André Anthony Moore, LMFT

Licensed Marriage and Family Therapist (New York State License: 001435)

Ketamine and Psychedelic Assisted Therapist certified by The Integrative Psychiatry Institute Practitioner of Eye Movement, Desensitization and Reprocessing (EMDR)

Use Nonverbal Sensorimotor Techniques to deepen Emotionally Focused Therapy

Prescription Pain Killers are on the Rise for Women When They Shouldn’t Be

A recent report from the Center for Disease Control states that:

  • About 42 women die every day from a drug overdose (including those from prescription painkillers). Since 2007, more women have died from drug overdoses than from motor vehicle crashes. More than 940,000 women were seen in emergency departments for drug misuse or abuse in 2010.
  • Prescription painkillers have been a major contributor to increases in drug overdose deaths among women. More than 6,600 women died from a prescription painkiller overdose in 2010. This is about 18 women a day; which accounts for nearly half of all drug overdoses that happen each day among women. In 2010, there were more than 200,000 emergency department visits for opioid misuse or abuse among women; about one every three minutes.

An article in Medpage reports that:

  • Prescription painkiller drug deaths have skyrocketed in women,” Thomas Frieden, MD, director of the CDC, told reporters during a press briefing. “It’s not only deaths, but there is also a great increase in the number of emergency department visits for misuse and abuse … of opioid painkillers.”
  • ED visits related to prescription opioid misuse or abuse “more than doubled” among women between 2004 and 2010, the study showed. Rates were highest among women ages 25 to 34, reaching nearly 50,000 ED visits for opioid painkillers in 2010.
  • Frieden said the increases in deaths and ED visits among women has tracked along with increased prescribing of opioid painkillers. Those prescriptions have risen “to an extent that we could not have anticipated, and which could not possibly have been clinically indicated,” Frieden said.
  • Frieden said the increase could have something to do with the fact that women are more likely to have chronic pain than men, and are more likely to be prescribed prescription opioid painkillers for their condition.
  • Also, he said, women often receive greater doses of these drugs than men, even though women are more likely to have adverse events from higher doses than men.
  • “We don’t understand why [women] are getting higher doses, when on average they should be getting lower doses” than men, Frieden said during the briefing.
  • And contrary to expectations, he added, the increases in death rates were greatest among women ages 45 to 54, at 21.8 per 100,000 population.
  • Frieden said clinicians “need to recognize women at risk. A lot of healthcare providers currently think just men” are at greater risk of death from opioid overdose.

It should also come as no surprise that an Atlantic Monthly Chart of the Day places the pain killer Vicodin at the top of at list of 15 drugs prescribed in America (Vicodin at 131.2 million vs. Zocor for high cholesterol, the next highest on the list  at 94.1 million).

And CTV News also reports that:

  • The greatest increases in drug overdose deaths were in women ages 45 through 54, and 55 through 64. The rate for each of those groups more than tripled between 1999 and 2010.
  • In 2010, overdose deaths in those two groups of middle-aged women added up to about 7,400 — or nearly half the female total, according to CDC statistics.
  • It’s an age group in which more women are dealing with chronic pain and seeking help for it, some experts suggested.
  • Many of these women probably were introduced to painkillers through a doctor’s prescriptions for real pain, such as persistent aches in the lower back or other parts of the body. Then some no doubt became addicted, said Dr. Andrew Kolodny, a psychiatrist who specializes in addiction at Maimonides Medical Center in New York City.
What could be the underlying cause of these trends? Is it possible that woman are feeling greater stress from a current resurgence of activist feminism expressed by people like Sheryl Sandberg in her recent book, Lean In, and magnified by the media? From a historical perspective, Sandberg’s message is simply a remake of the social activist feminism advocated by Gloria Steinem and other prominent feminists in the 70s who campaigned for the Equal Rights Amendment and co-founded political organizations such as The Women’s Action Alliance, The Coalition of Labor Union Women, Choice USA and The Women’s Media Center. In their own unique ways, each of these organizations put out a clarion call for greater entitlements for women based on the same assumption in the Enjoli commercial: That they could not only have it all but do it all. Today, in the aftermath of a housing bubble and an economic recession from which we’ve barely begun to recover, these assumptions are being seriously questioned and Sandberg justifiably criticized for placing more pressure on women who are already struggling to fulfill impossible demands and blaming other women for not trying hard enough.

