abnormal behavior, and diagnostic thresh-
disorder, 162, 163, 164, 166. See also in-
anticholinergic drugs, 142, 146 – 47, 174. See also Paxil (paroxetine hydrochloride)
antidepressants: for children and adoles-
adolescents, and antidepressants, 198– 99,
cents, 198– 99, 205 – 6; and emotional
blunting, 8; marketing of, 4, 17, 106 –
17, 121; risks of, 117–18, 198; for social
anxiety disorder, 120 –21. See also Paxil
advertising: by drug companies, 105, 106 –
17; for Paxil, 105, 121– 34. See also mar-
advocacy groups, and marketing, 136 – 37
antisocial personality disorder (aspd), 15 –
anxiety: causes and effects of, 19 –20,
104; and DSM-III, 2– 3, 39 – 42, 47– 48;
149 – 53; drug treatments for, 140 – 41,
ture and Statistics, 42– 47, 51– 56; and
anger, 162– 63; Freudian views of, 31–
DSM-IIIR, 97; maintaining DSM cate-
35, 154 – 55, 157, 160; historic views of,
8, 9, 11–14; and marketing of Paxil, 121;
as rational response to stress, 139, 168;
hoc committee on DSM-III, 54 – 55
anxiety disorders: and “chemical imbal-
Amitriptyline hydrochloride, as tricyclic
139; Freudian view of, 32– 34; and mar-
Braff, Zach, Garden State (film), 9, 182–
diagnostic categories of, in DSM-III, 54,
67, 76, 78–79, 92– 97, 195; psychody-
namic approaches to, 54; statistical per-
centages for, 199, 213n1. See also anxiety
Anxiety Disorders Association of America,
sciousness, 149, 153. See also neuropsy-
anxiety neurosis: DSM-II, 42– 43, 72; DSM-III, 46, 56, 75 –76; Feighner criteria for,
anxiolytics, as drug treatment for anxiety,
Burton, Richard, The Anatomy of Melan-
apathy, as “mental disorder,” 194, 199,
Canada, as source for prescription drugs,
attention deficit hyperactivity disorder
Carroll, Lewis, Alice in Wonderland, 58–
avoidant personality, and social anxiety,
Cassels, Alan, with Ray Moynihan, Selling
avoidant personality disorder (apd), 1; and
and DSM-III, 56, 74, 78–79, 92, 94 –
97, 114; and DSM-IV, 97; and marketing
children: danger of ssris to, 118–19, 142;
Ayd, Frank, Recognizing the Depressed Pa-
general drug treatments for, 168, 198 –
chronic, as term, and DSM diagnostic crite-
Beyond Therapy (U.S. government report),
biology: and mental disorders, 19 –20, 21,
63 – 64, 205; and perceptions of anxiety,
blood-clotting problems, as side effect of
cognitive-behavior therapy, 141, 162– 66,
blushing: and anxiety, 29 – 30; and social
Cohn and Wolfe, public relations firm, 117;
disorder, as term with biological connota-
tions, 56. See also mental disorders
Dr. Mukti and Other Tales of Woe (Self ), 9,
compulsive sexual behavior, as mental dis-
charities, funding for, 135 – 37; cultural
153; role of, in mental illness, 206; and
backlash against, 172–77; and fda, 112,
114, 229n72; guidelines and medical in-
Corrections, The (Franzen), 9, 172– 82,
ventories established by, 135 – 36; mar-
13 –14, 43, 101– 3, 104, 137, 199; rela-
114, 202– 4; and research funding, 73 –
culture: and diagnostic categories, 18; and
75; and side effects, 119; and ties to DSM,
Darwin, Charles: on anxiety, 20; Descent of
146 – 49, 151, 205 –7, 208; for children
Man, 29; The Expression of the Emotions
