How to care for me if I am freaking the fuck out.
I have occasional panic attacks. There are a lot of things that build up my nervousness and erode my control and deplete my resources, and eventually, this will result in a panic attack. Sometimes they just happen by themselves with no warning and no obvious cause. Some are primarily physical, some are primarily psychological, and some are a lot of both. Each of these feels very different and requires different things from me to manage, but all, in a word, suck.
People close to me, folks Captain Awkward would say are on Team Me, have expressed a desire to know how to deal with it when I am having one, so they can help. I'm so incredibly grateful to have such awesome friends.
Belatedly, here is the caresheet.
If I am having a panic attack, quick version.
TALK TO ME!!! About anything but the current situation. This is the single best thing you can do.
Don't feel guilty, and don't freak out worrying. This just happens sometimes. It will pass.
Ask what you can do. Check in every 15-20 minutes.
If I feel sick, make sure I can get to a bathroom. I probably won't barf, but who wants a mess? Sorry in advance.
Do not touch! Let me initiate.
Get me something to touch. Ice and a blanket, stuffed animals, and very calm pets are all first-rate options. (Excitable pets, not so much.)
I might need my meds. I usually carry several 1mg clonazepam pills with me in a tic-tac container. Sometimes a single loose pill in a pocket. They're small, seafoam blue-green pills.
I may need to lay down somewhere quiet and dark. I may fall asleep. This is normal and okay.
I may cry. Leaky no-sobbing tears are tension release and are only moderately bad. I'm still in control Actual sobbing is very, very bad. Contact the person I came with. Otherwise, keep talking to me and stay calm. I know it looks scary, but aside from being miserable I'm actually okay. If I do not have meds, get someone to bring them to me.
Do not transport. While having a panic attack, CARS VERY BAD. I will not get in one. If I am in one, you may need to pull over.
Get me home once it's over. I may need a ride. You can call my husband or my dad if you need to.
If I am having a panic attack, long version:
Don't feel guilty! You didn't cause it!
Don't let it fluster you too much. It's not cause for alarm. Remember: for you, it's something new and weird that I am doing. For me, it's a normal thing that happens sometimes. It's unpleasant and it will pass. I will be very sorry about it later.
Asking "Are you okay?" is really kind of you, and I appreciate your concern. You are on the right track, and I will try to be honest with you when you ask. Sometimes I suck at this, though, because I WANT to be okay and not inconvenience people.
A useful question, if I am not okay or you think I might not be okay, is "How bad is it? Scale of one to five?" What you really want to know is how not-okay I am.
0 = Normal background anxiety.
1 = First real discomfort. You don't need to worry, and it will probably go away.
2 = I am definitely uncomfortable and unhappy. I have deployed my personal coping mechanisms. It may go away, but it may not.
3 = I have a problem, and you should distract me and think about getting me somewhere safe. I may take a clonazepam to prevent it from worsening.
4 = This shit is not fucking around. I need my medication, period, and I need to get somewhere safe. Most of my bad ones are only at a 4.
5 = This is really bad. I am probably a total mess at this point. I will need medication, and you will have to do damage control on-site, without transporting me until I say I can take it. I am really, really sorry about this. Seriously, so fucking sorry.
I understand you probably don't know what to do! So, it's okay to ask! It isn't awkward or nosy. I will tell you what I need, or I will say "I don't know." The latter doesn't mean I'm too far gone for you to help me or anything. It just means I'm trying to figure out where I'm at, and what options might be available. Don't panic, don't push. I'll tell you when I know. Check back in 15 or 20 minutes.
When a panic attack is manifesting physically, I often get super-nauseated. Distracting (see below) helps. Counting forwards or backwards actually helps, especially in another language. I can only do this in Spanish and Italian. I've only barfed twice during a panic attack, twice in 15 years, but I'm borderline emetophobic, so I'm probably going to be pretty worried about it. Tell me it's okay to barf if I have to, make sure I can get to a bathroom, and let it go. Let's talk about possums!
Don't touch me unless I say it's okay to touch me, but don't be afraid to talk to me!
Talking to me is probably the single most helpful thing anyone can do to make me feel safe! Being talked to about something else entirely is really, really helpful! Ask me about my art, my writing, my favorite movies, my pets, my characters, whatever.
The dorky truth: when it is very, very bad, directly addressing my imaginary people, if you know them, has good odds of working well enough to pull me out of a complete freeze or total meltdown long enough for me to take action. You might have to deal with their grumbling, but they aren't too bad, I promise. Some are downright sweethearts. Try the Baron (your best bet), try Horatio, try whoever you know I am currently playing. In that order. (Yes, this is dorky as hell, and it is actually kind of embarrassing to put it down, but it is sometimes super-effective. Deploy it, but be respectful about it. They aren't "real," as such, but they are part of me. We don't take kindly to being treated poorly.)
