Psychiatry and medication vs. talk therapy

A good article that summarizes the status of psychiatry and the push towards more medication for insurance-accepting providers.

http://www.kevinmd.com/blog/2008/08/matthew-mintz-as-psychiatry-goes-so.html

While the author mentions that this is not necessarily a bad thing, I think that having divided care especially with the health care providers not having time and not being reimbursed to talk to each other is just another link that can fail you. You know my advice: if you can afford it, go with the providers that do not accept health insurance and try no medication longer than you think!

Brain programming and self-esteem

More and more I am convinced that my recent success in beating social anxiety has more to do with the amount of positive programming about myself that I got. It finally got to that critical level when I began believing it. And it could have been anything: tapes, more therapy, or anything else.

This is not a new idea, I encountered it in more than one self help books: You need to be sure that you are great and wonderful and beautiful and lovable. If people around you reinforce this idea, you will start believing it and acting on it.

Sometimes people make mistakes, even the smartest people act stupid at times. Allow yourself to do or say stupid things. It's not a big deal. Just apologize and move on not giving it a second thought. You will make better decisions if you strongly believe in yourself than if you worry about being wrong about anything you do or anything anyone else thinks.

Having this in mind, it makes a lot of sense to do as many as possible of the following

• Use tapes like those from Dr. Richards at the Social Anxiety Institute,
• Keep in touch with friends and family members that make you feel good, and excuse yourself from seeing people that make you feel bad about yourself
• Find a good therapist
• Participate in groups for SA or whatever groups where your presence is welcome and you are well-liked
  
• Do yoga. Yoga teachers are supposed to be supportive, so it is likely that in a yoga studio you would find a good environment for growing self-esteem

My yoga program was subtitled: Love living in your body. Every week we would hear a variant of encouragement to love our selves and our bodies. "Love your body for what it is now, not next year, not when you'll love 10 pounds or when you'll have a boyfriend. It's perfect, right now, just as it is. You can walk and run and jump and it doesn't hurt to do this. It helped grow these amazing children that you have and helps keep you alive. Touch your thighs and belly and arms and say Thank you, body, thank you!" It worked great and after more than an year of therapy in which I heard a lot of: you're wonderful just as you are, you just need to start believing it, it finally sinked in.

I'm playing with Facebook and Linked In these days and I am so happy to see people trying to connect to me... and I say that they are doing it because I am nice. It's great to love yourself, quite a novelty for me.

About.com

About.com has a page on social anxiety disorder and the moderator, Arlin Cuncic, released an article about the best SAD blogs. My blog is mentioned in that article positively... pretty neat if you think about it. I'm growing. The website is informative and has a forum and a newsletter. I think it's worth keeping an eye on it.

Thank you Arlin.

I am a Certified Yoga Teacher

Woohoo! I passed the exam. It wasn't that difficult, but while studying I realized how much we learned that other people do not know. I would have loved to go deeper into anatomy and physiology, and to have more power, better balance and less fear, but it only has to start here. I have a lifetime to learn and build my life and my body as I'd like them to be.

I learned an incredible gem yesterday that will probably help me better explain what yoga and meditation does to your mind. Imagine a jar with dirty water. The dirt in the water are our daily thoughts. There are lots of them and they are hanging around popping in and out and moving in no particular direction. You can't see through the water because there are so many thoughts. If you put the jar down and leave it there for an hour or so, all the dirt falls to the bottom and the water becomes clear. Yoga and meditation helps you slow down the stream of thoughts, let them rest, see clearly the things that are important and pick up the important thoughts and make them happen.

Treasure map

For the last week I worked on my treasure map: a display of pictures that inspire me. I never thought how much pleasure this exercise will bring me. I thought that once again I will think about all those cool things that I'd like to have but never will get around to doing them.

Instead, I had an enormous pleasure putting it together and looking at it. It has pictures with my family and all the time that we are going to spend having fun together. It has my dream house on the beach and a cool kitchen and a swimming pool, my organic vegetable garden, and my athletic endeavors: a triathlon, teaching yoga to kids, and the Appalachian Trail. It also has a picture of a hospital and a hospital dashboard and the verses of The Impossible Dream.

It also felt great to share it with my husband and my baby. It was the first time in my life that I actually dared to accept my dreams. Maybe not all of them will happen, but I have something that I'll see every evening before bed and I know that my priorities should be and what should make me happy. I don't think I ever expressed all these even to my husband.

What a great tool to share. On Saturday I will get it to my last yoga session and we will see each others... that will give us something interesting to talk about! Try it! It will give you a few happy moments, and once it's up you realize that it's not really as impossible as you thought.

Meditation and living in the moment

If you were around for a while you know my hunger for comments. While feeling better over the last couple of months, I (and my blog) survived without many comments for a while now. On Friday I had the great pleasure of finding two very nice comments... Woohoo! I inspired someone to do something about their anxiety.

A new social anxiety blog is out! Please welcome travel.trekker1 and wish her good luck in your journey. She seems like a good buddy for me so I am looking forward to more posts and communication.

And an additional note about the last blog I wrote about: Matt Ambrose at Overcoming Social Anxiety: this is a must read. It is kind and gentle. It is the best writing on social anxiety that I stumbled upon. It makes me feel good about myself when I read it.

The guys at the Mental Health Blog Research Study have their survey up and you can take it if you want to help research anxiety disorders and blogs. Email mhblog@tcnj.edu before July 10, 2008 if you are interested.

In one of the latest comments, a reader talked about how difficult it is to be living in the moment. I've been working on this for the last half an year, so I can tell you what worked for me:

- Some sort of vigorous activity that requires concentration and doesn't leave you time to drift into thinking. Ashtanga yoga does this for me. But it took a while. For weeks I kept just thinking how hard it is, what comes next, this is hard, this is easy, and when is the end of the class, etc. I'm now just concentrating on the current posture and it's great.

- In the beginning, use your senses with strong cues: eat something you really love with great attention and pleasure: enjoy a chocolate truffle for a minute or so, smell a great perfume, listen to the birds singing, or to the ocean waves. Eventually you will start being aware of all the chatter around all the time and you will feel and touch and smell things without judgment, for example smelling something foul will just bring awareness not necessarily disgust.

- Read. You will be surprised how many successful people (like Seth Godin or John Halamka) have some sort of meditative practice and preach living in the moment and utilizing the time while you have it... NOW! to do something rather than think about what you could have done or what you will do.

- When overwhelmed with thoughts, ask yourself if there's anything I can do about this right now (can you write an email, make a call, etc. to make the idea happen)? If yes, just do it, if not, let the thought go. I used to fantasize a lot about spending time with friends and intelligent discussions we would have, etc. Now when I think about this, I just smile, say I love you to my imaginary friends and then think: Hey but you are not really here so Good Bye, I'll see you next time! No beating up, no frustrations, no expectations.

And because my commenter mentioned Eckhart Tolle, here's the list of things that helped me in my journey:

- The yoga teachers training at the Yoga and Healing Center in Scotch Plains, NJ - graduation in two weeks... need go practice and learn
- A Yoga, Chocolate and Wine seminar with Yoga Dave
- A 3 hours seminar with Bijan and reading Effortless Prosperity daily lesson and trying to practice it
- Reading A New Earth - Eckhart Tolle

The wavy line of anxiety

I noticed that with anxiety you can't just relax and let things the way they are. You continuously need to push through and challenge yourself. Any time spent in the comfort zone makes the anxiety take over more and more... You can give yourself a dy off, but that's a bout it, next day just start over and get into challenges again and again.

Of course the ultimate cure is living in the moment and realizing that all these things we so dearly care about (like other people's opinions or what X and Z said) ultimately don't mean anything. So complete relaxation is the cure. But even if you get there, there is a lot of work in continuing to do it and not getting back into your anxious spot.

Here's a visual cue that I'm using to think about this: take a piece of paper and write down any activity that involves interaction with other people grouping them from the ones that cause most anxiety to the ones with least anxiety. I would have an interview on TV on the left side and friendly chatting with my husband or interacting with my happy kid on the right. Now draw a wavy line to separate the activities between comfort zone and anxiety zone.

The aim of every day is to push that line more and more to the left including more and more activities that are uncomfortable. Doing them time and time again will make them shift into the comfort zone.

When you relax and don't push, the line will not be stable: it just moves to the right and you get more and more uncomfortable.

So in order to make any progress or even keep the statu quo, you need to work all the time, every day and every hour and push that line. It's a Sisyphus job, but it's the only way you can live and enjoy life.

No rest for the weary! Good luck and keep pushing that line!

Excellent article

An excellent article in New York Times talking about using meditation in therapy:

http://www.nytimes.com/2008/05/27/health/research/27budd.html?pagewanted=1&_r=2&ref=health

Don't miss it!

