just wondering if anyone has managed to get hold of "Shyness: How normal behaviour became a sickness" by christopher Lane, Yale Universiy Press. The Sci-Am review indicates the book is about the decisionmaking process behind past and current reviews of the DSM manual.

The Sci-Am review indicates the book discusses the politicking and influence of the US pharmaceutical industry on the inclusion of new disorders in the Manual.

Not being familiar with the US but knowing that US diagnostic criteria often move across the Atlantic to the UK I wonder how valid the books thesis is.

kilt

Here's an article by the author from the New York Times, yesterday:
<center>The New York Times</center><center>
September 21, 2007 Friday
Late Edition - Final</center>
Shy on Drugs

BYLINE: By CHRISTOPHER LANE. Christopher Lane, a professor of English at Northwestern, is the author of the forthcoming ''Shyness: How Normal Behavior Became a Sickness.''



SECTION: Section A; Column 0; Editorial Desk; OP-ED CONTRIBUTOR; Pg. 19

LENGTH: 998 words

Chicago

FEW children relish the start of a new school year. Most yearn for summer to continue and greet the onset of classes with groans or even dread. But among those who take the longest to adapt and thrive, psychiatrists say, are children trapped in a pathological condition. They are so acutely shy that they are said to suffer ''social anxiety disorder'' -- an affliction of children and adolescents that, the clinicians argue, is spreading.

It may seem baffling, even bizarre, that ordinary shyness could assume the dimension of a mental disease. But if a youngster is reserved, the odds are high that a psychiatrist will diagnose social anxiety disorder and recommend treatment.

How much credence should we give the diagnosis? Shyness is so common among American children that 42 percent exhibit it. And, according to one major study, the trait increases with age. By the time they reach college, up to 51 percent of men and 43 percent of women describe themselves as shy or introverted. Among graduate students, half of men and 48 percent of women do. Psychiatrists say that at least one in eight of these people needs medical attention.

But do they? Many parents recognize that shyness varies greatly by situation, and research suggests it can be a benign condition. Just two weeks ago, a study sponsored by Britain's Economic and Social Research Council reported that levels of the stress hormone cortisol are consistently lower in shy children than in their more extroverted peers. The discovery upends the common wisdom among psychiatrists that shyness causes youngsters extreme stress. Julie Turner-Cobb, the researcher at the University of Bath who led this study, told me the amounts of cortisol suggest that shyness in children ''might not be such a bad thing.''

On what, then, do psychiatrists base their sweeping judgments? Most point to The Diagnostic and Statistical Manual of Mental Disorders -- the fundamental handbook of psychiatry. Yet a glance at the manual reveals that the diagnostic criteria for shyness are far from clear. The third edition, which was published in 1980, said that a person could receive a diagnosis of what was then called ''social phobia'' if he was afraid of eating alone in restaurants, avoided public restrooms or was concerned about hand-trembling when writing checks.

The same guidelines could hardly apply to youngsters heading to kindergarten, children not yet potty-trained and toddlers just learning to eat. So in 1987, the revised third edition of the manual expanded the list of symptoms by adding anticipated concern about saying the wrong thing, a trait known to just about everyone on the planet. The diagnostic bar was set so low that even a preschooler could trip over it.

Self-help books and magazine articles further widened the definition of social anxiety disorder to include symptoms like test anxiety, aversion to writing on the blackboard and shunning of team sports. These ridiculously loose criteria led to more diagnoses, until social anxiety disorder in children began to look as if it were spreading like the common cold among second graders.

Then, having alerted the masses to their worrisome avoidance of public restrooms, the psychiatrists needed a remedy. Right on cue, GlaxoSmithKline, the maker of Paxil, declared in the late 1990s that its antidepressant could also treat social anxiety and, presumably, self-consciousness in restaurants. Nudged along by a public-awareness campaign (''Imagine Being Allergic to People'') that cost the drug maker more than $92 million in one year alone ($3 million more than Pfizer spent that year promoting Viagra), social anxiety quickly became the third most diagnosed mental illness in the nation, behind only depression and alcoholism. Studies put the total number of children affected at 15 percent -- higher than the one in eight who psychiatrists had suggested were shy enough to need medical help.

