Women Are Depressed Because They Are Oppressed?

Amanda has an interesting mediation on the op-ed from Marianne Legato. I want to remark on two of her points, one of which is a stray comment I want to pick up, and another longer analysis of men and depression.

First of all, Amanda suggests that Legato's piece is a subtly sexist, agreeing with Jill at Feministe, who thinks that if the article claimed that women were the weaker sex it would be consistent with baleful patriachal screeds on women's inferiority. I don't necessarily disagree that there is some subtle sexism in Legato's piece, but I will argue, provocatively, that it is intentional. Now, I have no idea what Legato's motivations are, but I can imagine why someone like her would write a provocative op-ed, that signalled how underserved men are in medical research. I see this as a clever strategy. Let me explain: I am someone whose main line of research is studying why women are overdiagnosed as depressed and subsequently overmedicated. I have given dozens of presentations on what I think is problematic about (a) the criteria for both major and minor depression in the Diagnostic and Statistical Manual of Mental Disorders (DSM); (b) the subtle sexism influencing physicians to see women as mentally ill, rather than reasonably stressed out; and, (c) the greed of the pharmaceutical industry, wanting to sell SSRI drugs to women, who are known to be good consumers and easily manipulated by such advertisements (which play of women's fears of being a good mother, good employee and good wife).

Invariably, when I gave my talks to audience with a large number of male psychiatrists (not hard to do since most psychiatrists are still male), I would be pelted with obnoxious questions (well, they weren't really questions) that suggested I was simply not equipped to understand the complex neuroscience underlying psychiatric research, which illustrated why women are more likely to be depressed than men. Or, I was told that good psychiatrists are not manipulated by the pharmaceutical companies' hype. Or, I was told that the real problem was the General Practitioner's (GPs) who were lax in their prescribing patterns. This sort of response would drive me nuts. The audience would simply throw up a bunch of red herrings to avoid dealing with my argument: we are overmedicating women. So, being a practical feminista, I thought about strategy. How can I get this audience to actually listen to my presentation without either dismissing me as (a) a feminista or (b) a muddleheaded humanities professor ill suited to make sense of scientifically rigorous studies. My solution: change my presentations to illustrate that we are undermedicating men, who are 6x more likely to commit suicide, because we are not carefully examining the folk scientific views of women's overly emotional/pathological nature. By making that simple change in my presentation, I was able to hold off almost all of the obnoxious questions I got before. And, I didn't really change my point. I just got the male audience members to see why they should be invested in challenging the sexism that permeates psychiatric diagnoses and the pharmaceutical advertisements.

Was I selling out? Was I subtly sexist? Maybe. But, it was a pragmatic decision because I am not just theoretically interested in this subject, I want people to take notice of the problem and do something to stop the overmedicating of women. I guess when I read Legato's piece, I imagined she was strategically arguing about men's health issues to illustrate the importance of understanding how gender roles and gender stereotypes are bad for both men and women. Afterall, I think that feminism is not just about empowering women, but rather making life more bearable for everyone. Feminism is humanism.

Now, to the second point. Amanda argues:

One thing about this article bugged me, though.

While depression is said to be twice as frequent in women as in men, I’m convinced that the diagnosis is just made more frequently in women, who show a greater willingness to discuss their symptoms and to ask for help when in distress. Once, at a dinner party, I asked a group of men whether they believed men were depressed as often as women, but were simply conditioned to be silent in the face of discomfort, sadness or fear. “Of course!” replied one man. “Why do you think we die sooner?”

I’m of two minds on this. While I firmly believe that social conditioning about how to handle emotions predisposes women to get better quicker if they become depressed, I’m not sure that men really do suffer from it in the first place as much as women. It’s a numbers thing—depression is, more often than not, caused by having problems. And women have most of the problems that men have that could cause depression—losing jobs, grief, divorce, feeling aimless, whatever. But women have added risk factors for it, since women are by and large more likely to be raped and the victims of domestic violence, both of which, suffice it to say, are highly correlated to mental health issues. To boot, sufferers of domestic violence are likely to go to great lengths to conceal their problems as well. Of course, men are more likely to go to prison, but I doubt that comes close to equaling it out.

I can't tell you how sympathetic I am to Amanda's point here. For years I set out to argue the same thing, and finally gave it up when a very astute person at my dissertation defense confronted me with cross-cultural data. Now, Amanda's view that women are indeed more depressed because they are oppressed is an incredibly attractive theory. I believed that if we looked at women's situational depression as a manifestation of the cruelty towards women in a man's world then we would rethink how to treat women's depression outside of merely locking them up, lobotomizing them, or medicating them. The latter treatments always struck me as a nefarious way to cover up the evil deeds of patriarchy, to once again blame the victim. Alas, my beautiful theory--that women are depressed because they are oppressed--doesn't seem to square with what's on the ground. For example, if you look at epidemiological studies of African American women who live in incredible squalor or high risk neighborhoods, you don't always find higher prevalance rates of depression as compared to white women. That seems counterintuitive, since if you are poor, black single mom living in a crack neighborhood, the "depressed because oppressed" theory would surely predict you are severly depressed. And, yet, oftentimes this is not what the research bears out. Moreover, there are many populations all over the world where male rates of depression are far more significant than female rates.

Now, let me say that epidemiological data generated is only as good as the structured interviews used to get that data. And, the instruments used to study the incident rates of depression may be flawed insofar as the criteria used to pick out depression is flawed. Moreover, cultural notions of illness and disease further complicate how accurate or useful these epidemiological studies are. That is, depression might be a rather holy, spiritual afflication for a Shi'ite Muslim; what we think is pathology might be a revered state in that world. Or, consider Buddhists in Korea who accept that all life is essentially suffering. In answering questions designed to assess depressed thought processes, we might diagnose everyone in Korea as depressed.

My point here is that sometimes theories that really seem to fit with our experience of the world turn out to be incomplete. Moreover, we can risk being ethnocentric in expounding such theories, which was my problem. The downside of giving up my "women are depressed because they are oppressed" hypothesis was that I had to make far more subtle and complicated arguments about why some women, e.g. white, middle-class, good insurance, are diagnosed as depressed more frequently than black men. The details make murkiness of our intuitions. But, alas, I think this is a good and healthy step for feminist analyses to take.