Saturday, March 30, 2013

Panic Attacks as imitation of death

A woman in her forties who has suffered from relentless panic attacks and chronic anxiety from the age of 19 gave the following reason as to why she came down with the illness.
She was a newly married young girl who had moved with her husband to a small town in Upper Michigan near an Air Force base. She already was mother of two children, an year old boy and a 2 month old perfectly healthy girl.
Her arrival at the town was immediately followed by her newborn getting sick. The baby stopped tolerating whatever was fed to her. Numerous brands of formula were tried, but she just threw up all of them. And one day, when she was barely 3 months old, she took turn for the worse. The mother begged her sister-in-law to drive her baby to the doctor for she did not have a car but the latter found some excuse to not do so. Two days later the little girl, just 3 months old, died.
Just before death, a 911 call was made, and the policeman who had accompanied the paramedics to her house, told her, that his son too had died a similar death, and it was all the fault of the Air Force base who were discharging their chemical wastes into the water system.
The death caused a devastating depression in the mother, which only abated, and partially, when she started investigating the cause of the death, spurred by that policeman's remark, and found that 8 other similar deaths had occurred in that small town. All eight were children, all below the age of one, and all had died of arsenic poisoning. The more she explored this matter the less depressed she felt, but at a price. It seems as if another affect had to emerge in place of depression to extricate herself from the latter - a rage at the Air Force base for allowing the arsenic to seep in to the drinking water. She became convinced that the planes that were flying above her - the air force base was just a mile away from the apartment complex - were dumping chemicals in the Huron Lake - which was right next to the complex - and that was seeping in to the well water. Her investigation also led her to ask the local health authorities as to why she and her husband had not gotten sick from that contaminated water and was told because they were older and could tolerate small amounts of arsenic that was present in the well water. The same explanation was given to her as to why her year-old had not gotten sick, for his water needs were mainly being met by the same food and drinks that the adults were eating -  obtained from the local supermarket which got all its supplies from outside the town.
She approached the Air Force personnel but they refused to take the responsibility for the deaths, claiming that the arsenic in the well water had nothing to to do with them but was naturally present in that region. This did not satisfy the patient, and the rage she felt towards them continued to deepen, finally culminating in panic attacks. The panic was a defensive maneuver to prevent the rage turning into actual destructive behavior towards the Air Force people. The panic attacks which soon spilled from discrete episodes into chronic anxiety and were accompanied by the emergence of agoraphobia. The rationale of agoraphobia was to prevent her from coming anywhere near the Air Force base where losing control completely she could have attacked those people. Within months the agoraphobia worsened and was no longer limited to avoiding the Air Force base but extended to every thing that was of any distance from the house, the radius of which kept on shrinking. At this point she had a big fight with her sister-in-law who had reneged from her promise to take the child to the doctor and who lived in the same apartment complex. She stopped talking with this sister-in-law on whose invitation they had moved to that town and then their apartment itself came under prohibition and she had to leave town.
She came back to Metro Detroit where she had grown up. But this physical distancing herself from the site of the trauma did not resolve the problem. Her husband, the only living representative of that painful period now became the reminder of the Air Force base, and the object of the phobia. She blamed him for moving them to that infernal town at the invitation of his sister, it was he who had failed to take heed when she pointed that the water looked cloudy and which he had dismissed as a joke by quipping that the water must be full of vitamins and hence cloudy and good for your health rather than bad, and any contact with him provoked the same panic reaction. This left her with no choice but to divorce him. His becoming an alcoholic, perhaps to deal with his own sorrow at the little girl's death, also played a significant role in her opting for the divorce.
Twenty-five years later, when she came to me, she still suffered from panic attacks, which were characterized now primarily by the feeling that she is about to die. Analysis showed that behind this feeling of dying, which provoked the 'flight response' and gave rise to the phenomenology of panic attacks - sinking spell, breathlessness, rapid heart rate, sweating, all physiological responses that one would experience if one was physically running - lay fantasies of going and murdering the Air Force base people and then getting killed as a punishment. And as the illness progressed this aim went beyond its original purpose - the hatred of the Air Force base changed into hatred of the world in general and even her husband.  And when she could not move away any further from people physically her mind started running away from people in imagination, which was reflected in her racing thoughts and pressure of speech.
But the rage which was fed by the loss of her daughter and which was permanent and incapable of getting undone in reality, still pressed for discharge and still wanted some live person to be punished. After leaving that town her husband had served the role of the whipping boy. But once she divorced him and he was no longer available, the rage was forced to find complete strangers as representative of the Air Force Base. But since one cannot attack every person one runs in to unless one goes outright psychotic, she had to express this hatred by becoming eccentric and goofy-headed in dealing with people. This goofiness which made people think of her as mentally imbalanced and someone to be avoided was now her expression of revenge.
But the rage was still not quelled. Even after the isolation was more or less complete, the rage persisted. And finally with no live person left to kill she made part of herself as that object, the representative of the Air Force Base. And it was this part of herself that she felt as dying when she would have panic attacks.
It is interesting that her nightmares repeated this process in sleep. They were PTSD like in their structure. The dreams would start as typically wish fulfilling. They would first show her daughter alive. The patient would then be filled with happiness. The daughter would not just be alive but would be shown blossoming through different stages of life, from 3 months onward to a young school girl, to a teenager, to a fully grown young woman. She would be surprised at knowing that she had not really not died but had survived the arsenic poisoning and that they had moved back to Detroit where she had grown up. But even the dream would not maintain the facade for too long, the underlying rage would rear its ugly head and reality would break through. And soon all the villains, including her ex-husband, would take the central stage of the dream. And finally she would wake up in a panic fearful of her own death.
I would not be surprised if a similar imitation of death underlies the sleep apnea - an imitation of one's death to satisfy murderous impulses towards others. Even "the sinking feeling" that patients describe that precedes full blown panic attack may be a premonition of death. For we know that in dreams death and rebirth are often depicted by the same symbol: drowning.       


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