Northwestern University Professor Christopher Lane
This interview is part of the exclusive serialization of Cured: The Memoir. Thank you for reading!
Although Chris Lane and I had both been teaching at Northwestern University for many years, we didn’t meet until I reached out to him after reading his amazing book Shyness: How Normal Behavior Became a Sickness (Yale University Press). Shyness documents the ways we’ve pathologized anxiety and other human behaviors. It had a tremendous impact on me and contributed greatly to how I wrote Pathological and Cured. It’s a must-read.
Shyness won the Prescrire Prize for Medical Writing (France); has been translated into six languages; and has been debated in media outlets, including the New York Times Book Review, Le Monde, and TLS to Scientific American, New England Journal of Medicine, and The Lancet. Based on the American Psychiatric Association’s unpublished papers on DSM-III and in-depth interviews with leading psychiatrists involved, including Robert Spitzer, Shyness concerns the shockingly haphazard groupthink behind American psychiatry’s pathologization of normal mental life and ordinary behaviors, including seven new anxiety disorders and 105 other additions to the influential diagnostic manual in 1980.
Chris taught Victorian studies, medical humanities, and the history of medicine at Northwestern until his retirement in 2022. A former Guggenheim fellow with a previous appointment at Emory University, he specializes in 19th- and 20th-century psychology, psychiatry, and intellectual history. He held Northwestern’s Pearce Miller Research Professorship and remains a member of the university’s Center for Bioethics and Medical Humanities in the Feinberg School of Medicine.
As a journalist and author, Chris has written about psychiatric and medical side effects at Psychology Today for fourteen years. He’s the author of numerous essays and six books on the history of psychology and psychiatry.
There’s so much wisdom in this interview. Chris is beyond brilliant and one of the foremost thinkers on the history and sociology of medicine and mental health. Like Shyness, this interview is a must-read.
What does recovery from psychiatric illness mean to you?
We don’t spend enough time talking about recovery in mental health, and not just in psychiatry. I’m curious why and think it’s partly because diagnoses are commonly described as “life-long” and “disease-based,” implying years before even the smallest reduction in symptoms. That’s completely misleading, of course, but it ends up making the focus “treatment” rather than “recovery.”
For the DSM and its practitioners, recovery implies merely a reversal of the symptoms and criteria that went into forming a diagnosis. Clearly, that doesn’t go far enough, or tell us anything about the internal changes involved, not least when there are pressing questions about what’s in the DSM in the first place!
But the idea is that symptoms and behaviors that have caused intense, disabling distress no longer do so. That treatment—whether talk therapy or/and medication—has “neutralized” the distress to a point where it becomes bearable, allowing reflection and discussion, but also action. I think good treatment expands but also puts us in touch with the full and open-ended possibility of recovery—the points of difficulty we can recover from—so that we aren’t at the mercy of symptoms, but instead feel we have the wherewithal to face reality and tackle whatever parts of it are causing unhappiness and distress.
What do you think is the biggest misconception about recovery?
An infamous phrase in Freud’s late work refers to the conversion of “hysterical misery” into “common unhappiness.” The idea has drawn lots of commentary, but mostly it’s to point out that much of life could be considered “incurable” — that there’s no “cure” for being alive, in the sense of living without some amount of pain and suffering. What that suggests is that recovery is not in itself a state of perfection or complete resolution, but rather a way of facing daily life with its inevitable ups and downs—just without the distraction of symptoms sending our attention elsewhere. That doesn’t sound half as exciting or glamorous, I admit, but victory over any symptom, to the point where it stops causing pain or distress, is itself a wonderful thing—truly life-affirming in its way. I’m showing a bias toward psychotherapy, but I’ve always been fascinated by the truism that minute adjustments in thinking or perception can have massive, life-altering consequences in daily life. A chance response or throwaway remark may be all that it takes. Once one sees a situation or relationship with fresh eyes, it may be impossible to return to one’s former misperception—and that alone can be “enough,” in the sense of kickstarting a whole set of changes that lead to a strongly invigorated sense of wisdom and empowerment.
In your book Shyness: How Normal Behavior Became a Sickness, you give us an in-depth look at psychiatric diagnoses characterized by anxiety and phobias. You talk about recovery as a possibility. You wrote it in 2007. Was that the guiding philosophy at the time? Have you noticed a shift in the prognoses of those diagnosed with anxiety and phobias since then?
