Читать книгу Ten Steps to Relieve Anxiety - H. Michael Zal - Страница 11

A GAD Case History: Paul’s Story

“My anxiety is such a gut wrenching, horrible, terrified and scared feeling. It is a feeling of fear—I become a prisoner—scared to make a move—afraid that something bad will happen. I cannot sleep. At one point, I lost weight to the point that I had to drink extra liquid supplements. I feel a constant battle in my head. I get to a point that I just do not care what is wrong or right. I worry that I will never see the light and I will always be in the dark. It brings me to a point that I just want to run and never be found. It took me to such a low feeling that I could not go even one day without tears. I felt like I was in the bowels of hell. I cried unstoppably in the shower. I wound up on my knees just crying and feeling below nothing. I could go on but really didn’t want to. There is so much more.”

In spite of his gray hair, Paul appeared much younger than his fifty-eight years. He scrunched himself into the curve of the chair, looking timid and vulnerable. He never smiled; instead, he looked scared and apprehensive. Every time I asked him a question that made him feel uncomfortable or he shared a childhood trauma or a negative feeling, he nervously and continuously pulled on the hairs on his arm and rubbed the skin on his forehead. Whenever I felt that we had a particularly good talk where he shared significant material and had an insight, he would get up from his chair and say, “I guess this was a bad session.”

Paul had obsessive-compulsive overlap symptoms. He needed to double-and triple-check things. For instance, if he didn’t verify that the door of his house was locked when he left, he would become quite anxious. If his wife said that she had locked the door, he doubted it and had to go back and check. He liked things in order. “It gives me a sense of peace,” he said. He sought symmetry. If pictures on the wall were not straight, he had to get up and fix them. He would say, “The purpose of the picture is to be straight.” Paul could also be fidgety, had difficult falling asleep due to “thinking, thinking, thinking” and could become short of breath and hyperventilate when he was “nervous.”

It took Paul more than ten years to pick up the phone, call a psychiatrist and come for help. He was treated on an outpatient basis for depression for more than twenty-five years by two different psychiatrists. He could become tearful, angry and anxious. He was prescribed various psychiatric medications. On one occasion, he got so upset that he felt he could not function. He was hospitalized at a local psychiatric facility. Six months after his second psychiatrist retired, he called me for an appointment. Initially, he seemed like a GAD client. He had the classic triad of anxiety, worry and avoidance as well as a family history of emotional problems (his mother had a “nervous disorder”). However, he had not told his prior psychiatrists or myself the whole story. It took him many sessions until he shared his secret with me.

His parents were in their forties when he was born. His sister was fifteen years older and out of the house by the time he was six. Both parents worked, so he was raised by his grandmother. He spoke about never having a childhood and never getting to do anything with his parents. He played ball and hung out but doesn’t have many happy memories of his early days. When Paul was sixteen, his grandmother bled to death accidentally when she tried to cut a bandage off her leg. He vividly described his memory of the paramedics putting her in a rubber bag and his father rolling up the rug that was saturated with blood. “I still hear the zipper in my mind and see her in the bag,” he said.

His secret took place between the ages of ten and twelve. With much hesitation, he finally related that during this time he had been sexually abused. At first it was by some older kids in his neighborhood, like the eighteen-year-old who seduced him into taking off his clothes because he wanted to see if his new camera worked. When Paul was fourteen, a man in his thirties befriended him and also sexually abused him. Paul still had bad dreams and flashbacks of these incidents and had trouble watching related news on television. “It makes me sick to think about it,” he said. “They stole my childhood. I feel that I have a scarlet letter. I feel subhuman. Even when I go to confession, I do not feel clean. I feel dirty. I didn’t say no. I was scared and wanted to please them. I thought that they would hurt me. It caused me anger and rage. ”

These experiences left him fearful and timid all his life. He felt that he had to take extra precautions to be safe. He worried constantly and felt like an inadequate failure. He never told anyone about the abuse because he was embarrassed, guilty and shamed, all strong emotions that can be painful.

In spite of these traumas and the energy he used carrying around his secret for so long, he still graduated from high school and worked for many years at a steel company. He has three children from his first marriage, which lasted ten years, and has been happily married to his second wife for eleven years. Between Paul and his wife, they have eleven grandchildren. Paul still works a few hours each day in a small store, doing paperwork.

Paul’s Opinion of What Helped His Anxiety

“Therapy helped me. It made me look at things from a different perspective. I wasn’t always receptive but what you said gradually sunk in and helped me. The medications…were like wonder drugs. They have helped make things better. [They]…took away my negative thoughts and tearfulness. I stopped lying in the bathtub in despair. [They]…took away my edginess and [helped] me relax and not be as jittery. My religion and my spiritual life are very important to me. The Church has been very supportive. I go to Mass every day. I place a lot of faith in God and his always being there for me. No matter what religion you practice, if you pray he will answer you. You will not always get what you want but you will get what you need. Exercise is also helpful. I walk three to four miles a day. I’m constantly running and hiking. Being outdoors takes me out of my state of mind. I feel like I’m free and no longer a prisoner.”

