Yummies for Miss Bea (or Is a Deaf Cat Louder than Fear?)

I really liked the articles for this week. The idea of multiple vulnerabilities for a disorder is becoming more popular – but for good reason: it’s true! That being said, the notion of a genetic vulnerability paired with generalized and specific psychological vulnerabilities was not new to me.

What struck me was the differentiation between anxiety and panic. Of course these are similar concepts. But they are also different, but that difference was not always readily apparent to me. Thus, the explanations offered in the two articles offered some clarity.

First, I thought that Barlow’s term “anxious apprehension” for anxiety captures exactly what anxiety is quite well. The anxiety is always about something that might happen, that could happen, that will happen – but (usually) not about what is happening right this very second. Think about it. (I did.) Even if you are experiencing, say, performance anxiety, you are worried about what might happen during the performance – not what is happening at that second. I invite you to prove me wrong here. Is there a situation where the anxiety is about what is occurring right this very second? I say “no,” and so does Barlow who characterizes anxiety as a state of helplessness due to a “perceived inability to predict, control, or obtain desired … outcomes in … upcoming personally salient situations or contexts” (p. 1249, italics added).

What, then, is panic? Panic can be thought of as analogous to fear in that the threat is immediate. Thus, anxiety occurs in anticipation of fear or panic.

So, knowing this, I wanted to know how this all relates to anxiety disorders – especially Panic Disorder. This diagnosis has always been a little tricky for me to wrap my head around, and I’m not sure why. I understand the fundamentals of its manifestation (I have seen it) and I understand the diagnostic criteria (I think), but perhaps it was putting the two together that didn’t mesh well. And perhaps this is an artifact of the current diagnostic system. (I must admit, as an RA at Pitt, when giving the SCID and subsequently writing up diagnostic reports Panic Disorder – whether with or without Agoraphobia – was my arch nemesis.)

Imagine you are in your home. Imagine you haven’t left for days, weeks. You can’t. But you're out of [soy milk / carrots / cereal / toothpaste / tampons / some other necessity]. You need to go out. You need to go to the store. But you can’t go. You can't. You just can’t. Knowing that you need [insert necessity here] makes your heart race. You’ll need to go to the store. You need to drive to the store. What if there’s traffic? What if you need to make a left hand turn? What if there's construction and you don't know where to go? You’re having trouble breathing now. What if the store is crowded? What if you can’t find what you need? What if a store clerk asks to help you? What if you get anxious while you’re at the store? Of course you’ll get anxious while you’re there, you’re sweating already. What if you get so nervous you buy the wrong thing? What if you have a panic attack? What if you have a panic attack and you have to leave? What if you have to leave and you don’t get what you came for? What if you don’t get what you came for and you went out for nothing? And if you don’t get what you need, you’ll have to do it all again.

And what if you never get it right?

Ok. So here’s my issue. In the based-on-real-life-but-made-up example above, there is anxiety about having anxiety and anxiety about having a panic attack and during this anticipatory anxiety, panic-like symptoms appear. So is this panic or anxiety? I feel like I could make the case for either. I understand the distinction theoretically, but in real life not so much.

Another issue which I wish we covered is what it is, once the anxiety and panic is set in motion, that allows the person to function. For instance, the person in the above example had not left the house for about a month. Then this person was asked to cat-sit (for an extended period of time) for a deaf and equally anxious older feline whom we shall call Miss Bea (which is indeed the cat’s real name). Eventually Miss Bea started running out of food. Now, Bea, when she wants something, will ask for it. And being deaf, it seems as though she tries to be loud enough so she can hear herself. She can’t. But when she meows at the volume of Bea, the sound is ENORMOUS. Whatever it was, whether it be the enormity of the need or of the bond, Unnamed Anxious Person went out to get food. And continued to go out several times a week for the next few weeks to get something for this cat: special treats, toys, a comb, etc.

And so it goes Miss Bea is not my kitty anymore. Indeed, the Named Anxious Kitty will sit on the Unnamed Anxious Person’s bed and meow nervously (at least once a week) until her new (still nervous) owner returns from the store.

But… this unnamed anxious person is still anxious. Functionally there has been an improvement, but overall anxiety has improved little. Which brings me to the question that I had at the beginning of this class (and still has not been adequately answered): What does it mean to be “better”? What is improvement?