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Mental Health And Social Success

There are probably two main types of people who read a site like this. The first group wants to improve socially, and they may have quite a few problems, but they're more or less mentally healthy. The second group has some sort of mental health issue holding them back. In this article I'll talk about some of the main ones that hinder people's social success. Obviously this will be more a summary of information from other sources rather than another helping of my homespun advice.

Every so often I'll get an email saying, "Your site's advice is all well and good, but I don't think it will work for me. I have bad (mental health issue)." My answer is that my writing may not be of much use to them. I mean everything on this site assumes you have a minimum level of motivation and psychological togetherness. Some people's mental health problems may trump any ability they have to implement some suggestions they read on the internet. Those issues may need to be taken care of first. I mean you can hardly start trying to make friends if you can barely even go to a job without trembling and dry heaving for hours beforehand out of pure anxiety.

Self-help has its limits. For some people it's not as simple as them just 'snapping out of it' and 'using a little willpower'. They can't just pull together a bunch of inspiring books and web sites and cook up some One-Year Plan to single-handedly fix their lives. Their not being able to do this doesn't mean they're failures. It just means they're sunk in too deep to go it alone. They may need to see a therapist or try some medication to get more of a handle on things. When enough air has been taken out of their problems, they may be able to start using more self-help type advice.

Preamble to the list

Below is a list of some mental health issues people who have social problems may struggle with. I used my own judgment in putting it together so it's hardly authoritative. Still, I'm not totally unfamiliar with the field of psychology. Also, I could only include so much under each heading, so if you'd like more info, feel free to search around on your own. This site's Resource Links has some stuff that can get you started.

The descriptions come from two main sources, the Diagnostic and Statistical Manual, 4th Edition (DSM-IV), and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). The DSM-IV is published by the American Psychiatric Association. The ICD-10 is based on classifications from the World Health Organization.

The DSM-IV is a widely used handbook for mental health professionals that lists different mental disorders and the criteria for diagnosing them. A cliche is to refer to it as the 'bible' for diagnosing psychological conditions. If you've taken a Psych class you've probably heard all about it.

The ICD-10 covers all types of diseases, but has a section devoted to mental and behavioral disorders as well. I believe it's used more outside of North America. The criteria for certain disorders may differ somewhat between the two. For either of these resources, the criteria aren't considered perfect, just the best we have at the moment. Future editions hope to improve on them.

If you have one of these conditions, you probably already know all about it. If not, this may make for some interesting reading. I'd caution anyone not to try and diagnose themselves or anyone else just based on reading some descriptions. A qualified professional has to make that call. Also, you may notice you have some traits of certain disorders, but that's a far cry from being officially diagnosable.

Here they are. I'd recommend reading the excerpts as they can contain little gems about the conditions. I haven't edited them though so you may want to have a dictionary handy for some of the obscure words. Maybe Wikipedia as well to look up any terms you're unfamiliar with (both links open in a new window).

Conditions that directly impact social results

In my judgment, the following four mental health conditions are most directly related to socializing. The effects on the social lives of the people who have them can be quite devastating. Strong problems with any of them can lead to:

• Difficulty in making and keeping friends, making enough friends, or having any friends at all.
• Difficulty in forming romantic relationships. The worst-off may be involuntarily celibate or unwilling lifelong virgins.
• Social isolation, including becoming totally housebound.
• Other mental health problems such as depression and substance abuse as an understandable secondary effect.
• Significant interference in living a normal, fulfilling life (e.g., being chronically unemployed or underemployed).

Actually, the last of the four is a special case...

Social Phobia / Social Anxiety Disorder

Social Phobia, also commonly known as Social Anxiety Disorder probably wins the award for the condition that has the worst impact on people's interpersonal success. It sucks because not only do you get all the insecurities of being shy, but you're also held back by the often physically intolerable symptoms of being anxious, the worst of which is having a Panic Attack. It's not just that you're worried what people think of you, those thoughts also make you feel like you're going to throw up before, say, attending a party, and if you manage to make it there, that everyone will notice how on edge you are and judge you negatively for it.

The anxiety may apply to most social situations, or only occur in certain scenarios. Here are some other common problems, either not covered in the criteria above, or highlighted again:

Self-consciousness, fear of being judged negatively, fear of rejection

Poor self-esteem/self-confidence/self-image

Cognitive distortions

Under developed social skills due to a history of avoiding social situations

Anxiety directly hinders social skills, e.g., causes you to stumble over your words, blurt out odd statements, or clam up.

