How Normal Behavior Became a Sickness
Yale University Press, 2008
EDUCATIONAL OBJECTIVES The reader will be able to:
• Describe the development of the concept of anxiety over the past century and its effects on culture
• Describe how emotions have become pathologies in the development of diagnostic categories
• Describe how shyness became a pathology
• Describe how the concept of shyness as an illness was accepted by the public
• Describe why drug treatments have failed
• Describe the backlash to the pathologizing of shyness
Christopher Lane is the Pearce Miller Research Professor of Literature at Northwestern University. He has written for the New York Times, Washington Post, Boston Globe and the Los Angeles Times, as well as published more than fifty peer-reviewed articles in journals.
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 facade 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.
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. --Publishers Weekly
[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. -- Mother Jones
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. --New England Journal of Medicine