The Stress Doc Letter
Cybernotes from the Online Psychohumorist
JUL 2000, No. 1, Sect. 2
Excessive Arousal-External Source: "Phobia-Panic"
The April, May and June 2000 Stress Doc Newsletters have broadly sketched a
model for examining how states of physiological arousal impact our
perceiving-thinking-feeling-behaving self. The two variables are degree of
arousal -- from overaroused to underaroused and the source of arousal --
internal or external. The previous newsletter focused on excessive-internal
arousal-activation states: Agitation-Manic
Here is a compact 2x3 matrix model of "Six States of Physiological
Arousal - Activation." The two basic dimensions -- "Arousal
Source" and "Levels of Arousal - Activation" -- and the resultant
Six States of Physiological Arousal - Activation
Levels of Arousal - Activation
Insufficient Excessive Optimal Arousal Source
Internal Emptiness- Agitation- Relaxation- Exhaustion Manic Meditation
(Environmental) Boredom- Phobia- Alertness- External Inertia Panic Animation
As previously explained, the "Arousal Source" is a gradient, from
the biochemical (Internal Stimuli) to the environmental (External Stimuli). The
"Cognitive-Affective" (or "Thinking-Feeling") dimension
interacts with, affects and is affected by both biochemical and environmental
stimuli. Nature and nurture forge a complex blend. Both sources and
arousal-activation states excite or inhibit each other in an ongoing feedback
loop. The dimensional interplay influences the ability to: a) manage ones
psychophysiological arousal and resulting emotions, b) process and make sense of
past, present and future self-world information, including memories and dreams,
goals and visions and c) generate an array of responses to everyday problems and
opportunities from the adaptive or innovative to the dysfunctional or
Today, due to the Stress Doc's uncontrolled verbosity, the focus is just on
Excessive Level x External Arousal Source: "Phobia-Panic." Ideas and
descriptions will draw upon Websters Dictionaries (Third World New
International and New Universal), Rogets International Thesaurus: Fifth
Edition, the Diagnostic and Statistical Manual (DSM) IV and personal reflection.
The dictionary provides a broader framework for viewing the essence and
potentialities of these states. The DSM sharpens the functionality-dysfunctionality
focus. And before concluding this series, well even examine the boundary
lines between Internal and External Sources of Arousal as well as the borders
between Levels of Arousal - Activation. These border and boundary lines may
actually evoke synergistic interactions for "The Creative Edge."
II. External Source - Excessive Level
B. Phobia - Panic State of Arousal
1. Phobia. According to Websters, "phobia" comes from the Greek,
meaning fear and flight. The complete definition:
1) an exaggerated and often disabling fear usually inexplicable to the
subject, having occasionally a logical but usually an illogical or symbolic
object, and serving to protect the ego against anxiety arising from unexpressed
aggressive impulses. Fear, dread and hatred often cluster together.
DSM mentions a variety of phobias; lets examine two with broad
2) Specific Phobia marked and persistent fear that is excessive and
unreasonable cued by the presence or anticipation of a specific object or
situation, e.g., flying, heights or receiving an injection
Exposure to the
phobic stimulus almost invariably provokes an immediate anxiety response, which
may take the form of a situationally bound or situationally predisposed Panic
3) Social Phobia persistent fear of one or more situations in which the
person is exposed to possible scrutiny by others and fears that he or she may do
something or act in a way that will be humiliating or embarrassing. Examples
include: being unable to continue talking while speaking in public or not being
able to answer questions in social situations.
Those Abusive "A"s
Lets return to and expand upon Websters definition (1), which notes a
pervasive troubling dynamic -- how unexpressed aggressive impulses can lead to
conflict aversion and phobic states. Both personal and professional experience
intimate that the Phobic-Panic states are influenced by: a) biochemical and
genetic predisposition and b) psychological and interpersonal dynamics
comprising the Abusive Triple "A" Alarm, Aggression and
Abandonment. And according to the DSM, the earlier and the more unexpected the
trauma the increased likelihood of a pathological or dysfunctional effect:
"Separation Anxiety Disorder in childhood and sudden loss of social
supports or interpersonal relationships apparently predispose to the development
of this (Panic) disorder." The DSM also notes that, "Panic Disorder,
Phobic Disorders and Obsessive-Compulsive Disorders are all apparently more
common among first-degree biologic relatives of people with each of these
disorders than among the general population.
