Social Phobia: Are doctors too eager to drug us?

This week I ventured out into the blogosphere to see what other brain-related news people are talking about. Several blogs lead me to this op-ed in Friday’s New York Times on how psychiatrists are increasingly diagnosing social anxiety disorder in children, and consequently, prescribing anti-depressant medication as treatment. As the author points out, this is problematic because many anti-depressants have been linked to suicidal thoughts in children as well as other side effects. He then calls on psychiatrists to make the distinction between “social anxiety disorder” and “shyness” more clear cut in the upcoming edition of the Diagnostic and Statistical Manual (DSM V), which lists the standards by which mental disorders are diagnosed. I first saw this article linked to in a post titled “Shyness: Pathological or Normal Experience” in a blog authored by an anonymous academic in clinical psychology. Next, I looked at the post “Shy of a Phobia” by Jacob Sullum in Reason Magazine’s blog, Hit & Run. This blog is a little bit different in that it does not focus exclusively on neuroscience or psychology as it is part of a political magazine, but I thought Sullum’s comments on the Times piece were original and insightful.

Comment on “Shyness: Pathological or Normal Experience”

I would first like to say that I enjoyed your link to and commentary on Christopher Lane’s piece in the Times. I agree with your assertion that too many people are being diagnosed with social phobia if your figure of 13% is correct. In my opinion, a clinically significant psychiatric condition should, by definition, be something that occurs in a very small percentage of the population. Otherwise every single unfavorable aspect of human nature may one day be labeled as a disorder worthy of “treatment.” However, I partially disagree with your blaming the majority of the over diagnosis problem on drug companies. Also significant, in my view, is the fact that too many patients (and parents of patients) want something tangible to come of every doctor’s visit. The fact that these people are consulting with psychiatrists in the first place suggests that they are proactively looking for something to “cure” them. I imagine many would not be satisfied if their psychiatrist simply said there was nothing wrong with them. For many people, leaving the office with a diagnosis and a prescription makes the visit seem worthwhile. The same phenomenon can be seen in the over prescribing of antibiotics for viral illnesses that doctors know antibiotics won’t cure. Unfortunately, the side effects of psychoactive drugs are much more serious than those of common antibiotics.

Comment on “Shy of a Phobia”

I would first like to say that your take on Lane’s piece is original and insightful. It is true that in the case of psychological illnesses, there are no objective physical tests that can determine if a person has illness X or not. However, I do not think this fact excludes the DSM from being an invaluable resource for both patients and doctors. The truth is, right now the DSM is the closest thing mental health professionals have to x-rays and blood tests. Although I do think psychiatrists should have the freedom to prescribe drugs as they see fit, the DSM can help in determining if drugs are the best course of action, especially since so many psychoactive drugs have potentially harmful side effects that patients may not be aware of. The DSM has come a long way from it’s beginnings in Freudian theory of questionable scientific validity, and it would be of great value to everyone if it were to continue to be refined to reflect the growing scientific knowledge of mental illness and the brain. Maybe someday in the future a quick brain scan will tell doctors all they need to know about what mental illness a patient has, but until then the DSM is all we have.