and adolescents, 118–19, 142, 168, 198–
in Man and Animals, 14, 29, 47, 48,
99, 234 – 35n9; and emotional blunting,
219n46; and shyness as adaptive trait,
107, 151, 182, 238n28; and managed
health care, 194, 197– 98, 221n5; and
neuropsychiatry, 35 – 37, 104, 153, 162,
depression: drug treatments for, 153; and
DSM (The Diagnostic and Statistical Man-
marketing of drugs, 106 –17, 120 –21,
ual of Mental Disorders): and pharma-
134 – 35; side effects of medication, 117–
ceutical industry, 3, 6, 37, 104, 114, 120 –
21; revisions to and expansion of, 2– 3,
DSM-I (1952), 36 – 37, 38, 80, 91, 170
De Quincey, Thomas, Confessions of anDSM-II (1968): diagnostic categories of,
38, 40, 41– 42, 75, 92; and ICD-8, 37–
Diagnosis, The (Lightman), 9, 185 – 88,
diagnostic criteria, and DSM-III, 24, 38,
DSM-III (1980): and advocacy groups, 136;
46 – 56, 60 – 61; and avoidant personal-
94 – 97, 114; diagnostic criteria of, 24,
38, 56 – 69, 201–2; general expansion of
Dickens, Charles, Little Dorrit, 219n47
disorders in, 2– 3, 37, 68–70, 92– 97,
120 –21, 139, 141; inclusion of panic dis-
order and social phobia in, 17, 50, 71–
Feinstein, Alvan, on psychiatric diagnosis,
explosive disorder (ied), 15, 195; and in-
troverted personality disorder (ipd), 78,
anxiety disorders in, 92– 97, 120 –21;
anxiety disorder, 121, 122, 125 –26, 139;
approval of ssris in general, 1–2, 118;
9, 80, 81, 88, 91, 97, 202; selection and
229n72; and marketing of Paxil, 120,
51– 56, 202; and task force politics, 39 –
DSM-IIIR (1987), 43, 44, 202; diagnostic
DSM-IV (1994), 3, 15; diagnostic criteria
Franzen, Jonathan, The Corrections, 9,
Freedom From Fear (fff), 123, 125, 132, 136
in, 43, 97–101, 104; satire of, in Dr.
Freud, Sigmund: on anxiety, 19, 32– 35,
Mukti and Other Tales of Woe (Self ),
141, 154 – 55, 157, 160 – 61, 165, 168; and
191– 93; and social anxiety disorder, 76,
biomedicine, 26, 32, 166; Civilizationand Its Discontents, 34 – 35, 161, 188;
DSM-V, likely diagnostic criteria for, 194 –
concept of normal behavior, 27; The Egoand the Id, 160 – 61; and Emil Kraepelin,
on the form and speed of treatment,33 – 34, 154 – 55, 165; Inhibitions, Symp-toms and Anxiety, 34; “The Justification
sis,” 32– 33; Project for a Scientific Psy-
emotional blunting, from antidepressants,
chology, 31– 32; on the superego as a
cause of anxiety, 34 – 35, 160 – 62; and
systemic suffering, 205; “‘Wild’ Psycho-
analysis,” 154 – 55, 165. See also psycho-
Erwin, Brigitte, on social anxiety disorder,
of DSM-III, 25 –26, 46 – 47, 53 – 54, 75,
extroversion: and DSM-III, 82; cultural ex-
Garden State (film), 9, 182– 85, 188
Gelder, Michael, and DSM-III inclusion of
GlaxoSmithKline (UK), and health risks of
homosexuality, and DSM-II and DSM-III,
Paxil, 117–19, 139 – 49, 234 – 35n41. Seealso Smith, Kline and French; Smith-
Eternal Sunshine of the Spotless Mind
Huxley, Aldous, Brave New World, 169 –
and David J. Katzelnick, Social AnxietyDisorder: A Guide, 4, 20
insurance companies, and DSM diagnosis, 3
Griesinger, Wilhelm: Mental Pathology
intermittent explosive disorder (ied), 7,
and Therapeutics, 21, 29; and normal
