On June 23, 2014 at the age of 33, I had my first panic attack. It was, without a doubt, the most terrifying day of my life.
In his new book, My Age of Anxiety: Fear, hope, dread, and the search for peace of mind, Scott Stossel examines the history of anxiety disorders. This account of anxiety and panic disorders in America is a welcomed departure from the mind vs body debates of similar literature. And Stossel uses his memoir to “come out” as a successful author, editor, father, and husband who just happens to suffer from social anxiety and a host of various phobias. I appreciate the courage that it took for Stossel to publish this book and praise his ability to discuss anxiety, not as a weakness, but as an illness much like diabetes or cancer.
On that terrifying day, my husband and I were in the car traveling home from a much-needed long weekend trip to Vermont. We had driven through the Green Mountains, stopping at every brewery we could find along the way to sample many tasty offerings not available back home. It had been a great trip, a celebration of 3 years of marriage, but now on our way home, my mind was already back on work. What experiments did I need to set up that week? Did I analyze the data from that last experiment? Did I respond to that last email from my boss? When am I going to get my paper out? You see, I am a postdoctoral fellow doing research at Yale University. I am also actively looking for a job in an overly-saturated market. As I pondered these questions, I felt a vague pressure build up in the back of my head and my stomach turned queasy. It was around noon and I just thought that I was hungry, but as we exited the car and entered a restaurant, I felt the earth sway beneath my feet. I stood dizzily at the counter for a brief moment before I reached out to my husband when I realized I was going to pass out. What happened over the next 20 minutes or so was a blur, and though I never truly lost consciousness, part of me wished I had. My heart was pounding in my chest. My hands and feet became tingly, followed by numb, and I looked down at my clenched hands as they turned blue. The right side of my face went numb and my speech started to slur. I heard my husband yell out for someone to call an ambulance as I started hyperventilating. All I could think was, am I going to die?
Anxiety and its related disorders are the #1 form of mental illness in the United States. The National Institutes of Mental Health (NIMH) estimate that upwards of 40 million Americans suffer some form of anxiety disorder. So Stossel is surely not alone in his anxiety, and although his personal accounts of dealing with his illness make up less of the book than his expository on the history of anxiety, it was these personal stories that kept me turning the pages. From embarrassing explosive toilets at the Kennedy compound to failed exposure therapy sessions, Stossel finds humor in his misery. Throughout it all, he also manages not to define anxiety through any particular lens. That is, anxiety exists in all dimensions–it is biological, psychological, cultural, and sociological. Because of that, treatment for anxiety does not exist in a single pill box nor therapy session.
“Anxiety is at once a function of biology and philosophy, body and mind,
instinct and reason, personality and culture.”
The ambulance arrived and brought me to a small hospital in New Hampshire. There, the ER staff ran a barrage of tests and confirmed by both blood and urine that I was not (their first diagnosis) pregnant. After a few hours, the conclusion was that I had a panic attack. I thought, panic attack? Me? No way. I had played competitive sports in high school, I had given speeches and presentations to hundreds of people, I had lots of friends and was reasonably comfortable in social situations, I had defended a Ph.D. thesis, taught a class for Yale undergrads, and was somewhat successful in a very competitive research environment. Panic attack? No, not me.
Prior to the 1950’s, only Sigmund Freud and Soren Kierkegaard had written books dedicated to anxiety, not because it didn’t exist, but because it did not yet have a clinical definition. Anxiety disorders including post-traumatic stress disorder (PTSD), stress disorder (SD), panic disorder (PD), and obsessive-compulsive disorder (OCD) weren’t clinically defined until DSM-III was published in 1980. The ~30 years leading up to the ‘unveiling’ of anxiety disorders in DSM-III was a tumultuous time for psychiatry. Tranquilizer drugs including Miltown were helping the anxious feel better and allowing patients to leave mental health facilities to live on their own. But the problem was that although the medical community recognized that the drugs were working to reduce anxiety and depression, nobody knew how. These drugs incited a hot debate over how the brain functions. Was it “sparks” of electricity that allowed brain cells (called neurons) to communicate with each other or was it “soups” of chemicals that did the trick? We now know that “soups” of chemicals called neurotransmitters are the language of brain cells and that these early drugs (and many more to come) prevented brain cells from listening to their neighboring cells by blocking the neurotransmitter or its receptor. The result was a delay (or prevention) of the conversion of unconscious emotional stress signals in the brain to result in physical symptoms. Remarkably, the treatment for anxiety actually preceded the clinical definition and, therefore, the diagnosis of the disease.
Over the next few days I had recurring “episodes” of varying severity. From pressure headaches and nausea to the feeling that my heart was going to explode in my chest. At night I would awake in a fit of terror that I was having a heart attack. One morning I shot out of bed, clutching my chest with the acute sensation that my heart was being crushed in a vice. So, back to the ER I went. Though anxiety continued to be the diagnosis, I remained in the hospital for observation. That night, the doctors caught 2 “episodes” on the heart monitors and I unsatisfactorily left the hospital the next day with a prescription for Xanax.
Stossel has had a long struggle with the medications he’s used to help him cope with his anxiety and phobias. Between his accounts of popping a benzodiazepine such as Xanax or Klonopin when necessary to taking a daily seratonin reuptake inhibitor (SSRI) like Celexa or Paxil, you can sense his internal conflict with his dependency on drugs (not to be confused with drug dependence or addiction). Part of this struggle undoubtedly has a lot to do with some of the side-effects of either taking certain meds or weaning off them, but I also believe that a big part of it has to do with the social implications of anxiety and how best to treat it. As a “mental” illness and before the development of medications that worked, it was treated with talk therapy. However, the type of therapy received depends solely on the doctor and the sub-field of psychology he/she is trained in. Today we understand some of the biochemistry of the brain (not nearly enough, I admit) and we know how certain drugs work to block neurotransmitter signals. But I understand Stossel’s uncertainty in terms of why some meds work better than others for different individuals. When we know more about the etiology of anxiety, that is, the complex mixture of genetics and experience that cause it, we may be on the road to personalized mental health drug development. Till then, the diagnosis of anxiety for an individual patient mirrors the history of anxiety as a disorder–if the drug works, you have the disease.