Unhappiness, negativity, bitterness towards life in general or the specific things socially anxious people fear (understandable if you've had this condition for a long time)

Substance abuse to self-medicate anxious feelings

Specific fears: public speaking, eating or writing in front of others, using a urinal in front of others, calling someone on a telephone, answering a telephone

Really bad anxious feelings are not something someone can just snap themselves out of. A person with Social Phobia knows they shouldn't be as anxious as they are, but they can't help it. The physical feelings of nervousness can be very uncomfortable and are often too overpowering for someone to 'suck it up'.

Avoidant Personality Disorder

The first Personality Disorder I'll talk about. I won't get into it too much, but the whole idea of Personality Disorders is somewhat controversial. For one, where do you draw the line between just having a messed up personality and having an official disorder? Also, is it correct to label some personality traits, or even whole personalities themselves, as 'disordered'?

As the name implies, people with this disorder avoids others for certain reasons. Avoidant Personality Disorder basically describes a highly insecure, inhibited, self-conscious person who is preoccupied with other people viewing them negatively. You could think of it as an official label that sums up a kind of extreme shyness. It's closely related to Social Phobia as you can probably tell.

Many people have aspects of an Avoidant Personality Style, even though they would never be diagnosed with a disorder. Loosely, an Avoidant style is characterized by being reserved, preferring the familiar to the unknown, and being somewhat worried about how others see you. Avoidant Personality Disorder takes these more common, human traits to a life-hindering extreme.

Asperger's Syndrome

Asperger's Syndrome is an Autism Spectrum Disorder. Some clinicians don't consider it to be a unique disorder and instead see it as a kind of high-functioning Autism. It's interesting because it involves being born with a set of disadvantages in relating to people that cause most others to perceive you as having poor social skills. Asperger's has three main features: social difficulties, narrow and consuming interests, and peculiarities in speech and movement. I'll describe the social problems and leave you to look up the other stuff if you're curious.

Here are some social impairments 'aspies' may experience:

• In summary, they don't 'get' socializing on the instinctive level that typical people do. It doesn't come naturally to them. If they do learn social skills, they teach themselves what works and what doesn't in a more systematic, unemotional, abstract way.
• For various reasons, they have trouble empathizing with other people and figuring out what they're feeling and thinking. They also have problems interpreting their own emotions. These problems have been called 'mind blindedness' and alexithymia. This may cause them to inadvertently step on people's toes (e.g., being rude or insensitive without realizing it) or to not take certain positive actions (e.g., apologizing, making someone feel better).
• They have trouble reading other people's non-verbal communication (e.g., detecting the sarcasm in a statement, recognizing that other people are bored or annoyed with them).
• Having poor non-verbal communication themselves. This can include the aforementioned speech or movement peculiarities, such as talking in a flat or overly formal manner, interpreting things too literally, or pausing too long before speaking. Poor use of eye contact or body language is another problem.
• Generally coming across as unemotional, detached, and 'not quite there'.
• A tendency to speak too bluntly and honestly for most people's liking. This can include correcting people's mistakes when it's not appropriate to do so.
• Not being able to appreciate the value of certain things, like humor, small talk, manners and etiquette, or personal grooming and fashion.
• Insecurity and self-consciousness once they realize their people skills are below par.
• Any negative reactions their traits may draw to them and the social consequences of such. As a whole, they can come across as weird, uptight, or awkward.

People with Asperger's have a unique set of difficulties to overcome. Anything you do is to help them function better in the world, not to cure them. Regarding their interpersonal skills, social skills training may be prescribed to teach them how to more effectively act around others. Speech therapy may also aid them in having conversations. Some forms of therapy may be used to help them cut down on their obsessive interests.

Although it can cause some very bad social problems, on the whole Asperger's is more of a different way of being wired rather than a real 'disorder' that needs to be fixed. Their unique nature may give them advantages in other areas and allow them to accomplish and contribute quite a lot. Also, some people with Asperger's may decide they don't care all that much about being ineffective with people, and that they prefer to devote their time to their interests. That's an issue the next conditions gets at as well:

Schizoid Personality Disorder

This one is interesting because while people who meet its criteria technically experience an almost complete lack of interpersonal relationships, this isn't a source of distress for them, unlike with sufferers of some other conditions. The two main facets of this 'disorder' are being a loner with very little interest in other people, and having blunted emotions.

