Lessons From Social Anxiety

I think I have the world’s strangest form of anxiety disorder. I can stand in front of hundreds of people and speak without batting an eye. On a daily basis I have intense conversations about major life issues with patients from multiple different backgrounds without a tinge of nervousness. But if I am invited to a small social event or a dinner with people I do not know well I am a nervous wreck. I get sick to my stomach before the meal even begins.

I do not often show my nerves during the actual events and my wife is the only one who can tell that I am uncomfortable. I join in the conversations, tell stories and crack jokes, all the while wondering if I have said anything inappropriate or unknowingly offensive. I typically spend the drive home rehashing the evening, spending more time wondering what other people may have thought about something I said than I do on the actual events.

I found myself reflecting on my social anxiety after a recent church event. Everyone was kind and there was not a harsh word spoken yet my customary sense of inadequacy was waiting for me in the car ride home. As I thought about my feelings I wondered if others may have similar struggles. I wondered if anyone else present had been similarly anxious.   I thought of those who had declined their invitations and not come at all and wondered if some of those who were “unable to make it” were in truth “unable to deal with it.”

I realized that I had never considered the possibility that there might be others present with similar feelings and fears. As is often the case my anxiety limits my ability to consider and respond to the feelings of others. I have always assumed that I am the only one feeling inadequate in a given situation. As I reflected on the evening I gained a new understanding of the tendency for some people to form cliques, to migrate toward those they know well and to seem to wall off those with whom they are not familiar. Actions I have often considered to be selfish and inconsiderate might actually be about emotional safety.

I wonder if there might not be two social assumption traps into which we typically fall. The first trap is the assumption that no one is like us, the second trap the assumption that everyone is like us. I have fallen victim to the error of assuming that everyone in the room is comfortable except for me, that I am the only nervous person present. I wonder if others who are comfortable may wrongly assume that everyone is as comfortable as they are and also be oblivious to those who are struggling.

I wish I could sat that I have come up with a brilliant solution to the dilemma I have identified but I can’t. The only response that seems to be appropriate is grace. I need to be more gracious in my assumptions about what others are thinking. I need to choose to believe that people are not thinking negatively. On those occasions when others do think negatively, I need to be forgiving, realizing that they may be struggling in the same way I am. I need to be gracious to those who are quiet, gracious to those who talk too much, and gracious to those who I do not understand, for we are all alike in one important way- we are all imperfect, and we all have room to grow.

- Bart

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Love and an Irrational Fear of Alcohol

I have never had a drink. I have taken a few sips to see how something tasted but I have never downed a complete beverage. Alcohol wreaked havoc on my family so I have lived my life as if I was an alcoholic. I will not drink. I have a strong aversion to it and avoid it completely to the point of irrationality.

My wife learned about my irrationality early in our marriage. We had been married only a few months when she went to the wedding of a friend. I worked Saturdays at a market and was unable to attend so she went alone. When I came home late that evening she told me about the ceremony and reception. As a part of the story she mentioned having a glass of champagne for the toast. This bothered me terribly and I did not hide the fact well (I would never make it as a poker player, my face tells all).

She asked me what the problem was, it had only been a single glass of champagne. I told her that while there was nothing wrong with anyone drinking a glass of champagne, that the image of the woman I loved with a drink in her hand was terribly upsetting to me. I knew it was silly, but it really bothered me.

Lisa hasn’t had a drink since. Not because it is wrong for her to drink and definitely not because my argument was powerful and persuasive. She decided to never have a drink because she loves me. My revulsion to alcohol is irrational and extreme, but it is real and based on real hurt from my childhood. Alcohol is nothing more than a beverage to her and she gladly set it aside to ease my pain.

I thought of this story recently in counseling a patient. He is in the process of working a 12-step program after 30 years of an alcoholic life. He has fully embraced his recovery, going to counseling and hosting meetings for those he met in rehab. While he has been doing well with sobriety his relationship with his wife has struggled. One of the areas of conflict has been the coed nature of the meetings he hosts. His wife is not comfortable with him having friendships with women, even though he does not meet with them one on one.

