Myweb.wvnet.edu

THE GIANT WHO GOES WITH ME WHEREVER I GO: OF PANIC
AND ITS PAINS, W ITH A POSTSCRIPT ON
PSYCHOPHARMACOLOGY
Michael Blumenthal*
. . . the powerfulare always lied to since the weak are alwaysdriven by panic.
She [Elizabeth Bishop] is, of course, deeply aware that ever so oftenthe world is bound to shake, and not only with the thunder of waves,but also with the thunder of war or earthquake or the m ercilessdeath of a parent or the untim ely and guilt-inducing suicide of abeloved friend, In such circum stances, panic is a natural enoughreaction, a reflex im pulse to escape from the scene altogether. Andyet since one cannot escape one’s tim es or one’s destiny, such panichas to be controlled, and to control it is to set lim its, to m ap adefined space within which one will operate.
— Seam us Heaney, The Redress of Poetry Santa Clara, California, M ay, 2001. “M y giant goes w ith m e wherever I go . . . “ Em erson writes in his fam ous essay, “Self-Reliance,”and m ine––m y panic––has been with m e virtually all my life, m y mostloyal friend and com panion. It has, of course— as does all too m uch in am an’s (and, perhaps, a woman’s) life— probably to do with my m other: This essay was written in Marseille, France during the winter of 2002. The condition it describes, albeit gratefully now behind me, is one that afflicts, or has afflicted, manyof those I know, my closest friends among them. I no longer suffer the affliction, but myempathy for those who endure it, and my desire to document the affliction, serve asreason to now publish the essay.
m y absent m other, m y ailing m other, m y dying m other, m y dead andunsuccessfully mourned m other. W hen she tried, already dying, to drop m e off at elem entary school, I would cling, in a state of utter bereavem ent, to her dress until,finally, the principal was sum m oned to separate us and drag m e away.
And, in that scene, a cam eo of m y life to com e: a man unable to separate,and, therefore, hardly able to live. A m an unable to buy a round-tripticket to anywhere, given the likelihood that he would be unable toendure to the return date. A m an whose wound— if, indeed, likePhiloctetes, it has been a part of his strength— has also been his curse,and som etim es, even, his undoing. And is still— even at the age of fifty-two and father to an eleven-year-old boy himself— his curse now.
M y spirit sags, for it tires of this perpetually re-enacted dram a: the drama of unsuccessful separation, the grief of failed m ourning. Am an whose every capacity, whose every opportunity (and there havebeen many) has been nipped in the bud by a childhood pain he couldneither control, nor— in the intervening 40-plus years— has been able tom aster.
I have glimpsed, so often, the potential peace that lies on the other side of this pain. I have known it— alas, in m om ents only . . . butI have known it. “Because there’s nothing as composing as com posing,”I remem ber a writer I once knew inscribing a book to a friend. And I,too, have known these m om ents of com posure— in writing a poem ; inm aking love to a wom an; in feeling a sense of surrender to the beauty,and divine power, of nature; in swimm ing or skiing dow n a m ountain;in being at one with body, water, wind, sun, and snow.
And this is the greatest cost of panic and anxiety: the loss of one’s appreciation— and appetite— for the beauty, the wonder, thehum or, the strangeness of the world, when one is in its grip. The m aniaof wanting only one thing: for the anxiety, and its accom panying panic,to be stilled. “Love calls us to the things of this world,” St. Augustine,reinterpreted by the poet Richard W ilbur, inform s us. And this, aboveall, is the tragedy of panic: that it calls us away from those things, thatit informs all our choices with the lowest com m on denominator ofconcerns: our own fragile and deeply jeopardized sense of well-being.
Such a wonderful state, that peace of equanim ity, that com posure of being com posed. But why has it so rarely been m ine? Andwhere, I wonder, is the line between self-knowledge and self-pity—between understanding and exploiting one’s own ambiguous fate—crossed? And yet what is wisdom , if it is not a condition attained by achieving a certain distance from oneself? And what is panic, if it is notthe inability to attain that distance? Panic-stricken, I am m ired in a selfhood of the m ost dubious kind: a selfhood that fears for its verysurvival. I am sm all, endangered, desiring only one, life-constrictingthing: safety. In a state of calm , I feel adventuresome, open to theuniverse, its possibilities, its potential surprises. I am , as W hitman putit, large: I contain m ultitudes. “Tim e present tim e past and tim e future,” T.S. Eliot writes in The Four Quartets, “are all contained in tim e present.” Panic, however,destroys any such potential wisdom : Time past is annihilated in a hazeof anxiety; tim e present is a cauldron of dread and pain; tim e future isa bottom less pit just a half step in any direction beyond tim e present. Orlet me put it metaphorically: You have returned hom e to find your houseablaze. All your previous concerns are reduced to one: to put out the fire.