behavior, 27, 32; and scientific psychia-
International Classification of Diseases
(ICD), and updating of DSM, 3, 37– 38,
introversion, cultural view of, 158, 207– 9introverted personality disorder (ipd),
evolution of, and DSM-III, 9, 66 – 67,
Hardy, Thomas, The Mayor of Caster-
Hartenberg, Paul, Les Timides et la timi-
Hawthorne, Nathaniel, and his “philoso-
healthcare system, U.S.: and DSM, 3, 40;
and David J. Katzelnick, Social Anxiety
Healy, David, 43, 198; The AntidepressantEra, 25, 73; on categorical distinctions
in DSM-III, 69, 75 –76, 199; on drug
spective of DSM-III, 50; on regulation of
Jungians, and DSM-III classification of in-
Lewis, Sir Aubrey, and ICD-8, 38
kappa index of reliability, and DSM-III, 68,
Katzelnick, David J., with John H. Greist
and James W. Jefferson, Social Anxiety
100 –101; and social phobia/social anxi-
ety disorder, as DSM category, 7, 93 –101
Eternal Sunshine of the Spotless Mind
Lightman, Alan: The Diagnosis, 9, 185 –
88, 190, 244n32; Einstein’s Dreams, 185
Kesey, Ken, One Flew over the Cuckoo’s
Kessler, Ronald, and retention of mild dis-
kidney failure, as side effect, and Paxil, 118,
DSM-III, American Psychoanalytic Soci-
Kierkegaard, Søren, The Concept of Anxi-
Kirk, Stuart A., with Herb Kutchins, 68–
194, 197– 98, 221n5; and dtc market-
ing, 112; escalating cost of, and psycho-
and descriptive diagnosis, 36, 44, 63 –
marketing, pharmaceutical: and diagnostic
64, 205; and “introversion” as term, 79,
196 – 97; guidelines and inventories for,
135 – 37; of medical conditions, 134 – 35;
Kraepelin, Emil, 32, 35 – 36, 44, 166; and
of Paxil, 117–19; of psychotropic drugs,
Alzheimer’s disease, 177; biological per-
199 –200; satire of, in The Corrections,
spective of, 21–28, 218n32; and diag-
180 – 81; and social anxiety disorder, 4 –
nostic criteria of DSM-III, 61, 63, 64;
Lectures on Clinical Psychiatry, 22, 23
Kramer, Peter D., 78, 233n27; Against De-pression, 233n27; and “cosmetic psy-
ing, 105; and DSM-III inclusion of social
chopharmacology,” 17, 195; Listening to
phobia, 71–75; Fears and Phobias, 12–
Kutchins, Herb, with Stuart Kirk, 68– 69;
Marshall, John R., Social Phobia: FromShyness to Stage Fright, 135 – 36
Le Carré, John, The Constant Gardener,
Lewis, C. S., The Chronicles of Narnia, 181
medical insurance: and diagnostic criteria,
61; and psychoanalysis, 28– 35, 40; and
64; and DSM influence, 3; and psycho-
policy, 207. See also pharmacology; psy-
neurosis: deletion from DSM-III, 48– 49,
50 – 51, 52– 53, 60, 73; as diagnostic
mental disorders: acceptance of, and drug
treatment, 194 –202; alleged biological
foundations of, 19 –20, 21, 63 – 64, 205;
147– 48. See also cholinergic system; se-
definition and marketing of, 101– 3; di-
agnostic criteria for, 56 – 58, 61– 65; and
DSM inclusion, 197, 204 – 5; and phar-
Merck pharmaceutical company, 106Millon, Theodore, 43 – 44, 88, 89, 94, 95
office-related anxiety, and pharmaceutical
Mintz, Morton, The Therapeutic Night-
Moynihan, Ray, with Alan Cassels, Selling
panic disorder: and inclusion in DSM-III,
National Comorbidity Survey (1990 – 92),
paroxetine. See Paxil (paroxetine hydro-
