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By the time he reached his early thirties, James was a promising scientist who had all the makings of an academic star. He had earned a stream of fellowships and was on the path to tenure at one of Boston’s preeminent universities. But James had a problem: he dreaded speaking in public. Academic conferences terrified him, so he avoided them whenever possible. He rarely interacted with colleagues. As a result, his ideas didn’t circulate and his career stalled.

In frustration, James sought help from a psychiatrist, who diagnosed him with a mental disorder known as “social phobia” and prescribed a well-known antidepressant effective in the treatment of extreme inhibition. The medication alleviated his severe anxiety and enabled him to do the things he previously couldn’t do. His work gained public recognition, and he has subsequently risen to the top of his profession.

In recent years, James’s story has become increasingly common. Using an ever-expanding arsenal of neurochemical drugs, physicians now treat variants of mood and temperament that previous generations viewed as an inescapable part of life. In an earlier era, James’s fears might have forced him to change professions. Today, the exceptionally shy and the overly anxious, the hyperactive and the chronically unhappy can seek relief from their suffering though medical intervention. And the parameters of what constitutes a “mental disorder” have swelled. An estimated 22 million Americans currently take psychotropic medications—most for relatively mild conditions.

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