The two immortal words, always written in capitals, that appeared on the front cover of the Hitchhiker’s Guide to the Galaxy. And just because it’s been picked on for fame by science fiction, doesn’t make it any less true for us stuck in the real world. In fact, when you count up the number of TV shows and movies where characters have run around in circles screaming, "Don’t panic", it amounts to a supposedly comic epidemic. Not that it doesn’t happen in the real world. But, when it does, we spectators always look away in embarrassment, sometimes tinged with fear. After all, this one may have a good reason to panic. Have aliens just landed? Is this food poisoned? It’s easy to be paranoid. Panic is easily communicated. Try shouting "fire" in a crowded theater and find yourself arrested for some powerful criminal offenses when folk injure themselves trying to save themselves.

So how does panic get "disordered"? There’s a moment when uncertainty starts to get out of control, when fear of what may happen begins to build. Most of us control this all-too-human apprehension. But, when the uncertainty and fear never fade, they can bring life to a halt. It’s the paralysis we describe as the deer caught in the headlights. Except, people don’t stay paralyzed as the truck bears down on them. This is when the deer becomes a headless chicken running around the barnyard.

People with panic disorders are made to feel ashamed by our reaction to them. At a time when they need our help and support, we are turning away. Because they grow to fear more panic attacks, it’s easy to convert early symptoms into the full attack just by worrying about it. The disaster is provoked by a fear of that disaster. It most usually starts in the teen years and, unfortunately, more women than men have it — something which adds more shame to the men who cannot avoid displaying it. So, the first step is a full medical check-up. There can be physical reasons for these symptoms of sweating, weakness, fainting, chest pain, erratic heart beat, numbness in the hands, and so on. Only when these physical causes have been ruled out should you move on to discussing treatment for the disorder.

The problem of treatment is first to decide whether this should be treated purely as an anxiety disorder. In many cases, a course of beta blockers can steady the heart. Without one of the major symptoms to alarm you, there’s less chance of panic. No doctor will have the reflex, anxiety or panic, take Xanax. You should not think this way either and just buy the drug online without going near a doctor. If you’re reading this as a friend or relative of someone affected, encourage him or her to consult the primary caregiver. Even if there’s no current health insurance policy, it’s money well spent. There’s a place for Xanax, but it’s not during the early stages of the problem. Talk therapy, the best being cognitive behavioral therapy, is the best long-term solution to the problem. No matter how good Xanax, you need strategies for keeping anxiety and panic within "normal" limits without running the risk of dependence of a powerful anti-anxiety drug.