Case Study
Phase 1
I have lived with varying
degrees of this condition and its fears, unpredictable panic attacks,
worries and depression for the last 15 years. This personal case
study covers an extensive length of time and can really be divided
into two main phases. The initial phase, which had the outcome
of psychological and physical ill health and the second phase
in which changes were implicated, resulting in gradual improvement
over years and a satisfactory health outcome, both physically
and psychologically.
My background is
middle class and although my early family life was not free from
stress, I was always independent, outgoing and adventurous with
no tendency to form phobic reactions. I had also travelled widely
both overseas and in Australia without any ill ease and had always
used public transport.
The first symptoms
began with the first panic attack. I had suffered for 18 months
prior to this event with chronic diarrhoea, a complaint originating
from a holiday in Mexico in 1976. This became physically debilitating
as well as stressful psychologically, as, after numerous tests,
specialists and trips to hospital no formal diagnosis was reached.
It was then put down to 'irritable bowel syndrome' due to 'nerves'
(a diagnosis I never accepted) and I was prescribed Lomotil for
the diarrhoea and Valium for the 'nerves'. Although I managed
reasonably well, the complaint came back on and off.
I then had the first
panic attack. This panic attack was actually adaptive fear. I
was feeling fine and walking down a busy street, suddenly, without
warning, I realised I was going to be really ill (diarrhoea) and
there was nowhere to go. As well as being an extremely distressing
experience it left me feeling lacking in confidence in my own
bodily functions. This event changed my life and marked the transformation
from the outgoing, confident person that I was into the fearful,
anxious person I was to become.
I was suddenly gripped
with a terrible fear of a recurrence of this situation and the
public embarrassment associated with it. "What would I do?" How
would I get to safety?" Even thinking about it made me anxious.
As time went on
even when my stomach was not upset, any situation I felt was 'dangerous'
became associated with some fear - public transport, walking from
home or car or being trapped in any situation from which I could
not escape quickly. Soon these fears became minor panics and as
the disorder escalated, I found that I had increasing difficulty
with everyday tasks which involved moving from home or other safety
points such as my work and car, simple things had become terrifying.
I started to have frequent and unpredictable panic attacks, mainly
away from the home and which began typically with predictable
anxiety, now suffered in certain situations, followed by a feeling
of unreality and other physical symptoms, palpitations, sweating,
trembling and dizziness. These attacks would leave me feeling
physically and emotionally drained. I could not understand why
these panic attacks were occurring especially when physically
I felt O.K. No amount of 'self talk' and logical reasoning made
any difference. What I did not know at the time is that I had
become an agoraphobic and I was not equipped to deal with irrational
phobic fear.
I was forced into
a restricted existence and felt I was confined to a few safe places
and had the trauma of travelling to and from these places. The
effect on my social and life in general was devastating. I lived
with a constant base line anxiety level, which went up in peaks
with the panic attacks but never seemed to go away. There was
always the choice between non stop distress for the length of
time I was away form home and then exhaustion, or the anguish
of depression if I failed to go at all. I felt I was trapped in
my own unreasonable fears and I felt absolutely powerless to bring
these panic states under control. The burden of daily stress and
the failure to cope adequately with the normal simple routines
of living caused me to be increasingly depressed.
My social life was
unsatisfying and work became more difficult as I found it harder
to concentrate and I was constantly anxious. I was taking days
off when I could not reach work and had to turn back home with
feelings of failure.
I felt ashamed and
embarrassed about my situation and I began to feel isolated both,
at work and in my social life. I had many social anxieties of
what other 'normal' people would think of me if I revealed or
showed how frightened I was of everyday situations. I was afraid
they would think of me as strange for having such grossly unrealistic
fears. I was forced to lead a secret life, going to great lengths
to keep others from knowing about the panic attacks and phobias,
I saw my reactions as 'abnormal'. This view created greater stress
as it had a crushing effect on my self-esteem.
I confided in only
a few people - my parents. My mother was very sympathetic and
tried to understand, it disturbed my father. In the early stages
I told a few people who, because they could not understand, advised
me to 'just put your mind to it' and 'go and do it', 'don't be
silly', 'you've got to pull yourself together'. I then refrained
from telling people, this making me more secretive and selective
and adversely effected to a great extent social interactions and
relationships. I had two girlfriends who knew. The extended self-scrutiny
and at times self pity into which the agoraphobia had drawn me,
made me totally absorbed in this problem and although I very much
needed to talk I felt that I appeared self centred and had become
tiring to family and friends and experienced feelings of guilt
for complaining.
Two months after
the first panic attack l had consulted a G.P. who referred me
to a psychiatrist. In fact, I had several psychiatrists over the
following years. My problem was never correctly diagnosed and
the condition was given a variety of labels 'anxiety state', 'depression'
and 'free floating anxiety state'. The first psychiatrist prescribed
a Mayo inhibitor, which had dietary restrictions and was quite
strong. There was some improvement from feelings of disassociation
but the panic attacks continued. The psychiatrists did not help
me. They seemed intent on hypnotherapy and used psychoanalysis
to delve into my childhood even though I argued that I felt fine
up until the first panic attack. The failure of gaining help,
understanding and support form the medical professionals really
frightened me and I felt a terrible loss of hope in my chance
of establishing a normal existence. I felt powerless and the cost
to my self-esteem was enormous.
