Shyness: How Normal Behavior Became a Sickness [Paperback]

Christopher Lane (Author)

Book Description

Publication Date: December 2, 2008

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.

 

 

(20071101)

Editorial Reviews

From Publishers Weekly

"Before you sell a drug, you have to sell the disease. And never was this truer than for social anxiety disorder," concludes English professor and Guggenheim fellow Lane in this scathing indictment of the American Psychiatric Association and the psychopharmacological industry. In 1980, a massive overhaul of the psychiatry bible, the Diagnostic and Statistical Manual of Mental Disorders, added a host of conditions (social phobia among them) to the roster of mental disorders, creating a boon for the pharmaceutical industry, which, in the decades since, has brought to market a cornucopia of drugs to combat an ever-increasing number of mental illnesses. Lane finds a trove of troubling (and previously unpublished) material in the APA archive and in drug company memorandums, laying bare the APA's internal politics (as fierce as academia) and showing the growing influence of drug companies on psychiatry practice. Similarly alarming are Lane's dissections of big pharma's marketing of anti-depressants and description of how information about side-effects and withdrawal symptoms associated with popular prescription drugs such as Prozac and Paxil were withheld from the public. This controversial and well-documented book will spark its share of debates.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. --This text refers to an out of print or unavailable edition of this title.

Review

"[A] fascinating behind-the-scenes look at the making of the bible of modern psychiatry [that] explains how a once-ordinary affliction became a profitable disease."—Michael Agger, Mother Jones

(Michael Agger Mother Jones 20070924)

“This is not only an important account of the creation of a modern disease and its treatment, it is an explosive indictment of a system that is too simply materialist in both philosophy and behavior.”—Harold J. Cook, Wellcome Trust Centre for the History of Medicine at UCL

(Harold J. Cook 20071022)

“A marvelous book: disturbing and perturbing, a book that will be widely talked about and debated. It is extraordinarily well written, balanced, witty, and engrossing. Bravo!”—Arthur Kleinman, Esther and Sidney Rabb Professor and Chair of Anthropology, Professor of Medical Anthropology, and Professor of Psychiatry, Harvard University

(Arthur Kleinman 20071015)

“In Shyness, Christopher Lane outlines an apparatus that is one of the most powerful cultural forces in the world today. In pulling back the drapes and revealing the bumbling and hamfistedness of the new engineers of human souls, Chris Lane might help restore sanity to Oz.”—David Healy, M.D., author of Let Them Eat Prozac and The Antidepressant Era

(David Healy 20080108)

"Written with Chris Lane''s brand of verve and scholarship, Shyness is a riveting book about how certain so-called illnesses are complex cultural artifacts and certain so-called doctors are casting spells called diagnoses. A smart and bracing book about shyness—not to mention a shrewd and subtle book about psychiatric classification—is long overdue; after reading Shyness it is clear that only Lane could have written it."—Adam Phillips, psychoanalyst, author of Side-Effects

(Adam Phillips 20071128)

Read Christopher Lane''s recent op-ed contribution in the New York Times, "Shy on Drugs."

(http://www.nytimes.com/2007/09/21/college/coll21lane.html 20080131)

"Lane finds a trove of troubling (and previously unpublished) material in the APA archive and in drug company memorandums, laying bare the APA''s internal politics and showing the growing influence of drug companies on psychiatry practice. Similarly alarming are Lane''s dissections of big pharma''s marketing of anti-depressants and description of how information about side-effects and withdrawal symptoms associated with popular prescription drugs such as Prozac and Paxil were withheld from the public. This controversial and well-documented book will spark its share of debates."—Publishers Weekly

(Publishers Weekly 20071015)

"[An] excellent new book. . . . Shyness is a welcome contribution to psychiatric discourse."—Juliet Lapidos, New York Observer

 

 

(Juliet Lapidos New York Observer 20080131)

"Having gained access to archival materials from the APA, Lane provides a behind-the-scenes look at the haphazard, unscientific process used to revise The Diagnostic and Statistical Manual of Mental Disorders. . . . [A] superb, iconoclastic cultural study. . . . Highly recommended for university and large public libraries."—Library Journal

(Library Journal 20080201)

"There is a great deal that''s interesting in this book. . . . I recommend this book as a thought-provoking and informative read."—John D. Mullen, Metapsychology

 

 

(John D. Mullen Metapsychology 20080201)

"[A] stunning and revelatory book. . . . For a book that''s about the invention of a medical condition, Shyness is as riveting as a detective story. Lane writes elegantly and passionately about the need to maintain our consciousness about the maddeningly rich complexity of human emotion and thought."—Yasmin Nair, Windy City Times

 

 

(Yasmin Nair Windy City Times 20080201)

