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Last summer, in the midst of a terrible bout of panic attacks, a friend (and fellow sufferer) loaned me a self-help book on dealing with anxiety. I read it, took some parts to heart and dismissed others. One thing that stood out to me was this: that confidence has something to do with anxiety. The connection didn’t become clear to me until recently.

Something interesting happened in the midst of panic, and in a public place. I was standing in a check-out line, fumbling to get money out of my bag, when I came across an old school photo ID. The ID was from a community college where I adjunct as an English teacher. It’s a nice photo: while not glamorous in any way, it looks like me on a day when I felt good about myself. And not just how I looked, but my life in general. It was a moment of shock, revelation, but mostly of recognition. It was me, myself, looking confident.

I know this girl: I know who she is and what she is made of. This photo did for me what no amount of positive self-talk has done lately: it gave me a moment of confidence. It grounded me. I had no idea something so simple would have such a powerful effect.

This moment wasn’t about looks or vanity but simply one of self identity. Anxiety has a way of making you feel as if you don’t know who you are, or where you are. At the worst point in a panic attack, you may not even recognize your surroundings. It can feel as if you are separated from yourself and your life. It can be terrifying. In these moments, you need something to hold on to, something to ground you. It might just be your self that you turn to.

The crisis of confidence, of self, is clear to me now. You doubt yourself, you are afraid you will ‘lose it’ in public, or have a panic attack in front of others. You fear the unknown; you fear fear.

My moment of self identity passed quickly. But there is hope in this, too: anxiety can be dealt with, and I will start with that.

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My very own little GNA strands have finally proven what I’ve known all along: SSRI’s will not work for me.

About a month ago, I saw my psychiatrist, who asked me if I’d yet taken my pill.  No, I said, not surprisingly.  I want to, but no.  She then suggested a new test:  a DNA saliva test that would tell me what liver enzymes I had, and what genetic markers I might have, which would in turn tell the doctor what medications would work for me, and which would not.  Something about metabolism and how fast my body would metabolize certain drugs.  I did the test there in the office and was told I’d need to come back to discuss the results with the doctor.

Today, I finally got my results.

Let me refresh your memory on how I feel about prescription drugs and the pharmaceutical industry in general:  I hate them.  I loathe them.  I think pills in general (SSRI’s in specific) are evil and I am reluctant, to put it mildly, to take them.  When I took the GNA test, I hoped that it would show some reason for my aversion.  And I was not disappointed.

In regards to serotonin transmitters, I have a gene that causes ultra-rapid metabolism.  In plain terms, this means that any SSRI’s I take will go straight through my system, not staying long enough to produce positive effects, but long enough to cause nasty side effects.  Basically, all these years, doctors have been throwing SSRI’s at me (the new and improved treatment for depression/anxiety!) promising me that they would work, they would help.  Wrong.

Second, there is an indication that I have impaired folic acid metabolism.  Folic acid is turned into methylfolate in the body; methylfolate is a precursor to neurotransmitter synthesis (serotonin, dopamine, norepinephrine).  I was given a prescription for a ‘prescription food’ pill (more like a supplement).  I was given some pamphlets to peruse.

So what does all of this mean?  That for years– nay, decades– doctors have been winging it.  They’ve thrown pills at every problem and hoped for the best.  They’ve gambled to see what pill would work for each person, not having the slightest indication if that particular version or brand would work, what side effects might be, what other complications would arise.  It’s been a complete and total guessing game.  Trial and error performed on humans.  But with this new testing, the age of ‘personalized medicine’ has been born.

Another important implication from all of this is that what was recommended for me isn’t an actual drug.  It’s more like a supplement, which isn’t a far cry from an actual supplement… or from food.  The next step for me may well just be upping my nutritional game and investing in good organic foods that can be used medicinally.

Personalized medicine will be huge, I think.  But with results such as mine, will doctors start leaning more towards natural and nutritional based remedies over chemical ones?  Let’s hope so.

It’s my constant battle with myself:  to stay and face the danger, or flee from it. 

Except, there is no real danger.  My brain is playing games with me.  

Except, it doesn’t feel like a game.  It feels real.  It feels like actual danger.

