…But I’m not capable of explaining to you in this moment what is going on in my mind and body.
Thus my question tonight, how do you help someone know you are experiencing a panic attack or in the middle of a PTSD attack when you most need help?
This morning I was faced with multiple triggers – a screeching alarm, an unknown man opening my door who was angry, and then threatened and not listened to when I was in pain (among others). I was physically hurt and having an asthma attack, surrounded by things that plunge my mind into the dark despair of pain and trauma I’ve gone through. And then panic set in. Things only devolved from there.
The panic made the asthma worse which made the panic worse. The panic and the asthma meant I couldn’t soak to the man threatening me nor would he listen to me because I couldn’t express myself in a calm and collected manner. Him not listening to me made the panic worse because I needed him to understand but the harder I tried to be heard the worse things got. The result being more trauma added to what was already there, thoughts of cutting, inability to move, and consideration of suicide.
It happened so fast and yet there were so many points where things could have gone differently. Especially if I could have somehow explained:
I AM NOT ME RIGHT NOW. I’M EXPERIENCING PTSD. I’M HURT AND SCARED. PLEASE HELP ME.
If I could have somehow let the people around me know that I want being a bitch or a monster but that I’m in a state of almost unreality. A state that will only get worse if the other person reacts in anger or threats or confrontation. But I couldn’t.
I have all the skills learned from DBT (Dialectic Behavioural Therapy) for self soothing and distress tolerance. I have skills for setting up support systems of people who know how to help. But all the skills in the world won’t work in these moments of sheer terror. And they don’t help when I’m interacting with strangers.
The science behind it goes something like this (roughly, see your local neuropsychologist for more details): when you’re faced with a threat, your brain switches modes. The higher, decision making areas of the brain (i.e., prefrontal cortex) go offline. The parts of the brain that activate the fight, flight, freeze response take over. These are the limbic system – the amygdala and hippocampus – and they are more primal. These areas are reactive. They operate quickly and generally unconsciously. They are immediate and intense. It’s basically your animal brain – the prey trying to escape the predator to find safety. If you are further threatened, realizing there’s not even a hour of escape, the brain goes further offline and you enter a state of collapse. More than a freeze, this is almost submitting to the inevitable.
This is in part where the limitation of any skills based therapy like CBT or DBT occur. While I encourage developing skills, which makes then more accessible in steal situations, they require top-down thinking. Or thinking that first engages the decision making parts of the brain (prefrontal cortex), the exact brain structures that are not working when you’re in a terrifying situation. In the moments of fight, flight, or freeze you accessing the reasonableness of a proper adult.
When you experience PTSD, the fear induced is one of a near life threat. Thus the ability to not regress to that animal brain and act rationally is further compromised. The reality that surrounds you us not necessarily the actual reality. Your perception is skewed and everything is a threat.
Add to that the fact that those with Borderline Personality Disorder, the limbic system is known to be overactive and the prefrontal cortex not as resourced as healthy adults. Meaning, in a normal state, those with BPD are already set up to react quickly to anything that seems threatening and aren’t able to think straight.
So I am already set up to have a hard time in any stressful situation given my borderline mind. In a situating thatbtriggers my PTSD, I’m in the mental equivalent of a hypoglycemic coma or anaphylactic shock . But i can’t tell anyone. And i don’t look “sick” so no one stops to administer a proverbial glucagon or epi-pen. More often they react with insensitivity and uncompassionately only making things worse.
In these moments I need to tell you I’m having a panic attack, that i suffer from PTSD but vocalizing it is too hard. So what if I put it on a medic alert bracelet lime my diabetes diagnosis or allergies or in case of emergency contact? A medical professional might understand that, but I’m not sure a lay person would. And if anyone saw it, would it be further stigmatizing? Would they write me off as simply crazy and make things even worse? Would it invoke compassion? And even if they do then have compassion, each person experiencing panic or PTSD may have their own ways to treat it. We know a low blood sugar means drinking a coke or eating a cookie (gluten free for this celiac kid) or at worst glucagon. But where I need to sit and cry another might need to be isolated completely. I may want someone to hold my hand. Another person may be overwhelmed and triggered by any touch. There is no one way. And honestly I may need different things for different situations (sometimes being alone, other times not).