Living in the moment

One of my favorite authors, Irvin Yalom, describes the aim of therapy as opening up first to your therapist and then to the world. I loved his comment, lived by it and wrote a post about it a very long time ago.

However, with anxiety, I think you can be open all you want and still be anxious. It eases up some of the attempts to hide the anxiety, but it doesn't resolve the problem.

I think that with anxiety, the aim of therapy is to minimize the time a problem hangs out in your head. It used to be that I had problems that we discussed through multiple sessions: I worried about those things constantly for weeks: bad, very bad. Those are stale thoughts.

Let's say you have a 10 minutes phone conversation. You hang up and then start replaying the phone conversation in your head over and over again for days. You beat yourself up over what you should have said, you are very proud of what you said well, you interpret what you heard in numerous ways, you have emotions that might not have anything to do with the actual call, they are just emotions brought on by your thoughts and your interpretation of the phone call.

I knew that therapy was over when any of the issues I brought up were about one day old at most. The problems would come and go, wash over me, were processed in real time and went away. No stale thoughts, no interpretations. You can think clearly and not reactive with a fresh problem.

I am a project manager, so I do have problems that last days or weeks, but when I get back home, they don't exist and they shouldn't exist. Tomorrow is another day that I can deal with them, and looking at them with fresh eyes is always easier. Bringing my problems home is a sure way to trigger terrible-twos behavior and upset everyone else.

I am now working on really living in the moment and being present at any time, no afterthoughts, no interpretation. Something happens: it causes emotion: let the emotion be there, feel it, enjoy it, express it and move on to something else.

This is the aim of meditation and yoga, and I recommend either or both for social anxiety or just any kind of anxiety.

And another reason to live in the moment from Dr Rob.... And from Dr Rob again a great quote for good laughs. It's short enough that I am including it all to spare you the need to transfer over, but Dr. Rob's blog is a must read!

"Why did God make it that you have teenagers at the same time you are going through menopause?"

Wish me luck! I think I'll be there! I should perfect this living in the moment thing by then!

We are all in the same bucket

One of the first things that my therapist did with me and the most successful for gaining my trust was to explain that everybody has at some level the same anxieties that I have. She used herself and her experiences as an example and it was extremely powerful.

She made sure I understood that I am not crazy and that my thoughts are reasonable and my anxieties not so unusual.

It is tough and very lonely to have social anxiety without knowing what's going on. You feel really really lonely and you think you are some kind of monster that nobody wants to be with. Once you find out that it's not that uncommon, this knowledge comes with a bit of relief that there are other people having the same thing and that there is hope, but on the other side, you have a mental health issue/disease which officially puts you in a I'm at least a bit crazy category. Deciding to do therapy or taking medication is again a step forward, but it comes with the issue of having to admit it to others.

This is why establishing that you are not crazy is a great first step in therapy. Brilliant!

Once we know that we have social anxiety, we tend to identify all our traits that prove that we have social anxiety. Sometimes what is a simple difference between people's behavior becomes in our mind unbreakable proof of our being abnormal. And I think we feel attracted to people that are different and that we desire to be like and don't realize that there are enough people out there just like us.

Just recently I noticed this with me. I considered as a typical social anxiety trait the fact that I only dated two men in my life. I found out that my latest hero, John Halamka, married his first and only date. I don't know that he has social anxiety or not, I suspect not too much, but maybe some people are just more efficient this way. Friends that I stayed with, I liked from the very beginning, so is that so bad? Just like people that start drinking in college because they think that everybody else does. Some people just don't drink and some people don't need to date a lot! Does that make us unusual? Probably, but crazy... no!

So, take heart! You're probably not as weird as you think, and almost everybody has anxieties in one way or another.

Preparing for therapy

So you found out that you have social anxiety. And you read that the best treatment is a combination of drugs and therapy, probably CBT - cognitive behavioral therapy. I'm pretty sure you heard that you probably have a bio-chemical imbalance... oh, that sounds so good: it's not in your head, it's a disease!

Here's my take: forget about drugs... ignore drug advertisements, ignore doctors that insist that you can't do it otherwise, ignore articles. Forget about them. Be strong and work through it for an year. Then you can decide that what you're doing is not enough.

Drug companies and medical insurance companies are not on your side. They are in for making profit, not for keeping/making you healthy. There's a lot of money involved and they are all thrown to convince you that you need expensive drugs. Lots of doctors are biased by the same advertisements. Forget the free samples. They will not last forever and then you'll end up with an expensive drug that you'll probably have a hard time weaning from.

A word on Complementary and alternative medicine: I think it's mostly placebo. I also think placebo is a wonderful thing that you should fully benefit from. But don't spend a fortune on it. Keep an eye on the wallet. Hey, that $2 bottle of homeopathic medicine that makes you feel so good: go ahead and use it! Omega 3s are making you more calm: go for it! But hundreds of $ a month for this stuff, forget about it!

This leaves you with one task: finding a good therapist - the right therapist. Psychologists are OK, but don't necessarily insist on a doctor. My therapist is a psychiatric nurse and she's excellent. Ask around: ask doctors, friends, family. If you can afford it, a therapist that does not accept any insurance is a good sign: probably successful enough to not need it, and less hassled by insurance companies (and more willing to give that time and attention to you, not your co-payment). Insurance companies are not your friends. Forget their referrals, they will send you to the cheapest guy in town.

Two books you need to read before starting therapy:

• Health and Suffering in America: The Context and Content of Mental Health Care
  by Robert Fancher
• The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients
  by Irvin Yalom

The first is a very down-to earth book about mental health care and will give you some food for thought. The second one is more practical, and will clarify some of the things that will happen in therapy - patterns of interaction that we all go through.

I love Yalom. His books followed me on each therapy session and I always ended up admitting that he was right about this too.

It's not easy to go through therapy. There will be rough spots. There will be challenges. You need to find someone that will be there for you all the way. And you need to have the strength to go back again and again. Each step up will be preceded by a very difficult breakthrough. Don't give up because it's hard. Always know that this will be over and it will be better soon.

I imagined that in therapy you talk and talk and then you discover one thing that caused it all and then you talk about it and you cry and that's it... it never happened to me. I had a few moments of "this is it", here's the problem, but a week after that the problem was still there. So there are no rules.

And last advice: if a therapist does not work, just move on without judgment. It just isn't the right person at the right time: it's not you, nor the therapist, just grist for the mill. Forget about it and find someone else. The CBT therapist that I kept bitching about in my blog ended up being really helpful more recently. I just wasn't ready when I saw him. But somehow what he said in those first 5 weeks of therapy stuck with me and I'm remembering and appreciating it now. I guess I am now ready for cognitive-behavior therapy. Only I don't need someone to help.

More to come... I'm enjoying writing this.

New Blog

Check this new very interesting blog about social anxiety: - Overcoming Social Anxiety. Mat Ambrose is a freelance writer. The first articles are very well written... duh!

I'm very honored to be in his blogroll.

Starting therapy - my story

In 2004 I was not sleeping well and not feeling well. I visited my doctor and she diagnosed anxiety, prescribed Clonazepam and suggested that I start seeing a therapist.

I felt great on Clonazepam, but I hated that i needed more and more to sleep better. I took it for 3-4 months while I was under a lot of stress at work and then got off of it. The weaning was scary. My anxiety shot up very bad. I didn't sleep for a night or two. I resisted starting it over and after a week I was fine but I started being scared of medication.

I looked for a therapist and it looks like there's one at every street corner. I had the sense that I shouldn't just pick one, but I had no clue how to find the right one. At that time I had no idea that social anxiety was even defined. I had no idea what was wrong with me in the first place. I called a couple of therapists and found out they are really busy. I finally found one near my house that reluctantly found a time for me. I went there for 4 weeks and left disgusted. The therapist seemed to be more interested in my $10 copayment than my well-being. It did not go well.

I had the idea to search the web for extremely shy or something along these lines. I found books and I found that a disorder exists and it has a name. I ordered the books and started reading. I was not alone anymore... there were people that knew what I felt.

I got pregnant and momentarily dropped the idea of "fixing" the social anxiety. In April 2006, I decided it's time to attack it and get it over with. It took me two years. I am not over with it, I just accept myself and my social anxiety as part of myself. It's there, but it doesn't stop me from important things in my life.

I first went to a CBT (cognitive-behavior therapy) specialist. He was teaching at a big New York university, so I figured he must be good. I went there for 5 weeks. I didn't feel we were doing enough, and he felt he can't help me. He suggested that I see someone else, but did not offer any help with a name or anything. I failed again.

A month or two later I called a number that my new doctor gave me. It was supposed to be my last effort with therapy before giving up and asking for medication to help me cope. I was not optimistic. On the phone, this new therapist mentioned all the reasons why I shouldn't see her: too far away, no time, etc. but I said I don't know what else to do and that I need to talk to someone.

