Anxiety and panic attacks are normal reactions to a chaotic world. So why do we pretend otherwise?

A few years ago, I found myself in the emergency department with an IV sticking out of my arm, absolutely convinced I was having a cardiac event. Eventually, I was sent home with a few reassuring words and the advice to just "keep an eye on" things. Two years ago, I was in a crowded restaurant when I started hyperventilating so badly a waitress rushed over to bring me water, fearing I was about to pass out.

Yet when I describe these incidents to Matt Gutman, ABC News's chief national correspondent and author of "No Time to Panic: How I Curbed My Anxiety and Conquered a Lifetime of Panic Attacks," I feel the need to casually reassure him. "Oh it's fine," I say. But it takes one to know one. "No," he replies. "It's terrifying."

Much like Gutman, if you put me in front of a room full of people or at the top of a roller coaster, I'm fine. At other times, however, my body and brain go into overdrive, and the result can be confounding, embarrassing and yes, terrifying. "You are the person I'm trying to reach by writing this book," Gutman tells me during a recent video chat.

As he reveals in "No Time to Panic," panic attacks can take different forms and present themselves from different triggers. It's not always the people who seem most panicky who truly are. Some of us can cultivate what Gutman describes as s "public persona of jovial fearlessness," all while wrestling both the panic attacks and the self-perpetuating fear of them. "I embody a paradox," he writes, "the courageous coward."

And even though, as Gutman reports, nearly a quarter of Americans will experience a panic attack at some point in their lives, they are still often seen as somehow hysterical or weak. It's easy to see why people who suffer from them — especially men — can be reluctant to talk about them or get help. 

But after misreporting the early details of Kobe Bryant's fatal 2020 helicopter crash and earning a suspension from his job, Gutman has been forthcoming about his anxiety. He's also candid about the varied treatments he's tried, from ketamine-assisted therapy to ayahuasca to meditation. What he says now is that "I don't have a panacea. It doesn't exist, or it doesn't exist for me. But the one thing is to let people know that it's okay." Gutman talked to me about the unique challenges men face with panic attacks, and why we need to reframe our anxiety in a positive light.

This conversation has been lightly edited and condensed for clarity.

In you book, you talk about the idea that people who have these panic attacks may not be nervous Nellies. You can be a brave person, you can be a strong person, you can be an adventurous person, and you can still be vulnerable to these experiences. 

I think it's partly evolutionary, that there are some of us who are good at certain skills. I do think of myself as the person who would have been trying the weird looking mushroom. I feel comfortable in doing feats of physicality that other people think are insane. That in some ways is my comfort zone, and it's not putting it on. It's where I feel mastery.

But in certain social interactions where I feel that I might be judged, I feel that massive amount of fear of failure. In many ways, it makes tremendous sense. I know that the chances of being killed, let's say in Ukraine, are actually minimal for a reporter going there. The chances of me being killed within a mile of my home in a car accident are much higher, or as high. 

But the likelihood of me messing up on air and being judged by my peers and being told by the executive producers, "Listen, you have panic, and we don't trust you anymore because you're a loose cannon. We're going to excommunicate you from this tribe of ours, and you're no good to us," evolutionarily, my brain is like, "Oh, you're in the wilderness. That is the zone of death. That is where you need to be afraid." To me, that's catastrophic. It's with these human interactions, where there actually is a significant risk of obliteration.

For many of us, panic is not necessarily something we've had as our companion our whole entire lives. Often there's a traumatic component to it as well, which sometimes comes hand in hand with depression, anxiety, PTSD or ADHD. How does panic play into these other things that may be going on mentally and psychologically with us?

First, I think that it could be purely genetic. Obviously, we know, medically and scientifically and psychologically, that it is exacerbated by certain traumatic experiences. People experience trauma in all sorts of different ways and in all sorts of different phases in their lives. 

One of the other things I'm trying to say that panic makes sense. We should be terrified. Me speaking on television is insane. The whole concept of a failure happening is significant. The consequences are monumental. Anybody speaking in public or interacting with other humans, we are judged by our peers, and by the very nature of how essential cooperation is between humans in groups. That is as scary as a lion coming to kill us. 

