Arisha Jawad

Professor Chettiar

TA: Alexandria Sundarsingh

12th May, 2020

Final Exam

Question 4, part 1

In this essay, I argue that, the addition of major of major depressive disorder and social anxiety

disorder to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental

Disorders impacted the practice of psychiatry in the late-20th and early-21st centuries by shifting

the focus to more functional forms of mental illness, since there was a removal of clear

distinctions that had previously existed between “normal” an mentally ill people, and this rapid

surge in numbers led to psychiatry and pharmacology becoming integrated as one leading to a

shift from an individualized form of treatment to a generalized one.

The addition of major depressive disorder and social anxiety disorder to the DSM led to

psychiatry moving towards a more generalized and form of care rather than an individualistic

one that was implemented before. This is evident through how the number of practitioners, who

prescribed medicine without therapy, increased alongside double-blind studies increased to

ensure that drugs were now created to be applicable to everyone whereas before they focused on

treating the individualistic symptoms on people. As soon as these disorders became a part of the

DSM, according to Lane, “A signal therefore went out that researchers, mental health

professionals, and the drug companies should unearth fresh remedies…. Psychiatry also freed

itself to parter with pharmacology (and to treat social phobia mostly with drugs) by dismissing
psychoanalysis as costly and ineffective.” Whereas previously, in the 1960’s 1970’s, the

emphasis on anti-depressants and anti-anxiety drugs was never promoted in standalone drugs but

adjacent with psychotherapy or counselling, and the idea was that the patient would be helped

with these medications alongside therapy. However, in the early 21st century, since there was

such a rapid surge in numbers and depression almost tripled, prescribing medication seemed

much easier than treating patients with an individualized form of care now. Managed care

Furthermore the “bereavement exclusion” in the initial criteria for depression demonstrated how

people were being treated as a homogenous group.

Another way the inclusion of social anxiety and major depressive disorder impacted

psychiatry is through the shift in focus towards more “functional” forms of mental illnesses

increased due to the rapid increase in people being diagnosed with mental illness. According to a

study done during the early 21st century, “the rate of self-harm in the UK has risen by 68% in

girls aged 13–16 over the last 10 years” (Keles et al. 2020). This dramatic increase, and the

source itself, reflects a more considerable ongoing concern in psychiatry in the 21st century, that

was brought about due to the changes in the DSM in the late 20th century, which resulted in the

lines between “normal” feelings and being “mentally ill” becoming extremely blurry. This

explanation is partially responsible for explaining the rapid increase in people that were being

diagnosed with this disorder, after its creation, due to the extremely generalized symptoms it

consisted of, for example, “Loss of Interest or “weight loss or gain”. Whereas before clear-cut

distinctions would mostly be present to create clear distinctions between mentally ill people and

everyone else, for example, with schizophrenia, these symptoms coincided with normal feelings

and could have been applicable to anyone if marketed the right way, which they were,

eventually, by pharmaceutical companies. Therefore, the rapid increase in numbers can be

19th century, and according to a researcher, “because periods of sadness or grief are ubiquitous in

human experience and because sadness is often accompanied by such typical depressive

symptoms as sleeplessness or loss of interest, the concept of depression can be over-inclusive

and heterogeneous.” 1. The way the DSM was being used led to more people being over-

diagnosed and more people being medicalized who didn’t “warrant their diagnosis”2. It was this

generalization that led psychiatry to shift towards focusing on the more functional forms of

mental illnesses since the symptoms were extremely generalized and the lines between “normal”

feelings and mental illness became too blurry to be able to distinguish anymore

Furthermore, psychiatry focusing its increase on pharmacology also led to the

development of more drugs and more “awareness” created by these drug companies due to their

own self-interest, which was another reason for the rapid increase in the number of people being

diagnosed with these disorders. “Before you sell a drug, you have to sell the disease”3; this is the

strategy followed by pharmaceutical companies who used social media to advertise “awareness”

by romanticizing generalized symptoms of depression, to create a market for their drugs before

their release. In 1987, after the FDA approved directed consumer advertisement and drug

companies now began focusing on producing psycho-pharmaceuticals, for example,

tranquilizers, which had negative associations attached to it, were now marketed as anti-

depressants. In 1994, Prozac became the best-selling drug in the world, and the advertisements

used to promote it suggested that it would improve your life even if you did not have a mental

illness. The side effects of these drugs were rarely ever mentioned, and drug advertisements

1
This quote is from the lecture on social anxiety and depression.
2
From the lecture on depression.
3
Christopher Lane, Shyness, page 110.
oversimplified the conditions they had been treating. This helped integrate pharmacology and

psychiatry into a single unit during these years.

The focus of psychiatry shifted to more functional forms of mental illnesses after

deinstitutionalization and the increase in people with MDD and social anxiety. The integration of

major depressive disorder and social anxiety led to the number of people being diagnosed with

these illnesses increasing, partially due to their generalized symptoms and due to the

advertisements that drug companies created before releasing their drug. This led to a shift away

from a more individualistic form of care and towards a more medicalized one since it seemed

like a more efficient and cost-effective way of treating such large numbers.
 Part 2, Question 4

In this essay, I argue, that the gendering of medical treatment and diagnosis of mental

illness in the 19th and 20th changed over the course of 200 years, due to a confluence of social and

medical forces, all of which intended to allow men in power, who were creating these diagnosis’

or influencing them, to stay in power and maintain the power differentials among groups in

society. This gendering of mental illness led to certain minority groups in society being

marginalized further and being labelled “mentally ill” whenever they deviated from socially

acceptable norms. The gendering of mental illness changed from being done through medical

forces and evidence in the 19th century to being done more through and due to social and political

factors in the 20th century.

