Panic Attack in the Grocery Store

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I had a panic attack at the grocery store  Again.  This seems to happen every single month now.  I generally do my grocery shopping in one fell swoop, on payday.  I am not a person who enjoys leaving my house.  I wasn’t always this way, but I am now.

A Basic Definition of Agoraphobia

I’ve struggled with agoraphobia since puberty.  Agoraphobia, literally means fear of the market place.  If you’ve read Plato or Aristotle or any of the Greeks, the Agora is somewhat a hub of commerce, but more.  It’s where people hung out.

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In modern times, the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorder – Text Revision 4) classifies Panic Disorder as either existing alone or with Agoraphobia.  The notion is extrapolated to include the anxiety that a panic attack might come, especially in certain circumstances.   This leads to avoidance.  It can cause debilitating anxiety that has major consequences.  Some of the consequences of my agoraphobia have been:

Costs of Agoraphobia

 

  • I dropped out of college.  I was at the top of my class.  Panic attacks made the classroom an impossible environment.  I was only three courses and a fieldwork placement away from earning my diploma.  Subsequently, I have a lot of student debt and no piece of paper on the wall.

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  • I quit several jobs.  I can tell you that I am a smart and capable person.  But, talent, aptitude, and brains only count for so much.  It is more true to say that to be successful in a job, the most important thing is merely  being able to show up.  I’ve done every sort of job including fast food, telemarketing, library clerk-ing, volunteering for mental health groups,  insurance sales, pumping gas, landscaping, construction, bakery employee, shipping and receiving and the list goes on.  Some of these jobs lasted for a good amount of time, and some had me sneaking out, never to return, by my first lunch break.

 

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  • I have lost friends and I feel forgotten.  This is particularly difficult to think about.  Apparently, we are some variety of social creature.  And this socializing often involves going out and doing activities, attending parties, drinking, dancing, amusement parks and carnivals, seeing movies, shopping, dinner parties, restaurant hopping, road trips and travel, time at the beach, going to exhibits, concerts, plays, and playing sports.  It is hard on a friendship when one person has certain expectations to share in activities and the other person can’t make a commitment to attend a function, or really enjoy an outing if they’ve gotten that far.  Eventually, even if you have a heart of gold, people start looking elsewhere for activity partners and one day you find yourself secluded in a tiny apartment in a far away town and you know that people have forgotten you.

 

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Really, agoraphobia is a thief.  It steals one’s interacting with the world.  Places become no go zones.  There is the ominous feeling of gut sinking terror to imagine oneself in certain circumstances.  Everyone around you seems to be having a fun time.  You are not.  You are trying to hold yourself together and not let everyone see that you feel sea sick and overwhelmed and that you are trying to breathe normally and avoid hyperventilating.  You are trying to seem normal and not run — which is exactly what all body systems are priming up to do.  Eventually, you stop trying to fight these situations and you start finding excuses to just not be there.  Maybe you decide to start a blog and your cat becomes your best friend.  Maybe you don’t go to the doctor when you know you need to.  Maybe you retreat into memories of when you could travel and do things.

As I hope is obvious — this results in depression.  It results in feeling guilty.  It results in isolation.  And for many, it ends in suicide.

About Panic – Fight or Flight

There haven’t been any novel treatments for this disorder in my lifetime.  The basic approach is behavioural therapy.  Exposure therapy in particular.  The idea is that you face the situation, you feel the anxiety in its entirety, and eventually the anxiety loses its power.

What psychology skips over is that this is a pretty tall order.  Addicts experience a physiological response when they engage in their addiction.  The brain changes over time as a result of the neural pathways being influenced.  A panic attack, in the same way, is a physiological response to anxiety and fear.

Panic attacks can generate in two ways — one is from our thoughts – anxiety.  The other falls under ‘chemical imbalance’ in the brain.

The parasympathetic nervous system activates for no reason in panic sufferers.  The body goes into a fight or flight response.  Apparently, at some point in evolution, this was adaptive — it got you away from dangerous animals and made you hypervigilant to threats.  In the modern world, we are not constantly in actual physical danger, but the psychological mechanism still exists.

 

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The body gets ready to either fight the threat or run like hell.  Both options involve concentrating resources to certain body parts and shutting down things like digestion.  The senses are on red alert — and the brain stops being its usual nuisance and starts tracking stimuli and data and finding threats everywhere.   The cortisol and adrenaline are spewing through your veins.  You start to feel sick as your body gets ready to rid your stomach’s content so it doesn’t hold you back.  Your hands and face tingle like pins and needles.  Your breathing is shallow and fast.

