Abstract
This paper will examine how French neurotics are being transformed into ‘social phobics’ and how the appearance of this group may be tied to new personal and social ideals. There are many people and factors that contribute to this changing definition of mental illness. Amongst these, I will focus on the role of three groups who are most vocally acting as morality brokers in the creation of these new subjects: psychiatrists, patients’ groups and pharmaceutical companies.
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Notes
Officially, only physicians can interpret and diagnose patients’ symptoms of psychic unrest, but increasingly, people are seeking information outside of their physicians’ offices and are self diagnosing and subsequently informing their physicians of their self-assessed diagnosis (which, for many reasons, physicians often agree with). Drug companies, now through direct marketing in the United States, spread awareness of particular disorders and their treatments. This can increase the likelihood that individuals will be diagnosed with social phobia.
The novelty of this anxiety, however, has been challenged (Wilkinson 1999).
Dates vary depending on the country in question.
Etiological explanations are still proposed and much psychiatric research strives to identify the origins of mental illness, but etiological accounts are most often considered tentative. There are few cases in which the etiology of a mental illness is agreed on by psychiatric researchers. Etiological accounts are not meant to replace symptoms as the primary means of defining and diagnosing psychiatric disorders.
Depression was nonetheless more recognized than in the past, as Alain Ehrenberg has described in his book, La fatigue d’être soi (1998).
The official diagnostic criteria for social phobia in DSM-IV are as follows:
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A.
A marked or persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.
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B.
Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack.
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C.
The person recognizes that the fear is excessive or unreasonable.
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D.
The feared social or performance situations are avoided or else are endured with intense anxiety or distress.
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E.
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 a marked distress about having the phobia.
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F.
In individuals under age 18 years, the duration is at least 6 months.
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G.
The fear or avoidance is not due to the direct physiological effects of substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., panic disorder with or without agoraphobia, separation anxiety disorder, body dysmorphic disorder, a pervasive developmental disorder, or schizoid personality disorder).
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H.
If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e.g., the fear is not of stuttering, trembling in Parkinson’s disease, or exhibiting abnormal eating behavior in anorexia nervosa or bulimia nervosa.
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Specify if:
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Generalized: if the fears include most social situations (also consider the additional diagnosis of avoidant personality disorder). (American Psychiatric Association 1994, pp. 416–417).
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A.
This situation is not unique to France but is particularly influential there, as GPs make up more than half of all French physicians.
Positions of power include positions at university teaching hospitals, academic positions and popular culture interpreters of psychic unease.
For instance, the medical journal Prescrire independently reviews the evidence supporting requests for new licenses for medications. The journal has a subscription base of 27,000 and is read by an estimated 40,000 physicians.
French physicians are much more willing to accept North American models of depression than they are North American models of social phobia. Depression is more widely acknowledged to have biological factors at its base, even if they consider the disorder multifactorial.
This claim is supported to a certain extent by research on social phobia. While individuals with severe social phobia, particularly those with comorbid conditions such as depression or avoidant personality disorder, tend to suffer chronically from the disorder, people who suffer from lower-grade social phobia often experience full or at least partial remission (Rapee and Spence 2004). These cases of remitting social phobia, which often include a few social fears, such as public speaking, tend to support critics’ claims that young people who experience social phobia will often improve with time as their psychological resilience increases.
The looping effect only occurs when the thing labeled is what Hacking refers to as an “interactive kind,” such as a human, and not an “indifferent kind,” such as a quark.
The social phobia support group I attended provided a list of physicians who specialize in the treatment of social phobia. These physicians ‘see’ social phobia where other doctors might see neurosis.
I asked the president of the social phobia support group in Paris if the group received other resources from the industry and she said “Not at this time,” leaving open the possibility (and, I believe, hoping) that they would provide funding to the group in the future.
This situation has recently changed, but for most of the time the Parisian social phobia support group has existed, it was provided with free meeting space at a renowned Parisian teaching hospital where some of France’s high-profile cognitive and behavioral therapists practice.
It should be noted, however, that some social phobics view participating in these activities as potentially therapeutic challenges.
Other patients end up diagnosed with a range of conditions, such as schizophrenia or other anxiety disorders. But social phobia is nonetheless a condition that these patients readily relate to.
There is pressure on French GPs to please their patients because competition is high for clients. If French generalists do not maintain a large patient population, they can literally go out of business.
Researchers who specialize in social phobia have also called for a dimensional approach to the disorder. However, the way that French social phobics described the dimensionality of the disorder reflected a local understanding of temperament, character and ideal behavior.
While the same could be said about almost any form of mental illness, social phobia is considered particularly social in its nature because of the symptom list and its implications for one’s ability to interact with other people. A large part of the treatment, however, is biological in the form of SSRI antidepressants making a chemical imbalance appear to be the root of the problem.
Psychopharmacologist David Healy (2004) has described the plasticity of anxiety using the term “everyday nerves.”
