Mesdames, Messieurs —
My hope is that the award will increase attention to the cavalier, haphazard, and sometimes ludicrous ways in which 112 new mental disorders were formally approved in 1980. That year, the third edition of the Diagnostic and Statistical Manual of Mental Disorders appeared in the States and around the world, hundreds of pages longer than its previous incarnation, revolutionizing the landscape of mental health decisions in our schools and courts, our prisons and healthcare systems.
One of the most prominent of the new disorders, social phobia, was said to exist if individuals avoided public restrooms, disliked public speaking, and found themselves concerned about spilling food on their ties in a restaurant—that’s, of course, if they happened to wear ties to restaurants. Unfortunately, that’s not a joke. When more than half of any population—including in France and the United States—defines itself as shy, a psychiatric diagnosis that includes fear of public speaking is disturbingly close to making introversion a mental disorder. Close-enough, at least, for the DSM to include a warning about the risks of that confusion. Close-enough, too, for the drug companies to sense a $2 billion dollar global market awaiting them. The consequence? Millions of children and students are now taking, among other antidepressants and antipsychotics, Deroxat—or Paxil, as it’s known in the States (Seroxat in the UK). One has to be “fluent” in pharma-ese, you see, and relentless in the exposure of corporate secrets, to trace a drug’s real-world effects on public health.
[…]I witnessed academic squabbles that would make a five-year-old blush concerning whose research and final suggestions would enter one of the world’s most influential diagnostic manuals. I followed exchanges in which leading psychiatrists wrote to diagnose their critics and opponents with the very disorders they wanted to make official. I tracked arguments, too, for the inclusion of new disorders that not only quoted Carroll’s Alice’s Adventures in Wonderland, but also made one feel, like Alice, as if one was either tumbling down an intellectual rabbit-hole or witnessing a mad-hatter’s tea-party.
Chair of the DSM-III task force, Robert Spitzer knocked out the criteria for two mental disorders in minutes. Even startled colleagues were incredulous at his speed. One participant later told the New Yorker magazine (January 2003): “There was very little systematic research [in what we did], and much of the research that existed was really a hodgepodge—scattered, inconsistent and ambiguous. I think the majority of us recognized that the amount of good, solid science upon which we were making our decisions was pretty modest.”
The most surreal aspects of Carroll’s novel of course remain fiction. Unfortunately that is not true of Avoidant Personality Disorder, which became a mental disorder after discussion about it centered on whether diagnosable people preferred driving or taking the train to work (this was in New York City, of course, one of the few cities in the country with a large rail network). Nor is it fiction that the UK-US giant GlaxoSmithKline spent more than $92 million in the year 2000 on a campaign to promote diagnoses of social anxiety disorder. They called it “Imagine Being Allergic to Other People.”
At such moments, one could be forgiven for thinking that he or she had somehow joined the universe of the film Blade Runner, or was acting out a scene in Huxley’s Brave New World, where soma is so ubiquitous that it’s taken at the slightest distress, to inoculate us. But this is our world and culture in 2010. And the real and depressing outcome of such distortions, the New England Journal of Medicine discovered in January 2008, was that the entire 18-year history of SSRI antidepressants had been skewed by the false reporting and proven underreporting of negative data. Whole clinical trials buried at the back of filing cabinets, never to see the light of day because the outcomes didn’t suit the outcome wanted by the pharmaceutical house in question, which was in effect paying to have its own product assessed. On the basis of this very recent past, and on the backs of such questionable science, we have medicated millions of people around the world.
Christopher Lane, author of Shyness: How Normal Behavior Became a Sickness (Yale trade, 2007).