This essay oringally appeared on 3 Quarks Daily.
I had my first panic attack at age sixteen, which was (deargod) over 35 years ago. It happened during school, much to my teenage mortification. Some friends and I were hanging out in our high school newspaper office during a free period, sprawled on one of the crapped-out couches under the blinking fluorescent lights, just shooting the shit. All of a sudden, a wave of horror swept over me—no, that’s not the right word. It was a feeling of fear mixed with a kind of existential dread, washing over me in waves, and then my heart was pounding, the walls were closing in, and I was gripped with an intense feeling of unreality. (This is something that people with panic disorder don’t often explain—or maybe it’s different for everyone. But for me the worst part of a panic attack is the feeling that the world is unreal, that you’re trapped in some kind of cruel simulacrum and everything around you is fake. You yourself are fake.[i]) Apparently I was also gasping and sobbing, and saying over and over again “I want to go home. I want to go home.”
The next thing I remember clearly was my father carrying me out of the room in his arms. This part seems so incredible to me—How did he get there? Who called him? How long did it take? Why did he leave work in the middle of the day?—that I sometimes wonder if I’ve misremembered it or mixed it up with another memory. But I have corroborated this detail with semi-reliable sources, so I’m going to leave it here for the sake of my narrative. (I would do a lot for narrative.) The truly odd part is that once we got home, I didn’t stop saying “I want to go home” over and over again, even though my dad kept reassuring me that I was indeed home now. Clearly he was not on board with The Narrative, or he would have recognized a Metaphor when he saw one.
The things that happened next include: that particular panic attack lasted about an hour or two and left me drained and shaken; I stayed home from school for a few days because no one knew what was wrong with me; the case of mild eczema I’d had on my hands flared to Miracle-At-Lourdes proportions, leaving the skin from my fingertips to my elbows raw and flayed; for weeks I had to put ointment all over my hands and forearms and wind white cotton bandages around them twice a day; someone else had to do this for me, and that person was my father; my father also took out my contact lenses for me every night and cleaned them, since my hands were covered in white cotton and goo; when I returned to school I learned there was a rumor circulating that I had attempted suicide by cutting my wrists in the newspaper office (because: the bandages); I didn’t care about this rumor; I kept having sporadic panic attacks for months; no wait, I mean years—I mean forever, until now. And beyond.
It’s difficult to countenance now, but no one knew what to call “the episode” I experienced that day and for a long time thereafter. Now it’s so obvious, so much a part of mainstream understanding, that when you see a character on a TV show clutch his chest and topple to the ground, the person you’re watching with will nod sagely and say “panic attack”—as if we would be so naïve as to think it was a cardiac event. We are all post-Sopranos. But back then, in the 1980s, it was not so obvious. My parents took me to see my pediatrician, the same one who had given me my polio vaccine and nursed me through the measles, and he was flummoxed by “the episode.” There didn’t appear to be anything wrong with my heart or lungs, so he decided (wisely, presciently) that it must be a psychological issue. He recommended a psychiatrist he knew from med school, who had a fancy private practice in the big city. We lived in the suburbs of Philadelphia, and this doctor’s office was all the way downtown in Society Hill, a 45-minute drive away. To this day I wonder why on earth my parents chose to send me to this faraway person and pay gobs of (not covered by insurance) money for my sessions with him. I think my dad was deeply spooked by “the episode” and believed that the more trouble and expense he went to, the more he would appease whatever vindictive gods were punishing his family. Retributive gods. Just gods.
