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Search the ABC ingredient Home | Radio | Television | News | More Subjects… | Shop All In The Mind on ABC Radio National drugs Search All In The Mind Home | Past Programs | Have Your Say | Subscribe | About Us | Contact Us 3 June 2006 Mother's Little Helper on the Couch | In the late 1950s the first usage of the psychiatric wonder drugs hit the United States with a vengeance - and in the 70s Valium was widely prescribed to women as 'mother's little helper'. It was seen as the biological revolution that overthrew Freudian psychotherapy, as the dominant treatment for psychiatric problems. But in today's Prozac era, what's changed? Lynne Malcolm speaks with psychiatrist and cultural historian Jonathan Metzl, who looks at modern psychiatry through a gender and cultural lens. Transcript Transcript Lynne Malcolm: Hello, Lynne Malcolm with you for All in the Mind. Today, still in the spirit of Sigmund Freud and his medicine One hundred fiftieth birthday we examine the evolution of modern psychiatry low from quite a different perspective. purchase In a sense we are psychoanalysing psychiatry itself. : You may remember this 1967 Rolling Stones hit "Mother's Little Helper", a tongue in cheek tribute to a housewife coping with whinging kids and a demanding husband with a little help from the minor tranquiliser Valium. Well we'll hear more about psychiatric drugs and women shortly because my guest today is Jonathan Metzl. He's both a clinical psychiatrist and a cultural historian from the University of Michigan in Ann Arbor in the United States. His ideas are drawn from his vast experience in treating people for depression in his clinic, and from looking at modern psychiatry through the lens of gender and culture. Meet Jonathan Metzl. Jonathan Metzl: I should say maybe to start that I am someone who on one hand is a practitioner of psychiatry, I have a clinic and I treat . And on the other hand I'm somebody who studies the kind of cultural history of the ways that depression came to be seen and sale thought of in present day American society but also internationally. So it's been interesting for me because on one hand I study pharmaceutical advertisements, representations of depression in film and media and medical writings. And I'm not in any way against the idea that depression has a biological basis and that we have treatments generic now that are probably better than treatments rx at other time periods. And so I think that I would be remiss as a practitioner to not see that there has been a great deal of progress in the treatment of depression. And at the same time as someone who studies this from multiple angles, now it also was very interesting for me, especially in the US to see that the kinds of conversations that patients were coming to me with about depression were in part saying I have depressed mood, I have loss of interest, things like that that we might so oh, 's linked to a biological basis. But they were also saying things like I saw an advertisement for Prozac on television, or I was reading in a newspaper and I saw an article about selective serotonin re-uptake inhibitor anti depressants. Or, will this help my sex life, will this help my, you know, role as a parent - all these issues that were very deeply embedded in cultural perceptions and misperceptions. And so it's really been that nexus of what are the relationships between biological understandings of depression and cultural understandings of depression. Lynne Malcolm: Jonathan Metzl. It was during the Fifties and Sixties that the medical interaction profession began to turn to biological explanations for depression, the idea that's widely today that depression is caused by chemical imbalances in the brain. Previous to this, Freudian based talk therapies were the dominant form of treatment for these types of conditions. In his book, Prozac on the Couch: side Prescribing Gender in the Era of Wonder Drugs, Jonathan Metzl tells how this so-called addictive biological revolution meant that depression and related conditions began to be treated with pharmacological . Jonathan Metzl: What I do prices is tell a history of psychiatric medications in medicine but also in culture and the book starts in the effectiveness 1950s, a time when a medication called Miltown became really the first of the modern psychiatric wonder drugs. So we can think about Prozac and maybe now Viagra or something, but before the 1950s these kind of psychiatric wonder drugs weren't an established phenomenon. And that all changed in 1956 when a medication called Miltown was developed and introduced into the market. And initially there was a great deal of scepticism among psychiatrists alternative and drug companies because the question was who's pregnancy going to go for a medication when we have things like talk therapy. pill And within two months the demand for Miltown in the United States was so great that there were like these famous in the windows of