I went in once and was hooked. She had a few soundbites that I loved, among others "oh, men, my dear...". But the most important one was: "Ileana, no matter what will happen, I will be here for you." And she was there for me, even if it was difficult at time for me and her.

Next post will be about what I'd suggest that someone does before starting therapy... we all live to give advice, don't we?

What's up?

I had an offer to write an anxiety blog for a health web site. I just turned it down. I will continue to be my own boss.

But it made me think some and I had a few ideas for blog posts that I would like to write. Two years ago in April I seriously decided to attack my anxiety. Now, two years later, I just finished a long round of therapy and I think I won, at least for the time being. Two or three weeks went by and I didn't need to run back to my therapist for help. I can deal with life on my own! Woohoo!

So my posts will concentrate on what helped me in therapy. I'm pretty sure this might help someone.

As I mentioned before, I started a yoga teacher's training. I love it and it helps me immensely. My articles might sound esoteric and funny in respect to this, but you'll have to live with me.

It's good to be back to my own forgotten blog.

Call for research

I was asked to participate in a research about mental health and blogging habits. Sounds interesting. If you want to join the details are below.

I will get back soon with more posts!


Hello,
I am part of a research group from The College of New Jersey interested in gaining information on the views of authors of mental health blogs. This study is part of a research project of Dr. Yifeng Hu, a professor in the Communication Studies department at TCNJ. You have been contacted because you are the author of such a blog. Participation will involve responding to surveys about your mental health and blogging habits. The results are completely confidential. No respondent's personal identity will be requested or associated with any set of answers. We appreciate your time and help with our study and as a thank you for participating you will receive a $5 gift card (or you can choose to donate your amount to Mental Health America). If you are interested, please send an email to mhblog@tcnj.edu and be sure to include a link to the home page of your blog as well as your preferred contact email address. The survey will be sent to you via email within the next few weeks. Thank you in advance for your participation!
--
Mental Health Blog Research Group
The College of New Jersey
mhblog@tcnj.edu

Hi guys!

I've been up with a lot lately. Lots of work and taking care of my kid, but also lots of thinking and crystallizing my thoughts.

I started a yoga teacher's training. It's wonderful. I knew that the exercise and mediation is going to help with anxiety, but this is so much more than that.

Wendy, the teacher is insisting on being positive: no gossiping is allowed, no push backs... What can a bunch of people (mostly women) do when exercising a lot and being positive and open? A lot! So I keep going on my way to openness full speed.


This being said, I'm not sure I want to delve on the anxiety side so much. It helped me go through a phase and open up, but now I don't feel like throwing in everyone's face that I am an emotional mess... probably because I a not that much of a mess anymore. I'm not much into venting anymore. My new blog is Cool Yoga Mama. It might be a bit too sweet for some. I will strive to keep it all positive. Feel free to visit! I'd love to see you there!

And thanks for the support during this last year. It helped me immensely.

Quote

A quote from The Winter of our Discontent - John Steinbeck that the ones of you that have social anxiety might find helpful:

My sudden fear that I might be showing through was very great. I had made myself believe that the eyes are not the mirror of the soul. Some of the deadliest little female contraptions I ever saw had the faces and the eyes of angels. There is a breed that can read through skin and through bone right into the center, but they are rare. For the most part people are not curious except about themselves. Once a Canadian girl of Scottish blood told me a story that had bitten her and the telling bit me. She said that in the age of growing up when she felt that all eyes were on her and not favorably, so that she went from blushes to tears and back again, her Highland grandfather, observing her pain, said sharply: "Ye wouldna be sae worrit wi' what folk think about ye if ye kenned how seldom they do." It cured her and the telling reassured me of privacy, because it's true.

The whole book is wonderful and you should read it!

The things I love

It's almost two weeks since my father died and I am realizing that I mostly like to do things that I did with him: logic, math, thinking out of the box, hiking, skying. I just re-read the book I love most: The Winter of our Discontent - John Steinbeck and I realized he suggested it. He was reading books and underlining the parts he loved most... and I loved those parts too. I am glad I asked for books he liked this summer when I last saw him and I got a couple of books.

He was the utmost authority in my life. When he approved of something I did, it made me feel very good and accomplished. He was also very critical (did anyone doubt that with my social anxiety?) and I sometimes felt anxiety talking to him.

On a funny note, one thing he was critical about was my French... He was very good at it, and I wasn't that good. I found it ironical that I flew in an Air France flight to Romania to attend his funeral... thus one more time realizing how poor my French is.

When I left for US seven years ago, he had to learn English and to use a PC and do email and he did... at 75 years old. He had a dictionary and taught himself to use the PC and navigate the Internet without previously speaking English. He was pretty amazing and a great guy.

Models

I had this post already written, so I will publish it, but the next few days/posts will take a different turn, as my father unexpectedly (he was 82 and had a heart condition, so as unexpected as this can be) died yesterday. I am on the way to visit my family.

My first and best model was my father.
__________________________________


All my life I was in search of a model, someone that I can shape my life on. Someone that I can learn from. I kept looking and when I found someone that almost matched my dreams, I would put them on a pedestal and keep them on my Olympus mountain. I honored and feared them.

This might have been an important part in my social anxiety. I was shy with mostly everyone, but with my models, I was frozen. I couldn't say anything in fear of saying the wrong thing and making them reject me.

I must have lost a few friendships in my need that my friends are the perfect models, and in not accepting them to be in any way wrong or faulty, or just think differently. I would put them very high in my expectations, and when reality set in and I would see they are just human being, I left unsatisfied.

In this respect, I thing blogging has been a great help, not necessary me blogging as much as reading other blogs. As opposed to the rest of my life where I had one model that had to live up to my expectations, I found lots of models. I can enjoy and learn from each of them, but the pressure on them being perfect is not there... plus what do you know about a person from their blog?

So, who am I learning from these days?

Paul Levy - Last year I called Paul my hero... he's still my hero. He just recently got the awards for The Best Medical Blog and The Best Ethics/Policy Blog for 2007. Well deserved! I agree with the rest of the voters. Paul is cool.

John Halamka, MD - the CIO at Paul Levy's hospital, BIDMC, and a bunch of other places (like that insignificant Harvard Medical School). John successfully embodies the saying: accept what you can't change and do the most out of what you can change. He makes things seem simple, but acknowledges the complexity of each situation. He couldn't have done all the things he did with a different attitude. I think I will be raving about him a lot in future posts.

Jolie Bookspan-The Fitness Fixer - I met Jolie in person, the only blogger I have actually met. We liked each other and I hope we'll get to meet again and do things together. She's strong enough to do anything she wants to do. I love her ambition and what she does with her life.

Seth Godin - I think he has the most popular blog... and it is worth! I just subscribed and hung out for a month or two... this is the best that blogging has to offer. One short post after another, one small idea after another, he made me understand where I can go from here. I will talk about him some more as well, but I highly recommend his blog!

All my social anxiety friends and their progress: SA Dave, Drew at Shy and quiet, Leila as the Perfect Hypochondriac and "the Guy from Successfully Shy". Guys, you're all doing great! It is so good to see how much we've accomplished against our common enemy! I'm reading you all and keeping in touch with your progress. Keep going!

Anger

I ran into an article that explains that expressing anger might be helpful for your health and that couples that express anger are happier.

My father had a heart attack when I was 9. We were told it is not healthy for him to get angry. I hope they don't tell families things like this anymore these days. It really put too much pressure on us. Ever since anyone's anger made me very uncomfortable. I don't know what to say, what to do, where to hide and how to make it stop.

Over the last year, I had a different take on that. It's anger expressed in blog posts. Some of my favorites are the angry guys - The Angry Pharmacist, The Angry Doctor (not writing much lately - I suspect he's not that angry anymore), and Panda Bear, MD in hid good angry days.

Their anger is obviously not making me that uncomfortable because I am not expected to do anything, instead, I can appreciate that they might be right most of the time. The article mentions that as well... In anger you forget who you need to be nice to and just cut to the chase and say things as you really see them.

When people are angry, you can really find out what they are thinking.

Memory and anxiety

I keep wondering whether there is a link between my lifelong dealing with anxiety and my excellent memory for details.

I think it's partially an exercise thing... I kept being very attentive to any communication of any sort with anyone and kept rehashing it in my mind forever, that I think my memory got worked a lot. Now that I am not that anxious any more I find myself remembering details that nobody should remember. I know details from blog posts that were written an year ago. When Paul Levy's blog was the only one I read, it maybe made sense, but now I am reading a lot and still feel like I remember too many details.

This might make someone that cares about their privacy very wary, but I think there is a chance to meet people like me on the blogosphere. I pretty much read these things once, maybe twice if they are very interesting or have interesting comments. And I also keep track of a million details in the project I'm managing.

