How Shyness Became an Illness: A Brief History of Social Phobia

Might there be a brand of "shyness" serious enough to warrant medical attention? There is. It is "social phobia."

—Murray B. Stein, The Lancet (1996)

In 1993, Psychology Today magazine named "social phobia" the "disorder of the decade."¹ The irrational fear of having one's "social performance . . . carefully monitored" apparently surpassed in magnitude even depression (for which almost 200 million prescriptions are written annually in the United States alone).² A barrage of new studies confirmed that America was witnessing a pandemic of shyness. Yet until the mid-1980s, social phobia was barely reported, much less studied. In the space of less than ten years, an almost invisible problem had ballooned into "one of the worst neglected disorders of our time."³

Shortly after Psychology Today made its pronouncement, Newsweek asked readers if they were "Shy? Forgetful? Anxious? Fearful? Obsessed?" and offered them a how-to cure ("How Science Will Let You Change Your Personality with a Pill").⁴ The idea was that shyness is an illness best treated by drugs: "For the first time ever," the neuropsychiatrist Richard Restak was quoted as claiming, "we will be in a position to design our own brain."⁵ Pharmacology would enable us to design brains unafraid of eating alone in restaurants, speaking or writing in public, and using public rest rooms—the principal foci of social phobia.

"Cosmetic psychopharmacology," Peter Kramer called aspects of this emergent field in his best seller Listening to Prozac and worried that they conveyed a strong, perhaps unrealistic demand for mood brightening.⁶ The fantasy, as an anthropologist has noted of American psychiatric culture, is that patients will undergo "a kind of psychopharmacological plastic surgery."⁷ Indeed, the mystique of the drugs in question—Prozac, Zoloft, Paxil, and other SSRIs (selective serotonin-reuptake inhibitors)—depends on the belief that emotional problems derive almost entirely from faulty neurotransmitters and on the assumption that current ideas about what constitutes an emotional problem are objective and indisputable (fig. 1). But many of the traits and emotions for which people now take SSRIs are ones, like reticence, that American culture once welcomed and that other cultures still encourage. The decision to reclassify them as personality or mood disorders is surprisingly recent.

To explain how shyness became an illness requires that we examine several interrelated concerns: the biomedical emphasis and corporate sponsorship of the "new psychiatry"; the controversial justifications for widespread category changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM); a deep historical rift in psychiatry over etiology, treatment, and cure; and, finally, the fundamental assumptions of psychopharmacology about normality and about social integration and adaptation. A quick way to gauge the impact of psychopharmacology on our culture is to consider that a major dictionary now defines normal as "free from any mental disorder."⁸ The short history of social phobia encourages us to ask, with a swelling chorus of psychoanalysts, bioethicists, and even concerned psychopharmacologists, whether our drive for social and emotional conformity could overwhelm our tolerance for eccentrics, mavericks, and iconoclasts.⁹ Are the milder forms of misanthropy, for instance, tolerable when sociability ceases to be voluntary? If not, what will happen to the eccentricities that many still prize—traits and behaviors that thwart the type and degree of social adaptation or "adjustment" that is increasingly required of us?

The "Antisocial Behavior Orders" (ASBOs), which came into force in Britain in 1999, reflect the kind of social policy to which the idea of a mechanistic brain lends support.¹⁰ Indeed, psychopharmacology has revived with a vengeance Karl Menninger's dictum about the individual's "adaptive failure" and turned it into a social problem requiring a large-scale intervention.¹¹ But the most contrasting viewpoint—that the mind, being partly unconscious, is rather enigmatic; and that we are fundamentally...