When Britney Spears lost it in 2007, shaving her head and waving a baseball bat at anyone who approached her, I confess that my initial reaction was “get in! Now THAT’s what I call a protest!” A decade before the eruption of #metoo, there was a woman truly raging, in an industry that tends to reduce female anger to getting a bit feisty about your ex while wearing a push-up bra. The head shaving felt satisfyingly symbolic – see how swiftly the feminine mystique can be dispensed with! I loved her for that. It reminded me of Donita Sparks throwing her sanitary protection into an unappreciative Reading crowd, uttering the immortal line “eat my used tampon, fuckers!” Only that was L7, so you kind of expected it. This, though, was Britney!
After that I fully expected Spears to re-emerge, Alanis Morrisette-like, with a ton of songs dissing everyone in the music industry who’d ever exploited her. Instead, she shrank, with her father Jamie being assigned the role of her conservator, managing her wealth and personal decisions, in 2008. She grew her hair back, re-embraced the art of femininity and got back to business, gyrating and thrusting as before. Like many, I found it strange for her to be working so hard and so publicly if she was too ill to be in control of her own life. This week, after 12 years, Spears filed to have her father permanently removed from his role (though others may assume some control).
What gets me is the optics of the thing – the clipping of wings, the silencing of protest, the return to paternal authority. It’s like something out of Showalter’s The Female Malady, or one of those works of feminist fiction – Wide Sargasso Sea, The Yellow Wallpaper – in which a husband drives his wife insane by defining and treating her as such. It’s reminiscent of twentieth-century stories of fathers seeking to “manage” their socially embarrassing daughters by having them institutionalised or even lobotomised (the most famous example being John F Kennedy’s sister Rosemary). It’s a million stories, as Showalter documents, of psychiatric diagnoses being used as “punishment for intellectual ambition, domestic defiance, and sexual autonomy”. It looks like a woman being punished – and driven to the edge – for stepping out of line.
What I’m suggesting might sound anachronistic. Mental illness diagnoses may once have been weaponised, but there’s a general feeling that this died a death with deinstitutionalisation in the late twentieth century. We are clever now, psychiatry is clever, and when individuals have control of their own lives taken from them, it is only because they are truly ill. The trouble is, I bet that’s what fathers of lobotomised daughters and husbands of neurasthenic wives told themselves, too. How do you check the purity of your own motivations when judging the depths of another’s delusions?
However much outside observers speculate on Spears’ state of mind – she looked a bit weird in that video, her pupils are all funny, was that Instagram message a secret sign? etc. – you don’t have to decide she looks well to suspect there is something wrong in how she is being treated. Sick or healthy, it’s very hard to see how she might ever get out of it. There are few things that are harder to prove than sanity once you’re deemed to have fallen on the wrong side of it (see the Rosenhan experiment, which, for all its possible flaws, still rings true). And then there’s that feedback loop between treating someone as though they are “abnormal” and them behaving “abnormally”.
This process is captured beautifully in Wide Sargasso Sea. Jean Rhys’ 1966 novel reimagines the life of the first Mrs Rochester (aka Bertha Mason, the “madwoman in the attic” from Charlotte Brontë’s Jane Eyre). In Rhys’s telling, Rochester is a weak, frightened man, unable to cope with the different culture of his Caribbean wife and easily swayed by rumours about her “insane” family background. Antoinette – Bertha’s name before he takes it from her – finds she cannot please him, resorting to increasingly desperate measures. One night she asks him if he hates her:
‘“I do not hate you, I am most distressed about you, I am distraught,” I said. But this was untrue, I was not distraught, it was the first time I had felt calm or self-possessed for many a long day.’
If you’ve ever been in a similar situation, lines like this can hit you full in the gut, because they are so familiar. That moment when you know you’ve been outmanoeuvred by a man’s performance of sadness at your supposed insanity:
“We won’t talk about it now,” I said. “Rest tonight.”
“But we must talk about it.” Her voice was high and shrill.
“Only if you promise to be reasonable.”
You read it, and you want to scream in his face (only you’d end up in the attic, too). Reasonable, my arse.
I first read Wide Sargasso Sea as an A level set text in 1992. It was four years since I’d completed an eight-month stay in what was euphemistically called an adolescent unit. This was ostensibly for anorexia, but anything you did in that place could be construed as mad and usually was. I could write reams about that place – don’t worry, I’ll try not to – but one particularly delightful part of the daily routine was the handover, when night staff handed over to day staff, and vice versa. For reasons I will never grasp, this had to be done with everyone, patients and staff, gathered together in a room so that everyone could hear what was being reported about everyone else.
