An Interview With Christopher Lane

A couple of weeks ago, Christopher Lane, an English professor at Northwestern University, wrote an op-ed in the New York Times that was very critical of the diagnosis of social anxiety disorder, especially in children. His piece has gotten a lot of attention and generated some anger in the mental health world. Lane's new book, Shyness: How Normal Behavior Became A Sickness is just out. I have not bought the book yet, but if it's anything like his op-ed and the following interview we just did, then it ought to be fascinating.

So what inspired you to write the book?

Several things, really: Like many people, I’m sure, I felt bombarded by all the pharmaceutical ads for social anxiety disorder that came out a few years ago. I wanted to find out what was behind them and, indeed, what the psychiatrists meant by “social anxiety disorder.” The phrase sounded so ominous and, at the same time, so peculiar.

I had just finished a book on hatred and misanthropy in the nineteenth century, and some of the research for that book led me to recent studies on how medication might cure us of misanthropes today. Because the Romantics, in particular, greatly admired misanthropes, revering them as scolds fed up with greed and social corruption, I grew quite alarmed and began to wonder what would happen in our Enron-age if all those skeptics, curmudgeons, dissenters, and whistle-blowers were on Prozac and Paxil. Would we be more complacent about our problems or more motivated to tackle them? What would have happened in the Victorian age, too, if all those social critics pushing for reform had been medicated?

What did you run into in your research? Any surprises?

I unearthed an amazing archive of unpublished letters at the American Psychiatric Association about the creation of this disorder. Finding it involved lots of luck and a keen sense that this was a fascinating, necessary story worth pursuing. The Diagnostic and Statistical Manual of Mental Disorders is commonly known (whether seriously or as a joke) as the “bible” of psychiatry. Certainly, it’s true that people apply it chapter and verse! So I wanted to know how this complex manual went through so many dramatic changes. Who was behind them? And what was motivating their desire to add so many dozens of new disorders to the manual? Above all, were they right—and were their changes necessary and helpful?

And what did you discover?

Well, let’s just say I’m far more concerned about psychiatry now than I was going into this project. After all, I reviewed literally hundreds of the psychiatrists’ letters and memos. I know every small and major reform they pushed for, including highly confidential recommendations that of course were never made public, but that had serious consequences behind the scenes. And much of what they did was very questionable.

Some of them pushed for their own disorders to get adopted. Some wanted to promote their friends or thwart their enemies, and openly joked about that. Some of their sample sizes were embarrassingly low—-in one case involving just one person the advocate of the disorder had himself treated! That’s no basis for saying a disorder belongs in the DSM-—especially not if you’re claiming the manual is highly scientific. Even one of the main players has since gone public, saying much of their research was “really a hodgepodge—scattered, inconsistent, ambiguous.” That tells you something, but it’s honestly not even the half of it.

Give us an example of what you found.

One psychiatrist wanted approval for something he called “chronic undifferentiated unhappiness disorder,” which aimed to pathologize people who grumble and complain a lot. He actually said, “To be included in this category are persons who heretofore were known by the synonyms: ‘kvetch,’ ‘scootch,’ ‘noodge,’ and just plain ‘neurotic.’ ” Can you believe that? It would be laughable if the situation weren’t so serious.

Now, the psychiatrists like to say they’re interested only in addressing chronic suffering—-a person’s symptoms must truly be impairing, and so on-—but the criteria they list are far from being so. They’re responsible, then, for creating untold confusion about such key matters as where we should draw the line between shyness and social anxiety disorder.

What they do is list the most common fears and dislikes going, and then assert that these are symptoms of an unrecognized mental disorder needing potent drugs for suitable treatment. I find that very troubling, especially when you consider that over 5,000 Americans start a new course of Paxil every day.

The psychiatrists also love to say that their critics are prolonging people’s misery—-a response directed at me personally, after my op-ed in the New York Times warning about overmedicating youngsters. That’s a marvelous way to immunize yourself against criticism—-you just say everyone voicing concern about your policies is making other people suffer. That must also take some nerve, especially after they’ve said it’s fine to medicate someone with Paxil if they dislike “eating alone in restaurants” or fear hand-trembling when they write checks.

So, what would you say to someone who dislikes speaking in public?

First, I’d urge them to consider how many of us there are who don’t enjoy giving off-the-cuff speeches to colleagues. You’re talking about almost everyone! Then consider that there are easily affordable and widely available organizations out there for public speaking, such as Toastmasters, where people can practice and sharpen their skills. Public speaking is, after all, a skill. It used to be a required course in universities.

More generally, there are umpteen excellent, effective things you can do about anxiety that don’t involve medication. The problem is, meds have become the psychiatrists’ and doctors’ default. They’re proposed even when there’s the glimmer of a problem, as literally dozens of people emailing me about the op-ed in the New York Times stressed when telling me about their stories.

What I’d like, then, is for everyone to think much more carefully about what those meds could do to them or their patient or their child. I’d urge them to consult the medical literature that’s out there, because, I have to say, a lot of it is seriously frightening. Just take a look at the complete list of symptoms for Paxil, for instance, and not the one they used to rattle off in the ads. The complete list is what has fueled so many lawsuits against GlaxoSmithKline, maker of Paxil.

What does any of this tell you about where we are as a culture?

We’ve grown too blasé about these drugs. We’re used to thinking of them as a panacea for common, routine problems, and assume they won’t have any negative effects on us. But the web is chockfull of patient-support groups, with testimonies about the damage and harm these drugs can do. Many of the psychotherapists and psychoanalysts I know voice the same concerns repeatedly, because they often have to deal with the fall-out from medication.

Think about it this way: Since the drug companies sponsor the vast majority of psychiatric research, how many of them would be willing to pay the money required to investigate the side effects of their biggest money-makers? Of course, they want to draw a veil over that huge problem and pretend it’ll go away. But it’s not going to. The problem is just going to get worse. No one paid enough attention to that risk in the 1990s, when Prozac, Paxil, Zoloft, and all the others were being touted as miracle cures for everything, even mood brightening.

We need to think what all these meds will be doing to the next generation. What effect will they have on their powers of concentration? On people’s health? On the development and delicate balance of their central nervous systems? Even their capacity to form deep attachments?
People understandably opt for the least distressing solution to their problems. But to think that drugs always will be this for them is, unfortunately, an illusion and a mistake. I’m not saying people shouldn’t seek help. I’m urging them to be smart about the kind of help they ask for.

Posted by Philip Dawdy at October 1, 2007 12:03 AM
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