And then you’ll have some good-intentioned person say to you, “Just relax.  There’s nothing to be anxious about.”  That just makes it worse.

You feel embarrassed, naked, ashamed, guilty, and that you can’t control a single darn thing.  Ironically, there is more truth to life and the cosmos being uncontrollable than people realize.

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Treatment Options – Medication

Medication has been one answer.  When I was first diagnosed, decades ago, psychiatrists were still liberally giving out anti-anxiety meds.  Sedatives / tranquilizers, central nervous system depressants — basically the entire catalogue of benzodiazepine medications were used.

The problem — they were and are addictive and the body builds tolerance requiring higher and higher doses.  You also can’t just stop taking them — dependency, both physiological and psychological develops.  This class of medication featured powerful drugs that worked, but that did not work in the long-run, often requiring frequent dose increases and switching to or adding other benzodiazepines.

The body becomes so dependent on them that benzodiazepine withdrawal is a serious medical situation that has led to death, seizures, and other complications.

Medicine currently uses benzodiazepines for short term, acute situations.  To give an example of a non-anxiety usage, benzo’s are given to rehab patients going through delirium tremors as they withdraw from alcohol and other drugs like cocaine and heroin.

Since Prozac, an SSRI antidepressant, came out, there have been a myriad of different antidepressants and antipsychotic drugs that have become popular.  The name is somewhat misleading, as you’d expect an antidepressant to address depression and antipsychotics to address psychosis (hallucinations and delusions — departures from reality).

 

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Really, these drugs all work on the chemical imbalance theory.  Antidepressants change the level of serotonin and how it is absorbed and transmitted by the brain.  Norepinephrine, GABA, and dopamine are also brain chemicals that these meds monkey with.

The problem is that doctors know that they work for some people, but they don’t know why.  It’s not a solid science and according to some it’s a very irresponsible because the causes and effects are not known.  The potential for long-term effects aren’t well known.

Each of these medicines, used for psychiatric conditions, comes with a warning that people need to be monitored because there are indications that these medications cause suicides and in other cases homicides. The world of psychiatry has no qualms about playing with the fire that is meddling with things that science doesn’t yet understand.

Treatment Options – Psychotherapy

Then of course, there is therapy.  I already mentioned behaviour therapy.  To a degree, cognitive-behaviour therapy is effective in treating anxiety.  By and large, therapy is the best option but it requires a committed team approach from a qualified therapist and the patient.  Therapy is often not pursued because it is expensive and time consuming.  Many people, even those with generous private healthcare plans, can’t find adequate coverage for the costs of intensive treatment.  It is thus that most people are steered toward medication because it is affordable, very profitable for the drug companies, and it doesn’t place huge time burdens on doctors.

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Is there hope?

 

Well, somedays I feel there is no hope for treating panic disorder and agoraphobia.  There definitely is no cure.  I have by no means even touched on many other losses that are the result of the condition.  I grieve my own losses and as well as empathize and grieve with others who suffer.

Perhaps, hope needs to be seen in a Stoic sense.  Life is going to be hard.  Life is going to have challenges.  Change is inevitable and no one gets out alive.  We err when we believe that life must always be comfortable and that if we live a certain way, we’ll be happy, at peace, and feel fulfilled.  And the truth is — that isn’t often the case.

And so our challenge is to find a quality life despite the discomfort and losses and tragic things.  This is existential territory and I don’t believe there is just one correct answer.  I would make the point that, while we suffer horribly, we also have moments of joy, peace, and the sharing in compassion and intimacy with others.  We can still find things to value despite deep pain.

 

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Ultimately, there is wisdom in that the human spirit is geared toward survival.  I don’t believe this is an accident.  There is hope because we want there to be hope.  We don’t come into this world and kill ourselves at the first opportunity — no, we can imagine and we can dream and we can keep swimming against the strength of the tide.  Sometimes, the big picture is the only answer to how to thrive within our limitations.

Can you relate?

 

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Quiet Time

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Quiet time.  I remember that in elementary school it was used for discipline.  If a kid was acting up, they sat in the corner and had “quiet time”.  Parents today are encouraged to use “time outs” when rearing their kids.  Is it only for kids?  I’m sure you are shaking your head with a resounding no!

What seems very boring and is protested by many a child, is something that most adults wish they had more of.  The demands on our schedules and the constant assault of stimuli take their toll.  And yet, many people who do have the time and many people who don’t could use some quiet time.