Spasmophilia is a French culture-bound syndrome, for the most part. It is considered to be the result of a deficiency of magnesium and calcium. The symptoms of the disorder range from cramps, convulsions, loss of memory, insomnia, migraines, stress, anxiety, to the “neurotic triad” of hypochondriasis, depression and hysteria and other personalized symptoms (Durlach and Bara 2000, pp. 98–99, 129). Diagnoses of this condition reached their apex in the 1990s and have been on the decline ever since. However, the diagnosis lives on in French medical and popular culture. I was told by French friends, for example, that water high in magnesium is recommended to calm the nerves and aid sleep.
Cultural acceptance of shyness and passivity has been identified as a factor to account for cross-cultural variation in the rates of diagnosis of social phobia (Rapee and Spence 2004).
References
American Psychiatric Association 2000 Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) Text Revision (DSM IV-TR). Washington, DC: American Psychiatric Association.
American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) DSM IV. Washington, DC: American Psychiatric Association.
American Psychiatric Association 1980 Diagnostic and Statistical Manual of Mental Disorders (Third Edition) DSM III. Washington, DC: American Psychiatric Association.
André, Christophe 2004 Réponse d’expert. Psychologies. Paris.
André, Christophe 2008 Professor of Happiness. Ode Magazine: 73–79. March.
André, Christophe, and Légeron, Patrick 1995 La peur des autres: Trac, timidité et phobie sociale. Paris: Odile Jacob.
Bailey, Frederick G., ed. 1971 Gifts and Poison: The Politics of Reputation. London: Blackwell.
Bonaccorso Silvia N. and Jeffrey L. Sturchio. 2002 Direct to Consumer Advertising is Medicalising Normal Human Experience: Against. British Medical Journal 324(7342): 910–911.
Cabridain, Marie-Odile 1985 Managerial Procedures and Hospital Practices: A Case Study of the Development of a New Medical Discipline. Social Science and Medicine 20(2):167–172.
Castel, Pierre-Henri 2005 Un livre, un divan et un débat. Le Monde (Paris) Horizons Débats, Débats, lundi, 26 septembre.
Champion F and X. Briffault 2004 Unpublished.
Charles, Gilbert 2005 La guerre des psys. L’Express, 29 septembre, 116.
Clarke, Adele E., Janet K Shim, Laura Mamo, Jennifer R. Fosket and Jennifer R. Fishman 2003 Biomedicalization: Technoscientific Transformations of Health, Illness and U.S. Biomedicine. American Sociological Review 68(2):161-94.
Davis, John 1977 People of the Mediterranean: An Essay in Comparative Social Anthropology. London: Routledge and Kegan Paul.
Dumit, Joseph 2003 Picturing Personhood: Brain Scans and Biomedical Identity. Princeton: Princeton University Press.
Dunant ,Sarah and Roy Porter. 1996 The Age of Anxiety. London: Virago Press.
Durlach, Jean and Michel Bara 2000 Le magnésium en biologie et en médicine. Cachan: Editions Médicales Internationales.
Ehrenberg, Alain 1998 La fatigue d’être soi dépression et société. Paris: O. Jacob
Feldman, Jamie 1995 Plague Doctors: Responding to AIDS in France and America. Westport, CT: Bergin and Garvey.
Gaines, Atwood D. 1982 Cultural Definitions, Behavior and the Person in American Psychiatry. In Cultural Conceptions of Mental Health and Therapy, Anthony Marsella and Geoffrey White, eds. Pp. 167-192. Dordrecht, the Netherlands: D. Reidel Publishing Company.
Gaines, Atwood D. 1992 From DSM I to III-R; Voices of Self, Mastery and the Other: A Cultural Constructivist Reading of U.S. Psychiatric Classification. Social Science and Medicine 35(1):3–24.
Gaines, Atwood D. and Paul E. Farmer 1986 Visible Saints: Social Cynosures and Dysphoria in the Mediterranean Tradition. Culture, Medicine and Psychiatry 10(4):295-330.
GlaxoSmithKline. Les Phobies Sociales: Anxiété Sociale Pathologique (free educational CD-ROM and written guide). n.d. Marly-le-Roi, France: GlaxoSmithKline
Goffman Erving 1963 Stigma: Notes on the Management of Spoiled Identity. New Jersey: Spectrum.
Gilmore, David 1982 Anthropology of the Mediterranean Area. Annual Review of Anthropology 11. Pp. 175–205. Palo Alto, CA: Annual Review Press.
Hacking, Ian 1999 The Social Construction of What? Cambridge: Harvard University Press.
Hale Nathan G. 1995 The Rise and Crisis of Psychoanalysis in the United States. New York: Oxford University Press.
Healy, David 1997 The Anti-Depressant Era. Cambridge: Harvard University Press.
Healy, David 2004 Shaping the Intimate: Influences on the Experience of Everyday Nerves. Social Studies of Science 34(2):219.
Helman, Cecil 1984 Culture, Health and Illness. Bristol, UK: Wright.
Hershell, Helena Jia 1992 Psychiatric Institutions: Rules and the Accommodation of Structure and Autonomy in France and the United States. In Ethnopsychiatry: the Cultural Construction of Professional and Folk Psychiatries. A.D. Gaines, ed. Albany, New York: State University of New York Press, 307–326.
