The Stress Doc Letter
Cybernotes from the Online Psychohumorist ™

JUL 2000, No. 1, Sect. 2

Main Article

Excessive Arousal-External Source: "Phobia-Panic"

The April, May and June 2000 Stress Doc Newsletters have broadly sketched a model for examining how states of physiological arousal impact our perceiving-thinking-feeling-behaving self. The two variables are degree of arousal -- from overaroused to underaroused and the source of arousal -- internal or external. The previous newsletter focused on excessive-internal arousal-activation states: Agitation-Manic

Here is a compact 2x3 matrix model of "Six States of Physiological Arousal - Activation." The two basic dimensions -- "Arousal Source" and "Levels of Arousal - Activation" -- and the resultant six boxes.

Six States of Physiological Arousal - Activation

Levels of Arousal - Activation

Insufficient Excessive Optimal Arousal Source ----------------------------------------------------------------------

Internal Emptiness- Agitation- Relaxation- Exhaustion Manic Meditation (Biochemical)

(Cognitive-Affective)

----------------------------------------------------------------------

(Environmental) Boredom- Phobia- Alertness- External Inertia Panic Animation

----------------------------------------------------------------------

As previously explained, the "Arousal Source" is a gradient, from the biochemical (Internal Stimuli) to the environmental (External Stimuli). The "Cognitive-Affective" (or "Thinking-Feeling") dimension interacts with, affects and is affected by both biochemical and environmental stimuli. Nature and nurture forge a complex blend. Both sources and arousal-activation states excite or inhibit each other in an ongoing feedback loop. The dimensional interplay influences the ability to: a) manage one’s psychophysiological arousal and resulting emotions, b) process and make sense of past, present and future self-world information, including memories and dreams, goals and visions and c) generate an array of responses to everyday problems and opportunities – from the adaptive or innovative to the dysfunctional or regressive.

Today, due to the Stress Doc's uncontrolled verbosity, the focus is just on Excessive Level x External Arousal Source: "Phobia-Panic." Ideas and descriptions will draw upon Webster’s Dictionaries (Third World New International and New Universal), Roget’s International Thesaurus: Fifth Edition, the Diagnostic and Statistical Manual (DSM) IV and personal reflection. The dictionary provides a broader framework for viewing the essence and potentialities of these states. The DSM sharpens the functionality-dysfunctionality focus. And before concluding this series, we’ll even examine the boundary lines between Internal and External Sources of Arousal as well as the borders between Levels of Arousal - Activation. These border and boundary lines may actually evoke synergistic interactions for "The Creative Edge."

II. External Source - Excessive Level

B. Phobia - Panic State of Arousal

1. Phobia. According to Webster’s, "phobia" comes from the Greek, meaning fear and flight. The complete definition:

1) an exaggerated and often disabling fear usually inexplicable to the subject, having occasionally a logical but usually an illogical or symbolic object, and serving to protect the ego against anxiety arising from unexpressed aggressive impulses. Fear, dread and hatred often cluster together.

DSM mentions a variety of phobias; let’s examine two with broad application:

2) Specific Phobia – marked and persistent fear that is excessive and unreasonable cued by the presence or anticipation of a specific object or situation, e.g., flying, heights or receiving an injection…Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack.

3) Social Phobia – persistent fear of one or more situations in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing. Examples include: being unable to continue talking while speaking in public or not being able to answer questions in social situations.

Those Abusive "A"s

Let’s return to and expand upon Webster’s definition (1), which notes a pervasive troubling dynamic -- how unexpressed aggressive impulses can lead to conflict aversion and phobic states. Both personal and professional experience intimate that the Phobic-Panic states are influenced by: a) biochemical and genetic predisposition and b) psychological and interpersonal dynamics comprising the Abusive Triple "A" – Alarm, Aggression and Abandonment. And according to the DSM, the earlier and the more unexpected the trauma the increased likelihood of a pathological or dysfunctional effect: "Separation Anxiety Disorder in childhood and sudden loss of social supports or interpersonal relationships apparently predispose to the development of this (Panic) disorder." The DSM also notes that, "Panic Disorder, Phobic Disorders and Obsessive-Compulsive Disorders are all apparently more common among first-degree biologic relatives of people with each of these disorders than among the general population.

