Hold the Drugs, Please

Carrie Andrews 

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Writer’s comment: When I received my assignment for English 101, I immediately knew what I wanted to write about. Overcoming my anxiety disorder without drugs has been the most challenging obstacle I have ever faced. Anger and frustration accompanied me along this arduous journey, and this assignment allowed me to express these emotions on paper. After a brief brainstorming session with my computer, I had a solid base for an essay. I was amazed at how readily the words flew from the keys as I sat down to relay my experience. Writing this essay was highly therapeutic and surprisingly enjoyable. Jayne Walker’s astute criticism and never-ending support helped me to recognize the potential of this essay. - Carrie Andrews

Instructor’s comment: In English 101, I show my classes how a variety of writers create a sense of authority by deploying what Ezra Pound calls a “phalanx of particulars” from their own observations as well as from printed sources. Then I challenge them to do it themselves.
     Carrie Andrews, a studio art major, has a remarkable gift for sensory imagery. In this essay, she shows what it’s like to suffer from an anxiety disorder, and uses this vivid account of her own experiences to persuade readers that this disorder can be controlled without the use of medication.
     “Hold the Drugs, Please” transformed my understanding of anxiety disorders and their treatment. With its warm, engaging tone and vivid details, this powerful essay delights as well as instructs.
- Jayne L. Walker, English Department

