I hope to start a meaningful conversation around the suffering many of us experience as a result of our mental illnesses. 

You shouldn't read this if you're currently struggling with panic attacks so much that a detailed narrative of my panic attacks will trigger them.

I don’t enjoy talking about my suffering publicly, but I feel courageous enough to share it here, because:

  1. I’ve been impressed by LessWrong’s culture of kindness and respect.
  2. I hope I can help or comfort at least one person who is also afflicted by mental illness.

I don’t want your pity, but I want your love.

I don’t want your agreement, but I want your respect.

With that said,

 

My crippling anxiety and resulting panic attacks are by far (second place is not visible on the graph) the most difficult thing I’ve ever been through.
 

I had my first panic attack on January 1st of 2021. 

 

It felt like walking down the street on a stormy day and randomly getting punched in the face by Mike Tyson. I say stormy because in hindsight I had not been taking good care of my physical or mental health, and the signs were there.

My first panic attack was awful, and insidious, and hope crushing.

 

My second panic attack was more awful, and more insidious, and more hope crushing.
 

I don’t know how many panic attacks I experienced in the first two days. They blended into each other, and the high levels of anxiety I experienced in the anticipation of the next inevitable panic attack certainly didn’t help.
 

I call them panic attacks now, but for the first several days I had no idea what was happening to me.

 

I only knew terror. I only knew that my skin felt like it was burning. I only knew that I was fighting to breathe.
 

You know that feeling when you realize things aren’t going to be the same? I had only experienced a similar pit in my stomach when an awful thing had happened.

 

I felt like an animal trapped in a cave. There was a raging fire at the entrance, and that made me really afraid.

 

How could I escape?

 

I desperately wished I could feel better. I wished I could escape to somewhere calmer and brighter, maybe something permanent.

 

I vividly remember not being able to sleep those first two days. My God, my heart goes out to those of you who struggle with insomnia.

 

Before this experience I was not aware of how effective sleep is at healing your mind.

I was unable to ignore how sleep deprivation affected me, and how much worse it made panic attacks and their surrounding anxiety.

 

Thoughts that I could have typically brushed off as illogical, now gripped me.

Fear and anxiety that I normally could have pushed through, now felt insurmountable.

 

I suffered alone for two days while my mom was traveling, experiencing wave after wave of terror, never being able to rest my eyes, my mind, my soul. 
 

I would not wish this experience on anyone, no matter how evil.

 

Seeing my mom when she returned from her trip comforted me in ways that words can’t.

 

Words can’t describe.

 

My mom helped me go see a doctor, who explained that I was experiencing panic attacks, and that Lexapro, an SSRI, could help.The doctor also explained that benzodiazepines would help with my panic attacks, but I had read so many horrible things about their withdrawal symptoms that I was willing to accept my suffering.
 

Now I had heard of panic attacks before, but there were a few reasons I hadn’t thought that’s what I had been experiencing.

 

One, I thought panic attacks only lasted for 5-15 minutes, mine lasted for much longer. Two, I was unaware of how human bodies react to terror.

 

I think terror, is the perfect way to describe the psychological effect of panic attacks. Panic doesn’t feel quite right.

 

I learned a lot about panic attacks in the weeks following my first encounter.

  1. Homo sapiens evolved to experience extreme and sudden fear. Apes evolutionarily benefit from experiencing panic attacks. If a lion is chasing you, be tremendously afraid. It’s better to feel extraordinary fear than to die. And next time, don’t go anywhere near lions.
  2. The nervous system is responsible for making sure you experience suffering when you’re in danger. If you don’t experience suffering, why do anything?
  3. A panic attack is the big red button that the brain typically saves for extremely dangerous situations. Once the button is pushed, it cannot be unpushed.
  4. Once pushed, most people feel like they’re dying. They feel like they’re having a heart attack. Their breath quickens to an uncomfortable rhythm.Their bodies sweat profusely and shake. Their vision fogs. They lose grip on reality.
  5. Around a third of people typically experience at least one panic attack in their life. Neurotypical people typically only experience panic attacks when something awful has happened, or seems likely to happen.

 

Understanding the mechanisms that caused panic attacks helped me. But it didn’t help me much. 
 

I needed a cure, something reliable, maybe a pill, or words I could chant, or a god I could pray to.
 

