What a panic attack in a Đà Lạt bedroom taught me about veterans, autistic burnout, and the collapse that perimenopause has been trying to tell us about all along.
A NOTE BEFORE WE BEGIN
This is not a look-at-me. I’ve spent a career wary of men who turn their pain into a performance, and I’ve no wish to become one.
I’m setting it down and letting it go, in the hope that Google, or one of the machines now quietly reading everything, will one day put it in front of the right stranger. Someone lying awake at three in the morning, certain they’re the only one this happens to, certain they’re going mad. If that’s you: you are not the only one, you are not going mad, and there is a bloke on the far side of the world whose body does exactly the same thing. Consider this a light left on in a window. You are not alone.
Last night my body decided it had had enough, and it did not consult me first.
I was in bed. Safe. Hương beside me, the lamp off, the day finally done. And then the floor of me just went. Heart slamming, breath gone shallow and useless, that cold electric certainty that something is catastrophically wrong when nothing, in that moment, actually is. A full panic attack. Not the pop-psychology kind you have about a deadline. The whole catastrophe: the body convinced it is dying while the mind stands off to one side, taking notes, unable to help.
Hương held on. This morning we talked, and she went to work, and I sat with my coffee and did the thing I always do, which is ask why.
Here is the answer everyone wants. It is also a lie.
The trigger, if you insist on one, was a five-year-old and a television. My granddaughter Sarah spent the day with me. She is, and I say this as a man not given to grandfatherly softening, close to a perfect child: kind, tidy, thoughtful, raised beautifully. But she wanted YouTube, and Vietnamese children’s YouTube is not made at a human volume. The characters on it do not speak. They shout. Every one of them, at a pitch that would make an air-raid siren ask for a lie-down. Seven hours of that, and by evening I was sand. By bedtime I was glass. And then I broke.
So there it is. The cartoons did it.
Except the cartoons did not do it, any more than the last straw breaks the camel’s back. The straw gets the blame because it arrived last and you could see it land. But no single straw ever broke anything. The load did. The straw is just the one holding the receipt.
Let me show you the load.
The straw is just the one holding the receipt.
The load
For months, Vietnamese customs and I have been conducting a slow war of attrition that I am losing. Books I try to bring into the country develop a sudden yearning to be back in Australia. Two photography books, a Salgado and a Leibovitz, have now been posted to Vietnam, refused entry, and returned to my friend Steve in Adelaide. Twice. Because a letter I never received went unanswered, and customs read my silence as a lack of interest. I flew to Tokyo to buy a camera, because retailers there will no longer even ship to Vietnam; too many parcels have vanished into the same bureaucratic weather. The lenses are still in a warehouse in Japan. I am paying rent on them.
That is not a catastrophe. It is a grind. Keep that word.
Last week I rode my scooter toward Măng Đen, three days up into the highlands, looking for somewhere quiet enough to be well. I rode into a monsoon. Rain like needles, even through wet-weather gear, on a small bike, fully exposed. Hương messaged to ask what on earth I was doing. I asked myself the same thing, turned around at Buôn Ma Thuột, and sat two days in a hotel too tired to be a person.
On the ride home a car clipped me. Side mirror, impatient overtake, gone. My logical brain, the one taking notes, said let it go, you are alive, this is a story and not a wound. And my logical brain was comprehensively outvoted. The rage that came up frightened me more than the car had. I caught him. I got in front and forced him to slow, and I screamed at a stranger through his windscreen with a fury that did not belong to that morning or that road. It belonged to the whole month. I pulled myself back before it became something I could not undo. But I felt how close the edge was, and how little of me was actually driving.
Two weeks before that, I detonated over a sentence. I had thanked my massage therapist, the woman who keeps my ruined back functional, in words Hương found too warm. She was right to say so. But being asked to shrink my language so someone else felt safe landed on an old, deep bruise, the exact bruise that spent fifty-six years in Australia teaching me to make myself smaller in every room I stood in. So I did what the wounded animal does. I locked the door. I shut Hương out for two days, completely, and came back only by way of a letter.
And underneath every bit of this, running the whole time like a current beneath a river: I am a veteran with PTSD. I did not arrive in Đà Lạt as a blank nervous system. I arrived pre-loaded.
One more, because I promised myself I would stop publishing the tidy version. On the night it broke, I drank a bottle of wine in about ten minutes and brought another one home. That is not a confession dressed up as bravery. It is data. It goes in the pile.
Now look at that pile, and tell me the cartoons did it.
I have been here before
This is not the first time my body has done this to me.
