This is what someone with anxiety feels like in a big city

‘It’s not that I’m scared of people, but masses of them do make me anxious’

Cities are overwhelming. People swirl and swarm; trains break down. You are surrounded by people, but you can feel very alone. And for those who are anxious, the realities of the city can trip off a spiral of panic.

Now, the authorities are targeting the issue: yesterday, transport bosses and mental health experts held a conference in London to strategise about how to help those with mental health issues cope when they travel. It was the first of its kind. Some train operators already teach staff to deal with passengers who have dementia; now, the government is arguing that those with mental illnesses need the same attention as those with physical disabilities. The Mental Health Action Group estimates that 1 in 4 people will experience mental health issues, and 1 in 10 will live with one long-term.

It is easy to scoff that this is excessive – that feeling a bit clammy on the Tube is very different to navigating an escalator with a broken leg. But fear can be debilitating, and handling the frenzies of the city can be terrifying.

“One of the great things about London is also one of the things that hits my anxiety right where it hurts,” Mollie, a 20-year old assistant quips. “It’s not that I’m scared of people, but masses of them do make me anxious.”

How does her anxiety manifest? “When I get anxious I usually feel light headed and get racing thoughts,” she explains. “I can feel hot – or cold – and start to worry that I’m going to faint or be sick. A panic attack is a vicious cycle; you start to breathe funny because you feel faint, which makes you feel fainter, which makes you feel sicker.” Her brain trips off on one (“it’s basically a rapid-fire set of ‘what ifs'”). She handles it by distracting herself with “a picture of my cat on my phone – yes, I know, but still, it works – or a good playlist of calming music or a chilled out podcast”.

“I never hyperventilate when anxious, thank goodness,” says Ella, also 20, and who also suffers from anxiety. “I am very good at keeping it to myself. I usually go extremely hot, and my hands get wet. I also experience this wired falling sensation that I have never been able to properly explain to anyone.”

Public transport can be a trigger. “I live in south London, and often have to take a mainline commuter train to work – often filled to the brim with similarly sleepy and agitated people,” Mollie says. “The act of pushing myself onto the train makes me feel anxious – what if someone pushes back? Or is angry at me for daring to try and get on a packed train?

“And I worry about packed Tubes, too,” she continues. “What if there are too many people and I just can’t bring myself to get on the train? What if I’m then late for work, and my colleagues are unsympathetic as yet again I’m running 10 minutes late? What if I can get on the carriage and it breaks down mid-tunnel? What if I’m trapped on the Tube all day, in the heat, in the dark amongst strangers. What if there’s a terrorist attack? What if someone tries to assault me on the Tube, and there’s nowhere for me to edge away to?

Ella agrees. “My main trigger is public transport,” she says. “Tubes are an absolute nightmare – panic attack territory when a train stops between two stations.”

Fun is not straightforward. “I don’t drink when I’m in London,” Mollie explains. “It’s too much of a source of anxiety. I worry about being too drunk on the train, leaving myself vulnerable. I worry that, if I’ve had a bit too much to drink, that I’ll be sick on the train and people will sneer, maybe even shout at me. It’s the same with Ubers. What if I drink too much, and the driver attacks me? What if I throw up in the cab and get palmed off with a huge fine? It’s just better not to.” Ella agrees: “It sounds ridiculous but being hungover, and then having to sit in long meetings is horrible. I will avoid going out the night before if I know I have a day of meetings.”

Mollie also worries about her phone running out of battery, “which some may brush off as a ‘millennial problem’,” she concedes. “But I wouldn’t be able to access Google maps and find my way home. What if I need to contact someone for help?”

Worst of all, panic spirals are difficult to rationalise or predict – which makes things worse. “I took a trip to Paris a few weeks ago with my mother,” Mollie explains. “And as we sat down to eat dinner in a restaurant I found myself going into panic attack mode. I felt lightheaded, like I was going to faint. I was sure if I sat at the table and tried to eat dinner I would die. So I had to leave. I sat having a panic attack in a road not too far from the Eiffel Tower, I realised that I couldn’t be in public anymore. So me and my mum sat on our beds in the hotel eating club sandwiches. When it was over, I was mortified at having ruined a lovely trip over something so hysterical.”

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