Matt Casarino

I am one-half of Hot Breakfast!, Delaware's Premier Acoustic Dork-Rock Power Duo. The other half is Jill Knapp, who is the most wonderful thing on the planet.

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There are very few phrases more reviled, and defended, than "trigger warning."

And without making it a thing (because that's not what this post is about), I see both sides of the argument. Yes, most of us did survive not only years of higher learning but decades of internet-plundering-and-discovery without the need to be "warned" that a piece of reading or information might "trigger" us to recall, or even relive, a past trauma. And trying to predict what those triggers might be is a terribly daunting task; ya never know, in other words, what might set somebody off. But for Jared Leto's sake, what is the harm of warning somebody that material potentially perilous for those who have suffered trauma or even PTSD lies ahead? Sure, we didn't do this in the past, but we also wore wool in the summer and enslaved people in the past*. What is the harm of briefly warning readers that the following material discusses subjects that some might find disturbing on a personal level?

So that's my position - I won't judge anyone for using trigger warnings, and I won't judge if you don't. But again, that's not really what this post is about. It's about my recent experience being "triggered," and what it says about my specific anxiety issues.

I've written about anxiety and panic a few times on OPW, and I'm grateful for the opportunity. It's a tricky subject for me - I love having a semi-public outlet in which to share some of my experiences with panic attacks, but I'm painfully aware "anxiety" is becoming, to many, one of those buzzwords that, like "chronic lyme," "chronic fatigue," and "fibromylagia," causes certain eyes to roll. After all, there's no test for anxiety, and like "chronic lyme," anxiety produces no antibodies; when someone says they have debilitating anxiety, we pretty much have to take them at their word. Lately I'm becoming hyperaware that, while few people doubt anxiety attacks exist, some are starting to think it's one of those too-easy diagnoses people give themselves to explain, or allow, the little breakdowns that come when life is a bit overwhelming. And geez, who among us hasn't been overwhelmed?

(NOTE: I embedded a video from SNL above. But it might not show up on a mobile phone - if not, click here.)

Funny bit, yes? I laughed at a lot of it - even the barely audible sigh of contempt from the narrator as he claims the high-maintenance girl "quote has...anxiety." Yep, I laughed - right through the pit in my stomach. 

I know it happens. I know some people raise their eyebrows at the idea that "anxiety" is really anything more than the feeling they get before a test, or a job interview, or taking a tricky pool shot with $5 on the line. To them, it's a 21st-century excuse, a make-believe affliction. "We all have anxiety sometimes," they say. "Some of us just know how to deal with it."

Or that's what they wanna say, anyway.

Look, I get it. I do. If I didn't know first-hand what it feels like when your fight-or-flight mechanism goes on overload, how it compromises my hearing and balance, how my muscles shake uncontrollably while a very strange kind of fear grips my throat, how my heart rate increases and, more alarming, feels like my heart is pushing against my ribcage, how tears stream down my cheeks like they need to escape my eyes - and how all of that happens while I remain aware (on some level) that I'm actually fine, nothing is wrong, no one is trying to hurt me - maybe I'd suspect sufferers of anxiety are making mountains out of molehills, or wanting the kind of attention that comes with affliction. There have been a few instances (see: above buzzwords) when I've thought specific people were (are), at best, mistaking - perhaps deliberately - their conversion disorder or muscle pain for an invasive disease. 

But, of course, this attitude doesn't help. As a good friend told me recently, "keeping it to yourself because you're afraid of the eye-rolls behind your back is a great path to depression and agoraphobia." So that's partially why you're lucky enough to be reading this post. :) Because I suspect all of the above factors into why I was triggered into a pretty severe bout of anxiety while in the safest place I know from the description of a years-old online video: 

Reporter Discusses How an On-Air Panic Attack Improved His Life

I didn't see the video. Heck, I didn't even see the headline: Jill did, and she thought it was an important video for her to watch. She asked me if I wanted to, and I declined - I figured I might find it upsetting. 

What I didn't realize is I was already upset. And my attack had already started the moment she read those words aloud.

The idea of the guy having a public attack while simply doing his job was my trigger. I only heard a few words from the video - the anchor (not the reporter) was simply introducing the story - when I realized I was in trouble. I told Jill I would put on headphones so I couldn't hear the story. But Jill put her own headphones on instead - for about three seconds, when she looked at me and realized I was on my way. And even though she did everything right, I was in for a remarkably extended attack, complete with an eye-of-the-hurricane break in the middle, which I foolishly interpreted as a welcome ending. It was intense and exhausting enough that we had to cancel our social plans that evening - plans that actually included hanging out with our friend who said the wise words above.