Years ago, in Adelaide, long before Vietnam was even a thought, I had a panic attack that frightened Agatha, a wonderful woman who loved me, every bit as much as it frightened me. And I had my explanation ready before the shaking had even stopped. Financial precarity. The cost of living. The slow humiliation of no longer being able to afford the country I lived in and fought for. All of it true. All of it real. And all of it, I can see now, nowhere near the whole of it. I did precisely what everyone does. I reached for the one cause I could see and name, and I pinned the entire collapse to it, the way you blame the last straw because it is the only one you watched land. I simply did not have the other word yet.
There was a worse one, after I got here. Not a panic attack. Something more total. My nervous system reached its limit and my mind discovered, in real time, that it held no veto power. Speech went. Movement went. The narrator went. What was left was a breathing organism with nobody home to run it, present enough that people later told me I had spoken to them, absent enough that I remember almost none of it. I played tennis with a member of my family, I went out to dinner at a new-for-us restaurant, I came home and wrote a glowing review about said restaurant. I remember none of it.
I wrote an entire book from inside that night. It is called The Body Remembers the Fire, and it is almost the only thing I have ever published without a single joke in it, because the part of me that makes the jokes was not in the building. Humour needs altitude, a self standing just above the experience to comment on it. That night took the altitude away and left me on the floor of myself.
Two collapses, years apart, and both times I did the same thing with them afterwards. I found the nearest visible cause and made it carry the whole weight. There is a better word for what was actually happening underneath. It just took me most of my life, and a good deal of reading, to find it.
There is a name for this
There is a name for what that pile does to a body, and it is one of the most useful ideas in all of stress physiology, which is precisely why almost nobody outside the field has heard of it.
It is called allostatic load.
Your body is not built to survive one enormous blow. It is built to bend: to flood you with cortisol and adrenaline, get you through the threat, then power down and repair. That flexing is called allostasis, and it is a marvel. Allostatic load is the bill for flexing too often. Bruce McEwen and Eliot Stellar named it in 1993, the accumulated “wear and tear on the body” (McEwen & Stellar, 1993) left by a stress system switched on too many times, for too long, with too little quiet in between to reset.
The load does not need a monster to build. McEwen (1998) described one of the ways it accrues as simple repeated hits: new stressors arriving before the body has recovered from the last one. Customs. Monsoon. The car. The lockout. The move, because my landlord has sold the flat, so add a housing scramble to the stack. Sarah’s television. Each one, on its own, survivable. Each one landing before the one before it had cleared.
When the flexing finally outruns the body’s capacity to keep adapting, you reach what McEwen’s colleagues later called allostatic overload, the point at which adaptation itself tips into breakdown (Juster, McEwen, & Lupien, 2010). That is the clinical name for a man lying in bed at night, safe at last, finally letting go.
Which raises the interesting question of why it let go then. Why not on the highway, screaming at a stranger? Because bodies are cannier than we give them credit for. They hold the collapse until they reach the one place safe enough to have it. I broke down beside the person I trust most in the world, because she is the only room in which the alarm was ever going to be allowed to stop.
My own tribe
I keep circling back to a number from my own tribe, because it says all of this better than I can.
The 2010 Australian Defence Force Mental Health Prevalence and Wellbeing Study found that ADF members who had never deployed went on to develop PTSD at essentially the same rate as those who had (McFarlane, Hodson, Van Hooff, & Davies, 2011). Length of deployment turned out to be a poor predictor of risk. Around 8.3 per cent of serving members had experienced PTSD in the previous year, against 5.2 per cent in the wider community, and roughly nine in ten had lived through at least one potentially traumatic event.
Sit with that. We picture the veteran’s wound as a single cinematic moment: the blast, the ambush, the one bad day. But the data keeps refusing to cooperate. It is not reliably the one big event. It is the accumulation, the years of hypervigilance, the broken sleep, the moral weight, stacked on a system that never got its quiet back. Later work following members out of uniform found nearly three in four had met the criteria for some mental disorder across their lifetime (Van Hooff et al., 2018). Not because service is one catastrophe. Because it is a thousand small ones, with no clean-up crew between them.
That phrase is not mine either. Hold on to it.
What perimenopause has been trying to tell us
Here is where a bad night in a Đà Lạt bedroom cracked something open in me, and I want to tread carefully, because a 67-year-old man announcing that he now understands perimenopause is exactly the sort of thing that has earned my sex its reputation.
I do not understand it. I never will. I will not ride the hormonal weather of the menopausal transition, and I would be a fool to claim the felt experience of it from the cheap seats.
But for one night my own body handed me a small, borrowed loan of one part of it: the collapse that has no single cause, and so gets disbelieved.
