How a Biblical Counselor Thinks about Panic Attacks

If someone tells you she has panic attacks, how do you begin to use Scripture as your guide? (I am choosing panic attacks almost randomly. It is one of a dozen or so psychiatric diagnoses that is relatively common and not clearly identified in Scripture.)

First you have to know the basic description of a panic attack. You can get this from two sources: the person, or the more formal criteria in American Psychiatric Associations Manual, the DSM-IV. The two descriptions will usually be similar but not identical. You might as well get both.

Here is the DSM-IV criteria. Let’s say that many of them match the person’s experience. The symptoms start abruptly and reach a peak in around ten minutes. They include at least four of the following: accelerated heart rate, sweating, trembling, the feeling of being short of breath or choking, chest discomfort, nausea, feeling lightheaded, feeling detached from the rest of the world, fear of losing control, fear of dying, numbness, chills, or hot flashes.

These are troubling symptoms, and though we certainly care about heart rates, sweats, shakes, dizziness, and feeling detached, we have no assurance from Scripture that these physical symptoms will change even if we grow in Christ.

Are there any symptoms here that Scripture assures us can change? How about fear of death and fear of losing control? These are the spiritual symptoms of fear, and Scripture is all about fear, especially the fear of death. We might expect growth in this one.

Okay, enough work for now. You have just done important and applied theology. You have considered a psychiatric diagnosis while wearing your biblical lenses, and you have identified a way to be helpful. Our bodies are wasting away but our inner person (spirit, heart, soul) can be renewed (2 Cor 4:16). We are pleased to see the alleviation of physical symptoms when possible, but we are even more eager to see spiritual growth whether the physical symptoms improve or not.

Now dive in, get messy.

• “Could you tell me more? When was the last time it happened? What was it like for you?”
• “Where did your mind go when you thought you could die?”
• “How do you think we should pray about this?”
• “Have you talked to your physician about this?”
• “What do you think about this: let’s start focusing on fear in Scripture. Let’s see how our God speaks gently and powerfully to us as fearful people. These panic attacks seem like a fine occasion to become fear experts.”

One caution, and it is an important one. People say stupid, unhelpful, Job-comforter-like-things when they believe they have insight into the cause of panic attacks. There is a difference between knowing descriptions of panic attacks and knowing their explanations.

What causes panic attacks? That is an irresistible question—one we really want to answer. But we must resist trying to explain why it happens. When it comes to most psychiatric diagnoses, “I don’t know” is the best and most sophisticated summary of the cause.

This lack of insight, however, does not limit our ability to help. We do not have to know the causes of suffering—the eruption of physical symptoms in this case—to help someone. We have plenty of beautiful revelation that guides our ministry. We don’t have to speculate on causes and other matters for which Scripture does not give precise direction.

There are many books that could be written on this basic approach, so please don’t think that this is all a biblical counselor could or would say. Instead, think of this as a template that can navigate you through the complexities of many different psychiatric diagnoses.