Saturday, October 2, 2010

Panic and Suffocation

The problems with breathing, the shortness of breath and panic in the face of suffocation are rampant among my patients. Most of it stems from real suffocation at birth where for many reasons there wasn’t enough oxygen for the newborn. The most frequent reason was the massive anesthesia given to the mother or heavy doses of painkillers which effectively shut down the neonate’s breathing. Even epidurals can cause the shutdown. The baby cannot catch its breath. And because of that there is a panic state as death approaches. It is the same panic that adults suffer from time to time; a state that seems to come out of nowhere. Anything that is suffocating, even a biology class or a crowded noisy restaurant can set it off. The breathing problems are part of the reaction syndrome to lack of air early on. It would seem that it all comes out of the blue but in reality it is a reaction. Nearly always a reaction since panic is not a natural state in us humans. The question is “a reaction to what?”. If only we therapists could get use to asking “to what?”. Instead, we often stop there and begin our regime of suppression with pills. We are suppressing memory, and access to ourselves and our feelings.

There is research into this subject that claims it happens when a trigger is set off erroneously. It is not erroneous. It is precise, albeit symbolic. The feeling is the same whether in a room with lowered oxygen or in a crowded noisy restaurant. What is most likely to trigger off panic is the feeling of being trapped, stuck and unable to escape. Being in a situation that evokes all that; being trapped at the DMV in an interminable line and when you get to the counter they tell you that you need to fill the papers better. Or worse, being trapped in a home with rules and discipline and no love. Or being trapped in a job that has no future and no “room to expand.” That is the compounding factor. There are many ramifications that ultimately trigger off the earlier imprints. Being in a car with windows closed can do it, or in a room that is very stuffy. All roads lead to Rome. Sometimes just a passing thought can trigger the panic and the person is not even aware of what that thought was.

There is real suffocation and often the compulsive sighing that goes along with it. I call it the “Jewish mother-in-law syndrome.” But what seems to happen is fluctuations in what is known as the PC02 and lactate. PC02 is an index of the partial pressure of carbon dioxide and tells us how much carbon dioxide is in the blood. When they are high there is also a higher level of lactate and the result is the physiology of panic.

And what is this trigger? Remember there are higher levels than the pure physiologic one. And each higher level represents the basic brainstem reaction in its own way. Each higher level of the brain adds a different quality to an experience. So the second-line feeling system adds emotional tone and images, while the neocortex puts it all to words. And it works in reverse. A certain emotional situation or certain words addressed to the person, a demand or an insult, can run down the chain and trigger off the original panic. The origin is so deep down and so remote as to make the reaction a mystery. With deep personal access it no longer is a mystery.

Thus, the imprint of suffocation changes the physiology toward panic. Deep breathing diminishes panic for the moment. As does primal because a session that includes heavy breathing and crying lowers the levels. Later on, it will be painkillers (opioides) that will suppress panic; yet it is the deregulated painkilling chemicals associated with the early suffocation at birth that are partly to blame.

I have discussed the compounding process elsewhere; a lack of love, an oppressive household, an overprotective, suffocating mother can all add to the symptom. A mother’s real love and affection early on can also diminish the force of panic attacks by raising the inhibitory/repressive chemicals in the brain. There is an important difference between a suffocating, over-protective mother and one that offers true love. I had a mother like that; she had a terror of her kids getting sick and her having to take care of them. So she watched over them all of the time, never giving them freedom to make a mistake, i.e., suffocation.

There was, and is, a window of healing. To achieve that now means traveling down the chain of pain to origins and opening the window again. Otherwise, we are only left with pushing down the panic which can go on for a lifetime. What makes it all worse is when the mother is distant and unloving with her baby. It is why some children go into panic as soon as they cannot see their mother. It triggers off, perhaps, the anoxia again. A lifetime of disordered breathing can be set off during this critical window. This may be due to affects on some brainstem structures such as the medulla. In short, breathing difficulties can be first line symptoms, which can only be treated by descending down the levels of consciousness to the first line.

Let’s not make the mistake of considering the panic syndrome a maladaptive response. It is perfectly adaptive and commensurate with the asphyxiation that went on at birth or before. It would be abnormal if there were no “abnormal response.” When someone shuts off our air we all get panicky. That means we have triggered off our alarm system; cortisol pours into the system as we get ready to flee. And what we are fleeing from? Our memory.

Don’t be mislead about taking pills or shots to push down the panic. Pushing it back is not the same as erasing it. It stays and gnaws away until other organs, not the least of which is the heart, cease to function properly.


  1. OMG, this is the story of my life and my being!thanks Art

  2. As a kid as part of a game (mainly with siblings) we use to get in between 2 foam matresses (covering the body and head), and then we would have someone on top of them/you so that you could not get out or breathe properly. In about 10-15 seconds it would trigger a feeling of suffocation and panic--then the guy on top of you would have to get off immediately, because that panic would otherwise become outright terror. I suppose we were playing around with our birth imprints. Maybe a not-so-symbolic act-out?

    Another curiosity for when I was a teenager. There were times when I would wake up in the middle of the night where my system had literally shut down the "breathing instinct". I would have to "kick" my system into breathing by force of conscious will! No doubt more imprint stuff - well, the same imprint.