So what did I learn from this? Well, for one, this highlighted something I knew but couldn't really articulate: "triggers" are more than the various words, entities, locations, and situations that tend to get the fight-or-flight instinct churning. They can be ideas, concepts that suggest my issues go beyond my general phobias (which include being stuck in a big, chaotic crowd and getting trapped with a tight shirt halfway over my head) and into darker fears about public humiliation that I can maybe focus on a little harder. Because even though Jill tells me the reporter's panic attack wasn't graphic - he recognized he was in the very early stages when he smiled and simply ended his segment early - the thought of going through something similar, of being exposed while working in front of an audience, is nightmarish in a way I can't really express. (Even writing that sentence churned up the anxiety machine. I had to step away. It's now many hours later.)

So am I suggesting triggers are...good? In a way, yes. They hold secrets. Before that night, I thought my triggers were based in the locations where I had the worst attacks - grocery stores, the Verizon place (something about rows and rows of product), crowds in which I'm adrift. But now I know that there's a certain primal fear that can send my adrenal medulla into interstellar overdrive. And while knowing is decidedly less than half the battle, it's an important step. For me, anyway. 
_ _ _ _ _ _ _

This has been another eposide of Matt's Brain is an Asshole. Stay tuned for many, many more episodes. If you'd like to contribute to my Patreon, hold that thought until I create a Patreon. 

* We haven't actually stopped enslaving people, but that's One Post for another day.

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5/31 '17 9 Comments
Thanks for sharing this. I suspect that now that we're a little older, more and more of us have at least one "eye roller problem" ourselves and don't have any trouble at all accepting these explanations at face value.

Uhhh... Those of us with any degree of introspection, anyway.
I'm glad you said "at least". :)
I thought really hard for a moment but couldn't name a single person I know who thinks anxiety/panic attacks are some kind of make-believe thing. But I don't tend to hang out with the sort of people who would think that. So.

Myself, I never experienced anxiety with a capital "A" until I hit perimenopause. It happened to very roughly coincide with a couple of auto accidents I was in that happened in rapid succession, so there was the assumption that that was the ... genesis I guess? Anyway, not knowing what in the world was happening to me, once a knowledgeable friend suggested it might be panic attacks/anxiety, I RAPIDLY made phone calls to find a therapist. Busy moms of three can't afford to be paralyzed with debilitating symptoms.

Here's where it gets interesting. And why I've come to a couple of personal conclusions about it all. One, anxiety and panic are SO person-specific. The result is very much the same, but the genesis and ongoing struggle is a World of One for anyone dealing with it. And two, I think that—at root—we might be talking about a basic physiological event/process/cascade and while cognitive therapies can help one cope with the event, a more physiological approach to dealing with the problem would work better. At least, that was true in my case. (And someday I will come up with a perfect solution applicable to everyone and invite you to my Nobel acceptance ceremony.)

By physiological approach I'm not talking about meds here. I'm think about figuring out the wiring and the physical and chemical cascade and how to change that. Or at least endure it better.

What I did, as a long-time massage therapist, was to seek out a therapist who not only practiced SE but who *also* was a massage therapist. And we did all the SE stuff and it was marginally helpful, but finally I just said, "Look, can I just get on the table and have you work on me?" And that was the turning point. And then a year or two later, after we'd moved to Vermont and I was out trying to have a nice bike ride and not having it work (because elevating my heart rate above a certain point was inducing panic symptoms), I also recalled my own massage background and applied a breathing technique that I've used for decades and which is clinically proven to lower (among other things) cortisol levels. I started breathing that way basically all day every day for a week or so. And something about that process broke the cycle.

Since then, I've had comparatively mild episodes, and I can always link them to a combination of hormone shifts happening as a result of aging coupled with stress (of any sort that might raise cortisol levels). Always. And as my overall hormone levels even out and stop rising/falling/rising/falling/ad nauseum, so goes the frequency and strength of any anxiety.

Not sure why I'm sharing all of this, other than to say, "Go you!!" How wonderful have a useful epiphany around this stuff. Big steps, baby steps, 1/16th of the battle—who cares? It's just good to have an insight.
Thank you so much for sharing all of this! That's wonderful that you found...if not a cure, then some fantastic elixirs.

