The following four brief anecdotes (based on true stories) concern people who might be your friend, neighbor, or even family member. The condition being described in these anecdotes may seem somewhat benign, but when you think about it, you will realize that this disorder can cause a person to get stuck in life and miss out on much of what life has to offer.
Reuven’s Fear of People of Authority
Reuven gets extremely anxious when interacting with people of authority. When he was younger, he avoided interacting with his teachers as much as possible. As an adult, he tries to avoid interacting with his superiors at work. When problems arise at work, he tries to deal with them on his own, which does not always lead to a successful outcome. He knows that he would be more appreciated at work if he would interact with his superiors. He realizes that his anxiety is irrational, but he nevertheless feels helpless in overcoming his sense of fear.
Sarah’s Fear of Making Phone Calls
Sarah is a very friendly and outgoing young woman. She does not seem to be shy at all. She is well-liked by her friends, played the part of lead actress in her high-school production, and even gave a speech in front of the entire camp at the end-of-summer banquet. Incredibly, she gets extremely anxious when calling people whom she does not know well or does not know at all on the phone. This includes people whom she will never meet. The inability to see the other person’s face raises an irrational fear that perhaps the person on the other end of the line is not really interested in talking with her. Sarah will therefore not call a store to ask for store hours, will not make doctor appointments for herself, and she will not call a company to ask for information about their product. For years, her mother took care of these phone calls for her, but she now plans to move to a different city. The thought of having to make phone calls herself is frightening.
Rivka’s Fear of Speaking Up In A Group
Rivka is extremely afraid of speaking up when she is in a group of people, such as at a business meeting. Although she is very intelligent and creative, she cannot get her innovative thoughts out of her mouth when she attends meetings with her coworkers. She is viewed as a diligent employee who does not have that many ideas. Her boss has passed over her for promotions numerous times. Rivka is aware that her unwanted silence at meetings is preventing her from success, but she feels that her problem is unsolvable.
Yaakov’s Sweaty Hands
Yaakov gets very nervous whenever he meets new people. His anxiety causes him to have sweaty hands. The anxiety of meeting new people is not strong enough by itself to cause Yaakov to avoid them, but the inevitable handshake scares him. Additionally, he would like to look for a new job, but he knows that he would have to shake the hand of the job interviewer. This fear is keeping him stuck in his present low-paying and unsatisfying job.
How SAD!
Reuven, Sarah, Rivka and Yaakov all suffer from Social Anxiety Disorder (SAD), a condition formerly known as Social Phobia. SAD is an intense fear of one or more social situations that can cause extreme distress and inhibited functioning. The fear is usually of being harshly scrutinized or judged. Besides the anticipatory anxiety before a social interaction, there is often further anxiety after a social interaction, since people with SAD tend to think that they performed poorly.
SAD can be limited to one type of social interaction (as illustrated in the above-mentioned anecdotes), or it can be so pervasive that those affected might experience anxiety in all social interactions other than those with their immediate family.
Although individuals with SAD often realize that their fear is excessive or irrational, they still feel unable to disregard their feelings. Besides the emotion of fear, it is also common to have physical symptoms such as blushing, sweating, heart palpitations, and nausea. The physical symptoms of SAD often exacerbate the disorder, since people with SAD are hypersensitive about how they appear to others (or sometimes how they imagine they appear to others). Therefore, when they start to blush, sweat, or talk with a shaky voice it further reinforces their perception that others are thinking negatively of them.
The stories mentioned above may sound a little bit out of the ordinary, but in reality, SAD is one of the most common mental health disorders. Individuals with SAD can be quite adept at masking their condition, so that even close friends and acquaintances might not realize that there is a problem. It is estimated that seven percent of the population suffers from this disorder. Amazingly, it was not recognized as a disorder until 1985!
SAD is often referred to as the disorder of lost opportunities. A person can go through decades of his life with an inability to succeed and limited social interaction.
The Slippery Slope of SAD
People with SAD are desperate to overcome their fears. However, they often do not realize that there are psychological interventions that can help them face their fears. They sometimes turn to the oldest remedy for social anxiety – alcohol. When alcohol is the coping mechanism, alcohol dependency and addiction are often just around the corner. In fact, some studies show that one-fifth of people with SAD also suffer from alcohol dependence. SAD can also lead to depression simply due to the intense suffering that one feels due to social isolation.
This is why it is imperative for parents who see their child suffering from SAD to get the child help. It is not only the child’s happiness that is at stake but also his mental and physical health.
“I Am Just an Introvert!”
While introversion and SAD are often confused, they actually represent two different concepts that are not necessarily correlated. Introverts are people who enjoy observing from the audience rather than being the presenter. They enjoy quiet time for themselves and feel that their emotions should be kept private. They are not reserved out of fear, rather out of choice. By contrast, those with SAD are forced into unwanted social isolation out of an extreme fear of what might happen in a social interaction. In general, introverts do not let their tendencies prevent them from reaching their potential. Sufferers of SAD, however, will tell you that their dreams and aspirations were snuffed out by their disorder.
“You Are Pathologizing Normal Shyness!”
SAD is also different from shyness. Individuals who are shy may have mild anxiety when they have to be in the limelight or interact with new people, but they usually do not feel that they are suffering from social isolation or not achieving their potential in life. They would not meet the diagnostic criteria for SAD, because their shyness is not causing them any significant suffering or impairment of functioning. SAD can be distinguished from typical shyness by the strong feelings of anxiety and substantial physical symptoms that interfere with daily living. Specifically, it is the avoidance of anxiety-triggering situations that causes these individuals so much suffering. Our Sages were seemingly referring to this disorder when they said (in Avos 2, 5) that an excessively bashful person cannot learn. The inability to ask questions in front of the class or to a person of authority prevents the student from properly learning. This certainly is a considerable barrier to happiness and success in life.
Interventions
Fortunately, there are treatments for SAD, such as psychotherapy and medication. Goals of psychotherapy for SAD can include interventions like these: 1) learning that the fear is irrational, 2) learning skills of how to lower this anxiety, and 3) learning how to face these fears in a constructive and therapeutic manner. Since SAD is a unique type of anxiety disorder, it is important that the clinician have specific knowledge in how to treat SAD. Sometimes, it is necessary to supplement the psychotherapy with medication. The purpose of the medications that are prescribed for SAD is to diminish the feelings of anxiety that were causing them to avoid social interaction. The medication lowers the symptoms of the anxiety to a level that can be worked upon in therapy.
SAD is a real disorder. Those who are affected by it are not just being lazy or stubborn. They are suffering. The good news is that it is treatable and one does not have to lose out because of SAD.
May we all merit achieving our dreams and aspirations without the hindrance of our fears.
Rabbi Hauptman is Director of Relief of Baltimore, a mental health referral service. Contact him at ahauptman@reliefhelp.org or at 410-448-8356. This article was reviewed by Dr. Ariella Abraham, Psy.D., who specializes in Cognitive-Behavioral Therapy for anxiety and depression. Contact her at 845-709-3291.
