Social anxiety and the challenges of exposure therapy

It struck me as I jumped into the shower this morning, in the split second as I registered that the cold was not unbearable anymore, that the problem with winter is not winter but summer.

I wrote a piece about minor mishaps a while ago. One of my points was that if a crisis remains unresolved for a while it may cease to be a crisis as one adjusts to it. Winter is the same. As long as you have somewhere to live that offers reasonable levels of warmth in some rooms, eventually your body adjusts to the cold.

And just as you’ve become accustomed to it and have your bedtime routine worked out (in my case a hottie and four doonas, as well as copious layers of pyjamas), the Earth stretches as if from a long sleep and starts to exude warmth. The blossoms unfurl, the camellias drop liltingly to the ground in their prodigal abundance. Everything wakes up, and you have to adjust again.

This is not some idle complaint. It makes me think of exposure, now a central plank of short-term talking therapies for anxiety disorders and phobias. Exposure relies on the concept of increasingly difficult forays into feared experiences. These forays are graded so there is always a carefully calibrated level of discomfort, while the difficulty of the task increases. The theory is that the sufferer learns to tolerate an ever-greater degree of risk and is therefore able to deal with an increasing number of feared situations.

Exposure is an incredibly useful concept. I’ve never practised it in conjunction with a therapist, but I have a friend who is an exponent of it (he even wrote a book about it), and I practise it in very small ways.

But the challenging thing about exposure is that it is aligned to life yet also pitted against it. Creating a list of progressively more difficult tasks is a way of creating order, but the chaos of life is constantly intruding. And, depending on your disorder, it may not always be possible to retain control over the level of exposure.

Work is an area of life where I gain valuable exposure only to sometimes lose momentum. Because my work stops and starts, I don’t often get into a pattern of work. This is bad, because once the work starts again I not only have to adjust to the discipline but I also need to refamiliarise myself with processes and even skills.

As well, I have to ‘expose’ myself to a lower standard of self-care and housecleaning, which leads to an increase in anxiety levels.

I believe that I’d be able to gradually increase the level of work I was able to take on if I could control the flow of it – but that’s not the way the real world operates.

Social anxiety is another area where the exposure levels are difficult to control. According to psychologist Dr R. Reid Wilson, this is because the unpredictable nature of social life is such that it’s impossible to grade one’s exposures; and because their lifestyle may require the sufferer to carry out social tasks that go beyond their current level of comfort. 'When you have social anxiety, events that are high up on your list of threatening situations may take place before you have mastered your lower level tasks’, he says.

Dr Wilson’s excellent website is the first time I’ve come across a therapist who identified the unique difficulties of social anxiety in this way.

Another difficulty with conquering social anxiety he identifies is that the sufferer must focus on so many anxiety management skills at once, sometimes while performing a complex task like public speaking.

One way to get around the unpredictable nature of social exposure, according to Dr Wilson, is to simulate the scary situation using friends and family. For example, you could practise public speaking in front of a group of friends, conduct a role play on bumping unexpectedly into someone in the street, or ask someone to look over your shoulder while you practise writing.

Life, the universe and exposure

The chaos of life may pose a challenge to exposure therapy more generally. Unexpected stresses or adverse events in one area of life may temporarily lower our ability to challenge ourselves in the areas we need to work on. Sometimes I need to withdraw and regroup because of some unforeseen blow.

This is not to argue against exposure but to demonstrate how important it is for the individual to be in control of their therapy. This is the view of Bronwyn Fox, a recovered sufferer of panic disorder who has written books on the issue and now counsels sufferers.

The important thing is to get in touch with your gut feeling and obey it. I have learned this lesson painfully and slowly, sometimes suffering from too much exposure and sometimes not enough. In my experience both are harmful.

If I’d known about exposure earlier, there are definitely aspects of my social and working life I would have fought harder to retain, rather than simply letting them go because they were too hard. But not knowing about exposure also led me to throw myself into situations that were too difficult, which meant I got overexposed and therefore more phobic very quickly. In both cases I wasn’t managing my anxiety well because I didn’t have the knowledge or tools.

I’m not saying that everyone can expose themselves and eventually rid themselves of their anxiety. In my case I think there are some things that are just too hard and will be for a while, and perhaps forever. However, I do want to create some sort of graded exposure program.

