HOW TO DEAL WITH A PANIC ATTACK
A You can do this™ series pamphlet
By
Doctor Nik Riew
Summary: Nothing is going to happen to you. Time is going to pass. The situation is going to change. Take action. Tell your story. Use a script.
Summary Considerations: You can take a walk
You can think things through
You can take a pill
You can read the Bible or another book
You can think of all the others
You can take your own life
You can script your own story
You can do, and re-do the exercises, keep writing
Summary Tips: Other people cannot see your panic
Don’t worry about time
On the exercises: Do not be scared by the blank boxes. They are there for your use but there is no hurry. When you are ready, anchor your cursor there and begin typing. The boxes will expand for you as you type.
Do this first. Plan to get yourself to a safe place. Figuratively speaking, you need to take steps that will close and lock the doors, securely shut the windows, draw the curtains and one by one turn out the lights downstairs. Do this slowly, in a measured way. Normal habits are important just now. Wash yourself, clean your teeth, whatever is usual before coming up the stairs to the bedroom. It is better to be in, or to create, the most personal, comfortable, space.
What I mean is this. If it is at night you might actually takes those steps. But if it is on the bus, at work, in a queue, or whilst you are talking - if it is like that, then that is what I mean by figuratively speaking. Your safe state might be simply sitting and looking at papers, or the computer screen.
EXERCISE
Write in this box where your safe places will be (or your safe “states”)
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I have been doing this a long time now. I am not a doctor or a qualified therapist but I know my business. I am a professor of panic attacks. I call the people having these attacks a “panicker”. For many years I was a panicker myself which began when I had to meet a certain person towards whom I felt deeply guilty. After a time, during which I did not address the problem, the malaise became more general and I began to panic at times that were not connected to a specific person or event. Some animal was let loose that I could not catch. And it was growing. Tighter and tighter I folded my arms across me to hold my life together. More and more I averted my eyes from the world and began to picture the insides of my physical body. I became aware of the dangers that this fragile vessel and collection of organs faced. My fear of disease and death grew. The internal clock that measures the mathematics of life began to tick louder.
And then I went to
It was Artsibashev who, over those few cold and happy weeks, first outlined to me the series of considerations that I outline here for you, which I now call “script therapy”. For a while we corresponded but sadly he died.
The truth is that when I examined the considerations, developed the exercises and wrote through the panic, I stopped having a problem. I discovered that by simply writing a script for myself I could take control of my life and overcome my fears. I have my script that I constantly hone and rework. I follow this and I remain the star of my own life.
You can do this™ too.
You will notice that I use the phrase “series of considerations”. I could have replaced this with “series of steps” but this would seem odd considering that one possible step could be to take your own life. And I am not an advocate of that! I want you to consider what the cause of your problem is and I want to you complete the exercise boxes, and write your script for living. I want you to do this more than once. My guess is that for many people the safety of the shore is some distance away and the trip back may be a long one. So it will be necessary to take small steps with each round of exercises.
Some of you will find it unusual writing stories about yourself. Try to think of this as liberating! I want you to be truthful with yourself about what is happening to you but there is also no problem in reinventing yourself and then devising a plan to become the new you. Either may be positive.
Lets now look at the considerations.
I.
You can take a walk.
The blood supply has been pushed away from the body’s extremities and driven into the major organs. It’s so you can prepare for fight or flight reactions. It’s a sensible built in response to anxiety and fear. The problem with the panicker is that the body is doing this when there is no real cause to.
However, I have a cutting about someone without the fight or flight reaction. He had damaged his mind in an accident and now he could not perceive danger. I don’t mean that if an object was going to fall on him that he would not get out of the way. In this situation he would move as soon as the falling object got near. He could do that somehow. His mind could not, however, interpret and link a series of signs like a dark alley, a group of boys, low murmuring talk, glances, the danger signals. It made him vulnerable. He was killed, and able to be more easily killed, because of it. He was killed by a group of boys. So fear and anxiety have a positive function when they are related to real threats.
When you take a walk you give the heart a real reason to slightly race or quicken. Do not do major exercise as you will scare yourself even more. You will be convinced that this time it is a heart attack. That something catastrophic is going to happen to you.
