I woke up Tuesday morning to a white-out. Half-asleep, I looked out the window and forgot where I was. The fog rolled in, I thought. Everything outside was silent and still, puffs of tan air obscuring the tents across the street.
I went out to pee and the wind blew so hard it picked my skirt up and tore at my hair, kicked stinging beads of playa against my legs. It hissed faintly like blowing snow. I was used to seeing out to B and beyond, to the white spires of the commissary, but all of that was gone now, wiped away by gusting playa.
Photo by Dieter Rencken
A college professor once told me that Milton had gone white blind. When his vision started to fail, rather than the world fading into darkness, everything was gradually washed out by white light. All the references to evil he makes in his later writing are to its all-consuming brightness.
Being in the white-out felt like going white blind. My heart thrummed like hummingbird wings. When I got back into the trailer, my hands were shaking and I had trouble latching the door.
I sat on the bed for a minute and tried to get my shit together. I felt weird, and I couldn’t tell why — was I hungover? No. Was I hungry? No. Did I need to drink water? Never a bad idea, but I didn’t feel dehydrated.
The distance between the bed and the trailer door was enormous, an ocean of space. It was stretching out farther as I watched, and I waited for the floor to crack open from the strain. The edges of my vision dimmed and I was overwhelmed by the sensation that nothing I was seeing was actually real — that the world was more or less a giant video game and I was playing it, one step removed from reality.
That not-all-here sensation clued me in. I’d felt this way before, but not for a long time. I’m having a panic attack.
I have anxiety. Some days, anxiety has me. My most common reaction to stress is to become frightened; I sweat and shake and sometimes have panic attacks. I’m pretty good at handling my anxiety in the default world, but the playa isn’t always a relaxing environment.
I only had one panic attack at Burning Man this year. Explaining how I dealt with it might help you, fellow anxious Burner.
Photo by Ales Prikryl
1. Know yourself
Recognizing that a panic attack, not dehydration or a hangover or anything else was making me feel weird, was what made me able to deal with it.
Burning Man is stimulation central. Pay attention to your body as you Burn, and if you feel yourself going to the anxious place, move on to step 2.
2. Cope intelligently
My panic attacks always involve some shortness of breath, so I did some mindful breathing exercises. Then I queued up my “Stratosphere” playlist. Music is one of the best coping mechanisms I have for bad anxiety. Before coming to the playa I had carefully curated this playlist, populating it with the chillest, most laid back tracks in my music library.
These coping mechanisms work for me. Yours might be different, but the point is to know what they are, know how to use them responsibly, and come prepared to use all of them.
3. Take a break
Burning Man doesn’t sleep. It’s a ten-day party, social experiment, spiritual adventure, new romance, breakup, field trip, art parade… and it’s impossible to do it all, but a lot of people try.
On Panic Attack Day, I ended up skipping Burning Man. If you’re having a hard time, it’s okay to take a day off. It’s okay to chill out around camp for an extra few hours. If you need a break, take it. It’s better to recover for six hours than it is to have three shitty days because you wrecked yourself trying to push through.
On the other hand, if you find you’re feeling bad and need to get out, hop on your bike and get moving. The point is, don’t feel obligated to have someone else’s Burning Man. It’s your Burn. Do what works for you.
Photo by Peg Ortner
4. Talk to Exit Strategy Bear
Those who have suffered catastrophic breakdowns on playa (dead cars, rides that left without them, explosive breakups) speak in hushed voices of Exit Strategy Bear. A fuzzy avatar of opportunity, he appeared out of the swirling dust and sat with them, wrapped them in his puffy arms and reassured them it was all going to be all right.
When in direst need, invoke the spirit of Exit Strategy Bear. Sit with yourself and figure out what you really need from your Burn. Sometimes you need to go home. That’s okay. Peacing out early does not mean you failed at Burning Man. And sometimes just knowing you have the option to go home is comforting enough to let you keep going.
Take care of yourself. The playa is waiting.
This is a brilliant article. I love the idea of a playlist to help cope with anxiety. Any chance you might share yours?
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Unfortunately no–it’s in Google Music and there doesn’t seem to be a public share option. :P
But really it’s everything by HUVA Network, Steve Reich’s Solo Piano album, MGMT’s cover of “Electric Feel,” and a lot of Chopin. Think classical piano, minimalist piano, and ambient or downtempo electronic music.
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Interesting – I find piano music very much comforting in such situations as well :)
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Thank you for this!
