April 22, 2024
All In Her Head, by Misty Pratt
Misty Pratt is contending with all kinds of threads in her first book All In Her Head: How Gender Bias Harms Women’s Mental Health, including her own personal story of struggling with mental illness, and that of her grandmother—Chapter One begins, “I was five years old the night my grandmother lost her mind.” Pratt is also a researcher whose approach to her subject is based in science, such a basis only underlining that approaches to treating mental illness so often are not, but then neither are many alternative therapies, and that while mental illness is real, women’s experiences are also affected by a society rife with sexism and inequity, violence against women, and the pathologization of femaleness. Maybe it’s not just “all in her head,” but also sometimes it is, or else it’s in her body, or her family, or her workplace, and that’s not nothing. All this tangle of understanding and experience resulting in loud binaries like SSRIS for everyone vs. anti-psychiatry movements, but Pratt manages to blaze a path through the noise to suggest a kind of middle-ground to contend with the inherent complexity of mental illness (that anyone who’s thinking about it has to be contending with all kinds of threads or else they’re kidding themselves) which necessitates care and precision in applying treatments, as well as the message that women themselves are not broken. Pratt notes that puberty, pregnancy/childbirth and menopause are all times of great hormonal shifts when girls and women are especially vulnerable to mental illness, and imagines how different things might be if this reality was seen as normal as it actually is. Which is not to say that women have to suffer through these periods of their lives, but instead that patients deserve care without the message that there is something broken about them as people, and that researchers and doctors could put the pieces of the puzzle together to affect a more holistic understanding of just what women’s mental health might look like (and how anti-depressants affect them—Pratt cites a study stating that females are exposed to “higher blood drug concentrations and longer drug elimination times than males.”)
Pratt spent years trying to wean herself from anti-depressants, only to have withdrawal symptoms knock her right back down again, and she received very little guidance throughout this process, doctors telling her that she should just stay on the medication because it was simpler that way, because her children needed her to be functioning, internalizing the message that she was flawed and broken, that her mental illness was a genetic inheritance that had to define her. But this would turn out not be the case…
There is not cure for mental illness, Pratt writes, but that doesn’t mean that healing isn’t possible. And she shares her own journey to a deeper understanding of her experiences with psychiatry and medicine, making shifts in her life, working with good therapists, learning that feeling (and even feeling BADLY) is a normal part of being, that her anxiety isn’t just all in her head but also the result of living in a world where terrible things can happen but also that it doesn’t have be debilitating or a guiding force in her life.
And don’t worry, her conclusion is not prescriptive—after decades of people suggesting she try yoga or meditation, she knows that these one-size-fits-all cures are rarely helpful. And while there will be readers who might struggle with their lived experiences of mental illness running counter to Pratt’s (people who are all too happy to continue with their medication, for example), this is very much the point of the book: that everyone’s trajectory of mental illness and wellness will be different.
But through the lenses of gender and gender bias, those different trajectories can all be better understood so that patients can learn to tell a different kind of story, one of wholeness, strength and worth.
