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3rd January 1999

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A new drug for shyness ?

Of the recent "life style" pills, it was one for shyness that screamed for the most attention. True, Viagra, the headline-grabbing anti-impotence pill, has undoubted prurient appeal but reports of Seroxat, a drug that can make social lions of social lambs, were riveting. 

Just imagine. Horrendous social ordeals would become opportunities for charismatic conquest: pop a pill and win that heart, nab that job, charm that jobsworth what a breeze.

Only it was not to be. Seroxat is the brand name the generic is paroxetine and it transpires that it's not for shyness at all, but for social anxiety disorder (the new name for social phobia). This can be so severe that sufferers lead lonely and isolated lives. It is to shyness what clinical depression is to sadness.

This is not what you and I suffer from. We have the old-fashioned sort of awkwardnes that leaves us, when we get a chance to impress, without a coherent thought in our heads. Just 5% of the British population claim never to have been affected. 

Shyness is so complex it defies a universally accepted definition, but the childhood affliction that most people were believed to grow out of has been revealed to exist in epidemic proportions. Some 40% of the British admit to suffering from it to a debilitating degree and that number is nearer to 48% and rising in America. Dr Ray Crozier, psychologist and expert in shyness at the University of Wales, Cardiff, believes "everyone is shy some of the time''.

Shyness surveys rely by necessity on how people perceive themselves. ''There is a strong labelling component in all of this,'' admits Crozier. ''A non-shy person will tend to regard a certain social situation as difficult; they will think, 'I'm uncomfortable, but I'll get over it'. A shy person will think, 'I'm hopeless' and blame themselves.' '

The question is, says Crozier,"Do we just think, 'this situation is acceptable,' or do we think it says something about us as individuals? Those who think the latter, tick the shy box.''

Most shyness is hidden. Only between 15% and 20% of shy people fit the stereotype of the ill-at-ease person. They avoid social events and eye contact, and seldom smile. In casual conversation, they stumble over words and cannot sustain conversation.

The rest are privately shy. They may seem at ease, but feel inept, hide a pounding heart and wonder if the person tbey are talking to even likes them. When the conversation ends, they feel upset or defeated.

What unites the shy is acute self-conciousness, and it can strike anyone. Beth Gibbons, the singer in the rock music group Portishead, is so shy she used to sing with her back to the audience. Barbra Streisand was so badly afflicted that she could not sing in public at all for 20 years. This Life actor Daniela Nardini and motormouth Ruby Wax have both confessed to crippling shyness in childhood. The talk-show hosts Johnny Carson and David Letterman have both battled to overcome it.

So where does shyness come from? Are you born with it or is it something you acquire? It was only in the 1970s that researchers began to tackle these questions.

Dr. Philip Zimbardo initiated the Shyness Research Program at Stanford University in California and has found that shyness has been increasing steadily over the past 20 years. He has found that in addition to the 40% of respondents who reported being chronically shy, another 40% previously they no longer were, 15% more as being shy in some situations and only 5% as never shy.

Professor Jerome Kagan of Harvard University, also in America, is one of the world's leading experts on shyness. He revealed that just 15% of infants are very stressed by new situations, suggesting they were born with a temperamental tilt towards shyness.

This must mean most shyness is acquired through life experiences. A lot depends on parenting. "Shy parents," says Crozier, "expose their children to a restricted social life." Isolated traumatic events and family relationships also play a part.

Zimbardo's earliest surveys hinted at cultural differences in shyness. Japanese and Taiwanese students consistently expressed the highest level of shyness, Jewish students the lowest. In Israel, only 30% of college age students report being shy, vs 60% in Japan and Taiwan. Zimbardo found the key is in the way parents attribute blame or praise in the performance of their children. In Japan, if a child tries and succeeds, the parents get the credit. In Israel, it's the opposite. A child who tries is rewarded, regardless of the outcome and a person is likely to develop chutzpah, the audacity whereby one always takes a chance or risk, with or without the talent.

There are plenty of other theories. Kagan and the Harvard sociologist Dr. Stephen Cortmaker have found that women who conceive around September are particularly likely to bear shy children.

Light is waning then and the body is producing increasing amounts of melatonin which helps to set our biological clocks. As it passes through the placenta to the developing foetal brain, Kagan surmises, the melatonin may act on cells to create the hyper-aroused, easily agitated temperament of the shy.

That's as may be. Easier to accept is the theory that shyness is affected by the way children are handled by their parents: the overprotected growing up anxious and shy, while those whose parents do not shield them from stressful situations overcome their inhibition.

