Expert Maggie Scarf Finds That Depression Afflicts Up to Six Times More U.S. Women Than Men

UPDATED 09/15/1980 at 01:00 AM EDT Originally published 09/15/1980 at 01:00 AM EDT

Between fellowships at the Ford Foundation and at Harvard University six years ago, science and medicine writer Maggie Scarf stumbled upon an alarming statistic: For every male diagnosed as suffering from depression, there are from two to six females. "It was as if women had more flu or appendicitis than men, "she says. "It just didn't add up." Scarf resolved to find the explanation and interviewed more than 150 depressed women, combed the medical literature and talked with scores of authorities at seven teaching hospitals and mental clinics. The result, Unfinished Business: Pressure Points in the Lives of Women (Doubleday, $14.95), is the most extensive such investigation since psychologist Phyllis Chester's controversial Women and Madness, a 1972 work that Scarf endeavors to rebut. Scarf, 48, now teaches a seminar on nonfiction writing at Yale, where her husband of 27 years, Herbert Scarf, is Sterling Professor of Economics. The mother of three grown daughters, Scarf discussed depression and women with Judy Gould for PEOPLE.

How many depressed people are there in this country?

According to the National Institute of Mental Health, about 40 million people—or one in every five Americans—suffer at least moderate symptoms of depression. That's fairly staggering in itself, but here's the kicker: Two-thirds of the group are women.

What do these statistics mean?

That's a sensitive issue. Phyllis Chesler is probably the best-known proponent of the idea that depression is actually no more prevalent in women than in men, but that women tend to get labeled as depressed because of sexist bias. That, she says, is how society punishes and controls women who don't accept their feminine roles, or so her argument goes. I'm convinced that is false. The women I saw weren't suffering from labeling. They were in pain and needed help. No question about it.

Why so many unhappy women?

Women put much more of themselves into personal relationships, and when those relationships break up, go sour or just change, the thought of being alone can be terrifying. Some women would rather commit suicide than face being alone.

Is this just a cultural trait?

No, I think it's a biological tendency. In evolutionary terms, mothers forming tight bonds with their offspring ensured the survival of the species because the human newborn was the most helpless creature in nature. Twenty minutes alone, and it would have been destroyed. So nurturing is bred into the female. Modern civilization accounts for only one percent of human history. We live in a very frightening world that doesn't promote close relationships. Generosity is out of style. Selfishness is glorified. We call it independence.

What specifically leads to depression among modern women?

Every woman's life contains pressure points that are triggered by changes in key relationships. For adolescents, it usually has to do with separating from parents. During the 20s, it's about establishing intimacies and forging an identity in the work world. The early 30s is the most depressed age, even more so than menopause. That's when women are examining what they've done, looking critically at marriages and often feeling trapped. In the 40s, you get a return to the issues of adolescence. Only this time the trigger is your own children leaving the nest. In the 50s, it's the loss of attractiveness. In the 60s and 70s, the principal causes are loneliness and widowhood. Depression is really like a trick mirror. It shows in gigantic proportions the normal problems that every woman has to negotiate: independence, autonomy and the sense that one can survive on one's own.

Which group of women is most prone to depression?

A report by the late Harvard psychologist Marcia Guttentag found that young mothers without husbands are the most stressed, economically and emotionally. Other than that, depression cuts across all social classes.

Is the rate lower among career women?

Surprisingly, the rate among housewives and working wives is the same. I had thought, come the liberation, a lot of the issues of self-esteem would have been settled. But it just isn't so.

How is women's depression different from men's?

For women, it's a kind of death in life—feeling helpless, lonely, unable to move. Men, when depressed, tend to be self-critical and focus on their failure to achieve. Women are more inclined to despair endlessly, to hang onto the pain.

What's the psychological payoff to being depressed?

It's a passive way of saying, "I'm hurting," without confronting anyone with the message, "You're hurting me." It's a way of making other people take care of you and a way of avoiding painful realities. It's a bad bargain, but it's all done on an unconscious level.

What are the overt warning signs?

Basic rhythms are disrupted. There can be lots of irritability or fatigue, severe insomnia or tendencies to escape by sleeping for abnormally long stretches. Some women shift into a manic high, running around like machines—which can be considered a way of denying or fleeing from the depression. And appetites—for food or for sex—can totally dry up or, less typically, swing to excess.

Are postpartum blues folklore or fact?

A British study found that, among a group of women with no prior record of mental instability, 60 percent reported some transient depression after childbirth. Stanford Medical School in the late 1960s studied a group of women for three 10-day periods: late in pregnancy, immediately after childbirth and eight months after childbirth. The women were found to be three times more likely to cry in the 10 days after childbirth than during the other two periods.

Is the cause hormonal?

Scientists are far from a full understanding. It is known, however, that during pregnancy the estrogen level in a woman's body can be 100 to 1,000 times higher than normal. Following delivery, the level suddenly drops. Some researchers have suggested that this results in a biological state akin to drug withdrawal. In terms of hard facts, we know that pregnant women are less likely to suffer mental disturbances than women in general, and that immediately following the birth of a child, women are more likely to suffer disturbances.

Is menopausal depression also linked to a hormonal decline?

There is simply no scientific evidence that the hormonal decline in the middle years causes depression. It's important to understand that after childbirth—and before menstruation, for that matter—hormone levels decrease suddenly. But the hormonal decline preceding menopause takes place gradually beginning in the mid-30s. The tendency to relate depression in middle-aged women to loss of reproductive capacity is, however, as old as medical history. There may be an unconscious notion—in the doctor and the patient—that the loss of fertility is a female form of disaster. Accompanying it is the idea that by pumping in replacement hormones you can stave off the end of fertility and relieve the anxiety.

Are you saying that hormonal therapy doesn't work?

It certainly doesn't in relieving depression or in slowing the aging process. It may help ease physical symptoms such as hot flashes, but not without risk: A link between estrogen therapy and cancer of the uterus has been found in several studies. The depression of middle-aged women has less to do with hormones than with who they are and what's happening in their lives.

Are tranquilizers effective in treating long-term depression?

Absolutely not. Tranquilizers—Valium, Miltown and Librium are the three most prescribed—depress the central nervous system. The worst Valium ad I ever saw showed, as most of the ads do, a forlorn-looking woman. The text explained that she had a master's degree in fine arts but was living a life "centered around home and children." The ad suggested that Valium was the ideal treatment for the "continuous frustration" she felt in not being able to pursue her vocation.

Are you against all drug therapy?

No. Antidepressants such as Elavil and Tofranil are superb when properly administered. In severe cases such as manic depression, lithium therapy may be useful. The important thing is to seek referral to someone with sophisticated knowledge of diagnosing and treating depression. A lot of physicians don't have that knowledge.

What can a woman do to overcome her depression?

First, recognize it. Failure to recognize the problems raised in one stage of development before moving on to the next creates emotional baggage that can weigh a person down for years. To pinpoint unresolved conflict, group those years that seem to go together. Give them a title like "Great Mother/Bad Wife" or "Eight Disastrous Years." Ask: What are the most significant things that happened during those periods? What made them end? What did you feel then—about yourself and those around you? What did you want most, and did you achieve it? Once you know why you're depressed, overcoming it is much easier.

What are the chances of recovery?

Excellent. There is a 95 percent chance of recovery. The literature says that the average depression lasts four to 12 months. On the other hand, there's that wonderful phrase, "unless suicide intervenes." It's sad, but depression is the only psychiatric disorder with a high mortality rate.

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