Hysteria

04.10.15 9:25 AM ET

Meds Don't Make Women Crazy—Trauma Does

There’s a good reason women use more meds than men—trauma. A survivor of childhood rape makes the case for medication.

I remember parts of that night with surprising clarity.

I saw the men inside my mom’s room when I got up to go to the bathroom. I was 7 years old, and we lived in Philadelphia at the time. Half asleep, I remember thinking in a vague sort of way that something about the scene was off. Some internal alarm was set in my head, and I remember telling myself not to flush the toilet because of the sound it would make.

Sometime later I woke up, seized in truly indescribable panic. I was pinned under one of the men, in screaming pain so bad I went in and out of consciousness. I saw my blood everywhere: on me, on him, on my prized pink Strawberry Shortcake sleeping bag, on a knife taken from my own kitchen. With a child’s simple understanding of such things, I thought I was dead. I’d never really seen my blood before, at least not in such quantities and in the midst of violence. I thought the men had killed me and I was now a ghost, watching the gory scene from outside this world. I had no idea what was happening to me.

The trauma of the rape didn’t end in one night. It followed me onto the operating table, into the police lineup, into court. It dragged itself alongside my family and I felt like a shadow as I silently endured therapy, home visits from child welfare, and finally, school and a return to childhood. If only trauma could be left behind, marking a single definable point in time.

Like television rape and kidnapping survivor Kimmy Schmidt, I’m not entirely defined by the horrible things that once happened to me. I grew up to live a mostly happy, passionate, fulfilling life. Still, while survivors like myself are resilient, it’s not exactly accurate to call us unbreakable.

For some people who survive a near-death experience, whether it’s war or rape or a plane crash, trauma eventually dissipates. But for others, like me, it imprints itself into the neurology permanently. Decades of psychologists and group sessions and yoga and meditation are comforting but don’t necessarily “fix” what has been altered. The nightmares, the long inexplicable crying spells, the tendency to freeze and to go silent without warning, and the rages make you feel as if you’re irreparable. As if you’ll never be normal.

I didn’t start consistently taking medication for my severe PTSD symptoms until my 30s. Despite surviving two suicide attempts by age 22, taking psychiatric medication seemed to go against everything I stood for, and every time I was mandated to take it I eventually let it taper off. There was nothing wrong with me, I thought—there was something wrong with what had happened to me. If I kept fighting, I would eventually cross the line into normalcy. Why should I have to alter my brain chemistry after everything I already suffered? Why should I become a prescription drug zombie just to keep going?

Author Julie Holland’s new book, Moody Bitches, is partly about women medicating their emotions away. In her many Op-Eds and radio appearances Holland presents her thesis in shorter form: Women in the U.S. are over-medicated, and it’s turning us into emotionless husks. Doctors are handing out pills willy-nilly to housewives and career women who have perfectly good reasons to be “moody.” We should embrace our feelings, cry at work if we want to, refuse to take the man’s soul-diffusing drug cocktail.

When I reached out to Holland for this story, she explained that her book delves into more complex territory than her many recent Op-Eds, and isn’t solely about the overmedication of women. “There’s a lot more to my message than that, but it’s very hard to be complex, subtle, and all-inclusive in 800 words,” she told me.

Holland is right about one thing: 1 in 4 American women now take some form of psychiatric medication. But there’s a gaping hole in her analysis. While it’s true that a quarter of women are popping meds compared to only 1 in 7 men, it’s also true that women statistically suffer from mental health problems more often than men. And it’s not because we’re crazy bitches, or even moody bitches. It’s because we’re traumatized.

The statistical numbers of women on psychiatric medication is even with, or less than, the amount of women who experience rape, sexual abuse, or domestic violence in their lifetimes—all experiences that women face in higher numbers than men, and that can lead to life-altering PTSD. According to the National Center for PTSD, women are more than twice as likely to develop it than men, and sexual assault is more likely to cause PTSD than other events. That’s not even accounting for the population of women with other mental illnesses such as schizophrenia or bipolar disorder.

Even Holland herself admitted to the connection. She recalled seeing a lot of patients with PTSD during her tenure at NYC’s Bellevue Hospital.

“It seemed like the majority of the women I saw there with severe psychiatric symptoms, and especially drug and alcohol use problems, had a history of sexual trauma,” Holland said, adding that she does prescribe SSRI antidepressants in her own practice. “There is no question that antidepressants in general and SSRIs in particular can help immensely with the anxiety, panic, hyper-arousal, insomnia, and depression that accompany surviving a trauma.”

Daniel Freeman, a professor of clinical psychology at Oxford and author of the book The Stressed Sex, told me that women suffer mental health problem more often than men and the ratio is a “major, ignored public health issue.”

“There are a range of social and psychological factors that especially impact on women that should lead us to expect differences in overall rates of mental health problems,” Freeman said in an email interview. “The most obvious example is childhood sexual abuse.”

