Opinion
Now here we have a really fascinating article. It’s pertinent to a subject I’ve been worrying for days (and years and my whole life, really, but specifically for days here on B and W), the power and coerciveness of public opinion. We see that in politics, in ‘public relations’ and advertising, and we even (or perhaps especially) see it in the more mundane, secret, personal corners of life. In our friendships and romances, in how we feel at parties and meetings, at work and school, when we shop and see the doctor. Any time, in fact, that we’re not alone and unseen, public opinion is part of our landscape.
If you have diabetes or heart disease, you suffer regardless of who is watching you or how they perceive you. But the suffering that comes from being too short, too shy or too small-breasted is bound up with the way these characteristics are seen by other people.
Just so. We don’t mind from within being shy or short, we only mind insofar as we are consumer objects for other people. If other people prefer the tall and brash, the hip and the cool to short bashful geeks and nerds, and if we care what those Other People think of us, then we will do our best to stop being a short bashful geek and become hip and cool. But that transformation is so difficult – or it used to be, but now there is a pill. O brave new world. But do we remember to ask ourselves if we actually want to be hip rather than geeky? Or do we just go with the public opinion flow. And what of the loss involved when public opinion makes us all like one another, irons out all our oddities and wrinkles? And above all what of the anguish when the bullies still won’t leave us alone?
Kids pulled his tie so tight it nearly strangled him. They’d tease him about not having fancy gear. They’d call him ugly. He was buying ciggies and handing them out at the bus stop so that he’d be left alone. But after Christmas he tried to give up, and when he didn’t have cigarettes he’d get slapped across the face. No one wanted to play with him. No one wanted to be his friend. He got friendly with this one other lad and then he was accused of being gay. He just couldn’t respond in the way that other kids expected him to.
Be like us or else. Have the right gear, don’t be pudgy, don’t be clever or interested in politics. Don’t be shy or thoughtful or small-breasted or plain. So we mould and shape and form each other – distort and cripple and maim and stunt each other. It can be a high price to pay for fitting in and doing what the others expect.
The trend of pushing cosmetic this and that is unnerving. It seems like every time I turn on the radio, or read the paper, there’s an ad for a “cure” for something I didn’t know was a problem.
The country I live in is supposedly a free one, but I have moments of fear of a future where people who don’t choose to have themselves mutilated to fit in, wind up unemployable and starving.
It’s nothing new, as you pointed out. And I don’t really know if it is more prominent now or just more diverse (more things to find wrong with us.) I do think, and hope, that the voices rising against it, and for leaving us the @#$%^&! alone, will ring louder and clearer.
As for childhood bullying, that could use a whole ‘nother article from the one (or many) that could be done on the blandishments used by adults on adults.
Or what some adults do to children–e.g., has anyone else ever suspected that they didn’t really need all that stuff done to their teeth so much as the orthodontist needed a new car? Has anyone else wondered after a while why a steady stream of doctors never bothered to point out what was BETTER than normal about them?
That about people who feel like their bodies don’t really match their real selves–that one isn’t so simple. Even if the crap described above was all swept away, that alone wouldn’t suffice to help them figure out what to do. I have no easy answers here, it might be one of those case-by-case deals…
I think this article overly conflates issues about cosmetic surgery with questions about mental health:
‘Because “enhancement technologies” are usually medical interventions, they must be prescribed or performed by a doctor, not as “enhancements”, but as “treatments” for psychological or physical suffering. As drug industry profits have increased, so have the number of new medical disorders, from social anxiety disorder and premenstrual dysphoric disorder to erectile dysfunction and irritable bowel syndrome. The industry sells drugs by selling the illnesses they treat.’
The real sufering of premenstrual dysphoria, erectile dysfunction or irritable bowel syndrome can’t be denied so why characterise their treatments as ‘enhancements’ any more than replacing a worn hip or using insulin for diabetes?
This is a particularly misleading piece of reasoning:
‘GlaxoSmithKline spent more money advertising Paxil (paroxetine) and the newly popular “social anxiety disorder” for which it is prescribed than Nike spent advertising its top shoes.’
Well, as most people know, paroxetine, or Paxil/Seroxat is an SSRI antidepressant, so the money GSK spent advertising it is not due to the ‘newly popular “social anxiety disorder”‘ but the wide spread, well established and recognised problem of depression. And despite the next paragraph:
“much of it differs sharply from the kind of suffering that comes from ordinary medical conditions. Often (though not always) it is social in nature. If you have diabetes or heart disease, you suffer regardless of who is watching you or how they perceive you.”
Social anxiety disorder is not simply feeling a little anxious in public! This is not behaviour elicited by others it is pathological. The DSM-IV definition includes “Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack”, “The person recognizes that this fear is unreasonable or excessive”, “The feared situations are avoided or else are endured with intense anxiety and distress.”, “The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.”
Kerrick,
“I do think, and hope, that the voices rising against it, and for leaving us the @#$%^&! alone, will ring louder and clearer.”
Well I’ll do my best! Loud anyway, even if not clear.
“As for childhood bullying, that could use a whole ‘nother article from the one (or many) that could be done on the blandishments used by adults on adults.”
Just exactly what I think. I’m working on it. Or rather them.
PM, are you sure most people know that paroxetine or Paxil/Seroxat is an SSRI antidepressant? I doubt that, myself. Hell, most people don’t know the sun doesn’t orbit the earth – well that’s not quite true, but it’s close.
