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I keep having panic attacks at church. I don’t really know why. I have been having difficulty in crowded places — I think that is part of it. And maybe part of it is that my mind is coming to associate church with panic attacks. I go to church afraid I am going to have a panic attack. I get so nervous about it that I have a panic attack. That’s how panic attacks seem to work. I worry about panic attacks, which causes me to have a panic attack, which causes me to worry about them… It’s a vicious cycle.

Anyways, I know some of my friends and people in the church have been wanting to support me in this struggle, but don’t know exactly how. I thought I would write out how they can be helpful or unhelpful.

1. Please don’t stare at me or come up to me when you notice I am starting to panic.

This is when I am using my coping skills to try to stay calm. When people approach me or even just look at me intensely, I get self-conscious and my anxiety rises quickly. I get easily startled when anxious. People approaching me startles me, and it makes it harder to be calm.

2. Please don’t follow me when you see I am leaving the room due to a panic attack.  

When I am having a panic attack, I need to be alone. I need fresh air. I need space. I need rest. I appreciate people following me outside to see if I am OK, but I’m embarrassed about people seeing me in that state. In the end, it’s really not helpful, it just stresses me out.

3. Please do check in with me later to see if I’m OK.

I mean much later. Like in the evening if I had a panic attack in the morning. It usually takes me a few hours of rest to recover from a panic attack. When I am calm again, it is so encouraging when a friend asks me how I am.  And with my anxiety, a text or email is less stressful than a phone call because sometimes phone calls overwhelm me. Text me or email me to make sure I’m OK.

4. Make plans with me in the future.

Panic attacks can be so isolating. I feel so alone afterwards. I need time alone to recover from them. But after I’ve recovered, I feel distant from other people. Show me I am still valuable to you by making plans with me sometime soon. Let’s get coffee, go out to lunch, catch a movie. Show me I still matter to you, even when I’m having some problems.

5. Don’t press me to share details about what happened.  

I’m embarrassed sometimes that I have these problems. I am fine with you asking general questions like, “What is like to have a panic attack?” or “How do you cope?” But please don’t ask me to give you a play-by-play. It was embarrassing and traumatic and honestly, I don’t want to think about it too much. If I start thinking about panic attacks, then I have more panic attacks.

6. Listen to my story without judgment.  

I know panic attacks don’t make sense. They’re not logical. Mental illnesses are not always logical — they are illnesses. It often helps me to talk things over with people. But please don’t try to diagnose me, or judge whether I handled everything well. Please just listen and give me grace.

7. Give me permission to keep having panic attacks.

Sometimes I feel like there is pressure on me to “just stop,” to recover from my problems and be “normal.” I am working hard to be healthy. But the panic attacks may continue for a while. Please try to be OK with that. I am doing my best. I might keep leaving places due to panic attacks. Or maybe I won’t show up places, afraid of being triggered. Either is OK. Show me that either is fine. I am OK the way I am.

8. Ask me how you can help.

There might be something I need or something you can do in that circumstance. Again, don’t approach me right before, during or after the panic attack, but when you check in with me later, ask me if there is anything you can do to help. I don’t know if I will have any ideas, but it is so nice to be asked. It’s nice to know you are there for me.

9. Remind me you still want to be my friend.

I know panic attacks are not very “attractive.” I don’t like the nervous, scared person I seem to be when I have them. Show me in small ways that you still want me in your life. Show me I am OK just the way I am right now. Even if it’s just smiling at me when I come into church, or inviting me to parties, even though I might not feel up to coming. Remind me that you still want me around.

I have wonderful friends who have supported me through my mental illness. But sometimes people don’t know how they can be supportive. Hopefully this list can help.

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As a child, I hated the feeling of sand. I loved the beach and I didn’t mind sitting on a towel, but whenever one of my parents lifted me up to put my feet down in the warm, grainy sand, I’d scream. My parents thought I was “quirky” but, really, it was obsessive-compulsive disorder (OCD).

You see, I received what I consider the shittiest outcome of genetic roulette. As the oldest of three, it’s me who has to struggle with major depression, anxiety, panic disorder and OCD. In fact, despite not knowing a life without mental illness every day still poses a challenge. Sometimes, even the most mundane of tasks — like showering or doing the dishes — seem monumental. They seem akin to some monumental task like trying to win a Nobel Peace Prize or climbing Mount Kilimanjaro.

