This question is submitted by someone who feels alone and isolated and does not know where to turn.  It addresses how this person feels, what can be causing these feelings, and potential sources of help.

Dear Doctor Life Advice,

This is like the 5th panic attack in 3 days! I can’t help it but the tears keep welling up inside me at the drop of a hat and then I can’t stop the feeling of hopelessness and I feel so lost and I don’t make sense and I am wasting my life because my emotions are rendering me immobile. I am even to the point where I get so stressed over trying to look for the career of my dreams, I feel an attack coming on and then I have to find an escape! I really do feel like I am broken and I do NOT know what to do or where to turn. I don’t want to spend all my money on a therapist, but I don’t know what to do. Most of all I am scared the love of my life will only start to see this side of me and leave. I feel isolated and all alone. What are my options and what do I do?!

Signed: Isolated Alone

Dear Isolated Alone,

Let’s start by reassuring you that you are not “broken.” Many of us go through tough times when it all feels dark and alone, and we all deal with these times in our own unique way, there is no “right” way. Your question raises a some medical concerns.  Most importantly, you need to make sure you are not suffering from disorders such as Hypothyroidism, Electrolyte or hormonal imbalances, Depression, Anxiety, or Panic Disorder.Even if you have limited money, you need to see a physician to evaluate you for these conditions, just like you would if you had a big infection growing on your skin, or a seizure, or any other medical condition.  The conditions I listed above can all be medically treated, and the  right medication can be very helpful.  I’ve had many patients that have gone from being unable to leave their home in fear of panic attacks to being fully functioning and happy individuals. So first and foremost, you must get evaluated by a physician to find out if medication can help.

You sound like you are at a very stressful time in your life, and are feeling overwhelmed by everything.  You are looking for the career of your dreams. I can’t tell what that means from your question; more specifically if you’re trying to decide what the career of your dreams is, and how to obtain it, or already knowing what it is and trying to look for a job in that field.  Either way, if you’re not thinking clearly and are having crying spells, you need to focus on yourself and on getting better before you can pursue the career.  So let us talk about ways you can help yourself feel better.

Again, first of all, see a physician so you’ll know there’s nothing “organic” going on in your body that’s causing the symptoms. Meanwhile, start by watching your diet.  When we’re feeling down, anxious, or upset, we tend to seek out “comfort foods.”  These are usually sugars and carbohydrates.  They give us a quick lift, but then we end up crashing off of them and feeling worse.  Make sure you’re not following this diet pattern.  Another quick change you can make is to avoid alcohol.  Alcohol can cause both depression and anxiety attacks. Some people drink alcohol to sleep; it is true that it helps you fall asleep, but it causes what is called “fragmented sleep” which means you wake up many times during the night and won’t get restful sleep. Alcohol can also cause heart racing which can feel like panic attacks.

The above are all simple, straight forward actions you can take towards getting better.  To dig deeper, my concern about you is your poor impression of yourself.  The clues to that are your belief that you are “broken,” your harsh judgement of yourself that you are “wasting” your life, and your fear that the love of your life will leave you if he or she learns about the whole you. A more loving and compassionate way of looking at your situation is that you are going through a hard time trying to make some serious life decisions deal with overwhelming emotions and as a result you are not doing all the things that you want to be doing right now. Give yourself a break and send your harshest critic – the one that lives inside your head – on an ideally permanent vacation. This is easier said than done of course, so I’ll give you some techniques that can help.  Be conscious of all of the times in the day that you criticize yourself. Right now, you probably do it automatically and subconsciously.   Work on bringing your critic up to your conscious mind. Once you learn this, you have to be very careful not to kick yourself for having a critic in you.  Remember that this is an exercise in learning self-love and self-compassion, not another way for you to put yourself down. Once you become conscious of the critic, respond to it by thinking some positive thoughts, such as “I’m going to be kinder to myself than that.” Allow yourself to be imperfect, everyone is, and don’t judge yourself harshly for it. If you think you are “weak” because you are having anxious and crying fits, then remember that by those standards every human being on this planet is “weak.” In my profession I worry much more about my patients that don’t allow themselves to break down and cry than the ones that do.

I don’t know about your childhood and the level and caring and nurturing you received. Although it is true that our childhoods have everything to do with the level of self-esteem we form, the fact is that you are no longer a child. There is one person that can take care of you, love you unconditionally, and nurture you now that you are an adult.  That person is you. Make a commitment to taking good care of yourself, and stick to it. Aside from putting your inner critic in its place, you need to find activities that bring you joy and calm, and make a point of doing them regularly. Keep a journal, and every morning when you wake up, write this question in your journal: “What am I going to do today to show love and compassion towards myself?” Whatever answer you come up with, write it down, and then at night before you go to bed, log whether or not you did it.  If you did, log how it felt; if you didn’t, log the excuses you made and ask yourself why you are not taking care of yourself.

This brings me to the love of your life. When I read your question, it prompted me to post the quote by Marilyn Monroe (You can find all quotes under the category Words to Live By.)

“If you cant handle me at my worst,  Then you sure as Hell don’t deserve me  at my best.”

I love this quote because it drives home the essence of how the love of your life must love the whole you and not just you when you are at your best. Think about who you want as your long term lover and life partner: a person who will leave you when you are in distress and feeling alone and isolated, or a person who will stick by your side, hold you, and help you through your tough times? Don’t hide your true self from your love, or he or she will be loving a facade and not the true you. Ask yourself, is that what you really want?

I do love psychotherapy and do believe that it is very helpful, but you are right, it can be financially unmanageable. If you have health insurance, see if they cover psychotherapy; many insurances do. Whether or not it is an option, there are free options as well. Find your “support group.”  These can be family members, old friends, siblings, or actual support groups that are available in your community. You’d be amazed at how many free support  groups are around you that you’d never know about. Also, as I’ve indicated in my prior posts, I’m a big fan of mindfulness and conscious living. These are philosophies based on the belief that you have a healing presence inside you and that with practice, you can learn to heal yourself. If you use your favorite search engine you’ll find many books, resources, and groups that teach these. Yoga and meditation exercises are also another way to find a window into your inner healer. In general, I believe there is a lot to be found in the wisdom of the ancient philosophies. In the Western world we are beginning to learn to explore these methods of thinking and healing that have been known to the Eastern world for generations, and we are finding them so helpful in our fast-moving, stressful, and overwhelming daily lives. If you prefer reading to getting out there and looking for groups, then a very easy to book to start with that has lots exercises to help you is “The Power of Now” by Eckhart Tolle. Another book I’ve been recently introduced to is “The Four Agreements” by Don Miguel Ruiz, which will help you find ways to help yourself. If you like less spiritual and more practical books, then “Managing Your Mind” by Dennis Greenberger is a great place to start.

In conclusion, you asked me what your options are and where you can turn.  I’ve listed many options above, however, the key for you is to decide that you want to feel better, and commit to it as your first and foremost priority.  Once you do that, then you will find the path that will help you move forward and heal.

Best wishes for you in this difficult and potentially illuminating journey,

Doctor Life Advice