And I can tell you from experience it doesn’t work for panic, either. Instead, it made me more depressed than I had ever felt in my life. I remember telling a therapist later that I would have killed myself during that time but I was so apathetic I just didn’t have the energy to do it. I remember not being able to eat, because everything was dirt and clay in my mouth. And I started panicking daily again, off the Valium. I called my doctor and he was kinda short with me, and told me to double the Mellaril. That didn’t help, either.
The only good advice that he gave me was to find a therapist. I had already learned in my community college psych courses that meds are a band-aid, not a panacea, and that therapy would be necessary to make legitimate, enduring improvements. I first visited some clinic in Dallas that was supposed to specialize in anxiety disorders. I was in really, really, bad shape the day I went for my intake interview. It was around Christmas of 1990, the worst I have ever felt in my life. I had been taking the new dose of Mellaril, and to boot, I was sick with the flu. I remember being so disoriented from my anxiety and the medication that I wasn’t even sure if I was physically ill at the time, even though I was visibly shaking with the chills. So, I kept my appointment, on a dreary and rainy Texas winter evening. I remember being so nervous and shaky that I could hardly talk. The lady who did my intake was really sweet and sensitive, kinda grandmotherly, but she apparently didn’t have the authority to tweak my meds or intervene otherwise. She called someone else whom I never got to see, a Wizard of Oz of sorts, and almost seemed to be pleading with him or her when stating that “I have this young man here, and he is really anxious, and needs to see someone.” I was sitting there, shivering, excited about the prospect of something changing, but I was denied a visit with The Wizard for the time being. I remember sitting in the car in the parking lot afterwards, trying to conjure the energy and courage to drive home, and feeling scared in a new way because the notion of suicide was starting to feel like a legitimate option for the first time. And it wouldn’t stop raining, and my windshield wipers sucked. As with my first panic attack, there was this layer of creepy feeling that this was my destiny, that I had somehow known, all my life, that all of this would come to pass and that these were The Moments of Truth, unfolding according to some cruel prophesy.
I reluctantly called the anxiety clinic later in the week to discuss the next move, but the lady with whom I spoke broke the camel’s back. Inconceivably, she seemed insensitive, apparently not appreciating the gravity of what was happening to me. While talking about counseling, she told me something to the effect of “You don’t know how to live! You have no self-esteem.” I was so puzzled by her tone because she sounded critical and confrontational, the last thing in the world I needed at the time. Defensively, I said, “No, I’m actually very confident,” referring to my abilities as a functioning citizen, not quite appreciating the difference between self-esteem and confidence at the time. She corrected me, pointing out that the two are distinct, but again her tone was abrasive and condescending. I didn’t like where this was heading, so I didn’t sign up for that shit. And fuck you, bitch, for talking to me like that when I was damn near ready to die.
I continued in despair like this for a few more weeks, trudging through my job, pushing pencils over TPS reports with the hope of a slave or prisoner of war, until my appointment with a psychiatrist finally arrived. It was at the infamous Timberlawn, a private psychiatric hospital in Dallas. The place was somewhat legendary and had always been so dark and mysterious to me, like a haunted house on the hill where children had been murdered and eaten—or worse. I had heard that there were people there who cut themselves on purpose, a notion about which I was so horrified but kinda intrigued.
Well, it turned out that the place was very bright, clean, and nice. Even better, my doctor was not frightening in the least, but somewhat angelic, especially in the wake of the previous professionals before him. I remember him well, decades later, a Jewish fellow with afro-ishy hair; he reminded me of Ron Silver as Alan Dershowitz in Reversal of Fortune. He was calm and his voice was really soothing, slightly effeminate but not over-the-top. He wasn’t the least bit confrontational or insensitive like all those other fuckers. When I told him I was taking Mellaril, he laughed ever so slightly and just said, “Let’s stop that.” I immediately felt a tremendous sense of relief, knowing I was in better hands. He put me on imipramine, a popular antidepressant at the time used for treating anxiety disorders. He also gave me some more Valium, but just a few for emergencies. Okay, this all sounds much more reasonable. First glimmer of hope in weeks, since around Thanksgiving.
