Fear is a normal physiological response to danger. I was hiking along a stream when I suddenly saw a venomous copperhead snake coiled, ready to strike, right in front of me. Another step or two and it would have struck. Fear took over and did what it is designed to do – I froze, backed off, and ran away. Fear is innate. There is real danger. Freeze, flee, or if all else fails, fight the threat. My wife and I were once camping in the desert. She asked a local rancher what to do if a diamond back rattlesnake got in our tent. The old boy thought for a minute and said, “Get the hell out the tent.” Good advice.
Anxiety is apprehension, uneasiness of mind, a restless dread of some evil. Whereas fear fades when the danger is past, anxiety may hang on. It produces an energy that can cause us to be unable to sit still, think clearly, or relax. Extreme anxiety can stop you from sleeping or functioning in normal daily life. Anxiety may be caused by social or environmental factors like past trauma or abuse, stress, unrealistic expectations, accidents, injuries, or discrimination. It may also have a physiological or pharmacological connection, so it should be evaluated by competent physicians and pharmacists.
Panic is sudden massive terror, mortifying fear, that often is accompanied by tachycardia, cold sweaty palms, and lightheadedness.[1] Cardiac issues can cause identical symptoms, so it is vital for anyone experiencing a panic attack to be thoroughly checked out by a cardiologist and an electrophysiologist. Supraventricular tachycardia mimics panic and can be permanently cured by cardiac ablation.
Whereas fear is normal and acute, anxiety can be chronic, producing a nervous personality. The sudden massive terror, mortifying fear of panic stops you in your tracks, but it won’t kill you. It will normally pass on its own, although it can seem like forever for it to do so. Medication coupled with psychotherapy are indicated for both chronic anxiety and episodes of panic.
I’ve experienced a lot of both anxiety and panic in my life. I was an anxious child –trembling, sometimes crying, afraid of death, dying, heaven, hell, God, losing my parents, illness, being rejected, not fitting in. I was so anxious about losing or failing that I wouldn’t participate if I thought failure was a possibility. A lack of physical nurture, a culture in which certain feelings (especially anger) were labeled as “bad,” marital strife between my parents, family secrets, and other environmental factors produced an anxious little boy. Perhaps there are genetic or intergenerational factors as well.
Some of what I thought were panic attacks may have been caused by undiagnosed supraventricular tachycardia, which was finally diagnosed and treated by cardiac ablation only recently. Since the ablation, I’ve had no further episodes of tachycardia. Supraventricular tachycardia (SVT) would hit me out of the blue. Suddenly, my heart would race, and I would feel dizzy and weak.[2]
But, I’ve also had full-blown panic attacks, sudden massive terror, and mortifying fear, both before and after the ablation.
For me (everyone is unique), panic attacks are different than SVT. Something (often unidentifiable) triggers me, and I’m overwhelmed with sense of massive terror and dread. I can’t sit or stay lying down. If I’m in bed, I will bolt upright, snatch on some clothes, and walk briskly outside. All the scripture quoting, devil-rebuking, praying, calming apps, gentle music, deep-breathing, and meditative practices that normally help me in daily life are impossible. Energy is surging through my body. My wife tries to help, but I can’t listen. In my case, the panic usually happens in the dead of the night.
Then I become afraid of panicking, so the next day, I’ll feel a great deal of anxious energy as I dread the coming of another night. Eventually, my body becomes so exhausted with lack of sleep that I collapse and sleep for a few hours. Fear of fear becomes a self-fulfilling prophecy. Whereas the supraventricular tachycardia episodes would typically last for five or ten minutes (although one went on for hours), the panic attacks I’ve had can go on for days with waves of panic at night interspersed with more generalized anxiety during the daylight hours.
What triggers these panic attacks remains a mystery. In my teens, severe panic attacks seem in hindsight to have been connected to existential angst, meaning of life issues, deep questions about who I was. In my mid-30s, I lost my marriage, my career, my identity, and my son to suicide. Extended periods of panic ensued. Recently, issues have been coming up in therapy, I briefly stopped taking my antidepressant medication (because I had COVID, and it was contraindicated with Paxlovid™)[3], and I’d been reading a dark postmodern encyclopedic novel filled with very realistic descriptions of what is going in the minds of mentally ill, addicted, abused, and suicidal people.
Fear is normal. It protects us. It can save our lives. It needs no treatment.
Anxiety can effectively be treated by a combination of medication and talk-therapy. Both together are much more effective than either alone.
Panic requires the intervention of a seasoned psychotherapist combined with the careful administration of psychotherapeutic medication. Psychologists (who have either a Ph.D. or a Psy.D.) are the best trained interventionists for severe panic disorders, and psychiatrists (MDs) have the strongest background in psychotherapeutic medications. Finding the right medication at the right dosage often takes time and involves trial and error. Similarly, finding a therapist with whom you connect may also take time. In both cases, it’s worth it. A life free of panic attacks is a gift beyond description for those of us who know the depths of terror.
A good place to start is with your family physician who can recommend the specialists needed. Local mental health agencies, wise clergy, the American Psychological Association[4], the American Medical Association[5], and top-notch healthcare systems[6] are also good places to seek referrals.
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[1] https://www.etymonline.com/search?q=panic (Accessed 7 September 2024) says that the etymology of the word “panic” comes “from an earlier adjective (c. 1600, modifying fear, terror, etc.), from French panique (15c.), from Greek panikon, literally “pertaining to Pan,” the god of woods and fields, who was the source of mysterious sounds that caused contagious, groundless fear in herds and crowds, or in people in lonely spots. In the sense of "panic, fright" the Greek word is short for panikon deima “panic fright,” from neuter of Panikos “of Pan.”
[2] Supraventricular tachycardia is caused by an electrical short-circuit in the heart. The electrophysiologist finds the errant circuit and cauterizes it. The procedure is painless and relatively very safe.
[3] Paxlovid (a combination of nirmatrelvir tablets and ritonavir) is a registered trademark of the Pfizer pharmaceutical company
[6] Such as the Mayo Clinic, Johns Hopkins, Stanford, or Mass General
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