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Wednesday, 1 March 2017

Will he always love me? My explanation of panic attacks.

Originally published December 2014
have panic attacks. I've had them since my father died over three years ago. And yesterday I had one of my worst. The majority of them seem to happen when my husband and I argue. Yes, we argue - mostly about child-rearing practices. Yes, we argue in front of the kids. And Yes, we continue to work on our communication, and try to model good conflict-resolution skills. But, having said that, finding a cure for the arguments isn't really the issue. The issue is changing how I respond to these situations. It only seems to happen when I realize that my husband is angry, or he outwardly expresses his anger or frustration with the situation, and typically that only happens when I criticize him. That's the tipping point for me.

The everlasting love charm between the letter and the red glass murano

When we argue in the car and I have a panic attack (my husband is the driver), I want to open the door and jump out of the car! Or pull the steering wheel and drive us all into the ditch, or off a bridge, or into a pole! And if we argue in the bedroom and I have a panic attack, I want to open the window and jump out! I don't, of course. But in the moment I cannot for the life of me think of anything else to do except escape. My brain is screaming, "Danger! ESCAPE!"

This may sound shocking to many! Dangerous even! But please be assured that I have discussed this with psychiatrists, and I am not suicidal. I am not a danger to my family. I just have panic attacks; well, also depression and anxiety, and an eating disorder, in recovery. But still it's just a panic attack, not suicidal ideation; I don't want to die, I just want to escape.

If you've been following my stories you know that just over a month ago I finished a six-week full-day intensive treatment program for anxiety and depression; it's referred to as Day Hospital. And the staff there don't think I'm a risk to myself, or others; I suppose they wouldn't have discharged if they had.

My "Always and Forever" bracelet with Mr. and Mrs. Penguin

Before I did the program, this "Everlasting Love" charm was my talisman. As I shared in an earlier Marriage Monday postMr. and Mrs. Penguin (spotty head and smooth head respectively) remind me of the affirmation, "I love him and he loves me." If we have an argument and those words weren't enough reassurance to calm me down, I would spin this little heart charm around and say, "He will always love me." You'd think that after 20 years of marriage I might start to believe it! But I don't.

At first I didn't know why I had these panic attacks. Then I realized that they coincided with my father's death. I wondered why there was a connection. Had I previously thought of my parents as an escape route if I had an argument? Was there a cushion there, to catch me if my husband did abandon me, and now it was gone? But my parents had never been an escape route for me. First of all, I haven't lived in the same city as them since high school, although my mother moved here when she couldn't live on her own anymore. But even before she moved here she was using a walker - and she was blind. And my father had a hard enough time taking care of himself, let alone support me; he was never reliable and certainly never there to catch me. In my imagination, there are some couples who, when they fight, can walk out, and go to their parents' home. I don't know if couples actually do this, or even if it's a good idea, but I always wished I could run away and that my parents would be there for me. But they weren't.

I also wondered if my husband's anger was triggering a response. My father was a pretty passive person and didn't show much emotion, but there were a few incidents in my life where I was truly afraid of his anger. One time, when I was very young, my father pushed my mother and she fell to the floor. My little brother was there and I stood in front of my mother and my brother to protect them from my dad. Many years later, when this came out in therapy, my mother told me that wasn't really what happened - she had in fact tripped. But regardless, it was a little late then; I had always lived with that memory, and that fear. Another time, my father flew into a rage and chased me up to my room. I can't recall what precipitated that, but I remember getting to my room and barricading the door while he pounded on it. I suppose it could be an issue of me being afraid of my husband. But I'm not.
Me with my father in our front yard

While I was in Day Hospital I slowly started to learn WHY I have panic attacks. I have abandonment issues. I know that sounds cliche, but we were learning about these underlying patterns in our lives and the root causes of those. I need to understand why I am the way I am, before I can make change.

One of the tools that the Day Hospital used extensively was Jeffery Young's book, "Reinventing Your Life: The Breakthrough Program to End Negative Behaviour and Feel Great Again," co-authored with Janet S. Klosko. Young found that he had many patients where Cognitive Behavioural Therapy (CBT) didn't work; just changing their thoughts and behaviours was not enough. These people had chronic self-defeating personality problems, psychological problems like depression and anxiety, and recurring patterns in their lives. CBT was not sufficient to change these lifelong patterns. So Young and his colleagues developed what he calls the "lifetrap approach," which combines cognitive and behavioural techniques with psychoanalytic and experiential techniques.

