Monkey Mind Panic Attacks

Since I know you love hearing about them.  I am writing about my most recent panic attack which was yesterday at 2pm.  It lasted until just after 4pm.  This post will give the reader a picture into what a panic attack accompanied by chronic illness feels like.

In brief, if we named panic attacks, I would name this one like an interesting flavour of ice cream.  I’d name this panic flavour, Monkey Mind Panic.  Caution, contains nuts (pun intended).

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Monkey mind, a phrase I picked up a while ago, is “from Chinese xinyuan and Sino-Japanese shin’en 心猿 [lit. “heart-/mind-monkey”], is a Buddhist term.”  (Wikipedia)

I imagine the monkey habitat at the zoo.  A deafening, dizzying, cacophony of “Ew Ew Ah Ah.”

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Racing thoughts obviously go along with every anxiety disorder.  They play a particularly powerful role in the anxiety before, but also during a panic attack.

During a panic attack, it’s like an argument erupts in my mind.  The mind does not heed the warning, Don’t Feed The Trolls.

I wanted to tie this into chronic illness.  It might explain why I had the attack.

Here are some of the contributing reasons:

  1.  I have issues getting around my apartment.  I was spending the day and this night on my own
  2. I regularly take some serious medications, one of which is for my anxiety disorder.  I had run out on the weekend and the pharmacy didn’t deliver until later
  3. I have on-going concerns about my recent surgery.  I feel frustrated that the surgeon’s office has not returned my calls
  4. I have a phobia of vomiting and choking.  My stomach was off from a Meatloaf I made that was too fatty (I went on one of those Everyone loves Bacon kicks)

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So I add bits of those ingredients together and add the secret Monkey Mind ingredient that I called Existential Freak Out No. 9 aka “Oh my god, I’m going to die.  I am dying.  I need an ambulance.  I should call one.  I don’t need an ambulance.  I should be seeing the doctor more because there must be something they don’t know about.  I’m too young to die.  Everybody dies!  Yes, but no one is especially good at it…”

Okay, okay, take a breath.  STOP!!

And this is the quiet moment when the Monkey smiles at you and starts peeling a banana.  It’s gotten its way.

 

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This is that moment of lucidity, the calm inside the eye of the tornado.  It’s here that I remember that I talk a lot about mindfulness.  I give myself a nervous laugh at the irony.  The irony makes me feel more human and asserts that I’m not the only one who might be feeling this right now.

At this point I did what I needed to do.  In that moment, I need to calm my stomach, so I took a stomach medication.  I also needed to deal with the Monkey.  I did this by getting up, changing my perspective, hobbling around on my crutch and tidying up in the kitchen for just five minutes.  Then I took some breaths, called the pharmacy to ensure my medications were coming.  I then sat and waited.   Things were winding down, I was exhausted but I had to stay awake.  I decided to grab one of my journals and a Sharpie and make a list of words I knew in French.

My medication came and that solved the other physical issue.  I made myself a tuna sandwich.  Then I fell asleep.

So take what you will from that!  Can you relate?

 

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Pardon My Panic Attack

This past weekend I had an IBD flare.  I don’t deal with being sick well.  You’d think I’d take it in stride considering my illness is CHRONIC.  But, no.  I freak out.  I have a panic attack which snowballs into making things worse.

Anxiety and depression are components of chronic illness and are chronic illnesses themselves.  I tend to ruminate.  I notice every little pain and think the worst is happening inside me.  This past weekend, I thought I was dying.

When you feel so bad that you start to think you are dying, it sucks.  But in a way, it’s also the point where you may or may not be able to laugh.  Life — no one gets out alive!  It’s true!

There is a mindful way and an unmindful way to approach death.  The unmindful way was me freaking out and ushering in the suite of panic:  shallow breathing, dizziness, worsening nausea, restlessness, thoughts of going crazy/imminent death.  I started having some traumatic thoughts of choking on my “final breaths”.  That wasn’t mindful, but I’m not saying this in a judgmental way.

At such a point, what do you do?  My best solution was to reach out to another.  To just let the panic attack happen and blurt out all my feelings and worries to whoever will sit with me and listen.  Sometimes, we all lose it and need others to be mindful for us.

Different people may be or less helpful, appreciate them all.  If you pray, here’s a good time!  If you have a pet, then you are really lucky.  I have a cat.  She curled up with me and comforted me.  There is always someone that can pick up the ball when we can’t be mindful ourselves.  To seek comforting is human.  We don’t always get it the way we want, but we can appreciate the forms the universe takes in meeting our need.

Can you relate?  Who are the helpers when you are in need?  There are always helpers!

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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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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