From time immemorial men have been grumbling about the regular mood changes thatmany women experience. Most of these guys were grumbling, “she’s about to have herperiod.” But they did not conclude that we go regularly insane. Not until someone cameup with a diagnosis: Premenstrual Dysphoric Disorder (PMDD), and the pharmaceuticalcompany Eli Lilly & Co. seriously promoted Prozac as a psychotropic that would“improve” the symptoms of women with PMDD.
In June of 1999, when their patent on Prozac was about to expire, Eli Lilly & Co. beganto look for ways to persuade the American Psychiatric Association (APA) that PMDDbelonged in their diagnostic manual as a genuine mental disorder. Their marketing folkshad designed a snappy new feminine name for Prozac – Sarafem. Getting Prozacapproved for a new and different “mental disorder” would give new life to the patent –but first Lilly needed to prove that PMDD actually existed.
None of the Lilly staffers (male or female) paid any attention to a brilliant 1992 study, inwhich researcher Sheryle Gallant and her associates took the entire symptom list forPMDD and asked three groups of people to document every day for two months thesymptoms they experienced. The groups were women who reported severe premenstrualproblems, women who reported no such difficulty, and men. The answers did not differsignificantly among the three groups.
In 2001 television commercials and magazine ads began informing us that women gocrazy once a month: we don’t become irritable or unruly or fractious and crave chocolate,but we become mentally ill and need to be treated with the drug Sarafem. Voila! TheAPA, Eli Lilly (and other pharmaceutical companies), the media, and a few women (whosometimes feel frightened or unheard or upset – and long for respect for those feelings)had created a new medical condition.
The problem with PMDD lies in pathologizing the experience of women who complainof severe premenstrual emotional problems; taking a normal, if upsetting, set ofsymptoms and defining them as an abnormal disease. I’ve found that women with severepre-menstrual difficulties are significantly more likely than other women to be in difficultlife situations, such as being abused at home or mistreated at work. Diagnosing theirgenuine challenges as a psychiatric disorder hides the real sources for much of theirtrouble.
Fast forward a few years to 2003, when Dr. Rosemary Basson, generously funded byPfizer Pharmaceuticals, began promoting what she calls a “new model” of disorder thatwill require expensive drugs to cure or treat – female sexual dysfunction (FSD). Bassoncheerfully suggests that 43% of women suffer from this condition. “If they truly have nointerest in sex, yes, you could say they have a disorder,” she insists. Out goes lack ofpassion as a motivation for abstinence, in comes a lucrative diagnosis for a medicalcondition that she compares to appendicitis or a broken leg.
It seems that Dr. Basson is targeting psychiatric disorder definitions for wholesalerevision. Is she using the drug industry to understand women? Or do those who pay thepiper call the tunes? Is a dearth of satisfying sexual intimacy being recognized, or ismodern life being fashioned into a disorder?
“Diseases are not just out there in nature,” says Dr. Richard Smith, the editor of theBritish Medical Journal, who questions the very existence of many industry-backeddysfunctions. “They are creations in many ways, and where you draw the boundaries,and what you define as a disorder, is a very tricky business indeed.”
These boundaries that Basson (and behind her the pharmaceutical companies) challengesare some of psychiatry’s most authoritative, thrashed out over decades of debate. TheAPA’s diagnostic manual recognizes a condition called “hypoactive sexual desiredisorder,” (HSDD), a “deficiency or absence of sexual fantasies and desire for sexualactivity.” This might sound similar to what Basson is describing, but, as so often, thedevil is in the detail. How many women on any given night might be more interested innon-sexual than sexual activity? Is this “normal?”
Sex therapists recognize HSDD as being both puzzling and difficult to treat, becausecouples often have different levels of desire. I frequently work with women, andsometimes men, who complain that their sex drive does not “keep up” with their partner’slevel of desire. Sometimes I get calls from women who are being labeled “frigid” bytheir angry partners, or who see themselves that way. As a clinician I throw out thedisorder labels because they are not useful. Instead I help couples bridge the desire gapthat sometimes looms between them.
People contact marital therapists like me because they’re having relationship challenges.The World Health Organization definition of sexual problems includes a crucialprerequisite – they must be “unable to participate in a sexual relationship as they wouldwish.” Seems reasonable, don’t you think? But these criteria will be dumped if Bassonand her pharmaceutical cronies have their way. In place of the requirement that a clientmust complain of being unable to participate, they want to substitute a “scale of distress”fashioned after the grandly named International Index of Erectile Function. Since FSD isall about being female, isn’t this an odd juxtaposition?
But he who pays the piper at least expects to enjoy the music – and not to hear sour notes.“Industry has a narrowing effect on how we see problems through various mechanisms,all of which are to do with money,” says Amy Allina, policy director of the NationalWomen’s Health Network, who points to many causes of unhappy sex lives that might beoverlooked in drug-based research.
What about anxiety, grief, stress, fatigue or boredom? And what about life with a partneryou don’t like, much less want to be sexually involved with? What about lack ofcommunication? Does Big Pharma want to pay for highlighting such topics? You’dbetter believe it doesn’t. They’ll continue to fund the researchers who view the world ina way that promotes disorders that require the drugs that they manufacture.
Industry’s current favorite is a dramatic rise in the numbers alleged to be sexuallydysfunctional. Remember the 43% of women uninterested in sex? This figure wasderived from work led by paid Pfizer consultant/sociologist Edward Laumann who askedwomen, “During the past 12 months, has there ever been a period of several months ormore when you lacked interest in having sex?” Well, so what if they did? Does thatlabel them as having FSD? Is this a basis for diagnosing a disorder? If a woman isn’tturned on by the man she lives with, does this really mean that she’s mentally ill?
For hospital ethics committees to approve new-product trials, they must first have adisorder for the product to treat. No disease, no treatment. But if Basson’s campaign tochange definitions succeeds, sexual interest disorder will become a bona-fide problem towhich remedies may be properly addressed. I shudder to consider the implications.
To assume that women’s sex lives need medicating is to ignore the hundred and one otherthings that effect good sex. Psychologist Sandra Leiblum makes eloquent sense in theintroduction to the book she co-wrote with Judith Sachs, Getting the Sex You Want.“While the search is on for a miracle potion or fail-proof device that will transform sexand make it magical, it is my belief that, ultimately, women hold the tools necessary toget the sex they want. It is their willingness to do what needs to be done – whether itmeans taking hormones, starting therapy, or believing that they are entitled to sexualpleasure.” It takes courage for women to confront their sexual dissatisfaction. Andcourage doesn’t come in bottles, capsules, or tablets .
-Jill Denton is a Licensed Marital and Sex Therapist practicing in Los Osos. Shespecializes in helping people repair and strengthen their intimate relationships.