Tranquility Missing From Tranquilizers

Would you take a med for your anxiety if the doctor told you this about it?:

  1. It won’t fix your problem
  2. Your body will be addicted to it within a few months as it loses its effectiveness, and…
  3. When you are addicted, you will experience anxiety as a side effect of withdrawal (daily, when it’s getting close to dose time).

I’m talking about the benzodiazepine family – Xanax, Valium Klonopin, Atavin, et al – and I’m revisiting the tranquilizer problem because use of the addictive medication is growing globally. I browse various online peer support groups for anxiety, and it seems most people writing in are taking some form of medication long term, perhaps unaware they are making their problems worse.

Statistics from the American Psychiatric Institute say doctors write 50 million prescriptions a year for benzos, and that between 11-15 percent of Americans have a bottle of benzos in the house. The API report pointed out that the med is best used for short term relief of extreme anxiety. If intense fear is keeping you from working on recovery, I advise talking to your doctor about your recovery work and request a short run with a benzo –like 3 weeks max. Klonopin has the longest life cycle, meaning fewer doses per day.

I can talk about this because I was addicted to Xanax for several years. What I was taking to treat my panic attacks and agoraphobia actually delayed my recovery by years. I guarantee you cannot overcome your panic disorder and agoraphobia while you are addicted to benzos because they create anxiety. I can talk about this because I worked as a mental health social worker for 17 years and sat in with psychiatrists as they prescribed for clients of mine with a variety of mental illnesses. I’ve heard many a lecture about the dangers of benzodiazepines and have read widely on the subject.

Please listen to me. If you are not now engaged in regular work toward recovering from panic disorder, begin doing so at once and then schedule an appointment with your prescriber to begin a slow tapering off process. I went off benzos twice during my prolonged use. The first time was spread over a few months, and I felt somewhat anxious most of that time. After I was off, the anxiety totally disappeared. The second time was hard; it was in a medical addiction treatment center, and I was coming off both alcohol and Xanax. I had Valium for a couple of days, but then cold turkey.

I shook so badly for several days that feeding myself became problematic. Finally one of my fellow patients brought back from the kitchen one of those 2-foot long metal stirring spoons so I could transport food to my mouth. This could be you someday, is why I’m mentioning it.

Panic disorder can be totally overcome by anyone willing to put in the work required to re-wire the way you think, respond and create. I recently read the piece I’m providing a link for below; it’s the best story on benzos I’ve seen.


PTSD and Panic Disorder – the Big Difference


I get asked from time to time about the difference between “panic disorder” and “post traumatic stress disorder.”  I know about panic disorder from personal experience and PTSD from association as a mental health social worker. The definition of the word “trauma” is what separates the two anxiety disorders.

I developed PD as a result of having had one too many panic attacks. My first attack was at age 10, and I had episodes of panic attacks at various times during my youth. The one I had while traveling at age 19 was the topper – the one that turned me into someone so frightened of having another terrifying panic attack that I avoided travel for the next 30 years. What I experienced was a trauma. My traumatic event was a panic attack over essentially nothing. There was nothing real to frighten me, but the experience of the attack traumatized me.

Someone with clinical PTSD truly experienced something horrific. The person saw, heard, felt, smelled something that triggered their “fight or flight” system to become constantly alert to any new dangers. I had people on my caseload who were struggling with the symptoms of PTSD, the result of everything from wars to accidents to assault and abuse.

The “trauma” of having a panic attack is obviously vastly different from the “trauma” of a land mine or a vicious beating or a horrific accident, but the effects can be similar.  The hyper vigilance of a person diagnosed with PTSD is, from a brain mechanics point of view, much like the state of anxiety one feels fearing the effects of yet another panic attack. In both cases, severe anxiety can force the person into avoidance as a means of survival. Both disorders can create “agoraphobia.”

As horribly frightened as I was by panic attacks many times over the years, my suffering cannot compare to the suffering of someone who hears and sees the terrifying cause of their mental illness in dreams and flashbacks. That sort of agony is beyond my comprehension.

