Emily Dickinson's "Nervous Prostration" and Its Possible Relationship to Her Work
John F. McDermott, M.D. *
Because so little is known about her life, Dickinson has been a frequent subject of speculation by literary scholars. This reached a peak during the era of psychoanalytic formulation (Sewall 4) when her poems were used to postulate a major fragmentation of thought process, a psychotic mental breakdown and recovery (Cody 83).1,2 Major biographers began to urge caution in separating theory from fact (Sewall 4), or even further, to completely separate her work from her life, treating the poetry as pure creation (Porter 125).
Certainly poetry cannot be taken as autobiography, nor can it, as a form of fantasy, simply be used to project an image of the artist on a screen. The letters, on the other hand, with all their limitations and incompleteness as a diary of events, at least can offer a skeleton of life experience.
In recent years, biographical probes have examined the letters for patterns and events in Dickinson's life, and certain generally accepted behavioral themes have emerged, i.e. Dickinson's self described reclusiveness. Scholars have puzzled over its meaning. For example, some feminist authors have interpreted Emily Dickinson's withdrawal from the outside world as a conscious decision, "to practice necessary economics" in the service of her work (Rich 51). Wolff, on the other hand, in her carefully documented biography, concluded "By the last years of her life, Emily Dickinson had become altogether homebound, probably phobically so (167)." Garbowsky pursued this line of thinking further, suggesting the development of a specific over-arching phobia called Agoraphobia, the name commonly given to a fear of leaving home. While neither Rich nor Wolff can find events contributing to Dickinson's withdrawal and reclusiveness, Garbowsky suggests several episodes of acute anxiety in the process (92).3 [End Page 71]
This essay is a further attempt to piece together the story -- by examining the letters for hidden events and seemingly unrelated experiences described by Dickinson over a thirty-year time frame, experiences that if considered sequentially, may be connected to form a pattern.
What do we know for sure? Emily Dickinson presents us with a clear cut medical diagnosis late in life in an 1884 letter to Mrs. Holland: "The Physician says I have 'Nervous prostration'. Possibly I have -- I do not know the Names of Sickness (L873).4,5
What was "Nervous prostration"? Dickinson would have found it defined in her own lexicon, Webster's American Dictionary of the English Language as follows: "In medicine, a latent not an exhausted, state of the vital energies; great oppression of natural strength and vigor. Prostration is different and distinct from exhaustion; it is analogous to the state of a spring lying under such a weight that it is incapable of action; while exhaustion is analogous to the state of a spring deprived of its elastic powers" (379). Dickinson's "Nervous prostration," in other words, was a lesser form of the condition called nervous exhaustion. But by the 1880s, while these terms may have still been used by physicians with their patients, they had been subsumed under the accepted medical diagnosis of Neurasthenia (Beard, "Neurasthenia"). It included many symptoms, such as profound exhaustion, insomnia, pressure and heaviness in the head, palpitation of the heart, trembling of the muscles, as well as multiple fears, including fears "of open places or closed places, fear of society, fear of being alone" (Beard, American Nercousness). Neurasthenia was considered a physical illness due to actual loss of strength by the nervous system. The nerves were believed to have a natural electrical charge of energy which could run down, just like a battery, from over-exertion.6
Before attempting to trace the roots of this diagnosis made by Emily Dickinson's physician in her own life experience, it is important to trace the subsequent fate of the condition known then as Neurasthenia. Sigmund Freud found the concept to be overly inclusive, and in 1894 (Freud 217) separated out from it those conditions in which the main symptom was anxiety, especially those with acute "attacks" accompanied by physical symptoms of fear such as rapid breathing, palpitations, and sweating.7 But it was not until the middle of the twentieth century that researchers found a specific biological test that differentiated those who suffered from these acute "panic attacks" from those who suffered from more diffuse and generalized anxiety. As a result, in 1980, the diagnosis of Panic Disorder became officially recognized as a separate medical condition with specific symptom criteria needed for its diagnosis (DSM-III). [End Page 72]
Of course in 1883, Emily Dickinson's physician knew none of this. But he would undoubtedly have made the diagnosis of "Nervous Prostration" from the history of her anxiety symptoms. Let us attempt to trace these symptoms backward from his diagnosis to their possible origin. First, back to "the terror" of 1861-62. He would probably have known about some of the fears that had been building ever since "the terror" Dickinson described in her letter to Higginson: "I had a terror -- since September -- I could tell to none -- and so I sing as the Boy does by the Burying Ground -- because I am afraid" (L261).8 A letter to her cousins the following year suggests the terror had not subsided and was worse when alone:
The nights turned hot, when Vinnie had gone, and I must keep no window raised, for fear of prowling 'booger,' and I must shut my door for fear front door slide open on me at the 'dead of night,' and I must keep 'gas' burning to light the danger up, so I could distinguish it -- these gave me a snarl in the brain which don't unravel yet, and that old nail in my breast pricked me (L281).
