Johns Hopkins Magazine -- November 1999
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On panic and pain relief
Medication rarely best for panic disorder
"Skewed values" in Nanjing
On the "hierarchy" of inclusion
Another '49er remembers

On panic and pain relief

Can it be coincidental that the last two issues of Johns Hopkins Magazine would contain articles that are tightly linked in my life?

The September issue contained writer David Levine's positively brilliant illumination of the living hell endured by victims of panic attacks and/or anxiety attacks ["Prone to Panic," September]. The suffering that I endured from 1959 (age 16: first panic attack when my father died very young) until a knowledgeable psychiatrist correctly diagnosed my problem in 1991 and prescribed medication that rebalanced my brain chemistry, can only be understood by another victim. The general population cannot empathize with people whose brain chemistry has gone into fibrillation from wildly fluctuating stress hormones. Most medical insurance companies will not pay for psychiatric doctors' visits since the ailment is nebulous and its symptoms cannodt be meaningfully measured empirically.

Information I have gleaned on the subject over the last decade has piled up to where my family doctor of 30 years now defers the selection of medication and dosage to me and listens intently as I reveal new knowledge about panic disorder. My present regimen of [medication] and aerobic exercise appears to have brought the problem under control with negligible side effects, but I am one of those who will probably need medication the rest of my life.

Which leads me to Melissa Hendricks's article ["Just Give Me Something for the Pain," June] regarding pain and the reluctance of some doctors to prescribe potent painkillers. My parallel experience, and the experience of many other victims of panic disorder, is the reluctance of doctors to prescribe drugs like alprazolam on a long-term basis. I am sure they fear addiction or suicidally sufficient accumulation of pills. Yet panic disorder and suicide are not correlated as with depression. I want to live, and destroying myself with drugs never entered my mind--even when I was at the bottom of the anxiety pit, having not slept for four days. Why would a doctor withhold a medication from a sufferer when that medication has been shown to work superbly across a spectrum of attack intensities?

As long as dehumanization in the workplace and injustice in our society play hob with our emotional security, more victims of panic disorder will emerge. I pray that the medical system will be able to get them to understanding and equilibrium in a fraction of the time it took me and Mr. Levine.
John Occhuizzo, EdD

Medication rarely best for panic disorder

I certainly empathize with [David Levine's] long-term suffering ["Prone to Panic," September]. I am aware that one article does not reveal all the circumstances or the possible nuances of David Levine's anxiety, but I felt the need to respond to the solution that seemed to be proposed and emphasized. Namely, a medical model calling for medication rather than psychotherapy or counseling.

I have been in private practice [clinical psychology] for 25 years and have seen dozens of clients who initially express panic anxiety as their primary symptom. There is no doubt that this is one of the scariest experiences in the possible range of psychological disorders. However, and this is what I hope to emphasize, the medical model is rarely the best response. I have found that this disorder is one of the easiest to relieve, even given the intensity of the fear. In most cases, therapy allows one to get past the panic and get to work on the underlying anxiety and fear, which is where the real problem originates.

In modern times, it is tragic that a person suffering from panic anxiety (and many other disorders, for that matter) is led to believe that the only solution is medication. Pills may very well take care of the symptom and bring temporary relief, but they often carry side effects and never get to the underlying issues. I have had an endless number of clients who have taken this route before trying therapy. Once they experience the process of therapy and see what it can achieve, they are often shocked and, at times, angered, about how they have been misled.
William E. Ward
Montvale, NJ

David Levine responds:

I was very surprised and moved by the response from readers to my article. I received over 30 e-mail messages and letters from alumni, patients, and doctors. One man wrote that he felt as if he were reading his life story. Several people told me they never knew they had panic disorder until they read the article. One psychiatrist wrote, "Although I've treated patients with panic disorder for years, I never truly understood what it felt like to have it until now." And a mother described her daughter's struggles and said, "I hope you will continue to write about this and encourage college communities to be especially aware of how stress and change can affect students at this age." I plan to.

With regard to the two letters printed here, I'd like to make two points. First, epidemiologic research has found that adults with a lifetime history of (untreated) panic disorder might indeed be at greater risk for suicide attempts. And in the October American Journal of Psychiatry, Hopkins physicians Daniel Pilowsky and James Anthony conclude in "Panic Attacks and Suicide Attempts in Mid-Adolescence" that "adolescents with panic attacks were three times more likely to have expressed suicide ideation and approximately two times more likely to have made suicide attempts than were adolescents without panic attacks."

Secondly, I should note that my psychiatrist early on did offer me a choice between antidepressant medication and therapy coupled with a mild tranquilizer. I chose the latter and did not start on the medication I take now until several years later, when my panic attacks took a turn for the worse. The American Psychiatric Guidelines support the idea that medication and cognitive therapy "are equally effective and can be chosen on the patient's preference." However, it is generally believed by experts in the field that a combination of medication and therapy lead to better quality of life and outcomes in panic disorder.