I think I should just be happy about it!

The good, the wonderful and the rest

I noticed a few positive things this week. First, I was doing a user training. I did not have enough time to prepare and I didn't do a spectacular job. I did trainings with brand new computer users and I know what it takes to get them up to speed, but this time I just didn't have the time. One of the people at the course gave me an article from New York Times on how to teach computer skills. In the past this would have embarrassed me terribly. I would have been upset for days.

I'm not happy that I was criticized, and I wish I did a better job, but I recognize that the problem is not me not trying enough or not being able to do it, but the fact that you need time to prepare a training course. I am unhappy, but not paralyzed... this is new!

Along the same lines, the other day we had a few friends for brunch and we were talking about the American students not being culturally savvy enough to recognize a well-known Marx quote. I didn't recognize it either and that got me a bunch of sarcastic comments. I would have died from embarrassment. After the initial shock, I thought about why I don't know that... and I came up with an explanation that I think was instructive for everyone.

I grew up in the 70s-80s Romania. At that time Romania was a socialist country, but we weren't very close to Russia. Romania did not want to participate in invading Czechoslovakia in 1968. So I actually did not learn Russian, nor did I study Marx or Lenin. I pretty much kept up with what we learned in school: basically no foreign literature, dry and boring history and geography lessons, very little musical education and no other art education. I learned French and German in school and English in private lessons with my favorite teacher. I read all the books that I found in the house, but without much guidance from anyone. My parents were trying to keep sane at the those insane times by talking to each other and getting feedback from each other on the very crazy things that went on with their jobs.

I don't believe this is my fault. I am able now to round my education, and I'd like to, but, again, I recognize that there is a compromise between all that you want to do and what you can do... and I am choosing having a job, spending time with my child and family, reading other stuff and sleeping 7 hours a night or more. I hope I will be able to read and learn more with my child or when I retire. Until then, whatever culture I have is good enough.

And the third good thing, and the best, is my husband. When I started therapy we were both a bit nervous about it. It opened the possibilities that we will both discover things that we might not like; it is not uncommon for women to discover their power and "free" themselves of the evil men, etc.

Last year, whenever we had friends over or met other people, I would ask my husband to reassure me: Was I OK? Did I do well? How did I come out?

Now, when we go to bed, he cuddles and hugs me and says: I like you, I really like you. I like what kind of person you are, what kind of mother. I like that you are witty and smart and nice. I like the person you are... He used to reassure me to make me feel good about myself, but this is different. I think it's wonderful that I turned out into someone he likes and that I am now coming out of my shell enough for people to see that.

On the uncomfortable note, I am changing my gastro-enterologist and I feel very uncomfortable to face the old one. I called to ask for a test result and the nurse asked me to make an appointment. I got very anxious... There's more work to do. I am very uncomfortable confronting anyone. Bad news are difficult to give, I guess!

Oh, the Places You'll Go

Those of you that have been around last year might remember that I had a bad brush with a disease called preeclampsia and I lost a baby 5 years ago. It's anniversary time again and this year I'd like to do something special in preparation for this.

While I was pregnant, I was happy to get ready for the baby and one of the things I did was to buy children's books. Among others, Dr. Seuss's "Oh, the Places You'll Go!"

To give you an idea of how clueless we were, the day before I was 3 hours away from home installing an application in Production. I drove home that evening and in the car, I happily sang "On top of the world" with Karen Carpenter. I fast forwarded through the "This is Good Bye my love" song that was right after. On Friday, Valentine's day, I went for an Ob visit and told the doctor that my blood pressure was high due to a Pepsi I drank the day before. Next I know I am in the best hospital around with an IV, a catheter and discussing how very sick I was with a bunch of High-risk Obs.

To make it short, I was very sick, the baby was very early and very small, and I had to be induced so I won't die. The baby was stillborn. It was a very dramatic night, also in the mid of the Big Snowstorm of 2003, with nurses and doctors being stuck in the hospital for days.

After this nightmare, my husband got home the evening his baby died and finds a box. He opens it and inside was a book: "Oh, the Places You'll Go". Since then he can't stand the book. He has a difficult time having it in the house and just yesterday told me that it will at least be another 5 years before he will be able to read it.

I start crying each time I see it as well, and could not read it to the end without crying. It must have been so difficult for him... this year I had the power to read the book and it is an incredible book. I would hate to not have my son read it and learn it.

For this year's anniversary of our son's death I am going to quote a paragraph of this book each day and find meaning in it. Enjoy! Do read it if you haven't already! It is wonderful!

Tips

Giving tips: to whom, how much, when, how, etc. was a big issue for me. I had an idea what was customary back in Romania, but when I got to US I realized that's a completely different culture likely with different tipping rules. The envelopes in the hotel rooms and movies sort of give you an idea. I looked at my husband's habits figuring this will help me. I read Internet advice... things didn't match. I was confused and panicked whenever I was in a situation where tips were likely expected.

I think I got it now: there are no rules - each person does whatever they feel like: some tip more and everybody, others don't tip at all. You can get excellent service without tipping and people don't necessarily remember you even when tipping. So I am just listening to my heart and do what feels right at the moment.

I decided that during Christmas with the daycare center teachers. They are really nice to the kid, and while he has a teacher in a small group, she's there only 3 hours a day, and he is there 8 hours a day, so obviously there are lots of people taking care of him... so who would I give money and how much? Last minute, I decided: I'll get a bunch of nice chocolate gifts, enough for everyone. I got a small baby gift for one of the teachers that was pregnant. I put them all in a bag and wrote a nice note about thanking them for being his second family.

It went well... they are nice to the kid no matter what... and what they think or say behind my back... I don't care anymore. Nice words mean more to me than money and I think I made some people's life better when I said nice and heartfelt stuff.

Yesterday I got gas. It was really cold out here. And I thought about the poor guy that was in the frost all day filling up gas tanks, and I gave him two bucks. It felt the right thing to do.

Now I can relax about my tipping habits and find something else to worry about. So long!

Happy New Year!

Everybody is looking back at the past year and making resolutions for the new one, so here are mine. As achievements for 2007, I did well and I prepared myself for doing more this year:

• My first and best achievement is getting my son through his second year of life, healthy and happy. He turned from an eating, pooping, sleeping, crying and laughing blob into a little person that can get anywhere, communicate wishes and needs, be a social creature (just a bit shy, but very nice and friendly, making friends everywhere he goes) and a very loving and lovable part of the family. We can't imagine life without him.
  
• Family life and work had their challenges, but went well. It is a learning process and we're getting better at it.
• My health has not been spectacular. I dealt with a month long flare of ulcerative colitis, most of it during my vacation... that much for a relaxing vacation. But this has been bothering me for many years and I had no idea what was happening, so finding out what it is was a relief. It is easier to deal with something that has a name. I've also had a lot of colds during the last six months and I have no idea how to make this stop.
  
• As for social anxiety, I went from being afraid to tell anyone, to shouting out loud to everyone, and finally to a more rational position of being able to share it in appropriate contexts, being casual about it, but not blowing it into everyone's face. I have worked a lot on accepting myself.

What about 2008:

• Bracing up for the terrible twos... I'm sure my son will provide enough challenge and opportunity to learn... his emotional development especially is particularly interesting for me in understanding my own emotional issues.
• I need to get my health under control
• I'd like to build a support network of friends and family and work on balancing my life: add more fun and exercise to my current work and family only schedule.
  
• I want to become a better listener and I want to work on explaining what I am thinking so that people will understand where I am coming from.

Medication for SA

There was an article in New York times last week written by Dr. Carlat about being paid by a drug company to present a drug to other doctors. It has raised huge waves over the Internet and got me thinking at various levels. The aspect I would like to comment on now is the personal one - do you medicate for social anxiety or not?

My long time readers probably know already where I stand. I do not take any medicine for this and I am very happy with this decision... actually more and more happy the more I learn about it.


The problem is that therapy is not cheap. Insurance companies will not encourage therapy vs. medication because it is not cost-efficient for them. My insurance company has estimated the average annual cost for an anxiety disorder at around $1900. This includes doctor, medication and tests. Depending on the type of anxiety (low or medium) the doctor costs are between $600-$800. I am not sure how they calculated this, but they reimburse a therapist at $90/session for 20 sessions a year. This makes $1800, more than they plan to pay for both the doctor and medication.

So doctors are assaulted by both insurance companies to recommend medication and by drug companies to recommend their product (insurance might be more interested in cheaper drugs). Read that article in NYT... the push by drug companies can go beyong the short skirted girls with free samples and lunches and the ads we patients see on TV... it can go with respected doctors and researchers supporting one or another drug, with studies paid by drug companies. How can you not be influenced by all this?

