Shyness and Social Phobia: A Social Work Perspective on a Problem in Living
Walsh, Joseph, Health and Social Work
Among the anxiety disorders described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (American Psychiatric Association, 2001) is social phobia. Although not new to the nomenclature; the disorder has received a great deal of attention in the professional and popular press in recent years as a condition that is prevalent and is treatable. Of concern to me is the extent to which social phobia, of which shyness can be considered a mild form, is being conceptualized as a mental disorder with an emphasis on its treatment with medication.
Social phobia provides a striking example of the pathologizing of personality characteristics and the willingness of many consumers and professionals to accept or condone such stigmatization. This article describes the characteristics of social phobia, considers its status as a mental disorder, and discusses the kinds of nonmedical interventions that can be offered to those who seek to overcome it. I will refer to the condition most often as "social anxiety" to reflect my position that it represents a "problem in living" rather than a mental disorder. A problem in living is a person-environment transaction that blocks an individual's experience of satisfactory social functioning (Karls & Wandrei, 1994). A mental disorder is conceptualized as a dysfunction occurring primarily within the person (American Psychiatric Association, 2001).
The profession of social work is characterized by a consideration of systems and the reciprocal effect of people and their environments. Whereas strong arguments exist for the biological origins of some conditions, such as bipolar disorder and schizophrenia, the evidence is less compelling for many others. From a transactional perspective, most problems in living including shyness, arise from a variety of factors and can be resolved by altering one's relationship to the environment rather than by using drugs. Furthermore, from an empowerment perspective, people who are shy should not be encouraged to relinquish judgments about the nature of their mental status to professionals who maintain a medical orientation and perceive many problems as being caused by biological abnormalities. Social workers tend not to classify individuals as abnormal or disordered, because this tends to place problems "within" people.
ANXIETY AND SOCIAL PHOBIA
Anxiety is an unpleasant but normal and functional effect that provides people with warning signs for perceived threats (Rapee, 1996). Its physical and psychological symptoms prepare an individual to confront or avoid the threat. A person's genetic temperament, psychosocial development, past experiences, and cognitive appraisals of events all influence its regulation (Kaplan & Sadock, 1998). Anxiety begins as a physiological reaction to a threatening stimulus, and its symptoms include tension, autonomic nervous system hyperactivity (for example, racing heart, blushing, perspiring, dry mouth, trembling, difficulty swallowing, muscle twitches), and hypervigilance. Anxiety becomes problematic when it creates a sense of powerlessness, suggests a danger that is unrealistic, or produces a level of self-absorption that interferes with social functioning (Campbell, 1996).
Social phobia, also known as social anxiety disorder, is a fear of social situations and interactions. It is a fear of being judged negatively by others and leads to feelings of inadequacy, embarrassment, humiliation, and depression (Den Boer, 1997). People with social phobia may experience distress when being introduced to other people, being teased or criticized, being the center of attention, or being watched while doing something. Such people understand that their anxiety is irrational. The phobia may be considered a mental disorder when it interferes significantly with the person's interpersonal and social lives (American Psychiatric Association, 2001). …