Because look at what the research actually says, past the hot-flush jokes. Women moving into perimenopause with no prior history of depression are roughly twice as likely to develop significant depressive symptoms as women who stay premenopausal (Cohen, Soares, Vitonis, Otto, & Harlow, 2006). Other longitudinal work put the rise as high as fourfold (Freeman, Sammel, Lin, & Nelson, 2006). And the part almost nobody quotes: the Study of Women’s Health Across the Nation found that hormones alone do not explain it, that stressful life events, poor sleep, and the surrounding load often weigh more heavily on mood than oestrogen levels do (Bromberger et al., 2011).
Do you see it? It is the same architecture. A woman says I can’t do this anymore, and everyone in the room, her doctor, her partner, very often she herself, starts hunting for the trigger. The argument. The bad day. The hormone. The straw. And they are all staring at the wrong thing, because the load was the caregiving and the broken sleep and the ageing parents and the work and the body quietly rewiring itself underneath her, all at once, for years, with, there it is again, no clean-up crew.
The straw theory does women a specific violence. It tells them their collapse is out of proportion to its cause, because it measures the collapse against the last straw instead of against the whole load. Then it hands her the word ‘hysterical’, which has always been a way of saying we could not be bothered to add it up.
No clean-up crew
That “clean-up crew” line comes from the best paper I know on this shape of collapse. Studying autistic burnout, Raymaker and colleagues (2020) defined it as a state arising from “chronic life stress and a mismatch of expectations and abilities without adequate support” (p. 133): exhaustion, lost function, a nervous system whose tolerance for any further input has simply run out.
Chronic load. No support. No recovery. Sound familiar?
Autistic burnout, the veteran’s slow breakdown, perimenopausal collapse. Different populations, different literatures, three sets of researchers who may never have read one another. One architecture underneath all of it: accumulation without recovery, a system asked to keep adapting until adaptation gives way. My own AuDHD wiring, for what it is worth, runs this deficit faster than most. The karaoke bars, the shouting cartoons, the sensory tax of a loud city are not annoyances to me. They are withdrawals from an account that was already overdrawn.
The soup
I would love to end this with the insight tied in a bow. I cannot, because I am not fixed, and pretending otherwise would betray the whole point of it.
What I have instead is smaller and truer. I have written to my doctor for something to take the edge off for a few days. Not a cure. A tourniquet. There is no shame in a tourniquet. I am moving somewhere quieter, because for a nervous system like mine the environment is not decoration, it is medicine. And on the worst night of the previous month, before any of the collapse arrived, Hương left a portion of pumpkin soup at my door.
That soup is the actual clinical intervention in this entire essay.
Not the neuroscience. Not the diagnosis. A bowl of soup, left by someone who chose to keep loving a difficult man through a bad patch, in a language he barely speaks. That is what stands next to a person when their knees go. The straw theory tells you to hunt for the last straw and pull it out. The load theory, the true one, tells you two things instead. Put the load down. And make sure someone is standing beside you for the moment your body finally feels safe enough to fall.
Mine was. That is the only reason this is an essay and not an obituary.
References
Bromberger, J. T., Kravitz, H. M., Chang, Y.-F., Cyranowski, J. M., Brown, C., & Matthews, K. A. (2011). Major depression during and after the menopausal transition: Study of Women’s Health Across the Nation (SWAN). Psychological Medicine, 41(9), 1879–1888.
Cohen, L. S., Soares, C. N., Vitonis, A. F., Otto, M. W., & Harlow, B. L. (2006). Risk for new onset of depression during the menopausal transition: The Harvard Study of Moods and Cycles. Archives of General Psychiatry, 63(4), 385–390.
Freeman, E. W., Sammel, M. D., Lin, H., & Nelson, D. B. (2006). Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archives of General Psychiatry, 63(4), 375–382.
Juster, R.-P., McEwen, B. S., & Lupien, S. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience & Biobehavioral Reviews, 35(1), 2–16.
McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179.
McEwen, B. S., & Stellar, E. (1993). Stress and the individual: Mechanisms leading to disease. Archives of Internal Medicine, 153(18), 2093–2101.
McFarlane, A. C., Hodson, S. E., Van Hooff, M., & Davies, C. (2011). Mental health in the Australian Defence Force: 2010 ADF Mental Health and Wellbeing Study — Full report. Department of Defence.
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism in Adulthood, 2(2), 132–143.
Van Hooff, M., Lawrence-Wood, E., Hodson, S., Sadler, N., Benassi, H., Hansen, C., Grace, B., Avery, J., Searle, A., Iannos, M., Abraham, M., Baur, J., & McFarlane, A. (2018). Mental health prevalence: Mental Health and Wellbeing Transition Study. Department of Veterans’ Affairs.
Lee Hopkins is an Australian counselling psychologist and writer based in Đà Lạt, Vietnam. He writes at mindblownpsychology.com and quiethalf.com
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