Do you avoid public speaking? Shy away from eating alone in restaurants? Millions of Americans do, and countless American doctors would prescribe the social anxiety drug Paxil to treat this “widespread condition.” Northwestern English professor Christopher Lane disagrees.
According to Lane, perfectly healthy people are being misdiagnosed with mental illnesses because of the medical community’s flimsy definitions. In his new book “Shyness: How Normal Behavior Became a Sickness,” Lane challenges revisions to the Diagnostic and Statistical Manual of Mental Disorders, a widely used reference book considered the final word on psychiatric diagnoses.
Lane will launch his book tonight with a free public talk at 7:30 p.m. in Chicago’s National-Lewis University, 122 S. Michigan Ave., Room 5006.
In his book, Lane disagrees with many of the changes to the revised diagnostic and statistical manual, and alleges that the criteria for mental illness are now so broad that nearly anyone can be identified as having a psychiatric disorder and be prescribed drugs to treat it. Lane researched more than 30 years worth of American Psychological Association archives for his book and is the former director of psychoanalytic studies at Emory University.
The Diagnostic and Statistical Manual of Mental Disorders has nearly doubled in size in the last 26 years, an unprecedented “explosion” that hasn’t happened anywhere else in the history of medicine, Lane said.
Since 1968, more than 170 new disorders have been added to the manual, bringing the total to more than 350 – a number of diagnoses that Lane sees as too high.
People who display “excessive talking,” “tidiness” and a passive resistance to “fulfilling routine social and occupational tasks” may have Passive-Aggressive Personality Disorder, according to the manual, which was originally released in 1994. Patients diagnosed with Oppositional Defiant Disorder – usually children and teenagers – are known to “actively defy adults’ requests or rules,” and “deliberately annoy people.”
“I wish I were making this up,” Lane said. “In defining disorders this way, anyone could find anything wrong. Where do you stop?”
Ron Krasner, the interim chairman of the Department of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine, acknowledged the gray zones within diagnostic criteria, but said the manual’s revisions have actually increased diagnostic accuracy.
“A considerable amount of research goes into the (Diagnostic and Statistical Manual of Mental Disorders), and the criteria has changed over time because of increased clinical knowledge,” Krasner said.
Ever since the the manual introduced social anxiety disorder in 1980, each edition has moved the diagnostic bar lower and lower, so that nervousness during a job interview and fear of using a public restroom became symptoms of the disease.
Many sufferers of social anxiety disorder take the antidepressant Paxil. Lane said the drug’s side effects during its first clinical trial were so severe that internal memos from GlaxoSmithKline, Paxil’s producer, indicated that executives considered shelving the drug. He said a doctor who worked on the trials shared the memos with him.
However, the evidence never made it to the FDA, which approved Paxil in 1999. Drug makers followed with a $92 million advertising campaign. Doctors wrote 25 million new prescriptions for the drug in 2001.
Lane said Paxil is chemically similar to antidepressants like Zoloft or Prozac, but causes a “boomerang effect” when patients stop taking the drug. Withdrawal effects can include renal failure, insomnia and suicidal thoughts. Lane said Paxil can permanently alter neurotransmitters that send chemical messages in the brain.
“The kind of person you fall in love with on Paxil might be different than who you would love otherwise,” Lane said.
According to Krasner, “tremendous research” exists proving Paxil is safe.
“There are thousands of prescriptions and no one has thought about removing it,” he said.
Side effects are worse in children, whose brains can be completely “rewired” by neurological drugs, Lane said.
After 4-year-old Rebecca Riley died in February of an overdose of psychotropic drugs prescribed to treat her ADHD and bipolar disorder, a Massachusetts General Hospital inquiry discovered that 955 patients under seven years old were taking antipsychotic drugs in that hospital alone.
“No psychotropic drugs should be prescribed for children, period,” said Nelson Borelli, a Feinberg psychiatry professor. “It’s a crime.”
Psychiatrists today are too eager to prescribe drugs as a “quick fix,” Lane said.
“Neuropsychology only wants to treat the brain, not the mind,” Lane said. “Everything is a ‘chemical imbalance’ – but no one knows what a ‘chemical balance’ is because levels change all the time.”
Only very serious conditions like schizophrenia and paranoia require drugs, Lane said. Talk therapy is a safer and more effective solution to treat the majority of diagnosed mental disorders like anxiety and depression.
The fifth edition of the controversial medicine manual will be published in 2012, and Lane has seen proposals for “apathy disorder,” “internet addiction disorder,” and “premenstrual dysphoric disorder,” which essentially gives psychiatrists license to prescribe antidepressants to women suffering from premenstrual syndrome.
Lane said he hopes his book puts pressure on Diagnostic and Statistical Manual of Mental Disorders framers to tighten their diagnostic standards.
“It’s truly amazing that something so badly written and poorly thought through can affect so many lives,” Lane said.
Reach Sarah Sumadi at [email protected].
