Psychotropics, sociology and women: are the 'halcyon days' of the 'malestream' over

Sociology of Health & Illness Vol, 15 No, 4 1993 ISSN 0141-9889

Psychotropics, sociology and women: are the'halcyon days' of the 'malestream' over?

Elizabeth Ettorre and Elianne Riska

(Abo Akademi University, Finland)

Abstract The purpose of this paper is to lay the foundation for thedevelopment of a gender-sensitive perspective on psychotropicdrug use. This paper reviews existing research on psychotropicdrug use and highlights gender biases in three ways. First, areview of the early work on gender differences in tranquilliseruse reveals how 'one-dimensional' accounts are offered byproponents who are either 'no-objections', 'cautious-no-answer', 'women's-role' or 'political' advocates. Second, withspecial reference to women, a critical review of the two pre-dominant discourses, the medical and the sociological, areoutlined. It is argued that they have a common approach thatmakes women's drug use invisible. The paper concludes thatthe approach prevailing in current research is individualisticand gender blind and needs to be complemented with ananalysis that problematises gender.

Introduction

Psychotropic drugs comprise one of the most commonly prescribed cate-gories of drugs in industrialised countries. Over the past twenty years, thewidespread use of these types of drugs and specifically the potential forabuse and dependency of benzodiazepines have become an area of con-cern for scholars in a variety of fields (Cappell et al 1986). In assessingthe issue of psychotropics on an international scale, medical experts havesuggested that if the character of psychotropic drug use is to be under-stood and indeed effective health and social policies are to be developed,the abuse potential and dependency liability of these drugs be thoroughlyinvestigated (Idanpaa-Heikkila et al 1987, Medawar 1992).

During the 1980s, social scientists have responded to this challenge andprovided new ideas on the social and cultural aspects of psychotropicdrug use. For example, there have been sociological accounts of the socialand cultural meanings of psychotropic drug use (Cooperstock and© Basil Blackwell Ltd/Editorial Board 1993. Published by Blackwell Publishers, 108 Cowley Road,Oxford 0X4 UF, UK and 238 Main Street, Cambridge, MA 02142, USA.

504 Elizabeth Ettorre and Elianne Riska

Lennard 1979, Helman 1981, Gabe and Thorogood 1986, Montagne1985, 1991), of pathways to use (Caflferata and Meyers 1990) and of howtranquillisers have become a public issue and constructed as a socialproblem in Britain (Gabe and Bury 1988, 1991a, 1991b, Gabe et al 1991).These new social scientific ideas on tranquilliser use have added valuableinformation to the previous mapping of the socio-demographic character-istics of the users in the research of the 1970s (Cooperstock and Parnell1982). If one considers the importance of cultural and social factors withthe development of these ideas, one begins to question the traditional,dominant 'psychologistic' framework (Riska 1989), focusing on individualfactors related to use.

Regardless of the value of offering a sociological perspective as anaccompaniment to the medical perspective dominant in the field, a gen-der-sensitive perspective or more specifically a feminist perspective has,however, been lacking among the new contributions provided by socialscientists (eg Gabe 1991a, 1991b). It is not sufficient in explainingwomen's greater likelihood to use these drugs to say merely 'the recipi-ents' structural position in the household and the amount of social sup-port and social stress experienced by those in this position needs to beconsidered' (Gabe 1991a: 33). One must ask not only why and how drugsare used by women in this private sphere but also how women in theinterplay between the private and public sphere of social relations viewtheir dependency on these drugs. Given that little attention is given toproblems concerning women in medicine 'unless they relate directly tochildbirth or pregnancy' (Doyal 1981:222) this shortcoming is expected.

The development of feminist analyses in the field of tranquillisers hasbeen hampered for two reasons. First, any area of human behaviourdominated by the natural sciences tends to divide 'scientific' enquiriesfrom the social and cultural concerns (Arditti 1980, White 1991). Illnessand sickness were for a long time the sole prerogatives of the inquiries ofthe natural sciences. When the social scientists began to examine healthbehaviour and sickness, they were even themselves unsure about the sta-tus of their enterprise. While the division between sociology of and inmedicine for a while settled the dispute, the integration of the concems ofhealth seem to have provided the sociologists with a domain of their own.As even the representatives of the male-stream of medical sociology wereunsure of the status of their enterprise, it is not surprising that the voicesof women's concerns were left unnoticed.

Second, research on illness and health behaviour, of which drug use isa part, has been heavily embedded in the functionalist perspective pro-vided in Parsons' analysis of the sick role and the physician as the legit-imiser of this role (Parsons 1951). In Parsons' original account, both thephysician and the patient were described in masculine terms, but at heart,he proposed a gender neutral theory of human action. In Parsons'(1951:447) words the physician's role 'centers on his responsibility for theO Basil Blackwell Ltd/Editorial Board 1993

Psychotropics, sociology and women 505

welfare of the patient in the sense of facilitating his recovery from illness'(emphasis ours). Later research has typically assigned the sick role towomen as indeed empirical research tends to verify (Nathanson 1975,Verbrugge 1989). The paradox therefore is that in the area of medicalsociology one can hardly accuse sociologists for not making women visi-ble. In fact, the stereotypical female middle-aged patient with vague com-plaints is the typical 'problem' patient for the physician (Lorber 1975)while for researchers she has become an odd phenomenon since she any-how lives longer than the men despite her illness (Verbrugge 1985, 1989).

Interest in women's health issues in the 1980s has added new empiricalknowledge to the gender neutral research on morbidity of the past(Roberts 1991a, 1991b, Verbrugge 1985, 1989). Furthermore, recent femi-nist contributions in the analysis of the social construction of women'shealth and illness (Martin 1989, Daly 1990, White 1991:17-18) have high-lighted the need for examining the social and cultural context of medicineand medical practice as well as the social construction of gender and ill-ness. Yet, little of this research has found its way into the new social sci-ence perspective on psychotropic drug use. In short, gender neutralresearch and naturalistic assumptions about the character of genderdifferences in health have hampered the production of a feminist knowl-edge of health.

A gender-sensitive perspective is one which allows one to see womenand to explain the world from the position of women (Stanley 1990:3-15,Harding 1991). This means specifically that powerful gender dynamics,structuring culturally, politically and economically the meaning of 'mas-culine' and 'feminine'; the groupings of 'men' and 'women' and divisionsbetween a private and a public domain of social life are not taken as agiven but problematised and placed at the forefront of the analysis. Inorder to develop a feminist analysis of women's use of psychotropicdrugs, it is necessary to review critically previous work in the field and tomake visible the 'invisible paradigm' of male-oriented work (Bernard1989).