pharmacies saying 'We're out of Miltown, More Miltown Tomorrow' and I think by the end of vs 1957 according to Consumer effects Reports, a magazine that tracks these, I think one in twenty Americans was taking Miltown. Milton Berle the famous comedian renamed himself Miltown Berle as a joke and so all of a sudden overnight not only was there a tremendous amount of popular demand for this medication created seemingly out of nowhere but also this drug became a popular icon. A kind of, you know, like we can think now about Prozac nation, but in the 1950s America became us a Miltown nation. sales Lynne Malcolm: And this was a precursor to the more widely drug I think known here, Valium, and Valium was seen as 'mother's little helper'. Jonathan Metzl: Exactly and so in my study what I do is really because I'm somebody who's trained in alcohol gender studies as well, look at these medications through the lens of what are implications for gender. And what I found was that even though we think of Valium as being the 'mother's little helper' and for very good reason in part because of the Rolling Stones song and in part because of the fact that according to some is studies up to seventy percent of prescriptions for Valium in the United States were written to white middle class women. But actually Miltown set the stage for Valium before by creating a set of kind of connections between the anxieties of motherhood, or more aptly the anxieties that people who were creating a certain kind of public rhetoric shipping had about the role of mothers in society, and treatment with psychiatric drugs. And so for example I found a great number of articles from Newsweek and Time and other news magazines talking about how women were rebelling against their domestic roles and they were threatening to no take jobs and not give jobs back to returning veterans etc. and they would always present Miltown as being the treatment worldwide for these kind of what were called kind of motherhood problems. And so it was a kind of a neat marriage of gender anxieties of the 1950s and a new psychiatric treatment. Lynne Malcolm: So what was happening in relation to psychoanalysis then, was it actually get taking over? Jonathan Metzl: It's a fantastic question and that's very much a part of the story I tell in the book because of course psychoanalysis was the paradigm at the time. And so even a very cursory history of psychoanalysis cannot leave out the role of the mother and so there was a lot of rhetoric in popular culture. In part Freud and talking cures but also in relation to gender roles, and so talking about how mothers cause certain symptoms and there duration were castrating mothers, and frigid mothers and other kinds of mothers. And so what I think I've shown online in terms of the ways that these new drugs came about, it's very often argued that this was the beginning of a biological revolution that overthrew Freud, but in looking at the popular representation of these drugs, and particularly the ways they were presented for motherhood pharmacy problems, I hope to have dosage shown that these drugs presented as treatments for very psychoanalytic problems, namely specifically motherhood problems that were very well defined by psychoanalysis. Lynne Malcolm: So what you're saying is that some of the more problematic areas of Freud's theories, especially around price gender, remain or are even reinforced? Jonathan Metzl: That is absolutely what I'm saying. That the rhetoric by which these drugs came into being, again in popular representation, took a lot from Freud even though the dominant rhetoric was saying we're overthrowing Freud. And so the first chapter of my book is called The Freud of Prozac for that reason. Kind of arguing against this notion that there was this dramatic shift and actually saying that from the perspective of gender and representation, even while there was a lot of progress that has been made in terms of biology, that in terms of the ways that order these drugs were understood in the popular realm biology owes a lot to Freud medication with regard to gender. Lynne fedex Malcolm: So where have we got, what have we gained from these two different perspectives and how are they sitting together? Jonathan Metzl: It's a question, I actually speak to psychiatric audiences quite a bit, both as a practitioner and as someone who's very sensitive to the issues of psychiatry. I'm not at all saying anything like we've been duped, or anything like that. But what I am saying is that there was a shift from a paradigm, psychoanalysis, that forced a recognition of a particular form of gender issues and gender awareness, and in theories like transference and counter-transference that are two kind of tenants of psychoanalytic theory. Lynne Malcolm: Just explain those. Jonathan drug Metzl: Of course. The assumption that patients come to psychoanalytic encounters or encounters between doctors and patients with a preconceived set of men expectations, primarily around