This diagnosis was frequently irresponsible, and it also had human costs. After being prescribed Paxil or Zoloft for their shyness and public-speaking anxiety, a disturbingly large number of children, studies found, began to contemplate suicide and to suffer a host of other chronic side effects. This class of antidepressants, known as S.S.R.I.'s, had never been tested on children. Belatedly, the Food and Drug Administration agreed to require a ''black box'' warning on the drug label, cautioning doctors and parents that the drugs may be linked to suicide risk in young people.

You might think the specter of children on suicide watch from taking remedies for shyness would end any impulse to overprescribe them. Yet the tendency to use potent drugs to treat run-of-the-mill behaviors persists, and several psychiatrists have already started to challenge the F.D.A. warning on the dubious argument that fewer prescriptions are the reason we're seeing a spike in suicides among teenagers.

The recent book ''Nurturing the Shy Child: Practical Help for Raising Confident and Socially Skilled Kids and Teens,'' insists, ''Don't be afraid to try medication.'' ''When an S.S.R.I. is properly prescribed and monitored, medication can be very helpful,'' say the authors, two psychologists. This book says it is a sign of social anxiety disorder if a child complains about or tries to avoid asking the teacher a question or getting up from his or her desk to sharpen a pencil.

Clearly, there is a need to reconsider the diagnostic standards. A team of mental health experts has recently gathered to oversee a new edition of The Diagnostic and Statistical Manual, and this time they should make sure to carefully distinguish normal -- even healthy -- shyness from social anxiety disorder. They should also remove shyness from the lists of symptoms of avoidant personality disorder and schizoid personality disorder. With so much else to worry about, psychiatry would be wise to give up its fixation on a childhood trait as ordinary as shyness.

No idea.

Shyness has been documented in infants. Jerome Kagan (Harvard) did those famous studies into testing infant personality styles.

For example: they exposed an infant to a loud sound (say, a clap or crash). The infants who responded with fear/startle/crying grew up to be shy, introverted, inhibited types. The infants who didn't get upset grew up to be more extrovert, calm, etc.

IMONSHO, I am a fan of Peter Kramer's ideas about the SSRIs re-shaping personality. I have experienced it myself. My ADHD only came out with exposure to Prozac. (I think I am an Inattentive ADDer. Diagnosed, after Prozac, as a Combined ADDer.)

Before Prozac, the Impulsivity (to blurt out) was there, but it was held more internally (with me yelling out "you idiot" in my head). The Hyperactivity was manifested as things like severe impatience with waiting in lines, or waiting to be called on in class ("hands up anyone?" <G>.)

I'd rather manifest my personality/frustration/misery from the outside (extrovert) than from the inside (shy, introverted, repressed) b/c at least people can see how you are feeling (and dying of frustration) from the outside...

Being trapped in shyness (and panic and constant undercurrents of chronic anxiety) is hell.

It took me years to get my anxiety treated. (Pills are only 1/3 of the regimen that has worked at curing me, or so.)

But drug companies manufacturing 'syndromes' to treat is pretty evil, too.

The title bothers me.

It suggests that Shyness is "non pathological".

That is not true at all.

Shyness causes HUGE problems for people in life.

I'll think about that and come back and write more: the # of facets it affects someone's life in are endless.

There's a lot of variation in"shyness", depending on what your actual definition is.

In purebred dogs, shyness is generally a pretty bad fault. A shy dog is difficult to teach and will tend to to nip or even attack if startled or cornered.

in human beings, at least three qualities might qualify as shy. One of them is better labeled "reserved" and means someone who will evaluate the situation and understand the people before they open up. Another quality might be people who are inherently fearful. And the third form of shyness would be better called obliviousness, or difficulty observing and interacting with others. All three of these qualities are quite different, but they're both called shyness.

When I was in elementary school I was neither reserved nor fearful. But I had lots of obliviousness. However, not so much obliviousness that I was not made very unhappy because of having no friends. In fact, having no friends pretty much defined my first 10 years in school. would my life have been different if I'd been more aware of the people around me? I can't see how wouldn't be.

