When shyness becomes a pain

By Marion Scher

We all feel a little nervous at times, but it's when this fear keeps you trapped inside alonely world that you need to seek help.

When Austrian novelist Elfreide Jelinek was called to say she had been named the Nobel Laureate for literature in 2004, her first thought wasn't one of overwhelming joy, but rather fear of having to go to Stockholm to receive her prize. She didn't go and instead sent her publisher to accept the highest award any writer could receive. Jelinek suffers from Social Phobia Disorder, and the thought of even having to appear in front of an audience was far too much for her to bear.

Divorced mother of two teenage girls, Stella Coetzee (42), understands Jelinek's pain, as she too suffers from this disorder. "It's affected every part of my life so badly. When I drop my youngest daughter off at school and see a teacher inside the gate I go through the trauma of not being sure whether I should greet them or not – will they think I'm stupid? I seem to be in a permanent state of tears and insecurity."

Coetzee is not alone. Social Phobia Disorder or Social Anxiety Disorder is said to be the third largest psychological problem in the world today and, at the same time, one of the most unknown to most of us.

So what exactly is Social Phobia Disorder? Technically put it's the fear of social situations the involve interaction with other people, especially the fear of being judged and evaluated by others. This can take the form of thinking everyone waiting at the check-out till at the supermarket is watching you, even though you know it's not really true. You can't just pick up the phone and make a phone call, in case your call will be seen as pointless. A family wedding is a nightmare, when the buzz of voices around you all seems to be commenting on what you look like and why you're there. For most of us it would be a soft buzz – for someone with Social Phobia Disorder it would sound as though it were coming through a megaphone.

"Even when I look back to my high school days I can see that what others took for aloofness in me was in fact me sheer fear of interaction," explains Coetzee. "I forced myself to go to work everyday at the stationery shop where I had to deal with the public.That job didn't last long and from then I went from job to job until I had my second child and my husband felt I should stay home with the baby. That was such a relief for me – just me and my children – I could cope fine with that." For sufferers such as Coetzee the restrictions this illness place on your life are severe.

But there is help out there for this condition. One ofthe best methods of treatment is Cognitive Behavioural Therapy (CBT). "Research has shown that CBT generally works faster than any other treatment for this condition," explains clinical psychologist, Dr Colinda Linde, one of the country's leading experts in this field. "We see patients individually at first for about four sessions just to orientate them into the programme. After this they feel ready to join a group –which is a big step for sufferers of Social Phobia. They often doubt themselves at first, but when they realise that the other members of the group have the same problem as them they let the programme take over. In the group we practice social skills, just interacting and eventually leading up to public speaking.

"I've seen so many people over the years who have been turned down promotions at work, or amazing job offers, simply because it might involve presenting in front of others – even once a year. The results of the therapy are amazing – seeing these people being able to tackle their jobs and home life normally again."

One such patient who has successfully gone through the programme is 33-year-old Candice*. "I was quite a shy child and being continually anxious became a part of who I was. It wasn't until I was in my mid-20s that it really became qualified as a mental illness – one I didn't know existed. Around this time, in my capacity as a consultant in a large company, I was asked to give a presentation in the USA. I'd always been nervous when I had to give local presentations, but had been able to get through them – this time though I went into complete panic mode and felt this was way beyond what I could deal with.

"That was when I found help and the psychologist literally gave me emergency techniques to use. Somehow I got through the presentation and as soon as I returned to South Africa I joined a CBT programme. I didn't realise before then that I even had a problem – let alone that there were so many other people out there with the same problem."

But what causes this condition? According to research being conducted by the South African Medical Research Council, there is evidence suggesting Social Phobia could be inherited. Dr Christine Lochner, clinical psychologist and co-ordinator of Genetics of Anxiety Disorders at the Council comments: "Social Phobia often runs in families. Scientists are exploring the idea that heightened sensitivity to disapproval (typical of Social Phobia) may be physiologically or hormonally based. Other researchers are investigating the environment's influence on the development of SocialPhobia," she adds.

One of the big issues with such an illness is getting people who are socially phobic to see any kind of doctor and discuss their problem. And even then there's no guarantee that a general practitioner will identify it correctly as the patient is unlikely toknow its proper name. often a GP will simply prescribe tranquilising medication, which could temporarily calm someone, but not change their situation.

"The best treatment for this condition is a combination of the right kind of antidepressants and CBT," explains psychiatrist Dr Sheldon Zilesnik of the Crescent Clinic, Randburg. "There are a lot more people out there suffering from this illness than myself and my colleagues ever see. Not all social phobic people suffer from shyness – indeed, some are actually extroverted, but have specific phobias which are less common. There may be one or two specific situations such as suddenly being terrified that during a meeting they may have to answer a question.

"In men, as a result of this illness, we see a lot of alcoholism whereas in women this would more likely be substance abuse – both conditions obviously worsening the illness itself. After a few drinks, what would be adifficult social situation becomes easier for some men. For women calming drugs are often used to take the edge off situations. Unfortunately, because of the nature of the illness, when we suggest psychotherapy they resist, rather wanting a pill. They are literally scared to be in therapy," adds Zilesnik.

For 31-year-old Tracy Evans* even going to see a doctor and talk about her condition is a terrifying thought. "Everyone always said 'ag shame, she's very shy,' but I know it's more than being shy. When I'm with my family I'm fine, but in work situations, especially when I have to present anything, I really struggle. My heart pumps so fast and I break out in a sweat. The night before I won't sleep and when I do finally stand up to speak I will literally forget my own name and English sounds like my second language, which it isn't.

"I can go out to a social even ad dance in front of people, but when it comes to talking I'd rather die," she adds.

So what happens to these people if they don't get help? According to Zane Wilson, founder and director of the South African Depression and Anxiety Support Group (SADAG), it often leads to a high risk of substance abuse as well as suicide. "This is a very debilitating illness. Sometimes a social phobic person will shake so much in public that signing a cheque is hard to do. Often they stay in backroom jobs, such as computer programming, where they don't have to relate to people. Eating out is also very tough. They think people are watching how they hold a knife and fork, how they eat and cut up their food.

"This means that many sufferers never leave their homes. We've had people who are so scared of others hearing them urinate they have bricked up their windows. That's where SADAG comes in. generally they will call us as they can talk to us without being seen. We give them as much information as we can and often recommend specialists. But of course we can'tmake them get help," concludes Wilson.

"The treatment has literally given me my life back", enthuses Candice. "Unfortunately in this country mental illness already carries a stigma for many people. For a social phobic to admit going to a therapist is far harder, as they're so worried what everyone would think. The problem is we don't have a language for emotion. How do you give narrative to your feelings? Before I realised what was wrong with me I used to wonder why everyone else seemed fine and I was so apart. People need to know about and understand this illness."

*Names withheld

For more information on Social Phobia Disorder contact SADAG on (011) 784 1474. If you would like to take part in the research being carried out by the Medical Research Council, phone (021) 938 9229.

Copyright 2006, Used with permission from Marion Scher.