Ninteen eighty-nine was the year I began to lose my mind. Slowly but surely, reality as I once knew it began retreating into foreign territory. I clicked and jerked through the parameters of everyday life. As I struggled to mask the inner distortion, no one realized that my quiet exterior shell was a pretense. The doctors called it an anxiety disorder. I called it hell.
     Every day, I would try to sit through class as relentless waves of panic washed over me. Try as I might, I could never seem to rationalize my way out. Week after week I found myself in the doctor’s office, certain I had some strange, elusive disease. Blood tests and urine samples became a regular routine as my doctor began ruling out possible physical problems that could be causing my agitation. Hypoglycemia? Not really. Mitral valve prolapse? Nope. Hyperthyroidism? Most certainly not that. OK. What was wrong with me, then? Was I going crazy? I knew that my symptoms were extremely physical. This was not a figment of a hypochondriacal imagination. Then, the fateful words: “I think you’re suffering from an anxiety disorder.”
     Boy, did that ever change things. I was immediately referred to a psychiatrist — an anxiety specialist, actually. Right off the bat, he wanted to do what so many doctors and psychiatrists do nowadays — put me on drugs. This prospect made me uncomfortable. Was I really going to have to find peace through a prescription? I felt it to be the quick “cure,” the easy way out. No way. Drugs were a way to cover up the problem, not solve it, and that was one road I was unwilling to travel. Somehow I knew that my panic disorder stemmed from a psychological basis, not a physical one, despite the very real physiological symptoms I was experiencing almost daily. How tempting it was to say, “Sure, give me some antidepressants, I’m sick and tired of these terrifying episodes.” But I didn’t want to become dependent on a pill. I wanted to know that I was functioning on my own two feet, not hobbling along on crutches.
     Doctors often prescribe antidepressants for panic disorder because of their ability to dull this panic response in the brain. “Tricyclics” (TCAs) or “monoamine oxidase inhibitors” (MAOIs) achieve relief by cutting off the physical and psychological effects of the panic attack. The past few years, I have found myself in numerous psychology classes which invariably mention drugs, such as Prozac and Zoloft, that are “selective serotonin reuptake inhibitors.” Serotonin is a neurotransmitter which is believed to affect mood; these SSRIs work by blocking or “inhibiting” the reabsorption of this chemical and seem to be effective not only for panic and anxiety disorders but for depression as well.
     Another means of controlling a panic disorder is the use of benzodiazepines. These are tranquilizers such as Xanax and Valium, which not only can produce uncomfortable side effects (drowsiness, uncoordinated movements and difficulty with balance) but can also become addictive. Despite these drawbacks, long-term use of benzodiazepines is still the most common treatment for panic disorder. As with antidepressants, once the medication is withdrawn, the smoldering embers of panic once more erupt into flame.
     My friend Lynn is someone who has surrendered herself to medication. Like me, she began experiencing panic attacks when she was fifteen, and she has been on and off antidepressants ever since. Right now she is taking Zoloft, but one day she wishes to wean herself from medication. Her life at this point is “too stressful” to deal with, and she fears an anxiety relapse if she attempts to drop the pills. There have been times in the past when she has tried to brave the world alone, without chemical aid, and the anxiety has returned full force. This, unfortunately, is a typical reaction. Studies have revealed numerous instances where anxiety sufferers attempt to drop medication, only to have the discomfort come barreling back down on them. Often times it doesn’t just come back, but it comes back worse than before. This creates a vicious cycle that is not only frustrating but very difficult to break. Lynn doesn’t like the fact that she has to take medication, but she likes the symptoms of anxiety even less. These hellish attacks return because antidepressants and antianxiety medications can only offer temporaryrelief. They are not a cure. If anxiety disorders were based on a chemical problem, then medication would be necessary, but there is no solid evidence of this being true. The most viable explanation is psychological, as my instincts told me at the time.
     After I refused the kind offer of an antidepressant, the first stage of my therapy began. I had high hopes for this anxiety specialist. I was eager to attend the first couple of sessions, until he tried to turn me into an obsessive-compulsive (OCD) case. He would fire questions at me. “Do you find yourself washing your hands frequently?” Well, yeah, but I ride horses and clean stalls, so my hands get dirty. “Do your hands feel dirty after using hand lotion? Do you feel a desire to remove it?” No, it feels pretty good, actually. Questions about my daily routine were followed by suggestions of altering those routines and doing things in a different order. I began to get irritated as the questions and suggestions strayed further and further away from myproblem — panic attacks. No matter what I said, he wanted to convince me, and himself, that I was obsessive-compulsive. He refused to listen to my protests and explanations. Finally I gave up on him, and left more frustrated and confused than when I went in.
     Convinced that no one would ever understand me, I felt incredibly alone. Fortunately, I knew a therapist who had helped me in the past, and while she wasn’t an “anxiety specialist,” I realized that she was someone I could talk to. My sessions with Susan changed my life. She listened patiently as I recounted for her the debilitating panic episodes, never invalidating what I said. After a couple of sessions, she made me realize that my sense of solitude was a false perception. In fact, according to the National Institute of Mental Health, one in every nine adults suffers from a phobic or anxiety disorder, making it the most common mental health problem in America. What a relief to discover that I wasn’t the only certified basketcase out there. But why? What causes anxiety to reach such a terrifying level? Sure, everyone gets tense, and everyone at some point in their life will experience anxiety — the jittery flutter of our hearts as we prepare to give a speech or to take an exam that we haven’t prepared for.