The aim of this paper is to offer a review of the existing research onpsychotropic drug use and to highlight the gender blindness and biases inthis research. We do this in three ways. First, we will review the earlywork on gender differences in tranquilliser use and offer a clarification ofhow the 'one-dimensional' accounts are presented in the explanations andconclusions. In a related discussion, we will show that the predominantfocus has been epidemiological, drawing attention to individual ratherthan structural levels of concem. Second, with special reference towomen, we outline the two predominant discourses on psychotropic druguse: the medical and the sociological. We offer a critical review of thesetwo discourses visible in the field. We argue that the current sociologicaldiscourse is gender blind and is unable to explain the use of the predomi-nant users: women.

© Basil Blackwell Ltd/Editorial Board 1993


We suggest that studies on tranquillisers can be categorised into thosewhich are gender sensitive and those which are gender blind. We define agender-sensitive perspective on psychotropic drug use as one in which thecategories of women and the gender system are not taken as a given butproblematised and placed at the forefront of the analysis. We contendfurthermore that only when this distinction is made, will a broader under-standing of women's use of drugs, specifically minor tranquillisers, beachieved. If a truly new understanding promised by social scientists in thepast is to develop, paradigms prevailing in current research need to bequestioned, dissected and complemented with an analysis that problema-tises the existing sex-gender system.

Double rate of consumption and one-dimensional explanations

Since the late 1960s, research on psychotropic drug use has shown consis-tently that women tend to use these drugs twice as often as men. Areview of this literature indicates certain trends in the way in which thisfinding is explained. The authors of the early articles on psychotropicdrug use present interpretations of their data which contain gender biasesor gender blindness. In the following review we will examine with a 'femi-nist gaze' (Gamman and Marshment 1988) the varied conclusions ofthese authors' interpretations of the gender difference in psychotropicdrug use.

Parry's (1968) report from the first wave of surveys on the use of psy-chotropic drugs by US adults revealed that women were represented bymore than half of the users and that those affiliated to the Jewish religionhad above average rates of use. Noting that there appeared to be aninverse relationship between use and escape drinking. Parry suggests thatboth for women and Jewish people there is a strong taboo against heavyor escape drinking. He concludes: 'For neither group, however, are theresimilar well-structured and traditional objections to the use of psy-chotropics' (Parry 1968:805). This conclusion is made without empiricallytesting the attitudes of both groups towards the two substitute sub-stances. Additionally, the use of the notions, taboo and traditional objec-tions, suggests the existence of powerful cultural norms recognised by theauthor. Nevertheless, these powerful norms appear to infiuence drugusing behaviour as well as to allocate a moral imperative not to drink tocertain social groups. Moralistic assumptions about what is acceptablebehaviour for women target women as a distinct social group and fur-thermore, as being more prone to psychotropic drug use than men. Yet,these assumptions are not questioned by Parry.

Jasper Woodcock's (1970) survey of long-term psychotropic drug usersappearing on general practitioners' lists in England found that a highproportion (75 per cent) of these users were women. His conclusion is '. .© Basil Blackwell Ltd/Editorial Board 1993


. it would appear that the reliance upon psychotropic compounds isrelated to neither the attitude of general practitioners nor to the characterof the environment but to some factor both more personal to the patientand more all-pervading in the community. Whatever this factor may be,it affects women more powerfully than men, and the old more powerfullythan the young' (Woodcock 1970:174). The somewhat mysterious factoris not explored further or linked in any way to the structural position ofpowerlessness which women and old people occupy in society.

A national study of psychotropic drug use in British general practiceby Parish (1971:16) reveals that the sex ratio of use is 2.14:1 female tomale. In his conclusions, he poses a question rather than offer an expla-nation of these results when he says, 'These results highlight some inter-esting problems which require further research: Why are twice as manywomen as men prescribed psychotropic drugs?; There can be no conclu-sions to a report such as this but only questions' (Parish 1971:72). Yet,this article has in the later literature been referred to as providing anexplanation of the gender differences in psychotropic drug use.

In a much quoted article, Ruch Cooperstock (1971) attempted to pro-vide an explanatory model of the gender differences in psychotropic druguse and suggested that: 'Women are permitted greater freedom than menin expressing feelings. Because of this women are more likely to perceiveor recognize their feelings and more specifically to recognize emotionalproblems in themselves' (Cooperstock 1971:241). For Cooperstock(1971:241), women feel freer to bring these problems to the attention ofphysicians who 'expect that a higher proportion of female than malepatients will need mood modifiers'. While the important issue of the'feminisation' of psychotropic drug use is implicit here, the appeal to sex-role theory as a thorough explanation of the gender differences in use ofthese drugs is not adequate. Representatives of sex-role theory seewomen's drug behaviour as part and parcel of sex-role socialisation.Hence, drug behaviour is viewed as part of the sex role, almost natu-ralised, but unrelated to the issue of structural inequality built into thegender system.

The findings from Linn and Davis' (1971) study of 100 women psy-chotropic drug users in Los Angeles indicated the importance of two rela-tively independent socio-cultural factors: religious affiliation and referencegroup interaction. A discussion of their results relies heavily on the workof Parry (1968). Therefore, Linn and Davis (1971:339), following in thetracks of Parry, simply conclude that there is 'no structured objection' tothe use of psychotherapeutic drugs by women and Jewish people. Herewe see, as in Parry's early work, subtle moral undertones in this type ofexplanation.

In a large national study of American adults. Parry and his colleaguesfound that usage rates for psychotropic drugs was 'substantially higheramongst women than among men' (Parry et al 1973:782). The authors

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suggest 'tentative explanations' for this difference and note: '. . . amongwomen, a greater likelihood of visiting the physician, biologicaldifferences associated with the reproductive cycle, demands andallowances characterizing female social roles, and less use of altemativesubstances for coping with emotional distress, eg alcohol' (Parry et al1973:782). In retrospect, that this explanation was defined as 'tentative'reveals a certain ambivalence on the part of the authors. Here, we see evi-dence of yet another appeal to sex-role theory as an 'adequate' explana-tion of the gender difference finding.

Baiter, Levin and Mannheimer (1974) conducted a cross-national studyof nine Western European countries in 1972. This study revealed a similarpattern: women used psychotropic drugs twice as often as their malecounterparts. The scholars conclude: 'We are particularly impressed bythe unif̂ ormity of the findings for age and sex across countries and stillwonder to what extent the differences in rate of drug use between thesexes is a socio-cultural phenomenon. The impact of the feminist move-ments now ongoing in many countries may provide a partial answer inthe years to come' (Baiter et al 1974:774). Again, as is the case of the sex-role proponents, women's drug use is perceived as a question of femaleculture and certain values that women hold. In addition to implicitly con-taining a blaming the victim ideology, the conclusion presents thewomen's movement as grounded on cultural values rather than the struc-tural inequality of the existing gender system.

