by Anne Summers
There are many indications that women are increasingly unhappy with their female, which are family, roles. Behaviour that suggests that they are unable to cope with the narrow range of existence available to them has reached pandemic proportions in recent years. There are at least three ways in which people signify that they have reached a nadir of despair and desolation: seeking psychiatric treatment, taking drugs that blot out awareness, and engaging in self-destructive acts. In recent years there is inescapable evidence that women are resorting to these methods of signalling incipient breakdown in far greater numbers than men.
The Statistics of In-Patients for New South Wales psychiatric hospitals shows that by a small majority, there are more men than women in public hospitals.6 But when the psychiatric diagnoses are broken down by sex, some pertinent factors are revealed. The categories in which there is a clear majority of men are: alcoholic psychosis (477 men, 132 women), alcoholism (3246 men, 585 women), ‘other personality disorders’ (666 men, 634 women), mental retardation (509 men, 378 women) and ‘no psychiatric diagnosis’ (151 men, 148 women). The only category in which the difference is significant and which does not involve a possible hereditary defect is alcoholism, which is clearly a men’s disease in Australia at present. The diagnoses for women are rather different, and while the contrast between men and women is not as dramatic as with alcoholism, the differences are significant in the following diagnoses: schizophrenia and other paranoid states (2314 women, 2171 men), depressive psychosis (893 women, 398 men), ‘other functional psychoses’ (369 women, 235 men), depressive neurosis (2223 women, 1090 men), ‘other neuroses and psychosomatic disorders’ (452 women, 350 men), and drug dependence (326 women, 280 men). A clear majority of children admitted for behaviour disorders is also female.7 Statistics of in-patients in private psychiatric clinics are not available, but if they could be added to the figures for public hospitals it is likely that the numbers of women would greatly increase. Women who require only short-term hospitalisation, and whose families can afford it, are more likely to enter private hospitals or clinics. There is still a stigma attached to having to resort to public psychiatric treatment where people are more likely to be labelled, by society and by friends and neighbours, as ‘mad’. The person who enters a private hospital can use the more palatable label ‘nervous breakdown’.
That the in-patient figures from public hospitals are imprecise indications of the numbers of women suffering from some degree of psychiatric disturbance was indicated by the findings of the Canberra Mental Health Survey. This survey, conducted on a sample of the population of Canberra by the ACT Health Services Branch in 1971, found that a total of 26 per cent of the population suffered moderate or severe psychiatric disturbances.8 It is important that this survey was conducted from house to house rather than through doctors’ waiting rooms or the admission centres or out-patients section of a hospital, for it can by no means be assumed that all persons suffering from some degree of psychiatric disturbance will seek this kind of assistance. The survey divided its results into three categories, each of which revealed a higher rate of disturbance among women: Not disturbed: 70 per cent men, 69.3 per cent women; mildly disturbed: 15.7 per cent men, 20.8 per cent women; moderately–severely disturbed: 5.3 per cent men, 9.9 per cent women.9
Most women who had been admitted to psychiatric hospitals were hospitalised for what was diagnosed as ‘depressive neurosis’ and most had comparatively short stays in hospital: a clear majority was admitted for a month or less.10 We need more detailed figures on the psychiatric complaints of women in Australia, especially breakdowns by age over a ten-year period, to see whether or not this ‘illness’ is increasing, and increasing at a faster rate for women than for men. But it is likely that this is the case. In the US, where women’s family lives are fairly similar to those of Australian women, ‘national statistics and research studies all document a much higher female to male ratio of depression or manic-depression at all ages’.11 Depression appears to be becoming the female disease of the 1970s.
Depression in women can be, Chesler points out, ‘a way of keeping faith with their feminine role’.12 Two very common instances of female depression are closely associated with women’s mothering role: postpartum depression and menopausal depression. Even women who have accepted their female role willingly and uncritically often experience intense depression shortly after the birth of a child. This time of so-called female ‘fulfilment’ is very often accompanied by a realisation of just what that fulfilment entails for a woman: whatever degree of freedom she had prior to the birth of the child has been subverted by the appearance of a totally dependent infant who will regularise her life and minimise her ability to be anything other than a full-time mother. Fulfilment means entrapment, and so while, for men, fulfilment generally means the satisfaction of having achieved something they sought after, and a release from the tension channelled into the project, for women, maternal fulfilment is merely the beginning of a 16-year stint. The realisation of this often engulfs a woman when she first returns home with her new child and she succumbs to her fate by experiencing depression. Were she to renounce full-time care of the child, put it in a nursery or engage a nursemaid (if she could afford to), she would be in a much better position to feel fulfilled. Having accomplished the pregnancy and birth she would not have to totally subordinate her existence to the demands of the baby.
