Brand “you”: The emergence of social anxiety disorder in the age of enterprise

Medical taxonomy: Shifting conceptions of social dis-ease

The first vector concerns the process by which a transient disorder becomes recognized in an established taxonomy. While this occurred only recently with SAD, numerous scholars maintain the disorder has a lengthy history. For example, Kearney (2005) suggests the melancholic (i.e., unsociable, reserved) and phlegmatic (i.e., anxious, thoughtful) temperaments of the four humors indicate SAD’s universality. Similarly, a case where Hippocrates describes a patient who “dare not come in company, for fear he should be misused, disgraced, overshoot himself in gesture or speeches, or be sick; he thinks every man observes him, aims at him, derides him, owes him malice” (Burton, as cited in Lane, 2007, p. 12) is frequently presented as evidence of SAD’s timelessness (see Marks, 1970; McNeil, 2010). These descriptions, along with portrayals of anxiety such as Keats’ reference to the “wakeful anguish of the soul” (Pearson, 2007, p. 4) in “Ode on Melancholy,” William James’ complaint of awaking “morning after morning with a horrible dread” (Pearson, 2007, p. 1), and literary accounts of stage fright and shyness are believed to bolster the case for SAD’s universality.

However, it is doubtful that Hippocrates, Keats, or James would share this conviction. Further investigation of the Hippocrates case, for example, reveals the ancient physician felt his patient held a legitimate fear of mistreatment owing to others’ prejudices (Lane, 2007). Meanwhile, Keats’ (1820) poem is an ode not a complaint. For Keats, the melancholy of sadness was not to be escaped but rather cherished before fleeting; a “Beauty that must die / And Joy, whose hand is ever at his lips” (stanza 3). Likewise, the pit James (1902/2002) details was instigated by his recognition that life is inherently uncertain. For James, this was not a problem to be solved, but an ineluctable feature of existence.

Beyond such misinterpretations, arguments regarding SAD’s historical constancy rely on anachronism. Anxiety, for instance, has been experienced throughout the ages, but only became associated with fearfulness and discomfort in the 17th century and was not considered pathological until the 19th (Bound, 2004). Moreover, many qualities associated with SAD were once considered virtuous. The Greeks, for example, had no linguistic equivalent for social anxiety, but were known to prize bashfulness (Dowbiggin, 2009). Similarly, prior to the mid-19th century, both shyness and performance anxiety were considered advantageous in situations calling for vigilance, while blushing and embarrassment were lauded as “a check on ourselves, and as a sign to others, that we’re violating rules which ought to be held sacred” (Burgess as cited in Lane, 2007, p. 29).

While the timeline for SAD’s emergence is blurry, and could arguably be tied to a host of intellectual and social transformations that lead to the modern, interior conception of self and its instrumental ways of being (see Taylor, 1989), it is evident that pathological portrayals of social anxieties only began to surface in the mid-to-late 19th century. Often referred to as “the age of progress” (Zeldin & France, as cited in Dowbiggin, 2009), this era is marked by sweeping changes in values and configurations of self (Cushman, 1995). Prior to this period, identity was understood largely in terms of character, cultivated through moral virtue and demonstrations of modesty, humility, and restraint. However, this reserved perspective gave way in the consumer-driven culture of the mid-to-late 19th century to a flashier configuration of identity in terms of personality expressed through charm and charisma. Communicated through shame-based advertising, aimed to heighten awareness of offensive aspects of self (e.g., body odors, dandruff) that could be ameliorated through consumption, the new configuration of self encouraged a preoccupation with appearance, personal magnetism, and zeal. ⁴

As reticence lost its virtuous status, shyness came to be discussed in pathological terms. The first such description was offered by French psychiatrist Paul Hartenberg in his 1901 book, Les timides et la timidité, which detailed fears that resemble current descriptions of SAD (Fairbrother, 2002). Interestingly, Hartenberg’s work is overlooked in arguments regarding SAD’s historical constancy, something Lane (2007) attributes to his unsympathetic portrayal of the disorder as stemming from degeneracy and intellectual timidity. Nonetheless, it was important enough to grasp the attention of famed hypnotist Pierre Janet, who drew on it to coin the phrase “social phobia” (SP).

