Transcript Issues in the Medicalisation of Shyness

Sparing Blushes:
The Medicalisation of Shyness
Susie Scott
University of Sussex
• 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)
Shyness: a new cultural epidemic?
• Increase in self-reported shyness from 40% to nearly
50% USA population (Henderson & Zimbardo 2005)
• Clinical diagnosis of Social Phobia for 1-2% British
population and 3.7% USA population
(MHF 2004; NIMH 2005)
• SP = third most common psychiatric diagnosis, after
depression and alcoholism (National Comorbidity Survey
1994; Kessler et al 1994).
Epidemic or artefact?
• Rise in actual incidence
– Anxiety in late modernity
(Giddens 1991)
– Minimal, narcissistic and
saturated selves (Lasch,
Gergen)
– Dramaturgical stress of
interaction (Freund 1998;
Scott 2004)
• Increased diagnosis
– Cultural and historical
specificity of mental illness
(Porter 1997, Showalter
1987, McDaniel 2001)
– Visibility of shyness against
new cultural values of
assertiveness, extroversion
and vocality (Scott 2004)
– More people seeking help
and more help available
The medicalisation of
social deviance
• Expansion of medical power/knowledge into
everyday life (Zola 1972, Illich 1975, Conrad 1992)
• Moral panic
– Shyness as deviation from new cultural values
• Anti-psychiatry
– ‘problems in living’ (Szasz 1961)
– residual rule breaking (Scheff 1966)
– social intelligibility of symptoms (Laing 1967)
cf. communicative rationality of emotions (Crossley 2000)
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?
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 2005: 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