The worst of it culminated in my senior year of high school. After years of struggling with dermatillomania and trichotillomania, as well as depression and OCD, I finally had a mental health crisis. My hands, feet, and arms were covered in open wounds that clung to my grey uniform sweater and I started feeling exceptionally anxious in two particular classes – English and environmental science. It was almost comical in a dark sort of way, since English was one of the classes I excelled in. Suddenly, though, I couldn’t focus. My heart would race, I’d begin to sweat, I’d tap my foot so hard against the floor that my desk moved, and I couldn’t seem to shake the feeling I was going to vomit. After frantically getting up and leaving the room during a midterm exam, my psychiatrist diagnosed me with panic disorder, though the diagnosis didn’t do much. I attempted suicide and, after being released from a five-day stint in a psychiatric hospital, I was told I didn’t need to return to school except to walk during graduation.

I spent the last two months before graduation sedentary in my bed. Graduation came and went, and I missed out on the best part of high school. Things didn’t get better for me though – in fact, they got much, much worse. The summer passed and, eventually, I stopped eating, showering, and getting out of bed other than to use the bathroom. I isolated myself, stopped responding to texts, and basically cut myself off from the world. It was then that I brought up electroconvulsive “shock” therapy (ECT) with my psychiatrist and was advised (by him) that I should un-enroll from my first choice college because I would more than likely flunk out in the state I was in.

What had started off as a life of constant annoyances and anxieties had somehow transformed into a fight for my life, and so I made the decision to start ECT. With an aching heart, I un-enrolled from the college in Boston I was planning to attend and I gave my parents permission to break the lease on the beautiful apartment I had been planning to live in. Instead of celebrating “thirsty Thursdays” and going to themed parties in college, I was receiving shocks to my brain on Mondays, Wednesdays and Fridays that left me tired, achy and struggling with temporary memory loss. While my depression began to improve, my panic disorder grew worse and I found myself driving to empty parking lots and sitting in my car instead of attending class — not because I didn’t want to go, but because I was absolutely overwhelmed with anxiety. That’s what led me to dropping on-campus college and enrolling in an online college.

To be honest, my psychiatrist, and even my parents, didn’t think I’d see the day I could call myself a college graduate. I, on the other hand, was determined to prove them wrong. Although it took months of online classes and sometimes biting off more than I could chew, I ended up graduating from Southern New Hampshire University in the summer of 2016 and earning my BA in Creative Writing and English. Though I didn’t live the typical “college experience,” I obtained my degree and overcame all the obstacles my mental illnesses threw at me. I still struggle every day – I’m not going to lie and say I’m cured or doing much better – but I’m determined to achieve what I want out of life and I’m never going to allow my mental illnesses to stop me.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

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Last weekend, I cried.

I don’t cry much. When I do, it’s often because I’m hearing someone else’s pure pain and sorrow. That happens a fair amount when you’re a therapist. I may not allow the tears to break from behind my eyelids, but they’re there.

I cry when I feel loss or grief. I’ve wept openly when loved ones have died. I cried buckets over a friendship ending years ago. I cried trying to get used to my son being gone to college and still tear up a little when I leave his world, and reenter my own.

But last weekend, my tears were unexpected, and in front of a handful of people. I wasn’t embarrassed — that’s not true, I was a tad embarrassed — but I was mainly surprised at the need to get back in control and breathe.

What was the circumstance?

I was at a rehearsal of the “This Is My Brave” show, telling the tale of my own panic disorder.

Now, if you’ve been reading my blogs for a while, you know I’ve already talked about having panic. I’ve told the story about being accosted by my psychiatrist’s receptionist, as her curiosity got the best of her. She asked what exactly was wrong with me. I’ve written about my panic emerging, and how I fought off the realization I had a mental illness. I’ve revealed panic can cause me to tremble and shake at unexpected times. It happened at my mom’s funeral, for example, as I followed her casket down the middle aisle of the church.

I’d imagined talking about it in a speech would be a breeze.

Yet, last weekend, as these words started to come out of my mouth, my voice was suddenly jerky and I stopped breathing.

“Perhaps if you’ve ever talked with me one on one, you may notice I often lean against the wall, or steady myself with a chair. That’s my anxiety.”

I felt exposed. I was letting out a secret. I was choosing to allow people into my real world, the world behind the persona I create. I was handing over the keys to my hiding place, to anyone who might be interested enough to go in and take a peek.

But it wasn’t over yet.

“Anxiety was invading my life. I didn’t mind so much the panic itself. It was the shaking. I hated that my anxiety — my vulnerability — showed.”

That was it. Now I was being totally honest. It’s not that I have a problem or a mental health issue, that was, or is uncomfortable and even painful. It’s that others can see it. I can’t hide it — at least not all of the time.

I felt incredibly vulnerable. And tears were there to remind me of that fear.

