Mental Health

 email page    print page

All Topic Reviews
50 Signs of Mental IllnessA Beautiful MindA Beautiful MindA Bright Red ScreamA Casebook of Ethical Challenges in NeuropsychologyA Corner Of The UniverseA Lethal InheritanceA Mood ApartA Research Agenda for DSM-VA Slant of SunA War of NervesAbnormal Psychology in ContextADD-Friendly Ways to Organize Your LifeAddiction Recovery ToolsAdvance Directives in Mental HealthAggression and Antisocial Behavior in Children and AdolescentsAl-JununAlmost a PsychopathAlterations of ConsciousnessAm I Okay?American ManiaAmerican Psychiatric Publishing Textbook of Neuropsychiatry and Clinical NeurosciencesAn American ObsessionAngelheadAnger, Madness, and the DaimonicAnthology of a Crazy LadyApproaching NeverlandAs Nature Made HimAsylumAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderBeing Mentally Ill: A Sociological Theory Betrayal TraumaBetrayed as BoysBetter Than ProzacBetter Than WellBeyond AppearanceBeyond ReasonBinge No MoreBiological UnhappinessBipolar DisorderBipolar DisorderBipolar Disorder DemystifiedBlack-eyed SuzieBlaming the BrainBleeding to Ease the PainBluebirdBlueprints Clinical Cases in PsychiatryBody Image, Eating Disorders, and ObesityBorderline Personality DisorderBrain Circuitry and Signaling in PsychiatryBrave New BrainBreakdown of WillBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerCalm EnergyCassandra's DaughterCaught in the NetChild and Adolescent Treatment for Social Work PracticeChildren Changed by TraumaChronic Fatigue Syndrome (The Facts)Clinical Handbook of Psychological DisordersClinical Manual of Women's Mental HealthCognitive Theories of Mental IllnessCommonsense RebellionCommunity and In-Home Behavioral Health TreatmentComprehending SuicideConcise Guide to Child and Adolescent PsychiatryConquering Post-Traumatic Stress DisorderConscience and ConvenienceConsciousnessConsole and ClassifyContesting PsychiatryCoping With TraumaCopshockCrazy for YouCrazy in AmericaCrazy Like UsCreating HysteriaCritical PsychiatryCruel CompassionCultural Assessment in Clinical PsychiatryCulture and Mental HealthCulture and Psychiatric DiagnosisCultures of NeurastheniaDaddy's GirlsDante's CureDarwinian PsychiatryDaughter of the Queen of ShebaDaughters of MadnessDeinstitutionalization And People With Intellectual DisabilitiesDelivered from DistractionDepression In Later LifeDepression SourcebookDepression-Free for LifeDescriptions and PrescriptionsDestructive Trends in Mental HealthDevil in the DetailsDiagnosis: SchizophreniaDiagnostic and Statistical Manual of Mental Disorders DSM-IV-TRDirty Filthy Love DVDDisorders Of DesireDisrupted LivesDissociative ChildrenDivided MindsDr. Andrew Weil's Guide to Optimum HealthDr. Weisinger's Anger Work-Out BookDSM-IV SourcebookDSM-IV-TR CasebookDSM-IV-TR in ActionDSM-IV-TR Mental DisordersE-TherapyEccentricsElectroshockEmergencies in Mental Health PracticeEmergency PsychiatryEmotional and Behavioral Problems of Young ChildrenEmotions and LifeEmpowering People with Severe Mental IllnessEssential PsychopharmacologyEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics and Values in PsychotherapyEthics in Mental Health ResearchEthics in Psychiatric ResearchEthics, Culture, and PsychiatryEverything In Its PlaceFamily Experiences With Mental IllnessFatigue as a Window to the BrainFear of IntimacyFinding Iris ChangFinding Meaning in the Experience of DementiaFlorid StatesFolie a DeuxFor the Love of ItForensic Nursing and Multidisciplinary Care of the Mentally Disordered OffenderFountain HouseFrom Madness to Mental HealthFrom Trauma to TransformationGandhi's WayGender and Its Effects on PsychopathologyGender and Mental HealthGenes, Environment, and PsychopathologyGetting Your Life BackGracefully InsaneGrieving Mental IllnessHandbook of AttachmentHandbook