Schizoids generally aren't concerned by their solitary, non-social nature, so the issue arises as to whether they should just be left alone to live life as they want, even though others may see them as unhealthy. Or are they objectively disordered, even though they don't care about their 'symptoms' themselves, and other people should try to help them? Should a lack of interest in socializing be considered a problem in-and-of itself? To what degree should they be encouraged to change? Who has the right to decide what's in their best interests?

Actually, there's some question as to whether Schizoids truly aren't interested in other people, or if deep down they do desire relationships. Views on this disorder continue to evolve.

Other disorders with a less direct, though still powerful, impact on socializing

Really, any mental health issue can impact your social success. They can directly cause you to take socially counter-productive actions. For any psychological disorder you can think of, it probably has symptoms that are off-putting and drive other people away. They can also indirectly affect your social behaviors down the road by isolating you - and causing you to miss chances to practice for the future - or by putting you on a life path where you can't help but acquire poor interpersonal skills later on. I can't list everything, so here are some of the biggies:

Depression

This comes in many forms. There are more mild varieties. There's Major Depression, or clinical depression, which is much more crippling. Dysthymia is a years-long mild depression which some people describe as living life with the colors turned down. Bipolar disorder, formally known as Manic Depression, involves alternating periods of depression and mania. It's also not uncommon for depression to lurk in the background while other problems such as anxiety, anger, substance abuse, or self-destructiveness seem to be the main issue.

Socially, depression can lead to: Poor self-confidence, negativity and pessimism ("seeing the world through dark-tinted glasses", which is especially bad if spoken out loud), a loss of interest in activities that used to lead to socializing, a lack of interest in socializing itself, self-imposed isolation, cognitive distortions, being mopey and down-in-the-dumps to the point where you push people away, being irritable, moody, and touchy, and feeling like other people don't like you or are out to get you.

Anxiety

Like I said, this often goes hand-in-hand with depression. Generalized Anxiety Disorder involves excessive, uncontrollable and often irrational worrying about everyday things. Agoraphobia is often thought of as a fear of open or crowded spaces, but it's really more about someone fearing and avoiding situations in the outside world where they're worried they'll experience unpleasant anxious symptoms, usually a panic attack. Feared scenarios often involve being 'trapped' in the event that nervous symptoms occur. When someone becomes scared of feeling nervous under enough different circumstances, they're effectively afraid of leaving their home.

Like depression, anxiety can also manifest in strange ways. For example, Obsessive-Compulsive Disorder involves carrying out repetitive rituals to temporarily calm anxious feelings that appear in the form of irrational worries.

A person may not be scared of socializing itself, but be held back because they're anxious about other things like riding in a car, or eating in a restaurant. They may also feel too distracted, overwhelmed, and messed up to feel like socializing.

Personality Disorders

There are a bunch of these. They all involve long-standing, consistent patterns of behavior that are maladaptive and generally annoying to normal people. Many of them have false beliefs at their core (e.g., someone with Narcissistic Personality Disorder believes they're superior to others). I'll leave it to you to look them up if you want.

Disorders somewhat more relevant to younger kids

The two I'm thinking of are Attention Deficit / Hyperactivity Disorder (ADHD - it used to be called ADD) and the various learning disabilities. These two aren't so much direct mental health issues as differences in how the brain is wired. However, indirectly, ADHD and learning disabilities can lead to various social, academic, and mental health problems. Males are predominantly affected. They can affect social skills by:

• Harming a child's confidence and self-esteem.
• Causing them to 'externalize' and act out, and come across as annoying or disruptive to their peers.
• Causing them to internalize their feelings and become depressed, anxious, or withdrawn.
• Disrupt their ability to learn and interpret social cues and rules.
• Cause them to fall into a crowd that will teach them less-than-ideal social skills.

In the last ten years or so the idea of Non-Verbal Learning Disabilities has appeared. The profile of a child with this condition is very similar to someone with Asperger's Syndrome, to the point where the two are sometimes confused. Their cognitive weaknesses are more defined and specific, while kid's with Asperger's are all over the map.

Non-disorders that can hold you back in a similar way

Some people may not have a diagnosable condition but have severe enough problems in certain areas that they suffer in a similar way. They may have:

• Extremely poor self-confidence
• Extremely poor self-image
• Extreme bitterness
• Extreme negativity
• Extremely low trust in other people
• General issues stemming from a single traumatic experience
• General issues from experiencing a very poor past and upbringing
• Bits and pieces of several disorders, but not enough of any one to get a diagnosis, that are strong enough combined to screw up their lives.

I think if someone fits any of these descriptions, they probably need to address that problem first, otherwise many attempts to improve their social skills will be sabotaged.

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