Issues in the Medicalisation of Shyness

Susie Scott

Department of Sociology

• shyness “Easily frightened away; difficult of approach owing to timidity, caution, or distrust” (OED 2005)

• Social Phobia / Social Anxiety Disorder

“a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. (DSM IV, 1994: 416)

• Avoidant Personality Disorder“a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation” (DSM IV, 1994: 665)

The medicalisation of social deviance

• expansion of medical power and knowledge into more and more areas of everyday life

(Zola 1972; Illich 1975; Conrad 1992)

• Anti-psychiatry– ‘problems in living’ (Szasz 1961)– residual rule breaking (Scheff 1966)– social intelligibility of symptoms (Laing 1967)

Shyness or madness?

• being nervous and self-consciousness at a job interview

• feeling awkward and conspicuous at a party• blushing when addressing a large group• worrying about how you look when ‘performing’

in public (eating in restaurants, signing a cheque)

• dreading any social occasion

Shyness: a new cultural epidemic?

• Increase in self-reported shyness from 40% to nearly 50% USA population (Henderson & Zimbardo 2004)

• Clinical diagnosis of Social Phobia for 1-2% British population and 3.7% USA population

(MHF 2004; NIMH 2004)

• SP = third most common psychiatric diagnosis, after depression and alcoholism (Kessler et al 1994)

Shyness: a new cultural epidemic?

• Anxiety in late modernity (Giddens 1991)

• Cultural and historical specificity of ideas about mental illness (Porter 1997; McDaniel 2001)

• Visibility of shyness against cultural values of assertiveness, extroversion and vocality

Dimensions of the medicalisation of shyness

1. pharmacalogical ‘quick fixes’

2. psychotherapy (especially CBT)

3. self-help books and websites

1. Pharmacological treatments for SP and SA

• SSRI drugs (Seroxat, Paxil, Zoloft, Prozac)• rational, cost-efficient method• advertising and marketing

– portrayal of normal, everyday situations as problematic

– encourages self-diagnosis– medicalisation of ‘problems in living’?

Pharmacological treatments for SP and SA

• concerns about drug safety (Paxil and Seroxat)– severe withdrawal symptoms– side effects

• lawsuits against GSK; public hearings– biased reporting of clinical trial results

– inadequate labelling

• creating new disorders for new drugs?

Positive aspects of medicalisation

• increasing prescription but also increasing patient demand

• sick role (Parsons 1951) is preferable to deviance:

“[t]he great thing about my GP confirming I (probably) have SA is that I can let myself think that incidents such as that weren’t my fault as such: they happened and they affect me so much because of my SA”. (Titus)

Positive aspects of medicalisation

• comfort and relief“I knew it was more than just shyness. But it wasn’t until the last year or so, that I saw an article in a magazine, about a woman who had Social Phobia. It was like they were talking about me. I then looked up information on it, and it all started to make sense. All the things that I did, that I never would have imagined were connected, were part of the same problem. It was a relief.” (Una)

2. Cognitive-Behavioural Therapies for shyness

• therapeutic culture of the self (Rose 1990; Furedi 2003)

• ‘shyness clinics’– 6-12 week residential courses– coach and retrain the shy mind– client’s responsibility to change

“We do not want you to come unless you are ready, willing and motivated to get better.”

(Anxiety Network International, 2004)

2. Cognitive-Behavioural Therapies for shyness

• ‘Social Fitness’ or disciplinary power?aims “to convert maladaptive thoughts, attributions and self-concept distortions to more adaptive cognitive patterns, and training in effective communication skills, including healthy assertiveness and negotiation. People move from social dysfunction, withdrawal, passivity, and negative self-preoccupation to adaptive functioning, increased social participation, a proactive orientation, and empathy and responsiveness to others”

(Henderson & Zimbardo 2003: 11).

3. Self-help books and websites

• surveillance medicine (Armstrong 1983): the disciplinary gaze internalised?

• shyness as a barrier to success (work, relationships, friendships)

• individual’s moral responsibility to overcome their ‘problem’

3. Self-help books and websites

• Shaw (1979) Meeting People Is Fun.– devise a ‘campaign’ or ‘action plan’– learn tricks / techniques – hierarchy of social situations to be tackled:

• asking for an item in a shop

• visiting local pub

• formal dinner party

• Rapee (1998) Overcoming Shyness and Social Phobia.– practical assignments and ‘homework’ exercises – progress sheets and monitoring forms

3. Self-help books and websites

• www.shakeyourshyness.com

• www.socialphobiaworld.com

• www.social-anxiety.org.uk

• http://www.perfectpaws.com/shy. html

Demedicalisation and Resistance

• limits of medicalisation (Williams & Calnan 1996)

• passive patients or knowledgeable consumers?

• two Foucauldian ‘counter-discourses’:– 1. redefining shyness in positive terms

– 2. shifting the blame onto ‘society’

1. Positive reinterpretations of shyness

• positive consequences of shyness: – “being shy has helped develop my listening skills and

sensitivity to others” (Belinda)– shyness “has made me more sensitive and

compassionate” (Anna)

• being ‘successfully shy’ (Carducci 1999)• opportunity for self-discovery

2. Whose problem is it anyway?

• social model of disability

• labelling theories of deviance

“Why does shyness have to be seen as a ‘problem’, as other? Isn’t it

about time that it was seen as equal but different?” (Twinkle)

“I’d feel a lot happier if I felt that the burden wasn’t entirely on me to resolve the problem; if I felt that society at large was prepared to recognise my difficulties, and to adapt itself, just a little, to accommodate me.” (Urchin)

Summary

• medicalisation of social deviance– where do we draw the line between ‘normal shyness’

and mental disorder?– individualised problem

• three types of treatment – drugs, CBT and self-help

• demedicalisation and resistance