In Sunday's New York Times there was an interesting article by Dr. Julie Holland about how women's emotions should be appreciated and not pathologized.
First, let me tell you that I read Dr. Holland's book called Weekends at Bellevue and I hated it. She talked about her sadistic feelings (and sometimes actions) towards patients, and her own therapy to overcome this. While I realize that we don't all harbor the kindest feelings towards every single patient on every single day, and sometimes docs have rough stuff going on too, I was appalled. She whistled some song about here comes the parade when prisoners were brought into the ER. She was mean and disrespectful. Feelings are feelings, but to knowingly be sadistic and disrespectful to patients is inexcusable. I read it and was embarrassed to be a member of her profession.
Now that I got that off my chest, the article in Sunday's NY Times called Medicating Women's Feelings was interesting and thought-provoking. Holland writes:
WOMEN are moody. By evolutionary design, we are hard-wired to be sensitive to our environments, empathic to our children’s needs and intuitive of our partners’ intentions. This is basic to our survival and that of our offspring. Some research suggests that women are often better at articulating their feelings than men because as the female brain develops, more capacity is reserved for language, memory, hearing and observing emotions in others.
These are observations rooted in biology, not intended to mesh with any kind of pro- or anti-feminist ideology. But they do have social implications. Women’s emotionality is a sign of health, not disease; it is a source of power. But we are under constant pressure to restrain our emotional lives. We have been taught to apologize for our tears, to suppress our anger and to fear being called hysterical.
Dr. Jeff Lieberman, the past APA president tweeted that the article was 'anti-psychiatry.' I didn't see it that way at all. Holland talks about how anti-depressants clearly help some people, but she also discusses the high numbers of women who are treated with them. It's an issue we've discussed many times here on Shrink Rap: our illnesses are syndromic, they are decided by committees (with the help of research), but they can be inexact. Say you need 5 symptoms for 2 weeks to meet criteria for depression, and a patient comes in with only 3 symptoms for 10 days, but those three symptoms include profound sadness, suicidal thoughts, and a loss of appetite, I don't believe too many psychiatrists are going to stand there with a check-list saying, nope, you need 4 more days and 2 more symptoms before we can call it depression, come back then.
Was the article right? Was it just plain sexist? Are women moodier than men and is treating this a form of suppression? I am certainly moodier than my husband. But everyone I know is moodier than ClinkShrink and she's a woman. Should we accept and celebrate, depression in women, but not in men? Are some people over -diagnosed and over- medicated? Who is to be the judge of that if a patient says 'Look, this medicine helps me feel better'? Or are there people who are under-diagnosed and under-medicated? I suspect the answer is 'All of the Above,' and I still go with the idea that if you show up at my door and say you're suffering, and you want to try meds, I'm usually fine with that. But before you knock, know that I will also insist on therapy, at least at the beginning of treatment.
So I think questioning is fine. What is the role of the pharmaceutical companies in deciding what's an illness and what we treat? Do we under-diagnose or over-diagnose?
Emotions occur along a spectrum and they come and go over days or hours if not weeks or months. It's not anti-psychiatry to be skeptical or to question. And debilitating mental illness is not subtle. I do believe it's the subtleties, the symptoms that come and go in someone functioning normally that Holland may be talking about.
What do you think?