But, this time, what is being consum ed in the flam es is not m erely ahouse: it is your very soul.
There have been all too m any such conflagrations in my life:Bali, January, 1982: I am staying in the village of Peliatan, near U bud, w here I have been living with a fam ily of Balinese dancers andm usicians. I have a month’s round-trip ticket from W ashington, withjust four days to go before m y return flight. Then it happens:Contem plating a wom an I had m et just before leaving W ashington, whoI am anxious (as opposed to eager) to see again, contem plating m yperpetually ill parents, contem plating m y own, ever-jeopardized senseof self, I am seized by a sense of panic: I m ust get hom e. I m ust get hom enow.
Externally, there is no urgency whatsoever about this: Nothing particular awaits m e, no one is waiting who cannot endure four moredays of doing so. Yet nothing “out there” is the point: the point isentirely “in here”— it is in m y perpetually endangered-feeling sense ofself. And now, caught in this state of anxiety and panic; there is no otherrecourse: the self wants som ething that will pass, even tem porarily, assafety, som ething that will pass for home. M oney be dam ned— and atthe additional cost of m ore than $1,000— I exchange m y return ticket forone the next day. I go “hom e,” where, the next day, som e new anxietywill surely get the better of m e again . . . and does.
Cam bridge, M assachusetts, July, 1983: I am m arried, but m y brand-new marriage— entered into in anxiety, endured in anxiety, aboutto end in anxiety— is already in trouble: M y wife has stayed behind inW ashington, while I’ve gone on to begin m y new job in Cam bridge,trying to “figure it out.” She has a sum m er internship at the Library ofCongress, and one night, rather late, I call her at her D.C. apartment,only to find she’s not in. Then it begins, the panic and the sense ofendangerm ent: She is out with som eone else. She is sleeping withsom eone else. I am about to be abandoned once again.
Once the panic sets in, there is no stopping it, for the results of panic, as its dictionary definition suggests, are “groundless, pandem ic,contagious, or extravagant efforts to secure safety” or, if not safety, atleast relief. At about two in the m orning, I take the extraordinary stepof calling the boyfriend of an ex-girlfriend of m ine (one Iuncerem oniously dum ped), who lives in the sam e building, waking himup and asking him to please go check up on m y wife, as I am “worried”about her. (It is, of course, only m yself I am worried about: Panic isalways, in its truest sense, panic about the self.) M y wife, it turns out,has— m iraculously enough— not been sleeping out . . . she has m erelyunplugged the phone to discourage crank calls she has been getting oflate. W hen, finally, she calls m e at 3:00 A.M ., m y panic, m om entarily,subsides: I am safe, at least for now.
An airplane, any airplane, headed anywhere. The stewards and stewardesses begin serving the m eal, rolling their cart to the front of theaisle. I am , say, seated in seat #l8E, about m idway down the length ofthe plane. I’m a bit hungry, but nothing terribly serious. But hungerisn’t the point: panic is. Anxiously, I begin craning m y neck, wonderingwhen, finally, they are going to get to me. W ill they ever get to m e? Ibegin to worry, then to panic. W ill there ever be enough to nourish m ein this, m y perpetually jeopardized inner state? Will I ever genuinely befed? Panic, when it strikes, goes deep, resonates far. Our panicked hero m ay have wanted to divorce his wife from the very m om ent of theirm arriage, but— besieged by panic— there is nothing on this earth hem ore desperately wants than to stay m arried. (He wants it far moredesperately, in fact, than does the m an who is deeply, but calm ly, inlove.) Indentured for twenty years to a job he hates, if a panic shouldovertake him on the day he finally has the courage to quit, he will— witha feeling of relief bordering on salvation itself— gladly sign on foranother fifty years . . . till death, or the end of his panic, does him part.
(W orse yet, besieged by panic, he m ay well try to flee the very wife heloves, the very job he has always wanted, and adores.) But it is calm one desires— peace, the ability to focus on one’s m ore interesting thoughts, and on the things of this world, to dreaminteresting dream s. So, what, then, is this panic about? W hat is it thatfeels so jeopardized in its wake? W hat is the panic-stricken person reallyworried about? I’ll tell you w hat he is worried about: He is worried about his very being. He is worried about nothing less than his entire existence. Ina state of panic, he feels jeopardized to his very core, he loses all hisvolition as a free agent. He is a one-dim ensional m an, and his onem ission is relief from pain, relief from the panic that is his tem porary hell. And, for the panic to end, there is nothing— I repeat, nothing— hewon’t do, no price he won’t pay, no friend he won’t betray, no place hewon’t go, no plans he won’t change. And what of m y own dubious fate? From where, I wonder, does m y own panic derive? Here’s one possible narrative: At the age of eight days, a certain infant was taken— for reasons he has forever speculated on, and elsewhere attem pted to recount—from the bosom of his biological m other, and adopted by his biologicalaunt and uncle, the form er of whom had just undergone a radicalm astectom y. He doesn’t (now , as a fifty-som ething year old m an)rem em ber the event, at least, he doesn’t consciously “rem em ber” it. Buthe can im agine what that eight-day-old child— taken from the m ilk-producing, warm breast of his natural m other and given to a wom anwho not only could produce no m ilk, but who had only one breast atwhich to console him— m ight have felt: H e m ight have felt panic . . . aterrible panic, an inconsolable panic, a panic which— had he not been ahelpless infant— he would have given anything on this earth to quell.
