Generalized Anxiety, Or When Your Brain Makes You Think You're Dying

When I try to think of when the problems really started, I come up blank. I guess I've always been a bit of a worrier. But it would come and go. Sometimes, in the middle of the night, the voices in my head would remind me how close to being broke we were or that something in my life just wasn't adding up.

Then after a few days, I would find a silver lining, and the feelings would pass.

But I think it really started when we moved back to Ohio in 2010. No, I'm not blaming Ohio. But the circumstances that brought us there took their toll on my mental well-being. A long stretch of unemployment for my husband caused us to have to reboot our lives and relocate halfway across the country for him to find work, and the person who came out of the other end of that nightmare was a bit more brittle, a bit more prone to worry and breakdowns. They say what doesn't kill you makes you stronger, but I think sometimes it can make you a little crazier too. Even so, I was holding it together okay.

Except then I started having symptoms of irritable bowel. Eating would send me running for the bathroom almost immediately. I tried various diets with limited success, but it never really left.

Then, in the summer of 2011, I was driving back from Columbus to Dayton with my husband when a perfect storm occurred. We nearly had a devastating car wreck while I was behind the wheel thanks to a hugely reckless driver. And a series of tornado-spawning storms were moving through the state. Meanwhile, I received a call from my brother. Our kids were off on vacation nearly three hours away with him, and they were hiding in a shelter when they spotted a funnel cloud near Sandusky. They were all fine, of course, but our drive home was a bone-rattling nightmare.

And I'm not sure I really ever relaxed again after that. Whatever protective coating I had on my nerves had been burned away by the unceasing wash of cortisol and adrenaline from that one day. I guess you could say it was the tipping point between being an occasional worrier to someone who had upgraded her arsenal to panic.

A year later, I had my gallbladder removed.

A year after that, we were forced into an unexpected move by a dickhead landlord who decided he wanted to give his house to his kid.

In other words, stress became an ever-present thing for us, and though we'd always weathered our share of it, I realized I wasn't coping with it as well as I used to. It was leaving a lasting mark.

In that time, I realized I couldn't really drive on the freeway anymore. I'd become certain a tire would blow or that someone would side swipe my car. It was particularly bad if I had one of my kids in the car with me, because I was certain I would get them killed along with me. But even when alone, I would sit bolt upright, gripping the steering wheel like it might fly away, sweaty palms, the panic in my chest like a rat scrabbling to get free, convinced beyond all measure that if I gave into it even a little, the car would spin out of control and I would die. I started looking for ways to avoid social situations that required me to hop on a freeway and drive distances longer than a mile, unless my husband could drive me.

Around 2013, the endless heartburn and reflux started. 

In late 2014 came chronic nausea and bad sleep. I would wake up earlier and earlier every day. Then I started vomiting when I awoke, or at least feeling nauseated. I was convinced I had pancreatic cancer. Google was telling me so. Then I was having pain in my right flank. I finally went to the emergency room, and after copious bloodwork and a CT scan, they diagnosed a bladder and kidney infection. I thought with treatment, that would be the end of it. 

But the nausea continued into 2015. I went to the doctor, and they did some tests. He said, given my chronic heartburn, I very likely had GERD and to do a round of Prilosec to see if that eliminated symptoms. The nausea went away completely. It was miraculous. I thought I was reaching the end of the whole nightmare.

But then my agent started shopping my novel around in March and the stress REALLY kicked up. I was on the verge of a book deal, and I immediately started obsessing over my own death. The idea that I would never see my dreams come to fruition because I would die first stayed with me day in, day out. Then the chest pains started. And the palpitations. And pain between the shoulder blades. I stopped sleeping again. I would fly off into crying jags for no reason. I would get a twinge in my side and was certain I had appendicitis. In fact, every little unexpected sensation in in my body was a sign of certain death. I couldn't shake the fixation that my mortality was imminent. It was making me paranoid and miserable, and I'm sure I wasn't much of a picnic for the people around me either.

