Authors: Andrew Solomon
162
The quotations from Frank Rusakoff’s writings are taken from unpublished manuscripts.
166
For a discussion of the tradition of witchcraft among the Senegalese, see William Simmons’s
Eyes of the Night.
171
Reboxetine has passed all testing to date and awaits approval from the Food and Drug Administration. In a recent E-mail, Pharmacia writes: “With regard to reboxetine, we have not received Food and Drug Administration (FDA) approval in the United States, and we cannot speculate on a date when this medication may be available. Based on the approval letter Pharmacia received from the FDA on February 23, 2000, additional U.S. clinical trials must be conducted before the product can be approved.” For further information, I recommend visiting Pharmacia’s Web site at
www2.pnu.com
.
171
For more on substance P, see Merck’s Web site at
www.dupontmerck.com
. An introduction to substance P as an antidepressant is provided by David Nutt, “Substance-P antagonists: A new treatment for depression?”
Lancet
352 (1998
).
172
I take the number “about thirty thousand” from Craig J. Venter, “The Sequence of the Human Genome,”
Science
291, no. 5507 (2001), which said, in part, “Analysis of the genome sequence revealed 26,588 protein-encoding transcripts for which there was strong corroborating evidence and an additional 12,000 computationally derived genes with mouse matches or other weak supporting evidence.” I thank Edward R. Winstead for bringing this article to my attention. I thank Polly Shulman for her advice on the mathematical meaning of ten variations for each of thirty thousand genes.
173
That women suffer depression twice as often as men is repeated throughout the general literature. The statistical work to support this assertion was done and collated internationally by Myrna Weissman at Columbia University and was published as “Cross-National Epidemiology of Major Depression and Bipolar Disorder,”
Journal of the American Medical Association
276, no. 4 (1996).
173
That sex differences for depression begin at puberty is a fairly common idea, prevalent in most of the literature on the subject. See Susan Nolen-Hoeksema’s
Sex Differences in Depression.
173
While arguments about the biological components of women’s depression are inconclusive, it is undeniably the case that mood effects result from fluctuations of estrogen and progesterone in the hypothalamic and pituitary hormone systems. A discussion of these phenomena may be found in Susan Nolen-Hoeksema’s
Sex Differences in Depression,
pages 64–76.
174
The statistics on suicide among women who are pregnant or have just given birth are from E. Clare Harris and Brian Barraclough, “Suicide as an Outcome for Medical Disorders,”
Medicine
73 (1994).
174
This figure on postpartum depression reflects an extremely varied set of statistics on this issue. There are two problems in arriving at an accurate figure. First, how stringently one defines postpartum depression radically affects its apparent frequency. Second, many symptoms resembling those found in depression can in fact occur as physiological repercussions of childbirth. Susan Nolen-Hoeksema writes about one study in which “the seemingly high rates of depression in new mothers resulted from their acknowledgment of the aches and pains and problems in sleeping that come with pregnancy and having a new baby, rather than the presence of the full range of depressive symptoms.” She continues, “Estimates of the prevalence of nonpsychotic depression in women during the postpartum period range from 3 to 33 percent.” She provides an average of 8.2 percent. These quotations come from her book
Sex Differences in Depression,
pages 62–65. Verta Taylor, in her book on postpartum depression entitled
Rock-A-By Baby,
reports that 10 to 26 percent of new mothers experience this malady.
174
The statistics concerning severe postpartum and mild postpartum depression are taken from Susan Nolen-Hoeksema’s
Sex Differences in Depression,
pages 62–64. Menopausal depression is described on pages 70–71.
174
The statistic on rate of serotonin synthesis is to be found in Simeon Margolis and Karen L. Swartz, “Sex Differences in Brain Serotonin Production,”
The Johns Hopkins White Papers
(1998): 14.
174
The question of disenfranchisement as the source of women’s depression is amply discussed in a number of books and publications, including Susan Nolen-Hoeksema’s
Sex Differences in Depression,
Jill Astbury’s
Crazy for You,
and Dana Crowley Jack’s
Silencing the Self.
174
The statistics on postpartum depression in stressed women are in Susan Nolen-Hoeksema’s
Sex Differences in Depression,
page 68. Her quote is from pages 60–61.
175
On the parity of male and female rates of depression among college students, as well as proposed explanations, see
Ibid.,
26–28.
175
The overall statistics on male-to-female depression rates are in Myrna Weissman’s “Cross-National Epidemiology of Major Depression and Bipolar Disorder,”
Journal
of the American Medical Association
276, no. 4 (1996), working on the basis of her epidemiological studies (see the first note for chapter five, page 173, above). That women have higher rates of panic disorders and eating disorders while men have higher incidences of autism, attention deficit hyperactivity disorder, and alcoholism was discussed in a personal correspondence with Steven Hyman.
175
The information on the nature of female disenfranchisement is not taken verbatim from any one source. Numerous authors have described and explained these various phenomena in different ways. My list is not meant to be either definitive or exhaustive. For the reader who would like more in-depth explanations of these ideas, I recommend Susan Nolen-Hoeksema’s
Sex Differences in Depression,
Jill Astbury’s
Crazy for You,
and Dana Crowley Jack’s
Silencing the Self.
Professor George
175
The two feminist explanations of depression, as well as various summaries concerning the connection between depression and marital status, may be found in Susan Nolen-Hoeksema’s
Sex Differences in Depression,
pages 96–101.
