Face your phobia

DINESH is a 25-year-old software engineer. He won a gold medal upon graduation from his engineering college. He got a job and within a short span of time, impressed his superiors with his quality of work.

In spite of his achievements, he faced social problems. He found it difficult to go to a restaurant during recess. He felt that everybody was watching him and he might do something embarrassing.

At official meetings, he was tense and did not express his views, even when necessary. The most difficult task was attending parties. He was extremely tense, at times trembling, giddy with fear that others might ridicule him. Then he began to stay away. He knew that with his talent, he could be sent abroad but his phobia came in the way. He had similar problems earlier in attending functions, but now he was at a loss.

What is the problem with Dinesh? Did he become better? Did he go abroad? Before we find the answers, let us examine the problems he had.

Phobia is the irrational fear of a thing or situation. Social phobia is the irrational fear of social situations. It occurs in 2.4 persons per 100 population, more prevalent in men than women, even though recent studies say that it is equal. The problem most often starts during adolescence and early adulthood. The individual is scared and tense in social situations - like waiting for a bus in crowded places, at social gatherings like marriages, parties, and at restaurants. The anxiety is because he feels that something awful will happen to him, he may go wrong, behave in a silly way and others will ridicule him.

This results in sweating, trembling, feeling giddy and palpitation. Even though he knows/is aware that such behaviour is silly, he will not be able to overcome it. He starts avoiding social situations and this results in difficulties in carrying out his work and personal activities. Deteriorated interaction with others and personal distress result in a lower level of functioning and low self-esteem.

The causes of social phobia can be both individual and environment-related. A few people are shy and introverted. They do not have adequate social skills and etiquette, and this results in self-doubt and excess anxiety when exposed to social situations. This is extremely plausible in settings where families are conservative and do not allow their children much social exposure, resulting in deficiencies in learning adequate social skills.

It has become important in today's globalised competitive world to travel, interact and present oneself well. And when an individual is not able to meet this demand, over a period of time, he/she starts developing social phobia.

So what is the solution? In general, parents should allow their children to attend social gatherings. The individual should not shy away from social situations but try and learn new skills.

For those already afflicted with the disorder, having distress and disability, both medical and non-medical treatments are available. In terms of medication, drugs like fluoxetine and recent arrivals like moclobemide are useful. But those drugs take effect only after a few weeks, so there is a need to pursue treatment.

Psychological treatment in the form of cognitive behavioural therapy is useful, which aims at uncovering a person's automatic negative thoughts and cognitive schema, and helping an individual understand and overcome these negative thoughts, in a gradual and systematic way. Relaxation therapy is also useful in helping an individual overcoming basic anxiety and keeping it under control. One should understand that social learning is a lifetime process, and hence one needs to pursue it.

Coming back to Dinesh, he was on medication and underwent cognitive behavioural therapy. Gradually, he overcame his phobia. He is now attending parties and meetings and feels good about himself. He is likely to leave for the United States too.

DR. T.S.J. ANANDARAM

The writer is a psychiatrist at the Schizophrenia Research Foundation (SCARF) and Kumaran Hospitals, Chennai.

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