“Victoria spent a long part of Tuesday evening staring at the TV room curtains … On Wednesday afternoon, Victoria seemed very fixated on Madge in Neighbours … On Thursday morning, Victoria insisted on eating her cereal with a soup spoon despite an availability of dessert spoons … We are increasingly concerned about Victoria’s fixation on Madge and would like to alert staff in case this should extend to Scott and Charlene.”
This is literally how it would go. The curtain thing in particular has stuck in my mind (hey, maybe I am fixated?). I wanted to complain that I wasn’t staring at the curtains, only that would have constituted denial. In order to demonstrate a healthy grasp of reality, you had to accept that anything anyone else said about you was true.
It’s incredibly hard to convey what this does to you, knowing your every move is being over-analysed and noted down in order to be broadcast to everyone around you (a bit like being famous, I guess, which makes Spears’ situation all the more agonising). It makes you desperate to “act normal” but telling yourself to act normal is like telling yourself not to think of an elephant. It makes you do the opposite. It’s like Catch 22 (another cultural artefact I’ve neither seen nor read, but nonetheless have opinions about).
This is why Wide Sargasso Sea affected me so much and remains one of my favourite books. Antoinette made me think of me. And now she makes me think of Britney. And the worst of it is, it never goes away.
As Charlotte Perkins Gillman illustrates so terrifyingly in The Yellow Wallpaper, patriarchy doesn’t just tell women they’re mad, but can make them so. It deprives them of bodily autonomy, intellectual stimulation, community, a basic feeling of safety. I still have a “contract” I had to sign, aged 12, listing the privileges I had to “earn back” as part of my treatment for anorexia. I’m glad I still have it, otherwise I’d think I’d imagined denying girls books – books! – was still a thing in 1987. It becomes impossible to distinguish between symptoms of an illness and responses to its treatment. I am doubtful, for instance, as to whether I would have made meals last four hours had I been granted anything else to do other than stare at walls. Yet timing meals is something that stayed with me for years.
In Why Women Are Blamed For Everything, Dr Jessica Taylor draws parallels between the diagnostic criteria for borderline personality disorder and those formerly used for hysteria:
“They are essentially the same diagnosis. They are both targeting women and girls. They are both built around gender role stereotypes. They both oppress traumatised and abused women. Where hysteria (or ‘wandering womb syndrome’) was said to be caused by women’s hormones and biology, BPD is said to be a disordered personality. Both are innate, internal causes which need to be medicated, treated and dealt with.”
I increasingly see the mention of BPD in reports on anorexia and bulimia, with the implication that this makes sufferers less manageable during treatment. It makes me feel little progress has been made in recognising trauma. As Judith Herman writes, trauma survivors “often tell their stories in a highly emotional, contradictory and fragmented manner which undermines their credibility”. They don’t sell themselves well. They starve, binge, shave their heads, wave baseball bats. Meanwhile, self-styled guardians, calm as Rochester, maintain “[their] prerogative to name and define reality”. They get their conservatorships.
By the time I was aged thirty, I had a PhD and a full-time job, had been with my partner for five years and was thinking of starting a family. This didn’t stop a male family member from turning up unannounced at my partner’s place of work to berate him about how unstable I “really” was, even though I was “good at hiding it”. I had tried to persuade him not to, but that had been construed as me not being in touch with reality. This impasse was only resolved months later, at which point it was agreed that I wasn’t particularly ill, but that this meant I’d been making people think I was ill, which was in itself a mad thing to do. I’ve never really challenged this. There reaches a point where you have to go along with other people’s narratives – “yeah, soz for pretending to be mad, don’t know what got into me” – because you can’t be arsed to bring any more accusations your way by protesting. You try to speak and hear every word going through the “madness” filter before it reaches anyone else (“her voice was high and shrill”, as Rochester puts it. Isn’t it always? That’s how people talk when they’re scared).
So what can you do? Say what they want you to say. Grow your hair. Do your dance. The whole thing is profoundly patriarchal, when you think about it. Therefore you try not to think about it too much, otherwise you’d prove them right by genuinely losing your mind.
We can all identify someone having a stroke, can’t we? A sudden loss of function on one side of the body, drooping face, slurred speech, numbness. Sure we can — but that someone will most probably be a man.