Exposing myself

Recently I visited an arts event alone. I’ve done this heaps of times but it was in a venue that I was unfamiliar with. I’m an expert at subtle avoidance – I’ve been practising it my whole adult life – and I noted that two very effective avoidance strategies were in play: getting there late, and sitting in the back row.

The getting there late was partly my unconscious mind at work. I just missed the tram! How convenient!

Next time I will resolve to sit in a row that is somehow more ‘threatening’ (this could mean, for example, a row where the people look interesting, or towards the front, or both) and getting there before the event starts. I might have to tackle one of these tasks at a time. Even being in a room with others and experiencing my reactions can be difficult for me sometimes. The important thing for me is to stay with myself somehow, to practise mindfulness without buying into my fears.

And soon it will be time to get exposed to a completely separate dilemma – the extreme heat of a Melbourne summer.

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Scuttling social justice – Julia Gillard and the 2010 federal election

Australia is going to the polls in a month’s time. Julia Gillard, the Australian Labor Party prime minister, looks set to win. But, in playing so clearly to middle Australia, she is using her considerable political talent to further drag the ALP away from some of its primary responsibilities: the upholding of human rights and support for the disadvantaged.

For the benefit of overseas readers, Gillard, then the deputy prime minister, shocked Australia when, following weeks of Kevin Rudd suffering in the opinion polls, she deposed him in an unforeseen overnight 'coup' on June 23–24; knowing he no longer had the numbers, Rudd stepped down rather than face a leadership ballot.

It may be that the coup wasn’t quite as sinister as it must have appeared to international observers, despite the involvement of faceless union officials and the fact that Gillard got multinational mining companies onside by ending a terrible imbroglio over mining tax soon after taking power. Rudd appears to have been stuck in a compulsive, controlling, workaholic state that he was unable to shed – some have hinted at mental health issues, and it was impossible not to anticipate the advent of some sort of personal crisis.

The event was notable regardless, being the first time in Australian history that a first-term serving prime minister had been deposed. And, as most people know, Gillard became Australia’s first female prime minister.

An election was due anyway, but Gillard was always going to call it early because she wanted to rule as chosen prime minister, rather than being seen as a pretender. Now a snap election has been called for the 21 August.

There are a few things I’ve been dying to write about Gillard ever since her surprise ascension.

Like some others, I hoped that she was more radical than she appeared, and that with Rudd out of the way she would take some simple progressive steps such as allowing gay marriage (Rudd’s a god-botherer and has always opposed this; Gillard is an unmarried atheist with no kids).

It was difficult not to assume, or at least hope, that Gillard would be a little more radical simply because she was a woman. Having slogged her way to the top in a male-dominated party, surely she would have empathy for the marginalised, and go into bat for them once she got into power? My hopes were ill-founded – Gillard soon stated unequivocally that she had no plans to legalise gay marriage.

This should have been no surprise – Gillard as education minister and minister for workplace relations was disturbingly reactionary. Despite her frequent eloquent pronouncements on her commitment to education, she seems to have done absolutely nothing to reduce the glaring inequities of Australia’s education system, a two-tier system that blatantly favours private schools and suffers from hopelessly complicated federal–state funding arrangements.

Gillard specialised in gimmicky, hugely expensive policies that caught the attention of the media as they were designed to do, before at least partly crashing and burning on their ineptitude and lack of groundwork; but she did absolutely zilch to reduce the system’s glaring inequities.

The building and computers-in-schools programs that characterised her tenure were open to the most obscenely wealthy private school, despite the fact that public education has been severely underfunded for years in Australia, resulting in rundown schools and inadequate teacher numbers and support services. The aim of the building program was partly to stimulate the economy, but, writing in The Age, Kenneth Davidson said that ‘Funding directed to maintenance upgrades according to the greatest needs would have had the same economic stimulus impact dollar for dollar and a far bigger pay-off in terms of equity and efficiency’.

Moreover, the public schools were disadvantaged in their access to the building program because they had much less choice compared with the private schools about exactly what was to be built, and no ability to negotiate the cost, resulting in ‘inflated costs and dubious projects’.

With regard to the computer program, private schools benefited while some government schools couldn’t afford to pay for the infrastructure that extra computers would entail.