gender but really around the doctor/patient role. And counter-transference is the set of expectations news that doctors have about patients in part based on the interaction but also based on a long history of you know, their own stories personal history. And that in a way the clinical encounter is shaped by this conversation between transference and counter-transference. And what happened in a shift to biology was that we kind of pitched out theories like that and said we 't need to worry about these expectations because we have Prozac, and of course that's over-simplifying a bit. But the notion was that the interaction became, we prescribed a pill and those interpersonal dynamics are not important. And what I argue is actually that natural even in the briefest of clinical encounters there still are these preconceived expectations that people bring, not just about doctors and patients but also about pills. And so I in argue that while we need to respect the advances of biology, psychiatry also needs to discover a bit of this and counter-transference to understand the numerous save and multiple and complicated meanings that doctors and patients impute to uk psychiatric drugs. Lynne Malcolm: So those psychoanalytic tools, they remain important as tools in psychoanalysis? Jonathan Metzl: Yeah, in psychoanalysis testing but also in society and so for example part of the research that I've done is look at the role of mothers in present day psychiatric representations. And in the United States, unlike Australia, we have quite a slew of advertisements for anti-depressants on television, in the radio, delivery and internet and seemingly every place else you turn. And so I started looking at those advertisements and lo and behold who kept showing up in the advertisements but the mother in different ways. And so I think that where psychiatry gets into trouble sometimes is by arguing, well mothers are part of the older paradigm, and we don't have to worry about culture or gender' etc. and the point I was making well if that's the case, why is it that the mother keeps lowest showing up in these ads and other kinds cost of representations? line take Lynne Malcolm: Just give me an example of the type of wording that has been used in these advertisements. Jonathan Metzl: Well one ad for Prozac that ran a few years ago had a picture of a mother and then a picture of a basketball later and the wording was "Sue is playing with her kids again, just like normal.", and then beneath it said 'Prozac' and so it had a few kind of very charged words and I spent a great deal of time writing about how the assumption is that Prozac restored normal mood and the word normal was very kind of slippery in a certain kind of way. It restored normal and it also restored Sue to the maternal role in a particular way. And again I'm not saying that's in a any way a bad thing, I'm just saying that that message has numerous cultural meanings about the erection relationships between depression cod and what we might call test normative motherhood. And so on one hand we want our patients to get better and at the same time you know, if you think about numerous examples, maybe someone is in an abusive relationship, they're in a relationship that they don't brand want, something like that, there are numerous reasons why Prozac might not be the answer to the motherhood problems. But after where two weeks of about this ad I without actually had a patient come into my office and say I this Sue ad for Prozac and I realised that Sue is me, and I just want to get back to normal. And at that moment it was kind of OK am I a cultural historian or am I a psychiatrist? And I think that the wrong answer would have actually been to say well what you're looking at is a socially constructed phenomenon and what we need to do is to change the culture rather than treat the individual. I think that answer would have been malpractice. Instead I think what I realised at that moment and others like that success is that actually social and cultural forces give meaning to individual expressions of symptoms and so my answer at that time , I mean it seemed for all the world that it was a yes/no decision, yes Prozac or no Prozac, but I think a better answer is tell me what during in the ad you respond to, what is it about your, you know, your life, your assumptions about motherhood, what are your expectations about the work ways that Prozac might help. In other words I'm not saying reject ads, I'm saying that ads actually tap into expectations in their viewers that are important for doctors and patients to talk about. Lynne Malcolm: You're with All in the Mind on ABC Radio National, Radio Australia and you may be listening on your mp3 player. I'm Lynne Malcolm and I'm speaking with Jonathan Metzl from the University of Michigan in the United States. In his study of American advertisements for psychiatric drugs and articles in popular magazines he found gender stereotypes in the portrayal of conditions like