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Are you shy? 

Perhaps you are mentally ill and need Paxil

At the end of my junior year of high school, my parents sent me to a three-day program at Emory University to determine what the hell I was supposed to do with my life. I had utterly no idea where I wanted to go to college or what I wanted to study.

The program involved taking countless tests to measure intelligence, mental health, areas of interest and likely talent. There were no surprises in most of the tests. I was off the chart for literary arts and biological sciences – a conflict I was well aware of. The only surprise was learning that I would make a crackerjack forest ranger.

The low point of the experience was meeting with a psychologist. We had been warned that our parents might receive a letter suggesting that we would benefit from psychotherapy. Having unpleasant memories of being toted to a psychologist when I was about 5, I dreaded my session with the Emory shrink.

Sure enough, I'd barely settled into the chair when the doctor leaned forward and said, "I understand that you are extremely shy." Then silence.

"Yes," I said, "I guess I am." Silence.

"Do you have any friends?" he asked. The question took me by surprise. While I certainly was not part of the in crowd, I had a good many friends.

"Yes," I said, "I have friends."

"Well," he pressed on, "do you have as many friends as you'd like to have?"

"I have more than I deserve," I said, getting annoyed. "Friends can demand a lot. But a lot of people don't understand me, so I keep to myself until I get to know someone.''

"Yes," he prattled on, "some of the staff members have noticed how withdrawn you are. Perhaps your shyness and interest in biology explain why you would make a good forest ranger."

I left the room half amused and half horrified. "I think he told me I'm such a social retard that I can only sit in a tower and keep watch for fires," I told a friend later. I asked my mother daily for the next week if she had happened to receive a letter from the program. Happily, I was not declared insane.

But I'm pretty sure that had this experience occurred during this decade, the outcome would have been different. As Christopher Lane notes in a Sept. 21 op-ed in the New York Times, the psychiatric community now often diagnoses ordinary shyness as social phobia (also called "social anxiety disorder").

In fact, the American Psychiatric Association estimates that one in eight Americans suffers from social phobia at some point in life. Incredibly, it is now the third most common mental health diagnosis after depression and alcoholism.

As Lane, author of Shyness: How Normal Behavior Became a Sickness, observes, the relatively brief history of social anxiety is an example of the way the mental health professions continue to manufacture illness, often with the help of drug manufacturers.

Initially considered a relatively rare phenomenon, the definition of social phobia in the Diagnostic and Statistical Manual of Mental Disorders – psychiatry's bible – has become more vague with each new edition since 1980. Everything from test anxiety and ordinary shyness to fear of eating alone in a restaurant and dread of public speaking are among the diagnostic criteria. The biggest change occurred in 1987 when the APA removed the words "a compelling desire to avoid" from the definition, instead requiring only "marked distress."

This effectively more than doubled the number of "disordered" people under the original, more limited definition. And, of course, this enabled a huge number of people to qualify for insurance reimbursement for treatment of arguably ordinary shyness.

But what really put the diagnosis on the map was a $92 million advertising campaign by the makers of Paxil in the late 1990s. The theme of the campaign was "Imagine Being Allergic to People." The idea that you could take a pill to make other people seem more congenial created a bonanza for psychiatry and Paxil's maker. The bonanza continues. Children especially are vulnerable to the diagnosis – and the dubious use of drugs such as Paxil.

Interestingly, Lane notes that a new study from the U.K. found that shy children actually have lower levels of the stress hormone cortisol than their sociable peers. In other words, contrary to the popular wisdom that shyness causes stress, it may actually be a useful personality style.

Shyness, like depression, does not comply with our culture's idealization of productivity, extroversion and fame. Psychiatry has a long and ignoble history of (profitably) pathologizing those who deviate from perceived cultural norms, but the widespread diagnosis of social phobia is a milestone in that practice.

Cliff Bostock holds a Ph.D. in depth psychology. For information on his private practice, go to www.cliffbostock.com.

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