Here she seems more explicit in describing not only her fears, but the physical sensations as well: "snarl in the brain which don't unravel yet, and that old nail in my breast pricked me." What do they represent? Searching the letters further backward, for other examples of terror, a fear that agitates the body as well as the mind as Webster defined it, we find the earliest account in a clear and dramatic episode occurring in an 1854 letter to Susan Gilbert (L154). It contains a vivid description of extreme fear -- physical as well as emotional -- that she experienced on the way to church that very day:
I'm just from meeting, Susie, and as I sorely feared, my 'life' was made a 'victim' -- I walked -- I ran -- I turned precarious corners -- One moment I was not -- then soared aloft like Phoenix, soon as the foe was by -- and then anticipating an enemy again, my soiled and drooping plumage might have been seen emerging from just behind a fence, vainly endeavoring to fly once more from hence . . . How big and broad the aisle seemed, full huge enough before, as I quaked slowly up -- and reached my usual seat! . . . and there I sat, and sighed, and wondered I was scared so, for surely in the whole world was nothing I need to fear -- Yet there the Phantom was, and though I kept resolving to be as brave as Turks, and bold as Polar [End Page 73] Bears, it didn't help me any . . . During the exercises I became more calm, and got out of church quite comfortably (L154).
Here Dickinson vividly describes an episode of extreme anxiety, abrupt and unexpected, beginning on the way to church, reaching a swift crescendo during the service, then quickly resolving. Her clear description of the episode includes frightening physical sensations, feelings of unreality, and even visual distortions. The current generally accepted medical nomenclature defines the experience Dickinson described as fitting the essential features of a Panic Attack: spontaneous and unexpected, with sudden onset, accompanied by a sense of imminent danger or impending doom and an urge to escape. The term "spontaneous" is used because it illustrates a person not only terrified but baffled by the inability to find a reason for such extreme fear: "and wondered I was scared so, for surely in the whole world was nothing I need to fear". But there are more explicit medical criteria to be met if the experience Dickinson described is to match the medical condition called Panic Attack. A diagnosis of Panic Attack requires that symptoms meet a very specific threshold: "at least four or more (of thirteen) specific symptom criteria develop abruptly and reach a peak within ten minutes" (DSM-IV 395). Dickinson's own description specifies sensations that are consistent with these specific symptom criteria listed in the DSM-IV; i.e. her letter describes (1) sweating or hot flushes, (2) trembling or shaking, (3) feeling dizzy or light headed, (4) feelings of unreality and being detached from oneself and (5) the fear of losing control. So her own account details the criteria that are consistent with the diagnosis of Panic Attack.9
What happened next? Now let us move forward from the attack of January 1854 and examine a story that begins to emerge. The most common concern that develops in persons after a single unexpected Panic Attack is that another one might occur without warning and away from the safety of home. This "secondary" anxiety builds as the victim (the term Dickinson used to describe herself, or her "life" made victim) tries to construct a protective shield against the unexpected. What do we find in Dickinson's letters in the weeks and months immediately following the account of the terrifying event on the way to church? First, in a letter to her brother Austin, she related a new behavior: "I went to meeting five minutes before the bell rang, morning and afternoon, so not to have to go in after all the people had got there" (L159). Perhaps this was an attempt to control the circumstances around the first attack in church. Recall that she had walked trembling down the church aisle in the midst of the attack and in sight of everyone there: "How big and broad the aisle seemed . . . as I quaked slowly up." But arriving early [End Page 74] to meeting was not sufficient reassurance for Dickinson; the fear of loss of control in other social situations usually spreads. A further constriction of her life away from home began to develop. She declined to leave home to go to Washington with the family as planned (L157). Later that same year, in a letter to Abiah Root, she confessed "I don't go from home, unless emergency leads me by the hand, and then I do it obstinately, and draw back if I can" (L166). Again, within a span of several months following the Panic Attack, the continued development of homebound avoidant behavior in a letter to Susan Gilbert. "We go out very little -- once in a month or two" (L176). The withdrawal was rapidly developing in the months immediately following the described attack.10
Scientific evidence today suggests that the essential feature of Agoraphobia is not a fear of crowds or open spaces as formerly believed, but a fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of a Panic Attack (DSM-IV). It is a secondary, not a primary condition. The concern typically leads to increasing avoidance of a variety of situations that include being alone outside the home or being at home alone. Dickinson describes this latter fear and her growing dependence on her sister in a subsequent letter: "Vinnie has been all, so long, I feel the oddest fright at parting with her for an hour, lest a storm arise, and I go unsheltered" (L200). We can only speculate that the "storm" might represent one of a continuing series of unexpected attacks.