Young explains what he calls lifetraps: "A lifetrap is a pattern that starts in childhood and reverberates throughout life... Lifetraps determine how we think, feel, act and relate to others. They trigger strong feelings such as anger, sadness and anxiety."

The technical term for a lifetrap is a schema. "Schemas," as Young describes them, "are deeply entrenched beliefs about ourselves and the world, learned early in life. These schemas are central to our sense of self." Young's approach is called schema-based therapy because it addresses not just the symptoms (depression, anxiety, panic attacks, addictions, eating disorders, etc.) but also these underlying schemas, or controlling beliefs.

I have learned CBT in the past, the techniques for catching your thoughts, to identifying the cognitive errors, challenging the thoughts, and replacing those distorted thoughts. But I always had the impression that if I just worked hard at this and changed my thinking, I would be fine! And since I wasn't fine, I assumed I wasn't doing it correctly, and I was beating myself up. But in doing an assessment upon entering Day Hospital I learned that CBT is often not enough and that one of my core lifetraps is abandonment. Yes, I have other lifetraps as well but this one is having the greatest impact on my life at the moment.

The real issue is that I felt abandoned by both of my parents, at different times, for different reasons. The most powerful triggers for abandonment are illness, separation, divorce and death, and of course they had both abandoned me one last time; they both died within three years of each other. And before that I was slowing losing my mother to Alzheimer's Disease. But not all triggers are so obvious; they can be very subtle. 

When a lifetrap is triggered we are flooded with negative feelings - sadness, shame, anxiety and anger. And we can learn to run away from those feelings, because the feelings are too hard to face - hence the eating disorder. But in Day Hospital I learned that anything that feels "disconnected" can trigger the lifetrap. So when my husband and I argue, if there is any remote indication that my husband is going to "abandon" me, I panic.

One of the things a child needs to thrive is basic safety. A child who feels safe can relax and trust. Without this, a child, and later an adult, live in "fight or flight" mode, sometimes called the 911 emotion system. This describes me perfectly: "People who were abused or abandoned as children...[feel] there is nowhere they feel safe. They feel that at any moment something terrible might happen - someone they love might hurt them or leave them. They feel vulnerable and fragile. It takes very little to disrupt their equilibrium. Their moods are intense and erratic, and they are impulsive and self-destructive." Yup, that is me, in a nut shell.

In looking through the list of examples of "destructive early environments," there were a few that applied to me. The first was that "your parents fought all the time and you were caught in the middle." Another one was in relation to my father: "You became enmeshed with a parent and were expected to act as a substitute spouse." There was also a wide swing in my family between being "overprotected" and "parents not setting appropriate limits."

Each lifetrap has an understandable origin in childhood. Abandonment is one of the lifetraps related to a lack of safety or security in your childhood family. The abandonment lifetrap is the feeling that the people you love will leave you, and you will end up emotionally isolated forever, without emotional support, connection, strength, direction, or protection.

There are a number of possible origins of the abandonment lifetrap, and I will try to explain the ones that I think most likely apply to me. In most cases abandonment starts early, because it often takes place before a child can talk. This makes it difficult to identify and verbalize as an adult, but I will do my best.

The first origin of abandonment is that your mother was separated from you for a long period of time when you were a child, or you were raised by nannies.

One of the origins of abandonment is the absence of one person who consistently serves as a maternal figure. A child needs the stable presence of one caregiver, particularly during the first years. It doesn't have to be a parent, but if there is constant turnover it causes disruption. My mother wrote some memories for my brother and I, and from that I can piece together what life was like in my first few months and years.

Me at eight months having a bath in the enamel basin

When my mother was married at the age of 36, it was 1963. I was born a little more than a year later and she expected that, like most women of the day, she would stay at home and be a mother and homemaker. But it was the busy time for my father's photography studio, leading up to Christmas. So my mother brought me, as a newborn, to the studio so she could help my father. She'd leave me in a car bed and put me "somewhere in the studio," while she ran errands for Dad - and hoped to get back in time to nurse me. She said I was an easy baby and "didn't seem to mind the wear and tear of being dragged off to the office every day." They did that until after Christmas; I would be two months old by that time. It hadn't taken long for my mother, being in the studio every day, to realize that my father was not going to be able to support this new family on the profits from his studio. That she would have to go back to work.

