Welcome to an advice column by me, Sara Benincasa, a person with opinions. This column will not diagnose or cure anything. If I choose your question, I’ll change the details in order to protect your secret life as an avoidant billionaire who dresses as a bat and fights crime. Send all questions to saratoninnewsletter@gmail.com.
Dear Sara,
Recently I began having what I’m told are panic attacks. They are terrifying. I was fortunate enough to be with a friend the first time I had one, and they explained what was going on. I work from home and thankfully do not need to worry about dealing with them at an office. I have begun to stay home more often because I am afraid of having them at church or social functions.
I have no idea why this is happening. My life has not changed in any major way. I am anxious about the future of our country and about this election, but that’s not exactly a new thing. It is embarrassing to think that these panic attacks may be a result of those worries.
I don’t want to take any more pills. I’m getting older and I’m glad to only be on one prescription. I am not sure what to do.
— Confused and Scared
Dear CAS,
If you were drowning, I wouldn’t analyze your need for proper swimming technique. I’d throw you a life preserver and call in extra help. That’s the aim here, so please keep that in mind as we proceed.
First off, there are loads of reasons for the body to go into a panic attack: hormonal changes; sickness; stress; workload; the aging process; a new job; an impending move; the beginning or end of a significant relationship; dietary issues; and many more.
Now listen to Auntie Sara: It’s totally fine if you figure out that the Trump-fellating hordes of human pond scum are a trigger for you. Seriously, no compassionate human could blame you for being frightened by oh, I don’t know, the further loss of bodily autonomy; the increase in hateful speech and attitudes towards people who aren’t disability-free cis straight white men; and about a million other aspects of the MAGA pestilence, a disgusting and execrable aspect of This Current American Life.
That said, not everybody has a panic attack as a result of these worries. Some folks drink more. Some folks use drugs. Some folks become deeply depressed. And then there are those psychologically stable humans who use it as fuel for activism and who retain hope no matter what. But guess what? Even those people have moments of absolute rage, desperation, sadness, and even panic.
Panic attacks are a full-body response to fear. One might also say they are a full-body experience of fear. They are not just “in your head.” They can include increased heart rate, shallow breath, nausea, tingling in the extremities, blurred vision, and racing thoughts. I have dealt with agoraphobia since I was a child, and can tell you in all honesty that panic attacks can lead anybody to resist leaving the house!
The trouble is that, when left untreated, panic attacks happen even in one’s designated safe space. This can lead to a restriction of activities and a lowering of one’s quality of life. I don’t want that for you or for anyone. I was once so frightened of panic attacks that I didn’t even leave my bedroom very often, and then I almost died. I do not recommend this! It does not have to get this bad for you.
I understand your reticence to take pills. They have been lifesaving and life-enhancing for me, but I will not push them on you. I’m not your doctor. And hopefully your doctor will not push them, but merely suggest them as an option.
I do think you should see your general physician, and I would like for you to consult with a psychiatrist if at all possible. Remember, you don’t need to follow any advice these folks give you! But I want you to see a specialist who won’t merely write you a prescription and then send you off into the wild without regular follow-ups. This is a serious condition that deserves serious attention. It is also absolutely treatable.
If you do not wish to see an MD who specializes in panic attacks, I still strongly suggest seeing your general doctor to rule out underlying medical issues. I also very strongly encourage you to seek out a therapist. This can be a social worker, counselor, psychologist, or some combination thereof.
There are many ways to ease your pain, and I’ll throw a few at you here. Some may not be doable for you.
1) Regular cardio exercise
2) Regular gentle yoga and stretching
3) Reduction in caffeine intake
4) Reduction in sugar intake
5) Keeping to a sensible sleep schedule (my psychiatrist says that if you have trouble sleeping, don’t beat yourself up over it — get up and read something pleasant or listen to music until you feel sleepy)
6) Regular mindfulness meditation (try Headspace or Calm if you like apps)
7) Regular practice of yoga nidra meditation (I do one every morning while lying in bed using a YouTube video as narration)
8) Other forms of breathwork (I have worked with Breathwork for Recovery, but there are many different ways to access guided breathwork with a sensible, sensitive teacher)
9) The books and recorded talks of Jon Kabat-Zinn, Tara Brach (a Buddhist psychotherapist and meditation teacher), Andrew Weil (a physician and meditation teacher), the late Thich Nhat Hanh, Sharon Salzberg, and other meditation teachers have been life-changing for me. In particularly, I recommend Kabat-Zinn’s work with Mindfulness-Based Stress Reduction (MBSR), which was a key component of my own agoraphobia recovery
10) A good long walk, every single day you can manage it
Please don’t obsess over what is causing these panic attacks. Once you are able to ease the symptoms and get your head above water, you and a trained professional can explore root causes. It is folly to think that if we only are able to intellectually understand what’s causing our pain, that we can magically think it away. This is a medical issue that affects your body and mind, so let’s give it the respect it deserves.
I believe in you! One day, you will be able to pass on your experience and knowledge to help somebody else. You are not alone, I promise.
Dear Ms Sara and CAS,
I'll kindly try to add a word on word choice. Panic is not whatever someone says it is,
so it may be helpful to avoid that word if others suffice,- anxiety, waves of anxiety, dread, anxious spells, etc. Doesn't minimize the problem at all, but may help.
And another word... I don't know Salzberg at all, but since CAS says they're getting older, it's possible that a different set of writers and meditation guides may be helpful. There are lots of other resources which are not so similar in voice, stylized speech, and* kindly here.*..verbosity. ( TNH being one.)
CAS, if finding a competent therapist, vs the masses of "trained" ones, has been a problem, that is no obstacle at all. Your course will never rely on them.
Damn! This was done perfectly!