Moreover, in her determination to impose a national test (NAPLAN) on skills such as literacy and numeracy and a website that would allow parents to compare the relative performance of schools, Gillard fought with the overworked teachers she should have been supporting – teachers who feared that the website would lead to the creation of divisive league tables, and that the expertise of teachers working with students with specific needs would be overlooked.

Also, Gillard had been part of the ‘gang of four’ that replaced Cabinet government under Rudd. The Cabinet still sat of course, but apart from Finance Minister Lindsay Tanner, Treasurer Wayne Swan and Gillard, they were mainly asked to tick the boxes.

This anti-democratic tendency, a recipe for poor government, was part of the reason why MPs were willing to vote Rudd out; but I didn’t realise until after the ‘coup’ that it was Gillard, as part of the ‘gang of four’, who had urged that controversial emissions trading legislation be deferred until 2013 – a decision identified with Rudd at the time, and that had signficantly contributed to his poor showing in the opinion polls.

Perhaps the most shocking development since Gillard’s win has been her willingness to use the issue of asylum seekers as a political football. This was evident in the speech she gave on the issue on 6 July, when she signalled the possibility of a regional processing centre for refugees to be established in Timor L’este (using, incidentally, the inappropriate title ‘East Timor’).

But it’s become even more blatant now the election’s been called. In fact, ‘stronger borders’ is one of the key catchphrases on the ALP’s first television election advertisement featuring Gillard. Even before her asylum seekers speech, she was talking about ‘good migrants’ like her parents, with the strong suggestion that there was another sort of migrant that people were right to abhor.

This is simply astounding. I won’t go through the history of the issue, but since the Tampa incident in 2001, which saw the introduction of the notorious Pacific Solution whereby asylum seekers were removed to the island of Nauru for their claims to be processed, these vulnerable people have suffered to keep Australia’s politicians in power. And now the ALP, already accused of trying to please everybody on the issue, are indulging in shameless dog whistling, much more so than they did under Rudd.

Some progressives claimed that Gillard’s asylum seekers speech was nuanced and not as politically insidious as the selective media quoting would have it appear. It’s true that in some ways Gillard was trying to have it both ways – stating that those wanting greater border protection should not be labelled racist, any more than those concerned about children in detention should be labelled bleeding hearts. Responding to earlier criticism by refugee advocate and respected lawyer Julian Burnside, QC, she said:

… in the context of our migration program, the number of asylum seekers arriving by boat to Australia is very, very minor.

It is less than 1.5 per cent of permanent migrants each year; and indeed it would take about 20 years to fill the MCG with asylum seekers at present rates of arrival. This is a point well made.

On the second point [Burnside] is very, very wrong. It is wrong to label people who have concerns about unauthorised arrivals as ‘rednecks’.

Of course, there are racists in every country but expressing a desire for a clear and firm policy to deal with a very difficult problem does not make you a racist.

Elsewhere in the speech she affirms as an organising principle of asylum seeker policy ‘That people like my own parents who have worked hard all their lives can’t abide the idea that others might get an inside track to special privileges’.

This rhetoric is erroneous. It strongly suggests that the opinions of those fearful of the boats are every bit as well-informed and worthwhile as those who are steeped in the issue and have serious legal and moral concerns about government actions. And it completely ignores the fact that the role of a leader is to educate and lead rather than to pander to the whims of the least educated and politically aware; and to set an example and produce a vision that can make the nation more cohesive, not less.

Those criticising Gillard for aiming her narrow policies straight at the seats most under threat in Sydney’s west are fully justified. She should be explaining to the electorate the push factors that bring the boats here, and eliciting Australia’s collective compassion – the kind that erupted so forcefully after the January 2009 Victorian bushfires.

More generally, Gillard is encouraging voters to see this election as being all about themselves and their needs, rather than promising to look after Australia’s most disadvantaged, surely one of the major remits of any labour party worthy of the moniker? She has said that voters will choose the policies most useful to them and their families, encouraging the continuation of the solipsism that thrived under Howard.

Gillard has great charm and verve, and, it’s indisputable that since Labor’s coming to power in 2007 the conviction, authority and intelligence she has managed to project in speeches and interviews has only increased, despite the rubbish that so often spouts from her mouth.