To me, one of the great sources of comfort in the book was learning that I am not broken, that my panic and my anxiety are not the source of some weird genetic kink, that this actually totally makes sense. And I hope that everybody gets that message that a higher propensity to anxiety and panic makes so much sense. That, to me, is what the actual realm of normal should be. I feel like the whole spectrum should be shifted over a bit. 

I have been that person who has gone to the hospital, thinking something is medically wrong with me. As you say, the physical symptoms are almost indistinguishable. What is happening? And how common is this?

First of all, I'm so sorry. It's so scary and so just overwhelming. It's telling you that you are in a state of threat that is so significant, that unless you deal with it, you are going to die.

I don't have a panacea. I wish I did, like, "Meditation is the thing that's going to solve your problem, or this five minute hack." It doesn't exist, or it doesn't exist for me. But the one thing is to let people know that it's okay, that this is normal, that what they are feeling is not some evil trick on the brain. It is the brain telling them they need to sort something out, and it does feel like you are dying.

You are not crazy for thinking that you need to go to the hospital. Your brain is telling you to solve a threat that is imminent, and it will kill you unless you sort it out. 

If there's anything anybody takes away, it is that it's okay. I want to reduce the shame and reduce the stigma, on myself as well. That is so key, to strip away the self-hatred that I had lacquered on for years and years, adding a new layer every time I had a panic, a new layer of self hatred and anger over f**king it up yet again. And I'm sure that people like you feel, if you've been to the hospital, "Oh, I'm so dumb. Why did I go when I didn't need it?"

As you say though, the doctors there aren't going to say "You're having a panic attack." They're going to say, "Okay, it seems like everything's stabilized. Come back if it gets worse." You're not necessarily sure what even really happened to you. 

Something that came out after this book went to press was a new study that 40% of all admissions to American emergency departments for cardiac reasons are people having panic attacks. They found that only one to 2% of the people who are suffering a panic attack and are initially admitted for whatever cardiac reasons are treated on the spot. About a third of them are told that it's a panic attack or it's anxiety related and released to go home and figure it out. The majority are not told exactly what the hell's going on. And only one to 2% are diagnosed and treated the hospital. Which is awful. 

The statistics lean towards panic being more of a female problem. Yet the shame in not wanting to seem "hysterical," around not being the strong man, I think is probably not leading men to make that connection that what they're experiencing is panic. You say in the book, it's definitely not leading them to speak up about it. 

I think you're hitting the nail on the head. The inverse of the national incidence of panic disorder is substance abuse. Men are much more likely to abuse alcohol, especially, than women are. And that's because a lot of men mask anxiety through the use of substances, particularly alcohol.

I'm not a teetotaler. But I also believe that alcohol is the most dangerous and vile drug that exists on the market. The shamans in Peru, and most indigenous cultures, say that alcohol is a spirit that steals your soul. There is a lot of that in our society. That's one way that men mask their anxiety and panic. 

The other is that they just don't talk about it. I was so surprised when I started revealing this big secret, that most people accepted very readily, and with love, particularly men. The more I started talking about it, the more I realized these men were like, "You know what? I wake up in the middle of the night with these terrors. I don't know what it is." So many men and people in positions of power and great wealth experience this. I had no idea. I think most people don't have any idea. I think the people who are conducting the surveys don't have any idea. Because we don't know. 

I was someone who had been in therapy since I was 12 years old. I did not know that I suffered a panic attack for nearly 15 years after I suffered a panic attack and had hundreds of them in that space of time. I didn't exactly know what it was called, or what it was. If someone like me is going through that, I just can't imagine what a big subsect of American society is experiencing, and has no idea, and is not talking about it. 

And someone can be having a panic attack right in front of you and you may not know. It doesn't necessarily look like some of mine have looked. They're not all built the same way. 

If you'd had the heart attack kind every time, well, that's how people become agoraphobic. You've obviously found some way to live an amazingly fulsome life. But so many of the people in our panic attack support groups haven't left the house any years.

