Try Self-Care First (The Medicalization of Women's Distress)

My story doesn’t begin with my first prescription. It begins long before that — in 1928, when my mother was born into a world where asylums, psychoanalysis, and the belief that women’s suffering was a private flaw rather than a social fact shaped psychiatry. By the time I arrived in 1958, psychiatry had already begun its transformation: new drugs, new diagnoses, new authority. The DSM had just been born. Thorazine and the first antidepressants were reshaping what counted as illness. And the expectations placed on women — to cope quietly, to be agreeable, to absorb the emotional weight of everyone around them — were still firmly in place.

I grew up inside that shift without knowing it. The story I inherited was simple: if you struggle, it’s your chemistry. If you’re overwhelmed, it’s your brain. If you can’t keep up with the demands placed on you — as a daughter, a mother, a woman — the problem is inside you, not around you. By the time my own children were born in 1991 and 1997, the DSM had ballooned, SSRIs were everywhere, and the medicalization of women’s distress had become so normalized that it barely registered as a cultural choice.

It took withdrawal — the slow, disorienting unspooling of decades of medication — for me to see the larger pattern. My suffering wasn’t a personal defect. It was part of a lineage: my mother’s generation taught to endure silently, my generation taught to medicate silently, and my children’s generation coming of age in a world where diagnoses multiply faster than the conditions that create them.

Looking back across this timeline — from 1928 to now — I can see how I was handed a deeply patriarchal-shaped narrative. Psychiatry didn’t invent those pressures, but it absorbed them, codified them, and prescribed them back to us in orange pill bottles. My journey off antidepressants forced me to confront not just the drugs, but the worldview that made them seem inevitable.

This work, and this writing, are my way of mapping that terrain — the personal, the historical, and the cultural — so that none of us has to navigate it alone.

DSM Expansion, Psychiatry Milestones & Prescribing Growth

Generational Milestones

🟡 1928 — My Mother’s Birth

👶 Born before the psychopharmacology era 🟤 Psychiatry at this time is dominated by psychoanalysis and institutional care

🟤 1930s–1940s — Psychiatry Before Medications

Dominant model: psychoanalysis + asylums ⚡ Early somatic treatments (insulin coma therapy, ECT) emerge → No DSM yet; diagnoses are informal and inconsistent

🔵 1952 — DSM‑I (106 diagnoses)

📘 First standardized diagnostic manual 🟣 Early antipsychotics (chlorpromazine) and antidepressants appear → Marks the beginning of modern biological psychiatry

🟡 1958 — My Birth Year

Born during the earliest era of psychiatric medications → Only 106 DSM diagnoses existed; psychopharmacology was brand new

🔵 1968 — DSM‑II (182 diagnoses)

📘 +76 new diagnoses 🟣 Benzodiazepines surge; Valium becomes the top‑selling drug in America 🟤 Psychiatry shifts toward “neurosis” and “anxiety” as treatable conditions

🟤 1970s — Biological Psychiatry Gains Power

Research funding shifts toward brain‑based explanations. Deinstitutionalization accelerates → outpatient medication management becomes central

🔵 1980 — DSM‑III (265 diagnoses)

📘 Major paradigm shift: disorders reframed as biological diseases 🟣 Prescribing accelerates sharply 🟤 Psychiatry aligns with neuroscience + pharmaceutical industry growth

🔵 1987 — DSM‑III‑R (292 diagnoses)

📘 +27 new diagnoses 🟣 Prozac launches → SSRI era begins 🟤 Direct‑to‑consumer drug advertising begins to reshape public perception

🟡 1991 — Firstborn Arrives

👶 Born during the early SSRI boom 🟣 Antidepressant prescribing rising rapidly

🔵 1994 — DSM‑IV (297 diagnoses)

📘 +5 new diagnoses 🟣 Two DSM changes trigger major prescribing spikes:

• Social Anxiety Disorder formalized → immediate drug marketing

• ADHD criteria expanded to adults → stimulant boom 🟤 Psychiatry increasingly adopts medication‑first treatment models

