Madwomen

What we don't understand about women and mental illness.

Photo by Towfiqu barbhuiya on Unsplash

There’s a fabulous cover story in the Atlantic this week about once-respected journalist Lara Logan’s descent into paranoia, conspiracy theories, and far-right politics, and you should give it a read. It paints a disturbing and tragic photo of a woman who once seemed to have every door open for her, who underwent one of the most traumatic events possible, and whose life has since then largely broken down — and who has herself become (or perhaps revealed herself to be) ugly, bigoted, and only loosely tied to reality.

Reading about her descent has me thinking about a few other women I’ve known who unravelled as they entered middle age, although their unravelling was of a very different kind than Logan’s. One became convinced she was being stalked, followed, and harassed by dozens of people in a coordinated campaign; another began to see things on her body that weren’t there, and retreated into herself. I don’t know if either was formally diagnosed with schizophrenia, although it has been many years and as they took many steps away from reality, we lost what was already a very loose touch. I do know that both lived what seemed to be fairly normal lives for decades before the paranoia and hallucinations set in, and that it took a while to connect the women’s claims to mental illnesses. I know that these stories didn’t look anything like the popular culture version of schizophrenia: The white man in his 20s, tragically losing his ability to function, his brilliant future suddenly in shadow. The women I have known, although I did not know them well, had lived functional lives well into adulthood, and their symptoms made me and others around them wonder: Is this early dementia? Early Alzheimers? I suspect diagnosis and treatment, if it came at all, came slowly in part because of those same questions.

To be clear, I do not think Lara Logan is schizophrenic and I have no interest in diagnosing her as anything other than a conspiracy theorist; I share the profile of her only to say that it sent my brain branching off on a related but distinct path, not to say that Lara Logan’s story is an illustration of severe mental illness in women (I think her story is instead an illustration of right-wing brainworms). But the profile got me thinking about why paranoia shows up and how it manifests, which in turn got me thinking about a dynamic I’ve observed about paranoia in its most severe forms: That while the men I know who have had serious breaks with reality have seen that happen in their 20s and 30s, for women, it seems to come later — and symptoms of serious reality-disturbing mental illness seem to be different from those experienced by men.

This casual observation turns out to be true: For men with schizophrenia, onset typically happens in the teens or early 20s. For women with schizophrenia, symptoms are less tied to age — for some women they present in the teens or 20s, for others into one’s sixties. Women are twice as likely as men to be diagnosed with schizophrenia after the age of 40. Bipolar disorder, too, seems to present later in women than in men.