I have often said that a panic attack is the inverse of an orgasm. This usually gets a good laugh, because it incorporates the element of surprise — when I start the sentence, nobody sees orgasm coming (you’re welcome). But it also produces a laugh of recognition in anyone who knows that it’s true. And as our society slowly gets moving again, more people are becoming familiar with one of the least pleasurable involuntary responses imaginable.
Since I was a child, I have spent plenty of time with this particular abrupt form of terror. I have felt pained over the past year, knowing that many more people soon would feel its sickening grasp, too. Genetic makeup surely plays a part, as does personality. But trauma can help ready the soil in which panic disorder may sprout like a spiked weed.
Not everybody who has gone through the pandemic will experience panic attacks. In fact, I am sure it will be a minority of the population. But I am equally sure that it will be a sizable minority. In my most selfish and mean moments, I have wished many ills upon others, but I do not think I have ever wished them entry to this particular fellowship.
In the essay “In Bed,” part of her classic collection The White Album, Joan Didion writes of her lifelong struggle with headaches: “The physiological error called migraine is, in brief, central to the given of my life.” At the worst of it, she took to her bed “three, four, sometimes five times a month.” Replace migraine with panic attack, you have a fairly accurate description of my own life during The Bad Times.
The Bad Times happened when something unusual was afoot — as when I took myself off Prozac cold turkey at the age of thirty, reasoning that it had been years since panic attacks had induced a fit of agoraphobia; or when I was twenty-one and still on the wrong medication prescribed by an under-qualified pediatrician years earlier; or when I was a young teen, before I began seeing a social worker for therapy. During The Bad Times, I didn’t leave my home very often. During The Worst Times, I hardly even left my bedroom.
In every instance, I got good medical care, because I had a family that paid attention and wanted me to be healthy, and they had the money to get me help, and that’s how lifesaving mental healthcare gets delivered in this country. It is not fair, but it is the truth. I cannot dress that up to make it sound sweeter. You would know I was lying, anyway.
Talking about it and writing about it helped. These activities can be therapeutic, although they do not replace the work of therapy. But after my first book, Agorafabulous!: Dispatches From My Bedroom, was published in 2012, my brother — then studying to become a psychiatric nurse — offered his opinion that I had become over-identified with the diagnoses of agoraphobia, depression, and panic disorder. His point, expressed in other words and a slight Central Jersey accent (it’s a Philly/Brooklyn mashup) was this: if I continued to define myself by these illnesses, I would not grow. He was right, and I took steps to course correct.
I still did a fair amount of stand-up back then, and I talked about dating, shitty jobs, politics — nothing too heavy. I did not generally joke about my own mental illness in comedy clubs. Comedy people do talk about it a lot amongst ourselves, though. Some of us die from it, after all.
I have tried, in my way, to write about lots of other things: sex, death, food, addiction, trauma, recovery, meditation, shopping, a ghost with whom I lived, my celebrity boyfriend Frederick Law Olmsted, cats, music, musicians, gun control, homophobia, work, finance, Jesus, Medusa, etc. Some of the writing has been quite good. Some of it has been mediocre. Some of it has been garbage. The subjects change, and I tend to enjoy my brief deep dives into this or that. But somehow, my writing always returns to panic, to agoraphobia, to anxiety. Which is to say, I always return to fear.
Ten weeks into the haphazard, never-really-locked-down, never-really-quaratined version of whatever the hell they tried to do in Los Angeles, as selfish rich people still partied and booked their recreational travel, months before the city suspended certain air quality regulations in order to keep the overbooked crematoria going, I wrote an essay entitled “When We Went Inside.” The subtitle is, “An agoraphobe’s advice on how to go outside again.” Ten months later, it reads the same, only more so.
I have been thinking a lot about panic attacks, and not just because I had one last week after a particularly deep EMDR trauma therapy session and a particularly strong vat of coffee. Eye Movement Desensitization and Reprocessing is a wonderful healing tool, but one is advised to be gentle and, if possible, quiet after a session. I decided to skip all that and jump right back into the workday. I was emotionally raw, and for me, pouring concentrated caffeine on that was gasoline on a fire. Logging onto social media was another bad move.
I felt the tremors: the old nausea, the increased heart rate, the labored breathing, the sharp stomach pangs. Then it began in earnest: the giant rush of fear, the hot sweating, the adrenaline shooting through my body. I knelt by the toilet, my mouth watering, and I gagged but didn’t vomit. The old thought from childhood— if I can throw up, it’ll stop — and the newer one, the thing I’ve known since my teen years — No, it won’t. It stops when it stops. You do not have total control here. And on it went. I trembled and then I quaked.
I had brought my phone with me into the bathroom, so I put on an album of soothing music — I practice resting or meditating to it a few times a week, in order to cue up my body’s relaxation response. If you live long enough with this thing, you become your own science experiment. You get to be Pavlov and the dog (actually a rather sad experiment, once you read the details, but too convenient a metaphor to skip.)