The nineteenth-century perceptions about gender and mental illness were important

because they were defined by the influence of Darwin’s research which then gave rise to more

research, based on racist and sexist beliefs, emerging through men in power that benefitted from

racial and gender inequality in society. They ensured support for his work so they could maintain

control and power in society by creating certain stereotypes and ensuring anyone who did not

adhere to gender norms was labelled with a certain mental illness – which happened to be

“Hysteria” during the 19th century.

Darwin’s book, “Descent of Man”, stated that any mental stimulation can divert the

body’s energy from reproduction in women. Darwin’s ideology was further emphasized, by Weir

Mitchell during late 19th century, who even went on to implement a “Rest Cure” for women with

Neurasthenia, which involved forceful rest. Mitchell believed, due to their biological makeup,
women “as a rule, are thin and lack blood” and during the cure “I do not permit the patient to sit

up or to sew or write or read. The only action allowed is that needed to clean the teeth. “.

Furthermore, his treatment varied according to gender, and for men, he implemented the “West

Cure” which encouraged men to overly engage in physical exercise. During this time, treating

men and women differently became normalized as others during this time reinforced the idea of

women being inferior and passive beings and toxic notions of masculinity and also gave rise to

power relationships where the patient belonged to a marginalized group and the doctor was a

heterosexual white male. The effects of the rest-cure are evident by Charlotte Perkins Stetson

who published the Yellow Wallpaper in 1892 and it showed how doctor-patient relationships

took all autonomy away from women as patients, and allowed the doctor to be a authoritative

figure. This took away from treatments focusing on patient care and allowed other theories sexist

and racist “scientific” therories to come forth such as Cesare Lombroso’s “Criminal Man”.

Furthermore, this allowed them to label the “modern women”, one who was active and not a

stereotypical housewife, as mentally ill since she was no longer just a passive and submissive

figure.

During the 20th century, after Freud’s influence, scientific racism was reduced but instead

it was social factors that gave a rise to gendered perceptions about certain mental illnesses; the

impact of this can be seen by changes in the definition and criteria of mental illness that were

extremely specific to normative behavior among certain groups, and this also impacted the

narrative around certain groups since it created stereotypes. Freud changed perceptions around

gender and sexuality in the 19th century through his work on homosexuality which revolutionized

how gender and sexuality and mental illnesses correlated. Gendering of mental illness was no

longer due to a scientific basis but social norms and deviation from those. During the 20th
century, gender biases in psychiatric diagnoses became extremely prominent and often the

symptoms were stereotypically associated with women and when they did not want to conform

to gender roles or did not exemplify feminine behavior society expected them to – they were

labelled mentally ill and dangerous and sent to psychiatric hospitals for care. This is evident

through the film “Girl, Interrupted”; and the hypersexualizing tropes it uses to pit ‘good’ against

‘evil,’ and ‘feminine’ against ‘unfeminine’ which is tied up in representations of mental illness.

Lisa’s character is showed as being promiscuous, angry, and shows more “serious” symptoms of

mental illness. Whereas Susanna, has a less severe form of mental illness and she’s seen as

“moral” and good. At the end of the film, Susanna is released from the hospital and “chooses” to

get better and marry a man, refusing to continue life with Lisa, who remains at the hospital still

ill- as if she is facing the consequences of her unfeminine behavior. This created strict

boundaries between what was deemed acceptable for a certain gender to do and what was not

and led to certain stereotypes for minority groups in the 20th century, such as the ‘angry black

man’ and the ‘crazy housewife’. These stereotypes were created and acted as a form of control,

and coincided with political and social events of the time,

The impact of this can further be seen through how stereotypes led to certain minority

groups being further marginalized. During the civil rights movement in the 20th century, the

diagnosis of schizophrenia changed from having symptoms that were stereotypically associated

with white women or feminine men, to being associated with African-American men specifically

during the civil rights movement in 1950. Schizophrenia went through numerous transformations

as a diagnostic category including not only what psychiatrists have seen as its defining symptoms

but in psychiatric understanding of underlying causes. In the case for African American men,

diagnosis was amplified more for political reasons during the time period than medical ones; the
civil rights movement deemed them as a threat and led to 36% of people diagnosed with

schizophrenia to be African-American men. Since the creators of DSM were mostly doctors,

white men had authority at the time. People in positions of power recreate the same patterns that

previously allowed them to stay in power and this often includes the process of ensuring

minority groups are marginalized. This was done through creating these distinctions.

The significance of gender and race in the history of medical treatment and diagnosis of

mental illnesses during the 19th and 20th century is that it led to psychiatry itself becoming a tool

for the establishment, used to repress the most vulnerable groups in society, and to allow those

in positions of power to stay there; they maintained control through “scientific” theories in the

19th century that forced women to adhere to gender roles and by creating certain stereotypes in

the 20ththrough changing diagnosis. This still shapes the way certain minorities are perceived.