Episode Summary 10: Burnout vs Depression: The Mental Load of Mothers

Human beings, in fact, are responsive to their environment. That's what we're built to be. And if you're in a good environment, you're often happier, you can feel joy. But if you're in an environment that's so difficult, maybe it'd be poverty, racist, and you're working 16 hours a day, 18 hours a day, that's your environment. And you're going to respond to that environment. And somehow, they've convinced us not to pay attention to the environment.

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Hello and welcome to the Your Parenting Mojo podcast. Today, we're continuing our series on mental health and we're making a connection to an episode that I set up back in February when we talked with Dr. Allan Horwitz about the Diagnostic and Statistical Manual and how diagnoses are made. Even though I talked with today's guest Bob Whitaker first, I wanted you to hear from Dr. Horwitz first so you'd have the context for this conversation. So if you missed my chat with Dr. Horwitz where we looked at how the diagnostic process, which we might assume is very scientific and doesn't leave a lot of room for doubt, is actually not like that at all, you may want to listen to that first. If you're a Parenting Membership member, you have access to the deep dive in your private feed. If not, you can hear an excerpt in Episode Summary 9. So depression diagnoses in particular have soared over the past few decades, especially among women. And many of you listeners have told me about feeling overwhelmed by driving kids to all their extracurriculars and their therapy appointments and you rarely get time for yourself and you're not sleeping super well but your household still has to function. And maybe your partner is not pulling their share of the load. You might be feeling lousy so you go to the doctor, you get diagnosed with depression and you're prescribed medication. The problem is clearly you. You are not coping with life and you should take medication so you can feel better. But is it possible that you aren't actually the problem? I think it is. Our guest today is Bob Whitaker, a journalist who has spent decades investigating psychiatric treatment in America.

He won a George Polk Award and was a finalist for the Pulitzer Prize for a series of articles he co-wrote for the Boston Globe about treatments for schizophrenia, which became his book Mad in America. His New York Times best-selling book Anatomy of an Epidemic looks at what created the rise in depression and won the two thousand ten Investigative Reporters and Editors Book Award for Best Investigative Journalism. He's also the founder of Mad in America, a website that provides alternative perspectives on mental health. So in this interview excerpt Bob talks about what psychiatry is doing when individuals are diagnosed instead of a broken system. It's a form of social control. He traces the history of how women's distress has been medicalized over decades. And he shares some remarkable results from a New Zealand study that showed what actually prevents postpartum depression. And just a spoiler alert here, it wasn't medication. So here we go. I want to shift gears a little bit because a lot of the people who are going to be listening to this are women, right, are going to be mothers. And I've been thinking a lot about depression and burnout as that is linked to depression, right, because burnout is not a diagnosis. You can't be diagnosed with burnout using the DSM. And so when you get into a burnout situation, you tend to be diagnosed with, drum roll please, depression. And so I want to link this back to something you opened with at the beginning, right, this idea of psychiatry as a way of a model of social control. So I wonder, can you kind of talk us through how do you understand psychiatry as a model of social control, especially as it affects women?

Yeah, that's a great question. And it's really important. And just remember what the disease model does for a second. It focuses on the problems in the head of the individual, not in the social, the way we arrange our society. And I know where you're going with, we know as women, not only have the opportunity to work and become doctors and lawyers. I mean, if you're old enough, you can remember when women didn't have the opportunity really to become doctors and lawyers. But that's part of it. But they, of course, they also have become in the United States, which is basically needed to income so often to raise children, etc. And of course, women were left with the, still the bulk of the home duties, the cooking duties and all that. But rather than talk about that problem, how we're organizing our society, and then when the woman who's burnt out, or, you know, just, I'm not getting sleep and I have all these too many tasks, we say, oh, you're depressed, you're anxious, you're stressed. Here's a pill, you take it. The whole disease model doesn't respond to the context of people's lives. And if you have a society where one group of people is facing more stresses than the other group, okay, then you're going to see that's the group that gets diagnosed more. Now there's a long history, of course, of diagnosing women with anxiety disorders.

Hysteria.