Beyond these initial stirrings, social fears received little attention in the early 20th century. In fact, the PsycINFO database contains only two references to SP before 1965, both of which focused on school-phobic children (i.e., Kagan, 1956; Nursten, 1963). However, a shift occurred following publication of Marks and Gelder’s 1966 review of four kinds of phobias: animals and insects, specific situations (e.g., heights), social situations, and agoraphobia. Descriptions in the third category included “fears of blushing in public, of eating meals in restaurants, of meeting men or women, of going to dances or parties, or of shaking when the center of attention” (p. 218). In 1970, Marks added fears of writing and vomiting in the presence of others to this list. Yet he also cautioned about the “need to know more about social phobics before definitely classifying them on their own” (p. 383). Convinced SP was too intertwined with other conditions to be considered a diagnosis, Marks later sought to block its inclusion into the Diagnostic and Statistical Manual of Mental Disorders (DSM; Lane, 2007). However, the attention drawn by the 1966 review was sufficient to ensure SP a life of its own.

In Shyness: How Normal Behavior Became a Sickness, historian Christopher Lane (2007) provides an exhaustive examination of the momentum behind SP and SAD’s much-debated inclusion into the DSM. Absent from the first and second editions, SP initially appeared in the 1980 DSM-III. According to Lane and others who have investigated the context surrounding the publication (e.g., Horwitz, 2002), the DSM task force was strongly motivated to medicalize the taxonomy in response to attacks regarding the reality of mental illness (e.g., Szasz, 1960). Composed of scholars and practitioners who equated mental dysfunction with biochemical imbalance, the task force maintained the field could only be legitimized through adherence to objective science. Consequently, all reference to psychological, particularly psychoanalytic, explanation was abolished and the contextualized term “neurosis” was replaced by the internalized designation “disorder” (Lane, 2007). ⁵ Anxiety neurosis, a category fundamental to psychoanalysis, was subsequently divided into seven new disorders: agoraphobia, panic disorder, post-traumatic stress disorder, obsessive compulsive disorder, generalized anxiety disorder, simple phobia, and social phobia.

Despite SP’s inclusion in the DSM, many researchers and practitioners (e.g., Liebowitz et al., 1985) remained dissatisfied. Admitting its definition, as “a persistent, irrational fear of and compelling desire to avoid situations in which the individual may be exposed to scrutiny by others and fears that he or she may act in a way that will be humiliating or embarrassing” (APA, 1980, p. 228), could be perceived as broad, they worried the examples provided limited manifestation to specific situations (e.g., public speaking, public restrooms, etc.), while a more chronic, general, and serious form of disorder, rife with opportunity for scientific investigation, was being neglected.

In response, SP was recast in the 1987 DSM-III-R as “a persistent fear of one or more [emphasis added] situations in which the person is exposed to possible [emphasis added] scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing” (APA, 1987, p. 241). By the DSM-IV, concern over the need to differentiate it from other phobic disorders led to SAD being listed in parentheses alongside SP (McNeil, 2010). Here the definition shifted to …

a marked and persistent fear of one or more social or performance [emphasis added] situations in which the person is exposed to unfamiliar people or to possible scrutiny [emphasis added] by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. (APA, 1994, p. 416)

On first blush, such revisions seem minor. But where the initial definition highlighted irrationality and required a desire to avoid situations involving scrutiny, the latter simply involves a feeling of discomfort regarding possible scrutiny (e.g., fear of sounding foolish) in any situation, avoided or endured. ⁶ So where the original definition describes a rare occurrence, the current definition outlines one that is arguably inevitable. After all, most, at some point in their lives, confront situations where discomfort is experienced. Recognizing this, those who study SAD (e.g., Chartrand, Cox, El-Gabalawy, & Clara, 2011; McNeil, 2010) point out social anxiety is normal and only disordered when interfering with mood or educational, occupational, and/or relationship success. However, in the age of enterprise, it is easy to see how normal quickly descends into complicated. If one is to be confident, bold, and striving in interactions, while guarding against feelings to the contrary, it seems not only probable but culturally prescribed that social discomfort be experienced as problematic. After all, if networking and social prowess are vital for personal and economic viability, any perceived inability could be interpreted as interfering with mood or success. In this context, the rise of SAD seems hardly a mystery.

