Shyness, Anxiety

 Shyness

In 1917, The American Psychiatric Association (APA) recognised 59 psychiatric disorders. With the introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM), often called the psychiatrist's bible, in 1952 this rose to 128 disorders. By 1968 it was 159, 227 in 1980 and 253 in 1987. Currently DSM-1V has 347 categories and it would be a brave person who would anticipate anything other than a further increase in the next edition.

 Patients Waiting to See the Doctor,
with Figures Representing Their Fears
Rosemary Carson (b. 1962)
Photo Credit: The Wellcome Collection [Public Domain] 

In his splendid book Shyness: How Normal Behaviour Became a Sickness, Christopher Lane concentrates on just one of the many newcomers to the diagnostic canon. Drawing on documents exchanged behind the scenes during the creation of  DSM-111, he focuses on how, with the help of psychiatrists, journalists and drug companies, shyness, once seen as a normal variation of character or personality became incorporated into the DSM as social phobia or avoidant personality disorder. His critique sits alongside Allan Horwitz and Jerome Wakefield's dissection of the gradual extension of the boundaries of depression in The Loss of Sadness.

All psychiatrists are familiar with those whose crippling phobias and panic attacks prevent them from engaging in any form of social interaction, whilst major depression remains a worldwide scourge. Lane accepts this, but what concerns him is how one draws the line between the normal and abnormal. In a previous generation, says Lane, shy people were seen as introverted but not mentally ill. Now embarrassment at eating alone in restaurants, or concern about interacting with figures in authority is part of the definition of social anxiety disorder. How then have we redefined the shy individuals of his parents' generation into a new army of people with mental health problems?

... Lane and other critics, such as David Healey, accuse the drug companies of medicalising problems like shyness and unhappiness. The drug industry develops compounds such as diazepam, fluoxetine or paroxetine, and then promotes the creation of disorders for which these new drugs are the apparent answer.

... The psychiatric profession has had a key role in hyping vaguely defined ailments without much scientific research or credibility. This is partly the result of the reimbursement system that governs American psychiatry. Treat someone for shyness and the insurance companies will laugh at you. Treat someone with social phobia, with its DSM seal of approval, as disorder 300.23 and the bill will be paid...

(Simon Wessley, The Lancet, 2008) 

The crucial question for me is: How does one draw the line between the normal and the abnormal? That is a question to be answered by the professionals but unfortunately some drug companies and some psychiatrists seem to have blurred the answer.

Anxiety

Beata Beatrix, 

Dante Gabriel Rossetti, (1828-1882)

Photo Credit: Tate [CC BY-NC-ND]

…Anxiety is our civilisation’s curse: it would be surprising if children didn’t pick it up, and we adults should acknowledge our responsibility. Some days exposure to all media and regulation feels as if we are being overseen by a malevolent tyrant who has decided that people must not relax. “Keep ‘em scared, keep ‘em guilty!”

The message emanates not only from news bulletins with their moralising and generalising commentary. It infects every genre: documentaries, violently paranoid crime dramas, angry contemptuous satire, despairing think pieces. With every breath we are reminded of looming environmental disaster, pollution, threats to health from every conceivable foodstuff, street crime, foreign malevolence, terrorism, digital spying, financial instability and the prospect of a destitute old age. “Keep ‘em scared, keep ‘em guilty.”

The public conversation barely acknowledges the dull truths: that most of us aren’t desperate, most fellow citizens are reasonably kindly inclined, and our health and its services are better than earlier generations dreamed of. Even in the private sphere there is no rest from niggling anxiety: are we unfashionable, ludicrous, ugly, fat, unfit, wrinkled? Have we failed to acquire the latest "must have" or alternatively do we have so much we have personally ruined the planet? Should we spend hours on a Marie Kondu declutter, and if so, how to recycle our rejects without guilt.

Are we likely, quite accidentally, to end our career and reputation in an instant by saying or doing something that might be taken as racist, abusive, misogynist, ableist, white privileged, transphobic, homophobic? Oh, and are we looking after our mental health? Why aren’t we happy and positive every day – are we ill? If for a moment we reckon that life is a decent dry joke, science a hopeful marvel and our friends and family love us warts and all does that make us disgustingly complacent? 

…As for the lesser but corrosive anxieties we [the media] cause – the envious froth of fashion, showbiz, celebrity, and competitive interior decoration – for heaven’s sake, we’re only trying to entertain! Or, in the case of advertisers, to sell stuff. You don't have to pay attention. 

