"Oh, no!" I whisper to myself. I see it coming and I don't know what to do. I grip the steering wheel harder, my breath as uneven as my thinking.
My heart accelerates, my eyes dart. I pretend I'm not in danger, but my body betrays me. I'm trying to catch my breath, but the thing is, I'm not out of breath.
Stay calm, I think to myself; it isn't real.
Or is it?
I'm not sure.
I step hard on the gas trying to get away from it, but it hits me anyway. I pull off the road the first chance I get. I know there's no damage. There never is. I lean my head against the steering wheel at the hopelessness I've come to.
Anxiety attacks hit you like an oncoming car you can't swerve away from; you're nothing but pavement to them. Rapid breathing, heart palpitations, odd chest pains, crippling weak spells, obsessive thinking patterns -- because
there's nothing causing the symptoms, you're convinced of a pending psychotic break. In fact, the fear of going insane is one of the most common symptoms of anxiety disorder.
Therapy helped, but it was a little like coming through surgery without truly recovering. Major life issues got resolved, but the anxieties kept
popping up anyway. People say if you get at the root of a psychological
problem, it'll go away. They're wrong. Thousands of dollars and reams of insurance forms later, I learned what every amateur gardener learns the first week on the job: Pulling weeds out by the root doesn't get rid of them permanently.
I took up meditation. It worked in the dubious way low-fat cookies help
with sugar cravings. Sometimes you end up doing more damage than the damage you tried to avoid. Meditation or relaxation exercises would often be an open invitation to the family of dysfunction living inside me, my sisters of seizure. Often, I'd lie on my couch trying to relax, but would
literally seize up as the sisters climbed on me with little pickaxes. I'd
writhe and thrash, but it was no good; I couldn't get them out of me. Sometimes flushing them out helped. They'd ride the tears all the way down, until all I could feel was their absence.
The sisters of seizure understood etiquette, sparing me the embarrassment of panic attacks, chest pains and weak spells when other people were around. I lived under the rule of a polite pathology.
In full roar, my obsessive thinking took me over completely. I didn't so
much think during those times as I was
thought upon. The ending of any
relationship would bring the obsessive thinking to gale-force proportions. Gradually, my anxiety demons tired of my romantic failures and began to focus on something they could ride whether I was single, married or in between: time. I
became overwhelmed by my perceived lack of it. For years I thought I was just experiencing the normal time crunch of the overextended. But I never felt the corrosive obsession stronger than when I got laid off and had
nothing but time on my hands. I simply couldn't derail my thoughts off the clock. Women hear biological clocks ticking; I heard psychological
timers going off every few minutes to warn me that I didn't have time to do whatever I was doing.
Soon I was canceling dates, outings, sporting events and family get-togethers. Never mind my unemployment, I was out of time. Little by
little I left my house less and less. I got a lot done, but I couldn't begin to tell you what. The sisters of seizure, tugging at my sleeves for most of my life, became increasingly convinced they owned the shirt.
I couldn't sleep. I was in a stable relationship, in a satisfying job, making lots of money, but I couldn't sleep. It made no sense. The calmer my circumstances became, the louder my anxiety attacks clanged. I fell into a pattern -- one night I couldn't sleep, the next night I slept 16 hours. Over and over the pattern repeated until, exhausted, I crawled to my family doctor. He gave me Halcyon, a sleeping pill. It worked, but within days I needed higher and higher doses. He switched me to Ambien. The third night on it I collapsed onto my bathroom floor, passed out for hours. I woke up, climbed into bed and slept it off. The next day my doctor dispensed with sleeping pills altogether and pressed a prescription for Klonipin into my hand. It's the brand name for Clonazepam, a class of drugs called benzodiazepines, which slow down the nervous system. They're used mainly to treat epileptic seizures, but doctors often prescribe them for anxiety.
Trying all these pills actually added to my anxiety. I hate pills; I grew up believing aspirin was a cheap way out of pain. But I was too far gone to stand on ceremony. Beliefs tend to fly out the window when a crisis walks in the door.
My doctor suggested I see a psychiatrist.
"For what?" I asked him. "If I knew
what was wrong, I'd already be seeing one."
I'm no stranger to therapy, but
I'd always gone for a specific reason -- relationship troubles or family issues. What was I going to say on the couch: Nothing's wrong except I'm going out of my mind?
Besides, Klonipin worked. The problem with it, as singer Stevie Nicks found
out, is that it's highly addictive. After splitting with Fleetwood Mac, Nicks developed such a hard-core dependency on Klonipin that she ended up in drug rehab for weeks. What my doctor couldn't get me to do, the fear of being a pill-popper did. But before I could see a shrink I had to slip past
the barbarians at the gate. My HMO didn't want a personal visit with a board-certified physician or a licensed therapist to determine what I needed. They wanted somebody I'd never met to figure it out over the phone.
When you're being interrogated for needing care, your only hope is to sound
pitiful enough to deserve help. During the call I kept thinking, what if I
don't sound as bad as I am? What if I don't sound pathetic enough?
The phone attendant peppered me with a dozen highly personal questions,
click-clacking my answers into a computer. With every question, I felt I had
to "prove" my need for help. Finally, I blurted out "What makes you
qualified to determine whether I'm in enough pain to see a psychiatrist?
You're 1,500 miles away, you can't see how tired I am, the nervous tension or the circles under my eyes."
