The link between women and depression is notoriously problematic. While decades of research studies show that depression rates in women are higher than in men, explanations vary widely in both substance and depth. Recently Daniel and Jason Freeman have written about “The Stressed Sex” (OUP) arguing that higher rates of depression in women (20 to 40%) result from increasing pressure on women “to function as carer, homemaker and breadwinner.” In other words, the women who have it all by doing it all are most at risk of depression.

It is not surprising that Allison Pearson demands, “Does Daniel Freeman really think this is news?” and suggests that he “should get out more.” ( Pearson has first-hand experience as a survivor of depression, and of course has written the classic comic novel (“I Don’t Know How She Does It) about the impossibility of success: in the novel we see Kate Reddy’s nerves torn to shreds by her success at work and at home. She has it all because she does it all; the juggling of multiple tasks drive the narrative to farce, collapse, and finally a kind of renewal in which the ideal of having it all is (sort of) rejected.

As important as it is to understand how unrealistic demands – often self-imposed but in response to others’ expectations – foster unnecessary dissatisfaction, we should not lose sight of the more persistent, subtle and insidious vulnerability in women to depression. Daniel and Jason Freeman touch upon this when they say that a large part of women’s work is under-valued, such as domestic work, that as employees women are awarded less pay, and that women find it more difficult to advance in their careers. Lack of recognition may lock one into a bell jar in which one feels unseen, un-heard, un-real. We need resonance; we need a sense of effectiveness and value; without social and interpersonal reinforcement, we fall vulnerable to depression. And so it was that the very first study of women and depression by Brown and Harris (“Social Origins of Depression” 1978) found that it was lack of variety in one’s work and social isolation that were causes of depression. Staying at home, deprived of adult companionship, without personal recognition or financial reward for the daily grind of managing young children: Women were at greater risk of depression because women were more likely to be housewives. Not having the option to do more, not being allowed to juggle and stretch made them vulnerable.

There is a great deal to be said for juggling: it can offer good mental health, a sense of competence and effectiveness, variety both in tasks and companionship. Sometimes being unable to do everything arises from a wealth of choice rather than constraint; giving something up in these circumstances may be a cause of regret, but not of that the soul searing loss associated with depression.

The nub of the issue is where the source of energy to juggle comes from, whether from a deeply personal well or whether from ideology or panic over others’ disapproval.

In Pearson’s novel, Kate Reddy is described in the novel as “running on empty.” Emptiness – lack of energy, emotional loss - is frequently described by people suffering from depression. This emptiness is deep, dark and disordered, a disconnect between one’s life and one’s inner self. And herein is the connection between ideals of perfection and the impossibility of success and depression in women. Commitment to meet ideal standards is a commitment to an unreal and impossible standard; more importantly, it is commitment to someone else’s standards, and motivates actions not in response to one’s own needs and wishes, but it response to external standards.

When doing research on women and depression Dana Crowly Jack identified the invidious power of the Over Eye – that judge who comments and assesses our actions and feelings and even our thoughts, to check whether these comply with a standard of goodness. For women, the external judge is constructed in part from the ideals that may entrap us as we envy other women’s perfect lives, or as we suppose that someone else is the perfect girl everyone loves. The emptiness is loss of self, as the Over-Eye drives us forward, or, as Crolwy suggests in the title of her book, “Silencing the Self”. Some women I interviewed spoke of going through life in “gut gear”, a term that refers to a mode of acting and choosing that makes no reference to their own personal preferences or desires. Instead, what shapes their daily actions are external judgements and expectations alongside a supposition that their own needs do not matter.

The rates of depression have been higher in women (and adolescent girls) than in men since records began; neither the new ideals of having it all have nor the expanding nature of roles have increased rates among women; in fact, the Freemans’ findings that rates are 20 to 40% higher in women than in men actually suggest a decline from the 2008 statistics showing that over a lifetime women are 70% more likely than men to experience depression. (

It is not juggling that puts women at risk of depression, but what all too often drives hectic activity: a compulsion to please others, or to live up to an ideal and a mind-set in which one’s own desires are worth less than those of others. None of this is news, but it is important to track the shifting shape and the disturbing persistence of depression’s special impact on women. When we understand this, we will be better placed to understand and address the conditions under which people – women and men – are most vulnerable to depression.

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