How Far Out Are You?

I’d like to de-mystify agoraphobia a bit by discussing the various manifestations of classic panic disorder. I think most civilians equate agoraphobia with hiding in the house, but that’s not true all the time or even at all for everyone who suffers from this mental illness. My personal experience as well as what I learned from mental health clients and peer support group members led me to rate agoraphobia by severity:

Level 1. Housebound or mostly so.

Level 2. Partially mobile.

– Level 3. Mobile with a wall.

Many people who suffer panic attacks when they venture beyond their safe perimeter have experienced all three levels at one time or another. I ran the gamut more than once during my 30 years with agoraphobia. The housebound stage is usually the result of extra stressors; the increase in fear level that drives someone into a corner is demoralizing. Being inside can feel safe, although terror-stricken people will resort to hiding in small spaces to reduce the fear level.  A great day for someone at Level 1 is a trip all the way to the end of the block. The victim’s fight or flight system is on such a high stage of self-imposed alertness that unending anxiety is the result.  Someone at this high level of anxiety feels that a panic attack is so nearby that one dare not rock the boat.

When agoraphobes are at Level 2 they are able to work and go to school, though with great difficulty. Going to and from is likely the most difficult of every day’s difficult tasks.  Those  periods of vulnerability bring out an agoraphobe’s talent for catastrophic thinking.  Anything and everything can be a threat, but bridges, railroad crossings and long lines of streetlights are particularly troublesome for someone at this anxiety level. Work may be the easiest part of the day; a job that requires total focus on the work is good for the agoraphobe who wants to shut out anxious thoughts.

Many people with long-term agoraphobia spent a lot of time at Level 1. I did. When you are able to work and have relationships and feel free from heavy anxiety, you can become complacent. Eventually, though, being stuck at this level is heartbreaking because you are so near yet so far from complete freedom. You’re still a prisoner even if you have a good job and relationships.

So… the truth is out: No one is safe from agoraphobes because not all of them are locked up in their houses.  Some of them are moving about you, working with you, touching you, and even…. Yes! Agoraphobes can appear to be nearly normal, if not more so.

Start increasing your functioning level by decreasing your fear level with the help of “Un-agoraphobic.”


See if I Care…

When people ask me how I recovered from agoraphobia, I usually avoid a very long story by saying such things as “It was a process,” or “It’s a very long story,” or “I had a lot of help,”  but one thing I always say is “I had to learn to become blase’.” You know, that French word meaning a sort of satisfied boredom.  When I was in the grip of chronic panic attacks I was trying to control everything I could, probably out of desperation to be in control of something, since I couldn’t control my anxiety or fears.  As I came more in contact with others suffering from panic disorder through peer support groups I started or helped organize and my social work job at the Mental Health Center I discovered a lot of anxious people with perfectionist traits. I’m not referring now to “obsessive compulsive disorder,” but rather to the controlling behavior exhibited by those who suffer chronic panic attacks for no apparent reason.

I somehow knew my perfectionist, controlling habits were interfering with recovery from agoraphobia.  Learning to become blase’,  wasn’t that much of a stretch for me.  A lot of my habits are of a casual nature, so I just had to extrapolate from not making my bed to not  making a big deal out of speeded up breathing or heart rate or other kinds of false warning signs that can trigger panic attacks. I had to learn to stop caring about the outcomes of many many things I used to think were necessary to my well being. The whole business of letting go and letting down my guard didn’t happen quickly… but once I could see positive results from forced lack of concern about this or that, I allowed myself to  become kind of casual. The whole process over several years affected everything about me – the way I walk and talk and write and  listen. I can listen a lot better now that I’ve become less self-concerned.

Folks who suffer with agoraphobia will help their recovery efforts by learning to let go – a lot. The question of whether anxiety creates perfectionism or perfectionism creates anxiety is a circular one – worth pondering though. I’m thinking of how perfectionism and anxiety disorders co-occur because of an article written by Psychology Today blogger Max Belkin. His nicely written piece,         “5 Steps to Taming Perfectionism,” appeared in late July and links the obsession of perfect to both low self esteem and procrastination. I’m not saying that agoraphobes are necessarily perfectionists; just that there’s a trait toward controlling one’s surroundings that actually creates more anxiety.

Dr. Bilker advises those who have let perfectionism ruin their dreams to learn to accept themselves just as they are and to acknowledge that they are good enough just as they are. Self love is at the core of recovering from panic disorder and agoraphobia. Healthy self love always radiates out, so once you obtain it, walk it around and shine on some folks in the shadows.