What can we conclude then, about what Emily Dickinson experienced? How does it fit with current medical knowledge? Connecting the dotted lines between three points may form a picture: (1) She described an episode in 1854 that clearly meets the medical criteria for Panic Attack, (2) She probably had recurrences, e.g. the physical symptoms described in 1863 "snarl in the brain" and "nail in my breast," and (3) Her social withdrawal is consistent with Agoraphobia, which occurs in many victims of Panic Attack. While we cannot be certain about the number of attacks, we should note that Agoraphobia usually reflects the severity of the condition, i.e. those in whom the panic symptoms are most intense and repeated develop more severe Agoraphobia (Battaglia 1998).11
Thus it would seem reasonable to conclude, then, that the experience pieced together from Emily Dickinson's own words fits the current "three-layer" medical concept of this condition: (1) an acute Panic Attack that is extremely frightening, leading to (2) chronic anxiety and worry about another attack, resulting in (3) the development of a series of avoidances centering around protection from the unexpected, this latter stage known as Agoraphobia.12 It is important to emphasize, however, that Agoraphobia was [End Page 75] a secondary, not the primary condition. It is the psychosocial consequence of Panic, which is the primary medical condition, one understood today as physical, or biologically determined. It is likely, or at least possible, then, that it was the progression of social and emotional complications of the unrecognized Panic Attacks beginning in 1854, that caused her physician to diagnose "Nervous Prostration" in 1883.
Today, Panic with (or without) Agoraphobia is understood as a physical illness that affects several million Americans. Its onset is typically between adolescence and the mid-thirties. It has a familial (genetically inherited) pattern, so that first-degree relatives have a several times greater chance of developing some part of the spectrum of symptoms (Villand 146). While we have no firm evidence of the trait in the Dickinson family, Austin Dickinson did complain about palpitations of the heart which were of concern to his sister.13 Perhaps Austin demonstrated a constitutional predisposition to Panic, and one of its most common symptoms, but not the full-blown condition.
How do we understand the mechanism of Panic Attack today? Anxiety, the term for fear without a specific focus, functions as a kind of user-friendly internal alarm system in most of us, an alarm system that alerts us to danger, both internal and external. Panic Attacks are simply false alarms or perturbations of the system. Like a dysfunctional fire alarm that goes off at the wrong time, they are intense bursts of anxiety in the wrong place at the wrong time. Consider an analogy to a more familiar protective system in our body, our immune system. The immune system protects us by fighting off infection. It normally functions by producing antibodies that attack any foreign bacteria that invade our bodies. The familiar signs of inflammation, pain, redness and swelling, show it is doing its job. But for some people, the immune system becomes dysfunctional as a protective mechanism. It turns on and attacks its own host body. The resulting conditions are called Auto-Immune Disorders. Panic Disorder (multiple Panic Attacks) is a similar condition, the dysfunction of a normally protective system in the body.14
But why is all this important? Is it just another chapter in the many theories about Emily Dickinson's gradual withdrawal from society and decision to remain at home coincident with her choice of vocation as poet? Becoming an artist is not a sudden happening. It requires a gift that develops as part of a living process, an interaction between genetic endowment and environmental experiences. In Emily Dickinson's case that life process was a troubled one. But the period of greatest turmoil (1862) around her distress was also her period of great creativity. That is a fact. The rest is speculation.15 [End Page 76]
That speculation rests on a two-part assumption: (1) that Agoraphobia may have provided the opportunity for a deeper exploration of the inner self by restricting contact with the external world, while (2) the physical sensations of panic were transformed into poetic metaphor, that is, they served as the raw material for poetic creation.16
Many have commented upon and analyzed Emily Dickinson's concern with death or its use as a metaphor. For example, several recent articles in the Emily Dickinson Journal consider the mystery of death in her work. Ernst suggests that death is chosen as a means of going beyond the limited horizon of our own sensory experience (Ernst 7). In the same issue, Nesteruck describes her approaching death from "the inside" (Nesteruck 27). With this in mind, let us consider further how she might have accessed and examined the experience of death so vividly, and was able to go beyond it.