It was like throwing bricks in the Grand Canyon. My objections got swallowed up in a cavernous hole without so much as a sound. She granted approval for a psychiatrist, but only for three sessions. As an afterthought, she mentioned there's usually a four- to six-week wait for the psychiatrists in their panel.
I smashed four or five buttons on the phone, making her earphones pop. "I just spent the last 20 minutes telling you I'm in a crisis," I seethed into the mouthpiece, "and you're acting like I called with an inconvenient mosquito bite."
I got in the next day, but with a psychologist instead. She diagnosed me
with generalized anxiety disorder -- with a little obsessive-compulsive disorder (OCD) on the side.
Anxiety derives from the Latin word angere, which means to choke or strangle. In healthy people, the stress response (fight, flight or fright) is
provoked by genuine threats and is used to take appropriate action. But for
the 10 million Americans with generalized anxiety disorder, there is no
obvious stressor. They carry with them a more or less constant state of
tension and anxiety. Although sufferers recognize that their obsessive
thoughts and physiological responses are baseless, senseless and excessive,
they can't stop them -- no matter how hard they try.
Women have twice the risk for anxiety disorders than men do. The symptoms of anxiety disorders and heart failure are so similar doctors have
difficulty distinguishing between the two. For example, mitral valve
prolapse, a common heart problem, can have nearly identical symptoms as panic disorder. So can paroxysmal supraventricular tachycardia, a heart-rhythm disturbance. In fact, studies have shown that up to 60 percent of patients with chest pain who see their physician for heart problems are actually suffering from panic disorder.
Anxiety disorders frequently co-exist with OCD. According to the journal Biotech Business, "People with Obsessive-Compulsive Disorder experience unwanted, recurring and disturbing thoughts they are powerless to suppress. This causes overwhelming anxiety, prompting them to perform repetitive, ritualized, compulsive behavior to alleviate the anxiety."
I had OCD Lite. I was powerless to suppress the unwanted, recurring thoughts of time running out on me but it never expressed itself in something visible, like constantly washing my hands or repeatedly checking to see if the door was locked. I belonged to the half of OCD sufferers who have obsessive thoughts without the ritualistic behavior. I had the wattage, but not the plumage.
There is a growing belief among scientists that anxiety disorders emerge from neurobiological substances that trip the body's fire alarm even when there isn't any smoke in the vicinity. Neurotransmitters like norepinephrine, serotonin and dopamine help you prepare for danger by putting your body on red alert. If you're walking down a dark, deserted street and hear footsteps behind you, these neurotransmitters are going to jolt your heart, lungs and muscles into a state of anxiety.
But what if you're not in a dark, deserted alley with approaching footsteps
behind you? What if you're on the way to the beach with your body blaring a five-alarm bell that won't shut off? Scientists believe that people with
panic and anxiety disorders don't need to be in danger to feel all the physiological responses to it. Somewhere along the line, their bodies got stuck on red alert. Researchers believe that anxiety disorders aren't a sign of weak-kneed hypochondria, but of neurochemical excess or deficit.
They believe it. I didn't say I did.
So when the therapist and my family doctor urged me to go on an
anti-depressant, I refused. I ricocheted between anger, shame and pity at
the suggestion of it. I saw it as a total loss of control, an abdication of
personal will and direction. The next time a tough life choice came up, how
could I be sure it was me making the decision? Would I forfeit my life's
important decisions to a pill?
I was drowning in shame. What kind of man needs medication to cope with
everyday life? I asked myself. Had my life gotten that out of control?
My therapist seemed bewildered by the extent of my shame. "Why," she asked intently, "do you think it's strong to suffer and weak to fight?"
"Because," I shot back, "pills are for other people."
She folded her hands in her lap, staring at me. "If somebody on the street
threatened your life, would you consider it weak to defend yourself?"
- - - - - - - - - - - - - - - - - - - - -
Luvox (fluvoxamine maleate) is one of the newer selective serotonin
reuptake inhibitors (SSRIs). It's the first medicine approved by the FDA for the
treatment of OCD, and was actually developed for children and adolescents
who were driving their parents crazy with their rituals. Some kids, fearing
"contamination," insist their parents wash their laundry over and over, or
check their homework repeatedly or scream at their siblings for "infecting"
their room by walking into it.
Luvox was found to be so effective in treating OCD in children that it was just a
hop, skip and a jump to prescribe it to adults. It's now the most popular
medication for all OCD sufferers. It also showed great promise for
eliminating anxiety and panic attacks.
My legs dangled over the examination table as I waited for my family doctor
to write the prescription. I had nothing but contempt for people who used
pills as shortcuts. I saw them as the able-bodied collecting welfare;
people who were capable but unwilling to do the heavy lifting life demands.
And now I was one of those contemptible people. I was an utter
failure in my own eyes. I had fought and lost and I had no more fight in me, and for that I would never forgive myself. This is a mental cane I'll be walking around with, I thought to myself. The only thing missing is a Boy Scout to help me across the street.
All my life, the only pill I allowed myself to take was aspirin. Now I
was about to become the poster child for selective serotonin reuptake
inhibitors. Nothing knocks you off your ideological high horse faster than
an experience that rears up at your beliefs. As my doctor wrote the prescription, I
felt the sting of hypocrisy rising inside me. I brushed a tear away as I
accepted the slip of paper, vowing that no one would know.