By ELISABETH DE MARIAFFI
Saturday, March 10, 2018
Author of the novel Hysteria
When I was 15, I spent a month in hospital, recovering - or, rather, trying to kickstart recovery - from an eating disorder. I was in the adolescent ward; it seems to me now that the thing I needed most was a time out. Time to myself. I certainly got it. Despite a revolving cast of occasional roommates, what the month gave me, more than anything, was the breathing space I needed to start figuring things out. It wasn't an instant cure. The key word in time out was time.
I saw an occupational therapist one day a week, a psychologist another. No one offered anti-anxiety or antidepressant medication. I was a teenager in the early nineties; in those days, a prescription was much more the exception than the rule. I got my time out, and I got to go home and get better. No one ever suggested to me that I couldn't.
I wonder if that would be the case if I were 15 now, and admitted for the same problem.
History has shown that women have traditionally been more likely to garner diagnoses of mental illness, and in the 20th and 21st centuries, those diagnoses have frequently gone hand in hand with medications. It's worth considering the pressures and limitations that women experience, and how they may affect mental health. It's also worth considering whether, nowadays, we are always offering the right solutions.
For the past three years, I have been immersed in 1950s culture, particularly as it relates to women, and the then-burgeoning anti-anxiety industry: all part and parcel of research for a new novel, a psychological thriller not-accidentally titled Hysteria. But it's helpful to know that the history of these medications dates back just a little earlier than that, to the end of the Second World War.
In the late 1940s, a Bohemian-born scientist named Frank Berger was hard at work on a penicillin preservative when he accidentally discovered something entirely different.
The new drug, meprobamate, would go on to be marketed as Miltown, the first commercial tranquillizer. Berger's discovery revolutionized the psychiatric field, and in some sense, gave birth to the psycho-pharmaceutical industry as we know it today. Unlike their sedative predecessors, these new tranquillizers had applications far outside the walls of hospitals and institutions. Miltown was introduced in 1954; by mid-1956, one in 20 Americans had given it a try.
In Hollywood, tony lounges offered Miltown-infused cocktails: the Mil-tini, for instance, was simply a martini garnished with a pill rather than an olive. Television star Milton Berle was such a convert that he suggested he change his name to "Mil-town" Berle.
Despite the it-crowd connotation, Fortune reported in 1957 that tranquillizers had in fact captured the same share of the market in every part of the United States, in small towns and big cities alike. Miltown was now the fourth highest-selling prescription drug, over all, in the United States.
Never heard of it? That's likely because Miltown changed the landscape so completely that it was swamped only a few years later by the next new-generation drug: Valium.
Now, that's a name you've probably heard.
And, like Valium, Miltown and its tranquilllizer cohort targeted one market segment in particular: women.
Postwar America was feverishly marketing a new brand: women's return to home and hearth. As men flooded back into the workplace, the country needed a simple solution to ease job market woes. Women were encouraged to marry younger and have more babies - in contrast to their relatively more emancipated sisters of the previous three decades. Miltown, and its identical twin, Equanil, appear again and again in women's magazines of the day - both in the advertising and in the lifestyle columns.
The new tranquillizers were touted as a cure-all for women's woes. Tired, bored, listless at home? Change of life making you less lively? Pregnant and anxious? Fortune reported that they could even be used as a remedy for frigidity. While the medication did not "improve libido per se ... [women] willingly accepted their mates." Ironically, the drugs also offered a cure for nymphomania, if too much fervour was the problem. The message to husbands was clear: Whether your wife wants too much, or not enough - there's a tranq for that.
Mood-altering drugs have been marketed steadily to women since the 1950s, but when I talk to St. John's Status of Women Council executive director Jenny Wright, she reminds me that it wasn't until the late nineties that women were even included in the clinical trials - a fact I'd also seen reported in Scientific American. "Up until then, the drugs had only been tested on men," she says. Tests didn't take into consideration women's body mass and composition, reproductive system and fluctuating hormones. "So when you think about it, women have historically been given these drugs for years, without any evidence that it was going to work for us."
Today, statistics show that about twice as many antidepressants are prescribed for women as for men, a figure that holds true whether you're looking at Canadian numbers or data from the United States. It's a complex issue. It is positive and important that we're finally trying to destigmatize mental illness, and to ensure everyone has access to the help they need. Our goal to improve lives and deliver proper care is just right.
But a couple of years ago, when both my children were teenagers and attending high school, I began to notice a trend: It seemed to me that they almost never mentioned another girl without also confiding in me her diagnosis, and a few details on her meds. If it had been two girls, or even five, I might have been less alarmed. But as anecdotal evidence goes, this seemed epidemic. Now more than ever, we seem to want to control the unruly moods of women with drugs. And what do we think more unruly than the moodiness of a teenage girl?