of DepressionHandbook of Self and IdentityHealing the SplitHerbs for the MindHidden SelvesHigh RiskHope and DespairHow Clients Make Therapy WorkHow People ChangeHow to Become a SchizophrenicHow We Think About DementiaHughes' Outline of Modern PsychiatryHumanizing MadnessHysterical MenHystoriesI Hate You-Don't Leave MeI Never Promised You a Rose GardenI Thought I Could FlyI'm CrazyImagining RobertImpulse Control DisordersIn Others' EyesIn Two MindsInsanityIntegrated Behavioral Health CareIntegrative MedicineIntegrative Mental Health CareIntuitionJust CheckingKarl JaspersKissing DoorknobsKundalini Yoga Meditation for Complex Psychiatric DisordersLaw and the BrainLaw, Liberty, and PsychiatryLegal and Ethical Aspects of HealthcareLiberatory PsychiatryLife at the BottomLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLithium for MedeaLiving Outside Mental IllnessLiving with AnxietyLiving With SchizophreniaLiving with SchizophreniaLiving Without Depression and Manic DepressionLost in the MirrorLove's ExecutionerLoving Someone With Bipolar DisorderMad in AmericaMad TravelersMad, Bad and SadMadhouseMadnessMadness at HomeMadness in Buenos AiresManaged Care ContractingMandated Reporting of Suspected Child AbuseManic Depression and CreativityMary BarnesMasters of the MindMeasuring PsychopathologyMedia MadnessMedicine As MinistryMelancholy And the Care of the SoulMemory, Brain, and BeliefMental HealthMental Health At The CrossroadsMental Health Issues in Lesbian, Gay, Bisexual, and Transgender Communities Mental Health MattersMental Health Policy in BritainMental Health Policy in BritainMental Health Professionals, Minorities and the PoorMental IllnessMental Illness and Your TownMental Illness, Medicine and LawMental SlaveryMindfulness in Plain EnglishModels of MadnessMothers Who Kill Their ChildrenMozart's Brain and the Fighter PilotMultifamily Groups in the Treatment of Severe Psychiatric DisordersMuses, Madmen, and ProphetsMyths of ChildhoodNapkin NotesNeural MisfireNew Hope For People With Bipolar DisorderNight Falls FastNo Enemies WithinNolaNormalNot CrazyNovember of the SoulOf Two MindsOn Being Normal and Other DisordersOn Our Own, TogetherOn The Stigma Of Mental IllnessOrigins of Human NatureOut of Its MindOut of the ShadowsOvercoming Compulsive HoardingPathologies of BeliefPathways through PainPersonal Recovery and Mental IllnessPersonality Disorder: Temperament or Trauma?Pillar of SaltPoints of ViewPoppy ShakespearePosttraumatic Stress DisorderPsychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric Genetics and GenomicsPsychiatric Illness in WomenPsychiatrists and Traditional HealersPsychiatryPsychiatry and ReligionPsychiatry in SocietyPsychological Dimensions of the SelfPsychology and the MediaPsychopathia SexualisPsychopathologyPsychopathyPsychotic DepressionQuitting the Nairobi TrioRaising a Moody ChildRapid Cognitive TherapyRebuilding Shattered LivesReclaiming Soul in Health CareReclaiming the SoulRecollection, Testimony, and Lying in Early ChildhoodRecovery from SchizophreniaRecovery in Mental IllnessRedressing the EmperorRelational Mental HealthRemembering TraumaRepressed SpacesResearch Advances in Genetics and GenomicsRestricted AccessRethinking the DSMReviving OpheliaRewarding Specialties for Mental Health CliniciansSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSchizophreniaSchizophrenia RevealedSchizophrenia: A Scientific Delusion?Self-Determination Theory in the ClinicShunnedShynessSigns of SafetySilencing the VoicesSlackjawSocial Cognition and SchizophreniaSocial Inclusion of People with Mental IllnessSoul Murder RevisitedSounds from the Bell JarSpeaking Our MindsSpontaneous HealingStop PretendingStraight Talk about Psychological Testing for KidsStranger Than FictionStreet CrazyStudy Guide to the DSM-IV-TRSurviving Manic