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In a 2013 article for Time, Freeman and his brother Jason wrote that the psychiatric profession generally pays too little attention to gender difference when studying mental health. For some, that might be because it’s taboo to assert that women actually do experience more mental illness. A kneejerk feminist reaction would oppose the idea that women are “crazier” than men, and with good reason. But why do we question women themselves, who are actively seeking help?

“When you meet criteria for a mental health problem you are having real problems. You are having a number of symptoms, for a length of time, that are significantly impacting on your life,” Freeman said. “This three-pronged approach won’t capture mild everyday normal fluctuations in mood. But even when the surveys look at the severest end of the mental health problems, women are having more of these too.”

Freeman’s extensive research shows that the gender ratio is greatest when there are environmental or circumstantial factors playing a large role in a given mental health condition. It’s not just about rape and abuse, either—chronic strain, said Freeman, plays a huge role. Women are overworked, juggling careers with the bulk of domestic chores and parenting, all while being paid less than men and being expected to look beautiful, fashionable, and ageless. The pressure can build up, causing self-esteem problems and a constant feeling of failure, of not measuring up.

In some communities, you can add racism to the pressure boil too. According to feminist mental health activist Dior Vargas, who is Latina, people of color sometimes face a double-edged sword when it comes to mental health. There’s an extra stigma or tendency to deny mental health issues, and a discomfort with the existing options for treatment.

“Being on medication is frowned upon in our community and there’s a lot of mistrust in communities of color when it comes to the medical community,” Vargas told me, “We’ve been guinea pigs in the past, like in the sterilization of Puerto Rican women.”

Vargas herself started taking antidepressants in college, trying different prescriptions until settling on the right fit. A survivor of suicide, she says that medication helped her back away from the edge.

“I definitely don’t think antidepressants numbed me,” said Vargas, “I was able to think more positively, and look at life differently. I was more level. I had my ups and downs, but it helped me go through life. When things would go wrong, I wouldn’t fall apart.”

It’s important to acknowledge that medication sometimes comes with a price. SSRI antidepressants have been shown to lower sex drive in many users. And other meds—such as Lithium, long the drug of choice for treating bipolar disorder—have resulted in reports of listless, zombie-like feelings. It can be uncomfortable adjusting to a drug’s side effects. But for many, the decision to medicate can mean the difference between life and death. And that’s worth pretty much any minor side effect.

Military trauma expert, and author of the upcoming book Homefront 911, Stacy Bannerman is working to pass the Kristy Huddleston Act, named for a friend of Bannerman’s who was killed by her husband, a retired Marine. Huddleston’s death highlighted the fact that PTSD can act like a contagion, spreading to the friends and family members of those afflicted.

Combat veterans don’t struggle alone with post-traumatic symptoms. Research has shown that around half of veterans diagnosed with PTSD committed a severely violent act in the year preceding diagnosis, including stabbings and shootings. In Huddleston’s case, her life was ended by what friends of the family said was her husband’s untreated PTSD.

“We need to understand that when the soldier goes to war, the family is drafted,” Bannerman said. “It is impossible that a combat vet with an invisible injury like PTSD—it is impossible that his family will not bear the burden of that.”

Bannerman said that PTSD manifests symptomatically in different ways depending on gender. Contrary to popular understanding, the majority of people with PTSD are not military veterans. Bannerman said that even for female military veterans, it’s been shown that PTSD usually stems from military sexual trauma. For male veterans, it often stems from combat—and symptoms can reflect the violence of their source.

“I think medication in conjunction with therapy, counseling, and some somatic services is extremely well indicated,” Bannerman said, “Medication can help to stabilize an individual to the point where they can be receptive to therapies. It can curtail the significant aggression and extreme irritability and hyperarousal in veterans.”

That said, the Department of Veterans Affairs (VA) has a reputation for over-prescribing. The administration isn’t pushing antidepressants and cognitive therapy down the throats of veterans—they’re doping them up with opiates. But addiction is not an appropriate cure for any mental health problem, especially not trauma.

In an excerpt from the book Moody Bitches reviewed in The Washington Post, Holland writes that women need “a course correction so that we can live lives that truly honor how we feel. But in order to do that, we must be able to feel.” But this statement operates under an assumption that I find, from experience, to be false. Not all states of emotions are healthy, and some feelings were never meant to be honored.

My story doesn’t end in tragedy. Yes, sometimes I still have problems sleeping. Sometimes I hear the “r word” and flinch, my heart rate speeding. My PTSD triggers are still sensitive enough that, until recently, I avoided anything rape-related (films, TV shows, article assignments) as if it were a peanut allergy. In fact, this is my first time ever writing about what happened—despite many years working in the media. But now, if there’s an unexpected brush with the subject, I don’t shut down. I don’t cry for hours on end. I get up and move on with my day, meeting deadlines and laughing with friends and family. Medication gave me that superpower.