For those with social anxiety disorder, being out in public becomes unbearable. And as they avoid transport, shopping and socialising, isolation increases. Designing public spaces with positive mental health in mind is at least part of the solution.
By Dr. Louise Boyle
Geographies of health, illness and wellbeing
University of Glasgow
Introduction
“Every day is hell… Simple everyday things like walking down the street, taking the bus and making a telephone call fill me with absolute dread. Being around other people is completely unbearable.”
Sam’s story is a reality for many people who live with social anxiety disorder (SAD) and experience the fear that they will be judged by others.
People with SAD anticipate that they will suffer humiliation, and they find many of the environments that are part of daily life overwhelming and distressing. This often has serious implications for a person’s health and wellbeing.
Social anxiety affects how a person interacts with others and the world around them. Although some may avoid social or public spaces altogether, many others endure them while experiencing intense anxiety. Their patterns of social interaction may change and the social spheres of life can become much more difficult to navigate. They might push people away, diminishing their social worlds and increasing their feelings of loneliness and isolation.
Alex, who has SAD, says, “Social anxiety has made my world so much smaller. As it got worse, I started to get more insular. The more intense it got, the more I started to feel very lonely and isolated… I would avoid going to the shops or getting the bus during rush hour because there were too many people… The longer it went on, the more it started to affect work, close relationships and friendships… so my social life has… well, I don’t really have one.”
And Sam and Alex aren’t alone in feeling as though the world is a hostile place.
Navigating Anxious Spaces
For many people with social anxiety, public spaces are potential spaces of embarrassment and social humiliation.
Tim Cresswell, an expert in human geography, argues that a feeling of ‘out of placeness’ causes people to “question behaviour and define what is and is not appropriate for a particular setting”. For example, Sam scrutinises his own social actions and behaviour, and concludes, based on his assumptions about how other people will react to him, that he does not ‘belong’.
“I feel incredibly self-conscious when I leave my house. Walking through my town or just being in public is horrendous. I get palpitations and start to panic in any social exchange, as people can see that I am visibly anxious and think I’m weird or awkward. I just feel completely out of place and worry about what others might think of me.’
Consequently, the spaces Sam feels ‘safe’ to experience social contact in become increasingly limited.
For some people with SAD there are specific environments that trigger and exacerbate social anxieties. These are often places that support daily routines and social life, such as learning environments, workplaces and spaces of leisure.
Jade finds that many of the situations that trigger her anxiety are specifically related to university, encapsulating her fears of failure, authority figures and being negatively evaluated by others: “University has been completely overwhelming so far. I struggle every day in lectures, as I’m surrounded by hundreds of people and everyone seems to have groups of friends. I haven’t made any friends because I’m so self-conscious and shy. It’s very lonely.
MORE: Rob Bidder’s very relatable Body Squabbles comic on anxiety
“But what’s worse is I can’t function or concentrate in seminars because my anxiety is so intense. I’m on the verge of a panic attack just sitting there, terrified that I’ll be asked to read aloud or discuss my opinion on something, that I will humiliate myself in front of the class. I try to avoid these classes, but now I’m more isolated and it’s starting to affect my grades.”
For others, it’s seemingly insignificant informal ‘meeting points’ such as cafés and restaurants that seem to present insurmountable hurdles to social life. Recognising that social relationships are fundamental to wellbeing, Denise tries to maintain contact with close friends but often finds trips out to meet friends more distressing than rewarding.
“There’s been a few occasions where I’ve been on the brink of tears meeting up with friends for coffee. I find those places completely overwhelming; standing in line waiting to order is the worst, you know, having people stand that close to me like they could probably smell the anxiety. I worry excessively about placing my order, how I’ll sound, making eye contact with the barista and finding a seat. It’s unbearable. My friends don’t give it a second thought, but for me it’s unbearable, like I’m completely incapable of ordering a damn coffee.”
Living with social anxiety is time-consuming and exhausting as people attempt to manage or limit social contact. Planning routines and rehearsing conversations becomes a big part of life; people mentally act out situations in an attempt to circumvent negative experiences.
Alex says, “It takes a lot for me to get out in the first place. Every day I set myself a to-do list. I spend hours planning, constantly rehearsing situations in my head, running through every possible scenario for hours and hours on end. It’s the only way I can get around, but it’s physically, mentally and emotionally exhausting.”
(Mis)Understanding Social Anxiety Disorder
Historically, social anxiety has been understood as an integral part of the human condition, manifesting as anguish, shyness, solitude and a fear of performance. NICE reports that up to 12 per cent of people may experience it over their lifetime.
Despite this, it is often under-recognised and under-treated. Although relieving the symptoms helps to alleviate distress in the short term, it is only one part of a complex whole. The lack of public knowledge about social anxiety creates social barriers and stigmatising attitudes towards experiences of mental and emotional distress. And there is still a significant lack of therapeutic support available.
SAD was categorised as a psychiatric condition in 1980. But some think it’s less a personal condition than a symptom of something wrong with society. For instance, psychoanalyst Karen Horney argues that our modern culture of competition, individualism and social hierarchies instinctively breed social hostility that, in turn, fuels social anxieties and isolation. By pathologising distress, she suggests, we risk neglecting the underlying social experiences that might be harmful.
Our everyday environments have a significant impact on our mental health, where the routine stresses of everyday life can induce and amplify feelings of anxiety and distress. The fundamental first steps towards breaking down the personal, social and systemic barriers that sustain social anxiety include understanding the social and cultural conditions that enable social anxiety to thrive; learning more about how people experience and manage their anxieties; and fostering therapeutic environments that create a sense of internal and external safety.
Putting the focus on environments in order to improve the experiences of people with social anxiety could enable us to enhance spaces for everyone.
Originally published by Wellcome Collection, 11.14.2018, under the terms of Creative Commons Attribution 4.0 International license.