Yeah, yeah. Hysteria put, you know, men putting their wives away in asylums because they were no longer happy going back to the eighteen hundredths. So that's a longstanding thing. And you know, who gets electroshocked? It's mostly women and a lot older women who are getting electroshocked, okay? So, and that, that even goes back, you know, if you were in the asylums, you were seeing a lot more, you know, electroshock and that sort of thing being given to women. But there's a really interesting way to understand this also. You know, when the benzodiazepines came out, Valium and Librium in the nineteen sixties, now this was an era when a lot of women weren't working, right? They were staying at home. But those drugs were marketed mostly to women. Go look at the ads.

Milltown as well, right?

Milltown in that area? Milltown as well was the first.

And then we get- That was new to me, but yeah, it was quite something.

But go look at the ads. And basically, the ads are like, now we're in a male-dominated culture right at this time, right? So the ads are like this. I don't know if I should say this, but basically that's a, are a little bit to the men as well. Is your wife a bitch when you, when you come home? That's really, it's basically, is she nagging you? Is she unpleasant? Give her Valium and she'll be bringing you your slippers and a drink when you come home. And there's literally an ad like that. Okay. So we can see this pathologizing of women with the benzodiazepines too, because, you know, maybe they're frustrated with their life, et cetera, and they're not serving the men well enough. And basically, the idea was, well, this will relax them. They won't care. They won't get so emotionally involved with you. So now what happens is we switch from the antidepressants to the, no, excuse me, the benzodiazepines to the antidepressants. Now, one of the reasons we make this switch in the eighties is because the benzodiazepines were seen as addictive, right?

They were always seen as like a Band-Aid, right? It was never, oh, this is curing me. It's, yeah, this is helping me feel better and cope with this crappy situation.

Exactly. But then we also had that, that this Band-Aid can turn on you in the late seventies.

Yes.

So what comes now, when we, we, they're going to reconceive of anxiety as depression, really. Okay. As a new disease of depression. And, and the idea is you're not going to get addicted to the antidepressants. So that's part of what drove this reconceptualization is we're going to take these drugs. We used to have benzodiazepines and turn them into antidepressants. Now antidepressants can have a numbing effect, a quieting effect as well. So you can see again, well, maybe women are the target of antidepressants. And so that's a form of social control in its own way. And it's certainly, it's eliminating the social context for people's lives from the equation that leads to prescribing. So this is what happened. And, you know, you mentioned, I think in your notes, then look at all the girls now getting, getting diagnosed and medicated. I mean, it's unbelievable girls growing up and they have all these different pressures with social media, TikTok, body questions and all, and rather saying like, this is really an unhealthy environment for girls to grow up in. We diagnose them with depression or anxiety or eating disorders, or, and then we give them drugs. Again, we place it inside the head of the individual and not in how we're raising our children.

Yep, absolutely. Yeah. And, and I want to kind of pull through when the, the thread of the advertisements, I hadn't seen the, the ads for, for Milltown and for the Benzos. When I went on YouTube and searched antidepressant ads, the ones that came up for me were the, you know, two thousands era where there's the mother sitting on the park bench, staring sadly at her children and, you know, oh, you never feel happy. You're always, you're always down in the dumps. And, and then you take the antidepressant and all of a sudden, you can be a good mother again, right? You can engage with your children again. And, and it's exactly the same thing, right? It's not saying, oh, you have way too much to do because you're trying to work and be a parent in a capitalist society where there's not enough bodies to do all this work you're supposed to do and get your kids ahead. And your husband's not doing, you know, his part of the work if you're in a cishet relationship and, and that not the problem. None of that is the problem. The problem is in your head. And therefore, it is your thing to fix. And therefore, here's a medication that you can take. And so we, we think, you know, oh yeah, this was, this was a super patriarchal world and, you know, bring the, bring down his slippers, but actually the world has not changed so super much. And it's just the way that we talk about it has shifted slightly to fit better with how we perceive our role in this situation today is my perspective.

