The last time we met, the doctor told me she thought "we" needed to get me some "new coping methods". This is usually the part where I figure out how to change doctors, or just quit making appointments, because this is usually where they start giving me sales pitches on the wonders of CBT and stop reading things I hand them. I try not to be overly paranoid, but I got just about thirty years of "stop whining, you don't need medication, you just need to stop having the wrong feelings" and that makes a mark. I'm willing to give this one the benefit of the doubt, because she is an Energetic Young Thing who doesn't know me all that well yet, and also because she's not the therapist person. Frankly, I can ignore just about anything she says as long as she doesn't start pestering me to take something that won't end well, or threaten to stop letting me have something unless I toe the party line.

The therapist person has made no such noises. The therapist person is rather older than the doctor, which probably makes a difference, and is much more pragmatic. The doctor also suggested that perhaps Googling things made me more anxious and I might want to stop that, whereas the therapist person asked me if it helped, and when I told her it did, she just shrugged and went 'okay then'. It makes little difference what either of them say about that, as you will get me to stop thumbing through the proto-Hitchhiker's Guide right around when rigor mortis sets in -- there is a reason I bought a Kindle with lifetime 3G service -- but life is a lot less irritating when I don't have to pretend to be stupid or ignorant.

The irony is that the doctor may well be right, but in exactly the opposite direction as she thinks she is. What sparked that conversation was that she kept asking me what I was afraid of. I would guess she wants me to be afraid of a particular thing, and truthfully, I'd rather like that, too -- if I'm panicking over a thing, then I can deal with the thing, and quit panicking. Perhaps not always easy, but conceptually very simple. All I have to do is put my finger squarely on the thing that is driving me up a wall so I can tailor an action plan to it, and voilà. Improvement!

Annoyingly, this falls down in practice. I can certainly give you a reason for my stress, but on the whole, I'm not really afraid of anything. That is, I am dogged by a feeling of impending doom, as if I have done something terrible and am just skulking around waiting for someone to discover it and call me onto the carpet, but it is in reference to nothing in particular. It just exists, formless and omnipresent. I would love for it to have a proper corpus, because as all RPGers know, anything that has a proper stat sheet can be killed, regardless of what the scenario programmers intended.

I have tried forcibly nailing that damn feeling to something that I can affect, and it doesn't work. Geopolitical chaos is fucking terrible on me. In early 2011, when the Egyptians rioted and terrified Mubarak into resigning, I went: Okay. This is on the other side of the planet, where I am not, and all things considered, when the mobs have dispersed and the fires have been put out, the outcome is likely to be overwhelmingly positive. There is no reason for this to have thrown me into a panic, but it has anyway, so let's see if I can make myself feel like I'm doing something about it, and if that will finally make this shit go away. 

I speak several languages, and as it turns out the easiest way to make me furious on behalf of perfect strangers is to try to turn their internets off, so I pulled up Twitter in one window and IRC in the other, and spent a while translating the real-time bulletins from Le Monde and El Mundo, and relaying the various outside-access cellular internet numbers floating around the tweet-o-sphere. And by 'a while', I mean two, maybe two and a half days. Without food, or sleep, or any apparent effect on my physiological state at all. I hadn't yet talked myself into thinking the ER was a viable option, so I believe at that point I dragged myself a hundred feet down the road to the grocery store, bought a bottle of Robitussin gelcaps, and took them four at a time until I was far too high to pay attention to anything happening in my sympathetic nervous system, much less in Cairo.

[Simmer down. Robitussin gelcaps only have the one active ingredient. I know what 300mg of DXM does to me, and I'm not dumb enough to eat that much Tylenol. While it does last an annoyingly long time, the aftermath is also much less miserable than knocking back vodka.]

Years ago, I started calling this status panicus, by analogy to status epilepticus and status migrainosus. It happens when I've attained such a high baseline stress level that I'm primed for an attack, and once I've gone over the precipice, pretty much anything will kindle a second attack, up to and including the symptoms of the first. (I see now that I'm no longer the only one who uses that term, although I assume it's arisen independently many times over from people who saw the similarities.) I would argue that they were temporal lobe seizures, in fact, except that they last far longer than seizures do, and I don't experience changes in memory or consciousness while they're going on -- I'm A&O times like a kabillion, as evinced by the way I freak people out when they realize that I really am telling them, perfectly calmly and lucidly and in accurate medical terminology, what a motherfucking basket case I am right then, and can I please have some tranquilizers now. I'm equally on the ball right afterwards, less the effects of whatever I've snorked back to stop it.

[It's probably also worth noting that I've only ever gotten appropriate supportive care, in the wild, from 1) other people with this same issue, and 2) epileptics. Doctors, not quite so much.]

