Background to my interest in teaching children with autism

PSYCHOTHERAPY BEYOND THE FRINGE, continued

                                                            Chapter 10

                                    Panic — An Error Disorder

Introduction — Titanic Panic

Lots of people experience panic. It comes about as a result of an intense self-protective preoccupation with how the body feels when a strong autonomic nervous system response is occurring. Panic can be produced in three main ways. (1) It can come about as a result of escalating terror of ambiguity, leading to over-generalization, leading to increased ambiguity, leading to increased fear – as a spiralling growth of fear. This reaction, called the ‘catastrophic’ response, occurs in some people, who may also learn how to avoid it by ‘muting’ their reactions by a kind of inattention to the world around them. These events occur in some people who receive a diagnosis of schizophrenia. (2) It comes about most commonly as a result of a, partly habitual, error in the way normal bodily responses occur. Queeny’s case will be used to illustrate this kind of reaction. (3) It can come about as a result of a kind of accidental learning. One of Felicity’s own experiences will be used to illustrate this phenomenon.

A Miss Takes Mistakes

Queeny was a quiet, introspective lady in her early twenties. She was slim and attractive, and she was pleasantly conscious of her trim appearance. She was referred to Felicity, by a psychiatrist she had consulted, for treatment of a resistant panic disorder from which she had suffered for years.

Queeny was experiencing panic attacks in spades. She had been experiencing bouts of panic almost daily, and sometimes several times a day, for about six years. Half facetiously, Felicity suggested she must be pretty good at doing them by that time, and he wondered if she could do one for him now. She did. There actually was a purpose for putting her through the experience. Most often, if a person can bring on symptoms voluntarily, he/she knows how they are produced and can stop producing them. Also, Felicity considered it important to have a first hand view of what she was doing so that he would be able to focus on the specific sequence involved – even although the procedure used is more or less the same regardless of the succession of events.

But Queeny could not reverse what she was doing and could not stop or prevent a panic attack. Their reported frequency and regularity, coupled with the fact that they occurred anywhere at any time of the day, meant there had to be something occurring beyond the usual triggers. The psychological tests Felicity administered were not helpful. But he zeroed in quickly on the issue during his inquiry.

The regularity of the occurrences was due to an error she had made about bowel movements. Felicity was reminded in this of Deryk whose story was gossiped about earlier. She had the idea that it was very important for health to keep her bowels evacuated. Consequently, she had developed the habit of having a bowel movement prior to every meal and before she went to bed at night. Had her bowel movements occurred after each meal, Felicity would have explored the possibility of food allergies or sensitivities, such as an allergy to a grain or a sensitivity to lactic acid. But having a bowel movement before meals was most likely to be habitual – as she, in fact, confirmed.

Felicity explained the problem of too frequent bowel movements to Queeny just as he had eventually done with Deryk. He asked her to alter her bowel movement pattern to reduce her frequency by one bowel movement a day, maintaining each new reduced frequency for two weeks, until she was down to once per day. She had some difficulty adjusting to her new schedules, but she claimed to be doing so as the weeks rolled by. She also seemed to understand the reason for doing so, as though she knew that part of the panic-induction procedure involved tightening the rectal sphincter.

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