The Worst Thing

by Aaron Elkins

  “My brother?”

  “Your brother Richard.” She tapped the paper. “The one you were playing with. I was wondering how he felt about not getting kidnapped—how you felt about it, for that matter—if it created any issues between the two of you.”

  “Oh.” It had been a long time since I’d thought about Richard. “Richard died just a few months later. There was a polio epidemic in Istanbul that year. That had a lot to do with my mother and father’s breakdown too. It was all just too much for them.”

  She was shaking her head. “I should think so. Well, in any case, this is all in the long-ago past, it’s done, and we can’t change it. We need to work from the here and now and move forward.”

  “Good. I’ve had all the psychoanalytic depth interviews I’ll ever want.” Two, to be exact.

  “But what you’d better understand right from the start,” she went on, leaning forward with one hand propped on each black-draped knee and her cigarillo burning in the ashtray on the table, “is that the key to ridding yourself of anxiety that’s rationally groundless—phobias, panic attacks—is to face it head-on. The minute you stop running from the fear and decide to start confronting it and to start gaining some control over the situation and over your own life, you’re on your way. It’s not very complicated, but it does take nerve.”

  I shook my head. “I don’t know, Zeta. I am facing my fears. I’m actually leaving the country, going to Iceland. I’m working with an organization that’s just been through a kidnapping attempt and is worried about another. These are huge steps for me, but things have gotten worse, not better. I’ve had panic attacks three nights in a row. And last night I only headed off another full-blown one because I’d popped a pill the minute I thought I felt it coming on.”

  Zeta snorted and waved her cigarillo to brush away my protest. “No, you’re not facing your fears. You’re taking your trusty little bottle of happy-time pills to Iceland, aren’t you?”

  “My big bottle.”

  “Exactly, there you go. And when you get nervous because you think you feel an attack coming on, what do you do? You pop a pill—thereby avoiding the fear, not facing it. If you were going without your pills, then you’d be facing it.”

  “Are you asking me to do that?” I shook my head and laughed uneasily. “Because—”

  “No, that’s not what I’m asking you to do, although you shouldn’t laugh at it, because it very well might do the trick if you could see it through. It’s a relatively new approach, and for a lot of people it works. Flooding, we call it. Or exposure therapy. Or implosion therapy, although I find the term a little threatening. You just face down your fear all at once, with no crutches to lean on—you just do it. Panicked about riding in an elevator? You grit your teeth and get on one and ride it up and down and up and down until you’re over it, and by the time you get out you might be sweating, but you’ve pretty much got it licked. It’s extreme, all right, but it’s the quickest way to be done with it once and for all. It’s worked for other people, Bryan. It just might work for you. Same philosophy as beating your fear of horses by climbing right back up on the thing after it’s thrown you.”

  “Yeah, or learning to swim by being dumped in a lake.” I shook my head. “I don’t know, Zeta. It sounds as if it might be reasonable, just sitting here talking to you, but if push came to shove . . .”

  “Bryan, my boy, let me give you Dr. Parkington’s theory of panic-attack therapy in one sentence: In order to be rid of the damn things for good, you have to face whatever it is you’re most afraid of—the very worst thing. That’s the rule, no exceptions.” She paused to let this sink in. “You don’t fight it, you don’t try to avoid it or moderate it with pills, or relaxation techniques, or slow breathing, or anything else. You face it down, once and for all. In fact, you purposely make it as bad as you can for as long as you can, so you can prove to yourself that you can do it. That’s the price you have to pay.”

  “Pretty expensive price.”

  “Look, Bryan, what’s the worst thing you can imagine? Just tell me. The most panic-inducing situation you could possibly find yourself in.” She leaned interestedly forward.

  “Well, it would be a repeat of what I gave you to read.”

  “Yes, but let me hear you say it.”