I need quiet time right now.  I haven’t been bad or unruly, but I’ve done a lot more than I can usually handle today.  I was attempting to address my health needs and it all seemed to pile up on one day.  Today I saw my general practitioner, my eye doctor, my dentist, a physiotherapist, and went to the lab to have blood tests.

I’d also mention that I walked to all these appointments because it’s the end of the month and there is no money for taking taxis.  It was 31 degrees celsius here.  That might not seem like much to some, but I’m sure someone who reads this will have the experience of having to take medication that really messes up your internal temperature and you have photosensitivity.  It can make summers very difficult.

I also had several flights of stairs to climb.  Normally, that’s not a huge issue.  But earlier in the year I broke my knee cap and had surgery to repair it.  Knee surgery is not a quick recovery.  I am still dependent on a cane to go up and down the stairs.

So that’s my situation.  I didn’t tell you all of that so I could complain but rather to explain why I’m very pooped, sore, and in need of quiet time.

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I am reminded of a conversation I had a few years ago with a mentor.  We talked about disability and not being able to work a regular job.  That mentor said to me, “For you, managing your health IS a full-time job.”  Today, that rang true.

I am home now and it is late afternoon.  I have a lot of follow up to do with two of the doctors and with the social services for funding to get certain things paid for.  But, I’ve sorted out my paperwork and left it for the rest of the day.  I’ll call the pharmacy tomorrow.  I know when I’ve crossed my limit and need to just be still, quiet, and rest.  The hard thing for me, and probably for many, is that we either fly way past our limits and notice afterward when it really starts to hurt or we simply are in situations where there isn’t a choice.  

My heart goes out to all the parents out there

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I’d also like to talk to the people who just aren’t comfortable with quiet time.  This a real deal for many.  We get used to constant stimulation.  We run from boredom.  Quiet feels unnatural and might even scare us.  I can understand this.  For whatever reason, there comes a point where the brain and the body come to a screeching halt and will seize the quiet whether we want it or not.

In the Don’t Sweat The Small Stuff books there was a chapter about embracing boredom.  I wouldn’t quite frame it that way, but I’d say that embracing periods of quiet is beneficial.  Each day we have a certain amount of energy to spend.  There is physical energy to spend as well as emotional energy to spend.  Also, there is that fancy term “cognitive load” which refers to the number of things our brain is engaged in.

The stress response is quite interesting to read about.  If we don’t take care of ourselves, eventually we burn out, we shut down, and we die.  It’s legitimate to say that stress is a killer.

 

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Nowadays we see a lot of information coming out about noise pollution.  I urge you to pause and try to remember the last time things were absolutely quiet for a moment.  The last time I had that experience was during a power outage.  Even when everything is turned off, there is still the 60hz hum of electricity and the compressor in the fridge.  I paused during that power outage and I actually felt really good during the experience.

I’m a musician and so I know a bit about volume.  The decibel levels at some concerts have been measured and have exceeded that of a jumbo jet taking off.  We all know that can’t be good for us.  That said, there’s lots of good to be said about going to a concert once in a while.

So, I’ve made a partial argument about the attack on our ears.  To complete that argument I’d have you stand on the street corner as a low-riding Honda Civic with those noisy exhausts and the stomach flipping subwoofers drives by.  I even find the rumbling bass in popular movie theatre chains to make me feel queasy.  Mythbusters did an interesting show about that.

And, coming from the eye doctor, I should mention that our eyes take a beating each day too.  For many people, being in a shopping mall lit with fluorescent bulbs can mean a severe headache.  There is also evidence that many people are effected by the popular energy efficient bulbs.

Think about screen time.  I spend a lot of my day on the computer.  It takes its toll.  Television, same deal.  I don’t have one, but sitting in the doctor’s waiting room I noticed several people with their heads down absorbed in their phones.  I am thankful for companies noticing that our eyes can get tired… like Amazon did with the Kindle Paperwhite e-reader.  I have one and it was a good investment because I love to read.  For gamers, there are “gaming eyeglasses“.  They look a little funny, but who cares.  They aren’t cheap, but if you like your video games, you probably would benefit from the investment.  But, I’m not here to suggest shopping lists.  My point is, your eyes need a break!

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Quiet time is something to think about.  If you can’t find a block of time in your schedule, that’s okay.  I would suggest taking quiet moments. Gently close your eyes and get away from all the stimuli.  An easy tip might be to just take a long toilet break — tell others that you ate one too many chili cheese burritos at Taco Bell.  I bet they’ll allow you some privacy and peace.

