When you have anxiety as a child, you lack the words for what you feel inside your body, and what you feel inside your body is so acutely awful, so wretched and horrifying, most anxious kids will spend their time actively looking for ways to avoid feeling the percolating dread filling their chests, bubbling into their throats and tingling down their arms.
The more they turn away from their own feelings, the more they suffer. If no one intervenes, they grow into teenagers who can easily find unhealthy ways to numb their suffering (which achieves their goal of avoidance) through alcohol and drug use. By now, these kids have gone so long trying to avoid what’s in their bodies, they’ve grown to fear not just the feelings, but the bodies that contain the feelings. They can’t drop down into their feelings, so they rise up and get trapped inside their heads.
This disconnection between head and body makes ignoring your body easy. When they grow into adults, this separation can be so acute that in order to actually feel their bodies they need to overeat or undereat to the point of discomfort. They drink to excess or rely on drugs to either numb or amplify their terrifying feelings. Their relationship to their body becomes dysregulated and they’ll spend years trying to work through it all.
If you have children, how do you prevent all this from happening? Well, you must start teaching your child how to listen to her body. When she’s angry, ask her where she feels it and what it feels like. Don’t let her get away with “I don’t know” or “You’re so annoying.” Make this question a habit. Ask her to point to where she feels her sadness, her gladness, her laughter.
If we can begin to train our children to listen to themselves early, we have a much better chance of reaching them when they’re teenagers. And they have a much better chance of developing a healthy relationship with their body.
I’ve had a hard time writing blog posts about mental health this past month. There’s more than enough to write about, but I’ve been feeling overwhelmed by reality.
Anxiety is basically a fear of feeling fear, which means it’s a fear of experiencing and facing reality. And the reality of living in this world is very hard to face, even if you’re not the one in the direct line of suffering.
It’s hard to write blog posts about mental illness when kids are being separated from their parents at the border when black and brown people are killed because they’re not white, when white supremacists are bringing back the Swastika, when women’s rights are still up for debate, when patriarchy is still our default mode, when discrimination leeches its way through every category including gender, when the president of the United States is a white-nationalist leaning sociopath.
Our systems and institutions are so dysfunctional and dangerous they give rise to mental instability and it’s us, the people, who are persecuted for these structural deficiencies.
All this is to say, hi. I’m still here. I’ll write more soon, I promise. I’m just taking a mental health break from my mental health blog to shore myself back up.
In the past year, while I’ve been traveling and talking about my memoir LITTLE PANIC and my life long panic disorder, I’ve noticed something interesting: a lot of people claim to have something they don’t actually have.
Do you have a panic disorder?
Probably not.
Do you have an anxiety disorder?
Perhaps.
A panic disorder is the chronic suffering from repeated and frequent, unprovoked panic attacks. There are no triggers. It’s not anxiety a person feels in those periods of time, it’s pure, unadulterated panic. Life-threatening panic. I lived for 25 + years with a panic disorder. My life was interrupted by frequent seizures of unprovoked terror. The distinguishing feature of a true panic disorder is a person’s fear of having a panic attack. This fear becomes so intense that the sufferer will go to great extremes to avoid suffering from a panic attack. Their lives get very small, and often people become agoraphobic.
It becomes an untenable way to live, and often, depending on the type of person you are, the will to be freed from fear’s dictatorship, forces a person to make a choice: succumb or fight back. I fought back, only after succumbing.
It’s not a badge of honor to claim something that you don’t suffer from, but for some reason, many people claim to have a panic disorder when they don’t. This makes it harder for people who truly suffer to be seen and heard, and taken seriously.
So…you might have occasional panic attacks, and you might have a ton of anxiety, but unless your life has been altered daily by frequent bouts of panic, you, my friend, are in the clear.
And you know who else is in the clear? Me. I still have panic attacks, but only about two a year. I am in remission. I’d like to get clear about who suffers and in what way so that we don’t muddy the waters for those who truly need care. So, the next time you have a panic attack, you don’t need to worry that you have a panic disorder. You probably don’t.
BUT…if you do have frequent and chronic panic attacks that interfere with your everyday life, please go see a psychiatrist and a therapist. No offense to primary care physicians, but I find they don’t take mental illness as seriously as those in the mental health business.
Whenever something feels off in my body, it’s cancer.
Whenever someone says they “have to talk to me,” they’re going to end our friendship.
Whenever something even slightly out of the ordinary occurs, I respond the same way–with an automatic over-reaction. This is anxiety. It’s the most reliable feature of my personality and if you have anxiety, it’s familiar to you, also.
