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<title>Zk | 2013-11-08-small-update</title>
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<h1>Zk | 2013-11-08-small-update</h1>
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<p>type: post
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title: A Small Update
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date: 2013-11-08
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slug: a-small-update</p>
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<hr />
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<p>Both partners and several friends have expressed some concern of late over the
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pattern of anxiety and panic that has emerged after starting treatment for the
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same. To that end, I scheduled a phone session with my doctor to discuss that,
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and I think it’d be good to get down in words some of the results of the call.</p>
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<p>All of our concerns basically boil down to some variation of “I can’t tell if
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you’re getting better or worse”. On my end, in particular, it was worry that
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the benzo that I’m taking is “covering” or “hiding” anxiety that I would
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normally be able to cope with until it reaches the point that it turns into a
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panic attack. That’s because, over all, I’ve been feeling much better in terms
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of anxiety, and not as much in terms of panic. I was worried that I was missing
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a chance to head-off a panic attack through other coping mechanisms. This isn’t
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helped by the fact that I really worry about tolerance and addiction with
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benzodiazepines (though my doctor assures me that I’m on fairly low doses
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because I’m apparently ridiculously sensitive).</p>
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<p>The pattern of late (the last two to three weeks) has been that I’ll feel pretty
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okay for most of the day, but sometime in the late afternoon or evening, I’ll be
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overcome by a rush of dissociation/depersonalization/derealization that feels
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like I’m being reduced to a tiny part of my brain while I lose control of the
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rest of my mind and it goes into some null-space. I usually have to lie down,
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and I usually have to close my eyes and cover my ears because sights and sounds
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get too confusing and overwhelming. I also lose track of time (I usually spend
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about an hour and a half to two hours out and sort of unresponsive, but
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subjective time usually runs about 10-15 minutes), and can’t respond coherently
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speaking or writing. This happens about three to four times a week, and will
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very rarely be a series of rolling panic attacks with half hour breaks between
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them.</p>
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<p>The difference, as I’ve noticed and as my doctor explicitly pointed out, is that
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anxiety is now no longer such a big factor in my life. Panic of this type has
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been going on for months, now, but the amount of anxiety also in my life has
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historically been high. Very high.</p>
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<p>Panic and anxiety are, of course, very strongly correlated. The original
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response was to notice, say, a tiger in the bushes, have a psychological response
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(anxiety), followed by a somatic response (panic; adrenaline amplifying the
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sympathetic and parasympathetic nervous system) so that one can fight or flee.</p>
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<blockquote>
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<p>Does it feel good to explain? To boil this down to scientific terms and say
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hey, this is all a vestige of evolution?</p>
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</blockquote>
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<p>Generalized anxiety disorder, on the other hand, is having that psychological
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response all the time about things that don’t necessarily warrant anxiety, or
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having out-of-proportion anxiety about the things that do. I’ve lived with that
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all my life - literally: my mom tells a story that, when they first moved my
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crib into her hospital room after I was born, neither of us slept all night,
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instead just warily eying each other, anxious and nervous.</p>
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<p>Panic attacks are relatively recent for me, starting up sometime in my late
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teens and early twenties as any sort of regular occurrence, and those involve
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having that same somatic response, often - but not always - correlated with the
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psychological response of anxiety. These include all the symptoms of an
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adrenaline rush: pounding heart, racing pulse, shallow or quick breathing,
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tunnel vision, etc.</p>
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<p>Your whole body is one big feedback loop, though, and so effects happening in
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your autonomic nervous system - panic - can affect your central nervous system
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and, in turn, amplify the panic. In this way, panic compounds anxiety, and vice
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versa. This is why panic attacks often also include feelings of dread, feeling
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like one is dying or going crazy, depersonalization (feeling as if one is not
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real), derealization (feeling as if the world is not real), and dissociation (a
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disconnection from sense of self, body, or reality).</p>
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<p>When I go to lie down during a panic attack, I’m locked in a room at the very
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top of my head, a perfect cube, completely dark. All of my senses come through
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muffled and disjoint, the rest of the house of my mind is locked and shut away
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in some state I can’t access, and I can barely figure out the structure of the
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house of my body. Who knows what’s going on in the next room, or the room down
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the hall? There’s just that one little perfectly dark cube left for me to hide
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in while the rest of the house rocks and shifts and shakes in a storm of panic,
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or settles and creaks under its own weight.</p>
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<p>As the panic recedes, more and more doors are unlocked, more shutters thrown
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open, blinds lifted, curtains tied back as I regain control of mind and body.
