Why are social situations hard for people with MS?

For a long time, I have felt uncomfortable in certain social settings. Many parties bring back feelings of being in junior high school, when it seemed like nothing I said was exactly right. Even in smaller groups of people, I tend to feel like I am frequently "missing the moment" where a certain comment would be appropriate, only thinking of the perfect thing to say later. I spend much of my time in social situations trying to figure out why the cadence of the conversation often seems "off," pretty sure that I am a big part of the problem.

Recently, I have taken the approach of being quiet and listening to group conversations or talking to just one person at a time, only truly comfortable if I know the person well and there is not much background noise. Turns out there is a name for this phenomenon: impaired social cognition. It also turns out that MS might have a big role to play in this particular problem. I first looked at research about this topic a couple of years ago, in an article I wrote, Are People with MS "Socially Disabled?"
New research on this topic is being presented here at ECTRIMS 2012.
Social cognition is basically how we think about other people. Even though we are not usually aware of it, humans are constantly gathering "information" about other people – we look at what they are doing, what they are wearing, and all sorts of other things about their appearance. We listen to their accents, their choice of words and topics. We may even be close enough to smell their perfume or sweat.
We then (again, usually subconsciously) process this information and it guides us in what we think about these people and, in turn, how we feel about them and behave toward them. As we interact with them, we continue to add information to our mental files and further hone our feelings and behaviors around them.
A group of German researchers wanted to investigate whether social cognition was impaired in people with MS, as it is well-known that MS causes cognitive dysfunction, as well as psychiatric symptoms such as depression, both of which can impact relationships with other people.
They compared 45 people with MS to 45 people without MS (controls) by having participants watch “Movie for the Assessment of Social Cognition” (MASC) and using a standardized test. The people with MS also completed a short neuropsychological battery. Here is what they found:
  • The people with MS demonstrated significantly impaired social cognition when compared to the people without MS.
  • Performance on MASC was moderately correlated with cognitive function (namely verbal memory and executive function) in the people with MS. 
  • However, even people with MS without cognitive dysfunction demonstrated impaired social cognition.
What does this mean for us? In a way, this research makes me feel better about the situation. It gives me hope that I am not just "socially weird," but that there is a real reason for my awkwardness in some settings. This is my takeaway message from this research:
  • Don't be too hard on yourself. It's not your fault if you find social situations difficult. 
  • Low-stress, familiar social situations will probably be much easier and more pleasant. Nothing is wrong with having a couple of good friends and enjoying them, without striving to have a crowd of worshiping fans. 
  • Make social situations work for you the best you can. If you cannot be the life of the party, at least make the party pleasant by finding people you enjoy listening to or spending it with one or two people. 
  • Remember, life (for most of us) is not a stage. The things that matter usually are the small moments with the right people.

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Julie Stachowiak, PhD

Julie is the author of the Multiple Sclerosis Manifesto, the winner of the 2009 ForeWord Book of the Year Award in the Health Category. She is an epidemiologist who is also a person living with MS, Julie has an in-depth understanding about current research and scientific developments around MS. She also has first-hand knowledge of the frustrations and anxiety surrounding the disease, as she had MS for at least 15 years before receiving a diagnosis in 2003 and has had several relapses since her diagnosis.