One similarity of PD and PTSD is that in many cases the actual “threat” is not present – the fear is of a reappearance or a recurrence. In both cases, treatment requires a re-programming of the amygdala-controlled alarm system. My program in Un-Agoraphobic can lead anyone to overcoming chronic panic attacks through specific activities and processes. Intensive psychotherapy may be required to help a PTSD victim cope with and learn to live with the specific memories.

Here’s a link to an excellent (and readable) scholarly article on the role of the amygdala in anxiety. The Biology of Mood and Anxiety Disorders is a good place to do research on your disorder.


Methink Thou Doth Perfect Too Much

People I’ve known possessed by panic disorder tend to be perfectionists. I’m a recovered agoraphobe as well as a recovered perfectionist and the two are closely connected, as I shall explain.

When I was suffering anxiety at its highest level my “flight or fight” system was on overload and I behaved like an armed guard at the gate, alert to signs of danger. I, of course, thought I was protecting myself by trying to control everything around me, but instead I was maintaining my anxiety by feeding it.

People I met in various agoraphobia support groups over the years as well as folks with anxiety disorders I got to know as a mental health social worker all seemed to have a need to control things. I can understand that, because when you have no control over panic attacks, you want to be in control of something. I started having panic attacks at age 10 and became very insecure. I know now I developed certain rituals and specific needs about then and continued adaptive, controlling behaviors throughout my time with panic attacks.

Hiding in the house is the ultimate controlling attempt, as many an agoraphobe well knows, but most people with panic disorder do other controlling things as well. You are forcing your amygdala to be alert to ever more things when you try to make order within the chaos by creating a bunch of rules. You are now feeding your monster by organizing your kitchen.

Your need to have all your ducks in a row in whatever form your perfectionism takes is giving your alarm system way too much to do. It’s already afraid of panic attacks, and now you’re making it afraid of wandering ducks.  See what I mean? I realized that in order to recover I had to start letting go of trying to control things. I had to teach myself to become blasé. It works and it makes sense that it works. The less you have your amygdala doing, the lower the level of adrenaline in your system. Keep lowering the alert levels and eventually you’ll only be afraid of things like the sabre-toothed tiger that started this whole mess in the first place.

If you see yourself here, I advise making a list of things you probably over-control. It may take awhile to do so. As an example, one of my many controlling, perfectionist behaviors was to be a different person for other people and occasions so that I could control the situation and maintain calm: I’d behave blandly around someone excitable and  light hearted around someone depressed just to keep a balance. I needed predictability more than absolute order, so I would make an encounter turn out as well as possible by being the person I needed to be at that particular time. A friend finally made it clear one night when he said, “You’re a phony.”

If you’re working on the recovery program in Un-Agoraphobic you already started a journal in which you can make your lists. I advise letting go of controls as you feel safe, enjoying the lightness of that release of pressure. I came across a great piece on the problem of perfectionism, written by Elizabeth Lombardo for the newsletter Everyday Health. As a clinical psychologist and traveling lecturer, she found herself in the trap of constantly striving to improve everything in her life. She offers some sound advice for people who cannot be content with now. I hope you enjoy this read as much as I did. Here’s a link:


Acting Crazy

I love watching people try to act crazy. I’m about as familiar with mental illness as a non-clinician can be, so I carefully scrutinize efforts by actors to portray a particular form of mental illness. I’ll give you a brief bio, so you’ll understand my interest in this subject.

I suffered mental illness with agoraphobia for 30 years, during which time I worked with every kind of shrink imaginable, and spent at least 5 years in therapeutic groups comprising many manifestations of mental illness. When I overcame my craziness I got a job as a mental health social worker, assisting with care of severely mentally ill people, including folks with anxiety disorders. I spent 2 of my 17 years at the Mental Health Center working with homeless mentally ill wherever I found them: jails, hospitals, shelters, walking mumbling down the sidewalk (“Hi. I’m from the government. I’m here to help you.”)  And to top off all my face to face visceral experience with the world of mental illness, I was also an actor at one time – a theater major. That’s why I love watching actors trying to be someone like me.

