There are as many answers to this question as there are people who have been through it. Each of us lives it and tells it in our own way. But there is a common thread, a shared undercurrent, that will probably make anyone in that situation recognise themselves in what follows.
The first thing worth saying is that, when panic starts to attack, those of us who suffer it almost never know what it is. We have no name for it. We only know that it hurts in a way that resembles nothing that came before. That something has broken, but we cannot work out what. And that makes the suffering spread without us knowing how to contain it.
The day my life broke
In my case, the first time panic arrived is tattooed on my brain. I was cycling up through the Odenwald, the forests that surround Heidelberg. It was a ride like the ones I had been doing for years. The ones I enjoyed most. And suddenly, without warning, everything changed.
It began with an innocent question: why is pedalling so hard today? A question every cyclist asks a hundred times a year. But this time it didn't leave. It festered. And it brought friends. Why do my legs feel so heavy? Why am I breathing so fast on flat ground? And what's that dizziness? And then came the question that would become my shadow for years:
Could it be my heart?
That small cyst was beginning to metastasise. What happened over the following minutes has no kind name. My hands started shaking so badly I couldn't open an energy bar. Opening the bottle to drink became an impossible task. Breathing turned into hyperventilation. Tingling appeared in my left arm, electric shocks in my head, the urge to vomit, legs turned to jelly, the certainty of imminent collapse. And above all of it, that glue that binds every symptom of panic together: the sense of impending death. Not the fear of dying. The certainty that you are going to die. Now. On this trail. Far from home.
I ended up in the ER. My wife calling a friend to come and get me. Me on a stretcher, convinced that every second was my last. Until they attached the electrodes, a perfect electrocardiogram came out, and every symptom evaporated on the spot. As if they had never existed. Only the exhaustion and the bewilderment remained.
I was not a rare case. Emergency departments across half the world receive people like me every day, convinced they are having a heart attack when what they are having is a panic attack. The head of emergency medicine at Cedars-Sinai explains it bluntly: there is an enormous overlap between the two conditions, and telling them apart without an electrocardiogram is practically impossible. The American Heart Association says the same. That is why, when in doubt, the advice is always to go.
That would be the first of many normal ECGs... And the last day of my previous life.
The place
That night I went home thinking it was over. That tomorrow I would pick everything back up and what had happened would remain a simple anecdote. Unfortunately, neither life nor my mind agreed.
For a month and a half I managed to sustain an appearance of normality. But getting on the bike to train was an ordeal. Every pedal stroke carried a surveillance inside it. How's the pulse? Are you breathing properly? What was that just now? What used to be my greatest pleasure became a permanent interrogation. And, as any sane human being does, I started riding less to avoid uncomfortable situations. I swapped the bike for walking.
And then, not just the bike — even walking began to bring that surveillance. Those doubts. So I walked less. And less. And one day I realised I was shut inside my home. The prospect of going out terrified me. What if it happens again? What if this time it's real? What if this time I don't make it to the hospital?
What if?
The technical name for that behaviour is avoidance. And it is the mechanism by which panic disorder can end up turning into agoraphobia, exactly as the psychiatric reference manual (DSM-5) describes. It is not weakness. It is the logical response of a brain that has learned — wrongly, but learned — that certain places or activities are a threat to your life.
The worst part is that fear did not settle for taking the bicycle and the forests from me. Fear respects no sanctuaries. One day, at home — that refuge I had built out of renunciations — the tachycardia arrived. The tight chest. The short breath. The spinning head. And once again the same certainty: this is the end. I have to get to the hospital. There's no time.
Only to watch it all evaporate again once I was lying on the ER stretcher. Leaving me broken. And at first I would tell myself: well, that's that. It's the same as last time. Tomorrow I carry on as if nothing happened.
But it wasn't like that. It never was. Weeks passed, months, and the scene kept repeating. You don't know why it comes back. You don't know when. You only know that every moment of the day has become a death sentence that your brain pronounces and then withdraws, over and over, without rest. You are a lamb on its way to the slaughterhouse. A soul handed over to a firing squad that never actually shoots but never leaves either.
Your life has shrunk down to those four walls that once sheltered you and now feel like a cell. And even so, going out to buy bread or getting to work means defying them, crossing the border of a country at war.
It doesn't have to be the heart
Does any of this sound familiar? Does it resonate?
Maybe your panic isn't the heart attack. Maybe you are terrified of fainting in public with nobody helping you. Of the ground swallowing you while you speak in a meeting. Of catching an invisible virus. Of someone slipping something into your drink. Of going mad. Of losing control and doing something terrible you would never do. Of your child, your partner, someone you love, not being okay when you get home.
Here it is worth clarifying something that confuses a lot of people, including those close to the sufferer. Panic and generalised anxiety are not phobias. A phobia, according to the current clinical classification, is specific: spiders, planes, heights. It has a clear object and, outside of it, life can carry on fairly normally. Panic disorder and generalised anxiety are something else: they are overlapping layers, fears that breed one another, a palimpsest of constant hypervigilance over your own body and your own mind.
And they almost always end in the same place: social isolation, incomprehension (because from the outside nobody understands how you can be crying in front of the bread), and a cocktail that makes it enormously hard to start walking in the opposite direction.
If you are there
If you have read this far, and you have recognised any of these landscapes, I want you to know one thing before you close the tab.
You are not crazy. You are not broken. You are not weak. What is happening to you has a name, has an explanation and — most important of all — has a way out! It is not a fast way out, it is not a pill, it is not a breathing trick you saw in a video. It is a trail. A long one. At times brutally hard. With holes and traps that momentarily send you back to square one. But it exists, and it can be walked. I walked it. Many people have walked it before us. And although the maps change, the directions are remarkably similar.
If this has resonated with you, stay around. We will go slowly, in short posts, tackling each piece of the puzzle. And if you know someone who is in this place, share it. Sometimes knowing that a name and a way out exist is all a person needs to start looking for it.
A hug — above all to whoever is having a hard time right now while reading this.