Women, depression, and biological psychiatry: implications for psychiatric nursing.

TOPIC. The belief that taking medicine alone will eradicate depression can increase feelings of helplessness and dependence in depressed women, and deprive them of the opportunity to explore interpersonal reasons for the depression. PURPOSE. To examine the impact on depressed women of a purely biological approach to depression SOURCE. Clinical work with depressed women and review of related literature CONCLUSIONS. In a depressed woman who has a his tory of passive behavior, a purely biological approach has poor long-term effects. Key words: Biopsychiatry, depression, projective identification, women "My psychiatrist tells me there's nothing I can do to help my depression, except take the medication," reported Elizabeth in group psychotherapy. The belief that psychopharmacology without psychotherapy and participation in treatment and recovery will eradicate depression can increase feelings of helplessness and dependence in depressed women. Women in America have long been socialized to unconsciously, and often consciously, feel helpless and dependent in a variety of life situations. Clinical depression in women has been linked to situations that enhance helplessness and depression (Breggin, 1991; Kaschak, 1992). The powerful message from a biopsychiatrist to a depressed woman that the prescribed medications are her only hope for recovery may serve to increase feelings of helplessness and dependence. When the treatment of depression is chiefly biological, helplessness and dependence--along with feelings of frustration, anger, and oppression--may be acted out in transference. The depressed woman may frustrate mental health clinicians, including the biopsychiatrist, by using projective identification. By infusing others with feelings of helplessness, the depressed woman experiences her own feelings of helplessness and dependence less intensely, if only temporarily. Women and Depression Twice as many women as men in this country are diagnosed with clinical depression. Though research attempts to find genetic or physiological causes of depression have been numerous and earnest, biochemical and genetic research has not consistently supported theories that depression has genetic, biochemical, or gender-related physiological causes (Breggin, 1991; Kaschak, 1992; Ross & Pam, 1995; Tavris, 1992). A task force of the American Psychological Association in 1990 described increased depression in women over men related to several social factors including: 1. Avoidant, passive, dependent behavior patterns; pessimistic, negative cognitive styles; and focusing too much on depressed feelings instead of action and mastery strategies 2. High rates of sexual abuse in childhood so that depressive symptoms may be long-lasting symptoms of "post- traumatic stress syndrome" for many women 3. The burdens of marriage and childrearing, which fall much more heavily on women 4. Poverty, in which women and children are vastly over-represented (Breggin, 1991, pp. 319-320). "The Task Force found that women truly are more depressed than men primarily due to their experience being female in our contemporary culture," reported Ellen McGrath, chair of the 1990 APA study (Breggin, 1991, p. 320). This finding supports the findings of numerous studies which have explored sources of feminine distress (Belenky, Clinchy, Goldberger, & Tarule, 1986; Breggin; Brown & Gilligan, 1992; Chesler, 1972; Kaschak, 1992; Kaslow & Carter, 1991; Kleinman, 1988; Mirowsky & Ross, 1989). Kaschak identified women's depression as related to their ordinary, daily life issues: 1. The emphasis on relationship as defining success or failure as a woman 2. Loss of possible choices, such as access to careers and mastery-related tasks 3. Equating self-esteem with appearance 4. Self-denial embedded in self-esteem 5. …