Howard Forman, M.D.
Recently a young patient began her first session with me, "Everyone tells me all the time what a great girl I am and how they cannot figure out why I am still single and about to turn thirty." As I got to know Devorah* a little more, I learned that she is well-educated, professionally successful, has a wide-network of friends and involves herself greatly in chesed. I was able to observe at that first session that she was smart, of reasonable good looks, and presented herself both stylishly and modestly.
After reviewing with her the symptoms of some broad conditions that psychiatrists are often called upon to treat, there was nothing to suggest that Devorah had any psychological condition that would benefit from therapy. Although disappointed to be neither married nor a mother, she was not depressed, and to my knowledge, there is no medical treatment available for someone who is so far unlucky in the dating parsha.
I asked my new patient, "Can you tell me about your last date?"
She responded, "It has been a while because I really turn down most offers because I find going on dates so stressful. The last time I went out on a date was eight weeks ago and from the moment the boy arrived at my parents' home, I was sweating, my heart was beating so quickly, I felt my mind going blank, and when he would ask me questions, I would get even more nervous and would have difficulty speaking. I just could not wait for the date to end."
"How often do you get this nervous feeling with the sweating and your heart racing?" I asked.
"Only when I am on dates It never happens at work and in fact people at work come to me with their problems, because I am known as the level-headed one."
After a little more discussion, I was able to inform Devorah that she had Social Anxiety Disorder, defined as an ongoing "fear of one or more social situations in which the person is exposed to unfamiliar people or to possible scrutiny by others" and a condition in which "the individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing." I also told her that this is not an uncommon condition, that one out of eight Americans experience it, that it is most likely to appear during the period when someone in our community is looking for a shidduch, and that although not uncommon in men, is more likely to affect women.
I was also able to tell her that her experiencing these symptoms only in one area of her life is not surprising. Many of the people who have Social Anxiety Disorder are incredibly high achievers in areas that do not trigger their symptoms, as is the case with Devorah: The fact that she has many girlfriends and speaks without any fear in front of large audiences at work does not mean that she does not have the condition. It simply means that it is limited to a narrow slice of her social interactions.
More important than any fact about the condition, I was able to tell her that Social Anxiety Disorder can be treated successfully through psychotherapy, medications or, optimally, a combination of both. Devorah chose to try a combination of therapy and medication. The therapy focused on reversing some of the negative thoughts she began to experience from the moment she was told about a potential shidduch, which would escalate until the first date was over. (There were no second dates).
We rehearsed the feared situations and, most importantly, I made a contract with her that she was not to refuse any dates that her mother, who was working with her during the dating process, believed were appropriate. This way her anxiety would no longer lead her to avoid her fears as she began to see how she could manage them more effectively. With respect to medication, I helped her choose an anti-anxiety medication with very limited side effects.
In the four months since Devorah began treatment, she reports that although she is nervous on dates, she is able to enjoy aspects of the experience and she no longer experiences the terror she did before beginning treatment. She has had the experience of being asked on second dates, some of which she has accepted, and some of which she has declined. Her friends have shared with her that she just seems much more like the upbeat person they grew up with. I hope that I will soon be able to write a letter to the Jewish Press with the good news of her wedding, im yirtzeh Hashem.
* Names are changed to protect privacy.
Howard Forman, M.D. is a psychiatrist specializing in psychotherapy and medical treatment of anxiety and depression. A graduate of Columbia University and of the Albert Einstein College of Medicine, Dr. Forman's practice is specifically tailored to the needs of the frum community. He can be reached at 212-960-8171.