Women and depression

Depression is one of the most prevalent and least understood emotional problems which afflicts individuals in North American society Along with feelings of alienation and anomie, it leads the list of the modern individual's emotional complaints. It has been recognized as a problem since antiquity and descriptions of the symptoms of depression have been remarkably similar over time. Despite the general agreement in descriptions of the disorder, modern researcher, like their ancient counterparts, have consistently complained about their slow progress in understanding and treating the problem. Depression has been described as paradoxical, elusive and perplexing. (Beck, 1967) One of the most striking and perplexing aspects of depression in North America is the well established fact that women experience and are treated for depression in far greater numbers than men (Weissmand and Klerman, 1977) Many social workers in the field are well aware of the higher incidence of depression among women as they are frequently confronted by female clients who report that they feel sad, hopeless, and unable to cope with their lives. These complaints may range from mild but pervasive feelings of apathy, fatigue, boredom and gloom (frequently called the housewife's complaint) to intense and overwhelming feelings of despair which too often lead the woman to a desparate suicide attempt. Both the prevalence and the seriousness of depression in women is a cause for concern among mental health practitioners. Yet, except for research exploring forms of depression which only effect women (i.e. post partum depression) , there has been little systematic research into the causes and treatment of depression, specifically in women. However, there have been indications of greater interest in this area within the past ten years. Renewed interest has, in part, been sparked by the advent of modern feminism and feminist critiques of the mental health system' s understanding of female psychology and its treatment of troubled women. Feminists have focussed their attention on analyzing women's role in modern society and on explicating the effects which the feminine role has on the emotional difficulties which many women experience. Feminists have challenged many commonly accepted assumptions about the nature of femininity and have attacked the mental health community's acceptance of this traditional view of women. They have criticized treatment programs which are based on what they consider to be a distorted view of women and have proposed alternate ways of helping emotionally troubled women. The feminist challenge to the mental health system has special relevancy for the field of depression, the most common of all of women's psychiatric complaints. The challenge has raised many important issues for mental health practitioners. It has focussed attention the the links between women and depression and has raised questions about the ways in which practitioners analyze and treat depressed women. This paper is an attempt to examine the links between depression and women, and to look at the issues involved, in understanding and treating the problem. The first section examines the problem from the clinician and clinical researchers point of view. It looks at depression as a psychiatric problem. How prevalent is it? How is it defined? What causes it? How can it be treated? The issues which are dealt with in this section are: a) findings in the research on prevalence of depression, with particular emphasis on findings of female preponderance; b) the definition of clinical depression, the assumptions on which the definition rests and the problems involved in defining depression; and c) an examination of the 4 dominant explanatory and therapeutic schemes related to depression (organic, psychoanalytic, cognitive, and behaviorist theories). The emphasis in section C is on critically analyzing the major underlying assumptions which each theory makes in constructing and treating the depressed woman, The research evidence on which each theory rest is examined. Feminist and other critiques of the major theories of treatment approaches are presented. Section II looks at the feminist view of depression and women. Issues which are examined in this section are: a) feminist analysis and critique of the mental health community's treatment of emotionally troubled women; b) the feminist analysis of women's role in society and the relationship between women's role and depression; c) feminist approaches to working with depressed women. The focus in this section is on explicating the underlying assumptions of the feminist approach. Relevant research findings are presented as well as critiques of the feminist position. The final section summarizes those aspects of theory and practice which the author sees as significant to social workers who are working with depressed women. This section Includes a discussion of some of the conclusions which the author has reached about working with depressed women in this society, and suggestions for what the author hopes is a more integrated approach to the problem. In order to facilitate the analysis of the major issues and approaches to working with depressed women, a case example is presented in Section I and used throughout this paper. The case study is based on Sylvia Plath’s novel The Bell Jar which chronicles the life of Ester Greenwood, a 20 year old college student who becomes seriously depressed as she attempts to define her own identity as a woman and artist in 20th century North American society. This semiautobiographical novel can be taken as a document of Plath's understanding and explication of what it means to be a depressed woman. As it was written by a woman, who both endured and ultimately succumbed to that experience, it seems an appropriate choice for a case example and one which provides some insight into the desparate struggle which depressed women so often endure. The problem of depression and women is complex, and there is considerable disagreement among theoreticians, researchers and practitioners about how it can best understood and treated. the lack of clarity in the field and the conflicting approaches to the problem have implications for the women who seek help from the mental health community. As social workers, we are intimately involved in the problem of depression and women. As a profession we often, stand at the interface between the woman within her social world and the psychiatric treatment world. Frequently, it is we social workers who help a woman embark on her career as a mental patient. It is often our job to make an initial assessment of the woman 's mental state, and to extract relevant details of her life for presentation to the treatment community. In some settings, we may be engaged in the treatment process itself. We are often involved in the social ramifications of depression for the woman and her family. We may be asked to provide practical or emotional support for her, and on some occasions we are responsible for placing her children in foster care. In view of our extensive professional involvement with depressed women, It is important for us to be sensitive to the many issues in the field, and as a profession, to approach this problem with as broad and comprehensive an understanding of it as possible. It is hoped that this paper will be helpful in adding some clarity to this complex and difficult problem.Arts, Faculty ofSocial Work, School ofGraduat