As a disorder, SAD has been thought significantly under diagnosed, largely due to the fear that individuals with the disorder have concerning how they would be perceived if they reveal the extent of their social anxiety (Mennin, Fresco, Heimberg, Schneier, Davies, & Liebowitz, 2002). This fear is not so irrational in that the clinician would perceive the individual as being sick and apply a heavily stigmatized label upon the individual.

The bio-psychosocial factors thought to instigate the disorder may likewise represent an accurate assessment of a social reality. Culturally, a high premium is placed on uninhibited, extroverted, and socially proficient traits, and the knowledge that one’s traits are not valued, and are in fact considered pathological, makes fears of disapproval quite rational. Additionally, if one is functioning out of their perceived qualification (such as a poor or working class individual defying stereotypic expectations), then extroversion could be an invitation for retaliation and class enforcement. Not only could one’s true nature be exposed, but the person performing could be revealed an imposter, who ineffectively tried to embody characteristics culturally deemed desirable.

Put simply, individuals with SAD may have internalized the values of an individualistic society, which pathologizes those who do not embody relevant traits and qualities conducive to non-interdependence (a largely mythological state). Traits which began as functional shyness, may be complicated by messages of disapproval, resulting in maladaptive internalization of values inherently incongruent with individual strengths. This conflict between internalized values and inherited traits may create a very rational cognitive dissonance, like that found in individuals diagnosed with SAD. Educating the individual of the strengths found within introversive and introspective traits, which are otherwise socially depreciated, may better treat some symptoms of SAD. Aiding individuals to discern patterns of maladaptive socialization which pathologize inherent qualities can aid them in choosing what to internalize, and what to externalize, increasing the likelihood that social justice is achieved.

Though studies have found medication to be effective in the reduction of symptoms, gains are lost (symptoms return) as medication is discontinued (Bailey, 2002). Because of the resent proliferation of research, education, and treatment modalities biased towards the medical model, more effective psychosocial treatments are increasingly neglected, in favor of less effective or inappropriate pharmacological treatment (Bailey, 2002; Sharfstein, 2005).

Utilization of the DSM has been and will remain an interpretive and subjective endeavor. No one can come up with a list of mental health symptoms that will be universally interpreted, but instead, values and interpretations will guide the application of labels. The search for a genetic basis of mental illness will continue to find objective, biochemical / brain-imagery correlates, to subjective value laden labels, and they will continue to call this science.

When I was a child in the 1940s, I had the symptoms of Social Anxiety Disorder and the fact that I was raised to have opinions there was something wrong with it made it worse.    My getting over feeling that way seemed to be facilitated by my finding friends without that mentality who accepted me as I was and I think mothered me out of it. 

I’ve noticed that folks who make a to-do about that I am quiet will stifle me if I start talking.   I gather they may be concerned that I may be crazy and if they let me talk or show much initiative in other ways they might not know how to handle me.   

Seeing a therapist was not my idea and feeling bad emotionally really started as a result of seeing one.   For one thing I had family members who were indiscreet about spreading the information I was in therapy and found myself being treated differently.   

Seeing a therapist was confusing because I did not have the sophistication to deal with it.  My religious upbringing clashed with their thinking for one thing.  It caused me to have all kinds of questions that I stayed in therapy to find the answers too.    At some point maybe twenty years later,  I heard some ideas in a sermon that helped me to realize I don’t have to have the answers and felt a big sense of relief.     On the other hand while I was in therapy I felt under pressure and not allowed to be at peace about what they worried me about.   

What I needed years ago was to have in my life a bunch of ordinary folks who accepted me and nurtured me and such as that.    The drugs they put me on made me feel bad and it was never official that my lack of energy and other stuff was the drugs.   Such side effects tended to be blamed on my mental health.    If I did not take the drugs, I got in terrible shape which never seemed to be blamed on the drugs.    With the help of doctors and a knowledge of Chemistry I weaned myself off by small increments.   

My homosexual brother had some therapy where they talked about him having an absent father and a non nurturing mother.    I gather from a TV program I watched on EWTN that is a different opinion from the one that his sexual orientation is something he was born with.    I encountered the same opinions about my parents in my therapy.    I think my Mom could be described as a hostage taker.    She discouraged my friendships and never wanted me to get a job as maybe a part of keeping me somebody she could control.

There is an opinion that if you try to change things they get worse.    That applies to my experience.   The opinion that there was something wrong with my being quiet caused pressure to change with resulted in my becoming self conscious and more quiet.   

The folks who made a to-do about that I was quiet stifled any improvement  in me.  It may have been a part of not wanting to have to change their opinion or be disapproved of by their peers for spreading a false opinion.   Their opinions set them up as my betters and had I overcome the problem like they were shaming me I should they would no longer have that status in my life.   

Those adults in my childhood who were deliberately non nurturing because they deemed themselves wise about child psychology were changing themselves against their grain on the idea.   Their stifling their normal instincts to give the children the nurturing they normally want because they are not supposed to need it was trying to change everybody concerned against their grain.   It brought out the worst in everybody concerned.   

The school died of bankruptcy because those parents who disagreed and maybe had the financial means to improve things removed their kids from the school.