According to Julie Holland, a psychiatrist who has had her own Manhattan practice for 20 years, this sort of minimizing attitude does serious damage. Not only does it hurt women’s self-esteem, but it leads to women being diagnosed and medicated for psychiatric disorders at higher rates than men. In her new book Moody Bitches, Holland looks at how pharmaceutical industry ads target women, the hormonal differences between genders and our long, dark history of medicating women’s emotions. She shared her findings with AlterNet in a telephone interview, which has been condensed and lightly edited for clarity.
Allegra Kirkland: Why did you decide to call your book Moody Bitches? Is it a reclamation of language that’s traditionally been used to denigrate women?
Julie Holland: First of all, it was really a joke. I thought it was funny and so did other people I spoke to. Most of my patients are women. I certainly don’t typically call women bitches. Part of it was reclamation for sure. That was important to me. If anyone’s going to call me a bitch I want it to be me.…It is a sort of bigger message that it’s our birthright to be emotionally expressive—to feel deeply and to express what we’re feeling honestly. I really believe that not only would women be better off if they did a little more of this, but the world would be better off if women aren’t squelching a big part of them, and if men weren’t squelching that part of themselves too.
AK: The point of your book and your New York Times op-ed is that women should feel okay experiencing strong emotions—that it’s perfectly natural and can even be beneficial for us. But that message also applies to men.
JH: It absolutely applies to men. For sure.
AK: And men are bound by such strict definitions of how to behave in an appropriate “masculine” way.
JH: Right. This is totally about the suppression of the feminine, not necessarily the suppression of women. I’m sorry to use this word, but it’s about the yin as opposed to the yang. There’s a receptive energy and there’s a penetrative energy. We’re all trying to be more penetrative and we’re suppressing a lot of our sensitivity and intuition and empathy. I don’t know to what end. It seems to me that it’s not doing women any good and it’s not doing society any good. Our world is imbalanced and there’s a lot of penetrative energy: missiles and guns and rape and corporate greed and malfeasance. We need more feminine energy and we need to own that. I’m not suggesting that people who need psychiatric medications throw them away. That is definitely not my message at all.
First of all, I worked at Bellevue for nine years in the psychiatric emergency room and I saw many very sick patients. And I’ve had a private practice for 20 years in Manhattan where I’ve seen all kinds of people who really can’t get by without medication, be it anti-anxiety meds or sleeping pills. But I’m absolutely also seeing a trend where there’s a lower threshold for getting on medication, there’s a much lower threshold for staying on medicine. People are getting on and staying for decades on medicines that were studied for less then a year. These are medicines that are not approved to be taken for decades. With Prozac, there are people who have been on it since the ‘80s. And we’ve learned how difficult it is for some of these people to get off their meds. There is an absolute withdrawal syndrome…that isn’t always discussed. Keep in mind that 80 percent of psychiatric medications in America are not prescribed by psychiatrists.
AK: Right, you mention in the book that they’re prescribed by general practitioners.
JH: It’s also just the new normal. The more women who are on meds, the more it’s in the mix, it’s common, you have friends who are taking them, your doctor’s talking about them, you see all these ads for all these different meds. Did you see the Apple Watch commercial where at the very beginning of this beautiful, glossy video they show you like 20 different versions of the watch? So right away you’re not thinking, Should I get a watch or not? You’re thinking, Should I get the silver one or the white one? You’re already advancing the conversation....We’re seeing so many ads and people have so many friends on meds and it’s so easy to just get them from a doctor that it’s turning from, Should I be on psychiatric medication, to Which one should I take? So that’s new. I’ve watched it develop over 20 years and it’s really alarming.
AK: There’s a long history of women being medicated and even institutionalized for invented illnesses like hysteria and frigidity. Do you see the high rates of psychiatric drug prescriptions for women as part of that historical continuum or is this something new?
JH: What I’m starting to see more and more are these ads. There are great websites for ads from the ‘50s and ‘60s, not just targeting women. Remember at that time Big Pharma could only advertise to doctors. So they’re advertising to doctors basically saying, If this patient is calling you too much and bugging you, here’s a medicine that will get her to stop.
The ads now feature everyday women with everyday problems. First of all, there was 9/11, and there’s no question that led to an increase in money spent on advertising, targeting women who were scared, who are having a normal response to an unnatural event. The ads were completely targeting them. There was one that just read, “Millions can be helped by Paxil.”
AK: Which is an incredibly vague statement.
JH: Right. And there were just words: "worry," "anxiety," with a picture of a woman clutching her handbag walking down a city street. It was genius. It was evil genius, but it was genius. And now what they’re doing is killing me. I don’t know if you’ve seen those binge eating disorder ads. Shire makes Adderall, which is generic now, so the only brand amphetamine Shire has left is Vyvanse, which is a medicine for ADHD. It’s an amphetamine just like Adderall but it lasts 12, 13 hours. They paid some doctors and they paid for a full-page ad in the journal that the “study” ran in, and it says in the journal that they also paid the writers and the editors. So they have this Shire-paid, really crappy study showing that at high dosage every single day for weeks, Vyvanse separates out from placebo. Basically, they show that if you give a woman high-dose amphetamines every day, she will binge less.
They have ads where they show a woman surrounded by pizza and hamburgers and donuts and it says, "If you eat more than you want to and you feel guilty afterwards, you may have this disorder." Which is sort of like saying, "If you’re a woman, you have this."