     The “fight or flight” response is a nice little feature that we, like most (or all) animals, come equipped with. This handy alarm system goes off when we are confronted with a situation that requires us either to fight or to turn tail and run. When this wire is tripped, adrenaline troops through our veins, accelerating the heart rate and elevating the blood pressure. This army of sensation is natural when we are in a situation we perceive as dangerous; experiencing these symptoms randomly is not. A panic attack is a false alarm — there’s nothing to be afraid of, yet you experience the alarm response.
     Learning to turn off this false alarm is the fundamental element in gaining control over an anxiety disorder. It’s also the most difficult thing to do. When the crushing wave of panic washes over you, the logical thought process disappears and your body begins to function on pure instinct. Susan confirmed my original belief that this disorder is psychologically based but manifests itself physiologically — first the thought, then the response. So by changing the way you think and perceive situations, you change your response. Sounds easy, right? Far from it. I could see why so many people give in to medication — the symptoms are not only uncomfortable but they’re debilitating as well. At times I found myself wishing that my problem were chemically based; it would be much easier to pop a couple of pills each day than to struggle with the cognitive reframing techniques Susan was teaching me.
     This process didn’t offer me instant relief or quick results. In fact, the opposite was true. For weeks I felt I was making zero progress, breaking into frustrated tears as I watched the world move past me. I would pace the house, knowing I had things to do but unable to bring myself to leave the security of my domain. Thoughts of all the potential “disasters” raced through my mind: what if I have a panic attack on the freeway (which happened all the time)? what if I get sick? what if I pass out? what if I die? I lived in world of “what ifs,” and that was what Susan was trying to get me to change. She had me start answering my own questions. OK. If I have a panic attack while driving, I can always pull over. If I get sick, the worst that will happen is that I’ll throw up on myself. If I pass out, well, I’ll probably bump my head, but it’s not the end of the world. And if I died, I wouldn’t have to pay for therapy anymore.
     She made me see that there was always an “out” to every situation. This was a big deal, because I felt so trapped in my disorder that it had utter control over my every thought and decision. As an agoraphobic, I never knew when, or where, panic would rear its ugly head, and that was terrifying. Sometimes I would wish that I had a specific phobia, something I could point at and say, “This is what is I’m afraid of.” My fear was of fear itself, and the panic attacks would be uncued and unexpected, striking anywhere, anytime.
     Panic disorder not only alters your actions, but it also affects your perceptions of the world. This is another step in the cognitive reframing process — changing the way you perceive life and its situations. Everything seemed to have a dark haze around it, a constant rain cloud that decided to hover only over me. I would get easily discouraged and frustrated, as each panic attack knocked my self-esteem down a peg. Susan had me set for myself small, realistic goals that were easily obtainable: “Don’t be afraid to take baby steps.” I wanted to make huge leaps and bounds towards getting my life back, but that was only leading to failure and disappointment, which perpetuated the negative perceptions. I remember being afraid to think, “Gee, I feel pretty good today,” because as soon as that thought poked its head into my consciousness, I had a panic attack. Every time. Negative thoughts trigger negative reactions, and while I was trying to tell myself that I felt good, there was no conviction behind it.
     But by achieving small victories, I began to gain confidence. I would congratulate myself for leaving the house. Even if I only made it half way through town instead of all the way, at least I took a step forward. Every success needed to be acknowledged and recognized. I began to let myself feel good, without fear of losing it. But again, this was a slow process. Five years it took me to truly master the technique of cognitive reframing. Five years of one step forward, and two back. But it was these little successes that slowly began to rebuild my confidence, and confidence is the foundation for any healthy living.
     Gradually, I have learned to relax against the panic, and by doing so, I have taken its power away. At the first indication of an attack, the crushing wave of unreality still knocks the wind out of me, throws me off guard, and renders me helpless as it saturates my senses. I never have time to prepare and defend myself. It makes me feel tremendous loathing and resentment, not only toward this invisible entity but also toward myself. I hate being trapped in this nervous body. Slowly, anger overcomes fear. I want my life back, dammit. Instead of fighting the shortness of breath and pounding heart, I begin to invite it on. Instead of saying, “Oh shit, here it comes,” I say, “I’ve experienced this before. I know what it feels like. And while it really sucks, I know now that I’m not going to die, and that it will pass. Bring it on!” As soon as I begin thinking this with true conviction, the panic turns away, defeated.
     I’m proof that this disorder can be conquered — without drugs. I think of all the people out there who are suffering from panic attacks or anxiety, and I wonder if they realize it can be overcome. While cognitive/behavioral therapy doesn’t work its magic overnight, the end result is permanent. Relapses can and do happen, but now that I have truly mastered these techniques, they hold no power over me. To this day, I still feel the panic biding its time beneath the surface of my confidence, waiting for a chance to snag me once more in its sticky web. I’ll never let that happen. Instead of beating me down permanently, my panic disorder has transformed me into a stronger person, causing me to refocus and become independent. If I can triumph over this, I can master anything.

Sources

Most of the information in this essay was obtained through my therapist, Susan Love. Some I learned from David Hardy’s course in Abnormal Psychology at Sierra College (Spring,, 1996). I also consulted the following print sources: A3.

DuPont, Robert L.; DuPont, Caroline M. “The Treatment of Anxiety: Realistic Expectations and Risks Posed by Controlled Substances.” Journal of Law, Medicine, and Ethics vol. 22, n.30 1994: 206-214.

Greenblatt, David J.; Shader, Richard I. “Use of Benzodiazepines in Anxiety Disorders.” New England Journal of Medicine vol. 328, n.19 May 1993: 1398.

Handly, Robert, and Pauline Neff. Anxiety and Panic Attacks: Their Cause and Cure. New York: Random House, 1985.