The DSM is the only authoritative source for diagnostic definitions and criteria; it holds a special place in the eyes of physicians and psychiatrists around the world, especially those with relatively little training in psychology. The determinations within the DSM affect the prescriptions and, more importantly, the identities of millions of patients. The process by which such determinations are made therefore deserves careful scrutiny. Lane’s book explores this process of defining sickness, using the creation of “Social Anxiety Disorder” before the third edition of the DSM as a case study.

A psychiatrist named Robert Spitzer led the committee that authored the DSM-III. According to Lane, Spitzer’s goals had very little to do with ethics or the good of humanity. For Spitzer, the writing of the DSM-III was primarily a major opportunity to undermine the significance of psychoanalysis to modern psychology, replacing it with observable, quantifiable diagnostic criteria. Lane argues—successfully, I think—that the research behind these criteria is suspect, and that much of the definition of mental disorders came from neither ethical nor scientific reasoning.

In fact, many of the definitions in the DSM are scientifically ambiguous and blatantly unethical. According to Lane, the DSM-III’s conception of mental sickness arose primarily out of three things: first, Spitzer’s desire to make diagnosis a rule-based process such as those in the natural sciences; second, Spitzer’s personal value judgments about what behavior should be called normal; and third, the uniformly skewed incentives of his committee members.

Many of these researchers came into the committee with the primary goal of promoting their past research specialty (such as Oppositional Defiant Disorder) as a new disorder, in order to validate their years of hard work. Every single committee member had financial ties to U.S. drug corporations, who obviously wanted to define “sickness” to include as many Americans as possible. Furthermore, Spitzer hired these individuals largely under the condition that they would take part in his crusade against psychoanalysis.

Lane’s presentation of the process suggests that history is repeating itself. Scientists and even some psychiatrists have a tendency to see disequilibrium in the minds of their patients as a sickness—something independent of the lives these patients actually live. The best example of this phenomenon was what feminist writer Betty Friedan called “the problem that has no name,” the increasing depression and dissatisfaction of housewives as modern conveniences left them with less and less to accomplish. Instead of seeing that the discomfort and restlessness resulted from what the women saw as meaningless lives, the field of psychiatry viewed the “problem” through the lens of 1950s culture, and therefore prescribed tranquilizers as a solution.

Shyness makes the related charge that, due to the nature of the DSM, far too many doctors prescribe medication to psychological problems whose ultimate causes are inherent to the reality of patients’ lives. To merely prescribe Prozac to a person who hates their life is like sending a soldier with bullets lodged in his thigh back to the front lines with a bottle of morphine. Lane argues that the blindness of the DSM to contextual, psychoanalytical concerns, perhaps fatally, undermines its value as a diagnostic resource.

While Lane deserves great credit for the shocking and valuable research he presents, his own reasoning generally falls flat, because he depends on outdated and ridiculous humanist assumptions. Rather than trying to undermine and temper the haughty and preposterous claims of many influential neuropharmacologists, Lane’s arguments often attempt to drive a wedge between neuroscience and psychology. As is common of his humanist ilk, Lane apparently wants to see the human mind as more subject to metaphysics than to physics, and neuroscience offends that sensibility.

Lane’s annoying habit of using symbolic interpretations of random works of literature in his arguments illustrates the extent of his humanist bias. For example, at one point, Lane quotes Lewis Caroll’s Through the Looking Glass before launching into an interpretation of the novel. If we assume that Lane’s understanding is correct, the relevance of Through the Looking Glass is defined by the extent of Carroll’s experience and training as a psychologist. Because artists such as Carroll rarely know anything about the diverse topics to which their writings are applied, such arguments are almost always tremendous wastes of time and energy. Shyness is packed with such futile exercises.