by: Author Unknown,
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.
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.
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