That boy was m e— as is, now, that m an . . . panic-stricken still.
And what will cure that panic, what will bring relief? In all likelihood,nothing. For W .H. Auden was probably right, in that The one unnecessary griefIs the vain craving for relief,W hen to the suffering we could bearW e add intolerable fear . . . For the panic-stricken one, and all who share his unenviable fate, is leftm erely patrolling The landscape of his will and needW here he is sovereign indeed,The state created by his actsW here he patrols the forest tractsPlanted in childhood, farm s the beltOf doings m em orised and felt,And even if he find it hellM ay neither leave it nor rebel — W .H. Auden, “New Year’s Letter, (1940)" Beyond the tem porary balm , perhaps, of a Valium or a Paxil, the solace our panic-stricken hero seeks is one that— as Wallace Stevens posited in “Sunday M orning”— “can com e / Only in silent shadows andin dream s.” For m y brothers and sisters in this suffering, I would suggest, there rem ains a faint sliver of hope: that the sam e dark gods who toreus from that living breast will provide us with something equallywarm — som ething safe— to rest our weary heads against; thatsom ewhere, on the other side of panic, lies the solace of a soul, a hand,a com fort that can never be taken away, a heart not entirely beyondrepair.
M arseille, Septem ber, 2002. The view from the third floor bedroom window of my apartm ent in M arseille is not, despite its pastelhues, a particularly inspiring one. Just across the series of stone patioson which I w ould die were I to fall— or jum p— is a rather dilapidated,low-incom e building, inhabited m ostly by African im m igrants, whoselaundry hangs colorfully in the m istral-inspired fall breeze to dry. Thecourtyards below are pocked by the duff and detritus of floating garbageand discarded clothing. Only the slab of usually blue sky between thetwo buildings suggests a ray of optim istic hope, a world w orth lookingupwards into.
The fuel that propelled m e here to M arseille was not gasoline–– it was panic. The attack began when I arrived at the apartm ent I hadrented, sight unseen, in Paris in August of 2001, only to find, not theconsoling possibility of a new home, but a com plete disaster—dilapidated plastic furniture in every nook and cranny, a labyrinth-likem aze of tiny, uninhabitable rooms, random electrical wires running inevery direction, leaky antiquated plumbing, windows that seem ed tobang open and shut randomly, as in a scene from The Shining. After two days of weeping and panic-stricken phone calls to any and everyone I thought m ight be able to console m e, I woke on them orning of the third day, threw m y belongings into the trunk of m y car,and headed in a beeline Southeast towards Marseille and the consolingpresence of m y wife and son. Across the street from them , with thegenerous, and ever-forgiving help of my wife, I found another apartment.
Still shaken by the results of yet another panic-fueled “decision,” I would lean out my bedroom window to open and close the shuttersthose first few m ornings and evenings, debating as to whether m y “vaincraving for relief” m ight not best be satisfied sim ply by leaning a bitfurther and allowing m y “too too solid flesh” not to m elt, but sim ply toachieve its final resting place, and an infinitely longed-for tranquility,against the beckoning stone below. Forty-odd years of panic, it seem edto m e, had been m ore than enough. I wanted relief––at any price, andby any m eans. But what lay below, for som e reason— be it lack of courage, or sim ply a reservoir of still-enduring hope— did not quite seemthe solution I so desperately desired. I had always resisted— perhaps out of a naïve, som ewhat Em ersonian, faith in “nature’s way,” perhaps out of a certain Puritanand Freudian conviction that both the ailm ent, and its potential cure,were derived from within––the use of anti-depressants as a way out ofm y misery. I had, all m y life, been notoriously sensitive to “chem ical”intrusions of all kinds––caffeine, alcohol, hallucinogenics, even auninhaled, Clintonesque toke of m arijuana. A single glass of red wine––how utterly unfashionable for one living in France!–– is still enough togive m e a resounding headache and render m y entire night sleepless. The two previous stabs I had m ade at relief through psychophar- m aceuticals––a brief flirtation with Prozac in Budapest, and two weeksunder the influence of another SSRI (selective serotonin reuptakeinhibitor) called Celexa in Texas––had both left m e with a kind of“buzzy” feeling in m y brain, and feeling rather “outside” m y norm al self.
