Last August, I was in New York City doing media spots for my book, Peak Performance. In between interviews, I went on a long run in Central Park and didn’t eat or drink enough afterward. I went to meet a friend for dinner, but the place turned out to be a bar without a real kitchen. I had a stiff drink and a handful of kettle chips.
When I returned to my hotel two hours later, something felt off. Thinking quick calories would help, I downed some pretzels and apple juice. But it was too late. No more than two minutes after I started eating, my mind and body went haywire—my thoughts racing uncontrollably, heart palpitating, pulse thudding in my neck, stomach turning over, ears ringing. I was in the midst of a full-fledged panic attack, something I later learned can be triggered by dehydration and low blood sugar—both of which I probably had.
After about an hour, I was able to calm down and fall asleep. But I still felt jittery the next morning. So, before my six-hour flight home to Oakland, California, I went to an urgent care center. The doctor gave me a clean bill of health, suggesting that I was either still shaken up from the night before or perhaps had a lingering allergic reaction to something in the kettle chips.
Over the course of the next few weeks, however, I continued to feel off, a feeling that seemed to compound with every passing day.
I experienced a near-constant sense of unease and bouts of light-headedness. Tasks that were once easy and enjoyable made me tense and edgy. I again went to the doctor and received an EKG to make sure my heart was functioning properly, as well as a full panel of blood work. Everything looked fine, the doctor said. But I didn’t feel fine.
Things came to a head on a Friday morning about one month after the initial episode. I woke up and tried to read but couldn’t focus. I thought about running—an activity I’ve done nearly every morning for the past ten years—but felt terrified that if I did, something awful would happen. I resolved to go for a walk. I went to put my shoes on, my hands trembling. Once I finally got them on, I realized I’d forgotten socks. Finally, I made it outside. But no more than a quarter-mile into my walk, the top of my head began to tingle. I felt detached from my body, as if I was in a virtual-reality video game. Soon I was completely paralyzed by the sense that I was losing my mind. I decided that better than a walk was to find the nearest psychiatric crisis center, which, thankfully, was only a mile away.
When I arrived, a nurse handed me some paperwork to fill out. I asked for “the hard thing that people write on” because I—a professional writer—couldn’t find the word for clipboard. I considered calling my wife to tell her that I loved her but decided I didn’t want to scare her. A therapist finally called me back into her office. I talked with her for 45 minutes. She told me that I was experiencing anxiety and that’d I’d be OK. I felt better for a bit, only to have the same crushing sensations return just a few hours later.
Panic attacks are common. Research published in the journal Archives of General Psychiatry shows that 22.7 percent of people experience one at some point during their lives. Of those who experience an isolated attack, most have a shitty and worrisome few days and then get on with their lives. Yet a small number go on to develop a longstanding form of anxiety, joining the 18 percent of American adults who have an anxiety disorder and the 2 to 4 percent who suffer from more severe varieties, often relying on prescription anxiety medication. I now count myself among the latter group.
What’s interesting is that the panic attack in New York was my first encounter with debilitating anxiety of any sort. I’m 31 years old and have always prided myself on being calm and collected—at my best, even—under pressure. I’ve coolly weathered bear encounters, family medical emergencies, and large public speaking events. But my brain and body latched onto the experience of that initial panic attack, and it wasn’t long before I felt as if I had lost control of both.
In the weeks that followed, I increasingly became fixated on dark and intrusive thoughts. Awful what-if scenarios tumbled through my head for hours, sometimes days at a time.
“What if I’ll always be like this?”
“What if this leads to a life-threatening sickness?”
“What if I’m losing my mind?”
I no longer trusted myself around sharp objects for fear that I’d hurt myself on purpose. My stress levels were so high that something as harmless as the honk of a car horn could send my heart rate to outer space. If this sounds crazy, that’s because it is.
A particularly distressing moment occurred on a long car ride last October. Out of nowhere, I was pummeled by the thought, “You should just drive off the road and end it all right now. Your family will be fine without you.” It was as if I had become the thought and there was nothing I could do to escape. I knew somewhere deep down inside that I didn’t really want to kill myself; I had just enough self-awareness to realize these thoughts and feelings made no sense. But I would have given anything short of my life for the suffering to end. It was so painful. That drive was the hardest four hours of my life. I was terrified for days—terrified to get in a car, terrified to be around sharp objects, terrified to be alone.