Yet that isn’t always easy: we are beasts driven by a primitive instinct to keep up and fit in with the herd, and to keep checking every horizon to be prepared for flight or fight. Few of us with this animal instinct feel like predators: the rest of us are more like prey, trembling baby rabbits in a world of cats and foxes. Or, in our case pandemics, tumours, killer robots, Alzheimer’s, jihadists, obesity, extinction, the far right, the far left, Trump, King Jong-un, … personal humiliation…

No wonder the children pick it up. Especially when they are constantly assured that their generation will be poorer than ours and that exam grades are the basis of everything.

The bassline throb of anxiety distorts the gentler melodies of pleasure. Anxiety needs to be challenged, set in proportion, firmly left downstairs at night alongside the smartphone and the TV. Optimism, hope and energy need to be fed and shared. Yet how many of us put proper effort into that?

(Libby Purves, The Times, 2019)

Well Libby, where do I start with this?

 Are we unfashionable, ludicrous, ugly, fat, unfit, wrinkled? Yes, to most.

Have we failed to acquire the latest “must have”? Yes.

Do we have so much we have personally ruined the planet? No.

Should we spend hours on a Marie Kondo declutter, and if so, how to recycle our rejects without guilt. Who is Marie Kondo? I don’t recycle all my rejects and don’t feel guilty about this.

Are we likely, quite accidentally, to end our career and reputation in an instant by saying or doing something that might be taken as racist, abusive, misogynist, ableist, white privileged, transphobic, homophobic? No doubt some will think these things about me.

Oh, and are we looking after our mental health? I have no idea.

Why aren’t we happy and positive every day. Do we have any control over that?

Our friends and family love us warts and all - does that make us disgustingly complacent?

Guilty, disgustingly complacent.

The envious froth of fashion – You’re right. Complete and utter froth.

 Showbiz, celebrity, and competitive interior decoration. Let’s stick with froth – such a good word.

Or, in the case of advertisers, to sell stuff. You don’t have to pay attention. Too true. Use the remote to erase advertisements on TV. If reading turn the page when they appear.

We are beasts driven by a primitive instinct to keep up and fit in with the herd. I don’t know if you’re right there, Libby. Perhaps as children we are.

Anxiety needs to be challenged, set in proportion, firmly left downstairs at night alongside the smartphone and the TV. Optimism, hope and energy need to be fed and shared.

Should I be anxious if I am not anxious? Optimism, hope and energy need to be tempered with their opposites – the glass half full is still half empty.

Anxiety

A Girl of Trinidad
Edwin Long (1829-1891)
Photo Credit: Bury Art Museum [CC BY-NC-ND]

There has been an "explosion" in anxiety in Britain over the past decade, research shows, with the financial crash, austerity, Brexit, climate change and social media blamed for huge rises in the condition. The debilitating mental illness has trebled among young adults, affecting 30% of women aged 18 to 24, and has risen across the board among men and women under 55.

... The 2008 crash was characterised by unemployment. Young people who were just starting out in adult life had the rug pulled out from under them.

Asked to identify other factors which may help explain the big increase, Freemantle (Professor and lead researcher) added: "During this period [2008-2018] we had a recession, a vote to leave Europe, which was not popular among young people, social media became ubiquitous, there was increased concern about the climate, and there was a change of attitude towards [people disclosing that they have] anxiety disorder."

Some of these events may well have "contributed to feelings of hopelessness and powerlessness, coming as they did after years of financial insecurity", added Freemantle, director of the comprehensive clinical trials unit at University College London.

... But there is a clear generational divide when it comes to anxiety, which has not risen among those aged 55 and over. That is probably because they tend to be less affected by economic factors and uncertainties faced by young adults, such as in housing and job prospects, Freemantle said.

(Denis Campbell, The Guardian, 2020) 

Could it also be that some of those aged 55 and over take a more pragmatic view of life in general believing it is completely normal to be anxious sometimes? They grew up when the term anxiety was seldom mentioned, when it wasn't considered a health condition and that if you were anxious you just put up with it until it passed.  And don't some of the drug companies have a level of responsibility for this "explosion of anxiety"? Shyness, for example has been pathologised and is sometimes known now as 'social phobia' or 'avoidant personality disorder'. The so called cure, in some cases - drugs, of course.