Shyness: How Normal Behavior Became a Sickness |  | Author: Christopher Lane
Publisher: Yale University Press
Category: Book
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Rating:  18 reviews
Sales Rank: 136,040
Media: Paperback
Edition: 1
Pages: 272
Number Of Items: 1
Shipping Weight (lbs): 0.9
Dimensions (in): 9.1 x 6.1 x 0.8
ISBN: 0300143176
Dewey Decimal Number: 155
EAN: 9780300143171
ASIN: 0300143176
Publication Date: December 2, 2008
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Product Description
In the 1970s, a small group of leading psychiatrists met behind closed doors and literally rewrote the book on their profession. Revising and greatly expanding the Diagnostic and Statistical Manual of Mental Disorders (DSM for short), they turned what had been a thin, spiral-bound handbook into a hefty tome. Almost overnight the number of diagnoses exploded. The result was a windfall for the pharmaceutical industry and a massive conflict of interest for psychiatry at large. This spellbinding book is the first behind-the-scenes account of what really happened and why. With unprecedented access to the American Psychiatric Association archives and previously classified memos from drug company executives, Christopher Lane unearths the disturbing truth: with little scientific justification and sometimes hilariously improbable rationales, hundreds of conditions—among them shyness—are now defined as psychiatric disorders and considered treatable with drugs. Lane shows how long-standing disagreements within the profession set the stage for these changes, and he assesses who has gained and what’s been lost in the process of medicalizing emotions. With dry wit, he demolishes the façade of objective research behind which the revolution in psychiatry has hidden. He finds a profession riddled with backbiting and jockeying, and even more troubling, a profession increasingly beholden to its corporate sponsors.
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Showing reviews 1-5 of 18
 When is an Illness an Illness? December 16, 2007
Dr. Richard G. Petty (Atlanta)
31 out of 33 found this review helpful
Skeptics often assume that the only reason that diagnostic criteria are changed is financial: to line the pockets of the pharmaceutical industry. But there are several other important factors in play. One has to do with the whole way in which illness is conceptualized and a second has to do with the consequences of inaction. Te criteria for treating blood pressure and cholesterol were driven by the realization that even small abnormalities carry significant mortality and morbidity. When we classify an illness, we can either think of it as a "category," like strep throat or a heart attack: an illness that has clearly defined margins. Or we can think about it as a "dimension." So instead of seeing illness as a separate entity, we think of health and illnesses as lying on a spectrum, running all the way from being healthy and well, through mild degrees of just not feeling "right," to being severely ill. Reimbursement requires categorical diagnoses, even if they do not reflect clinical reality.
This second - dimensional - way of thinking is particularly useful when we are thinking about psychological issues. The world is full of people who are a little bit obsessive, or who get bad mood swings. But they are not bad enough to be called an "illness:" They are part of human variation. In fact, having some of these traits can be enormously beneficial: they have continued in the population because they have a survival advantage. If I need to have surgery, I sincerely hope that my surgeon will be mildly obsessive, rather than discovering a few weeks later that he had forgotten to do something he should have. The point then becomes one of asking, "Where do we place the bar between variation and illness?" We do not want to say that every restless child has attention deficit hyperactivity disorder, or that every unhappy soldier returning from war has posttraumatic stress disorder. So the answer to the question, "when is it an illness?" is usually defined on the basis of whether it is causing suffering, and whether, if left untreated, it would produce more or different problems in the longer term, in the same way that untreated diabetes increases the risk of heart, eye and kidney disease.
The trouble is that diagnostic criteria have been defined by committees charged with evaluating research data. Someone once said that a camel is a horse designed by a committee and some diagnoses look like camels. This is not only a problem in medicine. The world's foremost authority on locating acupuncture points recently lamented that the standard textbook contains errors because he was out-voted by a committee!
These two ways of looking at medical, and particularly psychiatric disorders, is one of the issues at the heart of this book.
Christopher Lane is the Miller Research Professor at Northwestern University, and he discusses the way in which, during the 1970s, a small group of leading psychiatrists met and revised and greatly expanding the Diagnostic and Statistical Manual of Mental Disorders (DSM).
He is critical of the efforts of these people and argues that the decisions about restructuring the DSM was careless, and strongly influenced by politics, personal ambition and the shadowy hand of the pharmaceutical industry. From the evidence that he provides, I am sure that there were elements of each. But I think that he underestimates the backdrop to the DSM project.
The first of the modern psychiatric medicines had begun to appear in the 1950s. But during those years and throughout the 1960s and 1970s American psychiatry was still dominated by psychoanalysis for which diagnostic differentiation was not very important. Many psychiatrists felt that the medicines should not be used, since they simply sedated people and thereby prevented them from doing the inner work demanded by psychoanalysis. The approach also lead to the neglect of many disadvantaged populations, for instance the elderly and intellectually challenged, for they were thought to be untreatable.
The new DSM set about trying to define and distinguish mental disorders based not on preconceived ideas about cause, but on the symptoms that patients exhibit. It was an attempt to bring an order that could be used to start scientific research and ultimately give guidance about treatment and prognosis. It was not about social control, and psychoanalysts were not involved simply because they were not interested in precise diagnosis.
Lane rightly emphasizes the role of social factors and social norms in the genesis of psychological distress, but then suggests that we need more psychodynamic psychotherapy.