I can’t tell you how bad I felt having to just decompress at camp with some of the veteran burners instead of going out and “experiencing”. Looking back I know I needed it and just hanging out and camp led me to meet many of the amazing individuals camping around us.
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I have a major anxiety disorder, but it hasn’t kept me from participating in Black Rock City. I’ve been an Oracle and I’ve helped run our own camp, Electro-Therapy, all with extreme anxiety. Travel gives me anxiety. We travel 3000 miles one way to come be a part of BRC. So, I end up waking early, when its most low key, and going to sleep early. The hum of the city comforts me and I sleep well. There are days when I struggke to come out of the trailer, but I wouldn’t stay home either. Just be aware that you will cry within 36 hours of arrival, that acclimation is a necessary evil, and that weird feeling of spatial dissonance will pass. Stay a step ahead of yourself by knowing what to expect. And water. Drink loads of water.
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Thank you, Sarah, for sharing. She recognizes the symptoms of a panic attack (which is an extremely real and objective event, medically), and took steps to help herself.
For people who might be interested in a more physiologic understanding of the phenomena, perhaps it would be worth reviewing what is, exactly, a panic attack (as opposed to just being anxious). A panic attack, classically, is a “hyperventilation attack”, medically. It starts with either very obvious (or subtle, over time), hyperventilation – either breathing too deeply, or too rapidly, or usually both. It can start over a minute, or over 10-15 minutes or so, depending on the over-breathing pattern. A feeling of shortness-of-breath is almost universal, and one should be very suspicious of a diagnosis of hyperventilation without the symptom of SOB, as we call it. (The patient often feels they “cannot breathe”, or are suffocating or having asphyxia – but the reality is that they are breathing too much, too freely.)
Hyperventilation leads to hypocapnia (low dissolved carbon dioxide level in the blood), immediately. This simultaneously leads to higher blood pH (more alkalemic, or less acid). This immediately leads to a sudden fall in blood ionized calcium, as calcium ions shift from the free (active) state, to the bound state (inactive). It is the low serum ionized calcium which leads to the most impressive of the symptoms, but the other preceding blood chemistry changes contribute.
The earliest symptoms, as the panic attack gets underway, are uneasiness and anxiety, a sense of shortness of breath, palpitations (high adrenaline output), and a from of “dread” or “doom”. This is the word we use to describe it, clinically.
In the next phase (not everybody progresses exactly alike along the spectrum), the SOB can get more severe, and the patient is visibly hyperventilating, to an outside observer. (The patients frequently are not aware of their breathing pattern, and will often assert that they “could not breathe”.) Now, the anxiety and sense of doom, or perhaps believing they are having a heart attack or stroke, can get overwhelming. They start having tingling around the mouth, and in the hands, and then in the feet (“paresthesias”, due to hypocalcemia). They feel dizzy and can get overtly confused or disoriented (brain dysfunction due to hypocalcemia and hypocarbia). At this point you have reached a full-blown panic attack. But it can get worse:
The pathognomonic symptom (the symptoms or sign that guarantees the diagnosis) is called “carpo-pedal spasm”, also called “hypocalcemia tetany” (resembles “tetany” causes by botulism). There is a very characteristic “posture” (or position) of the hand muscles (and therefore the fingers), which I could try to describe at length, but won’t here, as a picture is worth a thousand words. Also, at this point in a panic attack, the patient may be completely out-of-control with drastically increased depth of breathing and rapidity of breathing, terror and confusion, and may even have a seizure.
All of this will rapidly resolve, with zero long-term consequences, IF the patient will slow down their breathing, or can be induced to slow their breathing by various techniques at the bedside, or occasionally by intravenous sedation (rarely needed). The entire pattern is caused by escalating hyperventilation, and the entire phenomena is completely and rapidly reserved by stopping the hyperventilation. Unfortunately, many patients find it hard to believe that the entire episode is – or even could be – caused by breathing alone, since they felt like they were “unable to breathe”.
When a person is informed and educated about the entire sequence of events, and can learn to LIMIT their breathing depth and frequency as they fear a panic attack is coming on, or, if they use the “paper bag trick”, they can abort the panic attack, and not escalate into the whole spiral as described above.
