Death Grip (14 page)

We don't know what's going to happen.

We touched down as the 767 imperceptibly lost velocity, a banshee howl coming off malfunctioning ailerons that had raised but barely. The crosswise runways were blocked by ambulances and fire trucks, red and blue lights flashing off skid-mirrors of tire rubber. The plane lumbered to a taxi much too far along, well past the airport, everyone on board applauding when we finally slowed. Eighty minutes of
We don't know what's going to happen
. That's a panic attack: X number of minutes of
We don't know what's going to happen,
of an unending fear-filled present. As with a bad fever, you cannot imagine feeling any other way, whether reaching into your deepest past or on into the future: It's a moment in which you're sure, no matter how much evidence is produced to the contrary, that you've locked horns with the reaper himself.

The June 13, 2011, issue of
The New Yorker
ran a heartrending piece by Aleksandar Hemon about his infant daughter's rare pediatric cancer. Meditating on mortality, Hemon devotes a paragraph to the psychological barrier we erect between ourselves and imagining the instant of our own passing—we must, Hemon argues, in order to live, to avoid the paralyzing “attendant fear and humiliation of absolute helplessness” in the face of being eternally but one breath from oblivion. “Still, as we mature into mortality, we begin to gingerly dip our horror-tingling toes into the void,” Hermon writes, “hoping that our mind will somehow ease itself into dying, that God or some other soothing opiate will remain available as we venture into the darkness of nonbeing.”
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As I've grown older, lost friends—even had one pass as I held his hand after a battle against lymphoma—and had the myriad near misses of any lifelong climber, I have, in Hemon's words, “matured” into my mortality; I now accept it. But the panic-attack sufferer has no such luxury. Before I beat this thing, every attack, no matter how many others I'd endured, felt like the end—like being back on that 767 but one breath from oblivion.

It's no wonder that panic sufferers will do anything for a little peace.

Home that night in Albuquerque, I sat at the kitchen table trying to explain what I was feeling to my father and stepmother. I could see the concern writ in the creases of my dad's brow as he asked questions. Though he was only in his mid-forties, his hair was almost totally white. My father had originally wanted to go into psychiatry, and I'm sure feared I'd had a psychotic break. Was I seeing things? he wanted to know. Hearing voices or commands?

No, of course not, I told him. I just felt tides of tremendous, sourceless fear that seemed to worsen when I was alone. And maybe, also—it was time to confess—I wasn't eating very well. Which, of course, having seen my mother's eating disorder and how skinny I could get on climbing trips, my dad had suspected all along. “You don't have much subcutaneous fat,” he'd say when I returned from the road gaunt and ravenous. “I worry that you're not getting enough calories for being out climbing all day.”

Christmas break 1992 was a nightmare, a nauseous, tortured, insomniatic nightmare. Not only hadn't I been eating, now I had such a nervous stomach I barely
could
eat even when I wanted to. I canceled plans to spend two weeks bouldering at Hueco Tanks and tried to climb only once, a jaunt with a friend to Socorro only an hour away during which I had to bail midday as “it” came shimmering over again like toxic drizzle. I'd also come to associate exercise with the fear—with that StairMaster session and ER visit—and refused to get my heart rate up. I stopped jogging. On bad nights, in my peripheral vision, I'd see shadows shifting along the walls, creeping upward like spilled paint in some upside-down mirror world. My best friend, Sky, a nonclimber, was home from Georgetown, so I'd either hang out with him at his dad's house or hole up in my room playing Super Mario Bros and trying to will away the terror. With Sky, I went out once to a record store and again to the movies, and felt “it” happen: In these confined spaces, breathing forced, heated air, I'd begin to “suffocate” and have to run outside to regroup. I had another huge panic attack one night coming back to my dad's while he and my stepmother were out to dinner. Alone in the house, juicing with adrenaline, I called 911 again, my voice so reedy that the EMTs were shocked to find a scared, healthy young man and not an old woman having a myocardial infarction when they rang the doorbell.

