Welcome to Disorder Nation. As biomedical and pharmaceutical companies struggle to release newer, more effective medications to combat serious mental disorders like depression or bipolar disorders, some people’s attention turn to lesser disorders. Disorders like social anxiety disorder which, before 1980, was simply known as extreme shyness or “anxiety neurosis.” Sure, people get anxious in social situations, especially performance-based ones such as public speaking, but that’s normal for most people!
But leave it to the researchers (or in this case, the lack of research) to turn a normal feeling into something that can be diagnosed and, naturally, treated… By medication.
The Washington Post today has a great article entitled, Shy? Or Something More Serious?, that examines the short history of this disorder and where it came from.
The larger issue is when is a feeling a mental illness? Where do we draw the line in saying that this feeling is so bad, it deserves not only a name, but a whole set of diagnostic criteria, research backing, and multiple treatment approaches? Philip over at Furious Seasons makes the case that something that is so common as depression should no longer be considered a mental disorder.
It’s a philosophical question more so than a scientific question, given the current state of our science in the brain. Psychology has a century’s worth of research to suggest why we think, feel and act the way that we do, but you almost never hear about it in the same way you hear about medical research findings.
I think depression is a mental disorder, while most people who’ve probably been diagnosed with “social anxiety disorder” do not have a mental disorder. I don’t see the term “mental disorder” (or “mental illness,” take your pick) as being defined only by its rarity. For instance, if most Americans are obese, that doesn’t mean we should stop referring to it as obesity just because it’s become commonplace — the disease still has significant and very real health consequences on those who deal with it everyday.
As human beings, one could argue that all feelings we experience are “normal.” However, when a feeling becomes so intense and lasts for such a long time as to interfere with our ability to lead our normal lives, that’s when it crosses the threshold into abnormal. Or something that needs some attention. Or, shorthand, a “mental disorder.”
Most people who get diagnosed with social anxiety disorder have natural anxiety in some social situations, such as a holiday party. I say “natural” because it is natural for people to feel uncomfortable in social situations where they have to be personable, entertaining, agreeable, and a pleasure to talk to, all at the same time. It is natural to feel some anxiety if you need to stand before 1,000 people and give a presentation. If you didn’t feel a certain level of anxiety in this sort of situation, that means you’ve learned to overcome this natural inclination.
Most people find a little alcohol helps them in social situations because it makes them more relaxed. Public speaking is a little more difficult to tackle, but the more you do it (just as with any activity), the better and more relaxed you become.
Of course, some people in some social situations really do suffer from debilitating anxiety that requires specific psychiatric or psychotherapeutic treatments. But it is not a common-place concern at the level that requires medication for the vast majority of people.
However, it is not natural for people to live for months or years feeling devoid of energy, sad, dis-interested in everything, depressed, and generally not wanting to be around much. That’s depression. That is a serious a mental disorder because it is usually 180 degrees opposite of the way we’re used to being and living, and we want to get back to our “normal” selves.
Some people, like Thomas Szasz, M.D. have written extensively on these and related topics and, if you have an interest, are a must-read. Mental disorders are not fixed in stone, and as our understanding about the brain and human behavior increases, we’re likely to better refine these concepts with time.
19 comments
You make an interesting point. Rareness is not a criteria for physical illness. Hence if everyone in the World was obese, they would still be obese, or would they? Obesity is a culturally relative concept. No you say, obesity increases mortality, i.e. fat people don’t live as long as skinny people, all other things being equal (wait you say, all other things are never equal, that would be impossible, well okay, so hypothetically), well how long is it normal for a human to live? Not as long in Nigeria as in France or our Prozac Nation.
If everyone in New York City was depressed on 9/12/2001, does that mean depression is an illness or depression is not an illness? If some people in New York City are still debilitated by despair today, which ones are “depressed” the ones who lost more than one family member in the bombing, the ones who lost a fiance, or the ones who where just about to start that great job there the next day?
I don’t think depression is an illness. This doesn’t mean people who want pills to cheer themselves up should be denied them. It just means we shouldn’t require a pseudo medical exam before passing out the pills – after all you don’t have to have a medical prescription to order a drink in a bar (yet;). Oh wait, these drugs are way more dangerous and less understood than marijuana, alcohol, or any other recreational drug but they’re essentially recreational drugs and I’ve digressed.