With women, stroke symptoms are very different. They may present as a migraine-like headache, light-headedness, possibly a drop in co-ordination. Transient ischaemic attacks, or mini strokes, are often described by women as, “I felt funny for five minutes, but now I’m fine” or, “I had total brain fog for an hour, but I’m OK.”
The critical thing, says Dr Alyson McGregor, an emergency medicine consultant, is that these unique female symptoms are only now being pinned down. Many doctors, let alone the public, don’t recognise them, meaning women’s strokes are often misdiagnosed or undiagnosed.
Unsurprisingly, although men are more likely to suffer strokes, more women die of them; twice as many, in fact, as die from breast cancer. Strokes are the third leading female cause of death, but their symptoms are often brushed off as urinary tract infections, migraine or anxiety. This means proper treatment is frequently delayed, anticoagulants are prescribed at a lower, less effective dose than they are for men, and outcomes are poorer.
McGregor is one of America’s experts in the male-centric bias in the medical profession, which for years has nurtured doctors with the false belief that apart from the sex organs, men and women are biologically identical. While everything from textbooks and medical tenets to drug research and dissection mannequins treat male bodies as the human norm, she says women’s bodies react differently from their DNA up. (In fairness, a leading US medical school puts a wig on a mannequin to flag it as female.)
The unconscious sex bias in medical knowledge, which first came to my attention in Caroline Criado Perez’s book Invisible Women last year, is fairly jaw-dropping stuff. Heart attacks, for instance: men often get the classic symptoms of pain down the left arm, chest pressure, nausea, cold sweats, while women may present with only mild pain and discomfort, fatigue, possible shortness of breath and a strong feeling “something isn’t right”. They’re often told they’ve got a panic attack and anxiety, and sent home.
One study of cardiac misdiagnosis in 100,000 people showed that women under 55 who went to A&E with significant heart-attack symptoms are seven times more likely to be sent home than men, doubling their risk of death. Overall, women are three times more likely than men, in the US at least, to die after a serious heart attack.
Women’s hearts fail differently. After cardiac arrest, unlike men, their hearts have pulseless electrical activity — they flatline and they’re not shockable. Any TV hospital drama featuring doctors waving electric paddles on a woman is cobblers. (Apparently the only tools are CPR and adrenaline.) Plus, while men gather big clots of plaque in their blood vessels, women’s vessels absorb it, weakening and stiffening. This microvascular dysfunction stresses the heart, but — guess what? — angiograms aren’t designed to detect it. And, poignantly, women are the primary victims of Takotsubo cardiomyopathy — broken heart syndrome — thought to be caused by a massive surge of fight or flight hormones after a stressful event, such as a family death. Suddenly the left ventricle of the heart balloons and cannot beat properly.
Women are less likely to be treated for sepsis, arrhythmia and chronic pain conditions such as fibromyalgia. They’re less likely to be referred for tests for irritable bowel syndrome (IBS), and autoimmune and various neurological disorders. In other words they’re undertreated and underbelieved.
Women metabolise prescription drugs differently from men 40 per cent of the time, but most drugs are still tested almost exclusively on men. It’s cheaper and easier. The catastrophe of thalidomide tightened regulations to protect women of child-bearing age and many researchers then chose to exclude them completely. Big Pharma’s testing protocols are developed to identify male-pattern symptoms.
Take statins. A prominent female cardiologist, quoted in the book, says they have little benefit for the millions of women who take them — and there is zero evidence that they lower the risk of heart attack or stroke for women. Or aspirin: the anti-blood-clotting benefits of aspirin have been observed only in men; with women, they don’t outweigh the risks. Another study shows naltrexone, an anti-addiction drug, reduced the use of alcohol and drugs in men, but increased it in women.
Most roads in women’s health, though, lead back to a male idea of female anxiety. Women are more likely to receive a psychiatric diagnosis — always remembering “hysteria” is derived from the Greek word for uterus, “hystera” — and there is “a pervasive unconscious belief in medical culture that women are prone to illogical and unreasonable outbursts”. In other words, they’re attention-seekers and their complaints less believed. McGregor sees this implicit bias everywhere in medicine.
In one study of IBS, men were more likely to be offered x-rays, women anti-anxiety medicine and lifestyle advice. Another study showed severely injured women were less likely even to be brought to A&E (49 per cent women, 62 per cent men). The researchers ruled out all other factors and found subconscious gender bias.
