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Making Yourself Crazy December 2002

I am driving my three-year-old son to school down a winding country road on a bright autumn morning. We pass the horse farm on the corner, the nursery where bursts of flowers stand in relief against the clear blue sky. A Sesame Street tape is playing on the car stereo. Then, out of habit, I pat the side pocket of my pants and realize I have forgotten the antique silver case of tiny white pills - the mild sedatives I never leave home without - on my dressing table. Suddenly - with startling, yet predictable immediacy - a wave of fear begins to well up inside of me. At first it only laps around the edges of my consciousness. You can handle this, you can handle this, it's only a feeling, it can't hurt you, I tell myself. You almost never even take the pills anyway. It's just magical thinking, a rabbit's foot.

It's too late. My muscles are already tense, my shoulders hard as rocks. I try to take a deep breath; I can't get all the the air in. My heart starts to pound; my fingers tingle as my hands grip the steering wheel. I had hoped, when my family moved to the countryside from post-9/11 New York City, that rural life would be a tonic. But there is no safe haven. The wave curves upward, and begins to crash. Help me, is my silent scream to no one.No one is here - no one except my child, who I must, at all costs, protect from this. My throat itches, threatens to close. The flowers, the grazing horses, the smooth winding road all begin to take on a dark and ominous tinge. What if I pass out? What if I die, right here on this country lane? I squeeze the steering wheel and force myself to focus. The waves keep coming. They crash harder and harder until I am separated from the world, swept out to sea. I am drowning, and yet somehow I am still here, pulling my S.U.V. into the parking lot of the school, unstrapping my son from his car seat and - shakily, shakily - putting one foot in front of the other.

“Good morning,” one of the other moms calls cheerily.

I smile and wave back. I am beginning to return to land. Ten minutes have passed. I hug my son to my chest, breathe in his sweet scent. I am suddenly, unreasonably grateful to be alive, the way a soldier might feel after he's just side-stepped a landmine. My body has just gone through a war, though no one would ever know it, to look at me. I'm just a typical mom in my jeans and boots, my new sweater. I take some sort of perverse pride in this. I could be disintegrating inside, I could be seconds away from a dead faint, but no one - not even those closest to me - would ever be able to tell. 

I have suffered from panic disorder all my life, though I didn't have my first full-blown panic attack until I was thirty, and I was close to forty before I was properly diagnosed. I come by this disorder honestly, through every possible channel: genetic loading and the stresses of everyday life, all whipped up into a poisonous stew, a concoction floating inside of me since birth . My father - I now realize - suffered from panic attacks for most of his life, and was addicted to valium. I watched, as a child, as fear overtook him, and his eyes became distant, focused on something none of us could see. He lived his life, lost and confused, with a psychiatric illness that wasn't properly understood or given a name until 1980, when the Diagnostic and Statistical Manual of Mental Disorders labeled the condition: panic disorder. He died without ever getting help.

It is now clear to me that I spent most of my life warding off anxiety, going to great lengths to make sure I wouldn't feel it. Let me go to the beginning - or at least, as far back as I can remember. I was twelve or thirteen, and there was a nameless, faceless pressure building inside me, filling me in a way that felt unbearable. So I invented the kind of stories that would make sense of this terrible pressure. I created a stalker for myself, telling my mother that a man had followed me home from school one day. I was afraid to walk down the street by myself, afraid to be alone. And there were other lies, all baroque and complicated; they served to contain the feeling that I was, in fact, being stalked, defiled - when in reality, I was just a nice girl from the suburbs with a supremely undramatic life. I told lies so shameful, so embarrassing and hurtful that I - who have never shied away from exposing myself in print - can barely admit them here. And these lies made the explosive feeling slowly dissolve. I was so busy keeping track of what I had said, and to whom, that the shrieking noise inside my head died down.

I was secretly terrified that something was very wrong with me. Who makes up lies about stalkers? Was I mentally ill? Was I a pathological liar? Did pathological liars realize they were pathological liars? These were the questions that haunted me during my teenage years. By the end of high school, the lies started catching up with me. People were starting to wonder. After all, what suburban teenager could live such a checkered, dissolute life as the one I'd made up for myself? I lied about being pregnant when I was, in fact, still a virgin. I invented older, illicit boyfriends. But then, I went off to college and found a better way of quelling the wave: actual illicit boyfriends, pot, booze - not necessarily in that order. The next ten years are a haze. I felt driven to self-destruction - driven being the operative word. The panic was pushing me, creating its own momentum. I drank and did drugs every day. I learned nothing. I accumulated no useful life experience. I had boyfriend after boyfriend, choosing only men who had a great big T for Trouble sign emblazoned on their foreheads. My life became the sordid drama that I longed for as a teenager. I was in so much actual trouble that I didn't have time to think. I was too busy mopping up the messes I made, thereby maintaining the delicate balance between the drama of my life and the tension inside my head. What I didn't realize is that I would do anything - I was, in fact, doing anything - to avoid seeing what would happen if the scales were tipped.

