Note: This article was originally published in the Summer 2005 issue of The Meadows alumni magazine, MeadowLark.
By Charles Atkinson, MA, MSW, LCSW
Hello, my name is Charles Atkinson. I am a 55- year-old recovering from agoraphobia with panic disorder. The term “agoraphobia” derives from the Greek language. The interpretation of “agora” is a marketplace, and “Phobos” is defined as flight. Hence, agoraphobia literally means “flight from the marketplace.”
Further examination of the word agora reveals it was a place of intense commerce where goods were sold and bartered and the town’s social hub for exchanging exciting new ideas and concepts. Consequently, an agoraphobic could not venture into the marketplace for fear of overstimulation in unpredictable and chaotic surroundings. Therefore, at an unconscious level, the marketplace represented agoraphobia, a mirror image of his childhood environment.
Today, the definition of agoraphobia has been refined to include avoidance of a specific place or situation in which one feels trapped and may experience embarrassment. The terms “panic attack” and “anxiety attack” can be applied interchangeably.
Panic attacks occur when the sympathetic nervous system goes into overdrive and generates a cognitive distortion of second-order fear, or “fear of fear.” This emotion of fear is felt on both the conscious (physical) and unconscious (emotional) levels. The results are panic attacks that feel like the sufferer will lose control, go crazy or die.
It is not fully understood if agoraphobia with panic disorder has its fundamental inception in biology or is a learned behavior. I believe this disorder has its roots in both theoretical paradigms. However, additional schools of thought can be applied.
Dr. Shelley Uram, a Harvard-trained psychiatrist at The Meadows, helps articulate a layperson’s perspective of how the neuropsychiatry model of the mind and body adapt to stress and trauma. She explains that our amygdala is located in the brain’s limbic system.
The limbic system is located in the midbrain, where our emotions originate. Constant stresses, such as childhood traumas, rattle and sensitize our amygdala, which is also referred to as the “smoke detector,” a moniker indicative of its function. It does not gradually activate the sympathetic nervous system for the fight or flight response. It spontaneously stimulates the adrenal glands to flood the body with adrenaline.
This results in a state of arousal for the body and mind. If the brain continually perceives the message of an external threat, whether real or imagined, it will create an internal state of perpetual hypervigilance and angst. It is analogous to revving your car’s engine to the highest RPMs while in the park.
Pia Mellody’s longtime work in the area of trauma and addictions has resulted in a behavioral model called “Developmental Immaturity.” This model addresses the problems of being relational and achieving intimacy. To gain a better understanding of Pia’s model, imagine a tree.
The roots of the tree are childhood traumas, including physical, sexual, and emotional abuse. The trunk of the tree allows the core issues of immaturity to fester and impede personal growth. These core issues include problems with self-esteem, boundaries, reality, dependency, and containment. The branch of the tree denotes the secondary symptoms of unmanageability. This is the stage when addictions, depression, fear, and panic disorders appear. The leaves of the tree represent the final outcome of all of the dysfunctional stages and an inability to establish and maintain healthy intimate relationships.
My first panic attack occurred at age 27, six weeks after marriage. It was as if I were losing control, going crazy, and having an emotional breakdown. A visit to the emergency room ensued. The hospital medical staff said I was having an anxiety attack, gave me a tranquilizer, and sent me home. Not only did I feel emotionally trapped and ill-equipped to engage in an intimate relationship, but the sense of overwhelming fear and impending doom was ever-present. I tentatively speculated that marriage was the problem. It was too incomprehensible to think that the problem was endogenous to me. So began my journey through life, filled with hidden shame, fear, and depression spanning the next three decades.
After two years of visiting a myriad of psychotherapists and experimenting with numerous psychotropic drugs, I was still battling depression, fear, and anxiety. Fortunately, at 29, I found a psychologist who diagnosed my condition as agoraphobia with panic disorder. He explained that my disorder stemmed not from my perception of marriage but from the cognitive distortions and childhood trauma embedded in my psyche due to physical abuse. Recalling the physical abuse experience was so powerful that it felt as if my heart and soul were being suffocated. I could not address my childhood abuse issues.
However, as I developed more psychological ego strength and better-coping skills, I gradually reflected back on my childhood. I was physically battered multiple times between the ages of 5 and 13. I tried unsuccessfully to stave off my father’s abuse with my feeble attempts to express anger. My retaliation was met with scorn, disdain, and an escalation of violence. This violence would trigger my body to mobilize and prepare my internal milieu for the most primitive response: survival.
Today, my father would be labeled a “rageaholic.” His impulsivity and inability to contain his rage were equivalent to a ticking time bomb, ready to explode anytime for no reason. Since I was the oldest male child in the family, I was the focal point of his outbursts. This dysfunctional
behavior perpetuated the male rite of passage in our family. The father’s sins were being passed to the next generation as an acceptable form of discipline.
After decades of therapy, I found that the model that helped me grasp and understand my problems most clearly was Pia Mellody’s. Her approach illustrated that my father had an extreme failure to maintain his boundaries, contributing to my feelings of being exceedingly vulnerable and without boundaries. His constant verbal and physical abuse was an edict to our family; he was the boss. We were always one-down if he was in the perennial position of one-up.
Being one down all the time obviously had a negative impact on my self-esteem. Also, he emphatically and without question demanded obedience, putting himself in a position of omnipotence. This eventually distorted my reality, dislodging me from the spiritual path to my higher power. My father was continually on the verge of being out of control. His lack of control influenced my behavior, as I always tried to be in control and perfect.
As a survival technique, especially during the physical battering, I dissociated my emotions from my body. If I felt any feelings, I cognitively appraised them as anxious feelings. This psychological tactic of turning my anger at my father into anxiety within myself allowed me to function in a chaotic and unpredictable home.
Consequently, after decades of dissociating from my feelings, convoluting and twisting my emotions, I could not identify and appropriately express emotions. Therefore, every time I had a feeling, I assessed it as anxiety – and only anxiety. This increasing accumulation of stress and inappropriate processing of emotions provided a fertile environment for the onset of panic attacks. Pia Mellody would call this psychological process “carried feelings” or “carried shame.”
More pointedly, I felt shame during my father’s rage attacks, and he was shameless. As a vulnerable child, I symbolically swallowed all of his emotional frailties and inadequacies. The psychological process of feeling my shame, fear, and anger, plus my father’s feelings, was too overwhelming. A panic attack was the result of the carried fear and shame.
Healing the sins of the father is a Herculean effort. Many therapists employ traditional talk psychotherapies, which are extremely helpful. However, traditional talk therapies primarily engage the higher cortical portions of the brain. Some research indicates that childhood trauma seems to be locked in the more primitive limbic system. One of the most effective ways to access the limbic system of the brain is through modalities that stimulate the midbrain, or our seat of emotions.
An example of this modality is guided imagery used to re-experience childhood trauma as an adult. Pia Mellody uses this technique and others that bridge both portions of the brain, the frontal cortex (thinking) and the limbic system (feeling).
In closing, the abatement of the carried feelings is not the end; it is the beginning of one’s spiritual path. Ironically, recovery is not only achieved with the dissolution of fear but with the nurturing of joy.