First of all, if you’re not on the pill and you’re not on SSRIs, you’re going to go through a certain day or two when you’re eating more carbs or sweets before your period. They have ads for doctors where they say "binge eating disorder is a shameful disorder and your patient may not volunteer this information so be sure to ask whether they’re eating too much and feeling guilty about it." Fucking Shire. It’s not bad enough that all of these kids are taking their meds. They want to get some women hooked on speed before their patent expires. These are addictive medicines. … And there’s no evidence that this “disorder” has any pharmacological basis that needs to be medicated.
AK: You write that psychiatric drug prescription rates are highest for women between the ages of 35 and 64. This overlaps with the time when women are most likely to be raising families and at the peak of their careers. Do you think women are trying to handle all of these stressors and that’s why they are asking for and receiving psychiatric medications at higher rates?
JH: This is not going to go over well, but I’m going to say a couple of things. First of all, perimenopause symptoms in terms of insomnia, irritability and mood changes happen all through your 40s. People have this idea that menopause is a one-day event that occurs some time in your mid-50s. It’s not. It’s a marathon of symptoms through most of your 40s, into your 50s; it can last 7-14 years.
The other issue is that my practice is full of women in their late 30s and early 40s who would like a child. Maybe they’re not dying to be married, but they’d like a child. And they would prefer it to be in a monogamous relationship. And they’re living in New York City where guys have a shelf life ‘til they are 50 and no one really wants to commit because it’s possible they can upgrade somewhere else. And they’re not happy. They’re freaking out because this is something they always thought they were going to have and they wanted but they’re not getting.
So one thing I came across in the three years of researching this book is that there is evidence suggesting that SSRIs are interfering with mating. We already know that contraceptives totally interfere with mating, but it turns out that SSRIs also do so. I have so many patients that are on an SSRI and an oral contraceptive. In New York City that is a very common combination of medication, and it has a real impact on mating and sexuality. I’m afraid it’s this kind of self-fulfilling prophecy where people are unhappy because they’re not mating, but they’re on drugs that completely interfere with their ability to mate.
AK: The American Psychiatric Association says men are much less likely to seek treatment for anxiety and depression. Could that skew the rates at which women are diagnosed and medicated?
JH: If you look at other cultures there isn’t this two-to-one difference. There does seem to be a definite issue with hormones, in that if you look at kids’ rates of diagnosis of depression, or if you look at post-menopausal women versus men in that age group there’s not this two-to-one difference. But there is that difference when women are cycling, say from around 12 to 55.
AK: Two-to-one difference in terms of rates of diagnosis?
JH: Yes. There’s no question that men are more reluctant to seek psychiatric help. That’s always an understanding in psychiatric care that there are a lot of men who are undiagnosed who really need treatment but aren’t getting it because there is still a lot of stigma there. There’s very little of that for women. But it is this suppression of the feminine that’s at play.
AK: In some of the responses to your op-ed, some people took issue with framing mental health issues in relation to gender because, of course, not all men and women are the same. There are plenty of sensitive, intuitive guys and plenty of women who have no patience for the sob stories of others. Hormones obviously play a role, but how much can really be attributed to biology versus culture and nurture?
JH: You can’t really pick them apart. A 300-page book is very different than an 800- to 900-word op-ed.…There were major things I wanted in that piece that got cut out. Like I said in the beginning, there is the feminine, this yin and yang, in everyone. Not one person is all feminine or all masculine; we’re all a mix. Gender is fluid. I understand that. But I have to make some generalities. I’d say that everything I say in Moody Bitches that isn’t about hormones applies to both men and women. I think that the suppression of the feminine is a problem in both genders and the world needs more yin energy.
AK: I guess the only other concern is that it can end up reinforcing sexist stereotypes. Back when Hillary Clinton was running in 2008, members of the press actually asked if we could have a female president because she might get moody during her period. Maybe that connection could be reinforced in people’s minds?
JH: The other thing I’d say is that moody doesn’t necessarily mean hysterical. That someone can be emotionally expressive is not a bad thing. That’s sort of the message people are missing here. I’m sorry for the shorthand; I just didn’t think the title "emotionally expressive women" would sell books. But that’s what I’m talking about. The idea that a woman who is in tune with her body and knows how she feels and can speak her mind about it, that is scary to men. Emotionally expressive does not mean unstable.
AK: Some responses to your piece expressed concern that people who do genuinely need psychiatric help or medication would be discouraged because they’ll think they can just get through it or that their feelings are within the range of normal. So where do we draw the line?
JH: I am not anti-medication in the right situations. These pills work. They make people feel happier and more relaxed. I get why people take them. But I am suggesting that there are healthier ways that are less of a quick fix that I think some of these people who are on meds should try. The whole survival guide section of my book is about that. You can add all these things to meds, or you can do them instead of taking meds. This idea that you’re going to go to your internist or family doctor and get the same thing from them in six minutes that you get from talking to a therapist for an hour-long initial evaluation is ludicrous. You have to find out what the family history is, what the genetics are, whether there’s been any medication use in the past and what the response has been. I fear people are taking it less seriously.
The other thing that I would say is I have patients who take a little dose of SSRIs just in the week before their periods; I have patients who take medications during the winter but not the rest of the year. You don’t have to take a daily dose for years on end just because you have these phases where your mood is changing. You can take a more targeted approach instead of this blanket method. But obviously there are people who really do need their medication and I do not want to encourage them to man up. What I’m saying is, don’t repress or be scared to be sad or upset. The only reason we’re repressing all these feelings is for the comfort of other people, and I think that’s a huge problem.
For a record of all of Dr. Holland’s sources, see the notes section on moodybitches.com.
