by Anne Summers
Percentage of prescriptions given for sedatives, tranquillisers, and anti-depressants to males and females of different ages in the period January to March 197225
Legend: M is Male %, F is Female %
SOURCE Macquarie University, School of Behavioural Sciences
Of these drugs prescribed by general practitioners in the year 1970–71, 55 per cent were given to patients diagnosed as having mental disorders.26 Within this category of ‘mental disorders’ women constituted almost 70 per cent of patients.27 The sex differences in patients with mental disorders is set out in the table below:
Mental disorders28
Age group
Male
Female
Under 5
55 562 (1.0%)
52 153 (0.9%)
5 to 14
103 872 (1.8%)
75 753 (1.3%)
15 to 24
97 861 (1.7%)
283 073 (5.0%)
25 to 34
154 124 (2.7%)
434 261 (7.7%)
35 to 44
203 033 (3.6%)
493 561 (8.8%)
45 to 54
338 277 (6.0%)
620 837 (11.0%)
55 to 64
298 891 (5.3%)
650 475 (11.6%)
65 and over
413 853 (7.3%)
1 210 371 (21.5%)
Not stated
13.999 (0.2%)
29 460 (0.5%)
Total
1 679 472 (29.8%)
3 849 943 (68.4%)
Sex was not stated in 101 537 cases (1.8%).
The patients receiving prescriptions for what were diagnosed as mental disorders were, with the exception of alcoholics, predominantly women. Women greatly outnumbered men in attendance for psychosis; they constituted more than double male attendance for anxiety neurosis; they comprised 70 per cent of attendances for hysterical neurosis, and more than 60 per cent of attendances for depressive neurosis.29
These figures, as with those for in-patients in psychiatric hospitals, can indicate that women actually suffer from mental disorders in far greater numbers than do men or that, in the opinion of the diagnosing and prescribing doctors, such labels are appropriate to describe the behaviour of large numbers of women. It has already been pointed out that there are weighty social reasons for women to be susceptible to depression, that even the faithful fulfilling of the prescribed female role can result in feelings of depression.
The female ‘self ’ is based on a narrow range of activities that are confined to the one physical location. Its maintenance is very much contingent on continual male protection and approval yet the activities that comprise the area of female ‘self ’-validation are carried out in the isolation of the home with the husband absent for long periods of time. Women are socially isolated from each other as the withdrawal of the mother’s nurturance from the female child produces distrust and incipient hostility towards other women. Thus women have only the continued presence of their children – and not even this once they have grown up – to reinforce their feelings of self-esteem and worth. This is too flimsy a support for many women, especially if her children are excessively demanding and energy-draining and her husband remote or even critical of her efforts. This is the ‘fulfilled’ life of many women who have accepted their female role – small wonder the already insecure ‘self ’ disintegrates into depression.
But what of the woman who partially or totally rejects her female role? Her ‘self ’ has been socially constructed to require validation through motherhood: the process of reconstructing that ‘self ’ to thrive by other means is slow, painful and subject to frequent retrogression if not shored up by an actively supportive and understanding circle of people. But even such support can be threatened or invalidated by the existence of institutions that reinforce the sexist status quo and try to impose patriarchal notions of normality upon recalcitrant women.
Medicine in general (and psychiatry in particular) is just such an institution. Apart from the fact that the vast majority of its members are men who receive considerable personal benefit from the existing sexual division of labour (which is reflected in hospitals, clinics and surgeries as well as in their families), the psychological theories employed in medical training impute scientific validation to the socially derived system of sex differences. Both as men and as medical practitioners, most doctors have strict and traditional notions of what is appropriate behaviour for women. If a female patient displays behaviour that the doctor considers to be ‘unfeminine’ he is likely to label her ‘neurotic’. The dangerous double bind that women find themselves in is that they are labelled thus if they reject their female role or if they adhere too stringently to it. If a woman does the latter she is likely to be periodically or even chronically depressed and this thereby challenges the idea that the dutiful wife and mother is a happy and contented being. If she is aggressive, argumentative and rational; if she eschews child bearing and demands an abortion; if she spurns sexual or emotional dependence upon men; if she refuses to be a full-time child-minder, takes a job and puts her children in day care; if she has extra- or premarital affairs – if a woman does all or any of these things she is seen as rejecting all or part of her female role and is subject to ‘self ’-threatening social censure. If she confesses all or any of these things to the doctor from whom she is seeking medical assistance she is, at the very least, likely to be subjected to moralising and risks being labelled ‘neurotic’ and treated as such. Rather than allow women to choose what they will do with their lives, and recognise that any degree of restructuring of the childhood-acquired female ‘self ’ will produce some psychological stress, the medical profession dictates that contented compliance to the female role is a measure of mental health.
