Lecturer with anxiety. How to survive in academia? I've been a long time member of academia.SE but I created this alt account because the question is a bit embarrassing. I finished my PhD 4 years ago and after a 2 year postdoc at a different university secured a contractual lecturership. During my PhD I never realised I had fear of public speaking, because I always felt secure presenting in front of my supervisor. Even at conferences, his presence in the audience was enough to keep me relaxed.

Fast forward to my postdoc, I was mostly working and publishing by myself. So, even if I had to present something it was to my coauthors, with which I am okay. But as a lecturer doing research part of my time, I am involved in projects and seminars where I am expected to present my latest work. Being on my own has brought out my inner anxiety, so much so that I choked during a presentation, had to drink water to calm my nerves and apologise for my breathlessness and slurred speech. That was the most embarrasing thing in my life. Please note that the anxiety is not the result of me not publishing or doing research. I have published more than most in my department. Knowing that hasn't helped with the anxiety though. I am constantly making excuses to get out of project presentations and seminar talks. Fortunately, the anxiety is less intense in teaching and I am able to manage. 

How do I survive as an academic? Now even conference presentations seem daunting. I can publish exclusively in journals, but how do I get out of giving project and departmental presentations? How can I politely refuse to present without revealing my situation? Or better yet, how do I fix the whole thing? That one bad presentation has really messed me up.
Years ago, I gave up on the idea of a career in music when I developed severe performance anxiety. After I gave a terrible performance in front of a large crowd, I decided the thing I was going to do was 'face my fear' by signing up for something even scarier and going through with it. Result: an even more terrible performance in front of an even larger crowd, which I had nightmares about for ages, and I never performed again. So I know the feeling and can tell you that - based on my experience, anyway - throwing yourself off the deep end might be counterproductive. Suggestions instead:

Talk to colleagues about the issue, especially those you're close to and/or those who are openly supportive of mental-health stuff. I get the feeling that this is more common than most academics generally let on. I once watched an absolute legend of a faculty member in my subfield admit to considerable nerves in front of an unfamiliar crowd, which astounded me but shouldn't have.

Professional assistance: As 101010111100 says in a comment, it might be worthwhile to see if you can find a therapist who'll be on your side and work with you to find a way through or around this.

Toastmasters? I watched a former student of mine with major social anxiety gradually work through it with the help of a local group. The student went to a meeting and said nothing, and then went to another meeting and said nothing, and then introduced themself, and then gave a 10-second speech, and little by little practiced low-stakes public speaking until the idea of doing it felt a whole lot less terrifying.

Remind yourself about the 'spotlight effect': Not that I want to sound as if I'm trying to trivialize your feelings, but odds are that your audience paid a whole lot less attention than you did to your embarrassment. In general no one will notice a verbal slip-up or two, and even if you do come across as nervous or choke on water partway through, the audience is likely to be thinking much more about the content of your presentation rather than your delivery and state of mind. I saw a fascinating talk at a conference last spring and at lunchtime congratulated the undergraduate who gave it. The student blushed and admitted to an immense amount of embarrassment over having been so nervous. I said that while I could see some nerves in the presentation, I was thinking so hard about what was being talked about that I didn't care (beyond hoping the presenter remembered to breathe).