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.