Of course if everyone had broken legs or HIV or the plague or infestation with parasites then everyone would be disordered.
Are mental disorders like that, however? If the WHO came back and said ‘prevalence of mental illness is 98%’ then would we think ‘wow better divert more health care funding in that direction’ or would we think that they had missed the point, rather?
Grieving is not an illness. Grieving for loved ones who have passed on is not an illness. The DSM gives us one year to grieve before we have ‘depression’ and medication is appropriate. Ancient Greek society gave people four years to grieve before people were considered to be sick. How much does diagnosing people still grieving after one year (instead of after four) boost prevalence?
If only it was a philosophical issue. Unfortunately the issue is political as well (who gets treatment? who gets publicly funded / health insurance reimbursable treatment?)
I don’t think that people are more depressed now than they used to be. I think that we are expanding our concept. A concept that used to be reserved for people who were fairly catatonic is now being applied to people who want to feel ‘better than well’.
I know people are hurting… But I think it is a sad state of affairs when people are encouraged into dx of depression and medication / therapy instead of being encouraged into doing something meaningful in their community / becoming involved with things that are meaningful to them / reaching out to others etc etc.
Thanks to Sally and Alexandra for their thoughtful comments. It’s clear, however, that neither of you has suffered from true clinical depression if you don’t believe it’s an illness. Sure, everybody gets sad, grieves, etc. These are normal human emotions but are not the same as depression.
Science surely has a long way to go in determining causes and effective treatments for depression. Again, that doesn’t mean that there aren’t physical causes and pharmocological treatments that could be found.
As a long time sufferer of treatment resistant chronic depression, it is infuriating to read (or hear people say) that depression isn’t an illness with physiological causes. This is a denial of the conditions of millions of people who suffer from this terrible and sometimes fatal chronic disease.
Everybody gets headaches. That doesn’t mean that brain tumors aren’t real. Nobody would deny life saving insulin for a diabetic. It’s time to get past this senseless philosophical argument about depression (and a host of other “mental” illnesses). They’re real, they cause huge amounts of suffering and economic damage, and its time we unleashed the medical-research community to find a cure.
I’m not well-read on Szasz (his nonsense angers me), but isn’t his stance more that there’s no such thing as mental illness at all, that we’re all a bunch of whiny slackers looking for an excuse to pop pills and get out of personal responsibility? He seems pretty disdainful of even schizophrenia. He can’t mention bipolar disorder without putting it in quote marks and redefining it as depression. Although I can see the relevance to an article about over-medicalizing, it seems like an odd reference coming from a psychiatrist who does seem to think there’s such a thing as a mental disorder…. I personally think reading his libertarian-based crap is more likely to do harm than good for someone already looking for an excuse not to comply with treatment.
I didn’t say that I didn’t believe that depression was an illness. I did say that our concept of depression has expanded such that instead of it merely applying to cases that were extremely severe it is now applied to everything from boredom to grieving.
> As a long time sufferer of treatment resistant chronic depression, it is infuriating to read (or hear people say) that depression isn’t an illness with physiological causes. This is a denial of the conditions of millions of people who suffer from this terrible and sometimes fatal chronic disease.
I don’t think that anybody who is here said that… That being said, to say that a condition currently in the DSM isn’t an illness or isn’t a mental illness etc DOES NOT imply that the person is undermining the very real distress and suffering of individuals who have been diagnosed with the disorder.
Consider this: Witches suffered a lot in the middle ages.
Now consider this: THERE AREN’T ANY WITCHES
Get it?
Everybody gets headaches. That doesn’t mean that brain tumors aren’t real. Nobody would deny life saving insulin for a diabetic. It’s time to get past this senseless philosophical argument about depression (and a host of other “mental†illnesses). They’re real, they cause huge amounts of suffering and economic damage, and its time we unleashed the medical-research community to find a cure.
> I’m not well-read on Szasz (his nonsense angers me), but isn’t his stance more that there’s no such thing as mental illness at all, that we’re all a bunch of whiny slackers looking for an excuse to pop pills and get out of personal responsibility?
No, that is not his stance at all. Szasz stance is one of an activist for patient rights. He argues that psychiatrists should not have the power to involvountarily confine and force medicate people with a diagnosis of a mental disorder.