In the same way, the emphasis on anxiety as the go-to female condition means women themselves discount their inner wisdom and apologise for their feelings instead of trusting them. They “talk themselves down”. McGregor has seen women with heart-attack symptoms leave emergency waiting rooms because they or their husband persuaded them it was just anxiety. On similar lines, the Yentl syndrome describes the vicious circle whereby the more women try to explain their pain, the more doctors tune out. She is convinced women that process pain differently — but because the physiology is not understood, their pain isn’t properly tackled by existing drugs.
A pint of semi-skimmed, 20 Bensons, a scratchcard and, er, a porn pass . . . The odds on this becoming a regular corner-shop scenario crashed this week as Jeremy Wright, the culture secretary, announced that age verification checks for accessing online pornography would be delayed yet again, this time because the government forgot to inform the European Commission. No wonder it’s been called Sexit.
Age verification began as a thoughtful response by the coalition government to alarming NSPCC research that 65 per cent of 15 to 16-year-olds and almost a third of 12-year-olds access porn. That porn sites should be age-verified, as gambling domains already are, has a 67 per cent approval rating. The problem is that it’s technologically impossible to enforce.
From July 15, clicking on a porn site was supposed to generate a page where a user must provide proof via a credit card, passport or driving licence that they are over 18. Unfortunately Britain stands nobly alone in this endeavour against a global porn industry. And any fool can easily install a VPN (virtual private network): a bit of software which conceals your geographical location. British kids use them already to dodge rights issues, particularly to access US Netflix with its superior range of films.
A VPN would allow a porn user to swerve the UK age-blocker. And which punter wouldn’t do that rather than give personal details to the state-approved verification firm AgeID (which, unbelievably, has the same owner as Pornhub)? No amount of blah about safe encrypted data will reassure anyone that their name and mugshot won’t one day pop up alongside their taste for “watersports” and MILFs.
The alternative would be to go into a shop and, after showing an age ID, buy a £4.99 porn pass. While oldsters might find this no more embarrassing than the time they bumped into their mate’s mum while buying a copy of Razzle, young people have grown up under the total anonymity of the web. Besides, they would simply access porn on platforms such as WhatsApp, Reddit or Snapchat. And a VPN can make the internet an even more dangerous landscape, opening up blocked extremist, paedophile and drug sites on the dark web.
Yet whether age-verification is feasible should not distract from the bigger, more pressing question: does allowing the porn industry to pipe its product unrestricted into every home have toxic consequences? Ireland is reeling from the murder of Ana Kriegel, 14, found naked with extensive injuries and a ligature around her neck, killed by two 13-year-old boys. One of the boys was found to have phones containing thousands of pornographic images, many involving children and animals. The Irish prime minister has said he will be viewing Britain’s age-verification plans closely.
This, of course, is the most extreme scenario. Experts speculated in 1993 whether James Bulger’s killers were inspired by “video nasties” or were just disturbed children who’d have killed in any era. But there is no question that having immediate access to images once obtained only by writing to obscure PO box addresses has changed society. Police now investigate 1,000 cases of offenders viewing child abuse images each month: our jails could not accommodate them all so most are dismissed with a caution on a first offence. Many such men say that viewing “barely legal” porn involving teenagers on legal sites drew them to younger children.
There has also been a spate of deaths of women at the hands of partners who claimed they were engaged in consensual “sex games”. These include Anna Reed, 22, from Harrogate who was suffocated in a Swiss hotel room; Charlotte Teeling, 33, from Birmingham, who was strangled, as was Hannah Dorans, 21, from Edinburgh. Natalie Connolly, 26, was penetrated with a bottle of carpet cleaner and left for dead at the bottom of the stairs. All the men concerned argued that “rough sex” or “Fifty Shades of Grey games” had gone wrong, that these women had, in effect, consented to their own deaths.
These are scenes choreographed by violent pornography, which is not some rare category but just a click away. Researchers studying aggressive porn that involves slaps, hair-pulling and choking found that in 95 per cent of cases the actresses responded with expressions of pleasure, suggesting to the viewer that violence is desired.
Is it any coincidence that the first generation of children exposed to hardcore pornography before their first kiss have epidemic levels of mental illness? The extreme aesthetics of porn fuel body-hatred in young women, while psychologists are concerned that a growing cohort of young men are so desensitised by porn that they suffer erectile dysfunction and emotional disconnection from real women. Moreover, when sex is learnt through porn — a misogynist industry focused solely on male desire — girls prioritise their performance above their own pleasure.
