The Psychology of Shyness

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Do you consider yourself shy?  If so, how shy?  Shyness is that tendency to feel socially uneasy, awkward, tense, and anxious when confronted with having to interact with people.  Social situations presented by parties, school life, and work may instil a bit of fear in many people.  Shyness can vary in degree from slight to severe.

It is normal for people to be shy from time to time or be generally shy during social interactions such as meeting new people or presenting something to an audience.  Shyness becomes abnormal however when it is pervasive and so intense that it keeps the person from relating to others even if they need to or want to.  When extreme shyness starts to be debilitating to one’s career and everyday life, shyness has morphed into a mental disorder called social phobia or social anxiety disorder (SAD).

Acute shyness was not recognised as a mental health problem until 1980, yet not many people have sought treatment for it.  Perhaps it is not considered as serious as other mental health issues; hence, the sufferers endure in silence and often cannot get what they want out of life.  Acute shyness is actually a phobia, an all consuming fear which incapacitates a person from carrying out work-related interactions or even normal everyday activities.  A person with social phobia may be so afraid of talking to others that he may avoid going to family gatherings, school, or even the grocery.

The Pain of Severe Shyness or Social Anxiety Disorder (SAD)

Unreasonable fears of social embarrassment, other people’s negative opinions, or people’s expectations are some of what characterise severe shyness or social anxiety disorder.  Individuals who are extremely shy often have the following personality problems:

  • Low self-confidence and low sense of self-worth; feelings of inferiority
  • Trouble asserting themselves
  • Very sensitive to criticism
  • Putting one’s self down with constant negative talk
  • Negative self-image
  • Inadequate social skills
  • Excessive self-consciousness
  • Feelings of detachment
  • Emotional turmoil
  • Baseless negative perceptions and irrational thoughts

The tragedy of untreated social phobia is that it affects all spheres of the individual’s life, from career to personal relationships.  An extremely shy person may:

  • be bypassed for promotions
  • have limited job opportunities
  • not finish his education or may drop out of school as the complexities of social interactions may be too much to bear
  • resort to substance abuse in the attempt to derive some social courage from these
  • develop eating disorders such as bulimia or anorexia as a coping strategy
  • have the inability to establish intimacy in relationships
  • isolate himself from other people at work or even from family members
  • have difficulty starting or maintaining friendships
  • engender marital or familial conflicts due to low self worth

Indeed, a socially phobic person’s world is a lonely one where the sufferer imposes his self-isolation due to fears blown out of proportion.  Sometimes, the fears are so unreasonable but real to the people-phobic person that he may not even be able to carry out simple tasks that need being around and possibly communicating to strangers such as  going to the grocery, speaking to someone over the phone, using public restrooms, or trying out a new diner or cafe.

Because of these fears and self-imposed limitations, a very shy person may descend into depression and suffer from anxiety disorder as well.

Cause of Extreme Shyness

Social phobia may stem from a combination of many factors rooted in the biological, psychological, and environmental areas.  Some scientists believe it is genetic and that imbalances in hormones or brain chemicals contribute to feelings of anxiety and fear.  The environment may also shape the development and degree of SAD if an individual is constantly exposed to situations that decrease his level of self-worth and engender fear of being judged as inferior.  In many cases, it is not easy to point to one direct cause as the causes have not been clearly defined.

Treatment of Shyness

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A combination of psychiatric counselling and prescription drugs may be an effective treatment strategy for those with social anxiety disorder coupled with depression and generalised anxiety
disorder from SAD.  For those whose shyness is of a lesser degree, sans clinical depression or major panic attacks, only professional counselling may be all that is needed.

Counselling may involve Cognitive Behavioural Therapy (CBT).  Such therapy could include development of social skills; identification of the “whys and whats” of situations which are causing the social phobia; and improvement of perception and thinking patterns for better handling of social situations.

Prognosis for shy people opting to undergo CBT is very good.  One can overcome social anxiety if they follow and apply the cognitive strategies taught to them consistently in their daily lives.

