Shyness: How Normal Behavior Became a Sickness (Hardcover)

by Christopher Lane (Author)
Key Phrases: premenstrual dysphoric disorder, many neuropsychiatrists, rebound syndrome, United States, Robert Spitzer, The Diagnosis (more...)

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 Lane finds a trove of troubling (and previously unpublished) material in the APA archive and in drug company memorandums, laying bare the APA's internal politics (as fierce as academia) and showing the growing influence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.
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Review
?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 20071101)

?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 20080131)

"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 20090120)

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

"[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 )

"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 )

"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 )

"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 )

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Product Details

• Hardcover: 272 pages
• Publisher: Yale University Press; 1 edition (September 26, 2007)
• Language: English
• ISBN-10: 0300124465
• ISBN-13: 978-0300124460
• Product Dimensions: 9.3 x 6.3 x 1.1 inches
• Shipping Weight: 1 pounds (View shipping rates and policies)
• Average Customer Review: 4.2 out of 5 stars See all reviews (16 customer reviews)
• Amazon.com Sales Rank: #539,523 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

26 of 27 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 (TOP 500 REVIEWER)    (REAL NAME)

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

23 of 35 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)

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.

5 of 8 people found the following review helpful:

5.0 out of 5 stars deconstrucing shyness, March 23, 2008

By	A. J. O'brien (New Zealand) - See all my reviews (REAL NAME)

'Shyness' is a highly readable and important critique of how a common experience became an illness. While it is true that shyness can be crippling and disabling, is this enough to make it an illness? Does it need 'treatment' or simply support and acceptance? Of more concern is the role of the pharmaceutical companies in creating shyness as an illness. Just because it's in the DSM it doesn't have to be diagnosed and treated, in the way that the common cold, while definitely an illness, doesn't need to be diagnosed and treated. Christopher Lane has done a superb job of drawing together some diverse areas of study. From the rewriting of the DSM, to the machinations of the pharmaceutical companies, this book tells an absorbing and disturbing story. The discussion, in one of the of the later chapters, of recent literarary treatment of psychiatry is a welcome bonus.