Each person who entered our therapy clinic
answer a stack of questions before beginning treatment.
And during my years as a therapist there,
there was one question I always reviewed before meeting with a new client.
It asked this:
What is your purpose in life?
Defined as a central motivating life aim, something you're trying to accomplish.
Now, to be fair, this is a difficult question.
Identifying a single purpose in life feels really hard.
It also feels consequential.
Many people spend years searching for and developing their purposes,
and some never find it.
But typically we see responses like this:
to be an engaged parent,
to make meaningful change in my community,
to build a career I'm proud of,
to live for a long time, just keeping it simple.
But then there was the answer of one young woman
who I worked with.
Before meeting with her, as I always did,
I flipped to see how she described her purpose.
And she wrote this:
"To avoid being noticed by other people."
This young woman, a bright, witty, compassionate high schooler,
decided that her purpose in life
was to make sure that other people did not know that she existed.
This is the power of social anxiety.
At its core, social anxiety is about the fear of being rejected.
When we feel socially anxious,
we become hyper-focused on how we are appearing to others.
We scan the room looking for signs of threat and disapproval,
signs we might have slipped up and are at risk for rejection.
And then we seek comfort in signs of approval,
smiles, head nods, laughs and so on.
And while social anxiety can be exhausting,
it exists for a reason.
Social anxiety tries to protect us from rejection,
and it does that by tuning us in to the nuances and norms
and dynamics of a social group
so we can match our behavior to fit in with them
and ultimately avoid being rejected.
This is a good thing because humans are social.
We exist in social groups,
we rely on each other whether or not we like that,
but also more simply because rejection is painful.
Take a moment to think about your own rejection experiences,
however cringeworthy, we all have them.
Maybe you were ghosted after a first date.
Been there.
Maybe you were rejected from your dream job.
Maybe you were ousted from a friend group.
Rejection's unpleasant.
And social anxiety tries to protect us from it.
But social anxiety becomes problematic
when it begins to interfere with the life you want to live.
And this happens when your fear of rejection
becomes intertwined with your view of yourself.
When you believe you will be rejected
because you think you have some inherent flaw,
deficiency or failing of character.
You were ghosted after that first date,
and you believe it's because you were not lovable or attractive enough.
You were turned down from your dream job,
and you believe it's because you were not intelligent or competent enough.
You were ousted from that friend group,
and you believe it’s because you were not interesting or funny enough.
Our fear of rejection is really a fear of being less than.
Less than we want to be,
less than we think we should be
or less than we believe society wants us to be.
Now, over time,
this belief system can develop into social anxiety disorder.
When a person has social anxiety disorder,
they become overly concerned about other people scrutinizing them,
evaluating them harshly and ultimately rejecting them.
So much so that they begin to construct their lives around avoiding rejection.
Because if you can avoid being noticed by other people,
then those people have fewer data points on which to reject you.
Now, social anxiety disorder
is one of the most common mental illnesses in the world.
In the United States alone,
more than 12 percent of Americans at some point in their lives
will have diagnosable social anxiety disorder.
That's roughly 40 million people.
Now worldwide, the estimates are lower, they're four percent,
which in and of itself is interesting.
But based on current population estimates,
four percent of the world is roughly 300 million people
that will potentially have social anxiety disorder
at some point in their lifetime.
And despite how prevalent it is, it's widely misunderstood,
widely misdiagnosed
and often missed entirely.
This is because several myths about social anxiety pervade our culture.
The first myth is that people with social anxiety are happier alone.
The stereotype of someone with social anxiety as a recluse
who'd rather be hiding away alone in their bedroom
than out interacting with the world.
And this is simply not true.
In research conducted in my lab,
we find that people with social anxiety disorder
desire strong, healthy, intimate relationships
to the same degree as those without mental illness.
And they do socialize,
they’re not robotic aliens.
And when they socialize,
they often enjoy doing so.
In fact, when we ask people with social anxiety
how happy they are,
they report feeling happier when they are with other people
than when they're alone.
This is because not all social interactions are stressful.
Maybe someone feels socially anxious with friends
but not their romantic partner.
Or they feel anxious with strangers and acquaintances
but not people like their neighbors or coworkers.
So even though some interactions are stressful,
people with social anxiety are not devoid of the basic desire for human connection.
They just have trouble obtaining it in certain situations with certain people.
OK, so maybe then people with social anxiety do socialize,
and when they do, they enjoy it.
But it's with a small, tight-knit group of people.
And really, social anxiety is about avoiding the spotlight.
And this is the second myth.
Social anxiety is not necessarily about a fear of public performance.
While this is true of some people,
other people with social anxiety find performing in front of others
less anxiety-provoking
than smaller, more intimate conversations,
like when they have to carry a conversation one on one.
Many people with social anxiety excel in careers
that are intertwined with social evaluation and social performance.
Modeling, acting, sports.
In May of 2021,
Naomi Osaka declined to participate in press conferences of the French Open.
She courageously and preemptively shared
that they exacerbated her social anxiety.
Shortly thereafter, she received a wave of public backlash and scrutiny.
She goes on to play her first match,
of course, wins,
and then she withdraws from the French Open.
Many people were perplexed
about how someone could have social anxiety
and also be the number one ranked tennis player in the world,
lead a fashion campaign with Nike -- good choice --
and don the cover of Sports Illustrated in a swimsuit.
In an interview the year prior discussing her social anxiety,
Osaka explained:
"On the court is completely different.
I love playing at Arthur Ashe because it’s the biggest stadium,
and you feel the rumble of the crowd.
You kind of feel like a gladiator because it’s super-big
and there are so many people watching your match.