Chronic Pain and Depression

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People who have been diagnosed with a medical condition and experience chronic pain because of it are quite likely to develop depression.  Chronic pain is debilitating and can impact everyday life by rendering suffering individuals dependent, powerless, and feeling very sick.  Suffering because of pain is already enough to make someone depressed but the added negative psychological effects pain brings can help deepen feelings of sadness, fear, and hopelessness.

Understanding Chronic Pain

Chronic pain is the condition in which pain from an injury or illness lasts longer than what is considered normal.  Chronic pain causes the body to react negatively, thus contributing to problems in other areas even if these are not related to the original pain source.  A body in prolonged pain can exhibit mood disorders, muscle pain, fatigue, and impaired cognitive and physical functions. Sometimes, chronic pain causes neurochemical changes which increase the body’s sensitivity to the pain.  The afflicted may actually start feeling pain in other areas of his body.

The Pain and Depression Tandem

Chronic pain is difficult to cope with so that many sufferers go into a depression.  Unfortunately, depression can amplify pain; so that the cycle continues…more pain leads to deeper depression and so on.  Depression’s symptoms such as insomnia, lack of energy, loss of appetite, and decreased physical activity are factors that worsen pain.

Depression’s viability as a partner of pain may rest on the fact that both share the same two neurotransmitters: 5-HT and NA.  Neurotransmitters are chemicals in the brain that relay signals to help nerve cells communicate.  These chemicals send the messages for the heart to beat, the stomach to digest, and the lungs to take in air and expel it, among other signals.

Pain and depression often go hand in hand; but, they are not inseparable.  Depression may be treated separately with cognitive behavioural therapy and medication.  Relief from depression can decrease pain as well.

Physical and Emotional Issues Chronic Pain Induces:

A person experiencing chronic pain is often anxious and irritable.  He may also feel:

  • Angry
  • Constantly anxious or panicky
  • Mood swings
  • Low self-confidence
  • Confused
  • Decreased sexual appetite
  • Weight loss; weight gain
  • Physical weakening
  • Sleep disturbances
  • Fear of injury
  • Fatigue

All these symptoms also point to depression which needs to be treated in order to ease a patient’s pain and allow him to live capably with it.

Treatment

As mentioned, chronic pain and depression touch on the same neurotransmitters and nerve system.  As such, antidepressants can help relieve pain by making the brain change its perception of the pain’s degree while reducing the symptoms of depression as well.  New antidepressants such as Duloxetine HCL and Venlafaxine HCL do not have as much side effects as the older tricyclic antidepressants.

Depression can be further treated separately with talking therapies such as Cognitive Behavioural Therapy.  When depressive symptoms are reduced, the degree of chronic pain also usually decreases.

Physical exercise may also be recommended as part of the treatment plan.  Although it may be the last thing anyone in chronic pain would want to do, exercise is a necessary part of helping the body cope with the pain.  Consistent physical movement helps keep the body fit and less prone to more injuries and worsening pain.  Moreover, exercise helps dampen depression by increasing the very brain chemicals antidepressant drugs are designed to release.  A physician may help formulate a safe and effective exercise regimen for the patient.

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Cognitive Strategies for Dealing with Chronic Pain

There are no easy answers for dealing with chronic pain.  The person involved must make a lot of effort to take control of his condition and live successfully with it.  Some of the things a person in chronic pain can do are:

  • Learn as much as he can about type of chronic pain he is afflicted with.  Knowledge can lessen the fear that pain is causing more damage than what it is.
  • Know good sleep hygiene or habits that contribute to better rest and sleep.  Pain can be exacerbated by fatigue and a body that sees little rest.
  • Sidetrack pain or remove the focus from pain by engaging in things you like doing.  Being preoccupied with something of real interest could relegate pain into the background.
  • Knowing what thoughts are unhelpful and switching these for more positive ones in order to improve outlook and mood
  • Indulge in meditation and relaxation therapies in order to decrease overall muscle tension caused by pain.  Muscle tension actually exacerbates pain so a reduction of the tension could also spell pain reduction.