If I'm too shaky to talk back much, talk about your favorite movie, describe your favorite vacation in detail, tell me about an interesting hobby you have, tell me about your cats, talk about your story you are writing, your favorite series of books, whatever. Seriously. I honestly it doesn't matter how irrelevant it is. It will be helpful (even if it does not look like it is helping). You don't need to be interesting or make me laugh. I swear to you, I will not be bored. You could be describing the contents of a tube of toothpaste, and I would be riveted. Talk to me about something other than the freakout. Ask me relatively simple questions to encourage me to talk, but I may not be able to do more than yes/no. Adjust settings accordingly.
Don't ask me to talk about the panic attack or whatever set it off while I am still having the panic attack. It's important for me to figure out what caused it, yes, but that doesn't do any good while it's happening. Identifying the cause takes a back seat to not making it worse.
Ask me what I need you to do. Please ask again after ten or fifteen minutes. I sometimes become too frozen up to ask for help. I also sometimes lose track of time, and if I don't know how long I've been freaking out, I don't know when to apply countermeasures.
A drink of water helps sometimes. So does being able to rub something cold on my wrists/neck. If you see me doing this with ice, and the room isn't sweltering hot, it likely means I'm trying to head something ugly off at the pass while it's still a good ways away. Come talk to me about something else!
Being able to lean against someone sometimes helps, or being leaned against. It is important that this is body contact and pressure, but not actually being held, which actually makes things worse very quickly. No tentacles, please. No pushing, pulling, or restraining. I am a spooked animal. Pressure, contact. Slow motions. No grabbing! If I need you to squeeze me, I will totally ask!
I get cold sometimes, and a blanket or towel to wrap myself in can be really helpful, both for warmth, and to hide under.
A stuffed toy or soft cushion to hold on to are often really helpful, especially if they have velvety, furry, or microsuede-like textures. Like, shockingly helpful. So are friendly but calm pets. I prefer cats because cats can purr and generally don't move around much, but calm dogs are sometimes okay.
If I've been having a bad reaction for more than half an hour, I absolutely need a clonazepam. I keep my drugs in a tic-tac box in a front jeans pocket or a jacket pocket. If you can't find them, ask me where they are. I usually have one on me somewhere. My clonazepam looks like a pale seafoam blue-green pill a bit smaller than the end of an eraser. Flat, beveled edges, score line on one side, numbers on the other. They are 1 mg each. I carry anywhere from two to five. Give me ONE. Clonazepam is very strong. About five times stronger than Valium. It starts working in about 10-30 minutes, and peaks from one to two hours after I take it. If I have already taken one earlier in the day, it is safe to give me another. No more than that unless I say it's all right. I may occasionally take two, which will mean I will have to be driven home, and if that cannot happen, I will need someplace to lay down and sleep.
If I can lay down someplace quiet, that's great. If I manage to fall asleep, it's 100% okay to wake me unless I've said otherwise, but a little sleep often helps a lot, so if you can leave me there for a half hour to an hour or so, and then come and check on me and make me drink some water, that's great. I guarantee it will have helped A LOT. It's okay to come and wake me. Waking up alone can be creepy. Waking up suddenly is really unpleasant. Waking up to the sound of other people in the house just doing their thing is ideal; it assures me I am not alone, but allows me time to compose myself and re-engage at my leisure. Waking up gently with somebody there is all right.
To wake me: push down firmly on the corner of the bed and if I don't respond to the weight, touch my leg just above the knee with a firm but gentle grip and shake gently. (Yes, it's that specific. Very, very rarely, when someone startles me awake, I will kick or grab for whoever/whatever is touching me. I can't reach you if you are at the corner of the bed, or if you are standing too close to kick and just out of arm's reach, hence the just above the knee. My actual knees are really ticklish.)
During a panic attack, there may be tears of tension release. Not sobbing, just my eyes leaking. This is a thing that happens and it's normal for a panic attack, even if it's not fun. Check in. If I say "It's nothing, it's just a tension thing," I mean that. It's like a runny nose. Don't let it upset you too much.
Sometimes the leaking does mean that I am trying as hard as I can to hold back something VERY nasty. If I say I am barely hanging on, or if I'm flat-out sobbing-crying, we may have a big problem. My husband is a "safe person," as are my close friends. I'll need my meds, proabbly. Get me away from other people, if that is possible, or get me with my back to a wall in a quiet corner. If I am at an event with someone, they are probably a "safe person." Find that person and hand me over to them. This has never happened, but it's good to lay this stuff out.
