When I met Ann she was 31 years old, the mother of Jenny, 6, and Brian, 8. Ann's life -- her values, her ambitions, her relationships -- was right out of Middle America. She married her high-school sweetheart. To the pleasure of both their families, the two made their home nearby and soon began raising children. Ann worked hard to please everyone around her. She never considered herself especially pretty or bright, and was grateful for the security of familiar surroundings and traditional patterns.
When Brian was about 3 and Jenny was 1, the serenity of Ann's life was threatened by limited funds and limitless demands. Even little things began to make her feel weepy. Her mother suggested that she didin't look well and that she ought to see the doctor before she gave something to the children.
"I was accustomed to going to the doctor and taking his advice without question," Ann said, as she told her story.
"I'd been brought up to believe that the doctor is always right -- that his adivce was sound and in my best interest. Besides, I felt lucky that he took care of me.
"All he said was that I probably could use some iron and that Valium would take care of that lump-in-my-throat feeling. Just tense, that's all. And he was right. Once I started taking medicine, I even slept better -- for a while at least. I remember the day I discovered that the label said I could 'take as needed.' It was such a relief."
For almost a year, Ann punctuated each day with increasing doses of her "patience and fortitude" pills. When one pill didn't make the needed difference, she took another. When still more didn't change how she felt, she thought she had let the doctor down. Soon she began to feel frantic about everything.
"I know I should have told my doctor what I was feeling with those pills -- but it just never crossed my mixed-up mind. I didn't even know how that drug could just pull a reverse. I never talked to anyone about taking it, and no one warned me. But, boy, did I have my eyes opened. I finally realized I had a real problem. There I was -- screaming at those two children who adored me, getting so worked up that I threw something at Jenny. Can you imagine? I was taking Valium day and night to calm me down, but I was hysterical. I became so frightened at almost hurting my baby that I called one of those 'hot lines.'"
A trained counselor gained her confidence, assured her that her behavior was due to a serious drug reaction that was reversible with proper care, and suggested some public and private facilities that could meet her need for help.
Ann's "habit" was sizable by that time (instead of the original 15 milligrams, she was taking about 60 milligrams a day), so her system required careful withdrawal from the drug. Had she simply stopped taking the tranquilizers, all at once, she could have gone into a mild seizure. "That call -- and I don't know how I had the guts to make it -- was a lifeline for us all."
For too long the lonely anguish of women's drug and alcohol habits has been the subject of whispered confidences, gossip-column innuendoes, and hushed family embarrassment. For too long this anguish has been viewed as an individual fall from grace. Admittedly, every situation is different. These differences confirm the uniqueness of human experience, but they do not change a universal fact: an insidious epidemic has been raging among the women of this nation -- addiction to drugs. All kinds of drugs, in tablets, capsules and liquids -- tranquilizers, sleeping pills, diet pills, painkillers, alcohol -- over-the-counter and prescribed. And all of them legal. The combinations are mindboggling, literally and figuratively.
In 1978, the acting director of the National Institute on Drug Abuse told a congressional committee that, in the past year, 36 million women had used tranquilizers; 16 million used sedatives (sleeping pills); 12 million used stimulants (mostly diet pills); and almost 12 million women received prescriptions for these drugs from doctors for the first time.
Statistics that show the enormousness of the problem of prescription-drug use by women are shocking. Of the 160 million prescriptions written last year for tranquilizers, sedatives and stimulants, only about 10 percent were authorized by psychiatrists, the group of doctors whose training emphasizes the eefects of psychoactive drugs. The largest percentage of these prescriptions was written by general practitioners, internists and obstetricians-gynecologists. Sixty to 80 percent of all the drugs prescribed were for female patients.
During each of the past several years, 90 percent of the women seen in hospitals for drug-related emergencies used legal, prescribed drugs; and the greatest number of drug-related deaths were the result of a combination of drugs and alcohol.
Mental health experts estimated that about 10 percent of our population suffers from some serious mental disease, but that almost three-quarters of the nation is affected by disabling anxiety, insecurity, tension -- all the pressures of living. They also speculate that 70 to 80 percent of the symptoms of illness told to physicians, from sleeplessness to stomach aches, are the open wounds of hidden life strains -- an acceptable way to present pleas for relief.
