Monday, December 10, 2007

Labeling and Medicalizing Deviance

Christoper Lane, professor at Northwestern University, has a new book out called "Shyness: How Normal Behavior Became a Sickness," available on Amazon and other booksellers. Professor Lane was also interviewed in yesterday's AJC and I've excerpted a few of his comments which relate to the medicalization of deviance we've discussed in all my classes this semester. (emphasis mine)

On the revisions of the DSM by leading psychiatrists: "I was astonished at the carelessness of the psychiatrists and the degree to which their own self-interest often trumped scientific rigor. There are tremendous revelations of their own ambition and their willingness to sacrifice scientific rigor on the altar of expediency.

"Chronic social anxiety is indeed a problem. Two percent of the population suffers from a form of acute social anxiety to the point where it's truly impairing. But of the 98 percent that we might call "worried well," many are also encouraged to second-guess their behavior and to ask themselves: Am I shy, or is this possibly social anxiety disorder?

"Most people would characterize these criteria as run-of-the-mill traits far from chronic or debilitating. Nevertheless, the official symptoms now include public speaking anxiety, embarrassment about eating alone in a restaurant, fear that one's hand will shake when one is writing a check, and undue avoidance of public restrooms. It's an extraordinary combination of routine behaviors and very prevalent, common fears among people, with language that represents the entire picture as a biological dysfunction, rather than anything to do with psychology."

As we discussed, the behaviors remain constant, but what changes is the label in so far as moving it from the psychological realm to that of biology, of inherentness, of DNA. As he notes, that's an extraordinary development with very little research to back up the sweeping expansion of symptomology.

Lane on the role of Big Pharmaceutical companies and media manipulation: "
There are also increased rates of anxiety in the population as a result of terrorist attacks. And 9/11 played a surprisingly big role in the increase of drug-related advertising that we saw shortly thereafter. [Drug maker] GlaxoSmithKline was extraordinarily opportunistic here in running millions of dollars worth of ads in October 2001, right after the 9/11 attacks, with women saying, "I keep fearing that something awful is going to happen."

I'd insert a cryptic "LOL" right about here, but there's not even anything remotely funny about a drug company preying on the public's fear and anxiety following the worst criminal attack on our nation's soil in history.

On the selling of SAD (social anxiety disorder): "
One particular thing I talk about in the book is the $92 million that [Paxil maker] GlaxoSmithKline spent in the year 2000 alone pushing what they called a public awareness campaign for social anxiety disorder...they spent $3 million more than was spent on pushing Viagra that year on what Glaxo dubbed a public awareness campaign that would make people second-guess their behavior and view it in pharmaceutical terms.

"The campaign was called "Imagine being allergic to people." And the idea was to catch the shy and encourage them to view their behavior as something more: "Am I just shy, or is this potentially social anxiety disorder?" Once you have people doubting themselves and considering their behavior in that light, then "ask your doctor about Paxil as a suitable remedy" seems almost an imperative[...]

"What they don't record but what we now know is that Paxil is one of the worst antidepressants in terms of withdrawal symptoms...All this is very paradoxical, too, if you think that people can be going through this anxious time over a drug that was meant to reduce their anxiety about going to parties and concern about figures in authority."

Again, one feels like laughing at such a paradox, but it's more SAD than anything else.

On the relationship between Big Pharma, psychiatry and major research universities:
"For starters, they rely on researchers in psychiatry to evaluate their drug trials, and so there is a massive conflict of interest because the researchers are very keen that their anxiety disorder centers, and so on, continue to receive funding, which often comes directly from the drug companies. In terms of their own tenure at universities, the researchers have come to rely on that degree of external support. At the same time these experts are working for sometimes a dozen drug companies at a time, and they're very reluctant to bite the hand that feeds[...]"

Much of what Lane is arguing has been bandied around in the "wilderness" of labeling theory for quite awhile now. Jack Douglas calls it a "pharmaceutical holocaust" in the making, since we have very little data to show what the long-term effects of these psychotropic medications are on its recipients.

Here's an excerpt from one of Lane's papers with more data and research.
More on what I've written here. I strongly encourage those of you with an interest in this topic to read the AJC interview and then check out some of Lane's data.

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