Friday 18 January 2008
Humanity, thou art sick
Shyness is now ‘social phobia’, and dissent is ‘Oppositional Defiant Disorder’. How did everyday emotions come to be seen as illnesses?
‘In my mother’s generation, shy people were seen as introverted and perhaps a bit awkward, but never mentally ill.’
So writes the Chicago-based research professor, Christopher Lane, in his fascinating new book Shyness: How Normal Behaviour Became a Sickness. ‘Adults admired their bashfulness, associated it with bookishness, reserve, and a yen for solitude. But shyness isn’t just shyness any more. It is a disease. It has a variety of over-wrought names, including “social anxiety” and “avoidant personality disorder”, afflictions said to trouble millions’, Lane continues.
Lane has taken shyness as a test case to show how society is being overdiagnosed and overmedicated. He has charted - in intricate detail - the route by which the psychiatric profession came to give credence to the labelling of everyday emotions as ‘disorders’, a situation that has resulted in more and more people being deemed to be mentally ill.
Some claim that up to 50 per cent of the population will suffer from mental illness some time in their lives. A 2001 report titled Mental Health: New Understanding, New Hope, published by the World Health Organisation (WHO), claims that today between 10 and 20 per cent of young people suffer from mental health or behavioural disorders. Hans Troedsson, WHO director for child and adolescent health, has expressed grave concern about the mental health status of the world’s young. ‘It is a time-bomb that is ticking and without the right action now millions of our children growing up will feel the effects’, he warned. In the WHO report, it is claimed that mental disorders can be diagnosed ‘as reliably and accurately as most of the common physical disorders’.
Also, many more children and young people are on anti-depressants and other forms of medication today, particularly in the USA but also in Britain and other parts of Europe. Figures published by the UK Department for Children, Schools and Families in July 2007 show a huge year-on-year increase over the past decade in drugs prescribed by British General Practitioners for behavioural and mental disorders in children and young people.
Some argue that the increase in the number of prescriptions is a result of an increase in disorders. The leading British children’s charity NCH published a briefing in 2007, quoted extensively in the press, which claimed that the prevalence of emotional problems and conduct disorders ‘has doubled since the 1990s, to the current figure of one in 10 children’.
But Lane’s Shyness persuasively argues that there is something quite different going on. His painstaking research shows how the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of the psychiatric profession worldwide, has been transformed – by a handful of psychiatrists behind closed doors – from the thin handbook it was up until the 1980s into the hefty tome it is today, with hundreds of new, poorly specified and poorly researched syndromes being added.
Lane writes: ‘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 500-page volume… the introverted individual morphed into the mildly psychotic person whose symptoms included being aloof, being dull, and simply “being alone”.’ Shyness now allegedly almost rivals depression in magnitude, a ‘sickness’ for which ‘almost 200million prescriptions are filled every year’ in the USA. Apparently, social phobia – shyness – ‘has become a pandemic’, says Lane.
It only took a room-full of psychiatrists a few years to ‘massively expand’ their manual ‘and turn routine emotions into medical conditions’, Lane shows. The fourth edition of DSM appeared in 1994 ‘with 400 more pages’ than previously, and dozens of new disorders. WHO’s claim that mental disorders can be ‘diagnosed as reliably and accurately as most of the common physical disorders’ is clearly laughable; instead it seems that mental disorders can be created on a whim and attributed to all sorts of actually quite normal people.
The sad consequence of this state of affairs is that the range of ‘healthy behaviour’ is being increasingly narrowed. ‘Our quirks and eccentricities - the normal emotional range of adolescence and adulthood – have become problems we fear and expect drugs to fix’, Lane writes. ‘We are no longer citizens justifiably concerned about our world, who sometimes need to be alone. Our affiliations are chronic anxiety, personality or mood disorders; our solitude is a marker for mild psychosis; our dissent, a symptom of Oppositional Defiant Disorder; our worries, chemical imbalance that drugs must cure.’
Above all, those who really do need help – who suffer from real emotional or behavioural disorders – are increasingly losing out. As Lane states, by ‘dissolving meaningful distinctions between severe and mild cases’, the psychiatric profession ends up ‘trivialising chronic illness’. He points to the concerns of Arthur Kleinman, Harvard professor of psychiatry and medical anthropology, who warns that by including mild forms of anxiety and depression under the ever-widening umbrella of mental disorder, attention and resources are being diverted from diseases like schizophrenia and major depression.
This book should be read by anyone interested in stopping the rot in the discussion of human emotion and thought, and in halting the seemingly unstoppable expansion of the counselling industry.
Shyness: How Normal Behavior Became a Sickness by Christopher Lane is published by Yale University Press. (Buy this book from Amazon(UK).)
First published by spiked