alex hays
13 min readJan 14, 2021

I wish I could go back in time and tell myself this. I recall dishing out uninformed advice to people who were kind enough to share their traumas with me.

In conversation I’d eventually say something like “taking brain pills is bad, they stifle your sense of self and creativity” or some cliche nonsense. I’m writing this because I frequently see people online with similar sentiments — who say the exact same stuff I said.

“Meditate! It really helps me with my anxiety!”

“Go for a lil jog every now and then!”

I did not realize that what I was calling anxiety was not the same as what they were calling anxiety. The issue with that word — “anxiety” — is that it’s used as a catch-all for any antsy feeling.

What some people are experiencing is a very real, physical sensation that fires off the literal nerve running through the center of their heart (something called heart anxiety neurosis).

It’s like comparing chewing on an ice cube to being involuntarily submerged in an ice bath. “Yeah, chewing on ice is pretty uncomfortable, but I have to do this presentation so I’ll just get on with it”, versus, “I am trying to ride the train into town and I’m suddenly submerged in an ice bath of overwhelmingly awful sensations”.

Side-note: I want to point out that I am talking about two extremes, and there are many shades of anxious debilitation in-between these extremes. Speaking for myself, 98% of the time this extreme “ice bath” panic isn’t what I am experiencing. It is what I am trying to actively avoid experiencing. I’m not trying to suggest you don’t have “real anxiety” or some such bullshit if you’re not having fully fledged panic attacks. I am not saying less physically intense forms of anxiety can’t cause serious life derailment.

I’m framing this text by talking about the extremes of my own experience because, well, it was my experience. It feels like it’s a useful perspective to share. I do not mean for this to negate anyones subjective, internal experience. These days my anxiety is mostly controllable. I do sometimes run up against the edge of panic, but I can usually step back from the ledge and get myself into a calmer state.

I feel lucky (in a cursed kind of way) to have had an experience that allows me to empathize with those whose feelings I had previously disregarded. I now understand that some people do need brain pills so their mind doesn’t kick their physical being into fight or flight mode.

This is the story about why I am now a bit fucked in the head.

Someone placing sushi on a plate

In 2017 I was in Japan with my friend Bradley and I decided “oh hell, may as well try sushi while I am here”. I hadn’t eaten any meat or fish in about 8 years, but also thought “eh I can’t even remember why I stopped eating meat, may as well check out what the sushi in Tokyo is about”.

Truth be told I didn’t really like it and felt weird eating it, but tried a bunch of different types. I have no idea what I ate — it was one of those places where sushi goes around on a conveyor belt and you’re free to grab whatever.

While eating I started to feel extremely strange, like I’d slipped into a slight dream state. I just attributed it to jet lag and having a bit of a hangover as we had arrived the night before, and immediately went out drinking.

I was like “well, that’s strange”, ignored my body, and we left the sushi place. Right when we left I said “man, I feel super odd. Really not good at all.” My breathing became a bit labored and I started to get light headed. I had asthma as a kid and sometimes as an adult so I didn’t get too freaked out by this. I figured it was a high pollen count day or the “vacation cigarettes” I’d smoked the night before had caught up to me.

A few minutes after we had left the sushi restaurant I decided it would be best to go back to the place we were staying. Breathing was becoming harder and a good bit of worry was setting in. I had such infrequent asthma I didn’t think to carry my inhaler on my person, but I did have it somewhere in my luggage.

We walked for about 30 minutes before I pretty suddenly fell to my knees and could no longer properly see. My breathing had gotten more and more labored but, prior to my vision leaving me, I felt like I had to just power through and get back to my inhaler.

It got bad really quickly — like, within the space of 30 steps I went from yeah I can handle this to being involuntarily on my knees. My friend Bradley, who I was walking slightly behind, took a few more steps before he realized I was no longer in tow and glanced back to see me collapsed on the pavement.

We happened to be on a side street next to the busiest intersection in the world, Shibuya Crossing. Bradley helped me sit up on a small wall nearby and ran around the immediate area to get help. He didn’t know how to relate what was going on to nearby shopkeepers and ended up showing them an ambulance emoji on his phone, while pointing at me.

Eventually someone called a local medic, who ended up calling an ambulance. The lovely ambulance folks immediately put me on a stretcher and hooked up a bunch of stuff to my chest as if I was having a heart attack. So I thought “damn, I must be having a heart attack”.

Nobody spoke english and we didn’t know Japanese so it was mainly Bradley saying “sushi” and putting his hands around his neck to mimic choking. I was pretty much just a semi conscious blob with a bunch of electrodes strapped to my chest struggling my absolute hardest to breath.

This moment really stuck with me as I fully believed “I am having a heart attack right now”. I wasn’t fully cognizant of what was going on and didn’t link it to sushi until I got to the hospital.

