How Shyness Became A Disorder

When Does Social Anxiety Become A Disorder?

A few days back I came across a report by The Quint which claimed that 50.5% of Psychology students suffer from social anxiety. I was quite surprised to see these numbers since this would suggest that a majority of Psychology students have a problem of social anxiety. The report was quoting a study conducted in Ireland trying to understand how students cope with the mental health challenges of university education and what steps can be taken to make things easier for them.

You can access the study here.

The study used a tool developed by the World Health Organization as a pre-diagnostic interview to assess the state of mental health in different populations. The tool claims to have a strong correlation with clinical diagnoses. This basically means that if the tool says someone might have a disorder, they end up getting a diagnosis later on usually.

From what I have gathered about the tool so far, it can be used to assess the prevalence of bipolar disorder, major depression, panic disorder and social anxiety disorder to an acceptable degree. The focus of this story will be on the social anxiety disorder.

The tool seems to measure social anxiety through an adaptation of another tool, the Social Phobia Inventory which includes some of the following questions:

• Parties and events scare me

• I avoid talking to people I don’t know

• Talking to strangers scares me

• I am afraid of being criticised

If these sentences were not the part of an inventory meant to measure social anxiety in people, I would think this was the description of just another individual who was shy and sometimes nervous in social situations.

Shyness and nervousness are pretty normal human experiences. How then did they end up becoming disorders? And disorders that are so prevalent that they effect more than 50% of the students in my discipline?

History of Social Anxiety Disorder

Social Anxiety Disorder was earlier known as Social Phobia and in the earlier iterations of the DSM, it was simply a part of a larger group called Anxiety Neurosis.

Social Phobia first made its appearance in DSM-III along with another, similar disorder called Avoidant Personality Disorder. I have written at length about the shady conditions under which the third revision of the DSM was created under Robert Spitzer.

It was also in this edition that Borderline personality disorder made its appearance and Introverted personality disorder was dropped as a disorder.

To keep it quick, the committee that built DSM-III wanted to make it as empirical as possible and move away from the influence of psychoanalysis. But at the same time, the disorders that were included in the list had little empirical support, sometimes none.

To add to the murkiness of the whole thing, pharmaceutical companies had agreed to bankroll the conferences and meetings that this committee held for the sake of, in their own words, “Money, money and money.”

When the social phobia diagnosis was first introduced, there was pushback from researchers and psychiatrists. They believed there was very little demarcation between the anxiety experienced during agoraphobia and that experienced by those who had social phobia.

These criticisms were sidelined.

And soon social phobia became an illness and was later renamed as the social anxiety disorder. The disorder became so popular in North America at the time that it was named the disorder of the decade in the 1990s. A disorder which didn’t exist until a decade back was now popping up everywhere.

Magazines and newspapers ran with the title, “You’re Not Shy, You’re Sick” and variants thereof.

A poster by the Anxiety Disorders Association of America tried to explain what social anxiety felt like by saying it is like being allergic to people, much like we are allergic to dust, pollen or animals.

Turns out the Anxiety Disorders Association of America had two partners, one was the APA which was responsible for creating the DSM and the other was a group called Freedom From Fear.

Freedom From Fear was an advocacy group that was being financed by drug companies manufacturing anti-anxiety medications. This fact was not revealed for a few years after the campaign had ended.

The work of Christopher Lane has been vital in bringing these facts to light. His book titled, “Shyness: How Normal Behavior Became a Sickness” shed light on the processes that went behind deciding new disorders and pushing their treatment.

Today, Social Anxiety Disorder is considered a legitimate medical diagnosis and is usually treated with psychotherapy and anti-anxiety medications. Its prevalence is still being studied across different cultures although there is still little philosophical grounding in how the experience is distinctly different from that of intense shyness.

Does Social Anxiety Exist?

Of course it does.

I am not here to say that people who experience intense fear and nervousness in social situations are making it up. I am one of those people myself.

I have terrible social skills and often find myself floundering for words in a social setting.

What I want to question is the idea that it can be debilitating to the degree of being a disorder. I am sure there are people out there who are absolutely incapable of functioning in a social situation and go through extreme distress.

I do not think 50% psychology students experience anything close to that.

I think the DSM, for all it has done to make psychiatry more systematic and “objective”, it still has quite a lot of flaws and carries disorders that are an attempt at pathologizing normal human experiences.

I don’t think all mental disorders are made up or are a result of some big conspiracy between Pharma companies and the American Psychological Association but I believe each proposed disorder should be judged on its own merits.

And that is it for this week! Don’t forget that I have a giveaway going on and it ends on 17 January 2023!

The giveaway is not associated with either the author or the publishing house. I am doing it simply in my own personal capacity.

Good luck!