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I have to say that I feel satisfied with myself for addressing my health needs and for showing up to participate in the search for wellness and quality of life.  I was really proud of myself this afternoon for actually saying “no” to a request for me to go back out and attend to some things.  I was polite about it and explained that I had a busy day and I needed to stay home now, and could we make it for another day.  No problem!

There is an underlying wisdom to having periods of quiet and stillness.  We know, on a deep level, that all the stimulation, seemingly unavoidable, is not good for our body and minds.  Perhaps we are gently moving away from the glorification of things like “speed reading” and multitasking.  Perhaps we can enjoy just a moment of quiet.

I’d love to hear ways that you find quiet time!

Please leave a comment!

 

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I couldn’t resist

Bad Day vs. Bad Life vs. Irrelevant

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I woke up today.  Period.  Full stop.

It’s mid-morning and I’m feeling very rough.  My IBD is acting up, my therapist thinks I hate myself, and the Zapruder film seems to have been altered.

Basically, I woke up and automatically went on autopilot with a heading set for misery.

Recently, I saw this meme, which I initially found reassuring:

baddaybadlife

But of course, I’m not simple enough to just appreciate the sentiment for what it is.  I started thinking, “But wait, some people have had pretty tough lives.  What if it is actually a bad life?”  Can you relate?

Life not being fair is an understatement.  And this morning I felt angry.  I felt angry at people who had intentionally hurt me, people who had just abandoned me, people who discriminated against me, the poverty of a disability income, the flaws in the medical system, AND SO ON

Here’s the deal.  When we get in this state of mind, we’re increasing our suffering.  The mind thrives when it has a problem.  We make ego identities about being victims or survivors.  If we weren’t miserable about something, we’d feel miserable that we have nothing to complain about!  Such is the monkey mind.

Yet, we are human.  If we are constantly fighting negative thoughts, we put pressure on ourselves to believe and be something fake.  So I am telling myself, and you, to relax.  It is okay to feel angry.  It is okay to feel hurt.

Resisting all negative thinking will only strengthen it.  For instance, if I tell you not to think about elephants, what can’t you help but think about?  Elephants!

In Vipassana meditation we are asked to be aware.  Yet, there is a difference between naming what is going on and making judgments about life and self and others.  Acceptance and it’s subsequent “peace” comes, not from somehow liking a bad circumstance or event, but simply allowing it to be, as it is.

The path that neither resists nor attaches is the path toward equanimity.

So, will my day get better?  It’s actually irrelevant to ask or answer that question.  Peace is not found in a good day or any type of day.  Peace exists apart from the form of our lives.

 

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Grief: The Simple Version

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I sat in my new therapists’s office.  It was just after Christmas and New Years.  Today was our first session together.  After exchanging pleasantries, she said to me:

“When I got to work this morning, I got the news.  And I feel bad because it’s our first session and it falls on me to tell you this — J., your counselor for the past six years passed away on Saturday.  I’m sorry.”

** It was a huge punch in the gut **

He had stage four cancer that had gone undetected.  One day he went up to the ER because he had a very sore throat.  Three weeks later, he died.  I didn’t get to say goodbye.

A second story:

Sarah lived with her father.  Her mother died when she was just a baby.

Her father had sunken into a life of alcoholism and he found himself angry, bitter, and out of control.  He was verbally and emotionally abusive toward Sarah.

Sarah found comfort in her relationship with her grandmother, Rose.  After school, she would go there and do her homework.  Her grandmother taught her to knit and sew and make macaroons.

Sarah successfully survived her youngest years and went to school for web and graphic design.  She lived a big and blossoming life in the big, bold city.

Then one day she got a call.  Her grandmother had passed away during the night.  She quit school and became deeply depressed.  She started to feel physical pain all the time.  Many years later, Sarah would be officially diagnosed with fibromyalgia.

 

Grief

What is it?  Queen Elizabeth the II, regarding the death of Princess Dianna, said, “Grief is the price we pay for having loved.”

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Make no mistake, grief is not limited to those who have died.  It’s possible to grieve a marriage that ends, a friend who moves far away, the loss of some social or professional status, the loss of one’s health or the disability of partner / child, the things that were once your dreams and goals that never became.

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Grief is the experience of loss

 

Grief isn’t a predictable thing.  Some people naturally work through it.  Many people get stuck in what we in the biz call “complicated grief.”

