Social Anxiety Essays

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Here’s what I’ve tried: individual psychotherapy (three decades of it), family therapy, group therapy, cognitive-behavioral therapy, rational emotive behavior therapy, acceptance and commitment therapy, hypnosis, meditation, role-playing, interoceptive exposure therapy, in vivo exposure therapy, self-help workbooks, massage therapy, prayer, acupuncture, yoga, Stoic philosophy, and audiotapes I ordered off a late-night TV infomercial. “Given my history, I was brave to take the ipecac,” I wrote. But the whole experience was traumatic, and my general anxiety levels—and my phobia of vomiting—are more intense than they were before the exposure. She told me she’d had to cancel all her afternoon appointments on the day of the exposure—watching me gag and fight with the ipecac had evidently made her so nauseated that she spent the afternoon at home, throwing up.

Desipramine, another tricyclic, got me through my early 20s.

Or is it a philosophical problem, as Plato and Spinoza and the cognitive-behavioral therapists would have it?

Is it a psychological problem, a product of childhood trauma and sexual inhibition, as Freud and his acolytes once had it? Auden and David Riesman and Erich Fromm and Albert Camus and scores of modern commentators have declared—a cultural condition, a function of the times we live in and the structure of our society?

Sometimes this worry gets transmuted into low-grade physical discomfort—stomachaches, headaches, dizziness, pains in my arms and legs—or a general malaise, as though I have mononucleosis or the flu. Like a general monitoring the enemy’s advance, I keep a detailed mental map of recorded incidences of norovirus (the most common strain of stomach virus) and other forms of gastroenteritis, using the Internet to track outbreaks in the United States and around the world. For several years, in my mid-30s, I worked with a psychologist in Boston, Dr. gave me an article from an academic journal reporting on a clinical case of emetophobia successfully treated with this kind of exposure.“This is just a single case,” I said. And the only way to confront it is to throw up.”We had many versions of this conversation over the course of several months. Gently, reassuringly, she talked me through how the process would work. This increased my anxiety—because if they were worried, then I should really be scared, I thought. I worried that I might just keep dry heaving for hours or days. kept trying to convince me to take more ipecac, but by now I just wanted to avoid vomiting.