    At the risk of getting a bit boring, it's also curious the way I listen to driving dance-type music...I hold my breath for a period then breathe heavily, as a cyclic process throughout the song I'm listening to. No doubt more birth acting-out. Of course you could indentify patterns with "primary traumas" in just about anything we do.

    To say, I'm also suspicious that our tendancy to hold our breath when we are intensly focused on something may have something to do with oxygen-deprivation imprints as well? I.e. the relationship between anticipation and the saying "Don't hold your breath!".

    (For the record, my mother took No2 gas when in labour with me. There was a point where the nurse screwed up and accidentally gave her an overdose that she nearly passed out from, possibly creating the oxygen issue...other than that my birth was apparently "easy")

  3. Their explanation of this increase of oxygen for the cells is that with few CO2 in the blood the binding between hemoglobin and oxygen is very strong,which makes it hard for the cells to get it.
    With more CO2 in the blood these bindings are loose and that gives better release for the cells.

  4. I always felt very relaxed and comforted by the feeling of being squashed between two mattresses. I would wait for as long as possible until the air was too stale. I didn't want to get out! When it was Andrew's turn to be squashed, it would only be a few seconds before I could hear his muffled voice "Get off!! Get off me now!!"
    I had a curious experience when I was doing some extreme caving with some friends who had been convinced by a daredevil to try it. I was only doing it to spend time with a girl who was joining us. Each person was required to wriggle through a very narrow and long horizontal tunnel (very deep underground). It was so narrow that the only way to get through was to keep your arms by your sides and wriggle like a grub, and each time your shoulders get jammed you have to wriggle like hell. I got tired half way through, as it was a very long tunnel, so I stopped to have a rest. I was completely wedged in. As I lay there, in total darkness, I felt cosy and protected. I liked the feeling of being tightly cocooned deep underground, protected by all that solid, permanent rock. Weird huh?
    When I finally got out the other end and joined up with the others (still underground) some of them talked about how much they dreaded having to go back through the tunnel. Then somebody mentioned something about cavers having full-blown panic attacks in that tunnel.
    Of course I can't draw any insights from this experience because I have never fully experienced a birth-related memory/feeling, but I know that I was born very suddenly and came out like a missile....SPLOSH! My biggest fear is lying outside, in a huge open field, looking up at the sky. You want a panic attack? You got it.
    Maybe the mattresses and tunnel were not birth-related at all. Maybe I just needed a hug. Who knows.
    Art, I don't think you would've had much fun on that caving adventure! By the way, I hope you are doing ok in hospital.

  5. Very interesting ideas on causes of Panic disorder. I have suffered from this problem for 40 years, and there seems to be no cure for it. I came to a conclusion long ago that my trouble with anxiety and panic stems from brain damage of some sort that occurred as the result of having a difficult birth. I was dyslexic and constantly nervous as a child, and still have symptoms of ADD (inability to concentrate unless I'm in a totally quiet, distraction free environment). My life has been a hard one. ADD has taken a toll in just about every aspect of my often pathetic existence. I've asked myself which came first? - ADD or the panic brought on by pressure from my parents/teachers who couldn't understand why i just wasn't able to stay focused on anything.

    1. I had panic attack after drinking a strong cup of coffee and then had another one a few months later. I blamed it on being trapped and having no exit. im still terrified of them and its been 36 years . ive been on more medications and find that smoking medical pot helps the most.

  6. Hi Andrew,

    I see that you mention 10 to 15 seconds befor getting out of breath.
    Actually there is a method of detemining how much CO2 is in the blood by just counting the seconds befor you get out of breath.(without force)
    Mine is also a bit more then 10 - 15 seconds but there is theory that this is way too low and that normal should be 60 seconds!

  7. When I was eleven year I went through an appendectomy. The reason for that was I did not want to go to school. I did find out ... if I said that I had a stomach ache I didn’t need to go. After several days I was taken to a hospital to investigate… they find out it was nothing major wrong with me but for the "security" reasons they did decide to remove my appendix. This came as a shock to me and I didn’t dare tell that… the story of my stomach was a lie… I did not dare even think about it
    I got a syringe and was laid on a bed ... they placed an ether mask over my mouth. I was tied up with the some leather ramming for me to be still… but when the nurse started to drip ether into the mask I got a terrible panic ... I got out of the straps and ran down the hall. A nurse was chasing me and threatened me about that a doctor will come and he will not be as nice as she was. She got me finally to listen. Against my will they strap me down again ... I was told to count as long as I could… to se for how long before I fell asleep.
    The panic continued in a terrible dream ... the operating room was semi-circular with large windows out…for as much light as possible to come in ... these windows began in my dream to grow and become thicker and thicker ... I was stocked on the inside with some kind of sledge hammer witch I was beating the glass to get out… the glass flew in all directions… but it was useless the glass become just thicker and thicker and I gave up… I was lost.


  8. Dr. Janov,

    Couldn't panic and suffocation also be the result of being very young and small of course and having an abusing adult crush you while you were being sexually abused and wouldn't that serve as a first line trauma also?

  9. John: yes. but that is far from usual. Suffocation can happen in many ways. One patient was pulled under pool water and kept there by a tyrannical father. It can be first line and have terrible lifelong effects. AJ


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Quotes for "Life Before Birth"

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Bailey Endowed Chair of Animal Well Being Science
Washington State University

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