The past twelve months have been book-ended by two truly unhappy events.  Last August, I was at Nashville airport ready to board a plane to San Diego, what would have been my first trip to California.  It’s a long story, but in the end, I didn’t make it to San Diego.  I sat in the airport and cried, and popped Xanax.  I even got another flight for the next day but never made it.  I haven’t written about it because it was too painful.  Too embarrassing.  

It was like something you’d see in a movie, or see happen to someone else.  It’s something you never imagine would happen to you:  this is what would happen to someone else. This would never happen to you because you are in control, you can control your anxiety, you are strong.  This is the narrative in your head.  This is what you tell yourself in crowds, in movie theaters, on planes.  You are strong.  You’ve been through worse.  You have anxiety but it’s under control.  You would never let it get out of control.

This narrative has worked for you for years.  You don’t need medication because it’s under control.  

And then, you find yourself screaming in the last seat of a plane, a plane that is taxiing away from the airport, a plane already heading towards the runway.  You scream until they turn the plane back, go back to the gate.  You have to get off of the plane.  The entire cabin full of people knows it’s you because the captain has announced that there is an ‘anxious passenger’ that has to get off.  You are in the last seat and so you must walk past each and every passenger on the way to the door. You are embarrassed, humiliated.  

Two nights ago, Tori Amos played at the historic Ryman Auditorium.  I had a ticket and was looking forward to seeing her again at the Ryman.  I live less than five miles from the Ryman.  I took a xanax and got ready for the show.  

Well, you can guess how this turned out:  I never made it to the show.  Just being in the car caused me to panic.  Agoraphobia?  Probably.  But it’s been a year– a year in which I had ups and downs, went back and forth to work, traveled.  It’s tiresome, dealing with anxiety.  It wears me out.  It tears me down. 

In our culture, people don’t take anxiety (or depression) seriously.  Everyone has felt anxious about something in their lives: speaking in public, or flying overseas.  There are a thousand reasons to feel anxious, to feel nervous.  But having an anxiety disorder is so much different than nervous butterflies.  It’s so much more threatening.  Constant anxiety isn’t healthy and it’s not productive.  I myself have not taken it as seriously as I should have.  It’s already caused tremendous changes in my life: I’m unable to work, I’m unable to function like normal. I can’t bear to be away from my apartment.  I feel stuck, unable to make necessary changes.  

My body and mind are in constant fight or flight mode.  The question I’m asking myself is this:  will I run away or stay and fight?  

The good news:  The biopsy results are in, and they found nothing.  The bad news?  Erm, they found nothing.  Everything was normal.  No one has a clue as to why I have anemia.  Consequently, I have to see the gastroenterologist again next week, site of my latest anxiety meltdown.  Oh, Joy. 

Is it sad to be disappointed?  I’m glad nothing serious was found, but it would be nice to find the root of my problems.  This is kind of where modern medicine is failing me: rigorous testing but no results.  

It only took eight months, multiple drugs and a cadre of medical staff, but I finally got the endoscopy done.  If I’d done this last August, as I was originally scheduled to do, I would probably know the root cause of my anemia (and possibly of my anxiety as well) and be well on the way to recovery.  But, things being as they are, and me being terrified of sedation, I procrastinated.  The upside is I finally got through it, and I’m proud of that, regardless of the big fool I made of myself.  Sedation makes me uncharacteristically chatty, as many in the Nashville metro area are now well aware.  Sorry, Nashville! 

This is not new:  sometime in the early 90’s, I had an accident (a drunken romp on a playground at 4am) and dislocated my right arm.  In the ER, the nurse gave me an IV with Valium and something else; she said I’d be aware of what was going on, but I wouldn’t care.  I counted back from ten and was out at nine.  I awoke to a handsome doctor and expressed to him, quite eloquently I’m sure, that he was my hero.  I may have commented on his good looks, and may have made a pass at him, which I’m sure he appreciated.  Who doesn’t like being hit on by a drugged, hungover girl in her twenties still sporting last night’s clothes and make up? 

On Wednesday, I arrived early for my procedure but stalled as they were taking me into the operating room.  The anaesthetist was not only sweet and empathetic, he was really cute.  It took him and an entire group of staff to talk me into continuing; it also took several rounds of IV drugs.  

