The recent USA Food and Drug Administration (FDA) expert panel on the use of SSRIs in pregnancy, was a hard watch for various reasons, but, be assured, I’m not going to get into any discussion here about the risks of medication in pregnancy for reasons of my own sanity. No. My concerns were fourfold. The serious shortage of people with experience of actually caring for women with perinatal depression on the panel; the absence of evidence from anyone who has suffered, and I really stress that word suffered with it, who might share their views (The National Institute for Health and Care Excellence, NICE, in England and Wales, always hears from people with lived experience at its deliberations); and, relating to the last point, the denial of some of the panel about the reality of, and the need to treat (yes, I’m using the word – it doesn’t have to mean medication) perinatal depression, even though suicide is the leading cause of death in the first perinatal year in the UK. If anyone feels strongly this is due to prescription of SSRIs, please present the evidence. I can only say that having cared for a mother who was pregnant again after having survived attempting to take her own life and that of her new baby (who tragically died), the risk of this happening a second time was something we all took very seriously indeed. The women I listened to as a clinician convinced me of the reality of postnatal depression and psychosis, and while working on Out of Her Mind, the stories shared with me and reproduced in the book with their permission, moved me to tears.
Finally, however, it was the suggestion by one of the panel, that depression is more common in women because we naturally experience our emotions more intensely- that this is one of our gifts, not a symptom of ‘disease’. This has stayed with me. Really? None of the women I have met, or I who have had problems with my mood for most of life, experienced depression as a gift. More of a burden. And to suggest we are more emotional… I’ll leave that one with you.
But what is being really being said here?
First, let’s get rid of the ‘disease’ word. I don’t talk about depression as a disease, but I do think it’s an illness, a period of being unwell which for me doesn’t have to imply a biological cause. Having said that, as I wrote in my own memoir of depression The Other Side of Silence there is no single thing I’d call ‘depression’. The DSM checklist confined us to counting symptoms rather than trying understand and recognise what it’s really like to feel depressed. Depression can take different forms and have multiple causes. They can be biological, psychological, social, and to that I’d add the wider political environment too, very pertinent to women’s lives. There are factors that make us vulnerable, such as our genes, early environment, and for women especially, abuse and trauma. Then there are the stresses and life events that can trigger depression. In my recent blog on the mental health of young women, I described the multiple social factors that are contributing to their poor mental health, so I won’t repeat them here. Pregnancy and motherhood, particularly when there is little family support in a society where there is an epidemic of violence against women, and in an economic environment where women are struggling to hold families together, or parent alone, is, you would say enough to make any woman depressed. But it doesn’t happen to everyone, and that is where not only the presence of plentiful social support but also underlying vulnerability, biological, psychological and social, comes in. Your previous life experiences, your ways of coping, your family history and, guess what, your hormones. Men have those too, only they are (mostly) different ones, and they don’t go up and down all the time like ours do. That’s important. Some of us are much more sensitive to those hormonal changes than others. If you have post-natal depression you are more likely to have depression at the menopause too. Hell, there’s more than enough reasons for us to have more depression than men without us just being more emotional!
We know much more now than we did about how, for women, it is sometimes their hormones causing problems. In the past, feminists like me were angry at being ‘written off’ because of our hormones, somehow viewed as weak and less capable, but we cannot ignore our bodies. My generation of feminists were dismissive of biological explanations which generally painted us as inferior. Many feminists are still mistrustful of the life sciences, but according to the American biologist and feminist theorist Anne Fausto-Sterling we have a choice. We either push back against each claim about the causal role of the biological body, or we:
‘grapple with the reality of a body made up of cells and nerves and tissues, but still look critically at how bodies absorb and are inscribed by culture – how physiology and society, nature and nurture, are constantly co-creating each other, to the point where it doesn’t make sense to look at either of them in isolation.’ (From Sally Davies in Aeon)
Let’s not ignore the part that our bodies play too in how we experience the world. Yes we are steeped in our culture, but as women, we are surely more than this, we are ‘embodied.’
My latest book: Out of Her Mind: How we are failing women’s mental health and what must change is out now.
Patching the Soul 