I finally went to the doctor about the ongoing symptoms. He did some bloodwork, asked when I was last checked for seizures, and now has me on a heart monitor for a week and keeping a diary of my "episodes," what I'm doing at the time, and the symptoms I have. The diary is a useful thing--he thinks I may be having panic attacks, and I think he is probably right. I'm having a hard time accepting it; but that doesn't make him wrong.
I'm reading a book called Panic Disorder: The Great pretender. These are some of my thoughts just in reaction to the first couple of chapters. I will probably write a lot more in time.
... In moderate degree, anxiety can be termed "normal" and has various positive aspects. It can serve as a constructive force, increasing alertness and effort. Levels of anxiety within the individual's capacity to cope with it are conducive to learning and growth.
"Anxiety responses conditioned to stimulus situations objectively associated with danger are judged adaptive." It often serves a useful purpose in preparing a person for a potentially threatening or serious situation, such as an exam, speech, or battle. "It builds
character, enhances creativity, enlarges awareness of life's possibilities . . . keeps us on our social toes. Criminals commit crimes because they don't have anxiety."
"Under certain circumstances a low degree of anxiety may enhance such functions as performing on stage (The Yerkes-Dodson Law)." In addition, anxiety is frequently a strong motivating force in decision making, its unpleasantness pushing the individual toward the resolution of some inhibiting impasse caused by internal conflicts." The role of anxiety is particularly prominent in individual character formation and personality development. The uneasiness and apprehension aroused by the disapproval of parents, for instance, often brings about constructive changes in a child's behavior."
In a panel discussion on anxiety, Thomas P. Hackett, M.D., points out another situation in which anxiety is desirable. "We know through Irving Janis's work that a little preoperative anxiety is good for the postoperative condition, making postoperative depression less likely . . . I think that not only psychologic morbidity, but also physical morbidity is lowered in individuals who have 'appropriate' anxiety before surgery . . . From the lay press, one would get the idea that anxiety is not only unnecessary, but also bad, and yet we know that isn't true. It's a hard thing to convince someone to learn to control or live with, because basically it's an unpleasant state of mind, and so many people think that unmitigated happiness is the ideal."
Sidney Cohen, M.D., another panelist, continues this train of thought. "It is the unpleasant aspects of living from which we learn to cope, to deal with frustrating events, and therefore we have to educate individuals that being in a constant state of euphoria or pleasure is not a desirable way of life. ..." Every patient who walks into your office complaining of anxiety does not have to be silenced with medication. Explanation and reassurance may be all that is needed to calm the patient and facilitate growth. (pp. 34-35)
I don't have a "problem" with the concept that anxiety is useful. In fact, I've said this to other people. But for me there are two problems: (1) my level of anxiety is not "normal" and does not lead to beneficial growth; and (2) the anxiety is spiraling because the causes are not being resolved.
Pathological or unadaptive anxiety is more severe, intense, and pervasive. Rickels and Schweizer define it as follows. "If it is intense enough, persistent enough, or out of proportion to any known life circumstance, then it probably qualifies as abnormal." An abnormal or unhealthy degree of anxiety is reached when a person's ability to deal with the stress-producing situation is exceeded. (p. 35)
When I first read this paragraph, I reacted negatively to it because I focused too much on the words, "out of proportion to any known life circumstance." My thought was, "But I have plenty of legitimate sources of stress." That is a truthful reaction to those particular words, but for a while it clouded out the rest of the paragraph for me. From my writing below, it seems that I have exceeded my ability to cope with the anxiety-producing situations in my life.
"If the level [of anxiety] is considerable, it interferes with the effective performance of many classes of behavior. The generalized rise in muscle tension impairs coordination of movement. Mental concentration, the ready flow of associations, and the registration of impressions may all be diminished. (pp. 35-36)
I think this is a fancy way of describing some of my symptoms. I have little energy or muscle control. I am experiencing difficulty concentrating and problems with memory loss and general confusion. And my alertness is significantly diminished.
Here anxiety is seen as an imbalance of the benzodiazepine-GABA receptor complex. Since the advent of using a brain imaging technique called positron emission tomography (PET scan), the spotlight has been on neurophysiology and brain chemistry. Abnormalities have been found that are believed to determine vulnerability to anxiety attacks. (p. 39)
Anxiety is no longer seen as a single entity but rather as several discrete conditions or illnesses. These include panic disorder, posttraumatic stress disorder, generalized anxiety disorder, phobias, and obsessive-compulsive disorder. (p. 39)
So what happens when you take a person with a vulnerable nervous system and then pile on stress after stress?
The book talks about a possible link between panic disorder and depression... My therapist suggested that I may have some "hidden" negative emotions. I wouldn't call them hidden--and the concept of my emotions being hidden is where I'm getting stuck. No, they aren't hidden. I'm quite aware of my emotions--and in fact I'm doing all I can to cope effectively with them and with the situations that have created them. But that doesn't make things better. There's only so much distress that can be tolerated before the distress tolerance mechanisms don't really make me feel better anymore. My understanding of the concept of distress tolerance is that it's not meant to be a permanent way of life. It's meant to be a temporary measure until the situation improves. The assumption is that either it will improve with time or a solution will be found that can be implemented and result in improvement. But what happens when the solution isn't found and the situation doesn't improve? As my mother likes to say, "What if you're 60 and your life is still like this?" What a thing to say to a distressed person! That statement just keeps the person from seeking to improve the situation, creating a self-fulfilling prophecy. But there are also times when the question is legitimate. There are some situations that aren't likely to improve over time and for which there is no remedy. So what happens to the person who is faced with this situation? What happens to the person who is faced with a situation that not only doesn't improve but fluctuates--or deteriorates?
