People Are Taking Selfies During Panic Attacks. Why?

Raising awareness is a good thing, but some experts say it can be misleading.

Apr 16, 2016 at 11:02 AM ET

Amber Smith, a 22-year-old living in the UK, had a panic attack. She’s had them since she was 16, but this time, she took to Facebook to post a photo of herself before and after the incident. The thousands of resulting shares and supportive comments prove other sufferers are grateful for Smith talking honestly about her experience. Mental health experts say it’s always good to facilitate new conversations about mental illness, but that the portrayal can be misleading.

In Smith’s post, in the top selfie she appears “normal,” while in the bottom photo, Smith’s eyes are red and fearful, her hand covering her face as if to disguise crying:

Accompanying the photo is a long message, part of which reads:

I’m so sick of the fact that it’s 2016 and there is still so much stigma around mental health. It disgusts me that so many people are so uneducated and judgemental over the topic. They say that 1 in 3 people will suffer with a mental illness at some point in their life. 1 in 3! Do you know how many people that equates to worldwide?! And yet I’ve been battling with anxiety and depression for years and years and there’s still people that make comments like ‘you’ll get over it’, ‘you don’t need tablets, just be happier’, ‘you’re too young to suffer with that’

FUCK YOU. Fuck all of you small minded people that think that because I physically look ‘fine’ that I’m not battling a monster inside my head every single day.

In a show of support, a man named Pete Laws posted a similar shot on Facebook, saying he was inspired by Smith to “to join in to help raise awareness and understanding of an illness that affects millions of us. Including me.”

He wrote:

The photo on the left is me on a “normal” day and on the right is the side of me nobody sees. My struggle with anxiety.

Not enough people realise how real anxiety is and that you cannot just “get over it” as most people seem to think. It causes breathlessness, dizziness, stomach pains, headaches, trembling and shakes, palpitations and extreme fatigue. The smallest of worries can be blown way out of proportion and start an attack, stuff you would probably laugh at if you knew and that’s not even including the point where you become a social recluse because you can’t face even your best friends.

Psychotherapist and anxiety expert, John Tsilimparis, MFT, says though it’s hard to quantify the impact of such social media efforts to raise awareness, it’s overwhelmingly a positive thing. “I think it continues to raise awareness, heightening awareness to the fact that this is a real condition, it’s not for the weak willed, it’s not a moral failing,” he said by phone.

Of Smith’s particular rant about the way people react to her illness over the years—that people should stop telling her to simply try to be happier—Tsilimparis, who suffered from panic attacks throughout his twenties, said, “She’s right. Often if you tell people I’m taking medication, or I have to go because I’m feeling depressed, or suffering from depression, or have anxiety, or OCD, or having a panic attack, they will not give that compassion like if you said you said you’re taking medication for cancer or diabetes. They will look at you and say, ‘Oh, oh OK,’ and always have a little bit of an attitude. In 2016, we still have this type of fear from lack of education, a stigma for people with mental health issues.”

But Dr. Aarti Gupta, a licensed clinical psychologist and clinical director of anxiety treatment center TherapyNest, said that while getting these likes and comments on Facebook or Instagram certainly help “boost a person’s spirit and feel supported,” that it’s presenting a distorted image of the illness.

“My concern is that these types of ‘before and after’ photos may be inadvertently misleading to non-sufferers and spread a message that Panic Disorder is painful and uncontrollable,” she said by email. “Actually, in my experience, a vast majority of clients find measurable relief and symptom management through Exposure and Response Prevention (ERP) and Interoceptive Exposure techniques which allow the client to come face to face with distressing stimuli and places. With these techniques in mind, I’ve asked clients to take photos or videos of themselves during triggering situations—and many times, people that are in distress don’t look all that different on the outside, although they may be experiencing increased heart rate, sweaty palms, and shortness of breath on the inside. The goal of this exercise is for the client to be able to step outside their shoes and see what others are seeing during their panicky moments—that although they may feel out of control, others may not even notice.  I’ve seen clients gain huge relief over the fact that they don’t look ‘crazy’ or ‘scared’ during a panic attack.  Many times, this can be a major component of fear for  future, unannounced panic attacks. In the images that have been going viral, there is no indication that those “during” or “after” photos were taken as part of an ERP or Interoceptive Exposure exercise.”