Ducky

Thanks Sosninity.

The NYT article is longer and more in depth than the Sci-Am one by a long way. The fact that the Lane is an English Professor and not a science/medical one is interesting. His bio gives his speciality as Victorian and Modern British fiction.

(correct me if I'm wrong but Professor in the US is different to in the UK...Here a Professor is the top academician and head of a faculty but in the US a professor is what we would call a lecturer, some one with full academic tenure?)

I would agree with QueensU Girl that chronic and sustained shyness would have a huge effect on ones life through into adulthood, however is the lowering of the "bar" in the DSM to the levels indicated in the article feeding through to real life diagnosis and pharmacological intervention in the US?

A more detailed synopsis of the UK research mentioned by Lane can be found here

http://www.politics.co.uk/press-releases/opinion-former-index/children-and-family/esrc-children-stressed-six-month-before-starting-school-$477844.htm

The research was looked at the very specific issues surrounding children starting "proper" school, which in the UK is age 4.5-5.5. Whether this small study could be used to back up a thesis that shyness isn't so bad is stretching it a bit. The postulation that shyer kids don't get into such confrontational situations and don't annoy their classmates in the first few months of school is probably valid.

For Lane to imply that extending this to say that shy kids are less stressed as the classroom settles down and groups of friends form is a little cheeky but doesn't detract from the apparent thesis of the book that the DSM dignostic criteria may be lax.

I note that the NYT article doesn't mention the lobbying and politicking angle beyond saying that the makers of the drugs spend alot on advertising.

Can you tell me if adverts for prescription drugs appear in mainstream TV/media? It doesn't happen in the UK.

If general advertising does occur does this mean that parents will see ads and go to a medic requesting treatment with drug "x" and if the medic doesn't oblige move on to another medic who does?


kilt

...(correct me if I'm wrong but Professor in the US is different to in the UK...Here a Professor is the top academician and head of a faculty but in the US a professor is what we would call a lecturer, some one with full academic tenure?)Yes, here in the States a professor has a PhD and holds a tenure-track position at the institution of higher ed, whereas a lecturer may or may not have a PhD and does not hold a tenure track position, but instead may be part-time or have an annually renewable contract. It sounds like what you call a Professor would here be a department chair? Or maybe it is more like the Dean of the Faculty, or the President of the College?


...Can you tell me if adverts for prescription drugs appear in mainstream TV/media? It doesn't happen in the UK.

If general advertising does occur does this mean that parents will see ads and go to a medic requesting treatment with drug "x" and if the medic doesn't oblige move on to another medic who does? Yes, there have been ads on TV and in magazines for Zoloft, etc. with the Zoloft ad featuring some cute cartoons of depressed creatures who became happy and bouncy after Zoloft. I was on Zoloft for a year and hated it. I maintain that their ad campaign was an effort to drive the market for a useless drug. Of course, others would disagree with me, and that's fine.

As to Lane's desire to see shyness de-classified as a disorder: This echoes a lot of the discussions on this board about whether ADD is a disorder. IMNSHO, what needs to change is the prejudical, negative attitude toward mental variations in general, both mental illness and simple variations from the "norm." People in the workplace think nothing of sharing their cancer or heart disease stories with their co-workers. But who among us would bring up in the lunchroom the topic of our diagnoses of ADHD or OCD or other "disorder"? Maybe a few of us, but not many, because just as ancient and not-so-ancient people believed illness was akin to sin, so do many 21st century people still view various mental states to which they cannot relate as signs of something unclean.

Whenever something is recognized as a valid problem that there is effective treatment for, and thus ends up in the new DSM, there are always these people that get so ****ed off and write books about it. In their day, you sucked it up if you were a little shy or depressed or had anxiety attacks or the occasional paranoid hallucination. Nobody was happy and that was normal.

The thing is, they are not saying that the treatment doesn't make people lives better. If they do, that is interesting and valid. But so many just want to complain about that other people get meds, without even addressing the fact if this improves their lives or not.

God forbid that anyone's life is made any easier with the help of a pill, right? But where does that come from?

I guess we can see that "shyness", like anything, is a spectrum trait...