If I don't have a ride, or if I have to take a clonazepam, I will either need to rest it off, or have someone drive me home. Call my husband or my bff or my father (check my cell under ICE or Emergency Contact, check my wallet for a red card with numbers and medical information on it). This has never happened but, again, it's good to be prepared. Yes, you can tell my husband and my friends and even my dad what I was doing, even if I was at the BDSM club. It's totally, totally cool.
Just, you know, please make sure I have clothes on if it's my dad.
Don't try to transport me while I'm having a panic attack. Wait until it stops. If I am in a car when it happens, be ready to pull over if you have to, otherwise, keep driving unless I tell you to stop.
And, finally: I have been dealing with my panic crap for way longer than anyone else, and even I haven't found the Exact Right Thing to do. Don't worry so much about getting me out of it as getting me through it. Trying to stop me from panicking is not actually going to help, because I am already panicking. What I need is to feel safe while I wait it out. See, it isn't a thing that anyone else can stop. It's a thing I need to be gently supported through until I can stop it, or until it stops on its own. And, eventually, 100% of the time, it will stop.
All this is what works for me. Other people have other tolerances, their panic attacks will feel different to them than mine feel to me. If you have a friend who has to deal with this crap, it'd probably be a huge help if you'd ask them if there's anything you should know about how to help them when these things happen. And they do happen. It sucks, but it's no big.
I, and everyone else who lives with this, wish I were different. If I could snap my fingers and not be crazy, I would do it so fast. Alas, I can't become the kind of person who doesn't have these at all, ever. The best I can do -- and it is pretty damn good -- is to learn to cope with them and hopefully avoid them altogether for long periods of time. So, y'all are stuck with me as I am.
All I really ask is patience and understanding, and the acceptance of the fact that, if you are friends with me and spend any amount of time with me, there will be the occasional inconvenience and disappointment when I have to go home Right Now or can't make it to an event because I can tell it would be a bad idea.
I feel bad about that until I think about my friends, and how little it would be for them to ask this of me -- like, seriously, is that even an issue? -- and then I don't feel so bad. When you are a person with panic issues, it makes a huge, huge difference to know that you aren't going to be ostracized and people aren't going to be mad at you just because your brain chemistry decides to mess with you all of a sudden.
X-posted from Dreamwidth. Comment count:
People close to me, folks Captain Awkward would say are on Team Me, have expressed a desire to know how to deal with it when I am having one, so they can help. I'm so incredibly grateful to have such awesome friends.
Belatedly, here is the caresheet.
If I am having a panic attack, quick version.
TALK TO ME!!! About anything but the current situation. This is the single best thing you can do.
Don't feel guilty, and don't freak out worrying. This just happens sometimes. It will pass.
Ask what you can do. Check in every 15-20 minutes.
If I feel sick, make sure I can get to a bathroom. I probably won't barf, but who wants a mess? Sorry in advance.
Do not touch! Let me initiate.
Get me something to touch. Ice and a blanket, stuffed animals, and very calm pets are all first-rate options. (Excitable pets, not so much.)
I might need my meds. I usually carry several 1mg clonazepam pills with me in a tic-tac container. Sometimes a single loose pill in a pocket. They're small, seafoam blue-green pills.
I may need to lay down somewhere quiet and dark. I may fall asleep. This is normal and okay.
I may cry. Leaky no-sobbing tears are tension release and are only moderately bad. I'm still in control Actual sobbing is very, very bad. Contact the person I came with. Otherwise, keep talking to me and stay calm. I know it looks scary, but aside from being miserable I'm actually okay. If I do not have meds, get someone to bring them to me.
Do not transport. While having a panic attack, CARS VERY BAD. I will not get in one. If I am in one, you may need to pull over.
Get me home once it's over. I may need a ride. You can call my husband or my dad if you need to.
If I am having a panic attack, long version:
Don't feel guilty! You didn't cause it!
Don't let it fluster you too much. It's not cause for alarm. Remember: for you, it's something new and weird that I am doing. For me, it's a normal thing that happens sometimes. It's unpleasant and it will pass. I will be very sorry about it later.
Asking "Are you okay?" is really kind of you, and I appreciate your concern. You are on the right track, and I will try to be honest with you when you ask. Sometimes I suck at this, though, because I WANT to be okay and not inconvenience people.
A useful question, if I am not okay or you think I might not be okay, is "How bad is it? Scale of one to five?" What you really want to know is how not-okay I am.
