Recovery from Social Anxiety and Related Conditions

Dr. Robert F. Mullen
Director/ReChanneling

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The distinction between social anxiety and social anxiety disorder is in severity. We are not all affected by the same symptoms or relentlessness. The characteristics and traits are equivalent. These conditions originate homogeneously, their trajectories differentiated by environment, experience, and the diversity of human thought and behavior. While comorbidities dramatically benefit, the recovery methods identified are for social anxiety and social anxiety disorder, and reference to one includes the other.

Emotional Malfunction is Evidence
of Our Humanness

The recognition that almost everyone will develop at least one diagnosable mental disorder at some point in their life should go a long way toward eliminating prejudices and disinformation about social anxiety and all mental illnesses. This is an updated version of my first guest post, published in November 2020.

There is an aphorism that circulates among mental health professionals. Question: Why do only 26% of people have a diagnosable mental disorder? Answer: Because the other 74% haven’t been diagnosed yet.

The original title of this writing used the word “dysfunction,” defined as “abnormal functioning.” However, recognizing that mental disorders are not rare but common and universal indicates normality. “Dysfunction,” then, has been corrected with “malfunction,” which means a failure to function typically or satisfactorily.  “Mental illnesses are so common that almost everyone will develop at least one diagnosable mental disorder at some point in their life” (Reubens, 2017). We all experience emotional malfunction.

Why do we treat those experiencing social anxiety and other conditions with contempt, trepidation, or ridicule? We are hard-wired to fear and isolate things we do not understand, and we have been misinformed by history and the disease model of mental health. There are four common misconceptions about emotional malfunctions. They are (1) abnormal and selective, (2) a consequence of behavior, (3) solely mental, and (4) psychotic. 

Deconstructing these misconceptions will, hopefully, foster awareness and reduce the stigma surrounding mental health issues.

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A Malfunction Is Abnormal or Selective

“Neurosis” is no longer used as a diagnosis and has been replaced by “anxiety disorder diagnoses.” However, the more familiar “neurosis” paints a picture, and I like its pigmentation.

A neurosis is a condition that negatively impacts our emotional well-being and quality of life but does not necessarily impair or interfere with normal day-to-day functions. It is a standard part of natural human development. . Roughly, one in four individuals experiences a “diagnosable” neurosis.

According to the World Health Organization (2019), nearly two-thirds of people who experience a mental disorder reject or refuse to disclose their condition. Mental disorders are common, undiscriminating, and impact us all in some fashion or another. This commonality should convince us that we are all in this together, and there is no justification for stigma or shame. 

A Malfunction Is the Consequence of an Individual’s Behavior

Combined statistics prove that 89% of neuroses onset at adolescence or earlier. (ADAA, 2019a, 2019b; Baron et al., 1983; Bressert, 2019). Some, like PTSD and clinical narcissism, can onset later in life. The susceptibility to social anxiety, depression, and most other emotional malfunctions originates in childhood.

Most psychologists agree that this is a consequence of early childhood physical, emotional, or sexual disturbance. Many things can cause this. Perhaps parents are controlling or don’t provide emotional validation. Maybe the child is subjected to bullying or comes from a broken home. Behaviors later in life may impact severity but are not responsible for the onset. It is never the child’s fault, nor is it reflective of their behavior. This disputes moral models that we are to blame for our disorder (Corrigan 2006) or that it is God’s punishment for sin.  

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Emotional malfunction is not mental

Early civilizations viewed mental illness through the lens of supernatural forces and demonic possession. Hippocrates (4th C. BCE) and 19th-century diagnosticians examined the relative proportions of bodily fluids. Lunar influence, sorcery, and witchcraft were timeless culprits. In the early 20th century, it was somatogenic. (Farreras, 2020).The biological approach argued that neuroses are related to the brain’s physical functioning (McLeod, 2018, p. 1), while pharmacology promoted it as a chemical or hormonal imbalance. However, the simultaneous mutual interaction of all human system components—mind, body, spirit, and emotions—is required for sustainability and recovery.

The Emotionally Malfunctional are Psychotic

Surprisingly, the distinction between neurosis and psychosis is unclear to many. When someone sees, hears, or responds to things that are not actual, they are having a psychotic episode. Neurosis is a non-clinical term describing a spectrum of mental disorders that cause significant anxiety or distressing emotional symptoms. Few individuals experience psychosis (roughly 3.5% of the population). The balance of the population, ostensibly, experiences moderate and above levels of anxiety, stress, and depression (Folk, 2021). We are universally neurotic. Since most mental disorders are neuroses, we are all emotionally malfunctional to some extent.

