I missed half of sixth grade.
I’d wake up each morning dreading the panic attack I knew would hit in a few minutes. The first one of the day usually coincided with breakfast or the drive to the bus stop. The second generally hit around 11 a.m., sending me to the nurse, and from there, often home. Making it through a full day of school was an accomplishment.
I have to be honest: I’m still anxious, and I’m especially anxious about writing about my anxiety . I usually wait until I know someone pretty well to tell them about it.
But it’s important. Talking about anxiety and depression—and the fear and sadness that go along with both—eases the feelings of isolation and weakness that often stop people from getting help. For what it’s worth, almost everyone I’ve told about my anxiety throughout my life has responded with stories about their own struggles, or those of people they’re close to.
Which is why warning bells went off when I read Dr. Julie Holland’s recently published, New York Times bestseller, Moody Bitches.
In it, Dr. Holland claims that drugs are over-prescribed, that they’re misused, and that they’re a Band-Aid rather than a solution. I worry that the book will make people feel ashamed for taking medication for a mental issue and less likely to talk about it.
So I called Dr. Holland.
My first panic attack
My first panic attack coincided with a nasty flu when I was nine-years-old. My family was on a ski trip in Jackson Hole, Wyoming; my mother is a writer and managed to convince publications to send us out there for a different story year after year.
We’d stay in the same condo, in a cluster of houses atop a butte. “She’s a beaut!’’ my dad would say as we drove up the winding road.
Something on those trips always went wrong. Mishaps ranged from the annoying—my dad forgetting one of his ski boots—to the concerning, like the times my mom got altitude sickness and we’d end up in the emergency room. They’d hook her up to an IV, and we’d wait a few hours until her face regained some semblance of color.
But this flu was a doozy, even by our standards. I threw up for days. Now that I’m an adult, I can only imagine how unfortunate it must’ve been for my parents to get saddled with a sick kid in such a cool place.
That first panic attack is one of my clearest memories. I lay on the floor with my legs tucked under me, head resting on the wall-to-wall carpeting of the master bedroom. Sunlight came in through the slatted blinds and landed on the floor about a foot away from my face. As I stared at the striated shadow, I felt a fear grip me, a dread so intense that I was pretty sure I was dying.
In fact, I knew I was dying. And if I wasn’t dying, I knew that I would someday. And what happens when you die? I didn’t know, and when I tried to imagine it, I grew even more panicked.
All I could do was cry and tell my father how scared I was. And then go throw up in the bathroom, where the toilet had a picture of a cowboy hanging above it.
What 10-year-old goes to a shrink?
A few weeks later, back home in Lincoln, Massachusetts, I was still begging my parents to take me to the doctor. I’d gotten over the flu, but the dread remained, and with it the shortness of breath, the conviction I was dying, and the terror at what would happen once I did.
If you’ve never had a panic attack, the closest I can come to describing it is that it’s kind of like thinking about how big space is. What comes after the universe? And after that? But instead of shrugging your shoulders and thinking about lunch, an existential terror comes over you. It feels like you’re spiralling into a black hole in your own brain.
My parents took me to the doctor, and—of course—I wasn’t sick. Something else was going on. I’d always been a sensitive kid (my close friends from growing up still tease me because I couldn’t make it through a sleepover until seventh grade), but this was different. It was terrifying. I started referring to what I now know was anxiety and panic as “my worries.’’
I was lucky. Anxiety runs in my family, and I was blessed with parents who understood it and could see what was happening to me. After six months of “my worries,’’ they started suggesting I see a therapist.
What a gift that was, I now realize.
But at the time, I didn’t see myself as lucky at all. I sat on our kitchen counter after another panic attack, swinging my legs, adamantly refusing to go when my mother once again brought it up. Because what 10 year-old goes to a shrink? That was clearly weird and embarrassing and even worse than having to leave school because I might be dying.
“I feel like I have myself back’’
It was late into sixth grade at my new school when I finally relented. Middle school is tough for anyone, but being the new kid in a high pressure, all-girls environment turned out to be more difficult than I anticipated. It pushed me over the edge. I couldn’t deal with the spiralling anymore. I just wanted to be a normal kid. I used to be happy, outgoing, and confident. My worries had hollowed me out.
So at the age of 12, I started seeing a therapist whose offices were in a little yellow house outside of Harvard Square.
I sat in a big comfy chair, which surprised me. After a childhood spent paging through New Yorkers to read the cartoons, I was expecting to lie down on a flat, uncomfortable chaise longue while she sat behind me in a leather chair that spun around, writing stuff down as I spoke.
She suggested medication on my second visit. I refused. The only thing weirder than seeing a shrink in the first place was taking a pill for your brain. Her suggestions went on for a few months, until eventually, I reached a point of desperation, and said yes. She wrote me a script for Paxil.
I still remember the intense relief I felt two days after starting the drug.
“I feel like I have myself back,’’ I told my parents. It was the first time in two years that I made it through the day without collapsing in on myself. It was a godsend.
When I went back to seventh grade, I was the kid I knew I actually was all along. I didn’t slide into panic. Instead, I greeted everyone with excitement, cracked a few out-of-turn jokes in our first homeroom class, made everyone near me laugh, and got in trouble.
