Women in the Asylum

Posted 06/09/2009

I’d wanted to see The Walls, the new play now having its world premiere at Steppenwolf Garage Theatre, for both personal and professional reasons. Chicago playwright Lisa Dillman and the members of Rivendell Theatre Ensemble have created a dramatic and troubling work about women as victims of involuntary psychiatric hospital admission, once called commitment (as in “she was committed last week”).

If your idea of theatre leans more toward show tunes, you might want to take a pass on this. What’s extremely painful about The Walls is its historical accuracy. Dillman follows the lives of three women, one from the late 19th century, one from the 1930s, and one young woman who easily could have been sharing a seat with you on the L this morning.

What few people realize is the magnitude of involuntary psychiatric confinement that existed until about the 1960s. State psychiatric hospitals, like Manteno in downstate Illinois, contained thousands of patients in huge dormitory facilities. The hellishness of these places was the subject of the 1948 film The Snake Pit. As a result of the film’s widespread audience reaction, many of these hospitals were either closed or underwent significant rehabilitation.

Psychotropic medications had not been discovered, so patients with diagnoses such as depression (then called melancholia), anxiety (hysteria), or schizophrenia (dementia praecox) could not receive the Lexapro, Xanax, or Risperdal that would allow them normal or near-normal lives. Instead they were swept up and confined, often for decades, and frequently abandoned by their families, who wanted to do anything but admit “insanity in the family.”

It doesn’t take a lot of imagination to wonder why over the years a majority of patients receiving “help” for “mental illness” have been women. During the 1960s psychiatrist Thomas Szasz took the medical profession to task for its very loose standards of mental illness diagnosis and treatment in his book The Myth of Mental Illness. How much depression, anxiety, or even schizophrenia is essentially the only way a person can cope with what she deems a troubling and hostile world? How much mental illness is simply a failure to conform to majority standards of behavior?

Because of their low stress-buffering serotonin levels, women are simply more sensitive to the world than men. Some women are extremely sensitive, experiencing enough stress to surpass their fragile stress buffer. Tens of millions of women go through life as walking “open wounds” in an overly salted world created and controlled mainly by men. It’s a world where conformity is rewarded and non-conformity has variously been treated by institutionalization, lobotomy, and, recently, by lots of medication.

Fortunately, the legal system has made it extremely difficult to forcibly institutionalize anyone. The mega-psychiatric hospitals are long gone. The only real remaining involuntary hospitalization occurs in adolescent psychiatry. Not having access to the legal system, an inappropriate number of adolescents remain involuntarily confined, sometimes for the most minimal of diagnoses.

How The Walls works itself out for contemporary women is subtle (come to think of it, maybe not so subtle), but to me, distinctly gender biased. Although I believe antidepressants can be true miracle drugs in the right situation, doctors (generally male) vastly overprescribe them to women for symptoms that are often part of life (breaking up, losing a beloved pet). The health care system encourages prescription renewal for years, often without any follow-up.

It’s worth asking how much of this medication is prescribed for actual emotional illness and how much for failure to conform to the male ideal of a woman. Perhaps conformity isn’t exactly the right word. Rather, how many male doctors want their female patients to be more like an idealized image of themselves (“strong, tough, unemotional”)?

When a woman takes an antidepressant from the SSRI (selective serotonin reuptake inhibitors, such as Prozac, Celexa, Lexapro, Paxil, or Zoloft) group, her stress-buffering serotonin rises. The issue(s) that triggered her depression or anxiety may remain, but no longer trigger despair or panic. That’s a positive. When a woman is over-responding to an SSRI, however, she’ll feel curiously numbed out, neither sad nor happy, and she often won’t like the feeling, or lack thereof. Her serotonin levels are now up there with the those of the boys. “Welcome to Guyville, you’re one of us now. Don’t you feel better?” Not so good.

That’s the professional reason I wanted to see The Walls. The personal reason is a distinctly unpleasant story.

I was raised having been told that my grandmother died sometime in the 1930s, when my mother and her sister were children. In actual fact, when the girls were 11 and 7, my grandmother was forcibly removed to Manteno for what sounds like anxiety disorder with panic attacks. Over the next 50 years, coping with the nightmare of a state mental hospital, she (not surprisingly) deteriorated, blinded herself during an episode of agitation, underwent a lobotomy, and died when I was an intern in my twenties. So secretive was my family about her existence that I didn’t learn of all this until she had been dead for several years. Even now, trying to extract information from aged relatives is next to impossible.

“How could there possibly be a health tip in all this?” you might ask. The era of involuntary commitment may have passed, but it’s been replaced by three forces just as potent:
• Hurried physicians with itchy fingers on their prescription pads.
• Pharmaceutical companies that make big money when you take their drugs.
• Health insurance corporations that readily acknowledge it’s cheaper for you to maintain on meds than to work through your problems with a psychotherapist.

Let me resuscitate a mantra from the 1960s: Question Authority.

Be well,
David Edelberg, MD