I have a very few flashes of what happened after that; I don’t recall talking to the doctor or leaving the building.  I don’t remember seeing the anaesthetist again, though I feel I may have.  I don’t remember going to the drugstore and telling the cashier all about my procedure.  The cashier saw me yesterday and recounted the whole thing for me.  It’s fun embarrassing to walk into a retail store and hear stories about what you did the day before! 

Lately, I’ve noticed a big change in how others interact with me once they find out I have anxiety.  They are much more empathetic; they are kinder.  And most of the time, they truly do know what I am going through.  

The anaesthetist– I’ll call him Ralph– was one such person.  Ralph was very touchy-feely with me, and though I usually recoil from such persons, he actually did comfort me.  He also told me a secret, which was that he also has an anxiety disorder and is on meds.  How did this help?  Because he said one other thing:  He said when he had panic attacks, he felt as if he was going to die. That sealed it: that’s panic in a sucky little nutshell.  Everyone gets nervous; not everyone has a panic disorder.  And he said something else that hit home:  that folks with anxiety are normally healthier than they believe.  Anxiety can make you believe that you are sick, even when you aren’t.  

I had a similar experience last summer, when a three-hour panic attack sent me to the ER.  The doctor I saw there told me a similar story, and that she also had to take meds for anxiety.  Even my optometrist shared that she also suffers from anxiety and told me to take more B-12.  Friends and neighbors have also come forth and shared with me their experiences and coping skills.  

The empathy I’ve received has been truly overwhelming, and unexpected.  It’s not that I didn’t know others had anxiety; it’s more that the things I have anxiety over seem so trivial.  But that doesn’t matter.  It doesn’t matter what triggers the anxiety, it’s really all in how you handle it.  And what kind of support system you have.  I cannot express how important empathy is in these situations.  

Ralph called me later Wednesday afternoon to make sure I was ok.  Two or three other staff members also called that day and Thursday.  I’m sure they see this now and then; I’m sure I’m not the only difficult or anxious patient.  They never made me feel difficult, though.  That just tells me that these folks are in the right profession.  Because honestly, I am really difficult.  

 

This year began with a bang, and the pattern continues. 

Patterns:  this is part of what life with OCD is made up of.  Patterns, rituals, behaviors that seem like habits but are much more deeply rooted. The accompanying anxiety comes just at the moments it should, and is comes out as everything from anger to tears to pacing the room. 

The tears hit me the hardest; tears are the classic sign of weakness. You’re either crying like a girl or like a baby, both of which diminish the underlying reason. Both minimize the fact that crying can be a response to anxiety, overwhelming fear.  Feeling weak undermines confidence, which is said to be a factor in anxiety.

My ‘anxiety spiral’ goes something like this:  

Big/scary event===> anxiety===> rituals/tears/attacks===> SHAME, loathsome thoughts===> harsh rules to control===>more anxiety

I know it’s difficult to understand the kind of debilitating anxiety that some of us suffer from because at some point, most people feel anxious or nervous about something.  But this is different; it’s not just nerves, it’s literally a stress response to life or death; it’s the flight/fight response gone out of control.  It’s having a three hour anxiety attack in response to just lying in your own bed, your own personal safe spot.  It may just be a matter of semantics:  Anxiety is an all-purpose term, and does not describe my feelings exactly. 

Just get over it:  this is the pat response that I’ve heard more times than I care to remember.  If I could indeed just get over it, then it wouldn’t be a daily life issue.  I’d just get over it and move on to the next issue.  But I’m stuck; this is the hill or mountain that I can’t seem to get over.  Aren’t metaphors fun? 

I had a medical procedure scheduled for this morning.  My spiral started yesterday afternoon, after I’d done all of the chores I could think of and had nothing left to occupy my mind.  I got angry; I picked fights.  I drank chamomile tea.  I watched the Grammy awards and tried to think of anything else but this appointment.  Nothing worked; my thoughts grew obsessive and by midnight I could think of nothing else.  I lay awake until nearly 2am trying to convince myself to do this thing. 

I cancelled 30 minutes prior to the appointment. I feel guilty and the tone of the receptionist’s voice made me feel even more so. 

