“Just the Way I Am”: Denial Is the Enemy of Social Anxiety Sufferers
Confessions of an “Avoidance Addict”
By Amy Lemley
No one would ever call me shy. In fact, I am “the extrovert’s extrovert,” an attention-seeker, a ham. I love public speaking, being interviewed on television and radio, and having my picture taken. I talk to strangers. A lot.
Yet through it all, I have suffered from extreme social anxiety. And I’m not alone. An estimated 37 million people suffer from it in the United States alone. You know some of us, though we are so adept at covering up our fears that you might never suspect.
We are crippled at times by symptoms such as obsessive worry, a racing pulse, clammy hands, and blushing and sweating to such an extent that we’d rather be alone than suffer—no matter what the cost. We may sacrifice relationships. We may sabotage our own careers. We may self-medicate with alcohol and drugs.
However we respond, we do so under a veil of denial wrapped so tightly around us that we cannot move. We don’t know what is wrong. We don’t know there’s a name for it. Our secret is so shameful, our self-hatred so deep, and our belief in our power to change is so diminished that we feel hopeless and unworthy.
“It’s just the way I am…”
Many social anxiety sufferers are labeled “introverts” or consider themselves to be “just shy.” In their view, this is just how they are, an indelible part of their personality. But according to the Andrew Kukes Foundation for Social Anxiety, which reports that one in eight people suffers from social anxiety, a limited awareness of exactly what social anxiety is and how to detect and treat it sentences some people to a life of “less than”—less than happy, less than comfortable, less than successful.
Social Anxiety Defined
Simply put, social anxiety disorder is the fear of experiencing embarrassment, shame, rejection, or humiliation in the presence of others. It causes both emotional discomfort through obsessive worry and physical suffering that emanates from the core. Always, these symptoms are associated with human interaction.
The American Psychiatric Association’s Diagnostic and Statistic Manual of Mental Disorders, commonly referred to as the bible of mental health practitioners, specifies that symptoms of social anxiety must have been present for at least six months before that diagnosis can be made.
Trust me: Six months is nothing. According to the Anxiety Disorders Association of America, 36 percent of people diagnosed with social anxiety disorder “have reported symptoms for over 10 years before seeking help.”During those 10 years or, I suspect, longer, I have no doubt these people were told—and told themselves—this was just the way they were.
Healthy introversion does not preclude socializing. Although they generally prefer in-depth conversation to small talk, introverts are capable of attending parties and networking events, of coffee machine banter at work and across-the-fence neighborhood chat.
Self-proclaimed introvert Jonathan Rauch wrote in the Atlantic in 2003: “After an hour or two of being socially ‘on,’ we introverts need to turn off and recharge. My own formula is roughly two hours alone for every hour of socializing. This isn’t antisocial. It isn’t a sign of depression. It does not call for medication. For introverts, to be alone with our thoughts is as restorative as sleeping, as nourishing as eating.”
For someone with social anxiety, the tradeoff cannot be measured in hours spent socializing versus hours spent recovering. Instead, even a five-minute interchange—say, introducing two colleagues, placing a phone call, asking a question in a public forum, or asking a neighbor for a favor—can take (waste) hours of obsessive worrying. Before the event, a person may spend hours feeling a sense of doom, obsessively worrying and suffering physical symptoms.
Then, rather than merely recharging in solitude, the social anxiety sufferer returns from the interaction exhausted, with hours yet to spend rehashing the interaction and building a solid case for his or her own failed performance. Said something stupid? Yep. Sweated? Yep. Mind went blank? Yep. Everyone could tell I was nervous? Yep.
As an extrovert whose life is no longer dominated by social anxiety, I know that spending time with others—even when I am the center of attention—is what recharges me. When I shared this with a friend, who is an opera singer and voice coach, he told me about the advice he gives students on how to deal with stage fright. “Just before you go on stage,” he says, “Tell yourself, ‘I want this.’ Because you do.”
What’s the Difference?
Social anxiety sufferers know that their debilitating syndrome prevents them from doing the things they would like to do. Introverts are comfortable with their choice to avoid being the center of attention; they are capable of forging meaningful relationships and achieving career success. As for socially anxious extroverts like me, here’s how it goes: I make a meaningful and energizing connection with others. I agree to follow up (socially or in business). My fear of not following up perfectly leads to excessive worry. I avoid following up at all. The avoidance costs me the social or professional relationship. All of this causes a downward spiral.
Most mental health professionals consider avoidant personality disorder—the condition in which a person so fears the scrutiny of others that he or she simply avoids situations where others might sit in judgment—to be impossible to resolve. This news can feel like a death sentence for someone seeking help for social anxiety.
But the right treatment can replace avoidant behavior with proactive behavior in which a person feels the adrenaline flow, embraces it, and then uses it as energy to fuel success.
Can Medication Help—and Is It Enough?
Critics of pharmaceutical treatment of social anxiety charge that SSRIs are capable of creating “false extroverts.” But as I’ve explained, not all social anxiety sufferers are introverts.
Social anxiety is often dismissed as introversion. From early childhood, I seemed “sullen,” as my mother described me; I hung back, was quiet, tentative, fearful of the attention of others.
