Why new perspectives are needed for understanding depression in women.

Abstract

AbstractThe often-cited finding that is a problem particularly afflicting women is one that mainstream theoretical approaches have been unable to explain satisfactorily. Such theories have been critiqued as inherently dualist and reductionist and as employing concepts that are implicitly androcentric. Mainstream theories promote a view of depression as a form of individual disorder or psychopathology, capable of being understood without regard to the broader sociocultural context. Neglected within mainstream theory and research on depression are social-structural and discursive conditions that regulate women's lives and shape their experiences. Research informed by feminist standpoint and social constructionist epistemological perspectives provides one avenue for offsetting the limitations of mainstream approaches. At this juncture, forms of inquiry drawing on qualitative methodologies offer more useful, and potentially more emancipatory, strategies for understanding depression in women than mainstream approaches, because they can more fully acknowledge the lived experiences of women.In this article, I analyze limitations of the currently dominant, or mainstream, approaches to understanding and explaining in women. (f.1) Based on this analysis, I argue for the need to develop alternative theoretical and methodological perspectives. The limitations of mainstream approaches become apparent when the assumptions implicit in these approaches are considered from feminist standpoint and social constructionist perspectives. Within clinical psychology and adjacent fields, much research, and the practice it informs, is grounded in mainstream frameworks. When depression is conceptualized within mainstream frameworks, the accounts produced serve to medicalize and pathologize both women's bodies and women's experiences. From a feminist perspective, such approaches are viewed as lacking in emancipatory potential, because they do not share a feminist concern with women's empowerment and are more likely to collude with, than pose challenges to, oppressive conditions in women's lives. Not only are mainstream approaches likely to disempower depressed women, they also disempower women in general, because they promote androcentric, homogenized, decontextualized, reductionistic, and dualistic ways of understanding women's lived experiences and embodied lives.WHAT DO WE KNOW ABOUT DEPRESSION IN WOMEN?A short answer to this question is: not very much. In mainstream research on depression, gender is either ignored entirely or addressed only in terms of a female/male dichotomy, defined by individual of assignment. In the first case, research is conducted as though participants are interchangeable without regard to gender, on the assumption that theories of depression apply equally well to both females and males. In the second case, individual research participants are categorized as either female or male, and gender is addressed in this limited way by testing for sex in depression. Attention then focuses on whether differences are present between males and females in the rate or severity of depression (usually defined, respectively, as presence of diagnosable depressive disorder or level of self-reported depressive symptoms). And a consistent finding has been that rates or levels of depression are higher among women than men (cf. Bebbington, 1996; McGrath, Keita, Strickland, & Russo, 1990; Nolen-Hoeksema, 1990; Weissman et al., 1993).(f.2)Among mainstream depression researchers, there is also a consensus that reported evidence of differences in rates or levels of depression cannot be explained (or explained away) as merely the product of measurement or other methodological artifacts. Such evidence of differences in rates or levels of depression between women and men is now generally interpreted as reflecting a true difference and attention has shifted to the problem of accounting for the preponderance of women among the depressed. …