Don’t Call Them Panic Attacks

It was November, a bleak and melancholic time in St. Petersburg when it gets dark early, and the snow had not yet brightened the streets and people’s mood. I was 16 years old, sensitive, observant, and vulnerable. That day, after my English lesson with a tutor, I met my mother at the restaurant where she worked, and we went home together. It was unusual for her to leave the restaurant before midnight, and I cherished those special occasions when she did. On other days I would wait for her to come home, listening in my bed for the front door to slam. By that time the building was silent and dark, and when I heard that sound, I knew it was my mother. Once at home, tired, she wanted to shower and go to bed as soon as possible.

That day when we came home together, my grandmother and father were there. He was in a good mood, it was warm and cozy in the apartment, and that domestic scene appeared to me serene and endearingly normal. This was unusual, as my parents, while maintaining the appearance of a family, lived separate lives. My mother, unable to interest my father in family life, focused on her work as a chef. My father, unattached to anyone or anything, drifted between work and seeing other women, acting more like a free young man than a husband and a father. We rarely did anything together, and when occasionally the three of us went to a park, for example, I sensed that he would rather be somewhere else.

Watching that ‘happy family’ scene, I knew it was deceptive and ephemeral. I remember looking at my parents and grandmother and feeling tender about them. I smiled and then cried, and then suddenly I lost control of my body as a strong wave went through me from head to toe. It felt like a surge of energy that came from nowhere, but at the same time generated in my body. I got scared and thought that I might die in a few seconds. I started shaking, and I was unable to stop it. “I need to go outside,” I said, “I am feeling bad.” Cold air took the edge off the terrifying sensations as I stood in front of our building with my mother next to me. I kept breathing deeply, all at once beholden to that November cold. Back at the apartment, my fears of dying and shaking intensified. My inability to control my body and mind further aggravated my condition. I was trapped within myself and that was very frightening. “Please call the ambulance,” I asked. We did not have a phone at the apartment, and my father had to go to a phone booth to make the call. The ambulance arrived in a few minutes, but the doctor could not find anything wrong with me. Seeing me shaking, she suggested a tranquilizer. She gave me a shot and left. A few minutes later I could relax, the shaking slowly stopped, and I was able to fall asleep.

The next morning, I felt fragile, as if I were tired from crying the whole night. I went to school but could not focus on lessons or conversations with classmates. All I thought about was what if that horror would happen again. I did not have the right words to name it, as it did not fit any experience I had ever had before. I wanted to help myself, but I did not know how. I made it through the day, but in the evening the fears of death, and shaking returned. Before then, every time I got sick, my mother or my grandmother, especially, knew of some helpful remedy. For a stomachache — drink chamomile tea, for a cough — burn some sugar in a spoon over the flame on the stove, melt it in a glass of water and drink, for a sore throat — have a cup of hot milk with honey. But not this time. Neither my mother nor my grandmother knew what to do and how to help me. As for my father, an illness or injury, even a minor one like a scratched knee, always made him helpless and angry. I asked for the ambulance again. I could see it in the adults’ eyes that they were hesitant. I was not in pain or showing signs of a life-threatening condition. I also did not know how to explain clearly why I needed to see an emergency doctor. But I insisted and my grandmother went to make the call this time. The ambulance arrived, I got an injection, the medics left, but my shaking did not stop. We waited and waited, but I was unable to calm down. With that my fears escalated, and the shaking got worse. “Please call them again,” I begged. My mother and grandmother looked in the direction where my father was lying on the coach. “I have to get up early for work,” he said, “leave me alone.” My heart sank, but I was desperate for help, and as long as someone called the ambulance, their attitude did not matter. Either my mother or grandmother went out to make the call, and the same ambulance came back. It was long past midnight. The second injection worked, and I relaxed. I asked my mother to read me a children’s book and as I was listening to her voice unaccustomed to reading out loud, I fell asleep.

What followed was a few visits to doctors at a local outpatient clinic. No one knew how to diagnose me, and one doctor sent us to the next: from internist to neurologist to psychiatrist. The episodes of shaking continued, always in the evening, and almost daily. As time went by, anticipating their arrival I became less scared of them, but at the same time I was constantly focused on sensations in my body and mind, unable to pay attention to school and homework.

There is a belief among the Russians that there is always a doctor somewhere who knows how to diagnose your health problem and cure you. Such a doctor is always found through unofficial channels, with the help of a friend, a neighbor or a colleague. In desperate situations, Russians rely on these resources and find a medical professional they need. My mother did the same. She told some people at work about my problem, and someone knew a doctor at the Institute of Neurology and helped to make an appointment. The doctor I met was a man, I do not remember his face, but I remember him looking intently at me and listening closely to my words. He asked me general questions about home life and school, before moving on to my complaint. I gave him a very detailed description of my sensations during the ‘fear of death’ episodes, and after that he wanted to talk to my mother alone. As I was waiting outside, I thought that perhaps he had some bad news and to spare me preferred to disclose it only to my mother. “What did he tell you?” I asked as soon as she walked out of the room. “He gave me a prescription for medicine that you should take and told me to be gentle and accommodating with you.” I liked that, the idea of a pill gave me hope, and his advice to pay more attention to my needs pleased me as much.

The pill had a quick and calming effect. After taking it in the evening I felt relaxed, anticipation of something terrible happening to me was gone, and all sharp corners inside my mind were smoothed out. While the fear episodes diminished during the evenings, just like aftershocks following an earthquake, I felt small jolts of panic during the day. They always started with the question that I would suddenly ask myself “what if it happens again right now?” and sure enough that wave, a weaker one, would almost instantly run through my body. In a strange way I felt as if I were provoking it myself by poking some vulnerable and raw part of my sensitivity. Was this how I was subconsciously training myself to manage the unknown force raging inside me? Later I learned from the psychology literature how connecting to the present moment by feeling the ground you are standing on, looking outside of the window, or just consciously breathing can disrupt the onset of anxiety. But then, at 16, desperate and scared, I intuitively found some practices of my own, and they worked. Whispering to myself that I am alive, breathing deeply, and especially looking at my surroundings, diminished the intensity if my sensations and helped me to shift my focus from inside of myself to the outside. This self-guidance became my first step in managing myself during panic. Besides, I began taking a long walk every day after school. The motion kept my body engaged and with that my mind’s focus on a potential disaster softened as a rhythm created by my steps kept fears from sneaking in. With time these episodes became less frequent, and although they never fully disappeared, I felt I could manage them most of the time.

Years after, when I moved to the US, I learned about anxiety and panic attacks, and a therapist told me that this is what I had at the age of 16, escalated and ignored anxiety turned into a panic attack. ‘Anxiety’ sounded right to me, but my sensitive mind did not want to be reminded of crudeness and violence implied in the word ‘attack.’ ‘Attack’ made my body tense and alert, as if ready for one. ‘A moment of panic,’ gentler and easier to accept, served me better.

Anxiety has accompanied me my whole life. With time, I accepted that it might never go away and learned to anticipate it. As much as it caused distress and exposed my vulnerability, it let me become aware of my other side, the one that had the strength and capability to manage the moments of utmost fear, helplessness, and despair. Living with and anticipating anxiety has never been easy for me. The loss of my mother, and a surge of painful feelings and sad memories in its aftermath, weakened my own abilities for resilience, and I decided to try medication. To my relief, after a few weeks a minimal dose made a big difference. My responses to negative thoughts softened, and alertness to a possible flash of fear diminished. I became calmer and more relaxed, as if wrapped in an airy soft cushion protecting me from the pangs of darkness. It felt like after drifting in the sea for a long time, always watching for danger, I had finally landed somewhere safe.