This national malaise has particular significance for women, as the following facts indicate:
At every age over 15, more women than men receive treatment for mental-health problems. Except in the 25- to 34-year range, the institutional diagnosis of "depression" is far greater for women than for men. (This greater female proportion, seen at hospitals and clinics, does not include those who are similarly treated by general practitioners, private mental-health therapists, religious counselors, self-help groups, or those who are troubled but untreated.)
Women make the most visits to doctors. They have higher rates of admission to general hospitals and report more physical ailments.
Women enter and return to private psychiatric therapy in and out of hospitals more often than men.
Minimally, women are prescribed more than twice the amount of drugs that men are, for the same psychological symptoms.
Although women of almost every description are represented in this emotionally distressed group, single women present the fewest symptoms of mental disorder; married women with families, the greatest number.
A sizable percentage of women who finally seek help for emotional problems have already turned to alcohol or mood-affecting drugs for stress therapy.
In the past 10 years, the number of women who voluntarily sought help for alcoholism has doubled, but it still does not approach the 5 million females presumed to be alcoholics. The number of deaths from cirrhosis of the liver is rapidly increasing among women.
The "major" tranquilizers, rightly hailed for reducing the use of electroconvulsive shock treatments or brain surgery in severe psychotic disturbance, are now over-prescribed for traumas and neurotic conditions that would never have been treated by the earlier, dramatic procedure. In the same way, barbiturates and other heavy sedatives were replaced or supplemented by the so-called minor tranquilizers. But this breakthrough fostered competitive overproduction and foisted more of these drugs on larger populations -- for a wider variety of milder, nondisease conditions.
As drug proliferate and as medical care becomes increasingly fragmented, overprescription becomes commonplace -- and too easy to blame on the other guy. In surveys taken among doctors about overprescribing, the respondents overwhelmingly indicate concern about "other doctors" who engage in the practice, but denying being guilty themselves. As one docotr told me, "There are bad apples in any profession. The rest of us aren't responsible for them. That's a job for the authorities; it has nothing to do with me."
Even if many physicans sincerely believe that the drugs they prescribe are not dangerous, similar naivete cannot be attributed to the industry that produces and markets them, through the doctor, to the patient-consumer. I actually heard the head of a major medical advertising company describe how his company, through artful language and marketing campaigns, has helped "enlarge the whole concept of illness" in order to accommodate the classes of mood-altering drugs.
At a congressional hearing before the House Select Committee on Narcotics Abuse and Control in 1978, a representative of the Pharmaceutical Manufacturers Association (the industry lobbyists) was questioned by the chief counsel about the dismal, unattractive women seen repeatedly in medical journal ads. The unabashed response was:
"Illustrations in medical ads, as in all ads, are designed to attract the attention of the reader. They typically depict individuals whom the physician will relate to his own practice -- people like those he's seen in his own office."
Typically, in the single, double, or four-page ads that fill the pages (and the coffers) of the medical journals, one-half to two-thirds of the layout is pictorial. The visual impact is heightened by a phrase suggesting a diagnosis. To the busy professional reader, the message is clear, regardless of the small type that fulfills Federal Food and Drug Administration (FDA) requirements for indications of use, problems and drug composition. Although some ad campaigns were altered or corrected over the years, doctors once persuaded seldom change prescribing habits.
Thus, under the headline EMPTY-NEST SYNDROME, a full-page picture allows us to look inside five unpeopeled rooms in what was clearly once a busy home. At the bottom of the page, sitting all alone in the living room, is a middle-aged woman. The companion page urges in large bold type: TRIAVIL FOR DEPRESSION WITH MODERATE ANXIETY. And in just a bit smaller type: "In Many Cases a Result of the 'Empty-Nest Syndrome.'" In the text, the ad describes the "midlife crisis" as a critical crossroads at which depression and anxiety are common. To treat it (only its symptoms, of course!), this coping compound will provide simultaneous antidepressants and tranquilizers.
