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Sunday, May 18, 2008

Is shyness really a mental illness?

Shy persons, take note -- this not a self-help book. Readers may, however, glean insight into how social anxiety emerged in the '90s as a pandemic and was popularly referred to as the disorder of the decades. Christopher Lane, award-winning psychiatric researcher, examines mental illness generally and shyness in particular as they relate to our current system for identifying mental disorders.

"Shyness" centers on the 1980 publication of the Diagnostic and Statistical Manual of Mental Disorders III, revised from its predecessor, DSM-II. It was touted as scientifically superior and more user-friendly for professionals struggling to diagnose and treat mental disorders. DSM-II was less than an inch thick; the current version is a hefty 900-plus pages and has become the psychiatric bible not only for clinicians but for social service agencies, schools, courts, prisons, insurance companies and the pharmaceutical giants as well. That, according to the author, is part of the problem.

Lane contacted members of the psychiatric task force responsible for the DSM-II revision. They offered up diverse opinions, recollections and copies of memos, formal letters and research, which Lane uses to trace the contentious six-year vetting process for hundreds of mental disorders.

The group added more than 100 new entries to DSM-III, but Lane contends the process was undermined by personality and power struggles, as well as the interference of parties that should never have been involved. Particularly egregious was the influence of drug companies. As a result of the revisions, many individuals previously considered uncomfortably but nonpathologically shy received diagnoses of social anxiety disorder.

A well-heeled academician and ethics expert, Lane offers a painstakingly researched argument. But language that is sometimes shrill puts the work somewhere between scholarly and Michael Moore-ish -- plus it's a bit of a slog getting to the core issue.

What Lane says is this: In 1980, the number of mental disorders in the DSM system more than doubled. The process that extolled strict adherence to scientific rigor was just as influenced by politics, economics and rivalry. As a result, shyness emerged an illness.

The author is thorough and passionate -- but is he right? There will be outrage as well as accolades. Meanwhile, he recommends Dickinson and Thoreau to the painfully shy while they wait for the experts to figure it out. Perhaps Garrison Keillor should be added to the list.

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