I agree about things like IBS though, I wondered about that one when I read the article. But as for the DSM – surely you know that the DSM is not simply a transparent set of facts, that it is in fact highly controversial. You do know about the child who was tortured to death by therapists treating her for RAD or ‘Reactive Attachment Disorder’, a DSM-named [or constructed] ‘illness’ don’t you? You do know that plenty of people think that RAD isn’t an illness or a disorder at all but just a normal reaction to a painful situation? Can you really be certain that the same is never the case with putative ‘Social anxiety disorder’? Especially when drug companies stand to make a lot of money by convincing people it is a disorder and that pills can fix it?
I’m not claiming that sanction by DSM makes anything more ‘real’ (that is a whole different argument we don’t need to have ;-), rather that the stated criteria imply a considerable degree of distress. It is not ‘better than wellness’ to be able to go into social situations without crippling anxiety and panic! And the evidence suggests that paroxetine is able to relieve this anxiety (paroxetine, at higher doses than given for its antidepressant effect, is already widely prescribed for anxiety disorders).
Maybe I’m wrong with ‘most’ but many people are aware that paroxetine is an antidepressant (like Prozac/fluoxetine), especially here in the UK where the suicide scare with Seroxat has been widely publicised and talked about (although drugs aren’t directly marketed to patients here). But either way, it doesn’t remove the fact that the author, who -should- know what paroxetine is prescribed for, is implying that GSK is spending lots of money (the Nike comparison) marketing a drug (paroxetine) for a dubious disorder (SAD) when in fact it spending all this money marketing a drug for a very widespread and long recognised disorder (with a degree of organic basis I might add) that its drug treats very effectively.
Nothing better to do so I’ll address the issue of the DSM.
DSM is an attempt to systematise what is presented in the clinic and its treatment, not necessarily official recognition that something is ‘really’ a disease. As far as psychiatry is concerned if something is sufficiently troubling to see a doctor it is worth paying attention to, you can’t just tell the person that its ok because there isn’t anything wrong with them, its just a prefectly normal response to being abused or whatever.
If you think about obesity, it is a perfectly normal reaction, there is, in most cases nothing wrong with an obese person, so by your logic obesity is not a disorder or disease and should not be treated or researched. However obesity has serious clinical implications, similarly violent behaviour and whatever else characterises RAD have implications for the psychiatric clinic. Until we’ve identified these symptom clusters and investigated them further we can’t know whether something is a real, obvious, organic disease (e.g. epilepsy or hypothyroidism), a subtle disease with probable organic components but that is therefore still controversial (e.g. schizophrenia or obesity with a genetic component), normal reactions to an abnormal environment (e.g. RAD or general obesity in a refined sugar rich environment) and normal reactions to a normal environment that are inconveneient to someone (e.g. some of the explosion in ADHD? people that are naturally heavily built – I don’t know, I can’t quite think of an obesity analogy here)…where do you feel depression, dyslexia or autism fall in this spectrum?
I hadn’t heard about this Reactive Attachment Disorder death, but it seems to be one Candace Newmaker you are referring to, who died (suffocated?) during ‘rebirthing therapy’ carried out by two unlicensed unregistered psychotherapists, I’m not sure if such a therapy is a normal part of the treatment for this disorder by psychologists and psychiatrists, but I doubt it, I also couldn’t figure out who made the diagnosis – i.e. whether it was a psychiatrist. If someone died from ‘alternative’ therapy for cancer would you blame mainstream medicine for identifying cancer?!
As to IBS, isn’t that a primarily symptom driven diagnosis and thus exactly comparable to psychiatric disorders?
It is easy to think that all these silly psychiatric diagnoses are spiralling out of control, and that evil multinational pharmaceutical corporations and lazy doctors are just pushing drugs to anyone with existential angst, that doctors are just diagnosing healthy normal people with disease to label them and medicate them to please the parents – but this is an easy caricature and the reality is more complex and difficult.
I’ve never believed in multiple personality disorder/dissociative identity dirsorder, maybe it is iatrogenic, a protection strategy, attention seeking, suggestiveness, whatever – but it is associated with abuse, and is a pretty bizarre behaviour that seems to warrant treatment in my view – whether it is real, and what it means to be a ‘real’ disorder or disease, I’m not clear about. It only becomes morally fraught when we’re talking about medicalising inconvenience and difficulty for others without any obvious dysfunction or suffering, perhaps when parents are giving ritalin to a child to shut it up, not to treat something that is ‘wrong’.
PM, good points. But on the other hand – drugs are marketed here (a relatively new development and one that drives me into absolute frenzies of disgust – what on earth is the point of marketing prescription drugs anyway? to get people to pester their doctors to prescribe the advertised drugs, I suppose), so these fuzzy borders between real illnesses and syndromes and disorders and things that make us unhappy can be a problem. And the DSM may not be necessarily official recognition, as you say, but surely it is often understood as such. Yes, Candace Newmaker is the case I meant. The cancer analogy is an imperfect one, at least in the US, where – tragically and absurdly – anyone can set up as a therapist and ‘treat’ people. In some people’s hands, the DSM is a ticking bomb.
PS, PM
I do agree with your basic point though, that the whole subject is complex. But I don’t think I said anything to imply that it isn’t. It’s not simple and self-evident that shyness is normal and therefore fine, but it’s also not simple and self-evident that it’s a disease and needs medication.
Actually in some ways I think shyness is better than excessive confidence, but that’s another subject.