Suffering is Not Just for Succotash

People with panic disorder suffer almost continually from the buzz of anxiety. Certainly there is much worse suffering in the world, but the feeling of dread and hopelessness that sets in with the constant threat of panic attacks is hard to bear day after day. Do you get the feeling that you’ve lost the ability to change your picture – that you have forgotten how or where to find joy?

Prominent Buddhist spokesman Thich Nhat Han says you’re not looking hard enough. The Vietnamese monk advises us that we possess within us happiness and well-being; we just have to find it.  In his book The Heart of Buddhist Teaching, he says, “When you are suffering, look deeply at your situation and find the conditions for happiness that are already there, already available.”  He continues, “Please ask yourself ‘What nourishes joy in me?  What nourishes joy in others? Do I nourish joy in myself and others?'”

The place he advises us to go for relief from suffering is our memory bank. In his words, “If you are not experiencing peace and joy, you can remember having felt peace and joy, and you see that well-being is possible.” Summoning up past positive feelings when you are suffering can give you a present positive feeling. Employ visualizations as a tool to help you achieve this.

People oppressed by panic attacks and agoraphobia should be working daily on getting a positive flow going along the thought highway. Here’s to overcoming suffering through daily practices.

What’s in a Name?

Would agoraphobia by any other name be as ghastly? The word for avoidant behavior brought on by repeated panic attacks borrows a Greek phrase for “fear of place of assembly/ market place.” There are only two things wrong with this word: it’s long and it’s wrong.  The condition that causes such profound fear is created by fear of having a panic attack.  A crowded place is only one of many circumstances that can produce a panic attack in one whose alarm system is haywire. A long bridge,  long blocks of street lamps, a flickering light, a sudden noise, a harsh word, a memory, a sudden loss or tragedy are among things that can trigger a panic attack.

Of course, if we added all those other possible triggers, the word would circle the block a couple of times. What I – who has probably spoken, written and typed the word agoraphobia more than nearly everyone else – would like is a shorter word that captures the drama a little more accurately. Perhaps I’ll organize a contest on the blog at some point. In the meantime, what we’re really concerned with here is the effect that panic disorder has on a human and what steps said human can take to overcome the fear of panic attacks.

The level of fear is tremendously high that can cause a human to go to great lengths, almost any lengths, to avoid a repetition of the fearful event. We agoraphobes like to be close to home in stressful times just because it’s the place we’re least likely to feel fearful. Folks with other fear conditions have their own avoidance issues, but some of them keep close to home for safety and use the word “agoraphobic.”

I’ll describe a few other anxiety disorders that can cause the sufferer to avoid certain circumstances and places and when severe can force one into being homebound.  During my 17 years as a mental health social worker I worked with hundreds of people whose lives are disrupted if not controlled by fear. Much of my knowledge about mental illness came from my work, but I’ve learned also from personal experience, from reading and from YouTube testimonials.  The other disorders that can cause “agoraphobia:”

1. Post traumatic stress disorder. This anxiety disorder is caused by severe trauma that causes ongoing feelings of extreme fearfulness. Whether it’s a single event like a catastrophe, horrific accident, assault, or ongoing such as abuse, the tremendous blow to one’s ability to maintain is overwhelming.  People with panic disorder are very familiar with an amygdala on overload – constantly sending alert signals throughout the nervous system. Someone with PTSD can have “revved up” feelings ranging from mild agitation to terror so extreme it can’t be described, only experienced. I hope a lot of research money is going into help for PTSD victims. For reasons beyond belief we can’t seem to stop sending soldiers off to kill people in other countries, causing huge traumas in the lives of young people on both sides of the battle lines. Some PTSD victims are so fearful they become homebound.

2. Obsessive compulsive disorder.  By Wikipedia’s definition, this anxiety disorder is characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry. Most engage in defensive behaviors of some sort, from repetitive checking to excessive washing to extreme hoarding. The preoccupations can range from fairly benign to violent, sexual or religious thoughts. OCD, as with most mental illnesses, varies in degree. I had several OCD clients at the Mental Health Center and became accustomed to assisting someone with avoidance when I could. As a former sufferer of excess anxiety I was always attentive to need for safety. The cause is at least half genetic, according to Wikipedia, and the rest of what causes a person to begin extreme defensive behaviors is under study, as they say. OCD can be so severe it can limit mobility.