Then one day I couldn't get the chest pains to go away, and after spending an hour reading Google for signs of heart attack, I went back to the doctor. He wasn't even in the room five seconds before I broke down crying. I told him I thought I might be having a heart attack, or that I may just be losing my mind. That I couldn't get my thoughts under control, that I thought I might be dying.

They took my blood pressure and pulse and blood sugar. My blood pressure and sugar was normal, but my pulse was up over 100. I was shaking, speaking rapidly. I felt like I was coming out of my skin. He listened to my heart and my carotid artery and didn't hear any irregularities, but he ordered an EKG anyway, in part to be sure my heart wasn't fucking up, but also because I would have obsessed over it endlessly. I needed to know for sure. A little while later, the EKG came back completely normal. In fact, my heart was humming along beautifully. He showed me how very normal it was using some kind of doctory language and showing me the neat little lines on the paper. No sign of cardiovascular issues at all.

The sheer relief alone brought my pulse back down to normal. But he said I sounded very stressed out and that most of my problems could be related to anxiety. I told him that yes, that sounded reasonable. Given the phantom nature of my symptoms, I was more inclined than ever to agree. And the more I've studied Generalized Anxiety Disorder, the more certain I've become that this has been responsible for the vast majority of my issues.

He offered the lowest possible dose of Zoloft. A 25mg tablet cut in half. Doses 50mg and under are used for treating anxiety in particular. Anything over that is traditionally used for depression, which wasn't what I was dealing with. I said "Yes, please." At that point, I would have sucked down a quart of cow bile out of a camel's rectum if it would have helped.

The evening I picked up the prescription, I had another breakdown. I told my husband I might have to go back to the emergency room for my appendix. The only symptom was a little gas, but in my brain, the world was ending and, of course, I was dying. Any relief I received from a healthy EKG had evaporated, as the "problem" in my body had simply moved to another location. Even though where it really was was in my brain.

But 30 minutes later, after I came home and relaxed a little, the symptoms were gone. Though I knew it was only a matter of time before another "attack" happened if I didn't treat it. So that night I started taking the pills. About three days later, I felt . . . completely and utterly normal. More normal than I'd felt in years, in fact. A couple weeks after that, I bumped up to the full 25 mg dose and I haven't budged from it since.

Since then, I've received bad news and experienced stress. Not huge amounts, but enough that, untreated, they would have sent me into a massive tailspin. But instead, I handled everything with a cool head. When a couple of "almost" book deals fell through, I was upset, sure, but it didn't ruin my day. In fact, I got back to work that same day. Without the meds, I might have stopped writing for months.

I don't obsess anymore. I started sleeping normally again. I don't think about the worst case scenario. I can focus and get my work done. I don't agonize over my own mortality anymore. I don't fly off into irritable rages anymore. I don't have nausea or painful twinges or palpitations or chest pain anymore. My GERD symptoms have reduced by about 80%. Same for the irritable bowel that has plagued me for years. My husband has noticed a big difference in my temperament. I'm so much less of an asshole now (note: he never ever called me an asshole, but I think we both know I was toeing that line a little more frequently than usual the last few years, and disorders like this can have a major effect on the people you live with over time). Oh, and one other thing: I'M DRIVING ON THE FREEWAY AGAIN. 

People can say what they will about the risks of such medications, and maybe they're not right for everyone, but I can say this...they brought me back from the brink. They made me a functional human again. They put a thin layer of padding between my nerves and the sometimes overwhelming stimuli of living. When I revisited my doctor recently, all my vital signs were perfect. My resting pulse rate was below seventy. Cool as a fucking cucumber.

It's amazing to me what an unchecked brain can do to your body. Obviously, it's not the answer for everything. I need to hone my coping skills and start exercising and meditating again. But you never could have gotten me to sit still long enough to even consider those things before I started taking the medication, and I think that's its most important purpose. Rescue. 