In the context of earlier studies, Lader (1978) mentions the rate ofwomen's usage of psychotropics, specifically minor tranquillisers, as beingtwice as high as men's usage. His explanation for this rate is couched inmonetary terms: 'In cost effective terms tranquillizers are cheap. It ischeaper to tranquillise distraught housewives living in isolation in towerblocks with nowhere for their children to go play than to demolish theseblocks and to rebuild on a human scale or even to provide play groups.The drug industry, the govemment, the pharmacist, the tax payer and thedoctor all have vested interests in 'medicalising' socially determined stressresponses' (Lader 1978:164). Within this limited framework, the reader isunable here to consider further how and why it is that more women thanmen are represented in this social process of medicalising stress.

In their now classic article, 'Some social meanings of psychotropic dmguse', Cooperstock and Lennard (1979) reveal findings from a Canadianinterview study of 68 psychotropic drug users in which 76 per cent ofusers were female. Explaining women's use, these authors say: 'the major-ity recognised that their continuing use related to a variety of role strains.The most common strains and confiicts mentioned by female informantsrevolved around their traditional roles as wife, mother, houseworker,while males tended to discuss confiicts regarding their work or work per-formance' (Cooperstock and Lennard 1979:344). This explanation is infact an extension of Cooperstock's earlier work. However, in this papere Basil Blackwell Ltd/Editorial Board 1993


the authors' invocation to sex-role theory albeit inadequate is reachedthrough an appeal to the concept, 'role conflicts' for women.

The type of advocates

In the majority of the work cited above, the categories women, women'srole and the gender system are taken as a given and remain unproblem-atic. Neither notion, women, nor the gender system, is placed as the mainfocus of authors' conclusions, while their analyses are one-dimensionaland individualistic. For us one-dimensional analyses provide a myopicview of research material. As limited analyses, they either neutralisewomen and the workings of the gender system or assume that womenexist primarily as passive or expressive rather than active or instrumentalsocial actors in relation to men. We use the term one-dimensional asopposed to multi-dimensional. For us, multi-dimensional analyses prob-lematise gender and are carried out by examining critically the subtle,structural dynamics of gender. The individualistic focus of research onpsychotropic drug use implies an emphasis on the individual user ratherthan structural factors infiuencing use in certain social groups.

The above review of the conclusions of previous research demonstratesthe need for structural or multi-dimensional analyses, taking into accountthe complexities of the lives of women psychotropic drug users. Let uslook at the above conclusions in more detail in an attempt to analyse thiswork with a 'feminist gaze' (Gamman and Marshment 1988). Here, wesuggest that the above proponents making claims about the genderdifference in psychotropic drug use fall into four types: the 'no-objections'advocates, the 'cautious, no answer' advocates; the 'women's role' advo-cates and the 'political' advocates.

Firstly, we are told by the 'no-objections' advocates, the 'early' Parry(1968) Linn and Davis (1971), that for women there is no well-structuredand traditional opposition to the use of psychotropics. No reference inthis work is made to the unintended, public consequences of use forfemale users as a social group. These unintended public consequencesrefer specifically to the varied objections many women have when theyexperience the debilitating, sometimes addicting effects psychotropic drugshave on their lives as women. The main focus of the analyses and conclu-sions implies that the social category, women, is homogenised. There islittle scope for problematising the notion of difference amongst women asa social group, regardless of the fact that religion is mentioned as a dis-criminating variable.

There are also the 'cautious, no answers' advocates: Woodcock (1970)and Parish (1971). On the one hand. Woodcock (1970) suggests that therecould be some personal and more pervading factor in the communityexplaining women's high usage. But, the author provides us with no

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further reference to what this factor could be. On the other hand. Parish(1971) merely suggests further research to answer the gender differencequestion, regardless of the fact that this gender difference and over use bywomen is consistently noted in his massive work. Operating from one-dimensional analyses taking the gender system as a given, neither authoris therefore able to make conclusions sensitive to women users. Thereader is left somehow shortchanged and furthermore unable to drawtheir own conclusions because of the limitations of the data.

There are also the 'women's role' advocates suggesting that women'sroles are similar to the attributes of the female role in general(Cooperstock 1971); the 'demands of females social roles' (Parry et al1973) or the more specific role strains related to the demands of women'srole in the domestic domain (Cooperstock and Lennard 1979) explaintheir high rate of psychotropic drug use. While these authors highlightwomen in their analysis and hint at gender sensitivity, they operate withina notion of assumed gender-specific attributes and roles which womenhave. Here again, these authors similar to the 'no-objections' advocates,homogenise vvomen. They almost naturalise women's roles. Hence, notheory of gender relations is offered beyond sex-role theory, taken as agiven. Women's drug use is assumed to be part of their gender role andhence 'normal' for them. In this way their drug use is normalised andexplained.

Lastly, there are the 'political' advocates. Baiter, Levin andMannheimer (1974) and Lader (1978) who see the gender difference in theuse of psychotropic drugs from a conventional, political rather than agender-sensitive perspective. For example. Baiter, Levin and Mannheimer(1974) looking to the future suggest that the gender difference may be acultural phenomenon, to be changed at least partially by the politicalactivity of future feminists. Furthermore, Lader (1978) also politicises theissue by suggesting that women, particularly poor women, are bought offto keep medical costs down and priyate profits up. For these authors, it ismore expedient to look for answers on a political terrain rather than tode-construct the issues with a gender-sensitive awareness. To begin to de-construct the issues with gender sensitivity reveals the lack of powermany women psychotropic drug users experience and indeed confront inmanaging both their position in the class and gender system. That struc-tural inequality is inherent in the gender system is not a concem of thesepolitical advocates.

Overall, the claims of the above authors do not provide the reader witha sense of the complexities of psychotropic drug use for women. While allauthors look at women's high usage of psychotropic drugs with interest,their overly descriptive accounts lack a structural dimension informed bya gender-sensitive analysis.

The lack of a structural dimension in the above research can beexplained by the epidemiological approach prevailing in much of theO Basil Blackwell Ltd/Editorial Board 1993


research on psychotropic drug use (Tognoni et al 1981, Williams andBellantuono 1991) focusing dmg using behaviour on individual users.From a sociological perspective, this type of approach is a form of whatMills (1959) calls 'abstracted empiricism' inclined to psychologism as wellas being systematically ahistorical and non-comparative. For Mills(1959:79), abstracted empiricists make little use of the 'basic idea of his-torical social structure'. Related to this type of argument, Graham (1990)has recently contended that within the sociology of health and illness amaterial/structural model is needed to explain differences in health behav-iour and that epidemiological research with a focus on the individual islimited because many people, specifically women, assess their healthbehaviour in a less individualistic way.

Furthermore, although useful in mapping out pattems of health behav-iour and disease, an epidemiological approach tends to provide an unsat-isfactory basis for understanding women's health. In an epidemiologicalanalysis, gender is merely one of the many variables used in finding thecorrelations between social background factors, individual life styles andhealth. One author (Hansen 1989) has been critical of the epidemiologicalapproach in the field of psychotropic drug use. She has argued that pastdescriptive and explanatory work has effectively shadowed the need fortheoretical approaches cmcial for highlighting the gender issue and intum women's needs in the area.