When people pester me to name whatever it is I'm afraid of, I have a rather bad habit of brainstorming shit that may make them shut up. This is one of those situations where 'I don't know' and 'nothing' do not appear to be acceptable answers. 'I don't know' appears to be interpreted as 'I want you to coddle me but can't be arsed to invent a plausible reason why' and 'nothing' appears to be interpreted as 'I'm going to make you ask a million times so I feel like I'm controlling this conversation'. I doubt whether the doctor would appreciate it if my new coping method is telling her, politely, to stop fucking asking me that, because that more than anything is likely to drive me into a tailspin of "try to force my panic to be a corporeal thing > try to kill the corpus > discover that does not make the panic abate"-- repeat ad absurdum, or at least ad medicamentum.

I would particularly like to avoid that because it occurs to me that an unchecked death spiral of neurotic self-questions and unhelpful self-answers would result in a behavioral deterioration not unlike that which my mother has displayed over the past three decades. Imagine thinking you'd identified the source of your fear and devised a way to thwart it, and yet the terror remained. Over and over again, for years. Eventually, the convoluted loops of rituals and bizarre beliefs would become indistinguishable from paranoid schizophrenia. (I have in fact been asked if she had that, and had to say no, on the grounds that I'm unaware of any hallucinations, and acting like a spoiled teenager is not the kind of 'inappropriate affect' they mean.) It's the sort of thing the mi-go might read to their kids instead of If You Give A Mouse A Cookie.


  1. "What sparked that conversation was that she kept asking me what I was afraid of... but on the whole, I'm not really afraid of anything. That is, I am dogged by a feeling of impending doom, as if I have done something terrible and am just skulking around waiting for someone to discover it and call me onto the carpet, but it is in reference to nothing in particular. It just exists, formless and omnipresent."

    Sounds like a physiologically based fear state, probably an effect of the ongoing crisis / status panickus rather than a cause. The stuff you describe about brainstorming psychological causes and coming up empty is classic for that.
    Maybe it would help to remind the doctor that such a thing is possible? Here's a licensed pharmacist talking about his sense of chronic impending doom, which turned out to be caused by dangerously high blood pressure, and went away once he got on blood-pressure meds. (Search for 'peculiar sense of dread' to skip to that part of the page; it's a few screens down.)

    Best wishes and good luck.

    1. I already know it's physiologically-based. I haven't linked the research papers here, because they're behind a paywall, but there's fMRI evidence of abnormalities in the hypothalamus-pituitary axis and amygdala in Ehlers-Danlos/joint hypermobility patients. The researchers in that particular study scanned a bunch of patients with anxiety and panic disorders and were surprised to discover they could sort the images into 'bendy patients' and 'non-bendy patients' by sight.

      Unfortunately, it's not blood pressure. I know this because two of the medications we've tried are propranolol and clonidine, which are normally used to treat essential hypertension. They both sent my blood pressure through the floor -- clonidine so badly that my resting heart rate actually went up 20bpm in compensation -- and have now been added to the list of 'never ever give her these again' in my medical records.

      Applying some logic to what things work and what things don't, what appears to be wrong is that the part of the feedback loop that is supposed to shut off adrenaline and other stress hormones when they're no longer needed is broken. Propranolol, which acts to prevent adrenaline from having any of its normal knock-on effects no matter how much is in my bloodstream, was brilliant, except for having the sort of side effects that make doctors remind me very seriously that I am allowed to call 911.

      I can ride it out/sleep despite it if I pour enough anticholinergics and/or dissociatives into myself, or I can shut it down with GABAergic drugs like benzodiazepines that bang on the off switch directly. The problem I am running into medically is that doctors make frowny faces at me when I take whole bottles of Robitussin gelcaps, and reeeeaaaaaally hate writing rolling prescriptions for anything that has a street value. I much prefer the Xanax, mainly because it wears the fuck off faster.

      I may have made my point about that last time, when I explained that I broke down and took one of my precious Xanax after the landlady charged in on me with a workman again. She barged through at about lunchtime, and I had call at 7pm that night. My choice was give the clonidine again and potentially be unable to go on stage that night, or take the Xanax now, get my 4-hour coma overwith, and then caffeinate myself into performing. Evidently my telling her that I literally have to schedule my outages had not sunk in fully before.

  2. I'm sorry, I didn't mean to suggest *you* didn't know where it was coming from. Only that maybe a case study would help the doctor get it; didn't realize you'd already waved some at her. Will butt out now.

    1. No, no, you're fine, I'm just ranty. I have been hammering away at this with this one particular doctor for like a month already. The sticking point is that if I am right that my issue is GABA-related, there *isn't* any other way to fix it -- the only drugs that will work are things like benzodiazepines, or related compounds like the phenibut or the muscle relaxant Baclofen. They don't want to give me any, basically because they have street value. It's the same wall people often run into when they're trying to get treatment for chronic pain.

      I am thiiiiiiiiiis close to just finding myself a reliable drug dealer, honestly.


Post a Comment