Did Emily Dickinson die and come back to life? Perhaps the answer is both yes and no. What if an experience that simulated death became a regular part of her life? It is well known (Clark and Beck) that the physical sensations experienced by persons with Panic Attacks are perceived as more dangerous than they actually are, almost always as a feeling they are about to die (Hibbert).
Some of Dickinson's most remarkable poetry emerged following "the terror" and was marked by a unique capacity to search out and explore the experience of death. Poems from this period go beyond the generally accepted observation that Dickinson wrote from the "other side of the grave". They blur the line between life and death by creating a transition space between being and non-being, perhaps derived from Dickinson's own physical and mental sensations that accompanied the panic or "terror" -- feelings of unreality, detachment from the self, and loss of physical control so clearly detailed in her letter of 1854.17
Let us for a moment return to the time line of Dickinson's medical condition and attempt to relate it to the time line of some of her best known poetry, recognizing the uncertainty of chronological assignments as a limitation of this method of study. The "terror since September I could tell to none" marks the beginning of some of Dickinson's most famous poetry, perhaps her own way of telling "the terror" as well. Terror is a word often used by panic victims to describe the fear of death they have experienced.
First, the word "terror" coupled with "fright" appears in 1861-1862 poems linked with death:
It [Death] sets the Fright at liberty -
And Terror's free - [End Page 77]
Gay, Ghastly, Holiday!
Fright and death begin to merge:
The Soul has Bandaged moments -
When too appalled to stir -
She feels some ghastly Fright come up
And stop to look at her -
But the Fright, or Terror, becomes even further transformed. Among Dickinson's best known poems are those describing the actual experience of dying, e.g. the famous experience of death mimicking a pounding funeral inside her own head: "I felt a Funeral in my Brain" (Fr340), a poem that is considered figuratively an attempt to describe the terror (Bennett 65). These poems detail the experience persons with Panic Attack report today, sensations of detachment, out of body feelings of unreality, and losing control of one's own mind from overwhelming anxiety, the fear of "going crazy:"
And then a Plank in Reason, broke,
And I dropped down, and down -
Just as panic comes and goes, with times of intense fear and recovery from it, the poems allow the reader to oscillate back and forth between life and death: "I heard a Fly buzz - when I died" (Fr591). The very fact that Panic Attacks are reversible modifies the experience of death that they simulate.
During the year 1862, when Dickinson wrote to Higginson about the "terror" of 1861, she suggested she had not yet recovered from it. It not only marked the beginning of Emily Dickinson's greatest work but her most productive year as well, an estimated flood of 366 poems, twice as many as any other in her life, and more than all of the previous years of her life together. Is it possible that the poems of 1862 create and recreate the experience of the terror, translating it over and over again into metaphor? Consider the multiple physical sensations of recurring panic symbolizing death itself:
He fumbles at your Soul
As Players at the Keys [End Page 78]
Before they drop full Music on -
He stuns you by degrees -
Prepares your, brittle Nature
For the Etheral Blow
By fainter Hammers - further heard -
Then nearer - Then so slow
Your Breath has time to straighten -
Your Brain - to bubble Cool -
Deals - One - imperial - Thunderbolt -
That scalps your naked Soul -
Other verse seems to be searching for physical reassurance that one is still alive after the loss of the sense of self (or recovery from panic):
I felt my life with both my hands
To see if it was there -
I held my spirit to the Glass
To prove it possibler
It was not Death, for I stood up,
And all the Dead, lie down -
. . . . . . . . . . . . . . . . . . . . . . . . .
When everything that ticked - has stopped -
And space stares - all around -
In summary then, these examples of the poetry that emerged following the period of terror seem marked by a unique capacity to search out and explore the experience of being dead alternating with being alive. The sensitivity to sensations between being and non-being may have derived from Dickinson's own experience. Victims of Panic Attacks today describe the feeling that they are dying, but then coming back to life.