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Clumsy at first, stuttering, unable to fully understand language written or
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spoken, I start to inhabit more and more of myself to the point where I regain
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my connection with the world around - and within - me.</p>
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<blockquote>
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<p>Analogies, man… Do those feel any better?</p>
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</blockquote>
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<p>I feel almost split in two sometimes. There is this part of me that undergoes
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massive dissociation and depersonalization to the point where I spend an hour
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and a half all but comatose, and then there is part of me that is really here,
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is really present. I have to use the one to look at and investigate the other,
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to figure out what’s going on, but only sidelong. That other part of me is too
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magnetic, too easy to fall into, it seems. If I get too close, look to hard,
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then I risk slipping back into that side of myself, where muscles in my neck and
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back tense up, fists clench and unclench, head tics nervously to the side,
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heartburn climbs my esophagus, and I start to lose touch with what things are
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and how they work.</p>
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<p>I have to investigate, too. I have to find out what started things, whether this
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was triggered by anxiety, and if so, what (if anything) might have triggered the
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anxiety. I have to walk back down that path just to see if there was something
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I could notice sooner, some earlier point at which I could have subverted
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things.</p>
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<blockquote>
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<p>Of course. Because it always comes back to control, with you.</p>
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</blockquote>
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<p>To that end, my doctor thinks that the fluoxetine is helping quite a bit with
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the general anxiety, as is the alprazolam, though that will probably be
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tapered out before long. The treatment for generalized anxiety is working well,
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and continues apace.</p>
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<p>The treatment for panic, however, is being stepped up, to combat the obvious
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increase in panic over the last few months. I’m to keep a schedule of when
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panic attacks happen, including how long and how strong (which I already do with
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@foxproblems, of course; kudos, me). I’m to feel free to break up panic attacks
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with lorazepam (which, taken sublingually, acts very fast) and now also
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propanolol, a beta-blocker, which should help break up some of the somatic
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effects of panic such as the pounding heart, shallow breathing, tunnel vision,
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and so on (which, again, tend to cause me to panic more by their very
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existence).</p>
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<p>Do I think I’m getting better? Or worse?</p>
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<blockquote>
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<p><em>Mu</em>. Better and worse are falsehoods. Only change, and even that doesn’t
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matter.</p>
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</blockquote>
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<p>I think I’m getting better. The anxiety is to the point where I feel real,
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present, and…well, normal more now than I have in years and years. The panic
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is bad, but it’s also more visible by the very fact that the general anxiety is
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better. The somatic response is less connected to the psychological one these
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last few months that it may have seemed, because anxiety was <em>always</em> running
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high. Now that the anxiety is manageable, the beast that is panic is clearly
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visible. While I can’t necessarily remember everything, I don’t even think I’m
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having <em>more</em> panic now than I was before. It’s just that much more visible.</p>
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<p>That said, I’m super thankful for James and Russ for being so supportive, as
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well as Kris, Peri, Lu, Nakita, JM (especially JM, who has helped twice
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now in keeping [a][s] running while I fix my broken-down self), and a ton of
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others. I know I’m a sap, and I know I get maudlin a lot</p>
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<blockquote>
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<p>Understatement of the year.</p>
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</blockquote>
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<p>but you all deserve your thanks, and all my love. <em>You</em> are real. I’m real.
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This is all real. It’s hard to disentangle what is and isn’t sometimes, but I’m
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keeping on it, and you all are helping.</p>
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<hr />
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<p>I used to write with an ‘ally’, way back when, whenever I was writing
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therapeutically. It would be contrived elsewhere, and it probably seems
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contrived here, but sometimes it helps me, so please bear with me.</p>
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<blockquote>
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<p>Not that you give much choice.</p>
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</blockquote>
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</article>
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<p>Page generated on 2024-05-04</p>
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