Panic and the city: I thought I was dying two or three times a week

There was no apparent trigger to my panic attacks, they were caused by the capitalist city itself. Part of Transformation's politics of mental health series. Content warning.

Arran James
9 May 2014
 Wikimedia Commons.

London's Kilburn station resembled something like a technologically sufficient military bunker. Credit: Wikimedia Commons.

I used to think I was dying two or three times a week. I could never identify specific triggers.

It always started with the smell of burning. None of my friends could ever smell it. Soon it was cold electricity surging through my body, then the frenetic acceleration of breathing, skin cold and hot at once, my pulse trying to outpace the rise and fall of my chest, a stark sensation of separation from the situation around me, my mouth drying up and making it difficult to swallow, shooting pains running across my chest and arms, and the inability to gather my thoughts as they madly circled one another, echoing and overlaying, repeating and colliding, until finally they settled into the one grim thought, indistinguishable from an intensely visceral certainty: this is a heart attack.

According to official prevalence rates 1 in 100 people have panic disorder. Panic attacks are also a feature of other experiences coded by psychiatry, such as PTSD, and many people will experience panic attacks as irregular or isolated events.

We all live within conditions that trigger mental health problems like anxiety disorders, regardless of whether we’re mental health workers or “service-users”.

Urban living takes place in what Paul Virilio has dubbed ‘the city of panic’. As far back as the work of George Simmel’s “Metropolis and Mental Life”, there has been a tradition of viewing panic as the outcome of bodies in a hyperstimulating urban environment. Hyperstimulation is the way in which our bodies, our nervous systems, have been coupled to a more or less permanent state of excitation.

I remember one of my panic attacks distinctly. One night I went to Kilburn underground station to get out some cash to meet a friend at the pub. At the time the station resembled something like a technologically sufficient military bunker.

Machines blinking and screeching: ATMs beeping frantic dissonance against the shrieking noise of ticket machines, coins being dispensed from those same machines, barriers. Add to this a general buzzing of voices and bodies in motion, some colliding, others practically pirouetting to avoid doing so, and the disembodied voice of automated announcements overhead issuing injunctions, security warnings, echoing the “if you see a suspect package” posters plastered around all London’s tube stations. Indistinguishable from these, the clatter of trains passing overhead, the buzz of the street, the anxiety laced from leaving an overcrowded flat (a family of three kids and four adults crammed together).

The station itself was and remains decked with CCTV cameras, part of London’s near unbroken mechano-digital panopticon. There are aggressive spikes on every flat surface: an attempt to discourage nonhuman life.

The station was also the location for a police stop-and-search I’d been subject to, in which three officers had dragged me from the street back into the station. As I took out what little money I had left from my temp-job wages right next to where it had happened, the panic attack seized my body.

In those moments organs and sensations are individuated. I’m sure I experienced my body as fragmented, speeding towards explosion, collapse and dissolution.

When it was all over I never felt grateful to be alive or that I’d gained some authenticity. I just felt like I wasn’t quite there; there but elsewhere. This experience (depersonalisation) has been significantly linked to living in an individualist society.

I finally got control over my panic attacks on my own. Once I knew what they were they began to get less common and less severe. “You know what this is, you’re not dying” became my mantra for talking myself down.

But perhaps the biggest reason they became more manageable was the enacting of one of panic disorder's symptoms on the large scale. One way of dealing with panic is to avoid situations you think might trigger an attack. I took this to its logical conclusion and left London.

A combination of precarity, over-proximity, overstimulation and constant reminders of the inflated threat of terrorism combined inside me to produce the perfect storm of panic. The elements of that particular attack were a combination of more diffuse anxieties. Firstly, the permanent, generalised anxiety of not having enough money, of being in debt. Secondly, the more direct physiological agitation caused by being over-bombarded with information. Add to this the ever present reminders and machineries of surveillance, urban policing, and a media that still injects its audience with fear. The built environment drove my anxiety as it took on more and more the military-security aspect of a city under siege.

What dawned on me then has since been confirmed by empirical studies and theoretical investigation: there was no apparent trigger to my panic attacks because they were caused by the capitalist city itself.

States and capital both understand this process. They regulate the rhythms of our lived bodies, both over-stimulating them and providing the means to de-stress. They expose our bodies to all kinds of corporeal vulnerabilities - sickness, homelessness, malnutrition - in order to make us into dependent bodies.

Sick bodies need doctors, exposed bodies need protection, and bodies assured they are kept safe are quiescent. The politics of panic allow the state to activate an infinite number of others as threats, whether they are external (terrorists), internal (the unemployed) or those who straddle these domains (immigrants).

When panic, or any other psychic arrhythmia, sets in, even your own body becomes suspect, volatile, in need of psychiatric and/or psychological biopolitical regulation.

Hyperaroused bodies welcome the medication that will fix their agitation. One of the “service-users” I recently worked with summed it up perfectly for me: “I want to be happily sedated”.

I ran away from the causes of my panic: leaving London. That isn't always possible. What I learned through finding myself in a new environment and through training as a nurse is that it is by sharing our wounds that we can begin to heal. And some degree of healing is required if we want to fight. I dropped out of the Masters I was taking in part because of my anxiety, and I completely avoided confrontational situations because of it.

I still struggle with that anxiety, but its been a long time since I had a full blown panic attack. It's only by having fled to a new city, regrouped, and slowly learned to manage my own anxiety by sharing it with others- both other trainee nurses and patients- that I’ve been able to live without panic attacks.

There is an old cliché that people who work in mental health are the ones with the problems. What this means is that there exists a potential collective resource on both sides of the professional divide. The antipsychiatry of the past, and groups like the Icarus Project and the Hearing Voices network today, understood that we're all wounded and all trying to cope with being alive.

What is required is a politics capable of tackling the perceptual violence of overstimulation along with the other forms of violence within capitalism, such as sexism, racism, and transphobia, which we are already combating. We require a political therapeutics that is able to find militant forms of therapy and therapeutic forms of militancy.

Whatever else this praxis might look like, it will include the sharing of the wounds that we are all made to bear. It took me leaving my home city and travelling hundreds of miles away to Scotland to learn that. When I left, I left to be with someone that I'd fallen in love with. She was mad in a different way to my own madness. That relationship was my first experience of the sharing of wounds I would come to find with others. 

Mental illness is one of the fallouts from life in the neoliberal city. The fight against capitalism is also the fight for our minds.

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