There have been a few efforts to portray agoraphobia in film but no one is going to win an Oscar sitting around the house all day looking tense and preoccupied. Usually the mentally ill characters presented as agoraphobic have other problems, or there is an additional story line. How would you portray your illness on stage if you were asked to? I have had panic attacks in front of others who were  unaware of what was going on with me, so I guess I’d act as normal as I could. Or, one could take it in the other direction as Mel Brooks did in “High Anxiety.”

The truth is people are all different and there are many facets to every diagnosis, so there isn’t a set way for a schizophrenic person to talk or someone with major depression to behave. They are partly themselves and partly their mental illness.

My favorite example of actors going over the top in portraying craziness is the propaganda film “Reefer Madness.” This all came up because I read an article in “Everyday Health” titled “Anxiety on the Silver Screen.” I’ll post a link so you can read about anxiety in action.

Meditation Builds Brain Muscles

Science has proved that meditation is a useful tool for overcoming anxiety.

Though meditation in some form or another is vital to recovery from panic disorder, some people have great difficulty meditating. In my perpetual search for articles that make meditation user friendly, I came across one that gives literal muscle to the benefits of meditation by proving that beneficial brain changes occur while practicing some form of mindfulness.

The article, “Eight Weeks to a Better Brain,” by Sue McGreevey, referred to a study done through Massachusetts General Hospital that used study and control groups, employing neural imaging and other electronic techniques to measure brain activity. The article appeared in the hospital’s newsletter and cited the study, “Neural Mechanisms of Symptom Improvements in Generalized Anxiety Disorder Following Mindfulness Training.”

The study group went through an 8 week program that included guided meditation developed for Harvard Medical School called “Mindful Based Stress Reduction.” The 8 week session included various forms of mindful activity such as yoga, walking or specific focuses and a system for participants to use for daily meditation at home.

The principal author of the study report, Britta Holzel, said she is optimistic about the role of meditation in mental health treatment. In her words, “It is fascinating to see the brain’s plasticity and that, by practicing meditation, we can play an active role in changing the brain and can increase our well-being and quality of life.”

I set up a number of activities and practices in my Un-Agoraphobic recovery program that are designed to help create new neural pathways beneficial to your elimination of anxiety.  Such things as daily brain science research, journal writing, visualizations and skill learning are known to alter brain activity in desirable ways. I also set up a time for daily meditation.  It’s good to know that meditation not only rests the mind, it also alters the mind in beneficial ways.

I’m providing a link to the study report below.  The significant discovery was that those employing regular meditation and mindfulness practices showed increased gray matter activity in the hippocampus, in a region of the brain associated with memory, sense of self, empathy, and stress. The study also revealed a decrease in neural activity in the alarm center, the amygdala, for those who meditated regularly.

Ya Gotta Work It

My book Un-Agoraphobic came out in October and has drawn a few reviews – one of them quite negative. I felt hurt at first, until I thought about it. The reviewer called it “a waste of time.”  This person couldn’t have had the book long enough to even begin the recovery program I designed.  Unfortunately, some people think just reading a self help book will be enough to get them over whatever they have.

If you’ve been around much you learned that doing the minimal isn’t enough to get you very far in life. You got to do more than show up; you have to get engaged. My book clearly calls for working a daily routine involving research, journaling, doing visualizations and affirmations, learning a new skill, gaining the benefits of meditation and performing regular activities in order to change neural pathways. Change like that doesn’t happen after a short time of work and certainly not from just one reading of a book.

It took me a long time to put together everything I needed to do and to change in order to get over panic disorder and end panic attacks forever. I got discouraged many times, but I had to press forward because otherwise… well, I don’t want to think about otherwise.  A long history with panic attacks can hammer a person down until recovery doesn’t seem possible any longer. I’m glad I survived that dark time and dedicated myself to the hard work and courage it took to free myself from agoraphobia prison.