It's tricky to break out just how the numbers add up, but a Canadian Journal of Psychiatry study published in 2016 shows a 63-percent-jump in antidepressant prescriptions for young people in Canada: Between the years 2010 and 2013, more than five million prescriptions were dispensed - along with an additional 4.6 million for anti-psychotics. My sense, anecdotally, that an awful lot of girls seemed to be medicated holds up: A University of Saskatchewan study shows antidepressant use to be highest among girls aged 15-19, with prescription rates increasing 14.5fold over the study period.
When I ask my daughter, now almost 20, for her take on the issue, she agrees - but with a twist: Yes, it seems like a lot of girls, she says.
"And there were some who seemed to be almost competing - who's taking the most meds, who's most broken. But the thing is, of all the girls I knew taking meds, I never knew anyone who didn't need them. Or, at least, who didn't think she needed them. And I have a feeling that's really the same thing."
Looking at the history, it seems to me that much of our current practice is cultural.
While American scientists were developing sedatives and tranquillizers, women in Nazi Germany were being marketed a steady diet of amphetamine-filled chocolates. In Blitzed, an account of addiction in the Third Reich, author Norman Ohler describes the drug, Pervitin, as ubiquitous. It was a society that wanted its women to work faster, not lie down. Today in Canada, a 2014 study showed that incarcerated Canadian women are given psychiatric drugs in astounding numbers - upward of 60 per cent, in fact - including the anti-psychotic Seroquel, which advocates say is often used for the drug's off-label application: It's a sedative.
If women have been trained to think of mood as something that needs fixing, is it possible that we are simply more comfortable and therefore likely to ask for help at the doctor's office? Or is it the system that's been trained to see women as requiring repair, and doctors therefore more likely to suggest the drugs? Perhaps an equally valuable question is how much women's moods need to be "fixed" at all.
It's precisely this concern that Jenny Wright is working to address at a groundbreaking counselling program she runs in St.
John's. Aptly named "Right Here, Right Now," the service provides on-the-ground, walk-in counselling, available free of charge to any woman in the community. "We don't take an expert stance - our stance is that the woman is the expert on her own body, her own experience ... That goes for affluent women who want to come in and talk about relationship issues, or women with serious mental-health issues, with multiple diagnoses and medications."
Generally, long wait lists can make counselling, as an option, more the exception than the rule, even though psychiatrists seem to agree a combination of medication and counselling would best serve most patients.
When that Canadian Journal of Psychiatry study was published, lead author Mina Tadrous expressed concern over the possibility that medication was becoming the default for patients without access to non-drug treatment, saying, "Medications alone are not the only treatment."
Has Ms. Wright's program made a difference? "It's a game changer," she says. "These women need connection. They need someone to talk to who will really listen to them, someone who will believe them."
If that sounds familiar, maybe it's because the program's philosophy mirrors what women have been saying all along - and especially since the advent of #MeToo.
When I think about the time I spent in hospital - what I've called here a time out - it's often in those terms exactly: I think about what I gained in agency, in voice.
A month after coming home, I told my doctor I wanted to study ballet. My parents were against it: They worried that ballet's cult of thinness would trigger a return to the same anorexia. But the doctor told me I could do whatever I wanted. That agency was liberating. I owned my own recovery; he didn't want me to feel condemned to illness. Fifteen is an age of identity formation.
It's this identity formation that has me concerned. We live in what feels to me a diagnosis-happy time: I worry that young women will define themselves by the labels they are given now, that they won't be afforded the time, and the freedom, to recover that I was given. I also worry about girls who don't get the support, including medication, that they truly need.
There's no clear thesis to be gleaned here.
Ideally, we'd make the right help available to all women of all ages - and we'd acknowledge that that help will look different for individual women. But I get an uneasy feeling when I consider the cozy harmony between a society that has historically relied on telling women their moods are unruly and a society that makes a lot of money from selling drugs to regulate women's moods.
In Born for Liberty, author Sara Evans argues that polls showed the vast majority of women - as much as 92 per cent - did not want to give up paid employment at the end of the Second World War. Home they went anyway; but in large part, they weren't happy about it. What happened next? Writing in the journal Gender and History, American psychiatrist Jonathan Metzl says it best: "Women's unrest led to symptoms in men."
Yet, on page after page of the glossy women's magazines of the time, it's women who were being sold the cure - in the shape of a pill.
This piece of history has particular resonance right now. In less than six months of the #MeToo movement, we've already seen the first waves of backlash: When women speak to our own experience, when we insist on being heard, we're often told things have gone too far. There goes women's unrest, giving men symptoms all over again.
If that's the case, we may want to take a closer look at the cures being offered.
PHOTO ILLUSTRATION: BRYAN GEE. SOURCE IMAGE: GETTY IMAGES.