Anxiety: We worry. A gallery of contributors count the ways.

Even if I live to be a thousand years old I won’t forget my first panic attack, that first surreal journey into the paranormal dimensions of my cerebral cortex. Decades later, the memory is all white heat and jagged edges. Psychologists call these acute anxiety episodes “little deaths,” but victims of them will tell you there is nothing little about them. Next to a panic attack, death, when it finally comes, will be skipping through tulips.

It was a sweltering July day in 1980 and I was sitting in a Manhattan restaurant a few blocks from the Plaza Hotel with 70 carats of emeralds in my pocket. The stones were fresh from the infamously lethal Muzo mine in Colombia, and as a favor to a good friend who had smuggled them into the country, I’d flown to New York the day before to meet with a gem dealer, the father of a college friend from Brooklyn who had “connections.” Drinks with friends until 3 a.m. the night before was not the best idea, and the pitcher of black coffee I poured down my throat in the Palm Room a few hours later flooded my central nervous system with Jamaican voodoo and high-voltage insults. So after a testy morning of bickering over occlusions and color and squinting through jewelers’ loupes, I was a little on edge when the gem dealer invited me to lunch.

I heard a muffled “linguine Alfredo,” and that’s when the film snapped.

I first noticed the seizures in my fingers when we were seated — bizarre, neurological twitches that made my digits dance like grasshoppers on the linen tablecloth. A tic in my left eye kept shuttering my vision. The dining room was jammed to the fleur-de-lis wallpaper with red-faced white guys in blue suits and harried looking waiters in penguin costumes. Not my crowd. I remember hearing a muffled “linguine Alfredo” and the clinking of glasses at another table, and then the film snaps. This, as I’ve come to think of it, was the moment my first life stopped, where the film broke and the reel spun around and around, flogging itself.

I couldn’t move. I was suddenly, inexplicably, paralyzed with anxiety. As researchers would learn years later when they peered into our brains with PET scans, the electrical messaging between the amygdala and the anterior cingulate in my brain had gone “Tilt!’” The sudden storm of impulses surging between these tiny glands lit up my central nervous system like a Christmas tree hit by lightning. A neurological journey measured in milliseconds launched me across a threshold wider than any ocean, from my happy-go-lucky, anything-goes carnival of a life to a place that was scarier than the hospital scene with Heath Ledger’s Joker playing Russian roulette.

Tommi Musturi

The initial tremor of voltage wormed its way up the back of my neck in a vertiginous rush of heat. Before I could grab the table to steady myself, the snake uncoiled itself inside my head and struck my prefrontal cortex with a ferocity that made my heart pummel my ribs, trying to break out. In a flash, my arms and legs went numb from the elbows and knees down, a band of steel encircled my head, I trembled, sweat poured off my forehead, and the spinning behind my eyes was speeding up.

“Are you all right?” asked the dealer.

“Get me outta here.”

I couldn’t actually shape the word “dying” with my mouth, but that’s what I thought. That’s what I felt. This was it, the Joker, his hot tongue slobbering all over me. I reached for a glass of water but it flew out of my hand and shattered. I pushed back from the table and stood up and my friend caught me before my legs buckled. As we made our way to the door all I could think about was my wife and our 11-month-old son. They were so far away. I would never see them again; this was curtains.

What I couldn’t know at that moment was that I’d crossed a frontera, a border crossing separating my old life from the new, and there was no way back, any more than I could return to my mother’s womb or rewrite my genome. This was the new me, a verdict with no appeals, no chance at parole. My brain had betrayed me, and in this new life I would have to learn how to function in a suspended state between the deadening banality of the exterior world and the theater of the absurd that tormented me from within. I was now living with an intimate stranger, trapped, it seemed, between two profoundly distorted mirrors with no way out.

Once outside, I managed to get my bearings, but the storm raging at the center of my brain was getting worse. Panic deepened with each breath. The dealer took my pulse and blurted an expletive.

“Can you walk? I know a doctor up the street.”

Somehow, we got there. The next two hours are phantom memories. My heart was beating so fast — 220 beats a minute according to the doctor — that very little oxygen was getting to my brain. The doctor, an elderly German with kind eyes and soft, thick hands, laid me out on a bed in his office, covered me with blankets, gave me a shot of a barbiturate, and I was gone. When I came around a little while later, he said, “You have experienced an acute anxiety attack. I think you’re going to be fine, now, but I want you to take one of these if it ever happens again.”

I took the small vial of pills, thanked him profusely, and got up and left.

Thus began my descent into the world of acronyms (EEGs, EKGs, G.A.D.’s, LMNOPs), bewildered doctors, frustrated psychologists, and a three-ring circus of pharmaceutical adventures. Years later, after my second stint in a clinical study on depression and anxiety at the University of Arizona Medical Center, I made a T-shirt that read, “Lab Rat.”

