Panic disorder and agoraphobia: a sufferer's perspective

Journal of Affective Disorders 50 (1998) 65–74

Special article

Panic disorder and agoraphobia: a sufferer’s perspective

*Sandra Edwards, E.H. Uhlenhuth

Department of Psychiatry, School of Medicine, University of New Mexico, 2400 Tucker NE, Albuquerque, NM 87131-5326 USA

Received 25 June 1997; accepted 22 December 1997

Abstract

This is a story by a woman about her life with panic, agoraphobia, and depression. She tells us about the clinical features,the heritable components, the environmental contributions, the developmental penalties, the social consequences, and thetherapies for these conditions far more vividly than even the most dramatic of our systematic studies. But this is more than aclinical vignette. It is a human story of courage to proceed undaunted in the face of terror and despair to ultimately prevailover the most formidable internal obstacles. Nowadays I rarely see Mrs. Edwards. She is too busy living. I know she isproductively and gratifyingly employed and engaged with her family. Usually I learn of her adventures here and abroadthrough letters written in the same captivating style as the autobiography below. I have witnessed Mrs. Edwards reading herstory to others with similar problems, to medical students, and to psychiatric residents. The impact invariably was stunning.Making her acquaintance even in the dry print medium is an unforgettable learning experience. E.H. Uhlenhuth 1998 Elsevier Science B.V.

Keywords: Panic disorder; Agoraphobia; Depression; Patient perspective

1. Familial and developmental background that left those who loved him confused and indespair. His tirades were unpredictable and quite

I’d like to begin, not with my life, but with the devastating to me. At the same time, he was a majorlives of my parents and of their families long before influence in my life. In hindsight, I suppose his finemy birth. Since there has been much research into qualities outweighed his bad. He was a risk-taker andthe involvement of heredity and environment in his drinking often posed a danger to himself. He didpanic disorder and agoraphobia, I think this in- not always come home when expected and onformation is relevant. My father died in 1988 at the occasion he would be brought from a neighborhoodage of 85. He was an alcoholic who suffered from bar unable to manage his way home. I lived in dreaddepression and was verbally abusive to my mother, for most of my life of his dying, worried that I couldmy brother and to me. However, he was also a not live without him. These feelings continued intowonderful human being in many areas of his life and adulthood, even when I had been independent of him

for many years and no longer lived in the same city.*Corresponding author. My dependence was emotional.

0165-0327/98/$19.00 1998 Elsevier Science B.V. All rights reserved.PI I : S0165-0327( 98 )00007-X

66 S. Edwards, E.H. Uhlenhuth / Journal of Affective Disorders 50 (1998) 65 –74

My father’s father was also an alcoholic. He did different treatments, including shock treatments.not have a regular income. Therefore, there was little When I asked my mother what was the matter withsecurity in the lives of his wife and children. My her, she described herself as being a very depressedgrandparents’ marriage was unstable and they sepa- woman who cried all the time and was frightened ofrated. In 1927, during the time that my father first her husband leaving their apartment and of going outmet my mother, his father committed suicide by by herself. My father finally had to find help for herturning on his oven and cutting off ventilation. I and to find care for their son, who was then threeknow very little about my grandfather’s life. years old. Her symptoms are very familiar to me. My

My mother, who died in 1994 at the age of 90 and mother continued to have many fears until her deathhad lived with my husband and me since 1988, was and she had phobias for as long as I can remember.born in England and was the youngest of six children All of these events and losses colored my parents’when her father died. She came to the United States future as mates and as parents.as a nanny and met my father, a sailor, on Riverside My parents moved from Trenton to Philadelphia inDrive in New York City. Though I won’t dwell here 1936. My father’s mother, left behind in the stateon their differences, they were quite dramatic. How- hospital in New Jersey, died shortly after my birth inever, my father was determined to have my mother 1938. I have a photo of her holding me in her arms.for his wife. Before my birth, my father’s sister had become

