The Age Of Anxiety: Christopher Lane Takes On The Anxiety Industry

Christopher Lane, whom I interviewed on this site last month, has an adapted section of his book, Shyness: How Normal Behavior Became a Sickness, running in the WashPo today. It gives an accounting of how we got from shyness--or anxiety neurosis--to social anxiety disorder as a full-blown mental illness. Read his piece here. His discussion of how the SAD diagnosis was totally cooked and largely unscientific in the APA's 1980 DSM-III ought to piss some folks off.

As should a few other things:

"Is shyness really such a debilitating and widespread trait, or have psychiatrists merely made it seem that way? The psychiatric literature on social anxiety disorder is vast and well intentioned, tied to a host of drug trials and clinical studies aimed at lessening suffering. Chronic anxiety can be a serious problem needing treatment. But did substituting social anxiety disorder for anxiety neurosis blur an important distinction between ordinary shyness and that kind of paralyzing distress?

"My own research over the past three years, including several days' intensive work in the APA archives, suggests so. I was able to review hundreds of unpublished letters and memos written by members of the task force assembled to define new disorders -- and by mental health experts who'd heard and read about the changes and hinted at a process bordering on caprice."

Caprice in science? Never! Recently, I've begun to wonder about two bits of symptomology in bipolar disorder that I bet had an interesting--and perhaps personally-skewed--background when the APA defined manic-depression in 1980: pressured, rapid speech and heightened sexual activity. Consider: were he alive, JFK would be on Seroquel and Depakote for his well-known fast-talking and skirt-chasing.

Also, from Lane's article:

"After examining prescription rates for these three antidepressants [Prozac, Paxil and Zoloft] alone, David Healy and Graham Aldred of the North Wales Department of Psychological Medicine at Britain's Cardiff University reported in the International Review of Psychiatry that just over 67.5 million Americans had taken at least one of them in the 15-year period ended in 2002. More than 18.5 million of those had received a prescription for Paxil"

Sixty-seven million people? Wow. Five years later, I bet that number is pretty close to 100 million people, or about one-third of the population of the US taking anti-depressants for depression, bipolar disorder and anxiety. And that tells you something about who we are as a culture.