Observability: Recognizing social anxiety as disorder

Inclusion in a medical taxonomy is necessary but not sufficient for a disorder to thrive. It must also be recognized by professionals and the public as something disturbing, something to be escaped, and something evident in the broader population (Hacking, 1998). SP failed to thrive because it did not meet these criteria. It was neither disturbing nor widely observed. SAD initially risked the same fate. The experience of social discomfort was certainly well known, but the notion such anxieties were normal threatened SAD’s acceptance as a serious disorder (McNeil, 2010).

Lane (2007) contends this perception shifted primarily owing to marketing tactics employed by SmithKlein Beecham (SKB), makers of Paxil, the most common treatment for SAD. The pharmaceutical giant has made no secret that SAD’s inclusion in the DSM presented them with tremendous opportunities. As Barry Brand, product director for Paxil, told Advertising Age, “Every marketer’s dream is to find an unidentified or unknown market and develop it. That’s what we were able to do with social anxiety disorder” (Goetzl, 2000, para. 3). Embarking on a multibillion-dollar “public awareness” campaign deemed necessary because “patients with social anxiety disorder often share the common public misperception that what they experience is severe shyness” (SKB as cited in Lane, 2007, p. 122), the company bypassed healthcare providers entirely, owing to a timely removal of Federal Drug Administration advertising restrictions, to market Paxil directly to the public. Advocating consumers monitor themselves for loneliness, discomfort at parties, and a desire for fun, love, and better job performance, SKB undoubtedly raised SAD’s profile. But more importantly, by associating the disorder with every interpersonal and professional difficulty imaginable, SKB reframed social dis-ease as disease; something to avoid and, if necessary, escape.

While such campaigns introduced SAD to the public, enterprise culture ensures SAD’s observability. As branding, emotional intelligence, and networking are increasingly touted as the means to success, institutions have been transformed to accommodate, promote, and cultivate the new ideal, becoming what Foucault (1969/1972) referred to as “surfaces of emergence” (p. 41) for the disorder. If we consider the workplace and school in turn, it becomes evident how enterprise culture not only makes SAD more observable, but also enables it to flourish.

In the workplace, for instance, a vast array of experts (e.g., employment counselors, life coaches) have emerged over the past few decades to promote the vision of self as enterprise (Binkley, 2011). This way of being is perhaps most brazenly outlined by popular management consultant Tom Peters (1997) in online magazine Fast Company. Peters contends everyone has a chance to stand out in today’s market but one must first accept “you’re every bit as much of a brand as Nike, Coke, Pepsi, or the Body Shop” (section 2, para. 3). Like these corporations, Peters argues, success depends on identifying qualities that make one stand out from the competition by asking “What have I accomplished that I can unabashedly brag about?” (section 2, para. 8). Such boldness is necessary because “If you’re going to be a brand, you’ve got to become relentlessly focused on what you do that adds value, that you’re proud of, and most importantly, that you can shamelessly take credit for” (section 2, para. 8).

Once the brand is identified, individuals are enjoined to launch a “personal visibility campaign” (Peters, 1997, section 3, para. 8), marketing themselves, networking, and paying keen attention to others’ reactions. One should be cool, work the room, and use every interaction as an opportunity. While loyalty to contacts is advocated, it is not out of concern for relationships but to avoid damaging the brand. Prime loyalty, Peters argues, must be to one’s self. He states: “I know this may sound like selfishness. But being CEO of Me Inc. requires you to act selfishly—to grow yourself, to promote yourself, to get the market to reward yourself” (section 5, para. 4).

