Stop the Bullshit - Women Aren't More Likely to be Depressed than Men.

This morning, a wise older friend sent me an article he thought I might like: Mental health issues a huge challenge for NCAA in regard to student-athletes. I had to stop reading about two paragraphs in because I stepped in some bullshit.  

According to the American Psychiatric Association, women are "nearly twice as likely" as men to develop depression, anxiety and eating disorders. Add in the stress of sports commitments and you have a dangerous combination.

This is just stupid, bad science. It's the reason certain physicists or chemists have a hard time taking psychology seriously. 

Because, sure, it is possible that women actually have more depression or anxiety than men. But the fact remains that woman are disproportionately DIAGNOSED (there's a difference between being diagnosed with something and actually having something) with mental illness relative to men.

Why? Five reasons.

1. People attribute men’s negative emotions to EXTERNAL and UNSTABLE causes. "He is mad because he lost his job." "He is sad because his wife died." Or even just, "His team lost." However, people attribute women’s negative emotions to INTERNAL and STABLE factors. "She's a bitch." "She's having her period." "She always overreacts to things." "She's depressed." You wouldn't recommend counseling to someone who is temporarily sad or mad. You would recommend it to someone who was depressed or hormonally imbalanced.
 
2. Men are less likely than women to visit a doctor, period. This could be because it is seen as un-masculine to go to a doctor in our society. It could be because men are less afraid of health conditions than women -- when it comes to women's health, our culture encourages fear and paranoia . (I hate how we treat womanhood like a disease - every time I visit a doctor, whether for a large, gaping wound or a dislocated shoulder, they ask me when my last period was. Which is why, as far as I'm concerned, the only answer to that question is, "That's completely irrelevant - can you please just reduce my dislocation/stitch up my wound/etc.?"). Whatever the reason, fewer doctor visits inevitably results in fewer diagnoses.
 
3. Men are taught to suppress emotions. Yup. "Taught." Let me tell you a little secret that apparently masters of psychology know:

As far as I -- and possibly any REAL scientist -- am concerned, women aren't innately better at being sensitive to their environment than men. Women aren't innately better at empathy and interpreting other peoples' needs and emotions than men. It's a CLASSIC case of a self-fulfilling prophecy. 

If you'e taken any amount of psychology, I'm sure you've heard of the Rosenthal or Pygmalion effect -- and, inversely, the golem effect. The former is the phenomenon whereby the greater the expectation placed on people, the better they perform -- even if they have no idea about said expectations. The latter is the opposite:  lower expectations placed on people yield worse performance.   

People are social. We are all born sensitive to what others seem to expect of us, and we are all born with a desire to conform to these perceived norms and expectations. Little girls are told, over and over, that they are sensitive, that they are mothers and caretakers and princesses, and that they should behave as such.

Meanwhile, boys are told not to cry. They're called sissies if they get upset or frustrated too easily. They're taught that emotions are girly, and toughness is manly. So they don't really learn to detect human needs and emotions (or they use their manliness as an excuse not to have to).

This can lead to actual differences in male and female brains, as certain neural pathways are strengthened in women, while they atrophy in men, and vice versa. 

Then girls get a little older. They learn from society that when they get their periods, they're going to act all crazy and emotional, and there will be nothing they can do to control it -- which isn't completely true. Many women only know they're premenstrual because they looked at a calendar. Others know because their boobs got more sensitive. But a small number of women have gigantic hormonal swings and horrible cramps that keep them in bed for days every month. And they're taught that this is normal. Women: a little cramping is normal. Disabling cramps are not. They could be a sign that something is wrong - and there are treatments that could help. (I should add this to the list of things I wish all women knew.)

Boys are told the same thing - girls lose control when they get their periods. And that women's feelings are just wild and out of control in general. And then you end up with articles like this one, in which the author writes: 

But you know what I don’t really trust? What I’ve never actually trusted with any women I’ve been with? Her feelings.

If she approaches me pissed about something, my first reaction is “What’s wrong?”

My typical second reaction? Before she even gets the opportunity to tell me what’s wrong? “She’s probably overreacting.” 

My typical third reaction? After she expresses what’s wrong? “Ok. I hear what you’re saying, and I’ll help. But whatever you’re upset about probably really isn’t that serious.”