In 1964 there was no maternity leave for new mothers. Fortunately my mother had been successful in her young career working as a scientist at the National Research Council. When I was two months old she got part-time work doing research at Fisheries. At the end of the three-month contract she got a full-time job in the Biochemistry Department at Dalhousie University, first in paediatric research and then in the Med School, and worked there until my brother was born three years later.

From how my mother tells it, she had a very difficult time finding a caregiver to come to our home. The babysitter she did find had a child in the first year she was there. Mom later told me that she felt that the sitter had been neglectful, that she brought her own child and ignored me. When the sitter got pregnant again she decided not to continue working and Mom was on the hunt for a sitter again.

With no luck finding someone to come to our home, Mom eventually found a daycare program. At the same time she approached an older woman, a neighbour, who said she might be interested in babysitting. It was decided that since I loved the daycare I would go there a few days a week, and have a few days a week with Mrs. Scott. She was probably the first consistent and attentive caregiver I had and some of my fondest memories were with Mrs. Scott. After she moved away I wrote letters to her for years, probably until I was in university. It was very touching for me that Mrs. Scott's son was the minister at my mother's church and presided over her memorial service.

Another origin of the abandonment lifetrap is that you lost the attention of a parent when a brother or sister was born.

When I was three years old my mother entered the hospital to deliver my younger brother Thomas. My mother had antibodies to my brother's blood (called Rh factor) so she had to deliver early. The surgery was scheduled just before Chritsmas. My father would be busy at the studio during the holiday rush again, so my mother had made arrangements with a number of different people to babysit, and had them scheduled for days and evenings. 

After my mom went to the hospital, my Aunt Mary, my father's older sister, asked my Dad and I for dinner, and then asked me if I wanted to stay with her for Christmas. Of course I said, "Yes." I've mentioned before that she was my favourite aunt and her husband performed our wedding service. My mother and I talked about this many years later and we both agreed that Aunt Mary, having known her brother for a long time, probably knew that I wouldn't get cared for very well at home, alone with my father.

Me, three-years-old, at Christmas with my Aunt Mary on the right

My brother had a blood transfusion immediately after delivery and Mom didn't see him for two days. Other mothers had their babies brought to them so they could nurse but not Mom; she said it was hard to adjust to that, but even harder to go home and leave him there! Thomas had half-a-dozen blood transfusions in his first week, and had to stay in the hospital for a full month, even though mom was discharged after ten days.

My mom was home with me then, but every day she would call my dad at the studio and say, "I need to go to the hospital now to see this baby!" Dad would rush home and stay with me while Mom went to the hospital (they only had one car and being a child they couldn't bring me to the maternity hospital). Every day she could see Thomas, but only through a window, and she wasn't able to touch him. She could see that he was getting stronger every day, and slowly his jaundiced colour was disappearing. Being a mother now, I can only imagine how painful it must be to have a newborn baby and not have him with you! What kind of effect would that have on you?

Even though baby Thomas was home after a month, his iron was still low; at the end of two months he needed another blood transfusion. At that time, when Thomas was two months old, Mom went back to work and there was a new babysitter. Mom wrote about this time, "She wasn't the greatest babysitter in the world , unfortunately. She liked Thomas better than she liked Sheila, and also brought a nine-year old granddaughter with her on a number of occasions when this little girl was not in school. She didn't bring any toys, which meant Sheila had to share without a reciprocal arrangement, and that just wasn't very satisfactory. Anyway, she didn't last long." And the search for a caregiver began anew.

When Thomas was about ten months old my mother hired Mrs. Chaddock who was with us until I was thirteen. Mom was pleased because she would take us for walks, whereas previous sitters had apparently watch soap operas most of the day. And my brother then had a consistent caregiver.