If Peters is correct, and personal branding and marketing are required for career success, it is easy to see how the workplace has become a site of emergence for SAD. Those who are uncomfortable selling themselves, we are told, will fail in the new economy. In a world where relations are construed as a means of exchange between discrete economic units, such individuals are considered a liability; being one is to be avoided. Yet in the contemporary work world the experience of being such an individual is arguably more common. The value placed on networking and self-presentation implies that much is at stake in every interaction. We are told to monitor ourselves relentlessly to maximize every opportunity. Yet doing so is considered dysfunctional. Thus, in the workplace of enterprise culture, anxious self-surveillance is both pathological and prescribed.

Educational institutions provide another surface of emergence for SAD. As Jack Martin and Anne-Marie McLellan (2013) demonstrate in their investigation of historical and contemporary educational policy, research, and practice, the “traditional” view of education as enculturation has been diminished in enterprise society by a set of market-driven “progressive” discourses. This heavily psychologized, “student-centered” vision of education, Martin and McLellan argue, encompasses a regulatory ideal of “the triple E student” (p. 169) who confidently expresses opinions, takes initiative in utilizing strategies of enterprising self-management and promotion, and feels entitled to demand rights and authority in determining his/her learning. In this view of education, where confidence and initiative are considered markers of adjustment and future success, the once ideal student who sits quietly in the classroom is now construed as a problem (see Miranda, 2008); highly observable and in need of intervention.

Yale student Julia Lurie (2010) suggests this new outgoing ideal ironically contributes to a culture of silence on university campuses. Recounting her journey from exuberant, chatty, and intelligent-sounding (despite texting during classes) high school student to insecure and withdrawn sufferer of social anxiety and depression during her first years of university, she states:

… the expectation that despite any problem you may have, you must come across as happy, productive, and successful—leads students to believe that mental health problems are embarrassing and that admitting to them is a display of weakness. As a result, students struggling with mental health issues often feel alone or not good enough for Yale’s standards. When combined with the already intense and competitive nature of Yale, this culture of silence creates an awful environment in which to be unhappy. (para. 7)

Lurie’s description vividly outlines how enterprise culture leads many to live in psychologically isolated places, where they dare not reveal aspects of themselves that do not cohere with the ideal. Just as telling, however, is that the struggle to cope with university pressure is not construed by Lurie as part of the normal transition process, but rather as indicative of mental disorder. It is, of course, difficult to know whether Lurie’s problems were biologically based. But it seems unlikely. “Normally a relatively social person” (para. 4), Lurie only found herself less so when she became overwhelmed, and even then she maintained connections with close friends. Thus, it seems probable she was simply experiencing struggles commonly associated with transition. However, enterprise culture allows little room for unhappiness. On the contrary, any form of suffering is construed as a psychological problem to analyzed, managed, and escaped.

Together, the marketing of SAD and the valorization of enterprising characteristics in the workplace and educational institutions have created a context in which being outgoing and talkative is valued while silence, reservation, or social discomfort is considered deeply problematic. As Emily Martin (2007) states in her investigation of the ways neoliberal culture promotes mania, arguably the extreme end of the enterprising ideal, the message to workers and students who do not fit the exuberant ideal is “evolve or be killed off” (p. 273). As a consequence, social anxiety is more observable, frequent, and alarming. When it occurs it is considered abnormal; a disorder that is real, noticeable, and most certainly something to be avoided.

Cultural polarity: SAD, romantic and suspicious

Hacking’s (1998) third vector, cultural polarity, is the most original and least elaborated aspect of his work. To flourish, Hacking argues, a disorder must be situated between contrasting elements of culture, one virtuous and the other tending towards criminality. Hacking says little about why this might be, but his description of the tensions surrounding tourism, considered both romantic and suspicious, during the late 19th-century fugue epidemic implies that transient disorders concurrently evoke society’s greatest aspirations and its greatest fears.

