Phobia or faux-bia?

WASHINGTON (Map, News) - Shyness, fear of public speaking, reluctance to dine alone in restaurants — common discomforts or mental disorders?

Medicalizing ordinary emotions has generated big business for the pharmaceutical industry and psychiatric profession. In the new book “Shyness: How Normal Behavior Became a Sickness,” Christopher Lane examines the impact on health care and society when psychiatry’s bible, The Diagnostic and Statistical Manual of Mental Disorders (DSM), swelled from handbook into heavy tome detailing hundreds of new conditions such as social anxiety disorder, known as SAD.

The upshot? Up to 20 percent of Americans suddenly could be diagnosed with an illness warranting prescription drugs. SAD ads “raised public awareness” with headlines such as “Imagine being allergic to people” and “You’re not shy, you’re sick.” But, as Lane’s research reveals, the cost of blaming anxieties on brain chemistry imbalance goes beyond dollars, to drug dependency, debilitating side effects and consumers convinced they’re hamstrung by their physiology.

Lane, a Northwestern University professor (who was awarded a Guggenheim fellowship to study psychopharmacology and ethics), presents insiders’ candid accounts of the DSM revision process being addled by politics and drugmaker influence. Discomfort and inconvenient behavior were elevated to pathologies. One psychoanalyst told Lane, “We used to have a word for sufferers of ADHD. We called them boys.”

Paxil, after languishing two decades from disappointing clinical trials, finally found a market: SAD sufferers. By 2001, more than 5,000 Americans began treatment with the new blockbuster every day. Lane relates the task force power struggles, opportunistic marketing campaigns, the football star and screenwriters secretly hired to shill for pharmaceutical firms, and ways drugmakers spin research results — legally, if not ethically.

The author explains how psychotropic drugs work — and side effects from mood swings to sexual dysfunction to possibly permanent changes in cognition and personality. Patients described “rebound syndrome” — tapering off the drug unleashed anxiety more intense than what drove them to take it. Adding cultural perspective are advertisements from yesteryear and today. Some 1960s classics resemble bad B-movie posters, with frantic women trapped in spider webs. A 1970 ad advocates Serentil “For the anxiety that comes from not fitting in.”

The book addresses practical and philosophical questions. Does labeling introversion a disturbance reflect rigorous science or social norms, considering that of thousands surveyed, half described themselves as introverted? Lane examines the alarming trend of medicating children to “nip social anxiety in the bud” — begging the question whether it’s more about parental anxiety. Non-pharmacological antidotes to anxiety get coverage in the final section.

Those with social anxieties, take heart, you’re not alone. You’re apparently in the majority.

The Book

» “Shyness: How Normal Behavior Became a Sickness”

By Christopher Lane

Yale University Press, 272 pages, $27.50, October 2007

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