Chronic pain can change one’s life.  It can affect a person’s ability to work and live the way he was used to.  As such, it is important to factor in coping strategies into everyday life so that chronic pain and the depression it drags with it are not given the opportunity to radically lower one’s quality of life.

Immigration and Mental Health

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Immigrants, refugees, and asylum seekers are one of the most vulnerable social groups in the U.K. Most of these people are fleeing their home countries because of poverty, civil war, or a ruthless government.  Many of these countries are third world nations in which there are high incidences of disease, crime, torture, and separation from families.  As a consequence, some may have developed mental illness to some degree.  Others may have acquired some mental health issues owing to the stress of adapting to a new culture, system, lifestyle, and social treatment in their adoptive countries.

In the U.S., a high number of Asian American immigrants show depressive symptoms.  This is according to a 30-year old study, one reported by the University of Hawaii in 2011.  These people are stressed by the loss of their support system in their home countries and the pressing need to learn a new language and adapt to a foreign system.  Most of these immigrants may not have had mental health issues to begin with; but, the piling up of all the stressors from moving to a totally different country and society can contribute to the decline of mental health.  Children are particularly vulnerable to immigration stressors.

In the U.K., the African and African Caribbean communities have a high prevalence of depression and anxiety.  Everyday, people in these communities have to live with racism, difficulty in finding employment, bad housing conditions, and other stressors which can make many people, mentally ill.

Among African refugees and asylum seekers, PTSD is the most ubiquitous mental problem.  Mood disorders come second.  Some, being torture survivors, may be experiencing hallucinations, nightmares, panic attacks, sexual issues, acute phobias, and major depression.  These individuals may have difficulties forming relationships and developing trust.

Why Immigration Can Lead to Development of Mental Health Problems

When a person immigrates to another country or place, they face huge changes that they need to cope with:

  1. Upheaval of their social network and the need to re-establish personal, social, and business ties with new people
  2. Adapting from one type of socio-economic system to another
  3. Adapting to a new cultural system

Migrants have to leave the social ties they have built and try to forge new ones in the new host country.  Whatever role or profession they had occupied in their old place may have to drastically change to a lower profession or even a totally different one.  For instance, a respected dentist in her country may come to find herself having to occupy a much lower level position, such as a dental receptionist, in the new place.  The migrant may also have migrated to a place where her certification as a professional dentist holds no value or recognition.  In order to be certified as a dentist in the new country, she may have to study again to get the credentials.  Often, the migrant does not have the necessary financial means to fulfil such requirements.

The immigration process also puts a great strain on the migrant as his citizenship status and his economic status is highly uncertain.  Institutions may question his legality of stay in the country which in turn could impact his employment options, not to mention his options as a person without citizenship privileges.  He may also be vulnerable to situations involving violence, especially if he finds himself in refugee camps or detention centres where resources are meagre and conditions are harsh.  Such environments and the reality of powerlessness can trigger or create chronic depression, anxiety, trauma, and other mental health issues, even in mentally healthy people.

Treating Immigrants

Psychiatric treatment of immigrants needs to be approached from a cultural perspective.  Since most immigrants come from a different cultural background, it is important to understand how a migrant patient communicates.  Sometimes, patients with depression or panic attacks focus on unexplained physical symptoms such as pain, stomach upsets, fatigue, and the like.  When interviewed in a more relaxed social rather than clinical setting, the patient may reveal being burdened by social and situational stressors which they are usually reluctant to talk about as culturally, these may be deemed inappropriate medical topics.  Some cultures also highly stigmatise mental illnesses so that seeking professional attention on the matter is not something individuals may want to acknowledge they need or want to talk about.

Language is another barrier to treating migrants who do not adequately speak the tongue of the host country. In this case, language interpreters and culture brokers can effectively assist and vastly improve diagnosis and treatment by helping to span both cultural and communication gaps.