It is possible that while the development of Agoraphobia may have contributed to Dickinson's physical restriction, the Panic Attack(s) may have led to deepened emotional exploration as well, perhaps an attempt at coping, [End Page 79] at self-healing, a move forward rather than backward in her own life. The typical temporary and reversible nature of Panic Attacks, with quiet periods in between, may have allowed for transformation of frightening physical sensations into metaphor with the emergence of new imagery even while secondary fears were building. If symptoms of panic were a driving force in the flood of poems of 1862, if a medical illness was embedded in poetic expression, if the transformation of terrifying physical and mental sensations into vivid imagery did occur, then death could be felt as an experience that touches us all. But it goes beyond this. Beneath the poetic imagery of death, the sensations of personal estrangement may represent the essence of the artistic gift -- to experience the extremes of human emotion and recover its cognitive and emotional residue in art form.
Some research on the conflictual nature of inspiration suggests that poetry may be an ideal medium for this transformation of inner life into symbolic representation (Rothenberg). The poet documents not only her own concerns, but touches on the reader's concerns, starting the reader in the process of working them out as well. The reader continues the process the poet begins. In this case, the "near death" experience of panic described in Dickinson's letter may have been translated into the actual experience of dying (and being dead) in her poetry. But within the vivid images of death in Dickinson's poems also lie the depths of human terror, the artist's own experience of temporary loss of the sense of self. The reader may identify with the artist, not only at the level of physical sensation, but at a deeper psychological level in which the depths of loneliness and estrangement are derived from the experience of loss of the sense of self.
Why did Emily Dickinson not simply suffer as other Panic victims do? Why was she not paralyzed by her symptoms? The answer is that while a medical illness, or susceptibility to it, may be inherited, character is not. It is acquired. And it was her strength of character, built further on the pain of illness, that may have offered a pathway for innate talent to flourish. If you will allow that her symptoms of panic became embedded in poetic expression, it provides an illustration of how traumatic life experience, grafted onto underlying creative genius and personal courage, can convert passive suffering into active coping, an attempt at self-healing that went beyond what medicine had to offer. It may even answer Higginson's own awed question in the preface to the first publication of her poems: "We can only wonder at the gift of vivid imagination by which this recluse woman can delineate, by a few touches, the very crises of physical or mental conflict" (Poems  vi).
Emily Dickinson was not a mad woman; she was a complicated personality [End Page 80] who appears to have been attacked by an illness that was poorly understood at the time. Others (McDermott and Porter 1989) have shown, using modern biographical research methods, how her death poetry was not a simple repetition of the symptoms of that illness, how it "ascended" beyond the experience of death. If Panic Attack with Agoraphobia was her lot, then by struggling with it through poetic expression, she herself ascended beyond it. If her body was trapped by an illness, it is clear that her spirit was free.
John McDermott, M.D. is Professor Emeritus of Psychiatry at the University of Hawaii School of Medicine. He first became interested in Emily Dickinson when he and David Porter met as Scholars-in-Residence at the Rockefeller Foundation Study Center in Bellagio, Italy in 1985. He can be reached by e-mail at firstname.lastname@example.org.
* The author wishes to thank David Porter for his helpful comments.
1. Sewall points out that psychoanalytic interpretation emphasized the "darker" side of Emily Dickinson's personality, from parental inadequacy to frustrated love.
2. In a personal communication, Cody stated that his reconsidered diagnostic impression was that of a severe depression rather than a psychotic breakdown. The question of depression in her life has been considered by other Dickinson scholars as well, and will be examined further in a subsequent essay.
3. I admire the originality of the direction Garbowsky has taken, but there are limitations to her method, i.e. she used the poems as a primary database for making diagnoses just as Cody did. Garbowsky emphasizes Agoraphobia as the primary illness.
4. Reference to Dickinson's letters are from the Letters of Emily Dickinson edited by Thomas H. Johnson and Theodora Ward. Citations follow Johnson and Ward numbering system and approximate chronology. There is a natural human tendency in all of us to mix speculation with fact when so few facts are known about a person's life. In an attempt to stay as close to fact as possible, I will use material from the letters to represent autobiographical fragments from her life, then separately consider how these facts may have been elaborated in certain of her poems. The latter is a departure from fact and should be considered pure speculation.
5. The diagnosis was repeated in a different way and in a different context the following year: "The doctor calls it 'revenge of the nerves,', but who but Death had wronged them?" (L907). Here Dickinson supplies her own idea of loss as the stress or trigger for the illness. She was probably correct.