My favorite moment during the interview was how he asked me, tenderly but matter-of-factly, “Are you suicidal?” I paused, feeling embarrassed, but was so moved by the whole experience of being asked for the first time that I felt obliged to be open and honest. I looked down, avoiding his gaze, and said, “yes.” I didn’t cry, but part of me wanted to. His reaction was brilliant, in that he didn’t really react much at all, and he just quizzed me a bit more, a quiz that I myself have now given hundreds of times since: “I can tell you’re really upset and having a hard time, and I’m sorry … Now, lots of people feel suicidal from time to time. But I need you to tell me: Do you have intentions to harm yourself—are you in danger?” Energized by the whole interaction, I responded, truthfully again, “no.”
Unfortunately, Dr. Dershowitz would be the only skilled professional with whom I would interact for some time. We got my meds in order, but I continued to have panic attacks. They were definitely not as frequent as before, happening about twice a week instead of daily, but they remained just as frightening. Plus, during the down time, I was often worried about the next one that could happen at any moment. I had some agoraphobia as well, but it was kinda backwards from the traditional: Instead of having a fear of public spaces, I was more afraid of being alone because if I really did have a heart attack no one would be around to save me. So, for example, driving in the country was a reliable context for panic. But I couldn’t win: There was also a significant social component, in that I was also afraid that if I shit my pants or had a seizure in public the associated humiliation could almost be as bad as dying or going insane. Another cruel paradox was that drinking a few beers made me feel normal, even good, so that I was truly immune to panic when buzzed. Alas, a hangover was another one of the most dependable prompts for an attack. It’s true what they say about things going up having to come back down.
Disenchanted with the experience at the anxiety clinic, I figured I’d try just contacting a psychologist directly. Again, I turned to the PPO list for my insurance company and found a guy who was close to home. My sense was that he was particularly successful, but our therapy was pretty much a bust. We just talked, which of course was nice and maybe helpful on some level, but I don’t feel that we connected in a meaningful way, nor did we address the panic directly enough. Oddly, the conversation I most vividly recall is me telling him—sincerely, I wasn’t trying to be tacky or anything—about a recent blow job that led to the best orgasm I had ever had. My therapist suggested that perhaps it was so good because this gal was able to make me relax more than I had during previous sexual encounters, so I wasn’t worried about performance. That made a lot of sense to me, and I think he was right. But it didn’t help my panic attacks at all.
I moved to Austin that fall, in 1991, to start school at the University of Texas. That was the most exciting time of my life, getting away from home for the first time, reuniting with my friends who had made the exodus from Dallas to Austin before me, and becoming immersed among young, vibrant, beautiful, and open-minded people like I never had before. I recall walking around that campus, literally, with a big grin on my face as if I was the luckiest person alive. It was perfect.
Except I was still panicking. I soon signed up for a therapist at the university counseling center and was assigned to a youngish, Hispanic psychiatrist-in-training who was apparently doing his residency or some
thing. He kinda reminded me of how I might eventually be as a therapist, his suit obviously cheap and his tie askew, seeming slightly unsure of himself but smart and compassionate nonetheless. Indeed, we connected better than anyone since Dr. Dershowitz at Timberlawn. But this wasn’t enough, either. We conversed meaningfully, but again didn’t address the panic as directly as necessary. The attacks kept coming, even at school sometimes, so that I had to leave class every now and then because I’d start freaking out that I was gonna shit or piss my pants or throw-up or pass-out or something. I never did. I was actually doing really well at school, making straight As almost every semester. I loved studying, and would bust my ass doing so at least four nights a week. On the weekends, though, we partied like rock stars. Rock stars who really loved beer and pot. There didn’t seem to be any hard drugs in Austin back then, the good ol’ days. I hadn’t even heard of any white, powdery substances since I left Dallas.
