Shyness: How Normal Behavior Became a Sickness

I recently read a disturbing book, Shyness: How Normal Behavior Became Sickness, by Christopher Lane, about the selling of mental illness in order to sell therapy and therapeutic drugs.

Lane tells how attributes once considered within the normal range of human diversity came to be defined as mental illness, and how a therapeutic and drug industry sprang up around those definitions.  It is disturbing as an example of perverse market incentives undermine professional standards and scientific objectivity.

The book begins with an account of the academic politics behind the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which came out in 1980. The purpose of the original DSM, which came out in 1952, was to provide standard and evidence-based definitions of mental illnesses, to diminish the subjective element in psychiatry and to enable therapists to speak a common language.  In DMS-III, as a result of neuropsychiatrists outmaneuvering psychoanalysts, there was a great expansion of the number and scope of defined mental illnesses.

Among these was “social anxiety disorder,” which, according to some estimates, affects one in five Americans. This proved a great boon to the anti-depressant and anti-anxiety drug industry; according to Lane, nearly 200 million prescriptions for such drugs are filled every year. This is due to the drug industry’s massive and successful advertising and public relations campaign, to sell people on the idea they were sick and needed treatment.

DSM-IV came out in 1994 with an expanded list of mental illnesses, and a DSM-V is due out in 2015.

The American advertising industry has a long history of selling problems – dandruff, hair loss, “Mr. Coffee Nerves,” “BO: what your best friends won’t tell you” – in order to sell products. The most disturbing thing about this disturbing book is the advertisements selling people on need to drug themselves.

It is a bad idea, as Lane says, to encourage people to become dependent on drugs to cope with bad feelings. The use of psychopharmacological drugs is a step up from altering human behavior by means of brain surgery or electroshock “therapy,” but it, too, alters the brain in unforeseeable ways. By providing a chemical solution to emotional problems, you reduce the ability of people to cope with or live with problems. By chemically eliminating negative emotions, you blunt the ability to feel emotion at all. By biochemically altering the function of the brain, a delicate organ whose workings are imperfectly understood,  you may make irreversible changes whose effects you don’t know.

There are too many vested interests in the present system to expect change anytime soon.  DSMs are used as the basis for determining Medicare, Medicaid and other insurance reimbursement. To change the definitions to make them more narrow would be to cut off many thousands, maybe even millions, for needed therapy.  The therapeutic profession will not willingly a curtailment of the number of clients, nor will the drug industry willingly accept a curtailment of a lucrative market.

But many people really do suffer from “social anxiety disorder” and really do need medications.  “Social anxiety disorder” may include normal shyness, but I have met people who are unable to function in society at all without their medications. And I have had the misfortune to have to cope over an extended period with someone who needed to be on medications, but refused to take them.

So the question is not how to get rid of psychopharmocological drugs, but where you draw the line on using them.  And I, like most people outside the psychiatric profession, lack the expert knowledge to say where that line should be drawn.  I am grateful for Christopher Lane for calling attention to this situation, but I don’t know what to do about it. I am reduced to the pious hope that the psychiatric profession itself will push back against perverse market forces and reassert professional and scientific standards.

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One Response to “Shyness: How Normal Behavior Became a Sickness”

  1. Perette Barella Says:

    Hi Phil. I just finished Wendy Kaminsky’s book _I’m Dysfunctional, You’re Dysfunctional_ which is a critique of the self-help/recovery fads. One of her observations of these movements is that they also describe everything as a disease, so the problem is not isolated to the pharmacology industry. I personally think, more generically, many people just want easy solutions that eliminate personal responsibility or effort.

    Like

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