It makes me laugh now how obvious it must have been to Google that I was in extreme distress.
 

I don’t even have to go through my search history to give many examples of the queries I made. Here are a few: how to get rid of panic attacks, people recover panic attacks, medication best panic attack, medication efficacy panic attack, panic attack reddit, panic attack medication help reddit, etc.
 

I found more book recommendations than I could read, but I ended up reading: Hope and Help for Your Nerves by Claire Weekes, and The Anxiety and Phobia Workbook by Edmund J. Bourne.
 

Here’s what I learned from these books.

  1. For the love of all that is good, stop fighting your panic attacks. You cannot win.
  2. Claire Weekes recommends people do four things when they notice they’re ascending the elevator of anxiety (the last stop is a panic attack). One, face the symptoms, do not run away. Two, accept what you’re experiencing, do not fight. Three, float with your feelings, learn to do while suffering. Four, let time pass. [EDIT: I misremembered her steps significantly, and in a way that would reduce the effectiveness of her method. Thanks weathersystems!]
  3. From Bourne, I learned why a simple statistical model could have confidently predicted that I was at very high risk of developing a panic disorder. I wasn’t exercising. I wasn’t socializing (covid amirite), I was going through a stressful time (very unhappy at my first job), I was a generally anxious person, I was depressed.

 

Understanding the above, really helped me emotionally. I didn’t feel alone. I didn’t feel like my problems were insurmountable. 
 

With Lexapro, and diligent practice of Claire’s four step method I reduced the frequency and severity of my panic attacks.
 

After three months, I had the last panic attack that was comparable to the many I had experienced in the beginning.
 

But, my life still really really sucked. While I knew all of these things I should do, it still felt nearly impossible to apply them effectively.

 

Take for example Claire Weekes second step “Accept what you’re experiencing”. 

 

What the fuck is acceptance? I’ve never thought so much about what that word means.

 

At first I thought it meant I had to like, or at least not hate what I was experiencing, and that felt impossible. It felt like shooting someone in the leg and asking them to smile. 

 

I struggled with this problem for many many days.

 

Eventually, I came to a definition of acceptance acceptable to me; don’t actively try to change what you’re experiencing. It didn’t mean I couldn’t hate my panic attacks. It didn’t mean I wouldn’t suffer. It didn’t mean I would get better. Just don’t fight the current. Be ok with suffering.

 

I believe that Claire Weekes method is actionable and effective. And the more I’ve learned about my mind and body specifically, and about the mind and body generally, the more certain I am that it is the only effective method that can be done alone, and without guidance.

 

Her approach is one of the great truths of Buddhism reinterpreted and distilled for the modern human.

 

If you can’t change it, accept it.

If you can change it, change it.

 

All suffering is borne out of attachment. Suffering is the result of a conscious entity not accepting the contents of their consciousness.

 

If you accept what you cannot change, you will suffer as little as is possible.

 

Six months had passed from that first terrible night before I truly believed in that truth. And while keeping that truth in mind, I thought of all of the things I could change, and I started trying my hardest to change them.

 

I exercised regularly. I relaxed with yoga. I practiced deep chest breathing, I socialized the amount necessary to maintain sanity. I switched medications until one really helped me (SNRI), I learned to notice my anxious thoughts and to accept them. 

 

But importantly, I never forgot that if I wanted to suffer the least humanly possible I needed to accept what I couldn’t change.

 

Accept what you cannot change.

Accept what you cannot change.

Accept what you cannot change.
 

I have repeated this mantra countless times since I first learned it. I’ve accepted that I will suffer more than is necessary if I don’t repeat it often.
 

It’s been a little over a year since I had my first panic attack. 

 

And not only do I not experience panic attacks. 

 

I’ve never felt such little anxiety. 

 

I’ve never been as content and full of joy,
 

as 

am

right 

now


 

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7 comments, sorted by Click to highlight new comments since: Today at 9:35 AM

For some reason, early in life I acquired the opinion that emotions are a response to something specific. And I remember a time when psychiatric medications were far less common than they are now. So when I hear of people suffering anxiety, depression, etc, my first thought is always, what are the beliefs and living conditions that produce these feelings? And, can they be entirely relieved by concrete actions and/or a change in perspective?