But let’s be clear: there was nothing progressive about Rudd’s Labor party, and there’s nothing progressive about Gillard’s. Below are just a few examples of straightforward social justice actions Rudd and now Gillard have failed to take, apart from not allowing gay marriage. Not all of these would have involved the magic millions or billions that both these politicians love to announce; but they would have produced greater social justice for Australia’s most needy as well as improving environmental outcomes.

* No carbon tax

* No mandatory staff–resident ratios in aged care homes (such ratios exist in hospitals and child care centres), leading to a shocking lack of skilled nursing care and other staff for frail, ill aged people. This is despite a 2009 Four Corners report in which the Minister for Ageing, Justine Elliot, promised that the government would consider the issue as part of its review of aged care funding. In May this year the NSW Nursing Association had to call for such mandatory ratios – all the government had offered in the 2010 budget was ‘$500,000 to conduct a research study on staffing levels, skills mix and resident care needs in Australian residential aged care facilities’.

* No rescinding of the regressive changes to education funding made by Howard. These gave more money to wealthy private schools at the expense of government schools.

* No real increase to unemployment benefit (Newstart allowance), which has long given up even attempting to adequately cover the excessive costs of market rents. Because increases are measured against inflation and not male wages as the pension is, the dole will continue to decrease in value against the pension. The May 2010 budget refused a request by the Australian Council of Social Service for an increase of $42 a week for the Newstart allowance; this request was ignored. But in refusing the increase the government was also ignoring its own Henry report on taxation, which stated that ‘a single person relying on an unemployment allowance is well below the OECD benchmark for poverty’.

* No attempt to ditch the 30 per cent government rebate on private health care. Instead the government tried to make the 30 per cent rebate means tested (the rebate results in all taxpayers subsidising, for example, dental care for the wealthier while there is no national dental scheme for the poor, whether or not they pay tax. The bid to means test the rebate failed anyway because of a hostile Senate, partly the result of a preferences deal Labor had done with the conservative Family First).

* No change to the shocking lack of residential and respite places as well as educational services for children with severe disabilities.

* No change to outrageous tax breaks for property owners, with the result that tax-paying renters subsidise the wealthy. Negative gearing, which enables property investors to claim losses on their investments as a tax deduction, has encouraged property investment, thus helping to lift the cost of housing out of the reach of first home buyers. Home owners who live in their homes are exempt from capital gains tax.

* Not withdrawing our troops from Afghanistan. Despite the bravery and skill of our troops, Australia’s involvement in this war serves the sole purpose of maintaining the relationship with the US, which is supporting the very same corrupt, greedy warlords whose mass murdering, raping and pillaging contributed to the rise of the Taliban.

Despite this dereliction of duty, the government boasts about the tax cuts it has managed to budget for, while promising to bring the budget back into surplus within three years – on the backs of Australia’s most needy and marginalised, truly the forgotten ones in this election.

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‘Richmond’s not in his room!’ – Why I love the IT Crowd

I have spent too many hours of my life splayed out on the loungeroom floor watching reruns of a sitcom that has grabbed and colonised my heart, soul and mind. It’s called The IT Crowd and its controlled ridiculousness is keeping me semi-sane during what is proving to be a rather grim winter. This British comedy is written by the unfairly talented Graham Linehan, cowriter of Black Books.

Moss, Roy and Jen constitute the IT department of the chaotic but phenomenally successful Reynholm industries (that the company’s raison d’etre is never specified is a running joke of the show; one fan has set up a spoof company website). Stuck in the basement of the Reynholm tower, they’re cut off from the other workers in their airy offices who enjoy stunning views of London.

Moss and Roy are hapless nerds while Jen, their ‘relationship manager’, sees herself as their bridge to the normal world but too often is marginalised herself by association.

Then one day Jen spies a red door in the basement, and, as in Bluebeard’s castle, is only more determined to discover what’s behind it when Roy and Moss warn her that all hell will break lose if she does. After the initial terror of encountering Richmond, an unearthly Goth, she settles down for a chat with this sweet-tempered former high-flyer who has been banished to the server room because of his infatuation with the extreme metal band Cradle of Filth.

‘Richmond’s out of his room, he’s not in his room, he’s supposed to be in his room, why isn’t he in his room?’ laments Moss, his love of routine and predictability thwarted, the British pronunciation of ‘room’, less drawn out and therefore more formal sounding than the Australian version, adding weight to his objection.