The disease or pathographic model of mental health focuses on the history of deficit behavior. The American Psychiatric Association’s (APA) brief definition of neurosis contains the following words: distressing, irrational, obsessive, compulsive, dissociative, depressive, exaggerated, unconscious, and conflicts. The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the APA, uses words like incapable, deceitful, unempathetic, manipulative, difficult, irresponsible, and incompetent. 

This ‘defective’ emphasis has been the overriding psychiatric perspective for over a century. The disease model is the chief proponent of the notion that the mentally ill are dangerous and unpredictable. This perspective leads us to distance ourselves and deem them socially undesirable, resulting in stigmatization. The irony is that we are them, and this societal implication is a cause for awareness. 

The Family

Over one-third of family members hide their relationship with their malfunctional child or sibling to avoid bringing shame to the family. They are considered family undesirable, a devaluation potentially more life-limiting and disabling than the neurosis itself. 

The Media

The media stereotypes neurotics as homicidal schizophrenics, impassive childlike prodigies, or hair-brained free-spirits. One study found that over half of U.S. news stories involving the malfunctional allude to violence, perpetuating these harmful stereotypes and shaping public perception. Psychologists argue that more individuals would seek treatment if psychiatric services were less stigmatizing. There are complaints of rude or dismissive staff, coercive measures, excessive wait times, paternalistic or demeaning attitudes, pointless treatment programs, drugs with undesirable side effects, stigmatizing language, and general therapeutic pessimism. (Henderson et al., 2014; Huggett et al., 2018). The disease model reinforces the power dynamics between doctors and patients. Clinicians deal with 31 similar and comorbid disorders, 400-plus schools of psychotherapy, multiple treatment programs, and an evolving plethora of medications. They cannot grasp the personal impact of the malfunction because they are too focused on the diagnosis. 

A recent study of 289 clients in 67 clinics has revealed a startling truth -76.4% of them were misdiagnosed. This is not an isolated incident. An anxiety clinic, for instance, reported that over 90% of clients with generalized anxiety were incorrectly diagnosed. (Richards, 2019) These high misdiagnosis rates are a cause for concern, as they point to a systemic issue. Experts attribute this to the difficulty in distinguishing between different disorders or identifying specific etiological risk factors, a problem exacerbated by the DSM’s unreliable statistics. Even mainstream medical authorities have begun to criticize the validity and humanity of conventional psychiatric diagnoses (Kinderman, 2014). The National Institute of Mental Health believes traditional psychiatric diagnoses have outlived their usefulness and suggests replacing them with easily understandable descriptions of the issues. This is a call to action for all of us in the mental health field. 

Because of the disease model’s emphasis on diagnosis, we focus on the malfunction rather than the individual. Which disorder do we find most annoying or repulsive? What behaviors contribute to the condition? How progressive is it, and how effective are treatments? Is it contagious? We derisively label the malfunctioning individual ‘a mental case.’

Realistically, we cannot eliminate the word ‘mental’ from the culture. Unfortunately, its negative perspectives and implications promulgate perceptions of incompetence, ineptitude, and unlovability. Stigma, the hostile expression of someone’s undesirability, is pervasive and destructive. It’s not just a word or a label-it’s a force that can shatter lives. Stigmatization is deliberate, proactive, and distinguishable by pathographic overtones intended to shame and isolate. 90% of persons diagnosed with a mental disorder claim they have been impacted by mental health stigma. Disclosure jeopardizes livelihoods, relationships, social standing, housing, and quality of life. This is the human cost of stigma, and one we cannot afford to ignore. 

The disease model assumes that emotional distress is merely symptomatic of biological illness. The wellness model focuses on the positive aspects of human functioning that promote our well-being and recognize our essential and shared humanity. It’s a model that emphasizes what is right with us, not what is wrong. It’s a model that sees potential and determination, not incompetence and weakness. Recovery, under this model, is not achieved by focusing on our flaws; it is achieved by embracing and utilizing our inherent strengths and abilities. This is a model that can change the face of mental health care, and it’s a model we should all be excited about. 

Benefits of the Wellness Model

• Revising negative and hostile language will encourage the development of new, positive perspectives.
• The self-denigrating aspects of shame will dissipate, and stigma will become less threatening. 
• A doctor-client knowledge exchange will value the individual over the diagnosis.
• Recognizing emotional malfunction as a natural part of human development can lead to greater social acceptance and accommodation. 
• Recognizing that they bear no responsibility for the onset will revise public opinion, which currently suggests that people deserve their malfunction because it is a result of their behavior. 
• Emphasizing character strengths and virtues will positively impact self-beliefs and self-appraisal, leading to more open disclosure, discussion, and recovery/remission. 
• Recognizing proximity and susceptibility can help address the desire to distance and isolate. 
• Emphasis on value and potential will encourage accountability and foster self-reliance.