Analyzing SAD in terms of cultural polarity presents a challenge. Locating a disorder’s position in a culture requires a sense of what the disorder looks like. But SAD can look like almost anything. The situations one fears may be avoided or endured and the experience of distress may not be reflected in individual actions. Diagnosis is based purely on feelings. Nonetheless, in an effort to capture the cultural sentiments surrounding SAD, I focus here on two observable presentations: anxious/awkward social engagement and avoidance. ⁷

On the side of virtue, socially awkward and avoidant behaviors are associated with a host of romantic narratives regarding genius, solitude, and authenticity. Drawing on the pervasive, yet empirically unsupported, belief there are different kinds of intelligence (A. E. Woolfolk, Winne, & Perry, 2012), Westerners often presume a lack of social intelligence is supplemented by superior abilities in reason, mathematics, or composition. Great artists, scientists, and philosophers are among the many historical characters who stand alone; their genius making them unable or unwilling to connect with others.

The stereotyped dichotomy between social and academic intelligence is represented in both research (e.g., Rentzsch, Schütz, & Schröder-Abe, 2011; Wong, Owen, Tran, Collins, & Higgins, 2012) and popular culture by the character of “the nerd.” In its most beloved, Hollywood form, nerds are physically and socially awkward, yet intelligent, thoughtful, and well-meaning. Their cluelessness over basic social graces, something that comes easily for most, appears comical through sharp contrast with extraordinary intellectual capabilities in areas requiring extensive dedication and self-discipline, while the inability to play social games, along with excessive rumination over how to connect, endears others to the “nerd” through its assurance of sincerity and commitment to treasure relations.

Interestingly, these characterizations are also evident in the self-descriptions of the socially anxious. In a discussion board entitled “What is your greatest virtue?” on socialanxietysupport.com (stylicho, 2006), “loyalty” is the most frequent response. Other virtues include: kindness, generousness, fairness, humility, tolerance, empathy, logical, curious, inquisitive, compassionate, patient, persistent, and able to see beauty in plain things.

The pride taken in such virtues may be magnified by the perception they are in short supply. For instance, numerous scholars (e.g., Kovel, 1980; Lasch, 1979; Sennett, 1998) have argued the commodification of social relations in late capitalism has encouraged a brand of narcissism that limits capacities for loyalty, moral character, and intellectual depth, while fostering unhealthy longings for approval. The danger inherent in the subsequent preoccupation with securing personal and professional success through efforts to be well liked rather than achievement are vividly portrayed in Arthur Miller’s Death of a Salesman (1949). Taking on new resonance in the age of enterprise, this production, which is enjoying widespread revival, has been described by Joyce Carol Oates (1998) as “the most achingly contemporary of our classic American plays.” She states:

… it seems evident that America has become an ever more frantic, self-mesmerized world of salesmanship, image without substance, empty advertising rhetoric, and that peculiar product of our consumer culture “public relations” a synonym for hypocrisy, deceit, fraud. Where Willy Loman is a salesman, his son Biff is a thief. Yet these are fellow Americans to whom “attention must be paid.” Arthur Miller has written the tragedy that illuminates the dark side of American success which is to say, the dark side of us all. (para.7)

More recently, the view that showmanship is antithetical to virtue has captured the public imagination in Susan Cain’s (2012) popular TED talk based on her best-seller Quiet: The Power of Introverts in a World That Can’t Stop Talking. Praising the introvert as a center of depth, intelligence, and creativity, Cain enjoins such individuals not to disown aspects of themselves in the pressure to be loud, confident, and enthusiastic because “the world needs you and the things you carry.” For Cain, much has been lost in the bold world of enterprise.

