When all you have to fear is fear itself

A panic attack is like a cat: you don’t even know it’s there until it has pounced and you find yourself toppled onto the couch, smothered by fur and a flailing body, with four sets of claws sunk into you.

But then, that’s just the outside of the panic attack.

A panic attack is like being chased by a bear: it’s definitely happening and no one can fault you for wanting to outrun a bear. No matter how fast you run, with all your senses and good presence of mind, you know the bear will catch you. And eat you.

And even as you think this, lo, you trip over a rock and the bear has you.

A panic attack is like going swimming on a perfectly fine day, but you lose your focus for a second and you don’t see the very, very big wave behind the one you just happily swam under. You try to swim up through it but the water pushes you down. On the way down, the force of the water tumbles you and you’re not sure which way is up. You can’t find the sand below, you can’t see the light from above. You’re running out of air and even though you are an excellent swimmer and know you should pace your breathing, you can’t. This is how you will die.

That is a panic attack. If you want to add the bear and the cat, you can, because some are so bad it’s like they’re all happening at the same time.

Many people will have one, maybe two panic attacks at some point in their lives. There will be a sudden onset of terror, hot or cold waves, shaking, nausea, chest pain, dizziness, feelings of detachment. You may think you are having a heart attack.

But there is nothing chasing you.

Subsequent attacks will come because you are so afraid of what happened the first time.

Panic attacks are closely associated with university finals and new jobs. They are a disproportionate fear reaction to something predictable (like an exam). They can also come out of nowhere (like a feral cat).

Having panic disorder is all that’s been described, but it’s a way of life. For some, this is a thing that can happen every day. For most it will be over in a matter of minutes.

Feeling like you’re almost drowning one day for a span of a few minutes is awful to contemplate. Just like it would be if this were not a metaphor. Nobody wants to go to the beach every day and try to drown, just a little, as a new hobby.

When you have it in a sustained way – maybe nearly every day; maybe you’re good for a while and then you have a month when it feels like it’s never going away – that’s beyond unbearable. At some stage, when you’re paralysed by the fear, it does make you wonder if you’re dying. Or if dying might not be preferable.

Panic attacks are fear incarnate. Some people stop leaving the house. Many agoraphobics have attacks if they try to.

You may hear the term used interchangeably with “anxiety attack”; it’s not the same. In fact, the American Psychiatric Association’s DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) does not define anything as an anxiety attack. Anxiety is in it for the long run. Remember not to assume that having one or a couple panic attacks is the same as suffering from the disorder.

Anxiety can be the product of prolonged worry and brings with it a dreadful basket of sleep disturbance, irritability, physical tension, lack of concentration and all the things you might associate with being worried about something for a long time.

You can survive panic attacks in several ways: there are breathing and refocusing exercises, and reminding yourself that there is actually nothing to fear. For those who suffer acutely, they may find a thing that makes them feel safe, say, being in a certain room. Some people like to be held. Some people need to be alone.

Perhaps the cruellest thing about this disorder is that you can have panic attacks when you’re perfectly happy. That’s just how it works. Imagine missing all the best things in your life because something in you thinks even the good is frightening.

When someone has a panic attack – be it the drowning kind, the chased-by-bears kind or because they’re having a wonderful time at their own birthday party – they are not being melodramatic. They are not over-reacting or looking for attention. They are scared. Proceed with patience, understanding and support.

I wrote my first piece on panic disorders nearly 30 years ago. Why don’t we want to understand?