Early in my career I was asked to evaluate a patient who was a very prominent chef at an internationally known resort located about an hour away. One of the perks of his position was a very nice home provided by the resort and located right next door. Despite his extraordinary professional success, his international reputation, and the very comfortable lifestyle that his generous earnings afforded him, he tearfully described an overwhelming problem that was making his life miserable. He reported that he was able to walk the few feet from his home to the kitchen in the resort, but could not venture beyond this area without suffering debilitating anxiety and panic. On his bad days even walking next door became a terrifying ordeal, and he had been imprisoned in his own little world in this way for over ten years. In fact, to get to the hospital where I was located he had to be transported via ambulance while heavily sedated.

It became apparent that this individual was suffering from a severe case of what came to be known in later years as panic disorder and agoraphobia (literally, fear of a crowded area such as a marketplace), a condition in which people experience sudden surges of fear for no apparent reason at unpredictable times, particularly in places where escape is difficult. These unexpected surges of fear are characterized by sharply increased heart rate, blood pressure, muscle tension, and other physical signs in which the body gears up to handle an imminent threat or danger. This set of responses is called the flight/fight reaction. In situations of real danger, this surge in the sympathetic nervous system prepares us to be at our physical best: We are able to see more acutely, run faster, and perform feats of incredible strength. (Newspapers occasionally feature stories of these extraordinary deeds – for example, a 90-pound woman lifting a car off of a trapped child.)

But, if there is actually nothing to fear, this reaction is called a panic attack. With nothing dangerous happening, some individuals – those who are susceptible to developing panic disorder – experience the attack as a mysterious jolt out of the blue that they often attribute to a heart attack or some equally terrible bodily affliction, with death soon to follow.