Yet the intellectual prowess associated with social awkwardness and isolation is also tied to a set of darker cultural narratives. In its mildest form, social misfits are portrayed as arrogant and condescending, unable or unwilling to mollify those who cannot understand them. Their awkwardness creates awkward situations for us and their inability to follow convention makes them unpredictable, compounding the tension. As such individuals further disconnect, the narratives take more troubling forms. Some may be viewed as a threat to themselves, in the manner exemplified by quiet, awkward individuals such as the band Joy Division’s lead singer Ian Curtis. Known for lyrics conveying emptiness and alienation in songs such as “Isolation” and “Love Will Tear Us Apart,” as well as a jerky dance style he described as an effort to convey emotion, the fiercely talented yet socially disconnected Curtis took his life in 1980 on the eve of a much-anticipated American tour (Curtis, 1995). Many fear those who fail to connect may, like Curtis, find it all too much to bear.

Even more troubling is a set of narratives in which the misfits’ frustrations turn towards others. Emerging with substantial force in the gritty films of the 1970s, the dangerous loner narrative involves a cast of frightening characters: the angry loser, the sexual deviant, and—most terrifyingly—the psychopathic killer. Stewing over social disappointments and humiliations, such characters are often portrayed as lashing out against those they believe have rejected them. The angry social outcast narrative is so common it is even drawn upon to explain horrifying events when it does not fully align with the facts (Toppo, 2009). The tacit suggestion in such narratives is that those who fail to connect may be dangerous and should be regarded with suspicion.

SAD stands amidst these varied narratives. Those who struggle to relate quickly bring to mind tormented souls yearning to make contact in a glib, socially preoccupied world they are too bright to comprehend. This association with virtue enables SAD to be what Neufeld and Foy (2006) call “a palatable way to be disordered” (p. 459). Indeed, the connection to gentleness, kindness, and depth makes SAD far superior to more disturbing categories of illness such as anti-social personality disorder. Yet it rubs just a little too close. The disappointments and isolation that characterize SAD also bring to mind frightening visions of angry, ruminating loners. Such narratives provoke particular fear in enterprise culture, where every problem—be it local, national, or global—is framed as a matter of individual responsibility. In the world of enterprise where one is encouraged to take personal responsibility for and monitor all forms of threat, a phenomena Beck (1992) referred to as “risk society” (p.19), we are to attend not only to dangers within, but also to those looming around every corner. Thus, while awkward introverts and brilliant loners who fail to conform may be admired, they are also not to be trusted.

Release: The flight from responsibility

The final requirement for a transient disorder to thrive is, despite its troubling aspects, it must provide a form of release unavailable in the broader culture (Hacking, 1998). The primary means by which this occurs is through the provision of a singular, authoritative explanation for past and present difficulties that frees the diagnosed from self- and others’ scrutiny. While no research exists on how those with SAD make use of their diagnosis, investigations of other disorders (e.g., bipolar disorder, E. Martin, 2007; post-traumatic stress disorder, Summerfield, 2001) support the notion of release. In Fleishmann and Miller’s (2013) narrative analysis of 40 adults with ADHD, for example, diagnosis was consistently reported as a positive experience. Not only did it curb self-blame through identifying a “culprit” (p. 56) for interpersonal and academic problems, it also empowered through enabling access to medication, self-management strategies, and a community of others with ADHD. Emily Ford’s (Ford, Liebowitz, & Wasmer Andrews, 2007) reaction to her own SAD diagnosis suggests a similar form of release occurs with this disorder. She states:

One might not think a high score on a test of mental disorders would be something to celebrate, but I couldn’t have been happier. I wasn’t making it up! I actually had an anxiety disorder as well as moderate depression. When Dr. A. asked if I had allergies to any medications, I felt further vindicated. I was going to be prescribed something. It was real. It was real. (p. 49)