DepressionSurviving SchizophreniaSurviving SchizophreniaTaking Charge of ADHD, Revised EditionTaking the Fear Out of ChangingTalking Back to PsychiatryTarnationTeen LoveTelling Is Risky BusinessTelling SecretsThe Age of InsanityThe American Psychiatric Press Textbook of PsychiatryThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anger WorkbookThe Anorexic SelfThe Behavioral Medicine Treatment PlannerThe Betty Ford Center Book of AnswersThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Body in PsychotherapyThe Borderline Personality Disorder Survival GuideThe Broken MirrorThe Burden of SympathyThe Cambridge Medical Ethics WorkbookThe Case for Pragmatic PsychologyThe Center Cannot HoldThe Chemical Dependence Treatment Documentation SourcebookThe Chemical Dependence Treatment PlannerThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Condition of MadnessThe Construction of Power and Authority in PsychiatryThe Couples Psychotherapy Treatment PlannerThe Criminal BrainThe Cultural Context of Health, Illness, and MedicineThe Day the Voices StoppedThe Death of PsychotherapyThe Depression WorkbookThe Difficult-to-Treat Psychiatric PatientThe Early Stages of SchizophreniaThe Employee Assistance Treatment PlannerThe Employee Assistance Treatment PlannerThe Epidemiology of SchizophreniaThe Essential Family Guide to Borderline Personality DisorderThe Essentials of New York Mental Health LawThe Ethical WayThe Evolution of Mental Health LawThe Explosive ChildThe Fall Of An IconThe Fasting GirlThe Forensic Documentation SourcebookThe Forgotten MournersThe Gift of Adult ADDThe Good EaterThe Green ParrotThe Healing Power of PetsThe Heart of AddictionThe Heroic ClientThe Insanity OffenseThe Invisible PlagueThe Last Time I Wore a DressThe Limits of Autobiography The LobotomistThe Madness of Our LivesThe Mark of ShameThe Meaning of AddictionThe Meaning of MindThe Medical AdvisorThe Mind/Mood Pill BookThe Most Solitary of AfflictionsThe Mozart EffectThe Naked Lady Who Stood on Her HeadThe Older Adult Psychotherapy Treatment PlannerThe OutsiderThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Places That Scare YouThe Plural SelfThe Problem of EvilThe Psychology of Religion and CopingThe Quiet RoomThe Real World Guide to Psychotherapy PracticeThe Right to Refuse Mental Health TreatmentThe Rise of Mental Health NursingThe Roots of the Recovery Movement in PsychiatryThe Savage GirlThe Self-Help SourcebookThe Talking CureThe Trick Is to Keep BreathingThe Unwell BrainThe Virtuous PsychiatristThe Way of TransitionThe Wing of MadnessThe Wisdom in FeelingTheoretical Evolutions in Person-Centered/Experiential TherapyTherapy's DelusionsTheraScribe 3.0 for WindowsThis is Madness TooThoughts Without a ThinkerThrough the Looking GlassTo Have Or To Be?Toxic PsychiatryTransforming MadnessTraumaTraumatic PastsTraumatic Relationships and Serious Mental DisordersTreating Affect PhobiaTreating Chronic and Severe Mental DisordersTreating Self-InjuryTreatment and Rehabilitation of Severe Mental IllnessTreatment Plans and Interventions for Depression and Anxiety DisordersTwinsUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding DepressionUnderstanding ParanoiaUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnholy MadnessUnspeakable Truths and Happy EndingsUsers and Abusers of PsychiatryViolence and Mental DisorderVoices of MadnessVoices of RecoveryVulnerability to PsychopathologyWarning: Psychiatry Can Be Hazardous to Your Mental HealthWashing My Life AwayWhen History Is a NightmareWhen Someone You Love Is BipolarWhen the Body SpeaksWhen Walls Become DoorwaysWitchcrazeWomen and Borderline Personality DisorderWomen and Mental IllnessWomen Who Hurt ThemselvesWomen's Mental HealthWrestling with the AngelYou Must Be DreamingYour Drug May Be Your ProblemYour Miracle Brain

