Black Dogs and Blue Words: Depression and Gender in the Age of Self-Care

Jerry Seinfeld jokes that pharmaceutical companies could save time by naming all of their antidepressants “Cramitol” (“Cram it all”). Kimberly Emmons would likely agree. Her eye-opening Black Dogs and Blue Words opens up an original, potentially life-changing perspective on antidepressants and the companies who market them. Emmons, an English professor at Case Western Reserve University and an expert in medical rhetoric, offers shocking and persuasive evidence that women are not only the targets of these ads, but have become complicit in the targeting.

Emmons builds her case brick by brick. Although her prose is academic and dense in places, the slowly building logic and the reader’s ensuing sense of outrage make the book as hard to put down as any who-dun-it. In fact, the book is its own brand of who-dun-it. How did women become Big Pharma bullseyes? Solving the mystery requires understanding how the language of antidepressant advertising both reflects and shapes gender stereotypes. To illustrate, Emmons dissects print and broadcast ads word by word and frame by frame. She points out how words such as “excessive crying," “fatigue," “loss of zest,” and “tearfulness” have long been used in our culture to describe women’s emotions and alleged deficits, and how drug manufacturers have co-opted the phrasing to describe depression.

It gets worse. Analyzing the photographs that accompany the ads, Emmons demonstrates how they reflect our societal norms of acceptable female behavior. The ads feature sad women standing apart from their family, women whose disappointed children accuse them of being “no fun anymore,” and protective fathers with their arms around children, standing apart from mom, fixing her with baleful stares. Next frame, the woman diagnoses herself with depression. Next, she is shown at her doctor’s office requesting antidepressants, and, presto, next frame, the woman has been restored to her acceptable “gendered self.” How do we know? She reports her progress as she shops for the family groceries, or while playing with her children, or while involved in some other womanly scenario. Emmons also surveys children’s literature and that women’s magazine staple, the self-diagnostic quiz, with equally interesting and well-considered conclusions.

One of the book’s most fascinating chapters traces the history of the Diagnostic and Statistics Manual of Mental Disorders (DSM), which, as the title implies, spells out the criteria for diagnosing psychiatric illnesses. In one of her biggest bombshells, Emmons reveals that much of the language employed by Big Pharma to describe depression is not found in the DSM. Rather, drug manufacturers have cherry-picked synonyms primarily associated with women. Women absorb the ads, diagnose themselves with depression and make a beeline for the doctor’s office. The doctor, bombarded by the same marketing and lacking the time for a more in-depth probing, agrees. Prescription signed. Pills sold. And so we circle.

But don’t think that Emmons is anti-antidepressant, because she isn’t. Her view is much more reasoned. She acknowledges the good that medication can do under the right circumstances. But she also urges women to go from a regime of self-doctoring to a regime of self-care. Emmons uses “self-doctoring” to refer to women’s willingness to buy into the pharma-philosophy that emotional and social malaise stem from chemical problems which only can have chemical solutions. By accepting this rhetoric, says Emmons, women deprive themselves of their own personal narrative, one which may have little or nothing to do with clinical depression.

In contrast, self-care involves reacting to signals that something is not right with a conscious surveying of one’s life and all its circumstances. Perhaps medication will help. Or perhaps a much more profound change is in order. Learning how we have been manipulated, our lives altered by corporate profiteering, is depressing. Pass me the Cramitol. On second thought, don’t. It doesn’t have to be this way.

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