Beyond such personal vindications, Neufeld and Foy (2006) argue transient disorders provide two additional forms of release. The second, experienced by those who interact with the diagnosed (e.g., teachers, peers, family), occurs through attributing the individual’s troublesome feelings and behaviors to internal disorder rather than interactions. In the case of a social disorder, which by definition involves relations, this idea is particularly intriguing. ⁸ Might there be reason to believe at least some experiences attributed to SAD are not the consequence of interior deficit, but rather, like Hippocrates’ patient, reasonable reactions to mistreatment? Research suggests they may. A review of case literature reveals individuals with SAD have experienced high rates of bullying (Brozovich & Heimberg, 2011), prejudice (Weiss, Singh, & Hope, 2011), homophobia (Walsh & Hope, 2010), and family contexts that were manipulative and unsafe. Meanwhile, research in school settings (Blöte, Duvekot, Schalk, & Tuinenburg, 2010; Blöte, Kint, & Westenberg, 2007) suggests socially anxious youth are treated poorly by peers (e.g., ridiculed during presentations), yet teachers do not rate these peer behaviors negatively. Such findings raise the possibility that social anxieties originate in interactions, rather than individuals, and suggest discourse that locates anxiety interiorly may obscure these contextual issues, allowing others to be released from responsibility for behaviors that provoke or sustain discomfort.

The third form of release is granted to those who seek to cure the disorder (Neufeld & Foy, 2006). Once a set of behaviors and experiences are medicalized, any action aimed at correction, no matter how disturbing, can be justified through appeals to beneficence and value-neutral science (Moynihan & Cassels, 2005). Subsequently, those who seek to cure the disorder are released from responsibility for the negative implications of their work. Such release is evident in the two most common treatments for SAD: medication and cognitive-behavioral therapy. With respect to the former, Lane (2007) demonstrates pharmaceutical companies relied heavily on claims that their mission was driven by public good rather than personal profit to justify their actions in the wake of extensive litigation over the disturbing and sometimes fatal effects of SAD drugs. While cynics may dismiss this as legal strategy, numerous scholars (e.g., Cushman, 1995; Richardson et al., 1999; R. L. Woolfolk, 1998) maintain that psychologists rely on similar arguments to avoid examining the moral and sociopolitical dimensions of their work. For example, while CBT’s emphasis on collaboration and value-neutral techniques implies the approach is ultimately anti-authoritarian and emancipatory, it is fundamentally about shifting subjectivities in ways that encompass unmistakable power dynamics and disguised ideologies. Proctor’s (2008) analysis of CBT discourse, for instance, reveals the therapy is far from a collaboration of equals. On the contrary, paternalism is recommended throughout treatment and the term “collaboration” is often used when the word “compliance” would more accurately represent what is being advocated.

This authoritarian stance is strongly reflected in the recommended CBT treatment strategy for SAD, “transfer of control.” Initially described by Silverman and Kurtines (1996) for use with internalizing disorders (e.g., shyness, social withdrawal), transfer of control presumes the therapist is the expert in the disorder, the clients’ experiences, and the skills necessary for change. As such, the therapist is encouraged to control sessions rigorously, educating clients on their experiences while teaching them curative techniques. Once clients understand their anxieties, in the therapist’s terms, and are deemed competent in the skills necessary to control themselves, the therapist transfers control to them so they can manage themselves. Compliance in adopting these new ways of thinking and behaving is considered so essential that it has been deemed by CBT practitioners to be the most important determinant of successful treatment for SAD (Frei & Peters, 2012).

If SAD is construed as internal disorder, transfer of control may seem a legitimate strategy. However, if one does not accept that SAD emerges solely from within, or that psychology is a science free from ideological commitments, it becomes less palatable. The advocacy of transfer of control not only releases therapists from considering power dynamics involved in working with a population that may have difficulty contradicting authority, it also releases them from exploring a broad range of vexing questions including: What kind of a self does psychology promote? Does psychology merely classify and manage people in ways that conform with dominant ideologies? Do techniques of self-surveillance and self-management, what Rose (1990) refers to as “life as a skilled performance” (p. 238), provide a means to suppress and overcome anxiety? Or does rigid self-control simply produce more anxiety? And perhaps most importantly, is overcoming anxiety even a worthy pursuit or might it, as Kierkegaard (1844/1980) believed, serve as a critical source of information about particular interactions and conditions in which we live? Such questions do not admit easy answers, but they are questions worth examining if we, as psychologists, want to consider fully the broader implications of our work and not simply be released from this responsibility.