What has actually happened is that the advances in psychopharmacology have changed what we are able to do to help people; the nature of psychotherapy has also changed. Much of the psychodynamic psychotherapeutic approach has given way to shorter more cognitively based therapies, many of which have been proven to work in controlled studies. Not all of the developments have been positive: the medical model now dominates psychiatry, demand for services and financial considerations have lead to ever-shorter treatments for people in need. But those cannot really be blamed on the introduction of the DSM and the eclipse of psychoanalytic thought.
There continues to be a great deal of debate within psychiatry about the DSM: are we able to use brain imaging or genetic techniques to provide an objective basis for diagnosis? What human variations have erroneously been designated "mental disorders?" and many other issues. Work has already begun on the next revision of the DSM, which is currently due out in 2011. Lane argues that many more common behaviors, including excessive shopping, poor anger management and defiance could become pathologies needing treatment. He is right to warn about the possibility, but may not give enough credit to the careful work that is underway to see what qualifies as an "illness," and what does not.
This is an important, interesting and thought provoking book that should be on the "must read" list of anyone studying psychology, or anybody interested in the inner workings of medicine.
Richard G. Petty, MD, author of Healing, Meaning and Purpose: The Magical Power of the Emerging Laws of Life
A welcome blast of sanity for 2009 December 31, 2008
Carrie J. (Milwaukee, WI)
9 out of 12 found this review helpful
Add this book to my early favorites for 2009; It's an outstanding, fascinating expose of what went wrong with American psychiatry in the 1980's and 1990's. You can see exactly where the profession went off the rails and became corrupted by drug-company money--the author got access to the unpublished material that went into the third edition of its diagnostic bible, the DSM. Some of the original material is scandalous--some, flat-out hilarious. But all of it is very relevant to what's going on with psychiatry and Big Pharma these days. I had no idea so many crazy new disorders were created in the 80s and 90s, and with so little justification. A real eye-opener, and one I'm very glad to have read.
A superb read September 27, 2007
J. Arce (London)
29 out of 42 found this review helpful
I read this guy's op ed about shyness in the New York Times and thought it was spot on. I've just begun reading his book and it's even more damning of psychiatry and Big Pharma than you could imagine. That's because its based entirely on letters and documents the psychiatrists themselves exchanged. The confusion over where shyness begins and social anxiety disorder ends is, the author shows, one the psychiatrists created and the drug companies cleverly exploited.
This guy backs up his arguments. He quotes drug company execs explaining that they can massively increase prescriptions for social anxiety disorder by telling people their shyness is in fact part of a newly created anxiety disorder. The market is enormous, they brag, because half the population defines itself as shy. The psychiatrists, meanwhile, accepted drug company kickbacks; they also muddled everything when they came up with their absurd lists of symptoms for OVER ONE HUNDRED new mental disorders in 1980, including such patently ridiculous ones as "fear of eating alone in a restaurant" and "concern about going to parties" as signs supposedly of social anxiety disorder. Then look at the way they approved "avoidant personality disorder," "intermittent explosive disorder," and dozens more. No wonder the shrinks are now up in arms. I would be too if I was quoted saying so many ridiculous things. But the proof is in the documents they themselves wrote. Too bad for them, but very enlightening for the rest of us!
Read this book. You won't ever think about psychiatry and the drug companies the same way again. Given the evidence in this book, that's a good thing.
'Normal Behavior' Should Remain Normal Behavior June 14, 2009
Mary A. Weiss (Cottage Grove MN)
5 out of 8 found this review helpful
Dr. Christopher Lane tells us in "Shyness: How Normal Behavior Became a Sickness" that 'social phobia has become the psychosocial problem of our age', that one can be aptly labeled as mentally ill if not adequately outgoing, that despite a relapse rate on drugs of one in five, 'disordered' people are flocking to doctors for a simple pill that will fix their nature. Pharmaceutical companies would have us believe that fear of public speaking and avoidance of meeting new people should be instantly fixed with drugs, rather than confidence that comes with eperience. They would certainly not advocate viewing the movie "What About Bob?" in which Dr. Marvin counsels his patient Bob with 'baby steps, baby steps!' Those sufferers of sweaty palms have been told that there is a chemical imbalance causing them to feel that pit in the bottom of their stomachs when they first face a sea of seemingly unforgiving faces from beind a podium.
GlaxoSmithKline tells us that 'Paxil means peace' and that it has 'proven efficacy that spans a spectrum of disorders.' Dr. Lane tells us that Paxil often means such side effcts as large weight gain, suicidal ideation and rebound syndrome which makes it nearly impossible to discontinue the drug. The makers of Zoloft, Prozac et al, Dr. Lane tells us, demand not to be left out. But what the drug comapnies are doing is exactly that: leaving out the human equation. This book should be required reading for not only all those believing they suffer from a 'social anxiety disorder' but also the doctors who believe a pill is the best way for them to treat such a 'disorder'.
Mary Weiss
Cottage Grove MN
A much needed addition to the debate October 14, 2007
bookclubber
10 out of 17 found this review helpful
I recommend this book highly. It documents an alarming trend in psychiatry that we all should be paying more attention to. Like any other excellent modern polemicist, Lane's research is excellent and his style artfully makes an important point!
Showing reviews 1-5 of 18
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