“So don’t have friendships with women,” I interrupted. He defended the practice and explained that he was never alone with the women and that it was all centered around recovery. He told me he had invited his wife to the meetings so she could chaperone and see that there was nothing untoward going on, but she did not want to go. He could not understand why his wife was as bothered as she was. No explanation or protestation of innocence could sway her. He felt trapped, as he felt the meetings were important but wanted to respect his wife as well.

“Don’t have women at the meetings,” I said, “Make them men only.” I told him that his wife’s fears and concerns did not have to be rational to be respected. His wife had endured decades of his alcoholism and was no doubt deeply wounded. She did not owe him an explanation and did not need to defend her position. Instead of arguing with her, he should choose an act of love by telling her, “I understand,” and changing his meetings to men only.

I shared with him the story of my wife and the wedding champagne. I explained that while my request that she not drink was irrational and absurd, my wife honored it because she could. She loved me that much. My wife did not need to be persuaded by logic or convinced by argument. She needed only to understand my heart and my fears. After a little more conversation with the patient he decided that he would honor his wife’s request. He had been selfish in his drinking for years, he could now do this one thing for her.

As he left I thought of the incredible example of love my wife has been for the last 34 years. She has accommodated so much. Raised toilet seats, cupboards and drawers NEVER closed, as well as my fears, anger and anxieties. I thought of the hundreds of failed marriages I have seen over the years and how many times a marriage might have been saved if someone had let go of “being right” and simply given in out of love.

I went home that night and told my wife that she is wonderful and amazing. Because she is.

- Bart

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Love and Hate on Yelp

You can learn a lot by reading reviews on Yelp. While you can learn a little about the menu of a restaurant or the quality of service from a physician’s office, you can learn a lot about the person writing the review. You can learn a lot about our culture as well.

A physician colleague received a one-star review because the receptionist asked for a co-pay when a patient came in for a physical. The patient got angry, left the office and wrote the scathing review, calling the office “Dispicable.”

I received a one-star review from a patient who did not like the advice I gave. It may not have been brilliant, but it wasn’t like I told him to take poison or perform a coffee enema. Looking at one of his other reviews helped me understand. He also gave a one-star review to a strip club. Apparently he was upset at the “no touch” policy. For the first and only time in my life I have something in common with a strip club. In the eyes of this man we are both out of touch.

The Yelp page for a mechanic in town reveals something else about our society. We are a love it or hate it culture. His shop has 139 reviews, all but 7 of which are either 1 star or 5 star reviews. How can this be true? It can’t be. It is close to impossible that his service is always either terrific or terrible, the law of averages dictates that there should be occasions when he is just "okay." The reviews can't all be true. What is true is that we tend to publicly express our opinions in hyperbole, and that we are more concerned with persuading than we are with being completely accurate. When people post reviews it is not about informing a reader, it is about persuading others to join us in our love and hate.

Negative reviews reveal another dark aspect of our culture. We are often more concerned with ourselves than others, more concerned about avenging a perceived slight then we are at being understood. I read several one-star reviews written by people who had not actually utilized the business they were reviewing. A bad interaction with a receptionist, a missed appointment or dislike of a policy led a person to choose to leave the business. Even though their knowledge of the quality of the business was incomplete, they felt comfortable telling the world to stay away.

Perhaps the saddest observation is how disconnected we are. Most of the businesses reviewed on Yelp are small ones. Small businesses are not things, small businesses are people. People struggling to make a living and provide for their families, people who do not have business degrees or PR managers. Many small business owners are learning as they go. Scathing and spiteful reviews written over small misunderstandings reveal a culture in which people do not matter as much as things do. The lack of grace, the refusal to give the benefit of the doubt or to seek reconciliation, and the personal nature of many of the attacks is truly saddening.

Online reviews are here to stay and negative reviews are inevitable. As a businessman I understand that I have no control over what people say about me. Nevertheless I do have control over what I say about others. I can and will make it my goal to be truthful and  accurate in what I say, and as much as possible, to be kind, for my reviews say as much about me as they do about a business.