To be honest, I can't *NAME* a person who thinks anxiety is...um, I was about to say "all in my head." Let me rephrase. :) ...is an affliction being claimed by some people who just get a little overwhelmed from time to time. But "anxiety" is one of those words that make some eyebrows roll. "Oh, he has anxiety? Great. I get anxious sometimes too, sweetheart, but I can still have cold ones with the brahs."

Of course, when I put it that way, there's a damn good reason we can't name anybody like that...

Thank you again, I always love reading your insights - about this, and everything. A few techniques and meds have actually made these attacks a lot less common than they were at one point. Of course, my mind loves to whisper things like "c'mon, Casarino, you know they're just placebos, right? They're like Tinkerbell - they only work because you believe in them. The minute you stop clapping, they stop working."

Yeah - my mind is an asshole sometimes. Maybe I need to take my cue from another Simpson's episode and shove some crayons in my nose.
I totally get that. My brain is an uber asshole. I am the biggest science nerd anti-Tinkerbell body worker you will ever ever meet. I mean, if you ever actually do meet me. I have much seekrit disdain for Woo-Woo practitioners of every stripe. Show me the clinical data! Or talk with me about your years of experience with Technique X where it has worked over and over and over whether or not your client knew what you were doing or had any expectation of outcome.

In the absence of hard data I am quite happy to embrace mystery, but I want mystery with consistent results.
"...who thinks anxiety is...um, I was about to say "all in my head." Let me rephrase. :) ...is an affliction being claimed by some people who just get a little overwhelmed from time to time."

I wonder how much of the problem with 'eye rollers' is... laziness. I mean - look at how much effort you had to go through just to rework that phrase. If someone is too lazy to spend that kind of effort / time on actually discussing a problem with someone who faces it, I could see them taking a lot of 'shortcuts'. Like rolling their eyes rather than talk.

ETA: all of which is to say - I wouldn't worry too much about folks who are rolling their eyes. In my not so humble opinion - they've already let you know how much they're willing to invest in someone other than themselves.

May seem harsh, but I don't think it is any more so than they are to those with afflictions that they (the eye rollers) don't understand.
Gaaah! Thank you for mentioning this physiological link! I am convinced (and this is the ever-so-qualified Dr. Knapp with a music degree talking here) that Matt's root cause is *physical.* Like, he was fiiiiine for the 2 years when we first got together and for the prior 10 that we had been friends), and then when his gall-bladder went kablooey in 2013 they yanked it in an emergency surgery. The *very next day* he started having terrible GI problems that would leave him destroyed for 4-6 hours after, well, pooping. (Sorry babe.) And that went on for years, beyond any reasonable body-readjusting-to-no-gall-bladder period. And one day those post-poop episodes stopped cold, and that very day were replaced with crippling anxiety attacks. And on the rare day he didn't have an anxiety attack, he'd get a proctalgia fugax that would leave him in tremendous agony that nothing but time (hours!!) could help. Some days he gets both an anxiety attack and the butt-fugax. So try convincing me it ain't physical.

I will uneducately scream "Vagus nerve!" until I am dead. I so desperately want to be wrong.

When we've gone to doctors, we've gone to GI guys who stop listening at "gall bladder surgery" and prescribe bile salts. Or he's gone to his normally-super-awesome shrink who tells him "Go stand where you're sure to trigger an attack, and go have one in public and then you'll see it's not that bad to cry and shake and punch yourself and collapse in the Verizon store." (Sorry doc, gonna have to disagree with you here.) I want to scream. The love of my life, the center of my world, my perfect other half is hurting hurting hurting (and taking it like a champ!) and all I can do is watch the 3x/week torture. (Which I will take over 6x/week torture, but it's still torture.)

Sorry to vent. I would give a fucking kidney for an answer or a clue as to where to go next.
Oddly enough, I *just* this morning read a NYTimes article about a woman who had a couple years of crippling problems--GI, anxiety, headaches, I forget what else--and on a *whim* her doctor did some blood work to check thyroid levels and adrenaline levels. Thyroid, fine, adrenaline off the charts. Turned out to have a tumor on one of her adrenal glands.
I just read that! The one about the "pheo." My dear friend since middle school has it too, so I forwarded it along to him (though I'm sure it didn't tell him anything he didn't already know). But it made me feel like it's within the realm of possibility that Matt's affliction could be physical.

Xo!