Girls came up to me at recess and asked, “What happened? You’re different.’’
I just told them I’d had a really good summer.
“Most everybody in America wants to take a pill’’
It is because of my history with anxiety and medication that I was so intrigued by Dr. Holland’s book. As I read it, I was struck by how much she simplifies the issue.
In Moody Bitches, Dr. Holland tells of being called in as a psychiatric expert for a news program. Before the interview began, Dr. Holland chatted with the newswoman, who told her she hadn’t wanted to take medication when her therapist had recommended it. Dr. Holland told the newswoman about the different ways anxiety and obsessive behavior were serving her well: making her more perceptive in interviews, knowing what story to cover, and leaving “no stone unturned.’’
“She looked at me like I truly understood her,’’ Holland writes. “‘Yes!’ She stared at me dumbfounded. ‘Yes!’ she repeated. ‘It’s just who I am: I am nervous, jumpy. I’ve always been like this. Why would I want to medicate away my own basic personality?’’’
“Why indeed?’’ Holland writes.
Because not everyone’s anxiety is like that newswoman’s anxiety. I’m a reporter, and anxiety has only ever hindered me. Every time I should’ve picked up the phone or gone after a story and haven’t, it’s because I’ve been anxious about it.
Drugs should not be used to “medicate away’’ anyone’s basic personality; rather, they should be employed strategically when one’s disorder gets in the way of one’s true basic personality. There’s no room for nuance in Holland’s argument. As I read this passage, I began to feel guilty and question what was wrong with me that made it necessary to take anything at all.
And then I got angry. My doctor and I have worked together over many years to find ways for me to cope. Who is Holland to tell me that I’m getting rid of my basic self by taking a pill to stop debilitating anxiety?
Going right to the source
I picked up the phone and gave Dr. Holland a call.
“It comes down to whether you’re willing to make hard changes about how you’re living your life or whether you’d rather take a pill,’’ Holland told me.
“Most everybody in America wants to take a pill,’’ she continued. “And they work. But there’s no such thing as a free lunch. There are downsides.’’
Holland isn’t wrong on that last point. SSRIs, which I no longer take, have been found to lower sex drive, cause weight gain, and make patients feel dull. She does say, in one paragraph, “I’m not suggesting that all use of psychiatric medicines is counter-productive…Clearly there are times when we need to pull out the big guns.’’
But she then writes, “Cosmetic psychopharmacology is not unlike cosmetic surgery,’’ and goes on to say that when other women “get breast implants, the rest of us feel flat-chested…Suddenly, you’re the odd one out if you aren’t like your friends, taking something to ‘take the edge off.’’’
I don’t buy Dr. Holland’s argument that most people take meds because their friends take meds—or that peer pressure is the cause of most plastic surgery. I’m concerned that Dr. Holland’s book will give people—women especially—one more reason to stop opening up about their struggles. And that’s the worst thing you can do; hiding only compounds the problem.
“My breakthrough was having conversations with people and realizing I was hardly alone,’’ said Kat Kinsman, editor-in-chief of Tasting Table, former CNN managing editor, and author of the forthcoming book, Hi, Anxiety.
“Ten other people popped up and said they had it too, and having that normalized it,’’ Kinsman continued. “I don’t fault anybody for how they need to cope. If you need to take meds, you need to take meds.’’
Drugs are powerful
After college (where I still saw a talk therapist) and 10 years on the drug, I reached a point where Paxil made me feel sluggish, and where I couldn’t reach the emotional highs I knew I was capable of. I gained weight. Once again, I wanted my best self back.
So I tapered off of the Paxil. And it was a lesson in just how powerful these drugs can be.
It felt like an alien was living in my brain; I’d get occasional zaps where everything would go dark for a second or two, and I was wildly emotional. My boyfriend at the time took me to see the Celtics play the Heat, and I got so overwhelmed by the noise and lights and energy that I burst into tears. He was a great sport about it and went and got me a beer as I breathed in and out and realized I could see Chris Bosh’s glittering earring from all the way up in the bleachers.
The withdrawal from Paxil was brutal but not surprising. I’d once been hospitalized in high school after forgetting to take my pill for three days. I thought I was having a stroke—I couldn’t feel my face, gave them my wrong birthday, and eventually couldn’t say anything other than “I’m so scared.’’ The doctors in the ER checked the inside of my elbows for scars because they thought I was on heroin. They put me on morphine.
Not even scientists at the forefront of medical research know why drugs sometimes stop working for patients.
“The answer is that we don’t have an answer,’’ said Dr. John Herman, associate chief in the Department of Psychiatry at Massachusetts General Hospital. “The bad news is that it happens sometimes, and the good news is that we have alternatives.’’
Dr. Herman told me that many meds don’t have adverse effects over the long term, and that the real conversation with patients revolves around finding a medication that works without negative side effects. The patient must have “the determination and courage’’ to dry different approaches, he said.
And as important as getting off Paxil was, it became clear that I’d need to try a different approach. At 22, I blamed myself for my anxiety more than I had as a child.