The Xanax definitely helped me. It worked quickly to slow my heart rate and calm me down, but it came with the side-effect of rebounding when it was out of my system. Like clockwork, 12-14 hours after taking each pill, I would have an attack and take another one. But I did have a few good days. I even went to lab for a couple days until I had an “episode” there, where I laid down on my desk for a while before feeling well enough to walk out to the car to go home. At that point, back at home, I felt stuck and quite literally housebound, but with the efficacy of the Xanax, I was coming around to the idea that I might have an anxiety issue. Before this time in my life, I would have said that I understood anxiety and panic disorders. Unbeknownst to me, I would have been a big fat liar. There are no words to really describe how terribly hopeless and debilitating it feels like to have a panic attack or, somewhat ironically even worse, to feel like you might have a panic attack. Stossel described it well, saying that his attacks “reduced [him] to a helpless mass of quivering jelly”. I went back to my doctor, made an appointment with a psychiatrist, and got started on the SSRI Paxil.
I recently attended the Yale Psychiatry grand rounds because the guest for this particular meeting was none other than the author himself, Scott Stossel. By his own account, “medicated enough to be up here talking to you”, Stossel gave a funny and informative presentation about his book and his battles with anxiety. Somewhat cheekily playing with his audience full of psychiatrists, Stossel laughed at the irony of his position at the podium and suggested perhaps it was some sort of elaborate intervention for him. Most interestingly, Stossel provided us with some of the feedback he’s received from his book, which fell primarily into 4 classes. Group #1 were people who thought he was completely insane for publishing such a self-effacing book, but thanked him for having made them feel better about themselves. Group #2 were family members of depressed and anxious individuals, who praised him for giving them an ability to better understand what their loved ones were experiencing. Group #3 were patients themselves who were inspired by the memoir (I consider myself in this class). Some felt less alone, others may have felt worse, but all understood completely the emotional turmoils Stossel had faced. And group #4 were “ex-anxiety” patients who provided Stossel with various advice on curing his anxiety with remedies ranging from marijuana or a gluten-free diet, to traditional Chinese therapy or eye surgery. Throughout it all, Stossel remained seemingly at peace with his choice of publishing his book as a form of “meta-exposure therapy”, that is, publicly exposing his own greatest fear–that people would find out he had an anxiety disorder.
I, like Stossel, am fortunate enough to have a very, very supportive family. First, I would not have made it through this ordeal (ok, I know I would have, that’s my anxiety talking) without the enduring love and support from my surprisingly calm husband. He’s talked me down from impending attacks more than a few times and sat up with me throughout the nights I couldn’t sleep. He’s had to miss work and reschedule haircut appointments (which is a big deal!) to comfort me when I needed him and I can’t ever thank him enough for being there for me. Second, my mom and sister came down to “visit” (aka babysit) me for nearly 2 weeks. Though I was feeling better during most of this time–yes, Paxil works for me!–the puzzles, walks around the neighborhood, Slurpees, and Friends marathons were just the medicine I needed.
It makes some sense that anxiety may be the atrophied remnant of the ‘fight or flight’ reflex. As such, this evolutionarily conserved response would increase the chance of survival when activated properly. However, a panic attack is simply when the reflex kicks in at an inappropriate time, place, or situation. It is fitting then that the father of evolution, Charles Darwin himself, suffered from anxiety and was housebound for most of the final years of his life. He was not unproductive during this time as he was writing On the Origin of Species, his most famous work that described the heritable traits of animals he had documented in the Galapagos Islands. Dean Simonton, a psychologist at the University of California, Davis estimates that about 1/3 of eminent scientists suffer from anxiety and depression disorders. He suggests that some level of anxiety predisposes certain individuals to the creative thinking that promotes breakthroughs in science. Surely a low level of anxiety will increase the chance of survival, but it is also correlated with other positive traits including intelligence and leadership qualities, traits likely to be maintained throughout the evolution of humankind.
“My anxiety remains an unhealed wound that, at times, holds me back and fills me with shame–but it may also be, at the same time, a source of strength and a bestower of certain blessings.”
Stossel spent most of his life hiding his anxious tendencies, but I’m taking a different approach. I’ve been open and honest, as most of you who know me already realize, and I will not let this disease dictate who I am or what I can do. I am a scientist, an advocate for science literacy, a blogger, a Boston sports fan, a craft beer enthusiast, a homebrewer, and I also experience panic attacks. I am hopeful that my anxiety is situational and that my current state of future employment (or unemployment, as the case may be) is in the driver’s seat for now. But even if that’s not the case, and I continue to suffer from anxious tendencies for the rest of my life, I will not change my personality trying to hide it, nor will I let this disease define me. I thank Scott Stossel for standing up to his disease and being a crusader to change the way we think about anxiety, depression, and all mental illnesses. As we learn more about how our personalities are shaped by our cultural upbringing, society, and the genetics that control the release of neurotransmitters in our brains, I am hopeful that we will gain insight into treating, and maybe someday preventing, all forms of mental illnesses.
NOTE: This entry was written in October 2014, but I sat on it for a while. As we enter a new year and I start a new chapter of my life (I start a medical writer position this week!), I thought it was about time to publish it.