The assumption that people struggling with their marriages or
other domestic issues are suffering from depression is not supported by the way
depression is defined medically, said Jonathan
M. Metzl, Frederick B. Rentschler II Professor of Sociology and
Medicine, Health and Society at Vanderbilt and the study’s lead author.
The study, conducted using a Midwestern medical center’s
records from 1980 to 2000, appears in the Yale Journal of Biology and
Medicine.
Notably, Metzl said, the time period of analysis followed a
1974 decision that removed the term “homosexuality” from the Diagnostic andStatistical
Manual of Mental Disorders (DSM), the standard reference book of
psychiatric illnesses.
“As it became less acceptable to overtly diagnose
homosexuality, it became increasingly acceptable to diagnose threats to
female-male relationships as conditions that required psychiatric
intervention,” Metzl said.
“Doctors increasingly responded by prescribing antidepressants
when patients came to the office describing problems with heterosexual love and
its discontents.”
The researchers argue that this pattern became particularly
prominent after the advent of Prozac and other SSRI antidepressants and
widespread pharmaceutical advertising in the 1980s and 1990s.
20 years
of records
In their review of archived psychiatrist-dictated patient
charts from the expansive hospital system, the researchers discovered a
pattern.
“In the charts we analyzed, the pressures of attaining or
maintaining heterosexual relationships functioned as common modes for
describing depressive symptoms,” Metzl said.
But women and men with marriage woes “have little connection
to the current DSM criteria for depression and much more to do with ways that
society thinks that men and women should behave,” Metzl said.
“And yet these cultural pressures seemed to go a long way in
determining whether psychiatrists diagnosed depression or prescribed
antidepressants.”
“In many ways, the 1974 decision was a major step forward,”
Metzl said. “But as we show, implicit gender still functioned in the exam room,
and our analysis suggests that psychiatry still has work to do in that regard.”
Metzl conducted the study with Sara McClelland,
assistant professor of women’s studies and psychology at the University of
Michigan, and Erin
Bergner, a Ph.D. candidate in sociology at Vanderbilt.