Men are subjected to strain and stress and seek medical assistance yet are far less likely than women to be categorised as ‘neurotic’. Maybe this is partly because, as men, doctors can identify with the complaints of their male patients. Men are more reticent in consulting doctors than women; one survey of the use of health services in Sydney’s western suburbs found that of the total population who had consulted a doctor in the two months preceding the survey, women comprised 46.4 per cent and men 35.4 per cent.30The Canberra Mental Health Survey found that 32.0 per cent of women and only 16.9 per cent of men were having regular treatment from a doctor.31 Yet neither of these factors adequately accounts for the massive majority of women who are categorised as mentally ill by general practitioners and psychiatrists. The explanation would seem to lie in the fragile nature of the activities assigned to validate the female ‘self ’, and in the refusal of the medical profession to accede to women any independence from patriarchal definitions of how women should behave.
These definitions are imposed by drug therapy even upon women who have not been classified as neurotic. It was noted above that only 55 per cent of the prescriptions for sedatives, hypnotics and psychotropic drugs were for people who were diagnosed as having mental disorders.
This means that nearly four million prescriptions for these drugs were written for people who, even in the opinion of doctors, were not mentally unsound. Many of these drugs, particularly the anti-depressants, are potentially dangerous. Drug abuse is generally blamed on the patient who is said to have treated as a chemical panacea what the prescribing doctor intended as a palliative. Yet doctors continue to write millions of prescriptions without apparently considering the possible consequences this enormous dependence on drug therapy is producing.
Between 5 and 15 per cent of patients in Australian hospitals suffer from some drug-induced disease.32 A study of suicide attempts admitted to the Alfred Hospital, Melbourne, in 1973 found that three out of five people had taken overdoses of drugs prescribed by doctors for insomnia or depression and that 86 per cent had consulted a doctor in the two months prior to the attempt.33 Dependence upon drugs to alleviate social problems is actively encouraged by the manufacturers of
these drugs. Although they cannot be promoted directly to the public, these drugs are portrayed as miraculous cures in expensive advertisements in journals read by medical practitioners. These advertisements continually reinforce notions about what is ‘normal’ behaviour in women: they almost always show women – usually in family situations – in states of depression, anxiety or total breakdown. For instance, the anti-depressant Tryptanol, for which 884 473 prescriptions were written out in 197134, has recently been advertised in four-page glossy supplements in the Medical Journal of Australia. The first page shows a desolate-looking woman with small children around her saying, ‘I just can’t cope with things anymore’. The ‘medical’ advice contained in the centre pages warns doctors against prescribing tranquillisers ‘when the diagnosis is mixed anxiety-depression’ for this ‘may sidetrack the patient even deeper into depression’. Instead, ‘When mixed anxiety-depression is the diagnosis. Tryptanol. An effective anti-depressant with an inherent tranquillising effect can be more useful in relieving target symptoms such as *Anxiety *Agitation *Insomnia *Functional gastrointestinal disorders *Loss of interest *Functional somatic complaints *Loss of confidence and sense of importance.’ Page four shows the same woman, smiling gaily (even if doped to the hilt) responding to her children – obviously able to cope.35 Many other tranquillisers and anti-depressants are promoted in the same fashion.36 With this kind of promotion it is not surprising that the general practitioner, confronted by a woman mouthing almost identical complaints, will respond by prescribing one of these drugs.