At various times, I have developed anxiety-induced difficulties breathing, swallowing, even walking; these difficulties then become obsessions, consuming all of my thinking. Such is the nature of my obsession that I can tell you at any given moment exactly which nursing homes in New Zealand, cruise ships in the Mediterranean, and elementary schools in Virginia are contending with outbreaks. M., who had a practice at one of the city’s academic medical centers. “It’s from 1979.”“There have been lots of others,” she said, and reminded me again of her colleague’s patient.“I can’t do it.”“You don’t have to do anything you don’t want to do,” Dr. She and the staff nurse would reserve a lab upstairs for my privacy and would be with me the whole time. had attached a pulse-and-oxygen-level monitor to my finger. Suddenly I was struck by heaving and I turned to the toilet. I knelt on the floor and waited, still hoping the event would come quickly and then be over. (On the other hand, at some level I wanted to pass out, even if that meant dying.) After about 40 minutes and several more bouts of retching, Dr. At some point, I switched from hoping that I would vomit quickly and be done with the ordeal to thinking that maybe I could fight the ipecac and simply wait for the nausea to wear off. I hadn’t retched for a while, so I was surprised to be stricken by another bout of violent heaving.Listen to the audio version of this article: Feature stories, read aloud: download the Audm app for your i Phone. Recent epidemiological data suggest that one in four of us can expect to be stricken by debilitating anxiety at some point in our lifetime.If the usual pattern has held, as I stand up here talking to you now, I’ve got some Xanax in one pocket (in case I felt the need to pop another one before being introduced) and a minibar-size bottle or two of vodka in the other. And it is debilitating: studies have compared the psychic and physical impairment tied to living with an anxiety disorder with the impairment tied to living with diabetes—both conditions are usually manageable, sometimes fatal, and always a pain to deal with.I also suffer from a number of specific fears and phobias, in addition to my public-speaking phobia. Once, when I was lamenting to my father that there is no central clearinghouse for information about norovirus outbreaks the way there is for influenza, my wife interjected. I had originally sought treatment for a number of phobias, but after several months of consultations, Dr. determined—as several other therapists, before and since, also have—that at the core of my other fears lay my fear of vomiting (for instance, I’m afraid of airplanes partly because I might get airsick), so she proposed we concentrate on that.“Makes sense to me,” I concurred. I’d eat something, take the ipecac, and vomit in short order (and I would survive just fine, she said). Having passed the point of no return, I felt my anxiety surge considerably. Still, I was hopeful that sickness would strike quickly and be over fast and that I would discover that the experience was not as bad as I’d feared. As we waited for the nausea to hit, she asked me to state my anxiety level on a scale of one to 10. The monitor on my finger felt like an encumbrance, so I took it off. I was exhausted, horribly nauseated, and utterly miserable. I could feel my stomach turning over, and I thought for sure that this time something would happen. I choked down some secondary waves, and then the nausea eased significantly. “Man, you have more control than anyone I’ve ever seen,” she said. interjected that this was clearly not the case—I’d taken the ipecac, for God’s sake.) Eventually—several hours had now elapsed since I’d ingested the ipecac—Nurse R.To name a few: enclosed spaces (claustrophobia); heights (acrophobia); fainting (asthenophobia); being trapped far from home (a species of agoraphobia); germs (bacillophobia); cheese (turophobia); flying (aerophobia); vomiting (emetophobia); and, naturally, vomiting while flying (aeronausiphobia). When I was a child and my mother was attending law school at night, I spent evenings at home with a babysitter, abjectly terrified that my parents had died in a car crash or had abandoned me (the clinical term for this is separation anxiety); by age 7 I had worn grooves in the carpet of my bedroom with my relentless pacing, trying to will my parents to come home. She explained that we would try to apply the principles of what’s known as exposure therapy toward extinguishing my emetophobia.“There’s only one way to do that properly,” she said. She explained that a colleague had just successfully treated an emetophobe by giving her ipecac syrup, which induces vomiting. Then we would work on “reframing my cognitions” about throwing up. showed me the lab and told me that taking ipecac was a standard form of exposure therapy; she said she’d helped preside over a number of exposures for now-erstwhile emetophobes. when, on an unseasonably warm Thursday in early December, I presented myself at her office for my regular appointment and said, “Okay. After a time, I heaved again, my diaphragm convulsing. explained that dry heaving precedes the main event. The nausea began coming in intense waves, crashing over me and then receding. During each bout of retching, I would begin perspiring profusely, and once the nausea passed, I would be dripping with sweat. In between bouts of retching, I lay on the bathroom tiles, shaking. This was the point when I began to feel hopeful that I would manage to escape the ordeal without throwing up. (At one point, she asked peevishly whether I was resisting because I wasn’t prepared to terminate therapy yet. left, saying she had never seen someone take ipecac and not vomit.Or is it a spiritual condition, as Søren Kierkegaard and his existentialist descendants claimed? The truth is that anxiety is at once a function of biology and philosophy, body and mind, instinct and reason, personality and culture.Even as anxiety is experienced at a spiritual and psychological level, it is scientifically measurable at the molecular level and the physiological level.I have been known to take a discreet last-second swig while walking onstage—because even as I’m still experiencing the anxiety that makes me want to drink more, my inhibition has been lowered, and my judgment impaired, by the liquor and benzodiazepines I’ve already consumed. In 2012, Americans filled nearly 50 million prescriptions for just one antianxiety drug: alprazolam, the generic name for Xanax.If I’ve managed to hit the sweet spot—that perfect combination of timing and dosage whereby the cognitive and psychomotor sedating effect of the drugs and alcohol balances out the physiological hyperarousal of the anxiety—then I’m probably doing okay up here: nervous but not miserable; a little fuzzy but still able to speak clearly; the anxiogenic effects of the situation (me, speaking in front of people) counteracted by the anxiolytic effects of what I’ve consumed. And anxiety, of course, extends far beyond the population of the officially mentally ill.In short, I have, since the age of about 2, been a twitchy bundle of phobias, fears, and neuroses. At the end of the account I composed at her request, which was accurate as far as it went, I masked the emotional reality of what I thought (which was that the exposure had been an abject disaster and that Nurse R.And I have, since the age of 10, when I was first taken to a mental hospital for evaluation and then referred to a psychiatrist for treatment, tried in various ways to overcome my anxiety. was a fatuous bitch) with an antiseptic clinical tone.

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