The psychiatrist turned out to be hilariously Freudian. As in long-straggly-gray-beard, African-masks-on-the-wall, lie-back-on-the-leather-couch, tell-me-your-dreams Freudian. I don’t know what the current research tells us about the efficacy of classical psychoanalysis in treating panic disorder in adolescents, but my personal case study of n=1 reveals: it’s not that great. Don’t get me wrong: I loved the entire experience. It was a huge adventure to go into the big city once a week, especially to a cobblestoned neighborhood with tall slender brownstones, mysterious narrow alleyways, and ancient trees with little wrought-iron fences around them. I loved the musty library smell of the analyst’s office, the cramped staircase leading to the top of his house, the towering bookcases, the thick Turkish carpets. As a burgeoning young poet and self-professed “intellectual,” I had always pictured my adult self in such spaces. I loved the drives there and back with my father—the strains of easy-listening radio filling the sealed warm privacy of the car, the sporadic bursts of conversation, the rare feeling of safety and parental tenderness. My father and I would usually have dinner afterwards at the Dickens Inn, a faux-British pub on Headhouse Square that still exists.[ii] (No, I am not making up the name. Yes, it is obviously the reason I am now a Victorian literature scholar.) Fifty minutes of recounting my dreams to the analyst’s corniced ceiling; roast beef and Yorkshire pudding and a dark beer for my dad and fried clam strips and a Coke for me; a silent drive back to the dark sleeping suburbs—I could have gone on doing that forever.
In the end, it lasted for less than a year. This is the part of the story that strains credulity, and I nearly left it out of this essay—but in the end, Truth trumps even Narrative. Eventually my shrink decided that a more proactive approach was in order, and he roped in the rest of my family for some group therapy. The four of us had one, maybe two, sessions together; all I remember is sitting in a circle facing my parents, sister, and psychiatrist, sunk in misery and tilting my head forward to make a privacy curtain out of my hair. One evening, after we had all returned home from one of these family assemblies, my mother ambushed me in the upstairs hallway as I was on my way to bed. Her fingers closed painfully around my upper arm as she hissed into my ear, “Don’t think I don’t see what you’re doing. Faking this ‘illness’ in order to take your father’s attention away from me.” In a way, she wasn’t wrong. That year of my adolescence stands out as a shimmering oasis of attention and care in a blinding desert of parental neglect; who knows what contortions my unconscious would undergo to arrange such bliss? The only part she got wrong was assuming that I’d orchestrated my illness deliberately to undermine her. How could she not see how much I wanted her, too? The next day I told my father I was feeling better and didn’t think I needed to go back any more.
I was also not wrong. By that point the panic attacks had stopped, disappearing as mysteriously as they had arrived. I continued to feel intermittent, garden-variety anxiety throughout the rest of high school, college, and grad school, but I didn’t start experiencing regular panic attacks again until the early ’00s, right after September 11th. Again, I weathered a few months of unpredictable “episodes” of intense horror, unreality, nausea, racing heart, and dread, separated by long stretches of normality, that one day just stopped for no apparent reason. It’s convenient (and even a little self-aggrandizing) to imagine that our national trauma was the precipitating event for the return of my panic—that some intense, selfless sympathy with my compatriots was manifesting itself somatically—but it wasn’t that simple. Other national traumas that did not trigger periods of acute panic attacks for me include: the recession of 2008, the second Iraq War, the election of Trump, the George Floyd murder, the Capitol insurrection, and the global pandemic (so far). The truth is that my panic disorder was—and is—indexed primarily to my own circumstances: my own insular world of work conditions, relationship status, emotional support, and even diet and exercise habits. Which is not to say that I understand or have control over what causes these horrifying periods when I’m rocked by regular attacks. It’s just to say that there’s nothing noble about them. They are not romantic, photogenic, generative, illuminating, or intellectually interesting. Panic is a selfish bitch.
As intensely uncomfortable as panic disorder can be, however, it doesn’t hold a candle to its sneakier, crueller cousin: generalized anxiety disorder. If panic attacks are like flouncing drama queens throwing a tantrum over an imaginary slight, loudly demanding that you drop everything in order to soothe them, then generalized anxiety is the mousy governess hiding in the window seat plotting revenge. There are ways to respond to panic attacks in the moment that actually help blunt them: breathing techniques, certain physical movements, and—most importantly—not fighting them. There are no such quick-and-dirty tricks for generalized anxiety. Basically, GAD is like a long, drawn-out panic attack that unfolds over the course of months or years. There is significant comorbidity between the different anxiety disorders—panic disorder, generalized anxiety, agoraphobia, social anxiety, PTSD, and obsessive-compulsive disorder—which means if you suffer from one you likely suffer from another. I don’t know how others prefer to take their anxiety, but I’ve had two periods of GAD in my life, both lasting between eight and 18 months, and I would not wish it on my worst enemy.
