I was recently reading Dr Jessica Taylor’s latest book Sexy but Psycho: How the Patriarchy Uses Women’s Trauma Against Them. Taylor is a working class, radical, lesbian feminist who has a proven track-record working with traumatised women and girls. In this book she argues for a trauma-informed approach to working with women and girls and documents the long-standing tendency by the patriarchy (systems that uphold male power) to pathologise them as a result of their traumas, reframe them as mental illness, and unnecessarily medicate them for these ‘disorders’.
Pre-existing research shows that women are more likely to be diagnosed with depression, anxiety and somatic disorders, borderline personality disorder, panic disorder, phobias, suicide ideation and attempts, postpartum depression and psychosis, eating disorders and PTSD (Riecher-Rossler, 2016). Furthermore, women are more likely to be diagnosed with multiple psychiatric disorders at one time (Anxiety and Depression Association of America, 2019).
Taylor articulately argues how women are very likely to be diagnosed with a personality or depressive disorder after being assaulted by a man (Chapter 5). They are typically referred to mental health services as a result of abuse or assaults, only to find that they are subsequently diagnosed with incurable disorders which then work against them when pursuing legal action against their abusers (Chapter 6). This is a sophisticated form of victim-blaming which only serves to discredit the victim and offer excuses for the abuser.
She provides a sustained critique of the inherent racism, sexism and homophobia within the history of psychiatry – many of its disorders allegedly discovered in an attempt to control black people, women, and deviant sexualities, which unfortunately continues to this day, with these groups receiving the majority of diagnoses compared to white men (see Chapter 2).
Perhaps most concerning is the fact that women and girls are more likely to be medicated for these disorders – sometimes against their wishes and despite debilitating side-effects – which pharmaceutical companies are more than willing to profit from.
By way of example:
In 20 NHS trusts in the UK, Electroconvulsive Therapy was given to women twice as often than men (p.57)
Between Oct 2020-Feb 2021 in the NHS, 71% of patients who are chemically restrained by injection are women. 91% of children who are chemically restrained by injection are female (p.63).
At the point of publication, all of the young women who have died by euthanasia in the Netherlands and Belgium, under the practice of ‘psychiatric euthanasia’, and reported in the media, have been subjected to sexual abuse and significant trauma in the past (p.277).
I think that’s enough for now.
This prompted me to think about how Taylor’s work can inform my own research, investigating UK-based women’s use of online sobriety communities to abstain from alcohol.
Indeed, since World War II the UK’s alcohol consumption has changed significantly (IAS, 2020), with western women’s consumption rocketing along-side their increased disposable income and the relaxation of social mores around public drinking (Smith & Foxcroft, 2009). We know that women walk a tightrope of acceptability when it comes to drinking and are more likely to be stigmatised as a result of drinking behaviours than men. However, they are less likely to present for government-funded treatment. (For more information regarding women and alcohol consumption/recovery see Staddon, 2015 as a starting point).
The high rates of utilisation of online sobriety communities by women (Davey, 2021) could be interpreted as evidence that the demographics of ‘Alcohol Use Disorders’ are changing. We could potentially see this as a positive – that women are coming forward, despite risks of social shaming, to receive help and support for problematic drinking. Yet, does this serve them longer term?
Unfortunately, the patriarchal and medicalised system of public health requires binary criteria in order to allocate funding for research and services, and thus as researchers and clinicians we are pushed into the funnel of conformity to align our language and referrals within this framework. If we want to increase research on women’s alcohol use/recovery then we have to play by the rules, largely set by men. Does this woman have an AUD: Yes or No?
This is one of the reasons why research on social media-based online sobriety communities is almost non-existent. The communities don’t apply barriers to entry regarding ‘how bad was your drinking problem?’. They don’t make women report on their previous and current drinking behaviours. They don’t medicalise their decision to want help to stop drinking. A refusal to operate within the same language and frameworks means no funding but also no recognition of the work that’s being done, often by women for women, women supporting other women, sometimes from a trauma-informed perspective.
From the beginning, I resisted applying qualification criteria to my study regarding the extent of my participants’ previous drinking. I refused to put those frameworks, developed by men with little or no regard to women’s experiences, on the women who volunteered for my study. For instance, NICE (2011) guidelines for clinical treatment of alcohol use disorders only mention women specifically in relation to metabolic rates. I was challenged on this at a conference once and I’m pleased that I held firm. To assign my research participants with an AUD, irrespective of whether they self-defined as having one – or whether they ‘wanted’ one – further pathologises them and their experiences when it’s probably fair to say that most of the drinking population in the UK could meet the DSM criteria for AUD.
Indeed, having completed my interview transcriptions I can see how frequently (largely white, middle-class) women rejected the medicalisation of their previous drinking. Mostly, these women have described their experiences outside of a medicalised context. In using these online groups to obtain sobriety they have not been forced to conceptualise their drinking as an illness or a psychiatric condition. The vast majority self-defined as a non-drinker, or would say ‘I don’t drink’ if asked about their experiences. Some would say sober. Their drinking days, and their drinking identities, are behind them – they no longer carry around a disorder.
There is also a class angle to this; women who are less wealthy and less educated are more likely to be diagnosed with an AUD, and suffer more severe health and social consequences as a result (Marmot et al, 2010). Online sobriety communities overwhelmingly serve white, middle class, highly educated women (Davey, 2021), and so perhaps my findings are unsurprising. Yet, I think perhaps what this also shows is that women with socioeconomic capital (money, education and time) are able to access support and help through a medium which does not require them to comply with a medicalised model. Concerningly, it may be the case that women of less socio-economic means are pushed into the medicalised system and psychiatric diagnoses in order to obtain state-funded help which thus perpetuates the inequalities, because, as can be seen from Taylor’s work, once a woman is channelled into that system she is likely to experience repercussions in many areas of her life as a result, such as child-custody, prosecutions for abuse, employment tribunals, divorce alimony etc (p.54-6).
I would caution, however, that my research participants did not necessarily reject the medicalisation of their prior drinking due to radical feminist thought, such as Taylor’s, and so as feminist researchers we can situate women’s experiences within feminist frameworks but must be careful not to ascribe certain views and ideologies to participants themselves, unless where explicitly self-identified. It is more likely that my research participants were re-working their identities and past experiences to navigate gendered stigma associated with problematic alcohol use (another tool of control by the patriarchy).
Sexy but Psycho offers all readers – all genders, academics and non-academics – an opportunity to reflect on how they have either been pathologized by our medicalised, psychiatry-informed health and social services, or how they are (sub)consciously upholding such a framework that discredits, controls and undermines women and their power. Written for a wide audience, Taylor’s book has the potential to transform thinking in how we access, fund and write about women’s bodies and health, and their use of pharmaceuticals and alcohol.