There is much more fascinating material to discuss about the subject, but perhaps this information might be of interest. I have seen many hundreds of cases over the years, and find it a very interesting topic to teach and discuss. There is over 75 years of physiological research on the subject, not to mention specialized clinics, treatment programs, meditation and medication, all designed to help patients not fall into the trap, the spiral, of the next attack. Fortunately, there is zero lasting consequence (except anxiety), medically, even after hundreds of dramatic attacks. Education and strategies to avoid hyperventilation are the hallmarks of helping the person who is having panic attacks.
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Wow, that is an amazing walkthrough, thanks for that.
I have found that, if somebody is hyperventilating and I don’t suspect hypoxia, the best way to get them to control their breathing is to have them exhale, and hold it as long as they can. If they are hypoxic, that doesn’t tend to be very long :-). If they’re just hypocapnic, their breathing will, as you instruct, slow down relatively quickly. (Temporary) purposeful apnea is much easier to explain and maintain than purposeful bradypnea … and they wind up slowing down anyway. It’s also better, IMHO than having them *inhale* and hold it, as they are less likely to accidentally do a Valsalva … with the accompanying effects.
Why do I even bring this up? Because I HATE the paper bag method – too many well-meaning people using it on their hypoxic friends … and now they’re even worse off by the time I get there.
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Awesome, Doc! Thanks for the physiological explanation and signs and symptoms countdown. My daughter suffers from them, and it was kinda scary to watch the first time it happened.
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And Sarah, thanks for sharing your experience. This past year’s playa weather left me feeling kinda depressed. I struggled to respond differently than to just huddle down in my sleeping bag, in my tent. But for some parts of the day/night, that’s all I felt like doing. Oh well. It was still a cool burn: new other experiences had too, besides sad.
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I’ve suffered from panic attacks since I was 19 and I’m 62 now. I’m a veteran burner and I used to be agoraphobic because of the panic attacks. What worked for me and may work for others is first to let the fear wash over me. Then I write down my name and who to contact if I pass out. (I’ve never passed out yet) And then I breathe to the count of 4: In 2 3 4, out 2 3 4, in 2 3 4, out 2 3 4, over and over. Judging from the doctor’s comments, the controlled breathing is apparently what stops the attack. Maybe this will work for others, too.
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Thanks Sarah for sharing. My anxiety nearly stopped me going to my first burn last year but I made it and there was nothing to fear :) (so if you’re reading this and your indecisive about going, do it!!) It was challenging of course but it helped to tell friends when I felt particularly anxious and talk about it. It was comforting to know I wasn’t the only one that panicked during a white out. I slept the most out of anyone in our camp and spent more time in camp that I would have liked, that got me down sometimes but I need energy to keep the anxiety away so it paid off. Accepting that you can’t do it all is important.
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The topic is a good one – but just to be clear, this writer refers to comforts a lot of people might not have – a “window” a “door” and a “bed” – even a “playlist” that plays…Point being, that panic attacks can happen with any kind of support system, and the best strategy is to just accept that you will confront yourself on the Playa – your body, your mind, your heart – and at any given time someone somewhere is crying, so it might as well be you. You’ll get over it. Don’t leave.
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Unfortunately, there are a few other things that cause panic attacks, some of them rather more grim — pheochromocytoma and adrenocortical carcinoma being probably the grimmest — although any panic attack, regardless of the cause, is pretty damned grim while you’re having it. The good news is that panic attacks caused by simple hyperventilation respond well and abruptly to breathing into a paper bag, or controlled breathing. The bad news is that many panic attacks, particularly those associated with chronic generalized anxiety, may not resolve that easily; panic disorder can quickly become a syndrome. And once some evil (and unconscious) genie sends an order from the brain to the adrenal glands for three or five on-target-incoming-155mm-HE-rounds’ worth of adrenaline, the panic is going to last until that jolt of adrenaline gets metabolized AND the genie thinks the shooting’s stopped (and so stops sending the orders).
Damned genies!
However, specific panic attacks have a MUCH better prognosis than on-target 155mm artillery attacks. They just don’t FEEL that way while you’re having them.
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The 12-steppers have an acronym called HALT. They use it to describe when people are most likely to make very bad decisions. I added an S, so HALTS. Hungry, Angry, Lonely, Tired, Scared. In my experience, if I have one or two of these, I’m still functional, if somewhat less so. If I’ve got 3 or more, I am primed to do something stupid, and not in a good way :-). Fixing one (and, yeah, sometimes Hungry is also thirsty) makes it easier to fix the others … easier for somebody who’s tired to get some sleep, etc.
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