For me it starts in the stomach. One day I notice that I’ve got butterflies in my tummy, a feeling of nervousness like before a speech or a big test, but the feeling doesn’t go away. Soon it intensifies to a roiling near-nausea that is present 24 hours a day, seven days a week. Then come the feelings of dread and unreality (milder than during a panic attack, more like a scrim of fog between me and the rest of the world), and next the intrusive thoughts, the constant, merciless preoccupation with death. And not your everyday, average, wear-your-seatbelt, will-I-get-Covid worries about mortality. Ha ha! That stuff is amateur hour. My obsessive thoughts take the form of near-constant worry about what happens to us after we die: Is there a hell? Should I not be doing more to keep myself out of it if there is? What does infinity feel like? What if there is life after death and we can never be free? Are the people I loved who have died currently suffering? Is there no escape from an infinity of torment? Let me just say that it is difficult to carry on normal conversations with your friends at the pub when you are being tortured by thoughts of Nietzschean infinite recurrence. (I did get pretty good at it, though. I can also deliver a lecture on Joyce’s “Araby” while feeling like I’m going to throw up!) Why these particular obsessive thoughts? Why does my anxious brain decide to whisk me back to a “deep” fourteen-year-old’s faux-existential crisis? Why not rising authoritarianism, the global pandemic, the dying academy, the warming planet? One thing I will say about my personal roster of death-and-hell ruminations: they are relentless, and they are perfectly cruel. There is no solution to the problem of this particular torture, not even suicide.[iii]
The funny thing is that as I typed out this list of questions that were my constant companions for months and years, they felt utterly alien to me—histrionic, childish, almost funny. When you’re not in the grip of mental illness, or if you’ve never experienced it at all, it’s impossible to viscerally experience the horror. (As Gerard Manley Hopkins puts it: “O the mind, mind has mountains; cliffs of fall / Frightful, sheer, no-man-fathomed. Hold them cheap / May who ne’er hung there.”) I remember the thoughts I would think, and I can describe in words the bodily sensations I experienced, but it all feels as remote to me now as learning how to walk. Most of the time, I’m fine. I teach my classes, I write my writings, I walk my walks, I spend time with my partner, family, friends, and cats. (Of course cats are “family.” I just wanted to make sure you were paying attention.) I’ve had years of therapy, I’ve learned a lot about how to deal with my anxiety and panic, I’m wiser. But I know that somewhere deep in my brain there’s a line or two of code that can flip me right back into the nightmare at any time.
Worse than the predilection itself, though, is the knowing about it. You may not be able to invoke the bodily memory of the “episodes,” but that doesn’t mean you can’t worry about their return. The poet Robert Lowell, who suffered from debilitating bipolar disorder throughout his life, writes about the horrifying moment when he realizes his illness is returning in the poem “Skunk Hour”:
My mind’s not right.
A car radio bleats,
“Love, careless Love….” I hear
my ill-spirit sob in each blood cell,
as if my hand were at its throat….
I myself am hell
Virginia Woolf’s suicide letter to her husband began: “Dearest, I feel certain I am going mad again. I feel we can’t go through another of those terrible times.” This is the burden of consciousness: the capacity to remember the past and project the future. There is a reason that the first phase of Inquisition torture was “showing the instruments.” But I also want to say, urgently, that life is long and it is a mixture of things.
I am going to level with you: I’m not exactly sure why I wrote this essay. It’s not funny (I prefer to be funny). I don’t think it’s particularly edifying—as I’ve said several times now, if you don’t have a panic disorder it’s nearly impossible to understand what it feels like. This whole exercise seems far too personal—painfully self-revelatory without any narcissistic payoff. (Will anyone think me more charming, more intelligent, more witty, more interesting after reading this protracted confession? We think not.) I am also, frankly, terrified of being judged for my illness and condemned for my self-indulgence in writing about it. But something is driving me to write it nonetheless. My entire life I’ve been helped by people who knew what it felt like, even when those people were poets or essayists or philosophers I would never meet. When you’re drowning in a well, chipper reassurances called down from the bright rim above you don’t help very much. Sometimes you need someone splashing around next to you in the icy water who can show you the slippery handholds. Or just be there, next to you, breathing, in the dark. I hope this helps.