But off the court,
if I was ever thrown into a situation
where I had to speak in front of 100 people,
I feel like I would start shaking."
There is no one-size-fits-all profile of social anxiety.
Just like people who are depressed have different collections of symptoms
at different times for different reasons,
social anxiety looks different in different people.
And last and maybe the most problematic myth.
That social anxiety is fleeting and harmless.
Social anxiety is not just something you grow out of.
It doesn't magically disappear
when you graduate middle school or high school.
Without intervention, many people struggle with social anxiety for years,
for decades.
And social anxiety can influence every aspect of a person's life.
It can influence the hobbies they choose,
maybe opting for solo activities like reading, writing,
rather than things like team sports.
It can influence the careers people pursue.
Maybe opting for careers with more individual, like computer time,
versus things like sales or customer service.
And social anxiety could influence people's everyday lives.
Ricky Williams, star NFL running back,
Heisman-winning running back,
dazzled millions of people on the football field every week.
And yet he shared that he struggled with social anxiety, and because of it,
he had difficulty interacting with teammates,
running everyday errands
where he'd have to interact with people
and even interacting with his own daughter.
The real tragedy of social anxiety
is that it robs individuals of their greatest resource:
other people.
Other people help us overcome adversity,
like recovering from illness or after you bomb a job interview.
Other people help us celebrate milestones
like showing up to the birth of our child or a wedding or a graduation.
And other people help us overcome loss,
like grieving the death of a loved one.
Our fear of rejection gets in the way of obtaining and appreciating
the benefits of being accepted, the benefits of other people.
And in our modern world,
it is harder than ever to manage social anxiety.
We are more connected today than any time in human history,
and yet we are lonelier,
more depressed
and more socially anxious than ever.
We have endless tools to socialize,
and yet we're seeing a decaying social connection.
In a rapid amount of time,
our social structures have been upended and rewritten.
Technology and social media have created new standards
for social relationships and interactions:
"Do I post it, do I share it, do I like it, do I love it?"
We create these bizarre extensions of ourselves
through curated profiles and now avatars.
We try to make sense of unlimited feedback
from a massive and often invisible audience.
And the costs of social blunders are higher.
Things you do and things you say can live online forever
and subject you to unforgiving scrutiny,
reputation loss and even job loss.
It is a tough time to have social anxiety.
But the world will become more, not less, connected,
and the influence of technology and social media will grow,
not shrink.
Now is the time to address social anxiety.
And here's how.
The first and maybe easiest thing we can do is identify early.
Early detection is critical
because of those who go on to develop social anxiety disorder,
more than half will have developed it before their 14th birthday.
More than half.
And social anxiety puts people at risk
for developing other mental illnesses later on.
Of adults who were diagnosed with both social anxiety disorder
and a mood disorder like depression,
social anxiety came first 70 percent of the time.
Of adults who were diagnosed with both social anxiety disorder
and alcohol use disorder,
social anxiety came first.
It was developed first approximately 80 percent of the time.
What these data suggests is that social anxiety starts early,
and it puts people at risk for developing other mental illnesses.
But here's the incredible part.
Social anxiety can be reliably and accurately flagged
by asking just a few simple questions.
Questions like:
"Is your fear of rejection among one of your worst fears?"
And "Does your fear of rejection get in the way of doing things
that you'd otherwise want to be or enjoy doing?"
The cost of asking these questions is like 30 seconds and zero dollars.
We don't have to create new infrastructures.
We don't have to upend existing ones.
We can embed early detection programs into our existing structures
like at schools, new year orientation,
one-on-one counselor meetings
and in primary care settings.
Because if a doctor can screen for depression,
then she can also screen for social anxiety.
Early detection
and then appropriately intervening
can significantly alter the trajectories of young people.
The second thing we can do is harness our platforms.
One of the benefits of living in this hyperconnected world
is that a single person can have a ton of power.
They can use their platforms to create meaningful and lasting social change.
I mentioned Ricky Williams and Osaka,
who have used their platforms to share about their social anxiety.
And just from these two people, we’ve seen a ripple effect.
In response to Osaka's announcement,
Viola Davis,
Oscar, Emmy, Tony-award winning actress,
shared that she struggles with social anxiety.
A woman whose job it is as an actress
to embody and express the complexities of people
in very vulnerable and very public ways.
But frankly, these celebrities are not the poster children for social anxiety.
They're just three of the millions who suffer,
who were brave enough to talk about it.
And we can do the same with our platforms, however big or small.
In our schools,
in our workplaces,
in our communities and in our homes.
Because regular, candid and forthcoming conversations about mental illness
ultimately reduce stigma,
correct harmful myths
and get people the help that they need.
The last thing that we can do is foster social courage.
Addressing social anxiety is not about preventing or avoiding rejection.
Addressing social anxiety is about fostering social courage.
Being socially courageous means pursuing experiences
and knowing that your chances of rejection are not zero.
In fact, the chances that you get rejected at some point in your life,
at some point this year, are high.
And worse, you may be rejected as a function of who you are.
Things about yourself that you cannot change.
Where you come from,
what you look like or who you love.
Being socially courageous means pursuing experiences
because they are important to you
and knowing that the successes of those pursuits
are not contingent on your worth as a human being.
Being socially courageous means knowing your worth
and finding people and social groups
that love and accept that person.
And being socially courageous means asking that person out,
applying for that job,
speaking up at that meeting or that party
or giving that big talk on that big stage,
knowing that rejection lurks around the corner.
But the opportunity for growth and for purpose shines brighter.
A purpose not defined by ensuring that you go unnoticed in this world,
but a purpose that makes you feel most alive, most present
and most authentically you.
Thank you.