Psychiatric News November 7, 2003
Volume 38 Number 21
© 2003 American Psychiatric Association
p. 30
Media Cling to Stereotyped Depression Depictions
David Milne
Despite a gradual chipping away of some gender stereotypes in American culture, the popular media persist in linking those stereotypes to depression and the drugs that treat it.
A study that analyzes the depiction of depression in popular American magazines and newspapers from 1985 to 2000 shows how cultural and gender stereotypes get mapped onto SSRI antidepressants.
As SSRIs became more popular, there appeared a widening set of gender-specific criteria outside those in the DSM for dysthymic or depressive disorders, which these agents are designed to treat. A significant shift was seen in depictions of women’s mental issues from specific symptoms and medical terminology toward gender-stereotyped roles such as marriage, motherhood, and childbirth. In contrast, depression in men was described in terms connoting work, aggression, or athletics.
The new study by researchers at the University of Michigan Depression Center analyzing articles that include these depression-related stereotypes appears online by the journal Social Science and Medicine. The study’s lead author, Jonathan Metzl, M.D., Ph.D., assistant professor of psychiatry and women’s studies and director of the Program in Culture, Health, and Medicine at the University of Michigan, said he was surprised by the findings.
Even though the 1980s and 1990s were a time when women’s roles in society were firmly rooted in both the workplace and the home, the media’s coverage of women’s mental health focused increasingly on the latter.
"We thought we would find many articles that described how SSRIs helped women balance home and family or told of women rushing off to high-paying jobs," he told Psychiatric News. "But that depiction was not anywhere near as common or as powerful as the stereotype of the woman as the mother and wife. Meanwhile, at a time when men were reportedly getting in touch with their feelings, men’s roles as fathers or husbands—or even men’s emotions—received nowhere near as much coverage as did the ‘depression’ of not performing on the job or the playing field."
Metzl notes that this trend is important for patients and their physicians because it may influence the way they communicate with each other about mental health concerns.
He believes physicians need to look at the deeper messages behind cultural stereotypes. Metzl said that when patients request drugs, the prescribing physician needs to be aware of the ways in which stereotypes get mapped onto psychiatric drugs, regardless of whether a prescription ultimately results from the interview.
"There needs to be a bit more interrogation in the process. If a patient comes in and says she saw an ad in Cosmopolitan magazine and says ‘I now realize I need Paxil,’ do you or don’t you write the prescription? You can ask, ‘What did that magazine ad or story say to you? What changes do you feel might happen? Does it have to do with your role as a mother, or as an athlete, etc.?’ This way you can open up a more meaningful interaction."
Metzl does not blame the media for the way they cover drugs and mental health issues. Instead, he believes that gender stereotypes pervade the way we talk about mental illness—for better or for worse.
"Stereotypes are, of course, often based in lived experience and infuse the ways doctors and patients experience, describe, and ultimately understand depression," he said. "But at the same time, many articles also subtly implied that people who don’t adhere to these stereotypes need to be medicated."
He speculated that similar messages come from pharmaceutical ads, which, though promoting a public good, also use stereotypes to promote the message that brand-name drugs offer quick fixes for emotional problems.
This phenomenon echoes observations made in Metzl’s recent book, Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs, which takes a historical look at advertisements for psychiatric medications in the mass media and medical journals, from tranquilizers such as Miltown in the 1950s through Valium in the 1970s and Prozac, Paxil, and Serafem today.
"This is fascinating," said Nada Stotland, M.D.., M.P.H., a professor of psychiatry and obstetrics/gynecology at Rush Medical College and secretary of APA. "Dr. Metzl and his colleagues are to be congratulated for this important work." Stotland said she complained about this kind of advertising many years ago, when an ad depicting women’s life stages only in terms of family and reproduction was published in a journal on whose editorial board she was sitting. She believes these images have a certain emotional reverberations, but also reflect stereotypes and fail to capture the realities of modern-day life.
"Women are in the workplace, and men are investing more of themselves in their roles as parents. Employers increasingly recognize the impact of depression on women in the workplace," she said. "Many women are in service jobs in which not only productivity, but pleasant responsiveness to customers, is important. They may have families to support, little respect at work, and little job security. Other women are executives and professionals. In either case, the necessities of fulfilling job and personal responsibilities leave little room for the incursions of depression."
Stotland said that difficulty in relating to loved ones, especially children, might motivate a woman to seek treatment for depression more than any other symptom, but clinicians must be aware of all the responsibilities and pleasures in a woman’s life to assess her condition, monitor her response to treatment, and assure that full recovery from depression restores both her ability to love and her ability to work. She feels that advertisements using accurate psychiatric terminology and reflecting a more realistic vision of women’s and men’s roles could remind clinicians to attend to all the ways psychiatric disorders affect their patients’ lives.
"Dr. Metzl’s important research highlights the impact of culture on our understandings of gender and depression," Michelle Riba, M.D., a clinical professor and associate chair for education and academic affairs at the University of Michigan’s psychiatry department, told Psychiatric News. Riba, who is APA president-elect, also directs the psycho-oncology program at the University of Michigan Comprehensive Cancer Center.
"Moreover, Dr. Metzl does not vilify the media, pharmaceutical companies, the medical profession, or consumers, but instead works to explain how each of these entities live and work within the same cultural environment," she added.
"By analyzing the cultural context in which meanings of depression circulate, his findings enhance, rather than detract from, recent advances in the study of biological sex differences in mood disorders and are of great benefit to doctors and patients alike." 
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