The cost of shyness in an age of talk

Notebook

SHYNESS WAS once thought becoming in women, but it is not a moral quality. You are not better - more thoughtful, more compassionate, more sensitive to others - because you are shy. Still, I've always thought there was something attractive about shyness - diffidence, unease in company, according to the Concise Oxford - perhaps because it suggests hidden depths and therefore an interesting process of discovery ''putting someone at their ease ... drawing them out"; but more likely because for a long time I thought it was man's natural state.

A shy person at a party, for example, seemed to be doing no more than physically manifesting the inner terror of the rest of us, and in that way was a reassuring sight. I blame - if blame is the right word - where and how I was brought up. Loquacity and forwardness were still regarded with suspicion on the east coast of Scotland in the 1950s, where to say that someone had "the gift o' the gab" was pretty well to damn them as encyclopaedia salesmen from south of the border.

Then, and for a long after, teachers at Scottish universities with a high proportion of English students (St Andrews, Edinburgh) would complain that English voices monopolised tutorials while Scottish students shrank back, stunned by such confident articulacy. Once, as a reporter on a small- town weekly in the 1960s, I went to write a friendly piece on an old village pub. The landlady showed me the door before my first question. She said: "The only time I want my name in the papers is when I'm dead."

All changed, of course: television is filled with fluent Scottish voices and undaunted Scottish faces, gabbing away like Bruce Forsyth and pearly kings and queens. Britain has become an unreticent society. Confident speech and confident appearance matter more now than at any time in history - commercially, as a way of making money. The media, advertising, public relations, cold-call selling, the law, conferences, call-centres, politics - the great new industries of Britain depend on them. We are all encyclopaedia salesmen now and we want our names in the papers (obituaries come far too late). In a previous industrial age, you could be a quiet weaver, a shy miner, a dumb mechanic (employers, in fact, preferred them like that). But now even the practitioners of formerly silent crafts must be seen and heard. Authors spend as much time selling their books by speaking in bookshops as they do writing them. Monks need to appear on TV. After the age of the workers by hand and brain comes our age - the Age of the Workers by Tongue.

And what do the shy do in such an age, when their condition is no longer hidden by the reticence of society in general, when shyness might mean unemployment?

According to SmithKline Beecham and its supporters in the medical profession, they take a pill. Seroxat is the brand name - the generic is paroxetine - and last month it was licensed by the Government to treat "social phobia/social anxiety disorder" (or shyness), which means that it will be available on the National Health Service.

On Thursday, I went along to a press conference at the Royal Medical Society in Wimpole Street to hear about it. Smith-Kline Beecham had been stung by a front-page piece in last week's Sunday Times which linked Seroxat to other new "lifestyle" drugs, Viagra and Xenical (for obesity), and estimated that it could cost the NHS an extra pounds 700m a year.

Drug companies need the patronage of the NHS, and therefore public support, and the anxiety of our host, SmithKline Beecham's corporate communications director, Dr Lynne Smith, was apparent in her opening remarks. She said the Sunday Times story "incorporated a number of errors" and implied that it had trivialised "this misunderstood illness" by calling Seroxat "a pill for shyness". She said that social anxiety disorder was to shyness "what clinical depression is to sadness". But as the conference went on - and it lasted for almost two hours with slides, lectures, a video, and questions - it seemed to me that the paper had got the story pretty well right. Seroxat is an SSRI, a selective serotonin re-uptake inhibitor, which works by increasing the level of serotonin in the brain and inducing feelings of confidence and well-being.

It isn't a new drug. Since 1991 it has been prescribed for obsessive compulsive disorder and depression. But its new constituency - its marketing opportunity - is for the shy. All they have to do is recognise that they are socially phobic.

Professor David Nutt, the director of the psychopharmacology unit at Bristol University, came to the lectern. He wanted to begin with a story. That morning on the train to Paddington he'd fallen into conversation with a woman who turned out also to be in the medical profession.

"Oh, the shyness pill," she'd said when Professor Nutt told her of the conference he was off to. "I wonder if it could help me." She was scared of "presentations", where you have to stand up before an audience, speak and point to the slides on the screen. Her mouth dried, she couldn't think, her sentences were scrambled. She'd stopped doing them.

I expected the professor's point to be: no, the drug wasn't meant to help with such professional hazards, it was designed to treat this much more serious condition, social anxiety disorder (I imagined frightened old people behind the locked doors of tower blocks). But in fact the professor's point was the opposite. The pill may well be able to help her. Social anxiety disorder was precisely what she had - unlike the professor, who now began to talk in a relaxed way about the procession of statistics on the screen.

According to the professor (and SmithKline Beecham), between 2 and 5 per cent of the British population suffer from social anxiety disorder at some time in their lives. Women are more likely to have it than men. It usually strikes before the age of 20. Children have it, but most grow out of it.

Sufferers tend to be single, under-educated and under-achieving, and also to depend on alcohol and drugs. They also have much higher suicide rates, partly because of "co-morbidity", the tendency to develop other conditions - depression, alcoholism - after social phobia has set in.

"It's a common, lifelong, disabling, under-recognised and under-treated illness," said Professor Nutt. The words on the screen said that it led to "avoidance of social/performance situations" or enduring them with great distress.

The "feared situations" included dating, attending weddings, public- speaking, taking an exam, trying clothes on in a shop, calling someone you did not know on the telephone, writing a cheque, typing when someone was looking over your shoulder (a box, among others, that I'd most certainly tick), and eating in public. The professor said the socially phobic tended to avoid soup and peas in restaurants - giveaways for shaky hands - and go instead for easily managed forms of pasta.

I don't mean to mock. Shyness, obviously, can be a crippling thing; the roots of self-consciousness and poor self-regard are mysterious (as Darwin pointed out, humans are the only animals to blush). But this mixture of ordinary and extraordinary fears - fear of public-speaking in the same list as fear of public toilets - seemed a pretty poor guide to a specific condition - an illness, no less - with population percentiles and brand drugs attached to it. As did the list of symptoms: blushing and trembling on the one hand, vomiting and panic attacks on the other.

When the time came for questions, I asked Professor Nutt if he could differentiate between the symptoms of "ordinary shyness" - a term one or two speakers had used - and of social anxiety disorder.

The professor said they could well be the same. The first would become the second only if shyness caused "role impairment". In other words, if the shyness significantly affected the shy person's life or livelihood. I didn't have the wit to ask the supplementary that occurred to me later: Isn't that like saying Douglas Bader wasn't disabled because he could still fly aeroplanes? But then I wasn't on Seroxat, and noticed in fact that my hand was trembling slightly as I held the microphone.

Oprah Winfrey time. I am sure I could benefit from Seroxat. I get many of the symptoms it tries to cure. How many among us do not?

Dr David Baldwin, senior lecturer in psychiatry at the University of Southampton, said it was one of the safest drugs ever made and also that its leading side-effect in men was delayed ejaculation (not to be taken with Viagra, presumably).

But do I deserve to get it courtesy of a hard-pressed National Health Service? The NHS will buy it from SmithKline Beecham at pounds 20 for 30 tablets, one to be taken daily.

If (as Professor Nutt said) up to 5 per cent of the population have this illness, if (as Dr Baldwin said) more than half of the people who take the drug will need to go on taking it - no end in sight - to benefit, then the cost to the state of pounds 700m a year does not seem a wild overestimate.

The case for its subsidised supply to many of the people who will ask for it is not convincing, even in this, the tongue's great age.