4

The panic attacks finally lessened, but not until nine years after Matt’s death. Meanwhile, anxiety/panic disorder has been widely reported in the media. Millions of people suffer from the disease—more each year, it seems. And yet there continues to be a wide misperception about it. As someone said to me, “Your son died a long time ago, and you’ve got a successful career as a novelist, so what on earth do you have to be anxious or panicked about?” The answer is that years of stress or a single overwhelming incident can so weaken the body’s ability to handle tension that the smallest amount can cause the brain to trigger the release of stress chemicals. The effect on the body is similar to what someone would feel if suddenly confronted with a maniac jumping out of an alley, swinging an ax. In the latter case, the rapid heartbeat and heaving chest are appropriate spontaneous defensive reactions that the mind uses to urge the body to defend itself or race out of harm’s way. But with anxiety/panic disorders, the chemicals that trigger a fight-or-flight response are in undue proportion to the minor incident that caused the stress. Or else they’re released when there isn’t any apparent stress at all. I’ve had panic attacks walking down a street, going up an escalator, eating a hamburger, watching TV—in just about any benign situation I can imagine. Sometimes it was because the defective “valve” in my brain dumped stress chemicals into me for no other reason than that it was faulty. Other times it was because an unconscious association stimulated a massive stressful flashback to Matthew’s death.

My treatment was a combination of visits to a psychiatrist and a drug called Xanax. Part of a class of drugs known as benzodiazepines, Xanax (a cousin of Valium) works by affecting the ability of neurotransmitters to relay stress messages. Put simply, the drug stops the brain from sending out panic signals. It’s an effective drug. It works. The trouble is, its side effects include foggy thinking and short term-memory loss. These inadvertent results aren’t good for anybody, but for a writer they’re disastrous. One reason I wrote little for two years after Matt’s death is that I’d get to the middle of a sentence and not be able to remember how it began or how it was supposed to end. So the task became to use as little Xanax as possible while struggling to come to terms with Matthew’s death and get the broken part of me to heal. The trouble is, Xanax is addictive. I later discovered that only about a third of the people who take it for a considerable period of time ever manage to stop. There’s a phenomenon called “rebound.” If you take enough of it, your body gets so used to it that when you reduce it with intentions of stopping altogether, you reach a point where your body says “Wait a minute, what’s going on, I need that stuff, where is it?” In other words, you’re addicted; and when you try to stop you experience withdrawal, a stress that weakens the already weakened stress valve you’ve been trying to repair. The consequence is a panic attack caused not by the original trauma but by reducing the treatment for the trauma. What a mess. I started with four milligrams of Xanax a day. I reduced it to three and a half. Waited. Reduced it to three. Waited. Two and a half. Two. One and a half. One. And bang, I had clusters of panic attacks that forced me back to taking four milligrams of Xanax a day. I went through the process six times before I finally overcame the effects of withdrawal.

Don’t misunderstand. If someone close to you has died and you’re suddenly overwhelmed by panic attacks (the two frequently go together), there’s nothing wrong with taking Xanax if a psychiatrist prescribes it. I’ll say it again: a psychiatrist, preferably one with experience in grief counseling. Anxiety/panic disorder is an emotional illness with physical/psychological causes. A family doctor can temporarily treat the physical part by prescribing what amounts to a tranquilizer. But if the psychological causes aren’t also addressed, the source of the problem will never be solved, and the risk of getting hooked on medication is high. Indeed, not everyone who needs counseling requires drug therapy. In that regard, psychotherapists (they’re not physicians) can be as helpful as psychiatrists, and if they conclude that a drug like Xanax would be helpful, they can get a psychiatrist to prescribe it.

I’ve met many people so impaired by panic attacks that they need counseling, but for various reasons they refuse to use that resource. Their motive is often fear of what people will think if word gets out that they’ve been to a psychiatrist or a psychotherapist. This attitude goes back to an intolerant time when various emotional and physical diseases (depression and cancer among them) had a social stigma. My response is this: Anybody who thinks less of someone for getting psychiatric help isn’t anybody whose opinion has any value in the first place. A further excuse for not getting help is the notion “What do shrinks know? It’s all fake. I’m as smart as they are.” There’s an old joke that an attorney who tries to represent him- or herself in a court of law has a fool for a client. The same applies to anyone with an emotional disorder who thinks that he or she can handle it without the help of an expert. I’m proud to say I spent three years going to a psychiatrist (once a week to start, then once a month). My panic attacks had so aggravated my despair that I contemplated suicide several times, and I credit the psychiatrist for saving my life. After a four-year respite, the panic attacks returned, and without a second thought I immediately sought more help. What does a good psychiatrist or psychotherapist know that the patient doesn’t? Plenty.

I still have a bottle of Xanax in my medicine cabinet, but, knowing my illness better and knowing about alternative methods of treatment (breath control and biofeedback, for example), I’ve learned to use the drug the way I would an aspirin to subdue a headache. The last time I had the prescription refilled, I was pleased to discover that thirty pills of one-milligram strength (which I break in half) had lasted me two years. In the meantime, believing that knowledge is power, I continue to educate myself about the disease. There are many good books on the subject, but for me the most useful is The Anxiety Disease, by Dr. David Sheehan, a former director of anxiety research of the Department of Psychiatry at Massachusetts General Hospital. If you know someone who has suddenly become a victim of panic attacks, get that person this book. If you yourself are the victim, do what Dr. Sheehan tells you. Sometimes, when I feel an attack coming on and I don’t know which is going to kill me first, the “coronary” or the “stroke,” I reread several well-thumbed chapters of The Anxiety Disease, and remind myself of the true nature of the attack I’m having. That’s often enough to calm my symptoms.