I have learned to be a little more open-minded. Such conditions must sometimes have a purely organic cause. Maybe it's sometimes alright to use "meds" even when the cause is a life circumstance and not just a "chemical imbalance". But I still worry that millions of people are encouraged to pop pills unnecessarily.

To what extent do you think that your panic attacks can be explained by the circumstances of your life? You say you were at your first job and hated it. It is easy for me to imagine how that alone could lead to a feeling of terror - able-bodied adults spend most of their life in the workforce; maybe you were going to spend the rest of your life trapped in this same misery! It's natural that you wanted to escape.

Oh man, where to start...

I agree with the general sentiment of your post; it's something I've thought a lot about.

What causes mental illness?

 

Honestly, I struggle to think of a more multivariate problem. There's just so many variables, and in my own personal struggles it has been overwhelming trying to figure out which variables contributed the most to my mental illness.

But, for you, I'll try. <3

Here's an unranked list of the most important variables I could think of that contributed to my suffering:

my biology, genetics

my thought patterns

my physical health

my emotional health

my spiritual health.

 

These factors aren't all mutually exclusive, and I don't want to spend the effort of coming up with a list that is.

I'll now give a weight to each of those variables by how much I think each contributed to my mental illness and a sentence explaining my reasoning.

Genetics 30% - High levels of anxiety runs through my entire extended family. Twin studies have shown that when you drastically alter the environmental factors people still seem to end up having the same mental illnesses.

Thought Patterns 10% - My pattern recognition abilities, make me intelligent, and make me think of all possible problems. Think, catastrophizing, black and white thinking, etc. These intuitive, mental heuristics are great if all you care about is not dying, they suck at making you content.

Physical Health 20% - It's way easier to accept the psychical and psychological symptoms of anxiety when you. Just. Feel. Good.

Emotional Health 10% - Being alone is terrible, not feeling understood is terrible.

Spiritual Health 30% - Why suffer? I've figured out how to make my suffering meaningful to me, and that has made it much easier to accept my suffering.

 

That's me, and I'm reasonably confident in my weighting, but every individual has a different weighting, AND the most impactful factors may not even be on my list.

Thanks for writing this. As someone who went through something very similar, I largely agree with what you wrote here.

To make the "accept the panic" bit a more concrete: following someone's advice, when I'd start to panic, I'd sit down and imagine I was strapped to the chair. I'd imagine my feelings were a giant wave washing over me, but that I couldn't avoid them, because I was strapped to the chair. The wave wouldn't kill me though, just feel uncomfortable. I'd repeat that in my head "this is uncomfortable but not dangerous. this is uncomfortable but not dangerous..." Turns out that if you don't try to avoid the bad feelings, they don't last as long. My understanding is that by just sitting and taking it without flinching, you're teaching your brain that panic is not something to be feared which reduces their intensity and frequency.

Before doing that I felt terrible for about an hour. With that technique it was reduced to about 15 minutes, then I quickly (in a week or two) stopped having panic attacks.

I'm not sure I understand how "Three, distract yourself." fits with accepting panic though. I know for me, distracting myself was a way of not accepting. Of trying not to feel bad.

I fully agree with your point that "Distract Yourself" seems like bad advice. 

I misremembered Claire's steps pretty significantly.

Here they are:

  1. face the symptoms – do not run away.
  2. accept what is taking place – do not fight
  3. float with your feelings – do not tense
  4. Let time pass – do not be impatient.

I think I misremembered because in her exploration of step 3 "float with your feelings". She mentions in engaging in an activity that isn't thinking about what you're experiencing. Not in hopes that you will distract yourself, but so that you can begin living a normal life i.e. learn to do, while experiencing suffering.

I'll edit the post.

Thanks!

Ah. Ya that makes sense. It sounds like it's not so much about what to do in the moment of panic as what to focus on throughout your day-to-day life. Let yourself be interested in and pay attention to things other than that you feel bad all the time. Don't let your pain be your main/only focus.

Acceptance is really really hard. Basically you have to let the (negative) feeling be felt, let it wash over and go through you, but do not dissociate from it. But also don't ruminate on it. Let it happen, then let it go. Let it happen as many times and for as long as it takes. No matter how painful or strong the feeling is. 

But also, notice that many people confuse panic attacks with emotional flashbacks. They seem similar, but are quite different.

Beautiful :)