New challenges: the medical and sociological discourse

Traditional assumptions emerging chiefly from the medical communitysuch as, 'minor tranquillisers are safe and effective symptomatic reme-dies'; 'the doctor-patient relationship is sacrosanct or above criticism' or'the pharmaceutical industry is blameless or the benign helper of theorganised health care system' have been challenged as being 'false' or'outdated' both among medical experts and by social scientists them-selves. These challenges have been presented by representatives of whatwe here will characterise as a medical discourse and a sociological dis-course. By discourse, we mean here a way of conceptualising the prob-lem.

The medical discourse, based primarily on the claims of concemed rep-resentatives of the medical profession and pharmacologists, 'individu-alises' the issue of psychotropic drugs by drawing attention either to theutilisation, effects and consequences of these drugs for the recipients or tothe extent and pattem of use within a specific health care delivery system,a particular society or across cultures. The representatives of the medicaldiscourse interpret the rate of use as a public health concem and as aneed for change in health care delivery. Thus, the conclusions drawnfrom this discourse become indicators of the need for some level of



change. But, change here means technological modifications or proce-dural adjustments directed at the level of health care provision ratherthan addressing the structural aspects of use.

The sociological discourse has been established by the claims of sociol-ogists and anthropologists and informed by a societal perspective on psy-chotropic dmg use. It employs notions such as 'social control'; 'socialcontext and meaning of use'; 'public health consequences'; 'the manage-ment of everyday life'; 'medicalisation of stress'; 'the mobilisation of pub-lic opinion' and 'the emergence of a social problem'. While these socialdimensions of psychotropic drug use have the potential to become build-ing blocks for a critical perspective, these dimensions have so farremained impotent to explain women's use. This is because these authorsextol 'subjective meaning', 'contextual theorising' or 'micro levels of con-cem' to the exclusion of 'structural dynamics', 'gender sensitive theoris-ing' and 'macro levels of concern'. In the final analysis, the issues ofpower and stmctural transformation become irrelevant.

Overall, these discourses have existed in partnership rather than inopposition to each other. The sociological discourse has had a uniquerole to play in outlining the social problem of tranquilliser use as beingdistinct from the social consequences of that self-same use. In a powerfulway, separating 'use' from 'consequences' makes a subtle but clear analyt-ical distinction between the 'private' and the 'public', a distinction neces-sary for the development of a feminist analysis. On the other hand, thisdistinction has consistently been constructed (as we shall see) on male-focused terrains. The social scientific constructions signify how use,although problematic, can be not only beneficial to the promotion of apublic health model (a major concem of representatives of the medicaldiscourse) but also 'theoretically' valuable in developing 'a social problemperspective' for the sociology of health and illness (a major concem ofrepresentatives of the sociological discourse).

In effect, the sociological and the medical discourse have a commonapproach with an underlying concem for recognising the public health andsocial consequences of psychotropic dmg use. At first glance, this commonapproach may appear to be focused on a macro level of concem or toinclude a stmctural dimension. However, dmg using behaviour remains onan individual level and there is a lack of understanding of 'historical socialstmcture' and of the development of a material/stmctural model, needed toexplain gender differences in health behaviour. Given that the focus is onthe individual, it is not only limited but also makes women invisible. Aspointed out earlier in this paper, many individuals, specifically women,evaluate their health behaviour in less individualistic ways.

This, what we term, 'individualising-the-actor and neutralising-the-gen-der-factor approach', provides an unsatisfactory basis for understandingwomen's use of psychotropic drugs. In the final analysis, this approachfavours the individual and suffers from gender blindness.& Basil Blackwell Ltd/Editorial Board 1993


In order to develop a feminist account of psychotropic dmg use, wewill illustrate how the 'individualising-the-actor and neutralising-the-gen-der-factor approach' utilised within both the medical and sociological dis-courses have systematically excluded women. Here we argue that anunderstanding of the concepts of gender and the gender system and amulti-dimensional or complex definition of health behaviour have beenlacking. We examine first the medical discourse and then the sociologicaldiscourse on psychotropic drug use with its various strands of thinking.Our assumption is that the development of this common approach restson the foundation of malestream analyses. The resultant effect has beenthe barring of a feminist analysis in this subject area.

The medical discourse on psychotropic drug use

Over the years, psychotropic dmgs, particularly benzodiazepines, havebeen identified as creating withdrawal symptoms and pharmacologicaland psychological dependence (Owen and Tryer 1983; Petemsson andLader 1984; Cappell et al 1986; Montagne 1991; Smith 1985; Medawar1992). They have also been found to be frequently abused by chemicallydependent patients (DuPont 1990). While there is a wide range of thesedrugs available, it has been suggested that the needs for betizodiazepinescould be met by one or two compounds (Summers et al 1990; Medawar1992).

The medical discourse has been focused primarily on the individualbenefits of psychotropic dmg use for the patient and the doctor's needfor what Lader (1991:93) has referred to as 'thoughtful prescribing'.There is little hint that the medical discourse upholds the use of thesedrugs as 'medicalising everyday life' (Mondanaro 1989) or as a 'means ofsocial control' (Gabe and Lipshitz-Phillips 1984). Indeed, these drugs areviewed as necessary and an essential part of the medical armamentariumof drugs. In essence, the main theme of this discourse is that these dmgsare valuable to the individual patient, a sufferer of anxiety and stress,needing this type of pharmacological support. The problem is not themedication but its improper use. With this emphasis, the medical dis-course has been unable to explain the complex reasons why women morethan men are involved in a type of health behaviour that has the poten-tial to damage rather than promote their health. Additionally, there is noanalysis offered as to why women more than men pursue life styles need-ing pharmacological supports.

For example, although a high level of psychological dependency wasfound amongst 'present long-term users' in Murray's (1981:857) study,dmg taking was seen by these users 'as a means of sustaining life ratherthan a determinant course of treatment'. In later work, Murray andher colleagues (Murray et al 1982:1597) found 'high prevalence of both



physical and psychological ill health in the sample . . . and little evidenceof heavy reliance on either the doctor or medicines'. The former findinghad also been noted by Clare (1981) in a previous context. Here, patients'needs, whether physical or psychological, were upheld as the determiningfactor of use.

Around that time, Marks (1982), a consistent opponent of the medical-isation view, accused sociologists of shifting this 'patient' emphasis to theeffects of these drugs rather than the patient's need for them. He claimsthat 'the social implications of drug therapy is still in its infancy and theliterature tends to be sprinkled with ex-cathedra comments from sociolo-gists, predominantly expressing fears about drug effects' (Marks1982:351). In a later context he says, 'there is no evidence that such usereduces the appropriate reaction to the social ills that cause the stress,nor that drugs are being given for social problems' (p. 352). His solutionis that the presenting problems can best be reduced by 'appropriate edu-cation of doctors' (p. 350) and implicitly, sociologists.