So what are we patients left to do... I think I would resist as much as possible and do anything possible to avoid getting on meds. Happiness does not come in a bottle.

I am thrilled at the series of events that made me not take meds and try anything else: it basically had to do with the baby: I wanted to breastfeed at any cost. The baby was thriving and very healthy when breastfed and it kept me going and trying new things until it worked: a new therapist, exercise, meditation... anything to make it get better.

If this didn't convince you, read this article about someone trying to quit taking Effexor.

Just like everybody else

My kid is 2 and I just lost my illusion that I am somehow different than all the other mothers. I imagined that I am not as crazy and obsessed about him as all the others about their kids... I actually am, I can talk for hours about him, I have tons of pictures (I had a friend ask me today if the Internet is too small to hold all his pictures), I even think it's really cool to talk to him on the phone so I put him on with anyone (hmmm, anyone sees some social anxiety here?).

No comment

http://www.revolutionhealth.com/blogs/valjonesmd/vintage-dr-val-the--9305

I'm closing shop

I think that I will abandon my social anxiety blog. I love blogging, but I am so bored about blogging about my emotions and vents. I want to blog about computer systems and project management and databases and I feel confined in the title. I might get back one day and I will continue to read the blogs of my socially anxious friends.

I think I had some good posts and I hope I helped a person or two to at least not feel so lonely in their condition. I definitely learned a lot and found a lot of comfort in blogging and reading about others.

Here are my highlights for those that will get to my blog in the future:

1. Diagnosing social anxiety - how to tell your doctor
2. First step - therapy - find the right person, not the right therapy school
3. For spouses, friends and family of people with social anxiety: Dealing with emotional people I and II, and helping them.
4. How bad can it be. Also check my poll results.
5. Keep in touch with family and friends from college and school because it will be more difficult to find new ones later in life
6. A very popular post on emotional immaturity... My more recent opinion on this is that it is emotionally mature to occasionally be immature, just accept it, forgive yourself and apologize if needed and move on.
7. About openness
8. My big revelation
9. ... and snippets for people with social anxiety to not feel like they are the only ones feeling this emotional: dreading the publicity, blogging anxiety, doctor's offices

Thank you all for reading my blog, and commenting every now and then! Thank you for joining me in this journey. I will post a link to my new blog as soon as I will have something there.

Another doctor story - part II

I have a development going on about my previous doctor rant. I am not sure I can describe it as being successful in beating social anxiety, but it surely is an important step toward it. Some moments were awkward, but I made my point and I was listened to.

On a subsequent appointment, I gave the doctor the book "If Disney Ran your Hospital" (see this post for more details on this book). He was very happy to read it. A week later he called and asked what exactly made ,e give him the book, what needs to be improved in his practice. We talked a lot, but my main points were that I wasn't clearly told what I have to pay and given options to accept or not and that the office was not as family-like as advertised. The doctor found something that I apparently was overcharged for and promissed a refund and then told me that they will try to improve by the time I go there again.

I was supposed to go today and on Saturday, I got a hand-written card from the doctor thanking me for the book, with the refund, and a gift certificate for a restaurant. Also, when I called today to cancel the appointment, the person answering the phone was very energetic and helpful.

I think this is "mission accompli". Maybe the right way was to tell the doctor what was wrong from the very beginning without venting on the blog, but one way or another, I helped a medical office give better service. I feel bad about my previous post now... It was great to talk to the doctor and realize that he really really wanted to do things better.

Alternative medicine

I'm alone at home, fighting a cold and drinking some wine to help with it... This has nothing to do with alternative medicine (hmmm, maybe a little ;) ). I got the idea from Paul Levy's blog, so go blame him and his daughter.

A number of medblogers posted lately about alternative medicine (Dr. Rob has a post with links, and Panda Bear had a number of posts over the last couple of weeks). I had an first hand experience with this earlier this year. I must agree with them on everything they wrote. Here's my story.

Earlier this year I decided that I need to fight the mild hypertension that I had after my first pregnancy and through my second pregnancy. I studied the DASH diet, made plans to start exercising and read about the subject. From a book on the DASH diet, I found a book - What your Doctor doesn't tell you about hypertension. It had great reviews and was written my an MD. He hypothesized that there are lots of studies that show how XYZ vitamin or supplement is lowering the blood pressure a little bit and that if you actually take all of them at once, you can significantly lower the blood pressure. He also recommends a modified and even more aggressive form of DASH.

I got that book to my doctor and he politely noticed that the author does not correctly quote the studies he's referring to, that he doesn't believe in nutraceuticals and that probably the die from all those supplements will cause an allergic reaction. This last argument actually won the fight. The book landed in the trash along with some bottles of supplements that I had. I saved any money on additional supplements and instead started to seriously exercise. Within 6 months my blood pressure decreased from hypertensive levels to normal (not even pre-hypertensive). I'm now not even exercising that much and the blood pressure is still low. Some of it might have to do with lower anxiety levels.

The irony is that if I actually followed the advice in the book and had the same result, I would say that it was that that did it. I would be a strong supporter of alternative medicine and would shout loud and clear that those supplements did it for me.

My doctor's argument that the author didn't correctly quote the studies seemed like he was stumbling on a technicality, but it is important though because if someone actually knows how to read a research study, they would quote them appropriately.

And it's scary that I think I did the right thing with the information I had at the time: this was an MD. And had great reviews on Amazon. This is scary... How are we supposed to find correct and reliable information?

Makes me also wonder about trusting any of the doctor rating engines out there. I am a great believer in reading the Amazon.com reviews for books... but I don't buy any more books with medical information based on their reviews.

It's new poll time again

My October poll was How much does social anxiety affect your life?

The answers were:

• I don't have social anxiety 0 (0%)
• It actually helps me to have a better life 0 (0%)
• It doesn't affect me at all 0 (0%)
• It affects me somewhat, but not in major ways 5 (12%)
• It seriously affects me, but I still go on with my life 22 (56%)
• I don't have a life, it affects me that much 12 (30%)

My heart is with you, people that responded that they don't have a life and that their life is seriously affected by social anxiety, which makes 86% of respondents. I wish I could do something, anything for you... I guess that as long as you came and visited my blog, all I can do is to keep writing about social anxiety and dealing with it, and encouraging you to participate in any way that you feel almost comfortable participating.

Thank you so much for answering my poll.

November's poll has to do with the form of communication and interaction that you find most comfortable and uncomfortable.

I prefer one on one interactions: having someone pay 100% attention to me, I like speaking to a group in a formal prepared presentation, but not in an informal one (being asked a question in class), I tend to lead in a group, or try to be really invisible. I hate speaking on the telephone. I am OK with email and IM, but I hate when the answer to an email never comes back (I never know if the other person is just busy, never got the email, had no time and forgot about it, or just didn't care or want to answer). I don't like i-chat, but I think that's just because it's so hard to communicate anything. I guess in the same category, I absolutely can't do small talk. I need to talk important stuff 8-p)

What about you? Feel free to answer the poll and comment anonymously or not if you need to say more. Here's a task of the month for the don't have a lifers out there: post anonymously! I will try to be supportive!

What I was told and noticed myself is that with anxiety you have no easy way, you need to face it and challenge yourself... always. If not, it gets worse. It only gets better if you challenge it. It's like exercise: you need to keep doing it, otherwise it takes you over.

Grand Rounds and grand managers

Make sure you check Grand Rounds this week. Paul Levy is hosting it and the theme is a personal experience in a hospital that changed beliefs. What a wonderful idea! The change of perspective from medical professional to being in the patient's shoes. Brilliant as always!

And another blog that I recently started reading - Seth Godin's blog . Great marketing ideas and just plain good sense for websites and life. Here's a post that reminded me of Paul and his management style.

That's how most CEOs and top managers make decisions. Not based on unemotional data, but on emotion-rich, experience-based stories. And if management isn't permeable to the outside world, the whole organization is going to suffer, isn't it?

Bloggers, back pain and embarassment

Back in May, I had a post with a link to the Fitness Fixer. I am reading Jolie's blog since then and I like it very much. she had a Neck and Backpain Workshop for the last two week-ends relatively close to me and I went there. I also went to a yoga class with her. It was great! She's so different and challenging and seeing and doing this so different than everybody else (hmmm, just like me?). So if any of you live in Philadelphia, go meet her!

Jolie is very nice and very smart. I liked her a lot and I hope I will use what she taught us to never get backpain and to help some of my friends that do. Visit her blog! There is something to be learned from there.

I enjoy meeting people through blogging. It's easier and feels safer for us. I prefer this environment to anything else to getting to know others.

And now the funny part: I sent Jolie the comment I had in May about her blog, so she knew that I have social anxiety. She went out of her way to make me feel good. (Jolie, if you read this, you are great, and I love you very much and you did just fine, so please don't get upset with the rest of this) . Jolie challenged me more than physically...