A park is good, even at night. As you walk the effect of the attack may lessen a little because of the bodily distraction. You have to take advantage of that space – the distance you create between the body and the mind - and put some new element in place. Some train of thought that it going to lessen your consciousness towards panic. Lessening your awareness of the problem, so that you can look at the next consideration. It’s a behavioural first and then analytical second, way out.
EXERCISE
Write in this box the kind of physical activity that you can do in response to a panic attack. Remember to include activity that you can do at your work desk as well as outside.
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Here is a tip. Other people cannot see your panic. For a long time I was convinced that, whilst I walked light-headed into town, taking my pulse, and watching my reflection in windows and mirrors, other people could actually see me in terror. Then Dr Artsibashev told me that this is not so. If a person had a look of fear on their face and an obvious cause was nearby, say, a soldier with a gun, then we can interpret their fear. If not, the look could be mistaken for confusion, tiredness, stress, or even contentment. You look around you and try to spot the people in fear.
II.
You can think things through.
Everybody has a narrative script. I have a narrative script that I can begin to tell and against which I could claim what doctors call “reactive depression”, with associated panic attacks as a more general symptom. That story is one of relationship problems, and the death of sex and communication. This was followed by behaviour that resulted in full relationship breakdown, and estrangement from children. I became ill for the first time.
That kind of description gets you some way along the line but is only the start. It is not only the understanding of what has happened in the past that is important but also the “now-ness” value of any self-narrative. You have to get at what has just happened to bring on terror.
This is because the reason, cause and effect all become detached in time and place like a boat pushed out to sea for no purpose. We might say that the reasons are back on the shore, and the cause is now hidden in the sea that is all around. Something lost in the sea. The sea looks forever the same. The sea is covering and enveloping the cause and then presenting the problem. The effect is unsteadying, make it difficult to move and respond. Get used to the movement first. Then you need to catch and collect your “triggers”. What were you thinking about before the light-headed feeling came over you? What words, images and physical or emotional feelings do you associate with terror? Do you notice changes in your body temperature that is associated with certain events?
EXERCISE
Write, in a sentence, a self-narrative about you. Don’t think of the immediate past. Make a sweeping statement that covers a long period of time. Does it suggest triggers? What are they?
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What a thing is the mind! The mind plays tricks. The panicker gets too near the mind. Once you lose your peace of mind you can never get it back. Don’t expect to. Look for a different frame of mind that you can live with.
Our minds have the ability not only to discover facts but to screen them also. One of the things the screen should hide is the body, its interior, and its inner state. We wander through the journey of the day creating and responding to images of the outside world. Our minds are designed to create a film of the world. My mind tells me that there is a film, then it tells me that it is my film, and finally that I am in the film. A film made by me about a film about me within a film.
The panicker when affected cannot concentrate on this. He or she turns inwards, to the interior. Most panic attacks for example are concerned with bad events happening to the body. They do not concern, for example, bad events happening to the country or the city. Panickers, in short, lose sight of the big picture.
In my case I walked, racked with fear, feeling for my heart, worrying about my cells, looking tired and thinking about the medical history in my family. I became so afraid of death that I could not live. The film went on but I was absent. I was not in any of the scenes.
The brain should know much more than the conscious mind. When the conscious mind gets access to this extra information, the horror comes. This condition is specifically related to medical advancement in the nineteenth century, which created modern American Man. The nineteenth century saw the emergence of a new discipline - physiology. Before this Doctors talked to the patient and maybe they looked at the colour of their tongue. The new discipline focused upon gaining knowledge of the body through physical examination. New instruments were invented to look at temperature, blood pressures, heart activity, pulse rates. Memory and intuition died. Graphs and numbers emerged. In the space of just a few years our conscious mind had a new access to information about our physical insides. For some, and especially for panickers, this internal picture is enough to shift focus away from real life.
Understanding this fact alone does not in itself provide a response. You have to find a way of living with it instead. You need to un-learn the extra facts that the conscious mind has learned. Forget your essence. Remember your existence.
III.
You can take a pill.
There are many on the market. Mostly you need a prescription and advice from a medical professional or nurse. Do not consider herbal remedies. They are just taking your money. They do not work. Medicines fall into two main categories; anti-depressants and sedatives. Not everyone can use anti-depressants and in some ways they only mask the problem. I tried an anti-depressant called "--" but I never even made the ten days that you need for it to kick in because of fear. Anti-depressants can actually make panic attacks much worse. Some day you have to stop using them.