So imagine this morning when I can’t breathe and I’m crying hysterically and my voice is raised and no one can understand me if I could just point to something that says, I’m having a panic attack, I have PTSD, please be kind right now. This is what I need _______.
I saw something of the sort from another epatient
They aren’t precisely what I want to say, but they’re close. I worry though that they wouldn’t be taken seriously
I used to hang this on my door at home when I needed space:
But that doesn’t quite help people understand what is going on.
I’d need space somewhere to write what I need right now: Please talk calmly. Please let me sit. Please try to listen though it may be hard to understand. Please call my friend/therapist/doctor at _______.
And even then I still worry that it could make things worse given the stigma that still exists around mental health. Would those triggering me be willing to read a card? Would they understand to take it as seriously as needing emergency care for an allergic reaction? Would they dismiss it and just walk away as trying to get attention or call the police (this escalating things)? Or would they call an ambulance (for me that would make things worse, triggering more PTSD)? Would they freak out?
But what if it helped. What if I could have pointed to something, anything today? In a perfect world someone would realize what was going on, why I want acting rationally, reassess the situation and act compassionately. In my fantasy they would say something like “I’m sorry there was a misunderstanding and you’re hurting. Sit here and try to breathe and we can try to talk this through as you calm down. You are safe and no one is going to hurt you right now.” Or just a compassionate “I see you are suffering, how can I help?”
This likely won’t happen. But spontaneous compassion of another saying “hey, this person must be experiencing something and need help” without a prompt is even less likely.
Just imagine all the pain, misunderstanding, further traumitization, and associated medical consequences that could be avoided if it worked. Maybe i wouldn’t be sitting here, terrified to sleep playing the accumulated years of traumas that have too often played out like this with people who don’t understand. And not just with strangers but even with medical professionals when I’m in the hospital or loved ones or at work.
The ultimate question is how do I help you help me? How can I set up protections for myself for the times when I won’t be able to speak for myself? What would this look like?
I think I might experiment with it. But I’d love your input. For those who have experienced panic or PTSD or other mental health issues, what would you write as am alert if any? What would you put on that alert or keep off? What format would be most helpful?
For those caring for others what would you suggest? What would be helpful for you to know so you can provide assistance?
Or maybe you haven’t had to deal with such a situation yet. If you came across someone in such a situation, what would get your attention? Would you take it seriously? Would you be put off by it or find it useful?
In the end, medic alert or not, compassion is needed for anyone you may meet who seems to be overreacting. You cannot know if they may be just a breath away from attempting suicide or facing demons you can’t fathom. You may not know how truely vulnerable someone may be. There is no salve to ease the tenderness of vulnerability but compassion. Compassion costs nothing and can mean everything.
Update 8/10/2016: I posted this update as a separate post entitled Panic Attack Cards (A Follow Up) but have also included the same post below.
After writing a blog post on the need to inform others when I am having a panic attack, I did go back and make a few of my own cards. When Nikki Seefeldt over at I Live & Breath reposted the blog on her site, I was reminded that I wanted to share my solution. I’m posting the cards here so you can get an idea of what worked for me end hope that others will feel free to use them or adapt them to fit their needs.
I will note that some individuals suggested that I include more information like a website address. However, given that these are to be used in emergencies, I felt that the simpler the better and that the person helping will not have time to go to and search a website for helpful information while I’m having a panic attack. Others may find that they want more or less information for their cards. But I encourage anyone making their own cards to focus on only including the minimum necessary information to get the help you need in that moment.
You may save these images from my site or feel free to contact me via the comments below or on Twitter @GilmerHealthLaw and I can send you the files I worked on. They are designed to fit the size of a business card.
I only ask that you do not use these to make a profit for yourself or any other organization. I would like to keep these free and accessible to the community.