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The Social Anxiety Disorder Poker Game

Updated on February 11, 2016

Lupus and the Spoon Theory

For as long as I can remember, my mother has lived with lupus. It effects every aspect of her life, and it effects the lives of those who love her. But well-meaning as we are, we who love her cannot always understand what she's going through.

Some time ago, just before I moved out of my parents' house, she posted a link on her facebook page to a wonderful article by Christine Miserandino called "The Spoon Theory." (See the link for the full article.)

While having lunch with a friend, the author, a woman living with lupus, was asked by her best friend what it really felt like to have lupus. Upon realizing that her companion was not asking for the medical definition, the author found herself at a loss until, on an impulse, she gathered up a bouquet of spoons and handed it to her friend.

"I explained that the difference in being sick and being healthy is having to make choices or to consciously think about things when the rest of the world doesn’t have to. The healthy have the luxury of a life without choices, a gift most people take for granted.
Most people start the day with unlimited amount of possibilities, and energy to do whatever they desire, especially young people. For the most part, they do not need to worry about the effects of their actions. So for my explanation, I used spoons to convey this point. I wanted something for her to actually hold, for me to then take away, since most people who get sick feel a “loss” of a life they once knew. If I was in control of taking away the spoons, then she would know what it feels like to have someone or something else, in this case Lupus, being in control" (

I was moved by the article, and how brilliantly it conveyed the struggles of living with a chronic illness--specifically the frustration of having to live with a certain amount of loss--to someone who had never experienced it firsthand.

Some time later, I expressed to my mother the desire to come up with a similar theory to explain what it was like to live with social anxiety disorder. Her response was unabashed maternal pride and confidence in my abilities as a writer. Nice as the praise was, it didn't do much to help me actually come up with idea. Still, I thought I owed it to both of us to give it a try.

Stumbling blocks

One of the difficulties I had in coming up with an appropriate metaphor for social anxiety disorder vs. the Lupus Spoon Theory was that the spoon theory dealt with a physical pathology rather than a mental one.

Where there is a physical illness like lupus, there are signs and symptoms that can be seen and felt by the patient, and observed by the patient's loved ones. And for the most part, even when friends and family are not as understanding as we ought to be, there is a certain level of blamelessness which is understood where a physical illness is concerned.

This is often not the case with mental disorders--particularly the neuroses like social anxiety, depression, and various specific phobias. A large part of society will tell you it is "all in your head," and that overcoming it is merely a matter of common sense and willpower.

The Spoon Theory demonstrated how a chronic illness takes control of a person's life, and how they must always take the illness into account when making decisions. But someone suffering from a neurosis is made to feel a certain measure of shame or weakness if they consider and cater to their condition in the same way.

My mother might choose to take supper in her room if she was feeling feverish or tired or achy. But if I chose to eat apart from the family because after a particularly stressful day at work I felt a strong aversion to physical touch and the sound of human voices made my pulse spike, I was made to feel inconsiderate and rude.

Expressing to someone else how the thought of making a necessary phone call can make it difficult for me to breathe usually earns me more frustration and annoyance than sympathy. Numerous times I have felt the need to leave a party or other gathering simply because there were too many people and I couldn't endure the level of anxiety any longer. On many of those occasions, I faked a headache or some other minor sickness to avoid the irritation of whoever was at the party with me and had to take me home. At least if I had a headache or felt nauseous I wasn't simply being a wet blanket and ruining everyone's good time.

And then there is the difficulty of trying to explain what part of the control *does* belong to me and my mind. When I am reprimanded by my boss or a friend seems particularly condescending when informing me that she doesn't care for a TV show I like, or my roommate gets irritated and snaps at me, the fear I feel is physical real. There is a real burst of fight-or-flight adrenaline. And, if I cannot manage to ease myself out of my thinking errors or otherwise resolve the conflict, there is a real stream of cortisol in my system for at least an hour afterwards.

Truly, the key difference is that while someone with a chronic illness loses their supply of "spoons" throughout the day, someone with social anxiety sometimes stands to gain "spoons," but only if they can manage to respond properly to unexpected disruptions and stressors.

And that was when it came to me.

The Poker Game

A person with social anxiety disorder begins every day with a supply of poker chips and a hand of cards. Every day, I wake up and I count my chips and look at my hand. That is, I assess my overall mood, my confidence, my energy, and levels of stress from external sources, such as work, relationships, or chores that need to be done. Too many external stresses wear away at my confidence and energy, and that means I'll be low on chips when my day starts. Poor sleep, a case of the sniffles, muscle aches, or menstrual symptoms can also leave me without a lot of chips to spare.

