Extracts from Arnie Cooper interview with Christopher Lane and the Sun’s Magazine Article with the same title.
Christopher Lane is not a psychiatrist. But he has been researching the DSM – Diagnostic and Statistical Manual of Mental Disorders – and the process by which new disorders are added to it. What he discovered has made home a critic of much of modern psychiatric theory and practice.
Six years ago, he had just published hatred and Civility: The Antisocial Life in Victorian England, for which he studied the transition from Victorian psychiatry (out of which psychoanalysis was born), to contemporary psychiatrist, with its intense focus on biomedicine and pharmacology.
He was already skeptical about the emergence in 1980 of dozen f new mental disorders in the DSM-III (third edition) and he began to hear from many of his students at Northwestern University in Evanston, IL, that were in psychiatric drugs.
He got access to APA (American Psychiatric Association) archives and unpublished memos and he was troubled with what he found: evidence of drug-company influence (especially in the promotion of “panic disorder” by the maker of Xanax), questionable research (sometimes involving just one patient), sloppy thinking, dismissal of nonmedical approaches to psychiatric problems, and a degree of inventiveness with term and symptoms that struck him as playing fast and loose with the facts.
All of this served as the basis for Lane’s 2007 book, Shyness: How Normal Behavior Became a Sickness, in which he observes that behaviors once understood as natural reactions to one’s environment and upbringing are increasingly seen as innate conditions of brain chemistry, resulting from problematic levels of neurotransmitters, especially serotonin.
He suggests that because of the open-ended language in the DSM and the wide range of behaviors it pathologies, anyone who is shy – as he was as a teenager – now risks being diagnosed as mentally ill.
Lane has written 3 other books about the Victorian Era. He is editor of the anthology The Psychoanalysis of Race, and coeditor of Homosexuality and psychoanalysis he currently writes for the Huffington post and has a popular blog for psychology called side effects.
Cooper: Why should the average person care about the DSM?
The DSM is widely regarded as the bible of psychiatric diagnosis. Its authority extends not only to this country’s schools, prisons, court system and health insurance industry. It is highly influential in defining mental illness.
Since the first DSM in 1952, which had 106 disorders, the number has almost tripled. Are we getting sicker, or is something else at play?
The way psychiatrists define mental illness has itself changed radically. The first two editions of the DSM focused on observable traits and behaviors in patients, which were often described as “reaction” to particular incidents or stressors.
When the third edition came out in 1980, it defined virtually everything as a “disorder” which connotes and innate, lifelong malfunctioning of the brain rather than a moment of psychological distress that might be due to a brief change in circumstances. And this new method of defining mental disease has completely transformed the way mental-health professionals and the general public thinks about it.
Cooper: How did you become interested in the DSM?
I am a teacher, and I learned many of my students were on some kind of psychiatric medication, generally prescribed but sometimes not. I wanted to know why they and their doctors felt that drugs were necessary to treat relatively mild problems that earlier generations had dealt with quite differently.
Antisocial Behavior in the 19th Century
I had just finished writing a book on antisocial behavior in the 19 century, when the cultures’ judgment of such behavior shifted radically.
The Romantic Movement, which dominated arts and letters in the first half of that century often praised antisocial behavior and misanthropy in particular as a valid criticism of social vice, greed and stupidity. The Romantics lauded the outcasts as someone capable of commenting on what was wrong in society. By the end of the 19 Century however, the exact same behavior was held as suspect, pathological and even criminal in part because the values it exemplified were not conducive to social cohesion.
When Prozac came on the market in the late eighties, it was viewed as a kind of miracle drug. A 1994 cover piece in Newsweek was subtitled: “How Science Will Let You Change Your Personality With a Pill.”
It was a trendy way of thinking about self-improvement, along the lines of the sitcom Home Improvement.
Why don’t you take an antidepressant that could shape your personality into a more optimal one?
Peter Kramer Author of Listening to Prozac was one of the people responsible for the giddy reception of the drug. There was no virtually discussion in his book of the side effects and other downsides to taking an antidepressant without a clinical diagnosis.
