An anxious society : the French importation of social phobia and the appearance of a new model of the self

This dissertation examines the introduction of social phobia into France. My analysis is concerned with how this diagnosis, which is inconsistent with the psychoanalytic model that dominates French psychiatry, is increasingly being accepted by French physicians and patients. I argue that the diagnosis social phobia offers physicians and patients a justification for life difficulties that was not provided by existing diagnoses such as phobic neurosis, obsessional neurosis or 'normal' shyness.In 2003-4 I carried out one year of fieldwork in North America and France. During this time I conducted participant observation and interviews with clinicians and members of a social phobia support group. Throughout this thesis, it is my objective to understand the disorder from three perspectives: historical, ethnographic, and sociocultural.First, I examine French psychiatrists' claims that social phobia has existed in French psychiatric literature since the nineteenth century. I investigate the efforts of these French psychiatrists to prove that the diagnostic category has a legitimate place in French medicine. Second, I look at how a small group of Parisian psychiatrists who practice cognitive and behavioural therapy are fighting for greater awareness and acceptance of social phobia. Promoting social phobia is a means of spreading awareness of their therapeutic model. Their aim is to unseat psychoanalysis from its dominant position in French psychiatry. Many individuals prefer cognitive and behavioural therapists' explanations of social phobia symptoms to those of psychoanalysts because they are less stigmatizing and their predicted outcomes more optimistic. But many French clinicians reject the diagnosis social phobia and prefer psychoanalytic explanations for patients' symptoms. Some see it as a 'fashionable' disorder overly promoted by the pharmaceutical industry. Third, I investigate how social phobia is related to cultural behavioural ideals and societal expectations. I look at how these factors lead more people to become concerned about the symptoms of social phobia than in the past.In the end, I explain that French physicians and patients are choosing social phobia from among other possible labels for this set of symptoms. The way that they describe this diagnosis, however, blends multiple therapeutic models and they create an explanation of the disorder which most thoroughly and positively describes patients' experiences