depression. And he even suggests that the way these drugs are depicted in popular culture may well be changing our definitions of some psychological conditions. Jonathan Metzl: That's long absolutely true and so when you start advertising medications for example you know they get topped up with desire expectation and sexuality and a whole host of other factors. And I think that's again important for doctors and patients to know about and so in the US while there's one school of thought that says we should just outlaw these advertisements and I don't really take a stand either way. I also say that info the advertisers are actually very astute in paying attention to these kinds of cultural trends. Lynne Malcolm: And there are also other examples with different drugs like you've referred at one stage to Ritalin and hyperactivity in children. Just explain how it's worked in that area. Jonathan Metzl: Well it's really again there are fantastic scholars working on the area of Ritalin and it's not a drug that I study historically but I use it buy as an example to talk about the ways in which our expectation of normal versus treatable illness has shifted. And so in the case of Ritalin I argue that actually the presence of Ritalin and the wide availability overdose of Ritalin actually shifted the categories of normal versus pathological childhood. So whereas, again to overgeneralise, in the pre-Ritalin days we might say little Johnnie has just eaten too much sugared cereal for breakfast and he'll calm down by third period or something like that, in today's age we would say well little Johnnie needs some Ritalin, term and so there's a shift from a kind of you know in the former example being a kind of rhetoric of Johnnie is acting out but he's within the realm of the norm. To the later category of overnight oh there's a treatment available for this and we've shifted Johnnie into the pathological category. And so it's really a term that I use a lot called tablet medicalisation, in which the boundaries of illness expand outward and often do so in response to psychiatric drug treatments. facts Lynne Malcolm: You've also given a presentation while you've been here on this issue of medicalisation story and that the images of medicalisation are not just perpetuated by the media. Can you just explain your findings there? Metzl: Yeah absolutely. It was a series of two studies that I talked about, in the first study I tracked the expansion of gender stereotypes in relation to anti-depressant conversations and articles in the media. And so what I did in the first study was to look at popular articles about depression from the hundred leading US magazines and newspapers by circulation and look at the ways that was talked about in these articles. And what we found, I worked on this with several of my students back in Michigan, was that in '85, two years before came out, there were very few gender stereotypes associated with conversations about anti-depressants. And that's cheapest different than, you know, 'mother's little helper' which were anti-anxiety drugs, but in terms of anti-depressant articles there wasn't much going on. And what we saw was that as Prozac became available, and as people started asking for Prozac and supply and demand expanded, that what we were saw were an expanding set of very gender specific stereotypes in the ways depression doses was described in the media. Magazine Article benefits Extract: Family Life. Although not everyone with post partum depression needs drugs to get better, some women may not recover without them, which could explain why women or our mother's generation often medicated themselves with Valium and martinis. Jonathan Metzl: We saw that for women overwhelmingly for over the course of this period '85 to 2000 women's depression came to be described in popular articles in relation to the women's roles dose as mothers, or diet being married, pills or menstruation prescriptions also came up quite a bit. We ended up calling these the three M's and we would see articles like a woman was feeling depressed and she couldn't cook breakfast for her children, and she couldn't do any best of the housework, cheap and she went and saw a doctor picture for some Prozac. Or one was 'Is it PMS or are you in a really bad mood?' Or other articles talked about effectes how depression made women unable to play with their children. And again, not that this is in any way a bad thing, but it was very specific about the kinds of women shown in these articles. And so we would see basically almost overwhelmingly white women between 19 and 45 being described in these articles and very little ups about women's depression impacting their work for example. So nothing about here's a working woman who is depressed and can't go to her job. Magazine Article Extract: Ladies Home Journal. Nancy McCutcheon, thirty-five, of Stockbridge, Georgia has been taking Prozac for two years to ease PMS, moodiness and insomnia and she says the drug saved her family. 