Before winter break had ended, I'd agreed to visit my old psychologist in Albuquerque, “Dr. Smith.” He was an empathetic, low-key soul who'd counseled me during the Challenge Program years, hip enough that he kept Carlos Castaneda books in his office and would let me borrow them. Dr. Smith was a good listener and engaged in a dialogue of equals, the definition of a solid therapist: someone who cares about
you
—not just your diagnosis—and, without judgment, leads you through the tangled web of your broken thinking. Dr. Smith referred me to his mentor, a professor in CU's psychology department, and I began to see this new therapist, Jack, twice a week. Jack in turn referred me to a psychiatrist, which is often how these things play out—two complementary therapies. Unlike psychologists or therapists, psychiatrists are medical doctors generally focused on a
diagnosis
and on medicating symptoms, who might see you for a quick, fifteen-minute med check-in every three months and tend not to tangle with sticky issues like feelings. This doctor had the standard-issue sleepy demeanor and Sigmund Freud beard. We began experimenting with different antidepressants. The notion was that to treat anxiety you must first address any underlying depression. I tried Pamelor, the name-brand version of nortriptyline, but couldn't deal with the dry mouth, palpitations, and orthostatic hypertension. I quit after a week. We tried Trazodone, an atypical antidepressant, but it made me logy and glassy-eyed, as if I were taking horse tranquilizers; I stopped this drug after only two days. Finally we settled on a low dose (10mg) of Paxil, a selective serotonin-reuptake inhibitor or SSRI, in the same family as Prozac, Luvox, Lexapro, Celexa, and Zoloft. We've all heard of SSRIs, the supposedly cleaner second-generation antidepressants—since 2004 with an FDA black-box suicide warning for children and adolescents—that allegedly outperform the old pills. The party line is that, instead of barraging
all
the neurotransmitter systems, SSRIs are superior because they target only one—serotonin—and thus cause fewer side effects than the old tricyclics and MAOI inhibitors. (SSRIs are thought to increase the bioavailability of serotonin by inhibiting its removal from the synapses—that is, they inhibit the “reuptake” or re-absorption of serotonin by the presynaptic neuron such that more can bind with the postsnynaptic neuron.
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However, no demonstrable link between this specific chemical action and the treatment of depression has ever been established.) I took Paxil on and off for years, but could never go beyond 10mg without feeling “off”—sped-up, agitated, queasy, and effusive, which is against my nature. It also had undesirable side effects, including an emotional iciness if not a downright aggressive streak, difficulty reaching orgasm, and no longer being ticklish, all of which created issues in romantic relationships. Finally, in 2005, in the throes of benzo withdrawal, an updose in Paxil caused me to be labeled “bipolar” and nearly killed me. I have not taken an SSRI since.

In truth it was a person—Jack—who more than any drug helped restore me to sanity. Together, Jack and I worked through a panic-disorder workbook that tracked things like mood and anxiety levels, correlating them with time of day, food intake, situation, thought patterns, and so on. I also had to note the time of each panic attack, and what was going on in the hour precedent. Fortunately (or unfortunately), the attacks kept coming fast and furious, usually up on campus where I felt surrounded and trapped by my fellow students. As the weeks wore on, I began to see a pattern: low blood sugar, a hot, claustrophobic classroom or lecture hall, an elevation in hyperventilation, and then, finally, an attack. In seeing the pattern, I felt a renewed sense of control: If I could keep my blood sugar stable and learn to recognize and defuse escalating symptoms, then I could derail an episode. I could have my life back. I quickly learned to block catastrophic what-if thoughts and substitute in more sensible notions like,
No, you're not dying of dehydration again—look at how many times you've peed in the last hour
. And
No, you're not having a heart attack. You're young, your heart's strong, and it's just beating more quickly.
I could also adjust my breathing by taking slow, circular breaths in through my nose and out through my mouth. I could place my hands over my belly to bring my attention there and ensure I drew air down deep using my diaphragm, instead of taking hiccupping, upper-chest anxiety breaths. And I could run through the toe-to-head muscular clench-and-release that promoted a sense of calm, even while sitting in class. Soon I even stopped monitoring my distal pulse.

And on days when things were really bad, I could take one of the one-milligram Ativan (lorazepam)
*
pills the psychiatrist had prescribed, tiny white disks barely larger than cupcake sprinkles or spider mites. Like Klonopin and Xanax, Ativan is a fast-acting benzodiazepine.

“These are strong, Matt,” the doctor told me. We sat in his office, a sunny, upper-floor space in a tony building downtown, the mouth of Boulder Canyon white with snow-frosted pines through the window. “So I'm only going to give you ten a month. They can be addictive, and I don't want you taking them all at once.”