6. There was a 19th century medical focus on the nervous system and symptoms attributed to the "nerves," just as previous centuries had focused on understand- ing other organs, such as the heart and the liver. The diagnosis Neurasthenia coincided with the rise of neurology as a medical specialty in mid 19th century America, when knowledge about the brain was advancing rapidly in Europe. While Neurasthenia did serve to separate the more common and less severe "nervous" disorders from major ones, i.e. insanity, it also served as a reservoir of class and gender biases of 19th century society. The theory was based, not only on a concept of "nerve force" taken from physics, but on social Darwinism as well, that the educated classes had more highly advanced nervous systems, and therefore were more vulnerable to stress and depletion of nerve force. Women were thought especially vulnerable, had inherited a weaker nervous system than men, one that could function well in traditional female roles, but was inadequate when stressed by too much "brain work." It is likely that, while Dickinson's symptoms fit the medical diagnosis of Neurasthenia, their cause would have been inferred to a year at college and writing poetry, both notorious "risk factors" for nervous prostration or exhaustion. The possible impact of the 19th century treatment of Neurasthenia on Emily Dickinson will be the subject of a future essay.
7. Freud found Neurasthenia to be the most common condition affecting his patients and even diagnosed himself as suffering from Neurasthenia. In fact, his well- known experiments with cocaine were an attempt to find a treatment that restored energy to a depleted nervous system.
8. Webster's definition in her own lexicon illustrates the intensity of the word she chose: "Terror - extreme fear; violent dread; fright; fear that agitates the body and mind . . . Death is emphatically styled the king of terrors" (768). While the most common interpretation of Dickinson's "Terror" has been eye trouble and fear of blindness, another possible explanation will be explored here. For example, other references at the time suggest helplessness in the face of sudden unexpected attacks of fear, rather than concern about gradual loss of vision: "I remember a tree . . . whose leaves went topsy-turvy as often as a wind, and showed an ashen side -- that's fright, that's Emily" (L264).
9. While Garbowsky's theory of Panic Attack is confirmed, it is not possible to medically diagnose a person without examining him or her personally. One can only partially do so by using autobiographical data from Dickinson's own reports. They are incomplete reports at best without the amplification that is part of a full medical evaluation. However, this episode seems distinctly different, both qualitatively and quantitatively from other descriptions of anxiety in her life. The remainder of her letter to Gilbert is unremarkable, even humorous; it is not inconsistent with accounts from victims of a first Panic Attack who have experienced the typical sudden compete recovery and assume it was a freak occurrence: "how I clutched the latch, and whirled the merry key, and fairly danced for joy, to find myself at home!" (L154). Similarly, the 1862 letter to Higginson about "the terror" had a similar newsy flavor, aside from that frightening announcement.
10. Assuming that dates assigned to the letters by Johnson are reasonably accurate. While Dickinson showed some earlier signs of social anxiety, they seemed related to homesickness while at Mt. Holyoke. The rapid acceleration of homebound behavior in 1854 following the acute attack on the way to church seems qualitatively, as well as quantitatively different.
11. Since Dickinson's withdrawal from society was extreme by any measure, "I do not cross my Father's ground to any House or town" (L330), post hoc reasoning provides evidence, albeit circumstantial evidence, that she did have repeated severe attacks. In any case, while it may be technically correct to state that Dickinson chose to withdraw to her father's house to work, this choice seems to coincide with increasing fears of being away from home or alone at home.
12. Actually, Dickinson's gradual avoidance of all social situations went beyond simple Agoraphobia. Even within the safety of home, she often retreated to her room when visitors arrived, ran when the doorbell rang, was fearful of strangers and even friends. Typical of those who want social relationships but are afraid of them, she was fully aware of the irrationality of her own behavior: "Odd that I who run away from so many cannot brook that one turn from me" ( L245). It is probable that the Panic Attack(s), and the resulting Agoraphobia were complicated by the development of a further condition, the avoidant symptoms of a developing Social Phobia, concurrent with her increasing restriction to home.
13. "I don't understand your being troubled with the palpitation so much, but think it must be owing to a disordered system" (L71).
14. The diagnosis of Panic Disorder which requires multiple Panic Attacks, is not used here, as hard evidence exists for only one Panic Attack, the one Dickinson described in 1854. And while Panic is indeed a biological condition, the inherited tendency, or genetic susceptibility, probably requires a certain threshold to become expressed. That threshold may be reached when overwhelming stress provides the context for the first attack. The precipitating stress in Dickinson's life was most likely related to personal loss, as she herself noted, and rejection.