No, no, I'm with you on this. The stress is on, listen, the stress is on a lot of working people are pretty much through the roof, but clearly women are bearing the burden of that much more, especially in with home duties and, you know, who's doing the homework, the homework, who's taking care of the kids, who's taking the kids to the doctors, all that sort of thing. It seems like it's the responsibility of the mother to do all those things.

Yeah. Yeah. And I just want to pull out one more quote that really jumped out at me. Marisek, I don't remember the researcher's first name, but last name Marisek, depression is not something people have, but a set of practices authorized by the culture through which people express to others that they are suffering right. I'm not allowed to be angry. I'm not allowed to say that the system is what should be changed, but I'm allowed to turn that inward and be depressed and go and get a pill for it right.

Yeah. I couldn't agree more. This is the ideology that's out there with this narrative. It's one that produces money. It's one that excuses us from changing our society. I think what this quote says so eloquently is this, human beings, in fact, are responsive to their environment. That's what we're built to be. And if you're in a good environment, you're often happier. You're if you can feel joy, but if you're in an environment that's so difficult, maybe it'd be poverty, racism, you know, you're, you're working 16 hours a day, 18 hours a day, that's your environment. And you're going to respond to that environment. That's how we are built to be. And, but what happens with the DSM model, it removes the environment. It removes the context and it's a historical. Everyone knows who's read their religious texts, who's read their novels, who's gone to plays. We all know that we're responsive to environments. That's what we were made by nature okay. We are exquisitely responsive to our environment. And somehow, they've convinced us not to pay attention to the environment. Can I tell you a really quick story about environment related to postpartum depression, since you've mentioned. In New Zealand, they were doing this study where they had women, they gave them, here's what happened afterwards. Either they got regular care, and this is already more care than you get in the United States, or what they did, they gave people a nanny or a person to come to their house every day for six months okay.

They did what?

What they did was someone who came to their house and aid to help them with their duties of their house for six months. And I know that was compared to normal non-six-month daily care. Now, which group suffered from postpartum depression?

Not the ones who had the help, I'm guessing.

No, that's the point. But did that become like the form of care? No, because we still believe in these drugs and then we can fix it. But that's such, when I was in New Zealand, this doctor who was behind it was telling me this, he said, of course, we didn't make that the first line of care. But when he was saying to people, does anybody doubt that was the better response right. Nobody did.

Right. Nobody did. So you just heard an excerpt of my conversation with Bob. In the full interview, he walks us through how depression came to be understood as a chemical imbalance caused by too little serotonin. And as a spoiler, that theory was never actually proven. It was a marketing story created because psychiatry wanted to rebrand itself as a legitimate medical discipline and pharmaceutical companies wanted to sell drugs. He talks about the biggest government-funded antidepressant study ever conducted, the STAR-D trial, with over four thousand patients. And the public was told that it showed a 70% success rate. But when independent researchers looked at the actual data, they found massive problems. And the real number was close to 3% of people who were actually well at the end of one year. It's just one of many examples of research being manipulated to tell the story that serves the industry, not the public. We also talk about advertising, which was how pharmaceutical companies turned depression into a disease that needed lifelong medication. The ads have evolved over the decades, but they always deliver the same message. The problem is you, and not your circumstances. And Bob raises a really important question about why depression used to be episodic. It was something you recovered from, but now it's chronic and it's recurring. And that question is, what if the medications themselves are making people chronically depressed? If you want to understand not just that depression is being medicalized, but how that happened and why, you'll want to listen to the full episode. Full episodes are available to you immediately on a private podcast feed after you join the Parenting Membership. Learn more at yourparentingmojo.com/parentingmembership. And if you want to learn more about Bob's work, go to madinamerica.com. You'll find research, personal stories, and resources about alternatives to the standard psychiatric approach. Thanks so much for listening, and I will see you next time.

Hi, this is Jess from rural East Panama. I'm a Your Parenting Mojo fan and I hope you enjoy this show as much as I do. If you found this episode, especially enlightening or useful, you can also donate to help Jen produce more content like this and also save us from those interminable mattress ads. Then you can do that and also subscribe on the link that Jen just mentioned. And don't forget to head to yourparentingmojo.com to record your own message for the show.