This is now normalised in the mainstream: Teen Vogue ran a feature on anal sex, which most women find uncomfortable, even painful, but is demanded by some men because it’s a major porn trope. Teen Vogue’s anatomical diagram did not even include the clitoris.
Yet young women are not allowed to balk at porn. In the US high school comedy Booksmart, two girls watch porn on their phone in horror. One tries to tell herself she must enjoy it because “I’m a sex-positive feminist”. Not to love porn marks a girl out as uncool, conservative and “unwoke”. Age-verifying technology is, alas, a distraction from the real conversation we need with young people about porn. That it is not feminist nor is it positive sex.
Jayne Ozanne is right that conversion therapy is almost exclusively carried out by faith groups (‘It takes a lifetime to recover’, G2, 8 August). However, psychotherapists and counsellors should not be complacent. There are things we need to own and attend to.
First, there is a history of homophobic non-acceptance of same-sex love on the part, in particular, of psychoanalysis. Much has been done within that modality to make necessary revisions to theory and practice.
Second, the psychotherapy professional groups need to make it crystal clear that the answer to this problem of continuing – but non-professional – conversion therapy is not to take the entire profession under some kind of statutory regulation. The drawbacks of that are well-established by now. The Professional Standards Authority’s scheme of accredited voluntary registers is working.
Finally, we need to make it absolutely clear that if you come to psychotherapy wishing to explore issues of sex and sexuality, you will still be able to do so. There is no way in which the condemnation of conversion therapy should impose a cordon sanitaire on one of the main reasons people come to psychotherapists.
When I was chair of the UK Council for Psychotherapy in 2009-12, at the time when the memorandum of understanding banning conversion therapy was conceived, we wanted to reassure potential patients that sexuality was still something we expected our clients and patients to engage with. However, this reassurance slipped off the agenda because it was – wrongly – deemed too complex a matter.
Clarity on this issue is really important, because ‘conversion therapy’, the attempt to alter a person’s sexuality, is being conflated with any approach to gender dysphoria or gender identity confusion that isn’t ‘affirmative’, that is, agreeing that the person is in the ‘wrong body’.
There is an example of this in the Guardian very recently, the examples in the article and the films described are all gay conversion, but the journalist describes ‘conversion therapy’ as “any treatment aiming to change a person’s sexual orientation or suppress their gender identity”.
This matters, because, as Jesse Singal reports: “All else being equal, this research suggests that the most likely outcome for a child with gender dysphoria is that they will grow up to be cisgender and gay or bisexual. Researchers don’t know why that is, but it appears that in some kids, nascent homo- or bisexuality manifests itself as gender dysphoria. In others, gender dysphoria can arise as a result of some sort of trauma or other unresolved psychological issue, and goes away either with time or counselling. And in still others, of course, it is a sign that the child will identify as transgender for their whole adult life. While the actual percentages vary from study to study, overall, it appears that about 80 percent of kids with gender dysphoria end up feeling okay, in the long run, with the bodies they were born into.”
There has been no systematic research into the ‘gender affirmative’ approach; but claims of 100% ‘success’ rates from ‘gender affirming’ doctors (ie, of all the children treated with ‘gender affirmation’, none of them desisted).
The UK Council for Psychotherapy has launched a new Memorandum of Understanding on Conversion Therapy to include ‘gender identity,’ leaving therapists, counsellors, GPs and clinical professionals in a position where they may be afraid to do anything but agree with a patient’s self-diagnosis as ‘transgender.’ Anything other than ‘affirmation’ could lay a professional open to the charge of conversion or reparative therapy.
‘Affirmation’ is an untested approach to children with gender dysphoria, a result of demands by political activists rather than an approach developed on the basis of research and evidence.
Of course, we support the original Memorandum of Understanding on Conversion Therapy which outlaws attempts to change a person’s sexual orientation. But ‘gender identity’ should not be conflated with sexual orientation as if the two things are essentially the same issue. For gender dysphoria, the choice of approach is between ‘affirmation’ and ‘watchful waiting’ but its inclusion in the Memorandum suggests that the watchful waiting approach could be considered to be conversion therapy if a child subsequently desists.