As for the Triple A, my Jewish Tennessee Williams Family definitely set the stage. Let me count the ways:

1. Mental illness on both sides of the family, including life long depression of my paternal grandmother, my father’s depression, and my maternal uncle likely having undiagnosed childhood schizophrenia, 2. My father’s breakdown when I was 1½ years (diagnosed as "Manic-Depression") traumatizes both parents, 3. Being a biologically/psychologically sensitive child, I am flooded by the family tension, 4. Separation anxiety, a tendency to view disruption or threat as potentially catastrophic, and a low threshold for abandonment feelings are imprinted early, 5. A critical traumatic event: When I was seven or eight, one day harboring some anger toward my mother over some earlier conflict, I decided to show off my bravado in front of a playmate. In a somewhat cocky tone I said: "I’m still angry at you." It’s a blur what precisely happened next. My mother suddenly went ballistic, screaming at me and my friend, throwing the latter out of the house, with me retreating in terror. (Whether my psycho-biochemical sensitivity exaggerated the perceived intensity of her rage state is a legitimate question. Though she has a history of being a verbal volcano when acutely anxious or in a near panic state. Also, not having a strong emotional connection as a child to a withdrawn father, inevitably increased a sense of dysfunctional dependence upon my mother. In my psychosocially immature, distorted cognitive-affective state, I myopically magnified my father’s emotional weakness and, through a symbiotic identification with the aggressor, fearfully and irrationally deified my mother’s intellectual strength.)

Back to the traumatic episode. The aftermath is a fog, other than knowing that this encounter was the last time I raised my voice or expressed honest anger with her until my twenties. And I suspect some dissociative split occurred between my real self and my "too good" false persona. Showing anger meant I was bad, was disrespectful and, though never overtly stated, was weak and crazy like my father. (Actually my father’s depression and history of shock treatment was a family secret for almost two decades. Or, I blindly accepted the explanation that when my uncle helped carry his brother into my parent's bedroom, dad was coming home from a session with the back doctor.)

An attempt at loosening the emotional dependency bonds with my mother, some desire to take a maturational step, was squashed by this explosive encounter. Not surprisingly, with all this acute and ongoing trauma, incidents of being tormented by peers started increasing. I was a wounded pup, who began to have paranoia-like fears of being beaten up by peer pit bullies. Interestingly, decades later in an unguarded moment while discussing family history, my mother blurted out, "With all the pressures [dad’s illness and shock regimen, grandma’s amputation of both legs, the second while living with us, my black sheep uncle’s schizophrenic breakdown upon my grandmother’s death, and his ebb and flow from our house to the psychiatric hospital for several years] you weren’t going to give me any trouble!" And I didn’t.

And for much of my childhood and adolescence my real self retreated behind a depressive, phobic and addictive – numbing sports playing, television watching and masturbation – shell and fixed, "all is well" smile and persona. On the dark inside, I was fearfully freezing up.

6.The final and indefensible psychic crack in my frozen armor occurred with the death of my maternal grandmother, my unspoken ally (she spoke little English) a loving woman of uncommon empathy and serenity. Just before the start of adolescence, near daily episodes of panic (which I was ashamed to acknowledge to my parents) about being physically or mentally abused by peers was the disorder of the day. (I have no doubt, that lifelines to extended family such as my grandmother and my other maternal uncle, a heroic male role model, provided enough emotional ballast to prevent a psychotic break. But trust me, I was much too close to the edge for a long, long time.