175
Brown has also done much interesting work regarding “the role of life events in the onset of depressive disorders.” Various studies by him and his colleagues have found humiliation and entrapment to be key descriptive factors of depressogenic events for women. See “Loss, humiliation and entrapment among women developing depression: A patient and non-patient comparison,”
Psychological Medicine
25 (1995). Other scientists’ findings on the importance of roles in defining depression are reported in numerous articles. That a woman’s concern for her offspring should be a typical depressogenic event for her is consistent with traditional gender roles. However, one article states: “When in practice the man also had significant involvement in domestic roles this gender difference in onset did not occur.” For more on this topic, see J. Y. Nazroo et al., “Gender differences in the onset of depression following a shared life event: A study of couples,”
Psychological Medicine
27 (1997): 9.
175
Myrna Weissman’s evolutionary theories about depression and women I have taken from an oral interview.
176
The information about depression among adult survivors of childhood sexual abuse is in Gemma Gladstone et al., “Characteristics of depressed patients who report childhood sexual abuse,”
American Journal of Psychiatry
156, no. 3 (1999): 431–37.
176
For information about anorexia and depression, see Christine Pollice et al., “Relationship of Depression, Anxiety, and Obsessionality to State of Illness in Anorexia Nervosa,”
International Journal of Eating Disorders
21 (1997), and Kenneth Altshuler et al., “Anorexia Nervosa and Depression: A Dissenting View,”
American Journal of Psychiatry
142, no. 3 (1985).
176
Freud’s description of Dora occurs in his essay “Fragment of an Analysis of a Case of Hysteria,” in volume 7 of
The Standard Edition of the Complete Psychological Works of Sigmund Freud.
For a feminist discussion of Dora, see Jill Astbury’s
Crazy for You,
pages 109–32.
176
For a discussion of ideas of femininity and depression, see Susan Nolen-Hoeksema’s
Sex Differences in Depression.
For a discussion of the expectations of motherhood and postpartum depression, see Verta Taylor’s
Rock-A-By Baby,
pages 35–58.
176
The quotations from Dana Crowley Jack may be found in her book
Silencing the Self,
pages 32–48.
177
Jill Astbury’s analysis is in her book
Crazy for You.
The quotation comes from pages 2–3.
178
The comparative rate of male-to-female suicide is in Eric Marcus’s
Why Suicide?,
in which he states, “Of the approximately thirty thousand people a year who take their lives, twenty-four thousand are men and six thousand are women,” page 15.
178
The discussion of the rates of depression in single, divorced, or widowed men may be found in Myrna Weissman et al., “Cross-National Epidemiology of Major Depression and Bipolar Disorder,”
Journal of the American Medical Association
276, no. 4 (1996).
180
The statistics on depression among Jewish men may be found in Bruce Bower, “Depression: Rates in women, men . . . and stress effects across the sexes,”
Science News,
June 3, 1995, page 346.
180
The qualities of children with a depressed mother are spelled out in Marian Radke-Yarrow et al., “Affective Interactions of Depressed and Nondepressed Mothers and Their Children,”
Journal of Abnormal Child Psychology
21, no. 6 (1993). Also see Anne Riley’s NIMH grant proposal entitled “Effects on children of treating maternal depression,” page 32.
181
Bruce Bower’s “Depressive aftermath for new mothers,”
Science News,
August 25, 1990, reports on a variety of studies that have found infant depression as early as three months of age.
181
The effects of a mother’s depression upon her young appear immediate and grave. Tiffany Field, an expert in the field who has been publishing for over two decades, writes concerning an almost “neonatal” depression: “Infants show ‘dysregulation’ in their behavior, physiology, and biochemistry, which probably derives from prenatal exposure to a biochemical imbalance in their mothers,” page 200. See Tiffany Field, “Maternal Depression: Effects on Infants and Early Interventions,”
Preventive Medicine
27 (1998). Unfortunately, these malignant effects also seem to endure. Nancy Aaron Jones et al., “EEG Stability in Infants/Children of Depressed Mothers,”
Child Psychiatry and Human Development
28, no. 2 (1997), describes a study in which the children of depressed mothers were followed from three months to three years of age. Seven of the eight children who had shown EEG asymmetry as infants still showed this pattern of dysregulation at three years of age. However, studies have also shown that even the most basic of maternal attention and interaction can alleviate much of the problem. Martha Peláez-Nogueras et al., “Depressed Mothers’ Touching Increases Infants’ Positive Affect and Attention in Still-Face Interaction,”
Child Development
67 (1996), claims that the calm and intimate interaction of a mother touching her infant can have drastically positive effects on the infant’s mood and sociability. Other studies, such as Sybil Hart et al., “Depressed Mothers’ Neonates Improve Following the MABI and Brazelton Demonstration,”
Journal of Pediatric Psychology
23, no. 6 (1998), and Tiffany Field et al., “Effects of Parent Training on Teenage Mothers and Their Infants,”
Pediatrics
69, no. 6 (1982), demonstrate that parent education can ameliorate much of the damage done by maternal depression.
181
The study of children of depressed mothers nearly one year after maternal improvement is Catherine Lee and Ian Gotlib’s “Adjustment of Children of Depressed Mothers: A 10-Month Follow-Up,”
Journal of Abnormal Psychology
100, no. 4 (1991).
181
The information on a ten-year follow-up of social impairment, depression, panic disorders, and alcohol dependence is in Myrna Weissman et al., “Offspring of Depressed Parents,”
Archives of General Psychiatry
54 (1997).