As for the Triple A, my Jewish Tennessee Williams Family definitely set the
stage. Let me count the ways:
1. Mental illness on both sides of the family, including life long depression
of my paternal grandmother, my fathers depression, and my maternal uncle
likely having undiagnosed childhood schizophrenia, 2. My fathers breakdown
when I was 1½ years (diagnosed as "Manic-Depression") traumatizes
both parents, 3. Being a biologically/psychologically sensitive child, I am
flooded by the family tension, 4. Separation anxiety, a tendency to view
disruption or threat as potentially catastrophic, and a low threshold for
abandonment feelings are imprinted early, 5. A critical traumatic event: When I
was seven or eight, one day harboring some anger toward my mother over some
earlier conflict, I decided to show off my bravado in front of a playmate. In a
somewhat cocky tone I said: "Im still angry at you." Its a blur
what precisely happened next. My mother suddenly went ballistic, screaming at me
and my friend, throwing the latter out of the house, with me retreating in
terror. (Whether my psycho-biochemical sensitivity exaggerated the perceived
intensity of her rage state is a legitimate question. Though she has a history
of being a verbal volcano when acutely anxious or in a near panic state. Also,
not having a strong emotional connection as a child to a withdrawn father,
inevitably increased a sense of dysfunctional dependence upon my mother. In my
psychosocially immature, distorted cognitive-affective state, I myopically
magnified my fathers emotional weakness and, through a symbiotic
identification with the aggressor, fearfully and irrationally deified my mothers
Back to the traumatic episode. The aftermath is a fog, other than knowing
that this encounter was the last time I raised my voice or expressed honest
anger with her until my twenties. And I suspect some dissociative split occurred
between my real self and my "too good" false persona. Showing anger
meant I was bad, was disrespectful and, though never overtly stated, was weak
and crazy like my father. (Actually my fathers depression and history of
shock treatment was a family secret for almost two decades. Or, I blindly
accepted the explanation that when my uncle helped carry his brother into my
parent's bedroom, dad was coming home from a session with the back doctor.)
An attempt at loosening the emotional dependency bonds with my mother, some
desire to take a maturational step, was squashed by this explosive encounter.
Not surprisingly, with all this acute and ongoing trauma, incidents of being
tormented by peers started increasing. I was a wounded pup, who began to have
paranoia-like fears of being beaten up by peer pit bullies. Interestingly,
decades later in an unguarded moment while discussing family history, my mother
blurted out, "With all the pressures [dads illness and shock regimen,
grandmas amputation of both legs, the second while living with us, my black
sheep uncles schizophrenic breakdown upon my grandmothers death, and his
ebb and flow from our house to the psychiatric hospital for several years] you
werent going to give me any trouble!" And I didnt.
And for much of my childhood and adolescence my real self retreated behind a
depressive, phobic and addictive numbing sports playing, television watching
and masturbation shell and fixed, "all is well" smile and persona.
On the dark inside, I was fearfully freezing up.
6.The final and indefensible psychic crack in my frozen armor occurred with
the death of my maternal grandmother, my unspoken ally (she spoke little
English) a loving woman of uncommon empathy and serenity. Just before the start
of adolescence, near daily episodes of panic (which I was ashamed to acknowledge
to my parents) about being physically or mentally abused by peers was the
disorder of the day. (I have no doubt, that lifelines to extended family such as
my grandmother and my other maternal uncle, a heroic male role model, provided
enough emotional ballast to prevent a psychotic break. But trust me, I was much
too close to the edge for a long, long time.