  I hesitated. It didn’t strike me as the keenest idea I’d ever heard, but then, I was there for help and Zeta was offering it. I took in a breath. “The worst thing I can conceive of would be to . . . to . . .” Would be to wake up suddenly, startlingly, in the middle of the night and find that my current life had been a dream, that in actuality I was still chained by the neck in a dank, pitch-black cave . . . But I couldn’t even think it through, let alone say it. I just sat there mutely shaking my head, conscious that I was breathing through my mouth in little gasps. Over and above the rest of it, I was both angry at myself and embarrassed. What a pusillanimous, lilylivered weakling this panic thing turns you into.

  “Easy there, big fella,” Zeta said. “Never mind, you don’t need to tell me. But don’t let it go entirely either. Let’s say you did find yourself in the situation you’re thinking about. What exactly do you think would happen? How would you react?”

  “React? If it happened to me again? I’d lose my mind, I’d come apart. ‘Implosion’ is right. It’d kill me, Zeta.”

  She paused to relight the cigarillo—and, I suspect, to give me a chance to collect myself, which I did. I could feel my breathing return to normal.

  “Au contraire,” she said when she’d gotten it lit. “Nobody ever died from a panic attack, Bryan.”

  “Oh? And how could you know that?”

  Zeta laughed, a robust, two-note har-har. She even slapped her thigh. “Well, you’ve got me there; I can’t prove it. But we do know that extreme anxiety—panic—is a self-limiting phenomenon. It runs out of gas and ends on its own. You think it’s going to spiral up and up and blow you apart—”

  “Boy, do you.”

  “—but it doesn’t, does it? Has it ever? No, it can’t, because when the stress gets extreme enough it automatically activates the autonomic nervous system to kick in with a shot of beta-endorphin, and you calm down. Didn’t you ever have a panic attack when you didn’t have anything to take for it?”

  “Sure, the early ones, when I didn’t know what they were, before I had any medication. They were horrible. I was positive I was going crazy. I thought I was crazy.” I shivered. “It’s still what happens when I get one, in that brief period before the Xanax starts to act. Even now, when I know in my head that it’s only a matter of minutes before the med goes to work, it doesn’t do me any good until it actually kicks in. In my gut I know I can’t last, I know there’s no way that little orange pill can cope with this. I’m either going to lose my mind or die.”

  “Ah, but you don’t die, do you? And you don’t go crazy either. It all just quiets down after a while. Just the way it did in the old days, even without the medication. It just took a little longer.”

  “A lot longer. And yes, it quiets down. Until the next one comes along.”

  “Which takes . . .?”

  “I don’t know; days, weeks, months if I’m lucky. But sometimes it’s the very next night.”

  She jabbed the cigarillo at me. “That’s right, the next night. But never, ever the same night. Have you never wondered why? It’s because it takes a while for the beta-endorphins to filter out of your system and let the panic syndrome start building up again.”

  “Okay, all right, I’ll buy that. Tell me, then, how do we attack this thing? Short of this flooding idea. I’m not spending the night in a cave with a chain around my neck, I can tell you that.”

  “Well, if you’re serious, we do need you to do something along those lines—work through a panic-inducing situation without the meds—but not all at once, if that’s too much for you to think about right now. We build up to it, and in an analytical, modified way, with me right beside you. Now that’s not so awful, is it?�
�

  “Not so awful, is it,” I echoed, smiling. “Zeta, no offense, but I’m guessing you’ve never had a panic attack yourself. Am I right?”

  “Well, there have been moments when I—”

  “No. I mean a genuine, honest-to-God, full-blown panic attack.”

  “Well, no, not personally, but I’ve sat through them with a good many patients, and, in any case, you don’t have to have appendicitis in order to treat it, or . . .” She stopped. “No, you’re right, I haven’t,” she said more softly. “Why don’t you tell me what it’s like, Bryan? For you, specifically, I mean. Or would that be too nervous-making?”

  “No, not nervous-making, but not so easy to put into words,” I said with a sigh. I got up and went to the window. I was looking down at the lively, grungy, student-infested corner of Brooklyn Avenue and Forty-fifth Street, and at the old-fashioned marquee of the old Neptune Theater. One of the last of the single-screen movie houses in Seattle, built in the 1920s, they had a rerun of The Sting playing. “How are you about heights, Zeta?” I asked after I’d gotten my thoughts in order. “Comfortable with them?”