At the hospital the medical staff noticed faint red blotches on my chest to which they exclaimed “ohh” upon seeing, as I guess that meant some sort of anaphylaxis was going on. I was put on a drip of I don’t know what, felt much better after getting it into my system, and the Doctor asked if I enjoyed the sushi. I lied and said it was great.

Person laying in hospital with Doctor next to them

I think it was incredibly slight on the scale of what anaphylaxis looks like and I was incredibly lucky. I don’t think I was in any extreme danger of dying at the time. If I’d known I was allergic to anything I would have taken Benadryl with me and popped a few too many of those after I started to struggle with my breathing, and likely been fine. I know this now and I always carry Benadryl and my inhaler on me at all times. I do not feel safe leaving my apartment without these items on my person.

I didn’t know it yet, but this was a “line in the sand” of my life. My mental health and anxiety issues had very much just been turned from ice cube chewing to involuntary ice bath submersion.

When I got back to the US I had extremely physical sensations that I could only attribute to heart issues. I had no idea anxiety was a properly physical thing because of my preconceived, or ill-conceived, notion of it. I also did not realize going through a “oh no, guess I am going to die” type event could impart anxiety upon you like this. I did not immediately draw a correlative line between what had happened to me in Japan and what I was now experiencing.

I went to see so many doctors in the coming months. I remember one liver specialist vividly because he seemed so calm and unworried about me, even though I was worked up into a bit of a frenzy. “I drink like a whole six pack, sometimes a few times a week”. He asked if I’d stopped drinking once I started having issues and I said “well yes, of course”.

He listened to me explain all the physical sensations I was having — random extreme full body sweats, shooting pains in my back and chest and directly through my heart. I wasn’t doing anything that unhealthy other than drinking a bit more than is recommended, and he let me say my piece and said “if you stopped and you’re fine, you don’t have a problem. You look fine and your liver isn’t swollen. I treat a lot of people who are very sick and trust me, you are ok. We don’t need to do a biopsy or anything”.

The slight smile never left his face. I suspect he was relieved to have a patient he didn’t have to tell any grave liver-related news too. I left his office again feeling hopeless. All of the different visits for various blood work, diabetes tests, and what have you, went about the same as this. It was like taking your car in when the check engine light comes on and being told “we don’t know why the light is on, your car is fine, but we can keep running tests :)”.

I’d been to heart doctors and gotten EKG’s and all sorts to try and pinpoint any heart issues. Nothing had shown up. I knew intellectually that the stuff in Japan was not a heart attack. For some reason any mention of a heart attack threw me into a frenzy of negative emotions.

I had to stop watching Futurama because there is a surprising amount of heart attack jokes, and I couldn’t deal with them. They properly fucked me up every time. I’m guessing this was because I was pulled into the ambulance and had electrodes hurriedly strapped to my chest — in that moment I fully believed I was about to experience a Zap to fix my heart. Even though that was not the case, this “heart attack death” energy stayed deep within my psyche.

Appointments and tests continued. Everything kept coming back fine.

One day I was standing in my bathroom, covered in sweat, my whole body dripping like I’d been dancing in a sauna. Every muscle in my body was beyond tense. The muscles in my chest were squeezing the air out of my lungs like my body was a giant stress relief ball.

I was staring at myself in the bathroom mirror with my hand on my heart, sharp painful electricity striking directly through the center of my chest, and I just said out loud “that’s it, I’m done, I’m going to die. I’m done. I’m going to die”. I stared directly into my own eyes in the mirror. I’d just accepted this was the end of it. I was fucking sick of it.

I didn’t die of course, or else this text would be some strange obituary I’d managed to knock out before collapsing.

The pain and tension in my body slowly faded over the course of a few hours like it always did, even though this was by far “the worst one”. I lay in bed exhausted from the days “whatever medical thing that was happening to me”.

I went to another doctor to get more tests done. Everything seemed fine. My heart was fine, again. Relief and annoyance wash over me, again. He suggested I had been having panic attacks. “Do they happen randomly? At work sometimes? When you’re walking around? When you’re just watching a movie? Whenever, really.” Yes. Yes, they did, I said.

He asked, confused, had nobody else suggested I was having panic attacks? I told him no, and he laughed and said something along the lines of “this is Silicon Valley! You’d think someone would have brought this up to you by now”. I guess it’s a trend there. I left with a prescription for Lexapro.

I left gobsmacked. Is this what anxiety is? What in the ever living fuck??? Is this what I’d been telling people they should start meditating to “get over”, to go on lil jogs to ease. This wasn’t the same feeling I’d previously thought of as anxiety — that vague sense of unease I’d associated with the word. What. The. Fuck.

I started taking Lexapro and, after a while, the attacks had completely subsided. I couldn’t believe it. I felt terrible. I played back all the absolute nonsense I’d said to people in the past. I’d met their openness with unempathetic responses to a very serious, physical thing they were struggling to gain control over.

