As deinstitutionalization unfolded over the last decades of the twentieth century, millions of individuals like Gail Andrews increasingly occupied center stage in the quest for mental health. Andrews's personal issues had little in common with people such as Maxine Mason. Indeed, at first glance Gail Andrews had it all: a middle-aged professional living in Toronto in the early twenty-first century, she was trilingual, well read, a long-distance cyclist, and an accomplished musician. She had a great job as a senior executive at a major accounting firm. Other companies tried to recruit her as a partner.

Despite all this good news, Gail Andrews lived a life of emotional torment. Like millions in the early twenty-first century, Gail suffered from “social anxiety disorder” (SAD), aptly called “crippling shyness.” Although by all measures she was a professional success, nearly every situation that triggered her anxiety was work related: leading workshops, giving presentations, doing “power lunches,” even taking phone calls. Her fear of social performance left her “never able to relax.” In 2008 she told a reporter, “If you really knew me, you wouldn't like me … at all.”

At the turn of the millennium millions of people around the world reported feeling like Gail Andrews. They complained about being wracked by anxiety about social interactions, what the drug industry called being “allergic to people.”