Nobody ever taught us much about panic attacks in paramedic school, or at least to the degree that I remember. It may well have been a module in the wee psychology course we took, but the only thing I can really recall from that was giving a presentation on kleptomania and as I did, walking between the desks and casually nicking pens, lighters, and coffee cups. I thought I was being terribly clever. I also remember the instructor discussing the difference between type A and type B personalities and pointing directly at me sitting in the back corner with my feet up, as he said, “I can tell right now that you’re a classic type B.” I thought he was being terribly clever, too.
So when I wound up in a crisply pressed uniform behind the wheel of a very expensive piece of machinery, I had a very narrow definition of what a panic attack was: Chest tightening, difficulty breathing, hyperventilation, eyes agape, muscles tensed and quite possibly in a sitting fetal position, all things classic of an acute anxiety attack or, for that matter, an ST-segment elevation myocardial infarction. Or kidney stones even, because those fuckers hurt. On one particular call that sticks in my head the way they sometimes do, I asked a young man presenting in just such a way if there’d been anything particular stressful going on in his life, and was a bit confused when he couldn’t think of anything.
What was I missing?
Well, according to my many years of hindsight and personal experience since, I was apparently missing quite a bit. The word attack is a misnomer, at least as a general classification. It suggests something harsh and sudden, with immediately debilitating effects and easily identifiable triggers, but these things, episodes as I’ve come to call them, come in so many shapes and sizes and varied levels of both intensity and length that they can be unrecognised by even the person experiencing them. And sometimes we have no idea where they come from, either, at least in the moment.
I tend to go to bed early most of the time, so it wasn’t until the morning after the recent US presidential election that I found out who, according to the bizarro way they do it down there, had won. What followed were almost three days of Facebook posts, often angry but as often well-formed and punctuated correctly, in which I railed against rising fascism in the world and the quiet, educated people who were letting it happen. I was positive throughout all of this that my inner type A activist had been awoken and he was not a morning person. I was able to get groceries, make a meal, play some games, and watch a couple of movies without even realising that I was in the throes of a panic attack the entire time. I said attack there because that’s what the sweaty masses call it, and for dramatic effect. It was an episode. One of many different kinds on what is really a very broad spectrum of anxiety reactions.
Spectrum is probably the wrong word to use, though, because it suggests an orderly and easily quantifiable series of steps that too many people, many well-meaning clinicians for a start, consider hallowed:
But you and I, sitting in our big, hot Jacuzzi of stress, know that’s bullshit, don’t we? Scale might actually be a better word, suggesting changes depending on how much we had for breakfast that morning or if the cat is standing on the pad behind us.
The acute and immediately crippling ones can be called attacks, I don’t have any problem with that, but the episodes I really hate are the low, simmering ones that hover over you like a bad smell. I don’t often even know they’re sneaking up until I begin waggling my fingers in some sort of frantic dance (kind of like I am right now just writing about it). During these, you and your lizard brain play a tug of war, sometimes for hours. They are so ridiculously draining.
Another, milder form, can happen when you see someone approaching and though your face remains calm your mind starts yelling, “Don’t talk to me don’t talk to me don’t talk to me!” The person passes, and so does the episode. The election caused one that was either new to me or that I’d experienced before but wasn’t in a place to examine quite so readily as I am now.
No sir, I did not like it one bit.
The generally healthy folk around us will often see anger, fear, sadness, and other bizarre mixtures of emotions that seem completely unreasonable to them. Sometimes, though they don’t really get it, they understand in an abstract way what’s happening and will help, or at least be there for you if you need it (my brother). Sometimes they’ll walk away because, you know, you’re weird (most of my colleagues). Other times (my ex-wife who would actually laugh at me when I’d tense up in a shopping mall) they’ll reveal themselves as sociopathic gits that take great glee in shredding you even further. I tend to think those last ones are people who are just as unhealthy as we are, but that thought does little to ease the moral injuries they cause. Get away from them now, no matter who they are in your life.
Fear and anxiety are okay. Honestly, they really are. They’re part of a normal, healthy cadre of human emotions and they have purpose. Nobody ever runs to a shrink when they get anxious over an upcoming exam, they only focus tighter and study harder. You don’t pop a benzo because your nerves are jangled on a first date (and if you do, seriously?). Generalised anxiety disorders, and for me Complex PTSD specifically, manifest in hypersensitivity to simple things and that’s when it becomes a medical health issue.
You’re not a fruitcake because you’re wounded, no matter how that wound appears both to you or the outside world, and the ways it can appear are myriad. They’re not attacks, they’re episodes, passing events that can be confusing and distressing in and of themselves. It takes effort, but when you can recognise this and not let them feed on themselves, you’ve taken a great leap towards self-care and management.
There may be other reasons you’re a weirdo, but this isn’t one of them. Who am I to judge, anyway?