A year later, in a less authoritative tone, Marks (1983:142) says that'Before deciding that the prescribing practices of physicians are reason-able so far as benzodiazepines are concerned, it is important to make surethat their use is not reducing the search for social solutions to these stressdisorders'. Marks' later emphasis is a hidden warning to overprescribingphysicians and an indication that the simultaneous claims of sociologists(as we will soon see) are being heard.

On the other hand, a lone voice in this discourse comes from Hansen(1989) a pharmacologist who sees the use of benzodiazepines for socialand everyday problems as being perplexing. For her, benzodiazepine useis 'another side of the chemical curtain's effect which locks the user in aproblematic situation and makes Benzodiazepine usage a form of socialcontrol' (Hansen 1989:166). As a female pharmacologist, Hansen is a partof the medical discourse. Nevertheless, she makes an opposing claim aswell as being sensitive to gender.

Most recently, a defence of the medical discourse has been offered byLader (1991:93) who contends that 'primary care practitioners are becom-ing increasingly adept at exploiting techniques to cope with anxiety disor-ders without resorting to tranquillisers'. Given that Lader does notoutline what these medical techniques are, it is difficult to assess whetheror not these techniques are valuable from the consimier's point of view.

As we have seen from the discussion above, the medical discourse hasfocused primarily on the relative benefits of psychotropic drug use.Specifically, 'benzodiazepines have become regarded by medical practi-tioners and patients alike as safe and effective remedies' (Lader 1991:90).At most, research in this area points to the limitations of clinical medi-cine. However, these limitations can be overcome by vigilance and atten-tiveness on the part of prescribing physicians. It is assumed that thephysicians rather than the patients have the power to overcome theseO Basil Blackwell Ltd/Editorial Board 1993


existing drawbacks. There is no question that individual sufferers of anxi-ety and stress may not need this type of pharmacological aid. Althoughsome studies consider what may be helpful psychologically to withdrawfrom psychotropics (eg sympathetic listening, anxiety management andbehaviour therapy), these interventions are viewed as being outside of themedical discourse which is unable to offer an integrated approach(Hamlin and Hammersiey 1989). Furthermore, the fact that the majority ofthe sufferers are women is not seen as a problem. In this regard, the medicaldiscourse offers individualistic and gender-insensitive explanations of use.

The sociological discourse on psychotropic drug use

a. A concern for social consequences of useAlongside the medical discourse has existed a sociological discourse whichhas interpreted the issue of dependence on psychotropic drugs as part ofthe 'widespread questioning of the role of medical treatments' (Gabe andBury 1991b:453). The argument here is that criticism of the use of thesedrugs is part of a general crisis in medicine, a crisis in which doubts aboutdevelopments within medical practice are reflected. The representatives ofthe sociological discourse have illuminated some of the social and culturalprocesses which problematise dependence on drugs and more specificallydefine psychotropic drug use as a distinct social problem. Within this dis-course, drug intervention is viewed as a quick cure for many social ills(Gottlieb 1975) and the widespread use of benzodiazepines as an extensionof the idea of a 'culture of technology' (Porpora 1986).

Moreover, the sociological discourse has provided information aboutthe linkage of psychotropic drugs to a variety of individual, interpersonaland social levels: to an individual user's need for chemical comforts(Gossop 1988); doctor's love affairs with tranquillisers (Mondanaro 1989;tranquilhsers as a form of social control (Koumjian 1981); the tranquillis-ing of society (Sterling 1989) and the penetration of these drugs on theillicit market with the resultant abuse by injecting drug users (Black1988). More recently, detailed information on the relationship betweengender and pathways to psychotropic drug use has been provided(Cafferata and Meyers 1990).

Cooperstock and Parnell (1982) published a comprehensive review ofresearch on psychotropic drug use. In their evaluation of this research,they conclude: 'The benzodiazepines may be viewed like alcohol as socialdrugs. From an epidemiological perspective, this new definition demandsa re-conceptualization of the consequences of use of these drugs, andhence a more diversified approach to research' (Cooperstock and Pamell1982: 1192). Here, while recognising the importance of epidemiology andimplicitly the medical discourse, these authors attempt to focus the debateon an intellectual 'meeting ground' for the medical and social discourse.



'Public health consequences' become their overriding concern. They con-tinue: 'Given this broad conceptual framework, both the negative physi-cal and social effects of these drugs would be viewed as public healthissues' (Cooperstock and Pamell 1982: 1192).

Also, by focusing on tranquilliser use as social control and ultimatelythe tranquilliser issue as a social problem, representatives of the sociologi-cal discourse reflect a shared concem with their counterparts in the med-ical discourse. This concem is to consider social consequences of use asbeing equal to the public health consequences of psychotropic drug use.But, this underlying concem is based on a gender blindness evident inboth the medical and the sociological discourses. Continuing our exami-nation of the sociological discourse, we will next look at a shift from anemphasis on tranquillisers as social control to an emphasis on tranquillis-ers as a social problem and ultimately its effect on women.

b. Tranquillisers as social controlWaldron (1977) presents a strong case for the medicalisation or socialcontrol view in one of the first important discussions in the sociologicaldiscourse. She suggests that prescribing drugs to a patient who is dis-tressed by psychological and social problems is in many cases not med-ically justified; that the use of benzodiazepines can be identified with atrend in society which tends to medicalise problems of everyday life andthat prescriptions of these drugs increased rapidly during the 1960s and1970s, a period of increasing social problems. Waldron (1977:43) specu-lates further that the 'medicalization of these problems (social and eco-nomic problems) reduces pressures for societal change and this outcomeis advantageous from the point of view of those who profit from existingeconomic and political order'. Implicitly, Waldron attempts, by focusingon the macro-level, to 'raise' the issue of prescribed drug use to the levelof a social problem alongside alcoholism, suicide and homicide.Waldron's arguments lack, however, a clear theoretical foundation. Thisis primarily because the majority of her arguments are based on anunstated assumption: there is a 'hidden alliance' between the medical pro-fession, the pharmaceutical industry and the State.

In a similar vein of thought, Koumjian (1981) sees the use of Valium, aminor tranquilliser, as a means of social control and involved in the med-icalisation of everyday life. Koumjian observes that these drugs are fre-quently prescribed to old people, women and to those in lowersocio-economic groups. Koumjian's analysis is a convincing accountbecause his identifiable, most frequently prescribed groups can be viewedas traditionally powerless groups in society - the elderly, women and thepoor. Koumjian does suggest that the purpose of control emerges fromsocial concems. However, his arguments lack a theory of social agency inwhich the social actions of individuals are problematised and thusincluded within a structural or macro-level analysis.© Basil Blackwell Ltd/Editorial Board 1993


As the sociological discourse on social control develops, the claimsbeing made about 'control' become linked with individual rather thanstructural concems. Simply, whether the emphasis is on social conse-quences (ie in terms of social control or social problems) or more subtly,social meaning, the analytical practice of social scientists has been tofocus on the individual level as the main analytical site. This focus onmicro-level concems is a shared form of conceptualising in the medicaland sociological discourses. At the same time, structural issues such aspower, gender, race and class and the interplay amongst these issues areincreasingly neglected in sociological analyses, focused on tranquillisers associal control.

