A curious fact: In Spain, where I am from, two out of three prescriptions for psychopharmaceutical drugs (such as anti-anxiety medications and antidepressants) are written for women. In the US, a report found that more than one in four women used medication to treat a mental health condition, as opposed to 15% of men. One might say that we, women, are just sadder than men, but the reason is not so simple. A study commissioned by Spain’s Women's Institute concluded that for cultural reasons, women are more likely than men to recognize the presence of possible illnesses and seek help. More than a century of annual gynecological exams and the institutional monitoring of "women's issues" (from the first period to menopause) support this tendency. The same study found that we are more open to talking about our problems in the examination room, and that our typical way of expressing discomfort is crying. Men, on the other hand, show discomfort by becoming irritable, leading doctors to under-diagnose male patients and over-diagnose women.
But there’s more.
The fact that women are medicated more often than men is due to fundamental gender bias. The Women's Institute study indicates that doctors, unable to escape the social stereotypes that surround them, react differently to the same symptoms depending on whether they are reported by a man or a woman. Men receive more technical tests, while women are prescribed more antidepressants and anti-anxiety medications. Doctors adopt a more paternalistic attitude toward women, assuming that they are weaker, more emotional, and more vulnerable due to their sex. A doctor is more likely to diagnose a neurosis in a middle-aged woman than in a member of any other demographic.
The pathologization of the female mind is nothing new. History is full of examples. “Madness” in women has always been a subjective diagnosis, in the sense that a man (the authority) decided whether his patient was stable or unstable depending on whether she adapted to established norms or transgressed them. When a woman broke the expectations of chastity, submission, obedience, discretion, or silence typical of the "domestic angel" model, she was more than likely to be classified as crazy.
In the 19th century, people believed the cause of madness could be found in the female reproductive organ. Hysteria — a word derived from the Greek hysterika, meaning "uterus” — was the final diagnosis for countless conditions seen in women, such as fatigue, nervousness, irritability, boredom, egocentricity, or simply being unmarried. It was also then believed that women had a greater propensity for mental disorders than men; for this reason, they were hospitalized more frequently and prescribed more psychotropic medications. Having a uterus was synonymous with having problems.
The treatment for “hysteria” was none other than "pelvic massage": stimulating women with a dildo until the action brought them to "hysterical paroxysm" (orgasm) in order to release the accumulated dissatisfaction and stress. Vibrators did not acquire their reputation as sex toys until the middle of the 20th century, around the time it was recognized that "hysteria" was a nonexistent disease.
The mid-century period also saw the end of World War II and the birth of psychopharmaceuticals, which coincided with what Betty Friedan, in her 1963 book The Feminine Mystique, called "the problem that has no name.” Anti-anxiety and antidepressant medications appeared in the lives of American women immediately after they were forced back into the homes the state had called them out of to work during the war. During that time, TV, film, and advertisers returned to portraying the housewife as the model of perfect womanhood. As Friedan observes, once women were back inside the home, many of them began to exhibit symptoms of discomfort and sadness that they could not explain.
The World Health Organization integrated gender into the debate on mental health in 2001. According to official data, women experience more anxiety and depression than men. The ways doctors diagnose mental illness and the different ways men and women seek help surely factor into the numbers. But it might also simply be harder to be a woman. The WHO states that "the multiple roles that women fulfill in society put them at greater risk of experiencing mental and behavioral disorders than others in the community. Women continue to bear the burden of responsibility associated with being wives, mothers, educators and carers of others, while they are increasingly becoming an essential part of the labor force."
Teresa Ordorika Sacristán, a sociologist specializing in the issues of gender and mental health, states in a piece called "Where Does the Sadness of Women Come from?" that the difficulty in finding the solution to the problem "has its roots in the difficulty of clearly defining the boundaries between the ailments of life and the problems of life; in other words, the boundary between the normal and the pathological."
If in the 19th century, “hysteria” was a method of control over any behaviors aiming to break free from the corset of submissiveness, silence, and selflessness that the period imposed on women, then in order to find the solution to "the problem that has no name" one should ask what kind of corset still constricts the women of the 21st century. The ailments of this century seem to be linked to the frustrating model of the woman who is a "perfect ten”: a great worker but an even better wife, a girlfriend who is eager but quite independent, a sacred virgin but not a spinster — one who would never shed a tear, because being alone "was what she wanted.” In reality, we have the woman who dreams about becoming a mother but cannot afford it, one who wishes she were not a mother, but finds it is too late, one who wants more freedom but remains confined in a traditional environment, or one who works tirelessly but never receives the same recognition as her male officemate. What kind of suffering is normal, and what kind is pathological? What is, and what is not, "hysteria" in the 21st century?
What else needs to change in the next 50 years to make us women less sad?
Perhaps we are not examining the problem from the correct angle. Historically, the medical establishment has been used to pathologize women's behaviors, feelings, actions, and thoughts that deviate from the accepted norm. But while the norms have changed over the last 50 years, the pressure to conform and the tendency to jump to a diagnosis or prescription have not.
Today’s model of “having it all” is less outwardly oppressive than the expectations society has placed on women in the past. Yet we are not asking ourselves if trying to reach this ideal, with all the pressures and frustrations that brings, is what makes some women become ill and seek help.
If this is the case, we should treat not only the symptoms of anxiety and depression, but the man-made conditions that are part of the cause.