That is heartbreaking for anyone who experiences it, because it can limit you so deeply. It hasn't really limited you in your life, either. All while having that hanging over you and knowing it can strike at any time.

My biggest fear in my work is not so much like some people who feel like they're going die. My fear is, I'm just going to lose control and speak in tongues or say the wrong thing and get suspended for screwing up some massively important live special event like Kobe Bryant's helicopter crash.

Now that you've gone through it and you've had it happen, has it in some ways neutralized some of that fear?

In some ways, it did ameliorate the fear of it happening, because I did survive it. On the other hand, I realized that my worst fear did come true, which actually made doing cognitive behavioral therapy very difficult. I realized that I have very good reason to be afraid, so I had to find other sources. While I do believe that there are massive benefits to the psycho educational tentpole of cognitive behavioral therapy and the exposure part is well, I had to take some of that with a grain of salt. I had to find other remedies to help me. So yes, I know I've been through the worst or hopefully the worst. Once it happened, the worst was over, and then it was working on fixing it.

In the book you run through all kinds of possible remedies for panic. Ultimately what you come to is, there is no magic bullet. What have been among the most important things that you that have helped you through this and have helped you along the way in dealing with panic?

The connective tissue between all the psychedelic experiences is that it helped me get to a place that I struggled mightily to get to in my day to day, which is this altered state where I can actually grieve. I can cry, I can excavate some of this internal pain that I've been carrying around and do carry around. There was massive relief in getting there to that place, but it's really hard for me, and so I need help.

I didn't know that altered states — specifically the psychedelics, but breathwork too — helped me get to this place. I was terrified of going there. That was the one place I didn't want to go. But I used the the skill set that I have, the courageous part of the coward. I will run through fire. You're telling me I have to do this remedy, and it comprises massive amounts of vomiting and diarrhea and intestinal distress. Okay, I'll do it. I threw myself into the physical in order to get to the emotional, where I'm less strong or at least more hesitant. 

These altered states took me to this well of grief. I started digging out all the muck that had built up there over decades of burying grief, and digging out that muck made me feel a lot better. The problem with that is, it's constant maintenance. I need to get back in there. It's been a little bit since I've had a macro psychedelic experience. I've done some micro[dosing], recently, which is great. But I need to do another macro experience to excavate some of the muck that has congregated again in that well of grief.  

Near the end of the book, you speak directly to your male readers and you say, men, you might need to cry. 

We need to make more room in our society, just in general. But men have to take the reins of their own emotions. We can't blame anybody else for this. We need to find an avenue to express. Without it, we do things that are impulsive, and we make mistakes.

Want more health and science stories in your inbox? Subscribe to Salon's weekly newsletter Lab Notes.

There are many things that are good about being the way we are. What do you want to say to people who are who are struggling with shame and embarrassment, that maybe we can be kind to ourselves? 

Again, it's normal. Not only that, hypersensitivity to other humans' reactions is not only normal, it's an evolutionary advantage. We need people to be sensitive. If everybody were just walking around not caring what other people thought, there would be absolute chaos, and humans would not be able to cooperate in the most beneficial way. 

In our day to day, it can be crushing, and it can lead to mistakes. But evolutionarily, we are primed to be hypersensitive to the other people in our group, because everything depended on the group. If you run afoul, and you don't notice the cues that you're given, you're going to get kicked out. You're going to be on the savannah, and a lion is going to bite off your head. It is as threatening as life and death for humans, because all we depend upon are our social networks. 

So it's normal. And if you have a panic attack, one of the things that Mike Telch from the University of Texas says is that the actual period of your brain assessing the threat around it is 15 to 60 seconds. Whatever it is, it's a matter of seconds, and that's the worst of it. That's the peak of the panic, and the rest is downhill. Your body's dealing with anxiety, you're still burning off the excess epinephrine and cortisol for a little bit after that. But it's going to work itself through your system.

I want to tell all those people that it is going to be okay. You can survive this. You can certainly survive 15 to 60 seconds of panic, because you've been through anxiety your whole entire life.