'Shyness: How Normal Behavior Became a Sickness'
By Christopher Lane
MORE IN
BOOKS »
Introduction: Bashful No More
When my mother was six years old, she often pretended she was a horse. Painfully shy, she preferred galloping around on "four" legs to the ordeal of talking to strangers on two. The Germans were bombing London and southern England at the time, a source of terror for many children, and my grandparents—concerned about her safety—heightened her anxiety by sending her off to boarding school. Once there, my mother would cavort outside for hours. When that wasn't feasible, she withdrew to a practice room and played the piano with quiet intensity.
Yale University Press
No one found her especially odd or recommended medication for her quirky behavior. My grandparents shrugged off her equestrian impressions as the charming eccentricity of a girl blessed with a vivid imagination, and waited patiently for her to change. Years later, still playing the piano and still unconventional, she became a renowned music therapist and lecturer at London's Nordoff-Robins Center for children with learning difficulties. In my mother's generation, shy people were seen as introverted and perhaps a bit awkward, but never mentally ill. Adults admired their bashfulness, associating it with bookishness, reserve, and a yen for solitude. But shyness isn't just shyness any more. It's a disease. It has a variety of overwrought names, including "social anxiety" and "avoidant personality disorder," afflictions said to trouble millions (almost one person in five, according to some estimates).1 And since the early 1990s, when the U.S. Food and Drug Administration agreed that powerful psychotropic drugs were suitable ways of treating these conditions, countless Americans and Britons have daily swallowed large doses of Paxil, Prozac, Zoloft, and other pills for routine emotions that experts now consider medical conditions.
Unlike my countrymen in Britain, Americans are regarded as the most gregarious people on earth. So when large numbers of them say they find talking to a stranger terrifying and claim they would rather die than make a public speech, something dramatic is happening. "It is a part of the American character," Thomas Jefferson once enthused, "to consider nothing as desperate—to surmount every difficulty by resolution and contrivance." Nowadays, if we're to believe preeminent psychiatrists and fabulously profitable drug companies, almost 19% of the population is so fearful of others' judgments, it shuns activities that would risk incurring them. Gone are the days when we could value exuberance and shyness, as well as a vast repertoire of similar moods. Today many psychiatrists and doctors assert that those who aren't sufficiently outgoing may be mentally ill.
One reason for the skyrocketing diagnoses is that doctors and psychiatrists require a very low burden of proof. They say social anxiety runs the gamut from stage fright to paralyzing fears of criticism and embarrassment. (The most common nightmare scenarios are eating alone in restaurants, with fear of hand-trembling a close second, and avoidance of public restrooms third.) Some doctors also include, as symptoms of the disorder, fears of sounding foolish and of being stumped when asked questions in social settings—fears that doubtless afflict almost everyone on the planet. Considering these elastic guidelines, we can grasp quite easily why the "illness" is so widely diagnosed, but it's harder to say why so many take the diagnosis seriously, much less accept its judgment of mental debility. The transformation of shyness into a disease occurred behind the closed doors of carefully vetted committee meetings. Over the course of six years, a small group of self-selecting American psychiatrists built a sweeping new consensus: shyness and a host of comparable traits were anxiety and personality disorders. And they stemmed not from psychological conflicts or social tensions, but rather from a chemical imbalance or faulty neurotransmitters in the brain.
Beginning in 1980, with much fanfare and confidence in its revised diagnoses, the American Psychiatric Association added "social phobia," "avoidant personality disorder," and several similar conditions to the third edition of its massively expanded Diagnostic and Statistical Manual of Mental Disorders. In this five-hundred-page volume, the bible of psychiatrists the world over, the introverted individual morphed into the mildly psychotic person whose symptoms included being aloof, being dull, and simply "being alone."
The fact that psychiatrists often playfully call this reference manual their bible doesn't offset the reality that they follow its pronouncements chapter and verse. The influence of the DSM also extends far beyond psychiatry, to a vast network of healthcare agencies, social services, medical insurers, courts, prisons, and universities. It took the psychiatrists in question just a few years to update their manual and turn routine emotions into medical conditions, but their discussions—detailed here for the first time—rarely dwelled on the lasting consequences of their momentous decisions. Those expecting deep ruminations on what it means to call half the country mentally ill (the chief conclusion of the latest national survey), may be surprised to learn that the psychiatrists' fundamental concerns included how best to keep the Freudians out of the room, how to reward the work of allies, and who should get credit for plucking a term out of a dictionary. Tackling a vast array of human experience, the DSM drains it of complexity and boils it down to blunt assertions that daily determine the fate of millions of lives, in this country as in many others.
The fourth edition appeared in 1994 with four hundred more pages and dozens of new disorders. It sold over a million copies, in part because insurance companies require a DSM diagnosis before they will authorize reimbursement, while defense attorneys cite it as gospel when trying to explain or mitigate the charges against their clients. Until the 1990s, moreover, the DSM competed with a rival diagnostic system: the International Classification of Diseases (ICD), published by the World Health Organization in Geneva, is more favorably disposed to psychoanalysis and less reliant on ambiguous narrative. Since the publication of DSM-IV, however, the European system has lost some of its cachet. The DSM has by contrast assumed global authority, an outcome greatly increasing the importance of its once-local arguments about social anxiety and related disorders. Indeed, with managed care and the pharmaceutical industry, this reference manual has begun to transform how the world thinks about mental health. As one psychoanalyst recently lamented to me, "We used to have a word for sufferers of adhd. We called them boys."
When so many behaviors are viewed as disorders, is it possible to live a normal life without hitting up against one or more of them? "Where you thought your friends were just having normal troubles," explain Herb Kutchins and Stuart Kirk, "the developers of the American Psychiatric Association's diagnostic bible raise the possibility that you are surrounded by the mentally ill. Equally disconcerting to you, you may be among them." In Making Us Crazy, Kutchins and Kirk largely ignored the many hundreds of letters that circulated behind the scenes to document this controversial chapter of psychiatry, doubtless because neither scholar had access to them. The picture looks even more troubling when one reproduces these discussions, as I do further on, and puts them under an uncompromising microscope.
) lets talk about how people use the term "illness" when in fact they're shytting on people with ACTUAL problems.
