• There’s almost a 50% chance that a person will think of him- or herself as shy. But is that “just” shyness or does it imply the presence of a mental disorder? Many psychiatrists want to say that it’s a mental disorder. But they have little ability to distinguish social anxiety disorder from ordinary shyness, not least because they share so many traits.
• “Interestingly, the central elements of social phobia, that is discomfort and anxiety in social situations and the associated behavioral responses . . . are also present in persons who are shy” (Samuel Turner with colleagues in Behaviour Research and Therapy, 1990).
• “Might there be a brand of ‘shyness’ serious enough to warrant medical attention? There is. It is ‘social phobia’” (Murray Stein in The Lancet, April 1996).

• The third edition of the Diagnostic and Statistical Manual of Mental Disorders (1980) added 112 new disorders to the roster, almost doubling overnight the number of mental disorders on the books.
• DSM-IV (1994) added 58 more. Were they all necessary, much less carefully and scientifically defined?
• “The consensus was arranged by leaving out the dissenters” (Isaac Marks, University of London, 2005).
• The chair of the task force (Robert Spitzer at Columbia) overseeing the creation of the new disorders accepted only “kindred spirits” (his term) as participants.
• The task force met for 4 years before it even occurred to them to include other voices and perspectives.
• The person (John Frosch) added to the task force to correct this imbalance later resigned, complaining of an “Alice in Wonderland feeling.”
• “There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, ambiguous” (Ted Millon, a consultant to DSM-III, quoted in the New Yorker, 2005).
• Some of the patient sample sizes were embarrassingly low, sometimes involving just one patient treated by the sponsor of the proposal.
• One psychiatrist (Steven Hyler) pushed for the adoption of “chronic complaint disorder.” Apparent symptoms: “persistent and consistent complaining . . . in a high-pitched whining fashion which is especially noxious to the listener.”
• People with schizoid personality disorder are described by the DSM as “humorless or dull.”
• Passive-aggressive personality disorder. Official symptoms: “dawdling” and “procrastination” over things like doing the laundry and shopping.
• Oppositional disorder was created for those who seem “negativistic, disobedient, and ineffective.”
• One psychiatrist’s definition of “masochism”: “Oh, you know what I mean, a whiny individual . . . the Jewish-mother type”
• Discussion about “avoidant personality disorder” focused on whether people preferred getting to work by car or on public transportation.
• Social phobia was included in 1980 largely on the basis of one article appearing two decades earlier, which described roughly a dozen people experiencing social embarrassment. But the authors of the article said that on no count should this be considered a separate disease. They were ignored.
• In 1980, the “impairing” criteria for social phobia included

• fear of eating alone in restaurants;
• concern about hand-trembling while writing checks;
• avoidance of public restrooms.

• By 1987 (in DSM-III Revised), the stipulation about a “compelling desire to avoid” anxiety-inducing situations was deleted and replaced by “marked concern.” Also, the anxiety no longer needed to be actual; anticipating it was enough.

• In the 1970s, when it first developed Paxil as an antidepressant, GlaxoSmithKline (then SmithKline Beecham) was so unimpressed by the results that it considered shelving the drug.
• But in 2000, the year after Paxil received FDA approval to treat social anxiety disorder, GSK spent $92 million pushing Paxil as the remedy—almost $3 million more on advertising than Pfizer spent that year on Viagra.
• Paid consultants (some receiving fees from up to 17 different drug companies) were prepared to say that almost one American in five experiences social anxiety disorder in particular, and nearly one-third of the country suffers from some form of anxiety disorder.
• That first figure was based on a study involving randomized telephone calls to 526 urban Canadians. Their self-reported levels of social anxiety resulted in percentages ranging from 1.9% to 18.7%. The higher figure was widely reported in subsequent literature, as a claim about the likely social anxiety prevalence rates in the U.S overall.
• GSK has spent over $165 million in class action lawsuits since Paxil received FDA approval in March 1999 (Business News, March 28, 2006; Washington Drug Letter, April 3, 2006).
• GSK continues to call the drug “safe and well-tolerated,” even after acknowledging, in a confidential memo quoted in Shyness, that one-in-five patients suffers mild-to-serious side effects from Paxil.
• Information about some of those side effects was withheld from the public.