"This well-written book is a thoughtful examination of shyness and its relation to psychopathology. . . . I very much enjoyed reading Lane''s thought-provoking book, and I would highly recommend it for psychiatry residents, graduate students in clinical psychology, and other mental health professionals in training who are interested in the field of anxiety disorders, and more broadly in psychopathology and general mental health."—Brian J. Cox, New England Journal of Medicine

 

 

(Brian J. Cox New England Journal of Medicine 20080201)

"Lane provides a behind-the-scenes look at the haphazard, unscientific process used to revise The Diagnostic and Statistical Manual of Mental Disorders. . . . [A] superb, iconoclastic cultural study."—Library Journal

 

 

(Library Journal 20080201)

"This well-written book is a thoughtful examination of shyness and its relation to psychopathology. . . . I very much enjoyed reading Lane''s thought-provoking book."—Brian J. Cox, New England Journal of Medicine

(Brian J. Cox New England Journal of Medicine 20080201)

"Having gained access to archival materials from the APA, Lane provides a behind-the-scenes look at the haphazard, unscientific process used to revise The Diagnostic and Statistical Manual of Mental Disorders. . . . [A] superb, iconoclastic cultural study. . . . Highly recommended for university and large public libraries."—Library Journal (starred review)

 

(Library Journal 20080201)

"In his brilliant Shyness: How Normal Behaviour Became a Sickness, Christopher Lane painstakingly shows how the category of ''mental disorder'' has been expanded in recent decades, so that what were once considered normal emotions or everyday foibles—shyness, rebelliousness, aloofness, and so on—have been relabelled as phobias, disorders and syndromes."—Brendan O''Neill, New Statesman and Society

(Brendan O'Neill New Statesman and Society 20080201)

"An important new book. . . . The achievement of Shyness is to chart for the first time the events preceding the rise and fall of the SSRIs. Lane has marshalled a cache of unpublished data to explain the academic framework that allowed the rise to happen. [He] tells the complex story with impressive clarity. . . . Lane has done a valuable job in tracing the roots of the current crisis and he certainly isn’t calling for a reinstatement of Freudianism; what is needed now is another map to indicate a way out."—Jerome Burne, Times Literary Supplement

(Jerome Burne Times Literary Supplement 20080201)

"Fascinating . . . persuasive . . . [and] painstaking, [Shyness] should be read by anyone interested in stopping the rot in the discussion of human emotion and thought."—Helene Guldberg, Spiked Review of Books

(Helene Guldberg Spiked Review of Books 20080201)

"Overall, Lane''s scholarly account of this saga ensures that if you''re not already concerned about the over-medicalization of our mental lives, you will be."—Christian Jarrett, BBC Focus
 

(Christian Jarrett BBC Focus 20071201)

"Christopher Lane''s polemical Shyness features the manipulations that promoted social anxiety disorder to a national emergency."—Frederick Crews, New York Review of Books

(Frederick Crews New York Review of Books 20080330)

"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."—Robin Tierney, San Francisco Examiner

(Robin Tierney San Francisco Examiner 20080401)

"Lane "charges that the task force, dominated by neuropsychiatrists, often used bad science or no science at all, that it turned ordinary human emotions into diseases and that it created a climate in which pharmaceutical companies could get rich creating cures for often nonexistent complexes."—Richard Hicks, Atlanta Journal-Constitution (op-ed)

(Richard Hicks Atlanta Journal-Constitution 20080601)

"Would Henry David Thoreau and Emily Dickinson be given drugs today? In the1980s a small group of leading psychiatrists revised the profession’s diagnostic manual called the DSM for short, adding social anxiety disorder—aka shyness—and dozens of other new conditions. Christopher Lane . . . uses previously secret documents, many from the American Psychiatric Association archives, to support his argument that these decisions were marked by carelessness, pervasive influence from the pharmaceutical industry, academic politics, and personal ambition."—Scientific American

(Scientific American 20080708)

"Lane . . . notes that when psychiatrists diagnose the shy as suffering from social phobia, they mistake a variation in human temperament for a mental disorder; if anything, the diagnosis only adds to the sense of unease felt by shy people. He is also right in observing that the psychiatrists’ Diagnostic and Statistical Manual (DSM), the profession’s standard 900-page reference work, errs by designating other kinds of normal human variation as mental disorders and so exaggerates the incidence of mental illness. . . . [Shyness] provides vivid portraits of how DSM-III was constructed, over the course of six years."—Paul McHugh, Wall Street Journal

(Paul McHugh Wall Street Journal 20090120)

"Christopher Lane deconstructs the new psychiatric condition ‘social anxiety disorder’ as a creation of corporate psychiatry’s alliance with the pharmaceutical industry. He argues that shyness became a medical condition best treated by drugs as a result of battles between psychiatrists over diagnostic techniques. . . . This book compares best to Ray Moynihan and Alan Cassels’ Selling Sickness. Highly recommended for general readers, healthcare professionals and practitioners."—Choice

