Gerald’s Panic Attacks: A Story of Therapy

Today I’d like to tell you a story of therapy.  The story started three years ago when I met Gerald who found me online and came to me in tears.  (All names and details of this story have been changed to protect confidentiality.)

Gerald was a single 32 year old man living in Los Angeles.   Well built, athletic, funny, and ambitious, he had a lot going for him.  The only problem was he suffered with daily severe panic attacks that were impacting his life, affecting his job and making him generally miserable.  He described his panic attacks as intense, a 10 out of 10 on the scale, sudden, unexpected, and frightening.  They hit him when he was grocery shopping, walking down the street, driving in his car.  His first impulse during an attack was “to get away, get out, go far away.”

As I got to know Gerald, I realized that his panic disorder was not typical.  He was not afraid of his panic attacks as in most cases of Panic Disorder.  He knew what they were, and they were not going to kill him.  He found them uncomfortable but didn’t see them as dangerous.  He was not afraid of panic attacks, no.  He was afraid of something else, and that something else was giving him the attacks.

Therapy progressed and Gerald became more adept at handling his panic attacks, but the panic attacks persisted.  They decreased somewhat in intensity, but were still quite frequent.  I began to feel that they were trauma related.  We started probing into Gerald’s childhood for clues.

At first he was reticent to talk about his past, stating that he is in therapy to address his panic attacks and needs more tools to deal with them in the present.  I explained to him my theory, and asked him to indulge me.  Reluctantly he started to open up.

The narrative that followed left me truly saddened for Gerald.  He described a childhood one only reads about or sees in films.  He described his mother as an angry and vengeful person.  Having gone through a bitter divorce with Gerald’s father, she took out her rage on her son, referring to him often as “A clone of that bastard dad of yours.”  She took every opportunity to lash out at Gerald, and was physically and verbally assaultive. He tried all of his life to please and appease his mother.  When she died, he suffered immense guilt and tremendous grief.

I decided to start putting two and two together with Gerald.  We began the difficult work of tracing his panic attacks to any potential triggers in his environment that may have been reminders of a traumatic childhood, and a heart-wrenching relationship with his mother.  Now the real sources of the attacks began to illuminate themselves.

All this became fully apparent when we analyzed his last panic attack which took place at the grocery store.  He was in the middle of deciding between a brand name fabric softener and a store brand one.  The scent of one of the softeners reminded him of one his mom used to use.  He remembered remembering that at the grocery store, but thought nothing of it.  He then recalled that almost immediately after the scent of the softener, he had a full blown panic attack.  The attack was so intense that it consumed him and he directed all of his energy at containing it, never thinking that he was having an appropriate fear reaction to something that reminded him of his mother.

One by one the triggers started to pop out at us in therapy.  You cannot imagine Gerald’s relief at realizing the cause of his panic attacks.  Everything started to make sense.  He started to figure out triggers on his own, and would understand his panic attacks as a reaction to them, thereby immediately quelling them.

My work with Gerald took three solid years of weekly sessions and EMDR.  It was an emotional roller coaster ride for him, and truth be told, for me as well.  He had to face his grief, the loss of his mother as a door permanently shut on the hope of someday getting her approval.  He dug up years of unacceptable feelings for his mother, faced his deepest pain.  Gerald’s bravery and determination was admirable and ultimately led to success.  Together we were able to decrease Gerald’s attacks from happening daily to happening once every 3-4 months at most.  The attacks became shorter and easier to manage with each passing month of therapy.

The moral of our story is that panic attacks are not all made equal. Some are related to overdeveloped attunement to internal sensations, some are due to fears of losing control or death, and others are reactions to ubiquitous reminders of things we try our hardest to forget.