0 = Normal background anxiety.
1 = First real discomfort. You don't need to worry, and it will probably go away.
2 = I am definitely uncomfortable and unhappy. I have deployed my personal coping mechanisms. It may go away, but it may not.
3 = I have a problem, and you should distract me and think about getting me somewhere safe. I may take a clonazepam to prevent it from worsening.
4 = This shit is not fucking around. I need my medication, period, and I need to get somewhere safe. Most of my bad ones are only at a 4.
5 = This is really bad. I am probably a total mess at this point. I will need medication, and you will have to do damage control on-site, without transporting me until I say I can take it. I am really, really sorry about this. Seriously, so fucking sorry.
I understand you probably don't know what to do! So, it's okay to ask! It isn't awkward or nosy. I will tell you what I need, or I will say "I don't know." The latter doesn't mean I'm too far gone for you to help me or anything. It just means I'm trying to figure out where I'm at, and what options might be available. Don't panic, don't push. I'll tell you when I know. Check back in 15 or 20 minutes.
When a panic attack is manifesting physically, I often get super-nauseated. Distracting (see below) helps. Counting forwards or backwards actually helps, especially in another language. I can only do this in Spanish and Italian. I've only barfed twice during a panic attack, twice in 15 years, but I'm borderline emetophobic, so I'm probably going to be pretty worried about it. Tell me it's okay to barf if I have to, make sure I can get to a bathroom, and let it go. Let's talk about possums!
Don't touch me unless I say it's okay to touch me, but don't be afraid to talk to me!
Talking to me is probably the single most helpful thing anyone can do to make me feel safe! Being talked to about something else entirely is really, really helpful! Ask me about my art, my writing, my favorite movies, my pets, my characters, whatever.
The dorky truth: when it is very, very bad, directly addressing my imaginary people, if you know them, has good odds of working well enough to pull me out of a complete freeze or total meltdown long enough for me to take action. You might have to deal with their grumbling, but they aren't too bad, I promise. Some are downright sweethearts. Try the Baron (your best bet), try Horatio, try whoever you know I am currently playing. In that order. (Yes, this is dorky as hell, and it is actually kind of embarrassing to put it down, but it is sometimes super-effective. Deploy it, but be respectful about it. They aren't "real," as such, but they are part of me. We don't take kindly to being treated poorly.)
If I'm too shaky to talk back much, talk about your favorite movie, describe your favorite vacation in detail, tell me about an interesting hobby you have, tell me about your cats, talk about your story you are writing, your favorite series of books, whatever. Seriously. I honestly it doesn't matter how irrelevant it is. It will be helpful (even if it does not look like it is helping). You don't need to be interesting or make me laugh. I swear to you, I will not be bored. You could be describing the contents of a tube of toothpaste, and I would be riveted. Talk to me about something other than the freakout. Ask me relatively simple questions to encourage me to talk, but I may not be able to do more than yes/no. Adjust settings accordingly.
Don't ask me to talk about the panic attack or whatever set it off while I am still having the panic attack. It's important for me to figure out what caused it, yes, but that doesn't do any good while it's happening. Identifying the cause takes a back seat to not making it worse.
Ask me what I need you to do. Please ask again after ten or fifteen minutes. I sometimes become too frozen up to ask for help. I also sometimes lose track of time, and if I don't know how long I've been freaking out, I don't know when to apply countermeasures.
A drink of water helps sometimes. So does being able to rub something cold on my wrists/neck. If you see me doing this with ice, and the room isn't sweltering hot, it likely means I'm trying to head something ugly off at the pass while it's still a good ways away. Come talk to me about something else!
Being able to lean against someone sometimes helps, or being leaned against. It is important that this is body contact and pressure, but not actually being held, which actually makes things worse very quickly. No tentacles, please. No pushing, pulling, or restraining. I am a spooked animal. Pressure, contact. Slow motions. No grabbing! If I need you to squeeze me, I will totally ask!
I get cold sometimes, and a blanket or towel to wrap myself in can be really helpful, both for warmth, and to hide under.
A stuffed toy or soft cushion to hold on to are often really helpful, especially if they have velvety, furry, or microsuede-like textures. Like, shockingly helpful. So are friendly but calm pets. I prefer cats because cats can purr and generally don't move around much, but calm dogs are sometimes okay.
