Women's experiences of treatment of depression: Medicalization or empowerment?

Abstract

AbstractAn interview study was conducted in which women's experiences of diagnosis and treatment for depression were explored. Nine women who had been diagnosed by a physician participated in the study. Topics explored in the interview included how women came to be diagnosed as depressed, how treatment was experienced, how they understood the causes of their depression, and how being diagnosed had affected their view of themselves and their futures. Analysis involved a thematic approach guided by the topics addressed in the interview. The women's accounts also were analyzed with respect to the themes of and empowerment. All of the participants gave accounts of their depressive experiences, which were characterized by biomedical explanations and identification of anti-depressant drugs as beneficial in alleviating their distress. Although most women had made changes in their lives in conjunction with treatment, the changes made were likely to have disempowering consequences. Based on this analysis of the women's accounts, it was concluded that a understanding and treatment of women's depressive experiences cannot readily co-exist with personal empowerment. Suggestions are made for developing strategies for treatment of women's depressive experiences that offer the benefits of without precluding the possibility of personal empowerment.Feminist researchers and clinicians who work in mental health fields have often been critical of conventional psychiatric approaches to treatment of depression, particularly use of anti-depressant drugs, as fostering an inappropriate medicalization and pathologization of women's psychological distress (Ehrenreich & English, 1979; Greenspan, 1993; Penfold & Walker, 1983; Russell, 1995). Such distress, it has been argued, is better understood as arising in the context of the stressful character of women's everyday lives, rather than having its origins in female bodies (Caplan, 1995; Greenspan, 1993; Penfold & Walker, 1983). When a woman's distress is conceptualized as a medical problem, one for which a drug (such as an anti-depressant) is prescribed by a physician, her problems become medicalized (defined as a medical problem). At the same time, the treatment transaction is one in which the power to define the nature of a woman's problems rests largely with a medical professional.Partly in response to critiques of mainstream treatment approaches, feminist-informed modes of therapeutic intervention have been developed for addressing mental health problems, including depression, in women (Greenspan, 1993; Laidlaw & Malmo, 1990). is a central principle of feminist approaches to therapy (Brown & Brodsky, 1992; Sturdivant, 1980), not only guiding how a therapist conducts therapy, but also shaping the goals of therapy with a woman client. Thus, the process of feminist therapy is one in which a therapist attempts from the outset to reduce power imbalances inherent in the therapist-client relationship, by validating a woman's experiences and acknowledging her right to make decisions affecting her own life. As a goal of therapy, empowerment has been defined primarily at the personal level, focusing on a woman client's ability to control her own life and to make changes that would have positive consequences for her well-being and circumstances.Although feminist approaches to therapy have tended to emphasize empowerment at the personal level, other forms of empowerment are not necessarily ignored. Empowerment has also been defined in terms of actions intended to bring about social changes aimed at eliminating gender-based inequalities and inequities in the distribution of power and resources within society. And this form of empowerment also has been identified as a goal of feminist approaches to therapy for both therapy clients (Brown & Brodsky, 1992; Greenspan, 1993) and therapists (Greenspan, 1993; Lerman & Porter, 1990). …