For many years, my avoidant tendencies and fear of speaking up had me convinced that I was an introvert. I stayed in the background, always hoping no one would turn the attention to me. I was depressed, lonely, and confused. Medication and therapy turned this around. I am now friendly, outgoing, generous, and inclusive. I no longer require medication to manage my social anxiety.
I was not “just shy.” I was not an introvert. And treatment did not change me into any sort of “false introvert” who should have been left to her solitary tendencies.
Denial of my problem could have kept me in that rut—in that life of less than—indefinitely.
Although many people have criticized the pharmaceutical industry for seeming to suggest that introversion is a disorder, I do not consider their campaigns a disservice. On the contrary. For the millions of people who have lived in denial or rationalized themselves into avoidant behavior by concluding that this is “just the way they are,” those campaigns make a difference that goes beyond just marketing a product.
So often, we hear people talking about how relieved they are once they finally get a definitive diagnosis for their headaches, rashes, coughs, breathing difficulties, and pain. “At least I finally know I’m not crazy,” one friend said to me after learning she had Lyme disease.
The medication itself may not be the solution. But seeing our symptoms depicted and hearing the message that we don’t have to live this way any longer means the world. Mental health professionals are still learning about best practices for treating this disorder. Some may overmedicate. One man I know told me his doctor diagnosed him with a “chemical imbalance” and said he would require an addictive tranquilizer, for the rest of his life. This introduced drug dependence into the mix without presenting an opportunity to work on the underlying issues.
Modern medicine has other ways of eliminating the symptom rather than getting at the underlying emotional cause. Two of the most upsetting physical symptoms are facial blushing and sweating, technically known as hyperhidrosis. These symptoms themselves do not equal social anxiety; but the fear of exhibiting these symptoms and being noticeably nervous can have devastating consequences. Some sufferers will do just about anything to appear “normal.”
That willingness to try anything has given rise to a new medical industry: endoscopic thoracic sympathectomy. This delicate surgery is intended to quell facial blushing and sweating by destroying part of the sympathetic nerve trunk. But some scientific studies indicate that it offers no long-term benefit: “There is no reliable evidence for the effectiveness of endoscopic thoracic sympathectomy for excessive sweating in the face and hands or for flushing of the face,” according to a study by the Finnish Office for Health Care Technology Assessment. “Neither is there any evidence that this treatment has an impact on social phobia.” In fact, the study reports ETS can have significant short and long-term effects.
A Tragic Reality
Introverts are content in the level of solitude they choose. Shy people may wish for more courage, but they can maintain a comfort zone without being incapacitated. But social anxiety sufferers are at risk of serious health issues. And sadly, even death.
In 2009, Columbia University graduate Andy Kukes, 30, became overwhelmed by his inability to conquer social anxiety and took his own life.
Growing up in Florida, Andy epitomized the scholar-athlete. Only after entering Princeton University did this high school valedictorian begin to suffer from depression and anxiety. “Social pressures were becoming too much for him,” says his mother, Patricia Kukes.
“He did receive psychiatric help from numerous therapists and he was on many different types of medicine,” says his father, Jeffrey Kukes. “But after struggling for several months, he dropped out of school.” Six months later, he transferred to Columbia, where he had one friend from high school; he graduated summa cum laude and Phi Beta Kappa in 2001.
Back home in Florida after graduation, Andy became increasingly reclusive, socializing only with his immediate family and refusing to visit with outsiders or develop friendships. He took his own life July 14, 2009.
In his memory, Jeffrey and Patricia and Andy’s brother, Scott, have established the Andrew Kukes Foundation for Social Anxiety. “Our mission,”Jeffrey Kukes says, “is to educate mental health professionals about the diagnosis and treatment of social anxiety, provide help and a forum to assist social anxiety sufferers and their families, and to educate the general public about social anxiety.”
Achieving this laudable goal will move beyond pharmaceutical advertisements initial success in drawing attention to this problem to improving treatment protocols. Indeed, the AKF’s first major project was to produce an accredited 10-session continuing education and documentary video series.
Social Anxiety: The Untold Story
This program “Social Anxiety: The Untold Story: Diagnosis and Treatment” is now available for continuing education credits for the mental health professions. SATUS includes essential information and the most evidence-based clinical success for social anxiety on film. Numerous rare, perhaps one-of-a-kind interviews with real patients, are an integral component of the learning process. SATUS was written and facilitated by psychotherapist Jonathan Berent, L.C.S.W. who has worked with social anxiety sufferers of all ages since 1978.
SATUS is now available for continuing education credits sponsored by CMI Education – PESI.
The message? True introverts can rest easy. And those people who have rationalized their social anxiety by calling themselves introverts can find ways to overcome their fear and avoidance and move on to a more fulfilling life.
Amy Lemley is coauthor with Jonathan Berent, LCSW, of Work Makes Me Nervous: Overcome Workplace Anxiety and Build the Confidence to Succeed (Wiley, 2010) and Beyond Shyness: How to Conquer Social Anxieties (Simon & Schuster, 1993).