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Is it smart to trust your gut?

According to this interview with a science writer, the answer is no -- something that will come as no surprise to those who've experienced panic attacks, which consist of a all-hands-on-deck red alert, in the body and mind, a jackhammering heart and overwhelming desire to escape to safety, in response to no realistic threat at all. From the article:

Cognitive psychologists would use the word "de-bias"—if we're aware of these powerful mental proclivities and how they work, we can say no to them. We can utilize self-talk and say: "I don't have to subject myself to that. I can take a different route."

Sounds a bit like cognitive therapy, no?

Comedian Adam Ferrera on panic attacks.

This guy is funny:

I started getting panic attacks. Yeah, that's a nice way to go through life. "What a lovely day. ARGHHHHH!"

The only way to get rid of panic is to talk about it. Yeah, like I'm gonna call my friends and say, "I think I'm getting panic attacks." "Really?" they'd say. "Ever think you might be a pussy? It sounds like acute pussy syndrome to me. Check your urine; is it pink?"

I'm such an Italian. My friends are like, "So how's it going with the shrink?" I answer, "He didn't get nothing outta me. I love my mother; I ain't gonna roll on her."

Magic mushrooms ease anxiety in cancer patients.

We've touched on the potential for hallucinogens in treating anxiety before here on PANIC!, and now CNN has another story about the promise of trippy drugs, this time magic mushrooms. From the story:

Terminally ill cancer patients struggling with anxiety may get some relief from a guided "trip" on the hallucinogenic drug psilocybin, a new study suggests.

The study included 12 patients who took a small dose of psilocybin -- the active ingredient in "magic mushrooms" -- while under the supervision of trained therapists. In a separate session, the participants took a placebo pill, which had little effect on their symptoms.

By contrast, one to three months after taking psilocybin the patients reported feeling less anxious and their overall mood had improved. By the six-month mark, the group's average score on a common scale used to measure depression had declined by 30 percent, according to the study, which was published in the Archives of General Psychiatry.

Whatever works!

Image from here.

On chronic stress.

This Jonah Lehrer piece from Wired is a long look at the work of Robert Sapolsky, a Stanford scientist who has focused on the stress and its role in human health. His conclusions are that stress is really bad for you...

Chronic stress, it turns out, is an extremely dangerous condition. And not just for baboons: People are as vulnerable to its effects as those low-ranking male apes. While stress doesn’t cause any single disease — in fact, the causal link between stress and ulcers has been largely disproved — it makes most diseases significantly worse. The list of ailments connected to stress is staggeringly diverse and includes everything from the common cold and lower-back pain to Alzheimer’s disease, major depressive disorder, and heart attack. Stress hollows out our bones and atrophies our muscles. It triggers adult-onset diabetes and is a leading cause of male impotence. In fact, numerous studies of human longevity in developed countries have found that psychosocial factors such as stress are the single most important variable in determining the length of a life. It’s not that genes and risk factors like smoking don’t matter. It’s that our levels of stress matter more.

Furthermore, the effects of chronic stress directly counteract improvements in medical care and public health. Antibiotics, for instance, are far less effective when our immune system is suppressed by stress; that fancy heart surgery will work only if the patient can learn to shed stress. As Sapolsky notes, “You can give a guy a drug-coated stent, but if you don’t fix the stress problem, it won’t really matter. For so many conditions, stress is the major long-term risk factor. Everything else is a short-term fix.”

... and that stress is caused by being of subordinate in social or career rank or status...

...While doctors speculated for years that increasing rates of cardiovascular disease in women might be linked to the increasing number of females employed outside the home, that correlation turned out to be nonexistent. Working women didn’t have more heart attacks. There were, however, two glaring statistical exceptions to the rule: Women developed significantly more heart disease if they performed menial clerical work or when they had an unsupportive boss. The work, in other words, wasn’t the problem. It was the subordination....
The British civil service comes with one...feature that makes it ideal for studying the health effects of stress: It’s hierarchical, with a precise classification scheme for ranking employees (in other words, it’s the human equivalent of a baboon troop). At the bottom are messengers, porters, and security guards. Just above them are the clerical officers, followed by staff scientists and other professionals. This last group implements the policies dictated by powerful administrators who run the governmental agencies. Marmot wanted to investigate how differences in status “in people who are neither very poor nor very rich” might lead to measurable differences in health.

The differences are dramatic. After tracking thousands of civil servants for decades, Marmot was able to demonstrate that between the ages of 40 and 64, workers at the bottom of the hierarchy had a mortality rate four times higher than that of people at the top. Even after accounting for genetic risks and behaviors like smoking and binge drinking, civil servants at the bottom of the pecking order still had nearly double the mortality rate of those at the top....

The same effect applies even to the rich and famous. A few years ago, Donald Redelmeier, an epidemiologist at the University of Toronto, led a study of Academy Award-winning actors. His hypothesis was that having an Oscar gave people more control over their stressful careers. Instead of being forced to accept bad roles or work on mediocre movies just for the money, these stars could pick and choose their parts. This creative control, in turn, would lead to improved health outcomes. Redelmeier compared the award winners to two groups: (1) actors who had appeared in the same film as a nominated actor and didn’t get a nomination and (2) actors who had been nominated for an Academy Award but never won. The results were clear: People with Oscars lived, on average, four years longer than their less-successful peers, which represented a 28 percent reduction in death rate. As Redelmeier notes, this longevity boost is roughly equal to the effect that would come from “curing all cancers in all people for all time.”

Interesting stuff, offering more than a little insight into how stress can lead to anxiety disorders, why anxiety disorders can get worse over time, and why learning to manage your stress is key to managing anxiety disorders.

A Tibetan Buddhist master meditates away his panic disorder.