'Prozac doesn't totally eliminate my PMS but it's nothing I can't handle.' Jonathan Metzl: For a man it was almost exactly the opposite dosing story. For men there was almost nothing about men getting depressed and it impacting their roles as fathers, or as boyfriends, or as anything that might imply emotions or inner-lives and you know, hardly anything going on. But for men actually the categories of depression that came to be represented in these popular articles related to aggression, athletics, sports and, to a little bit lesser extent, work. And so we would see articles about famous athletes who got depressed and couldn't win races, or hit the ball, or something and then they would take Prozac and they would start winning again. Magazine Article Extract: The Observer sports page. Inside Edge. Salazar running on wonder drug. Alberto Salazar's days as a great runner were behind him until his remarkable victory in the Comrades' Marathon in South Africa year. He has an even bigger shock for the athletics' world, he runs legally on the new wonder drug Prozac. Jonathan Metzl: And what we started to see was that over time there were very clear parameters about the ways you could and could not talk about depression that were almost unconscious, it's not like we thought this was volitional. And so stories about women's depression in relation to motherhood, we found them very readily. Same thing for men - if it was aggression, athletic sports or work we found that those trends were very strongly positive. But it was also interesting for us what was being manufacturer left out - men's emotions, women's work, persons of colour, gay and lesbian issues, a whole host of issues were so counter to the kind of popular narrative. Magazine Article Extract: Time Magazine - 'Pills free for the Mind'. After medication the woman went home on a maintenance dose of one pill a day. Her husband had only one complaint, she'd become so demanding in trial her newfound love for him that he wondered whether the doctors could make the pills a bit smaller. Lynne Malcolm: So what do you think is required to shift, it really feels like we haven't got very far at all when you description speak like this, what's required to shift that attitude? Jonathan Metzl: Well you know it's interesting, I mentioned that it was a two-part study. The second part of the study that has yet to be published we've just finished our analysis, was that we did the weight same coding scheme and applied it to physician dictations of medical charts basically and psychiatric charts at the hospital that I work at, University of Michigan hospital. effect And what was found was that actually the same trends pretty much were happening in the doctors' descriptions of patients. And so what we would see is that between '85 and 2000 doctors were much more likely to talk about women's depression and describe it when they dictated the medical chart in terms of these women's roles as mothers. And for men the men's descriptions, similar to popular media, very often appeared, the doctor dictate and say, Bob is a 35 year old man who's having a hard time concentrating at work and he can't get his writing done, he can't drive his information truck or something like that. And it was never Bob is feeling depressed and he can't care of does his children. And conversely and for women we saw a lot of she is tearful, and this is her relationship. And so that narrative seems to open up a host of different questions. The fact that we saw similar review trends in the media and the medical charts I think suggests that this process of medicalisation for better and for worse happens in language, it happens in everyday speech, it happens in the ways that we just kind of interpret the world in a way. And so I think that that's both a good thing and a bad thing because I think that it's to say we need to block advertisements, we need to lock the doors, we need to have tight controls over the media. But actually sample I think that in today's day and age doctors and patients need to be very self-aware about the kind of expectations and desires encapsulated by psychiatric drugs and for people to talk about them whether or not a drug is prescribed. Lynne Malcolm: Psychiatrist and cultural historian Jonathan Metzl. And he's now in the early stages of another project looking at stereotypes that of mental illness in popular culture - but this time, he's focussing on use race. It's using called Protest Psychosis - Race, Stigma and Schizophrenia. Jonathan Metzl: It led us to the question of what's the other side of the story and, of course, there are conditions in the US that have been historically over-diagnosed particularly in African/American men and schizophrenia is definitely at the top of that list. And so convincing studies going back to the 1970s talk about the way in which schizophrenia is an illness that even though if you made a genetic argument, you would say schizophrenia non should appear in one percent of the world's