Moss, despite Graham Linehan’s denials, is clearly meant to be an Aspergers person. Not only does he thrive on routine but he’s technically proficient to the point of genius, socially clumsy, and entirely oblivious to nuance and Machiavellian craftiness; he even walks and holds his head in a way that is awkwardly wooden.

However, given that Moss’s most salient and attractive quality is his childlike need for certainty, it’s highly unlikely that the character represents an accurate portrayal of an Aspergers person. Yet it’s his childlike aspects that contribute most to his appeal, and perhaps they defuse the kind of criticism you might expect such a portrayal to evoke in the Aspergers community – I couldn’t find any criticisms of the character on the web, although that doesn’t mean they’re not out there.

Another reason for the seeming lack of criticism could be that while we often laugh at Moss’s unintentional funniness, we also chortle at his deliberate jokes, delivered in a self-consciously signature style that fans find adorable.

And generally speaking, Moss suffers far less than the other characters; he’s naturally cheerful, wins out against bullies (as in the first episode in the third series) and is canny enough to take advantage of amorous and financial opportunities (returning the attentions of a glamorous female psychiatrist in the first series; unintentionally stealing money from thieves in the third).

Like many women and probably men, I’m in love with Moss. This is partly because the actor who plays him, Richard Ayoade, is a very attractive man, with large brown eyes, a snub nose, finely sculpted cheekbones and a cherubic mouth; because Moss’s social incapacities make him so vulnerable that he arouses maternal instincts; because his character, and the actor who plays him, are both extremely funny (and sometimes their personalities seem to blend together, as if Ayoade and Moss were in league with each other); and because the childlike aspects of his nature promise a temporary, atavistic return to childhood.

Yet I couldn’t find much on the web about Ayoade himself, except for a frustratingly short beginning of an interview that seemed to suggest that he himself might suffer from Aspergers (he mentions a difficulty in maintaining eye contact with the interviewer while speaking) but in fact appears to show him in a very understated role in a satire.

Ayoade seems to lack his own website, despite what is clearly a huge fan base out there. The Channel 4 website for the show has clips and episodes that are frustratingly off-limits to Australians (I can understand the downloadable episodes being off-limits, but why the clips, including an interview with the actress who plays Jen?).

Despite Moss’s vulnerabilities he succeeds in life (if not romantically), partly because Jen and Roy both protect him from himself; he needs them to smooth the social waters, just as his esoteric knowledge is vital to the company but also occasionally useful to Jen and Roy.

Soon after Jen joins the IT department Roy and Moss are about to complain to the CEO, Denholm Reynholm, that Jen has no understanding of IT and they don’t want her as their manager. But as the three sit opposite Denholm while he barks to his inferiors on the phone, his conversation makes clear that he will ruthlessly sack any team who can’t ‘work as a team’ (gloriously sending up company-speak).

Knowing that all three of them will be sacked if the complaint goes ahead, Roy and Jen have to drag Moss away, assuring Denholm they had only come to the office to install voice activation on his computer. Moss can’t understand why he and Roy aren’t going through with the complaint; he just hasn’t been able to transfer the meaning of Reynholm’s phone conversation to his own situation. But later, in the second series, Moss demonstrates the usefulness of his peculiar genius; he’s able to tell by smelling it that the creepy new boss of Reynholm Industries, Douglas Reynholm (Denholm's son), has put Rohypnol in Jen’s tea.

Prisoners of gender

Aspergers is associated with maleness, but Moss isn’t the only one burdened because he’s male; all three main characters are ‘prisoners of gender’. They are extreme in their habitation of gender roles and they all suffer for it.

Roy is a standard nerd who tries hard to succeed romantically (a cause for much of the comedy) but always fails. The harder he tries the more ludicrous he appears; in one episode in the first series, with carefully pomaded hair and an oversized retro jacket, he attempts to proposition a girl while oblivious to the fact that a dollop of shit or chocolate (it’s deliberately never made quite clear which) is sitting in the centre of his forehead.