  “I’m not phobic about them, if that’s what you mean, but I’m not crazy about them either. If I’m stupid enough to get myself anywhere near the edge of someplace high, I generally wish I was someplace else.”

  “Okay. Then imagine that you’re standing right at the lip of a sheer two-thousand-foot cliff and not feeling too keen about it. No guardrail, nothing to hold on to. Your companion, standing next to you, suddenly, inexplicably, turns on you and shoves you—hard—and over the edge you go, out into space. The feeling you have at that moment, the exact moment when your feet leave the earth and you hang over the abyss, staring down—that heart-stopping, overwhelming, mind-shattering terror—that’s what a panic attack is like.”

  “I see. Well, I can certainly—”

  “Except,” I continued, “that it goes on and on and on, full-force, unabated, for thirty or forty-five minutes, or even an hour, never letting up in the least, your heart banging against your ribs as if you’ve got this panicked horse inside, trying to get out.”

  “I see,” she said more soberly, and I could tell that she was really trying to imagine it.

  “And while forty-five minutes of that hardly sounds like fun, it does sound endurable, doesn’t it? Especially because you know that there isn’t really any danger since there isn’t really any cliff and nobody’s pushed you off it. Besides, you’ve lived through this before, so you know it’ll be over soon, and all you have to do is wait it out, right?”

  “Not right?” she said.

  I turned from the window. “Ah, if only it worked that way, but it doesn’t. The thing is, you are absolutely, incontrovertibly convinced that this time you’ve slipped for good over another edge, from sanity to wherever the hell you are now, and there’s no way back. It’s like one of those science fiction movies, where you go through an opening to some other horrible dimension, and when you turn around the opening is gone: You’re in an alien world and there’s no way home.”

  Back to looking out the window now, speaking quietly, musing, talking as much to myself as Zeta. “Now you see—with absolute certainty—that all along your other, ‘sane’ self was the mirage and this horrible, unendurable state of unending terror—this is reality. You’re trapped in it with no possible way to get out, until your heart or your brain explodes with it, which can’t be very long because who could possibly take this for very long? As for knowing there’s no actual danger, that doesn’t compute at all. Your thinking mind is shut off. There isn’t room in your head for anything but the panic.”

  She’d sat through this without smoking, and her cigarillo had gone out. She relit it before saying anything. “Oh, my, my, my. That’s very graphic, Bryan. I think my own pulse is up a few beats.”

  I let out a nervous laugh. “Mine too.” I came back and sat down again. “Zeta, the one thing I’ve never understood about this: Why can’t I think my way out of an attack? I mean, if I know that nothing is really there, why can’t I tell myself that? That is, I do tell myself that, but I don’t believe it. Why is that?”

  Another wave of the cigarillo. “Ah, there’s the rub, all right. Sure, we like to think that our upper brains are in charge of things, because that big, round prefrontal cortex is so smart and advanced, and the funny little limbic system way down in the neck—which controls emotions like fear—is so primitive and squiggly and funny-looking. And it is primitive. But it’s also powerful. You see, by the time the cortex figures out what’s going on, the limbic system—specifically, the amygdala and the hippocampus—are running the show and it’s too late. Your head, as you so vividly put it, has no room for anything but the panic. Unfortunately, gut-level terror trumps reasoning and logic, whether you’re a mouse, a monkey, or a human being; an unfortunate biological fact. Thinking winds up doing you more harm than good, because your perceptions are all screwed up at that point, and you see things all wrong.”

  I nodded. It made sense to me. I came back and sat down. “So tell me, how do we attack this thing? Short of this flooding idea. I’m not spending the night in a cave with a chain around my neck, I can tell you that.”

  “Well, if you’re serious, we do need you to do something along those lines—work through a panic-inducing situation without the meds—but not all at once, if that’s too much for you to think about right now. We’re talking about cognitive behavioral therapy here. It’s more self-treatment than treatment. What we’d have you do is work through a series of graduated exercises to create a panic response—a very limited panic response—and help you analyze it while it’s going on. Your job would be to dissect exactly what you’re feeling, to focus on it and learn—”

  “Focus on it? Zeta, that’s the last thing I want to do.”