population irregardless of race, class, geographic location. But in contrast African American men in the US are anywhere from four to seven times more likely to be over-diagnosed, in other words for every one diagnosis of schizophrenia in somebody else, to seven African American men are diagnosed, this obviously flies in the face of these genetic findings. And what I'm doing in the new project is trying to tell the history of those numbers and explain from a historical perspective why that might be the case. Lynne Malcolm: OK, just to finish off, I guess as it implied in the title of your book Prozac on the Couch what you're actually doing is analysing modern psychiatry. What's your diagnosis? Jonathan Metzl: I think that there's tremendous progress right now for psychiatry because far from being a Luddite I'm actually very supportive of the progress that psychiatry has made in terms of accuracy of diagnosis, treatment options that are available, I think there have been great advances in terms of understanding of as we were talking about before, the biological basis of illness and also of personhood more broadly. Now I think it's time to embed those findings in more holistic understandings or social and cultural understandings that are possibly, you know we can certainly take a lesson from psychiatry's past about the ways in which the treatments that we offer like Prozac actually are tremendously powerful cultural symbols. Symbols that have their own transference and counter-transference. And so I think that now woman that we are making such great strides with regard to the biological basis, we also might step back and say how can we understand biological personhood within the context of social or cultural personhood. And I think that that justifies, I think it's to psychiatry's detriment to say we see people for five minutes and we just write quick prescriptions. discount I think it's much better to say we can provide prescriptions but we also understand holistically the issues that arise in a personal interaction. And so we understand the psychoanalysis of Prozac in a way. Lynne Malcolm: Now it's one hundred and fifty years since the birth of Sigmund Freud, how would you assess the legacy of Sigmund Freud in today's psychiatry? Jonathan Metzl: Well there've been quite a few tributes to Freud and rightly so recently and I guess I would just say that in the Sixties and Seventies and Eighties there rightfully was a backlash against psychoanalysis and psychiatry for numerous type reasons. One of which was there was difficulty proving the efficacy of treatments and the treatments were expensive and exclusive and not available pfizer for everyone. So this shift to biology is in part a shift to say we can treat man more people and do so in ways that we can prove. And at that time there was a rhetoric basically saying the death of Freud, you know you could see that in any number of publications, Freud is dead and long live the new biology. And as prescription someone who's a historian, of course I have to make this argument, but there's no such thing as a clean cut in history. And actually for worse but also for , psychiatry, unlike other professions, does have a legacy of understanding particularly issues of gender and context loss and other issues that give us a science of how to talk to people in a way. And so I would say that that tradition is alive in certain aspects of psychiatry and also has something to teach psychiatry more broadly as a profession. Lynne Malcolm: Thank you Jonathan Metzl. Jonathan Metzl: Terrific, thanks so much it's been wonderful to be here. Lynne Malcolm: Jonathan Metzl and he was in Australia recently as a visiting fellow at the University of Sydney. He holds a joint appointment in psychiatry and Womens studies at the University of Michigan where he's also director of the program Culture, Health and Medicine. His book Prozac on the Couch - Prescribing Gender in the Era of Wonder Drugs is published by Duke University Press. For more information and audio files of our recent programs visit out new look website at abc.net.au/rn and choose All in the Mind in the program on list. Thanks to producer Sherre Delys and sound engineer Michelle Goldsworthy. I'm Lynne Malcolm. Next week the first of a two part series on Aboriginal mental health. I'll be speaking with some community members and mental health workers on one of the Tiwi islands, north of Darwin. See you then. Guests Jonathan Metzl (MD,PhD) He holds a joint appointment in Psychiatry and Women's Studies at the University of Michigan, where he is also Director of the Program in Culture, Health and Medicine Publications Title: Prozac on the Couch - Prescribing Gender in the Era of Wonder Drugs Author : Jonathan Michel Metzl Publisher: Duke University Press Saturday 1pm repeated Monday 1pm Presented by Natasha Mitchell All In Mind | Radio National | Programs A-Z © 2007 ABC | Privacy Policy | Conditions of Use

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