Positioning Women, Mental Health and Depression on Canadian Health Care Agendas
Eansor, Donna Marie, Forum on Public Policy: A Journal of the Oxford Round Table
"I'd had a miscarriage which caused me to have a breakdown. I didn't know it was a breakdown but I went to my doctor and explained how I felt. He said there was nothing he could do for me, he had all these patients to see and perhaps the nurse could get me a cup of tea ..." (1)
Pauline Lee 2004
Pauline's story echoes many women's stories in the twentieth century and is also representative of women's her story about mental health concerns. Herstorically, women with medical health issues have been pathologized and over-medicated or under--recognized, under-treated and undiagnosed. The root of this inequality is in the diagnosis of "hysteria" during the nineteenth century, which assumed that a uterus and ovaries put women at risk for "nervous disorders". This flawed biological and scientific finding framed the mental health concerns of women as biological issues, matters of nature rather than issues about human rights and equality. As a result, women suffered inequality in every respect in society.
Feminist scholarship has critiqued "hysteria" and with decades of lobbying has exposed "hysteria" for what it is; overt sexism and bad science. Women were denied basic rights on the basis of "hysteria". (2) For example, under the law, women were not considered "persons", did not have the right to vote or access to educational opportunities. A vision of equality, hard work and vigilance guided the Famous Five in 1929 to the highest court in Canada to legally transform women into persons with entitlement to fundamental equality rights. (3) These feminists and those who followed stood by their position for women's equality, even in the face of many losses, to gain the right to vote and access to educational opportunities for Canadian women. More recently, significant strides toward equality have gained inclusion of equality provisions in the Canadian Charter of Rights and Freedoms (4); ratification of international agreements such as the Convention on the Elimination of all Forms of Discrimination against Women s and the right to equal pay for work of equal value.
There is no doubt that there has been significant progress in achieving the notion of equality as a basic human right for Canadian women. At the same time, there is a very real danger that this progress had led many to think that we have achieved substantive equality for women in Canada. This "no problem" perception emanates from the partial fulfillment of the substantive equality agenda for women and operates as a real obstacle to the identification of the unmet equality challenges that presently exist. Substantive equality for all women remains an "unfinished agenda" and the unequal treatment of women's mental health issues in Canada is an integral and critical component of this agenda. (6) Women and mental health issues are not on Canadian health care agendas.
Pauline's story reveals that women continue to be under treated or not treated at all and thereby denied access to the appropriate health care services. A cup of tea has been touted as preventative for all sorts of medical problems (7) and there is some evidence that green tea helps with depression. (8) Even so, a cup of tea is an inadequate medical response and a denial to Pauline of the right health care services having regard to her experience in the circumstances of a breakdown.
Whereas Pauline was under-treated and essentially left untreated, those women who are over-treated are equally denied appropriate health care services. A frequent choice of physicians and psychiatrists for women with mental health issues is the prescription of psychotropic drugs. Many women are over-medicated or placed on the wrong medication. Thirteen percent of women versus 9% of men consume these drugs and women are twice as likely as men to walk out of a doctor's office with a prescription for anti-anxiety or anti-depressive medication. (9) Moreover, little research has been conducted about how sex and gender differences affect the metabolism, overall efficacy and side effects of these medications over life courses. …