Overcoming Social Anxiety and Career Uncertainty: A Journey to Self-Discovery - Psychiatry

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Social anxiety and unemployment with no clear future?


I have been very introverted since childhood and have never dared to initiate conversations with others.
Throughout my school years, my teachers consistently commented that I was not good at expressing myself.
More than one teacher has told me that I needed to change my introverted nature.
There were times when I was called on to answer questions in class, and even though I knew the answers, I was too nervous to speak up.
During presentations, I would forget my lines, regardless of how hard I practiced beforehand.
As I grew older, I realized that I fit many symptoms of social anxiety disorder, such as feeling anxious while checking out when shopping, being afraid to make phone calls for appointments, and waiting for others to leave before I would use a public restroom.
I am the eldest child in my family, and while my parents appeared open-minded, they were actually very strict.
They always hoped I would be a role model for my younger brother.
Because of my introversion, I felt very insecure, and studying was the only area where I could find a sense of achievement.
I was once ostracized at school for being too introverted, but it never escalated to physical bullying.
I discovered that having good grades attracted friends.
My mother worked long hours, and my grandmother took care of me when I was young.
When I wrote Mother's Day cards for my mom, she would say that what I wrote was not true and would throw the cards away.
After that, I lost the desire to write cards for her and only wanted to write to my grandmother.
After my grandmother passed away, I stopped celebrating Mother's Day altogether.
When I was preparing for high school, my grades allowed me to apply to a school that was my first choice, but it was far from home, requiring a two-hour commute.
My mother wanted me to attend, but after I was accepted, she often felt too lazy to drive me to the station.
Waking her up in the morning took a long time, and when I called her after school to ask for a ride home, she would often be impatient.
In college, I was unsure of what to study, so my father decided for me to major in Information Management.
The school I got into required a four-hour round trip.
I wanted to live outside, but my parents refused and scolded me.
After many arguments, my father eventually allowed me to move out, but he chose the apartment and restricted me from riding a scooter or working, insisting that I focus on my studies.
Later, I was accepted into graduate school, and I lived with relatives during my studies and after graduation.
They also did not allow me to ride a scooter.
I was unhappy living with them because they did not do much housework, and the place was often dirty, which made me frequently allergic.
I felt uncomfortable expressing my feelings to them, and moving out was too expensive, which my parents also opposed.
At that time, I worked as a programmer.
When I first graduated and started looking for jobs, I often experienced migraines.
During my work, I frequently suffered from migraines, high eye pressure, palpitations, hair loss, and significant weight gain.
I underwent many tests, but doctors said my health was fine.
I was actively exercising, but it did not help.
I often faced bottlenecks at work and struggled to communicate with colleagues, ultimately leading me to quit.
In hindsight, I realized that I did not enjoy my major or my job; I was merely trying to meet my parents' expectations and societal standards.
Later, my parents asked me to move back home while I tried to find another job, but I had no interview opportunities because my qualifications were too high, and no one wanted to hire me.
I frequently experienced insomnia and visited a psychiatrist, who diagnosed me with mild depression.
When I sought help from my parents, they dismissed my concerns, claiming I was not sick and that the doctor was unprofessional.
Each time I reached out for help, they denied my issues and refused to confront them, often scolding me and saying that they had gone through similar experiences, so why couldn't I? They believed they had treated me well, and that being too good to children led to complaints.
They constantly "educated" me about filial piety and being a role model for my brother.
I was shocked to realize that my obedience throughout my life had led to such a result; I had been so compliant that I did not even know who I was, and I received this kind of response in return.
I did not want to be a role model for my brother; I just wanted to be myself, but I did not even know who I was.
They told me that I needed to make my own life decisions while simultaneously controlling my life.
How could they be so contradictory to this extent?
At that time, I felt that the consultations I had were rushed, with the doctor asking me a few questions as if they were in a hurry.
I felt very anxious and nervous during these sessions.
After two visits, I stopped going.
I knew that in society, people with professional skills are often more accepted even if their communication skills are lacking.
However, when I realized that my professional skills were insufficient and that no amount of effort could change that, I felt like my world was collapsing.
I could not even manage the most basic part-time job and was only good at studying, particularly in the humanities.
Afterward, I stayed home to prepare for civil service exams.
Now, I have been preparing for over two years and am currently working with my mother as her business assistant.
I feel that I am not suited for sales; I am just learning the basics of workplace interpersonal relationships because I do not understand even the most fundamental aspects.
My mother says I am like a child and claims that if it weren't for her help, I would be useless.
I often feel that my parents do not understand me, and we sometimes argue.
When I tell them this, they respond, "Why should I understand you?" At times, I feel an urge to attack them, but I never actually do.
Every time I see news about highly educated individuals committing suicide or children attacking their parents, I feel deep sympathy for them because I know they are not part of the "strawberry generation" or ungrateful; they are often more obedient and understanding than average people.
They have sacrificed a lot, but no one understands.
I do not want to become like them one day, but I do not know what job I can do.
I look at vocational training programs but feel that none suit me.
It seems that apart from studying, I am good for nothing.
I want to step out but do not know which direction to take.
I have no idea what I like, and I want to be understood but fear crowds, often falling into this self-contradiction.
I have left messages on the Lifeline's website more than once but received no response.
I later discovered that many people's messages also went unanswered, which made me very angry.
They are not professional doctors but volunteers.
I mustered the courage to open up to them, and if they cannot solve my problems, why do they accept requests for help and then ignore them? Isn't that similar to a manipulative partner deceiving someone emotionally? Is there room for improvement in social assistance services?
Due to my previous unpleasant experiences seeking help, I am very afraid to ask for help again.
However, I realize that if I do not seek help, my life is heading toward a dead end.
But I do not know if social anxiety can truly be cured.
When I see a doctor, I get nervous and cannot speak; I only dare to say that I have insomnia.
I do not know if they can help me find a job.
Are there such services? Moreover, since I am not earning money, if I need medical treatment, I can only ask my parents for help.
My previous experiences with psychiatrists were very brief, and they just prescribed me tranquilizers.
Is it necessary to undergo psychological counseling for it to be more effective? I do not know how to talk to my parents about this.
Is there any way to persuade them? Or are there recommended books or other self-help methods? I feel like I have too many problems.
Thank you for patiently reading my concerns.