I had to laugh at all the nice things she did for me that embarrassed the hell out of me: all we want is to be lost in the crowd, don't single us out. She hugged me and noticed how nice I am. She got me a ride for two blocks so I can get to the yoga class - Oh, the horror of riding in a car with 4 perfect strangers... I would have happily walked in the rain than try to make conversation. Good thing that it was really close.

My husband joked about the similarity of my feelings and my 2 years old's feelings when he sees a big dog or some other scary animal (we went to the zoo and he saw a big pig at the petting farm - he declared - nooo pig, no pig, no pig and clutched on tightly to my husband). The same with me: nooo people, please, no new people!

Thank you Jolie for challenging me in all sorts of ways! Now that the danger is gone, I am very amused at the whole situation, really!

Joke on social anxiety

My husband made up a brilliant joke:

"You are arguing with yourself and you are too shy to answer. Now that's social anxiety!"

About copying and feeding from this blog

I have noticed a website feeding off my and SA Dave's blogs. While that website seems to be in work, it makes us uncomfortable to see our posts copied somewhere else. This is not Technorati or Bloglines or some other common RSS feed, it has our blogs under headings with social anxiety, suggesting that we are somehow doing SA therapy. Please appreciate that we are not feeling good about this and stop feeding on our blogs.

They say that copying is a sign of flattery, but I don't feel flattered. I am feeling way more shy to write anything. I'm no expert. I have no medical degree. I can speak for what I feel about my anxiety and maybe that is what some of you feel, but I'm sure there are just as many people with social anxiety that do not find themselves in what I am saying and for which this is much worse.

Thank you for your understanding. I deleted my email from my blog, but I'm allowing anonymous comments, and will not post a comment if you mention it. So if you want to contact me just send a comment.

(BTW one other reason I'm shy about posting more is not getting any comments. I must be a bad writer lately... oh, we are so dependent on other people's feedback!)

Preeclampsia awareness

This is a post for those of you that are interested in pregnancy and preeclampsia issues.

My very good friend and founder of the Preeclampsia Foundation, Anne Garrett Addison (gosh, Anne, there are so many double consonants in your name!) was nominated as a Woman of Worth by L'Oreal

She just had an interview on NPR. It is worth listening to. It is a story of the need to empower patients in being active in their own care, in understanding their conditions and partnering with their doctors for their care. Anne has been my and hundreds of other women's mentor in becoming empowered patients. It was my brush with preeclampsia that made possible my researching more about social anxiety and about being able to live (pretty well) with it.

It is late at night and I really need to go to bed, but I will update this post with more relevant links about preeclampsia awareness and patient empowerment. I am very grateful that I had preeclampsia and that made me meet Anne. Thank you Anne for all that you did and are still doing for us and for me!

Growing pains

I think I'm growing a bit these days.

My first revelation is that it's unfair to judge anyone because you can never know everything that is going on with that other person. Unless you know all the factors how can you say whether someone is doing or not the right thing. This has to do with my last post and with my previous rants mainly about doctors. I got to understand a bit more about a couple of doctors that I complained about in the past. I got to see how one of them is really trying to do things better and I think this is what is important: continuous improvement rather than perfection.

My second growing point and the answer to all the people that get to my blog by searching for "is social anxiety ever going away" and "emotional immaturity" is that I will live with social anxiety for the rest of my life. It will not get better. I might lose jobs, opportunities, friends, relationships, etc. over this and this is OK. Other people are losing jobs, opportunities, friends, relationships, etc. over other things. I will have to accept it, live with myself, get over it as fast as possible and move on. Emotional waves will come and go, some will be stronger and more painful than others. I just need to know that they all will go away eventually.

I met someone that might be useful in achieving my impossible dream. I was breathless, speechless, said the wrong things, had the wrong attitude. It will not go away. I might fix it by sending an email or going back, or maybe not, but the only way to get that job is to continue to do this over and over again until it becomes so normal that I can do it without overwhelming emotions or until someone will be able to see through the emotional content. Either way the emotional maturity and the social anxiety won't matter anymore. The only person that this is a big deal for is myself.

It was painful to see someone interested in what I had to say and seeing me running away from talking about what I want to talk about most.

I will try to work on a marketing speech to help me get through easier, but I will expect even this to fail. I cannot win if I will always run away.

Malpractice

I read this article in Medical Economics and I got offended.... big time offended. You advise doctors to write notes that detailed to avoid a malpractice suit? This mean doctors spend more time writing notes than they spend talking to patients? And this for the 1% or less patients that would sue them?

Can't they come up with something more economic? Can they record the conversations during appointments - that would embarrass us a lot, but how is it different anyway? It can only be used if you sue them.

Can we come up with some promise that we are not set to sue them? Like marriage? In sickness and in health... We're not all after you! Shouldn't the lawyers work on doing something like that than on suing doctors... I guess that wouldn't bring enough money.

When I had a breast lump, I had two doctors give me breast exams without a chaperon. I very much appreciated their ability to see me for what I was - a scared woman - rather than a malpractice suit waiting to happen. These doctors gained my full respect. Of course I wouldn't blame anyone that uses a chaperon (you need to do what you need to do), but having the guts to do otherwise needs to be appreciated.

What a mess!

Piglet

I added my avatar on Social Anxiety Friends. I am Piglet... If you didn't read Winnie the Pooh lately, do so. It's really fun reading. Here's a description of the characters:


http://www.femail.com.au/learningthroughdisney.htm

Other books that we read to our kid that were fun:

- The Princess Bride

- Grimm's Fairy Tales - I got the complete works volume... they are not as fairy tales as you'd think! Lots of real life lessons!

- Mary Poppins - she's not that nice

- The Jungle Book

- The Wizard of Oz

New poll and old poll results

Here are the results of my latest poll:

Out of 29 voters

2 do not have social anxiety

The other 27 use the following to help with social anxiety (options are not exclusive, more than one item could be selected):

• 10 (34%) - Read books, blogs, etc.
• 9 (31%) - Do individual therapy
• 6 (20%) - Do nothing
• 5 (17%) - Take medication
• 5 (17%) - Exercise
• 4 (13%) - Blog, diary, other writings
• 2 (6%) - Meditate
• 2 (6%) - Other
• 0 - Group therapy (I guess I am not popular with the Phoenix group ;) )

I was impressed with the large number of people that do nothing and the small number of people that meditate... I guess you guys felt just like me when you tried to meditate. It never works well at home.

This inspired me for my October poll: how much does social anxiety affect your life. It affects my life a little, but not to a level that it stops me from doing things: I would avoid a party or talking to someone, but I still see people, work, do new stuff, etc. How about you? How bad is it?

Ending relationships

I just figured another SA quirk of mine. Another bulb was lit. What's nice about figuring these out is that once you realize what's going on, it becomes easy to recognize and easier to handle and it eventually goes away.

I mentioned that my doctor is leaving and I won't be seeing him. We had a very special relationship and it is sad.

However, when I first found out, I was thrilled. Whenever I am in a relationship, I am terrified by its ending. I don't enjoy what I have because I am scared of losing it. It was my nightmare that I will call to go see him with who knows what awful problem and I will find out that he's gone. Or that he will tell me that he doesn't want to see me anymore.

And this was so perfect. I am in a good place now, not many health-related issues lurking, nothing major going on, enough time to look for someone else, etc. What perfect timing! What opportunity to end a good relationship on good terms and put it on the shelf as a trophy and a proof that I can actually have a relationship.

So I am pretty good at starting a relationship, but then I am terrified that it will eventually end.

Even with my husband, I got confident enough lately that I am no longer scared of a divorce, I am pretty sure that we will separate by death, but I am often thinking about it. I don't wish it, but I am thinking at any moment what would I do if it happened. I need to be prepared for it at any time.

It's worse with friends. I am scared of commitment because I know that it will end. I'm afraid to start anything because I don't know how it will end and that I would lose everything I have.

Still around

I'm still around, but it's been some awful weeks. My whole family and I were sick for the last three weeks or so. Somewhere in the middle of this nightmare, I found out that my doctor is going to another hospital too far away from me. It seemed that there will be no end to the nightmare.

And today, the sun came out. I am on antibiotics and starting to smell things and feel good again, the baby gained enough weight and his cold is getting better too without antibiotics, and I am finally getting to a resolution to what I want in a new doctor. I even got a plan.

And to top it off nicely, my wonderful husband cooked dinner AND cleaned the kitchen this evening. Ladies, go away, he's taken!

Now, Dr. Rob is hosting the Ground Rounds next week, so I have until Sunday morning to come up with a good post.... so I need to get serious writing going!