Sandberg’s most important critics to date are Anne-Marie Slaughter in The Atlantic  who argues that she’s holding women to impossible standards for the attainment of personal and professional success, and Amanda Neville in Forbes who faults Sandberg for obsessively pushing women – or leaning on them – to achieve while ignoring their genuine need for a sensitive, respectful response to the real stresses of their everyday lives. Neville also believes that “a change in conscious (and sometimes unconscious) behaviors will encourage the “partners [in Sandberg’s groups] to become more self-aware and vigilant when it comes to issues related to leaning in” such as competiveness, cattiness and caginess,” as well as envy and resentment. What Neville doesn’t say in her critique of Sandberg is that virtually all of these conflicts are a consequence of women’s unconscious struggle with impostor syndrome.

At first blush, one might consider Brene Brown – a fifth generation Texan whose family motto is lock and load – to be the last person in the world to have a deeper handle on imposter syndrome, let alone an appreciation of why Gung Ho messages like Sheryl Sandberg’s and the one embedded in the Enjoli commercial might actually make women feel worse than they already do. But Brown is special for two reasons: First, she’s spent the last 10 years doing research on vulnerability, shame, authenticity and empathy. Second, she actually had a breakdown of sorts in front of hundreds of people at a TED Conference in Houston.

Brene Brown started her career as a researcher-storyteller with a “life’s messy, clean it up, organize it and put it into a bento box” mentality which in many ways resembles that of Sheryl Sandberg. Like Sandberg, she thought she could apply “a lean in approach to discomfort, knock it upside the head, move it over and get all A’s.” Her mantra in those early, incredibly naïve years was “If you can’t measure it, it doesn’t exist.” Well, it didn’t take Brown long to have her breakdown: The crushing realization that life was much too messy and complicated to be reduced to simple metrics. As a consequence, she plunged into a deep existential crisis. But she got lucky and found a good shrink – one who only sees other shrinks because “you have to have a large bullshit meter to see through other shrinks [which might also apply to high-powered, female corporate executives].” In the course of her therapy, Brown discovered two important things: First, that life is all about connection which is wired into us from birth. Second, the thing that unravels connection is shame, the excruciatingly painful feeling that I’m not worthy or good enough and believe I’m an imposter. Brene Brown calls this condition the Swampland of the Soul. She also learned from her research that in our culture shame is organized differently for women and men.

For women it’s all about “Do it all. Do it perfectly and never let them see you sweat…about unattainable, conflicting, expectations of who [women] are supposed to be.” Cultural norms dictate that they must be nice, thin, modest and use all available resources for appearance. On top of this – especially in today’s troubled economy – they must be able to bring home the bacon, fry it up in the pan and never let their lover forget he’s a man. Brene Brown has no idea how much perfume was sold as a result of that Enjoli commercial but she suspects that it gave a big boost to sales of anti-anxiety and anti-depression meds.

For men it’s all about getting up on a white horse and never, ever showing weakness. Cultural norms dictate that men must always show emotional control, value the primacy of work, focus single-mindedly on the pursuit of status and applaud violence. At one of her book signings, Brown tells us of a man who came up to her and said, “You say to reach out, tell our story, be vulnerable. But you see those books you just signed for my wife and three daughters. They’d rather see me die on top of my white horse than watch me fall down. When we reach out to be vulnerable, we get the shit beat out of us. And don’t tell me it’s from the guys, the coaches and the dads because the women in my life are harder on me than anyone else.”

So, in America today we have two types of Imposter Syndrome, one reserved exclusively for women, the other for men. Almost everything in our culture encourages us to numb our vulnerability. And, as Brene Brown points out, the impact of this numbing is felt equally by both men and women: “We are the most in debt, obese, addicted, medicated adult cohort in U.S. history. We take fat from our butt and put it in our cheeks…and the saddest part is that by numbing vulnerability we also numb joy, gratitude and happiness. We further make everything that’s uncertain certain, black and white and contaminate our children” who then grow into the culturally determined imposter syndromes reserved for women and men.

Ignoring vulnerability as Sheryl Sandberg insists on doing in her Lean In Circles is not a remedy for either type of imposter syndrome. The remedy is to be found in men and women slowing down, truly listening to, showing empathy for and seeing each other for who they really are, especially on their bad days. But this is a subject for another post.

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