If you feel like you're spinning out of control, there are things that can help. Life is suffering enough. Don't put more on your plate than is necessary.


Additional Thoughts on Writing to an Outline

A good while back, I railed mightily against outlines. Though more specifically, I think my railing was about the idea that you SHOULD outline if you want to write a good book. I still gnash my teeth at such "rules." My feeling is if you are an otherwise successful, productive writer, you should keep doing whatever it is that's helping you get there, whether you're making a copious outline or flying by the seat of your pants. I know writers on both sides of the divide, and no one is "right."

Over the years, though, I've noticed a shift in my work habits as I've started to add more to my plate. My basic commitment at the start of every year is to finish at least two novels and a half dozen or so short stories. And in order to do that, I have to put a bit more forethought into my projects. Recently I just completed my first book written completely to an outline. But before I get to that, I will lay down my typical process, which goes something like this:

1. Have vague notion in head. Could be anything from a weird concept or philosophy, a striking bit of scenery, a quirky bit of dialog, or a very strong image of a character personality trait. Write a few pages. Then stop.

2. Take a step back, see if it grows legs. Sometimes it does, sometimes it doesn't. I normally have to turn things around in my head for a few hours or even a few days, weeks, or even months. Sometimes I forget all about it. Other times, it lingers, and usually when it does, I know I've probably found something. Usually at this stage, I'll talk about the concept with someone, like a writer friend or my husband, and it will knock a thread loose that I can follow.

3. Write a little more. Sometimes that thread starts spooling out pretty steadily and I find I can more or less carry on until the end of the first act. Sometimes it comes with fits and starts. Anyway, I usually get a good way along before I have to take a few minutes to start getting my thoughts together about how the rest of the story is going to unfold.

4. Start outlining in the second act. I write down important dates. When is the story taking place? When does a pivotal event happen? When were characters born or when did they die? Sometimes that's relevant info. I also will plan out the next several chapters, usually bullet points for particular beats I want to hit through the middle part of the book as well as a very rough sketch of the third act and the ending. At that time I'm also assembling a list of revisions I'll need to do in the earlier parts of the book, usually to sew up plot holes that opened when I changed something, or additions to a character's background or motivations or some other miscellaneous bits.

5. Officially map out the third act and ending. Sometimes I stick with that ending, sometimes think of a new one as I'm working that I think would be better. There have been books that I knew the ending almost right out of the gate, and everything I've written has been in service of that desired outcome. Other times, it's completely inverted. I have no idea what the ending is really going to be until I've actually walked in a character's shoes. I will say that often times I have far more grim and gruesome endings in mind for characters only to find that by the time I get there, I find I'd rather have them live or find some kind of redemption. And people say I'm sick and twisted . . .

By the time I finish with this process, I have a very lumpy piece of fiction that has about three or four more rounds of editing and revision before I can slap a happy sticker on it. It usually needs more subplotting and character fleshing. It's also usually a great deal shorter than I'd like it to be.

Now to the book I wrote via an outline, which was really just a numbered list of short chapter summaries. You can make your outlines however works best for you. The informal method seems to suit me best.

Anyway, I knew I had to change things up with my process for BLIND SPOTS, because I wanted to make sure I had it done and to my agent in a certain period of time. By outlining the whole thing, it allowed me to know approximately how long it would take to finish as well as ensure that I wouldn't run into any brick walls that would stall my progress.

Let's talk about the pros to working with an outline first.

1. Energy Level/Momentum. My chief concern about outlining has always been that I would wear myself out writing the outline and have nothing left for actually creating the story. This actually happened to me the first time I wrote an outline for a book several years ago. A book I (shocker) didn't finish. Surprisingly that didn't happen at all with this story. Maybe it's because ever since I had that problem, I've become a far more practiced writer. Also, I wanted to finish this book for my agent, so I had that motivation pushing me along. But really, if anything, writing the outline actually got me EXCITED to write this time, because I loved the idea I'd come up with. It helped erase a lot of the doubts I'd initially been having about the story's potential, because after mapping it all out, I could see it laid out before me. Also, it gave me a pre-determined workload for each day. I knew what I needed to write in order to stay on track, and so I wrote it. In doing so, I finished on schedule.

