Lane responded to a few questions about his new book, Shyness: How Normal Behavior Became a Sickness, which were put to him by the political scientist Cary Federman, author of The Body and the State: Habeas Corpus and American Jurisprudence and a professor in the Department of Justice Studies at Montclair State University: Federman: Can you tell the readers of the Campaign for the American Reader a little about your new book, Shyness: How Normal Behavior Became a Sickness (Yale University Press)?Read an excerpt from Shyness and learn more about the book at the Yale University Press website.
Lane: Shyness takes a provocative look at far-reaching, often very questionable changes to American psychiatry over the last thirty years. The book uses social anxiety disorder as a lens through which understand and assess these changes, to ask pointedly whether all of them were necessary and suitably precise.
My short answer is no, they weren’t. In 1980, social anxiety disorder and 111 other newly created mental disorders were added in a haphazard, unscientific fashion to psychiatry’s “bible,” the Diagnostic and Statistical Manual of Mental Disorders (DSM for short). My research uncovers why so many new disorders were established in the first place. It also considers what the effect has been on us, as a society, of having so many common behaviors redefined as disorders that need some kind of treatment (invariably drug-related).
The book is provocative, as quite a few reviews have noted, because it reprints confidential memos from drug company execs advising colleagues to withhold or tilt discussion of drug-related side effects — in effect, to mislead the public about them so they wouldn’t seem so severe. Shyness also reprints several highly embarrassing proposals, including for a disorder called “chronic complaint disorder” that was meant to present as mentally ill people who complain too much about the weather and worry about their taxes.
All this might sound incredible — almost science fiction — but the general sweep described in the book is actually part of a trend in American psychiatry and medicine that has lot of bearing on our everyday lives. The DSM is consulted daily across the country — indeed, around the world now, from courts and prisons to schools, health insurance companies, and among mental health professionals of every stripe. It’s a manual that encapsulates, almost in bullet points, what psychiatry defines as mentally normal and disordered behavior. I was lucky-enough to get unrestricted — actually, unprecedented — access to the papers at the American Psychiatric Association in Arlington, Virginia, which document in vivid, sometimes embarrassing detail how these disorders were created. It’s not a pretty picture, I should add, but it does make for interesting reading.
First, readers get to see experts making up a lot of things as they go along. They also witness psychiatrists squabbling over very dubious changes to the diagnostic manual, and how their opponents questioned what they were doing, unfortunately with little effect. Finally, they also see that more experts have since come forward, admitting the amount of hard science they were going on was minimal, at times painfully so. The net effect is that the DSM, a manual that has sold in the millions and is routinely touted today as a pristine scientific document that just gets better with each edition, is in fact full of the most amazing language, guesswork, and questionable judgments you could imagine.
Federman: Literature and madness have been joined since Plato. But your book, Shyness, is not an investigation into the works of Rabelais, de Sade, or Flaubert, authors of classic works of literature that explore madness's various meanings. Rather, you discuss Jonathan Franzen's The Corrections and Will Self's Dr. Mukti and Other Tales of Woe, both of which characterize mental illness as a problem to be solved by pharmaceutical companies. Is chemical dependency the new madness?
Lane: It’s true that I focus more on anxiety than madness in the book — and that’s partly because madness has received quite a lot of airtime, especially in studies on nineteenth-century psychiatry. By contrast, anxiety is a timely, engaging subject that neuropsychiatrists treat as if it’s completely explainable because they view it as arising almost exclusively from a chemical imbalance in the brain. Actually, anxiety is a complex phenomenon that varies greatly from one culture to the next, and certainly one age to the next. It also straddles psychology, biology, and society — the mind, brain, and environment, if you will — so it’s a mistake to reduce it to one of these areas, such as the brain, and to neglect other factors, such as the mind.
I wanted to focus on contemporary literature, in particular, because some of it and quite a lot of films not only engage with the complexities of our minds but also question the widespread changes in neuropsychiatry and ask if they’re sound, appropriate, and necessary. I view Jonathan Franzen, Will Self, Alan Lightman’s novel The Diagnosis, and Zach Braff’s film Garden State as very much part of a cultural backlash against psychiatry and, indeed, the overdiagnosis and overmedication of ourselves and our children. So I wouldn’t exactly say that these writers characterize mental illness as a problem to be solved by pharmaceutical companies. It’s more that they ask whether so much medication is necessary in our culture, what its side effects are, and what the overall emphasis on meds is doing to us in the long-term.
Federman: Toward the end of your book, you seem to despair over the loss of psychoanalysis as a serious method to relieve psychic pain. What would psychoanalysis do differently regarding mental illness that Big Pharma isn't already doing?
Lane: I think psychoanalysis has been unfairly characterized, even maligned, by neuropsychiatrists who, it’s clear, often haven’t read what Freud wrote about anxiety. He was actually very astute about it — not at all reductive or off-the-wall, but prescient about its widespread effects, while admitting that, as today, it’s often initially a “riddle” to us which, when cracked, says a lot about our personalities and interactions with others.
But my concern and argument in the book amount to more than this. The issue is also that recent multimillion dollar “awareness campaigns” for social anxiety disorder and, more recently, bipolar disorder reduce the most complex parts of us and our conflicts to one thing only: a need for more pills. I do lament that shift as a loss, yes, because it oversimplifies so much and presents pat answers that, for a great many people, aren’t by any means lasting solutions to their suffering and distress.