Last week, I gave a big talk and was interrupted from the audience, by the woman running the show, telling me to hurry up and finish because people were walking out (actually, two women were just going to the bathroom). When the event ended, I was rushed out of the hall by another woman and into a smaller room to record a podcast. No one said thank you. No one emailed me the next day or the day after that. Obviously, they hated my talk and they hated me and I should just impale myself on something so that I am unable to ever travel and give talks again.
Not once did it occur to me that their behavior was unprofessional, or even–the horror–rude! Nor did it occur to me that not everyone is gracious, or even good at what they do. Nope, it was me. It’s always me. ME ME ME ME ME. I’m the worst. I’m the ugliest. I’m the dumbest. I’m the most pathetic. These are my first reactions always, and they are not healthy or good for me, and they are never correct (but they sure are narcissistic!)
Anxiety is all about the first reaction, and that first reaction is often never right. And that’s why creating a second response to every situation is important, because most likely the second response is the one that’s more accurate.
Here’s an example: have you ever run into someone you know who has to hurry away, or can’t stop and say hi, or just waves and keeps going and you think: shit, what have I done? Then you worry all day that this person is mad at you for reasons you cannot guess, but you know MUST exist? And then you get an email a day later from the person apologizing, and explaining that they had just left therapy, or had been broken up with, or got rejected from law school or were withdrawing from meds or a hundred other things that happen to us on any given day.
Think about all the times you went to a fantastic party, sang its praises to everyone for weeks after, but for some reason never emailed the host. You didn’t hate the party. You were so caught up in the post-party reverie, it slipped your mind. There are so many things that we let slip that hurt other people and we don’t even know. Just how we become gripped by anxiety at other people’s foibles, so too are we causing others to feel anxious. We just don’t know about it.
Building a second response is fairly easy, and here’s how it’s done: Start writing down all the times you thought something was your fault and it ended up not being your fault (they weren’t mad at me, they were heartsick!) Write down every time you were wrong about why someone was late (they didn’t die! They were just on a stalled subway!) After a while, you’ll see that your reasons and the actual reasons don’t line up, and you’ll come to accept that there are tons of reasons why things happen and you are almost always wasting your time guessing.
Next time someone snubs you, or turns up late, or calls at you from the audience to tell you that people are leaving, you’ll have an arsenal of options for what might ACTUALLY be going on. First responders may be heroes, but for people with anxiety, second responders are who we want to be.
This is a quick one because the paperback of LITTLE PANIC comes out tomorrow and I’m juggling a thousand tiny things.
Anxiety in kids manifests in a variety of innovative ways. I want to go over some of them so you know what to look for. Some of these ways don’t register to parents as anxiety because not everyone knows what to look for. So, here is your cheat sheet for some obvious expressions of anxiety in kids. (This is a VERY ABRIDGED list. I’ll add to it in time!)
OBVIOUS:
Your child doesn’t want to leave you Your child is stuck in a rumination loop, and won’t stop asking you “what if” questions Your child is always worried Child complains of headaches and stomachaches on the eve or day of any large or small event Your child won’t let anyone come for a sleepover Your child clings to you and cries when one of you has to leave Somatic symptoms like heart flutters in their chest and stomach, sweaty hands, dry mouth and a sense of being distant or far away.
NOT SO OBVIOUS:
Your child becomes extremely quiet and withdrawn Your child throws temper tantrums Your child is profoundly self-critical Your child has very low self-esteem Your child doesn’t try if there’s a chance they might fail (also known as a perfectionist) Self-grooming behaviors (picking at skin, biting fingernails, toe-nails, hair pulling) They suck their fingers or thumb and have trouble stopping They have trouble focusing Your child perseverates under stress Your child’s voice sounds strangled, choked, more high-pitched than usual or tight.
When you have an anxiety disorder, your entire sense of self is thwarted by your anxiety’s sense of self. Imagine anxiety as an adult arm-wrestling a baby. Your true sense of self is that baby and it’s always losing to the preternatural strength of anxiety. A haughty glance from a stranger doesn’t stick to the average passerby, but for those running on anxious fuel, it can topple even the most sublime morning.
Remember being a middle schooler walking down the street and that sense of flop sweat you got when cooler kids knocked you when passing, laughter cackling in their wake and up your spine? The minty dread filling your lungs, shame heating your skin as the flap of reality you try to keep nailed shut lifts, exposing the truth everyone else can see just looking at you–that your existence is not only unfortunate but a misfortune? For a kid with anxiety, these moments are “small t” traumatic, but they happen so often they shape your life. They accumulate, filling your days and dreams, your diary entries, your entire identity.