What it means is that for a health practitioner to offer any therapeutic support or exploration of underlying factors, motives or reasons for a cross-sex identity in childhood they are now taking a professional risk. Instead, a practitioner must confirm and therefore reinforce a child’s belief that they really are the opposite sex. If a boy thinks he’s a girl, he’s a girl. If a girl believes herself to be a boy, she’s a boy, no questions allowed.
No concession is given to children and young people whose identities are in development and highly susceptible to influence from parents, peers and professionals as well as an increasingly powerful transgender lobby. ‘Affirmation’ is not a neutral approach, it is a strong statement of belief that a girl can be born in a boy’s body and vice versa. No practitioner should be imposing false and non-scientific beliefs on a child or young person or knowingly mislead them about reality.
Ironically, the new MOU asserts that practitioners should be “free from any agenda that favours one gender identity […] as preferable over other gender […] diversities” and yet ‘affirmation’ explicitly favours one identity over another and is wholly dependent upon the agenda of trans activists who have fought to impose this approach.
The statement “no gender identity is inherently preferable to any other” hides the fact that this ideology says that one kind of sexed body is preferable to the other and that the only treatment pathway is medical change of the body to ‘match’ the identity. Under the guise of ‘support’, the assertion “your identity is right” is a cover-up for the underlying message “your body is wrong.”
Professionals are warned that ‘conversion therapy’ constitutes any attempt to ‘bring about a change in someone’s gender identity.’ In other words, even if a child’s belief does not match reality, it must be affirmed as the truth. In no other area of health care is a practitioner compelled to confirm a patient’s false belief. Protection of a child’s belief about which sex they are, by definition takes away all normal protections for a child’s body and fertility. Afraid to do anything which may lead to a change in identity, therapists are compelled to facilitate treatment to bring about medical change of the body.
With no trace of irony, righteous condemnation of ‘conversion therapy’ is used to justify the most extreme medical ‘conversion’ of the physical body into cosmetic imitation of the opposite sexed body. Why, uniquely in this case, are children and young people’s bodies not protected from unnecessary and invasive treatment with some effects irreversible and others unknown, while their beliefs are considered worthy of our greatest efforts at preservation?
Jenny Valentish doesn’t like labels. But if there’s one word she will ascribe to her history with childhood trauma and drug abuse, it’s “archetypal”.
“My story is fairly representative of women who have severe problems,” she says when we meet at her Sydney hotel in May. “It ticks boxes actually: sexual abuse, sexual assault, promiscuity, self-medication. It’s got everything, really.”
Valentish, 42, was born and raised in Slough, England – the same dreary industrial town immortalised in The Office, and a brutal poem by John Betjeman that calls on it to be bombed.
But her memories of childhood are clouded for another reason: when she was seven, a high school boy five years her senior began [raping her].
Too young to fully understand what was happening, she felt somehow complicit, and when she finally told her mother she underplayed the details. The boy – dismissed as merely a pest – returned throughout the summer. It would be 15 years until Valentish was able to sleep well again and decades until her parents found out exactly who they’d been inviting back to the house. To this day she has an “indescribable fear” of being touched on her hips.
“It was fairly pedestrian abuse when set against some of the stories I’ve heard,” she writes in her new book Woman of Substances, “but it set off a catastrophic chain reaction all the same.”
Valentish tells her story with brutal honesty and dark, wry wit – but the memoir is made more urgent by the research woven through it. It’s a startling and thorough investigation into the relationship between gender, trauma and addiction, and the women who fall through the gaps – with the writer offering herself up as the case study.
Valentish started drinking heavily when she was 13. She had blackout sex through her teens, swapped sex for drugs at 17, and spent most of her 20s abusing speed and harder drugs, and chasing dopamine in other ways – from kleptomania to eating disorders to compulsive sexual behaviour. She was working in the drug-fuelled music industry, as a publicist and a music journalist, and would often sneak out of the office in the morning to throw back drinks, speed or both at once, alone. Deprived of a normal childhood, she’d never learned to socialise while sober. “I needed at least three drinks in me before I could sit still,” she says.
As she tells her story, Valentish identifies a series of shortcomings of the medical and addiction treatment industries which have failed to understand and communicate how substance abuse affects women. “I had no idea that this was the case when I started writing,” she says. “I was just going to write about the female experience [of addiction] – there was going to be no call to arms.”