3. Social anxiety disorder. This anxiety disorder is the most common of such disorders according to Wikipedia, and apparently develops fairly early in life. It also comes with its own perfect acronym. I’ve known a few people with this SAD condition but can’t say that I’ve come to understand it. It’s described as “intense fear in one or more social situations causing considerable distress and impaired ability to function in at least some of life’s general activities.  These fears can be triggered by perceived or actual scrutiny from others.”  Panic attacks and fear of intimacy can confine one with what is also called “social phobia” to staying very close to home if not homebound.

4. Emetophobia  This disorder is one the Greeks hit the mark with: “vomit – fear of.” According, again, to what I read in Wikipedia, this disorder is characterized by excessive  fear of vomiting or seeing vomit or seeing others vomiting. The number of obsessions that arise in a person with severe emetophobia can cause the sufferer to avoid so many things that they can  become homebound.

5. Labyrinthitis.   A search of Harvard Medical School’s website for psychiatric studies reveals that researchers discovered a link between this inner ear disturbance and panic attacks. I suffered from labyrinthitis in my youth, about the same time I started having panic attacks, so I speak as an expert witness. In brief, the researchers discovered the neural signal that triggers sudden imbalance in the inner ear is so similar to the neural signal that triggers a sudden adrenaline flood that the amygdala as guard at the “incoming” gate could be misreading  the signal and mistakenly causing a panic attack.  The problem is so severe for people afflicted with labyrinthis that there are at least 3 online forums dealing with the effects of sudden vertigo. I read several entries by people who suffer regular panic attacks and have even become agoraphobic because of the threat of panic attacks. A similar condition, “vestibular neuritis” can be difficult to shake. I haven’t had vertigo since age 19 and long ago stopped having symptoms of slight loss of balance due to inner ear infections.  The condition is complex and extremely troubling. I’m going to discuss labyrinthitis and VN at greater length in the next blog. It would be a relief to these folks if they could find a way here to overcome the panic attack problem and then only (??!!) have to deal with the extreme dizziness, nausea, and blinding headaches. One entry I read was from a woman who said her labyrinthitis symptoms improved greatly once she was able to overcome the panic attacks.

Hope marches on.

Time to “come out”?

There are so many horrible things about being stuck in agoraphobia land that  it would be hard to list them all. One of the worst is the embarrassment of it all. I was never comfortable about revealing my deep dark secret to anyone because I was convinced people would think I was totally lame and weak and actually could do whatever it was if I really wanted to. I went to extremes in some cases to hide my anxiety problem from others because of my shame.

My most shameful experience was when my dear Grandma Mae died and I was unable to attend her funeral 120 miles away. My father was grieving over his mother’s death and unable to comprehend why I could not attend. Anyone with agoraphobia is familiar with those  disappointed looks when we’ve had to get out of one thing or another because of our inability to make a trip. The quandary is this: we  often don’t want to tell the person the real reason we’re unable to do something with them because it is so humiliating. And if you are able to summon the courage to reveal your seemingly weak-spined problem, what are you going to say? What words can you use to sound plausible? For many years I didn’t even have a name for what I had. I just thought I was crazy. I told some people I had “vertigo” and used dizziness as an excuse when I could.

Perhaps it’s time for agoraphobes to come out – to stand up and tell your stories.  I’m convinced that the lives of people afflicted with panic disorder will be easier when “normal” people can understand the science behind panic attacks. I’m hoping that once agoraphobia is de-mystified, those afflicted with it can feel safer about explaining themselves.

My assignment for you is to get a notebook and begin a study of the brain science behind panic attacks so that you can be professorial when you tell people about your restrictions. Learn as much as you can about the amygdala and its role in your misery and take good notes.  Once you become an expert you can say to a friend something like, “It’s a function of the amygdala that is mis-firing and sending blasts of adrenaline through my body by, essentially, mistake. It’s kind of like my system made me more susceptible to startle than most and sometimes a slight startle can be mis-directed by the amygdala and become a panic attack.”   Keep it simple, but keep the emphasis on the brain science  and this will help the “normies” comprehend the enormity of what you’re going through – through no fault of your own.

My feelings about the benefits of openness are echoed in the documentary”The Anonymous People.” It tracks several  former addicts who have organized to come out about their addiction and recovery. The former addicts decided to speak out because they want to help others recover, believing that treatment will become more widely available and acceptable once people understand how addiction works and how it can affect people from every part of society.

