"Belonging to a user organization is a great help in many ways. It is good to feel part of a group of individuals suffering from a common illness, as opposed to feeling isolated with a problem one does not understand and which makes one feel ashamed.
I have suffered from social anxiety since youth, and have tried various forms of therapy from the age of twenty. Psychoanalysis-based therapies brought little relief, and it is only since CBT, Cognitive behavioural therapy, has become widely used in France over the last ten years, that I have had much better results in improving my social difficulties. I still receive psychotherapy, however. It has taken a long time to find the right places to go, and CBT treatment centres in France are still largely understaffed.
My family did not really know how to react when my difficulties started, except to see them as personality traits. Of course, there was not much information to be had on social anxiety at the time, and my parents were sceptical of psychotherapists in general.
I think my friends had similar difficulties in identifying my social anxiety as a mental health problem. For quite a few people it is hard to separate the person from his personality-based difficulties, and I have often felt condemned for behaviour that is a result of my problem. On several occasions my mental health problems have created situations that have made colleagues at work uncomfortable, which in turn has made me less efficient and/or sociable.
In general, when people can see that my anxiety is a form of illness, however, they tend to be understanding and supportive.
I believe that the stigma and discrimination can be reduced through better information via the general media channels, and through creating heightened awareness in certain key professional groups, such as teachers, social workers etcetera.
I would also like to see much more information for patients about the different types of available treatment. Well, about anything that can prevent the feeling that there is no solution to the problem, really.
Personally, I talk openly about my experience with my girlfriend and intimate friends, but most of all, and most intimately, in Mediagora, which is a user group for people with anxiety-based problems. It is based in Paris, has existed since 1998 and represents our group in various federative meetings with other such organizations in France.
I first learned about Mediagora meetings on the Internet. To begin with it was a relief to find like-minded people I could share my difficulties with. Eventually I felt concerned about trying to help others get information as well, and became more involved in the work.
Finding Mediagora has been one of the most important factors in my recovery. Finding a therapist who has been willing to spend the necessary time working with me on an individual CBT-basis has been another, alongside with the support from close friends. Being able to adapt my work schedule to suit my slowed-down activity has also been vital. I cannot do any type of work, because the demands that might be placed on me could induce another bout of illness.
The factors that have impeded my recovery have been the lack of information plus the psychoanalysis-based therapy that I started out with, which simply did not address behavioural problems as directly as CBT. (On the other hand it never pretended to do so. In psychoanalysis you get someone who listens to you, which is a very important aid in finding one’s own solutions. To the contrary, in CBT, the therapist quite often does not listen to you, because he knows beforehand what needs to be done in your case – and too bad if you do not agree!)"
How can Juan’s story influence policy-making for mental health?
This is a valuable story about how to cope with social anxiety, perceived by Juan as an illness. One conclusion that jumps out is that people are very capable to judge what works best for them. Psychoanalysis did not work, CBT was very effective for Juan.
Juan also mentions the word ‘recovery’, although I am not sure whether he mentions this as a concept widely used these days to describe the aim to achieving one’s aspirations, or in the traditional sense as an improvement from an illness.
At the core of this piece is the importance of the user movement, and the conclusion that users gain great benefit from sharing their pain with each other. An important question is whether user involvement is a goal in its own right, offering stability, or a step towards integration into the community. At present Juan seems to be unable to work. Is the aim of full and paid employment desirable, and does close involvement with the user group encourage this? As so often, I doubt there are general answers, and every person may have different ambitions and challenges, and sometimes user movements are wonderful in their mutual support and generosity for people who experience so much stigma and discrimination. But we also have to guard that they do not become permanent places of withdrawal from society that reinforce discrimination, sometimes self inflicted. We need to offer opportunities for people, both to connect with soul mates and to find stability at work. People with mental health problems have to maintain their self-worth by interacting with the big world, while finding support from people with similar experiences.
Dr Matt Muijen, Regional Adviser, Noncommunicable Diseases and Environment, WHO/Europe