By far the most popular drug in Australia is the tranquilliser diazepam, which is sold under the tradename Valium. Usage of this drug has increased rapidly since it first appeared on the market. In the year April 1970 to March 1971, 941 090 prescriptions for Valium were written by general practitioners.37 Sixty-three per cent of these prescriptions were written for women.38 On 1 December 1972, Valium was placed on the NHS benefits list and since then its usage has increased spectacularly: by the end of December it had been prescribed more times than most other drugs were for the entire six-month period ending that month.39 In 1973–74, 4.6 million prescriptions were written for Valium, making it the most prescribed drug in Australia.40
One of the reasons these drugs are so heavily prescribed, and one that has accounted particularly for the enormous rise in the consumption of Valium, is that they are non-toxic. ‘The lack of fatal outcomes from overdoses of benzodiazepines is a great factor in explaining their popularity’41 as one journal succinctly phrased it. No risk of overkill. But there are a great many other risks, especially with Valium, and these appear to be overlooked by the prescribing doctors and to be unknown to the supplicant patients. Nothing on the bottle itself, the advertisements for Valium appearing in most medical journals, or the general practitioners’ pharmacological compendium mentions them.42MIMS, the Monthly Index of Medical Specialties, which is sent free of charge ‘to all doctors in active practice’ lists the following special precautions to be taken with Valium: ‘Moderation with alcohol; as with other drugs, precaution during the first three months of pregnancy’.43 How many women are aware of the latter warning? In effect it means that any woman who is likely to become pregnant – a substantial proportion of the female population – ought not to take Valium or any related drug. MIMS reports in relation to this group of tranquillisers that ‘Safety in pregnancy is not yet established although some have been used with apparent safety’.44 It could be argued that in order to avoid the slightest possibility of a tragedy similar to that caused by Thalidomide, Valium should not be prescribed to women who wish to have children. Other side-effects of Valium include ‘Drowsiness, mental confusion especially in aged, appetite stimulation, Agranulocytosis’ and doctors are advised that patients should be warned of a possible impairment of their ability to drive a motor car, the possible potentiation of alcohol, plus the possibility of physical dependence in patients using Valium.45 Yet not one of the dozens of the Valium-using people, men and women, I have spoken to has ever been warned of any of these dangers.
Valium is prescribed for a wide variety of problems experienced, particularly or solely, by women and this usage is encouraged by Roche Products, its manufacturer. One booklet produced by this company gives a list of ‘psychological problems of marriage’.46 These include frigidity, dyspareunia (painful intercourse), fear of pregnancy, childlessness, the tensions of mothering and fathering, and divorce. The cover of the book depicts the Chinese symbol for ‘trouble’ which is made by combining the symbols for ‘women’ and ‘roof ’. The ‘problems’ listed are all experienced mainly by women. The last page of the booklet provides pharmacological details of Valium. The unspoken implication of this booklet is that when women suffer anxiety about any of these ‘problems’ then Valium is the answer. A new pharmacological panacea has emerged that has the most insidious implications. It would seem more sensible to prescribe contraceptives to a woman who is frightened of pregnancy, and the Roche booklet does not dispute this, but it argues that ‘modern contraceptive measures are often fraught with emotional conflict’. The message seems to be: forget the problem, just assuage the anxiety.47
Women account for nearly two-thirds of the consumers of Valium – it is now widely prescribed by gynaecologists as well as by general practitioners and other specialists – and they are clearly being forced to resort to it as a means of blotting out awareness. Because Valium and these other much-consumed drugs do work. They anaesthetise, they dull responses, they create a sense of well-being. Problems no longer seem so threatening or overwhelming. No matter that they mute one’s psychic awareness, that they insidiously undermine a person’s capacity for acting upon the world and working to change their ‘self ’ and social environment – that potential that defines our humanity. They keep people functioning – humanoid robots perhaps – but at least alive and ‘able to cope’. The distraught ‘self ’, already ravaged by the contradictory demands of the female role, is lulled into quiescence and quietism. The possibility of restructuring is removed, and the doctors who glibly prescribe these mind-stoppers are guilty of something like mass psychic murder of the women of this country.