Related Topics
ShynessReview - Shyness
How Normal Behavior Became a Sickness
by Christopher Lane
Yale University Press, 2007
Review by John D. Mullen, Ph.D.
Jan 8th 2008 (Volume 12, Issue 2)

There is a great deal that's interesting in this book.  Chapter one contains an informative history of, "The Hundred Year's War over Anxiety".  Chapters two and three provide a great account of the inside wars that gave rise to the revised Diagnostic and Statistical Manual of Mental Disorders (DSM-III, DSM-IIIR and DSM-IV).  Chapter four is a clear and somewhat shocking history of how the drug company SmithKlineBeecham remarketed the inferior depression drug Paxil as treatment for social phobia.  On the other hand Chapter five, "The Rebound Syndrome", is a rather loose and unconvincing survey of the perils of withdrawal from the new anti-depressives. And Chapter six attempts to support the idea of a backlash against these medications with overly-long summaries of some recent and good fiction.  

I am going to take Lane at his word, supported by the book's title, that his main concern is that the new DSM metamorphosed normal behaviors into sicknesses, that shyness is a good example of this phenomenon and that this is a bad thing. 

The tale begins with the DSM.  It is a familiar story that in the mid 1970s the American Psychiatric Association selected psychiatrist Robert Spitzer to lead a panel that would re-write the diagnostic manual that classifies mental disorders, then called the DSM II (1968).  By 1994, the new DSM IV had increased the number of disorder categories from 182 to over 350.  Lane quotes a statistic that this definitional reorganization resulted in a thousand fold increase in cases of depression alone (43).  On this point I would have liked to have read how Lane would consider this different from similar results when the thresholds for hypertension or excessive cholesterol have been adjusted.  In any case Lane has unearthed a great deal about the internal battles and personality conflicts involved in this process, and it's an interesting story that's worthy of expansion into a small book unto itself.

What is Lane's case against the new DSM?  Spitzer's claim is that the old DSM was theory laden with psychoanalytic terms and assumptions to the point that it was difficult to diagnose a disorder without committing oneself to some variant of Freudianism.  The classic example is the diagnosis of anxiety neurosis that included the technical concept of repression.  The idea of the DSM II, IIIR and IV was to classify problems by means of symptoms rather than causes, thus rendering them theory neutral.  What's Lane's problem with this ideal?

First, he considers the exclusion of the term "neurosis" from the manual to be a form of anti-Freudian prejudice.  Lane quotes Spitzer objecting that the term has "psychoanalytic meaning" (51), with the implication that he had unearthed evidence of prejudice.  From Spitzer's standpoint calling persistent anxious behaviors evidence of "neurosis" is the equivalent of calling them evidence of "Zoloft deprivation".  The diagnosis itself directs the treatment.  Lane makes a good case with interesting historical research that Spitzer and cohorts did not look kindly upon psychodynamic therapies, and that this negative view was a prejudice rather than a scientific conclusion.  But he does not make his case that these imperfect motives negatively affected the results of Spitzer's stated program for a theory-neutral DSM.

Lane's second criticism is that the new DSM contains disorders that are not worthy of psychiatric intervention.  This is where Lane ties shyness into his central critique of the Spitzer program.  His discussion of the messy process of sorting out "anxiety neurosis", "social phobia", "agoraphobia", "panic disorder", "introverted personality", "avoidant personality disorder", "schizoid personality", "social anxiety disorder" and "shyness" is fascinating.  But it's not as scandalous as Lane implies.  Classification wars have consequences and are not unique to the psychological sciences.  Recall, for example, the recent controversies surrounding the redefinition of the astronomical term "planet" that resulted in the exclusion of the much-beloved-by-school-children "planet", Pluto.  In any case, the existence of a sloppy process of creation is not an argument against what was created.        

Lane's discussion of the psychiatric worthiness of some of Spitzer's new categories, social phobia (shyness) being the exemplar, skims some issues that a philosopher at least would spend some time on.  For example, there was a temptation to identify painful shyness with "introverted personality", a concept that was central to Hans Eysenk's personality classification scheme.  The objections were many.  First Eysenk's use was purely descriptive, implying nothing negative or in any way debilitating.  Second, the risk of using "introverted" as a disorder classification threatened to cast what is merely a "way of being" (quiet as opposed to loud, for example) as a mental illness.  Third, if "introversion" was defined as an extreme of shyness, it would imply a superiority of extroverted people over their quieter counterparts since extroversion has no natural extreme.  (Spitzer's reply that manic disorder was an extreme of extroversion seems to allow for an extroverted introvert since surely one could envision a manic introvert.  If Spitzer himself were shy he might have proffered that the extreme of extroversion is "character depth deprivation".  One could envision a Newsweek cover story documenting a disturbing increase in CDD in the U. S..) 