Half Empty and Half Full
Upon further reflection, and in the pursuit of confessional objectivity and
balance, perhaps an aptitude for dysfunctional caretaking, along with a
hypomanic and/or hyperactive propensity allowed periodic escape from the
depressive lows. My energetic side, along with an inherent or inherited (from my
maternal grandmother) capacity for "emotional intelligence" when I
wasn't cowering in fear, ironically, at times facilitated being a leader amongst
my peers. It's this Dr. Jekyll and Mr. Hyde split that was so confusing -- from
charmingly and compassionately extrovertish to fearfully and shamefully trapped
in the phobia and depressive closet.
Hopefully, this outline illustrates the connection between Phobia-Panic
States and The Triple "A": Alarm, Aggression and Abandonment. Both
being intimidated by others' anger, as well as being terrified of abandonment
and our own bottled up explosive rage, can be an oppressive catalyst for
emotional disconnection and depression, if not profound dissociation. When a
genetically sensitive individual is subject to bombardment by severe or
psychically subtle environmental stressors, it takes just minor interior
rumblings or quakings to trigger wild fluctuations in your inner seismograph.
Theres a highly active and highly unstable psychic fault line. All to easily,
inner cognitive-affective static, distorted beyond immediate understanding,
erupts into outer projections
as phobic states and panic attacks.
Yet, again, sometimes the glass is half empty and half full. For example,
being in college in the late 60s, drug experimentation was the social-cultural
order of the day. I suspect my subconscious, unspoken fear of having a psychotic
breakdown -- whether rational or bordering on the paranoid -- kept me from
experimenting with hard drugs.
And then there's the miraculous potential of facing one's dread and sharing
forgiveness. It wasn't till I was twenty-five, six years after learning of the
family secret, that I asked my father to discuss his breakdown and trial by
shock therapy. This, not surprisingly, became the critical step in our making
amends, in overcoming years of painful disconnection. As dad was talking about
his traumatic past, and me all too nakedly comprehending the horror, I crawled
in my father's lap. I threw my arms around him, embracing him with pure pain,
and then began sobbing, lovingly and unashamedly, in his arms.
Finally, as will be explored further in the next newsletter, anxiety,
agitation or even some social phobia can facilitate a need for solitude and
obsession. This mode when mixed with a need for expression of one's talents and
passions becomes the incubational proving ground for fertile imagination and
Websters captures the lay conception of "panic": extreme, sudden
and, often, groundless fear.
According to the DSM, "panic attacks":
1) typically begin with the sudden onset of intense apprehension, fear or
terror. Often there is a feeling of impending doom. This is especially likely
when a state or generalized "learned helplessness" has evolved.
During most panic attacks there are a cluster of symptoms: -- shortness of
breath or smothering sensations; -- dizziness, unsteady feelings or faintness
when I was in high anxiety periods as a child, all of a sudden my head would
swirl, spots seemed to dance before me and, feeling faint, I would lean up
against a wall to prevent myself from losing balance. Again, I was always too
ashamed and afraid to mention these episodes which invariably occurred when
alone in my room. Its as if in privacy I could finally experience the level
of stress that I was constantly trying to keep under control publicly. And this
was way before the age of ten; maybe as early as five or six. -- palpitations or
accelerated heart rate -- trembling or shaking; sweating -- nausea and abdominal
distress as a kid, stomach aches were a constant; (I hadnt thought of
this for a long while) -- depersonalization or derealization (feeling detached
or disconnected from your body, your sense of self or sense of place); as
mentioned, writing this essay has uncovered a possible connection between the
adult, out of body "mystical" moment and panic-induced childhood
dissociation -- numbness or tingling sensations -- flushes (hot flashes) or
chills -- chest pain or discomfort -- fear of dying; and -- fear of going crazy
or doing something uncontrolled during the attack.