Now that that's out of the way, what are my "situations?" Let's see...
Blindness. The physical condition fluctuates, and that fluctuation creates a situation that may be uncomfortable and require somewhat quick response. The limitations created by blindness result in stressful interpersonal situations at times; and using interpersonal effectiveness strategies may or may not result in positive resolution. Lack of positive resolution can result in basic needs not being met--or if they are met, the relationship remains strained and may continue to be a source of stress along with whatever stress the physical situation presents.
On top of this, other people's attitudes about blindness create limitations for me that can often not be anticipated; so the outcome of my efforts at accomplishing something like obtaining employment cannot be predicted--and over time I have learned to believe that the odds of failure are high or even certain because none of my own efforts have yielded success. I understand that odds of success are controlled by a number of factors and that I cannot know these factors; but because none of the factors have worked in my favor, I have become conditioned to expect failure. Fear of failure is a stress, so I use distress tolerance and emotion regulation to cope with it and go on anyway; but going on is also a stress, and there is no foreseeable resolution to this stress. So I must increase my use of distress tolerance and emotion regulation skills, and the situation only continues to escallate.
Blindness also has social implications; but I am hesitant to categorize my social difficulties solely as a blindness-related problem. For one thing, I am aware of a number of blind people who do not experience these problems. For another thing, I am aware that other factors in my life contribute in various ways to the problems. I guess that's an improvement in some aspect of my life--it makes blindness somewhat less stressful. But it makes solving the social problems more complicated. In some situations, it means recognizing that solving the problem would require sacrifices or changes that I find unacceptable. So I have to accept something less than what I want right now. Perhaps that may change, but in some ways hoping for that change creates additional distress whereas simply accepting the situation requires continuing the current level of distress tolerance related to feelings of isolation. The problem is that I experience waves of emotion, so my level of distress tolerance has to change with the waves because the waves are distressing and regulating the emotions requires the use of additional energy which I really need for tolerating the distress in the first place.
Migraines. This is an example of a situation which is deteriorating. The physical impact seems more significant to me because it causes more actual discomfort. The limitations also seem greater because there are no alternative techniques I can use to do normal tasks differently without assistance. The lack of response to treatments and the limitations of treatments I can avail myself of is also distressing.
Lack of income. I probably don't need to expand on this. Unemployment is stressful for anyone. For me it has been a fairly constant source of stress for most of the last seven years. When I have been employed it has been part-time or as a contractor, and as a contractor I had legitimate concerns about the duration of the work--and then was unceremoniously dumped with no explanation and an empty promise of more work sometime which never materialized.
Lifestyle I hate. I don't want to be single and have no children, period. I love kids, and I want to share my life with a man in marriage. I'd like both, but one would be acceptable if I can't or don't have both. Either one will do. But neither is really a possibility at this point. Again, that is a source of distress, and the distress is a source of distress.
Damaged relationships. Some of my relationships have been damaged by the other person's actions (or inactions) and some by my actions or lack of actions, including failing to keep in contact. Mending damaged relationships takes time, and the hurts inside me and the reminders of the painful events are distressing. It's easy for the stress about relationships that I have allowed to languish to get drowned out by other stress, but I do know that desire for improvement in these friendships is in there somewhere--and unlike some of the other tsources of stress, this is one I can do something about.
Need for opportunities to participate in activities that are intrinsically rewarding. This is an area where I think I may be able to work toward some resolution if my health will permit it. I can accept that my fear of health problems causes me to experience some additional symptoms (panic attacks), and I understand that panic attack symptoms become an additional source of stress and create an escallating situation. I cannot concede that the fear is unreasonable, and I cannot go into the activities without acknowledging the potential for problems associated with disabilities and medical conditions. So how do I regulate the distress? Would the distress be causing panic attacks if I wasn't using up my energy coping with so many other sources of stress? I would like to think not--the panic attack symptoms have increased in frequency and severity as my sources of stress have become more numerous and resolution has become less likely for more of those stressors.
So I am back to my original question. How can I stop the spiral? What do I need in order to get to a level of distress that I am capable of handling using DBT skills? Do I need different pleasant activities? Do I need someone to come in and help with some chores temporarily so that basic self-care/housekeeping tasks are not an additional source of stress? Do I need meds temporarily? Do I need different relaxation activities? Do I need more exercise? (And how do I exercise when panic is stealing my energy?) Do I need more distractions? Do I need to write missives like this more regularly? Do I need to scream and yell and cry? Have I reached some sort of plateau in therapy because my body just can't take any more stress without some kind of resolution? And is there anything that can be resolved somehow in any kind of tolerable amount of time?
Whew! What a lot of writing! I'm not done yet. Here's what I *have* done about this stuff during the last couple of weeks:
- Set up a music area in the living room--and discovered that playing does help significantly as long as I don't have a migraine.
- Made a point to pet my cats more often.
- Cooked up some food that is waiting to be frozen so I have less self-care to do for a few weeks.
- Set up a regular activity with a friend who likes music so we can play and sing together (via phone but still together).
- Started reading regularly.
- Made a trade with a massage therapist.
- Started talks toward launching a disability ministry at church
- Made contact with two potential local friends
- Made contact with some long-distance friends I had missing