Stuck on the chaise lounge: The female subject in psychiatry from pathology to Prozac
In 1900 in Austria, a girl named Ida went to meet Herr K. at a church festival. He was a friend of the family twice her age, and she thought his wife would be there. Instead, Herr K. arrived alone, led her to a secluded area, and kissed her. Ida tore away from him and ran back to the crowd, disgusted. Sigmund Freud, her psychiatrist, evaluated the incident in his now seminal work Fragment of an Analysis of a Case of Hysteria. He concluded: “the behaviour of this child of fourteen was already entirely and completely hysterical. I should without question consider a person hysterical in whom an occasion for sexual excitement elicited feelings that were preponderantly or exclusively unpleasurable.”
With Freud’s claims about the female psyche mostly discredited and the advances in treatment of mental illness over the years lauded, the average bystander might conclude that we’ve come a long way from labeling a normal reaction to sexual assault “hysteria.” But a long legacy of prescriptive and sexist science remains at the foundation of psychiatric medical treatment for women. From the first diagnosis of hysteria to the present-day disparities in mental health treatment, the tradition of medicating women’s emotions has held constant. Within this context, the line between empirical treatment and medicating the lived experiences of women grows dangerously thin.
Today, more women than ever take antidepressants. While women are more likely to seek professional help than men, a study published in 2017 by the CDC shows women are prescribed antidepressants at twice the rate of men. More female physicians are actually doing the prescribing, but they work within a system of medical knowledge that seeks to cure women of the very psychiatric symptoms associated with gender norms determined for them: stress from balancing work and family, sexual abuse, and higher rates of poverty. We can trace the arc of medical authority over women’s minds back to early roots in science and medicine that prioritized women’s conformity to norms within the family and home.
Treatment of psychiatric symptoms in women (by mostly men, until a few decades ago) has always been connected to ideas about sexuality and domesticity. Whether “over-sexed,” “repressed,” too attentive to their children, or too withdrawn, psychiatric diagnoses often centered on women's perceived domestic failures. At the turn of the 20th century, it was widely accepted that women should rest more and learn less. Barbara Ehrenreich and Deirdre English write in For Her Own Good: Two Centuries of the Experts’ Advice to Women, “Too much reading or intellectual stimulation in the fragile stage of adolescence could result in permanent damage to the reproductive organs and sickly, irritable babies…” The act of straying away from the framework of nurturing mother, whether perceived or real, could land a woman in the doctor’s office.
The first Diagnostic and Statistical Manual (DSM), a standard guide for clinicians in evaluating mental disorders, was published in 1952. It reflected mid-century ideas that pathologized female sexuality and kept alive a Freudian insistence on the final word of the subconscious. As Katharine Angel describes in “The history of ‘Female Sexual Dysfunction’ as a mental disorder in the 20th century,” impotence and frigidity in women were classified as sexual disorders, clinical categories described in psychological terms. Later DSM editions, such as the 1980 version whose authors promoted biological rather than psychoanalytic methodology, listed “inhibited sexual desire,” “inhibited sexual excitement,” and “inhibited (female) orgasm” as defined “psychosexual dysfunctions.” These diagnoses, with the certainty of their scientific jargon, carried the torch of sexism in medicine.
Women and their psychiatrists in the second half of the 20th century turned to new a new class of drugs to medicate their dissatisfaction. From benzodiazepines like Valium to relax and stimulants like Dexedrine to cheer up, “mother’s little helpers” were often used by housewives to relieve themselves of the discontent that came with a life of domestic drudgery. Women often requested these medications themselves, wondering if their problems stemmed from biochemical roots. These medications were at best minimally tested, and at worst, addictive and dangerous.
While the medical community has never been shy about shuffling women through unsubstantiated psychiatric cures, the exclusion of women from US clinical studies only ended in 1993, when the federal government passed the National Institutes of Health Revitalization Act. Before 1993, women had been subject to drugs and treatments that had only been tested on men. Despite these advances in clinical research, hazy research and controversial claims behind antidepressants continue to connect psychiatry’s flawed history with women and today’s status quo. One New York Times columnist likened Selective Serotonin Reuptake Inhibitors (SSRIs) to Valium, calling them the “new normal,” even as studies continue to diverge on the question of the efficacy of these drugs. A study in 2008 concluded that the difference perceived by people taking antidepressants compared to when they took placebos was negligible, even for patients with severe depression. For moderate to mild reports of depression, that effect grows smaller and smaller. The science behind antidepressants remains unclear.
Today, according to the American Medical Association, women make up as much as 57 percent of psychiatrists overall. Despite the recent proliferation of women practitioners, old notions of women as patients persist, and little evidence exists to support a seismic shift in the way female clinicians prescribe. Narratives used to sell now bygone cure-all tonics and sedatives for nerves reemerge in eerily similar ways to convince women of the power of antidepressants. The practices of even the most well-meaning psychiatrists, men and women alike, are steeped in a gendered medical history that frames women as the primary recipients of mental care and doctors as their protectors.
Theorists like Freud, Rorschach, and Jung established a tradition of unveiling hidden, true answers to problems like depression, and the effect of these theories can be seen today in the overprescription of poorly understood drugs. Pharmaceutical companies have framed depression as a chemical imbalance, as if the pills act to restore something that is missing, a claim that is largely unproven. Without comprehensive scientific conclusions to support the efficacy of SSRI’s, it becomes all too easy to diagnose women, who are more likely to experience contributing factors like sexual abuse, financial stress, and societal pressure, with any number of disorders that meet the criteria for medicine. Thus an already overused “magic pill” becomes a cure-all for the issues most closely associated with women.
As a Louis Menand from the New Yorker aptly put it: “For some disorders, such as depression, we may never know, in any useful way, what the underlying pathology is, since we can’t distinguish biologically patients who are suffering from depression from patients who are enduring a depressing life problem.” Menand’s “depressing life problem,” it seems, is simply being a woman. Outdated habits in clinical practice must give way to the socio-cultural complexities of womanhood — and in doing so, the complexities of life itself.
Barbara Ehrenreich and Deirdre English, For Her Own Good: Two Centuries of the Experts Advice to Women (Anchor Books, 2005).
Elizabeth Lunbeck, The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America (Princeton: Princeton University Press, 1995).
Julie Holland. “Medicating Women’s Feelings” The New York Times (28 Feb. 2015).
Image credit: Betty Draper (January Jones) in session with Dr. Arnold Wayne on Mad Men