It’s safe to say that virtually all of us know at least one woman who is being treated for depression. In his intriguing book, Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs, author Jonathan Metzl, MD, PhD offers some ideas on why that could be the case.
The book first came out in 2003, and Metzl, a practicing psychiatrist and Associate Professor of Psychiatry and Women’s Studies at the University of Michigan, found his book being given a lot of attention by other mental health professionals and the consumer health media. He has subsequently written articles and presented workshops on medicalization, the concept of turning something, even a relatively “normal” event, into a medical issue.
A good example of medicalization: drug-makers’ advertisements that depict depressed women as unable to fulfill their “normal” roles in the family.
Jonathan Metzl is also the Director of UM’s Program in Culture, Health, and Medicine.
I talked to Dr. Metzl about his interest in the topic, and whether or not women have indeed been convinced that their various difficult situations in life are clinically-treatable depression:
TM: What led to your interest in the combined topics of pharmaceutical marketing, women, and depression?
Jonathan Metzl: I work as a psychiatrist, in addition to teaching the history of psychiatry at the University of Michigan. In my practice over the past 10 years, I’ve seen increasing numbers of women come in requesting SSRI’s and other psychiatric medications, but doing so in reference to pharmaceutical advertisements that they might have seen either on television, in magazines, or on the Internet.
I got very interested in the scenes depicted on the advertisements, because it’s hard to look at them even for a few moments and not realize that they’re making very particular statements about mental illness and about the relationship between gender and mental health. One of the trends that I started to notice and wrote about is the relationship between mental health and what we might call ‘hetero-normativity’, or marriage.
I started to see in these advertisements increasing numbers of women who were shown as being healthy or treated or shown in happy family settings, with wedding rings, and other kinds of references that showed the indicator of their mental health wasn’t just that they felt better from depressive symptoms, but also that being mentally healthy is signified by marriage, children, or family.
I have no doubt that in some ways, one of the ways that people who are recovering from depression feel they can go on in their lives is related to their relationships. Women who feel better might start new relationships or improve their current ones, or be better mothers or girlfriends.
At the same time, I found myself becoming critical of these representations [by advertisements] because there’s nothing in the DSM [Diagnostic & Statistic Manual of Mental Disorders] or psychiatric literature that talks about how mental 
health or recovery from depression means automatically participation in a hetero-normative relationship. What’s happening is a combination in [these ads] of ideas about mental illness and health and societal pressures and norms and stereotypes about what it means to be a normal woman.
TM: What is a “normal” woman?
Jonathan Metzl: Right. Well, if you look at pharmaceutical representations (advertisements), it’s a woman who plays happily with her children, balances work and home, buys the groceries… all of these things that may or may not be related to mental health. Certainly there’s an open question – I feel strongly that medications like Prozac, Zoloft, Celexa, and other antidepressants are very beneficial for treating symptoms of depression: depressed mood, loss of interest, all the way to suicidal thoughts. But I don’t think there’s literature that talks about how these medications are effective treatment for having a husband who might be unruly or for buying the groceries or performing motherhood duties.
In a way, there’s a fine line between different definitions of normalcy, and we have to be careful about maintaining that boundary. We don’t want to say that antidepressants are treatment for women who are unhappy in relationships. We want to say clearly these are for men and women who are depressed.
TM: What does a woman do to make sure she gets good treatment for depression? Is talk therapy a necessary component for everyone?
Jonathan Metzl: I think it varies case by case. I’m not anti-medication. When used correctly, medication helps and saves lives. But it’s important to note, for instance, that most prescriptions for antidepressants in the United States are written not by psychiatrists but by primary care doctors in very short office visits of seven to 10 minutes or less.
What worries me is that a person goes in to talk to her doctor about something that may be difficult in their lives, and medication has become quick shorthand – ‘it sounds like you’re in a difficult situation, here’s some Zoloft.’ Antidepressants may be indicated in those cases, but you can think of numerous incidences ranging from mild depression to relationship difficulties where, say, a woman needs to leave a bad relationship or something like that, many other issues where other options – psychotherapy, social support – might be optimal. I think when medication becomes shorthand, we risk losing sight of those other options.
I don’t want to say that everyone who takes medication should be in psychotherapy; I think just like medication, psychotherapy works for some people and not for others. But I also think given the wealth of information we have on these medications — not just from psychiatry but also from popular culture — that doctors and patients need to be aware of not only mental health and illness but also about the social-cultural norms that surround us.
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