Paxil (paroxetine hydrochloride): and ade-
National Institutes of Health, and funding
marketing of, 4 – 5, 105 – 6, 117– 34, 136,
neo-Kraepelinians, 25 –26, 50, 63 – 64
approval of, 120, 125, 139; fictional por-
trayal of, 187; as Paxil cr (“Controlled
172; and diagnostic criteria in DSM, 69 –
Release”), 121; for public speaking anxi-
treatments, 149, 151, 153, 162, 167, 194 –
drome, 139 – 40, 142, 147– 48; as Sero-
and “neurosis” as term, 52– 53, 60, 65;
from, 7, 117–19, 120, 132– 33, 139, 141–
neuropsychiatry: biochemical focus of, 20,
102– 3, 204; as treatment for social anxi-
210 –11; and descriptive diagnosis, 35 –
36; and DSM-III, 46 – 47, 49 – 50, 60 –
personality disorders, 8, 66 – 67, 78 –79
psychoanalysis: counterintuitive perspec-
tive on anxiety, 34 – 35, 36, 165 – 66,
and advocacy groups, 136 – 37; and mar-
DSM diagnostic criteria, 3; and dsm-iii
pharmaceutical companies. See drug com-
task force perspective, 3, 25 –28, 46 –
ceptance of, 37– 38, 50; and medical in-
surance coverage, 40, 221n5; and neo-
pharmacological dystopia, and Brave New
Kraepelinians, 25 –26, 50, 63 – 64; and
pharmacology, 188; cosmetic use of, 16 –
tionship with psychiatry, 6, 34, 35 – 37,
40, 104; and self-recrimination, 161– 62;
mental illness, 106 –7, 134, 153; and psy-
and treatment of anxiety, 33 – 34, 154 –
chiatry, 104. See also neuropsychiatry;
World Health Organization, 3, 37– 38.
post-traumatic stress disorder (ptsd), 42,
167; and perspective of DSM-III, 46 – 47
ment for depression and anxiety, 13 –14;
contentious history of, 228n41; and
DSM-V, 195; first known as “Late Luteal
Freudian theory, 27. See also neuropsy-
173; and partial inclusion in DSM-IIIR
Prozac (fluoxetine hydrochloride), 2, 105;
psychotropic drugs: and diagnostic crite-
fictional portrayal of, 186 – 87; Listening
ria, 199 –200; and human identity, 169 –
to Prozac (Kramer), 169 –72, 177; as
240n8; as ssri, 117, 121, 147, 167, 169 –
sponses to, 204 – 5; drug treatments for,
bia/social anxiety disorder, 5, 100 –101,
psychiatry: biomedical focus of, 104, 208;
135 – 36, 160, 166 – 67. See also stage
(Kramer), 171–72; credibility of, and re-
Public Speaking–Social Anxiety Center of
form, 204 – 6; and DSM-III diagnostic
criteria, 18, 56 – 61, 195; historical refer-ences, 14 –17; and medical insurance,
40, 221n5; as partner to pharmacology,
Rankine, Claudia, Don’t Let Me Be Lonely,
Scott, Susie, on shyness, 116, 157– 58, 163,
and drug treatment, 139 – 41, 148. See
of, 118; as medication for children, 151,
renal failure, as side effect, and Paxil, 118,
209; and selfhood, 170 –71; side effects
of, 101, 118, 151, 153, 167, 171, 238n28;
reticence, drug treatment for, 102. See also
versus maois, 114, 233n26. See also anti-
road rage, 7, 202, 204. See also intermit-
Self, Will: Dr. Mukti and Other Tales ofWoe, 9, 188 – 93; The Quantity Theory ofInsanity, 188, 191– 92; The Sweet Smell
Rounsaville, Bruce, drawing of DSM-III
serotonin: and alleged links to depression
and anxiety, 13 –14; deficiency of, and
Sabshin, Melvin, and DSM-III, 40 – 41, 42,
marketing of Paxil, 123; and ssris, 147–