Though signs of a panic attack often mimic a heart attack for the sufferer—a rapid heart rate, chest pains, and becoming short of breath—anxiety and its attendant manifestations often go unnoticed by the outside world, something sufferers say compounds their ability to get sympathy or support for a debilitating illness. “But you don’t look sick!” is a common response many sufferers get when trying to talk about their illness with friends or family.

Tsilimparis says it’s important to understand that there are varying responses for people suffering from panic attacks.

“In my own severe anxiety episodes, I’m a little bit of a people pleaser as well as socially phobic, so I don’t want people to see, so nobody ever knew. I’d say I gotta go, or I’m not feeling well, but I never gave people the insight into seeing how awful I felt. Some people are able to keep it inside, and not show it, which is not good, because eventually you’re going to implode.”

While this coping mechanism may work for some sufferers, it’s not the case for everyone. “Most of the time, people do not look happy during the panic attack—you can see their face, they look worried, their eyes are sunken, there’s generally a bewilderment and a look of dread—but it’s varied,” he said.

In recent years, numerous health campaigns have surfaced online to promote awareness and raise research funds for everything from breast cancer to migraines. Recently, a photographer posted a photo series of snapshots of herself every time she had a migraine. The intense headaches were once thought to be caused by women’s emotions—one cure was believed to be marriage.

Excedrin recently launched a marketing campaign to let non-migraine sufferers to “experience a migraine” through virtual reality in what appears to be an effort to raise awareness about how debilitating they are. Those who tried it out said it was, indeed, awful, at least confirming that feeling someone else’s pain, as best you can, generates, if not money, or time off from work, empathy.

But the effectiveness of a mental health awareness campaigns is difficult to quantify, particularly when the thrust of the posts are people telling other people their experiences, without a specific organization to support, an activity to engage in, or even a place to go give money. In other words, it’s difficult to chart an overall increase in sympathy.

A piece from the Guardian last year looking at the proliferation of YouTube videos from often young women discussing mental health issues is proof there’s an untapped audience for online mental health support forums across platforms, concluding that the clearest success of any attempt at raising awareness for mental health issues is simply helping people talk about it easier. But similar to the criticism of mental health apps that guide users through counseling, the technology has moved far faster than the science, and the ensuing sympathy isn’t an effective replacement for traditional counseling or cognitive behavioral therapies.

Ultimately, these efforts by individuals to get sympathy is a workaround for a mental health system widely viewed to be in crisis, with far too many roadblocks to getting care—whether because of lack of access to a therapist, lack of insurance to cover it, and the third part of the puzzle, the stigma in talking about it at all.

“It’s hard to quantify the result,” Tsilimparis says of the social media campaigns. “I would say from when I was in therapy from early 1980s to now, 30 years later, things have improved drastically,” he said. But you just have to keep doing it and drive your cause forward. It is hard. [Sufferers] understand that no one will ever know what a panic attack is like simply by telling you what it’s like. You only know them by having them. But if this woman felt courageous enough to speak up and voice her opinion, it can bring acceptance and compassion from other people. It creates a little universality if someone sees this post and says I’m not alone.”

Dr. Gupta wanted to make clear that she can get behind spreading awareness and ending the stigma around mental health, but that “perhaps it can be accomplished in a way that spreads a more accurate perception of Panic Disorder—that it can feel scary, but is ultimately manageable with the right techniques. I feel the current images that are circulating may be perpetuating the idea that mental illness is scary and uncontrollable.  We need to undo this notion.”