No female is too young to be helped. The pharmaceutical company Pfizer advises doctors that Vistaril can reduce childhood anxieties. Accompanying the portrait of a tearful little girl are the words: "School, the Dark, Separation, Dental Vists, Monsters." On the next page the physician is urged to help when "the everyday anxieties of children sometimes get out of hand."
For the older female student, Librium may help her get "back on her feet" when "afflicted by a sense of lost identity in a strange environment . . . concerned over competition, apprehensive about national and world conditions, and confronted by the possible consequences of her 'new freedom' [which] may provoke acute feelings of insecurity."
Chemical solutions for other everyday human problems include:
"For anxiety that comes from not fitting in." Serentil.
"You can't set her free. But you can help her feel less anxious. Beset by the seemingly insurmountable problems of raising a young family and confined to the home most of the time, her symptoms reflect a sense of inadequacy and isolation." Serax.
"M.A. (Fine Arts) . . . P.T.A. (president-elect) . . . with too little time to pursue a vocation for which she has spent many years in training . . . a situation that may bespeak continuous frustration and stress." Valium.
For six years I listened -- to women, to their stories about themselves and about the others who were important in their lives. I heard the subtle truths about our chemical culture -- how its siren song may mesmerize any of us, and that it threatens all of us. I learned that we share a most compelling circumstance: We all conduct our lives in female bodies, along historically parallel paths, in culturally private worlds. It is the essence of the "female fix."
Each culture draws distinctions between appropriate male and female functions, but women have always received mixed messages. Contrast, for example, the image of the stoic, pioneering woman, shouldering the enormous family and home responsibilities with the image of an unworldly, delicate-natured woman, subject to frequent "vapours and distempers." The combination results in a woman who, while performing her household duties with uncommon strength, requires protection and help for her inherent weaknesses, particularly emotional ones. To some degree, these cultural-determined characteristics, our heritage, have become a self-fulfilling prophecy.
Troubling though it may be, there is strong evidence that one reason why women tend to take drugs to cope with problems is the frustration created by these contradictory images of women. The preference for legal nostrums may well be the result of a woman's sensitivity to social expectations, in fulfilling her "proper" role.
A very significant difference in the early conditioning of boys and girls is the degree to which boys have been urged to seek and take on challenges, in everything from competitive sports to exceeding the accomplishments of their fathers. Girls, on the other hand, have traditionally been guarded from, and admonished to avoid, "dangerous" -- that is, risky, pursuits.
Many of us had these protective messages. Although they were relayed in different ways, and with a variety of emphases, they have always been intended "for our own good." How many hours and years have women spent on analysts' couches, trying to overcome everything from sexual frigidity and fear of competition to the inability to make friends?
There are exceptions, but most women lack the willingness to take risks. This characteristic is critical in determining the scope of our ambitions; it can predispose us to self-limiting expectations and subsequent feelings of being trapped. When the possilbities of a positive return for an open, inquiring life are stifled, the opportunity for knowing our own strengths is delayed, if not destroyed.
Over the past decade research psychologists have examined the possibility of a double standard of health care, attributable to the effect of sex bias on diagnosis. Their investigations have found that such a double standard does exist; survey after survey reveals that clinical practitioners define healthy men and healthy women quite differently. In addition, the characteristics of "healthly adult" are consonant only with those attributed to males and conflict substantially with traits assigned to healthy females.
New definitions of socially accepted disease states tend to be consonant with cultural expectations. Men are not supposed to complain about pain; they often brag about how strong they are and how seldom they see doctors. Male physicians, however, expect women to be weaker than men -- even neurotic. Women, although biologically stronger than men, are permitted to experience and describe symptomatic ailments such as headaches, tiredness, "female problems." It is no accident that the word hysteria is defined as "an affliction of the uterus." Antiquated or not, the stereotype of the hysterical female remains beneath the cornerstone of contemporary physical and mental health technology and care.
Meanwhile, in their search for meaningful, comfortable, or healthy traditional lives, women have fallen prey to the medical industry's Pandora's box of packaged promises, which all too often contains punishment.