Social Anxiety Friends

Another reader sent me a link for my commenter Jay P. Check this out

http://www.socialanxietyfriends.com/

I registered yesterday and navigated a bit around. I got more hugs and welcome's than I am comfortable with, but it's a nice place. Does that prove that I have social anxiety or what?

A new friend

I have a new friend. I haven't had a "real" friend in a lot of years. I had friends that I wrote to, that I emailed or instant messaged with. I had friends that I met for a weekly event, like going to yoga twice a week, but that's about all. I had family friends that I could foist all the inviting/talking part to my husband.

I haven't had a "real" friend since college. And I am very confused and very shy about this role. All these problems that I never encountered: how will my husband react, how will her husband react, how will the world react? I should call... but when? what time is best? is it better to call when I am happy, unhappy or just when I am neither.

It's funny how I found the getting friends part really easy and entertaining. I did great and acted as if I had no anxiety at all. I had nothing to lose, but now that I won... I have so much to lose. And I feel stuck and scared.

Feels like listening to Beatles' Yesterday: "Yesterday, love was such an easy game to play!"

Marriage to a person with SA - comment

In response to my post below, Jay P commented that for some people with social anxiety getting married is only a dream. I will add the comment in its entirety, because it is very moving.

I will also change my profile to adress the fact that I only have mild social anxiety and that I apparently could quite easily overcome lots of problems. Even so, I made immense progress in the last year and I hope that this will encourage each of you SA sufferers to try to get to a point where social anxiety is affecting you less.

Many thanks, Jay, for your comment!

Jay P. said...
"Can you have a successful marriage with someone that has social anxiety? Apparently the most difficult thing is getting there - the whole socialising, dating thing." Exactly.Getting 'there' requires all the sorts of things that someone with social anxiety has difficulty facing. Such as those rather mundane, trivial things to everyone else like speaking, eye contact, and god forbid, being in a social context, anywhere!

Personally I've recently stooped to a new social anxiety low. I have more or less stopped speaking. I've begun to carry a small notebook around with me wherever I must go and if I am asked a question or even worst if I must ask a question, out it comes with pen in hand. Not surprisingly I've found that it limits conversation. Yes, thankfully shortens it.

I'm amazed that a relationship can develop when you're plagued with social anxiety. But don't get me wrong, I envy anyone that has.

It's not for a lack of good looks or intelligence that forbids me-likely anyone with social anxiety-from anything meaningful with the opposite sex. No, it's an apparent lack of personality under the guise of rudeness, insensitivity, even stupidity.

Of course my being is neither part nor sum of those things at all. It's all about being shy and how a sufferer is robbed of so many things in life because of it. A relationship, even marriage? Who'd even dare hope of such things?

Marriage with a person with SA

I occasionally see search strings about "husband with social anxiety" or the like. Can you have a successful marriage with someone that has social anxiety? After all, they might kill your own social life.

Apparently the most difficult thing is getting there - the whole socialising, dating thing. The two men that I ever dated I also married... I'm very efficient this way. Once married, people with social anxiety are apparently doing pretty well.

I think the key to making it is openness and communication. In my first marriage, we didn't communicate all that well and I think this is where it broke. It wasn't social anxiety that caused the break.

I told my current husband about social anxiety almost as soon as I knew what it was, and had him read a book about it. He got it and understood some of what was going on. Since then we both keep evolving and trying to understand what's going on. We talk a lot about my anxiety and find ways to help me.

It was important to realize that I need to be told ahead of time about plans for socializing and that I can refuse them. The simple fact that I can accept or refuse something made me comfortable enough that I hardly say no to anything these days.

Keep talking and being accepting of your social anxious friends or spouses and it will all be OK. Help them overcome their shyness, but be supportive when they can't and make sure you tell them when they are doing well in a social situation.

Grand Rounds and Polls

Susan at Rickety Contrivances of Doing Good put up this week's Grand Rounds. It is an interesting edition and it's subject is Narrative Medicine.

Pioneered by Rita Charon, an internist and professor at Columbia's College of Physicians and Surgeons, Narrative Medicine trains doctors and other caregivers to use careful listening and reflective writing to forge deeper connections with their
patients, resulting in better care.

Susan included my post on helping people with social anxiety in the first cut. Many thanks, Susan!

Go check the whole story. It sounds very interesting:

http://improbableoptimisms.blogspot.com/2007/08/grand-rounds-volume-3-number-49.html

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Second news is that I put up a new poll with questions on what are you using to help with your social anxiety. I think we are all curious what percentage of us uses medication vs. what else is used. I will leave this poll up through the whole month of September.

How to tell your doctor that you have social anxiety

This is a question that comes up quite often in the search strings on my blog...

So how do you tell your doctor? First thing to try is to just say it, prepare your "speech" in advance, repeat it, and then when at the doctor just take a deep breath and say it: I have social anxiety. For them it's not really as much of a big deal as it is for us. It's just another disease and another diagnostic code.

The thing is, each of us is different, my social anxiety mostly kicks in when I really like someone and want to be closer to them. So for me it worked quite well with a new doctor. I said it when I saw him the second time and it wasn't such a big deal. I had to repeat it again after I've been through a pregnancy with him and respected him much more. That time it was hell for both him and me; it came at the expense of his lunch break. It was very difficult but also very relieving. I felt very light coming out of that room... also emotionally drained.

So, again, try to say it, as difficult as it seems. If this doesn't work, write it down and send a letter and an email a week or so before your appointment. You might be embarrassed that the office staff might read it. I was very embarrassed to see my emails in my medical record. At the end of the day, for the medical office staff, you are just another patient with another diagnostic code, they don't really care that much. If anything, they will be nicer to you. The general idea of what social anxiety is that you're cutely shy and easily teasable. Few people really understand the emotional turmoil we go through.

Another idea is to say that you have anxiety. The doctor should not jump in with medication, they should send you to a therapist, psychiatrist or the like... Then the only person you need to give details to is the therapist. I recommend that you don't start dealing with social anxiety by taking medication. There's always the chance that you can do without and the medicine for SA are not innocent.

So good luck! and feel free to comment (anonymously or not) on how YOU told your doctor about it.

Rebuild your back

The other blog that I recently started reading is Dean Moyer's Rebuild Your Back. I love the way Dean is teaching others to deal with back pain. It seems to me like the right way to resolve it. Doctors and pain medicine can only do that much, chiropractors and other alternative medicine options seem to mainly work on "if you believe it, it will happen".

If you have back pain, visiting the site and the forum is a must. It just happened that about three of my closest friends had back pain since I started reading his blog... so I keep telling them: See, I told you!

The blog has other topics that I found both interesting and controversial, and the links to the Skeptic's Circle opened a different world to me.

Check it out! And thank you Dean for discovering me on the Grand Rounds and commenting on my blog.

I love my kid's pediatrician

I have a good positive post for you guys!

I love the pediatrician office. I am very proud that I found them and stayed with them. It's a small practice with 3 doctors. I think this is the best because it's small enough that you know each doctor , but big enough to cover all the hours, so you don't get to talk to some other doctor on call. It's always one of the three. Less than that and you would end up meeting a complete stranger for on-call. For more than that, it would be difficult to know each doctor and have unfragmented care.

I can ask for one of the doctors or just rotate through them as I wish. They are a bit far away from us, but they work with two of the best hospitals around and I think that is important. They are out of network for my insurance and I am actually happy about that because I know that they get paid a fair amount and don't have to reduce quality to cut costs.

They have evening hours, they get you in the same day for a sick child and they even come on the week-ends if needed. They are usually on time and I never had any issues with them.

At one of my first appointments, I felt attacked when the old doctor asked the usual questions about not leaving the baby alone on the adult bed, baby-proofing the house, fire arms, etc. I then realized they have to always ask these questions and it's not personal, so I relaxed.

Initially I rotated through each doctor to get to know them, but for 9 months or so, I just stayed with the youngest one. He has a kid about the same age as my kid and it's really cool to share the experience. He's fun: "Oh, I worry unnecessary about my kid as well." I love that he takes the time to talk to me and that listens to my concerns and reassures me. It's also cool that if I think he's missing something, I can go to the "old doctor" and ask about it.

____

I wonder what is it that makes this relationship so good and why am I so critical towards other doctors. I'm pretty sure it's something internal with me and how I react or come across to other people, but I can't figure out what it is.

I think this is more like a partnership for making sure the kid is fine. I think that doctor-patient relationships that are based on mutual respect are successful. If the doctor feels threatened, or if the patient feels unheard, the relationship just fails.

My view on Electronic Medical Records - EMR

I have read a lot about EMR systems, but I never really saw one. I imagine they handle appointments and allows staff to maintain a patient database. Maybe the more advanced ones electronically transmit data to insurance agencies and pharmacies and get lab results.

