The treatment of social phobia – 100 years ago

An important early work by the French psychiatrist, Paul Hartenberg, Les Timides et la Timidité, published in 1901, has been overlooked in the English language literature on Social Phobia. Hartenberg’s understanding of the phenomenology of social phobia is surprisingly similar to modern conceptualizations of the disorder. His description of the disorder corresponds very closely to the current DSM-IV criteria of social phobia. For example, he recognizes that socially anxious people feel anxious and ashamed in situations where there is no actual danger, and that these emotions occur only in the presence of others. Hartenberg clearly differentiates between social fears and other fears, noting that socially anxious people may be quite courageous in non-social situations. He also describes with considerable accuracy the typical symptoms of rapid onset anxiety. In a number of respects, Hartenberg approaches social phobia from a cognitive behavioral perspective, and describes an approach to treating social fears that is essentially graduated exposure to feared social situations. Hartenberg anticipated many advances in the area of social anxiety, and provided a number of insights that remain valuable.