Treatment of Social Anxiety Disorder or Neuroenhancement of Socially Accepted Modesty? The Case of Ms. Suzuki

This chapter presents the case of Ms. Suzuki, a modest Japanese woman who had worked as a clerk for more than 20 years. After she was promoted at age 43, she found herself unable to adapt properly to her management position because it required assertiveness and leadership. She saw a psychiatrist following her supervisor’s advice. She had some of the symptoms of social anxiety disorder (SAD), but it was uncertain whether she met the diagnostic criteria. To elucidate the considerations involved before initiating or refraining from pharmacotherapy, I refer to the ethical debates on neuroenhancement. First, medication would spoil her authenticity, because her modesty is part of her virtue. Second, medicating a person seeing a psychiatrist at her boss’s instigation might constitute a milder form of coercive treatment. Third, diagnosing Ms. Suzuki with SAD seems to endorse her company’s culture, whereas denying her disorder status would affirm Japanese culture’s oppressiveness toward women. When a case lies on the border between normality and pathology, relying on the psychiatric diagnosis for ethical guidance disguises value judgments for matters of fact. Therefore, we should explicitly state the conflicting values and the cultural influences on them to make better clinical decisions.