The panics, fears,
worries and depressions continued throughout the next few years
changing in intensity. I did reach a sort of adjustment to my
fears and problems but the quality of my life was not good and
although the initial extreme constant anxiety was lowered slightly,
I was using avoidance tactics. There were always feelings of loneliness
and isolation due to my change in lifestyle and largely lack of
support and feelings of failure and the ensuring bouts of depression.
I did not dare look into the future because it was too distressing
so I abandoned my ambitions and goals.
I instead took measures
aimed directly at daily survival. I took increasing amounts of
Serapax (prescribed by a G.P.). Serapax lowers muscle tension
and has a mood altering effect, giving some relief from anxiety
without sedation. 'Major challenges' such as going out or driving
to work would require a larger dose and I found that the effect
of this drug could be strengthened if taken along with alcohol.
Alcohol was one
of the only things that almost instantly lowered the anxiety and
I used it constantly to gain relief, usually in conjunction with
Serapax. I also smoked cigarettes. The reliance of these drugs
disturbed me and although I realised that they were actually creating
further serious problems, I could not exist or go to work without
them.
Although my first
thought everyday was what excuse could I have to stay home and
although going through the effort, anxiety and pure anguish of
driving into the city in traffic each day was very stressful,
I kept going and realised there could be no long term improvement
without some exposure to phobic situations.
Gradually over time
this constant unrelenting stress and reliance on Serapax, alcohol
and cigarettes began to take its toll on my overall health. I
felt exhausted, distant and preoccupied. I alternated between
anxiety and depression and had increased health problems, a lowered
resistance leading to colds, bronchitis and skin problems.
My parents at this
time moved interstate and I felt more isolated and alone than
ever. My physical and psychological state worsened until one day
I did not get out of bed to go to work, I was exhausted from fighting
this condition and felt there was no hope for a normal existence.
My problems seemed insurmountable and I even contemplated suicide.
I felt I had hit rock bottom! Ten years had now passed.
Phase 2
This crisis point also
proved to be the turning point. Something in me would not allow
me to give up. I forced myself out of bed and started to make
a plan of recovery - I felt my very survival depended on it. I
had to go 'up'.
The first steps
towards recovery were very painful and progress was slow. In the
following months I turned my attention to gaining knowledge about
my condition, Agoraphobia - (I now judged the doctors as completely
useless!) and constructively doing something about my physical
health.
I found a book on
Agoraphobia and gained very valuable information regarding my
condition and panic control. I also learnt from my reading that
clinical researchers are baffled by the absence of well defined
personality traits or 'premorbid' signals of oncoming agoraphobia,
most agoraphobics were originally no more sensitive than anybody
else to travel etc. but have passed through a trauma or a series
of super stresses and panic exploded and separation and attachment
concerns are awakened.
The knowledge gained
allowed me to accept the symptoms of my condition which was an
important step, as 'fighting it' further stimulates the nervous
system.
I decided that there
could be no long-term improvement of the condition if I was reliant
on tranquillisers, which I realised were not helping me anyway.
Withdrawal was a painful and arduous task I was on enormous doses
(prescribed by the G.P.!)
I gradually reduced
and suffered many distressing withdrawal symptoms - shaking inside,
derealisation, stomach problems, general anxiety and many panic
attacks. I was impatient and suffered many setbacks, feelings
of frustration and disappointment but I was gradually improving.
At the same time
I greatly improved my diet, eating lots of fresh fruit and vegetables.
When the Serapax was down to the stage where I was not taking
them on a regular basis I gave up alcohol and cigarettes. (The
cigarettes was the hardest!) and at the same time took up swimming.
I have always believed the swimming to be one of the greatest
elements of my recovery. It provided me with, apart from the physical
and health advantages, a sense of achievement, a goal, amazing
stress management due to the physical exercise and regular, deep
breathing. (I did not miss more than one day per week in the next
five years). It also provided me with social contact and I made
new friends. One friend in particular had problems too and we
were and still are very supportive of each other.
My physical health
improved dramatically from the very start and I think I had always
realised that I was blessed with an extremely strong constitution,
which bounced back very quickly after 10 years of extreme stress
and unhealthy living.
After some time,
although the phobic anxiety and panic attacks were still there,
I had a different attitude and tried not to be consumed with it,
it was this element of acceptance which helped me through the
most difficult times.
I began to try to
walk distances from the house on a regular basis. I had expected
set backs and tried to remind myself of my other achievements
when I failed or had a panic attack. I did deep breathing and
tried not to have negative thoughts. The improvement was slow
but with the combination of withdrawing from the tranquillisers,
alcohol and cigarettes and the swimming and a healthy diet my
perception of the world had changed. I could think more clearly
and I at least felt there was hope and I had some control over
my life. My achievements boosted my self-confidence and both my
sense of mastery and self esteem were increased.
Another event speeded
up my recovery. I accepted a position at work, which involved
2-3 hours per day walking around the city doing sales calls. Initially
this was extremely stressful, but I always completed my work (I
had to!) and gradually the anxiety level went down and although
I had many setbacks, felt a sense of achievement in my daily accomplishment.
The next few years have showed a very gradual improvement of the
agoraphobia- there is no quick cure for this condition but although
I still suffer some symptoms of anxiety in some situations, they
are not as severe and I feel I have the experience, knowledge
and skills to keep it under control.
My recovery has
not been easy especially in the first couple of years but the
final result has been worth the effort. I feel free from the nightmare
in which I lived for so long and can live a normal life again.
I feel an overall sense of achievement in the control I now have
over my life, and in my state of health and well being.
(Anon)
