No news is good news, somebody once said, and for the 200 people who turned up at the Drake Hotel the other evening to attend a free lecture by the Panic/
Anxiety/Phobia Clinic, the evening was a success because, well, nothing happened. Nobody had a heart attack. Nobody fainted. Nobody fled.
Those are not light matters for people who suffer from irrational panic attacks, a figure that may include up to 14 percent of the population. For reasons not immediately clear, such people are driven to avoid places and situations where they fear they might suddenly face a debilitating anxiety, lose control, fail to get help, embarrass themselves and quite possibly die.
Unlike ordinary fear, which creeps in gradually, panic attacks involve, according to one sufferer, ”a sudden onset of intense apprehension, or terror, often accompanied by a feeling of impending doom.” Nor are the triggers always negative. ”Your mind can distinguish between good and bad stress,” one speaker reminded the audience. ”Your body doesn`t.”
With that in mind, organizers of the phobia evening at the Drake paid careful attention to physical details. To reassure claustrophobics, who were nervous about elevators, they chose a meeting room on the mezzanine floor, reachable by stairs. Doors at the back of the hall were left open. Audience members were encouraged to stretch, wander around or go for water anytime they wanted.
Encouraging words for the phobics came from two clinical psychologists, Sherry Pfeffer Byer and James Brogle, who run the recently opened Panic/
Anxiety/Phobia Clinic, 680 N. Lake Shore Drive, and from guest star Jerilyn Ross, a Washington therapist and weekly radio talk-show host who heads the non-profit Phobia Society of America, a 9-year-old organization with 6,000 members that offers information and a directory of treatment programs.
”I`m so pleased to see you here,” Byer began, welcoming a crowd drawn by newspaper ads and word-of-mouth. ”I know that simply getting here involved a challenge. Driving downtown. Battling traffic. Wondering what floor it would be on. Or if good seats, in the back, would be available.”
War stories
But the star of the gathering, clearly, was Ross, 44, a trim, active woman who has skied down mountains around the world but who, for five years, had a phobia about ever going above the 10th floor of buildings, a major problem considering that she then lived among the towers of Manhattan.
”Why 10?” she asked the crowd, as she ran through her story. ”I don`t know. It wasn`t rational, but I really had this fear of being pulled over the edge of the building. I was humiliated. I was terrified.”
Few non-victims understand. ”Most people consider us the `worried well,` ” Ross noted. ”We can`t go to the store. Can`t fly. Can`t cross streets. Sometimes, we have to lie on the floor and hold ourselves. But if we could just pull ourselves up by our bootstraps, they say, we`d be OK.”
Ha!
Much of the evening was devoted to war stories about what phobics are up against (plenty) and to news of cures, a combination of education and group therapy, which have proven effective in stemming panic attacks in more than 80 percent of treated cases. Some sample histories:
– Overwhelmed with stress, one Chicago man, a professional model in his mid-20s, cut short a trip to a photo shoot in Greece. To relax, he was taught proper breathing and other mind-focusing techniques, though he had to be cautioned against using a stopwatch (too compulsive) to measure each breath.
– A wealthy Chicago matron found herself so overwhelmed that she moved into a downtown hotel connected to a shopping complex so she could fulfill her shopping needs without ever going outside. Last spring, after treatment, she was sufficiently recovered to go on a cruise out of Florida.
– One Indiana woman, stricken after graduating from college, returned home and remained in her bedroom for three years. Beginning therapy, she entered a clinic`s side door, rather than deal with the reception area, and, according to her therapist, ”shook like a bowl of jelly for 10 minutes.”
After a year of therapy, she was able to drive a car and move into an apartment with her old college roommate.
– An Indiana radio station manager, who spent 20 years wrestling with inner panic and never took vacations, recently flew to Disney World with his son and liked it so much they stayed a second week.
– A successful businesswoman found she could go anyplace, and even shop, as long as she could see her parked car, her symbol of escape.
Statistics are hard to come by because many phobics try to hide symptoms, but estimates are that between 10 million and 12 million Americans wrestle with some form of panic disorder. Less than 30 percent ever receive treatment. In a 1989 article in the New England Journal of Medicine, four researchers who studied the mental histories of 18,011 adults reported that 20 percent of those suffering from panic disorder have made suicide attempts, an incidence 18 times higher than among those with no mental impairment.