It was after this experience that I finally saw a psychiatrist and was diagnosed with a somewhat rare type of anxiety colloquially called Pure O—basically, OCD without the visible compulsions. Pure O is characterized by obsessions and anxieties that tend to latch onto the things that people care most about. For me, that meant my eternal optimism, my family, and my sense of purpose.
My anxiety took over my life. It was the only thing I could think about. Sometimes it still is.
When the anxiety is at its worst, I’m not present for anything. It’s as if I’m going through life with my hands in front of my face. It’s an overwhelming and devastating feeling that is very different from what I used to think anxiety was (feeling exceedingly nervous before a public speaking gig or butterflies on the start line of a marathon, for example). It can feel like I’m two different people. During “normal” periods, my non-anxious self knows how irrational my anxious self is being, but my anxious self doesn’t abide by reason.
Unfortunately, if it can happen to me—someone who literally wrote the book on mental peak performance, including sections like “Stress Yourself” and “Turn Anxiety into Excitement”—it can happen to anyone.
Mental illness arises from a complex linking between one’s genes and environment, and the triggers underlying its onset are often hard, if not impossible, to pinpoint. Not to mention, the same personality traits and brain chemistry that underlie our greatest gifts—for example, the ability to think obsessively and problem-solve relentlessly—can also give rise to our most awful curses.
Fortunately, in my experience, the obsessive thoughts and anxious feelings subside both in intensity and frequency. Seven months after my initial panic attack in New York and about four months after that god-awful car ride, the anxiety has lessened—and when it is there, it’s not as bad. I’ve successfully executed speaking gigs to five large groups, led a handful of workshops, run a marathon, and got on with editing my next book, all of which would have been unimaginable when this first began.
Though I’m still suffering more than I’d like, I’m making progress and am thankful to have help. I’m taking a medication called a selective serotonin reuptake inhibitor (SSRI), which is a drug that helps rebalance brain chemistry when it’s been thrown out of whack. It’s commonly used to treat depression but is also effective for severe anxiety disorders. I never thought I’d be on a medication like this. I’ve written articles extolling the benefits of exercise and nature instead of SSRIs for anxiety and depression. But then again, I hadn’t ever experienced severe anxiety or depression and had no idea how irrational, uncontrollable, and debilitating it could be. And yet I’ve got to admit, I still kind of have a stigma against these medications, including more potent anti-anxiety meds like benzodiazepines, which, of course, is odd because I’m taking them, and just goes to show how powerful and dumb stigma can be.
I’m also regularly working with a skilled therapist (Brooke, who is a godsend) who specializes in cognitive behavioral therapy (CBT), which is essentially a rehabilitation tool kit for the anxious brain. The SSRI opens up the space to retrain the brain, and the therapy is the training, or at least that’s the story I’m telling myself.
Even so, it’s hard to come to terms with an illness that affects my mind. When I injure my body, it’s easy to say “my calf is pulled” or “I have a stress fracture in my heel.” But if I don’t have control over my mind, I can’t help but wonder who am “I.” I’ve found some consolation in meditation, which has helped me realize that perhaps “I” am the awareness that lies underneath not just physical pain, but also thoughts and feelings.
It’s also hard to reconcile being an “expert” on performance and experiencing what I’m experiencing. At times, I feel like a fraud and an imposter, fragile and scared.
Even just writing this essay makes me anxious. I feel as if by writing about my anxiety, I’m trying to exert some kind of control over it, and that it will pay me back with a vengeance. But I was recently reminded by a retired psychiatrist friend that a big part of peak performance is playing through the pain.
Going through this experience has broadened my view of the human experience, and it’s also changed my perspective on my job. It’s shown me that it’s important to have practices and tools not only for minor setbacks and when everything is clicking—which has been the focus of my writing over the past five years—but also for when it’s not.