For example, aware that within the social control view 'blame has beenlaid at many doors', Helman (1981:521) chooses to focus on the individ-ual user. In a fascinating account, he looks at the social and symbolicmeaning of long-term psychotropic drug use and perhaps, more impor-tantly, he attempts to explain the 'perceived' control of the patient overtheir drugs by the use of metaphors. This work evidences a shift inemphasis from 'control of the patient by the doctor' to 'control over thedrug by the patient'. Regardless of whether the symbolic use of tranquil-lisers is, for the patient, a tonic, fuel or food, the key discriminating fac-tor is how the patient exhibits control over the use of the drug. ForHelman, this spectrum of control ranges from self-medication (tonic), tovariable control for social conformity (fuel) and finally, to little control(food). While social control is not an explicit theme in this work,Helman's findings are provocative given that the 'food' group, exhibitingthe least control of their drugs and being most dependent upon doctorswas, unlike the other groups, 100 per cent female. But, an explanation ofthe latter finding cannot be found in Helman's work.

Clearly, Helman's work illustrates specifically gender blindness. On theone hand, gender is a somewhat 'hidden factor', emerging from the data:women are consistently and predominantly the research subjects. On theother hand, data on the gender factor is subsumed or made invisible bydata on 'symbolic meaning', viewed by Helman as the most importantfactor. Most importantly, that women's use of psychotropic drugs andthe issue of 'food' are linked in Helman's work is indeed significant. Bythis time, gender-sensitive work (Orbach 1978) had already identifiedwomen's relationship to food as problematic. Hence, Helman's lack of adiscussion on the implications of the link between psychotropic dmg useand its symbolic meaning as food for women disregards the gender issue.

Along with these authors, Gabe and Lipishitz-Phillips (1984:538), chal-lenging the view that tranquillisers are a form of social control, contendthat this view is 'too mechanistic' and has resulted in 'over-generalisations'.Within the framework of their empirical case study, they then proceed todemonstrate quite convincingly that there is little support for the ways inwhich benzodiazepines are involved in the medicalisation of everyday life.

® Basil Blackwell Ltd/Editorial Board 1993


In analysing benzodiazepine prescribing and its use as a possible form ofsocial control, they consider five issues including doctors' power; patientdependence; gender and class ideology; oversocialised view of the personand the limits of functionalism.

By constant reference to their own data, they systematically attempt todemolish earlier claims that tranquillisers are a form of social control. Ineffect they call for 'theoretical modifications' and 'a model which treatssocial control as context dependent and not something to be assumed inadvance' (Gabe and Lipshitz-Phillips 1984:542). Nevertheless, it is impor-tant to point out two fundamental problems in this work: the firstmethodological and the second theoretical.

Firstly, while these authors state that 'the data on gender and class canbe used to support or reject the social control thesis' (Gabe and Lipshitz-Phillips 1984:537), they opt for the latter course of action in their finalconstmction of the data without giving sufficient explanation. Theirjustification for this course of action is that there are 'several ways ofinterpreting' the data on social class and gender and they offer what theycall 'counter interpretations'. This is problematic. When both interpreta-tions and counter interpretations from the data are brought out as simul-taneously supporting the authors' main conclusion (tranquillisers are nota form of social control), the conclusions themselves become equivocal.While the authors justify this methodological strategy by claiming theneed to be 'contextual', the only conclusion that can be made is thatwithin the conclusion is a 'counter conclusion' which itself is contextual(tranquillisers are a form of social control).

Secondly, it must be remembered that while the authors consider howtheir data contradict the social control argument with regard to a seriesof five theoretical issues, the issues that the authors select and in tum dis-cuss are self-chosen and not necessarily empirically based. It could beargued that two of the most important issues implicit in the social controldebate have been gender and class. Nevertheless, in their discussion, theauthors relegate these issues in their discussion to a single theoretical cat-egory, 'gender and class ideology' and thus prioritise micro-level (individ-ual) rather than macro-level (stmctural) concems. Furthermore, thetheoretical absence of the notions of gender, class and indeed race in theirdiscussions about doctors' power, patients' dependence, the oversocialisedview of the person and the limits of functionalism is perhaps a glaringomission.

Still, Gabe's further work (Gabe and Thorogood 1986), inclusive of theissue of race, does succeed on the sociological terrain in re-conceptualis-ing some of the consequences of use of these drugs for white women andwomen of colour. In our view, this later work does open the way for amore diversified sociological approach to research. For example, theauthors recognise the importance of contextual theorising; the social con-text of tranquilliser use alongside the management of everyday life andO Basil Blackwell Ltd/Editorial Board 1993


the use of these drugs as a resource. Nevertheless, they explicitly rejectthe social control viewpoint. It is obvious that their main analytical site isgendered (ie they are studying women), but their subjects, women, remainlimited within individual or micro-level concems. A concem for genderand its social organisation is in a sense sacrificed for a concem for theindividual. Thus, many questions conceming the 'feminisation' of illnessand in tum, tranquilliser use for women as a social group remain unan-swered.

c. Tranquilliser use as a social problemUltimately, the above work has laid the groundwork for a strand ofthinking in the 'social problems arena', while at the same time conceptu-alising the 'consequences of use' as a public health issue.

When Gabe and Bury (1988) assert that the excessive use of legally pre-scribed drugs represents a form of social behaviour that falls on the mar-gins between deviance and normality, they attempted to further demolishthe social control debate and to transform key issues to a more neutralterritory: a debate focused on social problems. Indeed, to conceptualisethe misuse of prescribed drugs from a social problem standpoint has thedual advantage of developing a certain level of theoretical (sociological)sophistication, while sharing a concem and approach with members ofthe medical discourse. This shared concem based on social problems 'inthe context of public health' is not contested. A focus on the social con-text of use is valued, while attention is focused on the somewhatunforseen consequences of the mobilisation of public opinion by themedia and the state's response (Bury and Gabe 1990, 1991).

The medical profession, excessive prescribing practices and problemswithin existing health care delivery systems are no longer the main focusof attention or indeed that problematic. Hence, the once heated debateabout social control between members of the medical and the sociologicaldiscourses is abated. A consensus is achieved: tranquilliser use isidentified as an emergent social problem but not a gendered problem.

Most importantly, the deviant user emerges more often than not as thefemale psychotropic drug user. This process creates a new deviant labelfor women. In discussing this labelling process, Downes and Rock(1982:154) suggest that 'the awarding of deviant identity' allows the sub-ject (the one awarded the deviant identity) 'little scope for negotiation orrebuttal' in society. In the light of these comments, we contend thatwomen tranquillisers users receive little benefits, if any, from beingawarded this deviant label.