I did a few other things that help me. We who are accustomed to panic attacks develop our own recipes, bags of tricks, toolkits. We each grow used to our own patterns, too — rising action, climax, falling action, denouement. I never know how long each one will last — will this be a bad one? Will this go on and off for an hour? Will it be quick, just a minute or two? I don’t know. Just wait. It ends when it ends. Worrying makes it worse.
I prayed. I know that once I break into a cold sweat and tears come to my eyes, I’m close to the end. I waited. The end arrived sooner than I expected. I didn’t trust it at first, but as I got up shakily I could feel the fear receding even further.
From start to finish, the whole thing lasted six minutes, maybe less. I was exhausted, and deeply relieved to be by myself.
Having a panic attack in front of a bus of fellow teenagers while on a trip in Sicily, or inside a plane bathroom as annoyed cross-country passengers bang on the door, or while waiting to go onstage to interview a celebrity at a convention, or while rehearsing one’s own keynote speech for a conference, or in a rowdy van of friends going to a concert — these are far less desirable situations, and I have been in all of them and many more.
I am less used to panic attacks now, and it takes me longer to recover. I suppose it’s rather like a hangover would be, if I still drank. For the rest of that week, I treated myself like a little kid with the flu. I skipped the caffeine, ate chicken noodle soup and mashed potatoes, soft things, comfort foods. I drank lots of water and I did not leave the house. I still meditated, and did my job — working from home is a blessing at these times.
Over 72 hours, I probably spent 36 in bed. I did an extra therapy session. I said no to favors. I said no to unpaid labor. I was enormously grateful for the freedom to do so.
Soon enough, I felt well enough to do errands, see my family, walk in the sunshine. When you’ve got a history of agoraphobia, you’ve got to keep that up — the going outside part. You can let yourself hide indoors for a bit, especially when recovering from something, but then it’s time to get back on track.
My meditation practice is much the same. You fall out of the good habit, and you don’t beat yourself up — you just start doing the good habit again. Begin again. And again. And again.
These attacks are no longer my constant companion. They happen a few times a year. They did not increase in frequency or severity during the pandemic. But for me they have taken on greater meaning, more nuance.
Panic disorder has in many ways helped shape and direct my life. It is a good life, perhaps in part because this condition has given me greater empathy for those who suffer because they sometimes think and feel without rational control.
I hate when people attempt to gloss over pain by barfing out some version of “Every cloud has a silver lining!” That said: there is nothing like a lifelong struggle with occasional, unpredictable, wholly unprovoked, incredibly potent, sudden, irrational explosions of fear to set one up to truly value the nice little things like quiet, boring moments of peace. I stop to smell the flowers, literally, because I don’t care if it slows down my walk or if it means I’ll be a few minutes later. I marvel at clouds passing quickly in the sky overhead. I smile happily when I see a shelf full of perfectly rolled white terrycloth towels.
I take delight in incredibly basic, banal shit because I know my life is easy, really, and unimportant in the grand scheme of things, so I may as well enjoy the parts when I’m not gagging by a toilet. The other day, I cried at Paul McCartney’s appearance with James Corden on “Carpool Karaoke.” Fuck you, I got out of bed that morning.
I don’t remember what it is like to not know how a panic attack feels. I can only imagine how previously “normal” people react when they find that instead of greeting the idea of a vaccinated, functioning society with delight, they feel a creeping terror at the idea of going outside the yard again.
I do not like to think of how terrifying it will be for people who will finally get hit with the aftereffects of the pandemic trauma in two, five, twelve months. It makes me very sad in particular to think about the children who will suffer in this way, and who won’t have the words for it, and whose parents may not understand or care.
I am lucky, in a way, that panic attacks were a known entity in my family long before I arrived on the scene. I am in at least the fourth generation of my lineage to have experienced panic attacks, and there is so much more.
Mental illness hangs thick from the vast, gnarled branches of my family tree, like Spanish moss, like choking vines. We are cursed by it and perhaps blessed by the compassion that sometimes comes from caregiving and care-receiving. Many of us have tried, as best we can, to be of service.
I cannot tell you all the stories because all the stories are not mine to tell. I can only tell you my story. I tell it over and over again. I say it in different ways, in different formats, but it generally ends with some version of this: you are not alone. You will be okay. You can get better. Don’t give up. Don’t hurt yourself. Don’t hurt anybody else. Give it time. This too shall pass.
These sound like empty platitudes, but they are not. People said them to me, and they turned out to be true, so I say them to people, and they believe me or they don’t. I was not sent here to fix anyone, and I am not a therapist or a doctor. This is the only medicine I have to give. It’s not for everyone. I trust they’ll find what they need.
I am trying, as best I can, to be of service. I am trying for others and I am trying for me. I tell stories, lots of stories, and I’ll keep telling this one until I’m done.