Half Empty and Half Full

Upon further reflection, and in the pursuit of confessional objectivity and balance, perhaps an aptitude for dysfunctional caretaking, along with a hypomanic and/or hyperactive propensity allowed periodic escape from the depressive lows. My energetic side, along with an inherent or inherited (from my maternal grandmother) capacity for "emotional intelligence" when I wasn't cowering in fear, ironically, at times facilitated being a leader amongst my peers. It's this Dr. Jekyll and Mr. Hyde split that was so confusing -- from charmingly and compassionately extrovertish to fearfully and shamefully trapped in the phobia and depressive closet.

Hopefully, this outline illustrates the connection between Phobia-Panic States and The Triple "A": Alarm, Aggression and Abandonment. Both being intimidated by others' anger, as well as being terrified of abandonment and our own bottled up explosive rage, can be an oppressive catalyst for emotional disconnection and depression, if not profound dissociation. When a genetically sensitive individual is subject to bombardment by severe or psychically subtle environmental stressors, it takes just minor interior rumblings or quakings to trigger wild fluctuations in your inner seismograph. There’s a highly active and highly unstable psychic fault line. All to easily, inner cognitive-affective static, distorted beyond immediate understanding, erupts into outer projections…as phobic states and panic attacks.

Yet, again, sometimes the glass is half empty and half full. For example, being in college in the late 60s, drug experimentation was the social-cultural order of the day. I suspect my subconscious, unspoken fear of having a psychotic breakdown -- whether rational or bordering on the paranoid -- kept me from experimenting with hard drugs.

And then there's the miraculous potential of facing one's dread and sharing forgiveness. It wasn't till I was twenty-five, six years after learning of the family secret, that I asked my father to discuss his breakdown and trial by shock therapy. This, not surprisingly, became the critical step in our making amends, in overcoming years of painful disconnection. As dad was talking about his traumatic past, and me all too nakedly comprehending the horror, I crawled in my father's lap. I threw my arms around him, embracing him with pure pain, and then began sobbing, lovingly and unashamedly, in his arms.

Finally, as will be explored further in the next newsletter, anxiety, agitation or even some social phobia can facilitate a need for solitude and obsession. This mode when mixed with a need for expression of one's talents and passions becomes the incubational proving ground for fertile imagination and innovation.

2. Panic

Webster’s captures the lay conception of "panic": extreme, sudden and, often, groundless fear.

According to the DSM, "panic attacks":

1) typically begin with the sudden onset of intense apprehension, fear or terror. Often there is a feeling of impending doom. This is especially likely when a state or generalized "learned helplessness" has evolved.

During most panic attacks there are a cluster of symptoms: -- shortness of breath or smothering sensations; -- dizziness, unsteady feelings or faintness – when I was in high anxiety periods as a child, all of a sudden my head would swirl, spots seemed to dance before me and, feeling faint, I would lean up against a wall to prevent myself from losing balance. Again, I was always too ashamed and afraid to mention these episodes which invariably occurred when alone in my room. It’s as if in privacy I could finally experience the level of stress that I was constantly trying to keep under control publicly. And this was way before the age of ten; maybe as early as five or six. -- palpitations or accelerated heart rate -- trembling or shaking; sweating -- nausea and abdominal distress – as a kid, stomach aches were a constant; (I hadn’t thought of this for a long while) -- depersonalization or derealization (feeling detached or disconnected from your body, your sense of self or sense of place); as mentioned, writing this essay has uncovered a possible connection between the adult, out of body "mystical" moment and panic-induced childhood dissociation -- numbness or tingling sensations -- flushes (hot flashes) or chills -- chest pain or discomfort -- fear of dying; and -- fear of going crazy or doing something uncontrolled during the attack.

Recurrent panic attacks constitutes Panic Disorder. According to the DSM, "in the great majority of cases Panic Disorder seen in clinical settings, the person has developed some symptoms of Agoraphobia. Agoraphobia is the fear of being in places or situations from which escape might be difficult (or embarrassing) or in which help might not be available in the event of a panic attack."

