Learning to play with others

Is a drug newly approved for social phobia a shyness cure or overkill?

Published May 12, 1999 4:00PM (EDT)

"I can remember hearing others laughing and talking in class as I sat
alone," confesses one woman about her high school years, which were often
spent by herself. "I used to take the long basement halls when walking from
class to class to avoid the main halls so that I would not be noticed by
the 'groups' as always walking alone and never with a friend."

This woman is sharing her experience in an online newsgroup -- which, in
this case, is not a gathering spot for outcasts who are on the brink of violent acts, but for those who are painfully shy. Here they can safely confide in each other -- from a distance -- about how difficult it is to voice their opinions, ask someone out on a date or, on a more serious note, keep on living. Shyness can be a minor part of a personality or something that can cripple a person's life. Some become so afraid of everyday situations -- like being introduced to others, being the center of attention or having to speak in front of a group -- that they withdraw completely. But where
shyness ends and social phobia begins is a tough call.

According to the Social Phobia/Social Anxiety Association, social phobia
(or social anxiety disorder) is the third most common psychiatric problem. Although it can start during childhood, social phobia usually takes hold sometime between the ages of 15 and 20, according to the National Institutes of Mental Health. The treatment of those afflicted is a big
market that could be served medically if someone started producing a magic
pill, or at least advertised it that way. Especially since reports from the Indiana University Southeast Shyness Research Institute and pioneering shyness psychologist Philip Zimbardo of Stanford University show that
shyness is on the rise. And as technology grows, and more
and more aspects of society become automated -- as ATM machines replace
tellers and online ticketing replaces travel agents --
doctors like Bernardo Carducci predict there will be more people without social skills.

So when the Food and Drug Administration on Tuesday approved Paxil, normally used as an antidepressant, as the first official
drug to treat social anxiety disorder, shyness specialists started speaking up. The drug, which is said to reduce anxiety, has been a godsend to people whose lives are often paralyzed. In fact, a study published in the Journal of the American Medical Association last August reported that it was effective. Paxil belongs to a class of anti-depressants called selective serotonin reuptake inhibitors (SSRI); it works by inhibiting the reabsorption of serotonin -- which is a neurotransmitter that sends electrical signals from one neuron to the next -- in the brain. This ends up increasing serotonin levels, which affects mood. Although psychiatrists routinely prescribe anti-depressant drugs like Paxil, Zoloft and Prozac to those with social phobia/shyness, companies like SmithKline Beechem couldn't promote it using that information. Now that SmithKline has the official FDA stamp of approval, it allows the company to start mass-marketing the benefits of the drug to the quieter set of our population.

"It's been demonstrated in clinical trials that it is effective in bringing relief to many people with this disorder," says Richard Koenig, spokesman for SmithKline Beechem. "And with this approval, we hope that this option could be made available to many more patients through their physicians."

But to those who might just be wallflowers at parties, who need a little
time to warm up before growing their social butterfly wings, drugs like
Paxil might not be the answer. Doctors fear that it might be construed
as a quick fix, and will be prescribed to those with only mild cases of
social anxiety. And it doesn't help that there have been media reports of this shyness cure-all finally having arrived. (Although Koenig says that SmithKline will take great pains -- through advertisements and educational programs -- to make sure that the drug is only used by those with serious bouts of social phobia.)

"What we can anticipate is that at least in the beginning
there will be lots of interest because people will see this as a panacea,
as the easy way out," says Carducci, director of Indiana University's
Southeast Shyness Research Institute and author of the book "Shyness: A
Bold New Approach." "What this doesn't do is teach you the social skills
necessary to engage in a social situation. It just drops your anxiety, so
you know how to feel comfortable at the party -- but it doesn't teach you
what to say."

That's where treatment such as cognitive-behavioral therapy is useful, says
Carducci. Rick Robbins, a 31-year-old accountant controller living in Jeffersonville, Ind., has been going to the Southeast Shyness Research Institute for the last year, where they do a combination of social skills development, goal setting and therapy. He now "epitomizes the successfully shy person," says Carducci.

For Robbins, shyness came on during his junior high years and stayed with him, making it a trying experience each time he would try to speak out while with a group of friends or talking with women. He says it was difficult because with members of the opposite sex, if you don't come off as confident, it was a strike against you from the start.

"I was probably depressed from what the shyness prevented me from enjoying," Robbins says. "There were times I thought I would never meet anyone or get married. For a long time I didn't attribute it to shyness, but now I look at it as it being a factor."

Over at the Palo Alto Shyness Clinic in Portola Valley, Calif., where Zimbardo is a consultant, there are similar success stories. Lynne Henderson, Ph.D., director of the clinic, says role-playing and confronting the situations that the person fears the most should at least
accompany medication. "We work with them to actively change their negative thinking patterns, challenging their beliefs and misconceptions they have about themselves," Henderson says. "We've had some
pretty serious cases. One fellow we worked with really had gotten to be so
withdrawn that he had no social contact and hadn't dated for a couple
years. While he was in the group he started to date, and got his business
back on track."

What the medication-only approach comes down to is a Catch-22 scenario:
Doctors say shy people already believe that their successes and failures
have to do with the situation or another person, and not themselves. And so
it's easy to see, says Carducci, "If people take Paxil and they start to
reduce their anxiety, they begin to attribute their ability to be social
and feel comfortable in an environment to the drug, and not to themselves.
So now, instead of the shyness controlling them, it's the drug."

Regardless of the respective merits of medication and
cognitive-behavioral therapy, many shy people have improved without
professional help. The woman who experienced the problems
in high school is now 40 years old with four children and deals with the demands of her job as a nurse. "I have seen many shy people in all professions that deal with the pressures and are doing the job right alongside of the extroverts," she writes to another newsgroup member who is having difficulty. "Shy people are everywhere, in all career fields. It also helps to seek out and find a friend that may have a harder time with it than you do. Being friends with shy people can sometimes bring out the strength in ourselves."

By Dawn MacKeen

Dawn MacKeen is a former senior writer for Salon, and author of a forthcoming book about her grandfather’s survival of the Armenian Genocide, "The Hundred-Year Walk: An Armenian Odyssey" (Houghton Mifflin Harcourt, January 2016).

MORE FROM Dawn MacKeen

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