As I listened to men and women speak candidly in the film about the suffering, the severely altered lifestyles, the shame, the degrading experiences I could certainly see parallels in the lives of addicts and the lives of agoraphobes.   Self esteem is an early victim in the life of an agoraphobe. A good way to retrieve your self esteem is to start educating others about the science of panic disorder so that you sound smart instead of freaky.  If you have an experience with coming out that might benefit someone else, post a short account of it to our address: for possible inclusion in the blog.


The “Alien” in You

Did you see the 1979 sci fi horror flick “The Alien” with Sigourney Weaver?  A terrifying destructive force in the form of a very scary creature invades a space ship and begins terrorizing the occupants. The most frightening aspect to the alien was that it could invade and take over a person’s body. When it happened, the person would behave sort of normally for awhile… until the awful reality came out.

The analogy of the cinematic alien to the alien creature called agoraphobia is uncomfortably clear. When I was suffering from panic disorder – the trembling sort of anticipation fear that makes you always feel as though something bad is about to happen – I felt like a victim of something strange and powerful that was inhabiting my body.  The toothy, snake-bodied creature exploded out through the chest of one space traveler it had inhabited and took two years off the lives of everyone in the movie theater. Kind of like a panic attack, only not as scary as the phenomena every agoraphobe fears.

The alien at one point emerged from hiding right in Sigourney’s face and she expressed such a convincing display of sheer terror that her first major role made her a movie star. Granted, she turned out to be an excellent practitioner of the thespian craft, but unless she’s had a panic attack she will never know the full meaning of terror in the way an agoraphobe does. Scared? You don’t know what scared means unless you’ve been through a horrific tragic event or have had a panic attack.

When you suffer panic disorder, the alien in you is bad programming. The panic control center in your brain – the amygdala – is an instant decision maker. No wishy washy ambiguity when the amygdala’s in charge. When the amygdala decides it’s time to be scared, it’s time to be scared and there’s apparently nothing you can do about it. That feeling of helplessness is one of the worst things about having a panic attack. As the hot blast of adrenaline is coursing through your body setting off alarms you’re like a frightened creature, desperate to escape danger. Luckily, there is something you can do about the alien in you.

The program in Un-agoraphobic will help you take control of your alien and re-train it to become a docile pet. No one need be a helpless victim of panic attacks. You can re-program your system so you’ll never have another panic attack – so you can go anywhere you want without the threat of the Monster suddenly appearing in front of you. Stay tuned to this blog and join the forum for questions and answers.

“Mindfulness” vs. Anxiety

“Mindfulness” is a hot topic these days and I think I know why. We have created so many ways to connect ourselves electronically to anything and everything anywhere and everywhere at any time day or night that mental disorders are being named after the phenomena. Continuous exposure to social media, broadcast television and electronic games can have adverse effects on some. The American Academy of Pediatrics calls “social media depression” what they’re seeing in alarming numbers of young people who have devoted their lives to their screens. It seems we need a break from the buzz.

Large corporations are beginning to set aside time and space for employees to reduce stress through meditation. Do a quick search of mindfulness and you’ll see pages of attention being paid to the simple act of living in the present moment.  When you continue to stay in that mindset, when you carry along with time, looking neither forward nor back, we call it meditation.  That mind cleansing process is being employed to save people from the loud buzz of daily life.

People with panic disorder know full well what daily buzz is about. The constant anxiety that comes from fear of having another panic attack keeps your engine revving all day and sometimes all night. I’ve been there; I know what it’s like to never have a calm moment, to get up knowing you’ll be controlled all day by the strong arm tactics of anxiety. That’s why mindfulness plays such a big role in the “Un-agoraphobic” recovery program. You’ll need to first learn how to practice meditation and then how to apply mindfulness tactics to your every day routine as part of your path to recovery.

I recommend you do a search of meditation techniques, find something that works for  you, and start practicing today. If your anxiety is too high, do a head to toe tense and release routine beforehand.  While seated, raise your feet a few inches off the floor and arch your toes away from you so that you feel a stretching across the top of your foot. Next, arch your toes toward you and continue this process of tightening and relaxing muscles (calves, thighs, buttocks, abdomen, shoulders, neck, arms and hands). Each stretch should last to the count of four, as should each release. Once you get your body loosened and have practiced focusing, sitting in meditation will be easier.

Once you learn meditation you own a valuable tool for diverting panic attacks. Ommmmmmm.