“Why can’t I just control my thoughts?’’ I cried to my shrink. “What is wrong with me?’’ I didn’t want to need medication, I told her. I should’ve been able to just get a grip, to pull it together.
“You’d treat diabetes if you had it,’’ she told me. “This isn’t your fault, this isn’t about whether you can control your thoughts. This is something that you have that you have to manage.’’
“It gets right down to stigma’’
My doctor started me on a few different things until we found a drug that worked. A combination of low doses of Wellbutrin and Buspar doesn’t make me feel dull or fuzzy and doesn’t come with the other side effects that I’ve so hated. While Wellbutrin is traditionally used to treat depression rather than anxiety, I’ve found that it works really well for me. I don’t need to take much each day, but I do need something to keep the anxiety from debilitating me. The meds give me a floor.
For all of my talk about how being on meds is totally fine (which I do believe), I still have a slight nagging in the back of my brain, an awareness of the stigma surrounding these issues and the drugs that treat them. As I write this, I’m wondering whether this article will change how people view me, and whether you think I’m crazy as you read this.
I’m not immune to falling down the rabbit hole of “Why can’t I just deal with this myself?’’ Dr. Holland’s book just serves to exacerbate feelings I’m already working to overcome.
But as Dr. Herman of MGH said, “It gets right down to stigma. I tell patients, ‘I’ve been wearing glasses since third grade, and they still haven’t cured my vision. I prefer to wear glasses and see the world clearly than be proud that I’m not wearing glasses.
“And likewise,’’ he continued, “I’d rather have to deal with the disappointment of taking meds than not see the world clearly because I’m looking through anxious eyes.’’
There’s always going to be somebody saying meds are bad
When we spoke, Dr. Holland told me no one should be on drugs for longer than six months to a year.
“OK, so what about me, who’s been on meds for about 12 years?’’ I asked Dr. Holland, and explained my history.
“If you have panic attacks and that’s for sure what they are, you’re definitely somebody who’s going to have to stay on SSRIs long term,’’ she said. She went on to add that everyone is different and the only way to be sure about what’s going on in your head is to see an actual mental health professional.
That’s the message I’ve receieved from my doctor and from Dr. Herman. But that isn’t the message that comes across in Moody Bitches.
Dr. Herman, upon hearing Holland’s hypothesis that meds are only appropriate to take for six months to a year, said, “My reflex is usually to say which medical school and residency did she go to where she decided this? What is the basis of her research?’’ He said that he has patients who’ve been on meds for 20 or 30 years, and they’re doing just fine.
Because I’m a reporter with access, I was able to call Holland up and ask her about my specific experience. But the average reader can’t call the author and get a special exemption.
I’m sure there are instances when drugs are prescribed even though other changes, such as exercise and diet, could make a big difference in women’s lives. But the argument that drugs are overprescribed isn’t necessarily true.
This is my individual story. I’m by no means saying everyone should take medication. I have a friend, for example, who recently told me she wished she’d never been prescribed antidepressants, because they only served to delay the process of getting her into talk therapy, which she found much more effective. I find talk therapy helpful, too, and use it in addition to my prescription. Whatever works for you. It’s the “one-size-fits-all’’ argument that I take issue with.
But meds do serve a purpose for many, including myself, and to portray them with a cover that looks like this…
…means that women could see it and think medications are bad, when in fact, science doesn’t support that argument. Doctors are not always just playing to big pharma.
Simply put, it’s just kind of a weird book
“There’s always going to be somebody writing about this kind of stuff and saying meds are bad,’’ Dr. Herman said. “I wish we’d be asking ‘how is somebody doing,’ not, ‘What are they doing to get there.’ If it’s safe and monitored by a qualified physician, let’s measure that.’’
Dr. Holland’s book eventually turns into a how-to guide for women in general. It ventures into strange territory when she goes into detail about the correct way for a man to bring a woman to orgasm using his fingers.
She also offers advice about dating: “The younger gals tend to go for men who excite and intrigue them,’’ she writes. “Often, as they mature, I remind them that the criteria need to change; they are shopping for a husband now, not a boyfriend.’’
I’ll keep that in mind the next time I go to the man store.
Everybody needs somebody
It feels strange to write this many words about anxiety, because, in fact, I don’t think about it very much. I have flare-ups, and moments when I know I have to take myself for a walk because I’m spiralling and worrying about something that isn’t nearly as big a problem as I’ve built it up to be.
But my anxiety doesn’t define me. Most people I tell about it are surprised. I’m certainly not visibly nervous. That’s because, along with lots of trial and error to find medication that stops my panic, I have coping mechanisms now as an adult that I didn’t have as a child. I can talk myself into being more rational, I can exercise, I can reach out to people whom I know will listen.
I’ve come to terms with the hand I was dealt (Dr. Herman stressed how genetic these things are), and I’m doing the work to get through it.
Being open about it has been a huge part of that work. If you’re reading this and identify at all, that’s pretty compelling evidence that you’re not alone. No one, no book, no school of thought, should make you feel guilty for what you feel or for how you cope with your own brain.