Herzlich, Claudine and Janine Pierret 1987 Illness and Self in Society. E. Forster, transl. Baltimore: Johns Hopkins University Press.
Hinze, Susan W. 1999 Gender and the Body of Medicine, or at Least Some Body Parts: (Re)constructing the Prestige Hierarchy of Medical Specialties. The Sociological Quarterly 40(2):217–239.
Huret, Marie 2002 La revanche des timides. Couverture, L’Express jeudi, 22 août, 52
Illich, Ivan 1975 Medical Nemesis: The Expropriation of Health. London: Calder and Boyars.
Johnson, Thomas 1985 Consultation-Liaison Psychiatry: Medicine as Patient, Marginality as Practice. In Physicians of Western Medicine: Anthropological Approaches to Theory and Practice. Robert Hahn and Atwood Gaines, eds. Dordrecht ; Boston : D. Reidel Publishing Company, 350–375.
Kahn, Susan Martha. 2000 Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Durham: Duke University Press.
Kaufert Patricia A. 1998 Women, Resistance, and the Breast Cancer Movement. In Pragmatic Women and Body Politics, Margaret Lock and Patricia Kaufert, eds. Cambridge, UK: Cambridge University Press.
Kessler, Ronald C, Patricia A. Berglund, Olga Demler, Robert Jin, Kathleen R. Merikangas and Ellen E. Walters. 2005 Lifetime Prevalence and Age-of-onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry 62(6):593–602.
Koerner, Brendan I. 2002 Disorders Made to Order. Mother Jones (July/August), http://www.motherjones.com/news/feature/2002/07/disorders.htm.
Laplanche, Jean and Pontalis Jean-Bertrand 1973 The Language of Psychoanalysis. New York: W.W. Norton and Company.
Le Moigne, Phillippe 2002 La Dépendance aux médicaments psychotropes: Enquête auprès des usagers et des prescripteurs CESAMES, Paris (this is a report).
Légeron, Patrick 2005 Une efficacité douteuse. In Le livre noir de la psychanalyse. C. Meyer, ed. Paris: Éditions des Arènes.
Lloyd, Stephanie. (2006). The Clinical Clash over Social Phobia: The Americanization of French Experiences? Biosocieties 1(2):229–49.
Lock, Margaret 1993 Encounters with Aging: Mythologies of Menopause in Japan and North America. Berkeley: University of California Press.
Lock, Margaret, Kaufert Patricia A. 1998 Pragmatic Women and Body Politics. Cambridge, UK: Cambridge University Press.
Luhrmann, Tanya M. 2000 Of Two Minds: An Anthropologist Looks at American Psychiatry. New York: Vintage Books.
Meyer, Catherine 2005 Le Livre Noir de la Psychanalyse. Paris: Éditions des Arènes.
Miller Jacques-Alain 2006 L’anti-livre noir de la psychanalyse. Paris: Seuil.
Moynihan, Ray and Henry David 2006 The Fight Against Disease Mongering: Generating Knowledge for Action. Public Library of Science Medicine 3(4):1–4.
Ohayon Annick 1999 L’Impossible Rencontre: Psychologie et psychanalyse en France 1919–1969. Paris: La Découverte.
Payer, Lynn 1989 Medicine and Culture. New York: Penguin.
Pélissolo Antoine 2004 Plus de clartés sur les thérapies. Paris, Libération.
Pitt-Rivers, Julian, ed. 1963 Mediterranean Countrymen. Paris: Mouton.
Prescrire 2003 Point de vue de la Rédaction: Gare a la médicalisation pharmacologique de l’existence. Revue Prescrire 237(mars):169–71.
Rapee, Ronald M and Susan H. Spence. 2004 The Etiology of Social Phobia: Empirical Evidence and an Initial Model. Clinical Psychology Review 24:737–767.
Rapp, Rayna. 1999 Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America. New York: Routledge.
Shorter, Edward 1997 A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley & Sons.
Szasz, Thomas Stephen. 1970 Manufacture of Madness. New York: Dell.
Thomas, Gregory Matthew 2002 Post-Traumatic Nation: Medical Manifestations of Psychological Trauma in Interwar France. Thesis. University of California, Berkeley.
Turkle, Sherry 1978 Psychoanalytic Politics: Freud’s French Revolution. New York: Basic Books.
Vuckovic, Nancy 1999 Fast Relief: Buying Time with Medications. Medical Anthropology Quarterly 13(1):51–68.
Wilkinson, Iain. 1999 Where is the Novelty in our Current ’Age of Anxiety’? European Journal of Social Theory 2(4):445–67.
Young Allan 1995 The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton: Princeton University Press.
Zarifian Edouard 1996 Le prix du bien-être. Psychotropes et société. Paris: Éditions Odile Jacob.
Zola, Irving Kenneth 1972 Medicine as an Institution of Social Control. Sociological Review 20:487–504.
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Lloyd, S. Morals, Medicine and Change: Morality Brokers, Social Phobias, and French Psychiatry. Cult Med Psychiatry 32, 279–297 (2008). https://doi.org/10.1007/s11013-008-9092-4
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DOI: https://doi.org/10.1007/s11013-008-9092-4