"If you tell panic, 'Get out, I don't like you,' then panic becomes your enemy and you cannot get rid of it. If you say, 'Yes, sir, panic, whatever you say is true,' then panic becomes your boss. The best method is to make friends with panic. Use panic in your meditation. Look at the panic, and use it as an object of mindfulness, of awareness."

Yongey Mingyur Rinpoche (profiled here) tells how he used his meditation practice to overcome panic.

Check out past PANIC! posts about meditation and panic, including this one in which I discuss having a panic attack in the middle of a meditation class.

Quantifying the cost to society of panic and anxiety.

What's the price of panic? What economic costs does it impose on individuals, businesses, and society?

We can probably make a fair assessment of treatment costs directly attributable to panic disorder. Beyond that, the short answer is, It's hard to say. Certainly there are lots of folks receiving treatment for physical ailments -- acid reflux, for instance, or heart palpitations -- that are not directly attributable to but are unquestionably contributed to by panic.

And then there are the costs of un- and underemployment.

Consider my story. More than once in my life, I've been unemployable, or damn close to it, thanks to panic. These were the times when agoraphobia took over, pulling the geographical boundaries of my life closer and closer, shrinking the world to the point that I couldn't even make it to the corner store without being overwhelmed by inexplicable but searing terror.

The prospect of making it through the day in a cold, claustrophobic cubicle farm can become unbearable during these times. I've panicked a number of times in office settings, and spent more than a few hours staring at the clock and counting off the minutes until 4:45 or 4:50 p.m. would finally roll around and I might sneak away from my desk before the official 5 p.m. quitting time without putting my job in too much jeopardy. When panic and agoraphobia have entered the picture, work for me has been a challenge to endure, even when I've had jobs that were both interesting and high-paying.

The prospect of commuting to and from work makes periods of agoraphobia even worse. My first panic attack took place on a highway (I-95 in Connecticut; see here), and over the years I've developed a mighty fear of scenarios common to commuters everywhere. The derailed commuter train, stuck in the tunnel between stations. The sweltering subway car, AC disabled; the press of sticky bodies as the train rounds a bend; the end-of-day summertime commuter-train stink. The rush-hour highway traffic jam, where it takes a full hour to get to the next exit. The line of cars in the left-turn lane, only one or two making it through before each green light turns red. When it comes to causing dread at various categories of rush-hour transportation, my agoraphobia does not discriminate.

When the agoraphobia gets bad enough, un- or underemployment is sure to follow. Investment analyst, book editor, web writer, legal-document proofreader, short-order cook . . . I've left or been let go from a number of jobs because agoraphobia had rendered me unable to drive on rush-hour highways and bridges, or ride a rush-hour subway, or take a rush-hour bus. Sometimes, I've been able to manage my fear to the point that I could work part-time; other times, I've worked during off hours (on the overnight shift at Kinko's, for example) so I didn't have to brave the crowds during regular commuting hours, or restricted myself to temp jobs because I didn't trust my ability to commit to a position for the long term.

Knock on wood, things have been better for me in recent years, so I no longer experience the prospect of attending a business meeting in an office downtown as an existential challenge. But things have been worse in the past, and I there's always the threat that agoraphobia will make them worse again in the future. I've been around long enough to know that, and accept it. And there's no escaping the fact that the career I've built for myself, as a marketing consultant and copywriter, allows me to spend most of my time in my home, always the safest, easiest, most comfortable place for a would-be agoraphobic to be.

Obviously, I'm not the only person whose career path has been sidetracked by periods of shaky mental health. There are millions of us out there, most of us silent about what we've endured, whether out of shame or fear of being found out by employers. Mental illness has imposed that cost on us, in addition to what we pay as individuals and as a society for treatment.

But how much is that, exactly? According to one study published in the American Journal of Psychiatry, lost earnings related to serious mental illness approach $200 billion per year. On average, those with serious mental illness have an annual income that's 42% lower than the average income for the rest of us ($22,545, versus $38,851).

As the study makes clear, this is just part of the total economic cost imposed by mental illness:

...it is important to recognize that the NCS-R yields a conservative sample for estimating economic impact. As a door-to-door survey, NCS-R did not assess individuals hospitalized in institutions, incarcerated in prisons or jails, or who are homeless. Indeed, NCS-R had so few subjects with schizophrenia or autism that these diagnoses were not part of the original epidemiological analysis, even though both are associated with chronic disability and lifelong loss of income on a far greater per capita basis than mood or anxiety disorders. 

Accepting this conservative estimate of a loss of $193.2 billion in earnings each year from serious mental illness, can we estimate the total economic impact of serious mental illness? In Table 1 we begin to answer this question, adding the new estimates of income loss to data from 2002 on the direct costs of health care and disability benefits, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) cash assistance, food stamps, and public housing financed by federal and state revenues. Missing are the costs of health care for comorbid conditions. Missing are estimates for the loss of productivity due to premature death and the loss of productivity of those with serious mental illness who are institutionalized, incarcerated, or homeless. Missing is the cost of incarceration, although as many as 22% of individuals in jails and prisons have been diagnosed with mental illness.... Missing is the cost of homelessness, although approximately one third of adult homelessness is associated with serious mental illness.... And, of course, missing from any such tabulation is the cost to family members who bear much of the emotional and financial burden of these illnesses. The $317 billion estimated economic burden of serious mental illness in Table 1 excludes costs associated with comorbid conditions, incarceration, homelessness, and early mortality.

This study focuses on the costs of serious mental illness in general; the cost of panic will be a fraction of this cost. The exact amount? Again, it's hard to say. But rest assured that it's in the tens of billions of dollars. Per year. If another study, this one from the Netherlands, is any indication at all, the cost is great indeed; there, the annual per capita economic cost of panic is estimated to exceed $20,000.