I did everything I could to shut up the voice yelling at me inside my head. You’re a psychologist. It’s your job to help others achieve change they need and want. Now you’re choosing to let people know not only that you struggle, but you’re going to tell them how they can tell you are? You’re “nuts.”

I may feel “nuts.” But my choice is clear.

I’m not ashamed of my vulnerability. If I can help one person who hides their struggle, then reveal, I will.

It’s me, being real. It’s me, being totally honest.

If I cry as I do it, then so be it.

You can hear more about panic and many other topics by listening to Dr. Margaret’s new podcast, SelfWork with Dr. Margaret Rutherford.

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Thinkstock photo via Pimonova.

When we talk about anxiety, we tend to say the same sorts of things.

“You will learn to manage your anxiety.”

“You will learn tools to ease in and out of panic attacks.”

“You will figure out what works and what doesn’t.”

“In the end, you will come out a wiser, more balanced person.”

We like this version of things because it’s full of hope and light and for the most part, it’s true. Sometimes, though, the line is a little curvier than that.

Yesterday, I went to a presentation on domestic violence. I sat in the second row in the seat closest to the wall and turned my chair slightly sideways, because it makes me feel safer to have my back to a wall. A row in front of me on the opposite side of the room, a boy mirrored my position. He wore a baggy sweatshirt, a backpack and a noticeable frown. One of his hands rested on the table and the other, in the pocket of his sweatshirt. There was no danger, no reason, but I panicked. I convinced myself the bulge in his pocket wasn’t just his fist, but a gun, and at the end of the presentation he was going to take it out and do something unspeakable. My heart rate spiked, my breathing became shallow and the rest of my body quickly followed into a full panic attack.

This isn’t the first time this has happened. Last month, I had to leave class because I had a panic attack while we watched a documentary on masculine violence in American cinema. That same week, I went to the park to call my parents and saw a fight instead. Teenage boys, shoving and punching and yelling at each other. On the phone, I asked my dad what I should do. Intervene? Call the police? He told me to leave before I got shot. My friends said the same thing later that night. They weren’t wrong to be worried because the month before that, one of my classmates did a local news presentation with security camera footage of a fight that ended up with one of the people being shot at a gas station near our college.

This thing, this violence trigger, has been a long time coming, but that doesn’t make it any easier to accept. I never thought here, years later, I would develop a new trigger for panic attacks. I thought I could identify the triggers I had, learn the tools I needed to learn and will myself to a more manageable level of anxiety — but here we are. Dealing with anxiety is not a straight shot towards a balanced, happy life. There are curves in the road — new triggers, new roadblocks and maybe old, unhealthy coping mechanisms. But with effort and hope, it can still be part of your upward trend. Instead of succumbing to these panic attacks, I am identifying the trigger and I’m working through it. You can, too. Don’t give up hope.

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Although it’s been three years since my last full blown panic attack, my mind remains littered by debris. When I make plans to go out with my wife or plan an activity with my children, fear of an attack tries to jail me. These days I am a bit more able to barrel through fear and allow reality to stomp the lies my brain tells me. However, because healing from panic disorder is a process, hurdles remain. I sometimes feel flurries, but they are usually rebuffed by a combination of my medication and deep breathing. I still carry a safety pack of snacks and water whenever I travel by car and public transportation remains out of the question, although it won’t be this way forever. Because panic disorder plants doubt grenades in my brain, my pride related to remission of attacks is sullied by internal accusations I am not pushing myself out of my safety zones fast enough. Sometimes my inner critic refuses to give me a break.

I have recently started examining triggers and although mine are singular to me, I imagine others experience them. My attacks have all begun with a physical sensation in my digestive tract. My attacks usually happen while driving. I’ve been blessed to never have been hindered by attacks in my home, nor have I ever been woken up by panic’s grip. Still, my third panic attack of approximately ten full-blown ones scarred me and the world I used to explore with reckless abandon has gotten somewhat smaller.

For reasons known only to my disorder, subtle changes in bodily sensation sets off my alarm. I have never felt chest pain or shortness of breath, nor have I experienced depersonalization or derealization. My symptom is overwhelming nausea, followed by intense fear I will be publicly humiliated by spilling the contents of my stomach or colon for all the world to see.

Panic attack is the ignition of our body’s fight, flight or freeze response. I imagine if my attacks are triggered by sensations in my digestive tract, followed by mortification as a result of the world pointing its finger and laughing, therein lives my perceived danger. The moment panic strikes, I am compelled to flee until I reach bed or bowl where I am confined for days. Panic is never pretty. Once confined, my process of establishing safe distances from home begins.