“Okay,” I said. “I'll be careful.” I'd never been much into pills, so the idea scared me a little—this notion of their potency. “How, um … well, how do I know when to take one?”

“Just keep them with you, and if you have a strong panic attack take a half or a whole pill. Or perhaps on really bad nights if you think you won't get to sleep, take a whole pill before bed.”

“Okay.”

I filled my prescription at the supermarket and brought home the bottle. It had a droopy-eye drowsiness sticker and a warning not to operate heavy machinery. The pills looked innocuous, so small you'd scarcely notice them going down. They didn't
seem
dangerous. And yet, if taken too long and/or at too high a dose, and especially if stopped abruptly, benzos can be exactly that.

Benzodiazepines lie in the family of minor tranquilizers, a class of drugs with which America has a long, tangled, love/hate relationship going back to Miltown, the first of the genre, discovered in 1950 and FDA approved five years later.
8
(Pre-Miltown, to squelch anxiety doctors might prescribe alcohol, barbiturates, or opiates. Despite being fundamentally useful and even lifesaving in measured doses, anxiety is also a condition man has long sought to eliminate, and many substance abusers are thought to be self-medicating against it.) Andrea Tone's authoritative
The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers
gives a great sociocultural recounting of tranquilizers' history, benzos and non-benzos alike. My takeaway from it is that each new anxiolytic (anxiety-reducing) medicine undergoes a boom phase of lavish acclaim and widespread prescription, followed by revelations of addictive properties, and an inevitable backlash.
Huzzah
, we think.
We've finally found the cure for fear.
Then:
Boom, backtrack. The cure, yet again, is worse than the disease.…

Benzodiazepines came into being thanks to Dr. Leo Sternbach, a Polish chemist who developed Librium for the pharmaceutical giant Hoffman-La Roche; this proto-benzo hit the market in March 1960,
9
and by October of that year doctors were writing 1.5 million new prescriptions a month for what was billed as the latest panacea against anxiety.
10
Librium went on to become America's most widely prescribed drug through 1968 and the dominance of its more potent sibling, Valium, another Sternbach creation and the world's most infamous benzo.
11
Valium, aka “Mother's Little Helper” as per the eponymous Rolling Stones song, had hit the market in 1963. It was, writes Tone, “the most widely prescribed pill in the Western world from the late 1960s to the early 1980s”
12
(1968 to 1981). In Valium's banner year of 1973, sales in the United States held at $230 million, or $1 billion in today's dollars,
13
and in 1978 alone Roche sold 2.3 billion tablets.
14

Over the years, however, it became clear that patients were becoming addicted to benzos (an estimated 10 million American Valium addicts in the 1970s
15
) and that poly-drug abusers were adding Valium to their quiver, and the pill slipped into disfavor. Then, in 1986, the heavily marketed Xanax (alprazolam), a fast-acting, high-potency benzo, took over as America's most widely prescribed medicine.
16
Never mind that the faster-acting strains are typically more addictive; today, worldwide benzo prescriptions number in the tens of millions. In 2007 in the United States alone, doctors wrote more than 82 million prescriptions for benzos,
17
up from 69 million in 2002;
18
and in 2010 alprazolam was America's eleventh-most prescribed drug, with 46.3 million prescriptions.
19
(After 2000, benzos still represent the leading class of drugs prescribed for anxiety disorders: 38 percent of the top ten drugs prescribed for anxiety, as opposed to SSRIs, which come in second at 21 percent.
20
) Benzos remain ubiquitous, often cited as the most commonly prescribed family of psychiatric medicine, though they do have other applications outside anxiety: for insomnia and seizure disorders, and as muscle relaxants. Physiologically, benzos have five main mechanisms of action: 1) As
anxiolytics
, for anxiety and panic disorders, and phobias; 2) As
hypnotics
, for promoting sleep; 3) As
myorelaxants
, for muscle spasms and spastic disorders; 4) As
anticonvulsants
, for fits due to epilepsy or drug poisoning (they are also administered to detoxifying alcoholics to prevent seizures, and given for acute psychosis with hyperexcitability and aggression); and 5) For
amnesia
—to block short-term memory during premedication for surgery or as sedation for minor procedures like wisdom-tooth extraction.
21
In layman's terms, they knock you flat on your backside. It's precisely because of this potency that benzos can be perilous.