Social phobia… The best way to translate it into Turkish is probably “the fear of what others will say”. Like in any other psychiatric illness here too biological, psychological and sociological factors jointly play a role. Looking at the biological aspect, the sympathetic system that organises the transition into the “fight or flight” position discharges.
Palpitations, sweating, shivering, reddening of the face etc and increased distress due to these… At this point I remember a patient of mine. As he entered the room, before he even spoke, I asked in a know-it-all manner: “Social anxiety is it?” I wanted to show what a great doctor (!) I was. The poor man said: “Oh dear, is it that obvious?” and his whole face turned bright red all the way down to his neck. Obviously his complaint had now doubled. Considering that in such cases amphetamine was frequently used as a precaution it could be considered that the dopaminergic system played a role in the disorder. Also, the effect of SSRI group drugs indicates the place of serotonin. As a sociological factor, if in a society concerns about “what people will think” are particularly high, like for instance in our society, the illness will worsen. It is common in people who in their past have been belittled. Being programmed towards performance by the parents or an important acquaintance also produces a predisposition. It is a common disorder. In short I could say that a diseased society is sufficient to make the individual ill. Social structures that expect high levels of success from its citizens and that do not approve of everything, aim the gun at their own feet. For example, if we look at the entry exams of highschools and universities or civil servant recruitment exams, the individual is expected to achieve an almost full score; the bar is set at the ceiling. The worst is that those with high scores are spoken of as “geniuses” and those with slightly less success as “a bit dull”, aiming directly at the personality. In fact, in some societies even this is not enough, people are adjusted for the next world. It looks like it is in fact the society that needs treatment. It is necessary to take precautions against the feeling in society that it will be held accountable as a whole, and it should be reminded that somewhere in the last analysis it is the individual that will be brought to account. With regard to treatment, a critical approach to social expectations should be taught. We should notice that the individual is programmed towards performance and should show him a way to “hack” this programme that takes away his will power!