To a neutral observer, the idea of choosing to have a panic attack makes no sense. As uncomfortable as panic attacks are, why would anyone choose to suffer in this manner? Learning the ins and outs of patients’ choosing to have panic attacks proves to be useful, as it provides the very means to their recovery. Largely their unconscious choice, patients do not realize why they do this to themselves; how can one feel that something which she perceives as overtaking her stems in fact from an unconscious choice of her own making?
How-ever, working with patients with anxiety shows over and over again that the timing of a panic attack in an individual’s mind correlates invariably with what she is feeling or doing at that point in her life. Many patients report, in time, that they see having panic attacks as a way to confine themselves within a horrible distress. For example, a patient who becomes excited about taking a trip with his fiancée—literally taking off in life, but also leaving his family for the first time—has a panic attack on the airplane, thus keeping himself from the present experience of the joy of the trip (and reconnects to growing up in the abusive home of his alcoholic, rage-filled father).
This phenomenon reminds me of the proverb, “a prisoner grows to love his chains.” In fact, this notion may account for prisoners’ literal reoffense after release from jail; they report not knowing how to handle the freedom of civilian life and functioning better within the confines of what they find familiar. If we anticipate that the other shoe will drop—that we will be blindsided by fate after feeling so good—it makes more sense to choose a panic attack to feel, psychically, more in control of the disaster by creating it. It is preferable to the sneak attack of what our mind anticipates will invari-ably occur.