A Continued Note on Silence
Voicing the reality of anxiety disorders
Image credit: Tara Holley
by Sarah Donahue
May 19, 2022
Iam six years old and gingerly balanced atop a rounded toilet lid, criss cross applesauce. My muscles stiffen as tears sting my eyes. For the past 30 minutes, I’ve been facing a conundrum: I can’t get myself to move.
It all started with a standard reading assessment — a mid-year check to document my progress. I felt sick as my teacher asked me to grab the special book I brought from home. This was a unique arrangement, a hope that I would read aloud if I could just practice with one of my favorites first. But it didn’t matter. I mutely signed the word for bathroom, balling my hand and tilting it side-to-side until a slight nod from my teacher indicated she fell for it. I hid.
For most of preschool and kindergarten, I remember wanting to cry daily from pure frustration. I was fun. I was smart. I talked constantly at home. I was capable of making friends, completing my schoolwork, and conversing with my teachers. I could read. Yet I couldn’t perform any of these skills in the classroom despite my desperation to connect with classmates and impress my teachers. Though I couldn’t articulate these gargantuan feelings at age six, I gravely understood my compartmentalized reality. It was simple: I couldn’t use my voice when I needed to the most. My words vanished, and my anxiety suppressed what was really there. I was captive to my own mind.
***
At play were two anxiety disorders, both very much interconnected and equally crippling: social anxiety and selective mutism. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders defines social anxiety as a persistent fear of scrutiny from peers in social situations. Selective mutism is similar in that it involves intense fear of judgment, but the social phobia is so great that affected individuals are physically unable to speak in triggering situations. This outcome is independent of any speech or developmental delays. The Anxiety and Depression Association of America indicates that about 7% of the country suffers from social anxiety. Selective mutism, however, affects less than 1% of the population and primarily impacts children.
Dr. Stephen Whiteside, a psychiatrist who works with anxious children and teens at the Mayo Clinic in Rochester, Minnesota, explained that selective mutism is often an extreme manifestation of social anxiety. Both disorders, however, are different from shyness. According to Whiteside, the distinction boils down to “a degree of severity.” While many experience general stress and social discomfort on a day-to-day basis, anxiety disorders elevate these emotions to a much larger scale. Though shyness and stress are certainly factors in the equation, those with anxiety diagnoses are “shy and quiet to the point that it is upsetting to them. [It] gets in the way of doing things that they want to do,” said Whiteside. For a person with social anxiety or selective mutism, their condition is more than silence. It’s a hurdle present in every aspect of life.
***
I didn’t recognize how bad my anxiety was until third grade, the year I transferred from my Montessori school into public school. I already realized that I did not like new situations, preferring the comfort of the familiar and routine. As it turned out, public school was very different from Montessori school. It was bigger and louder, with shiny tiled floors, a tumultuous cafeteria, and a foreign concept called a hall pass. Here, connecting with peers was a constant struggle, and I had an intense aversion to class participation. I never raised my hand to answer a question. In group projects, I just sat and listened. Even if I studied, which I often did diligently, I would cry during tests for fear that I’d be wrong. I was never able to excuse myself to get a drink or use the bathroom during a lesson. The paranoia over unwanted looks overrode my willingness to leave my desk. My intense fear wasn’t just affecting my social life, but my education as well.
***
However extreme one’s anxiety is, there is always a way to move forward. Whiteside’s clients do so through exposure therapy, a technique aimed to lessen anxiety. As he recently reiterated to me over the phone, “Exposure therapy, in its simplest form, is facing your fears, doing things that make you nervous to test the assumptions and expectations of anxiety.”
With this therapy, participants identify their fears before creating fear ladders, lists of increasingly stressful events stemming from the initial trigger. Exposures to these scenarios can help anxious individuals reason their way through negative ruminations that paralyze them. Every exposure makes the fear less triggering, reinforcing that reality is not as terrible as their amygdalae suggest.
At 15 years old, anxiety dominated my life. I would go days without speaking in class, wouldn’t ask questions if I needed clarification on an assignment, and sat alone at lunch. My parents knew that I desperately needed help, and when my mother stumbled upon an article highlighting exposure therapy, she signed me up for a five-day intensive program with Whiteside. I was subjected to my worst fears alongside a group of other teens. I resisted in every possible way — from flat-out refusing to operating as an absolute grouch. I couldn’t see how this approach could make me better. Instead, exposure therapy sounded like living my worst nightmares for days on end.
During exposures, I drew unwanted attention to myself. The key was repetition, and I obliged begrudgingly.
I dropped fistfuls of coins in the hospital lobby, the resulting clatter reverberating off the walls and vaulted ceiling.
I dropped change on a bustling sidewalk and blocked pedestrians as I scrambled to collect the coins.
I approached strangers to ask for directions, even if I already knew the answer.
I skipped across a crosswalk, a crippling task until my groupmates skipped along with me in an act of solidarity.
As I walked into a shoe store during my final exposure, my hands shook. It was my biggest test yet. As I approached the nearest attendant, I took a deep breath. “Um, excuse me, do you sell any dog toys?” The attendant said no with a quizzical look but didn’t laugh. I had survived. I felt a weight lift as the shop door slammed shut behind me. Despite a fleeting moment of weightlessness, my battle with anxiety was just beginning.
It wasn’t until I reached college that I fully committed myself to breaking my anxiety for good, providing myself with mini-exposures for practice. I joined clubs and went to events. I asked questions during office hours. I said “yes” to social events. I spent more time around campus instead of hiding in my room. I led student discussions during meetings, even co-founding and running my own club senior year. It was a long road, but in the end, my internal drive was stronger than any voice that wanted to limit me. I was articulate in spite of the anxiety willing me to be silent once again. Looking back at the girl crying on the toilet, I can’t help thinking she’d be proud of where we are. We’ve really come far, kid.
Sarah Donahue
Sarah Donahue is a graduate student in the Johns Hopkins University Science Writing Program. Before pursuing this degree, she studied chemistry and English as an undergraduate at Trinity College in Hartford, Connecticut. Her current work focuses on mental health and the environment. When she’s not working on science writing, you can find her crafting fiction pieces and dabbling in performing arts. She is based on Cape Cod, Massachusetts.