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44 of 50 people found the following review helpful
5.0 out of 5 stars When is an Illness an Illness?
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...
Published on December 16, 2007 by Dr. Richard G. Petty

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11 of 16 people found the following review helpful
3.0 out of 5 stars Important subject but needs more objectivity
Dr. Lane is on target generally and the book is quite readable, but it looses much of its potential thrust and impact due to excessive emotionality and unscientific opinion. At times more like something you might see in an Internet blog - a rant? Perhaps this is a sign of the times, have writers forgotten what the scientific method entails?
Published on July 31, 2009 by J. M. Manner


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44 of 50 people found the following review helpful
5.0 out of 5 stars When is an Illness an Illness?, December 16, 2007
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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
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12 of 15 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.
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3 of 3 people found the following review helpful
5.0 out of 5 stars Required reading, January 2, 2012
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This review is from: Shyness: How Normal Behavior Became a Sickness (Paperback)
This book,should be required reading for every psychologist, psychiatrist, counselor, and social worker in training, and is a must read for those already in practice. While there have been reviews that talk about Dr. Lane's ranting comentary, it is clear that some ranting is appropriate, given the lack professional overview of this important and unfortunate issue, including the danger to the unknowing public. His research is thorough and the text confronts much of the assumption (not limited to shyness) about the field, held by those who would normally bring the information to our attention. I am giving copies to the local psychological association for members to read and then hand to other members. I am appalled that an English professor, rather than a physician or psychologist, was led to write this but, after 36 years in the field, am not surprised.// Thomas McKnight, PhD., ABPP
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5 of 6 people found the following review helpful
4.0 out of 5 stars The Process of Making the Normal Abnormal Exposed, March 30, 2010
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This review is from: Shyness: How Normal Behavior Became a Sickness (Paperback)
Somewhat by coincidence I was reading this book while also reading the The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. The theme of both books is essentially the same: that modern psychiatry has medicalized otherwise normal conditions. In the Loss of Sadness, the authors argue that normal sadness reactions to life's toils and troubles have been redefined as abnormal via the use of symptoms exclusively, without regard to context or proportionality. Similarly, Christopher Lane argues in his book that shyness and its variants have been stigmatized as conditions requiring pharmaceutical care. Lane focuses on the behind the scenes maneuvering during the process of revising psychiatry's bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM). The main protagonist in Lane's drama is Robert Spitzer, a psychiatrist who pretty much bulldozes his vision of psychiatry into the DSM. That vision is one that places psychoanalysis in the background and brings neuropsychiatry, or the primary use of drugs to deal with conditions, into the foreground. The result is the creation and inclusion of Social Phobia and Social Anxiety into the listing of conditions that require medication.

The role of the pharmaceutical industry is explored, as it takes full advantage of the identification of this new disease and brings its full force of marketing strategies into play. Lane demonstrates with actual ads how Big Pharma marketed their drugs as solutions to life's routine problems, like being shy or nervous at a party. Perhaps the most concerning matter, however, is the push to have younger and younger children prescibed medications to address these supposedly serious conditions and to attempt to nip in the bud more serious developments, with a disconcerting disregard for the not insignificant side-effects of these drugs.

Lane also reaches into films and literature to show how a backlash against the mental numbing of America is forming. Can so many of us really be suffering from so many ailments? What does it mean for us as humans and for our relationships to be constantly drugged to feel better? Lane explores these themes through discussion of novels like The Corrections: A Novel (Recent Picador Highlights)and films like Garden State.

My one complaint with Lane's treatment is that, although he makes a solid presentation on the process that redefined shyness as an illness, there is only a glancing pass at what shyness really is, what its purpose is and how it can be an essential character trait. There is some suggestion for further reading from authorities like Susie Scott, Elisabeth Roudinesco and Jon Elster, but not enough in-depth discussion of shyness itself.

With the upcoming revision of the DSM slated for release in 2011, we may be at a crossroads where the issue of where we want to go for the next decade in mental health is critical. Do we continue on the slippery path of more medications for more "conditions", or do put the brakes on this trend and begin the process of reassessing ourselves and what it means to be humans who have emotions that correspond to life's circumstances.
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8 of 11 people found the following review helpful
4.0 out of 5 stars Explains how and why psychiatrists pathologized introversion, October 6, 2008
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This book is one of a growing number that question the scientific basis of psychiatry and in particular the pharmaceutical treatment of newly pathologized mental conditions. Lane convincingly describes how psychiatrists invent diagnoses based on quick-and-dirty studies, and how drug companies latch onto these diagnoses to justify marketing campaigns aimed at foisting lucrative products onto a gullible public. As Lane points out, this amounts to a colossal social experiment with little foresight or attention to the public safety risks.

The strength of this book is Lane's detailed description of the inner workings of the task force that developed the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual. The third edition heralded the DSM's rise from obscurity into the international bible of the mental health field. Lane gained unprecedented access to the APA committee's memos and letters, which illustrate just how unscientific the process was.