In the final analysis, women tranquilliser users with their newly founddeviant status become more now than ever before, open to publicscrutiny. This type of analysis creates the equation, 'Drug use as a socialproblem = women'. Deviant women and not the gender system is thefocus of attention. Given that tranquilliser use is conceptualised as an



emergent, gender-neutral social problem, the need for the gender dimen-sion of this issue to be made visible and problematised becomes urgent.

In the above discussion on the sociological discourse on psychotropicdmg use, we saw how this particular discourse has developed variousstrands of thinking from one focusing on tranquilliser use as social con-trol to one identifying the tranquilliser issue as a social problem. In otherwords, the notion 'social problem' along with its specific theoreticalframework and conceptual baggage gradually begins to take priority overthe notion 'social control'. Simply, social problem rather than social con-trol becomes imperceptibly established as a primary signifier of the use oftranquillisers in society. Tranquilliser use, a newly found social problem,emerges as gender neutral, regardless of the fact that women more thanmen continue to consume these drugs. These discussions demonstratequite clearly that a gender-sensitive perspective is absent among therecent contributions provided by sociologists in the field.

Conclusion

We have contended that previous research on psychotropic drug use isgender biased, gender blind and one-dimensional. We have demonstratedhow the individualistic focus of these accounts, whether medical or socio-logical, draws attention to individual rather than structural levels ofconcem and makes gender invisible. We contended that an 'individualis-ing-the-actor and neutralising-the-gender factor approach' is one sharedby those speaking from within both the medical and sociological dis-courses. In these discourses, an individualistic focus is emphasised;women's drug and health behaviour are naturalised and powerful genderdynamics, operating within personal and social relationships, social insti-tutions such as the medical profession, the media, the educational system,the state and throughout civil society remain invisible. The fact thatwomen have been found consistently to use psychotropic drugs morethan men is not perceived as problematic. We are only left with the ideathat tranquilliser use is an emergent social problem, without reference tothe structural inequalities which produce that problem for women. Theconstruction of the gender system of which tranquilliser use is a partremains totally out of focus.

For us a gender-sensitive approach not only recognises but avoids thetheoretical and methodological pitfalls with this previous research. Thistype of approach attempts to problematise both men and women's use ofthese drugs and to see the importance of the interplay between the pri-vate and the public domains of social relations (Ettorre 1992). If a newunderstanding of this issue is to be developed, it must explicitly prob-lematise gender as a socially constructed category and society as a systemof gendered relationships. Existing sociological research on psychotropicO Basil Blackwell Ltd/Editorial Board 1993


dmg use has neglected the dynamics of the gender system and its effectsupon women.

That gender-insensitive studies on women psychotropic dmg users havebeen produced mainly by malestream thinkers who have been genderblind reveals that the way in which research is done and what is studiedare inextricably linked (Stanley 1990; Harding 1987, 1991).

Address for correspondence: Elizabeth Ettorre, Abo Akademi University,Department of Sociology, Gezeliusgatan, 2A, 20500 Abo, Finland

References

Arditti, R. (1980) Feminism and science. In Arditti, R., Brennan, P. and Cavrak,S. (eds.) Science and Liberation. Montreal: Black Rose Books, 350-68.

Baiter, M.B., Levin, J. and Mannheimer, D.I. (1974) Cross-national study of theextent of anti-anxiety/sedative drug use. The New England Journal of Medicine,290, 769-74.

Bernard, J. (1989) The dissemination of feminist thought: 1960-1988. In Wallace,R. (ed.) Feminism and Sociological Theory. Newbury Park and London: Sage.

Black, D. (1988) Temazepam capsules. Lancet, 1 (8594), 1114.Bury, M. and Gabe, J. (1990) A sociological view of tranquilliser dependence:

challenges and responses. In I. Hindmarch, G. Beaumont, S. Brandon and B.E.Leonard (eds.) Benzodiazepines: Current Concepts (Biological, Clinical andSocial Perspectives). Chichester: John Wiley.

Bury, M. and Gabe, J. (1991) Hooked? Media responses to tranquilliser depen-dence. In P. Abbott and G. Payne (eds.) New Directions in the Sociology ofHealth. Sussex: Falmer Press.

Cafferata, G.L. and Meyers, S.M. (1990) Pathways to psychotropic drugs: under-standing the basis of gender differences. Medical Care, 28, 285-300.

Cappell, H.D., Sellers, E.M. and Busto, U. (1986) Benzodiazepines as drugs ofabuse and dependence. In Research Advances in Alcohol and Drug Problems,Volume 9, New York: Plenum Press.

Clare, A. (1981) Psychotropic drug use in general practice in Britain. In Tognoni,G., Bellantuono, C. and Lader, M. (eds.) (1981) The Epidemiological Impact ofPsychotropic Drugs. Amsterdam: Elsevier.

Cooperstock, R. (1971) Sex differences in the use of mood-modifying drugs: anexplanatory model, Joumal of Health and Social Behaviour, 12, 238-44.

Cooperstock, R. and Lennard, H. (1979) Some social meanings of tranquillizeruse. Sociology of Health and Illness. 1, 331-47.

Cooperstock, R. and Pamell, P. (1982) Research on psychotropic drug use. SocialScience and Medicine. 16, 1179-96.

Daly, M. (1990) Gyn/Ecology: The Metaethics of Radical Feminism. Boston:Beacon Press.

Downes, D. and Rock, P. (1982) Understanding Deviance, Oxford: ClarendonPress.

Doyal, L. (1981) The Political Economy of Health. London: Pluto Press.DuPont, R.L. (1990) Benzodiazepines and chemical dependence: guidelines for

clinicians. Substance Abuse. 11, 232-6.© Basil Blackwell Ltd/Editorial Board 1993


Ettorre, E. (1992) Women and substance use. London: Macmillan.Gabe, J. (1991a) Personal troubles and public issues: the sociology of long-term

tranquilliser use. In Gabe, J. (ed.) Understanding Tranquilliser Use: The Role ofthe Social Sciences. London: Tavistock/Routledge.

Gabe, J. (ed.) (1991b) Understanding Tranquilliser Use: The Role of the SocialSciences. London: Tavistock/Routledge.

Gabe, J. and Bury, M. (1988) Tranquillisers as a social problem. The SociologicalReview. 36, 320-52.

Gabe, J. and Bury, M. (1991a) Drug use and dependence as a social problem:sociological approaches. In LB. Glass (ed.) The International Handbook ofAddiction Behaviour. London: Tavistock/Routledge.

Gabe, J. and Bury, M. (1991b) Tranquillisers and health care in crisis. SocialScience and Medicine. 32, 449-54.

Gabe, J., Gustafsson, U. and Bury, M. (1991) Mediating illness: newspaper cover-age of tranquilliser dependence. Sociology of Health and Illness. 13, 332-53.

