When Blushing Hurts: Overcoming Abnormal Facial Blushing

Copyright © 2017 Enrique Jadresic, MD.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

iUniverse Star

an iUniverse LLC imprint

iUniverse

1663 Liberty Drive

Bloomington, IN 47403

www.iuniverse.com

1-800-Authors (1-800-288-4677)

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

ISBN: 978-1-5320-2054-4 (sc)

ISBN: 978-1-5320-2053-7 (e)

Library of Congress Control Number: 2014918577

iUniverse rev. date: 04/12/2017

Contents

Foreword to the First Edition (2008)

Prologue to the Second Edition (2014)

Acknowledgments

Part One

Personal/Medical Itinerary

Introduction

Chapter 1: Discovering the Emotions

Chapter 2: A Letter to My Doctor

Chapter 3: Is Pathological Blushing an Illness?

Chapter 4: Returning to Clinical Practice

Chapter 5: Options for Treating Social Anxiety Disorder/Social Phobia and Pathological Blushing

Part Two

The Light at the End of the Tunnel

Chapter 6: Lucia D.

Chapter 7: Barbara F.

Chapter 8: Benjamin S.

Chapter 9: Martin P.

Chapter 10: Monica G., Sebastian L., and Camila V.

Chapter 11: Daniel M.

Chapter 12: Francesca C.

Chapter 13: Nicholas R.

Afterword (2007)

Postscript (2014)

Bibliography

Appendix

To those who are hurting and are too embarrassed to reach out for help.

Blushing is the most peculiar and the most human of all expressions.

—Charles Darwin

Man is the only animal that blushes. Or needs to.

—Mark Twain

Foreword to the First Edition (2008)

Reading a book such as When Blushing Hurts gives rise to a multitude of reflections, questions, and approaches that go beyond the perusal of an eminently instructive text or a collection of clinical cases, characteristics that can clearly be assigned, of course, to this volume. When I consider the reason for this fascinating difference, the answer returns loud and clear: At the heart of the book is a personal testimony; an intense, decisive clinical experience; and a princeps case told with courage, genuine sensitivity, empathy, and honesty. This reason alone is enough to justify the attention given to it, but, fortunately for the readers, the book offers much more. It undoubtedly has the merit of shedding new light on a clinical disorder that is much more common than we can imagine; it also presents vital syndromic, nosologic, and therapeutic concepts as well as a universal call for an unprejudiced, objective, and holistic look at people who suffer, often in silence, from the dramatic ambiguity of the most human of all expressions.

The wealth of clinical, scientific, and technical information in the book is extraordinary. The distinction made between basic and higher emotions vis-à-vis blushing is precise and pertinent. The comment that It is incorrect to associate blushing only with fear or anxiety … opens up a thoughtful debate on adaptive responses, emotional expressiveness, neuropsychological sequences (and the reverse), and diagnostic criteria. For the latter field, the phenomenological description of the author presiding over a class meeting at school is revealing, and admirably so. The reflections and questions that succeeded the experience: the sequence of symptoms, irrational fear, expectations, perceptions, comments, and third-party interpretations; these are all valid and consistent. The questions that arise concerning differences in intergenerational attitudes toward blushing are also relevant.

The discussion of whether pathological blushing (PB) is an illness is a timely one in view of current and future debates on diagnostic and classification systems in psychiatry. Dr. Jadresic’s answer is clear: PB must be considered a morbid symptom or a psychiatric disorder when it is triggered by minor psychological precipitants, causes psychological suffering, and interferes significantly with a person’s academic/occupational functioning or interpersonal relations. Citing Edelmann, one of the few authors who have addressed the subject, he establishes needed clinical distinctions which provide the basis for differential diagnoses that, in the nosological context, are also crucial.

The chapter on therapeutic options is essential to the structure and purposes of the book. Drug therapy and cognitive-behavioral techniques are cited first, clearly a justified approach for treating both PB and SAD, a related disorder. The combined use of these methods is an equally valid alternative. The greatest and most novel emphasis, however, is on the endoscopic thoracic sympathectomy (ETS), a procedure that has existed for quite some time but has undeniably been perfected through modern technology. The author’s own case and various others included in the rich collection of the second part of the book are valuable contributions to the literature on the topic. Each case (documented with measurement scales and personal testimonies) offers a unique perspective and experience: from the grim reality of social ostracism to the joy of personal rediscovery, from deep depression and intense self-reproach to the decision to learn to live again, from the exploration of an enigmatic family incidence to the radical change in personality resulting from the treatment. The ethnographic character of these stories and the human warmth expressed in sincere gratitude give this book a deeper dimension. The opening quotes and the chapter notes are worthwhile additions: the former, telling; the latter, informative. Moreover, it should be understood that, to the best of our knowledge, this is the first book on the subject written by a psychiatrist, one more distinction that does justice to the quality, vision, and talents of its author.

