Thursday November 19 1998
Pill to melt shyness
Doctors have identified a drug that can overcome the misery of social phobia suffered by more than one in 10 Irish peopleMost people call it extreme shyness. According to some experts, up to eleven per cent of people in Ireland suffer from it. They prefer to call extreme shyness ``social phobia'' and they say that people who suffer from it experience unimaginable torment and isolation.
Now doctors believe Seroxat, a pill to counteract depression, can also help these social phobics or people who are, literally, painfully shy.
It's one of the great hidden psychiatric illnesses in this country. In these extreme shyness cases, sufferers are unable to leave their house or answer the phone.
The mere idea of talking to someone sends them into heart-stopping paroxysms of fear and panic.
A staggering 11 per cent of the population in Ireland are subject to this emotionally crippling ailment. Now, new research in Britain which reveals that the anti-depressant drug Seroxat successfully treats the condition has brought the plight of social phobics into the public mind for the first time.
The peak time for social phobia to hit individuals is between the ages of 14 and 16 years old, that delicate period in a person's life when he or she is forming serious emotional relationships with others. Women suffer from it more than men. However, the symptoms may not become obvious until much later.
Sufferers generally aren't aware that they have such a condition. By itself, social phobia doesn't bring on suicide but combined with other psychiatric illnesses victims are six times more likely than the general population to kill themselves.
Doctors usually only uncover social phobia after a patient has presented with other problems. It's also confused with states of 'co-morbidity like depression and alcoholism. However, social phobia often precedes these illnesses.
Social phobics become depressed about their inability to fulfil business and personal engagements. They may start to drink heavily as a means of overcoming their morbid timidity. Unlike manic depressives or alcoholics who eventually break down completely, many social phobics will function adequately left to themselves at home, even if their life has become a prison of their own making.
''This is very different to mere shyness,'' says Dr Frank O' Donoghue, director of the Department of Behavioural Cognitive Therapy in St. Patrick's Psychiatric Hospital in Dublin. ''It's not just hot flushes and a reddening of the cheeks. You feel nauseous.
''Someone suffering from the panic-attacks and fear that social phobia induces will experience severe palpitations, sweating, loss of breath, they'll get dizzy, feel as if they're about to die, start shaking, go numb and simply clam up entirely.''
When social phobia begins to set in sufferers dread being observed by others when they're doing something. It becomes impossible for them to perform even the simplest of tasks in public. They think they look stupid. They believe everyone else can see their fear and panic even when it may not be at all obvious.
Social phobics end up being too embarrassed to write anything in public. So, for example, signing a cheque becomes an excruciatingly painful chore, one which a social phobic will either avoid at all costs or struggle through with dread.
Social phobics avoid talking to people in authority and can't face up to being introduced to people they haven't met before. They feel crushed when teased and refuse to eat out because they can't stand other people watching them.
In particular, a social phobic can start to worry to a frightening degree months in advance of a significant public engagement. This leads to a horrendous and unbearable 'anticipation anxiety' that is replaced by guilt once the social phobic inevitably decides against fulfilling the engagement.
Tony (not his real name) is married with three children. A few years ago, in his mid-thirties, he began to find it difficult to look people in the eye when he was talking to them. It first started with business contacts then quickly spread to all social situations, including personal relationships.
Soon he couldn't look at people at all when he spoke to them. After a while, his hands began to tremble badly whenever he had to give a talk to other workers, demonstrate some practical aspect of his occupation or meet clients. He avoided his duties and eventually stopped going to work completely. Depression set in. The future looked grim.
As a child, Tony's parents quarrelled a lot. His father was an alcoholic. There was a lot of violence in the home. He was too shy to answer questions at school but he did marry and the marriage remains a good one. Many social phobics don't get married. They isolate themselves. Tony will be one of those to benefit from Seroxat.
Aside from drugs like Seroxat which reduce the panic and bolster feelings of well-being, social phobics can also undergo cognitive behavioural therapy of the kind available at Dr Frank O' Donoghue's in St Patrick's Hospital. The preferred option is to attempt to overcome the disability without drugs but this isn't always possible.
As with other phobias, part of the psychological cure for this particular social anxiety disorder is to expose the sufferer to small doses of the situations that bring it on. Social phobics will be helped by getting them to speak in public to two or three people. As progress is made, the audience gets bigger.
Seroxat is the first drug to successfully help social phobics in overcoming their illness without also inducing serious side-affects. It's already available in this country to counter depression, panic attacks and obsessive compulsive disorder and it is currently under consideration by the Irish Medical Board.
Having been passed for tackling social phobia in Britain it seems a mere formality that it will be used similarly here. Nevertheless, warns Dr Donoghue, it is not a miracle cure. Unless the pyschological causes are dealt with and the way a patient thinks is altered positively the drug by itself will solve nothing in the long term.
``Prolonged usage of Seroxat leads to a reduction in libido,'' concludes Dr O'Donoghue. ''It will raise a person's esteem to such a level where they can then start to function again and face the situations they previously had to run scared from. As with all drugs for psychiatric illnesses, though, it should always be the last resort not the first.''