Strangely, panic attacks seem to come out of nowhere, in places where there seems to be nothing to fear. The common symptoms: heart palpitations;
sweating; fear of dying, losing control or going crazy; faintness; dizziness; trembling; hot and cold flashes; shortness of breath; choking; nausea;
tingling; weakness; and feelings of unreality. The first attack is often so frightening that victims withdraw rather than face another, in public, alone. Some phobics stop using public transportation or shopping malls. Others become territory-bound, feeling safe only when they stick to a fixed route, from home to work to home. Some develop a compulsion to retrace routes they have driven, to make sure they have not inadvertently hit a pedestrian. Others spend hours organizing objects and possessions. Many hoard useless items, such as old newspapers, often filling rooms and blocking doorways.
”My first panic attack was like a heart attack,” one recovering agoraphobic, identified as ”Mary,” told the audience at the Drake. ”It lasted three minutes. I felt like I was at the bottom of a black pit. In a vacuum. Couldn`t breathe. My legs were rubbery, like I was walking at an angle.”
On the surface, agoraphobics, who fear being in open or public places, often look normal. They smile a lot. But they fear using public restrooms. They dread giving public speeches. (”What if I blush, go blank, pass out?”
one asked in a therapy class.) Many refuse to dine in restaurants, fearing they might be trapped, suffer an attack and be unable to leave. Those who do manage a meal out often insist on a table near the door. They ask for a check long before the meal is through.
The best medicine
If the fears of such phobics actually came to pass, the floors of public places would be littered with fallen bodies. That they aren`t is demonstrable truth that such morbid outcomes seldom, in fact, happen. But such intellectual arguments are hardly reassuring to those who suffer the effects of their own body`s predictions of doom.
Treatment is based on five steps: understanding the physiology of the problem, learning to recognize the onset of the panic symptoms, training in breathing control and muscle relaxation, learning to change the aggravating thought processes, and calming down body sensations.
The recovery rate, for those who pitch in, is above 80 percent, says Byer, who trained in counseling psychology at the Illinois Institute of Technology. Brogle, her partner, is a University of Florida graduate who has taught in the counseling department at the University of Notre Dame. As clinical psychologists, they have been treating panic attack victims for years. Four months ago, they opened the Panic/Anxiety/Phobia Clinic, which offers a 17-week program, built around weekly 90-minute meetings that Byer describes as ”a combination of education and group therapy.” The cost: $40 to start, plus a sliding scale of weekly fees, up to $75 a session.
A genetic nudge?
Many of the guests at the Drake`s panic-attack evening had already seen the clinic`s video, ”Panic: Unlocking the Mystery,” which includes an endorsement from Dr. David A. Spiegel, head of the anxiety-disorders clinic at the University of Illinois College of Medicine in Peoria.
”This can be a very disabling disorder and (the Chicago clinic) is providing group treatment that reflects state-of-the-art thinking,” Spiegel noted in a brief telephone interview. ”It`s important for people to know that there is treatment available, that this is an unnecessary disorder.”
Now a director of the Roundhouse Square Psychiatric Center in Alexandria, Va., and a major figure in phobia treatment, Jerilyn Ross noted that the causes of such debilitating phobias remain obscure, though researchers believe many of those afflicted inherit a genetic predisposition to panic attacks that surfaces under stress.
”Who else in your family worries a lot?” she asked the crowd. ”Did your mother dislike driving? Did your father refuse to fly? When did your first attack occur? What else was going on? And how many of you have a fear of driving? Do you worry about, `How will I get off?` Or, `Will I swerve into other cars?` ”
Although such fears may stem from separation anxiety, change anxiety, perfectionism or a strong need to always be in control, the crux of the problem is that thoughts from the past trigger the body`s flight-or-fight response. One solution is, simply, to think of something else.
”Focus on a time when you made it,” Ross advised. ”Try to stay in a situation long enough to see that you will survive. Or count backwards from 100 by 3. That will divert your mind. Or put a rubber band on your wrist and snap it. The twang will bring you back to reality.
”I`ve been in this field for 13 years,” Ross said as the evening wound up and people began wondering how to get out. ”I`ve treated hundreds of patients. I`ve spoken all over. Nobody I know has ever had a heart attack during a panic attack. Or swerved off a road. Or shouted obscenities. Or passed out. Or jumped out a window. The feeling is frightening, but not dangerous. The fear is different from the reality.”
Most of the 200 people in the room seemed relieved at the news. About 150 of them took information packets. About 50 filled out cards asking about treatment.
”Everyone knows someone who suffers from panic attacks,” Byer said later. ”Many of the people said they had come for someone else. But I also had a call after the lecture from a woman in Winnetka who simply said, `Thank you.` ”