I’ve encountered people along the way who are looking for a quick fix. These seem to be people who haven’t learned how to take charge of their lives and expect others, so-called experts, to fix them. They want to hear a few magic words or tricks or bombastic statements that will suddenly turn everything around. You meet people like that from time to time. They’re the ones blaming everyone but themselves, the ones who are always searching but never really looking. You have to look at yourself. You have to look at the possibilities. You have to look at your recovery as something to devote yourself to.

You can recover completely from panic disorder and agoraphobia by using my book and fully engaging in all the procedures and activities I’ve put in there. You have a lot of changes to make but you’ll never make the changes without hard, steady, day after day work.

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.”

Your Very First Suitcase

If your agoraphobia began early in life – for me it was age 19 – you may have yet to purchase your very own luggage. Who needs a suitcase when you can’t travel more than a few miles away from home – if that far? I probably used family suitcases for trips in my youth before a rather savage recurrence of panic attacks early in my sophomore year of college made me too frightened to travel more than the few blocks I lived from campus. And I wouldn’t travel freely again for another 30 years.

I clearly remember my first suitcase. I didn’t want to buy something shiny new and have people think this is the first time I took actual trips far off into the world. I hunted through second hand stores until I found the perfect statement.  It was a tan, heavy canvas thing with leather trim that folded out sort of like a wardrobe and had lots of cool side pockets. It made me look like a man who’d been abroad, or at least around.

With that suitcase I made a trip back to my parent’s house, my home, that I hadn’t been able to visit for 3 decades. The mountainous trip from Helena to Billings is stunningly beautiful. The first part trails the Missouri River to its origin – where the Madison, Jefferson, and Gallatin Rivers (all named by Lewis and Clark) combine near Bozeman (Three Forks).  Soon after that on the winding, climbing, descending freeway, the legendary Yellowstone River emerges from its namesake national park through Paradise Valley and announces itself to the world as it winds its way beside the highway through  geology ranging from mountainous to hilly to sandstone rimrocks and buttes.  Towering cottonwood trees suckle at its flanks the entire journey through Montana to where it joins the Missouri clear the heck over on the east end of the state. The soaring, glistening Absaroka Mountain Range and then the Beartooth Range, highest in Montana, are your constant companion on your right on that particular stretch of I-90. I was driving on an interstate highway for the first time in my life.  The previous, pre-agoraphobia times I traveled across the state, the massive national highway construction program was just underway.

I had already made months earlier my initial Very Big Trip from Helena to Butte 60 miles away to officially end my agoraphobia. And then I made the 2 hour trip from Helena to Missoula many times as I moved back to my favorite place in the whole world. But the trip from Helena to Billings was another matter – longer at 3 hours, and at times the openness – one of my panic triggers – goes on and on. Luckily I was in a state of awe the whole journey and pretty much didn’t have any anxious times. For this trip, where I was actually going to stay a few days I needed a suitcase.  And after that I took on many sorts of traveling bags as I came across them in thrift shops for my many trips to follow.

The final symbol of freedom from agoraphobia is a large suitcase with wheels, which I now possess. It’s red,  second hand, and large with many zippered nooks and crannies. The wheels say it all: I am a person who travels freely so much that I need wheels on my suitcase.

I’m certain you’re excited to take your first trip away from agoraphobia with a suitcase. Perhaps you should go ahead and buy a suitcase now so it’ll be there on that glorious day when you’re ready to take a long trip with luggage. I know! You can put it at the foot of your bed and call it your “hope chest.” Get it? Sometimes I am so brilliant in an ad agency way I scare myself.

You’ll get there, I promise. Work hard every day on your Recovery Program in Un-Agoraphobic and you will put it all together and solve your mystery with my vast knowledge and experience guiding you along.

If wheels on a suitcase make you look or feel old, try a couple of shoulder bags for a hip-ness  in your new traveling look.

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.