Panic, Biology, and Reason: Giving the Body Its Due

Article by Peter A. Levine, Ph.D., Director of the Foundation for Human Enrichment, www.traumahealing.com

The Substitute Tiger

My interest in the essential role played by bodily responses in the genesis and treatment of panic anxiety began quite accidentally in 1969. A psychiatrist, knowing of my interest in “mind/body healing”-a fledging arena at the time, had referred a young woman to see me. Nancy had been suffering from panic attacks for about two years. She had not responded to psychotherapy, while tranquilizers and antidepressant drugs gave her only minimal relief. The referring psychiatrist asked me to do some “relaxation training” with her. My attempts were equally unsuccessful. She resisted; I tried harder. We got nowhere. Since I knew almost nothing about panic attacks at the time, I asked her for more detailed information about the ‘how and when’ of her attacks. Nancy revealed that the onset of her first attack occurred while she, along with a group of other students, was taking the Graduate Record Examination. She remembers breaking out in a cold sweat and beginning to shake. Forcing herself to complete the test, Nancy then ran out, frantically pacing the streets for hours, afraid to enter a bus or taxi. Fortunately, she met a friend who took her home. During the following two years her symptoms worsened and became more frequent. Eventually she was unable to leave her house alone and could not follow through with graduate school even though she had passed the exam and was accepted by a major university.

In our conversation, Nancy recollected the following sequence of events: Arriving early, she went to the cafe to have a coffee and smoke a cigarette. A group of students were already there, talking about how difficult the test was. Nancy, overhearing this, became agitated, lit another cigarette, and gulped a second coffee. She remembered feeling quite jittery upon entering the room. She recalled that the exams and marking pencils were passed out and that she wrote vigorously. She became almost breathless at this point and quite agitated--I noticed that her carotid (neck) pulse was increasing rapidly. I asked Nancy to lie down and I tried to get her to relax. Relaxation was not the answer. As I naively, and with the best of intentions, attempted to help her relax, she went into a full-blown anxiety attack. Her heartbeat accelerated further to about 150 beats per minute. Her breathing and pulse rate then started to decrease. I was relieved, but only momentarily. Her pulse continued to drop, precipitously to around 50 beats per minute; she became still. Her face paled and her hands begin to tremble: “I’m real scared…stiff all over…I’m dying…I can’t move…I don’t want to die…help me…don’t let my die.” She continued to stiffen, her throat becoming so tight that she could barely speak. Nancy forced the words, “Why can’t I understand this…I feel so inferior, like I’m being punished…there’s something wrong with me…I feel like I’m going to be killed… there’s nothing…it’s just blank.” (We had rather unfortunately co-discovered, some years before it was reported in the literature, “relaxation-induced panic syndrome.”) Read on