I’m both smart and sane, so I don’t actually say any of this aloud. But I am often thinking it. Until she convinces me otherwise, I assume that her emotional reaction to a situation is disproportionate to my opinion of what level of emotional reaction the situation calls for. Basically, if she’s on eight, I assume the situation is really a six.

Which, honestly, is probably maddening enough to drive anyone to therapy. No one ever validates your feelings. You are constantly treated like you're overreacting. 

All of this means that two things happen:

• Men don't talk about their feelings as much. When they are sad, angry, anxious, scared, insecure, hurt, or whatever other negative emotion, they're less likely to talk about it to their friends, who are, in turn less likely to recommend visiting a psychologist. (And, as I mentioned before, people are less likely to recommend psychiatry to a man than a woman to begin with.)
  
• Women are made to feel like their feelings are out of control and irrational (producing a golem effect), and they're encouraged to medicate their completely normal feelings. 

 
4. Higher allostatic load in women than men. Put simply, most women experience more chronic stress than most men. For so many reasons.

One that comes quickly to mind is the fact that women are “evolutionarily” selected for their beauty -- something they have little control over. Sure, there's Spanx, and nice clothes, and hair products and makeup. That can help. But at the end of the day, the makeup comes off, and you are who you are. (On top of this, women are taught to compare their bodies to other women -- and even to animated and inanimate characters, like Princess Jasmine or Barbie. Let me tell you something: no little girl plays with a Barbie doll and feels bad about her body as a result. By telling girls not to hold themselves to unrealistic beauty standards and banning certain toys and movies, parents teach them to compare their child body to a cartoon woman's body. But that's another story - never mind.) 

Meanwhile, men are selected for their ability to provide -- something they CAN control. They can work hard, educate themselves, invest wisely, hunt well, ask for a raise, etc. Psychologists know that a sense of autonomy and control is healthy for humans. And that feeling a lack of control is pretty bad for us.
 
And then there's the whole discrimination, harassment, sexism and misogyny thing. Every woman faces this every day. People -- teachers, employers, coworkers, etc. -- automatically assume men are more competent than women. They usually make this assumption without even realizing it (making it an implicit, rather than explicit, bias), which means the chances of them changing their attitude and behavior are small. Women's contributions at work are ignored. Women are talked over and interrupted at meetings. Women are passed over for raises and promotions and excluded from company events -- which, sometimes, is a mixed blessing. Like when strippers are involved. Men: think about the toll it would take on you if half the people you interacted with were condescending to you.
 
And then there's the trade-offs women are forced/expected to make between job and family. And the disproportionate amounts of housework and childrearing. (Even couples in which both partners work full-time, women still tend to do 20+ hours of housework per week.) And the self-imposed feeling that they need to be perfect all the time and if they don't they've failed as a mom/wife/whatever (which, admittedly, I have a lot less sympathy for, but still, that's a factor). 
 
Then there’s wealth. Whatever’s happening with the wage gap right now (some people say it's disappearing, but in the wake of the Ellen Pao case, I read that Asian American women are still making $.77 per Asian men's $1.00, so clearly there's still a problem here), the wealth gap is still growing. This is partly because women’s jobs usually come with fewer fringe benefits. And their careers are often interrupted by having children, which limits their access to pensions and social security. 
 
Then there’s fear. It’s said that one in four women is sexually assaulted by the time she leaves college, and many universities have been charged with violating Title 9 because of their handling of sexual assault on campus. Serial rapists go unpunished and accumulate more victims while schools do nothing. Luckily, the tide seems to be turning on this. But still. It's a serious problem that women have to worry about.

Women are more afraid than men of walking alone, especially in strange cities or at night. Men are often surprised to learn that women think about things like, Will someone try to rape me if I walk home alone? Which, honestly, is sort of an irrational fear. As I wrote in Advantages of traveling while female, 

If you are raped (and, if you're a woman, there's something like a 20% chance of that), the odds of it being a stranger attacking you in an alley or climbing in through your window are pretty small. If you are raped, it will probably be by someone you know: a boyfriend, an ex, a classmate, a buddy, an apartment mate. 
 
Which is completely terrifying in its own right. 

