As we know, ancient physician Hippocrates sure earned his honour as the “father of medicine”. Even where mental health was concerned, he offered some foundational insights. On melancholia, now better known as depression, he made a clear distinction between the deep sadness that arose from life, and that which appeared to arise entirely within the patient. On the craziness of women, though, he deserves less praise.
The old, gendered idea of hysteria is brought to us, in part, by Hippocrates. Women, so absent of reason that they could not be trusted with state affairs, had moods determined by their wombs. This was far less a medical diagnosis than it was post-hoc rot: women were excluded from participation in Athenian life not by the state who decreed it, but by their own inferior biology. Bit like saying that the class of people you enslaved are just not as naturally smart as their masters. Look at the evidence: they’re in chains.
Oddly, it is Hippocrates’ plainly good insight about the two types of depression — that arising with social cause, and that arising from within — that is endangered within psychiatry. But, the silly one about women being crazier than men appears to be on the rise. This is not the fault of contemporary psychiatry — although the tradition endured in the profession for millennia — but is one buoyed by scientistic accounts in the popular culture. Women, we are so often told, are at much greater risk of mental illness than men.
As you might imagine, it was for many years the work of feminist scholars to resist the idea that women were especially inclined to go bananas. There was a time that an act of rebellion against gender norms could detain a woman in the asylum. There was also a time that feminism was explicitly critical of the medicalisation of what were essentially feminist acts. Being mouthy or dissatisfied or simply female was not, per the Hippocratic tradition, cause for detention or diagnosis. It was a reason to identify institutional sexism.
Now, the growing inclination — even and especially the feminist one — is to accept the codification of women as suffering mental illness in enormous numbers. Following the Sunday publication of a survey report by women’s health organisation Jean Hailes, women, particularly those in the 18-35 age-range, experience anxiety or depressive illnesses at actually epidemic rates.
This received very wide press attention. The Sydney Morning Herald called the results of a self-reporting survey “concerning”. Women’s Agenda also appeared to take the single study as overarching truth to the extent that they asked no questions about data collection methods, but instead “what’s going on?” with this apparent fact. The news about the many mentally unwell women in our nation even went global, and was reported on CBS. None of which is the specific fault of the organisation who commissioned the survey. It is more, I think, the general fault of a media age which (a) knows how to appeal to the grocery buyer (usually female) with sympathetic “proof” of the unusually and officially hard time she’s having, and (b) has little memory of the Hippocratic distinction between mental illness that arises with and without cause.
The so-called biopsychosocial model of mental health diagnosis — that which takes a patient’s entire life and body into account — has been dangerously misplaced. Former editor of the Diagnostic and Statistical Manual for Mental Disorders (DSM) Allen Frances withdrew from his retirement to campaign against this conflation of everyday troubles with psychiatric definitions. A very good 2008 Book, The Loss of Sadness, also written by eminent scholars in psychiatry, makes the same contention. Even those who have worked actively within the field of psychiatric nosology — nosology is the practice of classifying diseases — are tearing out their hair and begging general practitioners, those who most commonly diagnose and prescribe for anxiety and depression, not to understand every disorder exactly as it is written down in the DSM “bible”.
This, to be very clear, is not to dismiss the serious symptoms that both male and female patients confront. To suggest that we should heed the warnings of psychiatrist activists and not permit general practice to so easily diagnose is not insensitive to the very real concerns that very real people have. It is, however, to suggest that the term currently popular among popular feminists “gaslighting” — the individual practice of deluding another person, especially a woman, that they are mentally unwell — could be applied at the institutional level.
What if what you need is not a diagnosis, or an anti-depressant of the type often inclined to accelerate precisely the sort of weight gain that many women in the survey said made them feel depressed, but treatment for your everyday sadness and worry?
Again, to be gracelessly clear, this is not to suggest that there is one particular type of person or profession at fault here. Pharmaceutical companies certainly play their role in advocating for new listed disorders to match their latest drug, but they are not completely to blame. Contemporary liberal feminism certainly embraces identity labels, including those supplied by medical orthodoxy, but they are not completely to blame. GPs may over-diagnose and over-prescribe, but what else are they supposed to do in a fifteen-minute window and within a system that so rarely permits them to pass their patient on to specialist counsellors or, for more serious and rarer cases, to a psychiatrist?
Mental ill health is a problem that we everyday people, and the World Health Organisation, are largely agreed is immense. Unfortunately, and certainly in some cases fatally, this complex problem receives a simplicity of analysis, exemplified by organisations like Beyondblue. We bundle all disorders — from serious delusional disorders to mild social anxiety — together, and the consequences for patients, practitioners and researchers are not looking great.
Depression, for example, is often studied as it is treated: as a spectrum whose origin has become irrelevant. Which is to say that a person like me who has, at times, been made sad by life is treated identically to a person who is frequently deeply sad with a cause that could only be said to be internal.
Another curious, and contradictory, consequence of this simple and broad understanding of mental disorders is where women, and other selected marginal groups, are concerned. In the press around this latest study, and in the media release itself, “society” is held somewhat to blame for female sadness and panic — many journalists elected to emphasise “social media” as a cause. And, while, of course, it is entirely logical that certain social groups, including asylum seekers, the LGBTI community and Aboriginal and Torres Strait Islander peoples, suffer in disproportionate number to the general population, what we have again is an unhelpful bundling of all disorders into one.
If you are a woman or you are Aboriginal, you may be more likely to have what remains of the biopsychosocial model applied to your diagnosis. You would be, I’d venture, far less likely to be intensively treated in the case that you did have a far less common disorder. Those truly debilitating disorders which, as Frances says, occur in 5% of most populations regardless of the patient’s social status, lose funding.
There is, as reactions to this single survey suggest, great public confusion about mental health nosology and treatment. There are demands for “awareness” and very select, sometimes fleeting, moments in which particular groups of people are seen to need better medical treatment less than they do a better deal in life.
However, few are thinking it through and many simply believe that “awareness” of mental ill health, largely understood as amorphous and with no dependable origin, is sufficient.
This sloppy thinking, absolutely encouraged by a press who tends, outside specialist publications, to ignore the expert warnings of a person like Frances, is not good for anybody’s mental health.