I still to this day feel terrible about that but I haven’t apologized to them because its been years now and also I’m a coward.

I didn’t stay on Lexapro because of the side effects. Every time I went out to drink I got black out drunk. I tried not drinking, but I always ended up having “just one or two” which turned into maybe 3? I don’t know, I was black out by 2. Also my libido was like, upsettingly absent.

I ended up quitting my job as I was still in a bit of a state, even on this brain drug I’d previously admonished. I had to stop taking Lexapro as my health insurance had been canceled with my job exit. My life since then has been a daily balancing act of dealing with random anxiety flair up. It turns out running, meditating and not drinking really do help somewhat — but it’s a lot harder than “simply do those things and it goes away”.

Since I know what anxiety is now I can go through the motions of controlling it when I feel it raising its ugly head. I can pump the breaks, somewhat, to help it stop having such a large effect on my daily life. Still, it is not without its debilitation.

I freelance full time now. I feel like I have to. I have off days where I know I can’t make the commute to the office (I wrote this before Covid — places are much more remote friendly now). I live in Brooklyn and when I have to take a train to Manhattan there is about a 1/60 chance it’s going to trigger some sort of anxiety / panic attack and I’ll have to walk my ass home.

Sebastian Junger talks about his experience with this in his book Tribe — “…I went into the subway at rush hour to catch the C train downtown. Suddenly I found myself backed up against an iron support column, convinced I was going to die. For some reason everything seemed like a threat: there were too many people on the platform, the trains were moving too fast, the lights were too bright, the world was too loud. … For the next several months I kept having panic attacks whenever I was in a small place with too many people”.

Sometimes when I have to head into offices in Manhattan this sort of thing hits me, very infrequently mind you, but when it does it’s usually when the train is going over the bridge and I feel “stuck”. I jump off when the train arrives at the next stop and begin the several hour walk home. When I feel able to I then have to text someone “Sorry, something came up, need to bail today” — becoming a “last minute cancelation” type of person. I spend the walk trying to breathe normally and shake the feeling of deep fear. Being on the subway during this, waiting till it gets to its next stop, is hell.

Another fun thing is — if anything weird happens in my body, my body immediately snaps into “omg he is going to die” mode. I sometimes get a random sharp pain in my chest because my lungs are dumb and a bit messed up from smoking in the past. I know intellectually its not a big thing (I’ve had so many Doctors tell me this) but it feels almost impossible to stop my lizard brain from freaking out and taking the rest of me along for the ride.

It’s incredibly hard to convince yourself you are fine when every biological system in your body is yelling EMERGENCY!!!! OH NO!! And I’m there walking slowly, trying to breath normally, while having an absolute melt down inside.

Sometimes when people look the calmest, they are having the worst time.

The whole walk back after an involuntary train exit, trying to stave off the feeling of imminent death, in the back of my mind I’m thinking “what if this is the real thing!”, as I look up hospitals close to me I can maybe wander into “just incase”. It takes a while but, inevitably, whatever subconscious process has a stranglehold on my body releases its grasp, and I can relax and feel normal again.

Right now it’s about 5 years after the “sushi incident”. It’s gotten easier and easier to deal with anxiety each year, but I do need to constantly re-up on doctors OK-ing my health. If I drink? Much, much higher chance of having an anxiety attack in the following days. If I run and meditate often? Those things do lower the chances of having an anxiety attack, but it is not lowered to zero — and it doesn’t feel like they help any when you’re in a bad moment, experiencing panic.

I completely understand people who are on pills for this sort of thing now. If my experience wasn’t so singular, and my anxiety issues hadn’t become considerably milder over time (thank god), I would absolutely still be on Lexapro because otherwise I would not be a functional person. I know this is the case for many people who have been through deeper sustained trauma, or who’s brain chemistry is just out of whack for no good reason, and I can’t even imagine how they manage to deal with it for the rest of their days.

I guess what I’m trying to say is — don’t be like me. Don’t be unempathetic as hell and assume you understand what someone else is going through because you “also experience those sorts of feelings sometimes”. The English language, or maybe human beings in general, seem to be fairly bad at expressing internal states to each other, or believing what internal states other people are experiencing.

I also think this folds into the way people co-opt medical terms to mean something trivial. OCD? That used to mean “wash your hands till they’re bleeding”. Now it means you don’t like your desk being a bit of a mess. Words change their meaning, but the medical community can’t be like “well we need to call OCD something else because everyone who has a neat desk is calling that OCD now”.

I’m not saying the medical community should update terminology once words get co-opted by society at large, or hate on people using medical terms incorrectly. I’m mainly trying to frame why past-me took the claim of anxiety and panic so lightly. A lot of other people seem to do that as well. If you’re one of those people, I hope this might guide you towards not doing that so much.