If I've been having a bad reaction for more than half an hour, I absolutely need a clonazepam. I keep my drugs in a tic-tac box in a front jeans pocket or a jacket pocket. If you can't find them, ask me where they are. I usually have one on me somewhere. My clonazepam looks like a pale seafoam blue-green pill a bit smaller than the end of an eraser. Flat, beveled edges, score line on one side, numbers on the other. They are 1 mg each. I carry anywhere from two to five. Give me ONE. Clonazepam is very strong. About five times stronger than Valium. It starts working in about 10-30 minutes, and peaks from one to two hours after I take it. If I have already taken one earlier in the day, it is safe to give me another. No more than that unless I say it's all right. I may occasionally take two, which will mean I will have to be driven home, and if that cannot happen, I will need someplace to lay down and sleep.
If I can lay down someplace quiet, that's great. If I manage to fall asleep, it's 100% okay to wake me unless I've said otherwise, but a little sleep often helps a lot, so if you can leave me there for a half hour to an hour or so, and then come and check on me and make me drink some water, that's great. I guarantee it will have helped A LOT. It's okay to come and wake me. Waking up alone can be creepy. Waking up suddenly is really unpleasant. Waking up to the sound of other people in the house just doing their thing is ideal; it assures me I am not alone, but allows me time to compose myself and re-engage at my leisure. Waking up gently with somebody there is all right.
To wake me: push down firmly on the corner of the bed and if I don't respond to the weight, touch my leg just above the knee with a firm but gentle grip and shake gently. (Yes, it's that specific. Very, very rarely, when someone startles me awake, I will kick or grab for whoever/whatever is touching me. I can't reach you if you are at the corner of the bed, or if you are standing too close to kick and just out of arm's reach, hence the just above the knee. My actual knees are really ticklish.)
During a panic attack, there may be tears of tension release. Not sobbing, just my eyes leaking. This is a thing that happens and it's normal for a panic attack, even if it's not fun. Check in. If I say "It's nothing, it's just a tension thing," I mean that. It's like a runny nose. Don't let it upset you too much.
Sometimes the leaking does mean that I am trying as hard as I can to hold back something VERY nasty. If I say I am barely hanging on, or if I'm flat-out sobbing-crying, we may have a big problem. My husband is a "safe person," as are my close friends. I'll need my meds, proabbly. Get me away from other people, if that is possible, or get me with my back to a wall in a quiet corner. If I am at an event with someone, they are probably a "safe person." Find that person and hand me over to them. This has never happened, but it's good to lay this stuff out.
If I don't have a ride, or if I have to take a clonazepam, I will either need to rest it off, or have someone drive me home. Call my husband or my bff or my father (check my cell under ICE or Emergency Contact, check my wallet for a red card with numbers and medical information on it). This has never happened but, again, it's good to be prepared. Yes, you can tell my husband and my friends and even my dad what I was doing, even if I was at the BDSM club. It's totally, totally cool.
Just, you know, please make sure I have clothes on if it's my dad.
Don't try to transport me while I'm having a panic attack. Wait until it stops. If I am in a car when it happens, be ready to pull over if you have to, otherwise, keep driving unless I tell you to stop.
And, finally: I have been dealing with my panic crap for way longer than anyone else, and even I haven't found the Exact Right Thing to do. Don't worry so much about getting me out of it as getting me through it. Trying to stop me from panicking is not actually going to help, because I am already panicking. What I need is to feel safe while I wait it out. See, it isn't a thing that anyone else can stop. It's a thing I need to be gently supported through until I can stop it, or until it stops on its own. And, eventually, 100% of the time, it will stop.
All this is what works for me. Other people have other tolerances, their panic attacks will feel different to them than mine feel to me. If you have a friend who has to deal with this crap, it'd probably be a huge help if you'd ask them if there's anything you should know about how to help them when these things happen. And they do happen. It sucks, but it's no big.
I, and everyone else who lives with this, wish I were different. If I could snap my fingers and not be crazy, I would do it so fast. Alas, I can't become the kind of person who doesn't have these at all, ever. The best I can do -- and it is pretty damn good -- is to learn to cope with them and hopefully avoid them altogether for long periods of time. So, y'all are stuck with me as I am.
All I really ask is patience and understanding, and the acceptance of the fact that, if you are friends with me and spend any amount of time with me, there will be the occasional inconvenience and disappointment when I have to go home Right Now or can't make it to an event because I can tell it would be a bad idea.
I feel bad about that until I think about my friends, and how little it would be for them to ask this of me -- like, seriously, is that even an issue? -- and then I don't feel so bad. When you are a person with panic issues, it makes a huge, huge difference to know that you aren't going to be ostracized and people aren't going to be mad at you just because your brain chemistry decides to mess with you all of a sudden.
X-posted from Dreamwidth. Comment count: