Misconstrual of the month: naked librarians and involving buns

There must be a copy editor job vacancy at the office of Library review. How else to explain the driving sleet of slips, flubs, gaffes, muffs, typos, punctuation misfirings, and hair-raising solecisms in an article that appears in the most recent issue? With an effusive application of that endearing élan and derring-do of the "librarians rule" school to my professional bailiwick, two South Africans work up a mighty sweat as they trample hard over the conventions of English prose and punctuation in their contribution, The naked librarian: health librarians in the modern era [1].

Little more than a collection of boilerplate truisms and trite exhortations, this essay is a roll-up-your-sleeves call to action, a perky if not always entirely coherent ramble through the usual library science banalities, starting with that most hackneyed of clichés from the last couple of decades. Care to guess what it is? A phrase so familiar that we now hear it being solemnly intoned by bakers, candlestick makers and undertakers: "The only constant is change."

That, of course, is the famous quotation from Isaac Asimov. Nothing to misconstrue there. But back to our scantily attired article. For the next five pages we are marched out into the cold courtyard and put through a vigorous drill of platitudes and commonplaces:

Health information professionals have to envision the future and plan from there. We have to get rid of outdated ideas and revolutionize our way of thinking. Shrugging off the old coat of the stereotypical librarian, we must start off in our envisioned future, as 'naked librarians' turning into brand new and constantly evolving [sic].

After a laundry list of the challenges and obstacles, most of them "huge," facing health libraries in the "modern era," we are exhorted to "use the digital age" and "proactively anticipate the future implications." Once we have done all that "we will be educated in the latest technical lingo and sound just like computer scientists." (Now I know why I became a librarian.) But look at what else our naked chefs are cooking up: "One of the less mined (as yet) areas for us to explore and conquer, is how to make raw data available to everyone." Not even half-baked? Instead of worrying about a post-Google world we are exhorted in a memorably mixed metaphor to "step up to the plate, accept these challenges and go with the flow."

Now perhaps I'm being overly critical when I say that we librarians have really had enough of this. As Candy Hillenbrand wrote in her take on librarianship in the 21st century, "Desperate to slough off the old limiting stereotypes of the stern bespectacled cardigan-clad shushing controller of books, librarians are clamouring to convince themselves, each other and the wider community that there is far more to the humble librarian than meets the casual eye" [2]. Are we so hankering for attention that only disrobing ourselves in public will suffice?

Just what is this fixation on ripping off our tweedy garments and emerging unclad into the light, like Blake's Glad Day? Is some kind of mass psychosis making us want to run through the streets in puris naturalibus? I saw a sign the other day advertising evening classes in pole dancing. Is this part of some larger social pathology? Or have librarians been infected by the myriads of spores invisibly rising from the piles of discarded print materials in our denuded workplaces? What next? When the clothes are gone should we move on to trichotillomania? Please, let us put a stop to this depilatory process, expose the abuse, and doff this tired metaphor once and for all.

But back to the rapidly unravelling Steyn and de Wee. In the last section of their article they offer what I'm sure is meant to be an edifying quote from a newspaper column by Shelley Howells [3] that appeared five years ago in the New Zealand Herald. All very cute and fluffy in a condescending way, Howells' piece is an example of what has become a standard mass-media treatment of librarians. We are secret nonconformists, wise as serpents and clever as foxes. We are wily, rebellious and twee — not a stitch left of our old encumbrances. Here is Howells' opening sentence, as quoted by Steyn and de Wee:

Librarians rock. That reputation that they have involving buns, sensible shoes and shushing people is merely a cunning ruse, developed over centuries, to conceal their real lives as radicals, subversives and providers of extreme helpfulness.

At this point, having ploughed my way dutifully through the entire article, I had become accustomed to its many textual difficulties. I was beginning to understand the challenges faced by the squinting exegetes of the Dead Sea Scrolls. For here I was, rubbing my eyes in confusion. There was something very wrong with the passage. How to figure out the thats? What exactly were those buns? And how did involving buns relate to naked librarians? Flushed with curiosity, I decided to check the original newspaper article, hoping its text had not disappeared into the Internet Gehenna of 404 not-found error pages. I was lucky this time and found it. Here is what Shelley Howells actually wrote:

Librarians rock. That reputation they have involving buns, sensible shoes and shushing people is merely a cunning ruse, developed over centuries, to conceal their real lives as radicals, subversives and providers of extreme helpfulness.

The sharp-eyed among us will note immediately that in the original text there is no that after reputation. Oh what a difference one word can make! When I first read the sentence, Steyn and de Wee's slipshod insertion of the extraneous that in their quotation had thrown me off completely. It put a spanner in the syntactical works, so to speak, leading this innocent reader to think librarians' buns were being described in the same way as their shoes — with an adjective. The extra that altered the sentence's focus and led me to think impure thoughts. Was involving a typo for involuted? What would such buns look like? But then I was brought up short by the non-tensed verb phrase shushing people. It didn't seem to fit with the two previous attributes which I thought I was being told librarians possessed.

My apologies to those of you who aren't grammar buffs, but I have to get technical here. After seeng Howell's original text I was finally able to parse the sentence to my satisfaction. Buns is the object of the gerund involving, which may also be described as a non-tensed verb phrase with -ing participle. Buns is not the object of the verb have. Involving is the first word of a participial defining relative clause which tells us that which the reputation of librarians involves. It is not a participial adjective, as in these examples: dangling participles, burning buns, flaming idiots. For more information on all things participial, see the Cambridge grammar of English [4].

Confused by now? I certainly was. Dangled enough participles for today? I'm ready to hit the showers.

But Steyn and de Wee aren't finished yet. Feel the goosebumps rise as you thrill to their final rallying cry: "Let us shrug off our 'clothes' and get into the new gear of the future! ... From naked librarian to formidable information force."

Oh dear. It's -25 outside and I don't want to dangle for long. This radical subversive and provider of extreme helpfulness would much rather stay indoors and fully clothed, thank you.

References:

1. Steyn C, de Wee JA. The naked librarian: health librarians in the modern era. Library review. 2007;56(9):797-802.

2. Hillenbrand C. Librarianship in the 21st century - crisis or transformation? Australian library journal [serial on the Internet]. 2005 [cited 2008 Mar 4];54(2):[about 5 p.]. Available from: http://www.alia.org.au/publishing/alj/54.2/full.text/hillenbrand.html

3. Howells S. The secret life of tattooed and belly-dancing librarians. New Zealand herald [serial on the Internet]. 2003 Nov 28 [cited 2008 Mar 4]. Available from: http://www.nzherald.co.nz/section/story.cfm?c_id=5&objectid=3536464

4. Carter M, McCarthy M. Cambridge grammar of English: a comprehensive guide. Cambridge: Cambridge University Press; 2006.

Missing the obvious, Part 2: slapdash database grocery lists masquerading as articles in medical journals

Six months after a "research letter" entitled World Databases of Summaries of Articles in the Biomedical Fields was published by Falagas et al. in the Archives of Internal Medicine, a politely-worded demolition of that pretentious excresence has appeared in the same journal's issue of 14 Jan 2008. I vented much less diplomatically about Falagas et al. last July, shortly after it had been published. What was it that raised my hackles and got my goat? Without even nodding in the direction of a library, Dr. Falagas and his team (it actually took more than one person?) sat around a computer one day, scribbled a straggly list of a few databases "based on our previous knowledge" and a few they happened to come across in Google, and by some unattested miracle got their sophomoric effort published in one of the world's most important medical journals. Imagine Will Ferrell and Jon Heder doffing their figure skates and heading for the Moulin Rouge.

I groused at some length about how this inept and unscientific approach not only missed the obvious but apparently escaped any intelligent peer review. I made reference to the well-known Murphy's Law definition of an expert as a person who avoids the small errors while sweeping on to the grand fallacy. Unfortunately, in Falagas' farrago even the small errors were hopelessly compounded, and he swept irreversibly on to something approaching Grand Guignol.

With their letter subtitled "Getting the whole picture," Dr. Isobel C. Hoskins of CAB International and her two co-authors shine some welcome light on this Carnaval des spectres. With laudable courtesy and restraint — something I wouldn't be capable of under any circumstances — they list "some important omissions" from Falagas' shabby compendium of health databases: Global Health, CINAHL and PsycINFO, to name a few. They tactfully correct one of the grossest errors: "Readers should also be aware that the published list of additional databases includes hosts for databases such as Dialog and EBSCO rather than the databases themselves." As if his dilettantish approach wasn't bad enough, even Falagas' mistakes have errors. His misbegotten enumeration of database hosts omits OVID, for example. Hoskins et al. conclude by finally attempting the right thing and pointing to a health library website. They could have done better than supply a list of public health databases (CINAHL is not included), but in this weak suggestion Hoskins et al. are at least providing a hint to the readers of the Archives that it's all right to go beyond the input of colleagues and the Google prompt when looking for medical resources on the web.

In his two-paragraph reply, festooned with no less than four self-referential footnotes, Dr. Falagas welcomes the valuable input of "our colleagues." In a tone approaching that of a pronouncement from the Holy See he asserts his strong belief "that the availability of lists of databases ... is useful to researchers, clinicians, and other health care professionals." And he's not just whistling Gaieté parisienne. He goes on to puff more of his grocery lists, all of them published in major medical journals. And there are others he hasn't cited. This bloke pumps out more research than kicks at a cancan show (I count 298 PubMed citations to date). An extraordinary accomplishment considering that he seems not to have do-si-doed across the threshold of a library in his entire career. My question is: why doesn't he leave the choreography of knowledge-based information resources to those who know how to dance?

Before I get my petticoats into a real knot, I will briefly mention another of Falagas et al's forays into the world of databases and search engines — this time in a paper unaccountably published in FASEB Journal — comparing PubMed, Scopus, Web of Science, and Google Scholar. Did anyone at FASEB edit this article or even look at the contents? A reading of the first clause of its first sentence is not encouraging: "The development along with the spread of the World Wide Web (WWW) represents an informational [sic] revolution ..." There is much more where this comes from as the article develops and spreads. "In conclusion, scientific databases of biomedical information are frequently used by both clinicians and researches [sic]. In this article, we compared the content and various practical aspects in [sic] the utility of the main databases of biomedical scientific information. We found that PubMed remains an important source for clinicians and researchers ..." And on they go in this manner for five densely printed pages without a single original thought, spinning in all directions, legs lifted and twirling. Zoot alors! Kick. Kick. Kick.

A new wheeze tease: tobacco ads return to Canadian magazines

I should have been better prepared to have my flabber gasted, but I don't know what confounded me the most: learning that cigarettes are once again being peddled in Canadian magazines or the jarring use of the word "anyways" in the Canadian Medical Association Journal report that brought this depressing news to my attention [1]. Of course, the smelly reality of tobacco hawking gets a higher ranking in the shocked-and-appalled section of my catalogue of outrage. Vocabulary concerns aside, I am forced to reflect on the putrid fact that, like zot skunque de terriblay odeur, tobacco ads are back. I feel like poor Penelope Pussycat, squirming madly to escape the foul embrace of a love-struck Pepé Le Pew. L'amour toujours.

Having squandered my youth on the "fuliginous moyste vapours which trouble the harte and strike up into the head" [2], I can say I was duly formed (and possibly stunted) by cigarette culture. Surrounded by the floating signifiers of its advertising — and the choking fumes of its products — I coughed my way through the cloudy expanses of Marlboro country, trying every filter, flavour and flip-top box on offer. Now in my winded late middle age I can breathe a sigh of relief that I parted ways with the sacred herb years ago, and that my loved ones and I are no longer subjected to the throaty blandishments of cigarette commercials in smoke-filled rooms. At least, that's what I thought until I received this week's My NCBI update with the latest from CMAJ.

Le mew? Le purrrrr? Non, c'est le terriblay skunque fatale!
The otherwise grammatical CMAJ article informs us that, without fanfare and with little controversy, one of the Canadian tobacco industry's "big 3," JTI-Macdonald Corp. (the other two are Imperial Tobacco Canada Ltd. and Rothmans, Benson and Hedges Inc.) recently opened a new front in the ongoing tar wars. The makers of my former favourite wheeze tease are launching new products by advertising them in entertainment magazines such as Montreal's Mirror and Vancouver's Georgia Straight, and in the less-entertaining Canuck edition of Time. Yes, Canadian mags are rolling their own again. The smell of dollar bills and tobacco leaves has always made a good blend. Roger Collier, the journalist responsible for the CMAJ article, first reported last December on this new phase of tobacco shilling in the Ottawa Citizen.

I read with a creeping sense of unease about the new Mirage brand of smokes now being offered for our delight and delectation. Armed with their Exocets of nicotine and carbon monoxide, these new-fangled cigarettes are supposedly scented with vanilla so that they emit a "less lingering tobacco smell in an enclosed area." Through one of those grotesque coinages of the advertising industry this celebrated feature is termed "unique Less Smoke Smell (LSS) Technology." The only thing I smell here is a skunk. I submit that LSS will turn out to be about as effective at dispersing stinky cigarette smoke as my past practice of spraying Lysol and furiously swiping an open palm back and forth in the boys' room. You might as well try dousing Pepé Le Pew with Chanel No. 5.

Scent-imental over you
Way back in the wild and primitive days of my shaggy-haired youth, when Keith Richards could walk — and Elton John could pass for — straight, I also made liberal use of incense in my bedroom to hide the stench of my two smoking habits, and, like Elton, fooling nobody. How I and my friends must have reeked at our happenings, sit-ins, be-ins, and in-ins, daubed with patchouli oil, chewing Chicklets, and flourishing our trendy Gauloises. I confess to a certain nostalgia for that time. We would-be intellectuals frequented smoky coffee shops to gesticulate with glowing ash, listen to sitar music and talk about poetry, pointillism and proletarian revolution. Nowadays, it seems young people frequent fume-free coffee shops to listen to their mobile devices and talk about — coffee.

An aside. In a recent Lancet article [3] on the social commentary implicit in Dickens' Little Dorrit, James Horton too betrays a certain nostalgia for pipe and plume:

Little Dorrit is also Dickens' striking tribute to tobacco, his great smoking novel. From the opening pages, tobacco is rolled, lit, inhaled, smoked down to the fingers, stuffed into English and Eastern pipes, presented as cigars, traded in "snug" businesses, and used as refreshment and as an idle accompaniment to long journeys. Smoking, or rather ceasing to smoke, is the one means by which [Amy Dorrit's] father signals, even celebrates, the freedom of his new life after leaving the Marshalsea [debtor's prison].

Who scent you?
But that was then, and this is now. Physicians for a Smoke-Free Canada would like to stick it to Japan Tobacco and have called upon Health Canada and Health Minister Tony Clement to end JTI's advertising campaign, claiming that it is misleading and contravenes the 1997 Tobacco Act. In this country it is against the law to promote tobacco products by means "that are likely to create an erroneous impression about the characteristics, health effects or health hazards of the tobacco product or its emissions." Erroneous doesn't even begin to describe the breathtaking mendacity of the Mirage campaign. Tobacco ads are so offensive to good taste and common sense, they should be banned for that reason alone. Kel terriblay odeur!

Past perfumance
In June of last year the Supreme Court of Canada upheld the legal restrictions on tobacco advertising, dismissing an expensive, decade-long court battle which argued that such laws violate the right to freedom of expression. However, the court did admit that there is still a window of legitimate advertising in this country, through which the tobacco companies have now nimbly climbed with their glossy adverts and website bromides, after a long silence. For a decade big Canadian tobacco refrained from huckstering in mass-market publications, arguing that the restrictions were so limiting as to constitute a ban. Until 2003 they confined their efforts to "lifestyle" marketing through sponsorship of music festivals, car races and the like, until that route was closed off when a general prohibition on such stealth advertising came into effect. The Tobacco Act actually allows cigarette promotions that are "information advertising or brand-preference advertising," directed at adults in various ways, in "a publication that has an adult readership of not less than eighty-five per cent." Now that the Supreme Court has settled matters, the tobacco companies seem to have decided to exploit whatever opportunities are left to them. Hence the magazine advertising campaign. The three mags mentioned in the CMAJ article have a relatively large circulation. I'm not sure how it is determined that a particular publication's audience consists mostly of adults; although there would probably be general agreement that Time is not exactly at the top of a teenager's list of must-reads. Regardless, there is no doubt that tobacco's new ad offensive will increase the likelihood that kids will start to smoke [4] or (eww!) chew [5]. We can expect more clever and costly promo campaigns in the future. Come viz me to ze Cats-bah!

The ultimate target. "Eet ees possible to be too attractive, no?"
In the past ten years that the Tobacco Act has been in force, smoking prevalence in Canada has dropped from about 30% to 18% for Canadians 15 years of age and older. That's far too many clean sets of adolescent lungs to be endured. Air pollution can't finish the job properly. Something has to be done. Perhaps LSS "technology" will be the prime coolness factor, the lure that brings more lips to butts. As the insidious infiltration of tobacco advertising continues (see my post of 30 Dec 2007) my six young nephews are a pretty easy target. Alert to every nano-variation of current coolness, they have been firmly indoctrinated in the principles of our feckless, thoughtless, throw-away society. Critical thinking is still a great effort, so they prefer to let media dictate their needs. Like many males their age they are stolid, taciturn, twitchy with misfiring hormones, occasionally surly, mostly funny, optimistic, absurdly affectionate, and hopelessly normal. Their heads full of turbid, TV-fed fantasies of sex, slugs and pelf, they are paradigmatically unaware of the civilizing effects of etiquette, self-discipline and soap — I love them dearly. The three oldest are smokers, the other three probably will stay tobacco-free. But their luck so far in avoiding those nicotine-fuelled Exocets will start to run out as more ads for Camel, Craven A and Mirage start popping up like love-sick skunks around them. Whether for smoking or expectorating, tobacco products are ultimately designed for and promoted to youth. That's because adult users have the unfortunate habit of dying off. Here's hoping that as a member of WHO'S Framework Convention on Tobacco Control, Canada will follow Australia's example and ban all tobacco product peddling by 2010. Otherwise we'll all be singing Louvre come back to me.

For those who follow this sort of thing, over at the Scientific Misconduct Blog there is an interesting post on another kind of questionable magazine advertising, this time in the venerable British Medical Journal. In the 16 Feb 2008 issue 88.4% of ads are by pharmaceutical companies. Kel terriblay odeur, indeed.

Zugszwang
Now that they have begun to deploy their substantial forces, CMAJ's report concludes, keeping Canadian tobacco companies out of the ad game won't be easy. Richard Pollay, a University of British Columbia marketing professor who has followed tobacco marketing for twenty years, provides the closing remark: "The industry is endlessly creative, not only adapting to new legislation or changing public sentiment, but anticipating them. They're playing chess when everyone else is playing checkers." The next move is up to us.

Chess is as elaborate a waste of human intelligence as you can find outside an advertising agency. ~ Raymond Chandler



References:

1. Collier R. Cigarette ads return to Canadian magazines. CMAJ. 2008 Feb 12;178(4):384-5. PMID: 18268258

2. Gratarolo G, Newton T. A direction for the health of magistrates and studentes, namely suche as bee in their consistent age, or neere thereunto: drawen as well out of sundry good and commendable authours, as also upon reason and faithfull experience otherwise certaynely grounded. London: Imprinted by William How for Abraham Veale; 1574

3. Horton R. The resistance of Little Dorrit. Lancet. 2008 Feb 9;371(9611):468-9. PMID: 18271080

4. Lovato C, Linn G, Stead LF, Best A. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003439. DOI: 10.1002/14651858.CD003439

5. Morrison MA, Krugman DM, Park P. Under the radar: smokeless tobacco advertising in magazines with substantial youth readership. Am J Public Health. 2008 Jan 30. PMID: 17600263

Are shy people mentally ill?: the DSM and SAD

... because I'm good enough, smart enough, and — doggone it — people like me! ~ Stuart Smalley

I was born the year they first published the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its fourth edition as DSM-IV. I was a shy little boy. In fact, I was so shy, instead of wishing the ground would open up and swallow me, I dug my own little foxhole and crouched there for most of my childhood. Little did I know that the majestic architects of the DSM's careful categories and checklists would some day cast concerned looks at trembling little me in my hiding place and see another instance of a treatable social anxiety disorder. Nor could I have imagined how one day pharmaceutical companies would promote the idea that things like diffidence and embarrassment are ameliorable through drug therapy, that by swallowing a little green and white pill I could feel as if I had just aced the Endtime and placed my conquering toe upon the Mount of Olives.

What pill would they prescribe for the timid and empty-headed Georgiana Podsnap of Our Mutual Friend, who is so painfully shy she squeals like a panicky toddler at the prospect of being introduced to strangers?

Oh there's Ma speaking to the man at the piano! Oh there's Ma going up to somebody! Oh I know she's going to bring him to me! Oh please don't, please don't, please don't! Oh keep away, keep away, keep away!' These pious ejaculations Miss Podsnap uttered with her eyes closed, and her head leaning back against the wall. ... 'Oh there's Ma being awful with somebody with a glass in his eye! Oh I know she's going to bring him here! Oh don't bring him, don't bring him! Oh he'll be my partner with his glass in his eye! Oh what shall I do!' This time Georgiana accompanied her ejaculations with taps of her feet upon the floor, and was altogether in quite a desperate condition. (Charles Dickens, Our Mutual Friend, Chapt. 11, Podsnappery)

What about the terribly bashful Edward Ferrars in Sense and Sensibility, with his awkward silences and stiff politesse? What if he were popping Zoloft to make it through high tea with his formidable relations?

Edward Ferrars was not recommended to their good opinion by any peculiar graces of person or address. He was not handsome, and his manners required intimacy to make them pleasing. He was too diffident to do justice to himself; but when his natural shyness was overcome, his behaviour gave every indication of an open, affectionate heart. His understanding was good, and his education had given it solid improvement. But he was neither fitted by abilities nor disposition to answer the wishes of his mother and sister, who longed to see him distinguished - as - they hardly knew what. They wanted him to make a fine figure in the world in some manner or other. His mother wished to interest him in political concerns, to get him into parliament, or to see him connected with some of the great men of the day. Mrs. John Dashwood wished it likewise; but in the mean while, till one of these superior blessings could be attained, it would have quieted her ambition to see him driving a barouche. But Edward had no turn for great men or barouches. All his wishes centred in domestic comfort and the quiet of private life. Fortunately he had a younger brother who was more promising. (Jane Austen, Sense and Sensibility, Chapt. 3)

Fewer Eeyores, more Tiggers

Would we say that Georgiana and Edward, with all their social faults, were mentally ill and in need of medication? For those of us who have no turn for great men or barouches — who would rather stay home with the cat and The Cask of Amontillado than kiss cheeks at a cocktail party — our shyness may be limiting at times. It may be, as some say, merely egotism out of its depth; but it doesn't feel like a disorder. It's more like the way being myopic keeps one from taking up skeet shooting, or being dyslexic makes reading The Faerie Queene an exercise in futility. Life goes on, even if you're not a hotshot Spenser scholar.

Like many other normal human imperfections — stretch marks, baldness, flat feet — shyness is a fact of life you accept, if not embrace. Just as there are many bumptious bigwigs conquering the world on white horses and donning their crowns of laurel, there are also all the little shy people who are modestly content to pluck their bouquets of wallflowers and violets. Of course, introversion can occasionally get in the way of things; but we introverts have our various means of coping: bathroom mirror self-assertion, transcendental meditation, unlisted numbers, pimple cream, tequila.

But it appears that some DSMmers out there would claim I was mentally ill until, somewhere in the dirty bottom of the 1970s, I left my mirror, emerged into the sunshine, and realized that — doggone it — people liked me. Eeyore had turned into Tigger.


Toastmasters or Paxil?

Brian Cox holds a Canada Research Chair in mood and anxiety disorders at the University of Manitoba, so he is probably as qualified as anyone to comment on the health of the timid and insecure. In his review of Christopher Lane's new book, Shyness: how normal behavior became a sickness [1], which appeared in the January 31 issue of the NEJM [2], Cox agrees with Lane that psychiatrists should stop pathologizing and medicating shy children:

I find it interesting that the term "social phobia" has increasingly been replaced by the term "social anxiety disorder" in the official nomenclature. I don't believe that this is purely coincidental. Rather, it seems to me that if a general physician sees someone with a social phobia, the physician may recommend that the patient see a psychologist for behavior therapy, participate in Toastmasters, or use another self-help resource. However, if the same person receives a diagnosis of social anxiety disorder, a term that sounds far more serious, the physician might recommend more aggressive medical attention such as pharmacotherapy.

Shyness is not a "sickness" or a psychopathology, argues Cox, who conducted a study [3] a few years ago which found that many with extreme childhood shyness didn't meet the criteria to be diagnosed with an anxiety or mood disorder. Conversely, half the adults with severe social phobia did not view themselves as very shy when growing up. In his NEJM review, Cox states his conviction that it is important not to view shyness in young people as a form of mental disease requiring medical intervention, thereby potentially damaging their self-esteem and self-confidence. In other words, the kids are all right.

"Is she just shy? Or is it Social Anxiety Disorder?" (Advertisement for Zoloft in The American Journal of Psychiatry, August 2003)

The day I ran across Cox's book review I happened to be reading the 6 December 2007 New York Review of Books, which contains a beautifully written article, Talking back to Prozac [4], by the irreverent Frederick Crews, Professor Emeritus of English, UC Berkeley, and author of The Pooh perplex. Crews discusses three books that are critical of the mental health establishment and its relations with Big Pharma, one of them being Lane's Shyness. Also reviewed are Horwitz and Wakefield's The loss of sadness [5], and the release in paperback of David Healy's well known Let them eat Prozac [6], first published in 2004.

Crews begins with a fascinating anecdote about the 2002 appearance of star football player Ricky Williams on The Oprah Winfry Show. The brawny athlete went before the cameras to spill in a major way. He revealed that he suffered from social anxiety syndrome. Very touching. What didn't show up in the credits, however, was that Williams was a paid shill for Glaxo-SmithKline — not to do anything so flagrant as to tout its own product, Paxil, but simply to do a little "condition branding" by persuading Oprah's gullible glued eyeballs to believe that being "a shy person" could actually be a disorder requiring antidepressant medication.

Crews launches into an acerbic critique of the happy-drug industry. His verdict: "[O]ne thing is certain: the antidepressant makers have exploited our gullibility, obfuscated known risks, and treated the victims of their recklessness with contempt." As for the mental health industry, Crews wants a DSM that is "scientifically respectable; its users, instead of regarding disadvantaged classes as infested with mental illness, will gain an appreciation of socioeconomic reasons for unhappiness; and a brake will be placed on the expensive middle-class hypochondria that the drug companies have so assiduously encouraged and exploited."

These three books point us, as Crews asserts, "toward some uncomfortable insights about American psychiatry and its role within a far from rational health care system." He goes on to suggest the deeper significance of psychiatry's inability to settle on a discrete list of disorders that can remain impervious to fads and fashions. In a perfect storm of hypocrisy, for bureaucratized psychological treatment, and for the pharmaceutical industry that is now deeply enmeshed in it, confusion has its uses.

Now, I understand that there are some who suffer from debilitating fear of social situations and who may need to seek medical help, including drugs that moderate their symptoms. However, the tendency towards untrammelled use of expensive glamour drugs to medicate away what is simply an aspect of the human condition — that looks like the devil's bargain.

Long before Ricky Williams made his public confession on Oprah, an article appeared in The New York Times which made mention of Williams' "shyness syndrome," adding interesting details like the fact that he kept his helmet on during rookie-year media interviews. No indication yet of the money flowing from the stealth marketing Paxil pushers into the football player's bank account. But we are offered this shrewd comment: "[I]t is much easier to turn on the spigots of empathy and attention these days when you can cite a diagnosed imbalance in brain chemistry rather than an eccentricity, a character flaw or an economic disadvantage." Much easier as well to market your designer drug. Successfully hyped by socially anxious celebrities like Williams, Donny Osmond and David Beckham, social anxiety disorder has become a widely recognized "condition." Those who have the money can now buy happiness. Shyness is for losers.

The company accountant is shy and retiring. He's shy a quarter of a million dollars. That's why he's retiring. ~ Milton Berle

References:

1. Lane C. Shyness: how normal behavior became a sickness. New Haven: Yale University Press; 2007.

2. Cox BJ. Shyness: how normal behavior became a sickness [book review]. N Engl J Med. 2008 Jan 31;358(5):539-540.

3. Cox BJ, MacPherson PS, Enns MW. Psychiatric correlates of childhood shyness in a nationally representative sample. Behav Res Ther. 2005 Aug;43(8):1019-27. PMID: 15967173

4. Crews F. Talking back to Prozac. The New York Review of Books. 2008 Dec 6;54(19):10-14.

5. Horwitz AV, Wakefield JC. The loss of sadness: how psychiatry transformed normal sorrow into depressive disorder. Oxford: Oxford University Press; 2007.

