Snakes, Worms, Shyness and “Social Phobia”

Where to start. The first point to make is that both shyness and social phobias are dimensional quantities - we are all somewhere on the dimension - a theme that will become familiar to the reader of this website.

Shyness requires no explanation. A phobia comprises the development of fear and anxiety in a particular situation and a tendency to avoidance of that situation. A social phobia concerns fearfulness in social situations. It differs from agoraphobia (agora = a market place), where there is fear in open or exposed places and avoidance of them. Arachnophobia would be fear and avoidance of spiders.

We all tend to have pet fears – mine is snakes and this gives a clue to the developmental origins of phobic concerns. My earliest memories would be of my elder siblings returning from play on a local piece of heath land. Much of the talk would be about whether or not they had seen, trodden on, or been bitten by an Adder – the only venomous snake in the UK and one not infrequently encountered on that heath (and sometimes in our adjoining garden). The tone of the discussion was not one of pleasure, but of anxiety, respect, loathing and above all fear. Of course as a junior spectator one assimilated the same emotion. Later when with my wife in a tropical jungle I declined the opportunity to have my photograph taken with an exotic (but for me terrifying) five-foot serpent; my wife on the other hand willingly and in a relaxed fashion took the opportunity. Not only had I not wanted to touch the snake, but also as soon as we alighted from our canoe to walk the jungle trails I was apprehensively seeking out imaginary snakes with every footstep.

Years later I was gardening when my first child of 2 years remarked on the worm exposed by my digging. My wife’s reaction was to draw her back and remark that it was disgusting. However I intervened, talked about it along the lines of it being a mother and we should dig for the rest of the family, and said to my young observer that if she was really kind to it, I would allow her to hold it in her hand – an encounter that went without any concerns. For the rest of that childhood a happy relationship was had with “wormies”. It could have been very different.

The lessons I draw from this is that there is a developmental (growing-up) influence on the occurrence of some phobic concerns, phobic concerns can be induced by the reactions of those around us, and these can be enduring.

However clinical experience suggests that this is not always the case. Socially bold people do sometimes develop social phobias. My impression from observing for a common factor is that when an individual’s general levels of anxiety are sufficiently raised, then this may manifest as phobic anxiety (as an aside I should explain that phobic anxiety is an example of a Neurosis). I have seen it as a manifestation of alcohol-induced anxiety, as a manifestation of work-induced pressures, and in other situations where there is an uncommonly high level of induced anxiety.

In relation to the latter while an individual's inner world and experiences are important, so too is the situation. Experimental psychologists, particularly those with an interest in personality theory, have elegantly demonstrated what they term the “power” of situations. Thus one might be at the lower end of the dimension of shyness, but face a situation of considerable social challenge – meeting one’s sporting hero, an angry police-officer, or if one takes an extreme, the head of one’s religion or royalty. Clearly there is going to be differential social competence depending on the situation – from time to time one meets situations with real “power”. So too with social anxiety.

The actual leave of symptomatology is likely to be a product of one’s perception of the threat based on one’s experience (perhaps having been brought up by socially inexperienced or shy parents), the “power” of the situation at hand, and one’s background level of anxiety at that time.

The tendency in a good going phobia is to avoid the situation and this may aggravate the situation. There may be increasing fear in a normally reasonably managed situation; that experience when not undertaken may irrationally grow in threat.

How is it managed? – a big subject, but we will consider the principles.

Clearly any general aspects of the individual’s life that induce anxiety – physical or psychological need to be dealt with. Thus for example excess stimulant substances, metabolic diseases such as thyrotoxicosis, or occupational, family or financial threats would need to be dealt with.

Perhaps not surprisingly it can be alleviated by medication – a short-term anxiety-reducing drug such as a benzodiazepine (diazepam (also known by its trade name Valium) is the best known example). Thus twenty minutes after taking this medication a social fear could be overcome. However one cannot take such medication for long before the body becomes adjusted to its effects (what is called “tolerance”) and its efficacy wanes.

Anxiety lowering drugs that can be taken in the medium term without tolerance include most of the antidepressant drugs, as these also tend to have “anxiolytic” effects. However while these are taken they are useful, but quite a few people find their symptoms return after they are withdrawn – even after months or years.

Presently the preferred approach is psychological – behavioural and “cognitive” behavioural methods. While this is not my area of expertise, among the approaches used are methods such as “systematic desensitisation”. A list, that is an ordered hierarchical list, of feared situations is worked out with the patient. The patient is encouraged to confront the easiest (least-feared) situation, getting to overcome each item in turn, at a speed which the patient can manage. The person is taught that it is necessary to experience the anxiety that is induced, and taught about the symptoms of anxiety – both physical and mental – and how to control them. In particular the person is taught how anxiety rises and then falls back – typically in an hour or so. The idea is that exposed to the same level of threat the person experiences and adjusts to the threat – a process called “habituation”. Thus the induction of anxiety for a given item on the list becomes less and less after successive exposures to it. As well as actually undertaking the exercise in real life, some people find it helpful to sit in a quiet place and imagine the situation and effect of being in it – “imaginal exposure”.

As well as teaching desensitisation, there are a range of approaches that also consider the thinking that a person has about the situation that is feared, and helpful mental (or “cognitive”) strategies can be acquired.

In some situations other approaches may have value – I have encountered hypnotherapeutic suggestion overcoming months of phobic anxiety in moments (sometimes however there is gradual or rapid re-instatement afterwards). There was a vogue to use “flooding” or “implosion” – a psychological technique in which the person is exposed to their most feared items from their hierarchical list. In my case it would involve a trip to the reptile house of the nearest zoo and a night sitting in the snake enclosure – the idea being that after experiencing sustained fear eventually one would relax and realise that there is nothing to fear. Not nice and hence rarely used – fortunately! Also it clearly poses difficulty in terms of informed consent.

It could be argued that a degree of shyness is a virtue – it being a companion of humility and social discretion, and more acceptable than a relative lack of social inhibition, where social intrusiveness can be a handicap. Is it good to “work the room” with little insight. Excessive shyness however is a discomfort and a potential handicap – the implication of this account is that it can be overcome.

See also - Slipnot, Manson, Coolness and the Unnerving of Bourgeois Parents