Instead of reading him as saying ‘there are no mental disorders’ and denying the suffering of individuals one is better to read him as saying ‘mental disorders are the result of sickness in society / social structure rather than defecits or defects or dysfunctions within the suffering individual.
He thinks that the insanity defence should be done away with (people should take responsibility for their actions and we shouldn’t be overly paternalistic about people diagnosed as mentally ill by giving them diminished responsibility).
He thinks that often improved social supports ‘treat people’ better and more safely than medications (hence is against forced medicating).
He is a PATIENT RIGHTS ACTIVIST. Its just the drug companies and psychiatrists / psychologists who push the whole ‘we are fixing your brokenness ‘ line. And when patients (who are suffering) think they need to buy into that to be a ‘good patient’ and get a little help then well… Harm more than help? I reckon so…
Insightful post on depression and public speaking…
What is behind the mind walls? There may be a very complex issue that is in constant study. We have people of all kinds, including mentally ill, so-called normal minds, geniuses and so forth. The mind has been notorious to play tricks on us, let us down, skip to another level and so forth. It seems with the war between the brain and self there is never a winning ticket.
The fact is the mind holds the key to all areas of your body, but the central nervous system is the channel to the brain. In the majority instances if the brain is affected is a direct result of the central nervous system and spinal column. If the spinal column is crooked or injured then it will affect the nervous system, which works its way toward the brain. Once the brain is hit, the troubles begin and frequently do not quite until someone finds out the cause of the problem.
I tend to agree with the concept shynees by soical norms is a normal issues and as mentiond is a normal emoitional status. Yet its a serious problem. I’ve witness an incedint where is a child who is extremly shy push by his care givers to soicalize with others. Yes “forced”. I personally believe that we can break down this pattern by perhabs encourge and motivate the person to meet others, step by step that person start to condition him/her selve this new situation and therefore be prepare for larger scale meeting (parties, soical gethering)
Okay, the person who wrote this blog doesn’t know ANYTHING about Social Anxiety Disorder. Why are people so quick to believe that mental disorders are just concoctions cooked up by hypochondriacs?? I have Social Anxiety Disorder, and I can tell you that there is nothing “normal” about the level of anxiety I feel around people. And it can’t be chalked up to nerves. I feel the same way when I’m around people I’ve known for years! If you don’t know enough about a subject or if you don’t believe that something exists, keep it to yourself. It’s just plain wrong to accuse someone whose mind is already confused that they’re imagining something, simply because YOU don’t believe it exists.
THANK YOU
“Anxiety can lead to depression if no cured in its early stages.
Some natural anxiety remedies to look into are St.John’s Wort, SAMe, L-Theanine, and Tryptophan. There’s also cognitive behavioral therapy (CBT) and programs like Panic Away and The Linden Method, to name a few. Hope this helps!”
I find it interesting that at the end of the article depression is cast as something real, a serious mental disorder, right after “social anxiety disorder” is argued as something not so real and critiqued against normal to mild social anxiety, i.e. “shyness”.
You could potentially do the same with depression. Debunk depression by arguing against normal experiences of feeling lows like how everyone may experience their highs and lows or having mildly stonger lows and being diagnosed with “depression”. But that wasn’t done.
Some people do experience social anxiety to such a degree that they don’t know how to make friends. Have little or no friends. And have experienced periods of almost muteness in normal situations. Even posting on the internet having the potential to creating severe anxiety. That’s pretty serious and not simply “shyness”. What I described would be “social phobia” or “social anxiety disorder” and not “shyness”.
It’s funny that anything we feel now has a name. I can understand how depression can be considered a mental disorder. But social anxiety? come on, that’s just taking it too far.
As a sufferer of social anxiety disorder myself, I am simply appalled by such simple dismissals of a truly serious problem. It took me years to even admit to myself that I had issues with social anxiety, let alone to anyone that could help me with it, and the whole time had to deal with intense and irrational anxiety brought on by even things as simple as ordering a burger or calling a close friend (not that I was able to make many of those.)
It was only an intervention from a close relative that had recently sought out help themselves with social anxiety that I talked to a psychiatrist. When you have social anxiety you already have enough problems talking to someone about it in the first place. Denying that such an issue exists at all can do nothing but magnify the problem.