 

(Choice 20090401)

"Christopher Lane . . . calls psychiatry''s growing focus on children ''the perfect storm'' for overdiagnosis. ''You''ve got a constituency—children—who cannot make informed medical decisions for themselves,'' Lane says. In a fast-moving culture that heaps stress and high expectations on children, ''parents are in many cases under great pressure to ensure their child succeeds and is socially proficient. A child that doesn''t negotiate rapidly those hurdles can look very quickly as if he or she is falling behind, or displaying behavior that warrants medical concern.''"—Melissa Healy, Los Angeles Times

(Melissa Healy Los Angeles Times 20090902)

 2007 Top Seller in Psychology as compiled by YBP Library Services

(YBP Library Services )

"A provocative look at an important chapter in the history of modern psychiatry."—Judith Graham, Chicago Tribune

(Judith Graham Chicago Tribune )

"Lane''s authority in these matters is considerable since he had access to previously confidential documents for the American Psychiatric Association archives. . . . Highly recommended. All readers, but especially the general public and healthcare professionals and practitioners."—Choice

(Choice )

A 2007 Top Seller in Medicine as compiled by YBP Library Services

(YBP Library Services )

Selected as a 2008 AAUP University Press Book for Public and Secondary School Libraries.

(Best Book of the Year Selection Association of American University Presses (AAUP) )

"Lane argues in this well-researched . . . controversial book that shyness [has been] pathologized, to the detriment, especially, of children and teenagers"—Elsa Dixler, New York Times Book Review (Paperback Row)
 

(Elsa Dixler New York Times Book Review )

“Lane’s thorough trawling of the archives of the American Psychiatric Association, his discovery of unpublished internal memos from drug companies, and most especially his accounts of the deliberately obstructive activities of the companies’ marketing teams, make for compelling reading.” - Martin Guha, Journal of Mental Health

(Martin Guha Journal of Mental Health )

Highly commended for the 2008 Medical Book Award in the category of Mental Health, sponsored by the British Medical Association.

(Medical Book Award British Medical Association )

"Lane''s book is worth reading because...he does such an admirable job of exposing how the psychiatric profession and the pharmaceutical industry together manage to develop and popularize new ''mental diseases'' and the accompanying treatments apparently designed to increase profits...It is a solid book and one that is likely to remain current for several years, if not decades, to come."--Tana Dineen, Journal of Scientific Exploration

(Tana Dineen Journal of Scientific Exploration )

See all Editorial Reviews

Product Details

• Paperback: 272 pages
• Publisher: Yale University Press; 1 edition (December 2, 2008)
• Language: English
• ISBN-10: 0300143176
• ISBN-13: 978-0300143171
• Product Dimensions: 9.3 x 6.2 x 0.7 inches
• Shipping Weight: 14.1 ounces (View shipping rates and policies)
• Average Customer Review: 4.2 out of 5 stars  See all reviews (20 customer reviews)
• Amazon Best Sellers Rank: #200,630 in Books (See Top 100 in Books)

More About the Author

Christopher Lane teaches literature at Northwestern University and is a recent Guggenheim fellow. A London-born literary critic and intellectual historian, his work has appeared in the New York Times, Washington Post, Boston Globe, Los Angeles Times, Slate, Chronicle Review, and many other newspapers and periodicals. He is the author of, most recently, The Age of Doubt: Tracing the Roots of Our Religious Uncertainty (Yale, 2011). His other books include Shyness: How Normal Behavior Became a Sickness (Yale, 2007), winner of the Prescrire Prize for Medical Writing (France) and highly commended by the British Medical Association, translated into French, Spanish, Danish, Japanese, and Korean.

He writes a popular blog for Psychology Today called "Side Effects" (recent posts appear to the right). He also writes regularly for the Huffington Post.

Customer Reviews

Most Helpful Customer Reviews

41 of 45 people found the following review helpful:

5.0 out of 5 stars When is an Illness an Illness?, December 16, 2007

By 

Dr. Richard G. Petty (Atlanta) - See all my reviews
(VINE VOICE)    (REAL NAME)   

Amazon Verified Purchase

This review is from: Shyness: How Normal Behavior Became a Sickness (Hardcover)

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

10 of 13 people found the following review helpful:

5.0 out of 5 stars A welcome blast of sanity for 2009, December 31, 2008

By 

Carrie J. (Milwaukee, WI) - See all my reviews

This review is from: Shyness: How Normal Behavior Became a Sickness (Paperback)

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.

29 of 41 people found the following review helpful:

5.0 out of 5 stars A superb read, September 27, 2007

By 

J. Arce (London) - See all my reviews
(REAL NAME)   

This review is from: Shyness: How Normal Behavior Became a Sickness (Hardcover)

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.