We used to have far-more robust and expansive ways of thinking about anxiety and a host of related topics mentioned in my book — idiosyncrasy, eccentricity, even reclusiveness. Nowadays, all such things fall under the banner of “mental disorder.” One of the other 112 new disorders in 1980 was the absurdly named and defined “avoidant personality disorder,” and psychiatrists actually debated whether a symptom of it should be the choice of using one’s car or public transportation to get to work. I wish I was joking! Meanwhile, our understanding of what is normal shrinks so dramatically that experts began to call road rage “intermittent explosive disorder” and media reported the news with wide-eyed wonder but almost no hint of skepticism or irony.
So, all the available evidence suggests that mental health professions have gone overboard — frankly even haywire — in their thinking and zeal for medication: leading psychiatrists are now seriously talking about including apathy, excessive shopping, and overuse of the internet in the next edition of the DSM, due out in 2012. Think about it: apathy might become a mental disorder!
I think a lot of people — not just me — for a long time have had serious doubts about psychiatry but couldn’t until now put their finger on what exactly had gone wrong and why things became so one-sided and oriented toward medication. Large numbers of people are also worried about diagnostic overkill and are wondering when someone’s going to apply the brakes. But, right now, the train seems almost unstoppable and the only entity capable of applying some brakes to it, the American Psychiatric Association, is in fact committed to its hurtling along even faster.
Federman: Up until the 1990s, novelists focused on some character's unconscious thoughts as a way to drive the story, perhaps to make a larger point about the human condition. Now, in Jonathan Franzen's The Corrections, for example, he describes a pill-popping mother searching for happiness through better chemistry. Has literature lost anything by the disappearance of the unconscious and its replacement by the identification of chemical imbalances in the brain that can be rectified by pills?
Lane: I’d say that literature has indeed lost a lot as a result of these changes in emphasis, but I wouldn’t say the unconscious has disappeared as a result — more that it may be shifting into a slightly different register or form. As one psychoanalyst (Elisabeth Roudinesco) that I quote in the book aptly puts it, despite all the apparent remedies for suffering now available as pills, people still find another outlet for their unhappiness. So it’s not as if the underlying malaise or problem has been solved. In The Corrections, Franzen has Enid Lambert illustrate that point exactly. She has to find another way to live without making her “personality optimizer” a new crutch or drug of choice.
These are doubtless major issues for our culture. They’re also key issues for writers, as Franzen has pointed out in one interview quoted in the book, because meds may be altering not only the way people behave but also how they see themselves, in forms we can’t exactly fathom or predict. For starters, meds may affect writers’ creativity, including dimming their imagination and altering their inspiration. As Franzen noted, they’re also starting to change how we think about narrative conflict and resolution. As he puts it in one interview, the “story becomes: the chemicals in my brain were bad; I fixed those chemicals. From a humanitarian standpoint, that’s great, but it makes for a less interesting world.” In another, more practical sense, that story is also going to have less dramatic appeal than one that dwells on far-reaching psychological or existential conflicts — what Franzen elsewhere rightly calls “the darkness of sorrows that have no easy cure.”
Federman: Your book has a lot of reproductions of advertisements from big pharmaceutical companies, which you include as a way to demonstrate their manipulative power over language. There is an irony here, in that the founder of public relations in the United States, Edward Bernays, was Sigmund Freud's nephew. Viewed this way, it seems inevitable that psychiatry and Madison Avenue would be bedfellows. Is it, then, inevitable that shyness would give way to Social Anxiety Disorder?
Lane: True, there’s irony in Bernays’ connection to Freud, but Bernays also used psychoanalytic interest in the unconscious to manipulate public opinion in ways that really would have horrified Freud had he lived to see that development: There’s no two ways about that.
I’d say there are greater ironies in the book. One is that Robert Spitzer, the man selected to head the major task force responsible for all these changes in psychiatry, began his career as a Reichian psychoanalyst. And not the early Reich who extended Freud’s radical point about our unconscious drives colliding with civilization, but the later crank who believed in measuring and capturing “orgone” energy, as well as the influence of extraterrestrials! What’s bizarre is that Spitzer in his twenties admired such work and told me that in 1952 he actually wrote to the elderly Reich, asking why his own results weren’t especially impressive. Reich told him the reason was probably due to fall-out from the recently dropped atomic bomb!
So, okay, not someone to take very seriously, which makes it puzzling that the younger Spitzer did for a while. But, all joking aside, I don’t agree that psychiatry and Madison Avenue inevitably would become bedfellows. I view that collusion — or “Faustian pact,” as I call it in the book — more as the result of specific and ultimately self-limiting choices among neuropsychiatrists, in their wanting to shunt aside virtually all major questions about consciousness and the mind while stipulating, over and again, until it becomes almost a mantra, that our “disorders” are due to faulty chemistry or wiring in the brain or some genetic or hormonal “malfunction” that the right expert and drug maker will know how to fix.
So, no, it’s by now means necessary or inevitable that shyness would give way to social anxiety disorder. That shift is due to a grave mistake — a fault in reasoning — that we should correct, not shrug off or even excuse away as scientifically justified. There’s no justification for it. Indeed, the man responsible for identifying social anxiety in its most recent guise, Isaac Marks, formerly of the University of London, strongly urged Spitzer and others not to define social anxiety as a separate disorder. But Spitzer and his crew wouldn’t listen to him. As Marks told me, they “arranged the consensus by leaving out the dissenters.” And that became a worrying trend across the board.
It’s certainly not a good sign when one of the world’s leading anxiety and phobia scholars is left out of the picture because what he says doesn’t match those whose ambitions for psychiatry are fixed in a different groove.
Visit Christopher Lane's website.
--Marshal Zeringue