I am not surprised to hear that women are overdiagnosed with mental illnesses (Are women really more mentally ill than men? As a psychologist, I’m not so sure, 8 March). In my 30s, I developed systemic lupus erythematosus, which went undiagnosed for several years, my symptoms wrongly diagnosed by (male) GPs as stress triggered by a high-powered job. I was prescribed an antidepressant that made me hypomanic, and acquired a further diagnosis of bipolar disorder.
Eventually I found a GP who listened to me, and blood tests picked up antibodies and other diagnostic indicators for lupus. Apparently it’s common for lupus sufferers to overreact to drugs, but over the next few years a succession of (male) psychiatrists continued to insist I had bipolar disorder. I believed them: my mood invariably deteriorated during flare-ups, and when I was well, I felt wonderful.
According to the drug data, the usual drugs for bipolar disorder are contraindicated in people with lupus and associated kidney disease, so I didn’t take them. One psychiatrist suggested that I had self-diagnosed lupus as an excuse to refuse treatment and another wanted to hospitalise me “to find the right drug”. Didn’t they read my medical notes, I wondered, or question why I was prescribed steroids?
For more than a decade I believed I was an impossible case until I saw a female psychiatrist who, instead of relying on notes by previous psychiatrists, as her predecessors had done, took a full history. She consulted her (female) colleagues and concluded that I did not meet the criteria for bipolar disorder. Since then, I have never felt “bipolar” again or worried that I wasn’t helping myself by having a demanding job.
Would I have been so readily diagnosed as mentally ill if I had been male? I am white, middle-class and educated. What hope is there for those who aren’t so privileged?
Name and address supplied
• The increasing popularity of the idea that mental health is the result of issues in society, rather than issues in the individual, makes sense given the way in which those struggling with mental illness have been blamed for their problems throughout history. This applies to women in particular, whose struggles have long been denied and minimised – for instance, many medical professions still do not sufficiently prepare women for the impact of pregnancy and childbirth, both of which are physically and psychologically life-altering.
However, although I also find this idea conceptually appealing, I have yet to see any real evidence in favour of it. As with the nature versus nurture debate, the truth likely lies somewhere in between; though women who experience poverty seem to experience mental health issues disproportionately, not all of these women experience these issues in the same way, or to the same degree – why?
Where the balance between societal and individual factors lies exactly will require further investigation. Though we must acknowledge the impact of an oppressive society on women’s mental health, in the absence of more research, we would do women and girls a disservice if we do not also consider the role that genetic and biological factors may play in the likelihood of them developing mental health disorders. Understanding these factors may enable better treatment.
Juliette van Steensel
Cambridge
• I agree with the Dr Sanah Ahsan’s general argument that mental health “disorders” are more to do with power imbalances and societal factors than psychological or medical ones. But I don’t understand the gendered framing of the analysis. Dr Ahsan seems to be implying women’s mental health is affected by society whereas men with mental health issues are presumably driven by some sort of pathology or men are simply “weak minded” compared with women, perhaps? Otherwise, why make the article about gender and not mental health, per se?
We know men are less likely to seek medical diagnosis and far more likely to kill themselves. So the premise that mental health issues are more prevalent in women also appears contestable, but Dr Ahsan doesn’t seem to want to contest it.
Dr Jeremy Jacobs
Braintree, Essex
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