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Social Anxiety Disorder (first in a series ???)

This message is in response to several things:
 1) the thread about mental health issues and Guiding
 2) the Guider mentioned who did not want to attend a function where she was to receive an award
 3) my own interest in mental health issues and my position in Guiding as a Contemporary Issues trainer in the area of health

 I say "first in a series???" because I may post similar such "articles" about mental health issues in the future, if there is interest.  I would
 appreciate your response and feedback, as I hope to someday do training  sessions on similar topics.  Consider yourselves my "test audience".

 So, here we go... (disclaimer - I know nothing about the Guider mentioned who wouldn't attend to receive an award, this may not apply to
 her specifically in any way, but on the other hand may be at least part of the reason...)

 All too often in Guiding, we wonder about another Guider's actions (or inaction) ... why doesn't she want to receive this award?  why isn't she
 doing as good a job as she used to?  why doesn't she seem to care anymore?  Unfortunately, we usually never find out the real reason for
 our observations (not placing blame in any way, but who has time to talk in detail to every person who seems a bit "out of sorts"?)

 To take the first example given, there are stories about some Guiders who don't want to be recognized in public for what they do - they may go
 so far as to not attend functions if they think they are to receive an award.  We may think they are strange, or silly, and get quite
 frustrated with them.  In fact, they may have what is known as "Social Anxiety Disorder" (previously known as "social phobia").

 This disorder is marked by an extreme fear of showing anxiety to others in social situations, such as meeting new people or being scrutinized by
 others.  The person will try their very best to avoid such situations, for fear that they will become incredibly anxious (blushing, sweating,
 shaking, tense muscles, dry mouth, shaky voice, etc.) if they can't avoid them.

 You may say that someone like this is simply shy, but it goes beyond shyness, which is temporary.  It is estimated that up to 7% of Canadians
 may have social anxiety disorder, and that they may suffer for 15 -20 years before seeking any help.

 You may say that we all get anxious in certain situations in front of others - but people with social anxiety disorder may have difficulty
 writing/eating/working in front of others, expressing their opinions, joining an ongoing conversation, making a mistake, or even giving or
 receiving compliments (or, say, receiving an award from other Guiders).

 I don't suggest that you go up to such a Guider and say "I think you have social anxiety disorder and maybe you should see your doctor to get
 help" , as you may not have all the facts and something entirely different may be going on.  Perhaps, however, you could ask the Guider
 why she doesn't want to attend, or even better to ask "do you feel uncomfortable receiving an award in front of others; can we do this some
 other way that would be better for you?"

 There are treatments that work quite well for social anxiety disorder (talk therapy and/or medications), so if you or anyone you know thinks
 they might have this, they should see their family doctor.

*****
"those who call the shots
 are never in the line of fire
 why"  - Ani DiFranco
*****

Stress and Burnout (2nd of a series, it seems)

(NB I started this in May, saved the first part as a draft and only just now finished it)

 Stress and burnout have been mentioned often on the list of late, and seem to crop up at this time of year (April-June) in relation to our
 Guiding commitments.  In looking at the medical literature on this topic, most is about work stress, with some on life stress, and the
 question arises as to which category "Guiding stress" would fit into. Certainly, our Guiding commitments can probably be considered "work" in
 terms of the potential stressors encountered.  I wonder if perhaps Guiding can even create more stress than work in some situations (more
 later on this).

From a medical perspective, stress and burnout are not in themselves diagnoses, in that if a patient came to me for "stress" and required
 time off work, the term "stress" is not specific enough to put down on a employer's or short-term disability form.  Instead, one of the multitude
 of illnesses that appear to be related to stress would have to be listed.

 So, what exactly is stress then, if not a specific medical illness?  One definition calls it "... a condition in which there is a maladaptively
 high level of adrenergic arousal, which may be acute and/or chronic, resulting in a range of unpleasant physical, psychological and
 behavioural problems." (1)

 Hans Selye (a Canadian!) described the "general adaptation syndrome" in 1975 to explain what happens with persistent stress.  The first stage is
 the alarm reaction, in which any stressor triggers a "fight or flight" response in the body (the "adrenergic arousal" referred to above. (2)
 This response served primitive humans quite well when faced with a threat to survival, preparing the body to run from harm or fight with a
 predator. Unfortunately, we usually aren't facing the same sorts of stressors today, and when stress is prolonged our body moves on to the
 second and third stages of the general adaptation syndrome.

