teachers at the margins
Lisa Marchiano, a psychoanalyst, describing her encounter with a student who had a “panic attack” during an exam and didn’t want to take any more exams:
I asked this young patient of mine what in fact had happened during the first exam. She responded again, I had a panic attack. I lightly pressed her to move beyond the jargon and tell me about her actual experience as she took the exam. Eventually, she was able to tell me that, as the papers were being handed out, she become flushed and light-headed. Her heart was pounding, and her hands felt clammy. What happened then? I asked. She felt like running out of the room, but she was able to calm herself down enough to take the test. Though she successfully completed the first exam — and did okay on it — the fear that she might have another “panic attack” had prevented her from attempting the second exam.
What had happened here? One way of understanding this young person’s experience is indeed that she had had a limited-symptom panic attack. According to the diagnostic criteria for panic attacks in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a limited-symptom panic attack can be diagnosed based on a pounding heart, sweating, and shaking. Of course, as anyone knows who has ever taken an exam, performed in front of an audience, or asked someone they like out on a date, these are in fact utterly normal reactions to feeling nervous. I gently attempted to reflect this back to my young patient. “So you were nervous about taking the exam, but you didn’t run out of the room. You did it. You pushed through the fear feelings.” I wanted her to see this as a success, one that she could build on, that could help alter her stuck story that tells her she is too anxious to function adequately. Her response to my positive reframing was telling. She looked up at me from under her brows and held my gaze. “Yes,” she responded firmly. “But I had a panic attack.”