"Skewed values" in Nanjing

In "C is for Capitalist" [September], Joanne Cavanaugh appears to endorse the bias of expatriate American academics in Nanjing against Chinese students' demands for more practical business courses. Whether she came there already imbued with that virus or caught it from her hosts is irrelevant. What is relevant is that it may help explain, albeit indirectly, her having soft-pedaled or left unaddressed quite a range of other issues:

"Twitchy foreign investors who already struggle to get through the bureaucracy" are mentioned. Unspoken is the string of losses virtually all the major U.S. players have been piling up while chasing the chimera of that China pot of gold. Unmentioned is the hardball being played by negotiators for the various "trading-company" tentacles of the "People's Liberation Army"-- part of the regime's relentless quest to buy as fast and as much as possible those of the high-tech blueprints their undercover comrades don't manage to steal.

Not a word is said to alert the uninitiated reader to the fact that those recent "staunchly anti-American" "large-scale Chinese protests" in Beijing and Nanjing were Party-orchestrated and manipulated.

Nowhere does Ms. Cavanaugh report the xenophobic and racist invective hurled in the streets and over the air at "foreign devils," especially Americans. Not once does she let the innocently ignorant in on the reversion on Chinese TV to early-'50s propaganda movies denouncing U.S. "imperialism" and extolling the "heroic struggle" of the North Korean Armed Forces (together with hundreds of thousands of Chinese "volunteers") to "liberate" South Korea.

Not one word does she expend on the plight of Falun Gong, the contemplative sect reputed not long ago to have drawn a membership of some 100 million, including even Party undergoing "reeducation," presumably at some of the very slave concentration camps manufacturing even rosaries (!) for export to the U.S.!

I am hardly shilling for the powerful U.S. business lobby, singing the praises of our alleged "strategic partnership" with Beijing to hasten, in its self-deluded calculus, the advent of yearned-for megaprofits. Nor am I pleading for more courses laced either with an anti-business animus or simplistic "trade is peace" nostrums.

The most abject of Sino- and Clintonophiles, in any case, no doubt still will take umbrage at what muted criticism the author does level at the "People's Republic" dungeon society and its self-anointed leadership. For this reader, meanwhile, the space she awards Nanjing student Lu Lingyun's shallow-mindedly racist drivel about the supposed moral superiority of "Lemon Man" over "Banana Man" all too accurately conveys a sense of Ms. Cavanaugh's and the Nanjing Center executives' woefully misplaced priorities and skewed values.
Hans-Udo Kurr (MA'70)
Jackson Heights, NY

On the "hierarchy" of inclusion

One thing can be said about the controversy regarding the Woodson family connection to Thomas Jefferson; as Thomas Jefferson Foundation President Daniel Jordan put it, "It's done more to encourage a dialogue on race than the presidential commission [on race]." ["A Daughter's Declaration," September.]

I would like to point out a deeper issue as well. Thomas Jefferson inherited Sally Hemings when his father-in-law passed away. It is quite likely that she was a mulatto (half-white) slave. In fact, it was rumored that Jefferson's father-in-law, Wales, sired her, making her and Martha Wales Jefferson half-sisters.

Making the assumption that Hemings had Caucasian features, and lighter skin, it would be reasonable to assume that she would be a "house slave," having higher status as one who worked inside the house as opposed to outside in the fields.

It's very interesting that many involved with the biological connection to Jefferson did not attend the Getting Word program [an oral history project involving descendants of Monticello's slaves] that is portrayed in the photo on page 27. I was at that function and enjoyed it immensely. I found it to be a cross section of people of African American descent, with African Americans of all hues and some white people, too. In fact, at least 10 percent of these folks were white, but all were descended from African slaves.

It is also interesting that Ms. Cooley- Quille was not at this Thomas Jefferson Foundation-sponsored event--perhaps because the biological connection between Jefferson and his slaves was not part of the event. Not that the issue was downplayed, but rather, the fact that plantation life--which certainly included the slave population--was part of the American culture is much more important than whether or not you had a biological connection to the Massa.

Ms. Cooley-Quille [and some others who attended the] Monticello Association function are at the higher end of the hierarchy of American heritage regarding relation to the author of the Declaration of Independence. The members of the Getting Word project are at the lower end of the hierarchy, being descendants of the non-Woodson slaves. It seems that the hierarchy of inclusion is as pervasive as it ever was.
John Hughes
Vienna, VA

Another '49er remembers

Many thanks for "The Boys of '49" (September). Here is a '49 story from another perspective. As a T-8 sergeant on the Manhattan Project, I worked in a nuclear physics lab and later as part of the first atomic test team at Alamogordo, New Mexico. February of '46 found me at Gettysburg College picking up my final chemistry [course so that I could] be admitted to the graduate chemistry program at Johns Hopkins that September. With several other veterans (most married with children, as I was), we were to live a very frugal life on the $110 a month we received from the GI Bill.

There was little time to fool around. Life was classes, labs, library, and dissertation, with a few precious hours with the family late at night. But, as the first Christmas break approached, our class was informed of an ancient chem department tradition--an evening of fun in which a "spoof" of our professors was the highlight. I was picked to portray Dr. Clark Bricker (who was also a Gettysburg College graduate) Fortunately, my performance of Clark's lecture style was well received.
Robert B. Fortenbaugh (PhD '50)
Arendtsville, PA