Struggling for a tomorrow: lived time in social anxiety disorder

Abstract

In this paper, I develop a phenomenological account of social anxiety disorder (SAD) as a disturbance of lived time through an analysis of first-person accounts informed by Minkowski’s notion of disordered temporality. The core psychopathology of the patient, I argue, is a constricted sense of relational time. Instead of the ordinary sense of a taken-for-granted shared future, the patient experiences time as running a predetermined course toward their social death. This manifests itself in a relational life lived as if it might end at any moment or has already done so. Patients describe the end of their current relationships as self-evident and struggle against it by attempting to evade its immediate occurrence and to postpone it into the less eminent future. At times, patients succumb to passivity and self-blame, revelatory of a sense of an entirely lacking relational future. This phenomenological conceptualization provides an alternative to the predominant cognitive-behavioral (CBT) account of SAD. The CBT approach conceptualizes the core disorder as a set of dysfunctional beliefs about other people’s opinion of the patient. The phenomenological account elucidates a part of the subjective background on which these beliefs come to make sense to the patient. Further, with its concept of social death, the phenomenological account captures the existential contexts, which makes the intensity of the patient’s fear of rejection comprehensible. This way of understanding the patient and their psychopathology has important implications for diagnostic and psychotherapeutic practice.