Transcript Issues in the Medicalisation of Shyness

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 selfconcept 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 selfpreoccupation 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