How exactly should a cognitive, emotional or personality trait, introversion or extroversion, for example, become a treatable trait, that is, a situation worthy of professional attention?  Lane laments that Spitzer's group did not respect the criteria of "the 4Ds", significant distress, dysfunction, deviance and danger.  These criteria make sense for psychoanalysis, which is conceived as a long, painful, costly and personally transforming experience.  Lane quotes the psychoanalyst Otto Will approvingly, "I myself would not treat a person because he was 'introverted'" (83) and Lane shares the horror of psychiatrist Sally Satel and philosopher Christina Hoff Sommers that the DSM IV implies that 26% of Americans, ". . . qualified as having a mental illness within a given year." (201)  But what's the source of the scandal?  Certainly greater than 26% of Americans qualify as having one or more of the physical diseases listed The Merck Manual 18th Edition, which describes everything from runny noses to brain cancer.  Satel and Sommers complain that some of the conditions listed in the DSM IV require no professional intervention but the same is true of The Merck Manual.  He approves of Satel and Sommers' claim that, "suffering is sometimes edifying" (205) and notes, "We need more professional skeptics like Satel and Sommers …" (202) (These are the authors of One Nation under Therapy who all but accused PTSD veterans of being fakers and girlie-men.)  The point however is that with new therapies (behavioral, cognitive and drug) that direct their efforts at symptom relief rather than personal transformation, that are quicker, cheaper and effective, the 4Ds are hardly appropriate.  Does Lane object that The Merck Manual includes warts, acne and indigestion? 

The subtitle of Lane's book is "How Normal Behavior Became a Sickness."  What exactly is Lane's objection to the inclusion of shyness, under the heading of "social phobia" in the DSM?  In some instances he objects to the stigmatizing of a normal personality type (78).  Ironically, he seems to take such inclusion as implying that there is something wrong, as people, with those who are intensely shy.  Perhaps Lane's error is to maintain the old chestnut that a psychological or emotion disorder is in fact a personal defect, a sin of sorts, in a way that a common cold or ALS is not.  If this were true then it might make sense to classify and diagnose only those disorders that are unequivocally serious.  But, of course, it is not true.  The alternative is to look at what the DSM IV categorizes as sometimes horrible and sometimes annoying but in no way a reflection upon personal character.  In the latter case one could leave it to the sufferer as to whether he or she will be treated. 

My own view is that shyness, as a self-reflective way of experiencing life, contains positive potentials that are most often ignored.  But still the common phrase "painfully shy" is not an accident.  Shyness is very often painful.  The pain is surely not that of clinical depression, but neither does a skin rash feel like a pinched nerve at C-6,7.  Lane is working under a top-down model in which the mental health profession determines which patient discomforts deserve its attention.  In addition, he does not address the very restricted availability of psychodynamic therapies in comparison to the time and cost of generic Zoloft or the efficacy of the two combined.  In resting the profession's manual from the grip of one therapeutic tradition only, perhaps the greatest effect of Spitzer and company's work has been to empower the patient to achieve the care he or she desires and free up the practitioners to provide a wider range of options.

While I do not think Lane makes his case against the DSM IV or against its inclusion of social phobia, I recommend this book as a thought-provoking and informative read.

© 2008 John D. Mullen

John D. Mullen is Professor of Philosophy at Dowling College in Oakdale, New York.  He is the author of Hard Thinking: The Reintroduction of Logic into Everyday Life, co-author with Byron M. Roth of Decision Making: Its Logic and Practice, and the author of the widely read Kierkegaard's Philosophy: Self-Deception and Cowardice in the Present Age.

Comment on this review


Welcome to Metapsychology. We feature over 8200 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than twenty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from for purchases through this site, which helps us send review copies to reviewers. Please support us by making your purchases through our Amazon links. We thank you for your support!

Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716