You must of course believe in the diagnosis yourself. That isn’t always
easy. Regardless of what you know, mental disease just doesn’t feel as real
as physical disease. It can’t kill you (at least directly), but an undiagnosed
physical illness can. You have to trust that the doctor has sufficient acumen
to rule out other possibilities. It may be hard to decide if all you have is a
frightened person’s memory of what was said. If appropriate, it will be
helpful to talk to the doctor yourself, go in with the patient, or at least write
out a list of questions. Nothing beats an explanation from the person who
has actually done the workup.
Short of that, you’ll have to understand some basic physiological pro-
cesses, and improvise.
And, as we have previously stated, the fight or flight response creates
instantaneous physical changes to make the body ready to fight back or run
away. Heart and lungs rev up to redline. Vascular floodgates slam shut in
some places and open wide in others. Blood, supercharged with hormones,
is shunted from everywhere else to the muscles. Noncritical functions like
digestion are switched off.
As quickly as you can say psychosomatic, the body shifts from a resting
state to one of readiness for actions that more than likely won’t occur.
Imagine having your gas pedal to the metal and stomping on the brakes
at the same time. It’s got to hurt. The sensations in a panic attack are not
imaginary; everything the person feels is real, in that it is caused by some-
thing that’s actually happening in the body. What is imaginary is the belief
that these sensations herald impending doom.
Here are some of the more common symptoms, and plausible expla-
nations for why they occur:
SENSATIONS OF HEAT OR COLD. Heat comes from metabolism, burn-
ing food for energy. Blood rushes into the deep muscles, giving them lots
of fuel and an assortment of performance-enhancing drugs. The muscles
burn up this mixture like an SUV on high-test. They heat up and swell,
often causing sweating and flushing. Meanwhile, blood-starved extremities
feel cold, numb, and tingly, just as they do when they’ve been in one posi-
tion too long and are going to sleep.
Many of the strangest feelings associated with panic attacks have to
do with irregularities in breathing and related changes in blood chemistry.
A number of studies have shown that people with panic disorder tend to
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