Mei, 20~29 year old female. Ask Date: 2018/07/19

Dr. Wu Enliang reply Psychiatry


Hello, Nobody.
Thank you for taking the time to write.
You have truly faced many hardships over the years, and your situation is indeed very challenging.
I will address your questions one by one:
(1) Due to previous unpleasant experiences seeking help, I am actually very afraid to ask for help again.
However, I realize that if I don’t seek help, my life is heading towards a dead end.
I wonder if social anxiety can really be cured? Social phobia is a common anxiety disorder characterized by the following features:
- Fear of being observed in a group setting is a primary symptom, leading to discomfort from imagining others judging them and worrying about poor social skills affecting interactions.
- Sometimes, the anxiety is specific to public speaking, writing, eating, using the restroom, or interacting with the opposite sex.
- In certain groups or cultures, making eye contact can be a significant source of social pressure.
- Clinically, patients often monitor their performance in specific or general social situations, being overly concerned about how others perceive them, including their body language, facial expressions, and verbal communication.
- This is often related to low self-esteem and fear of criticism, manifesting as blushing, trembling, nausea, difficulty speaking, frequent urination, and urgency.
- In severe cases, it can escalate to panic levels.
- It typically begins in childhood or adolescence.
- It is often comorbid with avoidant personality disorder.
- Symptoms can fluctuate, and patients may sometimes mask their condition.
- The comorbidity rate is as high as 75%.
- It is also commonly associated with substance abuse/dependence.
- Additionally, it often co-occurs with agoraphobia, major depressive disorder, and alcohol dependence.