Amazing the capacity of others to make you feel badly for cancelling an appointment or rescheduling.  Shouldn’t healthcare professionals have more empathy?  Shouldn’t they be more understanding of anxiety?  I may be asking for too much. 

The thing is, I have fairly severe anxiety.  It’s been worse over the past year than it has my entire life.  My file reads like a case in the latest DSM.  The numbers are adding up:  300.3, 300.01, etc. (An amusing aside about numbers: they figure heavily in my OCD thoughts, and revolve around the number 3.  Irony is fun, isn’t it?) 

Louis Menand wrote about anxiety in The New Yorker recently; she reviews a new book written by Scott Stossel titled 
“My Age of Anxiety” (just out this month).  Menand not only discusses Stossel’s book, but also the (short) history of modern psychiatry, and the mentality of the way in which we (in America) approach the subject, both philosophically and medically.  Where does anxiety come from?  How do we treat it?  Depends on who you ask, really.  If you ask Big Pharma, anxiety is a transmittable disease and pills are the answer.  Ask a Freudian, and it’s psychoanalysis.  Ask a nutritionist, it might be a vitamin deficiency.  

What I gathered from reading the review (and a short excerpt of Stossel’s book in The Atlantic), is that no one really knows where anxiety comes from.  Could be genetics, could be environment.  Could be the stress of Modern Life.  Could be a stew made of all of these things.  And treatment might focus on many things.  And, most importantly, there’s no cure. I think this is the downside of Stossel’s book:  he has severe anxiety and self medicates, but nothing really works for him.  For another sufferer of anxiety, that’s downright terrifying.

Modern psychiatry has given us some hope, there are some pills that do work for some folks.  Yoga, meditation and diet changes work for others.  I’m hoping some combination of these things will help me, and soon.  I don’t mind feeling bad about missed appointments, but I do mind feeling anxiety for no reason.   

 

 

Recovery from any physical or mental trauma takes many forms. Sometimes, the road to recovery can surprise you. Mine was in the form of 100 steps.

The Hill, located on UT Knoxville’s campus, is a place of legend and mystery. Haunted by the ghosts of Civil War soldiers, and possibly a wolf, the Hill stands as the oldest part of the university. Walking up the Hill, from any side, was a veritable hike up a mountain. If you were unfortunate enough to have classes on The Hill, as many engineering/science/psychology majors do, then you were whipped into shape, and quick.
On the far side of The Hill, looking towards downtown Knoxville, you had a perfect view of the giant golden phallus, or as it is properly named, the Sunsphere. I was privy to this view several times a week for one or two semesters. I also had the best ass of my life, from climbing the 100 steps that rose up that side of The Hill.
For two semesters, I rented an apartment right on the river, close to downtown. This meant I had to walk down the main street towards campus; The Hill is the first building you come to from that side. Once you got to that side, you either had to bite the bullet and climb the steps, or you had to walk several blocks further and walk up another easier set of steps.
Steps are steps, right? Not in this case. The steps that faced the Student Center on the other side of The Hill were wide, with rails, and large landings between flights, so students carrying their weight in books could rest.
The steps on the downtown-facing side of The Hill were small, narrow steps, with few landings. They were steeper steps, inclining at an angle that was nearly straight up. By the time I reached the top of this flight, I was panting hard and my heart was beating nearly out of my small ribcage. But I did it every day and, with practice, and the help of two home-made cinnamon rolls from the Student Center bakery, I finally was able to climb those steps with ease. This was much more important than just climbing a mountain, this was saving my life.
How did the 100 steps save my life? Here’s how: exercise increases appetite, which forces one to eat more, which causes one to gain weight. And I needed to gain weight.
When I moved to Knoxville (for the second time) in 1998, I weighed in at 75 pounds. When I left in May of 1999, I had gained up to 95 pounds. And I owe it to two things: persistence of will, and that Hill.
I had an 8 o’clock class at least three days per week, and I would walk from my apartment to the Student Center most mornings, if I had time, and get two large cinnamon rolls. Then I would gather my courage and my books and walk up that Hill. I had to stop for breaks often, but I never quit. I even tried to drive to classes on the Hill on occasion, but there is a small circle of parking and with nearly 30,000 students on campus, chances of getting a space on the Hill were slim, almost nil. So I sucked it up and walked up the Hill.
On mornings when I didn’t go to get breakfast first, I had to walk up the less traveled back side of the Hill, the narrow steps. I met other students occasionally, but there was much less traffic. And when I left classes, I would catch a view of downtown and the Sunsphere, as I made my way back down the Hill.
During Christmas break, I came back to Nashville to visit with my family. They were so shocked to see how much weight I had gained that they took pictures. An aunt or cousin actually took a photo of my ass. I still have that photo, a happy reminder of what I had overcome. A happy reminder that even if you are down, you can pick yourself back up again. You can conquer whatever it is that has attacked your mind and body. You can do anything you set your mind to. Anything.

