causes and treatments. Because of this, access to medical care is inherently expensive — most psychiatrists, psychologists, and other counselors are unlikely to be covered by medical insurance, yet can easily cost up to $160 per visit — professional access is essentially a privilege which is a disastrous recipe for an affliction so common. As an additional consequence, treatment is financially slanted to favor only half-way remedies. By that, I mean someone can afford to see a psychiatrist once every three months to get a prescription for anxiety medications, which is a good thing, but can’t afford regular sessions for treatments like cognitive behavioral therapy (a fancy title for talking through your shit with a trained, impartial counselor, to re-train negative thought patterns), which is a bad thing.
I don’t have an answer, but there are many inspiring researchers out there doing incredible work for people who suffer from anxiety, panic, and other related disorders. One I find most exciting and consoling is Bessel Van der Kolk whose book The Body Keeps the Score, I can’t recommend enough. Although it’s primarily slanted for victims of early age trauma (including the study I cited previously), the subject-matter is no less relevant for sufferers of chronic anxiety and panic.
Finally, I’m writing this because it’s the new year and I’m thankful. First, I’m thankful that my experience hasn’t been any worse. Although in the initial days I had some very dark, challenging moments, recovery has generally been an uphill progression. I can count on one hand the number of times I’ve had a full-blown panic attack since that day in Tangier — some people in their worst states are unfortunate enough to experience multiple episodes every day — thankfully I’m not one of them, but much love to you if you are — you do have the ability to get better. Secondly, while there are extra challenges, I’m thankful this hasn’t interfered with my ability to hold a job, to date, to be social, to try old things and to discover new ones. To that end, some of the best therapy has been taking up new hobbies such as community theater and part time DJing — both of which I’ve said from the beginning would be done as much on my own terms as possible. Importantly, when you put yourself out there, you’re putting your brain out there as well, and giving it space to learn to live again. Thirdly, I’m thankful to the life-saving support I’ve received along the way. Except for that asshole Scott Bearden*(see below), my bad days have been equally matched with empathy, patience, flexibility, and encouragement from friends, family, coworkers, randos, and professional counselors. To you I am forever grateful. To those that don’t have a good support network, find someone, or someones, out there who cares because they do exist (Even if it’s the rest of the weirdos on Imgur — big ups to Imgur)!
I spent six weeks back in the US recovering after my initial panic attack. The decision whether to go back and finish my final seven months was difficult, but with great support and encouragement, I managed to do so — that decision to return and its ultimate payoff remains one of my proudest accomplishments to date. Since then, it’s been a humbling four years. When I’ve wanted to run, I’ve had to crawl, when I’ve wanted to jump, I’ve had to lie face down, when I’ve wanted to get up and go, I’ve had to stop for a shoulder to cry on. While it will always be there and subsequently affect the way I live my life, my anxiety is like an old friend, more than an unwelcome passenger now. I feel I know every inch, curve, and crevice of it. I know when it wakes up in the morning, I know what it eats for lunch, I know what shampoo bottle it uses at night. Yet, I also know it’s persistence and because of that I know more difficult days are probably somewhere along the horizon. But, having gone what I’ve gone through, I don’t measure my life in increments of anxiety anymore, and I’m far less frightened by the thought of what the future holds for the relationship between my old friend and me. There’s no symptom proven too insurmountable, and no feeling too glum for me to get through. No matter how difficult the moment, I’ve always come out the other side to find life as enthralling and full of possibility as it has always been. To paraphrase Dr. Malcolm, clearer heads, uh… find a way. That six inches of real estate between your ears is wonderful, awesome, and frightening all the same. Do yourself the favor — take good care of it.
*Scott Bearden isn’t an asshole. He’s the antithesis of an asshole, which is why enjoy so thoroughly throwing him under the bus any chance I get.