Wednesday, April 2, 2008

Think you're too shy? Just take a pill!

Tom Cruise had a point. And you have no idea how hard it is for me to admit that.

During the phase when his lunacy seemed at its most high – the period when his longstanding PR woman had stepped down and his sister had embarked on a misguided mission of showing us the real Tom – he participated in a now infamous interview with Matt Lauer. During the interview, Tom made it clear that he had no regard for the “pseudoscience” known as psychiatry. He spoke out against the abuse of drugs like Adderall and Ritalin. All drugs, he declared sarcastically, “only mask the problem”, and “there is no such thing as a chemical imbalance”. Drugs are “dangerous” and “mind-altering” he insisted. There are ways of changing behavior without using drugs, he implied.

If you can for a moment put aside the lunacy of the person doing the speaking, there are some genuine kernels of truth in several of the above statements. At the time, what made it difficult for people to see this may have stemmed from the fact that it was embedded in an unnecessary and unprovoked attack on Brooke Shields for her use of antidepressants to combat severe post-partum depression.

It also did not help that Cruise’s own behavior at the time suggested the possibility of a biochemical imbalance so profound that it was hard not to consider throwing some Depakote at him. But despite his irritating narcissism, the lunatic had a point. He did not however make it well.

A more cogent argument against psychiatry has been made in an interesting new book titled “Shyness: How Normal Behavior Became a Sickness”. It’s author, Christopher Lane, is an English professor and Guggenheim fellow at the University of London. Lane has written on a wide range of topics from psychoanalysis and race, to intimacy, hatred in Victorian England, and homosexuality. And if you think that such a range would dilute his latest tome, you would be wrong.

Lane attacks psychiatry for its increasing tendency to ‘medicalize’ normal behavior. He combed the archives of the American Psychiatric Association (APA) as well as documents from several drug companies, and found evidence that the APA and drug companies are involved in an unholy matrimony. Lane believes that the growing influence of drug companies on APA practice is reflected in the creation of new diagnostic categories, which in turn became opportunities for the psychopharmacological industry to cook up new lab-based solutions. And they do.

A central example of this, Lane notes, is the change in the definition of shyness. In a previous generation, shy people were considered to be introverted. Shyness was perceived as an aspect of personality, one end of the normal range of human sociability. Today shyness has been re-packaged as a mental illness that can be medicated. Lane notes that in 1990, the Psychiatry Bible, otherwise known as the Diagnostic and Statistical Manual, was completely overhauled, and almost 100 new categories of illness were added. Among these was a new condition called Social Anxiety Disorder. Or shyness.

But shyness is not a billable condition. Social anxiety however, is. Which points to another important component of the increasing medicalizing of ‘conditions’ such as shyness – the dependency of psychiatrists on insurance reimbursements. Lane believes that the distinction between crippling phobias and garden-variety shyness is deliberately being blurred by drug companies – and the psychiatrists they have in their back pockets - all for the purpose of marketing and selling new drugs.

Lane also points fingers at the unethical marketing of anti-depressants such as Prozac and Paxil, and what he argues were deliberate attempts to keep the public ignorant of their side effects and frightening withdrawal symptoms. He gives examples of celebrities who are paid by the drug companies to “out” themselves as having these new mental illnesses. When Delta Burke recently hospitalized herself for treatment of “hoarding behavior” [her words], I found myself cynically wondering if a drug company had paid for her endorsement. Surely there is no aspect of hoarding that made her a danger to herself or others?

There are many fallouts from this medicalizing of experiences that are normal components of the human condition – such as shyness, unhappiness, or eccentricity. Or even the odd erectile failure. For a start, it discourages people from finding non-medical solutions to their problems. I once had a lover who couldn’t get it up for a month. It sprang to life after he realized that I had not cheated on him. He did not need Levitra. Indeed, when I was trained as a sex therapist, I was told that 85% of erectile failure was psychological in nature and 15% of causes were organic. Today those numbers have been reversed and men are increasingly encouraged to drug it up rather than talk it out.

There are untold dangers of parents becoming increasingly over-reliant on psychologists and psychiatrists to help them raise their children. Some children go through childhood and adolescence collecting diagnoses – and taking pills. Who knows what the long-term effects of this might be?

Another problem is the loss of a sense of what constitutes the range of normal behavior. An example of this is the increasing over-diagnosis of ADHD. Lane quotes a psychiatrist who observed, “we used to have a word for sufferers of ADHD. We called them boys”.

A final concern is that research on conditions such as schizophrenia that truly impair human functioning end up being under-funded in favor of sexy new conditions like Body Dysmorphic Disorder. This condition even has its own Wiki page.

An unexpected irony is that I am forced to admit that the insane ravings of Tom Cruise end up containing more than a kernel of truth. The last thing we need is more influence from Scientologists discouraging people from seeking mental health help. And I don’t mean to be glib.

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