Summers turned into falls, and falls into springs (there is no legitimate winter in south-central Texas). Imipramine was switched to Paxil, and John Mackovich—praise the Holy Name of Jesus—gave way to Mack Brown.
At some point, I learned that the psychology department (my major) had a professor, Dr. Michael Telch, who was apparently some sort of guru on panic disorder and was running a progressive treatment laboratory that was allegedly producing results that were virtually unheard of in psychology, some estimates of success being greater than ninety percent. Dr. Telch had been a graduate student of the venerable Dr. Barlow at Stanford, a name with which I was already familiar so early in my psychology education. I contacted the lab and signed my ass up.
Because the treatment was part of a research program there were both treatment and control groups; I was randomly assigned to a group that was obviously some sort of control. Mine was a group therapy format, about 10 panic-ers altogether, very open-ended, where we basically just talked about whatever we wanted, but of course anxiety was often center stage. Our group leader was a really good listener, and really pretty. I enjoyed going to those meetings. All the patients were sweet people; no one was the least bit obnoxious. Everyone was self-conscious and sensitive, apparently to a fault. But if the world was more like my group, there would be no war, that’s for sure.
When that didn’t work (as it wasn’t expected to), the same group was provided the experimental treatment, which was supposed to work. It was a cognitive-behavioral exposure therapy, analogous to what might be used to treat, for example, a specific phobia of spiders. The idea is not new, the bottom line being that if you face your fear—in increasingly manageable doses as supervised by a therapist—the fear will eventually lose its steam. Over 300 years ago, philosopher John Locke described the process of what is now called systematic desensitization (although I suspect he wasn’t the first, either):
Your child shrieks, and runs away at the sight of a Frog; Let another catch it, and lay it down at a good distance from him: At first accustom him to look upon it; When he can do that, then come nearer to it, and see it leap without Emotion; then to touch it lightly when it is held fast in another’s hand; and so on, till he can come to handle it as confidently as a Butter-fly, or a Sparrow. By the same way any other vain Terrors may be remov’d; if Care be taken, that you go not too fast, and push not the Child on to a new degree of assurance, till he be thoroughly confirm’d in the former.2
And so, through the longest run-on sentence of the Enlightenment, Locke captured the essence of anxiety treatments that we use regularly today.
Seriously, this really is how we do it. If you are afraid of spiders, we find something spider-like that you can handle, something that arouses your anxiety to about a 4 or 5 on a 10-point scale. For some—no kidding—this might be simply saying the word “spider.” Once you have confirm’d your assurance of that task so that your fear decreases to a 1 or a 2, we raise the bar and find some other 4-5 stimulus to get used to, which might now be a cartoon drawing of a spider. We keep doing this until you’re ready to hold a dead spider or even be in the room with a live one.
If you have a fear of contamination we do the same thing but switch dirt for the spider. If it’s speaking in public, you give me a speech and we work up from there. Such exposure therapy is also part of treatment for trauma (you telling your story of victimization is one potentially feared stimulus to engage). Exposure can even be used in treating personality disorders. For example, a narcissist may become accustomed to failure if exposed to it in manageable doses and processed with a skilled therapist. Of course, some exposures are trickier than others because the feared stimulus is not readily accessible, but there are options. For example, with a fear of flying some of the exposure can be done via virtual reality. And so on.
With panic, much of the exposure involves provoking peculiar physical and psychological sensations. Leading theories assert that people who suffer from attacks are sensitive to internal cues, that is, bodily sensations that trigger a “false alarm” that the person is in danger, thereby activating his “fight or flight” response unnecessarily. Such internal cues include dizziness, heart palpitations, and shortness of breath. So, we practiced becoming accustomed to spinning in chairs, jogging in place, and breathing through a straw (not at the same time, at least at the beginning). For some patients, the primary trigger for panic is depersonalization—the strange feeling that one is not himself, as if he is stuck in some sort of waking dream. To approximate such experiences we were instructed to stare into a mirror. Turns out that staring into a mirror for 10-15 minutes can create some very peculiar subjective experiences. No kidding: I hallucinated, and it wasn’t trivial. In fact, one time when doing this away from the lab as “homework,” I panicked and had to call someone to calm me down. The other very interesting exercise that might surprise you is that we breathed from a bag of carbon dioxide. Apparently, many patients are “chronic hyperventilators”; perhaps due to chronic, low-grade anxiety, they don’t breathe as deeply as normal and instead do so in a choppy, shallow manner. Breathing as such disrupts the proper ratio of oxygen to carbon dioxide in the body which can contribute to uneasy feelings leading to panic. All that hippie crap about taking slow, deep breaths to relax isn’t just annoying mumbo-jumbo; there’s a medical explanation for why that feels good.