-          Bart

Wanted- Real Men

While my career plans changed often after I started college my main goal in life did not. For as long as I can remember I wanted to be a man. Not in the John Wayne, Arnold Schwarzenegger, action hero sense, but in the head of the household provide for your family, love your wife sense.

I was able to hang on to this goal through the years because it had meaning. It was clearly defined and easily understood. I knew that God desired all boys to become men and I knew what it meant to be a man in God’s eyes. I have spent my life pursuing this definition and the pursuit has led to success in the most important areas of my life, my roles of husband and father.

The definition of manhood was simple and straightforward to me 35 years ago. Times have changed and for many in our world the term now has so many meanings as to have no meaning at all. The result is a generation of young people who are rudderless and fatherless. It is not politically correct but I think it is time for real men to speak out about what true manhood is.

Real men love and live sacrificially, work to better themselves everyday and worry more about who they are instead of what they have.

Real men-

- Devote themselves to one woman, for a lifetime. I meet far to many males who go through life seeking casual relationships with as many women as they can find who are willing to service their sexual desires. Real men understand the importance of devotion.

- Are committed to their children. They realize being a father is the most important job they will ever do. They are willing to put parental success ahead of professional success.

- Practice self-control. They work to control their negative impulses. They set aside anger. They make home a safe place for their wives and children.

- Are men of faith. They submit to a higher authority. They live their lives according to the values defined by God. They live according to God’s moral code and not their own. They pass these values on to their children.

- Work for the long term security of their families. They deny themselves temporary pleasures and toys in order to save for the future.

- Make their own way in the world whenever possible. No job is beneath them and they do not look for a handout. They value work.

These characteristics of manliness are accessible and achievable by all men regardless of their background, ethnicity, education or status. They need not be defended, explained or justified, because they are true.

-Bart

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Boomerangs, Broken Windows and Responsibility

Australians lie. There is no purpose or task for which a boomerang is needed or helpful. From my experience they are nothing more than devices of destruction and mayhem. No matter how many times one reads "the instructions" they never come back when you throw them. Even if they did no finger-loving human would want to catch one in flight. The only possible use of boomerangs is as a tool for lessons in personal responsibility. 

Case in point: When my son was about 7 years old one of the boys in the neighborhood had a boomerang. Nate was playing at their house and asked if he could throw it. He had a pretty strong arm for a little boy and he gave it quite a heave. It was traveling pretty fast when it struck the window of their garage. It is basic law of physics that when an irresistible force strikes an immovable object that the boomerang wins. There was glass everywhere. It was time to buy a new window.

I was across the street when it happened and hurried over to survey the damage. I told the neighbor that we would pay for the window. He initially refused but I insisted. I turned to my son and asked him how much money he had in his piggy bank. "Nine dollars" was his hesitant reply. I told him he would be contributing that amount to the repair of the window and tears welled up in his little eyes, "But it was an accident!" 

I explained that even when we accidentally break something or do harm, something is still harmed or broken and someone will need to fix it. The window had to be replaced, that would cost money, and because the damage came from him he was responsible to for it.  We have to take responsibility for the consequences of our own actions even when they are unintentional. This wasn't punishment, it was just the way life worked. We went home and retrieved his life savings and I added the remainder. The neighbor graciously did the repair himself. 

Reflecting back on the story I am reminded that personal responsibility is a lost value. People are often quick to apologize but very slow to make amends. It seems no one wants to be held accountable for their mistakes. I see this all the time. Just this week we received a bill from a medical office. We were surprised because we had been asked to "pay in full" at the time of service had done so. The collections agent explained that they had made a mistake and "forgotten" to charge us for a portion of the services. My response that "payment in full" typically means you have "paid in full" and that we should therefore not have to pay for their mistake fell on deaf and uncaring ears. 

I have made similar billing mistakes in my practice but my worldview is different from that of the other medical office. In every circumstance I bear the expense of our mistakes. Both me and my son can attest that accepting responsibility is costly. Apologies are not. Here's hoping for a resurgence of responsibility in the world.

- Bart

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