I'm lying on the floor of a public bus in San Francisco's bustling mid-market corridor. I'm not sure how I ended up with my head rolling over a crumpled Starburst wrapper, but I am acutely aware that I can't breathe and my hands and face have gone completely numb. I instinctively look down, honestly unsure if my hands are still attached to my body. As two paramedics board the bus, I feel that sinking feeling in my chest -- the feeling when you hope the earth opens up, swallows you whole and you disappear. I start apologizing, "I'm sorry, I'm sorry, I don't know what happened." The paramedics, as always, are gently taking my vitals, asking for my name and telling me those dreaded words, "we think you had an anxiety attack."
Until about a year ago, my understanding of "an anxiety attack" was a brief few moments of panic, generally accompanied by chest tightness, clamminess and sweating. But when I started regularly passing out in public places, I realized that my previous understanding was of anxiety in its infancy -- the younger, tamer cousin of the fully developed anxiety beast that I would spend the next six months battling.
I started experiencing anxiety in July, but I didn't know what it was. I felt the physical affects -- chest pain, stomachaches and constant fatigue -- but the mental side of it, the side that actually recognizes anxiety, hadn't started. For months I fretted over the growing pain in my chest, worrying that I was developing asthma or a serious heart problem. I went to the doctor, but I was in perfect health. Offhandedly, the doctor mentioned it could be anxiety, and advised me to exercise more.
At first, the idea that I was experiencing anxiety seemed crazy. I showed all of the signs of a perfectly happy person -- I exercised almost daily, I had a good job with strong performance reviews, I was making new friends through a new improv comedy group. But as the physical symptoms got worse, the lens through which I saw my day-to-day experience started to shift.
I ran from my house to Ocean Beach almost every morning. When I didn't run, I spent the whole day beating myself up about it: How will your anxiety get better if you are not exercising? Why aren't you more motivated? At work, I felt I was never doing enough. I woke up in the middle of the night to check my email -- even if my inbox was zero -- or worry about whether or not a project I had recently finished was truly "good enough." Every day was about beating the person I was the day before: Today, I'm going to get more done than I did yesterday. I'm going to be the last one at the office so people don't think I'm not doing enough. Anxious thoughts swirled through a world where I had to constantly prove myself -- a demand that only I was making.
When I saw a psychiatrist, he asked, "So, what is making you anxious?" I was furious. If I knew, I would not fucking be here. By that time, I had been to the emergency room four times after having anxiety attacks that had rendered my limbs completely numb, my hands frozen in contorted positions and my eyes rolling around directionless in their sockets. I wasn't seeing a psychiatrist to talk about my feelings. I just wanted answers.
Though my anger at my psychiatrist quickly faded, his question led me to an important point of discovery: my anxiety was wedded to deep-seeded, anger-inducing guilt. I had a wonderfully supportive family, an extremely thoughtful girlfriend and a meaningful job that paid all my bills. I felt strongly that I had absolutely no reason to experience such extreme anxiety, and burdening my family and friends with what seemed like my own failure to appreciate my privilege and relative success both infuriated me and made me hate myself. I was in a horrible cycle of self-criticism, and I had no idea how to get out of it.
For several months, my daily routine shut down. Riding on a bus seemed like running a marathon. I cut out all caffeine. Friends escorted me in Lyfts to my doctor appointments just in case I passed out (ER bills add up, so I was adamant that I would not be getting in another ambulance even if I did pass out again). Slowly, my chest pain got a little better. I traveled to D.C. for work in April and was sure I would not make it through the trip without ending up in a hospital -- and my anxious brain had already crafted what would soon happen: I would embarrass myself, get fired, lose all of my professional contacts. I made it through the trip without any serious attacks, and even if I had ended up in an ER, none of my fears would have become reality -- I worked with great people who would have been very supportive. But anxiety doesn't live in reality.
Now, almost a year since my first anxiety-induced emergency room visit, I don't have a perfectly satisfactory answer to my psychiatrist's question, but I'm developing a clearer picture of how my anxiety develops. For many people, anxiety is chemical. No matter how many ways we attempt to explain away our anxiety, the bottom line is that our brains are not wired like other brains, and it makes us feel horribly self-critical when we're asked to overcome our anxiety -- the same way a disabled person might react if asked to "just try harder and climb up those stairs!" Some things just are not possible.
For the parts of anxiety that can be controlled, I'm learning that everything comes down to loving yourself. As a transgender person, self-criticism feels built into my DNA. I've spent 24 years feeling like I didn't belong, couldn't relate and didn't understand some of the most intrinsic parts of my peers' identities. Feeling like you are completely not fitting in from a young age creates self-hatred that does not go away with a few shots of testosterone (though hormone-therapy helps many of us feel more comfortable in our skin).
As a trans person, as a hyper-anxious person and as just a fucking person in our incredibly stressful world, I've found that the most important daily exercise I can do is to look at myself in the mirror everyone morning and say "I love you." Even if I don't really believe it that day.
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