Well, as clever as all this may sound, I was part of the 2-5% or whatever who didn’t respond to the treatment and kept panicking just as before. Fortunately, for ethical reasons, I was not shoved out the door but provided a graduate student therapist-in-training instead so we could keep on truckin’. My therapist and her supervisors must have thought I needed a lot of help, because we began with twice-a-week, one-and-a-half-hour sessions.
Jessica and I connected very well and would ultimately cure my panic. We continued the exposure therapy at first but it didn’t seem to help, again. I suppose she just needed to see for herself. But we talked about everything, much deeper than I had with my previous therapists. I dove in headfirst, caution to the wind, not hiding anything. I told her about how there had never been any affection in my home, that the only self-esteem I got from adults came from teachers at school. I told her about how hard I was spanked as a kid, and how I was forced to sit at the kitchen table for what seemed like hours because I was too “finicky” and food I couldn’t eat would not go to waste. I told her about all the drugs I had done. We talked about sex and masturbation and fantasies. I told her about the time when I was a little kid and found a baby blue jay wandering alone in the middle of the street. I didn’t know what to do because I had been told you weren’t supposed to touch baby birds or their moms might reject them. I ran inside to tell my parents but couldn’t get any help. When I ran back outside to do something, it was too late: It was a blue pancake, the car that had run it over being nowhere in sight. I told Jessica how I was crushed, destroyed, because I had made a bad decision and wasn’t able to save the baby by myself. All I fucking had to do was corral it out of the street without ever touching it. It would have been so e
asy.
And we talked about my deteriorating faith. I had grown up in a very God-fearing home: Although the emphasis was on the fear, I had always had a legitimate, functional relationship with Him. Even in college, despite not having been to church in years (outside of weddings and funerals), God had remained central to my life and identity. But it was college education that chipped away at my faith, and as doubt began to overtake me I was starting to feel “bitterly disappointed” just as predicted by Kurt Baier cited in chapter 1 of this book. I remember Jessica attempting to soothe my existential distress by noting that “there are different degrees of belief.” This felt like another challenge to my “black-and-white,” “all-or-nothing” thinking problems at the time, as she was trying to argue that one can believe without believing 100%. But I couldn’t buy into it. Once the seal broke on my doubt, there would be no stopping it, just some delays.
One day, while talking as such (I honestly don’t recall the specific topic; it could have been anything from God to masturbation), I had a full-blown panic attack right there in that little, windowless, almost-claustrophobic excuse for a therapy room. I remember feeling it coming on: I began to feel unreal, a little too present in the present moment. And then a sense of doom, as if something catastrophic beyond my imagination might occur soon, like the sun might explode and annihilate all of existence. My ears buzzed a little and my vision became grainy. It was hard to speak, but I managed, “I’m starting to have one now.”
Like Dr. Dershowitz, her reaction was remarkably calm; she might have even have smiled, just a little, and not inappropriately. She took my hand gently but it wasn’t soothing as one might predict. Instead, it added to the discomfort but, classic David Landers, I didn’t dare say this out loud for fear that it might make her uncomfortable. Then, the panic washed over me, that tidal wave of doom and tension and incoherence for the thousandth time—no, this was actually the first time this had ever happened. But then it passed, like it had a thousand times before.
Optimistic Nihilism Page 4