The start of a panic disorder.

Back when I developed a panic disorder, the striking symptom I had was not called a panic attack; it was called an anxiety attack. I was in a classroom when it struck. I thought I was going to lose control of myself and yell something out loud. I also felt suddenly as if I were going through some kind of accelerated physiological event of some kind. The attack subsided after a time leaving me wondering what had happened to me. When the attack recurred a second and then a third time, usually in a relatively quiet setting, such as the library or a classroom, I began to feel something was seriously the matter with me. Because I felt each time like I was getting ready for some sort of extreme physical exertion, I thought that was probably just what I ought to do. I started doing push-ups. I was a college freshman  then and able to do push-ups at that time, around 30 or 40. (Now I can do one or one and a half.) The panicky feeling did not go away. This went on intermittently for some time. I felt like avoiding certain places, like the library, but knew I could not, since I was pre-med.  I looked through the psychiatric textbooks, and decided I was probably schizophrenic or something terribly serious, so I went to see the college psychiatrist. Before speaking to him, however, I asked if seeing a psychiatrist was likely to interfere with my ability to get into medical school.

“Not unless you’re a psychopath,” the nurse told me.       

Unfortunately, I suspected that if I wasn’t a schizophrenic, I might very well be a psychopath, whatever that was; so I had to get better on my own. I shortly made two discoveries:

  1.  I was in my room one day, sitting with my roommate, when I suddenly became panicky. Still having in mind that I should exert myself physically, I got off the couch I was lying on, ran down the stairs, ran around the block, ran up the stairs and threw myself so hard against the couch that I hit my head against the wall. A few moments later, when I recovered from the pain, I realized the panic was gone. I knew at once it wasn’t the blow to my head that had dislodged something; I had managed to distract myself and distracting myself was what worked.
  2. The following year, I was still having attacks. One day, I was reading a magazine in my room, when I suddenly had an overwhelming sense of panic. I found myself getting annoyed. (I think the previous year I would have been frightened.) I told myself that something must have set off the attack—something unconscious, I presumed. I looked back at the magazine I had been reading to see if there was something on the previous page, sexual, or violent, perhaps, (these were the days when Freud dominated clinical psychology) but I couldn’t see anything. I thought about sounds I may have heard in the entryway. I thought about whatever might have occurred from one moment to the next which would explain such a dramatic reaction. I couldn’t detect anything. (Many years of clinical experience has not been able to explain to me even now why someone might one minute be feeling fine and the next panicky.)  What I realized that day in my dorm, however, was that, once again, the panic attack had gone away. I could drive the panicky feelings away by concentrating on something else, even by standing apart from myself and concentrating on the causes of the panic attack!

It turns out, that distracting oneself is a technique for coping with panic attacks. I tell patients that they can’t stop the panic attacks from coming, but they can learn to drive the panic away by using intellectual tools which serve to distract. These tools might be simple rote tasks, such as unwrapping chewing gum, or harder tasks such as balancing a checkbook. The harder tasks work better, but are harder to do. When you think you’re about to go crazy, or lose control of yourself, it’s hard to balance a checkbook.

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