For the sake of argument, let us consider a typical day as I might have spent it last year, when I lived at home, worked 40 hours a week, and went to school in the evenings and on weekends.

My Monday morning begins at 8:00 or 8:10, depending on how able I am to drag myself out of bed. I stayed up too late the night before chatting with my best friend online, which means my chips are down already. I find myself short a few more chips when I remember that I have class after work, which means I won't be home again until after 11.

My job is only about a five or ten minute drive from my house when the weather is good. Sometimes though, in Chicago in the middle of winter, snow comes unexpectedly overnight. Because my parents' garage can only fit the van, my little inherited car lives in the driveway. And when there is unexpected snow, you can bet I am cleaning it off the old girl's window five minutes after I was expecting to leave. If the roads haven't been plowed, add ten minutes. If the parking garage at work is crowded, add two minutes. If the elevators are crowded, add five.
I rush in late to work, and half my chips are gone.

I mumble good mornings and hope no one engages me in conversation just yet. I don't have the chips to put in the pool this hand.

My morning dose of Adderall, plus a cup of heavily sweetened coffee, plus a bagel or some other bit of solid food makes me feel more comfortable and replenishes my supply of chips like health hearts in a video game. Making timely progress on my daily tasks also adds to my supply.

But then, a coworker comes to confront me on some mistake I made. And this is where the game really begins. As soon as I am engaged in communication with someone, I have to play a hand, and I have to put in a few chips. Every social encounter carries the risk of loss. I pull out my cards and throw down my chips.

I examine my hand. How big was the mistake I made? Was it caught in time to prevent problems, or is there clean up to be done? Was the mistake even mine, or am I taking blame for someone else? Do I have a logical chance of defending myself, or is it just something I should apologize for?

And then social anxiety comes in when I try to read my coworker's poker face. How mad is she? How mad is she at me? Is it really the mistake I made, or is she taking out some unrelated frustrations on me just because I'm there? How much respect do I stand to lose or gain by defending myself or gracefully apologizing?

The social anxiety brain will always answer these questions with a worst-case scenario. She is very mad. And she is very mad at me. Or if not, she is using me as a whipping child because she has no respect for me. And in that case, I surely stand to gain no respect, and if I don't play my cards right, or if she calls my bluff, or if I fold, I lose everything I've put down.

Anyone else who happens to be in the room, whether or not they say anything, appears to be putting their chips down, too, forming opinions for or against me. With most people, my ill-programed brain assumes they're against me.

Rare are the occasions when I do not fold to someone who is simply more forceful than I am. But that means they walk away with whatever I put down when they engaged me in conversation. And as long as the conversation stays in my head, I'll keep knocking chips off the table and losing them under metaphorical sofas and cracks between the floorboards.

Retreating to the bathroom to listen to music or read a few pages of a book restores a little bit of balance. But it is not just confrontation that can lead to loss. Friendly debates can drain my chips if my hand of cards is not played well enough to convince them of my opinion. Even if I do manage to convince them, worries over whether or not they still like me afterwards can have me dropping chips again. So can little imagined signs of disdain in their voices or their body language, or imperfections I perceive in my own appearance, which I become convinced are all anyone focuses on.

I lose more chips worrying about what is behind their poker faces than I do actually putting chips down to play a proper hand. And every social encounter comes with worry about what people are thinking when they look at me.


In high school, I went through a therapy program to help me learn to manage my social anxiety. I learned about breathing techniques to engage the parasympathetic nervous system, and conditioning myself so that thinking the word "relax" would prompt me to breathe that way.

I learned to identify thinking errors. For example, if I found myself thinking that my coworker didn't like me, I am to ask myself, "How do you know that? Can you read her mind?"

In the case of anticipatory anxiety--that is, fear of a situation not yet encountered--I am to ask myself what the worst thing that could happen would be, and what the worst possible consequences are that would follow. Do I honestly think that I will never get a job if my voice cracks during a phone interview?

Sometimes, if I trust a person enough, just plain asking them if things are all right between us and honestly talking can help.

But sometimes, when the chips are really down, all that can build them up again is retreating and shutting out the world to regain my balance. Not everyone is going to be willing to accept that. But I hope this will help a few more people understand.


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      Ruth Perkins 3 years ago from New England

      You decided what chips to put down in this hub that made me thoroughly understand what you set out to say. You are a very good writer. Recognizing ALL disabilities is something that societies surely need to respect. You've paved the way for this. You should be proud. Thanks for the read