For social phobics, the simplest form of human contact can be terrifying. David Cohen reports
It all began at a formal dinner of Jonathan's firm. There had been the usual pre-meal chat over gin and tonic, then they sat down in their pre-allocated places and the main course was served. One of the company's star engineers, Jonathan, an ebullient Scotsman then aged 40, was familiar with the drill, but that night was different.

"I found myself becoming incredibly panicked about the people around me and what I was doing there," he recalls. "I started sweating, my hands trembled, my body shook, my heart was racing and I couldn't swallow my food. I was utterly confused. I was a very sociable person. I never had problems communicating with my colleagues before. But inside, I was exploding and something was saying: 'Don't look at me, don't talk to me, don't notice me, get me out of here now!' "

Jonathan thought it was a one-off. He had been the most junior executive at the dinner, and perhaps, without being conscious of it, he had felt pressure to impress his bosses. Anxiety in a social setting is something we all experience, he told himself.

"Afterwards, if my wife and I were invited out, I would be fine, but as soon as we got there, alarm bells would ring and I would have a panic attack," he says. "A couple of times I found it necessary to leap up and leave the room. It was totally irrational, but I felt people were looking at me. I started to dread people asking us out. Then I refused to go. My wife and I had words - she couldn't understand why I suddenly disliked seeing our friends.

"Things got worse. It was a severe strain to even go to the shops. After six months, it had become so chronic that I couldn't sit down and eat with my own family in my own home. Every formal meal or social situation triggered anxiety. I became reclusive. If I had to go out, I measured the distance from home. I felt so ashamed. For 10 years, I didn't say anything to anybody - explaining to my children that Daddy was unaccountably terrified of people was too much for me."

It was only when Jonathan's GP referred him to a psychiatrist that he first heard of a condition called social phobia. According to the Royal College of Psychiatrists, as much as 2 per cent of the population in the UK suffer from severe social phobia.

So what is it that triggers the functioning adult to revert to the shrinking shyness of a three-year-old? Is there a personality type that is most susceptible?

Gillian Butler, a consultant clinical psychologist at the Warneford Hospital, Oxford, who has treated dozens of social phobics, says social phobia is essentially a fear of being judged by other people and humiliated in public. "We all have that fear," he says. "It's a spectrum, which at one end shades into normal shyness and anxiety, but at the other becomes a phobia leading to avoidance behaviour and overtaking one's life.

"Sufferers may cease to be able to socialise or do everyday tasks like shop at the supermarket. They may actively avoid promotion and, depending on when it first strikes, may struggle to form intimate relationships. We don't really understand what triggers it, or whether introverted personality types are more prone. No neurological deficiency in sufferers has been found, but the onset of social phobia most commonly occurs in the late teens or early twenties - an age when people are finding their identity and most sensitive to criticism.

"There is an irrationality that sets in that causes sufferers to believe they are the centre of attention. Then at the precise moment they wish to crawl into the woodwork, their physical symptoms - of trembling, sweating, palpitating, dizziness - actually focus attention on them and make them more noticed.

"Furthermore, what they do to address the problem usually makes it worse. For example, one of my patients who worked in a typing pool blushed when she became socially phobic and used to put her hair and hand in front of her face. She was convinced that if she hid the blush, nobody would notice. But obviously, typing with one hand with your other hand over your face attracts more attention than blushing."

The acute pain for social phobics is that unlike reclusives, who choose to be solitary, they hate being alone. They desperately want to socialise, but it's as if they are allergic to people. Many take to the bottle to build their courage and some wind up alcoholic and depressed.

Bev Elvis, a 34-year-old divorced single mother from Bath, took to alcohol to "kill the anxiety" that simply taking and fetching her daughter from school entailed. "Most evenings, I found myself reaching for the lager to dull my fear," she says. "It didn't help. The next day, as I reached the edge of the playground, my knees would shake, my heart would pound, my neck would go rigid and my eyes would freeze. I was convinced that all the other mothers were staring at me. I always looked down at the ground; I never made eye contact and I never talked to anyone. I just stood in the corner trying to shrink, but feeling like a monster, like I was getting bigger and bigger until I filled the whole playground."

Bev spent most of her day crying and depressed. "I felt worthless - a waste of space," she says. "I cut my wrists. It was more of a cry for help than a serious attempt at suicide. I cut myself with razor blades while my daughter was at school one day. I didn't feel I was good enough to be alive."

It was at that low point that Bev's boyfriend, Paul, insisted she go to her GP for help. Bev thought her "depressed condition" was due to the triple trauma of having had an operation on her lung to eradicate a rare cancer, of losing her baby when four months pregnant and the breakdown of her marriage. Her GP prescribed anti-depressants as a short-term remedy, but felt her situation had gone beyond depression and put her in touch with Triumph over Phobia, the nationwide self-help group for phobics set up in 1987.

The group's approach is based on the system pioneered at the Maudsley Hospital in south London more than a decade ago. Simon Darnley, a cognitive behavioural psychotherapist, says the Maudsley treatment, known as exposure therapy, is a graded, step-by-step approach in which the sufferer learns to face their feared situation until their fear subsides to manageable proportions. "We start with a challenge that can be conquered and build it from there," he said. "Gradually, the sufferer begins to get some perspective on their thoughts and behaviour and on what other people might be thinking. It's about changing their habits and hardwiring in some new ones."

Joan Bond, a director of Top, claims that the success rate with this treatment is high and that most people are coping with their situations within six months. "But it is not a magic wand. People have to put a lot of effort into managing their phobias," she cautions.

For Bev Elvis, the challenge of going to a Top meeting where her most feared objects - human beings - would be present, was a daunting one. "The first time, I chickened out at the last moment," she recalls, "but my boyfriend bullied me into trying again. The next time, I arrived for the meeting 90 minutes early, then paced up and down the street outside debating whether to go in. As others began to arrive, I started sweating madly. There were 10 of us - it felt like a massive crowd.

"We sat in a circle and listened while people reported back what they had managed to achieve that week. I was amazed. There were people there who hadn't been out of their house for 30 years and were now able to catch buses. They had made contracts with themselves and were moving forward one step at a time. My first goal was to smile at people. I felt really stupid, but after a week of trying, it started to come more naturally. My next goal was to speak to one mum, any mum, in the playground. It was really difficult. What was I to say? I finally got out a 'good morning' and built up over weeks to a 'how's your daughter doing?' When I reported back, the people were so supportive - I felt like I'd won the jackpot."

Three years on, Bev holds down two jobs - one in a playgroup and one counselling the elderly. She has become friendly with other mums, and for the first time in her life, has a "best friend" with whom she socialises. "I still get anxious," she says, "but I have learnt to manage my anxiety and can handle more or less any social situation."

Jonathan, now 56 and retired from his engineering firm, also took on the Top challenge. He claims he has recovered, but is not cured. "I'm like someone whose leg was broken in a tackle," he says. "The memory of that awful company meal is a faultline that will forever run through my experience. Every time I enter a formal social situation, I feel the fear that struck me down that day, but the difference is I can let it go now - I can manage without having to run away and hide."

Triumph over Phobia can be contacted by writing to: TOP UK, PO Box 1831, Bath, BA1 3YX, preferably with a sae.

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