I flew home to Montana with a vial of Valium, a few emeralds and a rationalized story that I had “gotten a bad oyster.” I wanted more than anything to believe that story, but it was only a matter of time before the hair-trigger in my amygdala wasted that fantasy.

The second time the Joker struck was on a snowy evening the following November as I was rocking my son to sleep. The attack was ruthless, without warning, another world-class humdinger of a meltdown. “This is not good,” I told myself as I waited for the doctor in the emergency room, “this will not end well.”

The attacks came in shorter intervals over the next few years, and I soon learned that I knew more about acute anxiety than most of the doctors treating me. Tests revealed nothing abnormal. Their bewilderment was palpable. My refrain, “There has to be an organic source to this,” fell on deaf ears and glazed eyes as they scribbled out yet another prescription. Even 25 years ago, before PET scans and other imaging break-throughs, the inner workings of the human brain were an enigma to medical science. My doctors didn’t know that their best efforts to control the beast in my head were making the beast more and more uncontrollable.

Desperate, I threw myself into my work. Photojournalism forced me to break through the gravitational field pulling me inward, to turn outward and engage the world through the viewfinder. That hope, like so many others, was in vain. Nothing worked. Then one winter evening, a neighbor, a minister’s wife, knocked on our door. I cracked it open a few inches and saw her kind, gentle smile. “I think I know how you’re suffering, and I think this might help,” she said. She slipped a blue clothbound book through the slot: “Peace From Nervous Suffering,” by Dr. Claire Weekes. “This is for you. I have my own copy.” I read it cover to cover, that night, and then I curled up around that book and wept. Finally, someone understood my living hell. I wasn’t alone.

As a journalist I covered wars, presidential campaigns, natural disasters, you name it, all with the Joker on my back and that book in my camera bag. Claire Weekes went everywhere I went. She was a brave and brilliant pioneer in the field of emotional brain physiology, and her fearless insights and calm compassion gave me a fighting chance against the black pit of despair, a place to plant my feet on solid ground when the world all around me was heaving with madness and dissolution. But she, alone, could not stop the attacks. They kept coming, those E-tickets on the Anxiety Express, with varying intensity and varying frequency. You haven’t explored the farthest reaches of the existentially surreal until you’ve had a grand mal panic attack during an 8.2 earthquake in a war zone in the middle of the night. Alone, in a foreign country. Peak experience.

Related More From Anxiety Read previous contributions to this series.

Inevitably, the 10-year-long addiction to Valium led to intense medical detox, including a course of Dilantin to stop the seizures, and a year of mind-bending withdrawals from the benzodiazepine curse. Then came the terror of confronting the world metal-on-metal, without a buffer. This was yet another new frontera, the border crossing into my third life. If you survive this last crossing, you’ll always have something to laugh at, yourself, and an experience so absurd in its comedic/tragic dimensions that the only possible venue for objective reflection is in the funhouse mirror of the everyday.

I survived. The Thorazine, imipramine, benzodiazepines, opiates and rivers of alcohol, the serotonin reuptake inhibitors, the uppers and downers, inners, outers, laughers and screamers, are all markers of a distant past. I haven’t had a panic attack in many years, but there’s always tomorrow, or tonight, or 10 minutes from now. Ruthless, unprovoked, no warning.

When I paid my 10 bucks a few years ago to see “Batman: The Dark Knight,” one glance at the hideous feral leer of Heath Ledger’s Joker took me right back to that July day in New York City. Ledger was a brilliant, once-in-a-generation talent beset by the emotional anarchy of acute anxiety and one or more of its sinister first cousins; depression, insomnia, isolation, mania, personality disintegration and O.C.D., and that’s just the front row in the family portrait of demons. By the time the film was released, Ledger had already fallen into the abyss with the help of a cocktail of prescribed remedies, but of this I am certain. His Joker was no illusion, no dark fantasy of his imagination. His Joker, whom he described as a “psychopathic, mass-murdering, schizophrenic clown with zero empathy,” was the real deal, the mocking personification of the intimate beast trapped between two mirrors in both of our heads. When Jack Nicholson — who played the Joker in 1989 — was informed of Ledger’s death, he cryptically told reporters: “Well, I warned him.”

It’s a shame that our six degrees of separation could not be narrowed to one. Maybe, just maybe, I could have thrown that young man a life ring on a stormy night. Maybe I could have slipped a blue clothbound book through a crack in his door and somehow made a difference. And maybe not. We’ll never know. The Joker got there first.

(Anxiety welcomes submissions at anxiety@nytimes.com.)

Paul VanDevelder is a photojournalist, filmmaker and screenwriter, and the author of “Coyote Warrior: One Man, Three Tribes, and the Trial that Forged a Nation” and “Savages and Scoundrels: The Untold Story of America’s Road to Empire Through Indian Territory.”