Large numbers of women experience depression on reaching menopause. It is difficult to know the extent to which this is a learned response to the idea that already ‘worthless’ women have even less value once they are no longer able to fulfil the main role of women in a patriarchal society, and how much of it is hormonally induced. But the former idea is difficult to suppress, especially for a woman who has devoted her whole life to her family. Children are usually grown-up and often have already left home when their mothers begin menopause. It is often also the time at which the husband’s job is most demanding and requires him to be away from home for long periods each day. Or the husband may well have decided to seek the company of a younger woman. All too frequently the menopausal woman cannot but see her life as over: she knows of little else to do with her life except care for husband and children, yet now they barely need this care. It is too late for her to have another child to fill the gap and, in any case, the middle-aged woman having a baby is a subject of mirth or ridicule.
A third form of depression that is endemically female is what is inaccurately referred to as premenstrual tension. As there is virtually no medical and only sparse psychological and psychiatric research into this it is impossible to ascertain how great a proportion of women endure this monthly misery. But informed research among women of my acquaintance and conversations with sympathetic doctors suggest that the numbers are very high. ‘Tension’ is an inaccurate term since it is only one of many symptoms that afflict women for several days before their menses. Women who suffer from this affliction are overwhelmed by feelings of depression, moroseness, and irritability and are often so severely incapacitated that they are unable to go about their daily lives and work. There has been some speculation as to its causes and some doctors consider that it is related to increased hormonal activity, which leads, in some women, to a retention of body fluids. But a not uncommon medical attitude is that it is psychosomatic and either deserves no treatment or can be alleviated by tranquillisers or anti-depressants. This view is an arrogantly ill-informed attitude to what is a real and constant debility for large numbers of women and one that is not relieved by drug therapy. (Some women report getting some relief from taking diuretics, which activate excretion of fluids, but this is the only form of drug treatment that appears to have much effect.)
The extent and the seriousness of this form of depression is underrated because only women have to endure it. This is evident when we compare this – as well as the paucity of research into other problems such as vaginal infections, which only women suffer – with the high status and well-endowed research
programs devoted to heart disease, alcoholism and other afflictions to which men are more prone and which, therefore, have a more marked and discernible effect on the functioning of the economy. Women’s debilitations, on the other hand, are used to criticise them for being unreliable, irrational, and frequently absent employees, or for being neurotic housewives. Whatever the physical and psychological causes of premenstrual and other forms of female depression, they are obviously related to the stresses and contradictions involved in being a woman in a sexist industrialised society. Such afflictions are, to the best of my knowledge, unknown among women in non-industrialised societies, societies that while still being organised around a sex division of labour and often discriminate very harshly against women, nevertheless do not seem to involve them in the kinds of anxieties and uncertainties about their ‘selves’ that are so common in countries like Australia.
Women are caught in an enveloping double bind when they devote their entire lives to their families: their ‘selves’ are constructed on this premise, yet their ‘selves’ are threatened when they do it. The hostility, bewilderment or despair experienced by women who realise this is often turned inwards against themselves – depression – rather than outwards against the cause of their ‘self ’ dislocation – aggression. The quiet and passive endurance of anguish is typically female behaviour. And it is also because of women’s social conditioning that they are more likely than men to end up in psychiatric hospitals for conforming to their imposed sex roles. As Phyllis Chesler says:
The mental asylum closely approximates the female rather than the male experience within the family. This is probably one of the reasons why Erving Goffman, in Asylums, considered psychiatric hospitalization more destructive of self than criminal incarceration. Like most people, he is primarily thinking of the debilitating effect – on men – of being treated like a woman (as helpless, dependent, sexless, unreasonable – as ‘crazy’). But what about the effect of being treated like a woman when you are a woman? And perhaps a woman who is already ambivalent or angry about just such treatment? Perhaps one of the reasons women embark and re-embark on ‘psychiatric careers’ more than men do is because they feel, quite horribly, at ‘home’ within them. Also, to the extent to which all women have been poorly nurtured as female children, and are refused ‘mothering’ by men as female adults, they might be eager for, or at least willing to settle for, periodic bouts of ersatz ‘mothering’, which they receive as ‘patients’.13
There are large numbers of women who periodically capitulate to their extreme discontent and, no longer able or willing to control their frustration, disappointment or misery, manifest their feelings in such a way that they have to be temporarily incarcerated in an asylum. This is because they themselves request respite and demand to be taken from whatever situation it is that has precipitated the breakdown, or because their relatives cannot endure this constant demonstration of dolour, which is perhaps a reminder of the precarious state of their own psychic health. Sometimes people end up in psychiatric hospitals and are diagnosed without their being able to participate at all in the process. In a study of psychoses among female migrants it was reported that one depressed woman had been tentatively diagnosed as psychotic. Her certificate read, ‘The patient is lying in a bed, weeping bitterly. She does not respond when addressed in English, nor in Italian’. She was later found to be Ukrainian.14 For many of the women studied in this survey, even though most suffered from a degree of psychosis – many due to wartime experiences in labour camps – their depression and frustration were exacerbated by their being unable to communicate their feelings to the medical staff. The hospital had, prior to this study, apparently acted on the assumption that all migrants were either Greek or Italian and had only employed interpreters in these languages: it was found that these migrant women were among the noisiest and most difficult to handle in the entire hospital until they began being treated by nurses of their own nationality.15
This example may provide a clue to the psychiatric problems of many women. Even when actual illness exists it is exacerbated, and thus in the eyes of the medical staff is diagnosed as being more serious, by the inability of the woman to communicate to those around her what is wrong. Possibly she does not know herself, in which case even the most sympathetic husband or friend is likely to lose patience. It is rather unrewarding to have constantly to deal with a person who weeps continually and can only respond with, ‘I don’t know what’s wrong with me these days …’ Vast numbers of women, often with advice or pressure from impatient families, cope with this by imbibing massive doses of what they see as soothing panaceas: sedatives and tranquillisers.