I’ve written countless essays and articles that end with a practical tool kit. I stand by this work and those tools—they make sense for when things are going well. And yet, now, the lessons below—all of which I’m working on, none of which I’m even close to mastering—feel like they might be the most important ones of all.
Think Impermanence
When I’m in the thick of an especially bad episode, it feels like I’ll be stuck there forever. During these moments, I do everything I can to remind myself that the future is not predestined—that the sensations I’m experiencing will pass. I try not to tell myself “this is crazy,” but rather “this will pass.” This is hard to do. Even now, I sometimes still struggle to believe myself.
Let Go of Control
I have a Type A, conscientious, obsessive personality. I crave control. Historically, this has been a great strength; I’d guess that it has driven many of my accomplishments. But when it comes to anxiety, desiring control is counterproductive. I’ve found the more I try to control (and resist) my anxiety, the worse it becomes. On the contrary, the more I accept uncertainty—even if that means acknowledging I might actually get worse—the better I feel. This kind of release from control is an ongoing challenge for me and one that I expect to be the work of a lifetime.
Lean into It
If you walk into a room for the first time and see a tiger in the corner, odds are good that you’ll freak out. But if you’ve walked into that room more than 200 times and the tiger has never bothered you, you probably won’t think much of it. Anxiety is like the tiger. I’ve found that one of the best ways to lessen its stranglehold on me is to lean into it, to do what makes me anxious. This approach is called exposure therapy, and though it feels awful while you’re doing it, it has proven to be highly effective in treating anxiety disorders, especially OCD. I got over my bizarre and newly acquired fear of running by forcing myself to run every day for two weeks straight. During the first few runs, I felt a ceaseless sense of impending doom. By the last few, I felt pretty much normal. Exposure therapy can also be effective for distressing thoughts; going through it, however, is not easy.
Know You’re Not Alone
A close friend who has bipolar disorder told me that having a serious mental health disorder can feel like being on one side of a river when everyone else is on the other side. I used to be on the other side. I thought I knew what anxiety was and could look across the river and see it, but it wasn’t until I crossed for myself and experienced the worst of it that I had any real idea of just how debilitating it can be. More than anyone (outside of my therapist, psychiatrist, wife, and brother), it’s been helpful for me to speak with people who have also stepped foot on the other side of the river.
Exercise
Once I got over my fear of running, I got back into it with full force. I also started lifting weights regularly. I’ve found exercise to be especially helpful when I’m feeling down. A wide body of research shows that exercise is effective at treating both anxiety and depression. This is important since depression can be triggered by anxiety.
Practice Self-Compassion
When I’m at my worst, I feel guilty or angry with myself for feeling so anxious, sad, and having such intrusive thoughts when I have no real reason to. When this happens, I do everything I can to remind myself that mental illness is just that—an illness, affecting an organ (the brain) with extremely complex biochemical interactions. I tell myself that I would never feel guilty or blame myself for having a condition that affects my body, like the flu. I should be equally kind with my mind. I also try to remind myself that, over the long haul, this experience will make me stronger, kinder, and wiser.
Be Patient
Unfortunately, bad anxiety generally doesn’t subside overnight. At first, my expectation was that it would. When it didn’t, I became more anxious. Even though I still have my fair share of dark spots, I’m doing everything I can to dig in and accept that this is going to be an extended journey. When you’re in it, it feels awful and scary and vexing and completely removed from any normal experience. In those moments, sometimes all you can do is have hope, give yourself permission to feel whatever it is you are feeling, and be patient. I know firsthand that this is a lot easier to say than to do.
Perhaps the most important thing I’ve learned through this experience is that sometimes self-help isn’t enough. If you are struggling with mental illness, don’t be ashamed or embarrassed, and do not keep it to yourself. I can’t reiterate enough the importance of getting help. Talking to others who have had similar experiences can help. Therapy can help. Medication can help. If you or a loved one is in any kind of deep hole—anxiety, depression, anger, or something else—please seek out the support you need, especially from trained professionals. (You can talk to someone right now at the National Suicide Prevention Lifeline: 1-800-273-8255.) Even though it may seem impossible, it can get better.
Brad Stulberg (@Bstulberg) writes Outside’s Do It Better column.