`Hell is other people" are the much quoted words of French existentialist philosopher Jean Paul Sartre - words which must hold a special meaning for an estimated 11 per cent of the population who suffer, or have suffered at some point in their lives, from social phobia.
Social phobics are less likely to marry, or reach the top of their profession and are more prone to suicide attempts and alcoholism than their more socially adjusted peers. Because they have a low-profile disorder, in comparison to other phobias like claustrophobia and agoraphobia, social phobics are often dismissed as being shy.
For Marie Foley (not her real name) social phobia goes far beyond shyness. For most of her life she has been locked in a distorted existence where her every interaction with others is marked by fear, apprehension and anxiety.
"When I have to deal with others I become very anxious, very tense and very nervous," says Foley (31). "If I am in a group of people, I feel very awkward and very self-conscious and I'm constantly afraid that I will come across as being embarrassed. I'm totally focused on myself and how I come across. I feel all the attention is on me." The intensity of these feelings can cause her to blush, sweat and shake, the embarrassment of which prompts her to avoid contact with others whenever possible.
"I cut myself off from people. I have very few friends and I avoid contact with people at work. I'd never go out for drinks on a Friday after work and I'm in a job I don't particularly like but I have an office to myself and I'm afraid of moving in case I wouldn't get on with new people. I never meet fellas because I don't go out much."
The international definition of social phobia is "a marked or persistent fear of one or more social situations in which the person is exposed to unfamiliar people or to possible scrutiny. The individual fears that he or she will act in a way that is humiliating or embarrassing."
According to Dr Anthony Bates in his chapter on social phobia in The Stress File, an RTE/Blackwater Press publication edited by Colm Keenan, "all of us fear other people at some stage in our lives, have found ourselves blushing for no apparent reason and have felt terrified that others would notice our discomfort and laugh at us, but most recover from these distressing situations and become comfortable in social situations over time. Social phobics become less and less comfortable and gradually avoid people as much as they can."
It is the only anxiety, he says, in which men are in greater or equal number than women.
Foley suffers from generalised social phobia which means any number of social situations can cause extreme anxiety. Some phobics have a more focused form of the disorder where they react only to certain situations - such as making phonecalls or eating in front of others, sitting opposite others on a bus or ordering a drink at the bar.
Cognitive behaviour therapist Yvonne Tone recalls a former patient, a solicitor, who avoided signing documents in front of clients in case his hand would shake.
"His was a very circumscribed form of social phobia. As a coping strategy he would swing his chair around to a table behind him and sign the document out of view of the client."
Both forms of the disorder are characterised by an intense self-consciousness. Foley is a typical sufferer of generalised social phobia in that she is consumed by others' perceptions of her. According to Tone, this is what marks the gulf between shyness and social phobia. "While shy people may find it difficult to talk very freely with others, they don't worry to the same extent that they are being evaluated and criticised," she says.
Social phobia is often triggered by one or a series of humiliating or embarrassing episodes in childhood or adolescence. The trauma of being ostracised by her classmates when she was only five-years-old was the catalyst, Foley believes, for her social phobia.
"One of the girls in my class said something about the teacher and I snitched on her. The girl had an older sister in sixth class and turned everybody against me. Nobody would play with me or talk to me for ages but I obviously wasn't too shy then when I went up and told the teacher." One of 10 brothers and sisters, she says her family is "not very affectionate". She was teased over her shyness as a child by other members of the family.
"We never discussed things openly in our house. It was a case of being seen and not heard. When people would come to visit we would all be so quiet. I resented that but I am coming to terms with it and I am trying to move on. None of my brothers or sisters is as shy as me; they all have friends and are married and successful."
Queuing in supermarkets is another situation that can cause her extreme anxiety.
"If the queue is very long or very slow and I am having a bad day, I can start worrying that something will happen, that someone from work will see me and I will do something stupid and make a complete fool of myself. Then I get anxious that I will start trembling and blushing for no reason. It sounds silly when you try to explain it but seems very real when it is happening."
Social phobics develop coping strategies, often designed to avoid or mask the offending situation. Wearing heavy make-up to cover blushing, hiding behind a newspaper in a coffee shop to avoid the gaze of others or wearing extra clothing to hide sweating are classic avoidance strategies.
The nature of the disorder means that sufferers prefer to keep a low profile and often do not seek treatment, so it is difficult to gauge the true number of sufferers. Those who do seek treatment tend to do so between the ages of 25-30.
Cognitive behaviour therapy is one of the most successful ways of treating this complex disorder. It focuses on ridding patients of their negative distorted self-image and shifting the focus of their attention from themselves to those around them. Often patients are videotaped to show them how they interact with others and the type of safety behaviours they engage in. Sometimes therapy goes hand in hand with anti-depressant drugs treatment.
If social phobia goes untreated, one in every two sufferers will develop secondary symptoms such as depression and alcohol addiction.
Foley sought help in her late 20s because she felt her life was "just nothing, I was merely existing". She says after a year and a half of therapy for one hour a month she feels more positive and optimistic about the future.
"The video work we did in therapy showed me that I don't look as odd or weird as I'd imagined. It helped challenge my negative thoughts and stopped me jumping to conclusions about people. I'd like a different job, some fulfilment, to meet someone and have kids and lead a more exciting life. Just to live a little."