Trouble started in the form of rivulets of sweat dampening the waistband of my underwear. It was a bluebird afternoon in Phoenix in December of 2020, mid 60s, desert dry, and my heart was jackhammering against my ribcage. Breathing felt like I was sucking air through a stir straw. A small ABC News crew was arrayed before me, ready to broadcast the report I’d written that day, but with my vision narrowed to a needle’s eye, I could barely see them. I tried to swallow away the sandiness in my mouth but realized I’d forgotten how.
“I can’t swallow! How do I swallow?”
I quickly recognized my body’s reaction for what it was: not a stroke or a heart attack, but a panic attack. I knew this with certainty because I’d endured hundreds of moments like this in the past two decades. There was nothing specific that brought on this particular panic—and that’s what is often so terrorizing about them.
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But the news waits for no panic attack. We were about to go live on World News Tonight, and the director counted me down for the live portion of my report. What first came out of my mouth was I imagine to be the sound a chicken makes when it lays an egg. Still, I managed to get through the report without an event, even if it wasn’t as polished as it was when I’d rehearsed it. My colleagues appeared to be none the wiser. Which, at the time was what I was going for.
Panic in our society is encased in an almost impenetrable block of shame and stigma, and over two decades, I had become so ashamed by my bouts of panic that I’d assiduously hidden them, even from myself: When I documented them in my journals, I wrote in a kind of shorthand, a cuneiform indecipherable even to me.
In the months prior to that Phoenix afternoon, I had given myself a crash course in panic. I read medical journals, books on evolutionary science, how-to guides. But I hadn’t yet summoned the courage to reveal my secret. Only my wife and my therapist knew of my hidden affliction.
What I’d found in all that research stunned me. I learned panic was far more common than I’d imagined. According to a study published in the Journal of American Medicine, about 28% of Americans will experience a panic attack in their lifetime—that’s as many as 90 million people, more than the population of Germany. Many panic experts, like Dr. Michael Telch who heads University of Texas’s Laboratory for the Study of Anxiety, believe the figure is closer to 50%.
A panic attack is one of the few mental health phenomena that trick a sufferer into thinking they are going to die. And sadly, its chronic underdiagnosis increases the suffering of millions. Kelly Kropholler spent 17 years under the headset as an emergency dispatcher in California answering many hundreds of calls for both panic and heart attacks. Panic so closely mimicked a heart attack that it fooled even her practiced ears. “All of those physical symptoms of [peak] anxiety present as a heart attack clinically,” she told me, “[those suffering panic] breathe really shallow or really fast, feel sweaty, feel tightness in the chest, complain of numbness.”
So it shouldn’t be surprising that, according to a study published in 2022 in the journal Psychiatry, 40% of patients presenting at the nation’s emergency departments with cardiac symptoms actually meet the criteria for “panic-related anxiety (i.e. panic attacks or panic disorder.)” That is over 3 million people a year think they’re having a heart attack when in fact they are enduring a panic attack.
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That study also found that once panic patients are cleared of cardiac concerns—informed their heart is not the problem—only 1-2% of them are “evaluated and treated for anxiety in this setting.” Put differently, over 98% of patients go untreated for the ailment responsible for bringing them to the hospital. A different survey of ER departments, published in 2018 in the journal BMC Emergency Medicine, found that fewer than half are even informed that they’ve suffered a panic attack. Being told merely that “it’s not your heart,” without being told the source of your terrifying symptoms, can cause a one-off panic to bloom into full blown panic disorder.
My own first brush with panic took place as I was defending my senior thesis in college. For years afterward, as my career in radio and TV progressed, I suffered what I thought of as “nerves” during my live reports. It would be 13 years before I would put a name to those bouts, recognizing them as the classic symptoms of panic disorder. It’s not that I lacked for introspection or self-awareness in that time; I had begun therapy at 12, was well versed in the language of anxiety, trauma, and treatment. It’s that panic is regarded in a way that differs from common anxiety—it is too often seen as a mark of someone self-evidently “broken.”