This resort to drugs can take two courses. A woman can simply supply herself with large quantities of non-prescription drugs, thereby circumventing the need for doctors’ visits, which involve high costs and the chance of censure for her dependence on these substances. The Senate Select Committee on Drug Trafficking and Abuse found evidence that synthetic bromides – ‘bromureides’ – which it was submitted were major drugs of dependence in Australia, were not only freely available, but were consumed in enormous quantities. In the Melbourne area alone, 720 000 bromureide tablets were sold without a prescription each week in 1969.16 Drug companies were reluctant to cooperate with this investigation and supply exact figures of their own production of various drugs, but the written submission of one manufacturer stated: ‘“An analysis of known industry sales figures shows that the usage of mild analgesics in Australia is 0.63 tablets per person per day.” By simple calculation this reaches the staggering figure of 2,904.3 million tablets used by the Australian community in a single year.’17 The same committee heard evidence that suggested that there were 180 000 drug-dependent females – 4 per cent of the population – in Australia, compared with 90 000 drug-dependent males, and that the people treated for abuse of depressants including bromureides were predominantly female, mostly in the 40–50 age group.18 It was also reported that Australia is the third highest consumer per capita of codeine in the world.19 A survey conducted at Sydney’s Prince Alfred Hospital and the Department of Social and Preventive Medicine at Sydney University in 1972 found that 7.9 per cent of men and 14.7 per cent of women take aspirin daily; men were found to take a slightly higher daily dosage than women, but the numbers of women who were regular takers was substantially higher. The 1057 housewives interviewed gave the following reasons for taking aspirin daily: headaches, nerves, tension, habit, arthritis and joint pains.20 The survey also found that regular ingestion of preparations containing aspirin had been associated with both gastric ulcer and kidney damage. So the fact that women are taking non-prescription drugs, that is, drugs which are presumed not to be dangerous if taken in small quantities, is no guarantee that they are not doing substantial physical damage to themselves, nor can they be assured that the pain for which they sought the drug in the first place will be alleviated.
The New South Wales Health Education Council executive officer claimed in 1972 that an estimated 30 per cent of Sydney housewives were daily users of barbiturates or other drugs of dependence and that many of the social workers from his department had been shocked to discover that ‘Mum gets stoned at 6 a.m. and stays that way all day’.21 The Canberra Mental Health Survey found that 6.7 per cent of women compared with 2.9 per cent of men took headache pills or powders daily, and that 5.1 per cent of women compared with 2.4 per cent of men took sleeping pills or tablets each day.22
Any person who is tempted to use non-prescription drugs, especially painkillers, to deaden psychic pain will find this resort encouraged by those who profit financially from such drug consumption. In May 1973, the Pharmacy Guild of Australia made Panadeine its Product of the Month. That month’s issue of the Australian Journal of Pharmacy carried a full-page advertisement headed: ‘Panadeine promotions give a real lift to your analgesic sales’. The advertisement then went on to inform chemists of the most effective ways to sell more Panadeine.23 Since women assume most responsi
bility for shopping in Australia, they are more likely to be aware of, and to respond to, such a high-pitched sales campaign and their already existing susceptibility to abuse these drugs is encouraged.
The second form of drug consumption among women is the taking of prescribed drugs. Here the acquiescence of a medical practitioner is required but this seldom seems to be difficult to obtain. Most doctors are unable to do more with the constant stream of women complaining of elusive aches and pains or of general depression than write out a prescription for a substance that will at least lessen the woman’s awareness of her pain. Recently, since the dangers of kidney failure associated with overdoses of barbiturates began to be recognised, and with tranquillisers being made available on the NHS list, there has been a switch to prescribing tranquillisers, anti-depressants and non-barbiturate hypnotics. These are being seen by both doctors and patients alike as the latest panacea in the battle against tension and unhappiness.
In the year April 1970 to March 1971, more than eight million prescriptions were written by general practitioners for psychotropic drugs, sedatives and hypnotics; they amounted to 13.8 per cent of all prescriptions written by general practitioners for that year.24 The actual amounts prescribed would have been considerably higher than this since these drugs are frequently prescribed by specialists and by doctors in public and private hospitals. Each of these drugs is more frequently prescribed to women. A study of prescriptions written in Australia between January and March 1972 made by Anne Winkler at the School of Behavioural Sciences, Macquarie University, found that two-thirds of the prescriptions for the drugs in each category were for women.25