But the more she spoke to researchers, social workers, addicts and specialists, the clearer the paucity of data became. Although the drinking rate among men and women are actually about equal, and the pathways that lead women into drug abuse are heavily gendered, drug and alcohol research remains biased towards men.
“Nobody wants to use women in any kind of research. Not just about medications, but any kind,” she says. “You should be splitting up the data depending on where [women] are in their menstrual cycle, week one to four – and nobody wants to do that, because nobody’s got the money … Every argument ever comes down to funding, doesn’t it?”
For any woman who drinks or takes drugs, Woman of Substances makes for a frightening read. How many of us know that alcohol raises oestrogen levels, explaining why two beers can knock us out one week and slide right through the next? How many doctors tell women that each glass of wine they consume significantly increases their risk of breast cancer – along with polycystic ovaries, fibroadenomas, anxiety, sleep issues and memory loss?
“I couldn’t find this information anywhere either,” Valentish says. “That’s one of the reasons I wanted to write the book.”
There are other gaps too. While substance abuse is often linked to childhood trauma, women are more likely to be pathologised and treated for mental health disorders than to receive trauma-focused care. While women with severe eating disorders also often have substance issues, there are few clinics that will treat both at once. And while Alcoholics Anonymous – which was originally designed for men – focuses heavily on the idea of handing yourself over to a “higher power”, in Valentish’s experience what women need at that point is autonomy. “There’s a lot of catching up to do in the industry,” she says.
I think this paragraph is particularly interesting:
Some chapters ground her down so much she would end up writing through tears. Suddenly, all the coping mechanisms she used to fall back on came into play; the dopamine releases of smoking, Candy Crush, spending sprees and porn. “You can’t think about anything else if you’re watching porn,” she says. “So much porn was watched during the writing of this book. PornHub should give me some money.”
Women binging on porn to numb their emotions and block out the memories of abuse is not empowered, sexually liberated, or ‘sex positive’ in any meaningful way, and it raises questions about how many other women (and men) are consuming porn in this way.
“You often get them late afternoon on a Friday. If somebody doesn’t want to go home, that’s when you get these conversations,” says Alison Hamnett, director of operations across the north for Brook. They may start with asking for free condoms, but eventually the real story emerges: sexual exploitation, abusive relationships, precarious lives. Girls who don’t even feel entitled to refuse sex, let alone insist on protecting themselves.
Some are guarded. “Particularly if they are being groomed, they will have the answers to the questions down pat,” says Hamnett. “But the receptionist will say she saw a car outside drop them off – and the same car is coming with lots of young girls …” Posters hanging in the waiting room of the Manchester clinic where we meet explain the difference between exploitative and loving relationships: no, it’s not OK if he offers a roof over your head and expects sex in return.
The Burnley, Blackburn and Oldham clinics tend to see more grooming-gang victims, says Hamnett. In Liverpool, she found them dealing with a young homeless man, released from prison, who had been having sex in broad daylight in a car park while intoxicated. Manchester saw a young Muslim girl who was being radicalised. The checklist used with clients ranges from female genital mutilation to mental health issues. “We had a young woman of about 17, very intelligent, got all her A-levels and went to university,” says Hamnett. “She was bipolar and, when she was on her meds, she was great. When she wasn’t, she’d sell herself for sex.” The clinic helped her until she was too old to use its service, which is restricted to under-19s. They don’t know where she is now.
Brook’s expertise is in this area – where sexuality, deep-seated social problems and mental health issues collide – and is, says Hallgarten, what makes them “very good value for money”, as identifying the root cause of sexual risk-taking offers more chance of changing it.
But specialist clinics for vulnerable young people such as these are increasingly merging with more general services to save money. There is a push, says Hamnett, towards using GPs instead for contraception. That may work for young people with happy sex lives, but there is a reason appointments here last for up to 40 minutes, not the 10 minutes a busy GP might offer. “I feel as if we’re almost waiting a few years down the line for teenage pregnancies to go up,” she says ruefully. It is this sense of a clock being turned back that worries many.
Still furious about this. Who the fuck thinks “ah, person with a cervix, it me”? Women will miss screening because of this language. It’s not about reaching transmen – you could just *say* “women & transmen”. It’s about not saying “women” in a context that excludes transwomen.
Sarah Ditum is spot on with her analysis here, all this ‘inclusive’ language (‘pregnant person’, ‘chest feeding’, etc) has nothing to do with helping trans men, and everything to do with pandering to trans women.