What You Can Change _. And What You Can't - Martin E. Seligman [31]
Since that time, Celia has had about three attacks a month. She does not know when they are coming. During an attack she feels dread, searing chest pain, smothering and choking, dizziness, and shakiness. She sometimes thinks this is all not real and she is going crazy. She always thinks she is going to die.
Panic attacks are not subtle, and you need no quiz to find out if you or someone you love has them. As many as 5 percent of American adults probably do. The defining feature of the disorder is simple: recurrent, awful attacks of panic that come out of the blue, last for a few minutes, and then subside. The attacks consist of chest pains, sweating, nausea, dizziness, choking, smothering, or trembling. They are accompanied by feelings of overwhelming dread and thoughts that you are going to die, that you are having a heart attack, that you are losing control, or that you are going crazy.
The Biology of Panic
There are four questions that bear on whether a mental problem is primarily “biological” as opposed to “psychological”:2
Can it be induced biologically?
Is it genetically heritable?
Are specific brain functions involved?
Does a drug relieve it?
Inducing panic. Panic attacks can be created by a biological agent. For example, patients who have a history of panic attacks are hooked up to an intravenous line. Sodium lactate, a chemical that normally produces rapid, shallow breathing and heart palpitations, is slowly infused into their bloodstream. Within a few minutes, about 60 to 90 percent of these patients have a panic attack. Normal controls, subjects with no history of panic, rarely have attacks when infused with lactate.3
Genetics of panic. There may be some heritability of panic. If one of two identical twins has panic attacks, 31 percent of the co-twins also have them. But if one of two fraternal twins has panic attacks, none of the co-twins are so afflicted. More than half of panic-disorder patients, moreover, have close relatives who have some anxiety disorder or alcoholism.4
Panic and the brain. The brains of people with panic disorders look somewhat unusual upon close scrutiny. Their neurochemistry shows abnormalities in the system that turns on and then dampens fear. In addition, PET scan (positron-emission tomography), a technique that looks at how much blood and oxygen different parts of the brain use, shows that patients who panic from the infusion of lactate have higher blood flow and oxygen use in relevant parts of their brain than patients who don’t panic.5
Drugs. There are two kinds of drugs that relieve panic: tricyclic antidepressant drugs and the anti-anxiety drug Xanax, and both work better than placebos. Panic attacks are dampened, and sometimes even eliminated. General anxiety and depression also decrease.6
Since these four questions had already been answered “yes,” when Jack Rachman called, I thought the issue had already been settled. Panic disorder was simply a biological illness, a disease of the body that could be relieved only by drugs.
A few months later, I was in Bethesda, Maryland,7 listening once again to the same four lines of biological evidence. An inconspicuous figure in a brown suit sat hunched over the table. At the first break, Jack introduced me to him—David Clark, a young psychologist from Oxford. A few moments later, Clark began his address.
“Consider, if you will, an alternative theory, a cognitive theory.” He reminded us that almost all panickers believe that they are going to die during an attack. Most commonly, they believe that they are having a heart attack. Perhaps, Clark suggested, this is more than just a symptom. Perhaps it is the root cause. Panic may simply be the catastrophic misinterpretation of bodily sensations.
For example, when you panic, your heart starts to race. You notice this, and you see it as a possible heart attack. This makes you very anxious, which means your heart pounds more. You now notice that your heart is really pounding. You are now sure