Posted by hyperfocus on April 17, 2011, at 18:27:44
I originally wrote this as a comment to a blogger on another site and I figure that if anybody here wants a description of what social phobia is like and possible steps to recovery, it could be useful
Hey Nick, you don't know me but I feel like I know you pretty well. I also suffer from severe social phobia / Avoidant Personality Disorder - have had it for almost 20 years. Yes it is THE ABSOLUTE WORST. It's pretty damn painful - way past the point where you get used to the day-to-day pain and loneliness and isolation and depression and start believing it's normal to feel this way. Seemed like all the joy was sucked out of my life over the years by constant bullying and psychological abuse in school. I have exactly the same PTSD-like symptoms you have: vastly morbid and and paranoid and exaggerated fearful responses to the presence of other people, difficulty concentrating, distracting and recurring thoughts, andhedonia, dysthemia, constant anxiety, depression, feelings of worthlessness, thoughts about suicide. I've never had a girlfriend or any serious romantic relationship. And yes I did made a decision and do all the research you did and I found the exact cocktail you did and I was pretty close to trying to catch the bus too. The only reason I didn't try was the thought of what it would do to my family and the one or two people I considered my friends. So suffice to say I think I know what you're going though.
The thing is that I'm getting better. I used to be house-bound, like 24x7. Just checking the mail was a serious task for me and made me very stressed out and tired. The minute I go into my driveway I feel like everyone in the neighbourhood is looking at me, automatically tuned in to all my thoughts criticizing everything about me like my pants are too short or my legs are too skinny. I was isolated, cut off from everybody and everything - a prisoner in my own head. I'd forgotten what it was like to just talk on the phone normally or hang out with somebody.
But I'm getting better. Now I can go for a walk in my town. I can stop in a store for a few things. One day recently I passed a church having evening service. I stood outside and listened to them sing. I didn't feel like everybody was watching me and moreso I didn't care what anybody thought of me. Another time I got into a bus and as I was getting into my seat I whacked my head on one of the newfangled LCD screens they have in some buses now. Normally I would have been mortified and spent the rest of the trip feeling as if everybody was staring and laughing at me. But all I thought about was which %#@!^$ public servant had decided putting screens so close above the seats was a good idea. On the same bus I was staring at a girl with blue-dyed braids the whole time and it was only after I got off at my stop that I realized that I had thought very little about what the other people in the bus were thinking about me, which is fine because nobody on the bus even noticed me; I was just another normal commuter.
Here's the thing - I thought I was done. I thought my brain and mind were damaged and twisted and torn up and ground down beyond repair. I was sure that all the things I had lost - friends, girlfriends, academics, sports, career, youth, even just plain simple peace-of-mind were gone forever and I'd never get them back. I thought I'd never get back the 20 years I lost to this disease. But I was wrong. I am getting better. And seriously Nick, if I can get better then ANYBODY with Social Phobia can get better. Because I've had it just as bad, if not worse and just as long as other people with it.
First thing - you need medication. There are multiple things that are wrong with your brain - this is why you have this complex set of symptoms. If your doctors tell you therapy/CBT alone can cure you - find another set of people to look after you. They don't know what the heck they are talking about. The part of your brain responsible for rewarding you with good feelings from studying or reading or playing or interacting with people called the hippocampus has atrophied and needs repair. A part of your brain called the amygalda which is where your anxious responses originate has become oversensitive and enlarged. Plus all your stress reaction subsystems - like a part of your physiology called the HPA axis - are completely screwed up, leading you to feel hyperaware and tense when interacting with people and practically all the time. The levels of stress hormones like cortisol in your body are way too high. You absolutely need medication to correct these problems. You have majorly screwed autonomic reactions to things like people observing you or being out in public. It's sort of like getting hit with a football to the face and afterwards your body just reacts when someone does a long kick near you - you automatically turn away. This response isn't something you can control. You brain has become physically attuned to expect danger and attack whenever you are around people and you ABSOLUTELY NEED medication to fix it.
The big problem is that for social phobia most meds are rubbish. The only ones that have been shown to have a good chance of working for SP are:
MAOIs - Nardil usually or sometimes Parnate.