Women are also commonly victims of domestic abuse. Any of these things can lead to years of therapy - but the diagnosis isn't necessarily frustration, and the cure isn't necessarily an SSRI. 
 
5. Doctor biases. Studies have repeatedly shown that gender has a huge effect on mental health professionals' diagnoses. So it’s not that surprising that women are disproportionately diagnosed with certain kinds of mental illness. I mean, duh, right?

Psychiatrist Julie Holland, author of Moody Bitches: The Truth About the Drugs You're Taking, The Sleep You're Missing, The Sex You're Not Having, and What's Really Making You Crazy, wrote in a recent New York Times article, 

Medical chart reviews consistently show that doctors are more likely to give women psychiatric medications than men, especially women between the ages of 35 and 64. For some women in that age group the symptoms of perimenopause can sound a lot like depression, and tears are common. Crying isn’t just about sadness. When we are scared, or frustrated, when we see injustice, when we are deeply touched by the poignancy of humanity, we cry. And some women cry more easily than others. It doesn’t mean we’re weak or out of control. At higher doses, S.S.R.I.s make it difficult to cry. They can also promote apathy and indifference. Change comes from the discomfort and awareness that something is wrong; we know what’s right only when we feel it. If medicated means complacent, it helps no one.

Which, again, reinforces the idea that women are helpless to control their emotions. They need to be diagnosed and medicated. Instead of telling them it's okay to feel what they feel, or working with them to develop a strategy to identify negative behaviors and thought patterns... and what they can do to address them.

***

As long as we treat women like they are always overreacting, as long as women have a higher allostatic load than men, and as long as men are convinced that talking to a psychologist about their problems is somehow a threat to their manly identity, we're going to keep coming to the conclusion that "women are more likely to be depressed than men."

Even though, in 1981, suicide was 1.9 times higher in men than women -- and in 2012, the suicide rate had increased to 3-4 times higher in men than women.  

***

And now, a quick aside about SSRIs, because the amount of SSRIs being prescribed right now is kind of bullshit, too. 

SSRIs have all kinds of horrible side effects. And they don't even help a lot people. For example. SSRIs don't help with grief -- yet doctors routinely prescribe SSRIs to those who have lost a loved one. They don't really help with trauma, either, but they're often prescribed for that, too. 

(A few summers ago, I was talking to a buddy of mine, who happens to be a doctor. I mentioned how I'd been having bad dreams following this horrible experience involving a deranged coworker and a shotgun -- you know, the kind of thing that happens to women at an alarmingly high rate -- and this buddy told me, "Yeah, if we were in the clinic and you told me this, I'd be pretty busy, so I'd probably just prescribe you something. I know it wouldn't help, but that's just the way medicine is now.")

SSRIs won't help you make new friends or fall in love with someone new -- in fact, the serotonin sort of cancels out your dopamine activity, meaning that awesome reward feeling you get when you have a crush on someone new (not to mention your sexual attraction to them) is suppressed. People like to say that the reason SSRIs work is because some people don't have enough serotonin, so if you give them more they'll be happy. 

But that's sort of like saying, People with fevers don't have enough Tylenol, so if you give them more Tylenol their fever will go away. 

And, yes, SSRIs tend to work well in animal models. But have you ever asked yourself where scientists find these "depressed" mice?

The answer is, they don't find them. They make them. Using the "forced drowning" (also known as the behavioral despair or Porsolt focred swimming) test. Basically, they put a mouse in a round container full of water, from which the mouse cannot escape. They let it tread water, tread water, tread water, until it gives up. Then they pull it out of the water for some time, and do the test again. And again. And again. 

Eventually, the mouse begins to "look" depressed. It gains (or loses) weight. It stops interacting with the other mice. Its sleeping patterns change. It stops having sex. And then they give it an SSRI and it gets better.

But what about human depression? How do you "make" a mouse who's depressed because he lost his job and his wife left him and he isn't getting enough sleep? Is forced drowning similar enough to a complex human environment for these models to really tell us much? My guess would be no. It's much more complicated than that. 

The point is, SSRIs might be right for you. But there's also a good chance they're not. Think carefully before you begin medicating your emotions. Get a second opinion. And have an "exit plan."