I have panic disorder. I am usually living my life in a baseline state of anxiety, but on occasion, something will ignite a full-blown panic attack. Sometimes I am having a trauma response, because I suffer from PTSD and sometimes something triggers a flashback, which in turns triggers a panic attack. But not all PTSD episodes necessarily entail panic attacks. Sometimes I will simply get overwhelmed from sensory input because I am autistic, and I will be nonverbal or simply need to shut down for a while. Again, this does not necessarily mean I am panicking. And sometimes I panic because of completely unrelated things.
When I panic, it feels like my heart is stopping, or that my guts have been turned inside out, or that some sort of massive steam shovel or something has pulled out all my insides and rearranged them and dumped them into random places in my body. Sometimes I feel like the walls are falling in on me, and I can feel the space I am in (or at least my perception of it) going dark. Sometimes I start self-harming by punching myself or slapping myself or punching walls or hard objects or hitting my head against them. Sometimes I become dissociative and do not remember the incident. Sometimes none of these things happen and it manifests quite differently.
I had a panic attack this morning. I was on the subway with a whole bunch of people, and suddenly I started panicking. I was already primed to feel overwhelmed and vulnerable because of the events of the previous day and that morning. I felt like the walls of the subway car were collapsing, that the tunnel I was in was sealing me in, and I couldn’t breathe. People around me were looking concernedly at me and offering help but there were too many people and I got overwhelmed by the attention and the sensory input. Somehow I managed to mumble something—I don’t remember what, I think it might have been “I’m autistic” or something similar—and people backed off enough for me to escape at the next stop and go above ground. I don’t remember where I was, but my legs took me automatically to where I was going. Somehow. I ended up okay, but it was scary as heck.
And that’s the thing. I usually end up okay. In fact, I pretty much always end up okay. Even having that knowledge is a very powerful weapon in my arsenal I can deploy against panic attacks. I once took a class in techniques for dealing with anxiety and panic, and over time I have developed my own coping mechanisms to add to these. Now, sometimes it takes me a long time to actually become okay, but I do always know that I am going to get there. I didn’t used to have this knowledge, and panic attacks were much scarier back then. It was the kind of thing I could be told over and over and over, the kind of thing I could “know”, but not the kind of thing I would really “know know”.
My friends often ask me what is the most useful thing they could be doing for me when I have a panic attack. People often want to help. I understand this. When a friend of mine is in distress, especially obvious distress, my first instinct is to help. But often my friends are confused as to what practical action they could take that would be helpful to me. Hence the need for me to write some of this stuff out.
The most useful thing you can do is to sit quietly by me, or say “I’m here”, and then leave it at that.
I really just need to know that people are listening. That’s all.
If I need something specific I will usually ask for it: “someone please tell me to take my meds”, or “someone please tell me to get a glass of water”, or similar. This is because during a panic attack I often know exactly what I ought or have to do in order to free myself of that state, but I am unable to get myself to do it unless someone or several someones tell me to do it. So often I will ask for that. If I don’t ask for it, please don’t tell me to go do anything specific. Just let me know you’re there.
Sometimes I tweet or do other Internet things during a panic attack. I do this under “normal” circumstances, and it is not a sign that I’m “not really” having a panic attack. Tweeting is essentially thinking out loud for me. If I am tweeting during a panic attack, and I say things like “help” or “what do I do” or “I’m having a panic attack”, the most useful thing you can do is to say “I’m here” and leave it at that. Please don’t give me advice or tell me to do things if I haven’t asked you to do so, same as if you were with me in person and I were having the panic attack then.
Please do not touch me unless I request it and you feel comfortable touching me. If you offer touch to me please give me the chance to decline. (You may also decline without shame if I ask for touch and you are not able or do not wish to give it; consent goes both ways and even in my most panicked moments I will be standing by this.) Touch makes me very easily overstimulated and I need to not be overstimulated when I am panicking. This goes for touching my person just as much as it does for emoting touches at me in text online. I am very sensitive to both.
Do not tell me that panic attacks are “normal” or that “they happen to everybody”. I know these things, but in the moment I do not care because it feels very trivializing. Do not tell me that I am having “too many” panic attacks. I already deal with enough self-hate and I don’t need to further internalize the ableism of people who think this is the sort of thing I could fix if only I were to “just take a deep look inside” myself. If you tell me things like this, I will read it as a sign that you do not wish to listen to me and that you do not really wish to be my friend.
In short: if I am having a panic attack, please let me know you are there, and you are listening, and then leave me alone. If I need additional help, I will ask for it.
Being open about having anxiety, panic disorder, dissociation, PTSD, autism, and a whole host of related issues has done a hell of a lot of good for me and my mental health. I have learned that I am not the only one to go through things like this (again, that’s one of the things I used to “know”, but not “know know”—same as being trans, now that I think about it). Learning some of the vocabulary for dealing with these things has done wonders. I am convinced that knowledge is power, and knowledge of the names of things confers power over them. When I learned, for example, what catastrophizing was—imagining the worst possible scenarios, spinning out all kinds of improbable and unbelievable woes and consequences of everything negative in my life, and convincing myself they were going to happen—I suddenly realized that I was not alone in doing it. I’d thought I was the only one ever to do this. By knowing its name, I was able to recognize it when I started to do it. I may not have been able to stop myself from catastrophizing, but I was able to say to it, “Hello, catastrophizing, I see you again.” It still wasn’t my friend, and I still didn’t like it, but at least I could recognize it. And recognizing it was the first step towards gaining power over it.
Recognition is one of the most powerful tools I have in my kit. Having the knowledge that I have gone through this before and I have come through to the other side okay before is another powerful tool. Knowing that anxiety is maladaptive—that as a function it often does not serve the purpose it is supposed to serve—is a powerful tool. And having the knowledge that friends are there for me, by just having them say “I’m here” and nothing further, that is a very powerful tool as well.
My understanding of all of this is imperfect. But I’m learning slowly, adding to the toolbox as I go along. I have come to terms with the fact that I will never be able to eliminate anxiety and panic, the fact that I will always possess a somewhat low-threshold “overloaded” or a “too much sensory input” state, the fact that I will sometimes have panic attacks but that I have come out of them before. I am learning slowly. I’m not perfect and I will never be perfect. But I will learn and I will improve. I will persevere, because the alternative is to give up. And I won’t do that. Promise.