Medication treatment includes beta-blockers and anxiolytics as well as antidepressants, with the first two targeting symptom relief.
Cognitive-behavioral therapy (especially assertiveness training) and social skills training are necessary and effective treatments.
With appropriate treatment, social anxiety disorder can be cured.
(2) When I see a doctor, I get so nervous that I can’t speak and only dare to say that I have insomnia.
I suggest making notes of what you want to express before the appointment, similar to having a cheat sheet before a presentation, which can help you feel more secure and ensure you don’t forget anything.
You might also consider bringing a trusted person with you to alleviate anxiety.
(3) I’m not sure if there’s any service that can help me find a job.
Have you visited an employment service center? They have a lot of job information available.
Additionally, psychiatric hospitals typically have occupational therapists and employment specialists who can help objectively analyze suitable job options and provide career guidance.
(4) My previous experiences with psychiatrists were very brief, and they just prescribed me sedatives.
Is it necessary to undergo psychological counseling for it to be more effective? I would recommend checking your area for more patient doctors who will listen to you.
If you feel comfortable, please let me know your location, and I might suggest a place for you to seek treatment.
Yes, the combination of medication and psychotherapy yields the best results.
(5) Moreover, since I’m not earning money now, I can only tell my parents about seeking medical help and ask them to assist me.
I don’t know how to approach this conversation.
Is there any way to persuade them? Or do you have any recommended books or other self-help methods? Parents’ views often do not change easily.
I believe there’s no need to specifically persuade them or discuss it with them; you are already an adult and should be able to manage your own affairs and take care of yourself.
Under the National Health Insurance in Taiwan, medical expenses are not very high.
If you are facing financial difficulties, you might avoid going to a medical center and instead visit a clinic, which typically costs only 150 or 200 TWD, so you likely won’t need your parents' financial support.
Additionally, many counties and cities in Taiwan have "Community Mental Health Centers" that offer free psychological treatment, which you can also utilize.
Wishing you a speedy recovery.

Dr.
Wu Enliang

Reply Date: 2018/07/19

More Info


Overcoming social anxiety and navigating career uncertainty can be a daunting journey, especially when compounded by familial expectations and personal insecurities. Your experiences resonate with many who struggle with similar issues, and it's important to recognize that you're not alone in this.
Social anxiety disorder (SAD) is characterized by an intense fear of social situations where one may be judged or scrutinized. This fear can manifest in various ways, such as difficulty speaking in public, avoiding social interactions, and feeling overwhelmed in everyday situations like making phone calls or using public restrooms. These symptoms can significantly impact one's quality of life and career prospects, as you've described.

From your narrative, it seems that your upbringing has played a significant role in shaping your self-perception and social skills. The pressure to be a role model for your siblings, coupled with strict parental expectations, may have contributed to your feelings of inadequacy and self-doubt. It's not uncommon for individuals in similar situations to internalize these pressures, leading to a cycle of anxiety and avoidance.

The first step in addressing social anxiety is acknowledging its presence and understanding that it is a treatable condition. Cognitive-behavioral therapy (CBT) is one of the most effective treatments for social anxiety. CBT focuses on identifying and challenging negative thought patterns and beliefs that contribute to anxiety. It also involves gradual exposure to feared social situations, helping individuals build confidence and reduce avoidance behaviors.
In addition to therapy, medication may also be beneficial. Selective serotonin reuptake inhibitors (SSRIs) and beta-blockers are commonly prescribed to help manage anxiety symptoms. However, medication should be considered in conjunction with therapy for the best outcomes.
You mentioned feeling anxious during medical appointments, which is a common experience for many individuals with social anxiety. Preparing for appointments by writing down your concerns and questions can help alleviate some of that anxiety. Bringing a trusted friend or family member for support can also make the experience less daunting.

Regarding your career path, it's essential to explore what truly interests you. Many individuals feel pressured to pursue careers that align with societal expectations or family desires, often at the expense of their happiness. Reflecting on your passions and strengths can help guide you toward a career that feels fulfilling. Career counseling services can provide valuable insights and resources to help you identify potential career paths that align with your interests and skills.

It's understandable to feel hesitant about seeking help after previous negative experiences. However, it's crucial to remember that not all professionals will respond in the same way. Seeking out a mental health professional who specializes in anxiety disorders can make a significant difference. Look for therapists who have experience with social anxiety and who can provide a safe and supportive environment for you to express your feelings.

As for your parents, it may be challenging to communicate your struggles, especially if they hold misconceptions about mental health. Consider approaching the conversation with specific examples of how your anxiety affects your daily life and well-being. You might also share educational resources about social anxiety to help them understand your situation better. Ultimately, your mental health is a priority, and seeking help is a courageous step toward self-discovery and healing.

In summary, overcoming social anxiety and career uncertainty is a journey that requires patience and self-compassion. By seeking professional help, exploring your interests, and gradually facing your fears, you can begin to reclaim your sense of self and build a fulfilling life. Remember, it's okay to ask for help, and taking that first step can lead to significant positive changes in your life.

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