Middle school is made up of hundreds of those moments. For kids free of anxiety, these moments suck, but they manage to recover, reset and start again. For those with anxiety, these moments are torturous and paralyzing. They stick, and like sick cells, they metastasize. You grow more aware that something is wrong, but for the life of you, you can’t quite identify it. It’s not concrete, it’s abstract. One day you realize that what’s wrong with you is…you. There is literally nothing you can do but work day and night to hide this central fact from others. Something about who you are is fundamentally wrong. Your biggest fear is that others will begin to see what you’re desperately trying to hide. To be exposed for this wrongness–one you know means you are broken and disposable–equals the end of your life. That’s how you think, how you feel when you’re a child.
For a young person with anxiety, being exposed for the wrongness that lives inside you is a terror that never goes away. You are constantly trying to dodge the thing that makes you most ashamed. You pray thousands of times a day that no one will call attention to the wrongness running inside you that makes you so unlike the others. You thank the God you don’t believe in every night that you escaped the day without being found out, that you’ve succeeded to evade the inevitable spotlight that will burn your shameful flaws into the slow-drying cement of people’s minds. But your body thrums, every day, with the vibrating fear that you’ll be known for the thing that shames you most.
You have no control over who will out you; when it will happen or even how, but a few times a week without fail, it’s always an adult who does the most damage. Some teacher calls on you when your hand isn’t raised, threatening to topple your entire empire. In that moment, when all heads turn from their desks to look at you, when the teacher is waiting, when you haven’t heard what’s been asked because your brain has been filled with nothing more than the cacophonous prayerful incantations of DON’T CALL ON ME, DO NOT LOOK MY WAY, I AM BUSY DOING IMPORTANT NOTE-TAKING, PLEASE I BEG OF YOU, DO NOT ASK ME ANY QUESTIONS BECAUSE I DON’T KNOW, I AM SO DUMB, I AM WRONG, AND MY LIFE WILL END IF YOU EXPOSE ME. PLEASE DON’T MURDER ME. Your heart has been knocked loose from its shingle, the creases in your palms have grown humid and damp, and that slow creeping mortification has dropped like a wig to the floor. All the faces are waiting on you, smirks, eyes alive with schadenfreude.
When you call on a kid with anxiety, you are doing nothing more than “small t” traumatizing them. You are discouraging them from participating, you are creating in them reasons to avoid you and your class. You are hurting these forming brains more than you are helping them. TEACHERS, PLEASE STOP CALLING ON KIDS WHOSE HANDS ARE NOT RAISED.
Kids don’t learn when they’re afraid. Kids don’t learn when they’re forced to participate. Kids learn when they trust you. When they’re comfortable. When they’re engaged in positive, idea-generating ways. “But how do we get a student out of their comfort zone?” you might ask. Well, why not ask your student, in private, after class, how you can work together to get them out of their comfort zone? Because here’s the thing, it’s not up to you to decide the parameters of a child’s comfort zone. We have different learning styles, and a classroom environment doesn’t work for all of us. The environment itself, for many kids, is already outside of a kid’s comfort zone, and they’re existing in it all day, every day. They are trying to stay inside their comfort zone because they are so fucking uncomfortable inside the one that exists. For many anxious kids, the system itself is a danger zone, and it’s the system that needs to change so that it’s more comfortable for all kids. Yet we force even our most sensitive children to make their teachers more comfortable by meeting the teachers where they’re at, instead of demanding that teachers meet students where they are at.
We pressure our kids to conform to the institutional machinations of our world without ever questioning the institutions themselves. Human beings are variant, ever-evolving people. We are not meant to all exist inside the exact same framework. So, instead of forcing our kids to bend to meet our contours, how about spending more time teaching teachers how to bend to their students?
When your child is having a panic attack, do you know how to help them? Do you tell them that they’re okay? That they’re fine? Do you tell them to breathe?
Yes?
Okay.
Please stop doing that.
When your kid (or your sibling or friend or loved one) is having a panic attack, they are not fine and they are not okay. They know this. You know this. So, when you tell them that they ARE fine, when they are very clearly not, the person having the panic attack knows you are not someone they can rely upon. You are not being in charge of reality, which is what the anxious person needs. Having a panic attack is losing control–a terrifying place for an anxious person to be. If they are going to be soothed by you, you need to prove to your anxious loved one that you are capable of being the one in control, and in order to do that, you need to tell the truth.