M any of my closest friends’ encom ium s notwithstanding, I rem ainedthoroughly unconvinced of the m erits of better living through chem istry.
And yet, som ehow, I had now reached the lim it of the suffering I could––or, at least, wanted to––bear. On the recom m endation ofM arseille’s only English-speaking psychoanalyst, I m ade anappointm ent psychopharm acologist at M arseille’s m ilitary hospital in the l4thDistrict. Dr. Perez, a sym pathetic and attentive listener, indulged m yrather inept French description of m y accumulated woes and travails,along with m y hesitancy about drugs, sm iling patiently and shaking herhead. “There is som ething that I think m ight work for you,” she finallysaid, “and which I have prescribed for other patients with panic andanxiety problem s, with quite a bit of success.” “Je suis prêt à essayer tout ce que vous m e suggererez,” I replied in broken French . . . “I’ll try anything you suggest.” “Deroxat, 20 m g.”, the kindly doctor wrote on her white prescription pad, tearing off the sheet and handing it to me. “Let’s trythis for four weeks or so, and see how you feel.” The m ain therapeutic ingredient in the drug com m only known in France as Deroxat is paroxetine, a potent and selective inhibitor ofthe neuronal re-uptake of serotonin that belongs to the group of psychopharm aceuticals com m only known as SSRIs, which includesProzac, Paxil, Celexa, Zoloft, and Luvox. Since it was first reviewed asan antidepressant in l991, Deroxat (paroxetine) has been studied inseveral disorders with a presum ed serotonergic com ponent, includingobsessive com pulsive disorder (OCD) and––blessedly––panic. In shortterm clinical trials with patients suffering from OCD or panic,paroxetine was shown to be significantly more effective than a placebo,as has also been the case with depression.
In m y own case, within several days of first taking Deroxat, I felt a sm all, but m ost welcom e, decrease in the level of m y anxiety, the onsetof a stage alm ost approaching calm . Aside from that, I felt no differentfrom m y “form er” self––still thinking rather obsessively about sex (“W ethink obsessively about sex,” m y old friend, the poet Howard N em erov,m em orably rem arked, “except during the act, when the m ind tends towander.”), still dwelling som ewhat on the insecurities of my present andfuture, still trying, as best I could, to honorably fulfill m y writerlyvocation. But the bottom line is this: I felt calm er. And if poetry, asW allace Stevens suggested, is “the m ind in the act of finding/W hat willsuffice,” this small but profound alteration in m y daily condition–– I feltcalm er––m ore than sufficed.
Three m onths later, and I feel calm er still. Not perfectly, m ind you (and I am aware that the state I would have achieved by jum pingfrom m y third-story window is the only condition of undeniable hum anperfection), but better . . . m uch better. Which, for one who has spent hislife m ore or less ricocheting between states of anxiety and panic, is morethan enough to m ake him descend to his knees before whatevergod––spiritual or chemical––there m ay be. For it occurs to m e that this,too––this “artificial” intrusion into the norm al workings of m y body andpsyche––this, too, m ay be God’s work, after all.
“You m ust change your life,” writes Rilke, and I— albeit with a bit of “outside” help— finally changed m ine. It m ay, indeed, be “betterliving through chem istry,” but the bottom line is that that’s exactly whatit is: Better living. N ow, when I rise in the m orning and gaze out m y bedroom window, it is not the stones below, and the potentially prem aturetragedy they could m ake of m y life, I look upon, but the potentiallyredeem ing, and forward-looking, patch of Provençal blue above. Less eager now are the ghosts and dem ons of a childhood I have longstruggled with, but have never quite been able to conquer. Rather thandwell upon those depressingly beautiful lines from Auden’s “New Year’sLetter,” it is now these lines from W .B. Yeats’ “A Dialogue of Self andSoul” I tend to recall: I am content to follow to its sourceEvery event in action or in thought;M easure the lot; forgive myself the lot!W hen such as I cast out rem orseSo great a sweetness flows into the breastW e must laugh and we m ust sing,W e are blest by everything,Everything we look upon is blest.
Thanks to the sm all, oval-shaped white pill I swallow every night, I, too, am now able to “cast out rem orse” and feel, once m ore,“blest by everything.” And when I walk out at night beneath theProvençal sky, the only thing that trem bles, gratefully, are the stars.

Source: http://myweb.wvnet.edu/~jelkins/memoir2011/articles/blumenthal-panic.pdf