It was indeed part of the guiding philosophy at the time, and I still think recovery from anxiety and phobias is very much possible and desirable — that both conditions are debilitating and, ultimately, self-defeating. Both alert us to signals needing attention and, if we listen, to life changes we may be resisting, but it’s important to dwell on their root causes, to ask what purpose they’re serving even in derailing us and our plans. I’ve followed the rise (and partial fall) of CBT and DBT as anxiety treatments with interest, including because I still find both shallow and inadequate: they empower the ego, build it up with excitement about an anxiety-free future, but the excitement is generally short-lived, because the root causes are so often unexamined. I’m not saying these therapies have no role—they can pave the way for further discovery. Recovery may also need to pull on a variety of treatment methods to help one through. Which is fine, of course—whatever works.
SSRIs and benzodiazepines regrettably are still widely prescribed for anxiety, often far longer than FDA guidelines support, and both can affect patients with a slew of side effects, from acute and protracted withdrawal syndromes to PSSD (Post-SSRI Sexual Dysfunction) and emotional numbing. In the case of benzos, which are also dependency-forming, when faced with a fear of tapered medication, ultimately to zero, some will opt to stay on the drugs. In those cases, beta-blockers may be an important way to “step down” and so help them start their benzo or SSRI taper. With dependency-forming drugs, purism isn’t an option.
You interviewed Robert Spitzer, one of the men who shaped the way we think about psychiatric diagnoses, i.e., as biological, lifelong conditions. In Shyness, you don’t mention having discussed recovery with him, but did you? He was adamant that people couldn’t recover from disorders characterized by psychosis. Did you get a sense that he felt differently about neuroses?
Sadly no, we did not discuss recovery in the interview—I very much wish we had. I had just an hour with him, to go through piles of just-read DSM papers on the formalization of the anxiety disorders and how DSM-III ended up redefining them from short-term “reactions” into prolonged “disorders.” There was concern at the time that DSM-5 would end up pathologizing a lot more conditions, another point of focus in the interview. To this day, it remains profoundly disorienting to have heard Spitzer discuss the theoretical basis for approving “Generalized Anxiety Disorder”—“We came up with that name after we had anxiety neurosis in DSM-II and if you had panic there had to be something that was left over”—and then see psychiatrists and researchers invoke it as if it had a serious etiology and diagnostic rationale.
Your question about psychosis is very interesting, in that as DSM Chair Spitzer kept trying to formalize so-called “schizoid” and “schizotypal” disorders, in ways that would narrow the gap between psychosis and neurosis by offering more intermediary distinctions between them. At one point in the DSM-III discussions, before he was out-voted, he was keen on “schizoid personality disorder” (already in DSM-I and -II) serving as an umbrella term for Jungians pressing for the inclusion of “introverted personality disorder.” It didn’t happen, and we got “Social Anxiety Disorder” and “Avoidant Personality Disorder” instead. But the net effect of DSM-III and -IV was to render neuroses much closer in treatment and duration to the psychoses, to ratchet up a sense of their shared seriousness as conditions, but also, as you imply, to postpone discussion about recovery from them as somehow “premature” and trivializing.
What about the future of mental health care makes you most hopeful?
Part of the fallout from the “biological turn” in psychiatry involves a broad-based re-examination of assumptions about “precision medicine,” “targeted treatment,” and “evidenced-based diagnoses,” many of which—your own books show well—are not just inaccurate and untruthful, but actively misleading. They can quickly lead to multiple diagnoses and polypharmacy, in ways that not just hamper recovery, but make recovery from one’s meds, weirdly and paradoxically, a precondition for improved mental health. In my books and journalism, I’m pleased to play a role, however small, in this re-examination, especially when it involves investigating all such claims, their premises, and frequently poor outcomes. With its focus on data and evidence, the dynamism of the critique itself gives me the most hope.
If there was one thing you could say to people who are struggling with psychiatric illness and mental and emotional distress, what would it be?
I love the simple message of hope and support behind the song “Don’t Give Up,” by Peter Gabriel and Kate Bush. It came out in 1986, when I was at college and finally had come out myself after several years of confusion. I love the simple call-and-refrain parts of the song, where the man talks openly of feeling down, almost defeated, as if his best years were behind him, and the woman gives perspective and reassurance, to strengthen resolve and a sense that it will all work out, even if far from planned. It’s not at all a song about “pulling oneself together”—it’s a song, rather, about fearing that one is coming apart, but also realizing that such an outcome isn’t inevitable. That with patience and self-compassion a different ending is possible. Despite it all, I still hold to that hope. There is life in ridding oneself of illusions—including psychiatric ones. And recovery in self-acceptance, however humble or elemental.