15. Please note that while the foregoing assessment of a single Panic Attack with probable Agoraphobia is based on facts found in the Letters, the remainder of this essay is pure speculation based on the content of poems written during the time period.
16. The remainder of this essay will attempt to illustrate this hypothesis which suggests that the "terror" of 1861-62 represents a midpoint in an emotional chain reaction that began with a detailed description of a Panic Attack in 1854, and ended with the diagnosis of Nervous prostration in 1883.
17. The Panic Attack explanation is not inconsistent with Porter's idea of "aftermath" (10) or Stonum's claim that a poem speaks from a "traumatic phase" that has subsided (74).
Unless otherwise indicated the following abbreviations are used for reference to the writings of Emily Dickinson.
Fr The Poems of Emily Dickinson: Variorum Edition. Ed. R.W. Franklin. 3 vols. Cambridge: Harvard UP, 1998. Citation by poem number.
J The Poems of Emily Dickinson. Ed. Thomas H. Johnson. 3 vols. Cambridge: Harvard UP, 1955. Citation by poem number.
L The Letters of Emily Dickinson. Ed. Thomas H. Johnson and Theodora Ward. 3 vols. Cambridge: Harvard UP, 1958. Citation by letter number.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders ( cited as DSM-III). 3rd ed. Washington, D.C.: APA Press, 1980.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (cited as DSM-IV). 4th ed. Washington, D.C.: APA Press, 1994.
Battaglia, Marco, et al. "Anticipation of age at onset of panic disorder." American of Journal Psychiatry 155 (1998): 590-595.
Beard, George M. "Neurasthenia or nervous exhaustion." Boston Medical Surgical Journal 3 (1869): 217-220.
------. American Nervousness: Its Causes and Consequences. New York: Putnam, 1881.
Bennett, Paula. My Life a Loaded Gun. Boston, MA: Beacon Press, 1986.
Clark, Donald, and Aaron Beck. "Cognitive Approaches." Handbook of Anxiety Disorders. Ed. Last and Hersen. New York: Pergamon Press, 1988.
Cody, John. After Great Pain: The Inner Life of Emily Dickinson. Cambridge, MA: Harvard UP, 1971.
Dickinson, Emily. Poems By Emily Dickinson. Eds. Mabel L. Todd & T.W. Higginson. Boston: Roberts Brothers, 1890
------. The Letters of Emily Dickinson. Eds. Thomas H. Johnson & Theodora Ward, Cambridge, MA: Harvard University Press, 1958.
------. The Poems of Emily Dickinson. Ed. Ralph W. Franklin, Cambridge, MA: Harvard UP, 1998
Ernst, Katherina. "'Death' and the Lyrical I." Emily Dickinson Journal VI (1997): 1-24.
Freud, Sigmund. "The Justification for Detaching from Neurasthenia A Particular Syndrome: The Anxiety Neurosis" Collected Papers. Ed. Ernest Jones. New York: Basic Book, 1959.
Garbowsky, Maryanne. The House Without The Door: A Study of Emily Dickinson and the Illness of Agoraphobia. New Jersey: Associated University Press, Inc., 1989.
Guthrie, James R. Emily Dickinson's Vision: Illness and Identity in Her Poetry. Gainesville: UP of Florida, 1998.
Hibbert, George. "Ideational Components of Anxiety: Their Origin and Content." British Journal of Psychiatry 144 (1984): 618-624.
McDermott, John F. and David Porter. "The Efficacy of Poetry Therapy: A Computerized Content Analysis of the Death Poetry of Emily Dickinson." Psychiatry 52 (1989): 462-468.
Nesteruck, Fester. "The Many Deaths of Emily Dickinson." Emily Dickinson Journal VI (1997):25-43.
Porter, David. Dickinson: The Modern Idiom. Cambridge, MA: Harvard UP, 1981.
Rich, Adrienne. "Vesuvius at Home: The Power of Emily Dickinson." Parnassus: Poetry in Review V (1976): 51-52.
Rothenberg, Albert. "Poetic Processing Psychotherapy." Psychiatry 35 (1972): 238-254.
Sewall, Richard. The Life of Emily Dickinson. New York: Farrrar Straus & Giroux, 1974.
Shear, M.K. "Pathophysiology of Panic." Journal of Clinical Psychiatry 47:6 (1986).
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