Subject Appears Anxious - NYTimes.com Year: 2007 Location: St. Louis, Mo. Participant (s): Subject (F; 42), Bystander, Emergency Medical Service Technicians, Luggage Porter, Flight Attendant Environment: Airport (interior) Observed Event (s): Subject is observed walking in an agitated manner, burdened with carry-on luggage.[1] Subject enters a ladies room, sits on toilet and begins to sweat and breathe shallowly. Subject suffers a prolonged bout of diarrhea. Subject exits ladies room (after washing hands) and lies down on a bench. Bystander approaches, expressing concern. Subject says she feels "very unwell."[2] Bystander leaves hurriedly. E.M.S. Technicians arrive and take Subject's vitals while asking Subject about her current condition. Subject expresses regret, shame and embarrassment. Technicians offer Subject a ride to the local hospital, which Subject declines. Technicians procure orange juice and suggest to Subject that she eat something "solid" as soon as possible. Luggage Porter wheels Subject's luggage to gate. Subject boards plane and takes her seat. Flight Attendant presents Subject with in-flight turkey sandwich. Subject eats turkey sandwich. Subject falls asleep. Overall Affect: Subject appears anxious. Conclusions: Subject is prone to escalating, same-day panic attacks. Public nature of distress and any special attention intensify rather than alleviate symptoms. NOTE: Airline food may be indicated as an effective treatment modality. [1] Wheel-less. [2] Subject reports having had a milder attack that morning in a motel restaurant during which she remembered thinking that an overly solicitous waiter "looked like a giant egg wearing a tie." Subject was unable to eat anything and suggested to the examiner that low blood sugar may have contributed to later airport episode. Year: 2001 Location: Sonoma/Napa, Calif. Participant (s): Subject (F; 36), Subject's Harsh Superego Environment: Rental Car (interior) Observed Event (s): Subject is observed climbing into a sub-compact class rental car after announcing to her family (whom she has been visiting for several days) that she is "going out for a while." Subject drives to the nearby Mayacama Mountain Range, which separates the picturesque Sonoma and Napa valleys in the heart of California's "wine country." Upon nearing a summit, Subject's Harsh Superego is observed moving from its position behind driver's seat into the front passenger seat. Harsh Superego begins to bait Subject repeatedly with the phrase, "You should kill yourself; just drive off the edge right now."[3] Subject parks at a lookout point, presenting with several symptoms including sweating, hand tremors and global rigidity. Subject exits vehicle and sits on a curb, where she engages in deep breathing for approximately 5 minutes. Subject returns to car and, prior to starting the engine, is observed turning to Harsh Superego and commanding it to "shut the hell up." Conclusions: Mixing family, cars and mountain ranges places Subject at considerable risk of attack and impulses toward self-harm. Subject should in general avoid operating heavy machinery while in close proximity to Harsh Superego. [3] Subject reports in this moment experiencing a blinding headache coupled with ambivalence. The was no guardrail, which made it seem easy. But there was also this spectacular view, which made me hesitate. Year: 1994 Location: Staten Island, N.Y. Participant (s): Subject (F; 29), Subject's Boyfriend, Holiday Shoppers Environment: Shopping Mall (interior) Observed Event (s): Subject and Subject's Boyfriend are observed entering a mall crowded with Holiday Shoppers. They pause next to a large artificial Christmas tree, check their watches and exchange a quick kiss.[4] The two separate. Subject is observed watching Boyfriend walk away. Subject next inserts foam earplugs into her ears. Subject removes a scrap of paper from her pocket and studies it, looking concerned. Subject enters a store and examines the price tag on a pair of ISOTONER® gloves. After a 90-minute period of non-committal browsing, Subject is next seen engaged in "anxious flight." She hovers briefly near the Christmas tree, checks her watch and then makes a quick circuit of store entrances, peering inside for something or someone (Boyfriend?).