 The second stage is that of resistance, where people develop coping mechanisms to fight against the stress response.  Unfortunately, many
 are short-term measures (short absence from work, drinking, etc.) that don't deal with the real problem (the source of the stressors) and may
 in fact cause more problems by reducing performance levels. (2)

 The third stage, exhaustion, is reached when the demands are too high or are not being met appropriately (inadequate coping mechanisms). At
 this point, there can be both physical and emotional symptoms, such as headaches, digestive problems, more frequent viral illnesses,
 depression, and anxiety disorders (just to name a few). In addition, there can be impaired performance at "work", including difficulty
 concentrating, lateness/absenteeism, increasing mistakes or even accidents. (2)

 This third stage is also referred to as "burnout", and from the following description we can see how Guiding volunteers might
 be prone to this:  "Idealistic enthusiasm, conflicting roles, and extreme commitment are typical starting points for the development of
 this condition, in which mental and emotional exhaustion ultimately lead to apathy and revulsion against everything and everybody." (2)

 It may be difficult for people to admit to stress at work, or to do anything about it, because most people are financially dependent on
 their employer and may fear losing their job if they complain.  However, a volunteer commitment (like Guiding) is different - you may just quit
 and never return if you are frustrated enough.  In fact, when things are that stressful, there is likely even spousal/family encouragement to
 quit a volunteer position, unlike an employment situation.  And perhaps the idealism that can be involved with a volunteer commitment can even
 create more stress - lots of frustration can occur when reality intrudes on idealism.

 This brief overview was meant to help explain stress and burnout, so that we can recognize it when it occurs.  Obviously, prevention of
 burnout is the most desirable solution, by taking steps to deal with stress at an early stage (and there are lots of resources elsewhere
 dealing with stress management).  If at any time you are concerned that someone has crossed into the burnout or exhaustion stage, she should see
 a health-care professional immediately to rule out any serious consequences.

 1.  Hambly K and Muir AJ.  "Stress Management in Primary Care".
 Butterworth-Heinemann, Oxford, 1997

 2.  von Onciul J.  "ABC of Work Related Disorders: STRESS AT WORK", BMJ
 1996; 313: 745-748 (http://www.bmj.com/cgi/content/full/313/7059/745)

*****
"I don't know why the harder I try the harder I fall" - Blue Rodeo
*****
Personal Follow-up Also Posted July 10, 1999

 I have debated long and hard about whether to send a message I wrote about my own experience of Guiding burnout, and decided against it - as
 this is too public a forum for such a personal issue (but I did actually write it all out and it was quite "therapeutic").

 Instead, I just wanted to make two comments about my posting on stress and burnout:

 1) when researching this topic, the following sentence (quoted in the original message) really hit home for me -
 >   "Idealistic enthusiasm, conflicting roles, and extreme commitment are typical starting points for the development of this condition, in which mental and emotional exhaustion ultimately lead to apathy and revulsion against everything and everybody."
 (from the article by von Onciul in BMJ, full location in previous message)

 2) it has been nearly 8 months since I first thought that I might be "burning out".  My current feelings about Guiding are that of guilt, for
 all the things I thought I should have done but didn't/ couldn't.  I realize that this is quite irrational, but that's the way feelings are -
 you can't just explain or argue them away.  I'm not sure I'll be able to take a more active role in Guiding again until these feelings fade at
 least somewhat.  And, when I do, I hope to raise awareness of such mental health issues within Guiding (I've already started here on this
 list).

 YIGGGS,
 Jennifer

Depression

Jennifer Walker read "A Special Challenge" in the March issue of Blue-Print and wrote this letter to the editor.
Jennifer is a Family Physician in Edmonton, a Contemporary Issues Trainer and a member of Link.

I see people daily at work with the medical illness termed depression, and I also see a lot of the confusion, misunderstanding, and stigma surrounding it. The terms "depression" and "depressed" are commonly used to refer to feeling sad, but that is not only what this illness is about. And depression is most certainly an illness, not something that you can shake yourself out of "if you'd only try harder." There is a stigma around getting help for this illness, as if it is admitting to a weakness. I use diabetes as an analogy ? we would never dream of telling someone with diabetes, "You shouldn't need that insulin injection, what's the matter with you? Why can't you just not be diabetic?" Yet people with depression are often told by friends and relatives, "What's the matter with you? Why can't you just be happy?" Although generally well?intentioned, such comments often add to the guilt that is actually one of the symptoms of depression.

So if depression isn't just feeling sad, like we all do at times, what is it? There are various types of depression, but the symptoms of what is termed "major depression" are as follows: mood disturbance (sad or irritable); loss of interest in usual activities; sleep difficulties (too much or too little); feelings of guilt or worthlessness; fatigue or lack of energy; difficulty concentrating; change in appetite or weight; anxiety, agitation or feeling slowed down; and suicidal thoughts. If someone has at least five of these symptoms, most of the time, for at least two weeks, then they're depressed. If you know of someone who has these symptoms, they should see a doctor or other health care professional.

How does this relate to Guiding? Perhaps the Guider who used to plan all sorts of interesting activities for her unit, but doesn't anymore, actually can't find the energy to do it because she's depressed. Perhaps the girl who doesn't seem interested anymore, and is cranky and irritable at meetings, is actually depressed. When these girls or women drop out of Guiding, do we say "Oh well, she wasn't contributing anything anyway" or do we check that they're actually okay? If we're aware of the symptoms, perhaps we can encourage others to get help when it's needed, allowing them to remain as active Guiding members. I congratulate the Guider in the previous article for taking the time to help someone cope with depression.