Gabe, J. and Lipshitz-Phillips, S. (1984) Tranquillisers as social control?.Sociological Review. 32, 524—46.

Gabe, J. and Thorogood, N. (1986) Prescribed drug use and the management ofeveryday life: the experiences of black and white working class women.Sociological Review. 34, 737-72.

Gamman, L. and Marshment, M. (1988) Female gaze: women's views of popularculture. London: The Women's Press.

Gossop, M. (1988) Living with Drugs. London: Temple Smith (2nd ed.).Gottlieb, M. (1975) Pills: pros and cons or medications for school problems, Acta

Symbolica. 6, 35-65.Graham, H. (1990) Behaving well: women's health behaviour in context. In

Roberts, H. (ed.) Women's Health Counts. London: Routledge.Hamlin, M. and Hammersiey, D. (1989) Managing benzodiazepine withdrawal. In

Bennett, G. (ed.) Treating Drug Abusers. London, Routledge, 91-114.Hansen, E.H. (1989) How widely do women and men differ in their use of psy-

chotropic drugs?: A review of Danish studies. Journal of Social andAdministrative Pharmacy. 6, 165-83.

Harding, S. (1987) Feminism and Methodology. Bloomington: Indiana UniversityPress.

Harding, S. (1991) Whose Science? Whose Knowledge?: Thinking from Women'sLives. Ithaca: Comell University Press.

Helman, C.G. (1981) Tonic, fuel and food: social and symbolic aspects of thelong-term use of psychotropic drugs. Social Science and Medicine. 15, 521-33.

Idanpaan-Heikkila, J., Ghodse, H. and Khan, I. (1987) Foreword in PsychoactiveDrugs and Health Problems (ed.) same authors. Helsinki: The National Boardof Health and the Government of Finland.

Koumjian, K. (1981) The use of Valium as a form of social control. SocialScience and Medicine. 15, 240-8.

Lader, M. (1978) Benzodiazepines - the opium of the masses, Neuroscience. 3,159-^5.

Lader, M. (1991) Benzodiazepine withdrawal. In LB. Glass (ed.) The InternationalHandbook of Addiction Behaviour. London: Tavistock/Routledge.

Linn, L.S. and Davis, M.S. (1971) The use of psychotherapeutic drugs by middle-aged women. Journal of Health and Social Behaviour. 12, 331-40.

e Basil Blackwell Ltd/Editorial Board 1993


Lorber, J. (1975) Good patients and problem patients: conformity and deviancein general hospital. Journal of Health and Social Behavior. 16, 213-25.

Marks, J. (1982) The benzodiazepines - for good or evil. InternationalPharmacopsychiatry. 17, 342-58

Marks, J. (1983) The benzodiazepines: an intemational perspective. Journal ofPsychoactive Drugs. 15, 137—49.

Martin, E. (1989) The Woman in the Body: A Cultural Analysis of Reproduction.Boston: Beacon Press.

Medawar, C. (1992) Power and Dependence: Social Audit on the safety of medi-cines. London: Social Audit.

Mills, C. Wright (1959) The Sociological Imagination. Harmondsworth: Penguin.Mondanaro, J. (1989) Chemically Dependent Women: Assessment and Treatment.

Lexington, Massachusetts: Lexington Books.Montagne, M. (1985) The metaphorical nature of drug taking. Social Science and

Medicine. 26, 417-24.Montagne, M. (1991) The culture of long-term tranquilliser users. In Gabe, J.

(ed.) Understanding Tranquilliser Use: the Role of the Social Sciences. London:Tavistock/Routledge.

Murray, J. (1981) Long-term psychotropic drug taking and the process of with-drawal. Psychological Medicine. 11, 853-8.

Murray, J., Williams, P. and Clare, A. (1982) Health and social character-istics of long-term psychotropic drug takers. Social Science and Medicine. 16,1595-8.

Nathanson, CA. (1975) Illness and the feminine role: a theoretical review. SocialScience and Medicine, 9, 57-62.

Orbach, S. (1978) Fat is a Feminist Issue. London: Paddington Press.Owen, R.T. and Tryer, P. (1983) Benzodiazepine dependence. Drugs, 25, 385-98.Parish, P. (1971) The prescribing of psychotropic drugs in general practice. The

Journal of the Royal College of General Practitioners. Supplement 4, 21, 1-77.Parry, H.J. (1968) Use of psychotropic drugs by U.S. adults. Public Health

Reports. 83, 799-810.Parry, H.J., Baiter, M.B., Mellinger, G.D., Cisin, l.H. and Mannheimer, D.I.

(1973) National pattems of psychotherapeutic drug use. Archives of GeneralPsychiatry. 28, 769-83.

Parsons, Talcott (1951) The Social System. New York: The Free Press.Petursson, H. and Lader, M. (1984) Benzodiazepine dependence, British Journal

of Addiction. 76, 133-45.Porpora, D.V. (1986) Physicians' prescriptions of tranquillizers and tranquillizer

abuse. International J. Addictions, 21, 559-77.Riska, E. (1989) How the sex differences in the use of psychotropic drugs are

explained, Scandinavian Journal of Social Medicine. 17, 3-6.Roberts, H. (1991a) Women's health counts. Routledge: London.Roberts, H. (1991b) Women's health matters. Routledge: London.Smith, M.C. (1985) A Social History of the Minor Tranquillisers, New York:

Pharmaceutical Products Press.Stanley, L. (ed.) (1990) Feminist Praxis. London: Routledge.Sterling, S. (1989) Benzodiazepines, SCODA Newsletter, July-August, 5-7.Summers, R.S., Schutte, A. and Summers, B. (1990) Benzodiazepine use in a

small community hospital. South African Medical Journal, 78, 721-25.



Tognoni, G., Bellantuono, C. and Lader, M. (eds.) (1981) The EpidemiologicalImpact of Psychotropic Drugs. Amsterdam: Elsevier.

Verbrugge, L.M. (1985) Gender and health: an update on hypotheses and evi-dence. Journal of Health and Social Behavior. 26, 156-82.

Verbrugge, L.M. (1989) The twain meet: empirical explanation of sex differencesin health and mortality. Journal of Health and Social Behavior. 30, 282-304.

Waldron, I. (1977) Increased prescribing of Valium, Librium, and other drugs -an example of the influence of economic and social factors on the practice ofmedicine. International Journal of Health Services. 7, 37-61.

White, K. (1991) The sociology of health and illness. Current Sociology. 39.Williams, P. and Bellantuono, C. (1991) Long-term tranquilliser use: the contribu-

tion of epidemiology. In J. Gabe (ed.) Understanding Tranquilliser Use: the Roleof the Social Sciences. London: Tavistock/Routledge.

Woodcock, J. (1970) Long-term consumers of psychotropic drugs. In Balint, M.et al (eds.) Treatment of Diagnosis: A Study of Repeat Prescriptions in GeneralPractice. London: Tavistock.


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