Benzos - usually Klonopin (clonazepam) or Xanax(alprozalam).Some SSRIs like Paxil and Lexapro and Zoloft have had limited success but not close to what Nardil. Ditto some antipsychotics like Risperdal and Dogmatil. Xanax felt like a miracle the first time I took it but it hurt me in the long-run. Getting off benzos was really, really hard and to this day I think some of my physical symptoms like shakiness and sweating are worse because of them. That's not to say that most benzos - Xanax and Klonopin and Ativan et.al - aren't very effective in the short-term for SP and if you're in considerable distress then they may be a good option. But I don't believe in them for the long-term and they can adversely affect other meds and worsen your anhedonia and apathy. But if you're in a lot pain and absolutely need to function then they are fine to use in the short-term; you ARE NOT going to be hooked on or abuse benzos if you have a genuine anxiety problem, especially SP. If your doctor doesn't understand this then find another one who does.
The thing is I've found success with a combination of meds that don't seem to work on their own but combined and at the right dosage appear to be working synergistically and reversing the changes to my brain. I'm taking three medications in combination which have dramatically improved my social phobia: One is called amitriptyline which I guess you're pretty familiar with. The 2nd is called tianeptine - brand name Stablon. The third is risperidone - brand ame Risperdal. I know all three are available in the UK and are relatively cheap. It took me a long time to get the dosage combination because, for me at least, the effects of these meds are very dose dependent. Right now I take 200mg of amitriptyline 12.5 mg of tianeptine and 1mg of Risperdal, all at night before bed. The difference between these meds and all the others is that these meds have significant neurotrophic properties - they actually heal, protect and stimulate growth of parts of the brain. I really don't know enough about this theoretical stuff, but the prevailing neurotransmitter levels theory of depression is just one theory and may not be correct. Another theory is that depression and social anxiety are actually due to damage and atrophy of key brain structures like I described. These meds may help reverse these negative changes. I don't know how they work but the point is they do work on my social phobia which has been very stubborn and treatment-resistant for a very long time. I went through a ton of meds that didn't work but the point is I finally found these and I am getting better.
What you're going through as a form of PTSD - the same thing soldiers get when exposed to prolonged stress without rest. I know you might cross an intersection and feel like all the people in all the cars are looking at you and you're constantly expecting to be jeered at or humiliated. I know this can happen like a dozen times a day in different situations. But it's the same for many people who come back from war who sit in their house all day with a rifle waiting for the enemy to ambush them. It's exactly the same thing. You were placed in a situation (school) you could not escape from and subjected to extreme stress and danger for a long time. And now in practically every social situation in life every sense in your body is expecting at anytime to be ridiculed or humiliated. The reason for your extreme paranoia and anxiety is that your brain is constantly expecting attack, even in a situation where you rationally know none is to be expected. The problem is that your brain is damaged - not as in you're less intelligent - but it's become abnormally habituated to and expectant of stress and attack. It's not dissimilar to other phobias, really, but the thing is people can go through most of the day without getting into small spaces or interacting with spiders. Social phobia is like having arachnaphobia and living in a house full of spiders. People with other phobias like
agoraphobia are similarly disabled but these fears don't have to do with other people per se, so they can still function at a moderate level. Social phobia is probably the most difficult phobia to manage because it affects your entire life. I mean people are automatically tuned to give and receive love from other people and much of what we find gratifying in life has to do with this, so it is extremely distressing when we are cut off from other people because of social phobia and can lead to feelings of worthlessness and suicidal ideation.Yes it is true the distinction between brain/mind is fluid, and yes in principle therapy could fix your brain. But in my experience this is almost impossible.
So 2nd thing - you absolutely need to find both a medical practitioner and a psychotherapist who understands how to treat your condition and actually cares about you. I know how regimented healthcare is in the UK and you don't have much control over who you see. But it's absolutely vital you find people who can really help you. It could be just a GP or a school counselor. Just somebody who'll listen to you. A lot of doctors have this feeling: look in the textbook it says you have anxiety and depression and I'm giving you SSRIs for it if they don't work then it's not my fault or maybe you're not really sick or you're uncurable. You must stay away from doctors like that. As far as psychotherapy goes - it's not just that you're gonna go back to when you're a child or whatever. It's sort of like, well, let's say you're working out a complicated proof for a math theorem and you're stuck. You need to talk to somebody more experienced than you to help you see where you've gone wrong. Social phobia arises out of deeply buried issues surrounding shame. Together with the meds you have to open up to somebody about all the bad things inside your head. Again, it doesn't have to be a trained person, just somebody who genuinely cares about you.3rd thing: You have to learn how to heal. Mental illness is not a cold. You're not going to wake up one morning, unfortunately, and feel better and start living again after twenty years of it. It will take years to recover. And you have to be realistic as to what you can do before you're well. Like I know if maybe it hadn't been for the pressure of school, you might not have made an attempt on your life. The thing is there's no rush to finish school - you have to take things at your own pace. You're still very young and you have a huge amount of time to do the things you want. School is extremely stressful on the social phobic - just going to classes every day made me absolutely exhausted. What I'd recommend is that you put school on pause till you get better and find a job where you can work from home, so basically you can build your confidence in doing day-to-day work. If you're into computer programming then it's an excellent field to get into as you can work from home many days and telecommute and you can even freelance and pick the jobs you want to work. You also need to get your family involved. You need as many people in your corner as possible to fight this thing. There's no shame in talking about this fully and openly with people who care for you (I know it's vastly easier than it sounds and I still have to be frank and open with my family on how much this thing affects me.)