Jen is female in a way that is ludicrously stereotypical. When suffering from the monthly arrival of ‘Aunt Irma’ the cure lies in a girls’ night in, with Roy and Moss playing at being her faux girlfriends, all three dressed in terry towelling robes and watching predictable old chick flicks like Beaches and Steel Magnolias.

This should be offensive but largely isn’t because Jen’s workmates are equally stuck in their extreme masculinity. In fact, there’s only one moment when I was truly offended by the show’s portrayal of her.

It’s in the episode in which Jen becomes obsessed with a pair of red high-heeled shoes that are three sizes too small for her. While in this state of obsession she becomes incoherent. When asked for an idea about combating stress by the hyperactive Denholm, she responds ‘What? Shoes …’. But, back in the basement, while she’s mumbling about the shoes, when Roy calls her a ‘crazy bitch’ in an affectionate, condescending tone as he walks her into her office, it’s too much for this feminist to stomach. And the stereotype of women being obsessed with shoes is overwrought.

Return to childhood

Yet the whole show is overwrought, regularly venturing into surreal territory, making it difficult to be offended by the stereotyping. It’s basically a child’s world where the everyday and the magical are seamless parts of a whole, and where reality is often viewed as a series of extremes.

It’s a world of play, the unknown and the novel, girded by the iron certainties that children cling to because they are still so ignorant of its machinations, but also bounded by the terror that lurks when Roy and Moss enter social situations they aren’t equipped to deal with, and when Jen enters emotional situations in relationships that always seem to end badly.

This is why Moss is so vital to the show and why he is in some ways its central character; he’s a child who hasn’t grown up. His literal view of the world, his inability to understand nuance and sarcasm, in some ways reflect the child’s brain. Watching the show is an invitation to re-enter childhood.

And this is why Richmond is also an attractive character. Gentle and softly spoken, if a trifle melancholy, he adds to the fantastical nature of the show. Yet there is something very traditionally British about him; the way he speaks to Jen at his first appearance, not to mention his 19th-century costuming, has something of the period hero, as if Mr Rochester had blended with Bertha Mason to create not the madwoman in the attic but the sane gentleman in the basement; even his name has a 19th-century flavour.

As a social phobe I can’t help identifying with Richmond, stuck in the IT server room, not even the basement proper but a room off it, a secret room with a forbidding red door. Once out of his room, Richmond is ‘allowed’ to flutter freely around the basement in the first and second series but he never makes it back upstairs, although in the first series Jen tries valiantly to persuade Denholm to have him back.

A continuing obsession

I regret that this little world that Graham Linehan has created lives only in his head and those of his fans. I can’t bear that these characters do not actually exist, especially Moss and Richmond, although on some level I believe that they do. I'm hungry for information about the actors who portray them because that is a way of refusing to believe they aren’t real; the last thing I want is to see them in other shows playing different characters.

And for good or ill, I’ve watched each episode of the first and second series so many times on DVD that I now have the funniest sections on standby in my head; I’m liable to start smiling to myself for no reason as I ‘play’ one back, which has both advantages and disadvantages. (The third series has aired on the ABC and Australian fans now await the fourth, which is currently being aired in Britain on Channel 4.)

I don't have the DVD of the third series, but recently I realised I could watch repeats of whole episodes on Youtube. Yet watching the show on my PC doesn’t do it for me at all; it’s not just the poor quality of the footage but the fact that I don’t associate sitting at my desk with leisure. I love the whole DVD experience of sinking against cushions and losing myself in three indulgent hours of comedy paradise.

However, having now seen the first and second series in full, I think the content of the third series, which I originally watched on telly, isn’t quite as good, and it’s not just the Youtube factor that’s making me feel that way. The show’s becoming more like Seinfeld by the minute; Seinfeld is not surprisingly one of Linehan’s inspirations, and worth imitating, but the particular magic of character-based dialogue needs to be preserved.

Just one tiny example: when Jen and Richmond have their first conversation, Richmond says of Roy and Moss ‘I don’t know their names’. In the context this line is simply brilliant, illustrating how cut off Richmond is from the world and yet how self-chosen is his exile; Roy and Moss are no more than functionaries who form part of the background of the catastrophe he finds himself in. Why this is so funny is difficult to pin down, but it has a lot to do with the rarefied worldview of this underrated and now sadly lost character – somewhere between the second and third series he ‘got scurvy’ and was never seen again.

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