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Mental Health Matters Journal for Psychiatrists & GP's

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Literacy is a luxury that many of us take for granted.  We depend on written communication for information, guidance, and access to heath care information That is why SADAG created SPEAKING BOOKS and revolutionized the way information is delivered to low literacy communities. It's exactly what it sounds like.a book that talks to the reader in his or her local  language, delivering critical information in an interactive, and educational way.

The customizable 16-page book, accompanied by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood..

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 30 titles, such as TB, Malaria, Polio, Vaccines for over 30 countries.

suicide speaking book


Imagine never being able to sign a cheque in public without shaking, dreading speaking to people on the phone, making excuses so that you never have to attend parties and social gatherings, having to prepare yourself weeks in advance in order to attend your children’s school functions, and even finding it difficult to visit with your closest friends. All because you are scared you will embarrass yourself. These are just a few of the consequences that some social phobics have to endure every day.

The facts about social phobia are scary in themselves – it affects one in ten people; fewer than 25% of social phobics will ever receive adequate treatment and 50% of social phobics will also suffer from depression. “Social phobia is the second most common anxiety disorder,” says Johannesburg psychiatrist, Dr Wynchank. “Sufferers are preoccupied with appearing in public because they are afraid of humiliating themselves in front of others”.

But what is it really like to live with this silent fear constantly in your life? And what kind of devastating impact does it have on your overall functioning?

The work environment is one sphere in which social phobics can have great difficulties. “In most cases, social phobics will underachieve in work and never fulfill their full potential because of the limitations of their disorder,” says Dr Wynchank. Often, for example, social phobics will turn down promotions because they involve added duties such as public speaking.

Peter is a prominent medical professional in his fifties. Few of his patients would believe the kind of trauma Peter goes through every time he has to speak to a stranger on the phone. “I try and avoid it at all costs, “says Peter. “It can be very time consuming because I will often rather visit people than talk to them on the phone. It affects my work greatly.”

Sally, another sufferer, has an all-consuming fear of writing in public. Her last job, which involved writing in front of others, caused her great stress. “It was a constant worry, “she says.

Family relations are also put under a lot of strain when one member is suffering from social phobia. “I feel very dependent on my husband in some circumstances,” says Sally. “For example, I have had to appoint him as a trustee of all my accounts, and I have to take him with me whenever I go shopping so he can sign all the slips”. Maxine, a middle-aged housewife suffering from social phobia, finds that the disorder affects her relations with her children. “I like to watch my daughter do ballet, but I have to prepare myself for it days in advance. I even worry about driving to the rehearsal because I’m worried about having an accident. Sometimes I have to make excuses not to go.”

Finally, of course, social phobia affects how sufferers interact in social situations. Rachel finds any kind of socialising extremely stressful. “I can get very nervous and develop terrible headaches if I have to talk to people outside my immediate family,” she says.

Social phobia can be generalised – where the fears involve almost all social contacts – or non-generalised – where the fears are related to specific social activities or performance situations. Carol’s social phobia has got to such extreme proportions that it has affected every sphere of her life. Carol never leaves her house: “The only way I communicate with people now is over the internet,” she says. “This disorder has made my life so small – I feel like I have missed out on so much in life. My husband has to go to social functions by himself and makes excuses for me. I have also kept my disorder a secret from my family and friends because I am so embarrassed about it”.

The good news is that, if diagnosed correctly, social phobia is a highly treatable illness. Treatment for social phobia includes medication, psychotherapy and self-help methods.

Anti-depressant medication can be very effective at relieving anxiety symptoms. This type of medication works by restoring the underlying chemical imbalance in the brain. Today there are more medications available in this field than ever before, so if one drug is not successful there are always others to try.

There are a variety of therapeutic modes that can help with treating social phobia, including interpersonal and cognitive-behavioural therapy. In cognitive-behavioural therapy, therapists aim to reduce social fears and improve social skills in their socially phobic clients. Cognitive interventions which challenge irrational thoughts and faulty assumptions, role paying with candid feedback and social skills training are all effective techniques that are used. Patients also learn how to master relaxation techniques, such as visualisation, meditation and deep breathing.

It is vital that social phobics are educated about their illness and lifestyle changes that they should maintain as a result. Sufferers can empower themselves by joining support groups that provide a sense of acceptance and understanding. At the moment there is a very successful social phobia support group functioning in Pretoria under the leadership of two prominent psychiatrists.

“Social phobia affected every aspect of my life,” says Rachel. “The hardest was that you lose people you love and care about because of your fears. But by getting help from the Support Group in Pretoria, my life is beginning to return to normal”.


1. Using a telephone in public

2. Participating in a small group activity

3. Eating in public

4. Drinking in public

5. Talking to someone in authority

6. Going to a party

7. Writing while being observed

8. Talking face to face with someone you don’t know very well

9. Meeting strangers

10. Urinating in a public bathroom

11. Entering a room when others are already seated

12. Being the center of attention

13. Looking “straight in the eyes” of someone you don’t know very well

14. Giving a prepared oral report to a group

15. Returning goods or merchandise to a store to obtain a refund

16. Resisting a high pressure sales person.

If some of these situations worry you, talk to your doctor. Answering these questions and discussing them with your doctor can help determine if you suffer from social anxiety disorder.

Source: Adopted from Liebowitz Social Phobia Scale DSM - IV

With grateful acknowledgement to the following sources for information:

Pocket reference to Social Phobia (1995) – produced by the WPA Social Phobia Task Force under an educational grant from Roche, editor: S A Montgomery


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