And here's the 4th thing: you have to recognize that you're a very special person. The reason you have SP is because your mind works in a certain way. If you weren't unfortunate enough to develop SP at this age you'd probably be working as a scientist in computers or mathematics. It's not coincidence that literally every famous mathematician or scientists - people like Alan Turing or John Nash - developed symptoms of mental illness at some age. A lot of science- and math- inclined people get paranoid delusions or obsessions. It's just in your case it manifested itself at this age in this way. But you've got a long life to live. I think you've realized by now how hard it is in the modern world to actually take your own life. And EVERYBODY goes through a long period of bad times in their life - be it at 20 or at 30 or 60. I mean Star Wars is my favourite movie and you know how out of the darkest times the best things happen. Seriously, you will get back everything you've lost or was taken away. I don't know how or where it will happen but it will happen. It happened to me and I still don't believe it. But we're still the same people inside like when we were young. Once this disease starts to remit you'll find yourself feeling things you had forgotten.One important thing you have to realize is that you're not a coward. You may think you are but you're not. You're actually pretty strong. Most people wouldn't be able to handle this disease the way you have. And here's the most important thing - you are a good person. Some of the people who bullied you decided the best way to deal with their own low self-esteem and abuse by other people was to turn it on others. But you're not like that. Even when you decided to end it all you were still concerned about the people you cared about. There's a huge amount of evil in this world and it spreads like a virus but you decided not to spread it - that's really the best decision you ever made. I don't know what you believe in and of course that decision is up to you. But I'm just saying - what do you have to lose? I got to a point where, like you, I was at rock bottom. Nothing helped - not the meds, not therapy, not other people. I wanted to die, quite simply. But I had nothing to lose so, you know what, I prayed and I asked God to help me. And it helped - a lot.You're not going to turn into some automaton blindly following some ancient anachronistic rules. I was really afraid religion would change me, but it didn't. Well it did, but only in one small thing. It made me believe that there's a reason that we go through these things; a reason that we suffer. It is true that after we pass through difficult times we look back and realize how much stronger we became because of what we went through. And I couldn't believe it when I started to earn back some things I thought were gone forever.
The main argument I had about religion was that it's not rooted in reality - it's just something that makes you feel good. But I mean the truth is every Friday millions of people go to the pubs and clubs and drink alcohol and pretend just for a few hours to be somebody they're not and that life is a lot easier than it is. Same reason people go to watch Keira Knightly and Hugh Grant every month. Everybody, everywhere is looking for an escape, something to take the pain of living away, sonething to give them back belief in themselves. If you believe in God and it's just a fantasy, then so what? I don't think you're much different from most.
Anyway this is pretty pretty long... but I just wanted to let you know that you can get better and the steps you can take. Also I'd like to extend an invitation to join a mental-health and psych meds forum called Psycho-Babble. http://www.dr-bob.org/babble. It's a pretty cool place with a lot of good caring people who have gone through the same things we have and are also struggling to get better. Most of the stuff I learned about mental illness and psych meds I learned here and this site is the major reason I'm making progress against my social phobia. The thing about dealing with any mental illness is that for treatment-resistant cases like ours, you need basically to take your treatment into your own hands. You can't rely on the doctors because every day some new drug is coming out or some new combination is discovered that is successful and a lot of doctors just aren't interested in keeping up with the pace. But there are too many drugs and treatments out there for you not to find a solution that works for you. And well I know it's been a long hard journey, but I know there's still things you take pleasure in and people you care about. So just hold on to those things and hope. Hope is like the quintessential human emotion you know? There's probably like millions of people all over the world imprisoned unfairly for something they didn't do, just hoping to get out one day. So you're not alone in your suffering, if that's any consolation. And I think after this ordeal you're going to be a much stronger person with a good sense of what the right things in life are.
poster:hyperfocus
thread:983100
URL: http://www.dr-bob.org/babble/20110406/msgs/983100.html