Anxiety gets worse when it’s denied or hidden. Telling someone they are okay when they are not, makes their anxiety worse. Acknowledging that someone is not okay does not in fact trigger their anxiety, rather it allows the anxious person to relax a little knowing that someone is completely there with them. A person having a panic attack is afraid of what’s happening to them, and when the person they are with is calm and stable, able to recognize the situation for what it is, the anxious person can begin to feel safer.
So, are you supposed to tell the panicking person they are NOT okay?
Sort of, and no. A good approach is to acknowledge what’s happening, and that you’re there and will get through it with them. Ex: “I know you don’t feel okay right now, but I’m here with you and we’ll get through this together.” Remind them of the last time this happened, point out that they were scared then that they would never stop panicking, but that they did, and they will again.
Be conscious of mirroring back to your child whatever it is they’re afraid they’re doing or not doing. If they feel they are unable to breathe, tell them you are watching their chest and belly rise and fall, that even though they feel their body is shutting down, the person not panicking is watching and able to see that their body is not shutting down. “Yes, I know it feels like your body is closing down, this is what panic attacks do, remember? I am your emergency contact and I’m here with you, and I can tell you that you are going to be okay.”
Try and point out that feelings are not facts. Yes, your child might be CONVINCED that you’ll forget they exist after they’ve left for their school trip, but that’s just a feeling, some bad information their anxious brain is sending them, but it’s not a fact. The FACT is that you have never forgotten your child in the past, the FACT is that your child has never forgotten they have a parent, so it makes logical sense that no parent could forget they had a child. Separate their worries from reality with logical, evidenced-based facts.
Sit with them. Do not be busy doing other things while your child is panicking. Hold the anxiety with them. If they are hyperventilating, it is appropriate to have them breathe, but breathe alongside them. Show them how you would like them to be breathing (slowly in for a count of six, slowly out for a count of six. Keep doing this a few times). If they are not hyperventilating, having them breathe might actually induce hyperventilation, so do not tell them to breathe unless it’s necessary.
When they breathe, tell them to imagine they are inhaling blue, safe, clear and clean air and exhaling hot red, polluted mad air.
Remind them that panic attacks are false alarms. That their alarm has gone off when it didn’t need to, and now you just have to sit and be patient until the alarm begins to quiet. Their alarm is more sensitive than others so things that other people wouldn’t think are dangerous, threatening, or scary are all of these things to a sensitively-alarmed human.
Whatever you do, do not deny their experience. Do not diminish what is happening for them. Don’t tell them they are being ridiculous or over-dramatic. When you panic from actual danger, imagine if everyone dismissed your fear, telling you that you were being ridiculous and over-dramatic. Just because you don’t have the same fears as your child, doesn’t make them less traumatic for them to live through. Anxiety attacks happen when we mistake a non-threatening thing for a threatening thing. There are ways to acknowledge that the thing itself isn’t dangerous, that feeling afraid won’t kill you, while also communicating that you understand the fear is very real to them. Be your child’s life coach, their mental health advocate, their best friend. Treat them the way you want them to treat themselves. They are learning all of their behavior from you. Be their role model. It’s what they’ve always wanted from you.
As a professional worrier, I feel I have the authority to say that telling a worrier to think positively is as helpful as telling a sniper to loosen up. This is not only useless advice, it actually makes worriers more worried. You see, worry is a strategy we use to adapt to reality, which to us, feels uncertain, threatening, dangerous and harmful. The more a worrier worries, the safer we feel. You know what scares us? “Being positive.” If we were to start “being positive” we’d stop worrying, and worrying is what keeps our loved ones alive, the plane from crashing and our lab results from coming up terminal. Worry protects us; it keeps us safe. It’s our life-vest and telling us to be positive is asking us to remove the thing that keeps us afloat. You want us to be positive? Okay, then you go be anxious because SOMEONE HAS GOT TO WORRY OR THE WORLD WILL EXPLODE, AND MELT INTO LAVA AND FLAMES.
One of anxiety’s hallmarks is a fear of uncertainty. Worry tricks us into believing that worry will reduce this uncertainty. We become convinced that we are controlling our environment when we worry. Telling us to stop doing this is useless and naive. The truth is, worry is an avoidance technique. Worrying helps us avoid the thing we most fear. If you ask a worrier when they are actively worried, what they are most afraid will happen, they’ll be hard-pressed to tell you, truly, what they are afraid of.