The impact of emotional malfunction begins in childhood; recovery is a long-term commitment. The wellness model creates a blueprint and then guides, teaches, and supports individuals throughout the recovery process by emphasizing their intrinsic character strengths and attributes, which generate the motivation, persistence, and perseverance necessary for recovery. 

The adage, treat others as you want to be treated, takes on added relevance when we accept that we all experience some severity of mental disorders. Emotional malfunction is evidence of our humanness.

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References

ADAA (Anxiety and Depression Association of America). (2019a). Facts and statistics. Retrieved June 7, 2019, from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and depression-lgbtq/

ADAA (Anxiety and Depression Association of America). (2019b). What’s normal and what’s not? Retrieved August 12, 2019, from https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder/just-for teens/whats-normal-whats-not

Baron, M., Gruen, R., Asnis, l., Kane, J. (1983). Age-of-onset in schizophrenia and schizotypal disorders. Clinical and genetic implications. Neuropsychobiology, 10(4):199-204 (1983). doi:10.1159/000118011

Bressert, S. (2019). Narcissistic Personality Disorder. PsychCentral.  https://psychcentral.com/disorders/narcissistic-personality-disorder/. Accessed 3 November 2019.

Corrigan, P. (2006). Mental Health Stigma as Social Attribution: Implications for Research Methods and Attitude Change. Clinical Psychology Science and Practice, 7(1), 48-67(2006). doi:10.1093/clipsy.7.1.48

Farreras, I. G. (2020). History of mental illness. In R. Biswas-Diener & E. Diener (Eds), Noba textbook series: Psychology. Champaign, IL: DEF publishers. http://noba.to/65w3s7ex

Folk, Jim. (2021). Anxiety Disorder Statistics and Facts. anxietycentre.com. [Online]
Anxiety Disorder Statistics and Facts – AnxietyCentre.com

Henderson, C., Noblett, J., Parke,  H., Clement, S., Caffrey, A., Gale-Grant, O., Schulze,  B., Druss,  B., Thornicroft, G. (2014). Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry,  1(6), 467-482 (2014). doi:10.1016/S2215-0366(14)00023-6.

Huggett, C., Birtel, M.D., Awenat, Y.F., Fleming, P., Wilkes, S., Williams, S., Haddock, G. (2018). A qualitative study: experiences of stigma by people with mental health problems. Psychology and Psychotherapy: Theory, Research and Practice, 91, 380–397 (2018). doi:10.1111/papt.12167

Kinderman, P. (2014). Why We Need to Abandon the Disease-Model of Mental Health Care. [Online] Scientific American. https://blogs.scientificamerican.com/mind-guest-blog/why-we-need-to-abandon-the-disease-model-of-mental-health-care/.

McLeod, S. (2018). The Medical Model. [Online] Simply Psychology. https://www.simplypsychology.org/medical-model.html/ Accessed 2 July 2020.

Reuben, A., & Schaefer, J. (2017). Mental illness is far more common than we knew. Scientific American. Retrieved from https://blogs.scientificamerican.com/observations/mental-illness-is-far-more-common-than-we-knew/

Richards, T. A. (2019). What is social anxiety disorder? Symptoms, treatment, prevalence, medications, insight, prognosis. The Social Anxiety Institute. Retrieved June 14, 2019, from https://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis/

World Health Organization (WHO). (2019). Mental disorders affect one in four people. [Online] World Health Organization. https://www.who.int/whr/2001/media_centre/press_ release/en/#:~:text=Mental%20disorders%20affect%20one%20in%20four%20people%20Treatment,neurological%20disorders%20at%20some%20point%20in%20their%20lives. Accessed 17 January 2020.

Proactive Neuroplasticity YouTube Series

INDIVIDUAL RECOVERY. The symptoms of social anxiety make it challenging for some to participate in a collective workshop. Dr. Mullen works one-on-one with a select group of individuals uneasy in a group setting. ReChanneling offers scholarships to accommodate the costs. What is missed in group activities is provided in our monthly, no-cost Graduate Recovery Group. In this supportive community, graduates interact with others who have completed the program.  Contact ‘rmullenphd@gmail.com’.

Committing to recovery is one of the hardest things you will ever do.
It takes enormous courage and the realization that you are of value,
consequential, and deserving of happiness.