I’m eternally grateful for that Hill, though I cursed it during those long treks up. When I was finally able to go and purchase new jeans, I was thrilled with the muscles in my legs, and in my butt. I was proud. I had reason to be. I had gained twenty pounds, and it was because I had the courage to walk up that Hill every single day.

The first time I visited the psychiatrists office a few weeks ago, I was a quaking wreck of a girl. I could not sit long enough in the waiting room to fill out the paperwork, instead pacing nervously around the room and hallway. I felt ridiculous and not just a little bit like a circus act. The kids in the room stared.

I went back to that same waiting room today and talked to a therapist. We talked about a lot of stuff, but two things stood out to me as being very important and immediate: I have symptoms of PTSD, and those symptoms have never been treated.

I told her my sordid and long history of ‘mental illness’ (including my mother’s history as well) and she asked had I ever done any therapy for the trauma. I hadn’t and wondered why not? I had done behavior therapy, cognitive therapy, why not this too?

I’ve felt, very deeply, that what I went through was traumatic, even if no one else ever said it. I
am glad to finally have some validation of this. The event was 20 goddam years ago, and here I am, still dealing with the effects.

How can one not know that an event that changes your diet, your daily routine, your entire perspective on things and your life, in general, would be considered traumatic? Of course it is.

I do feel somewhat relieved in the fact that there are non-chemical therapies, and that my therapist had some book recommendations for me on other, newer therapies. I’m intrigued by the EMDR but trepidatious as well. Or terrified, as is my normal response.

I should just call this post Anxiety for the Anxious, honestly.

During my terribly exciting trip to the ER a month ago, the doctor asked if I was feeling anxious about anything. My reply was yes– I’m feeling anxious about what’s happening to me right now! Hyperventilating, shaking uncontrollably… Who wouldn’t feel anxious? Dumb question.

And then I tried to go back to life as it was, and found that not exactly possible. Or easy. Everything seemed to set off an anxiety attack: normal, everyday actions and events suddenly seemed overwhelming. When you are experiencing this kind of anxiety, everything is dangerous.

It’s hard to be in this world and not be scared, considering the amount of hate and spite that runs rampant around us. It’s also really hard to be happy when you are afraid of everything.

A particular quote from an Arthur Miller play keeps popping into my head: in “All My Sons”the son asks the father, “Don’t you live in the world?”

Different context, obviously, but my answer to this question is always ambiguous in my head. Part of trying to live in this world involves a certain amount of denial about what it really means to be human. There is also the need to know things, and knowing things is hard. And knowing things and seeing things and experiencing things brings anxiety.

So I guess if anyone ever asks me if I live in the world, my answer will be ‘sometimes.’ And always with a certain amount of help.

What I love about anxiety attacks is that you really feel like you might be dying. Like any second you might just fall over and die. Not a pleasant feeling. (And by not pleasant, I mean fucking horrible. I like to minimize.)

So when I’ve called the doctor over and over and can’t get a response from a doctor or nurse, well that just creates spikes in anxiety. It’s now 3:45pm and no one has returned my call. What a bunch of bastards.

I’ve heard others say that it’s selfish to not use healthcare if you have insurance or some kind of access. But what good is it if you can’t get the care you need? Lately I feel that the care providers I’ve seen have not listened to me, not taken into account each and every symptom. They focus on just one symptom, and treat it. Nothing else. I feel I need something more holistic. I used to rely heavily on homeopathic and herbal remedies, and it may be time to return to that mindset.

On the other hand, being forced to stay at home and rest isn’t the worst thing.

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