My mother returned to England engaged to my pregnant and married. Her child lived with myfather, about the same time he finished his enlistment parents for about three years (she was being cared forin the Navy. He, in his quest for my mother and by them when I was born). Later, my aunt took mywithout money, traveled to England by getting cousin back to Trenton. Within a short time shehimself a job on a freighter. There he married her in abandoned her, and the child was raised by hera civil ceremony; her sister and one of her brothers paternal grandparents, wonderful people who pro-served as witnesses. After a few days he returned to vided a fine life for this very loved child. Her motherAmerica, my mother to follow after she got her maintained almost no contact with her daughter untilpapers. my cousin became ill with Bright’s Disease and

When my mother returned to the United States to eventually died at the age of 23. My aunt died onesettle down with my father in Trenton, New Jersey, year later from cancer. She was in her 50s, anand after being there for only a month, she received alcoholic who had a very sad life. She married anda telegram that her sister had committed suicide, lived with several men, but none of these relation-taking her small daughter with her into the sea. ships had any lasting or caring qualities. I was aboutThere was never a reason given and I still have no 21 years old at the time of her death. She was aidea what precipitated this tragic event. lonely and tragic figure, although I rarely saw her.

My mother always said that in the early part of My brother, however, had a lot of contact with her intheir marriage my father was wonderful, considerate, his childhood and remembers her with warmth. Thecaring and that they were very happy. They had a last time he saw her, he was a young sailor. Heson after two years and then three years later a found her in a bar where she had been drinking. Mensecond son was born. In his sixth month he died were making unsavory remarks about her, and after asuddenly. My mother was in shock and several while, my aunt cried. My brother was very moved bymonths later it became necessary for my father to the depth of her sorrow.admit her to the state psychiatric hospital in New I learned also from my brother, who is nine yearsJersey. As it happened, my father’s mother was also older than I, that after his return from Vietnam, hein that hospital at the same time. I’ve heard stories suffered from panic attacks. He did not tell his wife,from my parents about my grandmother’s problems. and for quite some time he avoided certain places,She was paranoid, had delusions of grandeur and such as restaurants and barbershops. He found itbecame unable to care for herself, having mentally almost impossible to get on a bus or, if he was ableremoved herself from the real world. My mother was to take one, it caused him great discomfort. He wasin the hospital for a very long time and received able to overcome most of his difficulties on his own,

S. Edwards, E.H. Uhlenhuth / Journal of Affective Disorders 50 (1998) 65 –74 67

but he still has certain things that he is not comfort- City, when I was about four years old, feeling veryable doing. I believe he lives with his own private sad and fearful. I recall that it was raining and wedemons. This example, and that of my mother, were on a bus. I was crying and my parents weresupport the theory that there is a hereditary com- unable to console me. When I was five, it was timeponent in panic disorder. for me to attend kindergarten, but I became ‘‘hysteri-

At the time of my birth, the loveliest part of my cal,’’ and my mother was told that it was best to waitparents’ marriage had passed. My father had until first grade. I would not let my mother attend mychanged. He was now angry, bitter and verbally brother’s eighth-grade graduation because I was tooabusive to my mother. She had no outside resources afraid to go; I was five years old. My mother wasor support to call upon, and I have no memories of unable to convince me to take the bus with her. I ranmy parents’ relationship being a happy one. home from children’s parties. For my fifth and only

I entered the world as a bright-eyed baby with red birthday party, I recall walking into the room wherecurly hair. Early photos show no signs of my future the tables were set for the children and feeling a deepdifficulties. My parents lived in a working-class sense of sadness. I don’t know why. Each of theseneighborhood, crowded with row houses, which were incidents is unremarkable, and many children havefilled with large families. This neighborhood became had similar experiences and far worse home situa-my childhood world. I never moved until I left home tions than mine. However, future events in my lifeto get my own apartment. My mother told me I was make this history relevant.a good baby. My very earliest memories are of fear,beginning with being separated from my parents.