How Mental Illness Affects a Marriage

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One of the heartbreaking sad realities of a marriage in which one partner suffers from mental health issues is a broken relationship leading to divorce.  There is a strong link between divorce and mental illness, the highest ratios belonging to major depression, substance addiction, histrionic personality disorder, antisocial personality disorder, and PTSD (post-traumatic stress disorder).

A partner with a mental health disorder is often debilitated, emotionally, mentally, and even physically.  In many cases, cognitive functioning, social drive, sexual appetite, and social behaviour lie outside the normal limits of acceptance.  These may manifest on decreased or extreme levels, causing chronic stress, anxiety, fear, and frustration on the mentally healthy spouse.

Common Challenges a Marriage Faces with a Mentally Ill Partner

The vow to stay together “for better or for worse” is challenged by the fact that the tenor of the marriage changes as the symptoms of mental illness bring about these conditions:

  1. Loss of a sense of partnership

For the mentally stable partner, there is “no partner to turn to” when situations become   difficult.  The mentally ill partner however may come to depend heavily on the spouse for emotional, social, and even financial support.  Instead of a partner-based relationship, the healthy spouse may find himself or herself alone with the burden of keeping the family together, without help or support from the significant other.

  1. Financial issues

Mental health disorders debilitate and may cause a sick individual to lose his job or source of income.  In this case, it falls on his/her spouse to financially carry the family alone.  This puts a strain on the relationship with the healthy spouse developing resentments and the unhealthy one, being frustrated with himself and further worsening his mental condition.

  1.  Single parenting and taking the role of a caregiver

Not only does the healthy spouse lose a partner when mental illness strikes, he also has to assume the role of a caregiver who has to weather the storm of emotional upheavals mental illnesses bring.  The healthy partner also has to make decisions alone regarding children, if any, and steer the family into the right direction, almost without help from the spouse.  This often leaves the healthy partner feeling alone, trapped with an enormous burden from which there is scant relief.

  1.   Sexual distancing and loss of desire

The chronic burden of caregiving, dependency of partner, and other issues that may crop up can decrease sexual desire of the caregiving partner for the other.  If the mentally ill partner is experiencing major depression, he may lose his sexual appetite as a common repercussion of the malady.  Sexual distancing also erodes emotional closeness between partners which over time contributes to the dissolution of the marriage.

  1.   Social distancing and isolation

When the behaviour of the mentally unhealthy partner starts to become socially unacceptable and embarrassing, such as compulsive habits or lecherous remarks, friends may start withholding invitations and the couple may find themselves isolated from their former social groups.  Even family relations may place some distance from the mentally ill person, and in consequence, isolate the other stable partner as well through no fault of his own.  This could exacerbate the healthy spouse’s feelings of being alone with the burden of caring for a mentally ill patient.

According to John Gottman, psychology professor emeritus and author of over 40 books and academic articles on marriage and parenting, the four horsemen of the apocalypse that destroy marriages and lead to divorce are:  contempt, defensiveness, criticism, and stonewalling.  In relationships where one or both partners are dealing with their mental health issues, these four elements crop up more frequently, making a marriage with a mentally ill partner rather difficult to upkeep.

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What Can Be Done

There is no one-way-fits-all approach for helping a deteriorating marriage on its feet.  Just as it is with any malady, seeking professional help is paramount when the symptoms are still at their early stages.  In a marriage, early counselling coupled with medical treatment is key.  Sadly, couples who come in for counselling usually have gone years relating dysfunctionally with each other so that one spouse has already seriously been considering divorce.

It is best for both partners to seek counselling or therapy together.  The therapist can mediate between both parties, set a “no blame” environment, help the mentally ill partner acknowledge how his behaviour is affecting the relationship, and reduce relationship distress.  The therapist may also prescribe medication as part of his therapy plan in order to improve the mentally ill spouse’s ability to function and communicate.