Girls are more apt to be shy from infancy through adolescence, perhaps because parents are more protective of them than boys. Yet in adolescence, boys find that shyness is more painful, possibly because of sex-role expectations. Once into adulthood, gender differences in shyness disappear, and from then on it can strike at any time. A mid-life divorce, for instance, can set it off. And for successful, career-defined people, being fired from a long-held job can be similarly debilitating.

None of this explains why shyness is increasing at such an alarming rate. Here Zimbardo is unequivocal. He believes we are at the beginning of a new ice age of non-communication. The use of computers, faxes, phones, mobiles and the disappearance of bank tellers and shop assistants with whom to pass the time of day, all contribute to what he calls a worldwide epidemic of shyness, with increases of between 40% and 60% reported in many countries.

"Shyness is an insidious personal problem," he writes. "It is reaching such proportions as to be justifiably called a social disease. Trends in our society suggest it will get worse as social forces increase our isolation, competition and loneliness."

So could Seroxat be the answer? Seroxat is an SSRI, a selective serotonin re-uptake inhibitor (as is Prozac) which works by increasing the level of serotonin in the brain and inducing feelings of confidence and well-being. Crozier believes that while it is useful for sufferers of social anxiety, disorder, when used in conjunction, with behavioural therapy, it would be overkill and rather pointless. Shyness is largely due to the kind of society we live in and not something to be cured by medication.

Vegetarian diets: health habit or health hazard?

Becoming a vegetarian is being increasingly resorted to by Sri Lankans, some for religious reasons, others with the general belief that being a 'veggie' is good for your health.

Being vegetarian certainly has its plus points from a medical perspective. But there are minuses as well:

The Pluses:

1. Lowers blood pressure: Vegans, who consume a diet very low in fat, tend to have blood pressures lower than non vegetarians of similar age and sex. Much of this effect appears to be related to lowering of body weight in vegetarians (see below).

2. Lack of obesity: Obesity, a contributory factor in many diseases including heart disease is uncommon among vegetarians. This may be because 'veggies' tend to be more physically active than non vegetarians and also because a higher intake of dietary fibre may decrease food absorption.

3. Lowers Blood Cholesterol: This has been consistently demonstrated, even among Lacto vegetarians who consume milk and other dairy products. Lowest cholesterol levels are seen in vegans who consume no milk or other dairy products.

4. Less colon cancer: Diets high in animal foods may increase the incidence of colon cancer by increasing faecal concentrations of various carcinogens. It is also possible that carcinogens are produced by cooking meats at very high temperatures.

The Minuses

1. Osteoporosis: Some studies point to evidence that vegetarians are more likely to get osteoporosis than non vegetarians. But there is no wide acceptance of this theory and the issue is still under research.

2. Rickets: Vegetarian children who have limited exposure to the sun may be at risk of developing this bone disease. This is more so in vegans, those who do not consume milk or other dairy products.

3. Iron Deficiency Anaemia: Blood iron levels are significantly higher in non vegetarians than among vegetarians. So, being vegetarian is discouraged if a person already has reduced levels of the blood oxygen carrying pigment, haemoglobin.

4. Slow growth in children: Excessive leanness and slow physical growth has been reported among vegetarian infants and young children. This is more marked after weaning. For this reason a vegetarian diet is seldom recommended medically at a young age.

Sore throat bacterium may hide in cells

Streptococcus pyogenes, the cause of streptococcal pharyngotonsillitis or strep throat may escape antibiotics by slipping into the cells where antibiotic concentrations tend to be much lower, according to a study in a recent Lancet. The finding may help explain why, despite S. pyogenes's susceptibility to penicillin and related antibiotics, treatment fails to eradicate the infection in 5-30% of cases.

Dr. Revital Neeman and colleagues from Tel-Aviv, Israel, took throat cultures from 67 young patients with strep throat before and after treatment with antibiotics. They then tested the streptococci that grew for the presence of a gene called prtF-1. 

This gene codes for a protein called streptococcal fibronectin-binding protein, or protein F-1, which helps bacteria latch onto and enter the epithelial cells that line the respiratory tract.

The investigators found that while all 67 patients were cured of their sore throats, Spyogenes could still be cultured from the throats of 13 patients after antibiotic treatment. Although they felt and appeared well, such patients would be considered carriers, could spread the bacterium to others, and are at risk of coming down with strep throat symptoms again. In 12 (90%) of these cases, bacteria were carrying the fibronectinbinding gene. By contrast, in the patients in whom the bacteria had been eradicated, only 30% had bacteria carrying the gene. "Our findings suggest that protein-F1 mediated entry into cells is involved in the causative process of the carriage state," conclude Dr. Neeman and colleagues. In a commentary, S.H. Gillespie from London, UK, concludes that the investigation "directs future therapeutic research for eradication of carriage towards antibiotics that penetrate inside cells"

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