My experiences have led me to question my perceptions of humanity and myself. It seems clear I lack faith no one will offer to help me if I am in distress. My mind has convinced me the masses will run, be disgusted or stare as if I am a freak. It seems unreasonable to think no one will help, but my roots grew in toxic soil. My mother spent years hospitalized with major depressive disorder and my father struggled to keep my home from unraveling. Constant turmoil left no room for hugs, affirmations or support. I believe my adult self believes if my own family was unavailable, strangers won’t be either.

Introspection also revealed my stringent use of intellectualization as a defense mechanism. I have a history of being afraid to be wrong. I loathe the phrase, “I don’t know” and I hyper-focus on self-image. I am also deathly afraid to be made fun of and I am sensitive to criticism. It seems if panic is going to thrive anywhere, it is going to thrive in a person wound too tightly. Recently, I have focused on letting myself be the butt of a friendly joke. I admit flaw and I am liberated by admitting I don’t know everything. Admitting weakness is how I outed myself as a therapist with panic disorder in the first place and it is a decision that is freeing me from the inside of my own mind.

In recent weeks, I have begun the practice of acknowledging physical sensations and trying my best to let them be what they are. If I feel a rumble in my gut, I note the change and it goes away. If anxiety brings about slight nausea, I note it, remind myself I am not in danger and it helps. Whatever glitches I feel in my body, I am certain millions of others are experiencing the same thing. I have seen people vomit in public and while the thought terrifies me, I have ever pointed a finger and laughed, nor I have seen anyone else engage in such mockery either. My wife always reminds me bodily functions happen to everyone and it is a thought that helps keep me centered. When I think about ways to counter fear of humiliation, I imagine myself  announcing to everyone I might have a panic attack and my insides might explode. I suspect should I just put it out there and destroy the stigma, fear will recede. It is a strategy I am moving closer to employing as I unravel the mystery of my illness. As more and more people hear about my experiences, my shame recedes and I move forward.

I don’t suspect these strategies will work for everyone, but I hope there are some out there who will relate to lack of trust and use of defense mechanisms to compensate for insecurities as root causes. Gaining our freedom from panic disorder is a process that begins with a look inside. As with any enemy, in order to vanquish it, we must get to know the process of our disorder intimately. Although it is not who we are, it is part of us and with most any part of us, there is hope of gaining understanding and mastery.

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One year ago today, I had wires protruding from my body and trailing out of my shirt to connect to a machine on my hip. Due to my symptoms of heart palpitations, chest pain and vertigo, the cardiologist I visited recommended I wear a 24 hour EKG machine to map my heart patterns. I remember the hope that accompanied wearing the machine. Maybe, finally, they will discover what is wrong with me so I can get the help I need.

I also remember the shame, embarrassment and fear at having to wear this obvious machine to work. I put on the bravest face I could and tried to stand confidently at my cashier post. It was barely an hour into my shift when I began feeling the chest pain and racing heart that had been plaguing me for months.

Over the next several hours, the left side of my arm and face went numb. I was confused and did not know what I was doing or why I was standing with cash in my hand. Electric shocks ran up and down the left side of my spine, ending with bright bursts at the back of my head. I felt the blood drain from my face and my body felt like it was in an ice chest. My arms and the left side of my face twitched, seemingly controlled by an invisible finger that was poking the left side of my head with force.

My thoughts were on loop. I must be dying. What is happening to me? Is the monitor getting all of this? I’m dying and nobody is noticing.

One year ago today, I was still a month away from being diagnosed with a panic disorder. It took hundreds of dollars, an obscene amount of doctors and countless desperate moments to get to the diagnosis.

I never want to forget the darkness and hopelessness that occupied my day last March 29th. A year out, the difference between then and now is like night and day. I need people to know if they are in a place of desperation and fear I was in last year, there is healing for them.

The journey of therapy and medication that led me to where I am now was, not by any means, easy. The path is rough—a parabola of hills rather than a straight incline toward health. Between then and now, I had to get a leave of absence from work. There were days when I was too dizzy or too nauseas to leave my bathroom floor. There was a month when I simply could not eat. My throat constricted at the introduction of food and I lost weight that left me feeling frail and breakable.

But today, this March 29th is a day I am celebrating with depths of joy. I no longer experience panic attacks. I no longer loathe my body for its confusing and debilitating physical symptoms. If I do experience anxiety, therapy has taught me to locate my triggers and how I can healthily respond to my physical reactions.

Today I am celebrating because I have been given a new life. My chains of anxiety and fear are broken and I have the privilege of looking back on last year with a completely new perspective. I have learned to love my body and what it teaches me about my internal emotional state. There is healing for you. The path is hard and you may get discouraged, but there is a possibility of a life without panic attacks.

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Thinkstock photo via Olarty.

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