Lane uses the example of shyness to explore how a normal human trait can be transformed into an illness in need of expert intervention. In a culture that values aggressive sociability, being quiet and introspective becomes deviant. When this simplistic, mechanistic, and conformist approach is employed, almost anything can be turned into an illness. Indeed, the upcoming fifth edition (being developed in an atmosphere of intrigue and secrecy, perhaps at least in part in response to Lane's expose) may include such new disorders as internet addiction, sex addiction, parental alienation syndrome, and even hebephilia (sexual attraction to adolescents; I write in more depth about this and other questionable DSM diagnoses on my forensic psychology blog, at forensicpsychologist.blogspot.com). Lane makes the important point that the prevalence of a diagnosis can be made to fluctuate like the stock market by arbitrarily lowering or raising the threshold for diagnosis.

Although in exposing the inner workings of the DSM-III task force this book is quite educational, Lane's lengthy tangents and literary excursions make the book a bit disjointed at times, which is why I gave it four stars instead of five.

Those of you who are interested in more readings about how the psychiatric and pharmaceutical industries are hooking the world on dangerous drugs might want to check my Amazon list, "Psychiatry & Science - Critical Perspectives" (go to my profile and click on the lists).
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6 of 8 people found the following review helpful
5.0 out of 5 stars 'Normal Behavior' Should Remain Normal Behavior, June 14, 2009
This review is from: Shyness: How Normal Behavior Became a Sickness (Paperback)
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
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1 of 1 people found the following review helpful
5.0 out of 5 stars Nice book, December 10, 2012
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A really nice book, a lot of references, well written,, very interesting topic, fun and easy to read. Perfect for mental health workers and for general public.
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3 of 4 people found the following review helpful
5.0 out of 5 stars The appalling state of Psychiatric care!, January 24, 2011
Mr Lane joins eminent critics of therapeutic practice and diagnosis who realize indeed that the emperor has no clothes! I read the book through without putting it down! I found it quite compelling! Mr Lane writes plainly and concisely while providing the reader with extensive notes for further reference. His points are well taken at a time when unnecessary medical consumption threatens to bankrupt the country! While serious mental illnesses go untreated in the homeless communities, Mr Lane shows us that the insurance/pharmaceutical/psychiatric complex is expanding mental illness to include up to 50% of the US population by means of absurd and frivolous diagnoses such as shyness ( social anxiety disorder). Kudos to Mr Lane for sounding the alarm to all those who have ever considered therapy or psychotropic drugs. Years from now we'll reflect on this sad time in medical psychiatric practice. Caveat emptor!
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11 of 16 people found the following review helpful
3.0 out of 5 stars Important subject but needs more objectivity, July 31, 2009
By 
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This review is from: Shyness: How Normal Behavior Became a Sickness (Paperback)
Dr. Lane is on target generally and the book is quite readable, but it looses much of its potential thrust and impact due to excessive emotionality and unscientific opinion. At times more like something you might see in an Internet blog - a rant? Perhaps this is a sign of the times, have writers forgotten what the scientific method entails?
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6 of 9 people found the following review helpful
5.0 out of 5 stars If you've ever thought that Social Phobia looks a lot like ordinary shyness ..., March 22, 2008
If you believe that mental illness should not be marketed like
toothpaste or tampons...

If you wonder how a medication with side effects such as
disinhibition, unpredictable mood swings, hostility, aggression, and
suicidal ideation can be prescribed for anxiety about going to parties
or fear of being criticized...

If it troubles you that the FDA has approved such medications...

If you're outraged that the companies making the medications have been
allowed to remain silent about their side effects in some cases for
years...

Or, if you're just looking for a support group to help you deal with
your withdrawal symptoms...

...then read this book.

Christopher Lane's indictment of the psychological establishment, the
pharmaceutical industry and the government regulators who neither
regulate nor govern could easily be titled "How To Pathologize Almost
Everybody and Make a Billion Dollars Doing It." The book is a bluntly
honest exposé of the redefinition, expansion, and sometimes pure
invention of mental illness. It is breathtaking, frightening and
starkly detailed. In it the author lays bare the hubris, maneuvering
and outright chicanery that accompanied the writing of the third
edition of the Diagnostic and Statistical Manual (DSM-III),
psychology's comprehensive listing of anxieties, phobias, disorders
and syndromes which provides the theoretical as well as the legal
justification for finding something wrong with just about anybody. Not
coincidentally, the book also traces the psychiatrists' hidden and
not-so-hidden links to and support from the pharmaceutical industry,
which today rakes in billions making and selling the drugs that treat
the new found illnesses in the Manual.

Robert G. Chester
Author of "Asperger's Syndrome and Psychological Type," J. Psych Type,
Dec. 06.
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Shyness: How Normal Behavior Became a Sickness
Shyness: How Normal Behavior Became a Sickness by Christopher Lane (Paperback - December 2, 2008)
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