Illuminating Gender II

by Amber Dean, University of Alberta, Canada

Is it tenable to discuss mental pathology as a socio-historical and linguistic construction and as a 'true' debilitating condition? (Fee, "Broken Dialogue" 2)

1     Depression is not a problem that is likely to disappear soon, as the numbers of people receiving such a diagnosis are on the rise almost everywhere. Its chilling effects are experienced by over 100 million people worldwide (Culbertson), and the Canadian Mental Health Association (2001) projects that by 2020, depressive illnesses will be the leading cause of disease burden in Canada and other developed countries. Women apparently experience this thing called depression at approximately twice the rate of men (Bebbington; Culbertson; Kramer; Nolen-Hoeksema; WHO), with recent research showing that the female to male sex ratio for depression is commonly 2 or 3 to 1 (Stoppard, Understanding Depression). Put another way, approximately 25% of North American women will experience depression at some point in their lifetimes (Schreiber). A variety of explanations for this statistic have been posed, including arguments based on women's unique biology, or suggestions that our greater likelihood to seek help when depressed causes us to be counted more frequently in statistics on depression (Culbertson; WHO). However, women's greater help-seeking behavior has proven inadequate to explain our over-representation among the depressed (Formanek and Gurian; McGrath, Keita, Strickland and Russo; Nolen-Hoeksema). Thus far, researchers working from a scientific/positivist framework have been unable to adequately explain why so many more women than men experience depression. Not surprisingly, given the disproportionate numbers of women afflicted, depression has gained the attention of feminist scholars from across a wide range of disciplines. Working from different backgrounds, and often with divergent theories about material and/or discursive dimensions to depression, it is not surprising that feminist scholars have struggled to make sense of this phenomenon.

2     Depression presents feminist theorists with a significant problem: it makes sense to many of us to point out the ways that depression, as a concept, is constituted discursively. In particular, depression seems indelibly tied to powerful biomedical discourses, and also, for women, to the equally powerful discourses that dictate what a "good woman" should be. Yet to highlight these discursive dimensions of the phenomenon seems to preclude both an acknowledgement of depression as a source of pain and an acceptance of any form of treatment for this condition other than dramatic social change. Yet Prozac, only one among many antidepressants on the market, has been prescribed to more than 40 million people worldwide (Eli Lilly and Co.) and women make up about eighty percent of Prozac's users (Zita). Surely some of those 32 million women must identify as feminists, and many of them probably live with a deep inner conflict between their feminist ideology and their individual actions, a conflict that invokes silence and shame. Maria Caminero-Santangelo (1998) writes, for example, about hearing a woman at a Women's Studies conference speak about how her continued use of antidepressants was heavily criticized by many feminists whom the woman had previously considered allies, feminists who subscribed to a discursive understanding of depression which eschewed biomedical explanations or treatments. While the woman in question agreed with the critiques of her colleagues in theory, she also struggled with the fact that "when she was depressed, she could not work, write, or — often — even get out of bed" (10). In practice, then, her contributions to feminism would be virtually impossible without antidepressants. Gardiner (1995) discusses a similar experience of attending a feminist meeting that "assumed a consensus about social constructionism" (501) among participants, only to discover during meals and breaks that many of the women present were taking Prozac or other antidepressants. She notes that, ironically, "the potential contradiction between such private solutions and the publicly avowed ideology of social constructionism was never voiced" (501). Hence I would argue that the struggle between materialist and discursive explanations for depression is a particularly strained issue for feminism, and perhaps our only hope for a resolution is to locate our understanding of the phenomenon "in-between" the two conflicting poles of this binary (as some leading feminist psychologists have started to do).

3     This article explores the limitations of strictly material and strictly discursive explanations for women's depression and suggests that a model existing in-between these two dualities is essential to a more comprehensive understanding of depression in women. The narratives of women who live with depression provide a rich source of evidence by which to raise questions about the limitations of materialist and discursive theories on women's depression. A narrative approach also allows us to escape the confines of the scientific/positivist research that has proven inadequate to fully encapsulate the phenomenon of depression in women, while at the same time ensuring that the lived experience of depression is not lost in the rhetoric of theories that posit it as merely a matter of discourse. The article concludes with an evaluation of the material-discursive models for understanding women's depression recently posed by feminist psychologists Janet M. Stoppard and Jane Ussher.

A Narrative Challenge to the Scientific/Positivist Paradigm

Findings of research conducted within mainstream paradigms have provided few helpful directions for women in understanding and explaining their depressive experiences. (Stoppard, "New Perspectives" 81)

4     The methodology of this research starts from a different place than the mainstream (scientific/positivist) approach used to conduct the bulk of recent research on women and depression. In this paper I combine some of the principals of feminist qualitative methodologies with the literary method of narrative analysis, resulting in a feminist narrative analysis that is used to explore the meaning(s) of depression in women's recent writing on depression and in the transcripts of four oral histories conducted with women who live with depression.[1]These oral histories were conducted as part of the research for my Master's Thesis, which I successfully defended at Simon Fraser University in Burnaby, British Columbia, Canada, in 2002. For a more in-depth discussion of the methodology I employ in this article, please refer to that thesis, titled <em>A Melancholic Musing: Women's Narratives on Depression</em>. Information on accessing this document can be obtained at http://www.collectionscanada.ca/thesescanada/index-e.html Gluck and Patai (1991) indicate that narrative analysis is an appropriate method for interpreting oral history transcripts: "Contemporary literary theory," they explain, "made us aware that the typical product of an interview is a text, not a reproduction of reality, and that models of textual analysis were therefore needed" (3). The texts created from the oral histories conducted for this research are therefore read not necessarily as fact but as testimony about the meaning(s) of depression in these women's lives and about the ways in which these four women, alongside several recent women writing about depression, suggest that their understandings of depression are reflected (or not) by materialist and discursive theories on depression. It may seem contradictory to use "experience" as evidence in a paper that also has as one of its aims the furthering of discursive theories on depression. However, when lived experience becomes entirely unrepresentable in discussions of discourse, we no longer have a language to speak about the pain and impairment felt by people living with this thing we call depression. Also, when women speak about their "experiences" of depression they themselves often call attention to the ways in which they recognize this experience to be shaped by prevailing discourses. Hence experience, when viewed through this lens, need not be entirely antithetical to a discursive analysis.

5     Ussher documents the trend in the vast majority of research on women's mental illnesses to employ the "realist/positivist epistemology that has dominated science since the seventeenth century" ("Women's Madness" 209). Most researchers, whether operating from a biomedical or a psychosocial perspective, believe that knowledge is only possible through observation, and can therefore only be proven to be knowledge through the use of methodologies that promote standardization, replicability, and objectivity on the part of the researcher. Of course, feminist critiques of such methodologies, and in particular of the concept of objectivity, have been extensive (Code; Harding). This research looks to women's subjective experiences of depression not in the interests of uncovering the "truth" or locating a precise explanation for women's depression, but rather for the questions that these representations of experience raise about the limits of both material and discursive theories on depression.