In my early childhood, my parents took in a 3. Onset of panic attacksfour-year-old girl whose parents could not keep her.She lived with us until she married. This girl and I When I was 10, I had what I describe as an attack.were raised as sisters and we loved each other. My Perhaps it was a panic attack. Whatever it was, thisfather, however, in his determination to have her not event changed my life. I was in the school gym onefeel neglected, interfered when my mother discip- evening playing with friends, running, and for alined her. Throughout our childhood there were moment everything was black, although I didn’t faintconstant arguments and friction in our household, or fall. It was probably for only an instant. I thenmany having to do with my sister. Most arguments became overwhelmed with the most horrible feelingended with my mother in tears, as my father ranted of ‘‘not being there.’’ I became ‘‘hysterical’’ and ranon. My mother, in her attempt to take my part and the few blocks home. I remained in an agitated state,because of her anger toward my sister, created unable to control myself or to understand what wasdifficulties which must have been devastating to my happening to me. I clung to my mother in fear. Isister. The arguments were ugly, loud and vicious. explain this feeling now as one of disassociation or aMy sister became pregnant at a young age and was dream state. This began a downhill period, and bymarried. She was later diagnosed as ‘‘schizophrenic’’ the end of the school year, I would not go to school,and has been hospitalized numerous times. She has I would not eat and eventually, I would not leave mymany of the obvious signs of a person with schizo- room. I cried, I was depressed, I was afraid and Iphrenia and lives in a separate world with little to do was desperate. In July my father forced me out of thewith anyone, including her three children and many house to walk to the hospital emergency room. Thegrandchildren. whole way I pleaded and pulled to go home. I felt as

if I was ‘‘going crazy’’ and quite lost. It was decidedthat I must stay in the hospital. I didn’t know how I

2. Anxious antecedents could begin to handle such a difficult thing. Iscreamed and fought to go home, but ended up in a

I remember not wanting to leave my mother’s room where I spent the next nine days. I was testedarms when a neighbor wanted to hold me. I was and examined, but the only thing found was a heartoften afraid and recall on a rare day trip to New York murmur. While in the hospital I could not go to an


outside area to sit. At night I lived in fear that all the with an unremarkable record. I recall that I neverdoctors were gone and something terrible would thought I’d be able to attend high school and worriedhappen to me. A nurse came into my room at night incessantly about what would happen. It was neces-and tried to comfort me. I find it interesting that I did sary to take a bus to my school. After a rough start, Inot ask questions about my fears. Had I done so, my began to do rather well and I actually gained weightanxieties could have been diminished. I suppose I during my first year. I was learning the violin athad learned earlier that answers to my questions school and was in the high school orchestra. How-were not forthcoming. My sister and my friends ever, I found I sometimes could not go to thewalked to the hospital and stood outside my window performances on concert nights. I had difficultywhile I waved to them from above. I don’t remember going to the school in the evening, even with mymy mother coming to see me, which fits appro- parents. I was afraid, had anticipatory anxiety andpriately into one of her phobias – the fear of would begin to feel strange when I had to dohospitals and anything medical, a fear which kept her anything different than my usual routine. In myaway from doctors for more than 30 years. She junior year I flunked English, and I needed to attendpassed these fears on to my brother and me. The summer school. I had been deteriorating during thatdoctor told my parents that I was suffering from spring, which contributed to my failure, and I barelymalnutrition, that I might have epilepsy and rec- made it to the end of the semester. As a result, Iommended a psychiatrist at the clinic. I was then became housebound, having such generalized fearsent home. Other than feeling very precarious and that it was a struggle to walk to the top of my streetvulnerable, I have no further memories of that or to a neighborhood store. However, my father –summer. I know I began to see a psychiatrist, but I and this is just one example of why I loved him soremember little. very much – insisted that I attend summer school.

The years passed and I had periods when I was He took me every day in the car and waited until myrelatively free of these attacks. So I do not wish to class ended. He was working the night shift andportray my childhood as completely bleak. It was came home from work in the mornings. On thosenot. I had friends, we played on our street, there drives to school, in the heat of the summer, in thewere vacant lots to explore, and we sometimes left crowded and noisy city, I felt as if I was about to die,the security of our neighborhood to seek out adven- I had tunnel vision and the world looked distorted toture. I had a best friend with whom I still have me. But I completed the course. My fear was not justcontact. I loved her large family. We were city street of death, but of continuing in a hopeless conditionkids who played and fought together. But there were with no end.long periods when I was extremely frightened. I During that summer the psychiatrist at the clinicwould become agoraphobic about new places and prescribed Thorazine, a drug which, in retrospect,feel unable to do many things. My memories of the was inappropriate for my problems. The drug madepanic attacks are so terrible that I do not like to dwell me feel very heavy, dull and lifeless. I did not take iton them, even now. as regularly as prescribed since I couldn’t tolerate the

I had one period when I went to a child psychiat- side effects. Then there were nights when I’d takerist. I was doing well then, and I remember the trips two to escape through sleep. Summer drew to aon the train to town with my mother as pleasant. close, and I began my last term of high school andHowever, I humorously recall my parents telling me prepared for a January graduation. How I was goingnot to tell the doctor anything personal. At that time, to function after high school now became my full-the doctor recommended another EEG. No abnor- time concern. I couldn’t get a job because I couldn’tmalities were found. travel on public transportation except to my school.

As an example of how inhibiting the agoraphobiawas, for four years I never went outside of my

4. The emergence of agoraphobia school during my lunch break except when I had anattack and ran to escape. I simply followed the

I was fortunate, considering my history, to be able expected course of my day. On one occasion, afterto graduate from high school with my class, though attending a morning assembly, we were told to use a


staircase with which I was unfamiliar. I began disorder, have spoken on a three minute spot on aclimbing the steps and felt the beginning of a panic Santa Fe, New Mexico, radio station, and haveattack. As the fear heightened, I rushed from the talked to a middle-school class that was studyingschool into the street and found a policeman. He different mental illnesses. The things that helped mecalled my father, who came to get me. I never went when I recall times past are that my parents did lovewith friends after school to have a soda before me and during the most difficult times, I did forcecatching the bus home. I didn’t go on our senior trip myself to do some things. The latter is still the sameor to the prom. I went to one high school dance, principle that I live by today. I did what I felt waswhile my father waited for me in our car. I sat on a the impossible. Sometimes I failed and sometimes Ibench until it was time to leave. However, I felt didn’t. As Helen Weekes has written, ‘‘Feel the fearpleased that I had gone, as I always did when I had and do it anyway.’’been able to successfully accomplish something thatwas so difficult. I went to movies with friends, butonly to the theatre in my neighborhood. I was inmany ways a prisoner in a world with very distinct 5. Work and social historyborders. Graduation came and I worried that I wouldnot be able to attend the ceremony. I did, though, In the fall of 1956, something good happened towith some encouragement from my father. me. A woman I knew called to say that there was a

During the first few weeks after graduation, I had job in the laundry room at a local psychiatrica purpose, as my mother had had a cataract removed hospital, which was within walking distance of myand I cared for her and the house while she recuper- home. At this time it was a struggle to walk very farated. Slowly the winter days grew warm and I by day, but when night finally came, I’d be able toremained at home, unemployed and wondering what sit on my porch until bedtime. Night has often been apossible future I had. I began to have more and more time for me to recover, to find strength to get meanxiety and depression, and by summer I was again through the next day, a respite before tomorrow’shousebound. My parents took me back to the battles. In the evenings, I would sometimes go to thepsychiatrist, and I again took Thorazine, which was movies, often seeing the same movie several timesnot only ineffective, but put me in a stupor. Some- just to get out of my house. I went to the hospital totime during that summer I became quite desperate, apply for the laundry-room job, managing to getand my father took me to the hospital emergency there. I got the job. I was fortunate to have aroom. I truly wished to die, but was unable to act wonderful boss who had compassion and helped me.upon my thoughts. I worked a day, and then didn’t go back for two

Through the years, although I have often wished days. At the urging of my friend, I called work andthat my life would end, some inner part of me has was given another chance. I somehow forced myselfremained hopeful, and I have never attempted to return day after day. The hospital was new and thesuicide. I was underweight, had a very poor body laundry was not yet working full time, so at first Iimage, and my self-esteem was gone. What was to wasn’t very busy. I didn’t leave the laundry area allbecome of me? Yet during these periods of my life, I day, and did not eat lunch. It was October, and Ihave had friends. Some have been friends for many went to work, quietly cried and wondered what toyears, and I have been fortunate throughout my life do. I could not walk down the long hall to theto have had strong relationships. When possible, I bathroom, and waited until I got home at the end ofkept the truth about my problems to myself, feeling the day.ashamed and embarrassed. Sometimes, I think one But my boss, an Italian immigrant, was able to seeonly had to see me to know that I had something my sadness and desperation. He began to help me bywrong with me. It is only in recent years that I have asking me into his office and offering me some of hisbeen willing to discuss agoraphobia with those close coffee each day. Very, very slowly I began to cometo me, and now I will discuss it, when it appears out of my shell, enough to begin to know those Iappropriate, with those not so close. I have been on a worked with. I was the youngest at eighteen. Therelocal newscast that dealt with agoraphobia and panic was a twenty four year old woman and the others


were much older, poorer women, mostly African- into my twenties, even with the setbacks. I began toAmericans, women who could not read or write. see a therapist and he helped me a great deal. ILaundry work is very hard. At that time it was hot improved. At twenty two I fell in love again and leftall year, the temperature rising to 110 degrees in the home to move to my own apartment. This wassummer, and there was no air conditioning. I mar- without a doubt the wisest thing I ever did, and I amveled at the strength of these women and their grateful that I had the strength to do it.courage. They were an example to me. I began to I became a member of the Philadelphia Ethicalbring my lunch to work and was able to eat a bit at Society and was elected to the board for two three-lunch time. I began to laugh again, and to see some year terms. The Ethical Society is a humanisthope for myself. I also went down the hall to the organization which has a wonderful history of in-bathroom. I began to feel strength and to work hard. volvement in social causes – members worked toOne day my boss said, ‘‘Today you’re going to go end the injustices of child labor early in the century,up on the floors with me and help me deliver the were advocates for women during the women’slaundry.’’ He took me by the arm, and we walked suffrage movement, and were active during the Civildown the long hall to the elevator. I did not expect to Rights era. My father introduced me to this organiza-survive such a task, but I went. He showed me what tion and it offered me the education that I craved. Ito do, where to put everything, and then we returned had happiness during some of those years, mixedto the elevator and to the laundry. I felt such elation with the constant reappearance of symptoms whichthat day. I felt such warmth for this man. I will caused my life to diminish in quality.always remember that he cared. Slowly, I emerged It is difficult to decide what are the importantfrom a state of depression into a world which indeed incidents, the meaningful events that somehow showdid have sunlight. the power of panic disorder. It is noteworthy that I

I could go on a date, although it was always was never given a diagnosis by any doctor. I wasdifficult. I started to live with myself, to accept the simply told ‘‘nerves’’ or ‘‘anxiety’’ was the problem.strange feelings, the visual distortions, the feeling of I often felt as if I was ‘‘crazy’’ and I felt isolatedfaintness. I began to have fun after a very long time. since I never knew anyone else who had this strangeOne year after getting my job, I resigned and went to illness. I was ashamed. I actually first heard the termwork in my father’s used book store, which he had ‘‘agoraphobia’’ when, as a young mother, 32 yearsonly recently opened. I was also going to night old, I was watching television and heard it discussedschool, learning secretarial skills and taking a bus on a talk show. Helen Weekes, a British doctor andinto town. I fell in love. I was able to get on a bus writer, now deceased, was being interviewed. Iwith my new friend, and we’d go to see foreign films immediately ordered two of her books which dealtand old classics, things I had never been exposed to. with panic attacks.We listened at night to wonderful blues and jazz At twenty eight I had a major depression. It was arecordings on 78s. I managed to have pleasure, and time so filled with desperation that I did not leavemy world began to expand to the offerings of a big my apartment except to go to work. Work has oftencity. been what has forced me to continue, to not give up.

As often happened, when spring returned, the At that time I worked in town in an art gallery whichnights becoming lighter longer, the days warming, I was located just one block from my apartment.felt my anxiety begin to increase. Soon I was having People with agoraphobia are familiar with the feelingmuch more difficulty working and getting around, of being in a pit from which there is no escape andand my expanded world began to close in on me no hope. That was where I was in that dark summeruntil I became limited and had problems doing even and fall of 1966. In August, before I becamethe simplest of things. These repeated periods of incapacitated, I took a trip north to upstate New Yorkdepression and anxiety took their toll. I wondered if I by myself. I became so despondent that a psycho-would ever have joy in my life, ever be able to feel logist, who was at the same place, put me on a planesafe and content. to New York City. I was told that my father had been

I had some of my best times from nineteen and contacted, and I expected him to be at the airport


when I arrived. However, he was at home in 6. MarriagePhiladelphia waiting for my call. I called home, andwhen I realized I was alone, I hung up the phone in a I met my husband in the spring of 1967. We hadfrenzy. I managed to find the way out of the airport fallen in love, and I felt ready to commit myself in aand asked a cab driver to take me to Philadelphia. He way that I never had before. However, excitement iswas surprised, but I promised to pay him with some often a catalyst for panic and depression in me.of my own money and that of my parents which was Artemus knew of my problem. He was compassion-where I asked him to take me. We arrived in ate and concerned and due to my increasing anxiety,Philadelphia. All the neighbors were sitting out on we delayed what was to be a very small wedding andtheir stoops, watching as they always did, as I decided to simply go through the ceremony when itclimbed the steps to my house and, in tears, told my was the right time. And so we did, one warm Aprilmother and sister-in-law what I had done. My evening in 1968 at 8:00, in a Unitarian Church. Wemother said in an excited voice to my father that I had already written our own ceremony. There werehad arrived home and had taken a cab. My father no guests. I was in a terrible state of anxiety, andsaid ‘‘Well, pay the driver.’’ My mother replied, during the reading of our vows, I felt as if I would‘‘But she took the cab from New York City.’’ This die, my vision dimming, my heart pounding andmay sound funny, but at the time it seemed like the accompanied by a myriad of other old and all tooend of my life, and yet another humiliating ex- familiar symptoms. This experience is an example ofperience. how panic disorder has interfered with many of the

During that difficult time, I was for the first time most important events of my life.given an antidepressant, Elavil, which was a fairly When I became pregnant, I was terrified of givingnew drug in 1966. After about ten to fourteen days, I birth, of the symptoms related to my pregnancy, ofremember very vividly a weekend day when, for the being in a hospital, of something happening to me. Itfirst time, I felt there was possibly a way out of that was during my pregnancy that my husband and Idark pit. It was the beginning of a slow climb back moved to Albuquerque, where he had been offered ato being able to function again, and I began to feel a job at a local university. I gave birth to a beautifulbit better. I was on the antidepressant for five months son. He is our only child.when I decided that I wanted to discontinue it. It When my son was three years old, I began to haveseemed to me a sign of weakness, a symbol of being severe symptoms again. I began, as many timesa ‘‘sick’’ person. I have found this to be a very before, to narrow my borders. As the months passed,common feeling among people with panic disorder. I continued to deteriorate, becoming particularlyMany of us are also terrified of the side effects of afraid since I was now responsible for a small child,medication. Over the years, we become extremely a child I loved so very much. My husband, afocused on any bodily symptom that might be a sign musician, was planning to leave for Los Angelesof the beginning of a panic attack. with several of his colleagues for a performance, and

At this time, I also left my psychiatrist with whom as the day drew near, I felt totally incapable ofI was not happy. I returned to my therapist and caring for my son. I barely felt as if I could care forslowly began to withdraw from the medication. This myself. On the morning he was to leave, I complete-was a significant time for me, for I found that I was ly gave in to all my symptoms. My husband took menot able to approach again the kind of improvement to a local hospital on the advice of my doctor, andthat I had had in my early 20s. I was better, but the there I spent five terribly miserable days. I recall thepanic and depression were never far away. I was exact date when I entered the hospital. It was Marchconvinced now that even when I improved, it would 22, 1974, two days after my thirty sixth birthday. Mynot be for long and that soon I would again feel the husband says I have an uncanny ability to recallold and familiar feelings of despair. With these dates. The reason I am able to do this is because aexpectations, it’s not surprising that when I felt date will often revolve around what condition I wasanxiety increasing, the acceleration downhill was in at that time. I was again put on an antidepressant.very rapid. We tried a new one but ended up again with Elavil. I


insisted on leaving the hospital and Artemus brought another crisis, and while going through that crisis, Ime home. I walked into our home as if in a dream, had an attack of vertigo. It caused me to fall overfeeling that I was going to drift into a place from when I awoke one morning, and I found myselfwhich I would never return. Again, though, after unable to walk. This was diagnosed as positionalseveral weeks, I began to improve, and after six vertigo, and I have since met many people who havemonths, I wanted to stop my medication. I did so had bouts with it. My response though was extreme-very slowly. It would have been wise to have ly exaggerated, and it left me feeling unable to helpcontinued my medication, because I was just begin- myself.ning to come out of my nervous condition. On a day when I felt little hope and as lost as I’d

The years have passed. My son is now twenty ever been, my husband, Artemus, called myseven years old, I am fifty nine and my husband is psychiatrist. He talked to me calmly and asked if Isixty four. We still love each other and our son is a would be willing to try a medication that afternoon.wonderful young man. We have been through many The drug was Xanax. I took one tablet after talkingdifficult times. I know that living with a person who to him on the phone. An hour later, again afterhas agoraphobia is not easy. Through the years I talking to my psychiatrist, I took another one. I tookhave learned that honesty is the best way to survive yet one more after talking to him an hour later. Byand that keeping my feelings from my husband has that evening I was sitting down watching televisionnot worked. and feeling as if life would continue. There were

months of struggle ahead. Later I also began to takeimipramine, an antidepressant. I eventually started to

7. Modern treatments improve, to begin to have hope and experienceenjoyment. During this time, along with my drug

One day I read in the Albuquerque Journal’s therapy, I began to see a counselor who was training‘‘Action Line’’ that there was a Special Problems in a therapy similar to the one that had helped me soClinic at the University of New Mexico’s Depart- many years earlier. I continue to take the imipraminement of Psychiatry which treated panic disorder and and Librium every day. I am not in a hurry toagoraphobia. This was the first time I heard of there discontinue it and, in fact, with my history, I ambeing a place which could specifically deal with this reluctant to stop. My psychiatrist has reduced thein Albuquerque. I made an appointment and saw a amount from 200 mg per day to 125 mg per day.resident. I worked with him for several weeks, doing This was determined through periodic blood tests.relaxation exercises and hypnosis. A group was A few years ago, my psychiatrist put me in contactstarted with people who had contacted the Special with a psychologist to begin cognitive behaviorProblems Clinic, and for the first time in my life I therapy, to see if this might help me to do the manymet others with the same problems that I lived with. things which I still was unable but wanted to do –Unfortunately, what started out as a reasonable riding on buses, feeling reasonably comfortable in anumber of people slowly dwindled. Often there were new place, being in an airport, traveling out offewer than five of us at a meeting. In addition, the Albuquerque by myself. We worked hard together. Iresidents changed, and we would have to familiarize did a lot of reading and a lot of work trying toour new facilitator with our difficulties. Finally there overcome some of the things I believed impossible. Iwere only two of us, and we determined that when gained skills to help me at anxious times and Ithe doctor who was working with us at that time left, learned a lot about panic disorder. I had tasks to do,we would not continue. However, I was told that a such as taking buses and driving to Santa Fe. I feelvery important person in the field of panic disorder as if I will spend the rest of my life doing tasks, but Iwas coming to the Department of Psychiatry. I began now have some tools to help me. I traveled by air toto see this psychiatrist. He recommended medication Florida with my husband and mother in 1990 andafter hearing my history, but other than Librium, had quite a nice time, considering the difficulties thatwhich I took as needed, I was not willing to try I usually have on trips. We have flown to California,anything else. That is until I went through yet Memphis and Minneapolis and each trip I found


myself more willing to step a bit farther into the never forget the walk to that house, then climbingunknown, to take risks that I would not have taken the narrow staircase to the small space where Anne,before the medicine and behavioral therapy. More her family and others stayed for so long. In myrecently, I have traveled by myself to Santa Monica, emotional state, I was unable to control my tears. ICalifornia, Pittsburgh, Pennsylvania, Orlando, stood in that attic and looked at her letters and papersFlorida, and New Orleans, Louisiana, for confer- preserved under glass, written by this beautiful,ences of the Anxiety Disorders Association of innocent child. Pictures of her and the others were onAmerica. The most important task has been to the walls. Afterward, we left, subdued, and walkedunderstand the negative messages I give myself. I back to our hotel. The Librium helped, I got throughreappraise my thinking often and realize that my that night and before dawn the next morning, wedark, bleak, messages are not true or are highly took a cab to the airport and somehow we got on aexaggerated, that I will not die during a panic attack, plane to London. We had a four-hour layover, and Ithat I will have times of crisis, but that I can use the sat in that crowded airport not allowing myself toskills I have learned and that I have medication that risk getting up until it was time to board the planehelps stabilize me. for home. Upon my arrival home, I was left with a

Let me tell you about two events that explain how feeling of failure and defeat. I dwelled on the end ofI cause myself difficulties. In both instances I did not that trip and did not spend any time on the manytrust my feelings. In September of 1983 my husband, successes.son, sister-in-law and I went to England. I was at that Three years later, in 1987, I again ignored my owntime feeling secure enough to at least consider what personal guide, and again did not trust my instincts. Ihad always seemed an impossible adventure. Ar- was accepted into a two-year program at the Uni-temus was busy mapping out a travel plan, and I versity of New Mexico (UNM) Human Serviceswatched and listened while wondering how I could Department. I left a job that I enjoyed very much andmanage a month-long trip to a number of different began with enthusiasm and hope on what I feltcountries. Yet, I did not express myself. Looking would be a path to a career working with theback, I would have planned the trip differently – mentally ill. In addition to my classes, my placementthere would not have been so many places to visit, (practicum) was in the day treatment center at UNMwe would have stayed in England, possibly taking a where I was to work and learn. My initial feelings, iftrip to Wales. I would never, as we did, have I had been honest with myself, were negative,continued on to Amsterdam with yet further plans to uncomfortable and sad. I ignored the signs that thistravel by train to Brussels. I would have limited our was not a healthy setting for me, that there were tootime away from home to two weeks or less. Had I many reminders of my own history. I had placed sodone those things, our trip might have ended differ- much value on not giving up or changing my mindently. I still had little trust in my own instincts. On that I pushed back the turmoil that was happeningan October day, far from home, after an overnight inside me. After several weeks I fell into a majorferry trip over the North Sea to Rotterdam, Holland, emotional upheaval and depression which, as Iand then a train ride to Amsterdam, I arrived in a previously noted, ended up with my being treatedfrantic state. I could not eat and as the day pro- with medication. There are other examples but thesegressed, my condition worsened. I shook all that give some understanding of what I went through andnight and could not stop. I cried and believed I what was, at least partially, responsible for my pain.would never get home. As dawn approached myhusband, at my urging, became convinced that wemust get home. During that next day, I took Librium 8. The presenton a regular basis. Plans were finalized for the triphome and by the afternoon, I agreed to go to the I did not listen to my messages in the firstAnne Frank house, an important place that I wanted example. These could have protected me and wereto see. By taking the Librium every three to four sensible, considering a new experience such as ahours, I was able to find the courage to go. I will long trip to Europe. In the second example I again


ignored my feelings and what the tension in my body perfections. I like a quote by an unknown source thatwas telling me. At other times, I seem to have no a friend gave me as we discussed her study of Zendifficulty listening to my negative and destructive Buddhism. The words are:thoughts which cause useless worry. Trying toreprogram myself to replace these with positive, Our appointment with life is in the presentlife-affirming, thoughtful messages and feelings con- moment –tinues to be a lifetime project. The place of our appointment is right here, right

I have no unrealistic ideas of living happily ever now.after, just as no one has any such promise. I have nomagic formula for feeling better. Life is difficult for I’d like to live my life according to these wiseall of us. But rather than thinking of myself, as I words.have for most of my life, as an incomplete anddamaged person, as a coward, feeling embarrassedabout my inability to do what I believed everyone Acknowledgementselse does easily, I see that I have shown strength inbeing able to survive. I am a person who can have I would like to acknowledge the editorial assis-fun, while living with panic disorder, agoraphobia tance from my friend Kate Donner and the encour-and depression. Whatever the future holds, I want to agement of Dr. Uhlenhuth.call upon my strengths and not dwell on my im- Sandra Edwards

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Panic disorder and agoraphobia: a sufferer's perspective