Recurrent panic attacks constitutes Panic Disorder. According to the DSM,
"in the great majority of cases Panic Disorder seen in clinical settings,
the person has developed some symptoms of Agoraphobia. Agoraphobia is the fear
of being in places or situations from which escape might be difficult (or
embarrassing) or in which help might not be available in the event of a panic
This essay has been a poignant, wistful and painful experience; still,
hopefully a growing painful one. Under a dark cloud of impending doom, seeded by
expanding pressure, depressive sensitivity, bottled rage and a threatening
environment (which at times would allow me to hide out and escape from dealing
with age appropriate life tasks), no wonder there was impaired capacity for
concentration and learning in the realms of logic, math, science and abstract
reasoning. No wonder the irrational fears of catastrophic injury which
contributed to an emotionally battered child-young adolescent syndrome. No
wonder the sense of helplessness, shame and dread in key social and
school-related roles and relationships. When not able to escape or numb myself
or, perhaps, because of this habituated defense, too often there was the
encroaching edge of paralysis, phobia and panic. No wonder its taken so much
work, so much therapy and, even, biochemistry trials. No wonder I needed so much
emotional and financial help from friends, so much reconciliation work with a
dysfunctional yet recovering family, for so long to discover and rebuild a
healthier sense of self less dysfunctional, less fearful and panicked, less
depressed and less addictive. So now you can better understand why I was able to
do so well as a Stress and Violence Prevention Consultant for the US Postal
Service. I was determined to relive and achieve greater peace with my own past,
not just master new challenges. I'd been there way before "Going
Postal" was in vogue.
After their escape from Egyptian bondage, the Jews as a nation wandered in
the desert for forty years. Perhaps I'm just following a noble tradition.
Perhaps two words inspired by the Holocaust are my mantra: "Never
again!" And I too must remember:
The Poetic Scream
The vacuum shrieks
The hours weeks
The wail of solitaire.
Affixed the meat (and beat) of prayer.
May these words help us all
Practice Safe Stress!
Reader's "Higher Power of Humor" Section
New Age Proverbs From: we4and
Everything must be upgraded it seems, so here are some wise new Proverbs for
the Year 2000. (Can you remember the original??)
1. Home is where you hang your @.
2. The e-mail of the species is more deadly than the mail.
3. A journey of a thousand sites begins with a single click.
4. You can't teach an old mouse new clicks.
5. Great groups from little icons grow.
6. Speak softly and carry a cellular phone.
7. C:\ is the root of all directories.
8. Oh, what a tangled website we weave when first we practice.
9. Pentium wise, pen and paper foolish.
10. The modem is the message.
11. Too many clicks spoil the browse.
12. The geek shall inherit the earth.
13. There's no place like http://www.home.com
14. Don't byte off more than you can view.
15. Fax is stranger than fiction.
16. What boots up must crash down.
17. Windows will never cease.
18. Virtual reality is its own reward.
19. Modulation in all things.
20. Give a man a fish and you feed him for a day; teach him to use the Net
and he won't bother you for months!
Seek the Higher Power of Humor: May the Farce Be with You!
Mark Gorkin, LICSW, "The Stress Doc," is the Internet's
and America Online's "Online Psychohumorist". An experienced
psychotherapist, "The Doc" is a nationally recognized speaker, and
training and OD consultant specializing in Stress, Anger Management,
Reorganizational Change, Team Building and HUMOR! An expert advisor for
www.AdviceZone.com and iVillage/allHealth, his writings are syndicated by
iSyndicate.com and appear in a wide variety of online and offline forums and
publications, including AOL/Online Psych and Business Know How, Mental Health
Net, 4Therapy.com, WorkforceOnline, HRHub.com, SelfhelpMagazine.com, Financial
Services Journal Online, CONVENE (The Journal of the Professional Convention
Management Assn.), OpportunityWorld and Counsel ing Today. Recently, he has been
quoted and/or featured in such publications as Cosmopolitan Magazine, Bloomberg
Report/News, Forbes Magazine, FoxNews.com, Dallas Morning News and The
Washington Flyer. The Doc also leads his national "Shrink Rap and Group
Chat" for AOL/Digital City and WebMD.com. Check out his USA Today Online
"Hotsite" Website -- www.stressdoc. com . For info on his workshops or
for his free newsletter, email stressdoc@a ol.com or call 202-232-8662. Summer
2000, look for Practice Safe Stress with the Stress Doc, published by
(c) Mark Gorkin 2000 Shrink Rap Productions