The third resort of people in distress is to engage in self-destructive acts, behaviour that is risky to life or is likely to incur strong social reproof or punishment. These acts can be seen as instances of ‘mayday’ behaviour: they are engaged in to draw attention to a person’s plight. The most dramatic of these – for there is always the risk that it will misfire and become a grotesque confirmation of a person’s urgent need for aid – is what researchers on the subject are increasingly referring to as ‘suicidal behaviour’.48 The rate of successful suicides has increased dramatically in Australia since 1955 while it has remained constant in comparable countries like the United Kingdom.49 This increase has been in part because of the very large jump in the percentage of female suicides. These have increased from 5.4 per 100 000 in 1955 to 10.8 in 1965; by contrast the male rate increased by 3.7 per 100 000.50 But this statistic only obscures what has been an extraordinarily large rise in the number of women engaging in suicidal behaviour, particularly by means of self-poisoning. More than three-quarters of these attempts involve overdoses of drugs, especially barbiturates, which have been prescribed by a doctor.51 During an eight-year survey of patients attending a Melbourne western suburbs hospital after suicidal behaviour, it was found that there was a mean ratio of one man to every 2.4 women, that women made up 71 per cent of those who had used this means of drawing attention to their plight.52 The overwhelming majority of the women, many more than among the men, said afterwards that they had not wanted to die53 – their swallowing of massive doses of pills was a desperate attempt to get someone (anyone?) to recognise that their complaint was serious, that they had to have help, and that, everything else having failed, this seemed to be the most efficacious means of signalling this.
There are many other forms of ‘mayday’ behaviour, many of which may not be recognised as
such for not every instance of such behaviour will necessarily be a cry for help. But when a person, particularly a woman who has no other means of venting her frustrations, engages in a form of behaviour that for her is atypical, then it must be asked whether or not she is – even if subconsciously – calling attention to her malaise.
It has been found that women are more likely to shoplift than men, and that the greatest number of ‘offenders’ occurs in the 15 to 39 age group.54 If many of the younger girls can be classed as acting on dares – common among school children – the same cannot be said of women aged 20 to 39 and this was substantiated by the extreme readiness with which women admitted their guilt and gave no reason for the theft: 232 women compared with 179 men gave no reason, while a further 23 women (and only 4 men) gave ‘health’ as a reason.55 Over a quarter of the shoplifters came from suburbs of high social standing, and of these, 77 per cent were women, a further indication that this was not typical behaviour (assuming that people living in such suburbs are likely to have money and not be forced to steal for this reason).
A woman who neglects, or who physically attacks, her children may also be crying ‘mayday’ – saying, ‘Look I’m a bad mother, what’s wrong with me, why doesn’t someone help me’. The incidence of ‘baby-battering’ has risen greatly in recent years although it is often not detected unless the child has sustained serious and often permanent injury. In a society that professes to hold motherhood in high esteem, the woman who is a ‘bad’ mother receives swift condemnation. Where maltreatment is persistent and publicly observable, the children are usually taken away and placed in state custody: they are cared for, but what happens to the mother? Is she left, bereft and alone, to find yet another means of calling attention to her plight? It may be the case that it is the children who are the problem and that she will be happier without them, but this cannot merely be assumed. When women learn the qualities of nurturance as part of the process of acquisition of ‘self ’, they do not bash their children without suffering enormous guilt. Such action, even if induced by extreme anguish, can precipitate total breakdown of ‘self ’ for it will appear to the woman that she has negated one of the fundamentals of her personality, her ‘nature’ even. When women engage in behaviour that is so totally at odds with their expressed ‘self ’-conceptions they do not need punishment or censure. Rather they require sympathy and someone to whom they can try to articulate the immediate cause of their actions. Not someone who will push away their problems with a prescription, but a person (or group) who has some insight into the enormous ravages wrought upon the female psyche in a culture that is sexist and patriarchal.