When I ran my series Happy Ending, I had to get onstage and perform. I was terrified, but I did it because despite having a panic disorder, I was also born with a need to perform, so it’s also exhilarating. But I was always afraid of bombing. If you asked me what I feared the most about doing badly onstage, I would have said: “I’ll die.” But that wasn’t actually the fear. I was too anxious to even allow myself to think of my real fear. Anxiety is a tool we employ to avoid thinking of the worst case scenario.
Me freaking out (in a terrible outfit) in the green room at Joe’s Pub, before a show.
My actual fear of bombing would have been that I would have been exposing, to the entire audience, that I am fundamentally flawed. That I’m not good at the thing I pretend I’m good at, that I don’t belong on stage, that someone else would do whatever I’m trying to do much much better than me. My actual fear was that I would be revealed as an imposter. But this nugget of truth is what anxiety is protecting me from knowing–not helpful. And telling me to “stay positive” is bringing me even farther away from knowing what’s truly at the center of a worry. On top of this, that advice makes your worried friend feel farther away from you, more convinced that you will never understand them.
Me onstage at Happy Ending pretending to be the musical guest.
The truth is, telling someone to “look on the bright side,” is a way to help them escape their worries, not confront them. Aphorisms like “You just need to love yourself” or “You need to believe in yourself how I believe in you” are techniques that set the worrier up for more worrying. The worrier is scared of uncertainty. When they’re terrified, they’re stuck at one end of an extreme, and you’re trying to make them feel better by pulling them to the other side of the extreme, but where they need to be is in the uncertain middle. We need to help our anxious friends and loved ones learn that uncertainty is not dangerous. That it’s okay to feel afraid. The only way we can move through our fears is if we move toward them, not catapult over them. Perhaps, they are not the only ones afraid of the uncertain middle.
It’s easier to be a good parent when you are not a parent at all. I think if I actually were a parent (to a human child and not a dog child) I would not be able to respond to the daily traumas as rationally as I can with someone else’s child.
A couple of weeks ago, I was out of town with a few families and their children. There were several houses on the property, and we were all in one of the houses together, when one of the children, a four-year-old wandered out. Not long after, someone else brought him back in and he was crying. He’d gotten lost, the grown-up person explained, and was wandering outside, scared. His mother felt terrible and held him. “I’m so sorry,” she said. “I’m so sorry. That was a rare event. It won’t happen again,” she said to soothe him.
But, because I was that child, (and in some ways, still am that child) one afraid of not knowing what to do if I get lost, I over-identified with his experience and knew that what she was giving him was only half of what he needed. When she finally put him down, and we all went back to talking I felt unresolved on his behalf and knew that if no one closed the circle for him, he would not learn what to do when he got lost, and he would never feel safe enough to venture away from his mother.
He wanted to go back to the other house and play, so I asked his mom if I could take him. She said yes, and off we went. Outside I asked him to show me what happened when he got lost, and he walked me to the front door of the other house and reached his hand up to the knob, which was a good two feet too high for him. “Oh!” I said. “The handle is too high for you. What should we do? What are some ideas for how to get in if we can’t reach the handle?”
He thought about it, but couldn’t come up with an answer. “What if you tried to knock on the door? Knock hard so even a person with hearing aids can hear you.” When he knocked, a bunch of voices called out “COME IN!” but he couldn’t reach the handle, so he couldn’t come in. He looked confused. “Let’s knock again until they answer the door,” I said. So he did that, and the door opened.
And presto, we were inside. We hung out for a bit and when we left to go back to the other house, I asked him to tell me what he would do the next time he got locked out of a house, and he told me. It felt so easy and obvious to me, but if I were his parent, I don’t think it would have felt so easy and obvious. I would probably have done exactly what his mother did and soothed him, felt terrible on his behalf and left it at that.
Reality was terrifying to me as a child. I often didn’t know what to do and got lost. I was soothed all the time, but no one ever took the time to teach me the tools and skills for participating in reality; to prepare me for what to do when things went wrong. Soothing me without teaching me what to do, taught me that I was right to be afraid, that the world was too hard for me and that kept me in a state of fear. I had to learn how to undo it all once I became an adult. I’m still learning. Teaching other people’s children to do what no one taught me to do is healing, and I hope that some of these blog posts can help some parents to realize that soothing their children is just one part of making their kids feel better. The other part is teaching them what to do when things go wrong. Because a lot of things go wrong.
We are solitary creatures whose lives are as unknowable to others as they often are to ourselves. The messages I received early on suggested that there was a right way to be known, a correct way to be a person and I wasn’t being it. So, I looked to others as my barometer for how to be. This constant looking out to define myself based on the world’s idea of what was good and right was my attempt to become “normal”; to fit inside the world’s standards.