🟡 1997 — Second Born Arrives

👶 Born during peak growth in stimulant + SSRI prescribing

🔵 2000 — DSM‑IV‑TR (~297 diagnoses)

📘 Text revision 🟣 56% of DSM panelists have pharma ties 🟤 Managed‑care era → brief med‑check appointments replace psychotherapy

🔵 2013 — DSM‑5 (541 diagnoses)

📘 +244 new diagnoses (410% increase since 1952) 🟣 Global psychiatric drug revenue hits $88B. 69% of DSM‑5 task force members have pharma ties 🟤 Psychiatry faces criticism for diagnostic inflation + overmedication

🔵 2022–2024 — DSM‑5‑TR

📘 Updated text 🟣 Nearly 60% of contributors received pharma payments. Telemedicine + broadened ADHD criteria → stimulant surge 🟤 Renewed debate about the validity of psychiatric diagnoses

Timeline Citations:

Psychiatry Milestones (1928–1958)

• Lobotomy history — Smithsonian Magazine: https://www.smithsonianmag.com/history/lobotomy-remembered-180980090/ 

• ECT origins — NIH / NLM: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181586/ 

• National Mental Health Act (1946) — NLM: https://profiles.nlm.nih.gov/spotlight/qq/feature/national-mental-health-act 

• NIMH founding (1949) — NIMH official history: https://www.nimh.nih.gov/about/strategic-planning-reports/history-of-nimh 

• Lithium discovery (1949) — Medical Journal of Australia summary: https://www.mja.com.au/journal/2000/173/9/john-cade-and-discovery-lithium-treatment-mania 

• Chlorpromazine introduction — WHO essential medicines history: https://www.who.int/medicines/areas/quality_safety/safety_efficacy/essential_medicines/en/ 

DSM Expansion

• APA DSM history overview: https://www.psychiatry.org/psychiatrists/practice/dsm 

• DSM‑I through DSM‑5 diagnostic counts summarized by Kirk & Kutchins (The Selling of DSM): https://www.ucpress.edu/book/9780520209645/the-selling-of-dsm 

• Allen Frances on DSM‑5 expansion (Saving Normal): https://www.psychologytoday.com/us/blog/saving-normal 

Prescribing Trends

• Valium as top‑selling drug — NYT archive summary: https://www.nytimes.com/2002/03/19/health/valium-s-legacy.html 

• History of benzodiazepine marketing — Happy Pills in America: https://press.uchicago.edu/ucp/books/book/chicago/H/bo3627281.html 

• Prozac launch & SSRI era — FDA approval record: https://www.accessdata.fda.gov/drugsatfda_docs/nda/88/018936_prozac_toc.cfm 

• ADHD diagnostic expansion & stimulant rise — CDC data: https://www.cdc.gov/ncbddd/adhd/data.html 

• Global psychiatric drug revenue ($88B) — IQVIA Global Medicines Report: https://www.iqvia.com/insights/the-iqvia-institute/reports 

• Telemedicine stimulant surge — NEJM commentary: https://www.nejm.org/doi/full/10.1056/NEJMp2213920 

Pharmaceutical Influence on DSM Panels

• DSM‑IV conflicts of interest — Cosgrove & Krimsky, PLoS Medicine: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030512 

• DSM‑5 conflicts of interest — Cosgrove et al., PLoS Medicine: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001190 

• DSM‑5‑TR pharma payments — Psychotherapy and Psychosomatics (2022): https://www.karger.com/Article/FullText/525473 

Women, Psychiatry, and Patriarchy

• Gendered prescribing of tranquilizers — Andrea Tone, The Age of Anxiety: https://www.basicbooks.com/titles/andrea-tone/the-age-of-anxiety/9780465083328/ 

• Historical pathologizing of women — Ehrenreich & English, For Her Own Good: https://www.penguinrandomhouse.com/books/43664/for-her-own-good-by-barbara-ehrenreich-and-deirdre-english/ 

• Mad in America archives on women & psychiatric harm: https://www.madinamerica.com/category/women/

• Whitaker’s analysis of diagnostic expansion — Mad in America: https://www.madinamerica.com/2010/11/anatomy-of-an-epidemic/