 

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There are many things one can do when grief comes.  But, the truth is we don’t need more books or photo albums or the lighting of candles in churches.  There isn’t anything wrong with those things, but one needn’t seek a complicated answer.

In my own grief, I quite often fail to see the forest through the trees.  Nothing takes the pain away.  But, pain is simply pain.  Pain and suffering are different.

What if we accepted our grief?

What if we changed in such a way so as not to live in resistance to grief?

What if we just allowed ourselves to feel it?  

Does grief have a color>  A smell?   A voice?

 

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Loneliness: It is more complicated than that

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The last time I left the apartment was twenty one days ago.  In that period of time I haven’t had any visitors.  I had one personal telephone call.  I did write quite a few emails.

Being an introvert is some sort of hipster trend these days.  I notice that places like Reddit promote a sort of “I am emo, but I am not” ego identity.  One way I see this phenomenon is that its popularity grows in proportion to the widespread reality that people do feel lonely — even whilst in a crowded room.

As a teenager, many years ago, I had a group of people I could be around.  Some of them were friends, most of them were merely being friendly.  Back then, and in the present, I always felt like I could only fit in so much.  At a certain point, I just felt tired and unloved and misunderstood.

You may have heard that there is a difference between being alone and being lonely.  I know this to be true.  It can be more complicated sometimes, though.  Sometimes, if you have a health condition, you can’t get out of being alone.  You can’t go to the party or make coffee shop dates.  Perhaps anxiety leaves you paralyzed in the middle of the grocery store and you just want to run.

Sometimes we have the luxury of choosing to be alone and sometimes we don’t control it.  But loneliness goes further.  Loneliness is a feeling you can have even if someone is holding you in a warm embrace.

There is a common misconception that the grass is greener on the other side of the fence.  Maybe it is.  Maybe it isn’t.  The truth, for me, has been that loneliness isn’t squashed by something outside myself.  Still, my mind often insists that if so and so would just love and accept me and if I had friends, I would be happy and complete.  Deep down, this just is not true.

Maybe loneliness is really me not accepting me and me not loving myself.  It’s the “I wish I could love myself.”

I read a quote the other day that said, “there is no one on this earth that, if you heard their story, you couldn’t learn to love.”  Think about that.  How does it make you feel?  Maybe the starting point is simply to admit that one has the potential to learn to love oneself.

When we cannot accept ourselves, how can we accept others?  Let’s admit that this just might be the hardest work we might do in our lifetime.  Yet, as we open our hearts to others we see the good and the bad, and we see that we can accept them exactly as they are.  Love is an embracing of the whole package.  If we see this potential with the world outside of us, it must be true that it is equally applicable to the world within us.

Tomorrow, I am invited to a stranger’s birthday party.  At first I was shocked to be invited.  Then I felt happy.  Then I started to panic and had to do deep breathing.

Will I go?  I said yes, but a huge part of me wants to say no.  When the moment comes, I’ll make a choice one way or the other.  I accept that it might be an answer to my social needs but I also accept that sometimes I need to be gentle with myself and know that I don’t want to feel that overwhelmed.

“If your compassion does not include yourself, it is incomplete.” — Jack Kornfield

Perhaps loneliness is teaching a lesson to us.  What do you think?

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I Made The About Page

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I have just completed writing about myself and what this blog is going to be about.  Head on over to the ABOUT page and you can get filled in!

So, I’m assuming that you typed a certain keyword that brought you here.  Maybe it was something about mindfulness and inner peace or maybe it was something about the miraculous uses for apple cider vinegar in the day to day life of a professional clown.  Regardless, what matters to me is that you got here.

Do you ever look in the mirror and see the features of a relative?  Or, have you ever looked at a baby and said, “He has his father’s eyes”?

Have you ever felt a hunger pain and thought about people who have that same hunger pain in a disadvantaged part of the world?

Have you ever had an opinion about the cause of some senselessness you hear has happened?

The point I’m driving at is that of inter-connectedness.

You and I are connected with each other and every other person.  Further, we are connected with animals and nature.  We are a relational species.  This blog is a two way street — I relate to you, and you relate to me.  And in this moment we can share a bit of sanity and compassion.

I am not a perfect person.  I am not a guru or an author or some expert therapist.  I am a person who hurts physically and mentally.  By secular standards of success, I’m a complete failure!  And thank goodness for that — for through my searching and suffering I have  had moments of calm, moments of clarity, moments of contentment.  I have had horrible experiences, just as you have, and I’m hear to start a conversation.  Let’s begin a dialogue of the heart.

 

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