[5] Subject, who appears to be fighting back tears, leaves the mall after a considerable pause at the exit and catches a bus home, where she pours a large scotch and assumes a prone position on the couch. Conclusions: Christmas is not for everyone. A case of "holiday blues" that is exacerbated by prolonged exposure to "mindless consumerism"[6] is a pathology that is mildly relevant at best given Subject's other issues. [4] The consensus among research team members is that this kiss was "stilted," "self conscious" and "awkward." [5] Subject confirmed. [6] Subject's post-observation statement: "I felt the emptiness of the holiday, crushing me like a weight - the pressure to express gratitude and affection through kitchen tongs and earmuffs." Year: 1989 Location: Upper West Side, Manhattan Participant (s): Subject (F; 24), Subject's Family Members, Bystanders Environment: Unknown Restaurant[7] (interior) Observed Event (s): Subject is seated with Family Members. Her chair is against wall and pinned in by other diners on either side. As restaurant lights are dimmed, Subject is observed sweating and falling silent.[8] When addressed, Subject answers monosyllabically, occasionally displaying a slight stammer. Over the course of the meal, Subject appears to lack appetite and picks at food. Observers detect the smell of smoke. Subject appears increasingly concerned, as do some Bystanders. A waitperson assures Subject and Family Members that there is no need for worry. The smell of smoke becomes more pronounced. Bystanders appear mildly alarmed. The ambient noise level increases. Subject looks in pain. Waitpersons offer more assurances. Then smoke becomes visible at one side of the restaurant. A waitperson announces, "There is a small fire next door, but it's under control. There's no need to panic. Some patrons get up to leave. Subject is observed gazing at a table of diners nearby who are engaged in an argument. Subject is smiling.[9] Conclusions: Although Subject benefited greatly from social affect comparison, this coping strategy is unreliable given its random nature and near-total dependence on others' accidental misfortune and/or incidence of environmental threat or disaster. [7] Very expensive. [8] Subject reports having experienced a "sense of doom, dropping in front of me like a curtain, obscuring all other feelings." Subject also reports having a sense of unreality and separation from people and surroundings. Also reported: slight vertigo; tunnel vision; feelings of dread. [9] Subject describes having felt "a kinship, a sort of bliss" in this moment. Subject: "This was the first time I was ever surrounded by people who were much more freaked out than I was. Watching them get frightened, my symptoms lifted. Others had to bear the burden, to feel for once what I always felt. I felt superhuman, privileged, normal and everyone else was like the usual me. Year: 1973 Location: North Beach, San Francisco, Calif. Participant (s): Subject (F; 8), Subject's Father, Subject's Sister Environment: Pizzeria Restaurant (interior) Observed Event (s): Subject, Subject's Father and Subject's Sister are seated in a booth along the rear wall of a popular pizzeria restaurant, with an extremely vivid and large mural depicting presumably Italian persons eating pizza. Subject reports feeling already slightly nauseated from a combination of lack of adequate caloric intake coupled with experiential stress and interpersonal events from earlier in the day.[1]0 Subject seems mesmerized by the wall mural and is observed sweating and falling silent. Subject is rigid and displays a stricken expression.[11] Conclusions: Subject's inability to manage, process or express overwhelming emotions immediately will eventually manifest as extreme anxiety/panic. [10] In that event, Subject and Subject's Sister were observed running behind Subject's Father during a rushed, even somewhat frantic, shopping trip through Cost Plus to furnish a newly acquired rental apartment secured as a living space during Subject's parents' "trial separation." Subject's Father was seen impulsively purchasing an assortment of improbable items - including decorative dried Pampas grass - and "throwing" [Subject] the goods into a shopping cart. Subject reports feeling worried that Subject's Father was "angry, perhaps also sad." Subject also reports wondering if Pampas grass was purchased "to impress someone, like a girlfriend." Later, in said rental apartment's bathroom, Subject secretly perused a Playboy magazine with a mixture of fascination, arousal, confusion and mild disgust. [11] NOTE: First lifetime incidence of panic. Subject reports that she "did not know what was happening" and thought, "this is what it feels like to die." Julie Threlkeld is a writer, storyteller and stand-up comedian. She no longer suffers from panic attacks.