You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, "I have lived through this horror. I can take the next thing that comes along." You must do the thing you think you cannot do.
- Eleanor Roosevelt

When you live your life in a cautionary crouch, the greatest relief of all may come from simply standing up.
- Steve Phillipson

Angel and Jason: Pushed to the Brink by Panic

Over the last ten years, I have had the opportunity to work with people all along the economic spectrum. For some years I was a counselor at a residential treatment center–some would call it a halfway house–for chronically mentally ill adults located in Portland’s hard-scrabble Old Town. Working there, I came in contact with many people in the grip of drug and alcohol addiction. But what I didn’t understand back then was how acute anxiety conditions can be a major driver of drug and alcohol abuse.

That was the case for one of the residents of the halfway house named Angel. She identified herself and told her story in this 2008 Portland Tribune article. In the article, Angel tells reporter Chris Lydgate that shortly after she graduated from Lincoln High School “She began suffering from panic attacks, which she doused with vodka.” After a decade of being relatively functional despite increasing alcoholism, her ongoing panic condition eventually led to a harrowing downward spiral into addiction to street drugs and homelessness. She tells the reporter, “’I should have learned my lesson,’ she says, tears rolling down her cheek, her mouth clamped into a circumflex. ‘I get blindsided by the panic, and I just freak out.’”

I knew Angel, and her struggles reminded me powerfully of a prison inmate, “Jason,” who I worked with more recently. For years, Jason had also been “dousing” his acute panic condition with marijuana and heroin use. Sitting in the room with him, he at first appeared mellow and bored, but I soon realized that was a stoic front he had to maintain in prison, and that in fact he was on a constant hair-trigger for approaching sensations of panic. When he felt panic sensations, Jason would return to his cell as fast as he could to have the panic attack in there. He felt profoundly trapped: he desperately wanted to get off of heroin and have a career and a relationship with his son, but he felt hopeless, knowing he would almost certainly return to heroin after he released because he knew of no other way to live with the all-consuming panic. In the end, Jason’s anger and despair drove him to impulsively give up on therapy. Drugs were the only thing he knew that allowed him at least a faded life with the panic–they were his lifeline.

In addition to the intensive drug and alcohol treatment they both needed, it makes me sad to think of what a transformative effect exposure-based CBT would have had for Angel and Jason’s lives. They both lived in numbed misery. Panic denied them the pride and fulfillment of meaningful careers or the joy of taking care of their children. If only they had had the chance to engage in a course of exposure-based panic treatment, it could really have turned their lives around. I can only reflect that they’re both still out there, so far as I know. Maybe someday that chance will come.

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