Closing

This essay has been a poignant, wistful and painful experience; still, hopefully a growing painful one. Under a dark cloud of impending doom, seeded by expanding pressure, depressive sensitivity, bottled rage and a threatening environment (which at times would allow me to hide out and escape from dealing with age appropriate life tasks), no wonder there was impaired capacity for concentration and learning in the realms of logic, math, science and abstract reasoning. No wonder the irrational fears of catastrophic injury which contributed to an emotionally battered child-young adolescent syndrome. No wonder the sense of helplessness, shame and dread in key social and school-related roles and relationships. When not able to escape or numb myself or, perhaps, because of this habituated defense, too often there was the encroaching edge of paralysis, phobia and panic. No wonder it’s taken so much work, so much therapy and, even, biochemistry trials. No wonder I needed so much emotional and financial help from friends, so much reconciliation work with a dysfunctional yet recovering family, for so long to discover and rebuild a healthier sense of self – less dysfunctional, less fearful and panicked, less depressed and less addictive. So now you can better understand why I was able to do so well as a Stress and Violence Prevention Consultant for the US Postal Service. I was determined to relive and achieve greater peace with my own past, not just master new challenges. I'd been there way before "Going Postal" was in vogue.

After their escape from Egyptian bondage, the Jews as a nation wandered in the desert for forty years. Perhaps I'm just following a noble tradition. Perhaps two words inspired by the Holocaust are my mantra: "Never again!" And I too must remember:

The Poetic Scream

The vacuum shrieks
The hours weeks
The wail of solitaire.

AWOL leaks
Piranha beaks
Affixed the meat (and beat) of prayer.

May these words help us all…Practice Safe Stress!

Reader's "Higher Power of Humor" Section

New Age Proverbs From: we4and

Everything must be upgraded it seems, so here are some wise new Proverbs for the Year 2000. (Can you remember the original??)

1. Home is where you hang your @.

2. The e-mail of the species is more deadly than the mail.

3. A journey of a thousand sites begins with a single click.

4. You can't teach an old mouse new clicks.

5. Great groups from little icons grow.

6. Speak softly and carry a cellular phone.

7. C:\ is the root of all directories.

8. Oh, what a tangled website we weave when first we practice.

9. Pentium wise, pen and paper foolish.

10. The modem is the message.

11. Too many clicks spoil the browse.

12. The geek shall inherit the earth.

13. There's no place like http://www.home.com

14. Don't byte off more than you can view.

15. Fax is stranger than fiction.

16. What boots up must crash down.

17. Windows will never cease.

18. Virtual reality is its own reward.

19. Modulation in all things.

20. Give a man a fish and you feed him for a day; teach him to use the Net and he won't bother you for months!

Seek the Higher Power of Humor: May the Farce Be with You!

 Mark Gorkin, LICSW, "The Stress Doc,"™ is the Internet's and America Online's "Online Psychohumorist"™. An experienced psychotherapist, "The Doc" is a nationally recognized speaker, and training and OD consultant specializing in Stress, Anger Management, Reorganizational Change, Team Building and HUMOR! An expert advisor for www.AdviceZone.com and iVillage/allHealth, his writings are syndicated by iSyndicate.com and appear in a wide variety of online and offline forums and publications, including AOL/Online Psych and Business Know How, Mental Health Net, 4Therapy.com, WorkforceOnline, HRHub.com, SelfhelpMagazine.com, Financial Services Journal Online, CONVENE (The Journal of the Professional Convention Management Assn.), OpportunityWorld and Counsel ing Today. Recently, he has been quoted and/or featured in such publications as Cosmopolitan Magazine, Bloomberg Report/News, Forbes Magazine, FoxNews.com, Dallas Morning News and The Washington Flyer. The Doc also leads his national "Shrink Rap and Group Chat" for AOL/Digital City and WebMD.com. Check out his USA Today Online "Hotsite" Website -- www.stressdoc. com . For info on his workshops or for his free newsletter, email stressdoc@a ol.com or call 202-232-8662. Summer 2000, look for Practice Safe Stress with the Stress Doc, published by AdviceZone.com.

(c) Mark Gorkin 2000 Shrink Rap™ Productions