And then, one day, in my mid-twenties, I stopped. I simply couldn't do it any more. I had been running for so many years that I didn't even know I was running; chaos had become a way of life. And when the chaos was removed - along with the vodka, wine, cocaine, pot, and bad boyfriends - anxiety marched through the jagged hole in my psyche that chaos had left behind. Hello! it announced itself. I'm here to stay! And then the wave began to churn, slowly at first, then faster and faster until finally I was thirty years old and - irony of ironies, at least to me - I had finally gotten my shit together when it caught up with me. It pulled me into the depths, carried me with it to the unknown place I had always feared.

Panic Disorder is, simply put, fear of panic. Most people have experienced anxiety, and many have had a few, discrete panic attacks. But when these panic attacks begin to cluster together, and thoughts of panic - the terror of panicking again - begin to take up a great deal of conscious thought, panic disorder is the likely diagnosis. It seems so counterintuitive - even writing this down, it doesn't really make sense to me. Fear of panicking? Surely that's a cycle that can broken. Mind over matter, and all that. But mind over matter is precisely what panic is all about. The most insidious thing about panic is that it comes - or it seems to come - out of the blue. One minute, you can be happily engaged in an activity or a thought, and the next, you can be felled by a blow so sudden and unexpected that you are like an uncomprehending child, reeling from it. Sometimes panic is situational - people with panic disorder often don't like to fly, or drive on expressways, or spend time enclosed in crowds - but more often the panic is like the stalker of my youth - a shadow in the mind that suddenly springs forward. I have felt panicked in exercise classes; on line at the supermarket; at the hairdresser's. I have panicked at dinner parties, in hotel lobbies, in shopping malls. And the biggest danger of chronic panic is in living life crouched in a defensive posture, tensed and waiting for the next blow. Life can grow smaller and smaller in a quest for a safe zone where panic won't happen. In severe cases, there is no safe zone. It is possible - and this is a terrifying thought to me - that in panic disorder, even the walls of one's own bedroom can begin to feel dangerous, evocative of disintegration.

Panic breeds panic. Scientists believe that neuropathways become conditioned to panic, primed and ready for it. (As I write this - literally as I write this - my heart is skidding and thumping in my chest. All I have to do is think about it.) In a completely unscientific way, I see these neuropathways as grooves in the brain, deepening over time the way wrinkles deepen, creating their own, psychic face that I cannot see, only feel. I have become adept, in recent years, at sensing a panic attack coming on, and finally I have become willing to carry the little silver case of pills with me, and swallow one to avoid a full-blown panic attack - thereby averting the deepening of the rivulets in my brain.

What I have come to understand is that it all comes down to one thing: separation. The feeling of separateness - the fear of loss of love, loss of security, loss of self - is at the root of panic disorder, many psychiatrists say. In people who are constitutionally set up for panic, separation anxiety becomes something more than a fleeting fear. It becomes consuming, and the emotions and physical sensations surrounding it are as intense and real as if one's life really were in jeapordy. And that sense of separateness is a subtle, tricky thing to understand. Any situation can be a trigger. It can be nothing more than the way a particular breeze feels, a smell in the air, a distant, almost inaudible sound that evokes something prior - something wordless and inaccessible to the conscious mind - that tears the self from the world.

This inability to articulate the genesis of panic - and thereby analyze it - is why psychoanalysis does little to alleviate its symptoms. The preferred methods of treatment-cognitive and behavioral therapy, along with certain anti-depressants in the SSRI category are far more effective. And I've done it all: psychotherapy, behavioral therapy, cognitive therapy. Self-help books, self-help tapes, meditation, yoga, stress management. All of it helps - a little bit. If I were to do two hours of yoga a day, begin and end the day with twenty minutes of meditation, listen to self-help tapes in my car, read zen buddhism books before going to sleep at night, and see a behavioral therapist once a week, I probably would panic less. But I have a life to live, and that life doesn't allow for quite so many hours devoted to panic maintenance. So I muscle my way through. Though I can't always know what will trigger panic, I avoid situations that I know will be too much for me. I carry the little silver case in my pocket. I respect the panic beast; I know that it is bigger than me.

There is one thing that I do know works. Last year, I spent six months on an SSRI, and the panic went away. And it amazes me, still, that even though medication relieved me of all symptoms of panic - including, perhaps most importantly, the fear of it - I still chose to wean myself slowly off. The main reason for my unease with chronic medication was that it felt to me that in eliminating the panic I was also erasing some of what was good about me. Not all obession is bad obsession. Not all fear is unproductive. As a novelist, ironing out all of my creases was tantamount to removing my material - much of which comes, I believe, from the same rivulets in my brain where the panic resides. I've made a choice, for the moment, to live with the discomfort. I've made my peace with panic - but I reserve the right to change my mind any time.

In my medicine cabinet there is an unopened bottle of Prozac. I like knowing it's there. I flirt with the idea of taking it, and I know what my psychopharmacologist thinks: it's only a matter of time. It hasn't gotten bad enough. Yet.