A good example of a sedative is “—“. I took a low dose, just 10 mgs. The effect was dramatic. It slowed me wonderfully to create a gentle heart beat allowing the muscles, which had contracted to prepare for death, to relax gently. It gave me the space to do the kind of programme that I am outlining to you now. Suddenly I had a walk on part in the film again. Eventually I became the central character again. Don’t take pills without doing the other actions I suggest here.
IV.
You can read the Bible or another book.
My mother’s respite was the church. On Thursdays and Sundays she would send her children to church school for instruction. An old couple who knew nothing about God ran it, and they would organise us into two circles and we would read from the Bible. I got to know pretty well most of the wisdom books, histories, and the Gospels and Acts. Later I found that Mark was the shortest and the most effective remedy. Everyone in the action, and those passing by to look, seem confused. Events happen quickly, snapping between scenes and racing through time. I found it absorbing. It lifted me from my situation. Find a book that does this for you. Keep it alongside this pamphlet and remain on task.
V.
You can think of all the others.
Many people suffer from the condition. We talk about it little. Find out who you know that suffers also. Collect their stories and consider putting these into your own script.
I have collected many stories. A man was waiting on a train platform. He was waiting for the train to arrive with his daughter on it. The train pulled up on time and as he stood up to greet the train there was a shadow, which had suddenly blocked out the sun. He looked up and he saw the wing of a plane silhouetted against the sky. It was falling like a bird, he said. It hit the train, right there in front of him. His daughter was not on the train because she had been late for it. This made his story more newsworthy. After this he began to suffer attacks. At first, birds were the immediate cause, but then they became general.
You are not on your own. Think about this. If you found someone who had the same experience you might find it easier to deal with your situation. You can talk it through. You can swap narratives. Be careful though! Many people, even friends, back off when they find that you have these needs.
Here’s a further tip. Don’t worry about time. Try not to look at the clock. This can be a problem at night when you are trying to sleep.
VI.
You can take your own life.
Some people conclude that. It is a valid point of view but not one I agree with. There are ways to deal with panic attacks, however bad they get. Don’t ponder or keep your eyes here for longer than you need to.
VII.
You can script your own story.
As I write these words I have a sense of me. I have the sense of the image of me writing and I have the image of a reader who is reading and creating their sense of the writer. As you read these words what do you have of the sense of you? Beyond your mind representing the printed words and displaying the conceptual knowledge required to understand what I write, is there something more going on, moment by moment, to indicate to you that it is you who is reading and understanding? Do you know where you will be in a moment? Do you see your future? Are you in the film or at the moment are you absent without leave? Are you here and not here? If you are to step into the light again, to enter the film, you will need a script. Won’t you? Write this now.
EXERCISE
Use this box to begin telling your story and writing your script. Write about the immediate past. Write intensely about what has just happened to you. Try to be as truthful as possible. If you are not able to be totally honest this time don’t worry, even if what you write is complete fiction. Next time you can get nearer and make things a little plainer. Sometimes you can only glimpse what you need to from the corner of your eye. Some sea spray catches your attention. When you move your head to look the sea has swallowed up the mystery again. Try to bring together all of the reasons, causes and effects. Be sure to create safe places. Picture yourself acting normal even in the most bizarre circumstances. Good luck!
How truthful were you this time? % Target for next time? %
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VIII.
You can do, and re-do these exercises. Keep writing.
It helps. Keep writing until your script and reality can become one. From writing about the immediate past, you need to progress to writing about the future, stretching the horizon a little each time.
You probably need only one or two pages per day outlining the essential future action. Most of the day will be concerned with hanging around or rehearsing. You need not include all of the dialogue. Actors often improvise.
The concentration in this is both a healing process and a diversion away from thinking about the body. The “at risk” body. Your poor despised body is waiting for easing, for cooler times, for the clearing of the full up feeling inside, for the chest pain that is real or imagined to ease and the breast-plate bone to unclick when you can finally stand up straight, and come ashore. Then you can stop hugging yourself and you can stretch. And you can again become sleepy, and then you can sleep. And it doesn’t matter about the time. Keep writing.
****™ Murder Mile Publications, Hackney,
James A Bullion - Written March 2004 ; Revised December 2007.
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