2. Making Changes. The first thing I probably ever got wrong about outlining before was that doing so would restrict me from thinking freely, that it would rob me of the joy of the discovery and the mystery of writing without a guide. For some reason, I thought an outline had to be set in stone, when in reality, it was the opposite. The outline is a living, breathing thing. It can morph completely at your will. It is simply the brain's creative process in physical form. The outline I started with changed dramatically from the time I started it to when I penned the ending the other day. The mystery and thrill of discovery was fully intact. I added chapters, I changed character arcs and outcomes multiple times. The outline evolved as I went along. The only difference was I didn't waste HOURS upon HOURS writing a ton of prose first only to have to go back and delete and/or change it all because I decided to go a different direction. In fact, the outline made it easier for me to get the shape of the story I wanted the first time, and it probably shaved weeks off my original process. If I was having second thoughts about a chapter, I would change the outline instead, and then I would keep writing. If I did have to change something in a previous chapter, that was okay too. I changed it in the outline so I could see how it would all work first, and then I altered the manuscript. That way I still had a current version of my vision in front of me at all times, and I didn't get lost in my own maze, as I often would do when I would keep it all in my head.

3. Determining Length. Word count matters to me. It might not matter to you, and that's okay. But I'm a bit of a nut about it. Knowing the length of a story going in helps me a lot in regards to pacing. With the exception of my COLT COLTRANE books (which are closer to novellas, around 45-50K words each), I typically set out to write novels ranging between 80-90K. They can run a little longer than that, but to me, that's a perfect sweet spot for a long tale you can get lost in for a little while without losing months of your life. Knowing the length of a book also helps me with pacing. I can figure out how long each act needs to be and when to hit certain climactic beats. With an outline in hand, I am able to guesstimate an average chapter length (for me it's around 4K words) and then multiply that by the number of planned chapters to get an approximate book length. If I'm coming up short, I re-examine where I can develop sub-plots and add additional depth. For the first time with this outlined book, I managed to come only a few hundred words shy of reaching the 80K mark on a first draft. That almost never happens for me. Some authors overwrite the shit out of their first drafts. I'm a shirker. While I do still have more fleshing out to do, I have a feeling I won't be adding an additional 15K words in additional necessary plotting like I normally do.

So that covers the biggest pros of writing to an outline, but it wasn't all sunshine and roses in Anal Town (okay, that sounds wrong...). Let's talk about a few of the cons. 

1. Emotional arcs. The outline helped TREMENDOUSLY with making sure the basic plot and structural stuff was in place, but in the course of trying to get all that nailed down to spec, I found I had spent less time developing the mood of the story and the characters' emotional stuff. In other books, I often spend so much time in a character's brain that I tend to have to play catch-up with the plot stuff on revisions. That's something I need to make sure I'm factoring in if I write an outline for my next novel (and I probably will).

2. Prose Yuck. When I'm writing by the seat of my pants, the creative process feels a lot more immersive and I often find my natural voice comes through a bit more. When writing to outline, I feel a bit like I'm sitting in a seat above the story, which makes my voice seem a tad more stilted. I also lose a certain lyrical rhythm because I am trying to remain conscious of sticking to other pre-planned factors. I'm probably going to have to do a LOT more line editing with this draft because of it.

All in all, though, I think these kinks can be worked out with more practice. The pros of having the confidence a reliable road map gets me is worth it. I actually find myself anxious to start planning my next novel now that I know I can write effectively to an outline. Who knows. Maybe you'll see more books from me in the future...