But I wonder if they actually help the doctors at all. I suspect they are just electronic notebooks for doctors having them enter notes electronically instead of dictating them.

I wonder if the lab results and other documents are stored in the database as searcheable numbers or they are simply pictures of the other documents.

I imagine that a good EMR should allow the doctor to select options from lists of values and then generate codes and reports. I looked at my doctor's notes once. He started by dividing the sheet in 3 areas and labeled each with the subject he needed to cover. It could have been Chronic hypertension, right upper quadrant pain and heart (I'm making it up, I don't remember the details). Anyway, it would be nice to have a program where you just enter a few letters and it fills out the rest. If you have a category that is not in the list, you can enter it in a separate field and the program should be smart enough to "learn" it and use it next time.

Then, because hypertension was selected, it would open up a history of that and give the doctor options. The computer should suggest a billing code, but allow the doctor to modify it. It should give medication options and allow the doctor to pick one.

When done, it should generate any report that is needed: referrals, letters to other doctors, insurance papers, etc. and allow the doctor or staff to review it one more time before sending it electronically.

Is this what EMRs are about? I doubt it. I am building database software systems and I am very aware how difficult it is to build something with such high level of artificial intelligence, but if they don't do all that, why would we be surprised that doctors are slow to adopt them? What do they bring the doctors? I think that the existing systems are more about keeping the office lean (less staff) than actually helping the doctor.

Why am I writing all this? What a good question... I guess because I am dreaming to build such a system, but I see few chances to get there.

Another doctor story

My dear and beloved readers, I promise, I tried my best to not be critical, I wanted this to be my happy post and everything to be good. It is not. I am not unhappy, just sad with the way the world is. So here goes another doctor story.

I have this mild but annoying foot pain since I was pregnant - 20 months ago. It is only annoying when I walk for a long time (like our 10 miles hike from a month ago). It's not that bad, but I figured if I can make it go away why not try.

My doctor very warmly recommends this podiatrist and tells me that all the doctors he recommends are his friends, but his patients actually like this guy. This is big for my doctor.

I call and get a 7PM appointment - hey, appointment at a convenient time, amazing! They send me directions, they call me twice to confirm my appointment with an automatic message. This guy obviously has an EMR system... I am grounded. I loved him even before I met him.

When I get there, it turns out that he doesn't take my insurance, but the first appointment is free. I quit caring about my insurance a while back. The doctors I have the best relationship with are out of network anyway. So this doesn't put me off.

The doctor comes in with a laptop, examines my foot, asks the questions, etc. He finds a spot that hurts and explains what he thinks is wrong. I listen and then tell him: oh, so if I just wear wide shoes it should go away. He says that's not enough and sets me up for a X-ray and U/S. I am presented with a U/S paper where I promise that I pay $50 if my insurance doesn't. Hey $50 is not the end of the world.

The X-ray is perfect, On the U/S he shows me a black area that is supposed to be my infection. Before I know, I get a hydrocortizone injection, a pad on my foot and I am armed with a cream and pads ($24.5). I shyly ask if it might not just go away just by wearing wider shoes. Doctor becomes uncomfortable and hurries out the room. I am set up to have another appointment in a week.

Will my pain go away? Likely. Would it just go away if I wore wider shoes anyway? Probably. Would I go back to the doctor if he just told me that? Likely not, but just because I would feel better.

Why are we so hungry for intervention? Why is this doctor basically a vendor? A very good and courteous one, but at the end of the day just a vendor. That EMR system that he has needs to be paid for...

And BTW, I had to peek at the EMR system and saw his notes: they started with "This 37 yo female patient..." He typed that in... shouldn't that be automatic, generated by the system?

I lost any hope that I am not the most critical freak that ever existed.... Everybody likes this guy, even my doctor, and I don't? What's wrong with me? Can I just be happy?

ETA: Check out the development of this story.

Poll results

OK, so my poll results are:

11 - have social anxiety (SA)

3 - don't have social anxiety but want to find out more about it

1 - is here for other reasons than social anxiety

This result was very surprising to me. I did not expect the SA people to come out and participate. Many many thanks for participating and for reading. I realize that for some of you even taking this anonymous poll might have been difficult. I also realize that you are coming here again and again because you find yourselves in what I am writing, realizing that you are not alone or finding hope that your issues have chances to be resolved or at least become acceptable. I now feel responsible to keep writing and letting the world know about us.

I was hoping that more people don't have SA, but are interested in it. I was secretly dreaming that there are SA researchers out there that would try to learn more about SA and find ways to help us... I guess research money is not much and it's mainly given by drug companies, so research in this area will have something to do with medication.

Thank you again for participating. I will keep writing about SA and I will try to attract people that don't know much about it so we can increase awareness. The first step will be to edit my post on helping SA people and submitting it to the Grand Rounds this week. Wish me luck! Feel free to offer suggestions, anonymous comments are allowed!

Dr. Rob

I have a few blogs I started to read recently. One of them is Dr. Rob. He is on the list of the best 100 medblogs and pretty much everyone on the medical blogs world has a link to his blog. I am so happy that so many people like him. This alone makes the world a better place. He has a lot of common sense, is smart (hey a doctor building his own EMR... - I am in IT after all, this has to impress me) and very very sweet.

He surprised me this morning with a post on children's fears... as you'll see it's not just children's fears and it matches very well the subject of this blog. Make sure to read it.

Thank you Dr. Rob for writing... and if you ever get stuck in Newark, let me know. I'll be happy to offer a place to lay down, a dinner and an ear eager to learn about your IT achievements and not only...

Edited to add: Two more Dr. Rob posts that you should not miss

Read To My Patients and give it to your doctor to share with their patients.
http://distractiblemind.ambulatorycomputing.com/2007/07/23/to-my-patients/
It's wonderful. I especially like this part:

You are not crazy. I have a lot of people who are really anxious about
things in their life and they are worried that they are “going crazy.”
There is a huge difference between being “crazy” (psychosis) and struggling
in life. Everyone is struggling in life (no matter how “together” they
appear on the outside). One of the best parts of sitting in my seat is
that I have a whole bunch of people opening up to me with their insecurities
and anxiety. I have realized that everyone is just as insecure as I am
- and this really makes me feel better in my own struggles. If you
can’t share your anxieties with me, then who can you share them with?
I promise not to make you feel that you are feeling the wrong emotions.

Also check Perfect words ... how nice is that? http://distractiblemind.ambulatorycomputing.com/2007/07/25/perfect-words/

Please take my poll

Please fill in my poll on the righthand side of the main screen. I am so curious what attracts people to my blog, and especially what brings them back... I'm looking forward to seeing your answers.

Many thanks!

Helping socially anxious people

I love to check the search strings on my blog. A quite common thread is people that ask how can they help a socially anxious person. Of course there's the conventional path that they need to be encouraged to take and that I recommend: tell their doctor, find a therapist, read tons of books on the subject, read blogs and try to hook up with people that have the same issue, read blogs and try to hook up with people that don't have this issue, write a blog or keep a journal for their feelings, symptoms, etc.

In this post though, I'd like to talk about how to interact with them on a daily basis. The simple answer is just be there for them and let them know you are there for them. When I was pregnant I had a cyber-friend that emailed me each time I posted an update on the Preeclampsia Forum. Each and every time, I would get an email saying she's thinking about me, she's glad I'm doing well or sorry that I'm not doing so well. There were months when I didn't even get myself to answer those emails, but they kept coming. Thank you so much for those emails, N! They really helped.

So the long term solution is to reach out to them occasionally even if they don't answer back. But I think an even more interesting question is how to react to the emotional roller coaster they go through and they sometimes drag the other ones around into.

I stand by my previous posts ( see Dealing with Emotional People and Dealing with Emotional People - Part II) that when upset, you need to listen to their vent and empathise. Don't try to rationalize (it will just demonstrate to them they are irrational) and don't tell them it's all in their head. After they relax, make sure to reassure them that you still love them, you think they are fine, that this kind of meltdowns happen to everyone (an example of when this happened to you is great).

What about when they are overcome with shyness, obviously not being able to get over it: blushing, nervous, trying to say something, but can't, wringing hands, looking down, etc. I think you need to do the same: break the silence with a question, ask what are they thinking, say it's OK, they are fine, that you have time to listen. Don't go away trying to relieve them of their obvious discomfort, just help them go through it.

Sometimes the silence becomes so awkward for the socially anxious that they wouldn't start talking because the issue is too small and they made too big of a deal of it. This will extend the silence even more and make it even more awkward. All they want is to run away and hide. Don't let them run away. It will make them feel good for a short time, but will hate themselves later. Again, after the episode, make sure to let them know they are fine and you still love them. Don't laugh at how small their issues are.

The question that comes up in our heads time and time again after these episodes is: what is he/she going to think about me? He/she will run away and never want to see me again.