Q: Dr. Neuman, I am a 26 year old woman. I have had a very sheltered life. Even though I have always been enthusiastic about learning new things and being creative, I have never received any encouragement. I wouldn’t say I have very low self-esteem. I do believe I can do certain things I want to do, I just don’t know how to get about doing them. They are so incongruent with my family’s expectations of me. I have always had anxiety issues. I am afraid of animals, heights, darkness, closed spaces, traffic, fire, embarrassing myself because of excretory demands and in select cases, of social scenarios as well. In fact, my anxieties have been compounding and I have been unemployed for 3 years, to the point of rarely stepping out of my house and developing severe vitamin D deficiency. I have never been in a relationship. I have a master’s degree but I have never had the courage to apply for a job because I am too scared of a working environment. I am enrolled for a research degree but I feel thoroughly incompetent and am too scared to even talk with my supervisor. I honestly want to finish it rather than quit no matter how long it takes because I can’t bear the thought of quitting. I have even gradually dropped out of my social circles though I never find it easy to make real friends anyway . I can’t even take a class or a hobby because I am afraid of being judged by classmates. I feel like I have completely reached a dead-end. I am not suicidal but, I do feel like my present state is a culmination of all of my past and that somehow there is something unjust about it, like I do not totally deserve this state of despair. What can I do? I have been to a therapist once but it didn’t help and is just too expensive. My GP had given me anxiety and depression medicine but it didn’t seem to make a difference so I soon got off them. I know this has been a long ramble where I don’t know how much help the information has been. I just want to have a life of some sort which is easier on me.
– Anna
A: What you are describing is more than one emotional problem. If I were to summarize them, they would fall into two major classes: low self-esteem which is preventing you from fulfilling your obvious promise. I am afraid this problem is stubborn, especially if there are people in your life who are not encouraging you to be different. This is the sort of problem that gets better with psychotherapy, but it is likely to take years. One visit to a psychotherapist will not help. It may be that medication will be appropriate for you, but nothing you said makes me think so. You can go to any sympathetic mature person for psychotherapy. Your therapist does not have to be a psychiatrist or a psychologist. A social worker may be less expensive. Otherwise, find some clinic to go to. With the new medical programs, there should be somewhere close you can go to long enough to get better. The bottom line is you will have to do things that make you uncomfortable in order to get better; but getting better is not much more complicated than that.
You also have a severe social phobia. That responds to exposure therapy, which is also likely to take a considerable time, but not quite as long as insight therapy. The White Plains Hospital Anxiety and Phobia Center offers programs for people who visit from great distances. Short of that, you might want to read my book “Fighting Fear.”
– Dr. Neuman