My Opinion of What Helped Paul’s Anxiety

In therapy, we dealt with Paul’s feelings of guilt and shame. They initially came to the fore in discussing the situation when he took care of his mother, who had developed Alzheimer’s disease. She was very irritable and uncooperative. He felt upset, because on occasion he lost his patience and yelled at her. He had never spoken to anyone who took care of a relative with Alzheimer’s and did not know how difficult and frustrating that could be. He wasn’t aware that there is no one right way to provide care for an elderly parent and that his negative feelings were not unusual in this stressful situation. He did not realize that you can still love a person although you are angry at his or her behavior. I had him read The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease.¹ This was helpful. He commented, “I missed all the warning signs—the anger, the yelling, that I needed help.”

His feelings of shame, embarrassment and guilt that he still had about the sexual abuse were more difficult to dissipate. They were intertwined with his sense of identity. Somehow, he believed that these acts had branded him as a homosexual. Even at age fifty-eight, he was fearful that a gay man would try to seduce him, so he felt that he constantly needed to be on guard. In some way, in spite of his heterosexual orientation and lifestyle, he felt that he could still be a sexual victim. He was surprised to learn that those young boys who abused him were not necessarily gay; they were just experimenting sexually and wanted to feel powerful. I also explained to him that being gay had to do with your adult sexual preference and not how you walked or talked. I told him that I doubted that a gay male would pick on a heterosexual older man. We also talked about pedophilia. The two older men who abused him were pedophiles and not homosexuals. He did not know this. I showed him a wonderful Newsweek article written by movie producer Tyler Perry. In the piece Perry revealed that he also had been molested as a youth. He wrote the column to a young boy involved in the Penn State scandal to tell him that he wasn’t a victim—he was a survivor.²

To help Paul dissipate his considerable feelings of anger, I asked him to write a letter to the last man who sexually abused him. The following is some of what he wrote:

“I still remember and despise what you did to me after all these years. I remember the way that you lured me away from my friends. I still see the images in my head. It’s too painful for me to write down what you did to me. It sickens me. I still feel you, hear you and see you in my mind. You started something in my life that I thought was good and it wasn’t. What you did to me years ago is so disgusting and terrible, it still haunts me today. The actions performed by you on me and me on you make me sick. It has left me with years and years of memories that will never leave my mind. Now in this day and age of full media exposure, it seems to get worse.

“I can never, ever forget. The visual thoughts are haunting. I guess I cannot blame it all on you, because I am told that I may have been searching for something. But still, you were older than me. I despise what happened to me and think your actions were deplorable. I hate every thought of it. I hate every action that was done. Do I hate you?—no, I don’t—But I hate the sins of our past. Years ago, I was filled with rage, anger and fear, and sometimes I still am. Trust me, the memories will never stop. The emotional roller coaster never slows down or has an end. I share this with no one. It is my hell. The side effects never stop. It cost me plenty of tears, fear and anxiety, as well as feeling useless and hopeless. It’s a journey without an end.”

Paul was locked into his routine because it helped him feel more secure. It was difficult to get him to try something new and take a risk which he thought was dangerous. I asked him to try an exercise which I call “follow your nose.” I asked him to take a four-hour block of time, perhaps on the weekend when he was free, and do whatever he wanted. It sounds easy but can be hard for anxious people like Paul. He struggled with this concept. However, one day, he finally tried taking a walk in a different part of his favorite park. He actually enjoyed it.

Paul showed gradual improvement. It was difficult to quantify but there was a change. He looked more relaxed. He wasn’t pulling on his hair and rubbing his face as much and his nightmares and flashbacks were far less frequent. He seemed happier and talked more in therapy. He started to have more realistic expectations of himself and others, while focusing on his positive attributes. He tried to allow himself to be less perfect and less “scrupulous.” Although he was fearful, worried and hesitant, he tried new things and widened his “safe zone.” Before our sessions, he was afraid to go anywhere new, but he eventually visited his son in New England and took a trip to California with his wife to visit her children.

Before, his trips away from home were limited mostly to a theme park. He called this “my ultimate safe zone—a place to relax and have fun. I don’t have any scary dreams when I am there. I just feel free. I joke around and laugh with the kids.” I suggested to him that perhaps this was the one place that he allowed himself to lighten up, be juvenile and compensate for his lost childhood. I tried to get across to him that he could give himself permission to relax and enjoy life like he did in the theme park in other situations as well. At first, he complained that doing more would be out of his comfort zone and bring him into the unknown, which he found scary. However, he then came up with the phrase “experiment with life” and seemed more comfortable and less threatened by this way of describing his dilemma. He agreed that he would try to experiment more and his wife later said that he was doing so.

Medication helped Paul. He was most recently on an antidepressant. Perspective has helped. Education has helped. Exercising and a religious connection have helped. In an effort to have him share his story of abuse with someone other than myself, I asked him to speak with his priest and see what response he got. He agreed to do this. I hoped that the priest would further reduce Paul’s feelings of guilt, anxiety and shame.

Paul’s vignette illustrates some of the pain anxious people experience. It also highlights various treatment modalities. Next, we’ll look at steps to take and stories of several other special yet representative people as they share the anxiety in their lives with you. I will suggest possible solutions that they and I have used to relieve their anxiety, help them refocus, relax and enjoy life.