Dr. Mitch Prinstein, Chief Science Officer at the American Psychological Association, laments the enormous gap between panic sufferers’ need for psychiatric support and what’s typically offered. Most Americans, he says, will remember the 15-minute dental hygiene lesson they got in kindergarten, which has helped prevent tooth decay and cavities in generations of children. “Where is the 15-minute intervention to stop emotional dysregulation, depression, suicidality, anxiety, substance use?” he asked.”
Thirty-nine states plus Washington DC mandate sex education, but not a single state mandates mental health education. Why aren’t all middle schoolers taught what anxiety is, what a panic attack is, and how best to manage them? What would it have meant for me two decades ago, as a 21-year-old college senior, to recognize that my sudden episodes of “nerves,” which made me feel like I was molting into a werewolf, were in fact textbook panics attacks, and to have had help in treating them?
We all end up paying for that lack of intervention. In concrete terms there is the cost to our healthcare system of all those ER false alarms. That’s to say nothing of work absenteeism. Anxiety disorders likely cost the economy over $50 billion in 2020. According to the White House, and based on data from 2020, 29% of Social Security Disability Insurance beneficiaries were people with mental health disorders “or 2.4 million people—a share larger than beneficiaries who cannot work due to injuries, cancer, or diseases of the circulatory and nervous system, combined.”
Familiar as my panic in Phoenix may have been, it still stung. Over the previous year I had committed to meditating and medicating away my panic. That afternoon punctured my fantasy of having been cured.
Immediately after our live shot, I raced to Sky Harbor airport, dragging my carry-on and my shame hangover onto a Southwest flight bound for Los Angeles. Scanning Southwest’s self-seating aisle, I slumped into 13C, next to a woman quietly crocheting. We got to talking.
It turned out she was no stranger to panic attacks. We communed over the extent to which the condition had touched our lives. As we did, I felt the sensation of a burden being lifted. This, sharing I realized, was good medicine.
Inspired, I started confessing my panic to colleagues, friends, strangers at parties, pretty much anyone who would listen. I set out in search of more formal settings to share—support groups. When I failed to find any nearby in Los Angeles, I enlisted the help of the National Alliance on Mental Illness, the Anxiety and Depression Association of America, and the American Psychological Association. Even with their generous assistance, I was able to find on their registries only three operational panic-specific support groups in the country. By comparison, there are nearly 62,000 AA groups in the U.S.
I am fortunate. I have a loving family and sympathetic colleagues, offering me both the emotional bandwidth and the means to support my journey toward the end of panic, a multi-year effort during which I tried everything including cognitive behavioral therapy, SSRIs, benzos, breathwork, ketamine, psychedelic mushrooms, and other hallucinogens.
Not everyone has the same luxury, nor should they have to. We desperately need a more effective support structure for the panic and anxiety sufferers in our midst. We need support groups to fill the yawning void that I encountered when I first sought help. We need to embrace the range of treatments now available to sufferers—not just the prescription pills we reflexively reach for in our search for a silver bullet (though prescription pills indeed work for some), but for alternative therapies like the ones I tried.
In my journey, I found comfort in the words of holistic psychiatrist Ellen Vora, who allowed me to recognize the therapeutic power of crying. She told me we need “a cultural rebrand around crying,” and I’d argue that we need a similar cultural rebrand around both panic and anxiety disorders.
Part of the reason for panic’s quiet prevalence may be that its sufferers typically do not explode. They implode. Their anxiety does not spill out into the streets, into fights or car wrecks. They often suffer unnoticed—unseen and unheard. It is all the more incumbent upon us, then, to open our eyes and ears to their hardship.
For those still in panic’s chokehold, I can offer a few gentle words of counsel. Science tells us that the peak of an attack will likely last only 15 to 60 seconds – the time it takes for your brain to assess a threat. You will survive it; panic attacks won’t kill you, even if it feels like they will. And you’re more capable, even in the most severe throes of panic, than you think. This is why people can continue driving capably, or reporting in my case, in the midst of a panic.
To the unafflicted—or to those who haven’t yet suffered their first panic attack—I ask for understanding. We are your friends, family members, your colleagues. There are more of us than you think.
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Contributor: Matt Gutman