Women and Pills (part 2)

“Women who misbehave, who refuse to conform, and what is done to them.”

Women are controlled by medication; many women even control themselves, voluntarily submitting to sedatives or stimulants in order to suppress or enhance whatever it is about their mind or body that they believe needs suppressing or enhancing. We are taught to control our behaviour from childhood (this is a huge reason why so-called “high-functioning” girls and women don’t receive diagnoses of ADHD, Autism, and other cognitive conditions; we suppress and camouflage our symptoms so as to avoid “making a fuss”, so as to “be nice”, so as to go unnoticed — because being noticed equals being vulnerable). However, there are plenty of women out there who have resisted, and who still resist, the constraints of “natural” feminine behaviour, either voluntarily or because they have had no choice; and the way that the medical industry approaches these women is very significant in revealing our cultural biases.

 

Borderline Personality Disorder, or BPD, is so named because mid-century psychiatry split patients into roughly two camps: neurotic, and psychotic. Borderline patients were those on the borderline between these two; despite the fact that contemporary psychiatry has dispensed with these broad categories in favour of more specific and nuanced understanding of mental health, this label persists. BPD is overwhelmingly a “female” diagnosis — three quarters of borderline patients are female. Sometimes called “Emotionally Unstable Personality Disorder”, BPD relies on pathologising female behaviour as unnatural and in need of correction. The diagnostic criteria include promiscuity, alcohol and substance abuse, “frequent displays of temper” and a propensity toward violence — all traditionally “unfeminine” behaviours, meaning that a woman who is failing to fulfil her societal role can be effectively punished by a BPD diagnosis, while a man with similar symptoms would be treated for depression, anger management, or substance abuse problems.

BPD is overwhelmingly a “female” diagnosis — three quarters of borderline patients are female. Sometimes called “Emotionally Unstable Personality Disorder”

Beyond this, however, the other “BPD traits” are stereotypically traditional female behaviour (according to popular culture) dialled up to eleven: “Affective instability due to a marked reactivity of mood” seems directly drawn from the idea of the irrational, hormonal woman; while “Frantic efforts to avoid real or imagined abandonment” is a psychiatrist’s way of expressing the bunny-boiler trope — women who try to “trap” men into relationships, who are “crazy” and “overreact”. Although BPD is ostensibly difficult to diagnose, women and adolescent girls are often misdiagnosed with it — there is even an argument that psychiatrists and other mental health professionals will give out incorrect BPD diagnoses to “difficult” patients as a form of punishment for non-compliance, as well as to those who cannot otherwise be categorised because it is a “women’s disorder”.

 

By developing a diagnosis which relies on heavily stereotyped ideas of femininity and gendered behaviour, the psychiatric industry has effectively trapped all women within these constraints. (It is also worth noting that the diagnosis is problematic for a number of other reasons, and many patients and medical professionals are pushing for a complete overhaul). A BPD diagnosis, then, is just the latest in a long line of vague descriptors for female suffering: vague labels like “hysteria”, “neuroticism”, and “neurasthenia” have long been used to describe “nervous complaints” primarily attributed to women — “hysteria” is a particularly gendered term, deriving from the Greek husterikos (of the womb), since the condition was thought to be specific to women and was therefore associated with female-only organs. Victorian scientists went so far as to perform surgical hysterectomies on women in asylums, literalising the etymology of the diagnosis, in the search for a cure for female insanity. Despite our presence throughout human history, treatments for women’s health problems (whether psychological or physical) have been and remain woefully inadequate.

“hysteria” is a particularly gendered term, deriving from the Greek husterikos (of the womb), since the condition was thought to be specific to women and was therefore associated with female-only organs.

As discussed last month, any acknowledgment of the artifice and augmentation that go into the daily performance of femininity is forbidden. Our conception of “natural” feminine behaviour is confused: women must be nurturing caregivers for children and their husbands, but they must also be less emotional than they are; we deride women who are vacuous or shallow, but demand that they falsify their appearance and behaviour in order to attract men. The same conflict is visible in the BPD diagnostic criteria — between behaviour which is stereotypically female, and therefore undesirable, and that which is traditionally male, which is also inappropriate when exhibited by women. What, then, are women to do?

The answer, it seems, is to give themselves over into the hands of the good male doctors (they are almost always male, at least in the cultural imagination), and let them deal with the problem. The expectation of artificiality as an unseen part of women’s lives goes hand-in-hand with the medical industry’s attempts to (psychologically or literally) alter, tame, and restrain women and their behaviour. Furthermore, while we condemn women for abusing substances in a way that we do not condemn men, we are fine with women being medicated (often against their wills) as soon as those are the doctor’s orders. To return to the Victorian era, any woman who was considered to have failed to appropriately adjust to societal expectations — by being a bad mother, wife, or daughter — was at risk of being removed from society and left to spend the rest of her days in institutions — thus ironically perpetuating the very state of play that was so shockingly “unnatural” when chosen by the woman herself.

while we condemn women for abusing substances in a way that we do not condemn men, we are fine with women being medicated (often against their wills) as soon as those are the doctor’s orders.

In Leslie Jamison’s The Recovering, an account of her own alcoholism and recovery, she considers the cultural history of substance abuse, and describes the novelist Jean Rhys’s alcoholism as a particularly gendered experience:Rhys never understood herself as a rogue genius, like the drunk male writers of her generation. She was always forced to understand herself as a failed mother instead.” Our condemnation of women who choose substance abuse, or other selfish pursuits of personal pleasure, over domestic duties, knows no bounds. The figure of the troubled male genius, reliant on pills or booze as part of his creative process, is a cemented cultural myth; but a woman in the same position is tragic, sad, unnatural. Women’s job is to create and nurture life, not art; to suspend their own needs and desires for the sake of others. Women like Rhys, therefore, who abandon their role as caregiver to consume, rather than nourish, are shocking; Rhys’s alcoholism made her consume herself, instead of offering herself, to men and her children, for consumption.

Throughout the twentieth century, female writers and artists like Rhys dramatised the figure of the addicted woman, interrogating the cultural myths that surround femininity and substance abuse. This series for Polyester will look at how some of these creators have responded to the themes of medical misogyny, female mental illness, and addiction over the last hundred years, beginning next month with Jacqueline Susann’s cult novel The Valley of the Dolls.

 

Words: Nicola Watkinson

Illustration: Esme Blegvad