6. Healy D. Let them eat Prozac: the unhealthy relationship between the pharmaceutical industry and depression. New York: New York University Press; 2004.

Revised research on Iraq casualty statistics

ORB (Opinion Research Business), the independent UK-based polling agency, has produced more research on deaths in Iraq:

Following responses to ORB’s earlier work, which was based on survey work undertaken in primarily urban locations, we have conducted almost 600 additional interviews in rural communities. By and large the results are in line with the 'urban results' and we now estimate that the death toll between March 2003 and August 2007 is likely to have been of the order of 1,033,000. If one takes into account the margin of error associated with survey data of this nature then the estimated range is between 946,000 and 1,120,000.

The ORB survey makes no claim to be as rigorous as the two Johns Hopkins studies, Lancet 1 (2004) and Lancet 2 (2006) [1,2]. In contrast to the recent absurdly low mortality figures compiled by the Iraqi Ministry of Health and published in the NEJM [3], which I discussed in a recent post, the ORB statistics look like the best available until another thorough Lancet-style epidemiological survey is carried out.

The press release [DOC] of 28 January 2008 gives a more intimate perspective on these ghastly numbers:

Among the over 2,160 respondents who answered the question 20% said that there had been at least one death in their household as a result of the conflict which started in 2003. Within these households the average number of deaths was 1.26 people.

The data tables found in the New Casualty Tabs [PDF] break down the sources of death in a fashion approximately similar to Lancet 2 [PDF]. The responses to Question 2 ("How were they [members of the household] killed?") are interesting. They are divided into nine categories:

Gunshot	40%
Car bomb	21%
Other blast/ordnance	8%
Aerial bombardment	8%
Accident	6%
Sectarian violence	4%
Kidnapping and killing	1%
Other	2%
Don't know/refused	9%

Note the separate category for sectarian violence to which 4% of violent deaths are attributed. It is difficult to see why this was included. One is led to question the method by which the figures were derived. How is a "sectarian" death by gunshot separable from an "ordinary" death by gunshot? It is necessary to distinguish between the means of killing and the mode of killing. Otherwise there should be categories for "Killed by coalition forces," "Killed by mercenaries," "Killed by police," etc. The presence of sectarian violence as a category on this list is confusing and invites criticism.

After gunfire (40%), the largest number of deaths is attributed to car bombings (21%). That amounts to roughly 200,000 deaths resulting from this grisly tactic. The use of what the Pentagon refers to as "Vehicle Borne Improvised Explosive Devices" draws more attention than other forms of death. In Iraq we see it applied in the deadliest, most spectacular way. As Mike Davis tells us in his recent book Buda's Wagon: A Brief History of the Car Bomb [3], it is a technology that has proliferated incredibly since its first deployment in 1920 when a horse-drawn wagon was exploded by the anarchist Mario Buda near New York's Wall Street. No continent, save Antarctica, has been spared the car bomb's devastation. Davis describes it as a weapon whose use is "guaranteed to leave its perpetrators awash in the blood of innocents," a "categorical censure" that applies "even more forcefully to the mass terror against civilian populations routinely inflicted by the air forces and armies of so-called 'democracies'."

ORB, a non-government-funded group founded in 1994, conducts research for the private, public and volunteer sectors. According to a 30 Jan 2008 Reuters report, the director of the group, Allan Hyde, said it had no objective other than to record as accurately as possible the number of deaths among the Iraqi population as a result of the invasion and ensuing conflict. And the numbers are staggering. So far, most of the mainstream media continue to ignore this objective attempt at a just accounting of mass death in Iraq.


References:

1. Roberts L, Lafta R, Garfield R, Khudhairi J, Burnham G. Mortality before and after the 2003 invasion of Iraq: cluster sample survey. Lancet. 2004 Nov 20-26;364(9448):1857-64.

2. Burnham G, Lafta R, Doocy S, Roberts L. Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey. Lancet. 2006 Oct 21;368(9545):1421-8.

3. Davis, Mike. Buda's wagon : a brief history of the car bomb. London : Verso; 2007