There are, however, cases where the severity of mental illness mandates a separation, especially where the mental and physical health of children are involved.  Violent behaviour, for instance, may be one imperative for couples to distance themselves from each other.  Staying in a marriage where one is mentally ill is a case-to-case basis.  For some undergoing couple’s therapy, mental illness can somehow strengthen the relationship bonds; for others, however, sticking it out together just cannot be an option any longer.

The Link Between Intelligence and Mental Health

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High I.Q. and Mental Stability

Geniuses and highly creative people with high I.Q.s have always been linked to mental health problems such as depression, bipolar disorder, and schizophrenia.  Often we may picture a brainy computer geek who may be a programming whiz but prone to social awkwardness and withdrawals.  We admire masterpieces and learn of its gifted creators who oscillate between mania and depression.  Indeed, in the pantheon of great achievers, there are a number of personalities such as Beethoven, Virginia Woolf, Ernest Hemingway, Buzz Aldrin, and Jackson Pollock who have struggled with mental health issues during their lifetimes.  Even Aristotle was quoted to have said, “There is no genius without having a touch of madness. “

Some individuals with above average to superior I.Q.s commonly tend to exhibit symptoms from these three mental illnesses:  bipolar disorder, schizophrenia, and obsessive-compulsive disorder.  There are about 20-30 studies that support the “tortured genius syndrome,” the strong link between genius and madness.  One decade-long study on a 700,000 Swedish adolescents turned up surprising evidence, which was published in 2010.  Those teenagers that excelled in intelligence tests were four times more likely to have developed bipolar disorder.  Another study on children gifted with superior I.Q. above 130 showed that 65% of these kids had some sort of major depressive disorder.

Why is genius or superior intelligence linked to mental and emotional instability?  Brilliance instils the ability of being able to construct an inner world to fit their views and preferences.  However, when that worldview clashes with reality, it often leaves the person lost and unable to cope well.  Moreover, highly intelligent people are more sensitive to stimuli than average individuals.  Ellyn Saks, a University of Southern California mental health professor reiterates that “people with psychosis do not filter stimuli as well as others without the disorder, meaning that they’re able to ponder contradictory ideas simultaneously and gain insight into loose associations that the general unconscious brain wouldn’t even consider worthy of sending to consciousness.”

A Swedish study also found that many people diagnosed with schizophrenia or bipolar disorder are or have been in highly creative jobs that demand highly functioning cognitive skills and artistic cleverness in levels not usually employed by the average or normal individuals.  This is why artists seem to be functioning at a perspective so different from non-artistic or creative people.

Highly intelligent individuals have the ability to see novel patterns and innovative connections of things which the average intellect may not discern.  This ability also makes a very creative and smart individual, very vulnerable to feeling strong emotions, hallmarks of bipolar disorder.

It is however not entirely accurate to stereotype intelligent people as mentally unstable individuals.  Not all people with very high I.Q.s are unhealthy, mentally; but, there is a percentage of the gifted population that have developed depression and other major mental disorders because of their intellectual gifts.

As high I.Q. can be factor of developing mental illness, low or below average I.Q. can be contributory element as well.  Studies have also pointed out a direct correlation between low intelligence and depression.

Low I.Q. and Depression

Low I.Q. or a low intelligence quotient means lower than average cognitive abilities and problem-solving skills.  People with a 70-79 intelligence rating (below average I.Q. rating) have been surveyed by the Adult Psychiatric Morbidity Survey in England to be generally less happy than those with average or high I.Q.  People with less than average intellectual abilities often have difficulties catching up in school, getting hired in good paying jobs, earning sufficiently for their families, and earning peer respect and regard.  Because of these inabilities, people with below average I.Q.s tend to have poor relationships, low income, scant employment opportunities, and a lot of personal frustration.  These conditions alone are enough to drive a person into clinical depression.

 

Scientists are still unsure about the precise mechanisms on how intelligence affects mental health.  Perhaps there will come a time in which formulated cures would be available to help people balance their intelligence, high or low, against their propensity to develop mental illness.  Until such time, people need to understand that people with low or high I.Q.s may carry the extra burden of ill mental health and therefore should be treated with more understanding.