I have known Enrique Jadresic for many years. I am familiar with his illustrious intellectual heritage, I know of his brilliant professional background, I appreciate his contributions to Chilean and Spanish-language psychiatry and medicine, and I have witnessed his excellence in teaching. Despite the distance separating us, both in geography and in time, I am bound to him and to many other colleagues in Chile through a friendship that is more of an intense, warm brotherhood, reaffirmed by our common interest in the area we chose as the vital spark of our professional activity. While reading When Blushing Hurts, I once again admired his expository talent; his elegant, poetic pen; his thoughtful honesty; and his clinical ability. I join with him in calling on psychiatrists and health-care professionals to participate actively in the study of this and other clinical disorders, to approach issues of controversy and debate with both passion and objectivity, to explore the transcultural applicability of all clinical phenomena, to promote investigation, and to improve the level of information available to the general public on the clinical realities that we as physicians confront day after day. Enrique says in his book that emotions are an essential ingredient to the individual identity. From this it could be inferred that if a person’s emotional life is rich and sensitive, the identity of that person will be vital and solid, and fully human. Because, as Anatole Broyard said, a doctor, like a writer, must have a voice of his own, something that conveys the timbre, the rhythm, the diction, and the music of his humanity … Enrique Jadresic has done just that.

Renato D. Alarcón, MD, MPH

Professor of Psychiatry

Mayo Medical School

Rochester, Minnesota

Prologue to the Second Edition (2014)

It was in 2003 that I first had patients coming to me seeking relief from blushing. By 2007, when I wrote the first edition of this book, I had seen roughly 150 patients. It may not seem like many, but it was quite a large number for any doctor at that time, because people who suffered from debilitating facial blushing tended not to seek help, either simply because they did not know that help was available or because they did not dare come forward to ask. In other words, although blushing was a well-known phenomenon, most laypeople and health professionals were not aware that blushing could become a relevant clinical symptom and could even at times be disabling.

Back then, almost no one who arrived at my office sought me out directly, but they did so at the recommendation of a thoracic surgeon. The publication of When Blushing Hurts is undoubtedly what was most instrumental in changing that situation. Nowadays, most patients seek me out spontaneously, many of them telling me that I am the first person they have ever confided in since, out of embarrassment, they have not even shared their struggles with those they are closest to.

Over the last decade, I have met with more than seven hundred patients for their difficulties with blushing. I have also been in remote contact—through e-mail, Skype, and the social networks—with people from many different countries, mostly in Latin America but also in Spain, the United States, England, Poland, and South Korea. This list reflects the prevalence of a condition that, even just a few years ago, the medical world did not address adequately, and for me personally, it has meant an enriched clinical experience that has provided me with opportunities for reflection and learning.

In this second edition of the book, along with sharing new testimonies of women and men who have sought help for blushing, I have whenever possible updated the stories of patients whose cases were told in the first edition. I hope this approach will satisfy those readers who have expressed to me their desire to know the current situation of those people, while, at the same time, I adhere to the medical practice of carrying out a long-term clinical follow-up on the patients who consult us, especially when we are dealing with pathologies that we do not yet fully understand.

Finally, I am happy to say that there has been a significant increase in recent years in the number of scientific papers and publications on blushing. The work in this area has been done from very different perspectives, all of them valuable and complementary. The purpose of this new edition is to update our understanding on those who seek medical help for blushing in light of this new knowledge. While this book is aimed primarily at people who struggle with blushing, I also hope to introduce their family members as well as health professionals and interested readers to this exciting new field.

Enrique Jadresic

Santiago

November 2014

Acknowledgments

In the remote land of Chile, my native country, I was lucky enough to be contacted by a number of patients seeking relief for their uncontrollable facial blushing. What they shared with me sparked my interest and intellectual curiosity, but it also touched me deep inside: I felt identified and moved. If I have decided to tell some of their stories, it is because I believe that doing so can help other people all over the world who unknowingly, in silence and loneliness, suffer from the same affliction. I am deeply indebted to these patients, who trusted in me and gave me permission to use their testimonies as a major portion of this book. I am grateful to them not only for their generosity in agreeing to share their experiences with others but also for the creative resonance of their words. Their accounts motivated me to tell fragments of my own story, which is similar to theirs in many respects.

I would also