Samson, biblical figure, and antisocial per-
Seroxat. See Paxil (paroxetine hydrochlo-
Satel, Sally, with Christina Hoff Sommers,
One Nation under Therapy, 201, 205,
Shergold, Adrian, Dirty Filthy Love (film),
shyness: advocacy and support groups for,
schizoid, as term, 79, 81, 85, 86, 89, 91
136 – 37; cultural views of, and selfhood,
schizoid personality disorder (spd), 163,
8– 9, 17–18, 207–11; and DSM-III, 47;
interpretive history of, 11–16; medica-
95; evolution of, in DSM-III, 9, 80 – 91,
tion for, 16 –17, 102– 3, 121, 139, 204; as
social anxiety, 4, 18, 122, 157– 59. See
schizophrenia: and DSM-II, 38; and Emil
also introverted personality disorder
One Nation under Therapy, 201, 205,
side effects: of drugs for anxiety disorders,
141– 49; of Paxil in particular, 117–19,
120, 132– 33, 167; of ssris in general,
Spitzer, Robert L.: as chair, dsm-iii task
force, 6 –7, 38, 39 – 46; and DSM cre-
ation of categories, 79 – 82; and DSM di-
agnostic criteria, 56 –70; and DSM-II,
company, 37. See also GlaxoSmithKline;
37– 38, 41– 42; and DSM-IIIR, 96, 97–
101; and DSM neuropsychiatry frame-
Smith, Mikey, Social History of the Minor
work, 46 – 51, 60, 194 – 95; inclusion of
social phobia in DSM-III, 71–78; and in-
troversion as personality disorder, 78–
105 – 6, 117– 34, 136; and social phobia
nostic quizzes of, 135–37. See also Glaxo-
stage fright, 12. See also public speaking
statistical accuracy, and proliferation of
social anxiety disorder (sad): alleged bio-
logical origins of, 19 –20; and introver-
sion, 83; marketing of drugs for, 104 – 5,
Stevenson, Robert Louis, Strange Case of
116 –19, 120 –21, 137– 38; marketing of
Paxil in particular for, 105 – 6, 121– 34;
suicide ideation, as side effect of ssris,
threshold for, 4, 200. See also social
superego, and Freudian theory, 160 – 61
social phobia, 8, 9, 207; as anxiety disor-
Szasz, Thomas S., The Myth of Mental Ill-
der, 6, 19, 160 – 68; cultural views of, 12,
15, 17–18; diagnostic criteria for, 65, 78,92– 93, 99 –100, 102; and DSM-III, 7,
Tauzin, W. J. “Billy,” and phrma, 203,
DSM-IIIR, 96 –101; fictional view of, 193;
and pharmaceutical market, 98, 120 –21,
135 – 36, 144; and Pierre Janet, 30; re-
Thucydides, History of the Peloponnesian
der, 97–100; statistical percentages for,
213n1, 244n35; treatment and therapyfor, 153, 160 – 68. See also social anxiety
social services, and DSM influence, 3
Sommers, Christina Hoff, with Sally Satel,
withdrawal symptoms, and Paxil, 117, 118,
World Health Organization: and ICD, 3,
41; and ICD-8, 37–38; and mental-health policy, 200
Wurtzel, Elizabeth, Prozac Nation, 182
Zoloft (sertraline hydrochloride), 2, 105,
121, 147; marketing of, 117, 137– 38; as
treatment for intermittent explosive dis-
The Nature vs. Nurture Controversy George Howe Colt IT'S NOT JUST BROWN EYES. YOUR INHERITANCE COULD ALSO INCLUDE INSOMNIA, OBESITY AND OPTIMISM. YET SCIENTISTS ARE SAYING THAT GENES ARE NOT--QUITE--DESTINY. IN THE DEBATE OVER THE RELATIVE POWER OF nature and nurture, there may be no more devout believers in nurture than new parents. As my wife and I, suffused with a potent mix of a