WE are seeing widespread use of these drugs ostensibly on the grounds that they re enhancing neuron activity but like amphetamines they create many problems too.
Selective serotonin reuptake inhibitors (SSRIS) such as Prozac are now associated with a litany of medical problems, including sexual dysfunction and increased risk of suicide. These are serious effect for drugs that are represented as enabling people to be better than well.
(…) Meds downside
With meds, unfortunately, there is almost always a downside, even if it’s not immediately obvious. In the history of pharmacology many new drugs have been presented as he wonder cure, the remedy for everything. It takes about a decade for the long-term studies to catch up with that initial enthusiasm.
(…) Bipolar Disorder
If you follow the APA’s line, then most definitively we are seeing epidemic rates of social anxiety disorder and bipolar disorder, with the latter expanding by an eye popping 4,000 %. How did this come about? Before, bipolar disorder was understood to be exclusively an adult phenomenon. Now, the DSM –IV formalized bipolar disorder as a mental disorder among children.
First of all I would be leery of giving any children an antipsychotic, a class of drugs that is considered too dangerous for seniors. They are proven to lead to muscle tics and twitches, to increase weight, to raise the risk of diabetes and hypoglycemia, and to cause strokes. We’re not talking just about nausea or mild sexual dysfunction, as with antidepressants.
We are talking about serious psychological changes in growing children.
Creating the disease
Cooper: In your book on shyness you write, “before you sell a drug you need to sell the disease.”
Lane: One of the given of pharmaceuticals marketing is that you have to create need to expand the market. The criteria for social phobia in the SM-III included fear of eating alone in restaurant, avoidance public restroom and fear of one’s hand trembling when writing a check. In other words the requirements were so low that people who experience garden-variety shyness could be swept up in the diagnosis. 50% of people in any population around the world will define themselves as shy. So that the drug companies set out to do was to convince people that shyness might be a symptom of something more serious called “social anxiety disorder”.
The Paxil marketing campaign took a product that had produced spotty results in early trials – including one so riddled with side effects that the company had seriously considered shelving the drug – and turned into a blockbuster so called because its annual revenue surpasses $1 billion. When they realized that they could sell Paxil not simply for depression, where it was competing with Zoloff and Prozac, but also as the first FDA-approved drug fro social anxiety disorder, they went all out. They organized and funded a public-awareness campaign – “Imagine being allergic to people.” That didn’t even mention the drug but helped sell the condition. Large number of people went to their physician asking for free samples, which GlaxoSmithKline, of course made sure were abundant.
Social Anxiety Disorder X Shyness
(…) In my research I found that the percentage of people who experience acute shyness overlaps almost identically with the group the APA wants to suffer from social anxiety disorder.
After golfer Tiger Woods’s adultery scandal a number of articles have been written that tried to attribute promiscuity or adultery in men to a brain disorder. I find this questionable for a number of reasons.
First, its worrying to me that a group of psychiatrists is trying to determine how much sexual activity and how many encounters we can want or fantasize about before we are considered mentally ill.
(…) We need broader public discussion of this complex rather that the kind of psychiatrist judgment and ritualized shaming that goes on right now for those who prefer to remain non-monogamous. Good for them if that’s what they want.
Cooper: You claim that some famous individuals such as Emily Dickinson, Nathaniel Hawthorne and Henry David Thoreau would be diagnosed today as mentally ill.
Lane: Certainly I am truck by the difference between nineteenth-century understandings of mood and the contemporary assumption that happiness is the default. This is something Barbara Ehrenreich discusses in her book: Bright-Sided: How positive thinking and happiness have been taken as the measure for how well we are doing in life. In the nineteenth century there wasn’t so much cultural pressure to eradicate or manage negative emotions. On the contrary, they were understood to be part of the human condition. There is a beauty in Dickinson’s writing that comes from her working through great sadness.
Psychiatry would benefit enormously from a reinvigorated discussion of emotion – including its history and effect on depression, anxiety, and sadness – in ways that are infinitely more subtle and nuanced than what we’re seeing in the psychiatric literature today.
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