Another origin of the abandonment lifetrap, especially significant for me, is that your parents fought so much that you worried the family would fall apart.

hated when my parents fought. And they fought a lot. Usually about finances. I think. In the morning I could hear them arguing down in the kitchen. In the evening I could hear them arguing in bed - my bedroom was next to theirs. I wanted so badly to go and fix it! At one point I found my mother literally banging her head against a cupboard door. I now understand that she was just fed up, but It scared me that the person who was supposed to give me strength was so vulnerable. And then there were the times when the arguing got so bad that one of my parents would get in the car and drive away. It scared me SO much! And I usually ended up yelling at the parent who was still there, blaming them driving the other person to escape - and abandon me.
I lived in fear that my parents would get a divorce. If they divorced I would lose one of them. I suppose I knew that we would have to go with Mom, because she was the only person with an income. But I also felt it was my job to take care of my Dad; I was his emotional spouse. How could I do that if I lived with my mom? When I look back at that, from the position of an adult and a parent, I can only imagine the conflict that must have created in my head! So it became my mission, to prevent my parents from separating.

When my mother was 64 she lost her sight. She couldn't work anymore or drive. And she had to move out of our family home to an apartment that had bus access. My father refused to leave the family home. They separated - after being married for over 25 years. And I had an nervous breakdown, or what they now call a Major Depressive Episode. Their marriage had ended, and I had failed at my life's mission. And I got therapy for the depression and my eating disorder.

It has not gone unnoticed that the arguing with Mike seems to reflect what was so destructive to me as a child; unfortunately, this is what happens with lifetraps, we repeat these patterns, and it makes it very difficult to change them.

As Young explained in his book, a child needs a secure, stable family environment, where parents are predictably available, and physically and emotionally there for the child. My parents' marriage was not a stable base of support for our family. My mother was busy putting food on the table, as well as taking night classes, doing volunteer work, sewing, knitting, reading, etc. And my father was unpredictable. He made promises he never kept, and made plans that were never fulfilled. It was a constant cycle of hope, and then despair. Neither of my parents knew how to support me emotionally, mostly as a result of things that happened in their childhoods. I know that they did the best they could, with what they knew, at that time. But that doesn't change the fact that they were not able to be there for me in the way that I needed.

So where do I go from here?

In the first chapter of his book, Young explains the process of change, "The lifetrap approach involves continually confronting ourselves."  And promises to, "show you how to recognize [lifetraps], how to understand their origins, and how to change them." He adds, "We will teach you how to track your lifetraps as they play themselves out in your life, and how to counter them repeatedly until these patterns loosen their grip on you." I have my work cut out for me; first of all, learning not to overreact, and secondly, working on mindfulness, emotion regulation, and distress tolerance.

When I left the Day Hospital program, I asked the staff (social worker, occupational therapist and psychiatrist) what I needed in terms of therapy or a therapist once I was discharged. All three of them said I needed to find a therapist who wasn't married to one form of therapy, supporting Young's contention: "I have come to believe that integrating the best components of several therapies is far more effective than any one alone."

One important piece of advice from Young's chapter on abandonment, one that is particularly relevant for me was, "When you find a partner who is stable and committed, trust him/her. Believe that he/she is there for you forever, and will not leave." The staff also suggested that, in the midst of our busy lives, that we make time to check in with each other nightly, to maintain that connection.

This photo, that I keep on my dresser, is Mike on our wedding day, twenty years ago

There is no reason for me to be afraid that Mike is going to abandon me. He is one of the most reliable, dependable, loyal and honest people you could ever meet. He has seen me through recovery from my eating disorder - twice. He was there when I went off work on stress leave. He was there when I was suicidal, and he was never sure what he would find when he got home from work. He was there, at my side, doing full-time parenting, for the first eight months after our twins were born. He was there when I was thrown into parenting my aging mother. He was there when we had to pay off a massive debt. He was there when each of my parents died and all the grief, anger and sadness that followed. He was there when I was so ill that I was practically bed-ridden for two years. And he is still here even when I'm not functioning at full capacity. He has not left.

I am so tempted to write, "He has not left YET." But I am going to trust that "he will always love me," and remember why I have the everlasting love charm.

Now Mike knows that when I have a panic attack it's not really about him. There is no rational fear that he will leave me, just an emotional trigger. He just needs to give me a hug and remind me, "I'm right here. I'm not going anywhere."

Of course we avoid hugging when he is driving. Instead he puts his hand on my knee, to reassure me.

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