  “Bryan, listen to me. As long as you keep running from it, you’ll never get over it. You have to get used to it, that’s the only reliable way. You look objectively at exactly what you’re feeling and you prove to yourself, deep down, that you really can live through it, that your perceptions, your fears, are all wrong and you can beat them back. It’s like finally standing up to this bully that’s been terrorizing you and telling him: ‘Do your worst, you sonofabitch. Take your best shot. I’m not running anymore.’ ”

  She mashed out the cigarillo and paused—as if to prove to herself that she wasn’t literally chain-smoking—and then immediately pulled the next one from a pocket pack and lit it. She smoked Hav-a-Tampa Jewels, vanilla-scented little mini-cigars with wooden mouthpieces. Unlike most cigar smokers, she inhaled. “You see, avoiding it—taking a pill, for example, or just staying away from airplanes or telephone booths or whatever—does avoid the panic for the time being, yes, but it makes things worse in the long run because avoiding it is temporarily satisfying, so it reinforces the avoidance behavior—making you less likely than ever to give up the pills, or get on a plane, or go into a telephone booth. Does this make sense to you?”

  “I guess it does, yes,” I said without much enthusiasm. Simply staying on the pills and suffering the occasional attack was sounding better and better.

  “Frankly,” Zeta said, “given your line of work, I’m surprised that you don’t already know all this.”

  “This isn’t my line of work. This is the part of my work I go to great lengths to stay away from.”

  “Har-har! Well, you see, there’s my point right there.”

  I managed a pale smile. “Yes, I see. How long would this take, Zeta?”

  “Well, look, it’s never a sure thing, but for you—you’re a brainy, analytical type—I would say the outlook’s good. Assuming you don’t want to go the all-at-once implosion route . . . ?” A questioning lift of one eyebrow.

  “Not at the present time, thank you.”

  “Maybe later, we’ll see. I’ll leave it up to you. Sometimes we have the patient drink a couple of cups of coffee first to get the heart going and to accentuate the sensatio
ns. That really makes it fun.”

  “If it’s all the same to you, I don’t think I’ll need the coffee. If I do it at all. So, about this cognitive behavioral theory—how long?”

  “Oh, I’d say, oh, something like twelve or fifteen sessions, probably once a week, plus a little homework for you to do in between. Altogether, say three to four months. And I’ll never try to make you do or think anything. I may ask you, but it will always be up to you, it’ll always be at your pace, and that’s a promise. We might not totally cure you, but I’m betting you’ll be in a whole lot better shape.”

  “Okay, I’m game. But you know, I’m leaving the day after tomorrow and I’ll be gone all of next week, so I don’t suppose there’s any point in starting now.”

  Zeta put her blunt-nailed fingers to her temples, as if calling up psychic powers. “I seem to be receiving these thought rays telling me to please, for God’s sake, agree with the man that we don’t have to start now. I wonder where they’re coming from.”

  “Zeta, it’s no joke. Frankly, the whole thing terrifies me. Let me have a couple of weeks to get used to the idea. Besides, I want the trip to be as much vacation as work. It’d be nice to just, well, relax. If I have to pop a pill or two, so be it.”

  “I understand. Far be it for me to push you into anything. It wouldn’t do any good anyway. And there’s something else you’ll have to understand. Once we start—bye-bye, Xanax.

  “For three months? That’s a little scary.”

  “I know it is, Bryan,” she said in a gentler tone than she’d used with me so far, “but if you’re on a tranquilizer, you’re not going to benefit. The drug turns off the entire autonomic fight-or-flight response, so you can never really experience the full force of the anxiety. And that’s just what it is that you have to come to terms with before you can get yourself over the hump. And once you have, trust me, you won’t need the pills anymore. Well, not as much.”

  I sat quietly, slowly shaking my head. “I don’t know, Zeta,” I said once more.